腹膜透析相关性腹膜炎（PDAP）是导致腹膜透析技术失败甚至患者死亡的首要并发症，尽早获得准确有效的病原学鉴定结果指导抗感染方案是影响PDAP临床疗效的关键环节。本文系统回顾了广东省中医院腹透中心PDAP病原微生物检测方法及现状，在梳理国际临床实践指南和标准操作规程等临床证据的基础上，从“标本留取”“标本预处理”“培养条件”及“首次培养阴性处理”四个方面归纳总结了影响PDAP培养阳性率的技术要点和潜在改进措施；并以省中医腹透中心为示例，展示了如何结合现有临床证据，从患者宣教、多学科协作、标本处理等方面对单中心的PDAP标本处理及送检流程进行完善及优化，提供可行的单中心经验，供国内其他腹膜透析中心参考。

BackgroundDiabetic kidney disease (DKD) has become the leading cause of kidney failure, causing a significant socioeconomic burden worldwide. The usual care for DKD fails to achieve satisfactory effects in delaying the persistent loss of renal function. A Chinese herbal medicine, Tangshen Qushi Formula (TQF), showed preliminary clinical benefits with a sound safety profile for people with stage 2-4 DKD. We present the protocol of an ongoing clinical trial investigating the feasibility, efficacy, and safety of TQF compared to placebo in delaying the progressive decline of renal function for people with stage 2-4 DKD.MethodsA mixed methods research design will be used in this study. A randomized, double-blind, placebo-controlled pilot trial will evaluate the feasibility, efficacy, and safety of TQF compared to placebo on kidney function for people with stage 2-4 DKD. An embedded semi-structured interview will explore the acceptability of TQF granules and trial procedures from the participant’s perspective. Sixty eligible participants with stage 2-4 DKD will be randomly allocated to the treatment group (TQF plus usual care) or the control group (TQF placebo plus usual care) at a 1:1 ratio for 48-week treatment and 12-week follow-up. Participants will be assessed every 12 weeks. The feasibility will be assessed as the primary outcome. The changes in the estimated glomerular filtration rate, urinary protein/albumin, renal function, glycemic and lipid markers, renal composite endpoint events, and dampness syndrome of Chinese medicine will be assessed as the efficacy outcomes. Safety outcomes such as liver function, serum potassium, and adverse events will also be evaluated. The data and safety monitoring board will be responsible for the participants’ benefits, the data’s credibility, and the results’ validity. The intent-to-treat and per-protocol analysis will be performed as the primary statistical strategy.DiscussionConducting a rigorously designed pilot trial will be a significant step toward establishing the feasibility and acceptability of TQF and trial design. The study will also provide critical information for future full-scale trial design to further generate new evidence supporting clinical practice for people with stage 2-4 DKD.Trial registration numberhttps://www.chictr.org.cn/, identifier ChiCTR2200062786.

Context A Chinese herbal formula, Tiaopi Xiezhuo decoction (TXD), is developed from a classical Chinese prescription Sanhuang Xiexin decoction.Objective To investigate the regulatory effect of TXD on gut dysbiosis, as a treatment of constipation in patients with peritoneal dialysis (PD).Materials and methods The chemical content of TXD was assessed by high-performance liquid chromatography. A total of 29 PD patients were enrolled and treated with TXD orally (3 g crude drug/each/twice/day) for 3 months. Blood and faecal samples were collected at the beginning and end, to determine the changes in biochemical characteristics and gut microbial composition. The stool conditions were asked to be scored. Additional 30 healthy individuals were recruited as a control for the analysis of gut microbiota.Results Although having no significant effects on serum biochemical characteristics, 3-month TXD intervention improved constipation in PD patients: decreased 80% abdominal distention (p < 0.01), increased 2.6-fold sloppy stools (p < 0.05) and eliminated hard stool completely (p < 0.01). The analysis of gut microbiota showed that, compared to the healthy group, the microbial richness was reduced in PD patients. After a 3-month TXD treatment, this reduced richness was raised, and Paraprevotella clara, Lachnospiraceae bacterium 2-146FA, Phascolarctobaterium succinatutens, Lachnospiraceae bacterium 2-1-58FAA, Fusobacterium mortiferum, and Prevotella copri were accumulated in the intestinal flora. Furthermore, the bacterial species enriched by TXD correlated with the improvement of constipation.Discussion and conclusions TXD treatment may improve constipation by modulating gut dysbiosis in PD patients. These findings provide data to support the further application of TXD in the adjuvant treatment of PD.

慢性肾衰竭( chronic renal failure,CRF)是指各种慢性肾脏病( chronic kidney disease,CKD)发展导致的肾小球滤过率( glo-merular filtration rate,GFR)逐渐下降及进行性肾脏结构和功能的损害,全身多系统生理功能紊乱等临床综合征[1] ,现代医学主要以减缓肾衰竭发展进程为主要目标,但缺乏针对性、有效的治疗.慢性肾衰竭在中医归属于"水肿"、"关格"、"癃闭"、"溺毒"、"肾衰"等范畴,其病机为本虚标实[2] ,黄春林教授从浊毒证出发,以"补益脾肾、通腑泻浊、疏通肾脉"为法辨治慢性肾衰竭,在临床上取得较好的疗效,现将其临证经验及用药特点整理如下.

Review question / Objective: The objective of the proposed work is to evaluate the efficacy and safety of moxibustion as a treatment in improving fatigue in dialysis patients.Condition being studied: Fatigue is a highly prevalent and debilitating symptom in patients undergoing dialysis and is associated with impaired quality of life, cardiovascular disease, and mortality.The causes of fatigue in patients receiving dialysis are complex and multifactorial.Uremia, anemia, depression, quality of sleep and physical deconditioning can lead to fatigue in dialysis patients.There is evidence suggested that specific non-pharmaceutical interventions were potentially effective in improving dialysis related-fatigue, such as cognitive behavioral therapy, exercise, reflexology, aromatherapy, acupressure and moxibustion.By far, how to relieve fatigue in dialysis patients remained controversial.

目的 本研究旨在探索广东省名老中医黄春林教授“调脾泄浊方”对腹膜透析患者胃肠道症状的改善作用.方法 选取2017年12月至2018年12月在广东省中医院腹透门诊规律随访的维持性腹膜透析患者59例,随机分为中药组29例,对照组30例.中药组给予常规治疗+调脾泄浊方,对照组给予常规治疗+益生菌.观察两组患者的临床疗效,比较其胃肠道症状积分和中医证候积分结果,检测安全性指标,如实记录不良反应情况.结果 中药组患者的胃肠道积分和中医证候积分均显著下降,起到缓解腹胀、改善食欲以及软化大便等作用,并且未见不良反应.结论 与益生菌相比,“调脾泄浊方”对腹透患者胃肠道症状具有显著的改善作用.