Professor TANG Shui-Fu believes that the development of renal proteinuria in chronic kidney disease is due to the deficiency of spleen and kidney,which leads to the malfunction in lifting lucid yang and lowering turbid yin of the body and the internal retention of turbid-toxin.The early stage of renal proteinuria is mainly induced by qi deficiency of spleen and kidney,and the middle and late stage of renal proteinuria results from the long-lasting spleen and kidney deficiency together with damp-toxin accumulation and is characterized by the mixture of healthy-qi deficiency and pathogenic-qi excess.Aimed at the key pathogenesis of the dysfunction of ascending and descending of qi movement,Professor TANG Shui-Fu treated the renal proteinuria with the principal method of strengthening the spleen and tonifying the kidney,combined with method of eliminating dampness,draining turbidity and dissolving stasis targeted at the pathogenic-qi excess of damp-turbidity and stasis-toxin diffusing in the triple energizer.Meanwhile,the use of the method of replenishing and elevating Qi for regulating the qi movement of the spleen and kidney was stressed.In the early stage of renal proteinuria,the Chinese medicines with the actions of promoting the lifting of lucid yang such as Cimicifugae Rhizoma and Bupleuri Radix were added on the basis of herbs for strengthening the spleen and benefiting the kidney,so that the essence can be consolidated and proteinuria can be eliminated.In the middle and late stage of renal proteinuria,the course of the disease lasted a long time,and the internal attack of the pathogens caused the reversal and chaos of the lucid yang and turbid yin.In this case,treatment should follow the principal method of lowering turbid yin and by the assistance of the herbs for replenishing and elevating qi such as Astragali Radix,Atractylodis Macrocephalae Rhizoma,Poria,Dioscoreae Rhizoma,Cimicifugae Rhizoma,and Bupleuri Radix,so that the ascending and descending of qi movement can be coordinated,the lucid yang is raised and turbid yin is directed downward,the renal function is protected and the progression of chronic kidney disease is slowed down.

Objective To investigate the mechanism of Bushen Yixin Tablets in the treatment of diabetic nephropathy(DN).Methods The key targets of Bushen Yixin Tablets for the treatment of DN were predicted by network pharmacology.A high-glucose-processed MPC-5 cell model was constructed,enzyme-linked immunosorbent assay(ELISA),real-time quantitative polymerase chain reaction(RT-qPCR)and Western Blot were applied to verify the potential action targets and pathways of Bushen Yixin Tablets for the treatment of DN.Results Twenty-four active ingredients were obtained from Bushen Yixin Tablets.There were 131 targets involved in the treatment of DN by Bushen Yixin Tablets,and the results of pathway enrichment analysis showed that the key targets might mainly focus on inflammatory pathways,lipids and atherosclerosis.The further experimental validation showed that,compared with the high glucose group,the secretion level of matrix metalloproteinase 1(MMP-1)in the supernatant of MPC-5 cells in the medium-and high-dose groups of Bushen Yixin Tablets medicated serum were increased(P＜0.001),and the secretion levels of tissue inhibitor of metalloproteinase 1(TIMP-1)and transforming growth factor β1(TGF-β1)were decreased(P＜0.001).Compared with the high glucose group,the protein and mRNA expression levels of MMP1 and BCL-2 in the high-dose group of Bushen Yixin Tablets medicated serum were increased(P＜0.001),and the protein and mRNA expression levels of phosphatidylinositol 3-kinase(PI3K)and protein kinase B(AKT)were decreased(P＜0.001).Conclusion Bushen Yixin Tablets may play a protective role against DN by inhibiting the proliferation of glomerular mesangial cells and promoting the degradation of extracellular matrix through PI3K/AKT/BCL-2 pathway.

It is difficult to insert long-term dialysis catheters after severe stenosis or occlusion of the internal jugular vein and innominate vein. We used REcanalisation and balloon-oriented puncture for Re-insertion of dialysis catheter in nonpatent central veins (REBORN) in seven patients with severe central venous lesions, and all patients were inserted with long-term dialysis catheters successfully. None had severe complications such as pneumothorax, hemothorax, or pulmonary embolism during operation. All catheters functioned well after postoperative follow-up of 2 months. REBORN provides a novel approach to establish difficult dialysis pathways.
Humans ; Catheterization, Central Venous/adverse effects* ; Catheters, Indwelling ; Renal Dialysis ; Jugular Veins ; Punctures

Most of the active ingredients of herbs are secondary metabolites of plants. Cytochrome P450s (P450s) are hemoglobin-containing monooxygenases encoded by a super-gene family, which play important roles in the metabolic network of plants. This review focuses on the role of P450s on biosynthesis of secondary metabolites such as terpenoids, alkaloids, flavonoids and phenylpropanoids. This will provide references for biosynthesis and regulation of secondary metabolites in medicinal plants.

Objective To explore the correlation of disease activity with the primary syndromes of deficiency and excess types of lupus nephritis(LN). Methods A retrospective study was carried out in 134 LN patients,and the LN patients were differentiated into deficiency syndrome(deficiency group)and excess syndrome(excess group). The disease activity related indicators of systemic lupus erythematosus disease activity index(SLEDAI)scores, complements, inflammation indexes, and urine indicators were compared between the two groups. Results Of the 134 LN patients,33 cases were differentiated into excess syndrome,and 101 cases were differentiated into deficiency syndrome. According to the SLEDAI scores, 9.09％ of the patients in excess group were inactive, 4.95％ of the patients in deficiency group were inactive, and most of the patients in the two groups were at severe active stage. There was no significant difference of SLEDAI scores between the two groups(P>0.05) . The differences of complement C3 and C4 , inflammation indexes of C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR),urine protein,and urine occult blood were also insignificant between the two groups (P>0.05). Conclusion There is no correlation between deficiency-excess syndrome differentiation and disease activity of LN. Most of the LN patients with deficiency syndrome are at active stage,but not at remission stage.

Objective To investigate the therapeutic effect of Shugan Jieyu Capsules for the treatment of maintenance hemodialysis patients with insomnia. Methods Forty maintenance hemodialysis patients with insomnia were randomized into observation group and control group by random number table method,20 cases in each group. Patients of the two groups were given conventional maintenance hemodialysis and fundamental treatment for controlling blood pressure and glucose,regulating calcium-phosphorus metabolism,and relieving anemia. And additionally,the control group was treated with Estazolam Tablets orally,and the observation group was treated with Shugan Jieyu Capsules orally. By using Pittsburgh Sleep Quality Index(PSQI)scale,we investigated the changes of the quality of sleep in two groups before and after treatment,and evaluated the therapeutic effect. Results (1)After treatment,PSQI scores of the two groups were obviously decreased,and the difference was significant (P < 0.05 compared with those before treatment). The observation group had stronger effect on decreasing PSQI scores than the control group,the difference being significant(P < 0.05).(2)The total effective rate of the observation group was 90.0% and that of the control group was 75.0%, the difference being significant (P<0.05). (3)During the treatment,adverse reaction of morning dizziness or drug dependence was not shown. Conclusion Shugan Jieyu Capsules exert certain therapeutic effect for the treatment of maintenance hemodialysis patients with insomnia by improving the quality of sleep.

Objective: To investigate the clinical effect of a novel disposable ring versus that of the suture device in circumcision for redundant prepuce and phimosis. METHODS: We randomly assigned 470 male patients with redundant prepuce or phimosis to receive circumcision with a novel disposable ring (the DR group, n = 235) or the suture device (the SD group, n = 235) and compared the operation time, intraoperative blood loss, pain scores, wound healing time, and postoperative complications and penile appearance between the two groups of patients. RESULTS: All the operations were completed smoothly. Compared with the SD group, the DR group showed significantly shorter operation time (［7.49 ± 1.84］ vs ［3.83 ± 0.42］ min, P <0. 05), less intraoperative blood loss (［3.34 ± 2.59］ vs ［2.41 ± 1.01］ ml, P <0.05), lower intraoperative pain score (0.57 ± 0.76 vs 0.20 ± 0.47, P <0.05) and 6-hour postoperative pain score (3.42 ± 1.12 vs 0.48 ± 0.94, P <0.05), shorter wound healing time (［12.05 ± 2.80］ vs ［7.79 ± 1.65］ d, P <0.05), lower incidence rates of postoperative glans congestion or edema (36.17% ［85/235］ vs 2.56% ［6/235］, P <0.05), dysuria or strenuous urination (34.04% ［80/235］ vs 2.13% ［5/235］, P <0.05) and bleeding or hematoma (5.11% ［12/235］ vs 1.28% ［3/235］, P <0.05), and higher satisfaction with postoperative penile appearance (90.6% ［213/235］ vs 95.8% ［228/235］, P <0.05). There were no statistically significant differences between the SD and DR groups in the pain scores at the sixth night after operation (1.31 ± 0.96 vs 1.34 ± 1.07, P >0.05) or while the staples scraping the underpants or at the ring removal (3.49 ± 1.22 vs 3.36 ± 1.41, P >0.05). No obvious postoperative infection or delayed healing was observed except for 3 cases of wound dehiscence (1 in the DR and 2 in the SD group) and 8 cases of delayed removal of the staples in the SD group. CONCLUSIONS The novel disposable ring, with its advantages of short operation time, less bleeding and pain, good penile appearance, high safety, and simple operation, is obviously superior to the suture device in circumcision and deserves to be applied and popularized clinically. .
Blood Loss, Surgical ; Circumcision, Male ; instrumentation ; Disposable Equipment ; Edema ; etiology ; Humans ; Male ; Operative Time ; Pain Measurement ; Pain, Postoperative ; Penis ; abnormalities ; surgery ; Personal Satisfaction ; Phimosis ; surgery ; Postoperative Complications ; etiology ; Postoperative Period ; Suture Techniques ; instrumentation ; Sutures ; Wound Healing

Objective: To compare the clinical effect of a novel disposable circumcision device Ring with that of conventional circumcision in the treatment of redundant prepuce and phimosis. METHODS: Totally, 750 patients with redundant prepuce or phimosis underwent Ring circumcision (group A, n = 450) or conventional circumcision (group B, n = 300). We recorded the operation time, intraoperative blood loss, Visual Analogue Scale (VAS) intraoperative pain scores, postoperative complications, wound healing time, and patients' satisfaction with postoperative penile appearance, followed by comparison of the collected data between the two groups of patients. RESULTS: All the operations were successfully completed. Group A, as compared with B, showed significantly shorter operation time (［3.78 ± 0.42］ vs ［26.24 ± 3.99］ min, P <0.05), less intraoperative blood loss (［2.39 ± 1.01］ vs ［10.80 ± 3.57］ ml, P <0.05), lower pain scores intraoperatively (0.14 ± 0.36 vs 2.30 ± 1.46, P <0.05), 6 hours postoperatively (0.32 ± 0.78 vs 3.03 ± 1.56, P <0.05) and at the ring removal (3.35 ± 1.42 vs 2.78 ± 1.43, P <0.05), shorter wound healing time (［7.61 ± 1.60］ vs ［8.57 ± 1.37］ d, P <0.05), higher satisfaction with postoperative penile appearance (97.8% ［440/450］ vs 86% ［258/300］, P <0.05), and lower incidence of postoperative bleeding or hematoma (0.89% ［4/450］ vs 3% ［9/300］, P <0.05). No statistically significant differences were observed between groups A and B in the nocturnal pain score before the ring removal (1.45±1.02 vs 1.38 ± 0.92, P >0.05) or the postoperative incidence rate of edema (0.89% ［4/450］ vs 2.33% ［7/300］, P >0.05). There were no significant postoperative infections or delayed incision healing except for 1 case of wound dehiscence in each group. CONCLUSIONS Ring circumcision, with its advantages of shorter operation time, less blood loss and pain, higher safety, and better postoperative penile appearance, is easily accepted by the patients and deserves wide clinical application.
Blood Loss, Surgical ; statistics & numerical data ; Circumcision, Male ; instrumentation ; Disposable Equipment ; Humans ; Incidence ; Male ; Operative Time ; Pain Measurement ; Patient Satisfaction ; Penis ; abnormalities ; anatomy & histology ; surgery ; Phimosis ; surgery ; Postoperative Complications ; Postoperative Hemorrhage ; Postoperative Period ; Wound Healing

OBJECTIVETo evaluate the clinical efficacy and safety of treatment of chronic primary glomerulopathy (CPG) patients of Shen deficiency and dampness heat syndrome (SDDHS) by Yishen Qingli Granule (YQG) combined with low-dose Tripterygium Wilfordii multiglycoside Tablet (TWT).

METHODSTotally 231 CPG patients of SDDHS were enrolled in this study (including 60 patients from First Affiliated Hospital of Nanjing University of Chinese Medicine, 58 from First Affiliated Hospital of Nanjing Medical University, 46 from Xinqiao Hospital of Third Military Medical University, 35 from First Affiliated Hospital of Guangzhou University of Chinese Medicine, 14 from First Affiliated Hospital of Soochow University, and 18 from Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine). They were randomly assigned to the control group (116 cases) and the trial group (115 cases) according to block group method. There were 217 cases in the safety analysis set (109 cases in the trial group vs 108 cases in the control group), and 203 cases in the full analysis set (99 cases in the trial group vs 104 cases in the control group). All patients received basic treatment such as ACEI/ARB. Furthermore, YQG (consisting of raw astragalus 10 g, prepared Polygonum Multiflorum 10 g, Pyrrosia 10 g, 1.5 g each package, containing 10 g of crude drugs) was additionally given to patients in the trial group, each package, twice daily. The TWT (10 mg) was given, twice a day. The TWT dose was adjusted according to 24 h urinary total protein (UTP). The placebos of YQG and TWT were administered to those in the control group. The treatment course consisted of 24 weeks and the follow-up visit lasted for 24 weeks. The biochemical indices were observed before and after treatment including 24 h UTP, urine red cell count (U(RBC)), renal functions (BUN, SCr), blood routine test (WBC), and liver functions (SGPT, SGOT). Reverse reactions such as gastrointestinal discomfort, skin rash, and irregular menstruation were also observed.

RESULTSCompared with the control group, the total effective rate was better in the trial group (82.83% vs 61.54%, P < 0.01). Results of stratified comparison of UTP showed better efficacy in the trial group (0.8-3.0 g/24 h, P < 0.01). The UTP decline occurred in the trial group after 8 weeks of treatment, with stable action, showing statistical difference when compared with the control group (P < 0.01). In the trial group, U(RBC) level decreased after treatment but changed more significantly. But there was no statistical difference in the changes when compared with the control group (P > 0.05). After treatment, there were no statistical difference in safety indicators such as WBC, SGPT, and SGOT between the two groups after treatment (P > 0.05).

CONCLUSIONOn the basis of basic treatment such as ACEI/ARB, application of YQG combined with low-dose TWT had better effect in controlling proteinuria of CPG patients, and could help stabilizing their conditions with less adverse reactions.

Adult ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Kidney Diseases ; diagnosis ; drug therapy ; Kidney Glomerulus ; pathology ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; methods ; Treatment Outcome ; Tripterygium

The purpose of this study was to explore the clinical value of the platelet antibody screening and typing in platelets transfusion by using microcolumn gel immunoassay (MGIA). The platelets antigen-antibody reactions including the antibody screen and blood crossmatch were detected by MGIA. The results indicated that the detection of platelet antibody showed positive in 30 cases of aplastic anemia (AA), 11 cases of myelodysplastic syndrome (MDS), 24 out of 25 cases of leukemia and 1 out of cases of other diseases, while detection of platelet antibody showed negative in 20 normal volunteer donors. The number of platelet antibody crossmatch coincidence in 112 specimens of AA, 42 specimens of MDS and 95 specimens of leukemia were 45, 20 and 40, the coincidence rates were 40.18%, 47.62% and 42.11%. The mean corrected count increment (CCI) in 20 patients received platelet transfusion many times was 18.2 after crossmatch and 4.7 before crossmatch. It is concluded that the positive rate of platelet antibody screening is very high in patients with hematologic malignancies, the coincidence rate of platelet antibody crossmatch in 249 blood samples is between 40% and 48%, and the efficiency of using crossmatched platelets in clinic is enhanced significantly.
Anemia, Aplastic ; immunology ; Antigens, Human Platelet ; immunology ; Blood Grouping and Crossmatching ; Blood Platelets ; immunology ; Hematologic Neoplasms ; immunology ; Humans ; Immunoassay ; methods ; Isoantibodies ; blood ; immunology ; Platelet Transfusion ; methods