ObjectiveTo observe the clinical efficacy and safety of Chinese herbal enema combined with fumigation as adjunctive therapy for non-dialysis chronic kidney disease （CKD） patients of stage 3-5 with spleen-kidney yang deficiency and turbid toxin blood stasis pattern. MethodsA total of 120 non-dialysis CKD，patients of stage 3-5 with spleen-kidney yang deficiency and turbid toxin blood stasis pattern were randomly divided into treatment group and control group， with 60 cases in each group. The control group received conventional western medical treatment， while the treatment group additionally received Chinese herbal enema combined with fumigation， with enema and fumigation performed alternately， once every other day， three times a week. The treatment course for both groups was 4 weeks. The levels of serum creatinine （Scr）， estimated glomerular filtration rate （eGFR）， and the total score of traditional Chinese medicine symptoms were compared before and after treatment in both groups. The efficacy of traditional Chinese medicine symptoms and clinical efficacy were compared between the two groups after treatment. Adverse reactions in both groups were observed during the treatment period. ResultsThe total score of traditional Chinese medicine symptoms was significantly reduced after treatment in both groups （P＜0.01）. Compared to the control group after treatment， the treatment group showed significant decreases in Scr and the total score of traditional Chinese medicine symptoms， and a significant increase in eGFR （P＜0.05）. The total effective rate of traditional Chinese medicine symptoms in the treatment group （96.67%） was higher than that in the control group （46.67%， P＜0.01）， as well as the total effective rate of clinical efficacy in the treatment group （75.00%） versus that in the control group （28.33%， P＜0.01）. During the treatment period， the vital signs of patients in both groups remained stable， and there were no significant abnormalities in blood routine， urine routine， stool routine， liver function indicators， and electrocardiogram after treatment. ConclusionChinese herbal enema combined with fumigation as adjunctive therapy can significantly alleviate clinical symptoms， improve renal function， and demonstrate good safety for non-dialysis CKD patients of stage 3-5 with spleen-kidney yang deficiency and turbid toxin blood stasis pattern.

Edema is one of the typical symptoms of nephrotic syndrome， and symptomatic diuretics is mainly used in clinical practice but with unstable effect. This paper reported a case of refractory edema of nephrotic syndrome treated by acupuncture. The patient was mainly manifested as edema in both lower limbs， which were sunken when pressed and difficult to recover. After symptomatic treatment with western medicine， the effect was not obvious. In traditional Chinese medicine， this patient was diagnosed as spleen-kidney depletion and water-dampness internal accumulation syndrome. Based on the principle of “when swelling is below the waist， urination should be induced” in ZHANG Zhongjing's Essentials from the Golden Cabinet （《金匮要略》）， it is recommended to puncture at Shuidao （ST 28） and Shuifen （CV 9） to promote urination， at Sanyinjiao （SP 6）， Lougu （SP 7）， Yinlingquan （SP 9） and Zusanli （ST 36） to fortify the spleen and boost the kidneys and treat the root and branch simultaneously. After 3-day treatment， urine becomes smooth， and the edema of both lower limbs disappeared.

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.

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 analyze the clinical and molecular genetic characteristics of patients with cerebrotendinous xanthomatosis (CTX) to increase the awareness of the disease among clinicians.Methods:The clinical data, including the age of onset and diagnosis, clinical manifestations, neuroimaging and neuroelectrophysiology and the genetic data of patients diagnosed with CTX in the Department of Neurology, Qilu Hospital of Shandong University from March 2017 to December 2023 were retrospectively collected and analyzed.Results:A total of 18 patients were enrolled in this study, including 12 males and 6 females.The onset age was 10 (6, 29) years, with a minimum onset age of 3 years and a maximum onset age of 32 years; the period from onset to diagnosis was 19.00 (8.75, 24.25) years, with the shortest being 6 months and the longest being 35 years. Among the 18 patients, 16 patients had symptoms and signs of spastic paralysis, 9 patients had cognitive impairment and peripheral neuropathy, 8 patients had cerebellar ataxia, 3 patients had mental disorders, 3 patients had autonomic nervous dysfunction, and only 2 patients had seizures. Among the non-neurological symptoms, 9 patients had Achilles tendon xanthoma, of whom 1 patient was accompanied by patellar tendon xanthoma; 8 patients had adolescent cataracts, 6 patients had chronic diarrhea since childhood. All patients underwent brain MRI examination, among whom 15 patients had cerebellar dentate nucleus involvement, 10 patients had corticospinal tract involvement and 2 patients had normal brain MRI. Fourteen patients underwent nerve conduction and electromyography examinations, among whom 9 patients presented with multiple peripheral neuropathy characterized by motor or motor sensory demyelination. A total of 17 CYP27A1 gene variants were detected in 18 patients. The c.1420C>T and c.1263+1G>A were the hot-spot mutations in this cohort. Conclusions:Spastic paralysis, cerebellar ataxia, tendon xanthoma and adolescent cataracts are typical manifestations of CTX. The cerebellar dentate nucleus and corticospinal tract are mainly involved on the neuroimaging. It should be noted that some patients lack the typical characteristics mentioned above. The c.1420C>T and c.1263+1G>A are the hot-spot mutations in this cohort.

ObjectiveTo observe the effectiveness and safety of Qihuang Yishen Granules （芪黄益肾颗粒） combined with traditional Chinese medicine （TCM） chronic disease management on patients with diabetic kidney disease with deficiency qi and yin. MethodsTotally 140 patients diagnosed as diabetic kidney diseases with deficiency of both qi and yin were randomly divided into control group and trial group，with 70 cases in each group. Patients in the control group were treated with symptomatic treatment and routine chronic disease management. Patients in the trial group added Qihuang Yishen Granules and chronic disease management with TCM characteristics on the basis of symptomatic treatment. The course of treatment in both groups lasted for 6 months. The changes of laboratory indexes and chronic disease management level scores of the two groups of patients before treatment and after 3 and 6 months of treatment were compared， and their correlation were analyzed.The laboratory indexes of urinary protein and renal function related indicators such as 24-hour urinary protein quantification （24 hUTP）， serum creatinine （Scr）， blood urea nitrogen （BUN）， and estimated glomerular filtration rate （eGFR）， and control compliance rate， as well as blood glucose and lipid related indicators such as glycosylated hemoglobin （HbA1c）， low-density lipoprotein cholesterol （LDL-C）， triglyceride （TG） and control compliance rate were observed. The chronic disease management level scores included exercise，cognitive symptom management practice，communication with doctors， self-efficacy of symptom management，self-efficacy of disease commonness management. ResultsFinally，67 cases in the control group and 68 cases in the trial group completed the study. Compared with the group before treatment， the trial group had lower 24 hUTP and Scr， higher exercise score， total self-management score and all self-efficacy scale scores， higher TG at 3 months of treatment； at 6 months of treatment， the trial group had lower 24 hUTP， higher eGFR， and higher self-management scores and self-efficacy scale scores of all chronic diseases （P＜0.05）， and the control group had higher self-management total score （P＜0.05）. After 6 months of treatment， the trial group had lower 24 hUTP， Scr， LDL-C， and TG， higher eGFR， higher compliance rate of 24 hUTP， eGFR， LDL-C， and TG， and higher scores for all chronic disease management indexes compared with the control group （P＜0.05）. In terms of the correlation between laboratory indicators and chronic disease management level scores：there was a statistically significant difference in the correlation between 24hUTP and exercise，symptom management self-efficacy，and self-efficacy of disease commonness management （P＜0.05 or P＜0.01），all of which were negatively correlated. There was a statistically significant difference in the correlation between Scr and symptom management self-efficacy and self-efficacy of disease commonness management （P＜0.01），both of which were negatively correlated. There was a statistically significant difference in the correlation between eGFR and symptom management self-efficacy and self-efficacy of disease commonness management （P＜0.01），both of which were positively correlated. ConclusionQihuang Yishen Granules combined with chronic disease management of TCM can improve the level of proteinuria，renal function and lipid metabolism in patients with diabetic kidney disease with deficiency of both qi and yin，thus delaying the progress of diabetic kidney disease and also improve the level of chronic disease management of patients.

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 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:To study the characteristics of clinical, laboratory, imaging, genetic and differential diagnosis of McLeod syndrome.Methods:The clinical characteristics of 2 cases of McLeod syndrome confirmed by gene detection in Qilu Hospital (Qingdao) on June 27, 2018 and in Qilu Hospital of Shandong University on September 11, 2019 were analyzed retrospectively. And the characteristics of patients of McLeod syndrome reported in China were analyzed in combination with literature review.Results:Both of the 2 patients were adult male, aged 57 and 61 years, respectively, with a slowly progressive course, beginning with gradually involuntary movement of trunk and extremities, involving involuntary biting of the tongue and dysphagia. Two patients had mild cognitive impairment; one patient had emotional agitation. Imaging study showed atrophy of caput nuclei caudate. Neuroelectrophysiological examination of case 1 showed sensory axon neuropathy in both upper limbs with severe damage to the left ulnar nerve. Creatine kinase (CK) was mildly elevated in 2 patients. The peripheral blood smear of 1 patient showed increased acanthocytes, accounting for 13%, the other patient showed no increased acanthocyte. McLeod syndrome related gene was tested in the 2 patients, case 1 with deletion mutation of exon 2 of XK gene, and case 2 with hemizygotic mutation of XK gene c.898delC p.L300 *. Conclusions:The clinical manifestations of McLeod syndrome are various and the differential diagnosis is crucial. For elderly male with cephalic facial chorea, elevated CK level and neuromuscular diseases, the possibility of McLeod syndrome should be screened.

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.