Simultaneous Heart and Kidney Transplantation: A Systematic Review and Proportional Meta-Analysis of Its Characteristics and Long-Term Variables.

Patients with end-stage heart disease who undergo a heart transplant frequently have simultaneous kidney insufficiency, therefore simultaneous heart and kidney transplantation is an option and it is necessary to understand its characteristics and long-term variables. The recipient characteristics and operative and long-term variables were assessed in a meta-analysis. A total of 781 studies were screened, and 33 were thoroughly reviewed. 15 retrospective cohort studies and 376 patients were included. The recipient's mean age was 51.1 years (95% CI 48.52-53.67) and 84% (95% CI 80-87) were male. 71% (95% CI 59-83) of the recipients were dialysis dependent. The most common indication was ischemic cardiomyopathy [47% (95% CI 41-53)] and cardiorenal syndrome [22% (95% CI 9-35)]. Also, 33% (95% CI 20-46) of the patients presented with delayed graft function. During the mean follow-up period of 67.49 months (95% CI 45.64-89.33), simultaneous rejection episodes of both organ allografts were described in 5 cases only. Overall survival was 95% (95% CI 88-100) at 30 days, 81% (95% CI 76-86) at 1 year, 79% (95% CI 71-87) at 3, and 71% (95% CI 59-83) at 5 years. Simultaneous heart and kidney transplantation is an important option for concurrent cardiac and renal dysfunction and has acceptable rejection and survival rates.

Type 2 Diabetes and Chronic Kidney Disease: An Opportunity for Pharmacists to Improve Outcomes.

Chronic kidney disease (CKD) is an important contributor to end-stage kidney disease, cardiovascular disease, and death in people with type 2 diabetes (T2D), but current evidence suggests that diagnosis and treatment are often not optimized. This review examines gaps in care for patients with CKD and how pharmacist interventions can mitigate these gaps. We conducted a PubMed search for published articles reporting on real-world CKD management practice and compared the findings with current recommendations. We find that adherence to guidelines on screening for CKD in patients with T2D is poor with particularly low rates of testing for albuminuria. When CKD is diagnosed, the prescription of recommended heart-kidney protective therapies is underutilized, possibly due to issues around treatment complexity and safety concerns. Cost and access are barriers to the prescription of newer therapies and treatment is dependent on racial, ethnic, and socioeconomic factors. Rates of nephrologist referrals for difficult cases are low in part due to limitations of information and communication between specialties. We believe that pharmacists can play a vital role in improving outcomes for patients with CKD and T2D and support the cost-effective use of healthcare resources through the provision of comprehensive medication management as part of a multidisciplinary team. The Advancing Kidney Health through Optimal Medication Management initiative supports the involvement of pharmacists across healthcare systems to ensure that comprehensive medication management can be optimally implemented.

Novel insights in the clinical management of hyperimmune patients before and after transplantation.

Despite improvements in anti-Human Leucocyte Antigens antibody detection, identification, and characterization offer a better in peri-operative management techniques, antibodies remain a serious cause of morbidity and mortality for patients both before and after organ transplantation. Hyperimmune patients are disadvantaged by having to wait longer to receive an organ from a suitably matched donor. They could benefit from desensitization protocols in both pre- and post-transplantation period. Clinical studies are underway to highlight which best desensitization strategies could be assure the best outcome in both heart and kidney transplantation. Although most clinical evidence about desensitization strategies by using anti-CD20 monoclonal antibodies, proteasome inhibitors, anti-CD38 monoclonal antibodies, interleukin-6 blockade, cysteine protease and complement inhibitors, comes from kidney transplantation studies, many of the debated novel concepts can be easily applied to desensitization also in heart transplantation. Here, we discuss the candidates and recipients' management by using most common standard of care and novel therapeutics, desensitization endpoints, and strategies for future studies.

A double-blind, randomized, placebo-controlled, single-center clinical trial of jiaotaiwan for the treatment of insomnia symptoms caused by disharmony of the heart and kidney.

Background: Jiaotaiwan (JTW) is a classical tranquillizing prescription in traditional Chinese medicine (TCM) for the treatment of insomnia symptoms caused by disharmony of the heart and kidney (ISDHK). This study aimed to evaluate the effectiveness and safety of JTW for treating ISDHK in a double-blind, randomized, placebo-controlled trial. Methods: From September 2018 to February 2020, 128 participants with ISDHK were included in this single-center clinical trial. All participants were equally and randomly divided into either the JTW group (2-g JTW granules, b.i.d. for 7 days) or placebo group (2-g placebo granules, b.i.d. for 7 days). Pittsburgh Sleep Quality Index (PSQI) scores were set as the primary outcome, and polysomnography (PSG), 1H-magnetic resonance spectroscopy (1H-MRS), blood tests, and Disharmony of Heart and Kidney Scoring System (DHKSS) and clinical global impression (CGI) scores were used as secondary outcomes. Laboratory tests were used to evaluate the safety of JTW. All data were collected at baseline and posttreatment. Results: A total of 106 participants completed this clinical trial. Symptom relief was more apparent in the JTW group than the placebo group (PSQI total score: 9.34 ± 3.578 vs. 10.98 ± 3.073, respectively; p = 0.006). However, no PSG changes were observed between the two groups (p > 0.05). Higher CGI and lower DHKSS scores were observed after JTW treatment. Serum melatonin was increased in patients with ISDHK after JTW treatment (JTW, 339.09 ± 256.894 vs. placebo, 219.59 ± 169.045; p = 0.004). There were significant posttreatment differences in metabolites in the left cerebellum between the two groups (myoinositol: JTW, 13.47 ± 2.094 vs. placebo, 12.48 ± 2.449; p = 0.021; choline: JTW, 3.96 ± 0.657 vs. placebo, 3.65 ± 0.562; p = 0.008). In terms of safety, JTW had no noticeable adverse effects relative to placebo. Conclusion: JTW was effective and well tolerated for the treatment of ISDHK. The development of large-scale trials with longer follow-up durations is recommended to provide further evidence. Clinical Trial Registration: clinicaltrials.gov, identifier ChiCTR1800019239.

One Patient's Journey from Amyloidosis to Transplant.

This story was written by a patient with immunoglobulin light chain amyloidosis who had a stem cell transplant and eventually a heart and kidney transplant. She was treated by Horacio E. Adrogue, MD, FASN, and a team of health care professionals in the Division of Nephrology, Transplantation, and Hypertension at Houston Methodist Hospital in Houston, Texas. We appreciate her willingness to share her story and hope it will inspire others.

Heart and Kidney Transplant in a Patient on Total Artificial Heart Bridge Therapy for 318 Days.

There are few cases in the current literature that describe simultaneous heart and kidney transplant (HKTx) while on total artificial heart (TAH) bridge therapy. We present a case of successful HKTx after 318 days on TAH bridge therapy and renal replacement therapy. This case demonstrates that TAH placement is a unique and up-and-coming option for bridging patients with heart and kidney failure to HKTx. TAH is a promising bridging option for patients who do not qualify for left ventricular assist device placement. The survival rates to heart transplant and long-term outcomes after heart transplant on TAH bridge therapy are encouraging as well. However, it is crucial for clinicians to be vigilant of the wide variety of complications associated with TAH when managing patients on TAH bridge therapy.

Combined levosimendan and Sacubitril/Valsartan markedly protected the heart and kidney against cardiorenal syndrome in rat.

BACKGROUND: Cardiorenal syndrome (CRS) remains the leading cause of death in hospitalized patients for all disease entities. Sacubitril/Valsartan (Sac/Val) therapy has been proved to improve prognostic outcome in patients with heart failure or chronic kidney disease. This study tested the hypothesis that combined levosimendan and Sac/Val was superior to just one therapy on protecting the heart and kidney against simultaneous heart and kidney ischemia (I) (for 50-min)-reperfusion (R) (for 7-days) (i.e., double IR) injury (defined as CRS). METHODS AND RESULTS: Adult-male Spraque-Dawley rats (n = 40) were equally categorized into group 1 (sham-operated control), group 2 (double IR), group 3 [double IR+levosimendan (10 mg/kg by intra-peritoneum administration at 30 min/followed by days 1-5 once daily after IR procedure)], group 4 [double IR+Sac/Val (10 mg/kg, orally at 30 min/followed by days 1-5 twice daily after IR procedure)], and group 5 (double IR+Sac/Val+levosimendan). By day 7 after double-IR, the left-ventricular-ejection fraction (LVEF)/left-ventricular-fraction-shortening (LVFS) were highest in group 1, lowest in group 2 and significantly higher in group 5 than in groups 3/4, but they showed no difference between groups 3/4, whereas the circulatory heart-failure (brain-natriuretic peptide)/proinflammatory (suppression of tumorigenicity-2) biomarkers, blood-urea-nitrogen/creatinine and ratio of urine protein to creatinine (all p < 0.0001) exhibited an opposite pattern of LVEF among the groups. The protein expressions of inflammatory (tumor necrosis factor-α/interleukin-1ß/matrix metalloproteinase-9)/oxidative-stress (NOX-1/NOX-2/NOX-4)/apoptotic (mitochondrial-Bax/caspase-3/poly-(ADP-ribose)-polymerase)/fibrotic (Smad3/transforming growth factor-ß)/mitochondrial-damaged (cytosolic-cytochrome-C)/myocardial-hypertrophic (ß-MHC) biomarkers in LV myocardium exhibited an opposite pattern of LVEF among the groups (all p < 0.0001). The cellular expressions of inflammatory (CD68)/DNA-damaged (γ-H2AX) biomarkers and infarct/fibrotic areas in LV myocardium and kidney displayed an opposite pattern of LVEF among the groups (all p < 0.0001). CONCLUSION: Combined levosimendan and Sac/Val was superior to merely one therapy on protecting the heart and kidney as well as preserving their functions against double IR injury.

Effects of Estrogen on Cardiac mRNA and LncRNA Expression Profiles in Hypertensive Mice.

Estrogen is a vascular protection factor and plays a protective role in the pathogenesis of gender differences in cardiovascular diseases. This study was to address the possible mechanisms that may explain the relationship between estradiol configuration-17ß-estradiol (E2) and ventricular remodeling. Here, we show that a total of 1499 LncRNAs and 680 mRNAs significantly differently expressed were identified. This result indicates that estradiol has a global role in regulating heart gene expression profiles in female mice. Go and Pathway functional cluster analysis showed that the antagonism of E2 on cardiac remodeling and AngII-induced pathological changes in female mice may be related to physiological processes such as circadian rhythm disorder and ion channel dysfunction. Graphical Abstract.

Modeling of Focal Seizures with Automatisms in Rats with Pendulum Movements.

Phenotypical study was carried out in rats with pendulum movements. The animals exhibited a high level of abortive seizures in response to audiogenic stimuli and longer postictal catalepsy in comparison with those in Wistar population. Seizure severity positively correlated with the duration of poststimulus catalepsy (r=0.90). High aggressiveness towards humans, the absence of BP elevation in stress, lower body weights, and lower weights of the kidneys and spleen in PM rats are considered concomitant traits. Correlations were detected between startle-1 and BP in rats with pendulum movements (r=0.70) and between startle-10 and BP in narcotized Wistar rats (r=-0.0.71). The newly described signs in rats with pendulum movements did not contradict the signs of the focal seizure model with typical automatisms in humans.

[Clinical trials of treatment of woman menopause insomnia due to disharmony between heart and kidney by body and auricular acupuncture].

OBJECTIVE: To observe the therapeutic effect of body acupuncture combined with auricular acupuncture in the treatment of woman menopause insomnia induced by disharmony between the heart and kidney. METHODS: A total of 111 outpatients with menopausal insomnia were randomly divided into treatment group (n＝55, body acupoints plus auricular points) and control group (n＝56, body acupoints). For control group, Shenmen (HT7), Sanyinjiao (SP6), Anmian, Zhaohai (KI6), Shenmai (BL62), Sishencong (EX-HN1), Xinshu (BL15) and Shenshu (BL21) were needled with filiform needles, and HT7, SP6, Anmian, BL15 and BL21 were also stimulated with electroacupuncture (EA) for 30 min, once every other day, 3 times a week for 3 weeks. For the treatment group, auricular points as Kidney, Shenmen, Sympathetic and Endocrine around the ear canal and the ear cavity were punctured with filiform needles in combination with the same intervention methods mentioned above in the control group. The quality and efficiency of sleep were assessed by using Pittsburgh Sleep Quality Index (PSQI) scale before and after the treatment. The symptom scores of traditional Chinese medicine (TCM) and the therapeutic effect were determined according to the "Guide Principles for Clinical Research of New Drugs of TCM" (formulated by Chinese Ministry of Health, 1997). RESULTS: After the treatment, the scores of sleep quantity and effective rate of PSQI scale, and those of insomnia and dreaminess, dysphoria with feverish sensation in chest, palms and soles, paplpitation and irritability, fatigue and forgetfulness of TCM were reduced significantly in both groups compared with their own pre-treatment (P<0.05). Of the 56 and 55 cases in the control and treatment groups, 18 (32.1%) and 30 (54.5%) experienced a marked improvement in their symptoms, 28 (50.0%) and 22 (40.0%) were effective, and 10 (17.9%) and 3 (5.5%) failed, with the effective rate being 82.1% and 94.5%, respectively. The therapeutic effect of stimulation of the body acupoints plus auricular acupoints was significantly superior to that of stimulation of simple body acupoints in lowering scores of PSQI scale, insomnia and dreaminess, dysphoria with feverish sensation in chest, palms and soles, dizziness and tinninus, paplpitation and irritability, and tital fever and night sweating of TCM, as well as the effective rate (P<0.05). CONCLUSION: Both body acupuncture and body acupuncture combined with auricular acupuncture are effective in the treatment of woman menopause insomnia due to disharmony between the heart and kidney, and the two combined treatment was evidently better.

Clinical trials of treatment of woman menopause insomnia due to disharmony between heart and kidney by body and auricular acupuncture / 针刺研究

OBJECTIVE: To observe the therapeutic effect of body acupuncture combined with auricular acupuncture in the treatment of woman menopause insomnia induced by disharmony between the heart and kidney. METHODS: A total of 111 outpatients with menopausal insomnia were randomly divided into treatment group (n＝55, body acupoints plus auricular points) and control group (n＝56, body acupoints). For control group, Shenmen (HT7), Sanyinjiao (SP6), Anmian, Zhaohai (KI6), Shenmai (BL62), Sishencong (EX-HN1), Xinshu (BL15) and Shenshu (BL21) were needled with filiform needles, and HT7, SP6, Anmian, BL15 and BL21 were also stimulated with electroacupuncture (EA) for 30 min, once every other day, 3 times a week for 3 weeks. For the treatment group, auricular points as Kidney, Shenmen, Sympathetic and Endocrine around the ear canal and the ear cavity were punctured with filiform needles in combination with the same intervention methods mentioned above in the control group. The quality and efficiency of sleep were assessed by using Pittsburgh Sleep Quality Index (PSQI) scale before and after the treatment. The symptom scores of traditional Chinese medicine (TCM) and the therapeutic effect were determined according to the "Guide Principles for Clinical Research of New Drugs of TCM" (formulated by Chinese Ministry of Health, 1997). RESULTS: After the treatment, the scores of sleep quantity and effective rate of PSQI scale, and those of insomnia and dreaminess, dysphoria with feverish sensation in chest, palms and soles, paplpitation and irritability, fatigue and forgetfulness of TCM were reduced significantly in both groups compared with their own pre-treatment (P<0.05). Of the 56 and 55 cases in the control and treatment groups, 18 (32.1%) and 30 (54.5%) experienced a marked improvement in their symptoms, 28 (50.0%) and 22 (40.0%) were effective, and 10 (17.9%) and 3 (5.5%) failed, with the effective rate being 82.1% and 94.5%, respectively. The therapeutic effect of stimulation of the body acupoints plus auricular acupoints was significantly superior to that of stimulation of simple body acupoints in lowering scores of PSQI scale, insomnia and dreaminess, dysphoria with feverish sensation in chest, palms and soles, dizziness and tinninus, paplpitation and irritability, and tital fever and night sweating of TCM, as well as the effective rate (P<0.05). CONCLUSION: Both body acupuncture and body acupuncture combined with auricular acupuncture are effective in the treatment of woman menopause insomnia due to disharmony between the heart and kidney, and the two combined treatment was evidently better.

Clinical study of TIP technique combined with acupuncture and oral administration of Chinese medicine on chronic insomnia with syndrome of heart-kidney imbalance / 国际中医中药杂志

Objective To evaluate the efficacy of low resistance thought induction psychotherapy (TIP) technique combined with acupuncture and oral Chinese medicine in treating chronic insomnia elderly patients with syndrome of heart-kidney imbalance. Methods One hundred sixty-four chronic insomnia patients with syndrome of heart-kidney imbalance were randomly divided into four groups with 41 cases in each group. The control group was treated with family doctor contract, sleep health education and Tianwang-Buxin decoction as the basic treatment, the group A was treated with acupuncture and the basic treatment, the group B was treated with TIP technique and the basic treatment, the group C was treated with the combination of acupuncture and TIP on the basic treatment. After one month' treatment, scores of Pittsburgh sleep quality index (PSQI) were used to evaluate sleep quality, sleep efficiency, and the clinical efficacy. Results After treatment, scores of sleep time, sleep efficiency, sleep time, sleep disturbance, daytime function of the group A, B, and C were significantly lower than those in the control group (F value were 44.322, 92.808, 107.131, 79.467, 98.638 respectively, all Ps<0.001), and the group C were significantly lower than those of the test group A and B (P<0.01). Scores of upset, dizziness, tinnitus, hot flashes, and night sweats, hand foot and heart fever, forgetfulness, sores on the tongue and dry stool of the group A, B, and C were significantly lower than those of the control group (F value were 103.32, 135.91, 93.35, 77.61, 57.514, 92.283, 126.097, 53.217, respectively, all Ps<0.001), and the group C were significantly lower than those of the test group A and B (P<0.01). The total clinical efficacy of TCM syndrome and insomnia in group A,B and C was significantly higher than that in the control group (χ2=16.169, P<0.01), and the group C was significantly higher than the group A and B (χ2=8.504, P<0.01). The total clinical efficacy of sleep efficiency in group A, B and C was significantly higher than that in the control group (χ2=14.078, P<0.01), and the group C was significantly higher than the group A and B (χ2=8.856, P<0.01). Conclusions TIP technique combined with acupuncture and oral Chinese medicine can improve sleep quality of chronic insomnia elderly patients with syndrome of heart-kidney imbalance.

Clinical study of TIP technique combined with acupuncture and oral administration of Chinese medicine on chronic insomnia with syndrome of heart-kidney imbalance / 国际中医中药杂志

Objective@#To evaluate the efficacy of low resistance thought induction psychotherapy (TIP) technique combined with acupuncture and oral Chinese medicine in treating chronic insomnia elderly patients with syndrome of heart-kidney imbalance.@*Methods@#One hundred sixty-four chronic insomnia patients with syndrome of heart-kidney imbalance were randomly divided into four groups with 41 cases in each group. The control group was treated with family doctor contract, sleep health education and Tianwang-Buxin decoction as the basic treatment, the group A was treated with acupuncture and the basic treatment, the group B was treated with TIP technique and the basic treatment, the group C was treated with the combination of acupuncture and TIP on the basic treatment. After one month' treatment, scores of Pittsburgh sleep quality index (PSQI) were used to evaluate sleep quality, sleep efficiency, and the clinical efficacy.@*Results@#After treatment, scores of sleep time, sleep efficiency, sleep time, sleep disturbance, daytime function of the group A, B, and C were significantly lower than those in the control group (F value were 44.322, 92.808, 107.131, 79.467, 98.638 respectively, all Ps<0.001), and the group C were significantly lower than those of the test group A and B (P<0.01). Scores of upset, dizziness, tinnitus, hot flashes, and night sweats, hand foot and heart fever, forgetfulness, sores on the tongue and dry stool of the group A, B, and C were significantly lower than those of the control group (F value were 103.32, 135.91, 93.35, 77.61, 57.514, 92.283, 126.097, 53.217, respectively, all Ps<0.001), and the group C were significantly lower than those of the test group A and B (P<0.01). The total clinical efficacy of TCM syndrome and insomnia in group A,B and C was significantly higher than that in the control group (χ2=16.169, P<0.01), and the group C was significantly higher than the group A and B (χ2=8.504, P<0.01). The total clinical efficacy of sleep efficiency in group A, B and C was significantly higher than that in the control group (χ2=14.078, P<0.01), and the group C was significantly higher than the group A and B (χ2=8.856, P<0.01).@*Conclusions@#TIP technique combined with acupuncture and oral Chinese medicine can improve sleep quality of chronic insomnia elderly patients with syndrome of heart-kidney imbalance.

Prenatal exposure to angiotensin II increases blood pressure and decreases salt sensitivity in rats.

Renin angiotensin aldosterone system (RAAS) plays an essential role in the homeostatic control of arterial blood pressure, perfusion of tissues, and control of extracellular fluid. Its components are highly expressed in the developing kidney, general vasculature, brain, and heart. A modified intrauterine environment alters mechanisms controlling blood pressure (BP) and can lead to hypertension in the adult offspring and developmentally programmed RAAS can be involved in this process. There are very little data about the effects of increased angiotensin II (Ang II) concentrations during pregnancy on in utero development of the fetus. In our study, we administered Ang II to pregnant female rats via osmotic mini-pumps and evaluated the postnatal development and BP control in the offspring. To estimate possible developmental changes in sensitivity to salt, we exposed the offspring to a diet with increased salt content and measured plasma aldosterone levels and plasma renin activity. Increased Ang II during pregnancy raised BP in the offspring; however, salt sensitivity was decreased in comparison to controls. Relative weight of the left ventricle was decreased in the offspring prenatally exposed to Ang II, while relative kidney weight was reduced only in female offspring. Prenatal treatment led to increased aldosterone levels and decreased plasma renin activity, suggesting a complex physiological response. Our results suggest that conditions leading to upregulation of RAAS during pregnancy can influence the cardiovascular system of the fetus and have a long-term impact on the offspring's health.

[Application of kidney deficiency and blood stasis and disharmony between heart and kidney theories in patients with sleep disorders in perimenopause].

Perimenopausal syndrome refers to a series of physical and mental symptoms, caused by the fluctuation of the sex hormones in the menopause, which is one of the common diseases in gynecology. The incidence of sleep disorders in perimenopausal women is increasing significantly. Both Chinese medicine and Western medicine are trying to exploring its pathologic mechanism to find the safe and effective methods of treatment. Menopausal sleeping disorder is the same as the perimenopause syndrome and insomnia category in traditional Chinese medicine. Kidney deficiency is the basic characteristic of perimenopause, whether kidney essence, kidney Qi, kidney Yin or kidney Yang can lead to blood stasis. It is believed that this disease results from kidney deficiency in the root and blood stasis in the tip, and on this basis women affected by many factors will result in disharmony between heart and kidney. In clinical practice, The method of tonifying kidney and activating blood applied to treat perimenopause syndrome with insomnia was testified to be effective. Therefore the author thought that kidney deficiency and blood stasis and disharmony between heart and kidney were the key factors of patients with insomnia in perimenopause.

Influence of BNP and heart and kidney function of recombinant human brain natriuretic peptide on acute heart failure treatment / 药物评价研究

Objective To investigate the influence of BNP and heart and kidney function of recombinant human brain natriuretic peptide on acute heart failure treatment.Methods 120 cases from Jan.2011 to Dec.2016 in our hospital were chosen and randomly divided into two groups,the control group were given traditional treatment,the observation group were given brain natriuretic peptide on the basic of traditional treatment.The heart function,left ventricular ejection fraction,plasma BNP,urine output,serum creatinine,blood potassium concentration of two groups were compared.Results After 48 h,the total effective rate of the improvement of cardiac function in the observation group was 83.34％,which was significantly better than that of the control group 56.67％,the difference was statistically significant (P ＜ 0.05).After treatment,the heart function,left ventricular ejection fraction,plasma BNP,urine output of two groups after treatment were better than before treatment (P ＜ 0.05).And the heart function,LVEF ascending range,BNP concentration reduction and urine increased amount of observation group were better than control group (P ＜ 0.05).The serum creatinine concentration of two groups were slighter higher than before,the blood potassium concentration of observation group after treatment was slighter higher than before,the blood potassium concentration of control group was slighter lower than before,which had no significant difference,and after discontinuation which had no further intensified.Conclusion The recombinant human brain natriuretic peptide could be treating for acute heart failure treatment,and improve the heart function,decreased the plasma BNP level,dieresis and which had no adverse reaction on kidney function.

Application of kidney deficiency and blood stasis and disharmony between heart and kidney theories in patients with sleep disorders in perimenopause / 中国中药杂志

Perimenopausal syndrome refers to a series of physical and mental symptoms, caused by the fluctuation of the sex hormones in the menopause, which is one of the common diseases in gynecology. The incidence of sleep disorders in perimenopausal women is increasing significantly. Both Chinese medicine and Western medicine are trying to exploring its pathologic mechanism to find the safe and effective methods of treatment. Menopausal sleeping disorder is the same as the perimenopause syndrome and insomnia category in traditional Chinese medicine. Kidney deficiency is the basic characteristic of perimenopause, whether kidney essence, kidney Qi, kidney Yin or kidney Yang can lead to blood stasis. It is believed that this disease results from kidney deficiency in the root and blood stasis in the tip, and on this basis women affected by many factors will result in disharmony between heart and kidney. In clinical practice, The method of tonifying kidney and activating blood applied to treat perimenopause syndrome with insomnia was testified to be effective. Therefore the author thought that kidney deficiency and blood stasis and disharmony between heart and kidney were the key factors of patients with insomnia in perimenopause.

Time-course effects of aerobic exercise training on cardiovascular and renal parameters in 2K1C renovascular hypertensive rats

Exercise training (Ex) has been recommended for its beneficial effects in hypertensive states. The present study evaluated the time-course effects of Ex without workload on mean arterial pressure (MAP), reflex bradycardia, cardiac and renal histology, and oxidative stress in two-kidney, one-clip (2K1C) hypertensive rats. Male Fischer rats (10 weeks old; 150–180 g) underwent surgery (2K1C or SHAM) and were subsequently divided into a sedentary (SED) group and Ex group (swimming 1 h/day, 5 days/week for 2, 4, 6, 8, or 10 weeks). Until week 4, Ex decreased MAP, increased reflex bradycardia, prevented concentric hypertrophy, reduced collagen deposition in the myocardium and kidneys, decreased the level of thiobarbituric acid-reactive substances (TBARS) in the left ventricle, and increased the catalase (CAT) activity in the left ventricle and both kidneys. From week 6 to week 10, however, MAP and reflex bradycardia in 2K1C Ex rats became similar to those in 2K1C SED rats. Ex effectively reduced heart rate and prevented collagen deposition in the heart and both kidneys up to week 10, and restored the level of TBARS in the left ventricle and clipped kidney and the CAT activity in both kidneys until week 8. Ex without workload for 10 weeks in 2K1C rats provided distinct beneficial effects. The early effects of Ex on cardiovascular function included reversing MAP and reflex bradycardia. The later effects of Ex included preventing structural alterations in the heart and kidney by decreasing oxidative stress and reducing injuries in these organs during hypertension.

Acupoint Thread Embedding plus Psychotherapy for 43 Cases of Insomnia Due to DisharmonyBetween Heart and Kidney During Perimenopause / 上海针灸杂志

ObjectiveTo observe the clinical efficacy of acupoint thread embedding plus psychotherapy for insomnia due to disharmony betweenheart and kidney during perimenopause.MethodForty-three patients with insomnia due to disharmony between heart and kidney during perimenopause were intervened by acupoint thread embedding plus psychotherapy including cognitive and behavioral therapies,and then the therapeutic results were statistically analyzed.ResultOf the 43 subjects, 19 were clinically cured, accounting for 44.2%; 13 subjects were markedly improved, accounting for 30.2%; 9 were improved, accountingfor 20.9%; 2 subjects failed, accounting for 4.7%. The total effective rate was 95.3%. The serum E2level was significantly changed after intervention (P<0.01).ConclusionAcupoint thread embedding plus psychotherapy can produce a significant efficacy in treating insomnia due to disharmony between heart and kidney during perimenopause, and this method can up-regulate the serum E2level, enhance the production of estrogen, and improve ovary function.

Therapeutic Observation of Combining Yuan-Primary and Luo-Connecting Points for Insomnia due to Imbalance between Heart and Kidney / 上海针灸杂志

Objective To observe the clinical efficacy of combining Yuan-Primary and Luo-Connecting points in treating insomnia due to imbalance between heart and kidney, for providing novel method and evidence for the treatment of insomnia with acupuncture-moxibustion.Method Totally 100 insomnia patients due to imbalance between heart and kidney were randomized into a treatment group and a control group, 50 in each. The treatment group was intervened by acupuncture at Yuan-Primary and Luo-Connecting points, while the control group was by conventional acupuncture. The Pittsburgh Sleep Quality Index (PSQI), self-rating anxiety scale (SAS), and self-rating depression scale (SDS) were observed before and after intervention for efficacy evaluation.Result The PSQI item scores were significantly changed after intervention in both groups (P<0.05). The SAS and SDS scores were significantly different from that before treatment in both groups (P<0.05). After treatment, the SAS and SDS scores of the treatment group were significantly different from that of the control group (P<0.05). The recovery rate and total effective rate were 26.0% and 92.0% in the treatment group versus 12.0% and 86.0% in the control group, and there was a significant difference in comparing the recovery rate (P<0.05).Conclusion Combining use of Yuan-Primary and Luo-Connecting points is an effective approach in treating insomnia due to imbalance between heart and kidney.