The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease(CKD), cardiovascular disease(CVD), diabetes, osteoarthritis(OA), and gastrointestinal disorders. This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO(population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus. The guideline presents 26 evidence-based recommendations addressing 7 clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage≥3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases. The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.

The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease(CKD), cardiovascular disease(CVD), diabetes, osteoarthritis(OA), and gastrointestinal disorders. This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO(population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus. The guideline presents 26 evidence-based recommendations addressing 7 clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage≥3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases. The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.

Objective To understand the prevalence,treatment and influence factors of hypertension in maintenance hemodialysis (MHD) patients in Anhui Province.Methods A total of 2724 adult patients on MHD from January 1st 2014 to March 31st 2014 in 26 hospitals of southern,northern and central Anhui Province were investigated.Their demographic characteristics,primary disease,complications,medications,dialysis and laboratory examination were explored.The prevalence treatment rate and control rate of hypertension were analyzed.Associated factors for controlling hypertension [systolic blood pressure (SBP) ＜ 140 mmHg and diastolic blood pressure (DBP) ＜ 90 mmHg] were assessed by logistic regression analysis.Results (1) The prevalence of hypertension in the hemodialysis patients was 87.0％.Their treatment rate and control rate were 93.2％ and 23.9％ respectively.The average of SBP was (145.90±21.18) mmHg,and the DBP on average was (83.60± 12.21) mmHg.The most commonly used anti-hypertensive drug is calcium channel blocker (88.2％).Over one third (45.7％) of patients were treated with two kinds of anti-hypertensive drug,26.2％ with 1 kind,21.7％ with 3 kinds,and 6.4％ with 4 kinds or more.(2) Compared with non-hypertension patients,patients with hypertension have older age,higher body mass index (BMI),phosphorus,SBP and DBP,as well as lower hemoglobin and Kt/V (all P ＜ 0.05).(3) The multivariate logistic regression analysis showed that Ca ＞ 2.50 mmol/L (OR=2.084,95％CI 1.008-4.307,P=0.047) positively correlated with controlling hypertension,while smoke (OR=0.594,95％CI 0.356-0.911,P=0.046) and BMI 18.5 ～ 23.9 kg/m2 (OR=0.516,95％CI 0.293-0.907,P=0.022) negatively correlated with it.Conclusions High prevalence yet low control rate of hypertension in MHD patients in Anhui Province were observed.Hypocalcemia may be a protective factor for hypertension control,while smoke and BMI may be risk factors for it.

Objective To study the clinical effect of endovascular treatment on complex TASC-D type aortoiliac occlusive disease (AIOD). Methods Clinical data of 27 patients (35 limbs) of the TASC-D type AIOD were collected in Department of Cardiovascular Surgery and were retrospectively analyzed. According to the Fontaine staging and the corresponding imaging examination before surgery, the therapy programme was worked out. Two limbs received thrombectomies, and 33 limbs received endovascular treatments including 5 limbs received percutaneous transluminal angioplasty (PTA), 24 limbs received percutaneous transluminal angioplasty stenting (PTAS), and 4 limbs underwent catheter-directed thrombolysis. Patients were followed up for 3 to 36 months regularly by telephone or outpatient after operation. The clinical symptoms, ankle brachial index (ABI), complications and cumulative primary patency rates were evaluated. Results The overall success rate of endovascular treatment was 90.9% (30/33). Two limbs treated with PTAS and one limb with catheter-directed thormbolysis showed a poor outcome. ABI increased from (0.40 ± 0.15) prehospital to (0.82±0.20) for 1 month. After therapy for one year, the primary patency rate was 93.3%(28/30). At 24 months, the primary patency rate was 83.3%(25/30), and limb salvage rate was 94.3%(33/35). One limb resulted in above ankle amputation 10 days after admission to hospital, and 1 limb underwent toe amputation in 2 months after operation. Conclusion Endovascular therapy is a safe and effective method for TASC-D AIOD, which shows satisfactory clinical outcomes with short-term to mid-term patency rates.

Objective To investigate the projects and effects of the comprehensive and conservative treatment of patients with keen osteoarthritis and meniscus injury.Methods 120 patients with keen osteoarthritis and meniscus injury were randomly divided into the control group A(n =40),B(n =40)and comprehensive treatment group C(n =40).Patients in group A were treated with ozone and glass sodium injection;Patients in group B were treated with ozone,glass sodium and Triamcinolone Acetonide injection;Patients in group C were treated with ozone, glass sodium and Triamcinolone Acetonide injection,superlaser local irradiation,glucosamine tablet oral,Lornoxicam intravenous injection.The effects of the treatment according to keen joints function scores were compared after two weeks and six months.Patients in group C were randomly divided into group C1(n =20)and group C2(n =20)after one year,patients in group C1 with the same treatment as patients in group A and oral glucosamine tablet for one course of treatment,patients in group C2 without any further treatment.The follow up was completed for two years. Results The excellent and good rate in group C was better than that of group B and group C after two weeks (70.0%,22.5%,42.5%,χ2 =18.152,6.146,P <0.01 or P <0.05).After six month,the excellent and good rate in group C was better than that of group A and group B (87.5%,42.5%,60.0%,χ2 =17.802,7.813,all P <0.01).There was no significant difference between group C1 and group C2 after one years(t1 =2.014,P <0.01). There was significant difference between group C1 and group C2 after two years(t2 =16.152,P <0.01).Conclusion The effects of comprehensive conservative treatment are better than simple keen joint injection in patients with keen osteoarthritis and meniscus injury.The function of keen joint with maintenance care treatment is better than without maintenance care.Comprehensive conservative and maintenance care treatment is a good clinical treatment project.

Objective To investigate the incidence of metabolic syndrome (MS) in patients with gastric cancer, and to explore the relationship between MS and the tumor site and the influence of MS on surgical procedure and short-term outcomes of patients with gastric cancer. Methods The clinical data of 639 patients with gastric cancer who were admitted to the Affiliated Hospital of Qingdao University from January 2006 to June 2008 were retrospectively analyzed. Patients with MS were in the MS group ( n= 64) and those without MS were in the control group ( n = 575 ). The surgical and postoperative complications were reviewed and the tumor site, intraoperative conditions and short-term outcomes between the two groups were analyzed. All data were analyzed using the chi-square test or t test. Results The incidence of MS in patients with gastric cancer was 10.0% (64/639).The incidence of MS in female patients was 14.4% (27/188), which was significantly higher than 8.2% (37/451)of male patients ( χ2= 6.265, P < 0.05). The operation time of the MS group was ( 185 ± 133 ) minutes, which was significantly longer than ( 168 ± 50) minutes of the control group ( t = 2. 126, P < 0. 05 ). The number of lymph nodes dissected in the MS group was 18 ± 11, which was significantly lower than 21 ± 11 of the control group ( t = 2. 125, P < 0.05 ). The postoperative period of fever of the MS group was (3.0 ± 1.4) days, which was significantly longer than (2.5 ± 1.4) days of the control group (t = 2. 433, P < 0.05 ). The incidence of postoperative complications of the MS group was 31.3% (20/64), which was significantly higher than 14.3% (82/575) of the control group ( χ2 = 12.291, P < 0.05 ). The length of hospital stay of the MS group was ( 19 ± 11 ) days,which was significantly longer than ( 16±11 ) days of the control group ( t = 2. 141, P< 0.05 ). The mortalities of MS group and control group were 0 and 0. 5% (3/575), respectively, with no significant difference ( χ2 = 0.000,P >0.05). Condusions A low prevalence of MS is found in patients with gastric cancer. However, patients with gastric cancer complicated with MS may present with prolonged surgical procedure, reduced amount of lymph nodes dissected and increased incidence of postoperative complications, hospital stay and costs. Perioperative management of patients with gastric cancer complicated with MS should be paid more attention.

ition research with higher quality should be advocated.

Objective To prepare polyclonal antibody of transactivated protein 5 of hepatitis C virus nonstructural 5A (NA5ATP5) and to explore its expression in the liver tissues. Methods In Escherichia coil BL21, the prokaryotic expression vector pET32a(+)-NS5ATP5 was induced by isopropyl-β-D-thiogalactoside (IPTG), and it was analyzed with sodium dodecyl sulfate-polyaerylamide gel electrophoresis (SDS-PAGE) and Western blotting. And the purified protein was used to immunize the rabbit to prepare polyelonai antibody, with which we studied the function of NSSATP5 by determining the different liver tissues with the streptavidin-perosidase (SP) immunohistochemistry method. Results Recombinant NS5ATP5 (molecular weight: 65 kD) and polyclonal antibody were successfully prepared. NS5ATP5 expression in the liver of patients with chronic HCV infection was much higher than that of a normal person, and it was detected mainly in the cytoplasm. Conclusion The findings of the expression difference between HCV patients and normal people led to a novel diagnostic marker to detect HCV infection.

Objective To characterize the x-ray image of vertebral artery type of cervical spondylosis and explore its significance in rehabilitation treatment. Methods The X-ray films of 42 cases of vertebral artery type of cervical spondylosis were measured and analyzed. The treatment approaches including restriction of cervical movement,traction,epidural block and surgery were planned and implemented accordingly. Results The X-ray image revealed the following changes in the patients: the straightened physiologic curvature of the cervical spine,cervical vertebral unsteadiness,zygapophyzeal joint hyperplasia. Various treatment approaches are effective to patients with various manifestations. Conclusion Employing treatment approaches on the basis of X-ray images is of great signi-ficance for the effective treatment of patients with cervical spondylosis of vertebral artery type.