Objective To analyze the temporal trends of gout disezse burden in China from 1990 to 2021,and construct an age-period-cohort(APC)model to explore the independent effects of age,period,and birth cohort on epidemiological indicators,and predict the future burden of gout disease in China from 2022 to 2035.Methods Data on gout disease burden in China during 1990-2021 were extracted from the Global Burden of Disease(GBD)2021 database.Joinpoint regression analysis was used to assess temporal trends.The APC model was applied to evaluate the age,period and cohort effects on prevalence risk and disability-adjusted life years(DALYs).A Bayesian age-period-cohort(BAPC)model was employed to project the age-standardized prevalence rate(ASPR)and age-standardized DALY rate(ASDR)of gout in China from 2022 to 2035.Results From 1990 to 2021,the incidence,prevalence and DALYs of gout in China all increased substantially,with overall rising trends in the age-standardized incidence rate(ASIR),ASPR and ASDR.Compared with 1990,the incidence,prevalence and DALYs in 2021 increased by 160.45%,181.12%,and 175.93%,respectively,while their age-standardized rates increased by 23.74%,26.48%and 25.89%.Joinpoint regression analysis revealed that average annual percentage changes(AAPCs)of 0.73%for ASIR,0.82%for ASPR and 0.80%for ASDR during 1990-2021.In 2021,the number of cases and DALYs reached their peaks in males aged 55-59 years and females aged 65-69 years.Both prevalence and DALY rates increased steadily with age,with marked rises starting at age 30 in men and age 40 in women.Overall,males showed higher prevalence,DALYs and corresponding rates than those of females across all age groups.APC model results indicated that the age effect,period effect and cohort effects on prevalence and DALY rates presented an overall upward tread.Decomposition analysis showed that population aging contributed the most to the increase in incidence and DALYs from 1990 to 2021.BAPC projections suggested that by 2035,the ASPR and ASDR of gout in China reached 890.50 per 100,000 and 27.26 per 100,000,respectively.Conclusion The ASPR and ASDR of gout in China are projected to continue increasing from 2022 to 2035.Targeted public health strategies for high-risk populations are urgently needed to reduce the growing burden of gout.

Objective To analyze the effects of intravenous tirofiban following endovascular treatment on the prognosis of patients with acute anterior circulation large vessel occlusion stroke who did not achieve successful recanalization.Methods This retrospective study included consecutive patients with acute anterior circulation ischemic stroke who underwent endovascular treatment but did not achieve successful recanalization.These patients were retrospectively enrolled from the Department of Neurology at Nanjing Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,the Second Affiliated Hospital of Soochow University,Wuhan No.1 Hospital,and Yijishan Hospital of Wannan Medical College(the First Affiliated Hospital of Wannan Medical College)between January 2015 and April 2023.Baseline and clinical data were collected including age,sex,medical history(hypertension,diabetes,atrial fibrillation,hyperlipidemia),personal history(smoking and drinking),National Institutes of Health stroke scale(NIHSS)score at admission,trial of Org 10172 in acute stroke treatment(TOAST)classification(large artery atherosclerosis,cardioembolism,or other types),Alberta stroke program early CT score(ASPECTS)on admission,intravenous thrombolysis,onset-to-puncture time(OTP),collateral circulation status(poor collaterals:American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology[ASTIN/SIR]score 0-2;good collateral:ASTIN/SIR score 3-4),procedure duration(from femoral or radial artery puncture to device removal),occlusion site,number of passes for thrombus retrieval,and post-procedural modified thrombolysis in cerebral infarction(mTICI)grade.Patients were divided into a tirofiban group and a non-tirofiban group based on whether they received post-procedural intravenous tirofiban.The primary outcome is a favorable functional outcome at 90-day since onset(modified Rankin scale[mRS]score ≤ 3).Safety outcomes included mortality at 90-day since onset(mRS score 6),any intracranial hemorrhage within 24 h post-procedure,and symptomatic intracranial hemorrhage within 24 h post-procedure.1∶1 propensity score matchings using the nearest neighbor method was performed based on variables with P＜0.05 in the comparison between the tirofiban and non-tirofiban groups.Differences in primary and safety outcomes between the matched groups were compared.Univariate and multivariate Logistic regression analyses were conducted with favorable outcomes at 90 days as the dependent variable to evaluate the effect of intravenous tirofiban administration after endovascular therapy on 90-day prognosis in patients without successful recanalization.Results A total of 356 patients without successful recanalization after endovascular treatment were included,comprising 195 males and 161 females,with a median age of 70(61,78)years(32-92 years).Among them,76 and 280patients were assigned to the tirofiban and non-tirofiban groups,respectively.At 90 days,114 patients had favorable outcomes,while 242 had unfavorable outcomes.(1)Before the 1∶1 propensity score matching,significant differences were observed between the tirofiban and non-tirofiban groups in terms of admission NIHSS score,ASPECTS,good collateral circulation,intravenous thrombolysis,and mTICI grade(all P＜0.05).After 1∶1 propensity score matching,66 matched pairs(132 patients)were obtained.No significant differences in the baseline and clinical characteristics were found between the two groups after matching(all P＞0.05).(2)After 1∶1 matching,a significant difference was observed in the rate of favorable outcomes at 90 days between the two groups(48.5％[32/66]vs.30.3％[20/66],P=0.033)after propensity score matching,while no significant differences were found in 90-day mortality,intracranial hemorrhage within 24h,or symptomatic intracranial hemorrhage within 24h(all P＞0.05).(3)Univariate analysis after 1∶1 matching indicated that age,atrial fibrillation,smoking history,admission NIHSS score,M2 segment middle cerebral artery occlusion,good collateral circulation,number of passes for thrombus retrieval,and tirofiban treatment were factors influencing favorable outcomes at 90 days.Multivariate Logistic regression analysis showed that younger age(aOR,0.942,95％CI 0.906-0.978,P=0.002),lower admission NIHSS score(aOR,0.855,95％CI 0.777-0.941,P=0.001),good collateral circulation(aOR,5.534,95％CI 2.141-14.301,P＜0.01),tirofiban treatment(aOR,2.774,95％CI 1.092-7.046,P=0.032),and M2 segment MCA occlusion(reference:internal carotid artery occlusion;aOR,4.874,95％CI 1.428-16.632,P=0.011)were independent predictors of favorable outcomes at 90 days.Conclusions Intravenous tirofiban administration after endovascular therapy may improve 90-day neurological outcomes in patients with acute anterior circulation large vessel occlusion stroke who did not achieve successful recanalization without increasing the risk of hemorrhage.Further large-scale randomized controlled trials are warranted to validate these findings.

Objective To analyze the temporal trends of gout disezse burden in China from 1990 to 2021,and construct an age-period-cohort(APC)model to explore the independent effects of age,period,and birth cohort on epidemiological indicators,and predict the future burden of gout disease in China from 2022 to 2035.Methods Data on gout disease burden in China during 1990-2021 were extracted from the Global Burden of Disease(GBD)2021 database.Joinpoint regression analysis was used to assess temporal trends.The APC model was applied to evaluate the age,period and cohort effects on prevalence risk and disability-adjusted life years(DALYs).A Bayesian age-period-cohort(BAPC)model was employed to project the age-standardized prevalence rate(ASPR)and age-standardized DALY rate(ASDR)of gout in China from 2022 to 2035.Results From 1990 to 2021,the incidence,prevalence and DALYs of gout in China all increased substantially,with overall rising trends in the age-standardized incidence rate(ASIR),ASPR and ASDR.Compared with 1990,the incidence,prevalence and DALYs in 2021 increased by 160.45%,181.12%,and 175.93%,respectively,while their age-standardized rates increased by 23.74%,26.48%and 25.89%.Joinpoint regression analysis revealed that average annual percentage changes(AAPCs)of 0.73%for ASIR,0.82%for ASPR and 0.80%for ASDR during 1990-2021.In 2021,the number of cases and DALYs reached their peaks in males aged 55-59 years and females aged 65-69 years.Both prevalence and DALY rates increased steadily with age,with marked rises starting at age 30 in men and age 40 in women.Overall,males showed higher prevalence,DALYs and corresponding rates than those of females across all age groups.APC model results indicated that the age effect,period effect and cohort effects on prevalence and DALY rates presented an overall upward tread.Decomposition analysis showed that population aging contributed the most to the increase in incidence and DALYs from 1990 to 2021.BAPC projections suggested that by 2035,the ASPR and ASDR of gout in China reached 890.50 per 100,000 and 27.26 per 100,000,respectively.Conclusion The ASPR and ASDR of gout in China are projected to continue increasing from 2022 to 2035.Targeted public health strategies for high-risk populations are urgently needed to reduce the growing burden of gout.

Objective To analyze the effects of intravenous tirofiban following endovascular treatment on the prognosis of patients with acute anterior circulation large vessel occlusion stroke who did not achieve successful recanalization.Methods This retrospective study included consecutive patients with acute anterior circulation ischemic stroke who underwent endovascular treatment but did not achieve successful recanalization.These patients were retrospectively enrolled from the Department of Neurology at Nanjing Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,the Second Affiliated Hospital of Soochow University,Wuhan No.1 Hospital,and Yijishan Hospital of Wannan Medical College(the First Affiliated Hospital of Wannan Medical College)between January 2015 and April 2023.Baseline and clinical data were collected including age,sex,medical history(hypertension,diabetes,atrial fibrillation,hyperlipidemia),personal history(smoking and drinking),National Institutes of Health stroke scale(NIHSS)score at admission,trial of Org 10172 in acute stroke treatment(TOAST)classification(large artery atherosclerosis,cardioembolism,or other types),Alberta stroke program early CT score(ASPECTS)on admission,intravenous thrombolysis,onset-to-puncture time(OTP),collateral circulation status(poor collaterals:American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology[ASTIN/SIR]score 0-2;good collateral:ASTIN/SIR score 3-4),procedure duration(from femoral or radial artery puncture to device removal),occlusion site,number of passes for thrombus retrieval,and post-procedural modified thrombolysis in cerebral infarction(mTICI)grade.Patients were divided into a tirofiban group and a non-tirofiban group based on whether they received post-procedural intravenous tirofiban.The primary outcome is a favorable functional outcome at 90-day since onset(modified Rankin scale[mRS]score ≤ 3).Safety outcomes included mortality at 90-day since onset(mRS score 6),any intracranial hemorrhage within 24 h post-procedure,and symptomatic intracranial hemorrhage within 24 h post-procedure.1∶1 propensity score matchings using the nearest neighbor method was performed based on variables with P＜0.05 in the comparison between the tirofiban and non-tirofiban groups.Differences in primary and safety outcomes between the matched groups were compared.Univariate and multivariate Logistic regression analyses were conducted with favorable outcomes at 90 days as the dependent variable to evaluate the effect of intravenous tirofiban administration after endovascular therapy on 90-day prognosis in patients without successful recanalization.Results A total of 356 patients without successful recanalization after endovascular treatment were included,comprising 195 males and 161 females,with a median age of 70(61,78)years(32-92 years).Among them,76 and 280patients were assigned to the tirofiban and non-tirofiban groups,respectively.At 90 days,114 patients had favorable outcomes,while 242 had unfavorable outcomes.(1)Before the 1∶1 propensity score matching,significant differences were observed between the tirofiban and non-tirofiban groups in terms of admission NIHSS score,ASPECTS,good collateral circulation,intravenous thrombolysis,and mTICI grade(all P＜0.05).After 1∶1 propensity score matching,66 matched pairs(132 patients)were obtained.No significant differences in the baseline and clinical characteristics were found between the two groups after matching(all P＞0.05).(2)After 1∶1 matching,a significant difference was observed in the rate of favorable outcomes at 90 days between the two groups(48.5％[32/66]vs.30.3％[20/66],P=0.033)after propensity score matching,while no significant differences were found in 90-day mortality,intracranial hemorrhage within 24h,or symptomatic intracranial hemorrhage within 24h(all P＞0.05).(3)Univariate analysis after 1∶1 matching indicated that age,atrial fibrillation,smoking history,admission NIHSS score,M2 segment middle cerebral artery occlusion,good collateral circulation,number of passes for thrombus retrieval,and tirofiban treatment were factors influencing favorable outcomes at 90 days.Multivariate Logistic regression analysis showed that younger age(aOR,0.942,95％CI 0.906-0.978,P=0.002),lower admission NIHSS score(aOR,0.855,95％CI 0.777-0.941,P=0.001),good collateral circulation(aOR,5.534,95％CI 2.141-14.301,P＜0.01),tirofiban treatment(aOR,2.774,95％CI 1.092-7.046,P=0.032),and M2 segment MCA occlusion(reference:internal carotid artery occlusion;aOR,4.874,95％CI 1.428-16.632,P=0.011)were independent predictors of favorable outcomes at 90 days.Conclusions Intravenous tirofiban administration after endovascular therapy may improve 90-day neurological outcomes in patients with acute anterior circulation large vessel occlusion stroke who did not achieve successful recanalization without increasing the risk of hemorrhage.Further large-scale randomized controlled trials are warranted to validate these findings.

Objective To analyze the application value and clinical experience of intraoperative ultrasound in microsurgical resection of supratentorial cavernous malformations.Methods From March 2018 to March 2019,31 patients with supratentorial cavernous malformations were operated with assistance of intraoperative ultrasound in our hospital.Intraoperative ultrasound could clearly show the locations and sizes of the lesions,and relations of lesions with surrounding structures to choose appropriate surgical routes.The degrees of resection were judged and complications were recorded.The patients were followed up for 3-6 months,and modified Rankin scale (mRS) was used to evaluate the prognoses.Results In these 31 patients,35 cavernous hemangiomas were diagnosed by MR imaging before surgery;33 lesions were removed surgically,and the other two lesions located in the contralateral side of the operative field were not removed.The accuracy of intraoperative ultrasound guiding the lesions was up to 100％.There were no postoperative infections or deaths.During follow-up,mRS score of 28 patients was 0;the other 3 patients with postoperative neurological impairment recovered partially during follow-up.Conclusion With the help of real-time monitoring of intraoperative ultrasound and location technique of small pieces of hemostatic yam,patients with supratentorial cavernous malformations could acquire satisfactory prognosis through meticulous microsurgery.

Objective To analyze the effect of clinical application of ultrasound in microsurgical treatment of intramedullary tumors in the superior cervical spinal cord.Methods Retrospective study the clinical data of 15 patients with intramedullary tumors in the superior cervical spinal cord,which were underwent a laminectomy for microsurgical tumor resection during January,2014 and January,2018.Intraoperative ultrasound and neuromonitoring was accompanied by the whole surgical procedure for each case.The follow-up data was collected by outpatient department visits and telephone interviews.Results All the described patients were performed with microscopic tumor resection by using intraoperative neurophysiological monitoring and ultrasound.The pathological diagnosis was ependymocytoma (n=8) and astrocytoma (n=7).Gross total resections comprised 86.7％ of cases (n=13),and subtotal resections 13.3％ (n=2).The neurological outcome was as follows:Mc-Cormick scale grade Ⅰ,10 patients;grade Ⅱ,3 patients;grade Ⅲ,1 patient;and grade Ⅳ 1 patient;Follow-up was applied for (19.2±7.6) months in 13 cases and 12.0 months in 2 cases.Compared to the preoperative period,66.6％ of patients recovered postoperatively,20.0％ improved,6.7％ remained without deficit and deterioration persisted in 6.7％.Conclusion The microscopic resection of tumors is the effective way to cure this disease.By using intraoperative neurophysiological monitoring and ultrasound,the complete tumor resection and the minimal spinal cord injury were certainly achieved.

Objective The Female Sexual Function Index ( FSFI) was used to investigate the sexual life quality of patients who got laparoscopic peritoneal vaginoplasty of LuohuⅡ, so as to take measures to improve patients postoperative quality of life. Methods A total of 106 cases undergoing laparoscopic peritoneal vaginoplasty of LuohuⅡ were selected from January 2012 to March 2013. All patients got the questionnaire survey by FSFI and the FSDS-R questionnaire to evaluate the sexual function and psychological states. According to the existing problems, the intervention measures and health guidance were given to patients. And one year after surgery, their sexual function was evaluated again. Results The length of vagina was (12. 29 ± 1. 67) cm, which was significantly longer than before (t =2. 825, P <0. 05). The sexual desire, sexual arousal, sexual orgasm, sexual satisfaction, sexual pain and total score of FSFI were (4. 0 ± 0. 4), (4. 2 ± 0. 4), (4. 5 ± 0. 5), (4. 1 ± 0. 7), (5. 0 ± 0. 5), (4. 6 ± 0. 5) and (29. 7 ± 1. 2), which were significantly better than those before (t=7. 64, 3. 77, 6. 27, 8. 14, 8. 78, 7. 92, 36. 13, respectively;P <0. 01). Conclusions The sexual satisfaction of patients is increased after intervention. The patients with laparoscopic peritoneal vaginoplasty generally have sex problems and lack of the confidence, and effective intervention can improve the sexual life quality and satisfaction, as well as self-confidence of patients.

Objective To investigate the effect of chronic infection of Toxoplasma gondii on the spatial learning and memory capability in mice.Methods Toxoplasma tachyzoites(RH strain)were reanimated at 37 ℃ after 15 days' storage at-20 ℃,and injected intraperitoneally to mice of the experimental group each with 7.7?105.Normal saline was given to the control group,0.5 ml per mouse.Two months later,all mice were tested in the Morris Water Maze.Smears of the mice brain homogenate and pathological sections were examined.Results ① The density of cysts in the brain homogenate was 15/HP,and there was no evident pathological change in the hippocampus and adjacent areas of mice in the brain in the experimental mice.② Latency to platform,cumulative distance to the platform,total distance traveled in both experimental and control groups decreased significantly with the increase of training days(P