Sleep disorders and chronic kidney disease

Sleep disorders have a profound and well-documented impact on overall health and quality of life in the general population. In patients with chronic disease, sleep disorders are more prevalent, with an additional morbidity and mortality burden. The complex and dynamic relationship between sleep disorders and chronic kidney disease(CKD) remain relatively little investigated. This article presents an overview of sleep disorders in patients with CKD, with emphasis on relevant pathophysiologic underpinnings and clinical presentations. Evidence-based interventions will be discussed, in the context of individual sleep disorders, namely sleep apnea, insomnia, restless leg syndrome and excessive daytime sleepiness. Limitations of the current knowledge as well as future research directions will be highlighted, with a final discussion of different conceptual frameworks of the relationship between sleep disorders and CKD.

Effect of Electroacupuncture on Spermatogenesis in Rats with Oligozoospermia of Insufficiency of Shen(Kidney) Essence Syndrome

Objective: To assess the effect of electroacupuncture(EA) on expression of cytoskeletal proteins from Sertoli cells(SCs) and spermatogenesis in rats with oligozoospermia of insufficiency of Shen(Kidney)essence syndrome(OIKES).Methods: Twenty healthy male Sprague-Dawley rats were randomly assigned to four groups using a random number table: control,tripterygium glycosides(TG) treatment,sham and EA groups(n=5 in each group).A rat model of OIKES was established by oral gavage with TG.The EA group was treated with TG and received EA at Shenshu(BL 23) and Zusanli(ST 36) acupoints for 20 min,once daily for 30 days,while the sham group received EA at identical acupoints with skin penetration without stimulation.After 30 days,the ?nal body weight and coef?cients for the testis and epididymis were calculated and sperm parameters were measured.Immunohistochemical analyses were performed to detect expression of vimentin and α-tubulin in SCs and proliferating cell nuclear antigen(PCNA) immunoreactivity in germ cells.Apoptosis in germ cells was quanti?ed by the transferase biotin-dUTP nick end labeling assay.Results: Compared with the control group,the final body weight and testis/epididymis coefficients of rats in the TG-treated group were not significantly different,but the sperm count and motility were lower(P<0.05).Expressions of vimentin and α-tubulin were also signi?cantly weaker(P<0.01).The PCNA immunoreactivity of germ cells was decreased(P=0.059),whereas the apoptotic index of germ cells was increased signi?cantly(P<0.01).In contrast,EA at BL 23 and ST 36 acupoints signi?cantly improved the ?nal body weight as well as the sperm count,concentration and motility(P<0.01 or P<0.05).EA increased expression of vimentin and α-tubulin in SCs markedly,and signi?cantly enhanced PCNA immunoreactivity with decreased apoptosis in germ cells(P<0.01 or P<0.05).Conclusions: EA at BL 23 and ST 36 acupoints has protective effects on spermatogenesis in rats with OIKES.This effect seems to be achieved by attenuating TG-induced disruption of cytoskeletal protein in SCs.

月经过少辨治

脏腑功能正常运行及气血和调,才能经候如常;否则经血失常。月经过少有虚有实,虚为精亏血少,冲任血海亏虚,经血乏源;实乃瘀血内停,血行不畅或痰湿阻滞冲任血海,临床常见虚证或虚实夹杂,治疗应根据病机转化,虚者重在补肾滋肾,或濡养精血以调经,不可妄行攻破,以免重伤精血;实证宜活血通利,佐以温经、行气、祛痰,中病即止,不可过量久用;虚实错杂应攻补兼施。虚证包括肾虚血亏、肾阴虚、肾阳亏虚、气血亏虚,实证包括痰湿阻滞、气滞血瘀、虚实夹杂、肾虚血瘀、肾虚肝郁;月经来潮与肾-天癸-冲任-胞宫轴有重大关系,周期性变化与肾的盛衰和气血的盈亏密切相关,可根据月经周期性及节律性变化给予相应治疗;辨病与辨证结合-补肾益精、化瘀生新中药灌肠、补肾化痰等。

Shen(Kidney)-Tonifying Principle for Primary Osteoporosis:to Treat Both the Disease and the Chinese Medicine Syndrome

Primary osteoporosis （POP） is one of the most common diseases in the elderly people resulting in high risk of fracture and poor quality of life. In addition to the pathological changes in bone mass, most of the POP patients also suffer from Chinese medicine （CM） syndromes of Shen （Kidney） essence deficiency. Shen essences are highly related to bone. Shen essence deficiency plays an important part in the development of POP and a better diagnosis of POP could be made by combining CM syndromes with Western medicine risk factors. Treatments of POP should aim at both increasing the bone mass and relieving the syndromes of Shen essence deficiency. Clinical study confirmed that treating POP patients with Shen-tonifying herbs could increase the bone mass and relieve the CM syndromes of POP patients. Basic researches clarified the mechanism by which Shen-tonifying herbs increased bone mass in animal models. The mechanisms by which Shentonifying herbs relieve the CM syndromes are still in investigation.

Ambient Air Particulate Matter and Hospital Admissions for Chronic Kidney Disease in China:A Nationwide Case-Crossover Study

Incident chronic kidney disease(CKD)may be accelerated(could be indicated by repeated admissions to the hospital)by environmental triggers such as ambient particulate matter(PM).Additionally,hospital admission is a sensitive proxy reflecting the disease burden.However,the association of PM exposure with hospital admissions for CKD is still unknown,let alone the excess risks(ERs)in hospital admissions for CKD due to high PM level exposure.In this study,a two-stage time-stratified case-crossover study was conducted to investigate the association of ambient air PM exposure with hospital admission for CKD in 282 Chinese cities of prefecture-level or above during 2013–2017.City-specific associations of single and cumulative 0–3 days lagged exposure to fine particulate matter(PM_(2.5))and inhalable particles(PM_(10))with hospital admissions for total CKD and its subtypes were evaluated by the conditional logistic regression model,then were pooled using the random-effect model.A total of 3,490,416 hospital admissions for CKD were identified.We found that per interquartile range(IQR)increment in PM_(2.5) at lag02 and per IQR increment in PM_(10) at lag03 were associated with increases of 2.36%(95%CI:1.58%,3.14%)and 2.87%(95%CI:1.91%,3.85%)in hospital admissions for total CKD,respectively.Compared to control concentrations(PM_(2.5):35μg/m^(3);PM_(10):50μg/m^(3)),the largest ERs in hospital admissions for total CKD were 2.63%(95%CI:2.15%–3.11%)and 4.45%(95%CI:3.85%–5.06%)in association with exposure to heavily excessive PM_(2.5)(≥75μg/m^(3))and PM_(10)(≥150μg/m^(3)),respectively.Moreover,the attributable fractions(AFs)for CKD admissions were 2.83%for PM_(2.5) and 3.46%for PM_(10) during the study period.These findings suggested that exposure to PM_(2.5) and PM_(10) is associated with substantially increased risk and burden of CKD admissions.

“邪气盛则实,精气夺则虚”探析

对“邪气盛则实 ,精气夺则虚”的理论提出质疑。根据个人的临床实践 ,结合临床病例提出邪气盛既能致实 ,亦能致虚 ;精气夺既能致虚 。

从性早熟论肾精有余

肾脏因其独特的生理特性,故肾病多虚,但也不能因此而否定肾实证的存在。肾实证的主要病因有外邪侵袭或他脏所传。简述肾实证的源流,从肾精有余对肾实证作出补充。并从整体观念与三因制宜、既阴既阳与非阴非阳两个层次阐述性早熟的病因病机,以此论证肾精有余。提出了从肾、肝、脾三脏出发的泻肾治法。

八纲“证候真假”的实质探析

在"证候真假"中,无论真象抑或是所谓的"假象"都是疾病本质的真实反映,之所以言证候"真假",是为了提醒医者绝不能仅仅凭单个症状或舌象、脉象来判断病情下诊断,必须综合分析病情资料。"证候真假"中"寒热真假"的实质是寒证与热证的鉴别、"虚实真假"的实质是虚证与实证的鉴别,"证候真假"再次强调了四诊合参的重要性。