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Objective:To investigate the research competence and training needs of young general practitioners (GPs) in Guangdong province.Methods:A questionnaire survey on research competence and training needs was conducted in December 2020 among GPs from one selected economically developed area and one selected less developed area in Guangdong Province.Results:A total of 172 young GPs were included in the study. The survey showed that 75.6% (130/172) and 76.2% (131/172) respondents thought that participation in scientific research and research literacy were important, but only 11.9% (21/172) had participated in research project, among whom 81.0% (17/21) undertook data collection. The basic score of evidence-based medicine was 24.00(21.00, 28.00), and 55.2% respondents (95/172) were able search literature when they encountered problems and 43.7% (77/172) used domestic databases. The self-assessment score of scientific research ability was 14.00(12.00, 17.00), the score of research training needs was 41.00(31.00, 49.50), and the scores of "scientific research topic selection, scientific research design, statistical analysis, organization and implementation, and paper writing" were generally high. There was significant difference in the total scores of the two scales of evidence-based medicine basis and scientific research ability self-assessment among respondents with different educational background ( P<0.05). The basic score of evidence-based medicine of orientation-trained GPs was higher than that of non-orientation-tranined GPs; the average score of research training needs in female respondents was higher than that in males ( P<0.05). Conclusions:The study suggests that young general practitioners have inadequate experience in research participation and organization, and low self-ratings of research competence, but generally high personal efficacy in research. It is recommended that appropriate training content and well-organized intervention should be developed for young GPs.
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Chronic kidney disease (CKD) is a chronic renal structure change and dysfunction caused by a variety of causes.The incidence and prevalence of CKD have been on the rise,becoming a major global health problem.An increasing number of studies had shown that one of the important indicators of CKD progression was the disorder of gut microbiome and elevated levels of sernm endotoxin.Modern physicians of traditional Chinese medicine (TCM) believed that the main pathogenesis of CKD was spleen and kidney deficiency.And the therapeutic regimen was invigorating spleen and nourishing the kidney.Spleen is in the middle burner.It has the function of transportation and resistance to evil,which was extremely similar to the function of gut microbiome in metabolism and immunity.The latter might be one of the biological bases of physiological function of spleen.This comprehensive review presented the modern theoretical basis of spleen-based TCM treatment methods for CKD from the insight of modern gut microbiome and metabolism.Firstly,gut microbiome and its metabolism were associated with the spleen in TCM theory.Gut microbiome affected individual metabolism and immune function,which could provide a modern biological basis for explaining the physiological function of the spleen.Secondly,gut microbiome and its metabolism were correlated with CKD:intestinal flora disturbance occurred in CKD patients,producing enterogenous toxins as their metabolites,which become the important factors affecting prognosis.Thirdly,as for its origin,development and current status based on the spleen theory,CKD was one of various consumptive diseases.Spleen insufficiency was one of their critical pathogenic mechanisms.Therefore,tonifying the spleen should be a treatment method to maintain throughout the entire treatment.On the basis of our previous clinical studies and the hypothesis of gut microbiome and metabolism,we proposed further studies which were also based on system biology and its technology.
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Objective@#To investigate the relationship between the serum anti-Müllerian hormone (AMH) level and semen parameters.@*METHODS@#We collected the data about 726 outpatients at the Male Infertility Clinic of Jinling Hospital from September 2015 to November 2016, including 72 with non-obstructive azoospermia, 123 with oligospermia, and 531 with normal sperm concentration. We obtained the semen volume, total sperm count, sperm concentration, sperm motility, the percentages of progressively motile sperm (PMS) and morphologically normal sperm (MNS), and the levels of serum AMH, inhibin B (INH-B), total testosterone (TT) and follicle - stimulating hormone (FSH) of the patients, analyzed the correlation of the serum AMH level with the other parameters, and compared the AMH level among different groups.@*RESULTS@#The serum AMH level was found to be correlated positively with the total sperm count (r = 0.227, P 0.05). There was a statistically significant difference in the serum AMH level among the patients with non-obstructive azoospermia, oligozoospermia, and normal sperm concentration (［6.33 ± 4.26］ vs ［8.26 ± 3.98］ vs ［9.8 ± 5.19］ ng/ml, P <0.001).@*CONCLUSIONS@#Serum AMH is a biomarker reflecting the function of Sertoli cells and its level is significantly correlated with sperm concentration and motility, suggesting that AMH may be involved in spermatogenesis and sperm maturation.
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Humans , Male , Anti-Mullerian Hormone , Blood , Azoospermia , Blood , Biomarkers , Blood , Follicle Stimulating Hormone , Blood , Inhibins , Blood , Oligospermia , Blood , Semen , Semen Analysis , Sertoli Cells , Physiology , Sperm Count , Sperm Motility , Spermatogenesis , Spermatozoa , Testosterone , BloodABSTRACT
Abdominal aortic aneurysms(AAAs) is the most common aneurysm,and usually characterized by less symptom.While ruptured AAAs leads to high mortality.Abdominal ultrasonography can effectively detect AAA,decrease the AAAs-related mortality.However,screening AAAs causes some adverse outcomes,including psychological distress and immediate harms in treatment.Meanwhile,the prevalence of AAAs in sex and age is significantly different.Therefore,a reasonable and effective screening strategy is very important.This article search random control trials,systematic reviews,meta-analysis and guidelines in screening AAAs to obtain a reasonable screening strategy.
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ABSTRACT:Objective To explore the relationship between clinical manifestations and pathological changes in patients with IgA nephrophathy.Methods To compare the clinical pathological data of 300 patients with primary IgA nephrophathy,who were diagnosised in the Shaanxi Chinese Hospital from Jan.2008 to Dec.2012.Results① The young and middle-aged had the highest incidence of IgA nephrophathy, about 9 0%, hematuria and proteinuria was the primary clinical manifestations among all ages,the incidence of hypertension and abnormal renal function was higher among 60-year age,about 29.3% and 28%.② The IgA+IgM deposition measured by immunofluorescence was the most common pathological type(3 6%).The ratio of IgA deposition was higher in LeeⅠ-Ⅲ of IgA nephrophathy,while IgA+IgM deposition was more common in Lee Ⅳ and Ⅴ (45.5% and 81.8%). The deposition of C3 was common in all IgA nephrophathy(6 3 .3%).③ Lee Ⅰ-Ⅳ grades were the more common grades,covered over 96.3%.Hematuria and proteinuria were the primary clinical manifestations inⅠ-Ⅴpathological changes grading.The incidence of hematuria,proteinuria,hematuria with proteinuria,and hypertension had no significant difference in all pathologic grading,but abnormal renal function had significant difference in Lee Ⅴ(P<0 .0 5 ).④ Abnormal of urine protein and RBC did not have significant difference in Lee Ⅰ-Ⅴ;C3 depositions in serum had significant difference in Ⅳ pathologic grading(P<0 .0 5 ).The elevation of IgA in serum had significant difference in Lee Ⅴ(P<0 .0 5 ).The proportion of abnormal serum creatinine(SCr)increased with the pathological grades,showing a rising trend.Conclusion IgA nephropathy has the characteristics of diversification of clinical manifestations and pathology changes. The incidences of hematuria, proteinuria and hypertension in IgA nephrophathy patients have no correlation with pathological grading;but with pathological grade promotion,the incidence of abnormal renal function increases.
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This paper was aimed to summarize professor Huang Chunlin’s medication experiences, rules and prescription characteristics in the treatment of chronic nephritis through data mining on patients’ records of chronic nephritis. The records of 92 outpatients which met the criteria were collected. The total treatment number was 276. Text conversion was made on patients’ records. And the archive of patients’ data was established. With the support of Traditional Chinese Medicine Inheritance Support System, the medication experiences and prescription rules of professor Huang were summarized. The results showed that the top 20 herbs with relatively high using frequencies were mostly sweet in flavor and neutral in nature. The meridian distributions were mostly the kidney, spleen and liver meridian. The medication effects were mainly qi-reinforcing, yang-reinforcing, water-clearing and dampness-removing. Results from data mining showed 5 couplet medicines and 8 new prescriptions in chronic nephritis treatment. It was concluded that in Professor Huang’s syndrome differentiation of chronic nephritis, it was related to the spleen and kidney, and also related to dampness and stasis. The characteristics in medication were “high-dose for severe conditions”, “sweet in flavor and neutral in nature with outstanding effects”, “always related to the spleen and kidney”, “always related to dampness and stasis”.
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Chronic kidney disease (CKD) is becoming a global social problem. It is important to slow down the progression of CKD for economic and social concerns. In recent years, it has been found that colon is one of the vital organs which produce uremic toxins. And enterogenous uremic toxins are closely related to the prognosis of CKD. Theory of gut-kidney axis for the slowdown of CKD progression was raised by foreign scholars and became the research hot spot. Colon therapy with traditional Chinese medicine (TCM) has been widely used in clinical practice and is believed to slow down the progression of CKD by numerous clinical reports. However, low re-search quality and ambiguous results limited its further application. Under the guidance of senior TCM Professor Huang Chunlin, who emphasized the method of draining turbidity through bowels in the management of CKD, from the Nephrology Center, Guangdong Provincial Hospital of Chinese Medicine, as well as the modern theory of gut-kidney axis, we had carried out a series of exploratory researches which will provide data and methodology support for further confirmatory studies and improve its effectiveness.
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This paper summarized Professor Huang Chunlin's traditional Chinese medicine (TCM) medication expe-riences for patients with hypoalbuminemia in refractory nephrotic syndrome (RNS). This paper was divided into three parts. The first part was the overview of hypoalbuminemia in RNS. The second part was the TCM medica-tion experiences for patients with hypoalbuminemia in RNS which included the integrated application of tonifying the spleen, nourishing the liver and reinforcing the kidney. The third part was the explanation of the comprehen-sive application of Professor Huang Chunlin's TCM medication experiences for patients with hypoalbuminemia in RNS through the introduction of a typical case. TCM medication experiences for RNS treatment based on experi-ences of famous TCM doctors provided theoretical and practical basis for therapeutic regimen.
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IgA nephropathy is the most common primary glomerular disease in China without any specific treat-ment. Corresponding treatments are usually adopted according to different clinical types. Referred to the clinical classification principles and the experiences of his own, Professor Huang Chunlin presented traditional Chinese medicine (TCM) medication experiences for different clinical types of IgA nephropathy which had some clinical instructive significance .
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This study was aimed to analyze the formulas and classify the treatment of chronic kidney disease (CKD) by Dr. Huang Chunlin based on the data mining method. A total of 63 CKD outpatients' medical records by Dr. Huang were collected. And 226 formulas prescribed in the medical records were put in the Traditional Chinese Medicine Inheritance Support System (TCMISS). Data mining techniques were applied in the study of as-sociation rule mining algorithm and complex system entropy cluster, the usage frequency and the correlation of each single Chinese medicinal in order to sort out the prescription pattern of CKD. The results showed that to for-tify the spleen and tonify the kidney were found to be the basic method of CKD treatment . Through the applica-tion of TCMISS, the Chinese medicinals used in Dr. Huang's CKD treatment were Astragalus root, Eucommia, Epimedium, Cuscuta, Agastache, Danshen Root, Ligustrum. It was concluded that the TCMISS is of great value in the summarization of clinical experiences of well-known TCM doctors.
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This study was aimed to observe renoprotective effect and possible mechanism on Y i-Shui Sheng-Xin Yin in spontaneously hypertensive rats. Sixty 12-week male SHR rats were randomly divided into six groups , which were the Y i-Shui She ng-X in Y in low-dose group , middle-dose group , high-dose group , Benazepril group , model group and blank control group , and ten rats for each group . The SHR rats were sacrificed after eight weeks . The urine microalbumin , blood urea nitrogen and cystatin were tested in each rat . The HE and Masson staining method were used to observe changes of renal pathology . Changes of expression of transforming growth factor-β1 ( TGF-β1 ) , connective tissue growth factor ( CTGF ) , FN were detected by immunohistochemistry . The results showed that compared with the blank control group , blood pressure in model group was associated with a significant rise after 8 weeks. Compared with the model group, blood pressure in the Yi-Shui Sheng-Xin Yin middle-dose group, high-dose group and Benazepril group significantly decreased. Compared with the blank control group , urine microalbumin , blood urea nitrogen and cystatin in model group were associated with a significant rise . Compared with the model group , urine microalbumin , blood urea nitrogen and cystatin in the Y i-Shui She ng-X in Y in middle-dose group , high-dose group and Benazepril group significantly decreased . Pathological examinations showed that pathological changes in model group were faster than all drug-groups , appeared pathological changes of glomerular hypertrophy , glomerular basement membrane thickening of heterogeneity and extensive vacuoles degeneration . Immunohistochemical staining showed that compared with the blank control group , expressions of TGF-β1 , CTGF and FN of rat kidney tissue in model group were obviously up-regulated ( P < 0 . 05 ) . Compared with the model group , expressions of TGF-β1 , CTGF and FN in the Y i-Shui She ng-X in Y in , middle-dose group , high-dose group and Benazepril group were down-regulated ( P < 0 . 05 ) . It was concluded that Y i-Shui She ng-X in Y in can reduce SHR rats' early renal glomerulosclerosis and renal interstitial fibrosis , which play roles of delaying the progress of hypertension and protecting kidney . Its mechanism of action may be related to TGF-β1 , CTGF , FN signal pathways .
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This study was aimed to analyze the medication and herbal prescription rules in the treatment of nephrotic syndrome (NS) by Prof. Huang Chunlin with Traditional Chinese Medicine Inheritance Support System ( TCMISS ) . Prescriptions used for NS treatment were collected and the data was entered into the TCMISS . The commonly used herbs and herbal prescription rules in NS treatment by Prof. Huang were summarized through the association rules, revised mutual information, complex system entropy cluster and other unsupervised hierarchical clustering methods. The results showed that based on the analysis of 280 prescriptions from 68 patients, the fre-quency of each herb and association rules among herbs included in the database were identified. And the basic NS treatment prescription by Prof. Huang Chunlin and 8 new prescriptions were mined from the database. It was concluded that data mining is of great practical value to the summarization of clinical experiences of well-known TCM doctors.
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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.
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Humans , Colon , Drugs, Chinese Herbal , Pharmacology , Therapeutic Uses , Enema , Kidney , Pathology , Renal Insufficiency, Chronic , Drug Therapy , Pathology , Treatment OutcomeABSTRACT
<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>
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Adult , Aged , Female , Humans , Male , Middle Aged , Blood Urea Nitrogen , Creatinine , Blood , Drugs, Chinese Herbal , Therapeutic Uses , Enema , Integrative Medicine , Kidney Failure, Chronic , Blood , Therapeutics , Urea , Blood , Uric Acid , BloodABSTRACT
[Objective] To investigate the relationship between serum leptin level in chronic renal failure (CRF) and Qi or yang deficiency syndrome of spleen and kidney. [Methods] Thirty-eight cases of CRF and 16 healthy subjects as control were enrolled in this study. The CRF patients were classified as Qi /yang deficiency syndrome of spleen and kidney (pattern 1) and non-Qi/yang-deficiency syndrome of spleen and kidney (pattern 2). Serum leptin level was detected by enzyme-linked immunosorbent assay and nutrient parameters such as serum albumin (ALB), C-reation protein (CRP) and pre;ilbumin (preAlb) levels were also observed. The relationship of leptin level and nutrient parameters with Qi or yang deficiency syndrome of spleen and kidney was observed. [Results] The serum leptin level of pattern 1 was higher than that of pattern 2 ( P 0.05) . [ Conclusion ] Serum leptin may be the partial material base of Qi or yang deficiency syndrome of spleen and kidney and this is worthy doing further research. The uncertain relationship between nutrient parameters and Qi or yang deficiency syndrome of spleen and kidney may be due to the increase of type Ⅱ error which results from the small sample size.