ObjectiveTo observe the clinical efficacy of renal failure enema for retention enema as an adjuvant therapy in patients with chronic kidney disease stages 3-4 and its effect on serum uremic toxins including indoxyl sulfate （IS），p-cresol sulfate （PCS），and trimethylamine oxide （TMAO）. MethodsA total of 60 patients with stage 3-4 chronic kidney disease in the Department of Nephrology，Affiliated Hospital of Tianjin Institute of Traditional Chinese Medicine from June 2023 to November 2023，were divided into a control group and an observation group. Each group consisted of 30 patients，and the random number table method was used for the division. Both groups received routine symptomatic treatment of traditional Chinese medicine （TCM） and Western medicine in the department. The observation group，based on the treatment of the control group，was additionally given 100-200 mL of the hospital-made renal failure enema capsules once every other day. The total treatment course was 4 weeks. The changes in serum creatinine （SCr），blood urea nitrogen （BUN），uric acid （UA），24-hour urine total protein quantification （24 h UTP），and serum uremic toxins such as IS，PCS，and TMAO were compared between the two groups before and after treatment. The total clinical effective rate of TCM and Western medicine was calculated and the adverse reactions were recorded. ResultsBefore treatment，the baseline levels of the two groups were comparable. After treatment，the total effective rate of the observation group （80.0%，24/30） was superior to that of the control group （53.3%，16/30），and the difference was statistically significant （Z=2.267，P=0.023）. After treatment，the TCM pattern scores of the two groups were lower than before，and the constipation symptoms in the observation group were improved（P<0.01）. Compared with the control group after treatment，the observation group showed decreased TCM syndrome scores，and the difference before and after treatment was larger （P<0.05）. Compared with before treatment，the SCr in both groups decreased after treatment （P<0.05）. BUN levels decreased in the observation group（P<0.05），and IS and PCS levels decreased in the observation group（P<0.05，P<0.01）. Compared with the control group after treatment，the IS level of the observation group decreased （P<0.05）. During the trial，no adverse reactions occurred in either group. ConclusionRenal failure enema can be used as an adjuvant therapy for patients with CKD stages 3-4. It can not only slow down the progression of renal function but also effectively down-regulate the levels of uremic toxins. In addition，it can significantly improve the TCM syndrome of kidney disease patients，which makes it worthy of clinical application and promotion.

Humans ; Intra-Abdominal Fat/diagnostic imaging* ; Coronary Artery Disease ; Body Mass Index

Objective To determine the prevalence and treatment of chronic obstructive pulmonary diseases (COPD) among citizens in Ningbo. Methods A multi-stage stratified random sampling was applied to select 8 neighborhoods and 3 villages out of 7 districts in Ningbo, people who were older than or equal to 40 years were enrolled as subjects. Information on the prevalence rate and treatment conditions of COPD was collected through respiratory symptoms and treatment questionnaire and lung function screening. Results A total of 5865 people were screened, 5674 of them met inclusion criteria and completed questionnaire and lung function test. Among whom, 3044 people were men (53.6%, the average age is 55.7±11.4), 2630 women (46.4%, the average age was 55.3 ± 10.7);473 of them were diagnosed with COPD, the overall prevalence rate was 8.3%, including 354 cases who had never been diagnosed as COPD, accounted for 74.8% of the total cases diagnosed with COPD, mainly in stage ⅠandⅡof the disease. There were statistically significant differences between diagnosed and undiagnosed patients in the overall COPD group and among different gender groups ( stagesⅠandⅡ) and (stagesⅢandⅣ). Among the 473 COPD cases, 119 (diagnostic yield 25.2%) of whom had been diagnosed with bronchitis, only 48 (41.2%of the diagnosed) received drug treatment, only 13 patients were treated regularly with medication. Conclusion The overall prevalence rate of COPD among those over 40 years of age in Ningbo was quite high and mainly had stagesⅠandⅡof the disease. The number of the diagnostic yield and those who received regular treatment are quite low. The current situation of diagnosis and treatment are far from satisfaction, management of COPD should be strengthened to reduce the burden for family and society.

Objective To observe the intervention effect of Schisandrin B (Sch B) on cisplatin induced acute kidney injury (AKI) in mice and its possible mechanism.Methods Twenty-five BALB/c mice were randomly divided into blank control group, model group, low and high dose of Sch B intervention groups and Sch B control group. Olive oil with Sch B was administered by gavage at the dose of 20 mg/kg or 100 mg/kg for low and high dose of Sch B intervention groups respectively; olive oil with Sch B 100 mg/kg was applied by gavage to the Sch B control group; the same volume of olive oil was perfused into the gastric cavity in the blank control group and model group; the above measures in various groups were consecutively used for 5 days. On the 3rd day of the experiment, AKI mice model was established by intraperitoneal injection of cisplatin (20 mg/kg) once and the same measure was given to the low and high dose of Sch B intervention groups; 1 mL/kg normal saline was injected into the peritoneal cavity in the bland control group and Sch B control group. At the end of the experiment, the serum creatinine (SCr) level was determined; apoptosis of renal tubular epithelial cells were detected by using terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) assay; the morphological changes of renal tubular epithelial cells were observed by hematoxylin eosin (HE) staining, and renal tubular injury score was evaluated; p53 protein content in the kidney tissue was measured by immunohistochemical analysis; furthermore, expressional level of p53 protein in renal tissue was tested by Western Blot.Results Compared with the blank control group, the level of SCr (μmol/L: 86.77±10.97 vs. 14.37±0.81), renal tubular injury score (9.67±1.20 vs. 1.00±0.45), the count of apoptotic renal tubular epithelial cells (cells/200 power field: 20.00±2.13 vs. 2.30±0.40) in the model group were all increased (P < 0.05 orP < 0.01), and p53 protein content (cells/400 power field: 13.40±2.66 vs. 57.30±3.82), and the expression of p53 protein [absorbency (A value) ratio: 0.79±0.09 vs. 1.42±0.09] in model group were decreased (bothP < 0.01). Compared with the model group, in the low and high dose Sch B intervented groups, the level of SCr (μmol/L: 21.98±5.52 and 37.45±5.04), renal tubular injury score (5.67±0.76 and 6.17±0.65), the count of apoptotic renal tubular epithelial cells (cells/200 power field: 10.60±1.05 and 11.60±1.45) were all reduced (allP < 0.01), p53 protein content (cells/400 power field: 42.40±3.67 and 45.90±2.31) and the expression of p53 protein (A value ratio: 1.36±0.16 and 1.25±0.11) were increased (bothP < 0.01). HE staining showed the pathological changes of renal tubules, such as renal tubular epithelial cellular fusion, vacuolization, cast formation, and tubular lumen constriction/dilation in model group; the pathological changes in kidney tissues observed in low and high dose Sch B intervention groups were milder than those in model group.Conclusion Sch B plays a beneficial role in the cisplatin induced AKI in mice, and its protective effect might be mediated by decreasing SCr, regulating p53 protein expression level and inhibiting the apoptosis of renal tubular epithelial cells.

Objective To explore the protective effects of schisandrin B (Sch B) on hypoxia injury induced by cobaltous chloride (CoCl2) in human proximal renal tubular epithelial (HK-2) cells, and the possible mechanism thereof. Methods HK-2 cells were randomly assigned to four groups:control group (Con, cells were untreated), CoCl2 group (CoCl2, cells were treated with 600μmol/L CoCl2 for 24 h), Sch B pretreat group (CoCl2+Sch B, cells were pretreated with 1μmol/L and 10μmol/L Sch B for 2 h) and Sch B group (Sch B, cells were treated with 1μmol/L and 10μmol/L Sch B for 2 h). CCK-8 kit was used to detect the cell viability of four groups. Flow cytometry was used to detect the apoptotic rate of four groups. The protein expression of hypoxia-inducible factor 1α(HIF-1α) was assessed by Western blot assay. The expressions of HIF-1α and inducible nitric oxide synthase (iNOS) mRNA were determined by RT-PCR. Results Compared with the control group, after treated with 600 μmol/L CoCl2, the cell viability was decreased, and the apoptosis was increased, the expressions of HIF-1α and iNOS mRNA were up-regulated in HK-2 cells. There was no significant difference in the expression of HIF-1α mRNA between control group and CoCl2 group. Compared with the CoCl2 group, after pretreated with 1μmol/L and 10μmol/L Sch B, the cell viability was increased and the apoptosis was decreased, the expressions of HIF-1α and iNOS were down-regulated in HK-2 cells. There were no significant differences in the cell viability and apoptotic rate between control group and Sch B group. Conclusion Pretreatment with Sch B can reduce the apoptosis of HK-2 cells by inhibiting the expression of HIF-1α and iNOS mRNA, which shows protective effects on hypoxia injury.

Objective To investigate the therapeutic effect of traditional Chinese medicine(TCM)recipe of nourishing kidney and activating blood for treatment of cisplatin induced acute kidney injury(AKI)in mouse model. Methods Twenty-one male BALB/c mice were randomly divided into three groups:control group,AKI model group and treatment group with the above TCM recipe(each n=7). The AKI model was reproduced by a single intraperitoneal injection of cisplatin 20 mg/kg;the TCM recipe with dosage of 10μL · g-1 · d-1 was given to the treatment group,while equal volume of normal saline was given to the model and control groups by gavage,lasting for 6 days in all groups. The changes of each mouse body weight were observed;mouse venous blood serum creatinine(SCr)level was detected,changes of renal tissue weight and its histopathology were observed under light microscope,and the score of acute tubular necrosis(ATN)was calculated. Results Compared to the control group,the body and renal weight in AKI model group were significantly lowered〔body weight(g):17.18±0.29 vs. 19.33±1.43,renal weight(g):0.28±0.01 vs. 0.32±0.11,both P<0.01〕,and SCr and ATN scores were significantly increased in AKI model group〔SCr(μmol/L):86.77±10.97 vs. 14.37±0.81,ATN score:3.33±0.52 vs. 0.17±0.41,both P<0.01〕. Compared to AKI model group,the body weight(g:18.70±0.28)and renal weight(g:0.31±0.01)in the treatment group were markedly increased,and SCr(μmol/L:21.98±5.52)and ATN scores(2.00±0.63)were significantly lower than those of the AKI model group(all P<0.01). Under optical microscope,there were mouse renal tubular epithelial cell edema and necrosis,renal interstitial inflammatory cell infiltration,the glomerular form roughly normal in the AKI model group;compared with the AKI model group,in the treatment group the degree of mouse renal tubular necrosis was significantly reduced and glomerular form was basically normal. Conclusion The TCM recipe of nourishing kidney and activating blood can reduce SCr and improve the pathological changes of renal tissue in cisplatin induced AKI mouse models,thus it has therapeutic effect for treatment of AKI in mice.

Objective To explore the effect of schisandra chinensis fruit ethanol extract on nephrin and desmin ex-pression in adriamycin(ADR) induced podocyte injury in vitro. Methods Conditionally immortalized mouse podocytes were treated with ADR for 24 h in vitro, then the medium was changed to medium with SE(250 mg/L)for 24 h. Podocytes were di-vided into four groups:control group,model group, SE intervention group and SE group. The expression of nephrin in podo-cytes was detected by immunofluorescence. Western Blot was employed to assess nephrin and desmin expression. Transcrip-tion level of nephrin and desmin were determined by qRT-PCR. Results Nephrin expression was distributed along the cell membrane in linear or granular pattern in control group and SE group. Fluorescence intensity in model group was lower than that of control group SE group and SE intervention group. There was no significant difference of nephrin and desmin protein and mRNA level between control group and SE group. Compared with the model group, protein and mRNA level of nephrin was lower than that of control group and SE intervention group. The protein expression and mRNA transcription of desmin in model group was higher than those in control group and SE intervention group (P＜0.05). Conclusion SE(250 mg/L)has no harmful effect on the podocytes in vitro. SE can protect the podocytes from damage by adriamycin in vitro. SE not only up-regulate the expression of nephrin, but also down-regulate of desmin expression.

Objective To study the change law between deficiency of kidney-Yang and stagnation of blood, and supply a study evidence for the therapy method of invigorate the kidney and promoting blood flow. Method 37 Wistar rats which were made of the model of deficiency of kidney-Yang, were randomly divided into three groups:control group, model group and treatment group. Changes including appearance, general objective sign, organ weight, microcirculation and blood rheology were recorded. Result Phenomenons, including rare fur, depression, lazy, duck stools and purpl dim in micrangium micrangium, occurred in model group. The weight of adrenal body and seminal vesicle and the contents of serum andrusol in model group were lower than those in control group. And in model group, significant increasing TC and LDL-C and decreasing HCL-C were observed. Conclusion Deficiency of kidney-Yang is associated with stagnation of blood, and the time delay of stagnation of blood can lead deficiency of kidney-Yang.

Objective To detect the risk factors for type 2 diabetic nephropathy(DN).Methods A case-control study was conducted,136 hospitalized DN patients and 152 hospitalized type 2 diabetic patients without DN as control group were enrolled in the study.Information including demographic characteristics,history of diabetes and diabetic nephropathy,behaviors,social psychological characters,clinical data and laboratory data was collected retrospectively.Statistic methods including ?2 test,u test and non-conditional logistic regression were conducted to detect the risk factors of DN.Results Between the cases and the controls,there were significant differences in the course of diabetes mellitus(DM),being complicated with hypertension,hyperlipidemia,coronary heart disease,diabetic retinopathy,diabetic foot,diabetic peripheral neuropathy,pulse pressure,laboratory features as tiglyceride,total cholesterol,creatinine,uric acid,and behaviors including control of systolic blood pressure,exercise after DM.Results of multivariate logistic regression analysis showed that course of DM(OR=2.48 95%CI:1.87～3.42),being complicated with hypertension(OR=1.38 95%CI:1.09～1.62) and blood creatinine level(OR=6.23 95%CI:3.03～9.82) were risk factors for DN.Conclusion Longer course of DM,with hypertension and high level of blood creatinine were the risk factors of DN.DM patients should strictly control their blood pressure and blood sugar,periodically inspect renal function and blood creatinine,and correct dyslipidemia to prevent the development and progression of DN.

Objective:To investigate the expression of mmp-2 in mesangial proliferative glomerulonephritis(MsPGN) rat renal tissue and the effects of nourishing kidney and activating blood flow recipe of TCM. Methods: 54 Male SD rats were divided into control group, MsPGN group and treatment group with nourishing kidney and activating blood flow recipe of TCM. Immunohistochemical staining, flow cytometry, western blot and RT-PCR were used to check the protein expression of mmp-2. Results: In MsPGN group, following with the disease progressing, the glomerulus grew graduatly, ECM increased, the basement membrane of glomerulus was thicker. The immunohistochemical staining showed that the chief positive granules were deposited in glomerulus and renal tubular, the expression of mmp-2 was lower than that in control group, but in treatment group the expression of mmp-2 was higher than that in MsPGN group. Conclusion: In MsPGN renal tissue, the expression of mmp-2 was reduced, its activity was weakened. Nourishing kidney and activating blood flow recipe of TCM could induce the expression of MMP-2 and partly recover the activity. Nourishing kidney and activating blood flow recipe of TCM could resist glomerular sclerosis and postpone the course of chronic renal failure.