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The recommended intakes of protein and energy play a key role in medical nutrition therapy (MNT) management in patients with chronic kidney disease (CKD). In September 2020, the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) released the clinical practice guideline for nutrition in CKD, which updated its previous version published 20 years ago. In October 2020, "Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group" published KDIGO 2020 clinical practice guideline for diabetes management in chronic kidney disease. The opinions and recommendations on protein and energy intakes from these two guidelines were different. This article compares and discusses the differences among various national and international guidelines so as to facilitate the clinical practice for CKD patients.

Objective: To describe the clinical manifestations, neuroimaging, cerebrospinal fluid(CSF) cytology and prognosis of Leptomeningeal metastases(LM). Methods: The clinical manifestations, imaging features and CSF cytology of LM patients admitted to Henan Provincial People's Hospital from May 1, 2015 to May 31, 2020 were retrospectively analyzed. The overall survival (OS) was evaluated by the time from the diagnosis of LM to death. Results: A total of 88 patients with LM were enrolled in the study, and the median age was 59 years (range:28-78 years). There were 42 males (47.7%) and 46 females (52.3%). According to the pathological classification, it was lung cancer in 58 cases (65.9%), gastric cancer in 13 cases (14.8%), breast cancer in 7 cases (8.0%), melanoma in 1 case, esophageal cancer in 1 case, gallbladder cancer in 1 case, renal cell carcinoma in 1 case, double source cancer in 2 cases, and unknown source in 4 cases. The median Karnofsky Performance Scale (KPS) score was 50. LM was the initial manifestation of cancer in 34 patients. All patients had LM-related clinical symptoms, including headache in 73 cases (83.0%), nausea and vomiting in 63 cases (71.6%), abnormal physical and mental behaviors in 37 cases (42.0%), seizure in 41 cases (46.6%). Cranial nerve involvement was observed in 23 patients (39.0%) and spinal nerve involvement in 20(33.9%). There were 61 patients (83.6%) who showed neuroimaging features of LM. Tumor cells or atypical cells were found in 90.8% of patients for the first time, and activated monocytes in 47 cases (54.7%). The median OS was 13.0 weeks (95% CI :2.9-23.1) with the 1-year survival rate of 19.1%. Univariate analysis of survival indicated that lung cancer, lower KPS score, tyrosine kinase inhibitors (TKIs) and whole brain radiotherapy were favorable predictors of survival ( P <0.05). Conclusions: The overall prognosis of LM is poor. Good physical condition, TKIs treatment and whole brain radiotherapy might improve clinical outcomes of LM patients.

Objective: To explore the neuromechanism of nicotine dependence, structural covariation networks (SCNs) based on voxel-based morphometry (VBM) were used to study the synergistic changes in gray matter volume in different cerebral cortices of nicotine dependent individuals. Methods: During the period from August 2016 to February 2018, a total of 118 long-term smokers and 57 non-smoking healthy controls (both 18-55 male volunteers) through online platforms and leaflets were recruited. The subjects were scanned with SIEMENS Skyro 3.0T magnetic resonance scanner and underwent routine MRI sequence (preliminary elimination of intracranial lesions) and 3D-T1 (3D-mprage) sequence structure. Two imaging experts used Matlab software platform to carry on segmentation by using SPM8, and to find out the differences between the two groups of brain regions, and differences in brain regions as region of interest (ROI) structure association network analysis. Results: The gray matter volume (GMV) of the right anterior central gyrus and the left inferior parietal lobe in the smoking group decreased(voxels size were 55 and 284, respectively), and no gray matter volume (GMV) area increased. The network structure of covariant analysis found that when the inferior parietal lobe as the seed points, the smoking group showed a rising trend in left parietal lobe and left temporal pole, bilateral middle temporal gyrus, left postcentral gyrus and right middle frontal gyrus gray matter volume, and a downtrend in the right side of the left medial frontal gyrus, superior parietal lobe, bilateral temporal gyrus, left cingulate gyrus and left cerebellum (central) compared with the control group. Conclusion: In long-term smokers, there is a volume change of gray matter in the brain structure. Abnormal changes in the structure covariant network of the inferior parietal lobe can lead to impaired brain function in nicotine dependent patients.

Objective: To analyze the clinical presentation, imaging features, and the mutation of the pathogenic genes in a Chinese Han atypical neuroaxonal dystrophy pedigree. Methods: A family of atypical neuroaxonal dystrophy pedigree who came to Henan Provincal People's Hospital in July 2016 was included. Clinical presentation, imaging features of the pedigree were analyzed, and all exon gene detection of the proband was performed to capture the target variations, then verified by sanger sequence. Another 4 family members' and 100 normal healthy controls' gene sequence of the mutations were also verified. Results: The proband(Ⅱ(3)) of the family presented with walking unsteadily, intellectual disability, glossolalia, dystonia, epilepsy, and autonomic nervous dysfunction. The magnetic resonance imaging (MRI) of the proband showed cerebellar atrophy and iron deposit in basal ganglia. The gene detection showed the PLA2G6 gene compound complicated mutation of 80 codon p.A80T in the exon 3 and 331 codon p.D331Y in the exon 7. The two sisters of the proband (Ⅱ(1),Ⅱ(2)) had the same mutation, the father of the proband carried the p.A80T, however, the mother carried the D331Y mutation. One of the proband's sister (Ⅱ(1)), whose onset age was 10 years old, had the similar symptoms with the proband. The proband's another sister(Ⅱ(1)) had abnormal gait at 24 years old. However, the MRI of the two sisters all showed cerebellar atrophy. Conclusion: We report a PLA2G6 compound complicated mutation in an atypical neuroaxonal dystrophy Chinese family, that is the p. A80T and p.D331Y mutation, which may be a pathogenic mutation to cause the family's disease.

Objective: This study was to describe the clinical characteristics of Anti-leucine-rich glioma inactivated 1 protein(LGI1) antibody associated limbic encephalitis. Methods: Clinical data including clinical features, laboratory and radiological findings, treatment and prognosis of the 9 patients were analyzed. Results: In all 9 cases, 6 cases experienced epileptic seizure, 5 cases had psychosis, 7 cases presented with memory impairment, 4 cases showed faciobrachial dystonic seizure, 2 had refractory hyponatremia. One case presented with typically acute Guillain-Barre syndrome (GBS). Anti-LGI1 antibody was detected in 6 cases in cerebrospinal fluid (CSF) samples and 9 in serum samples. Seven cases out of 9 had brain imaging abnormalities. All 9 cases found no evidence of tumors. Eight cases were given immune therapy. During a 1-16 months follow-up, 1 case had complete recovery, 5cases had various degree of sequelae , among whom 4 had memory disturbance and 1 case had changed personality. 2cases were lost to follow-up. Conclusions: Limbic encephalitis is the most common manifestation of anti-LGI1 antibody associated encephalitis. Faciobrachial dystonic seizure (FBDS) is a specific symptom which favors an early diagnosis. Tumor is uncommon to see. The disease has a relatively favorable prognosis while impaired memory can be seen as a common sequelae.

Objective: To analysis the clinical manifestation, radiological data, laboratory findings of neuromyelitis optica spectrum disorders (NMOSD) to help physicians have a deeper understanding of the disease. Methods: The clinical manifestations, radiological data, laboratory findings of NMOSD patients from People's Hospital of Zhengzhou University between June 2015 and June 2016 were retrospectively analyzed. Results: Fourteen patients with NMOSD were enrolled, consisting of 3 males and 11 females. The onset age ranged from 15 to 62 years, in average 39.64. Among them, there was 1 case with history of hyperthyroidism, 3 cases with Sjögren syndrome (SS). Major clinical manifestations were vision loss in 4 cases, nausea and vomiting in 4 cases, limbs numbness and weakness in 6 cases. All the 14 patients were received the cerebrospinal fluidcell surface antigen antibody detection, and the results were strong positive 6 cases (6/14), positive 7 cases (7/14), weak positive 1 case (1/14). Abnormal signals in the thirdventricle, midbrain aqueduct, oblongata, pons and cervical, thoracic spinal cord were found by Magnetic Resonance Imaging (MRI). Fourteen patients were treated with glucocorticoid, among them 8 received immunosuppressive therapy. All the 14 patients were followed up, and 9 patients had different degrees of sequelae, including vision decline in 4 cases, numbness and weakness in 5 cases. Conclusions: Neuromyelitis optica spectrum disorders frequently occur in young female. Clinicians need to consider the possibility of NMOSD for acute or subacute blurred vision, nausea, vomiting, numbness and weakness of limbs or trunk and psychiatric symptoms. NMOSD can not be easily excluded for those special patients with atypical clinical manifestations, and relevant inspections should be performed as far as possible in order to make the correct diagnosis.