OBJECTIVE: To investigate the changes of connective tissue growth factor (CTGF) protein and CTGF mRNA in kidney tissue of rats with adriamycin (ADR)-induced nephropathy and to study the effects of compound Biejia Ruangan tablet (CBJRGT), a traditional Chinese herbal medicine for treatment of liver fibrosis. METHODS: A rat model of ADR-induced nephropathy after one-sided nephrectomy was established. Forty-five Wistar rats were randomly divided into 5 groups: normal control group, sham-operated group, untreated group, lotensin-treated group and CBJRGT-treated group. Pathological changes of the kidney tissue were observed by microscopy after 10-week drug administration. The expressions of CTGF protein and CTGF mRNA in the kidney tissue were measured by the methods of immunohistochemistry and in situ hybridization. RESULTS: The expressions of CTGF protein and CTGF mRNA in the normal and sham-operated groups were decreased in the intracytoplasm of glomerular mesangial cells, renal tubular epithelial cells and interstitial cells. Compared with the sham-operated group, the expressions of CTGF protein and CTGF mRNA in the untreated group were markedly increased and the development of renal fibrosis in the untreated group could be observed. CBJRGT could significantly decrease the expressions of CTGF protein and CTGF mRNA, and there was no significant difference between CBJRGT-treated group and lotensin-treated group. CONCLUSION: CBJRGT may suppress the development of fibrosis through down-regulating the expressions of CTGF protein and CTGF mRNA.

Objective Through factor analysis of the quantified syndrome information of 558 cases of kidney yang deficiency syndrome,the constructing feature of kidney yang deficiency syndrome was revealed,which provides clinical data support for the objectification,standardization and normalization of kidney Yang deficiency syndrome.Methods Firstly,the frequency analysis of symptoms,tongue and pulse signs of 558 patients with kidney Yang deficiency syndrome was carried out,and then the main syndrome information of the patients with kidney Yang deficiency syndrome was quantified.Finally,the common factors and their representative variables of kidney Yang deficiency syndrome were screened out through factor analysis,and the constructing feature of kidney Yang deficiency syndrome was analyzed combined with TCM syndrome knowledge.Results Eight common factors with eigenvalues greater than 1 were extracted by principal component analysis,and the cumulative contribution rate was 60.483%.After the factor rotation,the representative variables with the absolute value of load coefficient greater than 0.45 in each common factor were selected.The representative variables of F1 are afraid of cold and fond of warmth(0.947)and intolerance to cold(0.932).The representative variables of F2 are waist pain(0.754),waist and knee weakness(0.720)and cold in waist and knees(0.466).The representative variables of F3 are depression(0.749),insomnia(0.711)and diarrhoea(0.470).The representative variables of F4 are thin fur(0.819)and white fur(0.768).The representative variable of F5 are tinnitus and deafness(0.687),frequent nocturnal urination(0.591)and decreased libido(0.587).The representative variables of F6 are pulse sinking(0.766)and pulse weakness(0.736).The representative variables of F7 is thready pulse(0.942).The representative variable of F8 is pale tongue(0.961).External syndrome of disease location involved in these common factors are waist,bone,brain,ear,anterior Yin,posterior Yin and reproductive function.The disease nature involved in these common factors is deficiency and cold.Conclusion The basic constituent units of kidney Yang deficiency syndrome include disease location syndrome elements and disease nature syndrome elements.The disease location is kidney,and the abnormal changes of kidney location are mainly external symptoms of waist,bone,brain,ear,anterior Yin,posterior Yin and reproductive function.Its disease nature is deficiency and cold.Yang deficiency leads to external cold.Yang Qi deficiency can not warm the body surface resulting in the appearance of external cold syndrome.

Objective:To investigate the effect of extemal diaphragm pacemaker(EDP)on the duration of mechanical ventilation,diaphragm function,and other prognosis in coma patients with difficult weaning after brain injury surgery. Method:A total of 66 postoperative coma patients with brain injury were enrolled and divided into control group(n=33)and experimental group(n=33)according to the random number table method.The control group was treated with conventional drugs and mechanical ventilation in ICU,and the experimental group was treated with EDP on the basis of the control group,20 minutes each time,twice a day for 14 consecutive days.The mechanical ventilation time and respiratory parameters of the two groups were observed at the start-ing point(within 72-96 hours of mechanical ventilation after operation)and the end point(the day of suc-cessful weaning,and the day after the end of treatment cycle if the patients were not successfully weaned).The changes of diaphragm thickness(DT),diaphragm thickening fraction(DTF),and diaphragm excursion(DE)were observed by ultrasound,and other prognostic parameters were recorded. Result:There was no significant difference between the two groups at the time of enrollment(P＞0.05).After treatment,in terms of respiratory function,except for the control group with no statistical difference in shal-low rapid respiratory index before and after treatment(P＞0.05),the mechanical ventilation time of the experi-mental group was significantly shorter than that of the control group,and the success rate of offline was im-proved.Tidal volume and shallow rapid respiratory index of the two groups were improved compared with that before treatment,and the tidal volume of the control group was increased after treatment with statistical difference(P＜0.05).The tidal volume of experimental group after treatment was increased compared with be-fore treatment,and the shallow rapid respiratory index of experimental group was decreased compared with be-fore treatment,with significant differences(P＜0.001).In terms of diaphragm function,there was no statistical significance in DT,DTF and DE between the two groups before treatment(P＞0.05),and there was a signifi-cant difference in the composition ratio of DT changes between the two groups after treatment(P＜0.001).DTF and DE showed significant differences between the two groups and within the two groups after treatment,(P＜0.001).In terms of prognosis,the rate of recovery,mortality and length of hospital stay in the experimen-tal group were lower than those in the control group,but there was no significant difference(P＞0.05). Conclusion:EDP treatment can shorten the mechanical ventilation time of coma patients with difficult wean-ing after brain injury surgery,improve the success rate of weaning,improve respiratory parameters,and im-prove diaphragm function.However,it did not reduce the probability of recovery,mortality and length of hos-pital stay.

ObjectiveTo study the correlations of the characteristics of kidney Yang deficiency syndrome in patients with chronic kidney disease （CKD） with clinical indicators and to explore the risk factors of kidney Yang deficiency in CKD. MethodThe differentiation of traditional Chinese medicine （TCM） syndrome classified the 225 CKD patients who met the inclusion criteria into two groups： one group of kidney Yang deficiency syndrome （99 patients） and one group of non-kidney Yang deficiency syndrome （126 patients）. The symptoms， tongue manifestation， pulse manifestation， and accompanied symptoms of the kidney Yang deficiency syndrome group were recorded. The syndrome characteristics were summarized by factor analysis and clustering analysis. The levels of hemoglobin, red blood cell count, urinary protein, urinary glucose, creatinine, urea nitrogen and glomerular filtration rate were compared between the kidney Yang deficiency syndrome group, the non-kidney Yang deficiency syndrome group and the normal control group by ANOVA and non-parametric test. The binary logistic regression model was employed to analyze the correlations of lifestyle， body mass index （BMI） with syndrome. ResultThe high-frequency symptoms of CKD patients with kidney Yang deficiency syndrome were waist pain， fear of cold， favor of warm， lethargy， fear of cold at waist and knees， etc. The patients mainly presented deep pulse， thready pulse， or weak pulse， and the tongue with white coating， greasy coating， or thin coating. A total of 13 common factors were obtained， which can be classified into 5 categories. The patients with kidney Yang deficiency syndrome mainly had symptoms in limbs （especially lower limbs）， chest， bladder， fleshy exterior， and stomach， with the main manifestations of deficiency-cold， Qi deficiency， fluid retention， and blood stasis. The clustering analysis classified the patients into 11 categories， which reflected that kidney Yang deficiency syndrome mainly presented the symptoms of Qi deficiency， blood stasis， and fluid retention， with fleshy exterior， limbs， spleen， stomach， ears， mind， and bladder involved. The results of clustering analysis and factor analysis were consistent， both of which indicated that the patients were weak with deficiency-cold， accompanied by fluid retention and blood stasis. Frequency analysis also showed that common symptoms mainly included Qi deficiency， fluid retention， cold-dampness， and blood stasis. Compared with the non-kidney Yang deficiency group， the kidney Yang deficiency group showed a large proportion of patients in stage 3-5 CKD， elevated urea nitrogen （P<0.05）， decreased glomerular filtration rate， hemoglobin， and red blood cell count （P<0.05）， and increased qualitative grade of urine protein. In addition， the results of regression analysis showed that female， little or no exercise， and diet preference were the risk factors for kidney Yang deficiency syndrome in CKD （P<0.05）. ConclusionThe disease location and manifestations have correspondence in the CKD patients with kidney Yang deficiency syndrome. The TCM symptoms are correlated with clinical indicators. Hemoglobin， red blood cell count， glomerular filtration rate， urea nitrogen， and urine protein can reflect the connotation of kidney Yang deficiency syndrome in CKD to a certain extent. Additionally， related risk factors in life can affect the occurrence of kidney Yang deficiency syndrome in CKD.