Objective:To analyze the clinical characteristics of elderly-onset gouty arthritis and risk factors of tophi.Methods:A total of 1 239 gout patients were retrospective selected in the outpatient department of the Gout Clinical Medical Center of the Affiliated Hospital of Qingdao University from 2016 to 2022. According to age of onset, they were divided into the young and middle-aged group(aged<60) consisted of 826 cases, and the elderly group(aged≥60) consisted of 413 cases. Compare the clinical characteristics of elderly with Young and Middle-aged patients.Results:The systolic blood pressure, fasting blood glucose, creatinine, regular exercise, comorbidities, and tophi in the elderly group was higher than that in the middle-aged and young group. The proportion of diastolic blood pressure, serum triglycerides, eGFR, serum uric acid, alcohol consumption rate, and family history of gout was lower than that of young and middle-aged group( P<0.05); In the elderly-onset group, the initial site of arthritis was commonly observed in the first metatarsophalangeal joint. The proportion of the first attack with the upper limb joint was higher in old age group than in young and middle age group( P<0.05). Renal underexcretion type was the main subtype in the elderly group, and the proportion of overproduction type was higher than that of the young and middle-aged group( P<0.05). The logistic regression analysis showed that age, urea nitrogen, disease duration≥10 years and family history of gout were risk factors for tophi in elderly patients( P<0.05). Conclusion:The elderly-onset gout has unique clinical characteristics, characterized by a higher prevalence of tophi, a higher rate of complications. An initial site of arthritis commonly observed in the first metatarsophalangeal joint and the predominant type of uric acid excretion is renal excretion impairment. Early diagnosis and treatment, control of blood uric acid levels, smoking cessation and alcohol, regular exercise should be applied to prevent or delay the formation of tophi.

Objective:To analyze the influencing factors of gout patients and explore whether there is an interaction between serum uric acid and diastolic blood pressure affecting the onset of tophi.Methods:A total of 4 798 gout patients were retrospective selected in the outpatient Department of the Gout Clinical Medical Center of the Affiliated Hospital of Qingdao University from September 2016 to May 2020. It was divided into tophi group and non-tophi group to compare the differences in indicators. A logistic regression model was used to analyze the influencing factors of tophi, and an interaction model was constructed to analyze the interactions.Results:Multivariate logistic regression analysis showed significant associations between age, diastolic blood pressure, alcohol consumption history, gout family history, blood uric acid, urea nitrogen, and creatinine clearance and tophi formation. The results of blood uric acid-related interaction analysis showed a significant interaction between blood uric acid and diastolic blood pressure( Pinteraction=0.014), and the risk of developing tophi in low diastolic blood pressure and high diastolic blood pressure group increased by 34.4%( OR=1.344, 95% CI 1.105-1.635, P=0.003) and 95.4%( OR=1.954, 95% CI 1.558-2.450, P<0.001) in the high blood uric acid group compared with the low blood uric acid group. The results of diastolic blood pressure and blood uric acid subgroup analysis showed that there was no statistical difference in the risk of developing tophi in people with low uric acid levels( P=0.238), but in people with high uric acid levels, the risk of developing tophi was 67%( OR=1.670, 95% CI 1.379-2.022, P<0.001) higher than that in the low uric acid group. Conclusion:Age, diastolic blood pressure, combined alcohol consumption history and gout family history, blood uric acid, renal function are related to the occurrence of tophi. High uric acid and high diastolic blood pressure have interaction on the occurrence of tophi. Attention and proactive intervention shall be applied to this group of patients.

Objectives To understand the effect of intraperitoneal injection of naringenin,a SMAD3 inhibitor,on the skeletal muscle after acute contusion in a mouse model.Methods Seventy-two mice of 7-8 weeks old (20-24 g)were randomly divided into a control group,an acute contusion (B)group,an acute contusion+1％DMSO injection (C)group and an acute contusion+naringenin injection (D)group,each of 18.The acute contusion model was created by hitting the right tibialis anterior muscle in mice of all groups except the control group.Intraperitoneal injection of I％DMSO and naringenin were given to group C and D respectively every day until execution,while the 18 mice in the control group were fed without injury or injection.The time of injury was set as Day 0.After being fed for 28 days,all mice were executed and the right tibialis anterior was harvested.Western blotting was used to detect the difference of SMAD3,pSMAD3,Collagen Ⅰ,and α-SMA expression among the 3 groups.Hematoxylin-Eosin (HE)staining and Masson staining were used to detect the difference of pathological changes.Moreover,the appearance of fast twitch contraction and tetanic contraction were also documented to figure out the quality of the injured skeletal muscle.Results Compared with the control group,the SMAD3 and pSMAD3 level in injured skeletal muscle increased,but both were less in group D than group B and C.Similarly,the average level of Collagen Ⅰ and α-SMA in all three injury groups was higher than the control group,but the level of these indexes were lower in group D than that in group B and C.HE staining showed more mesenchyme in injury groups than the control group.Masson staining found the upregulation of fibrosis in injured muscles,with the area of fibrosis in group D significantly lower than group B and C.Compared with control,the injured skeletal muscle had significantly poorer fast twitch and tetanic contraction performance,with the condition of group D significantly better than group B and C.Conculsion The naringenin,a SMAD3 inhibitor,mitigates the phosphorylation of SMAD3 after acute contusion in a mouse model.The fibrosis and scar formation was alleviated,hence improving the healing of the injured skeletal muscles.

Objective To investigate the clinical status of health literacy and uncertainty in illness among patients after hemopoietic stem cell transplantation and to analyze the influence of health literacy on uncertainty in illness. Methods Inpatients after hemopoietic stem cell transplantation in Hematology Department of He'nan Provincial People's Hospital were selected as subjects by convenience sampling from January 2015 to March 2017. The cross-sectional study was conducted with the health literacy scale and Mishel uncertainty in illness scale (MUIS). Simple correlation, correlation analysis and hierarchical regression analysis were used to explore the influence of health literacy on uncertainty in illness. Results The score of MUIS of patients after hemopoietic stem cell transplantation was (76.69±27.65) along with more than 80% of patients with a medium or a high level of uncertainty in illness. The score of health literacy was (92.33±14.58) with more than 90% of patients with a low or medium level of health literacy. There were significant differences in the score of uncertainty in illness among patients with different education levels and average monthly earnings (F=4.243, 5.746;P<0.05). The total score of health literacy as well as the score of basic health care literacy, disease control and prevention literacy and first aid literacy had negative correlations with the total score and scores of dimensions of uncertainty in illness (r=-0.298--0.363; P<0.05). Hierarchical regression analysis showed that dimensions of health literacy had a single predictive power on uncertainty in illness along with explaining 42.8% of the variance separately. Conclusions The uncertainty in illness among patients after hemopoietic stem cell transplantation is in a high level and the health literacy is in a bad level. Beyond education levels and average monthly earnings, health literacy has influence on uncertainty in illness separately.

Anything in the universe can be explained by Yin-yang theory of Chinese medicine. Synaptic connections in the central nervous system also embody a balance between Yin and Yang. To discover the synaptic processes of gathering,storing and retrieving information in the brain is a hotspot field of modem neuroscience. This paper attempts to analyze the synaptic connection in both structure and function from Yin-Yang theory. The connections of axons and dendrites between neurons arc malleable and constantly changing, showing a Yin-Yang balance anatomically. Remodeling, stabilization and plasticity changes of synaptic processes also embody the relationship of contradictions, conflicts and transformation of Yin-Yang functionally. Therefore, it is possible to achieve an unexpected result to solve some modem medical problems by using the thoughts and methods of Chinese medicine.

BACKGROUND: Chinese medicine is rich in recognition and treatment for rheumatoid arthritis(RA) and has achieved attractable progression in researches of recent several years,characterized by variable therapeutic methods, definite therapeutic effects and few toxic side effects. Therefore, it is important scientifically and socially to further search for the effective drugs and methods for the treatment of RA in the field of Chinese medicine. There are few reports on whether Chinese herbs inhibit or block the destruction of cartilage and bone and promote their metabolism and repair for damage or not by variable approaches,targets and links in RA occurrence.OBJECTIVE: To probe into the mechanism of Chinese herbal tongbiling on cartilage destruction.DESIGN: Complete random design and control experimental study based on the experimental animals.SETTING: Golden Chamber teaching and research room of guangzhou university of traditional Chinese medicine.MATERIALS: The experiment was performed in Comprehensive Experimental Room of First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from August 2002 to December 2003,in which,35female Wistar rats were employed,clean grade,weighted(110±20) g,provided by Animal Experimental Room of First Military Medical University of Chinese PLA, with qualified animal No. 2002A041.After 3 days adaptive breeding,Wistar rats were randomized into normal group,model group and total alkaloidal of tongbiling group(TBL group). TBL was extracted in Phytochemistry Room of Tropical Disease Institute of Guangzhou University of Traditional Chinese Medicine.METHODS: The animal model was prepared on rats with collagen-induced arthritis. After treated with gastric infusion in groups,the pathological sections were done on phalangeal joint of rat and chondropathy was observed after routine HE staining. The chondrocytes were cultured. The chondrocytes were stimulated with rrIL-1β in vitro and resulted in matrix decomposition of chondrycyte to prepare pharmaceutical model,TBL of various concentrations added and dexamethasone(DXM) was applied in the control. After 48 hours culture,the upper clear solution if cell was collected and glycosaminoglycan (GAG) content was measured with alcian blue method,and nitric oxygen (NO) content was assayed with method of aqua fortis reduction.MAIN OUTCOME MEASURES:①Primary results: Effect of TBL on phalangeal chondropathy in rats with collagen-induced arthritis and on matrix decomposition of chondrocyte induced by rrIL-1β.②Secondary results: Effect of TBL on induction of NO synthesis from chondrocytes by rrIL-1β.RESULTS:①It was indicated in evaluation on HE pathological section of phalangeal joint: The severity of cartilage destruction in TBL group was less than that in model group(P<0.05).②TBL of various concentrations and DXM inhibited remarkably the decomposition of choncrocyte proteoglycan (P<0.01) and NO synthesis (P<0.01).CONCLUSION: TBL inhibits phalangeal cartilage destruction of rats with collagen-induced arthritis. It is indicated in the results of experiment in vitro that TBL is against the decomposition of choncrocyte proteoglycan,which is probably achieved by inhibiting NO synthesis.

[Objective] To investigate the effect of Erteng Mixture (EM) on activated T-cell CD69 expression and Jurkat cell cycle in rheumatoid arthritis (RA) and to explore its possible cellular immunoregulation mechanism. [Methods] Jurkat cells were cultured with different kinds of components extracted from EM. After 72 hours, proliferation rate of Jurkat cell were detected with thiazolyl blue colorimetry (MTT) to screen the active component. Whole blood from RA patients were incubated in RPMI-1640 culture with various concentrations of chlorofonn component extracted from EM or with Genistein. Thirty minutes later, phytahematoagglutinin (PHA) were added successively into the culture. After 24 hours, CD69 expression rate of T lymphocytes activated by PHA was analyzed by flow cytometry. Jurkat cells were cultured with various concentrations of chloroform component extracted from EM and with methotrexate ( MIX) for 48 hours. After then, Jurkat cell cycle was analyzed by flow cytometry. [ Results ] Chloroform component extracted from EM had the strongest inhibitive effect on proliferation of Jurkat cells. Chloroform component (10 mg/L and 20 mg/L) could markedly inhibit CD69 expression on PHA-activated T lymphocytes. Chloroform component 10 mg/L blocked Jurkat cell cycle at G1 phase, which differed from MTX blocking Jurkat cell cycle at S phase. [Conclusion] Chloroform component extracted from EM could significantly inhibit the early activation of CD4 T lymphocytes in RA and inhibit the energy and material synthesis in T-cell, thus hindering DNA synthesis and decreasing the cellular G2 phase transformation. This study will provide an experimental basis for clinical application of EM in treating RA.