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:Eosinophilic esophagitis (EoE), an allergen/immune-mediated chronic disorder of the esophagus, is witnessing an incremental rise in its global incidence. However, data in China are very limited. This study aimed to clarify the characteristics of EoE in Chinese adults at our medical center.Methods:We collected information, including clinical characteristics and endoscopic findings, relative to all cases of adult patients who met the pathological diagnostic criteria for EoE at our institution from January 2019 to May 2024. Patients diagnosed with reflux esophagitis (RE) were matched in a 1∶1 ratio based on age and sex, and comparisons were made between the two groups.Results:The overall detection rate of EoE in our hospital was approximately 0.05%, with a trend increasing yearly. In total, 61 patients met the diagnostic criteria for EoE, of whom 42 (68.9%) were male. The median age was 53 years. The clinical manifestations of EoE patients were diverse, with common symptoms including dysphagia, acid reflux, and upper abdominal pain. Serological examination revealed that 23.1% (9/39) of patients had increased absolute eosinophil counts. Allergic diseases were observed in 73.8% (45/61) patients. Most patients exhibited typical mucosal changes in the esophagus during endoscopy, the median EREFS score was 3 points. The most commonly administered treatment included proton pump inhibitors, and 13 patients received steroid treatment. During a follow-up period, 42 patients (68.9%) exhibited clinical symptom improvement or pathological remission. In comparison to Western countries, patients with EoE in China typically presented with milder disease severity and a more favorable prognosis. No significant differences were observed between younger and older adult groups regarding clinical symptoms, the proportion of comorbid allergic diseases, medications, or the rate of improvement ( P for all>0.05). Additionally, patients with EoE more commonly presented with dysphagia (29.5% vs. 1.6%, χ2=15.96, P<0.001), comorbid allergic diseases (73.8% vs. 13.1%, χ2=45.67, P<0.001), increased eosinophil counts (23.1% vs. 3.3%, χ2=7.61, P<0.01), and a positive response to corticosteroids when compared to patients with RE. Conclusions:This study systematically determined the clinical characteristics of adult EoE patients in China. Compared to Western countries, patients from China typically presented with milder disease severity and a more favorable prognosis. No significant clinical manifestations or prognosis differences were observed between younger and older patients. EoE can be differentiated from RE based on symptoms, the presence of comorbid allergic diseases, and the degree of serum eosinophil infiltration. For patients suspected of EoE, endoscopic esophageal biopsy will facilitate early diagnosis.

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:Eosinophilic esophagitis (EoE), an allergen/immune-mediated chronic disorder of the esophagus, is witnessing an incremental rise in its global incidence. However, data in China are very limited. This study aimed to clarify the characteristics of EoE in Chinese adults at our medical center.Methods:We collected information, including clinical characteristics and endoscopic findings, relative to all cases of adult patients who met the pathological diagnostic criteria for EoE at our institution from January 2019 to May 2024. Patients diagnosed with reflux esophagitis (RE) were matched in a 1∶1 ratio based on age and sex, and comparisons were made between the two groups.Results:The overall detection rate of EoE in our hospital was approximately 0.05%, with a trend increasing yearly. In total, 61 patients met the diagnostic criteria for EoE, of whom 42 (68.9%) were male. The median age was 53 years. The clinical manifestations of EoE patients were diverse, with common symptoms including dysphagia, acid reflux, and upper abdominal pain. Serological examination revealed that 23.1% (9/39) of patients had increased absolute eosinophil counts. Allergic diseases were observed in 73.8% (45/61) patients. Most patients exhibited typical mucosal changes in the esophagus during endoscopy, the median EREFS score was 3 points. The most commonly administered treatment included proton pump inhibitors, and 13 patients received steroid treatment. During a follow-up period, 42 patients (68.9%) exhibited clinical symptom improvement or pathological remission. In comparison to Western countries, patients with EoE in China typically presented with milder disease severity and a more favorable prognosis. No significant differences were observed between younger and older adult groups regarding clinical symptoms, the proportion of comorbid allergic diseases, medications, or the rate of improvement ( P for all>0.05). Additionally, patients with EoE more commonly presented with dysphagia (29.5% vs. 1.6%, χ2=15.96, P<0.001), comorbid allergic diseases (73.8% vs. 13.1%, χ2=45.67, P<0.001), increased eosinophil counts (23.1% vs. 3.3%, χ2=7.61, P<0.01), and a positive response to corticosteroids when compared to patients with RE. Conclusions:This study systematically determined the clinical characteristics of adult EoE patients in China. Compared to Western countries, patients from China typically presented with milder disease severity and a more favorable prognosis. No significant clinical manifestations or prognosis differences were observed between younger and older patients. EoE can be differentiated from RE based on symptoms, the presence of comorbid allergic diseases, and the degree of serum eosinophil infiltration. For patients suspected of EoE, endoscopic esophageal biopsy will facilitate early diagnosis.

Adult ; Humans ; Non-alcoholic Fatty Liver Disease/complications* ; Cross-Sectional Studies ; Folic Acid/therapeutic use* ; Risk Factors

Nonalcoholic fatty liver disease (NAFLD) is becoming increasingly common as the global economy grows and living standards improve. Timely and effective preventions and treatments for NAFLD are urgently needed. Retinol-binding protein-4 (RBP4), the protein that transports retinol through the circulation, was found to be positively related to diabetes, obesity, cardiovascular disease, and other metabolic diseases. Observational studies on the association between serum RBP4 level and the prevalence of NAFLD found contradictory results. Some of the underlying mechanisms responsible for this association have been revealed, and the possible clinical implications of treating NAFLD by targeting RBP4 have been demonstrated. Future studies should focus on the predictive value of RBP4 on NAFLD development and its potential as a therapeutic target in NAFLD.

Aim To study the effects of total saponins of Panax japonicus(TSPJ) on liver inflammation of natural aging rats.Methods The experimental rats were allocated into seven groups (twelve rats in each group): three months group, nine months group, fifteen months group, twenty-four months group, and TSPJ low-, mid-and high-dose groups(10, 30, 60 mg·kg-1).When the rats were eighteen months old, the TSPJ low-, mid-and high-dose groups of rats were given lavage treatments with TSPJ 10,30, 60 mg·kg-1 respectively until twenty-four months.During lavage, we stopped a day every week for six consecutive months.HE staining was used to observe the pathological morphological changes.Western blot was utilized to test IL-1β and TNF-α protein expressions.RT-PCR method was adopted to test IL-1β, IL-6, IL-12, IL-17α, TNF-α, IFN-γ mRNA expressions.Results HE staining observation showed that as the rats grew older the hepatic cord and sinusoid were arranged in more severe disorder, and the fat vacuole and inflammatory cells were increased significantly.While every dose group of TSPJ could improve these pathological changes distinctly.The IL-1β, TNF-α protein and IL-1β, IL-6, IL-12, IL-17α, TNF-α, IFN-γ mRNA expressions were increased gradually as the rats grew older, and every dose group of TSPJ could reduce their expressions to some extent.Conclusion TSPJ could protect the aging rat liver to some extent by inhibiting the liver inflammation.

Non-alcoholic fatty liver disease (NAFLD) has become one of the major metabolic diseases.In view of the defects of traditional animal models, this study was the first to establish the NAFLD model of Mongolian gerbil (Meriones unguiculatus) with simple feed formula which is similar to human (from simple fatty liver to steatohepatitis, fibrosis,Liver cirrhosis).This study discussed the mechanism of rapid fatty liver deposition in Mongolian gerbil, revealed its molecular mechanism,main regulatory target and network function of fatty liver susceptibility.We provide a new animal model of NAFLD with relatively clear background and less time-consuming for clinical treatment and new drug development.The theoretical and practical basis for the breeding of inbred strain NAFLD gerbil was established.

Objective:To investigate the effects of airborne fine particle on cell viability and inflammation in human bronchial epithelial cells.Methods:Atmospheric PM2.5 samples were collected by PM2.5 sampler.PM2.5 morphology was observed by scanning electron microscope (SEM).Human bronchial epithelial cells (BEAS-2B) were treated with PM2.5 at different concentrations (0,50,100,200,400,800 μg/mL) for 12,24 or 48 hours,and the cell activity were evaluated by cell counting kit-8 (CCK-8).The mRNA expression levels of (granulocyte-macrophage colony stimulating factor,GM-CSF) and TNF-α were detected by quantitative real-time PCR (qRT-PCR).Western blot was used to detect the protein expressions of GM-CSF and TNF-α.Results:According to SEM,the shape of PM2.5 varied,and the diameter was different and mostly equal to or less than 2.5 μm.CCK-8 assay showed that different concentrations of PM2.5 exposure for 12 hours,24 hours and 48 hours resulted in loss of cell viability of BEAS-2B cells (P＜0.05).Different concentrations of PM2.5 increased the mRNA and protein expression of GM-CSF and TNF-α,and the higher concentration of PM2.5 induced higher expression,which have statistical significant difference between the groups (P＜0.05).Conclusion:Atmospheric PM2.5 can cause inflammatory response in human bronchial epithelial cells.They can reduce cell viability,which may be related to the PM2.5 trigger and aggravation of bronchopulmonary inflammatory diseases.