Colon may provide new therapeutic targets for treatment of chronic kidney disease with Chinese medicine / 中国结合医学杂志

Chronic kidney disease (CKD) has become a worldwide health and social problem. Retarding its progression to end-stage renal disease is beneficial both to the patients and the healthcare system. Plenty of clinical trials have indicated that enema with Chinese medicine could effectively prevent chronic renal failure, and was widely used in the clinical practice. However, studies on mechanism were still nearly blank, which may prevent further improvement of therapeutic efficacy. Recent studies had discovered that colon was an important organ where uremic toxins were generated. The uremic toxins involved could not only promote CKD progression, but also was closely correlated with CKD mortality. Reducing production and promoting excretion of toxins were confirmed to reduce renal tubule interstitial fibrosis and delay renal progression. On the basis of the theory of gut-kidney axis above, we had conducted pilot clinical researches to evaluate the effect of enema with Chinese medicine on the intestinal flora, gut barrier, enterogenous uremic toxins and renal protection. The preliminary results revealed that rheum enema through colon could accelerate intestinal dynamics, improve intestinal barrier function, regulate intestinal flora and reduce production and absorption of intestine-derived uremic toxins such as indoxyl sulfate, which may reduce renal fibrosis and delay renal progression. Further studies could provide more evidence for colon as a new therapeutic target for the treatment of CKD with Chinese medicine.

Effects of Chinese herbal enema therapy combined basic treatment on BUN, SCr, UA, and IS in chronic renal failure patients / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To assess the clearance role and safety of Chinese herbal enema therapy (CHET) in clearing enterogenic uremic toxins in chronic renal failure (CRF) patients, thus providing evidence for further optimizing the comprehensive treatment.</p><p><b>METHODS</b>Using nonrandomized concurrent control trial, 96 CRF inpatients of Department of Nephropathy, Guangdong Provincial Hospital of Traditional Chinese Medicine, from March 2010 to December 2010 were assigned to the treatment group and the control group according to their willingness. All patients were treated with basic treatment referring to clinical plans in the non-dialysis phase, while those in the treatment group were additionally treated with CHET, once daily, 2 weeks as one therapeutic course. The symptoms, serum enterogenic uremic toxin levels [including indoxyl sulfate (IS), blood urea nitrogen (BUN), and uric acid (UA)], and serum creatinine (SCr) were observed in the two groups between and after treatment. The adverse reactions were also monitored during the treatment period. The clinical efficacy and safety were also assessed.</p><p><b>RESULTS</b>Totally 84 patients completed this clinical observation, 48 in the treatment group and 36 in the control group. The levels of SCr, BUN, and IS were obviously lower in the treatment group after treatment, showing statistical difference when compared with before treatment (P<0.01). There was no statistical difference in each index in the control group between before and after treatment (P>0.05). The post-treatment the IS level was lower in the treatment group than in the control group with statistical difference (P<0.05). Symptoms like fatigue, soreness of waist and knees, constipation and edema were partially relieved in both groups (P<0.05, P<0.01). The ratios of anorexia and nausea in patients of the treatment group was lowered after treatment (P<0.05). Besides, patients in the treatment group could defecate for more than once daily during the enema treatment period, dominated as rotten and soft feces. No severe adverse event occurred during the treatment period.</p><p><b>CONCLUSION</b>CHET combined basic treatment could lower the serum levels of enterogenic uremic toxins (IS and BUN) of CRF patients in a short period.</p>

Morphometrical study of undifferentiated mesenchymal cells of periosteum germinal layer from different parts of the body and its clinical significance / 中华创伤杂志

Objective To find a way to measure and count plane distribution of cells distributed on single layer and compare differences of undifferentiated mesenchymal cells of periosteum germinal layer from different parts of the body.Methods After counting the number of undifferentiated mesenchymal cells of periosteum germinal layer from different parts of the body microscopically and figuring out the number of cells per area unit in each periosteum specimen,the obtained data were statistically analyzed and the stratum structure of periosteum observed microscopically.Results The homogeneity of variance test showed homoscedasticity,with no statistical significance(P＞0.05).The analysis of variance found homoscedasticity but showed no statistical significance(F=0.253,P＞0.05).The periosteum of patel- la,tibial plateau and costa had two layers,while the periosteum of costal cartilage had three layers. Conclusions There is no conspicuous difference upon proliferation and evoluting activities of periosteum from different parts of body.Therefore,it is unnecessary to choose specific parts for drawing the periote- um in clinical situation.In the meantime,the structure of periosteum from different parts diversifies.