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.

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:To investigate the effect of urate-lowering therapy (ULT) on body fat and visceral fat areas in patients with gout and to analyze the related risk factors.Methods:A total of 140 patients with gout eligible for enrollment were recruited from the gout clinic in the Affiliated Hospital of Qingdao University from Sept. 2018 to Sept. 2019. After 2 weeks of washout, all patients were treated with benzbromarone for consecutive 12 weeks. The data of blood biochemical, body fat (BF), body fat percentage (BFP) and visceral fat area (VFA) were collected, and the differences before and after ULT as well as the risk factors affecting the changes of BF, BFP, and VFA were analyzed.Results:The diastolic blood pressure (DBP), alanine aminotransferase (ALT), serum uric acid (sUA), BF, BFP, and VFA were significantly decreased after ULT ( P<0.05). The results of multivariate stepwise linear regression analysis showed that sUA, creatinine (Cr) and glomerular filtration rate (eGFR) were independent risk factors affecting the improvement of BF and VFA (P<0.05). Lower serum uric acid levels in patients with gout before and after ULT indicated better improvement effect of body fat and visceral fat areas( P<0.05). Conclusion:Gout combined with hyperuricemia is closely related to visceral obesity. In addition to lowering the serum uric acid level, ULT could also benefit the body fat and visceral fat area in patients with gout to some extent.

Objective To observe the significance of preoperative peripheral serum inflammatory cyto-kines and blood routine in predicting postoperative DVT in patients with neurosurgery.Methods A total of 156 pa-tients from the Department of Neurosurgery form April 2016 to April 2017 were recruited in this study.According to the incidence of postoperative deep venous thrombosis(DVT),patients were divided into DVT group(48 cases) and non-DVT group(108 cases). The date blood routine(including hematocrit,hemoglobin,neutrophil count, monocyte count,white blood cell count,platelet count)and serum inflammatory cytokines(including TNF-α,IL-1β,IL-1β,IL-6,IL-8)of two groups by t tests were compared.The possible risk factors for postoperative DVT in neurosurgical patients were analyzed by multivariate analysis logistic regression.The predicted cutoff value is deter-mined by plotting the subject's working characteristic(ROC)curve.Results Between the control group and DVT group,there were significant differences in preoperative blood neutrophil count,hemoglobin,TNF-α,IL-6 and IL-8(P < 0.05). Multivariate analysis logistic regression showed that the level of neutrophil count and concentration of serum TNF-α concentration were increased,indicating they may be the risk factors of DVT.For the neutrophilic granulocyte count,the value of specificity and sensibility was 82.7%and 61.7%respectively.For the TNF-α level, the value of specificity was 72.3% and the value of sensibility was 83.1%. Conclusion The level of preoperative neutrophil count and the concentration of TNF-α have value in predicting the occurrence of postoperative DVT in neurosurgical patients.

Objective To explore the efficacy of sulfasalazine for treatment for epilepsy induced by gliomas .Methods The patients with epilepsy caused by gliomas in neurosurgery department were recruited from March 2006 to December 2013 .Epilepsy was controlled with sulfasalazine .The efficacy of sulfasalazine for treatment for epilepsy induced by glioma were analyzed to calcu-late the 50% response rate ,75% response rate and seizure-free rate .Meanwhile the outcomes scores of therapy of sulfasalazine for varieties types of epilepsy were evaluated ,according to the end result of scoring criteria in epileptic seizures .Results A total of 31 patients were controlled with sulfasalazine .The average reduction rate of seizure frequency per month was 54 .32% ,61 .71% , 75 .74% after three months of treatment .The differences of average reduction rate of seizure frequency before and after the treat -ment have an evident statistic significance (P< 0 .01) .The 50% response rate ,75% response rate and seizure-free rate per month af-ter treatment with sulfasalazine have significant higher than those before treatment (F= 20 .007 ,P< 0 .01) .After 3 month of thera-py ,four different types of epilepsy was 100 .00% ,100 .00% ,84 .62% and 75 .00% in improvement rate added complete control rate .Those have no statistical difference(P> 0 .05) .Conclusion Sulfasalazine can effectively control seizures ,and both effective va-rious types of epileptic .

Objective To explore the protective effect of Mn (Ⅲl)tetrakis (4-benzoic acid) porphyrin (MnTBAP) on rats after intracerebral hemorrhage (ICH) and its mechanism.Methods Sixty-six adult SD rats were randomized into sham-operated group,control group and experimental group (n=22).Rats in the latter two groups were performed stereotactic injection of autologous tail arterial blood to induce ICH models;the rats in the experimental group were given 2 μL MnTBAP (100 μg/μL) by intracerebroventricular injection 30 min after ICH,while the rats in the control group were given normal saline of same volume.The expressions of 4-hydroxynonenonal (4-HNE,a marker of lipid peroxidation),3-nitrotyrosine (3-NT,a reliable marker of protein nitration),8-hydroxy-2'-deoxyguanosine (8-OHdG,a marker of DNA oxidative damage),Zonula occludens-1 (ZO-1,a kind of tight junction protein) and myeloperoxidase (MPO,a marker of neutrophil) in the perihematomal brain tissues 24 h after ICH were detected by immunofluorescence;protein expressions of ZO-1 and matrix metalloproteinase-9 (MMP-9) were detected by Western blotting 24 h after ICH;brain water content and modified neurological severity (mNSS) scores were measured 24 and 72 h after ICH.Results As compared with those in the control group,3-NT (264.53±83.99vs413.22±89.16),4-HNE (245.64±73.10vs 391.41±51.43),8-OHdG (221.53±68.25 vs 332.32±94.93),MPO (296.14±66.34 vs 431.59±102.68) and MMP-9 (0.75±0.07 vs 0.96±0.04) expressions in perihematomal brains of experimental group were significantly decreased,while the expressions of ZO-1 (0.74±0.05 vs 0.56±0.06) were significantly increased (P＜0.05).The mNSS scores (9.33±1.37 vs 11.33±1.51;6.17±0.98 vs 9.50±1.38) and brain water contents in the experimental group were significantly lower as compared with those in the control group 24 and 72 h after ICH (80.41％±0.69％ vs 82.48％±0.94％;79.78％±0.65％ vs 81.57％±0.82％) (P＜0.05).Conclusion MnTBAP could protect injured brain tissues by alleviating oxidative and nitrative stress,decreasing neutrophils invasion and MMP-9 activation at early stage of ICH;meanwhile,MnTBAP could relieve the blood-brain barrier disruption and neurological deficit following ICH.

Molecular mechanisms underlying the effects of Fyn on cell morphology, pseudopodium movement, and cell migration were investigated. The Fyn gene was subcloned into pEGFP-N1 to produce pEGFP-N1-Fyn. Chinese hamster ovary (CHO) cells were transfected with pEGFP-N1-Fyn. The expression of Fyn mRNA and proteins was monitored by reverse transcription-PCR and Western blotting. Additionally, transfected cells were stained with 4',6-diamidino-2-phenylindole and a series of time-lapse images was taken. Sequences of the recombinant plasmids pMD18-T-Fyn and pEGFP-N1-Fyn were confirmed by sequence identification using National Center for Biotechnology Information in USA, and Fyn expression was detected by RT-PCR and Western blotting. The morphology of CHO cells transfected with the recombinant vector was significantly altered. Fyn expression induced filopodia and lamellipodia formation. Based on these results, we concluded that overexpression of mouse Fyn induces the formation of filopodia and lamellipodia in CHO cells, and promotes cell movement.
Animals ; Blotting, Western ; CHO Cells ; Cricetinae ; Cricetulus ; Genetic Vectors ; Green Fluorescent Proteins/genetics ; Mice ; Proto-Oncogene Proteins c-fyn/genetics/*metabolism ; Pseudopodia/*metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Time-Lapse Imaging ; Transfection

Objective To discuss the diagnosis and surgical management of multilocular cystic renal cell carcinoma (MCRCC) and to evaluate the gene function of the mutation of von Hippel-Lindau (VHL) gene in MCRCC. Methods Seventeen MCRCC cases (11 men and 6 women) out of 512 cases of renal cell carcinoma from 2000 to 2010 were retrospectively analyzed. The mean age of the 17 patients was 46 years (37-61 years). Ultrasonography and CT were available in all 17 cases, and 1 case was misdiagnosed as parapelvic renal cyst. The mutation of VHL gene was detected by PCR in the specimens of can-cerous tissue and adjacent normal tissue from 11 cases of MCRCC. Results Three of 17 cases underwent nephron sparing surgery, the others underwent radical nephrectomy. One case underwent unroofing of parapelvic renal cyst, but the rapid frozen pathology of the cyst wall showed renal cell carcinoma of clear type. As a result, radical nephrectomy was eventually performed. All 17 cases were confirmed as MCRCC by eva-luating pathological characteristics, such as the cyst wall lined by single or several layers of clear tumor cells and the nuclei which were small and anachromasis. Clinical stages of all cases were T1N0M0, in which there were 14 cases with pathological T1G1 and 3 cases with pathological T1G2. All patients underwent a follow-up of 9 to 36 months (mean, 12 months) without recurrence or metastasis. Mutation of VHL gene was detected in 7 of 11 cases (64%), but all adjacent normal tissues were negative. Conclusions As a rare subtype of renal cell carcinoma, MCRCC is difficult to diagnose. CT is an essential measure in diagnosis of MCRCC preoperatively. Because of the good prognosis of reported cases, nephron sparing surgery for the treatment of MCRCC is recommended. VHL gene mutations may play an important role in the carcinogenesis of MCRCC.

Objective To explore the anatomical basis for clinical application of the compound flap pedicled with arterial arch of palpebral margin by observing eyelid blood supply and anatomical structure and to prove that it is an ideal method of repairing the eyelid defect for clinical application. Methods 15 adult cadavers (30 eyelids) were dissected. The origin, course, branches, diameters and vessel networks of palpebral margin arterial arch were observed particularly. 30 cases of eyelid marginal defect were reviewed and the therapeutic effect of this method evaluated. Results Eyelid was constituted by 5 layers: skin, subcutaneous tissue, muscle, tarsal plate and conjunctival layers. Most eyelid vessels were mutually anastomosed to form a constant vessel network. Palpebral margin arterial arch and peripheral arterial arch were formed by dorsal nasal artery branches and lacrimal artery branches, both of which nourished the eyelid tissue. All the compound flaps of 30 cases survived completely without any complications. All cases obtained satisfactory results functionally and esthetically. Conclusions The arterial arch of palpebral margin is constant and the blood supply of the compound flap is reliable. It can repair full eyelid defect with the same kind of tissue, and obtain satisfactory appearance. It is an ideal method of repairing the eyelid defect.

OBJECTIVETo introduce a method of repairing facial tissue defects caused by various factors.

METHODSThe reverse narrow pedicle lateral maxillocervical fasciocutaneous flap was designed with its pedicle located in front of auricle. The size of the flaps ranged from 5 cm x 6 cm to 10 cm x 11 cm. The length and width of the pedicle ranged 2 cm-5 cm and 1 cm-1.5 cm.

RESULTSThis fasciocutaneous flap was used in 21 cases. All flaps survived except 1 flap showing distal skin necrosis.

CONCLUSIONThis fasciocutaneous flap didn't include any major blood vessel. The ratio of the pedicle width to flap length broke that of traditional flap and was reverse transfer. The transposition of the narrow pedicle flap was easy. The postoperative appearance (color, texture, cosmetic aspect) was satisfactory. This method was a new design and was ideal for large facial tissue defect repair.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Face ; surgery ; Female ; Humans ; Infant ; Male ; Middle Aged ; Surgical Flaps