Determination of the microstructure and chemical composition of tophi

Objective:To explore the tophi in different parts of the human body of microstructure and main chemical components.To lay the foundation for further revealing the inflammatory response mechanism of gout patients.Methods:Use microscope,scanning electron microscope,etc.to observe the microstructure of tophi,and use scanning electron microscope energy spectrum analysis,X-ray fluorescence analysis,X-ray diffraction analysis,etc.to detect and analyze the main crystalline components and chemical elements of tophi.Results:Through HE staining and scanning electron microscopy,the tophi is irregular block shape and its interior is needle shaped and radial.The energy spectrum analysis showed that the main elements of tophi were C,N,O,Na,etc.X-ray fluorescence analysis was used to detect tophi in the knees,elbows,and feet,the main elements of tophi were Cl,S,Ca,P,etc.X-ray diffraction analysis showed that the main crystalline components of tophi were sodium urate hydrate and sodium dihydrogen urate hydrate.Conclusion:The mainly elements of tophi are C,N,O,Na,Ca,Cl,S,P,etc.The main crystalline components of tophi were sodium urate hydrate and sodium dihydrogen urate hydrate.

Multiple gouty tophi in the head and neck with normal serum uric acid:A case report and review of literatures

BACKGROUND Gouty tophus is rarely reported in the head and neck areas.To the best of our knowledge,this is the first report on multiple gouty tophi in the head and neck with normal serum uric acid(SUA)levels.CASE SUMMARY We report a case of multiple gouty tophi in the nasal dorsal and auricle regions with normal SUA levels.The patient was admitted to the hospital with a chief complaint of recurrent nasal swelling and pain for 3 years,which was aggravated for 3 d.The patient’s SUA level had been regularly reviewed in the outpatient department and had been successfully controlled for several years.Resection of the nasal masses was performed.Cartilage from the right ear cavity was used to repair the nasal defects.The pathological report confirmed a nasal gouty tophus.No recurrence or deformity was found after a 1 year follow-up.CONCLUSION Normal SUA cannot completely negate the diagnosis of gouty tophus,especially in some rare regions.

Sepsis complicated with secondary hemophagocytic syndrome induced by giant gouty tophi rupture: A case report

BACKGROUND Gouty tophi are a chronic granulomatous caused by a deposition of monosodium urate crystal deposition in the body.Once broken,it may easily induce severe infection.Sepsis complicated with secondary hemophagocytic syndrome induced by gouty tophi rupture is extremely rare in the clinical setting,and no such serious complications have been reported in literature.CASE SUMMARY This is a 52-year-old Chinese male patient with a 20-year history of gouty arthritis.At admission,the gout stone in the patient’s right ankle was broken and it secreted a white mucoid substance.During the course of treatment,the patient suffered from systemic inflammatory response syndrome multiple times.His condition gradually deteriorated,further complicated by hemophagocytic syndrome.After thorough removal of gout lesions and active anti-infection treatment and control of blood uric acid level,combined with multidisciplinary cooperation,the patient was finally cured.CONCLUSION Sepsis complicated with secondary hemophagocytic syndrome induced by gouty tophi rupture is extremely rare in the clinical setting.Timely and accurate diagnosis is very important to save patients'lives.

Osteochondral lesion of talus with gout tophi deposition:A case report

BACKGROUND Osteochondral lesion of talus is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone.It arises from diverse causes,and although trauma is implicated in many cases,it does not account for the etiology of every lesion.Gout is a chronic arthritic disease caused by excess levels of uric acid in blood.Intraosseous deposition of monosodium urate in the clavicle,femur,patella and calcaneus was reported previously.Gout is common disease but rare at a young age,especially during teenage years.Osteochondral lesion caused by intra-articular gouty invasion is very rare.CASE SUMMARY We encountered a rare case of a 16-year-old male who has osteochondral lesion of the talus(OLT)with gout.He had fluctuating pain for more than 2 years.We could see intra-articular tophi with magnetic resonance image(MRI)and arthroscopy.We performed arthroscopic exploration,debridement and microfracture.Symptoms were resolved after operation,and bony coverage at the lesion was seen on postoperative images.We had checked image and uric acid levels for 18 mo.CONCLUSION It is rare to see OLT with gouty tophi in young adults.While it is challenging,the accuracy of diagnosis can be improved through history taking,MRI and arthroscopy.

Construction of an easy-to-use predictive model for ultrasound-detected tophi to improve the detection of hidden tophi

Background:Musculoskeletal ultrasound is used in clinical practice to evaluate gout patients and is an effective imaging tool for the detection of tophi.The aim of this study was to analyze the factors associated with ultrasound-detected tophi in gout patients and to construct a clinical model to predict its occurrence and improve the detection of hidden tophi.Methods:Data of gout patients admitted to Beijing Jishuitan Hospital from January 2015 to December 2021 were collected.The complete and detailed information from gout cases with completed musculoskeletal ultrasound was included in the analysis.Univariate and multivariate analyses were used to identify independent factors associated with ultrasound-detected tophi.A nomogram was used to visualize the clinical predictive models.Results:Among 517 gout patients,rheumatologists found that 67 patients(13.0%)had subcutaneous tophi by visual observation,while musculoskeletal ultrasound revealed that 123 patients(23.8%)had ultrasound-detected tophi with odds ratio[OR](95%confidence intervals[CIs])=2.20(1.81-2.67).Disease duration,upper limb joint flare(ULJF),persistent joint pain(PJP),uric acid,and homocysteine levels were independently associated with ultrasounddetected tophi,and they had ORs(95%CIs)of 1.092(1.050-1.136),3.732(2.312-6.025),1.864(1.086-3.200),1.003(1.001-1.004),and 1.015(1.000-1.030),respectively.After balancing the complexity and accuracy of the model,Model 2(incorporating disease duration,ULJF,PJP,and uric acid)was chosen to create a nomogram to predict the occurrence of ultrasound-detected tophi.The nomogram had good discrimination(consistency index[C-index]=0.774)and excellent calibration,demonstrated by calibration curves.Conclusion:Using easily available indicators,such as disease duration,the nature of the joint pain,and uric acid levels,we successfully developed an easy-to-use clinical model to improve the detection of hidden tophi.

MMP 3在评估痛风性关节炎骨侵蚀中的临床应用

目的探讨血清基质金属蛋白酶-3(MMP-3)在痛风性关节炎合并有痛风石患者中发生骨侵蚀的临床应用研究。方法采用回顾性研究方法,依据2015年美国风湿病学会/欧洲抗风湿联盟痛风分类标准以及痛风发作关节的X线、肌骨超声或双源CT检查结果,收集2022年6月至2023年3月于南京市第一医院风湿免疫科就诊的159例痛风性关节炎患者,分为无骨侵蚀组85例及有骨侵蚀组74例。采用乳胶增强免疫比浊法检测两组血清MMP 3水平,比较两组血清MMP 3水平的差异,综合影像学结果,评估血清MMP 3水平对痛风性关节炎患者骨侵蚀的评价及预测效能,分析痛风性关节炎患者骨侵蚀发生的影响因素。结果有骨侵蚀组血清MMP 3水平显著高于无骨侵蚀组150.31(74.99,216.55)ng/mL vs 60.15(43.58,75.34)ng/mL,差异具有统计学意义(P<0.001)。血清MMP 3水平预测痛风性关节炎患者骨侵蚀的最佳截断值为118.19ng/mL,曲线下面积(AUC)为0.811。多因素Logistic回归分析结果显示血清MMP 3水平是痛风性关节炎患者发生骨侵蚀的独立危险因素(OR=1.04,95%CI 1.02~1.07,P<0.001)。结论血清MMP 3水平与痛风性关节炎患者骨侵蚀的发生密切相关,对于痛风性关节炎骨侵蚀的预测提供一定依据,具有临床应用价值。

痛风急性发作危险因素分析

目的分析痛风急性发作的危险因素。方法4649例痛风患者根据是否处于急性发作期分为急性组(302例,痛风急性期)和慢性组(4347例,痛风慢性期),采用单因素分析法及多因素Logistic回归分析法分析痛风急性发作的相关因素和危险因素。结果两组血清γ-谷氨酰转移酶(GGT)、门冬氨酸氨基转移酶(AST)、总胆红素、直接胆红素、间接胆红素、血糖(GLU)、甘油三酯(TG)、血尿素氮(BUN)、肌酐(CREA)、尿酸、肾小球滤过率、合并痛风石比较,P均<0.05。多因素分析显示,高GGT、AST、GLU、TG、BUN、CREA及合并痛风石是痛风急性发作的独立危险因素(P均<0.05)。结论GGT、AST、GLU、TG、BUN、CREA及合并痛风石是痛风急性发作的危险因素。

手术切除手足关节痛风石患者康复情况影响因素分析及临床预测模型

目的 分析影响手术切除手足关节痛风石患者康复情况的危险因素,并构建临床预测模型。方法 选取2017年1月至2021年6月我院收治的手术切除手足关节痛风石的病例105例,根据患者术后4个月康复情况分为显效组65例和非显效组40例,记录患者性别、年龄、病程、高血压病、糖尿病、高脂血症、术后饮酒、手术方式、医嘱依从性、术后清淡饮食、术前痛风发作情况、术后心理状态、术后功能锻炼等因素,对相关因子进行单因素分析,并对有统计学意义的因子再进行多因素logistic回归分析,并建立风险预测模型。随后使用该模型对剩下的40例患者进行评估,结果采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)进行统计分析,检验该临床预测模型的预测效能。结果 两组在年龄、术后饮酒、手术方式、医嘱依从性、术后清淡饮食、术后心理状态这6项危险因素上比较,差异有统计学意义(P<0.05)。对这些因素使用logistic回归分析构建临床预测模型。通过ROC曲线评价该模型的鉴别效度,结果显示:AUC=0.867,敏感度为81.3%,特异度为83.3%。结论 手术切除手足关节痛风石患者康复情况受多种因素影响,以此建立的临床预测模型对手术切除手足关节痛风石患者康复情况预测具有良好的判别能力,值得临床应用与进一步研究。

手术治疗膝关节巨大痛风石1例

患者,男,43岁。因发现左膝关节肿块4年,左下肢活动受限半年余入院。患者既往有大量饮酒史。2006至2012年,左膝红肿疼痛间歇性发作,每年2次,曾在外院诊断为痛风,期间不规则服用碳酸氢钠片及苯溴马隆片,症状缓解,近几年未发作。4年前无明显诱因下左膝内上方出现一鹌鹑蛋大小的肿块,无明显疼痛,未予特殊处理,后肿块逐渐增大,至2013年发现肿块大小增至约5 cm×5 cm。

单源双能量CT在显示痛风结石沉积中的应用研究

目的 研究单源双能量CT在显示痛风结石沉积中的价值.方法 回顾性分析22例临床确诊痛风患者的单源双能量CT图像,观察关节、周围滑膜、肌腱韧带走行区有无绿色痛风石沉积,记录痛风石沉积部位、大小、范围及周边骨质情况,与常规CT检查对比观察结果.结果 22例患者的单源双能量CT检查共发现283处痛风结石沉积,常规CT发现128处,其中大小在0.1～0.3cm范围内痛风结石,单源双能量CT能清晰显示、标记,常规CT不能发现,单源双能量CT显示痛风结石沉积能力和敏感性均高于常规CT.结论 单源双能量CT在显示痛风结石沉积中有较高的特异性和敏感性,为痛风患者早期诊断提供了一种全新的无创性的检查技术.

痛风石的微观结构及化学成分的测定

目的:探讨人体不同部位痛风石的微观结构及其主要化学成分,为进一步揭示痛风患者的炎症反应机制奠定基础。方法:应用显微镜、扫描电镜等方法对痛风石的微观结构进行观察,并应用扫描电镜能谱分析、X荧光分析、X射线衍射分析等手段对痛风石的主要晶态成分和化学元素进行检测分析。结果:通过H&E染色和扫描电镜对痛风石进行观察,发现其为不规则块状形态,内部呈针形、放射状;对痛风石进行能谱分析,发现其主要元素为C、N、O、Na等;应用X荧光分析对膝、肘、足部位痛风石进行检测,发现其主要元素分别为Cl、S、Ca、P等;通过X射线衍射法检测发现痛风石的主要晶态成份为尿酸钠水合物和尿酸二氢钠水合物。结论:痛风石主要由C、N、O、Na、Ca、Cl、S和P等元素构成,组成化合物主要为尿酸钠水合物和尿酸二氢钠水合物。

Characteristics of ocular abnormalities in gout patients

·AIM: To characterize the clinical features of ocular surface in gout patients in coastal area of Shandong Province in China. ·METHODS: A total of 380 consecutive gout patients were examined from January 2011 to May 2011. According to the course of gout, patients were divided into group A (【5 years), B (5 -10 years) and C (】10 years). Group D (control group) was consist of 50 healthy subjects. Eyelids, lateral canthus, medial canthus, palpebral conjunctiva, sclera and cornea, anterior chamber, lens, anterior vitreous were examined by slit lamp to find whether there were deposition of uric acid crystals, ocular vascular tortuosity, redness and subconjunctival hemorrhage. The ophthalmic exams of visual acuity, intraocular pressure, fundus were used to assess any gout-related eye disease. ·RESULTS: Uric acid crystals were found in 3 patients and the positions of the deposite were in corneal stroma, corneal epithelium and superficial stroma, and sclera respectively. The incidence was 0.79% . Dilatated and tortuous blood vessels in conjunctiva and sclera surface were found in 38 (23.8% ), 40 (44.0% ), 58 (45.0% ), 9 (18.0% ) patients in groups A, B, C and D, respectively. The differences between group B and D, group C and D were statistically significant( 【0.01, 【0.01).Transparent vesicles with metal -like reflected light in subconjunctiva were seen in 26 (16.2%), 29 (31.9%), 41 (31.8%), 2 (4.00%) patients in groups A, B, C and D, respectively. The differences between A and D, B and D, C and D were statistically significant ( 【0.05, 【0.01, 【0.01). Subconjunctival hemorrhage was found in all groups, the difference among the four groups showed no statistically significance. · CONCLUSION: Gout can cause ocular surface abnormalities, such as tophi deposition, subconjunctival transparent vesicles and hemorrhage, and vascular changes. These features have important clinical significance in early detection of the gout and prevention of eye injury. ·

Spinal gout:A review with case illustration

AIM To summarize clinical presentations and treatment optionsof spinal gout in the literature from 2000 to 2014, and present theories for possible mechanism of spinal gout formation.METHODS The authors reviewed 68 published cases of spinal gout, which were collected by searching "spinal gout" on Pub Med from 2000 to 2014. The data were analyzed for clinical features, anatomical location of spinal gout, laboratory studies, imaging studies, and treatment choices. RESULTS Of the 68 patients reviewed, the most common clinical presentation was back or neck pain in 69.1% of patients. The most common laboratory study was elevated uric acid levels in 66.2% of patients. The most common diagnostic image finding was hypointense lesion of the gout tophi on the T1-weighted magnetic resonance imaging scan. The most common surgical treatment performed was a laminectomy in 51.5% and non-surgical treatment was performed in 29.4% of patients.CONCLUSION Spinal gout most commonly present as back or neck pain with majority of reported patients with elevated uric acid. The diagnosis of spinal gout is confirmed with the presence of negatively birefringent monosodium urate crystals in tissue. Treatment for spinal gout involves medication for the reduction of uric acid level and surgery if patient symptoms failed to respond to medical treatment.

双能CT成像在痛风诊断中应用效果分析

目的观察双能量CT在痛风石成像诊断中的应用效果。方法整群选择2013年5月—2014年8月间在黑龙江省医院CT室进行检查的47例有关节痛并怀疑痛风患者资料作为研究对象,所有患者均行痛风"金标准"检查,均具有双能量CT检查资料,记录诊断准确性。结果 47例具有痛风金标准检查资料的患者经过双能CT检查经过图像后处理及痛风分析后,有43例存在绿色痛风结石,诊断符合率为91.5%,与金标准资料比较(χ2=2.261,P=0.152),差异无统计学意义。结论双能量CT检测痛风石在临床痛风诊断中具有较高的应用价值,是一种新型影像检查技术,在临床具有较大的应用空间及发展潜力。

两例秃鹫(Aegypius monachus)痛风病自然病例的诊断和病理学观察

本研究以尸体剖检和组织病理学方法诊断了2例秃鹫(Aegypius monachus)痛风病并进行系统的病理学观察。结果表明2只秃鹫均表现为严重的痛风性关节炎和内脏痛风。尸体剖检显示双侧跗关节和趾关节明显肿大,关节腔内积有大量灰白色黏稠的尿酸盐结晶。除脑和脊髓外,全身组织器官表面和切面散在或弥漫性分布大小不等的点状、细针状、条索状和斑状的痛风结节。组织病理学观察显示全身各组织器官内均散在或弥漫性分布大小不等的圆形、椭圆形红染的Ⅰ型和Ⅱ型痛风结节。Ⅰ型痛风结节呈向日葵样或车轮状,完全是由以中心向周围辐射状排列的尿酸盐结晶构成;Ⅱ型痛风结节为典型的肉芽肿,结节边缘为多核巨细胞和上皮样细胞构成的特殊肉芽组织,结节中央为呈放射状排列的尿酸盐结晶。全身组织器官的实质细胞轻度到严重的坏死。本研究在国内首次系统阐述了秃鹫痛风病自然病例的病理变化,明确痛风结节的组织学结构。

四肢多发痛风石的手术治疗

2008年6月-2015年1月,我科对23例四肢多发痛风石患者（102个部位）选择性手术切、刮除部分痛风石,疗效满意,报道如下.

手部痛风石切除术后临床护理康复

目的:探讨手部痛风石术后护理以及注意事项。方法:选择9例行痛风石刮除术患者,总结术后的治疗、护理及康复等经验。结果:手部痛风石切除术后,经过积极护理康复治疗,9名患者切口均可愈合,手关节功能基本恢复,痛风石均未见复发。结论:针对手部痛风石患者,总结出一系列行之有效的术后护理及康复的办法。

河南省儿童口腔疾病综合干预项目地区4868名学生牙周健康状况调查

目的:了解河南省儿童口腔疾病综合干预项目实施5年后,项目学校和非项目学校5~6级学生牙周健康现状及其影响因素。方法:2020年采用随机整群抽样法在河南省参与2015年全国儿童口腔疾病综合干预项目的8个县(区)中抽取项目学校和非项目学校5~6年级学生共4 868人进行口腔检查。结果:4 868名受检者中,牙龈出血检出率为53.53%,牙石检出率为48.75%。儿童口腔疾病综合干预项目学校学生牙龈出血检出率(50.68%)低于非项目学校学生(56.35%),差异有统计学意义(χ^(2)=15.746,P<0.05)。2年级时牙齿进行过窝沟封闭的学生牙龈出血检出率(50.82%)低于未进行过窝沟封闭的学生(55.35%),差异有统计学意义(χ^(2)=9.642,P<0.05)。多因素logistic回归分析结果显示,城乡、干预学校类型、父亲最高学历、甜饮料摄入频率是牙龈出血的影响因素,城乡、性别、年级是牙石的影响因素。结论:河南省儿童口腔疾病综合干预项目地区儿童牙周健康状况有所改善,项目可能从一定程度上对儿童牙齿健康状况起到了保护作用。

VSD治疗足部痛风石破溃伴严重感染创面的体会

Objective Investigate the clinical effects of Vacuum Sealing Drainage(VSD)in the treatment of 11 cases of foot tophi rupture with severely infected wounds.Methods From January 2017 to January 2019,11 patients with foot tophi rupture and severe infection were enrolled in our department.There were 9 males and 2 females,aged from 27 to 68 years old.All patients were treated with VSD after debridement.The treatment time was 7d-42d,with an average of 17d.Results All patients were followed up for 6 months after VSD treatment.All the wounds healed well without complications.Conclusion VSD is used to treat foot tophus rupture with severe infection of wounds.It is easy to operate and satisfactory in clinical results.

双能CT检测对非布司他治疗尿酸盐结晶痛风患者的疗效评估

目的探讨分别给予非布司他和别嘌醇缓释胶囊治疗尿酸盐结晶痛风患者的临床疗效及双能CT的疗效评估。方法以天津第一中心医院风湿免疫科2015年6月~2016年5月就诊的100例痛风患者为研究对象,随机分为两组,其中A组50例,给予非布司他20mg^40mg.1次/日口服;B组50例,给予别嘌醇缓释胶囊250mg.1次/日口服。分别记录治疗前后尿酸结晶数、平均尿酸晶体体积、血清C反应蛋白(CRP)及血尿酸值变化;通过双能CT(dual energy CT,DECT)对尿酸盐结晶溶解的疗效进行评估。结果 A组治疗前后尿酸盐结晶数、平均尿酸盐晶体体积、血清CRP及血尿酸值改变具有统计学意义(P<0.05)。B组治疗前后血清CRP及血尿酸值改变具有统计学意义(P<0.05),尿酸盐结晶数、平均尿酸盐晶体体积改变无统计学学意义(P>0.05)。降尿酸治疗1年后,A、B组在血清CRP及血尿酸值改变无统计意义(P>0.05),在痛风石数目、尿酸盐结晶数、平均尿酸盐晶体体积改变具有统计意义(P<0.05)。结论对有尿酸盐结晶痛风患者给予非布司他治疗,可在尿酸持续达标的基础上,持续溶解尿酸盐结晶,疗效明确,优于别嘌醇缓释胶囊,具有很好的临床运用前景;双能CT检测对有尿酸盐结晶的痛风患者的治疗起到监测疗效和评估作用。