从肝治心法逆转自发性高血压大鼠左室肥厚的实验研究

目的 :观察从肝治心法逆转自发性高血压大鼠左室肥厚的作用。方法 :采用自发性高血压大鼠(SHR)模型 ,观察从肝治心法组方治疗对大鼠血压、左室重量 /体重 (LVM /BW )、血浆内皮素 (ET)、血管紧张素Ⅱ(AngⅡ )、醛固酮 (Ald)等影响。结果 :从肝治心法组方具有温和的降压和逆转左室肥厚、抑制血浆内皮素的产生、降低血管紧张素Ⅱ及醛固酮水平等作用。结论 :从肝治心法具有逆转高血压左室肥厚的作用。

吴鞠通月经病证治心法

1 弘扬《内经》“二阳之病发心脾”秘旨 吴鞠通在《吴鞠通案·调经·池氏案》[1]中说：“经云：二阳之病发心脾,女子不月.二阳者,阳明阳气受伤,肝来克土……盖胃和则不呕,肝不来克,纳食旺,自然生血,经所谓中焦受气取汁,变化而赤,是为血.又谓营出中焦,阳气充满,则血无阻滞.此等调经法,世人绝不知之.”他在《吴鞠通案·带下·达女案》中又说：“初因内伤生冷,又加伏暑湿热,去冬寒热频仍可知,以至经闭、淋、带、腹痛等症.现在食太少,大便溏.议先与和腑.经谓二阳之病发心脾,女子不月.应从此处人手,近世罕知.再补土者,必先行湿,土恶湿故也.”

原发性低血压证治心法

原发性低血压证治心法４４３６００湖北省秭归县中医院胡兆明原发性低血压症好发于２０～４０岁之间体质虚弱的女性，按１９７９年我国心血管疾病会议确定的诊断标准，是指血压持续低于１２／８ｋＰａ而临床无器质性疾病的一类病症。其发病因素与遗传有关。从中医辨证角度...

糖尿病辨治心法

作者从四个方面探讨糖尿病辨治规律 :(1)多饮症状明显者 ,以宣肺清热法 ;(2 )多食症状明显者 ,以通利大便法 ;(3)多尿症状明显者 ,以温肾救阴法 ;(4 )多饮多食多尿较著者 ,以活血化瘀法。能准确指导遣方用药 。

Is overhydration in peritoneal dialysis patients associated with cardiac mortality that might be reversible?

AIMTo study the relationship between overhydration （OH） in peritoneal dialysis （PD） patients and cardiac mortality.METHODSOH, as measured by body composition monitor （BCM）, is associated with increased mortality in dialysis pa-tients. BCM has been used to guide treatment on the assumption that correcting OH will improve cardiac morbidity and mortality although data demonstrating causality that is reversible is limited. We wished to determine if OH in PD patients predicted cardiac mor-tality, and if there was a correlation between OH and cardiac troponin-T （cTnT） levels. Finally, we wished to determine if improving OH values would lead to a decrement in cTnT. All prevalent PD patients over the study period of 57 mo who had contemporaneous BCM and cTnT measurements were followed irrespective of transplantation or PD technique failure. We also studied a cohort of patients with who had severe OH （〉 ＋2L）.The Fresenius Body Composition Monitor was used to obtain hydration parameters. cTnT levels were done as part of routine clinical care. Data was analysed using SPSS version 20.0.RESULTSThere were 48 deaths in the 336 patients. The patients that died from cardiac or non-cardiac causes were similar with respect to their age, incidence of diabetes mellitus, gender, ethnicity and cause of renal failure. However, the patients with cardiac causes of death had significantly shorter dialysis vintage （10.3 mo vs 37.0 mo, P 〈 0.0001） and were significantly more overhydrated by BCM measurement （2.95 L vs 1.35 L, P 〈 0.05）. The mean （standard error of the means） hydration status of the 336 patients was ＋1.15 （0.12） L and the median [interquartile range （IQR）] cTnT level was 43.5 （20-90） ng/L. The cTnT results were not normally distributed and were therefore transformed logarithmically. There was a statistically significant correlation between Log （cTnT） with the OH value （Spearman r value 0.425, P 〈 0.0001）. We identifed a sub-group of patients that were severely overhydrated; median （IQR） hydration at baseline was ＋2.7 （2.3 to 3.7） L. They were followed up for a minimum of 6 mo. Reduction in OH values in these patients over 6 mo correlated with lowering of cTnT levels （Spearman r value 0.29, P 〈 0.02）. CONCLUSIONPatients that were overhydrated had higher cTnT, and had deaths that were more likely to be cardiac related. Reduction in OH correlated with lowering of cTnT.

Clinical Observation on Physiological and Psychological Effects of Eight-Section Brocade on Type 2 Diabetic Patients

Objective： To observe the physiological and psychological changing of type 2 diabetic patients after practicing Eight-Section Brocade, to evaluate the clinical curative effect, and to provide a safe and effective self-regulating method for type 2 diabetic patients. Methods： This study is a random controlled trial, the 54 type 2 diabetic patients were randomly assigned into the intervention and the control group. The intervention group was given a 2-month period of Eight-Section Brocade practice, then a comparison between groups was made. The intervention group continued to do Eight-Section Brocade practice for 2 months, so it was 4 months＇ intervention all together for this group, and then a comparison within the intervention group was made. Results： There was significant difference 4 months later on HbAlc in the intervention group （P〈0.05）. There was significant difference between the intervention and control groups on obsessive-compulsive, depression, anxiety and hostility scores after 2 months＇ practice （P〈0.05）. There was significant difference between 2 and 4 months＇ practice on hostilities scores within the intervention group （P〈0.05）. Conclusions： As an important part of the traditional Chinese medicine, Eight-section Brocade has physiological and psycholozical effects on type 2 Diabetic Patients.

MYOCARDIAL LESIONS AFTER LONG-TERM ADMINISTRATION OF METHAMPHETAMINE IN RATS

Objective To demonstrate the myocardial lesion associated with long-term administration of methamphetamine in rats. Methods The experimental models of intoxication of methamphetamine were established in Sprague-Dawley rats. Methamphetamine hydrochloride （3 mg·kg^-1·d^-1） was subcutaneously injected to rats in methamphetarnine-treated group （n = 16）, and normal saline at the same dose was injected to rats in control group （n = 16）. After 1 week and 8 weeks of injection, 8 rats in each group were sacrificed and their hearts were examined with light microscopy and electron microscopy, respectively. Results After 1 week of methamphetamine exposure, loci of contraction band and cellular degeneration were present in subendocardial myocardium. Cellular degeneration, myocytolysis, and contraction band necrosis became prominent and extensive in methamphetamine-treated rats after 8 weeks. Hypertrophy, intracellular vacuolization, and fibrosis were also observed. The ultrastructural feature showed marked swelling and degeneration of mitochondria, enlargement of sarcoplasmic reticulum, and dissolution of myofilaments. No obvious cardiac myocyte lesions were observed in rats of control group. Conclusion Methamphetamine abuse daily for a long time may result in an increased risk of cardiovascular lesions similar to cardiomyopatby.

Cardiovascular co-morbidity in chronic kidney disease:Current knowledge and future research needs

Chronic kidney disease(CKD) is recognised as a health concern globally and leads to high rates of morbidity,mortality and healthcare expenditure.CKD is itself an independent risk factor for unfavorable health outcomes that include cardiovascular disease(CVD).Coronary artery disease is the primary type of CVD in CKD patients and a significant cause of death among renal transplant patients.Traditional and non-traditional risk factors for CVD exist in patients with CKD.Traditional factors include smoking,hypertension,dyslipidemia and diabetes which are highly prevalent in CKD patients.Non-traditional risk factors of CKD are mainly uraemiaspecific and increase in prevalence as kidney function declines.Some examples of uraemia-specific risk factors that have been well documented include low levels of haemoglobin,albuminuria,and abnormal bone and mineral metabolism.Therapeutic interventions targeted at more traditional risk factors which contribute to CVD,have not had the desired effect on lowering CVD events and mortality in those suffering with CKD.Future research is warranted to delineate clear evidence to the benefit of modifying non-traditional risk factors.

Use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction

The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no consensus on the ideal treatment or treatment pathway for ureteral obstruction owing, in part, to the varied etiologies of obstruction and diversity of institutional practices. Additionally, different clinicians such as internists, urologists, oncologists and radiologists are often involved in the care of patients with ureteral obstruction and may have differing opinions concerning the best management strategy. The purpose of this manuscript was to review available literature that compares percutaneous nephrostomy placement vs ureteral stenting in the management of ureteral obstruction from both benign and malignant etiologies.

Major comorbid disease processes associated with increased incidence of acute kidney injury

Acute kidney injury （AKI） is commonly seen amongst critically ill and hospitalized patients. Individuals with certain co-morbid diseases have an increased risk of developing AKI. Thus, recognizing the co-morbidities that predispose patients to AKI is important in AKI prevention and treatment. Some of the most common co-morbid disease processes that increase the risk of AKI are diabetes, cancer, cardiac surgery and human immunodefciency virus （HIV） acquired immune defciency syndrome （AIDS）. This review article identifies the increased risk of acquiring AKI with given co-morbid diseases. Furthermore, the pathophysiological mechanisms underlying AKI in relation to co-morbid diseases are discussed to understand how the risk of acquiring AKI is increased. This paper reviews the effects of various co-morbid diseases including： Diabetes, cancer, cardiovascular disease and HIV AIDS, which all exhibit a significant increased risk of developing AKI. Amongst these co-morbid diseases, inflammation, the use of nephrotoxic agents, and hypoperfusion to the kidneys have been shown to be major pathological processes that predisposes individuals to AKI. The pathogenesis of kidney injury is complex, however, effective treatment of the co-morbid disease processes may reduce its risk. Therefore, improved management of co-morbid diseases may prevent some of the underlying pathology that contributes to the increased risk of developing AKI.

Analysis of Cardiotoxicity from rh-Endostatin Therapy Combined with Chemotherapy

OBJECTIVE To evaluate the cardotoxicity from recombinant human endostatin(rh-endostatin)combined with chemotherapy. METHODS A total of 12 cancer patients treated with rh- endostatin combined with chemotherapy were selected,and their clinical data collected.Their symptoms,including cardiopalmus, chest distress,dyspnea and changes in their electrocardiogram (ECG),myocardium enzymogram and left ventricular ejection fraction(LVEF),were observed during the drug treatment.These indicators were used for early diagnosis of cardiotoxicity. RESULTS Compared with a pre-therapeutic value,there was a significant increase in the CK-MB value at one week after starting the treatment as well as at the end of treatment(P<0.05).There was a significant change in the ECG at the end of treatment, compared to a pre-therapeutic condition(P<0.05),but there was no significant difference when comparing the pre-and post- therapeutic LVEF values. CONCLUSION It was recognized that mild cardiac adverse reactions exist in the regimen of recombinant human endostatin combined with chemotherapy.This therapy caused definite injury to the cardiac muscle,but cardiac functions were not obviously changed.CK-MB and ECG may be used as indicators for early monitoring cardiac toxicity.Vigilance against cardiac adverse reactions should be heightened during a course of rh-endostatin combined with chemotherapy.

Baroreflex dysfunction in chronic kidney disease

Chronic kidney disease （CKD） patients have high cardiovascular mortality and morbidity. The presence of traditional and CKD related risk factors results in exaggerated vascular calcification in these patients. Vascular calcification is associated with reduced large arterial compliance and thus impaired barorefex sensi-tivity （BRS） resulting in augmented blood pressure （BP） variability and hampered BP regulation. Barorefex plays a vital role in short term regulation of BP. This review discusses the normal barorefex physiology, methods to assess baroreflex function, its determinants along with the prognostic significance of assessing BRS in CKD patients, available literature on BRS in CKD patients and the probable patho-physiology of barorefex dysfunction in CKD.

Podocyturia: Potential applications and current limitations

Chronic kidney disease is a prevalent condition that affects millions of people worldwide and is a major risk factor of cardiovascular morbidity and mortality. The main diseases that lead to chronic kidney disease are frequent entities as diabetes mellitus, hypertension and glomerulopathies. One of the clinical markers of kidney disease progression is proteinuria. Moreover, the histological hallmark of kidney disease is sclerosis, located both in the glomerular and in the interstitial compartments. Glomerulosclerosis underscores an irreversible lesion that is clinically accompanied by proteinuria. In this regard, proteinuria and glomerular sclerosis are linked by the cell that has been conserved phylogenetically not only to prevent the loss of proteins in the urine, but also to maintain the health of the glomerular fltration barrier： The podocyte. It can then be concluded that the link between proteinuria, kidney disease progression and chronic kidney disease is mainly related to the podocyte. What is this situation due to？ The podocyte is unable to proliferate under normal conditions, and a complex molecular machinery exists to avoid its detachment and eventual loss. When the loss of podocytes in the urine, or podocyturia, is taking place and its glomerular absolute number decreased, glomerulosclerosis is the predominant histological feature in a kidney biopsy. Therefore, tissular podocyte shortage is the cause of proteinuria and chronic kidney disease. In this regard, podocyturia has been demonstrated to precede proteinuria, showing that the clinical mana-gement of proteinuria cannot be considered an early intervention. The identifcation of urinary podocytes could be an additional tool to be considered by nephrologists to assess the activity of glomerulopathies, for follow-up purposes and also to unravel the pathophysiology of podocyte detachment in order to tailor the therapy of glomerular diseases more appropriately.

Lipid abnormalities in kidney disease and management strategies

Patients with kidney diseases continue to experience significant cardiovascular disease(CVD) morbidity and mortality. Although there are many important risk factors playing a role in the pathogenesis of CVD in chronic kidney disease(CKD) patients, dyslipidemia(elevated triglycerides, elevated oxidized low-densitylipoprotein and low/dysfunctional low high-density) represents one of the modifiable risk factors. Renal failure patients have unique lipid abnormalities which not only have complex role in pathogenesis of CVD but also cause relative resistance to usual interventions. Most of the randomized trials have been in hemodialysis population and data from CKD non-dialysis, peritoneal dialysis and renal transplant populations is extremely limited. Compared to general population, evidence of mortality benefit of lipid lowering medications in CKD population is scarce. Future research should be directed towards establishing long term benefits and side effects of lipid lowering medications, through randomized trials, in CKD population.

Bio-feedback treatment of fecal incontinence: Where are we, and where are we going?

Fecal incontinence is a disabling disease, often observed in young subjects, that may have devastating psycho-social consequences. In the last years, numerous evidences have been reported on the efficacy of bio-feedback techniques for the treatment of this disorder. Overall, the literature data claim a success rate in more than 70% of cases in the short term. However, recent controlled trials have not confirmed this optimistic view, thus emphasizing the role of standard care. Nonetheless, many authors believe that this should be the first therapeutic approach for fecal incontinence due to the efficacy, lack of side-effects,and scarce invasiveness. Well-designed randomized,controlled trial are eagerly awaited to solve this therapeutic dilemma.