Tophaceous wound represent a severe complication of end-stage gout, characterized by the deposition of monosodium urate (MSU) crystals leading to localized tissue ischemia, chronic inflammation, and non-healing ulcers. The pathological mechanism involves the formation of MSU crystals under persistent hyperuricemia, inflammatory encapsulation, and mechanical compression of the vascular system due to tophus enlarge-ment, ultimately resulting in chronic non-healing ulcers. This article consolidates current evidence to outline an integrated management strategy for such wounds, combining systemic metabolic control with localized interventions. Effective treatment depends on maintaining serum uric acid levels below 300 μmol/L through urate-lowering agents, including conventional drugs and novel urate transporter 1 inhibitors such as AR882, complemented by anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs and glucocorticoids to alleviate pain and reduce inflammation. Topical agents and advanced dressings are utilized to support healing and manage exudate. Debridement, which encompasses sharp, ultrasonic, and micro-techniques, is essential for removing necrotic tissue and MSU deposits, with efficacy assessed via local uric acid monitoring. Surgical reconstructions, including skin flap grafting and tendon or ligament reconstruction, are indicated for significant tissue loss or functional impairment. Long-term management emphasizes continuous metabolic control, personalized rehabilitation, and lifestyle modification. The comprehensive treatment of tophaceous wounds requires multidisciplinary collaboration to balance local repair and systemic regulation for improved prognosis. Future research directions include gene therapy to regulate purine metabolism and artificial intelligence-assisted personalized treatment plans, to achieve precision medicine for tophaceous wounds.
Humans ; Wound Healing ; Gout/therapy* ; Uric Acid/blood* ; Debridement

Objective:To analyze the clinical characteristics, cerebrospinal fluid (CSF) and other auxiliary examination results of febrile children with convulsions in order to provide the evidence for clinical recognition of central nervous system (CNS) infection and its etiology.Methods:The clinical data of 64 fever patients with convulsions admitted at the Department of Neurology, Shanghai Children′s Medical Center, Shanghai Jiaotong University School of Medicine were analyzed retrospectively.According to the results of the routine biochemical examination of CSF, they were divided into 2 groups as CSF normal group (44/64 cases, 69%) and CSF abnormal group (20/64 cases, 31%). Their age, gender, clinical manifestations, physical symptoms and auxiliary examination results were compared between the two groups. Logistic regression analysis was performed to explore the independent risk factors of abnormal CSF results.Twenty children with abnormal CSF results were divided into the normal glucose group (12/20 cases, 60%) and the glucose reduction group (8/20 cases, 40%) according to the glucose level of CSF.The fever duration, serum inflammation markers, CSF routine and biochemical indexes of the two groups were compared. Results:According to Logistic multivariate unconditional regression analysis, the mental state change ( OR=435.99, P=0.010), abnormal neurological signs ( OR=65.25, P=0.023) and vomiting ( OR=20.56, P=0.048) were the high risk factors of abnormal CSF results.Among the children with abnormal CSF results, in the glucose reduction and normal glucose groups, the fever duration was 12.50 (7.75-16.75) d and 4.00 (3.00-5.75) d, respectively; the level of CSF protein were 3 000 (1 745-3 000) mg/L and 648 (469-1 734) mg/L, respectively; the erythrocyte sedimentation rate (ESR) was 71.50(56.00-97.50) mm/1 h and 20.50 (12.00-26.00) mm/1 h, respectively; the procalcitonin level was 2.76(0.90-20.72) g/L and 0.23 (0.03-1.00) g/L, respectively; the C-reactive protein (CRP) level was 123.00 (33.00-177.75) mg/L and 12.50(4.25-57.75) mg/L, respectively.The fever duration, CSF protein level, ESR, procalcitonin level and CRP level were statistically different between the glucose reduction and normal glucose groups (all P<0.05). Conclusions:In fever children with convulsions, vomiting, the mental state change, and abnormal neurological signs are the high risk factors of abnormal CSF results, suggesting the possibility of CNS infections and the need of early diagnosis by CSF and other auxiliary examinations.In addition, a low level of CSF glucose in children with abnormal CSF results may be a potential and powerful clue for purulent meningitis.Timely etiological tests are required for confirmation, and antibiotics treatments should be applied as early as possible.

From the perspective of efficacy evaluation based on the literatures of MEDLINE database,the study carries out a bibliometrics study on domestic and foreign acupuncture clinical trials of the past three decades.The study involves the statistical classification on different systems and diseases,as well as statistics of diseases species on RCT or non- RCT involved,which will provide ideas and directions on diseases selection for the efficacy evaluation and re-evaluation researches in the field of evidence based medicine.

Taking Science Citation Index Expanded (SCI-Expanded) as information source,and using methods of bibliometric analysis,Chinese Medicine international co-authored articles which published from 1998 to 2010 were statistically analyzed on publish year,document growth,active fields,etc.,aiming to look for status and trends in International Collaboration of the Traditional Chinese Medicine,and to be a reference for researchers.

To have an overview of the international status and trends of complementary and alternative medicine (CAM) research, and to provide a reference tool for researchers.

Based on the literatures in MEDLINE database and EMBASE databases this article has carried out a bibliometrics study on foreign clinical researching institutions of acupuncture and moxibustion to screen those institutions who had more published articles as our major cooperation and exchange objects in the future,hoping for providing information basis of TCM international scientific research.

This article is basing on the literatures of Pubmed database, collecting and analyzing recent-year abroad researches that related on Chinese anti-neoplasms herbs and botanicals.

By summarizing PUBMED documents of the recent 10 years,which focus on the overseas acupuncture treatment of cancer,the author analyzed the overseas status of acupuncture treatment on cancer,searched the priorities and problems,and advocated advices for domestic researches of clinical and fundamental acupuncture treatment on cancer.

This article reviewed development and current situation of Complementary and Alternative Medicine(CAM) in developed countries such as european countries, Japan, South Korea, Australia and the United States of recent years. The items included in this study were the situation of medical treatment, construction of medical institutions and associations, medical cost and the insurance. The article also made a suggestion on the development of TCM in China in order to ensure her leading role in the field of traditional medicine in the world.