Objective:To explore the therapeutic characteristics of population with gout achieving treat-to-target (T2T) indicators through real-world research and evaluate their safety.Methods:A total of 3 287 patients diagnosed with gout by rheumatologists in 21 first-class tertiary hospitals in 10 provinces, municipalities, and autonomous regions in China from January 2015 to December 2021 were included in this polycentric cross-sectional study. The database included patients′ general information, disease characteristics, and clinical application of traditional Chinese and Western medicine treatment measures. SPSS and Excel software were used for data analysis. Frequency analysis, cluster analysis, and factor analysis were used to summarize the characteristics and rules of treatment measures for patients with gout who achieved the target after treatment. The occurrence of adverse events (AE) was recorded during treatment.Results:After treatment, 691 visits (7%) achieved the serum urate (SUA) target, and the most frequent use of urate-lowering therapy (ULT) was febuxostat, followed by benzbromarone. The most common treatment options were following: GroupⅠ: traditional Chinese medicine (TCM) decoction-TCM external treatment-physical exercise-proprietary Chinese medicine; GroupⅡ: ferulic acid-nonsteroidal anti-inflammatory drugs (NSAIDs); Group Ⅲ: allopurinol-sodium bicarbonate-benzbromarone; Group Ⅳ: glucocorticoid-colchicine; Group Ⅴ: febuxostat. A total of 5 898 visits (60%) chieved manifestations of joint pain VAS scores target, and the most frequently used drug to control joint symptoms was NSAIDs. The frequency of use of drugs to control joint symptoms were 2 118 times (usage rate reached 35.9%), while the frequency of ULT were 2 504 times (usage rate reached 42.5%), which was higher than the joint symptom control drug. The most common treatment options were following: Group Ⅰ: proprietary Chinese medicine-TCM decoction-TCM external treatment-physical exercise; Group Ⅱ: NSAIDs-colchicine hormones; Group Ⅲ: allopurinol, Group Ⅳ: benzbromarone; Group Ⅴ: febuxostat. A total of 59 adverse events occurred during treatment.Conclusion:The proportions of gout patients who reach target serum urate level & good control of joint symptoms are both very low, and ULT and anti-inflammatory prescription patterns are very different from international guidelines, so it is necessary to strengthen the standardized management of gout patients. At the same time, life intervention measures account for a certain proportion of the treatment plans for the T2T population, and further exploration is needed.

Objective:To investigate the influences of morphological characteristics of skull base ovale foramen in the puncture difficulty of percutaneous balloon compression (PBC), surgical efficacy and postoperative complications in patients with idiopathic trigeminal neuralgia (ITN).Methods:One hundred and twenty-seven patients with ITN, admitted to our hospital from January 2020 to January 2021, were collected. Dyna-CT three-dimensional imaging of the oval foramen at the skull base and PBC treatment were performed on the included patients, and the morphological data of the oval foramen were measured. Numeric Rating Scale (NRS) was used to assess pain degrees before and after surgery. The differences of cross-sectional area and exposure Angle, puncture difficulty and time, NRS scores before and after surgery and incidence of complications were compared in patients with ovale foramen at different forms. The correlations of puncture time with puncture difficulty and cross-sectional area of ovale foramen in skull base were analyzed.Results:The foramen ovale in skull base of 127 patients included standard oval shape ( n=82), almond shape ( n=9), narrow and long shape ( n=13), fissure shape ( n=8) and irregular shape ( n=15). Different morphological characteristics of the skull base ovale foramen could lead to significant differences in the difficulty of puncture, exposure angle, cross-sectional area and puncture time ( P<0.05). Puncture time was positively correlated with puncture difficulty and cross-sectional area ( r=0.359, P<0.001; r=0.280, P=0.007). The patients with skull base ovale foramen of different forms showed no significant differences in the differences of NRS scores before and after PBC and occurrence of postoperative complications ( P>0.05). Conclusion:Dyna-CT three-dimensional imaging can visually display the morphological characteristics of the oval foramen at the skull base; this technique can be used to guide the puncture of the oval foramen and effectively evaluate the difficulty of puncture in PBC, but it does not affect the postoperative pain improvement and complication incidences.

Objective    To investigate the technique and efficacy of left atrial appendage (LAA) occlusion during off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary artery disease (CAD) and atrial fibrillation (AF). Methods    From 2013 to 2018, 84 elderly patients with CAD and AF with reduced left ventricular ejection fraction (LVEF< 50%) underwent OPCABG in our department. There were 54 males and 30 females at age of 70-82 years. They were divided into a left atrial appendage (LAA) occlusion group (n=56) and a non-LAA occlusion group (n=28). Postoperative antithrombotic therapy: the LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic therapy” for 3 months after operation, then was changed to aspirin + clopidogrel “dual antiplatelet” for long-term antithrombotic; the non-LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic” for long-term antithrombotic after operation. The clinical effectiveness of the two groups was compared. Results    All patients underwent the surgery successfully. There were 56 patients in the LAA occlusion group, including 44 patients of LAA exclusion and 12 patients of LAA clip. The time of LAA occlusion was 3 to 8 minutes. There was no injury of graft vessels and anastomotic stoma. Early postoperative death occurred in 2 patients (2.4%). There was no statistical difference between the two groups in postoperative hospital stay (P=0.115). Postoperative LVEF of the two groups significantly improved compared with that before operation (P<0.05). There was no stroke or bleeding in important organs during hospitalization. During follow-up of 1 year, no cerebral infarction occurred in both groups, but the incidence of bleeding related complications in the LAA occlusion group was significantly lower than that in the non-LAA occlusion group (3.6% vs. 18.5%, P=0.036). Conclusion    For elderly patients with CAD and AF with reduced LVEF, LAA occlusion during OPCABG can effectively reduce the risk of stroke and bleeding related complications, and without increasing the risk of surgery.

Objective:In general, patients with seropositive rheumatoid arthritis (RA) are considered to show an aggressive disease course. However, the relationship between the two subgroups in disease severity is controversial. Our study is aimed to compare the clinical characteristics and prognosis of double-seropositive and seronegative RA in China through a real-world large scale study.Methods:RA patients who met the 1987 American College of Rheumatology (ACR) classification criteria or the 2010 ACR/European Anti-Rheumatism Alliance RA classification criteria, and who attended the 10 hospitals across the country from September 2015 to January 2020, were enrolled. According to the serological status, patients were divided into 4 subgroups [rheumatoid factor (RF)(-) anti-cyclic citrullinated peptide (CCP) antibody (-), RF(+), RF(+) anti-CCP antibody(+), anti-CCP antibody(+)] and compared the disease characteristics and treatment response. One-way analysis of variance was used for measurement data that conformed to normal distribution, Kruskal-Wallis H test was used for measurement data that did not conform to normal distribution; paired t test was used for comparison before and after treatment within the group if the data was normally distributed else paired rank sum test was used; χ2 test was used for count data. Results:① A total of 2 461 patients were included, including 1 813 RF(+) anti-CCP antibody(+) patients (73.67%), 129 RF(+) patients (5.24%), 245 RF(-) anti-CCP antibody(-) patients (9.96%), 74 anti-CCP antibody(+) patients (11.13%). ② Regardless of the CCP status, RF(+) patients had an early age of onset [RF(-) anti-CCP antibody(-) (51±14) years old, anti-CCP antibody(+) (50±15) years old, RF(+) anti-CCP antibody(+) (48±14) years old, RF(+)(48±13) years old, F=3.003, P=0.029], longer disease duration [RF(-) anti-CCP antibody(-) 50 (20, 126) months, anti-CCP antibody(+) 60(24, 150) months, RF(+) anti-CCP antibody(+) 89(35, 179) months, RF(+) 83(25, 160) months, H=22.001, P<0.01], more joint swelling counts (SJC) [RF(-) anti-CCP antibody(-) 2(0, 6), Anti-CCP antibody(+) 2(0, 5), RF(+) anti-CCP antibody(+) 2(0, 7), RF(+) 2(0, 6), H=8.939, P=0.03] and tender joint counts (TJC) [RF(-) anti-CCP antibody(-) 3(0, 8), anti-CCP antibody(+) 2(0, 6), RF(+) anti-CCP antibody(+) 3(1, 9), RF(+) 2(0, 8), H=11.341, P=0.01] and the morning stiff time was longer [RF(-) anti-CCP antibody(-) 30(0, 60) min, anti-CCP antibody(+) 20(0, 60) min, RF(+) anti-CCP antibody(+) 30(10, 60) min, RF(+) 30(10, 60) min, H=13.32, P<0.01]; ESR [RF(-) anti-CCP antibody(-) 17(9, 38) mm/1 h, anti-CCP antibody(+) 20(10, 35) mm/1 h, RF(+) anti-CCP antibody(+) 26(14, 45) mm/1 h, RF(+) 28(14, 50) mm/1 h, H=37.084, P<0.01] and CRP [RF(-) anti-CCP antibody(-) 2.3 (0.8, 15.9) mm/L, Anti-CCP antibody(+) 2.7(0.7, 12.1) mm/L, RF(+) anti-CCP antibody(+) 5.2(1.3, 17.2) mm/L, RF (+) 5.2(0.9, 16.2) mm/L, H=22.141, P<0.01] of the RF(+)patients were significantly higher than RF(-) patients, and RF(+) patients had higher disease severity(DAS28-ESR) [RF(-) anti-CCP antibody(-) (4.0±1.8), anti-CCP antibody(+) (3.8±1.6), RF(+) anti-CCP antibody(+) (4.3±1.8), RF(+) (4.1±1.7), F=7.269, P<0.01]. ③ The RF(+) anti-CCP antibody(+) patients were divided into 4 subgroups, and it was found that RF-H anti-CCP antibody-L patients had higher disease severity [RF-H anti-CCP antibody-H 4.3(2.9, 5.6), RF-L anti-CCP antibody-L 4.5(3.0, 5.7), RF-H anti-CCP antibody-L 4.9(3.1, 6.2), RF-L anti-CCP antibody-H 2.8(1.8, 3.9), H=20.374, P<0.01]. ④ After 3-month follow up, the clinical characteristics of the four groups were improved, but there was no significant difference in the improvement of the four groups, indicating that the RF and anti-CCP antibody status did not affect the remission within 3 months. Conclusion:Among RA patients, the disease activity of RA patients is closely related to RF and the RF(+) patients have more severe disease than RF(-) patients. Patients with higher RF titer also have more severe disease than that of patients with low RF titer. After 3 months of medication treatment, the antibody status does not affect the disease remission rate.

OBJECTIVE：To observe the safety and other related indexes of canagliflozin in the treatment of type 2 diabetes complicated with high risk of cardiovascular disease. METHODS ：Totally 306 patients，admitted to Hainan Provincial People ’s Hospital and Haikou People ’s Hospital ，with type 2 diabetes complicated with high risk of cardiovascular disease were selected from Dec. 2018 to Apr. 2019. They were divided into observation group （153 cases）and control group （153 cases）according to random number table . The control group was treated with in sulin，metformin or sulfonylureas conventional hypoglycemic therapy ， and the observation group was treated with Canagliflozin tablets 100 mg，once a day ，po，on the basis of control group. The course of treatment was 1 year in both groups. The levels of HbA 1c，BMI，SBP，DBP and eGFR before and after treatment were observed in 2 groups，and the incidence of safety （including death from cardiovascular causes ，myocardial infarction ，ischemic stroke ， hospitalization for heart failure and death from any cause etc. ） after treatment and serious ADR/ADE （including hypogly- cemia，diabetic ketoacidosis ，fracture，acute kidney injury 68622942。E-mail：zhaixin0123@126.com etc.）during the treatment were recorded. RESULTS ：A total of 5 patients in the control group were not followed up ， in which 3 quited and 2 were lost ；and 4 patients in the observation group were not followed up ，in which 1 quited and 3 were lost . Before treatment ，there were no statistical significance in the levels of HbA 1c，BMI，SBP，DBP and eGFR between 2 groups（P＞0.05）. After treatment ，HbA1c levels of 2 groups，BMI and SBP of observation group were all significantly lower than those before treatment with the same group ；HbA1c level and SBP of observation group were significantly lower than those of control group （P＜0.05）. eGFR levels of 2 groups after treatment were significantly higher than before treatment with the same group ，while the observation group was significantly higher than that of contrl group. The incidence of death from cardiovascular causes and death from any cause in observation group were significantly lower than control group （P＜0.05）. There were no statistically significant differences in other safety indexes and the incidence of serious ADR/ADE between 2 groups（P＞0.05）. CONCLUSIONS ：Canagliflozin can significantly reduce the incidence of death from cardiovascular causes and death from any cause in type 2 diabetes patients complicated with high risk of cardiovascular disease，ameliorate blood glucose and blood pressure ，and do not increase the occurrence of serious ADR/ADE.

Objective    To summarize the application and clinical effect of left anterior minimally invasive thoracotomy to surgical repair of subarterial ventricular septal defect (VSD) in children. Methods    From October 2015 to April 2019, 21 children with subarterial VSD underwent surgical repair via left anterior minimally invasive thoracotomy. There were 13 males and 8 females, aged 5-13 (9.1±2.2) years, and weighing 22-55 (35.6±9.5) kg. The diameter of subarterial VSD was 4-15 (9.1±3.3) mm. Eight patients had right coronary valve prolapse, and 4 aortic valve regurgitation (3 mild and 1 mild-to-moderate). The minimally invasive surgery was performed via left parasternal thoracotomy through the second or third intercostal space. The peripheral perfusion was performed with femoral arterial and venous cannulation. After aortic cross-clamp (ACC), subarterial VSD was performed with direct suture of patch closure through an incision on the root of pulmonary artery. Results    All patients successfully underwent surgical repair (patch closure, n=15; direct suture, n=6) of subarterial VSD through left anterior minimally invasive thoracotomy. The cardiopulmonary bypass time was 45-68 (57.1±6.3) min. The ACC time was 23-40 (32.6±4.7) min. The postoperative ventilation time was 5-9 (6.3±1.3) h, postoperative in-hospital time was 5-8 (5.7±1.0) d and drainage volume was 33-105 (57.5±17.7) mL in postoperative 24 h. No death, residual VSD shunt, atrioventricular block, wound infection or thoracic deformity occurred during the perioperation or follow-up. Only one patient still had trivial aortic valve regurgitation. Conclusion    Left anterior minimally invasive thoracotomy could be safely and effectively applied to surgical repair of subarterial VSD in children, with satisfactory early- and mid-term outcomes.

Objective: To summarize the safety and effect of modified surgery for hypertrophic obstructive cardiomyopathy(HOCM) with concomitantly significant mitral regurgitation(MR) through a single transaortic approach. Methods: From January 2008 to June 2018, 93 patients with HOCM and significant MR underwent modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach. Preoperative left ventricular outflow tract pressure gradient(LVOTPG) was 51-199 mmHg(1 mmHg=0.133 kPa). Preoperative interventricular septum thickness(IVST) was 17-30 mm. All patients had significant MR with SAM phenomenon. The modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach was performed under cardiopulmonary bypass and aortic crossclamp. Results: All patients successfully underwent the surgery of modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach. No early death and interventricular septal perforation were occurred. In the early postoperative period, two patient(2.15%) received permanent pacemaker implantation due to the complete atrial-ventricular block. At discharge, postoperative LVOTPG(7-31 mmHg) and IVST(11-19 mm) were significantly decreased compared with the preoperative values(P<0.05). All patients had none or trivial MR. The mitral valve pressure gradient(MVPG) was 0-6 mmHg. SAM phenomenon disappeared in all patients. At a mean follow-up of(40.53±27.11) months, no patient had significant residual left ventricular outflow tract obstruction. All patients had none or trivial MR. No SAM phenomenon occurred. Conclusion Modified surgery of Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach could be safely and effectively applied for patients with HOCM and concomitantly significant MR.

Objective: To investigate genotypes and drug susceptibility of the 100 strains of Candida glabrata isolated from 100 women (including 50 pregnant women) in order to study the drug-resistance and gene polymorphism, and to investigate the correlation of drug-resistance, gestation and gene polymorphism. Methods: Multilocus sequence typing (MLST) technique was introduced to identify sequences of 6 housekeeping genes from 100 isolates of Candida glabrata. The results were compared with sequence information in MLST databases by Clustalx software to determine a strain allelic profile and sequence type (ST). Drawing the phylogenetic tree by weighted paired group average method and the minimal spanning tree method of MEGA6.0 software, the microevolution and relationship between different strains were analyzed. ATB FUNGUS semi-automatic system was used to test the drug susceptibility. Fisher analysis method was used to analyze the correlation between the genotypes and pregnancy.Ridit analysis method was used to analyze the correlation between the genotypes and drug susceptibility. Results: The 100 isolates belonged to 34 clone sequences. There were 53 isolates belonged to ST-7 ( 26 isolates of pregnancy), 7 isolates belonged to ST-3 (3 isolates of pregnancy), 6 isolates belonged to ST-19 (5 isolates of pregnancy ), 3 isolates belonged to ST-15 (1 isolate of pregnancy), 2 isolates belonged to ST-10 (2 isolates of pregnancy), 1 isolate belonged to the other types of ST. Total of 100 isolates of Candida glabrata were 100% sensitive to fluorocytosine and amphotericin. The effect of itraconazole was poor with the sensitive rate of 20%. The resistance rates of fluconazole and voriconazole were 4% and 1% respectively. All genotypes were sensitive to voriconazole except ST-X1. In the correlation between genotype and itraconazole resistance, ST-7 as the standard group, the Ridit values in the group of ST-15, ST-19 and other types of ST were not included the mean Ridit value of the standard group in itraconazole (0.5). The system evolution tree was built using the neighbor-joining method (NJ) . All genotypes could be divided into 3 groups, as Ⅰ, Ⅱ, Ⅲ. Group Ⅰ had 44 cases, group Ⅱ had 53 cases , group Ⅲ had 3 cases . All the collected clinical strains had small genetic distances during molecular evolution. Conclusions ST-7 was the dominant genotype in Guiyang. No correlation between different STs and patients′ pregnancy was found. The different drug susceptibility in itraconazole between ST-7, ST-15, ST-19 and other STs were found. The Candida glabrata associated with VVC showed highly discrimative diversity. However, the phylogenic analysis exhibited genetic similarity among the strains studied.(Chin J Lab Med, 2018, 41: 596-600)

Objective To evaluate the outcomes achieved by using left internal mammary artery(LIMA) to radial artery (RA) total arterial composite grafts in minimally invasive direct coronary artery bypass grafting (MIDCAB) for patients with multiple vessel disease.Methods From January 2009 to September 2015, 39 patients(24 males) with multiple vessel disease underwent MIDCAB with LIMA-RA total arterial composite grafts without cardiopulmonary bypass in our hospital .MIDCAB was performed through a left anterior minithoracotomy .Results All patients successfully underwent MIDCAB with LIMA-RA total arterial composite grafts.No patient required to convert to strenotomy during the surgery.Mean operation time was(176.1 ± 14.1)min.Revascularization was performed for 2 target vessels in 11 cases, 3 target vessels in 25 cases and 4 target vessels in 3 cases.Mean postoperative ventilation time was(21.9 ±27.9) h.Mean ICU time was(2.8 ±2.1) days, and mean postoper-ative inhosptial time was(11.2 ±3.3)days.There was no early death in perioperation.At a follow-up of 6 to 86 months[aver-age(27.5 ±18.0) months], one patient died.The overall survival at 2 years postoperatively was(96.0 ±3.9)%.The paten-cy rate of LIMA was 100%.The overall patency rate of RA grafts at 2 years postoperatively was(91.8 ±4.0)%.Conclusion MIDCAB with LIMA-RA total arterial composite grafts is a safe and effective procedure with favorable early and mid-term out-comes for patients with multiple vessel disease .

Based on the suMmary of the implementation of two-way referral system in Changning district,the article describes the system construction,path design,information platform support and achievements,taking into account of general practitioners,specialist and patients.Through a series of reforms,a two-way referral service and its operation mechanism with the local characteristics has been established in Changning district,which guides the first contact care at community and two-way referral as a rational medical service system.