Acute gouty arthritis is an inflammatory disease characterized by redness,swelling,heat,and pain in the joints.It mostly occurs at the distal ends of the limbs,especially in the toe joints.The six climatic exopathogens,which include wind,cold,summer-heat,dampness,dryness,and fire(heat),are the general term for exogenous pathogenic factors.This article explores the pathogenesis and treatment approaches of acute gouty arthritis from the perspective of the six climatic exopathogens.All the six climatic exopathogens can lead to the occurrence of acute gouty arthritis,among which"fire"is the most closely associated with this disease.Wind-pathogenic factor accumulates without dissipation and transforms into fire internally;cold-pathogenic factor congeals without warmth and transforms into fire after long-term stagnation;when wind and dampness interact and cannot circulate,they stagnate and transform into fire;dry-pathogenic factor accumulates internally without release,transforms into fire,and consumes yin;fire stagnates and intensifies when it cannot be discharged.It can be seen that the six climatic exopathogens are the inducing factors for acute gouty arthritis,and"fire"is the key factor and the general summary of the disease occurrence.Therefore,it is proposed that the core therapeutic principle is clearing heat-fire.Simultaneously,combined with clinical practice,methods are supplemented,such as expelling wind,dredging collaterals and relieving pain;warming yang,dispelling cold and eliminating arthralgia;drying dampness,strengthening the spleen and facilitating joint function;and moistening dryness,nourishing yin and dredging collaterals.Acute gouty arthritis is not simply treating based on the theory of fire.By tracing back to the root cause,treating both the symptoms and the root cause,it is hoped that this can provide a theoretical basis for the clinical treatment of acute gouty arthritis from the perspective of the six climatic exopathogens and broaden the therapeutic ideas.

Objective To investigate the effect of Jiawei Simiao powder on the Toll-like receptor 4(TLR4)/nuclear factor-κB(NF-κB)signaling pathway through miR-146a in monosodium urate(MSU)crystal-induced RAW264.7 macrophage inflammation models,and to explore its anti-inflammatory mechanism.Methods A cell model of gouty arthritis was established by inducing RAW264.7 cells with MSU crystals.Cells were divided into control,model,Jiawei Simiao powder,and colchicine groups and cell viability was assessed using the CCK-8 method.Levels of interleukin(IL)-1β,IL-6,and tumor necrosis factor(TNF)-α were measured by enzyme-linked immunosorbent assay.Expression levels of miR-146a miRNA and TLR4,myeloid differentiation factor 88(MyD88),TNF receptor-associated factor 6(TRAF6),and NF-κB p65 mRNA were detected by quantitative real-time polymerase chain reaction amplification technology,and protein expression levels of TLR4,MyD88,TRAF6,and phospho(p)-NF-κB p65 were evaluated by Western blot.Results miR-146a expression was significantly decreased in the model group compared with the control group(P＜0.01),while mRNA and protein expression levels of TLR4,MyD88,and TRAF6,and protein expression of p-NF-κB p65,IL-1β,IL-6,and TNF-α were significantly increased(P＜0.01).In contrast,miR-146a expression was significantly increased(P＜0.01)and mRNA and protein expression of TLR4,MyD88,and TRAF6,and p-NF-κB p65 protein expression(P＜0.01),as well as IL-1β,IL-6,and TNF-α levels(P＜0.05)were significantly decreased in the Jiawei Simiao powder and colchicine groups.Conclusions Jiawei Simiao powder may alleviate MSU crystal-induced macrophage inflammatory responses by upregulating miR-146a,suppressing TLR4/NF-κB signaling pathway activation,and decreasing secretion of inflammatory factors.

Objective To investigate the effect of Jiawei Simiao powder on the Toll-like receptor 4(TLR4)/nuclear factor-κB(NF-κB)signaling pathway through miR-146a in monosodium urate(MSU)crystal-induced RAW264.7 macrophage inflammation models,and to explore its anti-inflammatory mechanism.Methods A cell model of gouty arthritis was established by inducing RAW264.7 cells with MSU crystals.Cells were divided into control,model,Jiawei Simiao powder,and colchicine groups and cell viability was assessed using the CCK-8 method.Levels of interleukin(IL)-1β,IL-6,and tumor necrosis factor(TNF)-α were measured by enzyme-linked immunosorbent assay.Expression levels of miR-146a miRNA and TLR4,myeloid differentiation factor 88(MyD88),TNF receptor-associated factor 6(TRAF6),and NF-κB p65 mRNA were detected by quantitative real-time polymerase chain reaction amplification technology,and protein expression levels of TLR4,MyD88,TRAF6,and phospho(p)-NF-κB p65 were evaluated by Western blot.Results miR-146a expression was significantly decreased in the model group compared with the control group(P＜0.01),while mRNA and protein expression levels of TLR4,MyD88,and TRAF6,and protein expression of p-NF-κB p65,IL-1β,IL-6,and TNF-α were significantly increased(P＜0.01).In contrast,miR-146a expression was significantly increased(P＜0.01)and mRNA and protein expression of TLR4,MyD88,and TRAF6,and p-NF-κB p65 protein expression(P＜0.01),as well as IL-1β,IL-6,and TNF-α levels(P＜0.05)were significantly decreased in the Jiawei Simiao powder and colchicine groups.Conclusions Jiawei Simiao powder may alleviate MSU crystal-induced macrophage inflammatory responses by upregulating miR-146a,suppressing TLR4/NF-κB signaling pathway activation,and decreasing secretion of inflammatory factors.

Acute gouty arthritis is an inflammatory disease characterized by redness,swelling,heat,and pain in the joints.It mostly occurs at the distal ends of the limbs,especially in the toe joints.The six climatic exopathogens,which include wind,cold,summer-heat,dampness,dryness,and fire(heat),are the general term for exogenous pathogenic factors.This article explores the pathogenesis and treatment approaches of acute gouty arthritis from the perspective of the six climatic exopathogens.All the six climatic exopathogens can lead to the occurrence of acute gouty arthritis,among which"fire"is the most closely associated with this disease.Wind-pathogenic factor accumulates without dissipation and transforms into fire internally;cold-pathogenic factor congeals without warmth and transforms into fire after long-term stagnation;when wind and dampness interact and cannot circulate,they stagnate and transform into fire;dry-pathogenic factor accumulates internally without release,transforms into fire,and consumes yin;fire stagnates and intensifies when it cannot be discharged.It can be seen that the six climatic exopathogens are the inducing factors for acute gouty arthritis,and"fire"is the key factor and the general summary of the disease occurrence.Therefore,it is proposed that the core therapeutic principle is clearing heat-fire.Simultaneously,combined with clinical practice,methods are supplemented,such as expelling wind,dredging collaterals and relieving pain;warming yang,dispelling cold and eliminating arthralgia;drying dampness,strengthening the spleen and facilitating joint function;and moistening dryness,nourishing yin and dredging collaterals.Acute gouty arthritis is not simply treating based on the theory of fire.By tracing back to the root cause,treating both the symptoms and the root cause,it is hoped that this can provide a theoretical basis for the clinical treatment of acute gouty arthritis from the perspective of the six climatic exopathogens and broaden the therapeutic ideas.

Objective:To explore the related clinical characteristics of myocardial injury caused by venomous snake bites, and to provide a reference for cardiac protection and treatment in patients with venomous snake bites.Methods:A retrospective analysis was conducted on 294 patients with venomous snake bites admitted to Chongqing Emergency Medical Enter from January 2020 to December 2022. They were divided into the myocardial injury group ( n=90) and the non-myocardial injury group ( n=204) according to the presence or absence of abnormal electrocardiogram or/and cardiac troponin I (cTnI). The research subjects were divided into the mild group ( n=213), the moderate group ( n=57), and the severe group ( n=24) according to the severity of clinical manifestations. The time from bite to admission, laboratory indicators related to myocardial injury, electrocardiogram and echocardiogram of each group were analyzed and compared. Myocardial injury and electrocardiogram manifestations caused by bites from different types of venomous snakes were analyzed. Results:The abnormal electrocardiogram caused by venomous snake bites was mainly manifested as changes in the ST-T segment, and 84 patients showed abnormal electrocardiogram (28.6%). Compared with the non-myocardial injury group, patients in the myocardial injury group were older ( Z=-1.984, P=0.047), the time from bite to admission and the length of hospital stay were longer, and the systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lower (all P<0.05). The levels of cTnI, lactic acid dehydrogenase (LDH), creatine kinase (CK), creatine kinase MB (CK-MB), a-hydroxybutyrate dehydrogenase (a-HBDH), C-reactive protein (CRP), and the ratio of the peak of mitral valve velocity E to the peak of early diastolic velocity e at the annulus (E/e) in the myocardial injury group were higher than those in the non-myocardial injury group (all P<0.05). The left ventricular ejection fraction (LVEF) was lower than that in the non-myocardial injury group ( Z=-3.160, P=0.02). Compared with the mild group, the age of patients in the severe group was significantly older ( P=0.024), and the time from bite to admission was shown as mild group

Objective:To explore the related clinical characteristics of myocardial injury caused by venomous snake bites, and to provide a reference for cardiac protection and treatment in patients with venomous snake bites.Methods:A retrospective analysis was conducted on 294 patients with venomous snake bites admitted to Chongqing Emergency Medical Enter from January 2020 to December 2022. They were divided into the myocardial injury group ( n=90) and the non-myocardial injury group ( n=204) according to the presence or absence of abnormal electrocardiogram or/and cardiac troponin I (cTnI). The research subjects were divided into the mild group ( n=213), the moderate group ( n=57), and the severe group ( n=24) according to the severity of clinical manifestations. The time from bite to admission, laboratory indicators related to myocardial injury, electrocardiogram and echocardiogram of each group were analyzed and compared. Myocardial injury and electrocardiogram manifestations caused by bites from different types of venomous snakes were analyzed. Results:The abnormal electrocardiogram caused by venomous snake bites was mainly manifested as changes in the ST-T segment, and 84 patients showed abnormal electrocardiogram (28.6%). Compared with the non-myocardial injury group, patients in the myocardial injury group were older ( Z=-1.984, P=0.047), the time from bite to admission and the length of hospital stay were longer, and the systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lower (all P<0.05). The levels of cTnI, lactic acid dehydrogenase (LDH), creatine kinase (CK), creatine kinase MB (CK-MB), a-hydroxybutyrate dehydrogenase (a-HBDH), C-reactive protein (CRP), and the ratio of the peak of mitral valve velocity E to the peak of early diastolic velocity e at the annulus (E/e) in the myocardial injury group were higher than those in the non-myocardial injury group (all P<0.05). The left ventricular ejection fraction (LVEF) was lower than that in the non-myocardial injury group ( Z=-3.160, P=0.02). Compared with the mild group, the age of patients in the severe group was significantly older ( P=0.024), and the time from bite to admission was shown as mild group

ObjectiveTo investigate the effect of modified Simiaosan on miR-223-3p and NOD-like receptor thermal protein domain associated protein 3 （NLRP3）/interleukin-1β （IL-1β） signaling pathway in rat model with acute gouty arthritis （AGA） and explore the anti-inflammatory mechanism of modified Simiaosan on AGA. MethodA total of 72 8-week-old male SD rats were selected. They were divided into blank group， model group， colchicine group （0.3 mg·kg^-1）， high-dose modified Simiaosan group （31.75 g·kg^-1）， medium-dose modified Simiaosan group （15.75 g·kg^-1）， and low-dose modified Simiaosan group （7.875 g·kg^-1） according to random number table method， with 12 rats in each group. Except for the blank group， monosodium urate （MSU） crystal suspension was injected into the right ankle joint of rats by the Coderre method in other groups to replicate the rat model with AGA. The drug administration groups were given the corresponding drug solution by gavage， and the model group and the blank group were given an equal volume of sterile sodium chloride solution by gavage for one week. The circumference of the rats' ankle joint was measured， and the swelling degree of the ankle joint was calculated. Hematoxylin-eosin （HE） staining was used to detect the pathological morphological changes in the synovial tissue of the ankle joint. The levels of IL-1β， tumor necrosis factor-α （TNF-α）， and interleukin-6 （IL-6） in the serum of rats in each group were detected by enzyme-linked immunosorbent assay （ELISA）. Western blot was used to detect the protein expressions of NLRP3， Caspase-1， and apoptosis-related spot-like protein （ASC） in synovial tissue of rats in each group， and real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to detect the mRNA expressions of NLRP3， Caspase-1， and ASC and the expression of miR-223-3p in synovial tissue of rats. ResultCompared with that in the normal group， the swelling degree of the ankle joint in the model group was higher （P<0.01）， and the synovial tissue structure was disordered. Synovial cells proliferated obviously， and a large number of inflammatory cells were infiltrated. The levels of IL-1β， IL-6， and TNF-α in the serum of the model group increased significantly （P<0.01）， and the protein and mRNA expressions of NLRP3， Caspase-1， and ASC increased， while expression of miR-223-3 decreased. Compared with the model group， the swelling degree of ankle joint in the colchicine group and high-dose and medium-dose modified Simiaosan groups was lower （P<0.05）. Synovial cell proliferation and inflammatory cell infiltration of the colchicine group and high-dose， medium-dose， and low-dose modified Simiaosan groups were reduced to varying degrees， among which the colchicine group and high-dose modified Simiaosan group improved most obviously. The levels of IL-1β， IL-6， and TNF-α in the serum of rats in different dose groups of modified Simiaosan and colchicine group decreased significantly （P<0.01）， while the protein and mRNA expressions of NLRP3， Caspase-1， and ASC increased （P<0.01）. The expression of miR-223-3p in synovial tissue of the medium-dose and high-dose modified Simiaosan groups and colchicine group increased significantly （P<0.01）. Compared with those in the colchicine group， the levels of IL-1β， IL-6， and TNF-α in the low-dose modified Simiaosan group increased greatly （P<0.01）. In the medium-dose modified Simiaosan group， the protein expressions of NLRP3， Caspase-1， and ASC increased， and the expression of miR-223-3p decreased （P<0.05）. In the low-dose modified Simiaosan group， the levels of IL-1β， IL-6， and TNF-α increased greatly （P<0.01）， as well as the protein and mRNA expressions of NLRP3， Caspase-1， and ASC， while the expression of miR-223-3p was decreased （P<0.01）. ConclusionModified Simiaosan may play an anti-inflammatory role by intervening in the NLRP3/IL-1β signaling pathway via regulating miR-223-3p.

Objective:To evaluate the efficacy and safety of febuxostat in the treatment of hyperuricemia with hypertension.Methods:Randomized controlled trials (RCT) on the treatment of hyperuricemia with hypertension using febuxostat were retrieved from Medline, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database from January 2013 to July 2023, according to the retrieval strategy. Two trained researchers completed the literature screening, quality evaluation, and data extraction. Meta-analysis was performed using RevMan 5.3. The fixed-effect model or random-effects model was used to analyze the research data, and subgroup analysis was conducted to identify the source of heterogeneity.Results:A total of 5 RCTs involving 456 patients (228 in the experimental group and 228 in the control group) were included in the meta-analysis, all of which were English-language literatures and foreign studies. In the treatment of hyperuricemia with hypertension, febuxostat showed a statistically significant difference in reducing serum uric acid (sUA) levels compared to control drugs [MD(95% CI)=-1.31(-2.55, -0.07), P=0.040]; there was no statistically significant difference in reducing systolic blood pressure (SBP) [SMD(95% CI)=-0.12(-0.51, 0.27), P=0.540] or diastolic blood pressure (DBP) [SMD(95% CI)=-0.15(-0.40, 0.09), P=0.220]. Subgroup analysis showed that the difference in intervention drugs in the control group may be the cause of heterogeneity in sUA levels, and the difference in intervention time may be the cause of heterogeneity in SBP levels among different studies. There was no statistically significant difference in the incidence of adverse reactions between the febuxostat group and the control group [RD (95% CI) =-0.01(-0.08, 0.06), P=0.770]. Conclusion:Febuxostat has a significant advantage in improving sUA levels and is relatively safe in the treatment of hyperuricemia with hypertension, but it does not show significant advantages in blood pressure control.

ObjectiveTo study the clinical efficacy of the Qingre Lishi Huazhuo method on patients with chronic gouty arthritis of dampness-heat obstruction syndrome and the effect on nucleotide-binding oligomerization domain-like receptor 3（NLRP3）/interleukin-1β （IL-1β） signaling pathway to preliminarily explore its mechanism. MethodSixty patients with chronic gouty arthritis of dampness-heat obstruction syndrome were enrolled and divided into a treatment group （30 cases） and a control group （30 cases） according to the random number table method. Thirty people were assigned to the healthy group. Patients in the control group were treated with oral Febuxostat， while those in the treatment group were treated with modified Simiaosan combined with Febuxostat. Treatment lasted four weeks. The general clinical data， traditional Chinese medicine （TCM） syndrome scores， serum uric acid （UA）， serum creatinine （SCr）， blood urea nitrogen （BUN）， fasting blood glucose （FPG）， low-density lipoprotein （LDL）， triglyceride （TG）， total cholesterol （TC）， erythrocyte sedimentation rate （ESR）， and C-reactive protein （CRP） of patients were recorded. Enzyme-linked immunosorbent assay （ELISA） was employed to measure the levels of IL-1β，TNF-α， and IL-6，and the levels of NLRP3，cysteinyl aspartate-specific protease-1 （Caspase-1）， and apoptosis-associated speck-like protein containing a CARD （ASC） were detected by Western blot. ResultBefore treatment， the levels of body mass index （BMI）， systolic blood pressure （SBP），diastolic blood pressure （DBP），UA，SCr，BUN，FPG，LDL，TG，and TC in both groups significantly increased （P<0.05，P<0.01），and the levels of HDL significantly decreased as compared with those in the healthy group（P<0.05）. Additionally， the levels of IL-1β， TNF-α， and IL-6 in both groups significantly increased before treatment （P<0.01）. Compared with the results before treatment， patients in the two groups had significant reductions in tube pain， joint tenderness， joint swelling，joint fever， activity disorders， body fatigue， sliminess， bitter mouth， yellow and red urine， and tongue manifestation scores （P<0.05，P<0.01）. Compared with patients in the control group after treatment， those in the treatment group had a significant decrease in joint fever， body fatigue， sliminess， bitter mouth，sticky stool，yellow and red urine， tongue manifestation score， and pulse score （P<0.05）. The total effective rate in the treatment group was 80.0% （24/30）， higher than 56.7% （17/30）in the control group（χ²=11.916，P<0.05）. Compared with the results before treatment， BMI， SBP， DBP， UA， SCr， BUN， FPG， LDL， TG， TC， ESR，CRP， IL-1β， TNF-α， IL-6 levels， and VAS score in both groups significantly decreased （P<0.05，P<0.01）. Compared with patients in the control group after treatment， those in the treatment group had decreased DBP，ESR， IL-1β levels， and VAS score （P<0.05）. Western blot results showed that before treatment， the protein expression of NLRP3， Caspase-1， and ASC in peripheral blood mononuclear cells （PBMCs） of patients in both groups were higher than those in the healthy group （P<0.01）. Compared with the results before treatment， the protein expression of NLRP3， Caspase-1， and ASC in PBMCs in patients of both groups after treatment decreased （P<0.05，P<0.01）. Compared with the control group after treatment， the treatment group showed decreased expression levels of NLRP3 and Caspase-1（P<0.05）. ConclusionThe Qingre Lishi Huazhuo method can effectively improve the clinical symptoms and reduce inflammation of chronic gouty arthritis of dampness-heat obstruction syndrome with good safety. The mechanism may be related to the inhibition of the NLRP3/IL-1β signaling pathway.

Objective:To analyze the level of self-management and its influencing factors in patients with systemic lupus erythematosus (SLE).Methods:A cross-sectional study. From January to December 2021, patients with SLE in the Department of Rheumatology and Immunology in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine were selected as the study objects by convenience sampling method. A total of 135 questionnaires were distributed in this study, 135 were recovered, and 128 were valid. The general data of the patients were collected, and the self-management level, self-efficacy, family care and meaning in life of the patients were evaluated with the chronic disease self-management behavior scale, general self-efficacy scale (GSES), family adaption partnership growth affection resolve index (APGAR) and the meaning in life questionnaire (MLQ). Multiple linear regression analysis was applied to explore the factors affecting the self-management of SLE patients.Results:The total score of chronic disease self-management behavior scale in the 128 SLE patients was (28.77±6.58) points. Pearson correlation analysis showed strong correlation between self-efficacy, sense of life meaning and self-management ( r=0.748, 0.717, both P<0.001), there was a moderate correlation between family care and self-management ( r=0.560, P<0.001). Multiple linear regression analysis showed that educational level ( β′=0.457), disease activity ( β′=-0.211), self-efficacy ( β′=-0.372), family care ( β′=-0.510), meaning in life ( β′=-0.386) were influencing factors of self-management level in patients with SLE (all P<0.05). Conclusions:The self-management level of SLE patients needs to be improved. Disease activity, self-efficacy, meaning in life and other factors can affect the patients′ self-management level.