The Gut Microbiome,Mental Health,and Cognitive and Neurodevelopmental Disorders: A Scoping Review

BackgroundNurse practitioners encounter many patients with concerns related to mental health, cognitive disorders, or neurodevelopmental disorders. Marketing of supplements and foods geared toward the gut microbiome and mental health has increased, despite limited evidence of efficacy.MethodsA scoping review of the literature published through November 2021 was conducted using the Arksey and O’Malley framework to map the findings. Thirty-two articles ultimately met inclusion criteria.ResultsFindings were mapped to summarize the current state of knowledge regarding the gut microbiome, mental health, and cognitive and neurodevelopmental disorders as well as clinical implications for the nurse practitioner. The relationship between the gut microbiome and mental health appears bidirectional. Currently, there is limited evidence for probiotic supplements for mental or cognitive health. Of the 32 articles surveyed, 12 related to probiotic interventions, with 9 demonstrating benefit to mental or cognitive health related outcomes, and 5 specifically demonstrating benefit in depression. There is evidence to support interventions such as diet changes, physical activity, and stress management as ways to support a healthy gut microbiome, which may in turn benefit mental or cognitive health.ConclusionResearch on the gut microbiome, mental health, and cognitive and neurodevelopmental disorders continues to evolve. At present, nurse practitioners can provide evidence-based counsel regarding lifestyle factors to improve physical and mental health, which may also influence the gut microbiome.     

Pathogenesis of liver injury in Takayasu arteritis: advanced understanding leads to new horizons

Liver injury in Takayasu arteritis (TA) is a rare phenomenon. Most symptoms are nonspecific, and the exact pathogenesis remains to be elucidated. Early diagnosis and new treatment methods are important for an improved prognosis. A summary of the clinical information and mechanistic analyses may contribute to making an early diagnosis and development of new treatment methods. A PubMed search was conducted using the specific key words “Takayasu arteritis” and “liver” or “hepatitis” or “hepatic”. Symptoms and treatment of TA with an accompanying liver injury were reviewed retrospectively. Many factors are presumed to be involved in the mechanism of TA with liver injury, including the immune response, genes, infections, and gut microbiota. There are several lines of evidence indicating that immune dysfunction is the main pathogenic factor that triggers granuloma formation in TA patients. However, the role of genetics and infections has not been fully confirmed. Recently, the gut microbiota has emerged as an essential component in the process. We reviewed in detail the current concepts that support the complex pathogenesis of TA accompanied by liver injury, and we presented recent theories from the literature. Finally, we discussed future research directions of liver injury in TA.     

表皮生长因子对大鼠肠缺血-再灌注所致肠黏膜通透性改变的影响

目的观察大鼠肠缺血再灌注后外源性表皮生长因子(EGF)对肠黏膜通透性和肠、肝、肾功能改变的影响 .方法80只3级雄性Wistar大鼠,随机分为假手术(C)组、肠缺血(I)组、肠缺血再灌注(IR)组和EGF治疗组.IR组和EGF治疗组均用微血管夹夹闭肠系膜上动脉根部45分钟,之后放松血管夹形成再灌注.在再灌注即刻经颈静脉分别注入EGF 100 μg/kg或生理盐水,分别于伤后2、6、12和24小时将动物活杀.C组仅分离肠系膜上动脉根部而不夹闭,I组在缺血45分钟后即刻活杀.取血检测肝、肾功能, 血浆二胺氧化酶(DAO)活性和D乳酸浓度;取小肠、肝和肾组织进行形态学观察 .结果①与C组相比,各组动物血浆丙氨酸转氨酶(ALT) 和尿素氮(BUN)均明显升高,但EGF治疗组升高的幅度显著低于IR组(P <0.05).②EGF治疗组的血浆D乳酸浓度和DAO活性在伤后升高的幅度均明显低于IR组(P<0.01).③EGF治疗组肝、肾和小肠黏膜充血、水肿、炎细胞浸润及局灶性坏死的程度较IR组显著减轻 .结论伤后给予外源性EGF显著减轻了缺血再灌注所致肠、肝、肾功能的损伤,其主要作用环节是促进了EGF与受体的结合及随之发生的信号传导.     

Understanding the Molecular Mechanisms of the Interplay Between Herbal Medicines and Gut Microbiota

Herbal medicines (HMs) are much appreciated for their significant contribution to human survival and reproduction by remedial and prophylactic management of diseases. Defining the scientific basis of HMs will substantiate their value and promote their modernization. Ever‐increasing evidence suggests that gut microbiota plays a crucial role in HM therapy by complicated interplay with HM components. This interplay includes such activities as: gut microbiota biotransforming HM chemicals into metabolites that harbor different bioavailability and bioactivity/toxicity from their precursors; HM chemicals improving the composition of gut microbiota, consequently ameliorating its dysfunction as well as associated pathological conditions; and gut microbiota mediating the interactions (synergistic and antagonistic) between the multiple chemicals in HMs. More advanced experimental designs are recommended for future study, such as overall chemical characterization of gut microbiota‐metabolized HMs, direct microbial analysis of HM‐targeted gut microbiota, and precise gut microbiota research model development. The outcomes of such research can further elucidate the interactions between HMs and gut microbiota, thereby opening a new window for defining the scientific basis of HMs and for guiding HM‐based drug discovery.     

Stem cell therapy for knee osteoarthritis: a narrative review of a rapidly evolving treatment with implications for physical therapy management

Background: Stem cell therapy has emerged as a new, exciting treatment for repair of articular cartilage in osteoarthritis (OA), which currently has no cure. Regenerative cell therapies can potentially offer alternatives to total joint replacement for patients with OA. A variety of cell-based therapies have been developed involving the use of autologous and allogeneic mesenchymal stem cells (MSCs). To date, these stem cell therapies have been shown to be safe and efficacious, but information on the long-term clinical outcomes for joint function is lacking. Also lacking is information regarding post-treatment rehabilitation strategies and their effects.

Objectives: The purpose of this narrative review was to evaluate the current literature in relation to stem cell therapy for knee OA and to highlight the importance of physical therapists establishing and researching suitable care management and rehabilitation procedures for patients receiving stem cell therapy.

Major findings: The results of this literature review show that MSCs have been safe and effective at reducing pain and improving joint functionality and cartilage quality. The review also found that both autologous and allogeneic stem cells were able to produce similar clinical improvements in pain scores and cartilage repair and restoration. There is a lack of research evaluating the influence of rehabilitation on cartilage repair.

Conclusions: Current research shows that significant improvements in joint pain and function continue for approximately 2-year post-stem cell procedure. There is currently a lack of research into rehabilitation protocols which could potentially improve joint function further.     

Effects of orthopaedic manual therapy in knee osteoarthritis: a systematic review and meta-analysis

Objective

This systematic review to aimed to evaluate the effects of orthopaedic manual therapy (OMT) on pain, improving function, and physical performance in patients with knee osteoarthritis (OA).

Weight loss via a low-carbohydrate diet improved the intestinal permeability marker,zonulin, in prostate cancer patients

BackgroundAccumulating evidence suggest that gut microbiota may impact urologic health including prostate cancer (PC), potentially via affecting intestinal permeability (IP). Studies have indicated that disrupted IP may be improved by healthy diets and weight loss. In the Carbohydrate and Prostate Study 2 (CAPS2) clinical trial, which showed that a low-carbohydrate diet (LCD) reduced weight significantly in men with PC and suggestively slowed PC disease progression, we explored the impact of LCD on an IP marker, zonulin and an inflammation marker, high sensitivity C-reactive protein (hsCRP).MethodsCAPS2 was a 6-month randomized controlled trial testing a LCD intervention vs. control on PC progression using prostate-specific antigen doubling time (PSADT) as the marker. All 45 participants had prior primary PC treatment, PSADT >3 and <36 months, and body mass index (BMI) ≥24 kg/m².ResultsAt 6-month, zonulin decreased in the LCD arm (median −8.3%, IQR −16.6, 0.3%) while the control increased slightly (median 1.4%, IQR −3.0, 13.3%; p = .014). No changes were observed in hsCRP. Linear regression models showed that weight change was significantly associated with log(PSADT) such that the greater the weight loss, the longer the PSADT(p = .003). There was a similar inverse trend between change in zonulin and log(PSADT) (p = .050). Nevertheless, the mediation analysis showed that zonulin was not a significant intermediary mechanism of the effect of weight change on PSADT (p = .3).ConclusionFuture studies are merited to examine further the potential association of IP with inflammation and to clarify if improvement in IP is associated with decreased PC progression. Trial registration: {"type":"clinical-trial","attrs":{"text":"NCT01763944","term_id":"NCT01763944"}}NCT01763944.

KEY MESSAGES

• Gut microbiota may impact urologic health including prostate cancer, potentially via affecting intestinal permeability.
• Weight loss significantly improved intestinal permeability in prostate cancer patients.
• Improvement in intestinal permeability was associated with slowed prostate cancer progression as indicated by the PSA doubling time.

     

Surgical treatment for acromioclavicular joint osteoarthritis: patient selection, surgical options, complications, and outcome

Osteoarthritis is one of the most common causes of pain originating from the acromioclavicular (AC) joint. An awareness of appropriate diagnostic techniques is necessary in order to localize clinical symptoms to the AC joint. Initial treatments for AC joint osteoarthritis, which include non-steroidal anti-inflammatory drugs (NSAIDS) and corticosteroids, are recommended prior to surgical interventions. Distal clavicle excision, the main surgical treatment option, can be performed by various surgical approaches, such as open procedures, direct arthroscopic, and indirect arthroscopic techniques. When choosing the best surgical option, factors such as avoidance of AC ligament damage, clavicular instability, and post-operative pain must be considered. This article examines patient selection, complications, and outcomes of surgical treatment options for AC joint osteoarthritis.     

Usefulness of the acromioclavicular joint cross-sectional area as a diagnostic image parameter of acromioclavicular osteoarthritis

BACKGROUNDAcromioclavicular joint (ACJ) space narrowing has been considered to be an important diagnostic image parameter of ACJ osteoarthritis (ACJO). However, the morphology of the ACJ space is irregular because of osteophyte formation, subchondral irregularity, capsular distention, sclerosis, and erosion. Therefore, we created the ACJ cross-sectional area (ACJCSA) as a new diagnostic image parameter to assess the irregular morphologic changes of the ACJ.AIMTo hypothesize that the ACJCSA is a new diagnostic image parameter for ACJO.METHODSACJ samples were obtained from 35 patients with ACJO and 30 healthy individuals who underwent shoulder magnetic resonance (S-MR) imaging that revealed no evidence of ACJO. Oblique coronal, T2-weighted, fat-suppressed S-MR images were acquired at the ACJ level from the two groups. We measured the ACJCSA and the ACJ space width (ACJSW) at the ACJ on the S-MR images using our imaging analysis program. The ACJCSA was measured as the cross-sectional area of the ACJ. The ACJSW was measured as the narrowest point between the acromion and the clavicle.RESULTSThe average ACJCSA was 39.88 ± 10.60 mm² in the normal group and 18.80 ± 5.13 mm² in the ACJO group. The mean ACJSW was 3.51 ± 0.58 mm in the normal group and 2.02 ± 0.48 mm in the ACJO group. ACJO individuals had significantly lower ACJCSA and ACJSW than the healthy individuals. Receiver operating characteristic curve analyses demonstrated that the most suitable ACJCSA cutoff score was 26.14 mm², with 91.4% sensitivity and 90.0% specificity.CONCLUSIONThe optimal ACJSW cutoff score was 2.37 mm, with 88.6% sensitivity and 96.7% specificity. Even though both the ACJCSA and ACJSW were significantly associated with ACJO, the ACJCSA was a more sensitive diagnostic image parameter.     

Homeopathic remedies for the treatment of osteoarthritis: a systematic review

Osteoarthritis is a common rheumatic disease. Limitations of conventional medical management of this condition indicate a real need for safe and effective treatment of osteoarthritic patients. The authors review the clinical evidence for and against the effectiveness of homeopathic medicines in the treatment of patients with osteoarthritis. A systematic review of all randomised controlled clinical trials of homeopathic treatment of patients with this condition is presented. A comprehensive search yielded four trials which are discussed in detail. The authors conclude that the small number of randomised clinical trials conducted to date, although favouring homeopathic treatment, do not allow a firm conclusion as to the effectiveness of homeopathic remedies in the treatment of patients with osteoarthritis. The clinical evidence appears promising, however, and more research into this area seems warranted.     

Gastrointestinal permeability to polyethylene glycol: an evaluation of urinary recovery of an oral load of polyethylene glycol as a parameter of intestinal permeability in man

The permeability of the gastrointestinal tract was investigated by means of polyethylene glycol (PEG), given orally. The PEG solutions contained oligomers with molecular weights from 414 to 1206. The urinary recovery of ingested PEG was determined by high performance liquid chromatography (HPLC). Considerable inter- and intra-individual variations in recovery were found in a reference group of 33 healthy subjects. Intake of food did not change the recovery of PEG, 6.11% (SEM 0.52, n = 13) compared with that for the reference group, 6.45% (SEM 0.39, n = 33). The PEG recovery in a group of ileostomy patients was 5.86% (SEM 0.62, n = 13). No correlation was found between PEG recovery and small bowel transit time. The lipophillic properties of PEG were determined by measuring the partition coefficients in 1-octanol/water and in methylhexanoate/water systems. From these results, correlated with the values for the hydrodynamic volumes of PEG, it was concluded that the intestinal permeation of PEG observed was probably determined by the hydrophillic/hydrophobic properties of the mucosal membrane, rather than by the presence of intercellular junctions or paracellular pores. The PEG molecules with molecular weights from 414 to 1206 were, therefore, not suitable as solitary probes for permeability studies in man.     

A systematic review to determine the optimal type and dosage of land-based exercises for treating knee osteoarthritis

Background: Exercise has been acknowledged as an effective non-pharmacological intervention for osteoarthritis. Consensus regarding the type of exercise i.e., aerobic or resistance, weight bearing or non-weight bearing, and dosage i.e., frequency, loading, duration, or intensity, is yet to be reached.

Objective: The purpose of this review was to address two questions: (1) is there a difference in clinical outcomes between different exercise programmes; and (2) what is the optimal dosage of exercises for people with knee osteoarthritis.

Methods: A systematic review was conducted. A study of published (AMED, CINAHL, MEDLINE, EMBASE, PubMed, and the Cochrane Library) and unpublished literature (WHO International Clinical Trials Registry Platform, current controlled trials and the United States National Institute of Health Trials Registry, and Open Grey) was undertaken in January 2013. Studies assessing the clinical outcomes of different types and dosages of exercise for people with osteoarthritis of the knee were included. Methodological quality was assessed using the critical appraisal skills programme (CASP) randomized controlled trial (RCT) appraisal tool.

Results: Ten studies assessing 958 knees from 916 participants were included. Exercise significantly improved pain and function for people with knee osteoarthritis. There was no significant difference in outcomes for different types of exercise i.e., aerobic versus resistance, weight bearing versus non-weight bearing. There was no significant difference in respect to the intensity of exercise i.e., high- versus lower-intensity resistance or aerobic exercises. The quality of the literature was moderate to high.

Conclusions: While exercise appears to improve symptoms and optimize function for people with knee osteoarthritis, the optimal form and dosage of exercise remains unknown.

Funding: None.

PROSPERO Registration Number: CRD42012002811.     

Evidence-based practice: review of clinical evidence on the efficacy of glucosamine and chondroitin in the treatment of osteoarthritis

PURPOSE: To evaluate past and current evidence from randomized controlled trials on the efficacy of glucosamine sulfate (GS), glucosamine hydrochloride (GH), and chondroitin sulfate (CS) for the treatment of osteoarthritis (OA). DATA SOURCES: An extensive review of four meta-analyses and a review of the findings of the recently published Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) funded by the National Institutes of Health. FINDINGS: Review of previous studies on the efficacy of GS, GH, and CS in the treatment of OA showed inconclusive results because of weak research design. The GAIT attempted to provide clarity on the use of GH and CS in treating knee pain from OA by using a rigorous research design to elicit cause and effect. The GAIT results showed that GH and CS were not effective in reducing knee pain in the study group overall; however, these may be effective in combination for patients with moderate-to-severe knee pain. IMPLICATIONS FOR PRACTICE: There is now clinical evidence indicating that recommending GS, GH, and CS for the treatment of mild knee pain from OA is ineffective. Further research needs to be done to identify specific characteristics in patients that results in a positive response. Until the findings of the GAIT undergo further peer review, the results of the research needs to be interpreted with caution.     

Effects of non-pharmacological conservative treatment on pain,range of motion and physical function in patients with mild to moderate hip osteoarthritis. A systematic review

ObjectiveThe purpose of this review was to identify the effects of non-pharmacological conservative treatment on pain, range of motion and physical function in patients with mild to moderate hip osteoarthritis.DesignA systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.SettingWe searched MEDLINE, PEDro, Scopus and the Cochrane Library databases for randomized controlled trials related to non-pharmacological conservative treatments for hip osteoarthritis with the following keywords: “hip osteoarthritis,” “therapeutics,” “physical therapy modalities,” and “combined physical therapy”. The PEDro scale was used for methodological quality assessment and the Oxford Centre of Evidence-Based Medicine scale was used to assess the level of evidence. Outcomes measures related to pain, hip range of motion and physical function were extracted from these studies.ResultsTwelve studies met the inclusion criteria. Most of the studies showed high level of evidence and only two showed low level of evidence. High quality of evidence showed that manual therapy and exercise therapy are effective in improving pain, hip range of motion and physical function. However, high quality studies based on combined therapies showed controversy in their effects on pain, hip range of motion and physical function.ConclusionsExercise therapy and manual therapy and its combination with patient education provides benefits in pain and improvement in physical function. The effects of combined therapies remain unclear. Further investigation is necessary to improve the knowledge about the effects of non-pharmacological conservative treatments on pain, hip range of motion and physical function.     

原发性膝骨关节炎易感基因多态性位点的系统综述

目的 对原发性膝骨关节炎(PKO)易感基因多态性位点进行系统综述。方法 检索PubMed、Web of Science、中国知网、万方数据库和中国生物医学文献数据库从建库至2020年12月有关PKO遗传易感性与基因多态性的文献,进行系统综述。结果 纳入有关人类PKO易感基因多态性位点的文献共42篇,涉及有关PKO发病的细胞信号通路包括炎症反应、受体信号通路、转录因子信号通路、骨相关信号通路等,包括炎症因子基因、趋化因子基因、Toll样受体基因、转录因子基因、肥胖相关基因、骨相关基因等多个基因多态性位点。结论 炎症因子基因和骨相关等位基因多态性很可能与PKO易感性有关。