Objective To evaluate the effects ofYiqi Yangyin Huoxue Formula on clinical endpoints of diabetic nephropathy patients.Methods Totally 95 patients who were involved into the six-month DN clinical RCT for observation in 2008 were retrospectively collected and screened. There are 47 cases in the trial group, who were chronically treated by integrated traditional Chinese and Western medicine therapy which mainly adoptingYiqi Yangyin Huoxue Formula. There were 48 cases in the control group, who were chronically treated with Western medicine. Follow-up visits were conducted in 2011, 2012, 2013, and 2014 respectively. Long-term incidence rate of renal function progress/deaths were compared in the two groups.Results Five cases died in the trial group, among which one case died of renal failure. Eight cases died in the control group, among which five died of renal failure and multiple organ failure. The incidence of endpoints entering end-stage renal disease and renal function progress was much lower than that of control group. Conclusion Integrated traditional Chinese and Western medicine therapy dominated byYiqi Yangyin Huoxue Formula has good clinical efficacy of kidney protection, and can slow the progress of DN patients entering end-stage renal disease, and better than single Western medicine intervention.

OBJECTIVE:To establish the HPLC fingerprint chromatogram of Danzhen headache capsules. METHODS:HPLC method was adopted. The column was Dikma Diamonsil C18 with the mobile phase of methanol-acetonitrile-water(gradient elution) at the flow rate of 1.0 ml/min;the temperature was 40 ℃,the detection wavelength was 340 nm,the sample size was 20 μl and the detection time was 65 min. RESULTS:RSDs of precision,stability and reproducibility tests were no more than 0.23%;13 com-mon peaks were identified in 10 batches of Danzhen headache capsules and the similarity of all samples were higher than 0.90. CONCLUSIONS:The method is simple,accurate and reproducible,and can be used for the process stability evaluation and quali-ty control of Danzhen headache capsules.

Objective:To analyze the clinical features, imaging findings and gene test of patients with type Ⅱ Alexander disease.Methods:All the clinical data of three cases with type Ⅱ Alexander disease from August 2018 to June 2020 in the Department of Neurology, Qilu Hospital of Shandong University (Qingdao) and Qilu Hospital of Shandong University were collected, and their clinical and imaging findings were analyzed retrospectively.Results:All the three patients were middle aged and old men with a chronic progressive course, beginning with weakness of one or both lower limbs, followed by dizziness, dysarthria, dysphagia, sphincteral disturbances, constipation and orthostatic hypotension. Three patients all experienced misdiagnosis (hydrarthrosis, cerebral vascular disease, alcoholism, respectively) at early stage of the disease. Cranial magnetic resonance imaging (MRI) showed mild supratentorial periventricular leukodystrophy, which was not specific. Sagittal cranial MRI demonstrated medulla oblongata and upper cervical cord atrophy called “tadpole atrophy”, which had high suggestive value. The results of gene analysis showed heterozygous mutation of glial fibrillary acidic protein gene, which had been reported as pathogenic gene; c.1091C>T (p.A364V) in exon 6, c.722C>T (p.R258C) in exon 4 and c.197G>A (p.R66Q) in exon 1, respectively.Conclusions:Type Ⅱ Alexander disease is an autosomal dominant disease, most with point mutations, rarely with deletion mutations. Type Ⅱ Alexander disease should be suspected when a patient had signs of lower brainstem involvement such as dizziness, ataxia, pyramidal sign, autonomic dysfunction, especially when cranial MRI showed mild supratentorial leukodystrophy, and medulla oblongata and upper cervical cord atrophy.

Objective To study the correlation between two indicators of the intestinal barrier(i.e.,serum endotoxins and D-lac-tate)and enterogenic uremic toxins,including indoxyl sulfate(IS)and urea nitrogen,in patients with chronic kidney disease(CKD).Methods A total of 260 CKD patients were selected from outpatients and inpatients of the Department of Nephrology and Endocrinology,Wangjing Hospital,China Academy of Traditional Chinese Medicine,from April 2019 to August 2021,and were divided into the CKD stage 3 group(n=51),the CKD stage 4 group(n=130),and the CKD stage 5 group(n=79),according to CKD stage.Patients'age,gender,disease duration,and past medical history were recorded.Serum IS,urea nitrogen,serum endotoxin,D-lactate,and blood cre-atinine were detected.The estimated glomerular filtration rate(eGFR)was calculated.Patients'faeces were retained to detect the levels of Escherichia coli and Bifidobacterium bifidum colonies.The correlation between serum endotoxin and D-lactate and enterogenic uremic toxins was analyzed.Results Comparison of general data:There were no significant differences in age,gender,course of disease,previ-ous diabetes mellitus,and bifidobacteria levels between the three groups(P＞0.05),but there were significant differences in pre-exist-ing hypertension and coronary heart disease,IS,serum creatinine,urea nitrogen,eGFR,serum endotoxin,D-lactate acid,and E.coli(P＜0.05).Correlation analysis:Spearman analysis showed that serum endotoxin and D-lactate were significantly positively correlated with IS,urea nitrogen,and serum creatinine(P＜0.05),and negatively correlated with eGFR(P＜0.05).The results of Pearson analy-sis showed that serum endotoxin and D-lactate were significantly positively correlated with E.coli and Bifidobacterium(P＜0.05).Mul-tivariate linear regression analysis showed that IS was the independent influencing factor of serum endotoxin(P＜0.001)and IS and urea nitrogen were the independent influencing factors of D-lactate(P＜0.05).Conclusion Elevated serum endotoxin and D-lactate lev-els in patients with CKD are associated with enterogenic uremic toxins.

Objective To explore the clinical characteristics of late-onset ornithine carbamoyltransferase deficiency (OTCD) in order to improve the clinicians' understanding of this disease.Methods The clinical,therapeutic and follow-up data of two patients with late-onset OTCD diagnosed in the Department of Neurology,Qilu Hospital of Shandong University from November 2017 to February 2018 were collected and analyzed.Results Case 1 is a 17-year-old male who was admitted into Qilu Hospital with recurrent dizziness and vomiting for 4 months,sudden mental abnormality and convulsion for 3 days.The liver dysfunction,respiratory alkalosis and hyperammonemia (434 μmol/L) had been found before his admission.His blood ammonia fluctuated obviously from 180 μ mol/L to 2998 μmol/L,though he was given hemodialysis and arginine infusion,and died on the fourth day after admission.Case 2 is a 15-year-old male,complained with recurrent dizziness,vomiting,bluntness and somnolence for 20 days.He was found with hyperammonemia (600 μmol/L) and liver dsyfunction in a local hospital.He was getting better after intravenous administration of arginine and liver protective drugs.After admission,the blood ammonia,liver function and amino acids,acylcarnitine profiling in dried blood spots,and organic acid analysis in urine were normal,and he has not recurred since restriction of protein diet.Brain magnetic resonane imaging of both patients showed cytotoxic edema of bilateral frontal lobe and insular cortex,and their genetic detection both showed c.119G＞A(p.R40H) hemizygous pathogenic mutation of OTC gene inherited from their respective mothers.Conclusion Unexplained hyperammonemia and acute encephalopathy with insular and frontal cortical involvement should be on the alert to the urea cycle disorders,especially OTCD.Early diagnosis and reasonable treatment are the key to changing the prognosis.

Objective: To analyze the level and trend of microbial contamination in food in rural compulsory education schools in Baiyin City, so as to provide a reference for playing an early warning role in eliminating potential food safety hazards as soon as possible. Methods: According to the "National Food Contaminants and Harmful Factors Risk Monitoring Workbook", etc., 8 pathogenic bacteria such as Salmonella, Listeria monocytogenes, Staphylococcus aureus, total bacterial count, and 2 hygienic indicator bacteria of coliform were tested. Results: A total of 908 food samples were collected from 2013 to 2021, 47 were positive and the overall positive rate was 5.18%. The positive rate of samples collected in different years showed a downward trend year by year. The detected pathogenic bacteria ranked from high to low as follows: Escherichia coli (1.87%), Bacillus cereus (0.99%), Staphylococcus aureus (0.44%), mold (0.33%), Listeria monocytogenes (0.22%). Hygiene indicator bacteria total number of bacteria exceeded the standard rate was higher (2.09%). Among all kinds of food, milk and dairy products, frozen food, cold food, barbecue, rice and flour products had higher positive rates. According to quarterly statistics, the positive rate in the first and second quarters was relatively high. Conclusion There are different degrees of microbial contamination risks in the food of rural compulsory education schools. All relevant departments should pay attention to the current situation of school food hygiene and safety in poverty stricken areas, and strengthen rural compulsory education school food, especially for milk and dairy products, frozen food, cold food, Supervision of key foods such as barbecue, rice and flour products, and efforts to improve their safety standards, do a good job in school food hygiene and safety, and ensure the healthy growth of young people.

Objective:To report a family of Zellweger spectrum disorders (ZSD) caused by mutations in the PEX10 gene and to increase the level of awareness of the disease among clinicians. Methods:The clinical and genetic data of a brother-sister co-morbidity family with ZSD due to PEX10 gene mutation admitted to the Department of Neurology, Qilu Hospital of Shandong University in July 2022 were collected and a literature review was performed. Results:The proband was a 24-year-old female who was admitted to the Qilu Hospital of Shandong University due to unstable walking for 8 years and aggravated for 1 year with squatting effort. Cranial magnetic resonance imaging (MRI) showed cerebellar atrophy, electromyography suggested peripheral neuropathy with motor and sensory involvement, and pure tone hearing threshold measurement showed neurogenic deafness. The 15-year-old brother of the proband presented with "unsteadiness in walking and difficulty in squatting for 2 years". His cranial MRI and electromyography were similar to those of the proband, and his laboratory results suggested abnormal liver function. The whole exon sequencing results of the proband suggested a compound heterozygous mutation in the PEX10 gene with c. 992G>A(p. R331Q) and c. 988T>C(p. C330R) mutations and both were likely pathogenic mutations and respectively from her parents. And her brother also carried the above variants. A total of 9 case reports in English literature (1 of which was published by domestic scholars) were retrieved from major domestic and international databases on PEX10 gene mutations causing ZSD, with a total of 15 patients, most of whom had childhood and adolescent onset. The most common initial symptom was slowly progressed ataxia. The majority of patients showed cerebellar atrophy on cranial MRI and peripheral neuropathy was found in the most patients.The 2 patients were suggested to have phytic acid-free food, at the same time, they bagan taking L-arginine and ursodeoxycholic acid. Fortunately,both the ataxia symptom and liver function of them were dramatically alleviated 3 months later. Conclusions:For the patients with unexplained ataxia with polyneuropathy and abnormal liver function,the possibility of ZSD should be considered. Phytic acid-free food, L-arginine and ursodeoxycholic acid supplement may be beneficial for the ZSD patients.

Objective:To explore the current status of cognition of medical and nursing staff in dental hospitals on the risk early warning management of inpatients, so as to provide a reference for the further construction of an emergency and critical illness risk early warning system for inpatients in dental hospitals.Methods:This study adopted the phenomenological research method in qualitative research. From January to August 2020, purpose sampling was used to select 15 medical and nursing staff from a number of dental hospitals in Zhejiang Province, Jilin Province, Liaoning Province, and Shanxi Province as the research objects. The semi-structured in-depth interview was conducted with medical and nursing staff, and the interview data was transcribed, coded, categorized, described, and summarized.Results:A total of four themes were summarized, namely, the insufficient management ability of medical and nursing staff to grasp the emergency and critical illness risk early warning of inpatients, the difficulty of medical and nursing staff to implement the risk early warning of emergency and critical illness of inpatients, the status quo of the demand of medical and nursing staff for the risk early warning management of emergency and critical illness of inpatients, and specialized indicators for medical and nursing staff to improve the risk early warning management of inpatients.Conclusions:The medical and nursing staff of dental hospitals have a lack of understanding of the risk early warning management of inpatients. There is an urgent need to improve risk cognition and first aid capabilities in order to establish an emergency and critical illness risk early warning management system for inpatients in dental hospitals.

Objective:To develop the Early Warning Assessment Scale of Nursing Risk after General Anesthesia for Patients in Dental Hospitals, so as to provide reference for clinical nurses to identify and predict nursing risk in the early stage.Methods:The entry pool of the Early Warning Assessment Scale of Nursing Risk after General Anesthesia for Patients in Dental Hospitals was formed by consulting the relevant domestic and foreign article, referring to the results of the previous qualitative interviews, and retrospective analysis of the patient's medical records. After two rounds of Delphi expert consultation and project analysis, the initial assessment scale was formed. From January to December 2021, 115 inpatients in the Hospital of Stomatology of Jilin University after general anesthesia were selected by convenient sampling to test the predict performance of the scale.Results:The expert authority coefficients of the two rounds of consultation were 0.855 and 0.825 respectively. The Early Warning Assessment Scale of Nursing Risk after General Anesthesia for Patients in Dental Hospitals included 25 items. Cronbach's α coefficient of the scale was 0.721. The area under the receiver operating characteristic curve of subjects was 0.865 [95% confidence interval (0.790, 0.939) ]. When the cutoff value was 15.500, the sensitivity of the scale was 0.722, the specificity was 0.899, the Jordan index was 0.621, and the predict performance was the best.Conclusions:The Early Warning Assessment Scale of Nursing Risk after General Anesthesia for Patients in Dental Hospitals is scientific and feasible, and can be used for the assessment and early warning of postoperative nursing risk of patients under general anesthesia in stomatological hospitals in China, helping nurses to identify the nursing risk of patients at an early stage.

Objective We aimed to observe the effect of the traditional Chinese medicine(TCM)-based"tertiary hospital-community integrated"treatment program in patients with diabetic kidney disease.Methods A total of 126 patients from the Jiangtai and Cuigezhuang Communities in Chaoyang District were randomly divided into the experimental group and the control group(n=63 patients per group).In the experimental group,the"tertiary hospital-community integrated"treatment program was implemented(including TCM differentiated health preservation,chronic disease management,comprehensive diagnosis and treatment program of integrated Chinese and Western medicine),while in the control group,the existing chronic disease diagnosis,treatment,and management program in the community was implemented(including chronic disease management with regular follow-ups,diagnosis and treatment program of Western medicine).The observation period was 6 months,with 3 months as a course of treatment.The 24 h urine total protein level(24 hUTP),the serum level of creatinine(Scr),and the estimated glomerular filtration rate(eGFR)were compared between the two groups,as well as the effective rates of 24 hUTP,Scr,and eGFR,the rate of achieving standard glucose levels and normal lipid metabolism,including low-density lipoprotein-cholesterol(LDL-C),triglyceride(TG),and glycosylated hemoglobin(GHB),the level of patients'self-management,and the medical service in utilization.Results There were 120 patients included for analysis(60 in the experimental group and 60 in the control group).The difference in 24 hUTP was significantly different(P＜0.05),while Scr and eGFR were not statistically different between the experimental and control groups after 3 months of treatment.The differences in 24 hUTP,Scr,and eGFR were statistically significant after 6 months(P＜0.05).After 6 months of treatment in both groups,the effective rates of 24 hUTP,Scr,and eGFR were higher in the experimental group than in the control group(78.3％,48.3％,and 50.0％in the experimental group and 35.0％,18.3％,and 15.0％in the control group,respectively)(P＜0.05);after 6 months,the LDL-C,TG,and GHB qualified rates were higher in the experimental group than in the control group(75.0％,83.3％,and 71.7％in the experimental group and 56.7％,63.3％,and 46.7％in the control group,respectively;P＜0.05);comparing the self-management levels of the two groups after 3 and 6 months of treatment,the total self-management score and the total self-efficacy score were both higher in the experimental group than in the control group(P＜0.05);comparing the time of hospitalization and hospitalization costs of the two groups 6 months after enrollment,the time of hospitalization and hospitalization costs were lower in the experimental group(P＜0.05).Conclusion The"tertiary hospital-community integrated"TCM-based treatment program improves renal function,glucose and lipid metabolism,and patients'self-management;it can reduce the economic burden of families,save medical resources,and improve the utilization of medical services.