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Sample records for gout flare twenty-four-hour

  1. Twenty-four hour care for schizophrenia.

    Science.gov (United States)

    Macpherson, Rob; Edwards, Thomas Rhys; Chilvers, Rupatharshini; David, Chris; Elliott, Helen J

    2009-04-15

    Despite modern treatment approaches and a focus on community care, there remains a group of people who cannot easily be discharged from psychiatric hospital directly into the community. Twenty-four hour residential rehabilitation (a 'ward-in-a-house') is one model of care that has evolved in association with psychiatric hospital closure programmes. To determine the effects of 24 hour residential rehabilitation compared with standard treatment within a hospital setting. We searched the Cochrane Schizophrenia Group Trials Register (May 2002 and February 2004). We included all randomised or quasi-randomised trials that compared 24 hour residential rehabilitation with standard care for people with severe mental illness. Studies were reliably selected, quality assessed and data extracted. Data were excluded where more than 50% of participants in any group were lost to follow-up. For binary outcomes we calculated the relative risk and its 95% confidence interval. We identified and included one study with 22 participants with important methodological shortcomings and limitations of reporting. The two-year controlled study evaluated "new long stay patients" in a hostel ward in the UK. One outcome 'unable to manage in the placement' provided usable data (n=22, RR 7.0 CI 0.4 to 121.4). The trial reported that hostel ward residents developed superior domestic skills, used more facilities in the community and were more likely to engage in constructive activities than those in hospital - although usable numerical data were not reported. These potential advantages were not purchased at a price. The limited economic data was not good but the cost of providing 24 hour care did not seem clearly different from the standard care provided by the hospital - and it may have been less. From the single, small and ill-reported, included study, the hostel ward type of facility appeared cheaper and positively effective. Currently, the value of this way of supporting people - which could be

  2. Epidemiology of inpatient gout in Australia and New Zealand: temporal trends, comorbidities and gout flare site.

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    Robinson, Philip C; Kempe, Sarina; Tebbutt, Ian; Roberts, Lynden

    2017-06-01

    To assess the epidemiology of inpatient gout in Australia and New Zealand during the years 2009-2014. Using the Health Roundtable Limited (HRT) dataset, all patients with a coded ICD10 primary or secondary discharge diagnosis of gout from a HRT participating Australian or New Zealand hospital between the years 2009 and 2014 were identified. The number of inpatient gout admissions, length of stay, body site of gout flare, temporal trends and comorbidities were assessed. During 2009-2014, the number of gout admissions increased significantly in Australia and New Zealand. The rate of inpatient gout admissions relative to the population and total HRT admissions rose in Australia and stayed static in New Zealand. Lower limb presentations were the commonest anatomical site of gout in admitted patients. Length of stay over the course of the study decreased both in patients admitted for gout and in those in the entire HRT dataset. Patients admitted for gout have longer length of stay compared to patients admitted for other reasons. Cardiovascular disease, infection and stroke were the commonest conditions that were complicated by an episode of inpatient gout. There was no influence of month or season on the pattern of gout admissions. The number of gout admissions rose in Australia numerically and as a proportion of the total population and total admissions. Gout is an increasing problem affecting individuals and the community as a whole in Australia. © 2016 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  3. Twenty-four-hour ambulatory blood pressure monitoring in very elderly patients

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    Cappelleri, Claudia; Janoschka, Alin; Berli, Reto; Kohler, Sibylle; Braun-Dullaeus, Ruediger C.; Heuss, Ludwig T.; Wolfrum, Mathias

    2017-01-01

    Abstract Elevated blood pressure (BP) is frequently diagnosed in very elderly hospitalized patients. Accurate diagnosis of hypertension is challenging in the hospital environment, due to the “white coat effect,” and both overtreatment and undertreatment can adversely affect clinical outcome. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) has the potential to avoid the “white coat effect” and accurately guide the management of hypertension. However, effects of the hospital environment on ABPM are unknown in the very elderly. We set out to enroll 45 patients, age ≥70 years, with elevated conventional BP during hospitalization in this observational study. It was prespecified by protocol to assess initially the difference between 24-hour BP during hospital-admission and home follow-up. Subsequent analysis should investigate the change in anxiety (Hospital Anxiety and Depression Scale-A [HADS-A]) after discharge, the correlation with change in 24-hour BP after discharge, and the prevalence of orthostatic hypertension. Thirty-one patients were included in the final analysis (age 83.5 ± 4.4 years; 71% female). Twenty-four-hour BP decreased significantly after hospital discharge (systolic from 133.5 ± 15.6 to 126.2 ± 14.4 mm Hg [millimeter of mercury], P = .008; diastolic from 71.0 ± 9.0 to 68.3 ± 8.6 mm Hg, P = .046). Anxiety level (HADS-A) decreased significantly after discharge, from 7.5 (interquartile range [IQR]: 4.0–13.8) to 5.0 (IQR: 4.0–8.0, P = .012). The change in anxiety was a predictor of change in systolic BP after discharge (F[1,20] = 5.9, P = .025). Sixty-one percent of the patients had significant orthostatic hypotension during hospital stay. In conclusion, 24-hour BP in very elderly patients is lower in the home environment than during hospitalization. This phenomenon seems to be directly linked to a lower anxiety-level at home. Reassessing hypertension at home may decrease the

  4. Isolated total RNA and protein are preserved after thawing for more than twenty-four hours

    Science.gov (United States)

    de Oliveira, Ivone Braga; Ramos, Débora Rothstein; Lopes, Karen Lucasechi; de Souza, Regiane Machado; Heimann, Joel Claudio; Furukawa, Luzia Naôko Shinohara

    2012-01-01

    OBJECTIVE: The preservation of biological samples at a low temperature is important for later biochemical and/or histological analyses. However, the molecular viability of thawed samples has not been studied sufficiently in depth. The present study was undertaken to evaluate the viability of intact tissues, tissue homogenates, and isolated total RNA after defrosting for more than twenty-four hours. METHODS: The molecular viability of the thawed samples (n = 82) was assessed using the A260/A280 ratio, the RNA concentration, the RNA integrity, the level of intact mRNA determined by reverse transcriptase polymerase chain reaction, the protein level determined by Western blotting, and an examination of the histological structure. RESULTS: The integrity of the total RNA was not preserved in the thawed intact tissue, but the RNA integrity and level of mRNA were perfectly preserved in isolated defrosted samples of total RNA. Additionally, the level of β-actin protein was preserved in both thawed intact tissue and homogenates. CONCLUSION: Isolated total RNA does not undergo degradation due to thawing for at least 24 hours, and it is recommended to isolate the total RNA as soon as possible after tissue collection. Moreover, the protein level is preserved in defrosted tissues. PMID:22473407

  5. Managing Gout Flares in the Elderly: Practical Considerations.

    Science.gov (United States)

    Abhishek, Abhishek

    2017-12-01

    Gout is common in the elderly, affecting an estimated 4.7 million people aged > 60 years in the USA alone. The incidence and prevalence of gout increases, and male predisposition to gout reduces, with increasing age. The elderly have more comorbidities, and gout manifests differently, with more frequent involvement of knees, ankles, and wrists at disease onset, systemic upset, and tophi. Comorbidities and polypharmacy make the management of gout flares challenging in this population. Intra-articular corticosteroid injection remains the treatment of choice for accessible joints, oral prednisolone is preferred over low-dose colchicine, and non-steroidal anti-inflammatory drugs (NSAIDs) are best avoided. Xanthine oxidase inhibitors (XOI) remain the first-line treatment for hyperuricemia in the elderly. Arhalofenate, an emerging uricosuric anti-inflammatory drug, prevents gout flares while reducing serum urate. It may be particularly relevant in the treatment of gout in the elderly as they are unable to tolerate long-term colchicine for flare prophylaxis and frequently have contraindications to corticosteroids and NSAIDs. However, given its modest urate-lowering effect, it can only be used in combination with an XOI, and the safety and efficacy of this drug has not been examined in the elderly or in those with chronic kidney disease. Diuretics and beta-blockers should be discontinued where feasible, whereas low-dose aspirin can be continued if otherwise indicated.

  6. Current gout treatment and flare in South Korea: Prophylactic duration associated with fewer gout flares.

    Science.gov (United States)

    Choi, Hyo Jin; Lee, Chan Hee; Lee, Joo Hyun; Yoon, Bo Young; Kim, Hyoun Ah; Suh, Chang Hee; Choi, Sang Tae; Song, Jung Soo; Joo, Ho Yeon; Choi, Sung Jae; Lee, Ji Soo; Shin, Kee Chul; Baek, Han Joo

    2017-04-01

    To evaluate treatment patterns and clinical factors affecting gout flare in South Korea. We retrospectively examined data from 401 patients seen at nine rheumatology multicenter clinics, under urate lowering therapy (ULT) more than 6 months after stopping prophylactic medication. Demographic data, clinical and laboratory features were collected at the initiation of ULT, upon stopping prophylaxis, and 6 months after. The mean age was 52.2 years and mean disease duration was 25.0 months. The male-to-female count was 387 : 14. The most common ULT starting agent was allopurinol 83.8%. Colchicine (62.3%) was the most commonly prescribed prophylactic agent. During ULT, 134 of the 401 patients (33.4%) experienced at least one gouty attack in the period from stopping prophylaxis to 6 months later. The duration of prophylaxis was different between those with serum uric acid levels below 6 mg/dL and those over 6 mg/dL (P = 0.001). Of the 179 patients (44.6%) who attained target serum uric acid (SUA) levels (6 mg/dL) at the end of prophylaxis, those taking gout flares during ULT. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  7. Variability in the Reporting of Serum Urate and Flares in Gout Clinical Trials

    DEFF Research Database (Denmark)

    Stamp, Lisa K; Morillon, Melanie B; Taylor, William J

    2018-01-01

    OBJECTIVE: To describe the ways in which serum urate (SU) and gout flares are reported in clinical trials, and to propose minimum reporting requirements. METHODS: This analysis was done as part of a systematic review aiming to validate SU as a biomarker for gout. The ways in which SU and flares.......3%) of these reporting at more than just the final study visit. Two ways of reporting gout flares were identified: mean flare rate and percentage of participants with flares. There was variability in time periods over which flares rates were reported. CONCLUSION: There is inconsistent reporting of SU and flares in gout...... studies. Reporting the percentage of participants who achieve a target SU reflects international treatment guidelines. SU should also be reported as a continuous variable with a relevant central and dispersion estimate. Gout flares should be reported as both percentage of participants and mean flare rates...

  8. Brief Report: Validation of a Definition of Flare in Patients With Established Gout.

    Science.gov (United States)

    Gaffo, Angelo L; Dalbeth, Nicola; Saag, Kenneth G; Singh, Jasvinder A; Rahn, Elizabeth J; Mudano, Amy S; Chen, Yi-Hsing; Lin, Ching-Tsai; Bourke, Sandra; Louthrenoo, Worawit; Vazquez-Mellado, Janitzia; Hernández-Llinas, Hansel; Neogi, Tuhina; Vargas-Santos, Ana Beatriz; da Rocha Castelar-Pinheiro, Geraldo; Amorim, Rodrigo B C; Uhlig, Till; Hammer, Hilde B; Eliseev, Maxim; Perez-Ruiz, Fernando; Cavagna, Lorenzo; McCarthy, Geraldine M; Stamp, Lisa K; Gerritsen, Martijn; Fana, Viktoria; Sivera, Francisca; Taylor, William

    2018-03-01

    To perform external validation of a provisional definition of disease flare in patients with gout. Five hundred nine patients with gout were enrolled in a cross-sectional study during a routine clinical care visit at 17 international sites. Data were collected to classify patients as experiencing or not experiencing a gout flare, according to a provisional definition. A local expert rheumatologist performed the final independent adjudication of gout flare status. Sensitivity, specificity, predictive values, and receiver operating characteristic (ROC) curves were used to determine the diagnostic performance of gout flare definitions. The mean ± SD age of the patients was 57.5 ± 13.9 years, and 89% were male. The definition requiring fulfillment of at least 3 of 4 criteria (patient-defined gout flare, pain at rest score of >3 on a 0-10-point numerical rating scale, presence of at least 1 swollen joint, and presence of at least 1 warm joint) was 85% sensitive and 95% specific in confirming the presence of a gout flare, with an accuracy of 92%. The ROC area under the curve was 0.97. The definition based on a classification and regression tree algorithm (entry point, pain at rest score >3, followed by patient-defined flare "yes") was 73% sensitive and 96% specific. The definition of gout flare that requires fulfillment of at least 3 of 4 patient-reported criteria is now validated to be sensitive, specific, and accurate for gout flares, as demonstrated using an independent large international patient sample. The availability of a validated gout flare definition will improve the ascertainment of an important clinical outcome in studies of gout. © 2017, American College of Rheumatology.

  9. Assessment of myocardial viability in patients with myocardial infarction using twenty-four hour thallium-201 late redistribution imaging

    International Nuclear Information System (INIS)

    Yang Xiangjun; He Yongming; Zhang Bin; Wu Yiwei; Hui Jie; Jiang Tingbo; Song Jianping; Liu Zhihua; Jiang Wenping

    2006-01-01

    Rest thallium-201 ( 201 Tl) myocardial perfusion imaging has been widely used for evaluation of myocardial ischemia/viability after myocardial infarction, but the ideal timing for imaging after injection to maximally estimate viability is not well established. Thirty-six patients with myocardial infarction underwent the initial, 3 h, and 24 h redistribution imaging after intravenous injection of 148-185 MBq 201 Tl. The initial and 3 h images, the initial and 24 h images, and the 3 and 24 h images were compared double-blinded. Out of the 184 abnormal segments based on the initial imaging, 56 (30%) segments improved by at least 1 grade on the 3 h imaging while 78 (42%) segments improved by at least 1 grade on the 24 h imaging. The 24 h late imaging detected more viable myocardium than the 3 h imaging did, with a significant difference (χ 2 =5.680, p=0.017). There were 158 abnormal segments on the 3 h imaging, with average 28% (44) segments improved by at least 1 grade on the 24 h imaging. There were 128 initial abnormal segments with no improvement on the 3 h imaging. Out of these segments, the 24 h late redistribution imaging detected additional redistribution in 26 segments, taking up 20%. Twenty-four hour late 201 Tl imaging will demonstrated additional redistribution in patients who have incompletely reversible defects on early redistribution imaging at 3 h. (author)

  10. Using natural language processing and machine learning to identify gout flares from electronic clinical notes.

    Science.gov (United States)

    Zheng, Chengyi; Rashid, Nazia; Wu, Yi-Lin; Koblick, River; Lin, Antony T; Levy, Gerald D; Cheetham, T Craig

    2014-11-01

    Gout flares are not well documented by diagnosis codes, making it difficult to conduct accurate database studies. We implemented a computer-based method to automatically identify gout flares using natural language processing (NLP) and machine learning (ML) from electronic clinical notes. Of 16,519 patients, 1,264 and 1,192 clinical notes from 2 separate sets of 100 patients were selected as the training and evaluation data sets, respectively, which were reviewed by rheumatologists. We created separate NLP searches to capture different aspects of gout flares. For each note, the NLP search outputs became the ML system inputs, which provided the final classification decisions. The note-level classifications were grouped into patient-level gout flares. Our NLP+ML results were validated using a gold standard data set and compared with the claims-based method used by prior literatures. For 16,519 patients with a diagnosis of gout and a prescription for a urate-lowering therapy, we identified 18,869 clinical notes as gout flare positive (sensitivity 82.1%, specificity 91.5%): 1,402 patients with ≥3 flares (sensitivity 93.5%, specificity 84.6%), 5,954 with 1 or 2 flares, and 9,163 with no flare (sensitivity 98.5%, specificity 96.4%). Our method identified more flare cases (18,869 versus 7,861) and patients with ≥3 flares (1,402 versus 516) when compared to the claims-based method. We developed a computer-based method (NLP and ML) to identify gout flares from the clinical notes. Our method was validated as an accurate tool for identifying gout flares with higher sensitivity and specificity compared to previous studies. Copyright © 2014 by the American College of Rheumatology.

  11. Twenty-four-hour esophageal pH monitoring in children and adolescents with chronic and/or recurrent rhinosinusitis

    Directory of Open Access Journals (Sweden)

    V.R.S.G. Monteiro

    2005-02-01

    Full Text Available Gastroesophageal reflux (GER disorder was studied in children and adolescents with chronic and/or recurrent rhinosinusitis not associated with bronchial asthma. Ten children with a clinical and radiological diagnosis of chronic and/or recurrent rhinosinusitis, consecutively attended at the Pediatric Otolaryngology Outpatient Clinic, Federal University of São Paulo, were evaluated. Prolonged esophageal pH monitoring was used to investigate GER disorder. The mean age of the ten patients evaluated (eight males was 7.4 ± 2.4 years. Two patients presented vomiting as a clinical manifestation and one patient presented retrosternal pain with a burning sensation. Twenty-four-hour esophageal pH monitoring was performed using the Sandhill apparatus. An antimony probe electrode was placed in the lower third of the esophagus, confirmed by fluoroscopy and later by a chest X-ray. The parameters analyzed by esophageal pH monitoring included: total percent time of the presence of acid esophageal pH, i.e., pH below 4 (<4.2%; total number of acid episodes (<50 episodes; number of reflux episodes longer than 5 min (3 or less, and duration of the longest reflux episode (<9.2 min. One patient (1/10, 10% presented a 24-h esophageal pH profile compatible with GER disorder. This data suggest that an association between chronic rhinosinusitis not associated with bronchial asthma and GER disorder may exist in children and adolescents, especially in those with compatible GER disorder symptoms. In these cases, 24-h esophageal pH monitoring should be performed before indicating surgery, since the present data suggest that 10% of chronic rhinosinusitis surgeries can be eliminated.

  12. Updates on the treatment of gout, including a review of updated treatment guidelines and use of small molecule therapies for difficult-to-treat gout and gout flares.

    Science.gov (United States)

    Soskind, Rose; Abazia, Daniel T; Bridgeman, Mary Barna

    2017-08-01

    Gout is a rheumatologic condition associated with elevated serum uric acid levels and deposition of monosodium urate crystals in joints and soft tissues. Areas covered: In this article, we describe the role of currently available drug therapies for managing acute gout flares and used in reducing serum urate levels. Further, we explore the role of novel small molecular therapies and biologic agents in the treatment of refractory or severe gout symptoms. A literature search of MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations Databases (1996-June 2017) was conducted utilizing the key words 'gout', 'interleukin-1 inhibitors', 'acute gout', 'gout treatment', 'urate lowering therapies', 'hyperuricemia', 'colchicine', 'pegloticase', 'lesinurad', 'xanthine oxidase', 'xanthine oxidase inhibitors', 'allopurinol', 'febuxostat', 'uricosurics', 'probenecid', and 'benzbromarone'. All published articles regarding therapeutic management of gout and hyperuricemia were evaluated. References of selected articles, data from poster presentations, and abstract publications were additionally reviewed. Expert opinion: Numerous therapies are currently available to managing acute gout flares and for lowering serum urate levels; advances in the understanding of the pathophysiology of this disorder has led to the emergence of targeted therapies and novel biologic preparations currently in development which may improve the clinical management of severe or refractory cases of disease that fail to respond to traditional therapies.

  13. Diurnal and twenty-four hour patterning of human diseases: acute and chronic common and uncommon medical conditions.

    Science.gov (United States)

    Smolensky, Michael H; Portaluppi, Francesco; Manfredini, Roberto; Hermida, Ramon C; Tiseo, Ruana; Sackett-Lundeen, Linda L; Haus, Erhard L

    2015-06-01

    The symptom intensity and mortality of human diseases, conditions, and syndromes exhibit diurnal or 24 h patterning, e.g., skin: atopic dermatitis, urticaria, psoriasis, and palmar hyperhidrosis; gastrointestinal: esophageal reflux, peptic ulcer (including perforation and hemorrhage), cyclic vomiting syndrome, biliary colic, hepatic variceal hemorrhage, and proctalgia fugax; infection: susceptibility, fever, and mortality; neural: frontal, parietal, temporal, and occipital lobe seizures, Parkinson's and Alzheimer's disease, hereditary progressive dystonia, and pain (cancer, post-surgical, diabetic neuropathic and foot ulcer, tooth caries, burning mouth and temporomandibular syndromes, fibromyalgia, sciatica, intervertebral vacuum phenomenon, multiple sclerosis muscle spasm, and migraine, tension, cluster, hypnic, and paroxysmal hemicranial headache); renal: colic and nocturnal enuresis and polyuria; ocular: bulbar conjunctival redness, keratoconjunctivitis sicca, intraocular pressure and anterior ischemic optic neuropathy, and recurrent corneal erosion syndrome; psychiatric/behavioral: major and seasonal affective depressive disorders, bipolar disorder, parasuicide and suicide, dementia-associated agitation, and addictive alcohol, tobacco, and heroin cravings and withdrawal phenomena; plus autoimmune and musculoskeletal: rheumatoid arthritis, osteoarthritis, axial spondylarthritis, gout, Sjögren's syndrome, and systemic lupus erythematosus. Knowledge of these and other 24 h patterns of human pathophysiology informs research of their underlying circadian and other endogenous mechanisms, external temporal triggers, and more effective patient care entailing clinical chronopreventive and chronotherapeutic strategies. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Gout

    Science.gov (United States)

    Gout is a common, painful form of arthritis. It causes swollen, red, hot and stiff joints. Gout happens when uric acid builds up in your ... The crystals can also cause kidney stones. Often, gout first attacks your big toe. It can also ...

  15. [Changes of twenty-four-hour profile blood pressure and its correction of patients with arterial hypertension on the background of combined antihypertensive therapy application].

    Science.gov (United States)

    Solomennchuk, T M; Slaba, N A; Prots'ko, V V; Bedzaĭ, A O

    2014-01-01

    The aim of this research was the study of efficiency and endurance antihypertensive therapy on the basis of fixed combination of enalapril and hydrochlorothiazide (HCTZ) and enalapril and HCTZ in combination with amlodipine according to the twenty-four-hour (? day-and-night) monitoring of blood pressure (? 24H BPM) of patients with arterial hypertension (AH) 2-3 severity. The study included 33 patients with 2-3 grade of hypertension (average age--54,40 ± 3.45 years). All patients performed ? 24H BPM before treatment and after 12 weeks of therapy. The combination of enalapril and HCTZ allowed to achieve target levels of blood pressure in 79% of patients, amlodipine additional purpose--in 86% of patients. We found that this therapy has a corrective effect on daily blood pressure profile, significantly reducing the load pressure and blood pressure variability. During treatment with the combination of enalapril and HCTZ combination of enalapril, HCTZ with amlodipine optimal daily profile of blood pressure after 12 weeks of reaching respectively 63.1% and 71.4% of patients. The treatment with combination of enalapril and HCTZ and adding of amlodipine is characterized by good endurance and high adherence to treatment.

  16. Patients with gout have short telomeres compared with healthy participants: association of telomere length with flare frequency and cardiovascular disease in gout.

    Science.gov (United States)

    Vazirpanah, N; Kienhorst, L B E; Van Lochem, E; Wichers, C; Rossato, M; Shiels, P G; Dalbeth, N; Stamp, L K; Merriman, T R; Janssen, M; Radstake, T R D J; Broen, J Ca

    2017-07-01

    Chronic inflammation associates with increased senescence, which is a strong predictor for cardiovascular disease. We hypothesised that inflammation accelerates senescence and thereby enhances the risk of cardiovascular disease in gout. We assessed replicative senescence by quantifying telomere length (TL) in a discovery cohort of 145 Dutch patients with gout and 273 healthy individuals and validated our results in 474 patients with gout and 293 healthy participants from New Zealand. Subsequently, we investigated the effect of cardiovascular disease on TL of all participants. Also, we measured TL of CD4 + and CD8 + T lymphocytes, B lymphocytes, monocytes, natural killer cells and plasmacytoid dendritic cells. Additionally, we assessed the potential temporal difference in TL and telomerase activity. TL in PBMCs of healthy donors decreased over time, reflecting normal ageing. Patients with gout demonstrated shorter telomeres (p=0.001, R 2 =0.01873). In fact, the extent of telomere erosion in patients with gout was higher at any age compared with healthy counterparts at any age (pgout with cardiovascular disease had the shortest telomeres and TL was an independent risk factor for cardiovascular disease in patients with gout (p=0.001). TL was inversely associated with the number of gouty flares (p=0.005). Patients with gout have shorter telomeres than healthy participants, reflecting increased cellular senescence. Telomere shortening was associated with the number of flares and with cardiovascular disease in people with gout. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  17. Twenty-four-hour ambulatory blood pressure monitoring for clinical evaluation of hypertensive patients in primary care: which groups would most benefit?

    Science.gov (United States)

    Grezzana, Guilherme B; Stein, Airton T; Pellanda, Lucia C

    2017-04-01

    Arterial hypertension is an important risk factor for cardiovascular outcomes. Blood pressure (BP) control levels remain largely out of target among primary healthcare (PHC) patients. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) may contribute toward the identification of cardiovascular risk groups. To assess concordance between conventional office BP measurements and 24-h ABPM of hypertension control in cardiovascular risk groups of PHC hypertensive patients. A cross-sectional study with 569 hypertensive patients was carried out. The evaluation of BP was performed by a PHC doctor, and the 24-h ABPM was performed by a different and blinded provider. The therapeutic targets for BP followed the guidance of The Eighth Joint National Committee, the Brazilian guideline, and the 2013 European Society of Hypertension. Considering the hypertension control therapeutic targets, the guidelines were not similar and were used to evaluate differences in BP value concordances compared with BP standard measurements. After a multivariate logistic regression analysis, a conventional BP was used in comparison with ABPM in different cardiovascular risk groups of hypertensive patients. According to the ABPM by European Society of Hypertension guideline, the subgroup of inactive patients (P=0.006), with altered glycemia (P=0.015) and over 30 mg/dl albuminuria (P=0.001), presented discordance among methods. When a conventional BP measurement in comparison with the ABPM results according to the Brazilian ABPM guideline was used, the discordance occurred significantly in inactive (P=0.001) and microalbuminuria more than 30 mg/dl (P=0.022) subgroups. However, in this comparison, a concordance between high-density lipoprotein more than 60 mg/dl (P=0.015) and obesity (P=0.035) subgroups occurred. Uncontrolled glucose levels, a sedentary lifestyle, and the presence of microalbuminuria correspond to some cardiovascular risk groups that would particularly benefit from 24-h

  18. Gout

    NARCIS (Netherlands)

    van Durme, Caroline; Nussinovitch, Udi

    Gout is the most common cause of inflammatory arthritis. It is caused by the deposition of urate crystals in synovial fluids and surrounding tissues, which may lead to inflammation. For the past few decades, increasing evidence has shown that there is a relationship between serum uric acid, gout,

  19. Gout

    Directory of Open Access Journals (Sweden)

    Hanan Abdel Rehim

    2014-01-01

    Full Text Available Gout is a crystal deposition disease caused by raised levels of uric acid in the blood (hyperuricaemia with persistence of hyperuricemia at levels higher than a serum saturation of 6.8 mg/dl leads to formation of monosodium urate (MSU crystals and their deposition in joints and other tissues. However, only a minority of individuals with elevated serum uric acid (sUA levels ever develop gout, emphasizing the importance of other factors in determining crystal formation including Genetics, Gender, age, Diet and alcohol intake, Obesity, some medications and medical conditions a correct diagnosis of gout is essential for the appropriate management, in 2011 the European League Against Rheumatism (EULAR published an updated evidence based recommendations for diagnosis of gout. Although gout is well understood condition and good therapeutic options are available, it tends to be poorly managed, so The 2012 The American College of Rheumatology (ACR guidelines for Management of Gout were designed to emphasize safety and quality of therapy and to reflect best practice. New approaches to urate lowering have led to mechanism-based therapies such as: non-purine, selective inhibitor of xanthine oxidase, URAT-1 inhibitors and a recombinant chimeric mammalian uricase. Three IL-1β antagonists - anakinra, rilonacept and canakinumab are being evaluated as an emerging therapies for gout.

  20. Using serum urate as a validated surrogate end point for flares in patients with gout

    DEFF Research Database (Denmark)

    Birger Morillon, Melanie; Stamp, L.; Taylor, E W

    2016-01-01

    Introduction: Gout is the most common inflammatory arthritis in men over 40 years of age. Long-term urate-lowering therapy is considered a key strategy for effective gout management. The primary outcome measure for efficacy in clinical trials of urate-lowering therapy is serum urate levels, effec...

  1. Serum urate as surrogate endpoint for flares in people with gout

    DEFF Research Database (Denmark)

    Stamp, Lisa K; Birger Morillon, Melanie; Taylor, William J

    2018-01-01

    Objectives The primary efficacy outcome in trials of urate lowering therapy (ULT) for gout is serum urate (SU). The aim of this study was to examine the strength of the relationship between SU and patient-important outcomes to determine whether SU is an adequate surrogate endpoint for clinical tr...

  2. Twenty-Four-Hour Ambulatory Blood Pressure Monitoring in Hypertension

    Science.gov (United States)

    2012-01-01

    Executive Summary Objective The objective of this health technology assessment was to determine the clinical effectiveness and cost-effectiveness of 24-hour ambulatory blood pressure monitoring (ABPM) for hypertension. Clinical Need: Condition and Target Population Hypertension occurs when either systolic blood pressure, the pressure in the artery when the heart contracts, or diastolic blood pressure, the pressure in the artery when the heart relaxes between beats, are consistently high. Blood pressure (BP) that is consistently more than 140/90 mmHg (systolic/diastolic) is considered high. A lower threshold, greater than 130/80 mmHg (systolic/diastolic), is set for individuals with diabetes or chronic kidney disease. In 2006 and 2007, the age-standardized incidence rate of diagnosed hypertension in Canada was 25.8 per 1,000 (450,000 individuals were newly diagnosed). During the same time period, 22.7% of adult Canadians were living with diagnosed hypertension. A smaller proportion of Canadians are unaware they have hypertension; therefore, the estimated number of Canadians affected by this disease may be higher. Diagnosis and management of hypertension are important, since elevated BP levels are related to the risk of cardiovascular disease, including stroke. In Canada in 2003, the costs to the health care system related to the diagnosis, treatment, and management of hypertension were over $2.3 billion (Cdn). Technology The 24-hour ABPM device consists of a standard inflatable cuff attached to a small computer weighing about 500 grams, which is worn over the shoulder or on a belt. The technology is noninvasive and fully automated. The device takes BP measurements every 15 to 30 minutes over a 24-to 28-hour time period, thus providing extended, continuous BP recordings even during a patient’s normal daily activities. Information on the multiple BP measurements can be downloaded to a computer. The main detection methods used by the device are auscultation and oscillometry. The device avoids some of the pitfalls of conventional office or clinic blood pressure monitoring (CBPM) using a cuff and mercury sphygmomanometer such as observer bias (the phenomenon of measurement error when the observer overemphasizes expected results) and white coat hypertension (the phenomenon of elevated BP when measured in the office or clinic but normal BP when measured outside of the medical setting). Research Questions Is there a difference in patient outcome and treatment protocol using 24-hour ABPM versus CBPM for uncomplicated hypertension? Is there a difference between the 2 technologies when white coat hypertension is taken into account? What is the cost-effectiveness and budget impact of 24-hour ABPM versus CBPM for uncomplicated hypertension? Research Methods Literature Search Search Strategy A literature search was performed on August 4, 2011 using OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, and the International Agency for Health Technology Assessment (INAHTA) for studies published from January 1, 1997 to August 4, 2011. Abstracts were reviewed by a single reviewer. For those studies meeting the eligibility criteria, full-text articles were obtained. Reference lists were also examined for any additional relevant studies not identified through the search. Articles with unknown eligibility were reviewed with a second clinical epidemiologist and then a group of epidemiologists until consensus was established. The quality of evidence was assessed as high, moderate, low, or very low according to GRADE methodology. Inclusion Criteria English language articles; published between January 1, 1997 and August 4, 2011; adults aged 18 years of age or older; journal articles reporting on the effectiveness, cost-effectiveness, or safety for the comparison of interest; clearly described study design and methods; health technology assessments, systematic reviews, meta-analyses, or randomized controlled trials. Exclusion Criteria non-English papers; animal or in vitro studies; case reports, case series, or case-case studies; studies comparing different antihypertensive therapies and evaluating their antihypertensive effects using 24-hour ABPM; studies on home or self-monitoring of BP, and studies on automated office BP measurement; studies in high-risk subgroups (e.g. diabetes, pregnancy, kidney disease). Outcomes of Interest Patient Outcomes mortality: all cardiovascular events (e.g., myocardial infarction [MI], stroke); non-fatal: all cardiovascular events (e.g., MI, stroke); combined fatal and non-fatal: all cardiovascular events (e.g., MI, stroke); all non-cardiovascular events; control of BP (e.g. systolic and/or diastolic target level). Drug-Related Outcomes percentage of patients who show a reduction in, or stop, drug treatment; percentage of patients who begin multi-drug treatment; drug therapy use (e.g. number, intensity of drug use); drug-related adverse events. Quality of Evidence The quality of the body of evidence was assessed as high, moderate, low, or very low according to the GRADE Working Group criteria. As stated by the GRADE Working Group, the following definitions of quality were used in grading the quality of the evidence: High Further research is very unlikely to change confidence in the estimate of effect. Moderate Further research is likely to have an important impact on confidence in the estimate of effect and may change the estimate. Low Further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate. Very Low Any estimate of effect is very uncertain. Summary of Findings Short-Term Follow-Up Studies (Length of Follow-Up of ≤ 1 Year) Based on very low quality of evidence, there is no difference between technologies for non-fatal cardiovascular events. Based on moderate quality of evidence, ABPM resulted in improved BP control among patients with sustained hypertension compared to CBPM. Based on low quality of evidence, ABPM resulted in hypertensive patients being more likely to stop antihypertensive therapy and less likely to proceed to multi-drug therapy compared to CBPM. Based on low quality of evidence, there is a beneficial effect of ABPM on the intensity of antihypertensive drug use compared to CBPM. Based on moderate quality of evidence, there is no difference between technologies in the number of antihypertensive drugs used. Based on low to very low quality of evidence, there is no difference between technologies in the risk for a drug-related adverse event or noncardiovascular event. Long-Term Follow-Up Study (Mean Length of Follow-Up of 5 Years) Based on moderate quality of evidence, there is a beneficial effect of ABPM on total combined cardiovascular events compared to CBPM. Based on low quality of evidence, there is a lack of a beneficial effect of ABPM on nonfatal cardiovascular events compared to CBPM; however, the lack of a beneficial effect is based on a borderline result. Based on low quality of evidence, there is no beneficial effect of ABPM on fatal cardiovascular events compared to CBPM. Based on low quality of evidence, there is no difference between technologies for the number of patients who began multi-drug therapy. Based on low quality of evidence, there is a beneficial effect of CBPM on control of BP compared to ABPM. This result is in the opposite direction than expected. Based on moderate quality of evidence, there is no difference between technologies in the risk for a drug-related adverse event. PMID:23074425

  3. Mortality Pattern within Twenty-Four Hours of Emergency Paediatric ...

    African Journals Online (AJOL)

    The highest mortality within the first 24 hours of admission was recorded among patients with malaria (89.0%) followed by protein energy malnutrition. CONCLUSION: Majority of deaths among emergency paediatric admission occur within the first 24 hours of admission and are associated with clinical conditions such as ...

  4. New and Pipeline Drugs for Gout.

    Science.gov (United States)

    Keenan, Robert T; Schlesinger, Naomi

    2016-06-01

    Gout is the most common inflammatory arthropathy in the western world. Affecting millions and accounting for lost wages, increased health care costs, and significant disability, it remains a burden for those afflicted, their families, and the health care system. Despite the availability of a number of effective therapies, gout is often inadequately treated, and its impact on the patients overall health and well-being is underestimated by physicians and patients alike. For many decades, controlling acute flares was the priority in the management of gout. More recently, however, a deeper understanding of gout pathophysiology has resulted in a new appreciation that gout impacts the patient with consequences well beyond the episodes of acute inflammatory arthritis. Reflecting the chronic nature of the disease, gout treatment needs to be chronic as well, and aimed at reducing the underlying cause of gout-hyperuricemia-as well as the symptom of acute attacks. Therapy therefore requires both urate lowering and anti-inflammatory strategies. Unfortunately, the most commonly used urate lowering and anti-inflammatory treatments may be problematic in some gout patients, who often have multiple comorbidities that establish relative contraindications. Novel urate lowering therapies, and new medications to treat and prevent acute gouty flares, can not only improve care of the individual; they can also lead to a better discourse for the edification of those who manage and are managed for this underestimated disease. In this paper, we discuss new and pipeline drugs for acute gout, prophylactic anti-inflammatory therapies as well as urate lowering therapies.

  5. Ultrasonography in the diagnosis of asymptomatic hyperuricemia and gout.

    Science.gov (United States)

    Puig, J G; Beltrán, L M; Mejía-Chew, C; Tevar, D; Torres, R J

    2016-12-01

    Sonography has detected urate deposits in 34%-42% of the patients with asymptomatic hyperuricemia. This may prompt reclassification of asymptomatic hyperuricemia into "asymptomatic gout" and consideration of urate lowering therapy (ULT) to resolve urate deposits. In patients with gout and no visible tophi, sonography has detected urate deposits in half of the patients. This may allow diagnosing "tophaceous gout" and influencing the serum urate target level, prophylaxis to avoid acute gout flares during ULT, and clinical follow-up. Current accessibility to sonography may better classify patients with hyperuricemia and gout and contribute to delineate therapeutic objectives and clinical guidance.

  6. Risk Factors for Gout and Prevention: A Systematic Review of the Literature

    Science.gov (United States)

    Singh, Jasvinder A.; Reddy, Supriya G.; Kundukulam, Joseph

    2014-01-01

    Purpose Our objective was to perform a systematic review of risk factors and prevention of gout. We searched Medline for fully published reports in English using keywords including but not limited to “gout”, “epidemiology”, “primary prevention”, “secondary prevention”, “risk factors’. Data from relevant articles meeting inclusion criteria was extracted using standardized forms. Main Findings Of the 751 titles and abstracts, 53 studies met the criteria and were included in the review. Several risk factors were studied. Alcohol consumption increased the risk of incident gout, especially beer and hard liquor. Several dietary factors increased the risk of incident gout, including meat intake, seafood intake, sugar sweetened soft drinks, and consumption of foods high in fructose. Diary intake, folate intake and coffee consumption were each associated with a lower risk of incident gout and in some cases a lower rate of gout flares. Thiazide and loop diuretics were associated with higher risk of incident gout and higher rate of gout flares. Hypertension, renal insufficiency, hypertriglyceridemia, hypercholesterolemia, hyperuricemia, diabetes, obesity and early menopause were each associated with a higher risk of incident gout and/or gout flares. Summary Several dietary risk factors for incident gout and gout flares are modifiable. Prevention and optimal management of comorbidities is likely to decreased risk of gout. Research in preventive strategies for the treatment of gout is needed. PMID:21285714

  7. Management of Gout in a Hospital Setting: A Lost Opportunity.

    Science.gov (United States)

    Wright, Sarah; Chapman, Peter T; Frampton, Christopher; O'Donnell, John L; Raja, Rafi; Stamp, Lisa K

    2017-10-01

    Management of gout is frequently suboptimal. The aim of this study was to determine the proportion of patients presenting to Christchurch Hospital for a gout flare and to determine whether management for both acute flares and urate lowering was in accordance with international recommendations. A retrospective audit was undertaken of all admissions to Christchurch Hospital from June 1, 2013, to May 31, 2014, in which gout was coded as a primary or secondary discharge diagnosis. Information including demographics, comorbidities, concomitant medications, treatment of acute gout, and urate lowering was collected. A total of 235 acute admissions for gout in 216 individuals were identified. Eleven individuals had 2 admissions and 4 individuals had 3 admissions. In 95/235 admissions (40.4%), gout was the primary diagnosis. Gout accounted for 95/77,321 (0.12%) of acute admissions. The treatment of acute gout was prednisone monotherapy in 170/235 (72.3%) of admissions. Serum urate was measured at some point during 123/235 (52.3%) of admissions, with only 19/123 (15.4%) at target urate level (gout are similar to that observed in other studies. Failure to initiate, change, or recommend alterations in urate-lowering therapy to achieve target urate in people with gout admitted to hospital represents a significant lost opportunity to improve longterm gout management.

  8. Gout and comorbidity: a nominal group study of people with gout.

    Science.gov (United States)

    Singh, Jasvinder A

    2017-09-15

    Comorbidities are common in patients with gout, yet qualitative research is lacking. The study objective was to examine the impact of gout on comorbidities. Nine nominal groups were conducted. Patients with gout discussed and rank-ordered their concerns in response to the question, "How does gout or its treatment affect your other conditions and their treatment?" Nine nominal groups had 45 gout patients, with mean age 61 years (standard deviation (SD) 10.7) and mean gout duration 14.9 years (SD 12). Of these, 62% were men, 45% African-American, 51% married and 63% were currently using allopurinol. The most frequently cited highly ranked concerns among the nine nominal groups were: (1) interaction of gout medication with medications for other medical conditions (three groups); (2) worsening of other medical comorbidities, including hospitalizations (seven groups); (3) worsening of anxiety and depression (three groups); (4) significant dietary changes for gout that contrasted with diet for other conditions (three groups); (5) new diseases diagnosed due to gout (three groups); (6) irreversible joint damage (three groups); (7) inability to exercise and weight gain (four groups); and (8) gout misdiagnosed as another health condition (three groups). Other domains ranked highly were: (1) impact of gout on daily life and activities, including the ability to work and social activities (six groups); (2) medication side effects, real and perceived (nine groups); (3) weight loss due to gout related to frequent flares (one group); and (4) cost and burden (three groups). Gout and the medications used for its treatment have a significant effect on comorbidities and their management. These findings provide insights into potential targets for improving outcomes in patients with gout.

  9. Treat to target in gout.

    Science.gov (United States)

    Perez-Ruiz, Fernando; Moreno-Lledó, Aitana; Urionagüena, Irati; Dickson, Alastair J

    2018-01-01

    The treat-to-target (T2T) approach has been successfully implemented in a number of diseases. T2T has been proposed for rheumatic diseases such as RA, spondyloarthritis, lupus, and recently for gout. The level of evidence for such approaches differs from one condition to the other (moderate to high for hyperlipidaemia, for example). Practice is based on the best available evidence at any time, and in absence of good evidence for T2T in gout, some suggest a conservative only-treat-symptoms approach. Evidence suggests that not treating gout to target in the long term is overall associated with worsening outcomes, such as flares, tophi and structural damage, which is associated to loss of quality of life and mortality. Different targets have been proposed for hyperuricaemia in gout; lower than 6 mg/dl (0.36 mmol/l) for all patients, at least gout. © The Author 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  10. Clinical features of gout

    Directory of Open Access Journals (Sweden)

    R. De Angelis

    2012-01-01

    Full Text Available Gout is a metabolic disease characterized by hyperuricemia and the deposition of monosodium urate (MSU crystals in the joints and soft tissues, consisting of a self-limited acute phase characterized by recurrent attacks of synovitis and a chronic phase in which inflammatory and structural changes of the joints and periarticular tissues may lead to persistent symptoms. Acute gout is characterized by a sudden monoarthritis of rapid onset, with intense pain, mostly affecting the big toe (50% of initial attacks, the foot, ankle, midtarsal, knee, wrist, finger, and elbow. Acute flares also occur in periarticular structures, including bursae and tendons. The presence of characteristic MSU crystals in the joint fluid, appearing needle-like and showing strong negative birefringence by polarized microscopy, is pivotal to confirm the diagnosis of gout. The time interval separating the first attack from subsequent episodes of acute synovitis may be widely variable, ranging from a few days to several years. During the period between acute attacks the patient is asymptomatic even if MSU deposition may continue to increase silently. The factors that control the rate, location, and degree of ongoing deposition in gouty patients are not well defined. Chronic gout is the natural evolution of untreated hyperuricemia in patients with gouty attacks followed by pain-free intercritical periods. It is characterized by the deposition of solid MSU crystal aggregates in a variety of tissues including joints, bursae and tendons. Tophi can occur in a variety of locations including the helix of the ear, olecranon bursa, and over the interphalangeal joints. Their development is usually related with both the degree and the duration of hyperuricemia. About 20% of patients with gout have urinary tract stones and can develop an interstitial urate nephropathy. There is a strong association between hyperuricaemia and the metabolic syndrome (the constellation of insulin resistance

  11. Gout treatment: survey of Brazilian rheumatology residents.

    Science.gov (United States)

    Amorim, Rodrigo Balbino Chaves; Vargas-Santos, Ana Beatriz; Pereira, Leticia Rocha; Coutinho, Evandro Silva Freire; da Rocha Castelar-Pinheiro, Geraldo

    2017-05-01

    To assess the current practices in gout management among Brazilian rheumatology residents. We performed a cross-sectional online survey among all the rheumatology residents and those rheumatologists who had just completed their training (post-residency (PR)) regarding their approach to gout management. Results were compared with the 2012 American College of Rheumatology (ACR) gout guidelines and with the responses of a previous survey with a representative sample of practicing Brazilian rheumatologists (RHE). We received 224 responses (83%) from 271 subjects. Among all respondents, the first-choice treatment for gout flares was the combination of a nonsteroidal anti-inflammatory drug + colchicine for otherwise healthy patients. A target serum urate 75%. Less than 70% reported starting allopurinol at low doses (≤100 mg/day) for patients with normal renal function and gout guidelines, especially among PR. However, some important aspects of gout management need improvement. These results will guide the development of a physician education program to improve the management of gout patients in Brazil.

  12. Illness Perceptions and Mortality in Patients With Gout: A Prospective Observational Study.

    Science.gov (United States)

    Serlachius, Anna; Gamble, Greg; House, Meaghan; Vincent, Zoe L; Knight, Julie; Horne, Anne; Taylor, William J; Petrie, Keith J; Dalbeth, Nicola

    2017-09-01

    To examine whether illness perceptions independently predict mortality in early-onset gout. Between December 2006 and January 2014, a total of 295 participants with early-onset gout (gout. In a Cox proportional hazards model adjusted for predictors of disease severity and mortality in gout (number of tophi, serum urate level, and frequency of flares), consequence beliefs, identity beliefs, concern beliefs, and emotional response to gout were associated with all-cause mortality (hazard ratios [HRs] 1.29, 1.15, 1.18, and 1.19, respectively; P gout and severity of symptoms, as well as concerns about gout and the emotional response to gout, were independently associated with all-cause mortality. Illness perceptions are important and potentially modifiable risk factors to target in future interventions. © 2016, American College of Rheumatology.

  13. Twenty-Four Hour Structure of Vigilance under Prolonged Sleep Deprivation: Relationship with Performance

    Science.gov (United States)

    1986-03-01

    MC: i I Ii atar 0V_ l - (1C)dVI IC I-o fla’.iUcr aniid S trog-tq3tZ. dummoi tsi~r acec Lio ie i stenicv Of "forbi ddern zones’’ for 51 ec.,i) inl data...1971, pp. 109-148. ""roughton, R. Fiorhythm.4c variations in consciousress and psychological functions. Canad. Psychol. Rev., 1975, 16%217-239. Campbell

  14. Role of Twenty-Four-Hour Ambulatory Blood Pressure Monitoring in Children on Dialysis

    Science.gov (United States)

    Sutherland, Scott M.; Begin, Brandy; Salsbery, Kari; McCabe, Lonisa; Potter, Donald; Alexander, Steven R.; Wong, Cynthia J.

    2011-01-01

    Summary Background and objectives Pre- or postdialysis BP recordings are imprecise, can be biased, and have poor test–retest reliability in children on dialysis. We aimed to examine the possible differences between pre- and postdialysis BP levels and 24-hour ambulatory BP monitoring (ABPM) in diagnosis of hypertension (HTN). Design, setting, participants, & measurements Twenty-four children on dialysis had 24-hour ABPM in the interdialytic period, and values were compared with average pre- and postdialysis systolic BP (SBP) and diastolic BP (DBP) recordings that week. Each patient had an echocardiogram to determine presence of left ventricular hypertrophy (LVH). Results By ABPM, 8% of patients had white coat HTN and 12% had masked HTN. There was no significant difference in diagnosis of systolic HTN based on ABPM daytime SBP mean or load and postdialysis SBP. However, only 15% of patients had diastolic HTN based on postdialysis measures, whereas 46% of patients had significantly elevated daytime DBP loads and 71% had high nighttime DBP loads on ABPM. Forty-eight percent of patients were SBP nondippers. Children with LVH had higher daytime and nighttime SBP loads, significantly higher daytime and nighttime DBP loads, and lesser degree of nocturnal dipping of SBP compared with those who did not. Conclusion ABPM is more informative than pre- and postdialysis BPs and improves the predictability of BP as a risk factor for target organ damage. Diagnosis and treatment monitoring of HTN among pediatric dialysis patients is enhanced with addition of ABPM. PMID:21273374

  15. Twenty-four-hour shift work, depressive symptoms, and job dissatisfaction among Japanese firefighters.

    Science.gov (United States)

    Saijo, Yasuaki; Ueno, Takeji; Hashimoto, Yoshihiro

    2008-05-01

    The influence of a 24-hr shift-work burden on firefighters' mental health has not been fully investigated. The purpose of this study is to clarify the relationships between specific workload items among firefighters engaged in 24-hr shift work and job stress as estimated by the generic job-stress questionnaire on depressive symptoms and job dissatisfaction from the National Institute for Occupational Safety and Health (NIOSH). The subjects were 1,301 firefighters. The questionnaire covered age, gender, job type, job class, marital status, smoking and drinking habits, number of attendances, turnout time, extra work hours, average nap-time, the Center for Epidemiologic Studies Depression Scale (CES-D), and questions from the NIOSH generic job-stress questionnaire, including those on job satisfaction. In multivariate logistic regression analyses, a model that included all variables except the measures from the NIOSH generic job-stress questionnaire showed that shorter nap-time had significant higher odds ratios (ORs) for depressive symptoms and job dissatisfaction, but the significances disappeared in a fully adjusted model. In fully adjusted logistic regression analyses, low quantitative workload, low variance in workload, high intra- and intergroup conflict, low social support from a supervisor, high role conflict and ambiguity, and low self-esteem had significant higher ORs for depressive symptoms and/or job dissatisfaction. Amount of workload, variance in workload, intra- and intergroup conflict, social support from a supervisor, role conflict and ambiguity, and self-esteem were significantly related to depressive symptoms and/or job dissatisfaction among Japanese firefighters. Moreover, inadequate nap-time may affect their mental health. (c) 2008 Wiley-Liss, Inc.

  16. Twenty-four-Hour Measurement of Intraocular Pressure in Guinea Pigs (Cavia porcellus).

    Science.gov (United States)

    Ansari-Mood, Maneli; Mehdi-Rajaei, Seyed; Sadjadi, Reza; Selk-Ghaffari, Masoud; Williams, David L

    2016-01-01

    The objective of this study was to measure intraocular pressure (IOP) in intact, healthy guinea pigs (15 male, 15 female) every 2 h for a 24-h period. First, IOP was measured by using rebound tonometry (RBT). After a 1-min rest period, 0.5% proparacaine ophthalmic solution, a topical anesthetic, was applied to both eyes; 4 min after anesthetic instillation, IOP was measured by using applanation tonometry (APT). The IOP was lower during the light period (0700 to 1900) than during the dark phase (2000 to 0600). The lowest IOP by both RBT and APT (3.68 and 13.37 mm Hg, respectively) occurred at 0700, whereas maximal IOP occurred at 2300 for RBT (8.12 mm Hg) but at 2100 for APT (20.62 mm Hg). No significant differences in IOP between the left and right eyes or between RBT and APT were noted. In addition, daily variations in the IOP of guinea pigs seem to be independent of sex and body weight. The results of this study may be beneficial in the diagnosis and observation of glaucoma in guinea pigs.

  17. Twenty-four-hour blood pressure among Greenlanders and Danes: relationship to diet and lifestyle

    DEFF Research Database (Denmark)

    Jørgensen, Marit Eika; Pedersen, M.B.; Siggaard, Cecilie

    2002-01-01

    Greenlanders have a lower rate of cardiovascular mortality and morbidity than Danes, possibly due to lower blood pressure. However, 24-h blood pressure has never been measured in Greenlanders. The aim of this study was to compare the 24-h blood pressure of Greenlanders and Danes, and to analyse t...

  18. Twenty-four hour blood flow in the forefoot after reconstructive vascular surgery

    International Nuclear Information System (INIS)

    Jelnes, R.

    1986-01-01

    Local blood flow in the forefoot (SBF) was measured continuously during 24 hours by 133xenon clearance technique in 10 patients prior to and at least 1 year after successful reconstructive vascular surgery for severe arterial insufficiency (mean: 18 months, range: 12-36). A group of 10 patients with normal peripheral circulation served as a control group. In spite of a considerable increase of the ankle/arm systolic blood pressure index--preoperative: 0.30 +/- 0.12, postoperative: 0.78 +/- 0.28 (mean +/- 1 SD)--the SBF decreased by 50% (p less than 0.001) following reconstructive vascular surgery during day activities. During sleep, however, SBF increased by 80% (p less than 0.001). The relative changes in SBF from day to night at the postoperative examination did not differ from that of the control group, i.e., the normal 24-hour blood flow pattern had been obtained. These changes in SBF are explained by the reappearance of peripheral vasoregulatory mechanisms. Postreconstructive hyperemia was evaluated by the same technique. The changes in SBF following surgery in the positions supine, awake and supine, asleep were found to be insignificant (0.80 less than p less than 0.90). It is concluded that the long-term postreconstructive hyperemia merely is a reflection of the normal 24-hour blood flow pattern

  19. When Twenty-Four Hours Is Not Enough: Time Poverty of Working Parents

    Science.gov (United States)

    Harvey, Andrew S.; Mukhopadhyay, Arun K.

    2007-01-01

    Individuals can be money poor, time poor or both. While income is the most used indicator of poverty, broader indexes including non-monetary aspects of deprivation have been proposed and measured. As one such measure, our study focuses on the element of deprivation arising from the time deficit of many working people. The usual poverty threshold…

  20. Twenty-four hour blood flow in the forefoot after reconstructive vascular surgery

    DEFF Research Database (Denmark)

    Jelnes, R

    1986-01-01

    Local blood flow in the forefoot (SBF) was measured continuously during 24 hours by 133xenon clearance technique in 10 patients prior to and at least 1 year after successful reconstructive vascular surgery for severe arterial insufficiency (mean: 18 months, range: 12-36). A group of 10 patients...... with normal peripheral circulation served as a control group. In spite of a considerable increase of the ankle/arm systolic blood pressure index--preoperative: 0.30 +/- 0.12, postoperative: 0.78 +/- 0.28 (mean +/- 1 SD)--the SBF decreased by 50% (p less than 0.001) following reconstructive vascular surgery...... during day activities. During sleep, however, SBF increased by 80% (p less than 0.001). The relative changes in SBF from day to night at the postoperative examination did not differ from that of the control group, i.e., the normal 24-hour blood flow pattern had been obtained. These changes in SBF...

  1. Osteochondral lesions in developing rats intoxicated with thallium twenty four hours after birth.

    Science.gov (United States)

    Barroso-Moguel, R; Villeda-Hernández, J; Méndez-Armenta, M; Ríos, C; Galván-Arzate, S

    1992-01-01

    An i.p. injection of a solution of thallium acetate in deionized water at a dose of 32 mg/kg, in 24-h-old rats, produces morphological and biochemical alterations in both cartilaginous and osseous tissues. From the beginning, there are alterations in the cartilaginous cell as well as in chrondrine, osteoblasts, osseous tissue and bone marrow. Rats were sacrificed at 24, 48, and 72 h and also at 7 days. Two animals survived for 50 days. One showed total irreversible alopecia while the other one had partial alopecia with discrete recovery. Both showed a low weight and a size of 8 cm. Microscopically, degenerative changes were produced consisting of alteration and death of many cartilaginous cells, uneven metachromasia and the chondrine and decrease of the growth cartilage, scanty bone trabeculae with few osteoblasts. The bone marrow showed few myeloblasts and megakaryocytes. Progressive cellular damage throughout the 50 days of survival represents a response of the thallium ionic accumulation and recycling in cellular mitochondria of all the body's cells. This appeared in our study as irreversible and progressive osteochondral alterations with atrophy of the skin and its adnexa, hyalinization of elastic and collagenous fibers with intense interstitial edema.

  2. Current and future therapies for gout.

    Science.gov (United States)

    Pascart, Tristan; Richette, Pascal

    2017-08-01

    Gout is a common disease responsible for recurrent flares triggered by the deposition of monosodium urate crystals secondary to longstanding hyperuricaemia. The management of gout implies both the treatment of flares and the treatment of hyperuricaemia itself. Recent improvement in the understanding of the disease led to the development of new drugs. Areas covered: This review covers data related to 'old' treatments of flares and hyperuricaemia, evidence on the recently approved drugs and emerging therapies in development. Expert opinion: Recent data provide a good grasp of the optimal use of colchicine, corticosteroids and NSAIDs for the treatment of flares. Interleukin-1 blocking therapies have an increasing role in the management of difficult-to-treat gout. Sub-optimal use of allopurinol is common and its potency to reduce serum uric acid (SUA) levels is underestimated. Febuxostat effectively reduces SUA levels. New uricosurics, notably lesinurad and arhalofenate, in combination with xanthine oxidase inhibitors, offer promising perspectives to help a greater number of patients achieve sufficient SUA reduction.

  3. Polyarticular gout attacks following cerebrovascular accidents: is hemiparesis in fact protective? 2 cases and a review of the literature.

    Science.gov (United States)

    Hsiao, Susan J; Vaynrub, Maksim; Furer, Victoria; Samuels, Jonathan

    2010-09-01

    Cerebrovascular disease appears to have implications on rheumatic diseases, including gout. Accumulating evidence suggests that hemiparesis exerts a protective effect against gout via the down-regulation of mechanical and neural modulators of inflammation in neurologically impaired extremities. We present 2 divergent cases of unilateral gout following cerebrovascular events. One patient with a hemorrhagic stroke developed polyarticular gout only on the ipsilateral side to his hemiparesis, while another patient with basilar artery thrombosis and locked-in syndrome suffered a polyarticular gout flare only on the side that had regained limited function. As suggested by these cases, the effect of hemiparesis on gout is complex. Further insight into the interplay between gouty flares and hemiparesis may lead to novel therapeutic strategies for gout.

  4. Management of Gout and Hyperuricemia in CKD.

    Science.gov (United States)

    Vargas-Santos, Ana Beatriz; Neogi, Tuhina

    2017-09-01

    Hyperuricemia and gout, the clinical manifestation of monosodium urate crystal deposition, are common in patients with chronic kidney disease (CKD). Although the presence of CKD poses additional challenges in gout management, effective urate lowering is possible for most patients with CKD. Initial doses of urate-lowering therapy are lower than in the non-CKD population, whereas incremental dose escalation is guided by regular monitoring of serum urate levels to reach the target level of gout flares with presently available agents can be more challenging due to potential nephrotoxicity and/or contraindications in the setting of other common comorbid conditions. At present, asymptomatic hyperuricemia is not an indication for urate-lowering therapy, though emerging data may support a potential renoprotective effect. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  5. Gout and Pseudogout

    Science.gov (United States)

    ... Therapist? Media Find a Hand Surgeon Home Anatomy Gout and Pseudogout Email to a friend * required fields ... joint or in different joints. CAUSES Causes of Gout Crystals form when people make too much, or ...

  6. Health care utilization in patients with gout: a prospective multicenter cohort study.

    Science.gov (United States)

    Singh, Jasvinder A; Bharat, Aseem; Khanna, Dinesh; Aquino-Beaton, Cleopatra; Persselin, Jay E; Duffy, Erin; Elashoff, David; Khanna, Puja P

    2017-05-31

    All published studies of health care utilization in gout have been cross-sectional to date, and most used a patient-reported diagnosis of gout. Our objective was to assess health care utilization and its predictors in patients with physician-confirmed gout in a prospective cohort study. In a multi-center prospective cohort study of U.S. veterans with rheumatologist-confirmed gout (N = 186; two centers), we assessed patient self-reported overall and gout-specific health care utilization with the Gout Assessment Questionnaire (GAQ) every 3-months for a 9-month period. Comparisons were made using the student's t test or the chi-square, Wilcoxon rank sum test or Fisher exact test, as appropriate. Mixed effects Poisson regression was used to assess potential correlates of gout-related health care utilization. Mean age was 64.6 years, 98% were men, 13% Hispanic or Latino, 32% were African-American, 6% did not graduate high school, mean serum urate was 8.3 and mean Deyo-Charlson score was 3.1. During the past year, mean gout-related visits were as follows: rheumatologist, 1.5; primary care physician, 2 visits; ≥1 inpatient visits, 7%; ≥1 ER visits, 26%; and urgent care/walk-in visit, 33%. In longitudinal analyses, African-American race and gout flares in the last 3 months were associated with significantly higher rate ratio of gout-related outpatient visits. African-American race and lack of college education were associated with significantly higher rate ratio for gout-related urgent visits and overnight stays. African-American race and recent gout flares were associated with higher outpatient utilization and African-American race and no college education with higher urgent or inpatient utilization. Future studies should examine whether modifiable predictors of utilization can be targeted to reduce healthcare utilization in patients with gout.

  7. The epidemiology and treatment of gout

    Directory of Open Access Journals (Sweden)

    McGill NW

    2011-12-01

    Full Text Available Neil W McGillInstitute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Camperdown, Sydney, AustraliaAbstract: The development and expression of gout depends on three key steps: (1 chronic hyperuricemia, (2 the growth of monosodium urate (MSU crystals, and (3 interaction between MSU crystals and the inflammatory system. Epidemiological studies have continued to improve our understanding of the environmental and genetic factors which influence chronic hyperuricemia and gout. The influence of obesity, alcohol, race, sex, age, and specific dietary components will be discussed below. The primary mechanism of hyperuricemia is insufficient renal clearance of uric acid which in turn is dependent on transport of uric acid in the proximal renal tubule. Knowledge of the transport mechanisms has improved understanding of the genetic influences on gout and is relevant to understanding of the effects of drugs which can increase or decrease renal uric acid clearance. The application of established principles of management including diagnosis through crystal identification, the gradual introduction of hypouricemic therapy with the use of prophylaxis to reduce the risk of flares, identification of a suitably low target of plasma urate, a progressive increase in therapy to achieve the target and taking steps to encourage good compliance, has the potential to improve outcomes for patients with this very common affliction. The potential role for new therapies will also be discussed.Keywords: gout, hyperuricemia, allopurinol, febuxostat, lesinurad, pegloticase

  8. Epidemiology of Gout

    Science.gov (United States)

    Choi, Hyon

    2014-01-01

    Synopsis Gout is the most prevalent inflammatory arthritis in men. The findings of several epidemiological studies from a diverse range of countries suggest that the prevalence of gout has risen over the last few decades. Whilst incidence data are scarce, data from the US suggests that the incidence of gout is also rising. Evidence from prospective epidemiological studies has confirmed dietary factors (animal purines, alcohol and fructose), obesity, the metabolic syndrome, hypertension, diuretic use, and chronic kidney disease as clinically relevant risk factors for hyperuricemia and gout. Low-fat dairy products, coffee, and vitamin C appear to have a protective effect. Further prospective studies are required to examine other proposed risk factors for hyperuricaemia and gout such as the use of β-blockers and angiotension-II receptor antagonists (other than losartan), obstructive sleep apnoea, and osteoarthritis, and putative protective factors such as calcium-channel blockers and losartan. PMID:24703341

  9. Treat-to-target (T2T) recommendations for gout.

    Science.gov (United States)

    Kiltz, U; Smolen, J; Bardin, T; Cohen Solal, A; Dalbeth, N; Doherty, M; Engel, B; Flader, C; Kay, J; Matsuoka, M; Perez-Ruiz, F; da Rocha Castelar-Pinheiro, G; Saag, K; So, A; Vazquez Mellado, J; Weisman, M; Westhoff, T H; Yamanaka, H; Braun, J

    2017-04-01

    The treat-to-target (T2T) concept has been applied successfully in several inflammatory rheumatic diseases. Gout is a chronic disease with a high burden of pain and inflammation. Because the pathogenesis of gout is strongly related to serum urate levels, gout may be an ideal disease in which to apply a T2T approach. Our aim was to develop international T2T recommendations for patients with gout. A committee of experts with experience in gout agreed upon potential targets and outcomes, which was the basis for the systematic literature search. Eleven rheumatologists, one cardiologist, one nephrologist, one general practitioner and one patient met in October 2015 to develop T2T recommendations based on the available scientific evidence. Levels of evidence, strength of recommendations and levels of agreement were derived. Although no randomised trial was identified in which a comparison with standard treatment or an evaluation of a T2T approach had been performed in patients with gout, indirect evidence was provided to focus on targets such as normalisation of serum urate levels. The expert group developed four overarching principles and nine T2T recommendations. They considered dissolution of crystals and prevention of flares to be fundamental; patient education, ensuring adherence to medications and monitoring of serum urate levels were also considered to be of major importance. This is the first application of the T2T approach developed for gout. Since no publication reports a trial comparing treatment strategies for gout, highly credible overarching principles and level D expert recommendations were created and agreed upon. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  10. Chronic tophaceous gout

    Directory of Open Access Journals (Sweden)

    Thappa D

    1993-01-01

    Full Text Available A rare case of chronic tophaceous gout, in a 27-year-old female on diuretics for chronic congestive cardiac failure with characteristic histopathological and radiological changes is reported.

  11. Hyperuricaemia and gout

    African Journals Online (AJOL)

    size and even seasonal changes in levels of serum uric acid.8 ... Lifestyle modification is recommended instead.13,14. Acute gouty attack or ..... hepatic and cardiovascular adverse events.7. Uricase ... Pain management in gout. Curr Pain.

  12. A cross-sectional internet-based patient survey of the management strategies for gout.

    Science.gov (United States)

    Singh, Jasvinder A; Shah, Nipam; Edwards, N Lawrence

    2016-03-01

    Almost half of the patients with gout are not prescribed urate-lowering therapy (ULT) by their health care provider and >50 % use complementary and alternative therapies. Diet modification is popular among gout patients due to known associations of certain foods with gout flares. The interplay of the use of dietary supplements, diet modification, and ULT adherence in gout patients is not known. Despite the recent interest in diet and supplements, there are limited data on their use. Our objective was to assess ULT use and adherence and patient preference for non-pharmacological interventions by patients with gout, using a cross-sectional survey. People who self-reported physician-diagnosed gout during their visit to a gout website ( http://gouteducation.org ) were invited to participate in a brief anonymous cross-sectional Internet survey between 08/11/2014 to 04/14/2015 about the management of their gout. The survey queried ULT prescription, ULT adherence, the use of non-pharmacological interventions (cherry extract, diet modification) and the likelihood of making a lifelong diet modification for gout management. A total of 499 respondents with a mean age 56.3 years were included; 74% were males and 74% were White. Of these, 57% (285/499) participants were prescribed a ULT for gout, of whom 88% (251/285) were currently taking ULT. Of those using ULT, 78% (97/251) reported ULT adherence >80%. Gender, race, and age were not significantly associated with the likelihood of receiving a ULT prescription or ULT adherence >80%. Fifty-six percent of patients with gout preferred ULT as a lifelong treatment for gout, 24% preferred cherry extract and 16% preferred diet modification (4% preferred none). Men had significantly lower odds of preferring ULT as the lifelong treatment choice for gout vs. other choices (p = 0.03). We found that 38.3% participants were highly motivated to make a lifelong dietary modification to improve their gout (score of 9-10 on a 0

  13. Any sleep is a dream far away: a nominal group study assessing how gout affects sleep.

    Science.gov (United States)

    Singh, Jasvinder A

    2018-02-23

    There are no qualitative studies of sleep in gout; the aim of this study was to examine the impact of gout on sleep. Nine nominal groups were conducted, oversampling for African-Americans and women with gout. Patients discussed and rank-ordered their concerns. Nine nominal groups with 46 gout patients were conducted with mean age, 61 years (s.d. 10.6) and gout duration, 14.9 years (s.d. 12); 63% were men, 46% African-American, 52% married, 46% retired and 63% were allopurinol users. The most frequently cited highly ranked concerns could be divided into three categories. The first category, character of sleep interruption, included the concerns: severe and complete sleep interruption by gout flare pain (nine groups); and inability to get rapid eye movement sleep (one group). The second category, causes of sleep interruption, included: inability to get into a comfortable position during sleep (six groups); anxiety and depression associated with severe gout pain (seven groups); sleep interruption by moderate chronic joint pain (three groups); frequent trips to the bathroom interfering with sleep (two groups); gout medication side effects (four groups); frequent trips to the emergency room (one group); joint swelling with physical/functional deficit interfering with sleep (two groups); and flare pain interfering with sleep apnoea management (two groups). The final category, consequences of sleep interruption, included: effect on daily functioning (two groups); worsens other health conditions, which then affect sleep (four groups); and cumulative effect on sleep (one group). Gout has significant impact on sleep quantity, quality and architecture. Sleep disruption due to gout has several pathways and significant consequences.

  14. Effects of Febuxostat in Early Gout: A Randomized, Double-Blind, Placebo-Controlled Study.

    Science.gov (United States)

    Dalbeth, Nicola; Saag, Kenneth G; Palmer, William E; Choi, Hyon K; Hunt, Barbara; MacDonald, Patricia A; Thienel, Ulrich; Gunawardhana, Lhanoo

    2017-12-01

    To assess the effect of treatment with febuxostat versus placebo on joint damage in hyperuricemic subjects with early gout (1 or 2 gout flares). In this double-blind, placebo-controlled study, 314 subjects with hyperuricemia (serum uric acid [UA] level of ≥7.0 mg/dl) and early gout were randomized 1:1 to receive once-daily febuxostat 40 mg (increased to 80 mg if the serum UA level was ≥6.0 mg/dl on day 14) or placebo. The primary efficacy end point was the mean change from baseline to month 24 in the modified Sharp/van der Heijde erosion score for the single affected joint. Additional efficacy end points included change from baseline to month 24 in the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) scores for synovitis, erosion, and edema in the single affected joint, the incidence of gout flares, and serum UA levels. Safety was assessed throughout the study. Treatment with febuxostat did not lead to any notable changes in joint erosion over 2 years. In both treatment groups, the mean change from baseline to month 24 in the modified Sharp/van der Heijde erosion score for the single affected joint was minimal, with no between-group differences. However, treatment with febuxostat significantly improved the RAMRIS synovitis score at month 24 compared with placebo treatment (change from baseline -0.43 versus -0.07; P gout flares (29.3% versus 41.4%; P gout flares in subjects with early gout. © 2017 The Authors. Arthritis & Rheumatology published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology.

  15. Gout Self-Management in African American Veterans: A Qualitative Exploration of Challenges and Solutions From Patients' Perspectives.

    Science.gov (United States)

    Singh, Jasvinder A; Herbey, Ivan; Bharat, Aseem; Dinnella, Janet E; Pullman-Mooar, Sally; Eisen, Seth; Ivankova, Nataliya

    2017-11-01

    To explore gout self-management and associated challenges and solutions in African Americans. We conducted semistructured interviews with 35 African American veterans with gout, who received health care at Birmingham or Philadelphia Veterans Affairs (VA) medical centers, had filled urate-lowering therapy (ULT; most commonly allopurinol) for at least 6 months, and had a ULT medication possession ratio ≥80%. The interview protocol was constructed to explore key concepts related to gout self-management, including initial diagnosis of gout, beginning medical care for gout, the course of the gout, ULT medication adherence, dietary strategies, comorbidity and side effects, and social support. Thirty-five African American male veterans with gout who had ≥80% ULT adherence (most commonly, allopurinol) were interviewed at Birmingham (n = 18) or Philadelphia (n = 17) VA medical centers. Mean age was 65 years, mean body mass index was 31.9 kg/m 2 , 97% had hypertension, 23% had coronary artery disease, and 31% had renal failure. The main themes motivating African American veterans to better gout self-management were fear of pain, adherence to medications, self-discipline, lifestyle changes, information gathering, and developing a positive outlook. Birmingham participants more frequently revealed skipping gout medications. More Philadelphia participants discussed lifestyle/diet changes to prevent gout flares, indicated limiting social activities that involved drinking, and sought more information about gout self-management from health care providers and internet sources. Identified themes, including cultural differences by site, led to the development of a patient-centered intervention to improve gout self-management in African American men with gout. © 2017, American College of Rheumatology.

  16. Hyperuricaemia and gout.

    Science.gov (United States)

    Shipley, M

    2011-09-01

    Gout is increasing in prevalence throughout the world, particularly in developed countries. The causes are dietary--purine-rich foods, high saturated fats, fructose-containing drinks and alcohol. Gout is also drug-related and associated with increased obesity, hypertension, insulin resistance and metabolic syndrome. Although very readily treated, there is evidence that physicians fail to optimise the treatment and achieve low enough serum urate levels, while patients fail to comply with the treatment and dietary advice. Standard treatment of acute attacks is with non-steroidal anti-inflammatory drugs, colchicine or steroids. The standard urate-lowering agents are allopurinol and uricosuric agents. Newer urate lowering agents are now available for refractory gout. Increased understanding of the membrane transporters involved in urate excretion in the kidney and the genes that control them and of the way that sodium urate crystals cause inflammation via the innate immune system and the inflammasome offers hope for new therapeutic approaches.

  17. New treatments for gout.

    Science.gov (United States)

    Mapa, Janet B; Pillinger, Michael H

    2010-05-01

    Gout is a commonly occurring medical condition that can lead to significant morbidity. Therapies available for the treatment of both acute and chronic gouty arthritis have not changed significantly since the 1960s. Although these treatments are well established, they are often contraindicated in the presence of various different comorbidities, including diabetes, renal insufficiency, hypertension and gastrointestinal disease, all of which can occur frequently in patients with gout. Therefore, new treatments are needed. This review describes recent advances in therapeutics for gout, including drugs designed to reduce levels of urate and to inhibit acute or chronic inflammation. While some of these strategies are currently available, others are undergoing regulatory evaluation or are at earlier stages of development.

  18. Gout in the spotlight.

    Science.gov (United States)

    So, Alexander

    2008-01-01

    Understanding how uric acid crystals provoke inflammation is crucial to improving our management of acute gout. It is well known that urate crystals stimulate monocytes and macrophages to elaborate inflammatory cytokines, but the tissue response of the synovium is less well understood. Microarray analysis of mRNA expression by these lining cells may help to delineate the genes that are modulated. Employing a murine air-pouch model, a number of genes expressed by innate immune cells were found to be rapidly upregulated by monosodium urate crystals. These findings provide new research avenues to investigate the physiopathology of gouty inflammation, and may eventually lead to new therapeutic targets in acute gout.

  19. Twenty-four-hour exposure to altered blood flow modifies endothelial Ca2+-activated K+ channels in rat mesenteric arteries

    DEFF Research Database (Denmark)

    Hilgers, Rob H P; Janssen, Ger M J; Fazzi, Gregorio E

    2010-01-01

    We tested the hypothesis that changes in arterial blood flow modify the function of endothelial Ca2+-activated K+ channels [calcium-activated K+ channel (K(Ca)), small-conductance calcium-activated K+ channel (SK3), and intermediate calcium-activated K+ channel (IK1)] before arterial structural...... remodeling. In rats, mesenteric arteries were exposed to increased [+90%, high flow (HF)] or reduced blood flow [-90%, low flow (LF)] and analyzed 24 h later. There were no detectable changes in arterial structure or in expression level of endothelial nitric-oxide synthase, SK3, or IK1. Arterial relaxing...... arteries, the balance between the NO/prostanoid versus EDHF response was unaltered. However, the contribution of IK1 to the EDHF response was enhanced, as indicated by a larger effect of TRAM-34 and a larger residual NS309-induced relaxation in the presence of UCL 1684. Reduction of blood flow selectively...

  20. Phosphorus loss to runoff water twenty-four hours after application of liquid swine manure or fertilizer.

    Science.gov (United States)

    Tabbara, Hadi

    2003-01-01

    Phosphorus (P) added to soil from fertilizer or manure application could pose a threat to water quality due to its role in eutrophication of fresh water resources. Incorporating such amendments into the soil is an established best management practice (BMP) for reducing soluble P losses in runoff water, but could also lead to higher erosion. The objective of this study was to test whether incorporation of manure or fertilizer 24 h before an intense rain could also reduce sediment-bound and total phosphorus (TP) losses in runoff. A rainfall simulation study was conducted on field plots (sandy loam with 6-7% slope, little surface residue, recently cultivated) that received two application rates of liquid swine manure or liquid ammonium polyphosphate fertilizer, using either surface-broadcast or incorporated methods of application. Incorporation increased the total suspended solids (TSS) concentrations in runoff but mass losses were not affected. Incorporation also reduced flow-weighted concentrations and losses of dissolved reactive phosphorus (DRP) and TP by as much as 30 to 60% depending on source (fertilizer vs. manure) and application rate. Phosphorus is moved below the mixing zone of interaction on incorporation, and thus the effect of the amount and availability of P in this zone is more important than cultivation on subsequent P losses in runoff. Incorporating manure or fertilizer in areas of intense erosive rain, recent extensive tillage, and with little or no surface residue is therefore a best management practice that should be adhered to in order to minimize contamination of surface water. Results also show comparatively lower P losses from manure than fertilizer.

  1. Twenty-Four Hour Non-Invasive Ambulatory Blood Pressure and Heart Rate Monitoring in Parkinson’s Disease

    Science.gov (United States)

    Stuebner, Eva; Vichayanrat, Ekawat; Low, David A.; Mathias, Christopher J.; Isenmann, Stefan; Haensch, Carl-Albrecht

    2013-01-01

    Non-motor symptoms are now commonly recognized in Parkinson’s disease (PD) and can include dysautonomia. Impairment of cardiovascular autonomic function can occur at any stage of PD but is typically prevalent in advanced stages or related to (anti-Parkinsonian) drugs and can result in atypical blood pressure (BP) readings and related symptoms such as orthostatic hypotension (OH) and supine hypertension. OH is usually diagnosed with a head-up-tilt test (HUT) or an (active) standing test (also known as Schellong test) in the laboratory, but 24 h ambulatory blood pressure monitoring (ABPM) in a home setting may have several advantages, such as providing an overview of symptoms in daily life alongside pathophysiology as well as assessment of treatment interventions. This, however, is only possible if ABPM is administrated correctly and an autonomic protocol (including a diary) is followed which will be discussed in this review. A 24-h ABPM does not only allow the detection of OH, if it is present, but also the assessment of cardiovascular autonomic dysfunction during and after various daily stimuli, such as postprandial and alcohol dependent hypotension, as well as exercise and drug induced hypotension. Furthermore, information about the circadian rhythm of BP and heart rate (HR) can be obtained and establish whether or not a patient has a fall of BP at night (i.e., “dipper” vs. non-“dipper”). The information about nocturnal BP may also allow the investigation or detection of disorders such as sleep dysfunction, nocturnal movement disorders, and obstructive sleep apnea, which are common in PD. Additionally, a 24-h ABPM should be conducted to examine the effectiveness of OH therapy. This review will outline the methodology of 24 h ABPM in PD, summarize findings of such studies in PD, and briefly consider common daily stimuli that might affect 24 h ABPM. PMID:23720648

  2. A Predictive Model to Classify Undifferentiated Fever Cases Based on Twenty-Four-Hour Continuous Tympanic Temperature Recording

    Directory of Open Access Journals (Sweden)

    Pradeepa H. Dakappa

    2017-01-01

    Full Text Available Diagnosis of undifferentiated fever is a major challenging task to the physician which often remains undiagnosed and delays the treatment. The aim of the study was to record and analyze a 24-hour continuous tympanic temperature and evaluate its utility in the diagnosis of undifferentiated fevers. This was an observational study conducted in the Kasturba Medical College and Hospitals, Mangaluru, India. A total of ninety-six (n=96 patients were presented with undifferentiated fever. Their tympanic temperature was recorded continuously for 24 hours. Temperature data were preprocessed and various signal characteristic features were extracted and trained in classification machine learning algorithms using MATLAB software. The quadratic support vector machine algorithm yielded an overall accuracy of 71.9% in differentiating the fevers into four major categories, namely, tuberculosis, intracellular bacterial infections, dengue fever, and noninfectious diseases. The area under ROC curve for tuberculosis, intracellular bacterial infections, dengue fever, and noninfectious diseases was found to be 0.961, 0.801, 0.815, and 0.818, respectively. Good agreement was observed [kappa = 0.618 (p<0.001, 95% CI (0.498–0.737] between the actual diagnosis of cases and the quadratic support vector machine learning algorithm. The 24-hour continuous tympanic temperature recording with supervised machine learning algorithm appears to be a promising noninvasive and reliable diagnostic tool.

  3. Twenty-four-hour variations in blood glucose level in Japanese type 2 diabetes patients based on continuous glucose monitoring.

    Science.gov (United States)

    Hajime, Maiko; Okada, Yosuke; Mori, Hiroko; Otsuka, Takashi; Kawaguchi, Mayuko; Miyazaki, Megumi; Kuno, Fumi; Sugai, Kei; Sonoda, Satomi; Tanaka, Kenichi; Kurozumi, Akira; Narisawa, Manabu; Torimoto, Keiichi; Arao, Tadashi; Tanaka, Yoshiya

    2018-01-01

    High fluctuations in blood glucose are associated with various complications. The correlation between glycated hemoglobin (HbA1c) level and fluctuations in blood glucose level has not been studied in Japanese patients with type 2 diabetes. In the present study, blood glucose profile stratified by HbA1c level was evaluated by continuous glucose monitoring (CGM) in Japanese type 2 diabetes patients. Our retrospective study included 294 patients with type 2 diabetes who were divided by HbA1c level into five groups (≥6.0 to level and CGM data was analyzed. The primary end-point was the difference in blood glucose fluctuations among the HbA1c groups. The mean blood glucose level increased significantly with increasing HbA1c (P trend  levels of maximum blood glucose, minimum blood glucose, each preprandial blood glucose, each postprandial maximum blood glucose, range of increase in postprandial glucose from pre-meal to after breakfast, the area under the blood concentration-time curve >180 mg/dL and percentage of the area under the blood concentration-time curve >180 mg/dL were higher with higher HbA1c. Mean glucose level and pre-breakfast blood glucose level were significant and independent determinants of HbA1c. In Japanese patients treated for type 2 diabetes, the mean amplitude of glycemic excursions did not correlate with HbA1c, making it difficult to assess blood glucose fluctuations using HbA1c. Parameters other than HbA1c are required to evaluate fluctuations in blood glucose level in patients receiving treatment for type 2 diabetes. © 2017 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

  4. Twenty-four hours hypothermia has temporary efficacy in reducing brain infarction and inflammation in aged rats

    DEFF Research Database (Denmark)

    Sandu, Raluca Elena; Buga, Ana Maria; Balseanu, Adrian Tudor

    2016-01-01

    in aged animals. Because the duration of hypothermia in most clinical trials is between 24 and 48 hours, we questioned whether 24 hours exposure to gaseous hypothermia confers the same neuroprotective efficacy as 48 hours exposure. We found that a shorter exposure to hypothermia transiently reduced both...... inflammation and infarct size. However, after 1 week, the infarct size became even larger than in controls and after 2 weeks there was no beneficial effect on regenerative processes such as neurogenesis. Behaviorally, hypothermia also had a limited beneficial effect. Finally, after hydrogen sulfide......-induced hypothermia, the poststroke aged rats experienced a persistent sleep impairment during their active nocturnal period. Our data suggest that cellular events that are delayed by hypothermia in aged rats may, in the long term, rebound, and diminish the beneficial effects....

  5. Twenty-four-hour urinary water-soluble vitamin levels correlate with their intakes in free-living Japanese schoolchildren.

    Science.gov (United States)

    Tsuji, Tomiko; Fukuwatari, Tsutomu; Sasaki, Satoshi; Shibata, Katsumi

    2011-02-01

    To examine the association between 24 h urinary water-soluble vitamin levels and their intakes in free-living Japanese schoolchildren. All foods consumed for four consecutive days were recorded accurately by a weighed food record. A single 24 h urine sample was collected on the fourth day, and the urinary levels of water-soluble vitamins were measured. An elementary school in Inazawa City, Japan. A total of 114 healthy, free-living, Japanese elementary-school children aged 10-12 years. The urinary level of each water-soluble vitamin was correlated positively to its mean intake in the past 2-4 d (vitamin B1: r = 0·42, P vitamin B2: r = 0·43, P vitamin B6: r = 0·49, P vitamin C: r = 0·39, P vitamin B12 (r = 0·10, P = NS). Estimated mean intakes of water-soluble vitamins calculated using urinary levels and recovery rates were 97-102 % of their 3 d mean intake, except for vitamin B12 (79 %). The results show that urinary levels of water-soluble vitamins, except for vitamin B12, reflected their recent intakes in free-living Japanese schoolchildren and could be used as a potential biomarker to estimate mean vitamin intake.

  6. The Twenty-four Hour Workday: Proceedings of a Symposium on Variations in Work-Sleep Schedules

    Science.gov (United States)

    1980-10-01

    represent, to some extent, stereotyped responses; thus we cannot be sure that they correspond to real feelings, even subjective ones. Shiftworkers...hours; - Part-time work; - Overtime and moonlighting . The present paper considers the various effects of the irregular work hours imposed by shift work...in press). Fifty nurses were shown an ’in-service’ training film on the use of Radium therapy at 2030 or at 0400. Their memory for the information

  7. Twenty-four-hour duration of effect of intranasal corticosteroids for seasonal allergic rhinitis symptoms: clinical evidence and relevance.

    Science.gov (United States)

    DuBuske, Lawrence M

    2012-01-01

    Seasonal allergic rhinitis (SAR) symptoms are often most severe and/or disruptive during overnight and morning hours, resulting in cognitive/performance impairments and reduced quality of life throughout the following day. Surveys of allergy patients and health care practitioners reveal a common perception that intranasal steroids (INSs), many of which are dosed q.d., fail to adequately relieve symptoms for a full 24 hours. This review assessed whether perceptions of the 24-hour duration of action of INSs correspond with duration of action documented in clinical literature. SAR clinical trial literature of the last 5 years was reviewed to identify studies of INSs incorporating morning instantaneous (A.M. NOW) or instantaneous assessments of 24-hour duration of action. In numerous placebo-controlled trials of INSs in patients with SAR, treatment was associated with significantly greater improvements in A.M. NOW symptoms from baseline versus placebo. For congestion, this is noteworthy, because patients often cite this symptom, especially in the morning, as the most bothersome symptom. Comparison of A.M. NOW and daily scores suggests minimal drop in efficacy at 24 hours postdose. In several studies, INS treatment was found superior to intranasal or oral antihistamines in A.M. NOW symptom improvement. Once-daily INSs have potential for effective 24-hour symptom relief; however, there is an apparent disconnect between these findings and patient/physician perceptions. This discrepancy may be explained, in part, by less-than-ideal treatment adherence among "real-world" patients versus subjects treated in clinical trials. Proactive counseling can encourage proper INS use and help maximize treatment benefits.

  8. Treatment approaches and adherence to urate-lowering therapy for patients with gout

    Directory of Open Access Journals (Sweden)

    Aung T

    2017-04-01

    Full Text Available Thanda Aung,* Gihyun Myung,* John D FitzGerald Division of Rheumatology/Department of Internal Medicine, University of California, Los Angeles, Los Angeles, CA, USA *These authors contributed equally to this work Abstract: Gout is the most common inflammatory arthritis characterized by painful disabling acute attacks. It is caused by hyperuricemia and deposition of urate crystals in and around the joints. Long-standing untreated hyperuricemia can lead to chronic arthritis with joint damage, tophi formation and urate nephropathy. Gout is associated with significant morbidity and health care associated cost. The goal of long-term therapy is to lower the serum urate level to promote dissolution of urate crystals, reduce recurrent acute gout flares, resolve tophi and prevent joint damage. Despite the presence of established gout treatment guidelines and effective medications to manage gout, patient outcomes are often poor. Etiology for these shortcomings is multifactorial including both physician and patient characteristics. Poor adherence to urate-lowering therapy (ULT is prevalent and is a significant contributor to poor patient outcomes. This article reviews the treatment strategies for the management of hyperuricemia in chronic gout, gaps in quality of care in gout management, factors contributing to poor adherence to ULT and discusses potential interventions to achieve improved gout-related outcomes. These interventions include initiation of prophylactic anti-inflammatory medication when starting ULT, frequent follow-ups, regular serum urate monitoring and improved patient education, which can be achieved through pharmacist- or nurse-assisted programs. Interventions such as these could improve adherence to ULT and, ultimately, result in optimal gout-related outcomes. Keywords: gout, adherence, urate-lowering therapy 

  9. Gout. Radiological aspects

    International Nuclear Information System (INIS)

    Restrepo Suarez, Jose Felix; Pena Cortes, Mario; Rondon Herrera, Federico; Iglesias Gamarra, Antonio; Calvo Paramo, Enrique

    2000-01-01

    In this paper we reviewed the clinical and radiological aspects of gout, showing the most frequent radiological findings that can guide to the correct diagnosis of the disease. The cases that we presented here have been analyzed for many years in our rheumatology service, Universidad Nacional de Colombia, Hospital San Juan de Dios, Bogota

  10. Multiplicative interaction of functional inflammasome genetic variants in determining the risk of gout

    NARCIS (Netherlands)

    McKinney, Cushla; Stamp, Lisa K.; Dalbeth, Nicola; Topless, Ruth K.; Day, Richard O.; Kannangara, Diluk R. W.; Williams, Kenneth M.; Janssen, Matthijs; Jansen, Timothy L.; Joosten, Leo A.; Radstake, Timothy R.; Riches, Philip L.; Tausche, Anne-Kathrin; Liote, Frederic; So, Alexander; Merriman, Tony R.

    2015-01-01

    Introduction: The acute gout flare results from a localised self-limiting innate immune response to monosodium urate (MSU) crystals deposited in joints in hyperuricaemic individuals. Activation of the caspase recruitment domain-containing protein 8 (CARD8) NOD-like receptor pyrin-containing 3

  11. Multiplicative interaction of functional inflammasome genetic variants in determining the risk of gout

    NARCIS (Netherlands)

    McKinney, C.; Stamp, L.K.; Dalbeth, N.; Topless, R.K.; Day, R.O.; Kannangara, D.R.; Williams, K.M.; Janssen, M; Jansen, T.L.Th.A.; Joosten, L.A.B.; Radstake, T.R.; Riches, P.L.; Tausche, A.K.; Liote, F.; So, A.; Merriman, T.R.

    2015-01-01

    INTRODUCTION: The acute gout flare results from a localised self-limiting innate immune response to monosodium urate (MSU) crystals deposited in joints in hyperuricaemic individuals. Activation of the caspase recruitment domain-containing protein 8 (CARD8) NOD-like receptor pyrin-containing 3

  12. A qualitative and quantitative analysis of the characteristics of gout patient education resources.

    Science.gov (United States)

    Robinson, Philip C; Schumacher, H Ralph

    2013-06-01

    Patient education is an important aspect of gout management, but there is evidence that many patients lack adequate knowledge of their condition. Our aim was to examine the characteristics of gout patient education resources. Ten gout patient information resources were examined for readability (Flesch-Kincaid reading level, the Simple Measure of Gobbledygook measure and the Flesch Reading Ease Score), qualitative characteristics such as figure and jargon use and whether they included information on the major points of gout. The median readability grade level of the examined resources was 8.5. The difference in readability grade level between the highest and the lowest education resource was 6.3 grade levels. The information content of the resources was high with an average of only 3.9 proposed criteria of 19 (19 %) absent from the resources. Jargon use was low and concepts were usually explained. However, important information regarding acute flare prophylaxis during urate-lowering therapy initiation and titration and treating serum uric acid to target was absent from 60 % of the patient education resources. There was poor use of key messages at the start. Gout patient resources have a wide range of readability. Thirty percent of resources were above the average reading level of rheumatology outpatients reported in previous studies. Sixty percent of gout patient resources omit education items that could impact on patient adherence and in turn patient outcomes. Further research is needed into the literacy levels and education requirements of patients with gout.

  13. [Chronic tophaceous gout].

    Science.gov (United States)

    González-Rozas, M; Prieto de Paula, J M; Franco Hidalgo, S; López Pedreira, M R

    2013-09-01

    Gout is a common illness, usually of unknown etiology, is more frequent in men, and with a prevalence that increases with age. It is characterized by recurrent episodes of acute arthritis due to the deposition of monosodium urate crystals in joints. The underlying disorder in most cases is hyperuricemia, usually as a consequence of impairment in its renal excretion. Although it is generally believed that both the diagnosis and treatment are simple, the truth is that the level of adherence of clinical decisions using the existing guidelines is poor. We describe a case of chronic tophaceous gout, and review the general characteristics of this condition. Copyright © 2011 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  14. The Filipino and gout.

    Science.gov (United States)

    Torralba, T P; Bayani-Sioson, P S

    1975-05-01

    Hyperuricemia and gout has been recognized among the Filipinos in Hawaii, Alaska, and mainland United States for almost two decades. Several studies bearing out this impression have been reviewed. The awareness of these observation prompted an extension to the Filipino in his natural environment. These studies showed a lower mean of serum uric acid values in healthy subjects when using comparative enzymatic spectrophotometric determinations. Aside from genetic factors, Filipino hyperuricemia may become manifest because of environmental stress, including dietary stress, and investigators postulate that some Filipinos possess a renal defect that may lead to hyperuricemia due to renal inability to compensate for an increased purine intake which may occur in the shift from a low-purine Filipino diet to a high-purine Western diet in his new environment, as in the case of the Filipino immigrant. The clinical profile of gout as it exists in the Philippines has been compared and found to be similar generally to that of other series. The control of the hyperuricemia and gout has been satisfactorily accomplished in the Filipino patients with the long-term use of allopurinol, sometimes complemented with colchicine taken daily.

  15. Systemic corticosteroids for acute gout.

    NARCIS (Netherlands)

    Janssens, H.; Lucassen, P.L.B.J.; Laar, F.A. van de; Janssen, M.; Lisdonk, E.H. van de

    2008-01-01

    BACKGROUND: Gout is one of the most frequently occurring rheumatic diseases, worldwide. Given the well-known drawbacks of the regular treatments for acute gout (non-steroidal anti-inflammatory drugs (NSAIDs), colchicine), systemic corticosteroids might be safe alternatives. OBJECTIVES: To assess the

  16. Gout: Value of bone scanning

    International Nuclear Information System (INIS)

    Oliva, J.P.; Cardenas, R.; Bell, L.; Gonzalez Griego, J.

    1986-01-01

    11 male patients with gout were studied by means of bone scintigraphy with 99m TcMDP. This diagnostic method rendered possible the diagnosis of clinically or roentgenologically occult bone involvement. Bone scintigraphy may be useful procedure to monitor therapy of gout. (orig.) [de

  17. Solar flares

    International Nuclear Information System (INIS)

    Zirin, H.

    1974-01-01

    A review of the knowledge about solar flares which has been obtained through observations from the earth and from space by various methods is presented. High-resolution cinematography is best carried out at H-alpha wavelengths to reveal the structure, time history, and location of flares. The classification flares in H alpha according to either physical or morphological criteria is discussed. The study of flare morphology, which shows where, when, and how flares occur, is important for evaluating theories of flares. Consideration is given to studies of flares by optical spectroscopy, radio emissions, and at X-ray and XUV wavelengths. Research has shown where and possibly why flares occur, but the physics of the instability involved, of the particle acceleration, and of the heating are still not understood. (IAA)

  18. Management of hyperuricemia in gout: focus on febuxostat

    Directory of Open Access Journals (Sweden)

    Mattheus K Reinders

    2010-01-01

    Full Text Available Mattheus K Reinders1, Tim L Th A Jansen21Clinical Pharmacy, Atrium Medisch Centrum Parkstad, Heerlen, The Netherlands; 2Rheumatology, Medisch Centrum Leeuwarden, Leeuwarden, The NetherlandsAbstract: Gout is the most common inflammatory arthritis in an elderly population, and can be diagnosed with absolute certainty by polarization microscopy. However, diagnosis may be challenging because atypical presentations are more common in the elderly. Management of hyperuricemia in the elderly with gout requires special consideration because of co-medication, contra-indications, and risk of adverse reactions. Urate-lowering agents include allopurinol and uricosuric agents. These also must be used sensibly in the elderly, especially when renal function impairment is present. However, if used at the lowest dose that maintains the serum urate level below 5.0 to 6.0 mg/dL (0.30 to 0.36 mmol/L, the excess urate in the body will eventually be eliminated, acute flares will no longer occur, and tophi will resolve. Febuxostat, a new xanthine oxidase inhibitor, is welcomed, as few alternatives for allopurinol are available. Its pharmacokinetics and pharmacodynamics are not significantly altered in patients with moderate renal function or hepatic impairment. Its antihyperuricemic efficacy at 80 to 120 mg/day is better than “standard dosage” allopurinol (300 mg/day. Long-term safety data and efficacy data on tophus diminishment and reduction of gout flares have recently become available. Febuxostat may provide an important option in patients unable to use allopurinol, or refractory to allopurinol.Keywords: aging, febuxostat, hyperuricemia, gout, pharmacotherapy, xanthine oxidase

  19. Calcium oxalate stone and gout.

    Science.gov (United States)

    Marickar, Y M Fazil

    2009-12-01

    Gout is well known to be produced by increased uric acid level in blood. The objective of this paper is to assess the relationship between gout and calcium oxalate stone formation in the humans. 48 patients with combination of gout and calcium oxalate stone problem were included. The biochemical values of this group were compared with 38 randomly selected uric acid stone patients with gout, 43 stone patients with gout alone, 100 calcium oxalate stone patients without gout and 30 controls, making a total of 259 patients. Various biochemical parameters, namely serum calcium, phosphorus and uric acid and 24-h urine calcium, phosphorus, uric acid, oxalate, citrate and magnesium were analysed. ANOVA and Duncan's multiple-range tests were performed to assess statistical significance of the variations. The promoters of stone formation, namely serum calcium (P stone patients and gouty calcium oxalate stone patients compared to the non-gouty patients and controls. Urine oxalate (P stones patients. The inhibitor urine citrate (P stone gouty patients, followed by the gouty uric acid stone formers and gouty calcium oxalate stone patients. The high values of promoters, namely uric acid and calcium in the gouty stone patients indicate the tendency for urinary stone formation in the gouty stone patients. There is probably a correlation between gout and calcium oxalate urinary stone. We presume this mechanism is achieved through the uric acid metabolism. The findings point to the summation effect of metabolic changes in development of stone disease.

  20. Flare stars

    International Nuclear Information System (INIS)

    Nicastro, A.J.

    1981-01-01

    The least massive, but possibly most numerous, stars in a galaxy are the dwarf M stars. It has been observed that some of these dwarfs are characterized by a short increase in brightness. These stars are called flare stars. These flare stars release a lot of energy in a short amount of time. The process producing the eruption must be energetic. The increase in light intensity can be explained by a small area rising to a much higher temperature. Solar flares are looked at to help understand the phenomenon of stellar flares. Dwarfs that flare are observed to have strong magnetic fields. Those dwarf without the strong magnetic field do not seem to flare. It is believed that these regions of strong magnetic fields are associated with star spots. Theories on the energy that power the flares are given. Astrophysicists theorize that the driving force of a stellar flare is the detachment and collapse of a loop of magnetic flux. The mass loss due to stellar flares is discussed. It is believed that stellar flares are a significant contributor to the mass of interstellar medium in the Milky Way

  1. Discordant American College of Physicians and international rheumatology guidelines for gout management: consensus statement of the Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN).

    Science.gov (United States)

    Dalbeth, Nicola; Bardin, Thomas; Doherty, Michael; Lioté, Frédéric; Richette, Pascal; Saag, Kenneth G; So, Alexander K; Stamp, Lisa K; Choi, Hyon K; Terkeltaub, Robert

    2017-09-01

    In November 2016, the American College of Physicians (ACP) published a clinical practice guideline on the management of acute and recurrent gout. This guideline differs substantially from the latest guidelines generated by the American College of Rheumatology (ACR), European League Against Rheumatism (EULAR) and 3e (Evidence, Expertise, Exchange) Initiative, despite reviewing largely the same body of evidence. The Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN) convened an expert panel to review the methodology and conclusions of these four sets of guidelines and examine possible reasons for discordance between them. The G-CAN position, presented here, is that the fundamental pathophysiological knowledge underlying gout care, and evidence from clinical experience and clinical trials, supports a treat-to-target approach for gout aimed at lowering serum urate levels to below the saturation threshold at which monosodium urate crystals form. This practice, which is truly evidence-based and promotes the steady reduction in tissue urate crystal deposits, is promoted by the ACR, EULAR and 3e Initiative recommendations. By contrast, the ACP does not provide a clear recommendation for urate-lowering therapy (ULT) for patients with frequent, recurrent flares or those with tophi, nor does it recommend monitoring serum urate levels of patients prescribed ULT. Results from emerging clinical trials that have gout symptoms as the primary end point are expected to resolve this debate for all clinicians in the near term future.

  2. Gout Classification Criteria: Update and Implications

    Science.gov (United States)

    Vargas-Santos, Ana Beatriz; Taylor, William J.

    2016-01-01

    Gout is the most common inflammatory arthritis, with a rising prevalence and incidence worldwide. There has been a resurgence in gout research, fueled, in part, by a number of advances in pharmacologic therapy for gout. The conduct of clinical trials and other observational research in gout requires a standardized and validated means of assembling well-defined groups of patients with gout for such research purposes. Recently, an international collaborative effort that involved a data-driven process with state-of-the art methodology supported by the American College of Rheumatology and the European League Against Rheumatism led to publication of new gout classification criteria. PMID:27342957

  3. Bilateral Olecranon Tophaceous Gout Bursitis

    Directory of Open Access Journals (Sweden)

    Güzelali Özdemir

    2017-01-01

    Full Text Available In this case, we present a patient with the diagnosis of bilateral olecranon tophaceous gout. After the surgical treatment, there was no limitation of range of motion or wound problem at 6th month control.

  4. Gout: radiographic findings mimicking infection

    International Nuclear Information System (INIS)

    Rousseau, I.; Raymond-Tremblay, D.; Cardinal, E.; Beauregard, C.G.; Braunstein, E.M.; Saint-Pierre, A.

    2001-01-01

    Objective: To describe radiographic features of gout that may mimic infection. Design and patients: We report five patients with acute bacterial gout who presented with clinical as well as radiological findings mimicking acute bacterial septic arthritis or osteomyelitis. Three patients had delay in the appropriate treatment with the final diagnosis being established after needle aspiration and identification of urate crystals under polarized light microscopy. Two patients underwent digit amputation for not responding to antibiotic treatment and had histological findings confirming the diagnosis of gout. Conclusion: It is important for the radiologist to be aware of the radiological manifestations of acute gout that can resemble infection in order to avoid inappropriate diagnosis and delay in adequate treatment. The definitive diagnosis should rely on needle aspiration and a specific search for urate crystals. (orig.)

  5. Febuxostat in the management of gout: a cost-effectiveness analysis.

    Science.gov (United States)

    Smolen, Lee J; Gahn, James C; Mitri, Ghaith; Shiozawa, Aki

    2016-01-01

    To determine the cost-effectiveness of febuxostat vs allopurinol for the management of gout. A stochastic microsimulation cost-effectiveness model with a US private-payer perspective and 5-year time horizon was developed. Model flow based on guideline and real-world treatment paradigms incorporated gout flare, serum uric acid (sUA) testing, treatment titration, discontinuation, and adverse events, chronic kidney disease (CKD) incidence and progression, and type 2 diabetes mellitus (T2DM) incidence. Outcomes were estimated for the general gout population and for gout patients with CKD stages 3/4. Modeled treatment interventions were daily oral febuxostat 40-80 mg and allopurinol 100-300 mg. Baseline patient characteristics were taken from epidemiologic studies, efficacy data from randomized controlled trials, adverse event rates from package inserts, and costs from the literature, government sources, and expert opinion. Eight clinically-relevant incremental cost-effectiveness ratios were estimated: per patient reaching target sUA, per flare avoided, per CKD incidence, progression, stages 3/4 progression, and stage 5 progression avoided, per incident T2DM avoided, and per death avoided. Five-year incremental cost-effectiveness ratios for the general gout population were $5377 per patient reaching target sUA, $1773 per flare avoided, $221,795 per incident CKD avoided, $29,063 per CKD progression avoided, $36,018 per progression to CKD 3/4 avoided, $71,426 per progression to CKD 5 avoided, $214,277 per incident T2DM avoided, and $217,971 per death avoided. In patients with CKD 3/4, febuxostat dominated allopurinol for all cost-effectiveness outcome measures. Febuxostat may be a cost-effective alternative to allopurinol, especially for patients with CKD stages 3 or 4.

  6. Juvenile intraosseous gout of the calcaneus

    International Nuclear Information System (INIS)

    Yun, Chun-Ho; Fang, Yang-Kai; Hung, Yu-Chung; Shih, Shin-Lin; Huang, Jon-Kway

    2005-01-01

    Gout presenting as an osteolytic lesion is exceedingly rare in children with asymptomatic hyperuricemia. We report the clinical and radiological presentation of intraosseous gout in a 13-year-old boy. (orig.)

  7. Glucosamine: Can It Worsen Gout Symptoms?

    Science.gov (United States)

    ... symptoms? My husband takes glucosamine supplements to treat gout. But I'm wondering if glucosamine, which contains shellfish, may actually worsen gout symptoms? Answers from April Chang-Miller, M.D. ...

  8. Juvenile intraosseous gout of the calcaneus

    Energy Technology Data Exchange (ETDEWEB)

    Yun, Chun-Ho; Fang, Yang-Kai; Hung, Yu-Chung [Mackay Memorial Hospital, Department of Radiology, Taipei (Taiwan); Shih, Shin-Lin; Huang, Jon-Kway [Taipei Medical University, Department of Radiology, Taipei (Taiwan)

    2005-09-01

    Gout presenting as an osteolytic lesion is exceedingly rare in children with asymptomatic hyperuricemia. We report the clinical and radiological presentation of intraosseous gout in a 13-year-old boy. (orig.)

  9. Flare energetics

    Science.gov (United States)

    Wu, S. T.; Dejager, C.; Dennis, B. R.; Hudson, H. S.; Simnett, G. M.; Strong, K. T.; Bentley, R. D.; Bornmann, P. L.; Bruner, M. E.; Cargill, P. J.

    1986-01-01

    In this investigation of flare energetics, researchers sought to establish a comprehensive and self-consistent picture of the sources and transport of energy within a flare. To achieve this goal, they chose five flares in 1980 that were well observed with instruments on the Solar Maximum Mission, and with other space-borne and ground-based instruments. The events were chosen to represent various types of flares. Details of the observations available for them and the corresponding physical parameters derived from these data are presented. The flares were studied from two perspectives, the impulsive and gradual phases, and then the results were compared to obtain the overall picture of the energics of these flares. The role that modeling can play in estimating the total energy of a flare when the observationally determined parameters are used as the input to a numerical model is discussed. Finally, a critique of the current understanding of flare energetics and the methods used to determine various energetics terms is outlined, and possible future directions of research in this area are suggested.

  10. Solar flares

    International Nuclear Information System (INIS)

    Kaastra, J.S.

    1985-01-01

    In this thesis an electrodynamic model for solar flares is developed. The main theoretical achievements underlying the present study are treated briefly and the observable flare parameters are described within the framework of the flare model of this thesis. The flare model predicts large induced electric fields. Therefore, acceleration processes of charged particles by direct electric fields are treated. The spectrum of the accelerated particles in strong electric fields is calculated, 3 with the electric field and the magnetic field perpendicular and in the vicinity of an X-type magnetic neutral line. An electromagnetic field configuration arises in the case of a solar flare. A rising current filament in a quiescent background bipolar magnetic field causes naturally an X-type magnetic field configuration below the filament with a strong induced electric field perpendicular to the ambient magnetic field. This field configuration drives particles and magnetic energy towards the neutral line, where a current sheet is generated. The global evolution of the fields in the flare is determined by force balance of the Lorentz forces on the filament and the force balance on the current sheet. The X-ray, optical and radio observations of a large solar flare on May 16, 1981 are analyzed. It is found that these data fit the model very well. (Auth.)

  11. Multiplicative interaction of functional inflammasome genetic variants in determining the risk of gout.

    Science.gov (United States)

    McKinney, Cushla; Stamp, Lisa K; Dalbeth, Nicola; Topless, Ruth K; Day, Richard O; Kannangara, Diluk Rw; Williams, Kenneth M; Janssen, Matthijs; Jansen, Timothy L; Joosten, Leo A; Radstake, Timothy R; Riches, Philip L; Tausche, Anne-Kathrin; Lioté, Frederic; So, Alexander; Merriman, Tony R

    2015-10-13

    The acute gout flare results from a localised self-limiting innate immune response to monosodium urate (MSU) crystals deposited in joints in hyperuricaemic individuals. Activation of the caspase recruitment domain-containing protein 8 (CARD8) NOD-like receptor pyrin-containing 3 (NLRP3) inflammasome by MSU crystals and production of mature interleukin-1β (IL-1β) is central to acute gouty arthritis. However very little is known about genetic control of the innate immune response involved in acute gouty arthritis. Therefore our aim was to test functional single nucleotide polymorphism (SNP) variants in the toll-like receptor (TLR)-inflammasome-IL-1β axis for association with gout. 1,494 gout cases of European and 863 gout cases of New Zealand (NZ) Polynesian (Māori and Pacific Island) ancestry were included. Gout was diagnosed by the 1977 ARA gout classification criteria. There were 1,030 Polynesian controls and 10,942 European controls including from the publicly-available Atherosclerosis Risk in Communities (ARIC) and Framingham Heart (FHS) studies. The ten SNPs were either genotyped by Sequenom MassArray or by Affymetrix SNP array or imputed in the ARIC and FHS datasets. Allelic association was done by logistic regression adjusting by age and sex with European and Polynesian data combined by meta-analysis. Sample sets were pooled for multiplicative interaction analysis, which was also adjusted by sample set. Eleven SNPs were tested in the TLR2, CD14, IL1B, CARD8, NLRP3, MYD88, P2RX7, DAPK1 and TNXIP genes. Nominally significant (P gout were detected at CARD8 rs2043211 (OR = 1.12, P = 0.007), IL1B rs1143623 (OR = 1.10, P = 0.020) and CD14 rs2569190 (OR = 1.08; P = 0.036). There was significant multiplicative interaction between CARD8 and IL1B (P = 0.005), with the IL1B risk genotype amplifying the risk effect of CARD8. There is evidence for association of gout with functional variants in CARD8, IL1B and CD14. The gout-associated allele of IL1B increases

  12. Update on Importance of Diet in Gout.

    Science.gov (United States)

    Beyl, Randall N; Hughes, Laura; Morgan, Sarah

    2016-11-01

    Gout is an inflammatory arthritis caused by deposition of monosodium urate crystals within synovial joints. Although it is most well-known for its arthritis, gout has an intimate relationship with many other cardiovascular and metabolic conditions. Current recommendations support aggressive medical therapy to treat gout, whereas dietary counseling has become less emphasized. This article argues for the absolute importance of dietary counseling in gout and proves why this counseling may impact the long term well-being of a patient with gout. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. ATYPICAL GOUT: SPINAL TOPHACEOUS INJURY

    Directory of Open Access Journals (Sweden)

    Maksim Sergeevich Eliseev

    2013-01-01

    Full Text Available Spinal injury in gout occurs rarely at a young age. In the past 5 years, the Pubmed has published only 44 papers on this site of tophi mainly in gouty patients over 40 years of age. We report two such cases in patients with chronic tophaceous gout in a 28-year-old man with a 3-year history of gout and in a 30-year-old man with its 7-year history. In both cases, spinal injury with tophus masses gave rise to neurological symptomatology. Computed tomography and magnetic resonance imaging were of informative value in identifying the causes of pain. In one case, the patient underwent laminectomy; histological evidence confirmed the gouty genesis of spinal injury.

  14. Flare Observations

    Directory of Open Access Journals (Sweden)

    Benz Arnold O.

    2008-02-01

    Full Text Available Solar flares are observed at all wavelengths from decameter radio waves to gamma-rays at 100 MeV. This review focuses on recent observations in EUV, soft and hard X-rays, white light, and radio waves. Space missions such as RHESSI, Yohkoh, TRACE, and SOHO have enlarged widely the observational base. They have revealed a number of surprises: Coronal sources appear before the hard X-ray emission in chromospheric footpoints, major flare acceleration sites appear to be independent of coronal mass ejections (CMEs, electrons, and ions may be accelerated at different sites, there are at least 3 different magnetic topologies, and basic characteristics vary from small to large flares. Recent progress also includes improved insights into the flare energy partition, on the location(s of energy release, tests of energy release scenarios and particle acceleration. The interplay of observations with theory is important to deduce the geometry and to disentangle the various processes involved. There is increasing evidence supporting reconnection of magnetic field lines as the basic cause. While this process has become generally accepted as the trigger, it is still controversial how it converts a considerable fraction of the energy into non-thermal particles. Flare-like processes may be responsible for large-scale restructuring of the magnetic field in the corona as well as for its heating. Large flares influence interplanetary space and substantially affect the Earth’s lower ionosphere. While flare scenarios have slowly converged over the past decades, every new observation still reveals major unexpected results, demonstrating that solar flares, after 150 years since their discovery, remain a complex problem of astrophysics including major unsolved questions.

  15. Flare Observations

    Science.gov (United States)

    Benz, Arnold O.

    2017-12-01

    Solar flares are observed at all wavelengths from decameter radio waves to gamma-rays beyond 1 GeV. This review focuses on recent observations in EUV, soft and hard X-rays, white light, and radio waves. Space missions such as RHESSI, Yohkoh, TRACE, SOHO, and more recently Hinode and SDO have enlarged widely the observational base. They have revealed a number of surprises: Coronal sources appear before the hard X-ray emission in chromospheric footpoints, major flare acceleration sites appear to be independent of coronal mass ejections, electrons, and ions may be accelerated at different sites, there are at least 3 different magnetic topologies, and basic characteristics vary from small to large flares. Recent progress also includes improved insights into the flare energy partition, on the location(s) of energy release, tests of energy release scenarios and particle acceleration. The interplay of observations with theory is important to deduce the geometry and to disentangle the various processes involved. There is increasing evidence supporting magnetic reconnection as the basic cause. While this process has become generally accepted as the trigger, it is still controversial how it converts a considerable fraction of the energy into non-thermal particles. Flare-like processes may be responsible for large-scale restructuring of the magnetic field in the corona as well as for its heating. Large flares influence interplanetary space and substantially affect the Earth's ionosphere. Flare scenarios have slowly converged over the past decades, but every new observation still reveals major unexpected results, demonstrating that solar flares, after 150 years since their discovery, remain a complex problem of astrophysics including major unsolved questions.

  16. DIET IN GOUT AND HYPERURICEMIA

    Directory of Open Access Journals (Sweden)

    O. V. Zhelyabina

    2017-01-01

    Full Text Available The paper reviews the most important works devoted to the study of the impact of individual foods and food components on the risk of gout, its clinical manifestations and the level of uricemia. It considers some mechanisms probably underlying the impact of dietary patterns on the level of uricemia. It is shown that the available data on possible alterations in the diet with their proper application can considerably affect both the incidence of gout and the course of the current disease.

  17. The genetic basis of gout.

    Science.gov (United States)

    Merriman, Tony R; Choi, Hyon K; Dalbeth, Nicola

    2014-05-01

    Gout results from deposition of monosodium urate (MSU) crystals. Elevated serum urate concentrations (hyperuricemia) are not sufficient for the development of disease. Genome-wide association studies (GWAS) have identified 28 loci controlling serum urate levels. The largest genetic effects are seen in genes involved in the renal excretion of uric acid, with others being involved in glycolysis. Whereas much is understood about the genetic control of serum urate levels, little is known about the genetic control of inflammatory responses to MSU crystals. Extending knowledge in this area depends on recruitment of large, clinically ascertained gout sample sets suitable for GWAS. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Crystal-proven Gout and Characteristic Gout Severity Factors are Associated with Cardiovascular Disease.

    Science.gov (United States)

    Disveld, Iris J M; Fransen, Jaap; Rongen, Gerard A; Kienhorst, Laura B E; Zoakman, Sahel; Janssens, Hein J E M; Janssen, Matthijs

    2018-04-15

    Our aim was to examine the prevalence of cardiovascular disease (CVD) in patients with crystal-proven gout compared to arthritis controls. Further, we analyzed the association between characteristic gout severity factors and CVD to provide further support for a pathogenetic relationship between gout and CVD. Patients with arthritis referred for diagnosis were consecutively included in the Gout Arnhem-Liemers cohort. Joint fluid analysis was performed in all referred patients; controls were negative for crystals. Patients' characteristics and different manifestations of CVD and gout severity factors (disease duration, attack frequency, tophi, affected joints, high serum urate acid level, joint damage) were collected. Gout patients were compared with controls for the prevalence of CVD. In addition, the association between characteristic gout severity factors and presence of CVD was analyzed. Data from 700 gout patients and 276 controls were collected. CVD was present in 47% (95% CI 44%-51%) and 24% (95% CI 19%-29%) of gout patients and controls, respectively. Corrected for confounders, gout was still strongly associated with an increased prevalence of CVD compared to controls (OR 3.39, 95% CI 2.37-4.84). In patients with gout, disease duration ≥ 2 years, oligo- or polyarthritis, serum urate acid > 0.55 mmol/l at presentation, and joint damage were independently (p patients with gout, characteristic gout severity factors were associated with CVD.

  19. A survey on the beliefs and knowledge of gout management in new medical graduates - New South Wales, Australia.

    Science.gov (United States)

    Terrill, Matthew; Riordan, John

    2018-02-01

    To assess the beliefs and knowledge of gout management in new medical graduates. A survey on gout management was sent to new medical graduates during their orientation week, New South Wales, Australia. Of 15 hospital networks, 11 agreed to participate. From these, 168 graduates responded (23.7% response rate). Most (81.1%) felt that gout was a serious disease, 51.2% answered that they had been taught adequately to manage acute gout, only 37.2% for chronic gout. In an acute gout flare, 63.4% answered they would continue urate lowering therapy and 67.2% were aware of first-line pharmacological management options; 28% answered the correct dosing regimen for colchicine. Chronic management was answered poorly. Only 42.0% stated they would titrate allopurinol dosing to a target urate level; 23.5% would check the urate level monthly. More than half, 56.8%, were aware that medical prophylaxis is indicated when initiating urate lowering therapy. Of this subgroup, 46.7% (25.9% overall) knew that non-steroidal anti-inflammatory drugs and colchicine were recommended and 28.4% (15.4% overall) answered the correct timeframe of use. Close to one-third (35.0%), were aware of febuxostat, probenecid and benzbromarone as second-line urate lowering therapy. The findings of this study suggest that new graduates' knowledge of gout management, especially chronic management, is suboptimal. Many felt their teaching on gout management inadequate; this is a potential target for intervention. Up to date university education which covers chronic management may lead to better clinical outcomes for this burdensome disease. © 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  20. Association Between Gout and Aortic Stenosis.

    Science.gov (United States)

    Chang, Kevin; Yokose, Chio; Tenner, Craig; Oh, Cheongeun; Donnino, Robert; Choy-Shan, Alana; Pike, Virginia C; Shah, Binita D; Lorin, Jeffrey D; Krasnokutsky, Svetlana; Sedlis, Steven P; Pillinger, Michael H

    2017-02-01

    An independent association between gout and coronary artery disease is well established. The relationship between gout and valvular heart disease, however, is unclear. The aim of this study was to assess the association between gout and aortic stenosis. We performed a retrospective case-control study. Aortic stenosis cases were identified through a review of outpatient transthoracic echocardiography (TTE) reports. Age-matched controls were randomly selected from patients who had undergone TTE and did not have aortic stenosis. Charts were reviewed to identify diagnoses of gout and the earliest dates of gout and aortic stenosis diagnosis. Among 1085 patients who underwent TTE, 112 aortic stenosis cases were identified. Cases and nonaortic stenosis controls (n = 224) were similar in age and cardiovascular comorbidities. A history of gout was present in 21.4% (n = 24) of aortic stenosis subjects compared with 12.5% (n = 28) of controls (unadjusted odds ratio 1.90, 95% confidence interval 1.05-3.48, P = .038). Multivariate analysis retained significance only for gout (adjusted odds ratio 2.08, 95% confidence interval 1.00-4.32, P = .049). Among subjects with aortic stenosis and gout, gout diagnosis preceded aortic stenosis diagnosis by 5.8 ± 1.6 years. The age at onset of aortic stenosis was similar among patients with and without gout (78.7 ± 1.8 vs 75.8 ± 1.0 years old, P = .16). Aortic stenosis patients had a markedly higher prevalence of precedent gout than age-matched controls. Whether gout is a marker of, or a risk factor for, the development of aortic stenosis remains uncertain. Studies investigating the potential role of gout in the pathophysiology of aortic stenosis are warranted and could have therapeutic implications. Published by Elsevier Inc.

  1. Upper Extremity Compartment Syndrome in a Patient with Acute Gout Attack but without Trauma or Other Typical Causes

    Directory of Open Access Journals (Sweden)

    John G. Skedros

    2018-01-01

    Full Text Available We report the case of a 30-year-old Polynesian male with a severe gout flare of multiple joints and simultaneous acute compartment syndrome (ACS of his right forearm and hand without trauma or other typical causes. He had a long history of gout flares, but none were known to be associated with compartment syndrome. He also had concurrent infections in his right elbow joint and olecranon bursa. A few days prior to this episode of ACS, high pain and swelling occurred in his right upper extremity after a minimal workout with light weights. A similar episode occurred seven months prior and was attributed to a gout flare. Unlike past flares that resolved with colchicine and/or anti-inflammatory medications, his current upper extremity pain/swelling worsened and became severe. Hand and forearm fasciotomies were performed. Workup included general medicine, rheumatology and infectious disease consultations, myriad blood tests, and imaging studies including Doppler ultrasound and CT angiography. Additional clinical history suggested that he had previously unrecognized recurrent exertional compartment syndrome that led to the episode of ACS reported here. Chronic exertional compartment syndrome (CECS presents a difficult diagnosis when presented with multiple symptoms concurrently. This case provides an example of one such diagnosis.

  2. Solar flares

    International Nuclear Information System (INIS)

    Brown, J.C.; Smith, D.F.

    1980-01-01

    The current observational and theoretical status of solar flares as a typical astrophysical problem is reviewed with especial reference to the intense and complex energy release in large flares. Observations and their diagnostic applications are discussed in three broad areas: thermal radiation at temperatures T 5 K; thermal radiation at T > approximately 10 5 K; and non-thermal radiation and particles. Particular emphasis is given to the most recent observational discoveries such as flare γ-rays, interplanetary Langmuir waves, and the ubiquitous association of soft x-ray loops with flares, and also the progress in particle diagnostics of hard x-ray and radio bursts. The theoretical problems of primary energy release are considered in terms of both possible magnetic configuration and in plasma instabilities and the question of achieving the necessary flash power discussed. The credibility of models for the secondary redistribution through the atmosphere of the primary magnetic energy released in terms of conduction, convection, radiation and particle transport is examined. Progress made in the flare problem in the past decade is assessed and some possible reasons why no convincing solution has yet been found are considered. 296 references. (U.K.)

  3. Recurrent painful calf swelling associated with gout.

    Science.gov (United States)

    Kovarsky, J; Young, M B

    1978-01-01

    A 30-year-old man had a recurrent painful calf swelling associated with gout that mimicked thrombophlebitis and possibly muscle tear. This painful calf swelling occurred in the absence of a subjective history of arthritis of the knee. A constellation of clinical signs was highly suggestive that gout was the cause of the painful calf swellings. Patients with similar conditions, after careful exclusion of thrombophlebitis, might be spared unnecessary and potentially dangerous anticoagulation or surgical intervention by early diagnosis of gout.

  4. The impact of gout on patient’s lives: a study of African-American and Caucasian men and women with gout

    Science.gov (United States)

    2014-01-01

    Introduction The aim of this study was to examine the impact of gout on quality of life (QOL) and study differences by gender and race. Methods Ten race- and sex-stratified nominal groups were conducted, oversampling for African-Americans and women with gout. Patients presented, discussed, combined and rank-ordered their concerns. Results A total of 62 patients with mean age 65.1 years, 60% men, 64% African-American, participated in 10 nominal groups: African-American men (n = 23; 3 groups); African-American women (n = 18; 3 groups); Caucasian men (n = 15; 3 groups); and Caucasian women (n = 6; 1 group). The most frequently cited high-ranked concerns among the ten nominal groups were: (1) effect of gout flare on daily activities (n = 10 groups); (2) work disability (n = 8 groups); (3) severe pain (n = 8 groups); (4) joint swelling and tenderness (n = 6 groups); (5) food restrictions (n = 6 groups); (6) medication related issues (n = 6 groups); (7) dependency on family and others (n = 5 groups); (8) emotional Impact (n = 5 groups); (9) interference with sexual function (n = 4 groups); (10) difficulty with shoes (n = 4 groups); and (11) sleep disruption (n = 4 groups). Compared with men, women ranked the following concerns high more often: problems with shoes (n = 4 versus n = 0 groups); dependency (n = 3 versus n = 2 groups); and joint/limb deformity (n = 2 versus n = 0 group). Compared with Caucasians, African-Americans ranked the following concerns high more often: dietary restrictions (n = 6 versus n = 0 groups); severe pain (n = 6 versus n = 2 groups); gout bringing the day to a “halt” (n = 2 versus n = 0 group); effect on emotional health (n = 4 versus n = 1 groups); and the need for canes/crutches during flares (n = 2 versus n = 0 group). Conclusions Gout has a significant impact on a patient’s QOL. Important differences in the

  5. The genetics of hyperuricaemia and gout

    OpenAIRE

    Reginato, Anthony M.; Mount, David B.; Yang, Irene; Choi, Hyon K.

    2012-01-01

    Gout is a common and very painful inflammatory arthritis caused by hyperuricaemia. This Review provides an update on the genetics of hyperuricaemia and gout, including findings from genome-wide association studies. Most of the genes that associated with serum uric acid levels or gout are involved in the renal urate-transport system. For example, the urate transporter genes SLC2A9, ABCG2 and SLC22A12 modulate serum uric acid levels and gout risk. The net balance between renal urate absorption ...

  6. Epidemiology of gout and chondrocalcinosis

    Directory of Open Access Journals (Sweden)

    M. Govoni

    2012-01-01

    Full Text Available Gout is the most common cause of inflammatory arthritis affecting at least 1% of the population in industrialized countries. It is closely associated with hyperuricemia and is characterized by formation and reversible deposition of monosodium urate crystals in joints and extra-articular tissues. Several studies suggest that the prevalence and incidence of gout are rising. Numerous risk factors may in part explain this increasing trend including dietary and lifestyle changes, genetic factors, diuretic use and comorbid conditions such as hypertension, diabetes, cardiovascular disease, chronic renal disease and the metabolic syndrome. Chondrocalcinosis is characterized by the deposition of calcium pyrophosphate crystals in articular tissues, most commonly fibrocartilage and hyaline cartilage. Sporadic chondrocalcinosis is a common condition in the elderly and frequently associates with osteoarthritis. Hereditary haemochromatosis, hyperparathyroidism and hypomagnesaemia are metabolic disorders that predispose to secondary chondrocalcinosis.The prevalence of chondrocalcinosis is still rather uncertain and varies depending on the diagnostic criterion used in different studies.

  7. Gout disease-specific quality of life and the association with gout characteristics

    Directory of Open Access Journals (Sweden)

    Jan D Hirsch

    2010-03-01

    Full Text Available Jan D Hirsch1,4, Robert Terkeltaub4, Dinesh Khanna5, Jasvinder Singh6, Andrew Sarkin2, Micki Shieh2, Arthur Kavanaugh3, Susan J Lee3,41Skaggs School of Pharmacy and Pharmaceutical Sciences, 2Health Services Research, 3Center for Innovative  Therapy, Division of Rheumatology, Allergy, and Immunology, University of California San Diego, La Jolla, CA, USA; 4Veterans Administration San Diego Healthcare System, La Jolla, CA, USA; 5Department of Medicine/Rheumatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; 6Department of Medicine/Rheumatology, Minneapolis VA Healthcare System, Minneapolis MN, USAPurpose: Assess the association of gout characteristics with health-related quality of life (HRQoL using a new gout-specific HRQoL instrument, the Gout Impact Scale (GIS.Patients and methods: Gout patients completed the GIS (five scales [0–100 score each] representing impact of gout overall [three scales] and during an attack [two scales] and other questions describing recent gout attacks, treatment, gout history, comorbidities, and demographics. Physicians confirmed gout diagnosis, presence of tophi, and most recent serum uric acid (sUA level. Relationships between gout characteristics and GIS scores were examined using analysis of variance and correlation analyses.Results: The majority of patients were male (90.2% with a mean age of 62.2 (±11.8 years. Approximately one-half (49.7% reported ≥3 gout attacks in the past year and the majority (57.9% reported experiencing gout-related pain between attacks. Patients had appreciable concern about their gout (“gout concern overall” scale, 63.1 ± 28.0 but believed their treatment was adequate (“unmet gout treatment need” scale (38.2 ± 21.4 below scale mid-point. Significantly worse GIS scores were associated with increasing attack frequency and greater amount of time with pain between attacks (most scales, P < 0.001. Common objective measures such

  8. Twenty-four-Hour Ambulatory Blood Pressure Monitor Heart Rate: A Potential Marker for Gestational Hypertension in at-Risk Women

    Science.gov (United States)

    Booker, Corenthian J.; Dodson, William C.; Kunselman, Allen R.; Repke, John T.; Legro, Richard S.

    2013-01-01

    We prospectively correlated the 24-hour ambulatory blood pressure measurements (ABPM) to conventional sphygmomanometer blood pressure measurements (CSM) in women at risk for gestational hypertensive disorders (GHTNDs) and identified predictive factors from ABPM for GHTND. We analyzed 73 women with ≥1 risk factor for developing a GHTND. Using both the CSM and ABPM, the systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), and heart rate (HR) were measured for 24 hours during three periods (14 to 24 weeks; 24 to 32 weeks; and 33 weeks to delivery). Correlation between the CSM and ABPM lessened as pregnancy progressed. Seventeen (25%) of women developed a GHTND. MAP variability increased in the GHTND group versus those without a GHTND. The odds of developing a GHTND increased 1.5 times for every 1 beat per minute increase in the ABPM 24-hour HR at visit 1 and reversed by visit 3. In women at risk for a GHTND, CSM and ABPM correlate less well as pregnancy advances. HR changes in at-risk women may be a marker for the development of a GHTND and may reflect increased sympathetic activity and/or decreased baroreceptor sensitivity. PMID:22147639

  9. Twenty-Four-Hour Central Pulse Pressure for Cardiovascular Events Prediction in a Low-Cardiovascular-Risk Population: Results From the Bordeaux Cohort.

    Science.gov (United States)

    Cremer, Antoine; Boulestreau, Romain; Gaillard, Prune; Lainé, Marion; Papaioannou, Georgios; Gosse, Philippe

    2018-02-23

    Central blood pressure (BP) is a promising marker to identify subjects with higher cardiovascular risk than expected by traditional risk factors. Significant results have been obtained in populations with high cardiovascular risk, but little is known about low-cardiovascular-risk patients, although the differences between central and peripheral BP (amplification) are usually greater in this population. The study aim was to evaluate central BP over 24 hours for cardiovascular event prediction in hypertensive subjects with low cardiovascular risk. Peripheral and central BPs were recorded during clinical visits and over 24 hours in hypertensive patients with low cardiovascular risk (Systematic Coronary Risk Evaluation ≤5%). Our primary end point is the occurrence of a cardiovascular event during follow-up. To assess the potential interest in central pulse pressure over 24 hours, we performed Cox proportional hazard models analysis and comparison of area under the curves using the contrast test for peripheral and central BP. A cohort of 703 hypertensive subjects from Bordeaux were included. After the first 24 hours of BP measurement, the subjects were then followed up for an average of 112.5±70 months. We recorded 65 cardiovascular events during follow-up. Amplification was found to be significantly associated with cardiovascular events when added to peripheral 24-hour pulse pressure ( P =0.0259). The area under the curve of 24-hour central pulse pressure is significantly more important than area under the curve of office BP ( P =0.0296), and there is a trend of superiority with the area under the curve of peripheral 24-hour pulse pressure. Central pulse pressure over 24 hours improves the prediction of cardiovascular events for hypertensive patients with low cardiovascular risk compared to peripheral pulse pressure. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  10. Diurnal Variation and Twenty-Four Hour Sleep Deprivation Do Not Alter Supine Heart Rate Variability in Healthy Male Young Adults.

    Directory of Open Access Journals (Sweden)

    Daniel S Quintana

    Full Text Available Heart rate variability (HRV has become an increasingly popular index of cardiac autonomic control in the biobehavioral sciences due to its relationship with mental illness and cognitive traits. However, the intraindividual stability of HRV in response to sleep and diurnal disturbances, which are commonly reported in mental illness, and its relationship with executive function are not well understood. Here, in 40 healthy adult males we calculated high frequency HRV-an index of parasympathetic nervous system (PNS activity-using pulse oximetry during brain imaging, and assessed attentional and executive function performance in a subsequent behavioral test session at three time points: morning, evening, and the following morning. Twenty participants were randomly selected for total sleep deprivation whereas the other 20 participants slept as normal. Sleep deprivation and morning-to-night variation did not influence high frequency HRV at either a group or individual level; however, sleep deprivation abolished the relationship between orienting attention performance and HRV. We conclude that a day of wake and a night of laboratory-induced sleep deprivation do not alter supine high frequency HRV in young healthy male adults.

  11. [Twenty-four hour time and frequency domain variability of systolic blood pressure and heart rate in an experimental model of arterial hypertension plus obesity].

    Science.gov (United States)

    Pelat, M; Verwaerde, P; Lazartiques, E; Cabrol, P; Galitzky, J; Berlan, M; Montastruc, J L; Senard, J M

    1998-08-01

    Modifications of heart rate (HR) and systolic blood pressure (SBP) variabilities (V) have been reported in the human syndrome arterial hypertension plus insulin-resistance. The aim of this study was to characterize the 24 h SBPV and HRV in both time and frequency domains during weight increase in dogs fed ad libitum with a high fat diet. Implantable transmitter units for measurement of blood pressure and heart rate were surgically implanted in five beagle male dogs. BP and HR were continuously recorded using telemetric measurements during 24 hours, before and after 6 and 9 weeks of hypercaloric diet in quiet animals submitted to a 12h light-dark cycle. To study nychtemeral cycle of SBP and HR, two periods were chosen: day (from 6.00 h to 19.00 h) and night (from 23.00 h to 6.00 h). Spontaneous baroreflex efficiency was measured using the sequence method. Spectral variability of HR and SBP was analyzed using a fast Fourier transformation on 512 consecutive values and normalized units of low (LF: 50-150 mHz, reflecting sympathetic activity) and high (HF: respiratory rate +/- 50 mHz, reflecting parasympathetic activity) frequency bands were calculated. The energy of total spectrum (from 0.004 to 1 Hz) was also studied. Body weight (12.4 +/- 0.9 vs 14.9 +/- 0.9 kg, p vs 147 +/- 1 mmHg, p vs night: 71 +/- 1 bpm) but not after 9 weeks (day: 91 +/- 4 bpm ; night: 86 +/- 2 bpm). Concomitantly, the efficiency of spontaneous baroreflex decreased at 6 weeks (36 +/- 1 vs 42 +/- 2 mmHg/ms, p energy of HRV was found after 6 but not after 9 weeks. LF energy of SBPV was increased at 6 but not at 9 weeks (table). [table: see text] In conclusion, this study shows that an hyperlipidic and hypercaloric diet induces transient variations in autonomic nervous system activity which could be the physiopathological link between obesity, insulin-resistance and arterial hypertension.

  12. Twenty-four-hour simultaneous subcutaneous basal-bolus administration of insulin and amylin in adolescents with type 1 diabetes decreases postprandial hyperglycemia

    Science.gov (United States)

    The purpose of this study was to examine the effect of continuous subcutaneous (sc) replacement of amylin and insulin for a 24-h period on glucose homeostasis in adolescents with type 1 diabetes. Thirteen adolescents with type 1 diabetes on insulin pump therapy participated in a randomized, controll...

  13. Short-Term Reproducibility of Twenty-Four-Hour Intraocular Pressure Curves in Untreated Patients with Primary Open-Angle Glaucoma and Ocular Hypertension.

    Directory of Open Access Journals (Sweden)

    Shuo Xu

    Full Text Available To assess the short-term day-to-day reproducibility of 24-hour intraocular pressure (IOP curves in various respects in untreated primary open-angle glaucoma (POAG and ocular hypertension (OHT patients.47 subjects with POAG and 34 subjects with OHT underwent IOP measurements every 2 hours in both eyes for consecutive 48 hours by a non-contact tonometer (NCT. IOP values at each time point were recorded. Mean IOP, peak IOP, time difference of peak IOP between two days and IOP fluctuation were also calculated. Intraclass correlation coefficients (ICCs and Bland-Altman plots were used to evaluate reproducibility.ICCs of the entire IOP values for a complete 24-hour curve were 0.577 and 0.561 in POAG and OHT patients, respectively. ICCs of IOP values at different time points ranged from 0.384 (10am to 0.686 (4am in POAG patients and from 0.347 (6am to 0.760 (4am in OHT patients. ICCs of mean IOP, peak IOP and IOP fluctuation were respectively 0.832, 0.704, 0.367 in POAG patients and 0.867, 0.816 0.633 in OHT patients. Only 37.23% and 35.29% of the peak IOP time points appeared within the time difference of 2 hours in POAG and OHT patients, respectively, while 53.19% and 48.53% appeared within 4 hours in POAG and OHT patients, respectively.A 24-hour IOP curve in a single day is not highly reproducible in short-term and has limited use for evaluating individual IOP condition. Mean IOP and peak IOP for a 24-hour IOP curve are useful parameters in clinical follow-up, while IOP value at a certain time point, IOP fluctuation and peak IOP time point should be interpreted with caution.

  14. Trends in C-Reactive Protein Levels Are Associated with Neurological Change Twenty-Four Hours after Thrombolysis for Acute Ischemic Stroke.

    Science.gov (United States)

    Gill, Dipender; Sivakumaran, Prasanthi; Wilding, Peter; Love, Madeleine; Veltkamp, Roland; Kar, Arindam

    2016-08-01

    Elevated inflammatory markers such as C-reactive protein (CRP) are associated with worse outcomes in patients thrombolysed for acute ischemic stroke (AIS). To investigate whether changes in CRP levels are associated with neurological change after thrombolysis for AIS. Retrospective analysis of a single-center database of consecutive thrombolysis cases for AIS from October 18, 2011, to June 15, 2015, inclusive. Multivariate regression analysis was used to investigate the relationship between change in CRP 12-24 hours after thrombolysis and change in NIHSS (National Institutes of Health Stroke Scale) score 24 hours after thrombolysis. The other potentially confounding predictor variables included in the model were CRP on admission and NIHSS score before thrombolysis. Complete data were available for 108 out of possible 435 eligible patients. Increases in CRP levels 12-24 hours after thrombolysis were negatively associated with reduction in NIHSS score 24 hours after thrombolysis (coefficient .08, 95% confidence interval .031-.129, P = .002). Thus, on average, for every 12.5 mg/L additional increase in CRP 12-24 hours after thrombolysis, NIHSS score at 24 hours improved by 1 point less. While it was previously known that elevated CRP levels are associated with worse outcomes in patients thrombolysed for AIS, the current work demonstrates that changes in CRP levels after thrombolysis also relate to neurological change, and thus may have scope for use as prognostic markers. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. Twenty-four-hour plasma tryptophan concentrations and ratios are below normal in obese subjects and are not normalized by substantial weight reduction

    DEFF Research Database (Denmark)

    Breum, Leif; Rasmussen, Michael H; Hilsted, Jannik

    2003-01-01

    BACKGROUND: Plasma tryptophan concentrations and the ratio of tryptophan to other large neutral amino acids (plasma tryptophan ratio) are reportedly low in obese subjects. The plasma tryptophan ratio predicts brain tryptophan uptake and serotonin production. If this ratio is low in obese subjects......, serotonin function may also be low. Plasma tryptophan concentrations and ratios have been measured only at single time points in obese subjects; it is not known whether low values for these 2 variables persist throughout a 24-h period. OBJECTIVE: Our objective was to determine whether plasma tryptophan...... concentrations and ratios in obese subjects are lower than those in normal-weight subjects throughout a 24-h period and whether they increase when body weight is reduced. DESIGN: Plasma tryptophan concentrations and ratios were examined in obese subjects before and after weight loss and in nonobese control...

  16. Twenty-four-hour central blood pressure is not better associated with hypertensive target organ damage than 24-h peripheral blood pressure.

    Science.gov (United States)

    de la Sierra, Alejandro; Pareja, Julia; Fernández-Llama, Patricia; Armario, Pedro; Yun, Sergi; Acosta, Eva; Calero, Francesca; Vázquez, Susana; Blanch, Pedro; Sierra, Cristina; Oliveras, Anna

    2017-10-01

    Central blood pressure (BP) is increasingly considered as a better estimator of hypertension associated risks. We aimed to evaluate the association of 24-h central BP, in comparison with 24-h peripheral BP, with the presence of target organ damage (TOD). Cross-sectional study of 208 hypertensive patients, aged 57 ± 12 years, 34% women. Office (mean of 4 measurements) and 24-h central and peripheral BP were measured by the oscillometric Mobil-O-Graph device. TOD was assessed at cardiac (left ventricular hypertrophy by echocardiography), renal (reduction of glomerular filtration rate and/or microalbuminuria), and arterial (increased aortic pulse wave velocity) levels. A total of 107 patients (51.4%) had TOD (77, 35% patients left ventricular hypertrophy; 54, 25.9% renal abnormalities; and 40, 19.2% arterial stiffness). All SBP and pulse BP estimates (office, 24-h, daytime, and night-time) were associated with the presence of TOD, after adjustment for age, sex, and antihypertensive treatment, with higher odds ratios for ambulatory-derived values. Odds ratios for central and peripheral BP were similar for all office, 24-h, daytime, and night-time BP. After simultaneous adjustment, peripheral, but not central, 24-h and night-time SBP and pulse pressures were associated with the presence of TOD. TOD in hypertension is associated with BP elevation, independently of the type of measurement (office or ambulatory, central or peripheral). Central BP, even monitored during 24 h, is not better associated with TOD than peripheral BP. These results do not support a routine measurement of 24-h central BP.

  17. Twenty-Four-Hour Blood Pressure Monitoring to Predict and Assess Impact of Renal Denervation: The DENERHTN Study (Renal Denervation for Hypertension).

    Science.gov (United States)

    Gosse, Philippe; Cremer, Antoine; Pereira, Helena; Bobrie, Guillaume; Chatellier, Gilles; Chamontin, Bernard; Courand, Pierre-Yves; Delsart, Pascal; Denolle, Thierry; Dourmap, Caroline; Ferrari, Emile; Girerd, Xavier; Michel Halimi, Jean; Herpin, Daniel; Lantelme, Pierre; Monge, Matthieu; Mounier-Vehier, Claire; Mourad, Jean-Jacques; Ormezzano, Olivier; Ribstein, Jean; Rossignol, Patrick; Sapoval, Marc; Vaïsse, Bernard; Zannad, Faiez; Azizi, Michel

    2017-03-01

    The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure (BP) lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report here the effect of denervation on 24-hour BP and its variability and look for parameters that predicted the BP response. Patients with resistant hypertension were randomly assigned to denervation plus stepped-care treatment or treatment alone (control). Average and standard deviation of 24-hour, daytime, and nighttime BP and the smoothness index were calculated on recordings performed at randomization and 6 months. Responders were defined as a 6-month 24-hour systolic BP reduction ≥20 mm Hg. Analyses were performed on the per-protocol population. The significantly greater BP reduction in the denervation group was associated with a higher smoothness index ( P =0.02). Variability of 24-hour, daytime, and nighttime BP did not change significantly from baseline to 6 months in both groups. The number of responders was greater in the denervation (20/44, 44.5%) than in the control group (11/53, 20.8%; P =0.01). In the discriminant analysis, baseline average nighttime systolic BP and standard deviation were significant predictors of the systolic BP response in the denervation group only, allowing adequate responder classification of 70% of the patients. Our results show that denervation lowers ambulatory BP homogeneously over 24 hours in patients with resistant hypertension and suggest that nighttime systolic BP and variability are predictors of the BP response to denervation. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01570777. © 2017 American Heart Association, Inc.

  18. Twenty-Four-Hour Real-Time Continuous Monitoring of Cerebral Edema in Rabbits Based on a Noninvasive and Noncontact System of Magnetic Induction

    Directory of Open Access Journals (Sweden)

    Gen Li

    2017-03-01

    Full Text Available Cerebral edema is a common disease, secondary to craniocerebral injury, and real-time continuous monitoring of cerebral edema is crucial for treating patients after traumatic brain injury. This work established a noninvasive and noncontact system by monitoring the magnetic induction phase shift (MIPS which is associated with brain tissue conductivity. Sixteen rabbits (experimental group n = 10, control group, n = 6 were used to perform a 24 h MIPS and intracranial pressure (ICP simultaneously monitored experimental study. For the experimental group, after the establishment of epidural freeze-induced cerebral edema models, the MIPS presented a downward trend within 24 h, with a change magnitude of −13.1121 ± 2.3953°; the ICP presented an upward trend within 24 h, with a change magnitude of 12–41 mmHg. The ICP was negatively correlated with the MIPS. In the control group, the MIPS change amplitude was −0.87795 ± 1.5146 without obvious changes; the ICP fluctuated only slightly at the initial value of 12 mmHg. MIPS had a more sensitive performance than ICP in the early stage of cerebral edema. These results showed that this system is basically capable of monitoring gradual increases in the cerebral edema solution volume. To some extent, the MIPS has the potential to reflect the ICP changes.

  19. Twenty-four-hour endocrine and metabolic profiles following consumption of high-fructose corn syrup-, sucrose-, fructose-, and glucose-sweetened beverages with meals.

    Science.gov (United States)

    Stanhope, Kimber L; Griffen, Steven C; Bair, Brandi R; Swarbrick, Michael M; Keim, Nancy L; Havel, Peter J

    2008-05-01

    We have reported that, compared with glucose-sweetened beverages, consuming fructose-sweetened beverages with meals results in lower 24-h circulating glucose, insulin, and leptin concentrations and elevated triacylglycerol (TG). However, pure fructose and glucose are not commonly used as sweeteners. High-fructose corn syrup (HFCS) has replaced sucrose as the predominant sweetener in beverages in the United States. We compared the metabolic/endocrine effects of HFCS with sucrose and, in a subset of subjects, with pure fructose and glucose. Thirty-four men and women consumed 3 isocaloric meals with either sucrose- or HFCS-sweetened beverages, and blood samples were collected over 24 h. Eight of the male subjects were also studied when fructose- or glucose-sweetened beverages were consumed. In 34 subjects, 24-h glucose, insulin, leptin, ghrelin, and TG profiles were similar between days that sucrose or HFCS was consumed. Postprandial TG excursions after HFCS or sucrose were larger in men than in women. In the men in whom the effects of 4 sweeteners were compared, the 24-h glucose and insulin responses induced by HFCS and sucrose were intermediate between the lower responses during consumption of fructose and the higher responses during glucose. Unexpectedly, postprandial TG profiles after HFCS or sucrose were not intermediate but comparably high as after pure fructose. Sucrose and HFCS do not have substantially different short-term endocrine/metabolic effects. In male subjects, short-term consumption of sucrose and HFCS resulted in postprandial TG responses comparable to those induced by fructose.

  20. The period of the day affects the twenty-four hour blood pressure response to an acute combined exercise session in Brazilian jiu jitsu athletes

    Directory of Open Access Journals (Sweden)

    Rafaello Pinheiro Mazzoccante

    2015-09-01

    Full Text Available AbstractThe purpose of this study was to compare the effect of a combined exercise session performed at different periods of the day on the 24h blood pressure (BP response. Anaerobic threshold (AT and 12 repetition maximum (12RM tests were evaluated in nine Brazilian jiu-jitsu athletes (male (22±3.7 y; 176±5.0 cm; 73.4±9.7 kg; 6.8±2.1 % body fat. Four experimental sessions were performed: resistance exercise followed by aerobic exercise [Morning (MornS and Afternoon (AfternS] and Control (C [Morning and Afternoon]. The morning sessions were conducted at 09:00 a.m. and the afternoon sessions were conducted at 3:00 p.m. The resistance exercise consisted of three sets at 90% of a 12RM for six resistance exercises. The aerobic exercise consisted of 15min at 90% of the AT. Blood pressure (BP was measured before, during and 1h (Microlife(r BP3A1C after the performance of exercises in laboratory, and then during daily activities for the succeeding 23h by ambulatory BP monitoring (Dyna-MAPA(r. Analysis of the area under the curve (AUC indicated significant reductions in blood pressure parameters at various time points during the 24h monitoring period. For systolic BP (SBP, significantly lower values were shown following the morning session versus the control (MornS: 1756.2±100.8 vs. C: 1818.2±84.3 mmHg*15h; p < .05 and total-24h (MornS: 2695.8±143.3 vs. C: 2784.1±143.2 mmHg*24h; p < .05. The total-24h mean BP (MAP was also significantly lower following the morning session versus the control (MornS: 2015.7±121.2 vs. C: 2087.3±153.8 mmHg*24h; p < .05. There were significant differences in the sleeping AUC of SBP (AfternS: 883.6±27.0 vs. C: 965.2±67.9 mmHg*9h; p< .05, diastolic BP (DBP (AfternS: 481.4±30.9 vs. MornS: 552.9±34.2 and C: 562.1±52.3 mmHg*9h; p < .01 and MBP (AfternS: 651.9±22.4 vs. MornS: 708.7±43.1 and C: 726.9±64.7 mmHg*9h; p < .01. The combined exercise performed at different periods of the day contributed distinctly to the reduction of BP. The morning session was important in reducing SBP and MBP in the total-24h monitoring, while the afternoon session reduced SBP, DBP and MBP during sleeping in jiu-Jitsu athletes.

  1. Twenty-four hour total and dietary fat oxidation in lean, obese and reduced-obese adults with and without a bout of exercise.

    Directory of Open Access Journals (Sweden)

    Audrey Bergouignan

    Full Text Available It has been hypothesized that obese and reduced-obese individuals have decreased oxidative capacity, which contributes to weight gain and regain. Recent data have challenged this concept.To determine (1 whether total and dietary fat oxidation are decreased in obese and reduced-obese adults compared to lean but increase in response to an acute exercise bout and (2 whether regular physical activity attenuates these metabolic alterations.We measured 24-hr total (whole-room calorimetry and dietary fat (14C-oleate oxidation in Sedentary Lean (BMI = 21.5±1.6; n = 10, Sedentary Obese (BMI = 33.6±2.5; n = 9, Sedentary Reduced-Obese (RED-SED; BMI = 26.9±3.7; n = 7 and in Physically Active Reduced-Obese (RED-EX; BMI = 27.3±2.8; n = 12 men and women with or without an acute exercise bout where energy expended during exercise was not replaced.Although Red-SED and Red-EX had a similar level of fatness, aerobic capacity and metabolic profiles were better in Red-EX only compared to Obese subjects. No significant between-group differences were seen in 24-hr respiratory quotient (RQ, Lean: 0.831±0.044, Obese: 0.852±0.023, Red-SED: 0.864±0.037, Red-EX: 0.842±0.039, total and dietary fat oxidation. A single bout of exercise increased total (+27.8%, p<0.0001 and dietary (+6.6%, p = 0.048 fat oxidation across groups. Although exercise did not impact RQ during the day, it decreased RQ during sleep (p = 0.01 in all groups. Red-EX oxidized more fat overnight than Red-SED subjects under both resting (p = 0.036 and negative energy balance (p = 0.003 conditions, even after adjustment for fat-free mass.Obese and reduced-obese individuals oxidize as much fat as lean both under eucaloric and negative energy balance conditions, which does not support the hypothesis of reduced oxidative capacity in these groups. Reduced-obese individuals who exercise regularly have markers of metabolic health similar to those seen in lean adults. Both the acute and chronic effects of exercise were primarily observed at night suggesting an important role of sleep in the regulation of lipid metabolism.

  2. Comparison of the “Twenty-Four Hour pH Monitoring Test” Results of the Pregnant and Non-Pregnant Reflux Patients

    Directory of Open Access Journals (Sweden)

    Mehmet Vural

    2010-08-01

    CONCLUSIONS: Although only significance detected in the longest reflux time in proximal test results, other proximal test results of the pregnant group were markedly worse also. In the larger study groups this difference can be elucidated more meaningfully.

  3. Severe tophaceous gout and disability: changes in the past 15 years.

    Science.gov (United States)

    López López, Carlos Omar; Lugo, Everardo Fuentes; Alvarez-Hernández, Everardo; Peláez-Ballestas, Ingris; Burgos-Vargas, Rubén; Vázquez-Mellado, Janitzia

    2017-01-01

    Epidemiologic data from recent decades show a significant increase in the prevalence and incidence of gout worldwide, in addition to changes in its clinical expression. Our objective was to compare the frequency of the severity of gout and disability in two patient groups at our clinic during different periods. We included and compared data of two groups: group A (1995-2000), patients from previous report, and group B (2010-2014), the baseline data of current patients participating in a cohort (GRESGO). This evaluation included data of socioeconomic and educational levels, demographics, associated diseases, previous treatment, clinical and biochemical data, and disability evaluated using the Health Assessment Questionnaire (HAQ). We included data of 564 gout patients. Participants were 35.7 ± 12.7 years old at onset and had 12.0 ± 9.2-years disease duration at their first evaluation in our department. Group B patients were younger, had higher educational and socioeconomic levels, and had more severe disease. However, this group had less frequency of some associated diseases and significantly higher HAQ scores. With increased HAQ score, a higher number of acute flares and tender, limited-to-motion, and swollen joints were seen. The spectrum of gout has changed over the past decade. A higher percentage of our patients had a severe form of disease, were younger, had earlier disease onset, and had more disability reflected in higher HAQ scores. In our current patient group, the variable most associated with disability was limited-to-motion joints; however, the number of acute flares and tender and swollen joints was also higher in patients with greater disability.

  4. 2016 updated EULAR evidence-based recommendations for the management of gout.

    Science.gov (United States)

    Richette, P; Doherty, M; Pascual, E; Barskova, V; Becce, F; Castañeda-Sanabria, J; Coyfish, M; Guillo, S; Jansen, T L; Janssens, H; Lioté, F; Mallen, C; Nuki, G; Perez-Ruiz, F; Pimentao, J; Punzi, L; Pywell, T; So, A; Tausche, A K; Uhlig, T; Zavada, J; Zhang, W; Tubach, F; Bardin, T

    2017-01-01

    New drugs and new evidence concerning the use of established treatments have become available since the publication of the first European League Against Rheumatism (EULAR) recommendations for the management of gout, in 2006. This situation has prompted a systematic review and update of the 2006 recommendations. The EULAR task force consisted of 15 rheumatologists, 1 radiologist, 2 general practitioners, 1 research fellow, 2 patients and 3 experts in epidemiology/methodology from 12 European countries. A systematic review of the literature concerning all aspects of gout treatments was performed. Subsequently, recommendations were formulated by use of a Delphi consensus approach. Three overarching principles and 11 key recommendations were generated. For the treatment of flare, colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), oral or intra-articular steroids or a combination are recommended. In patients with frequent flare and contraindications to colchicine, NSAIDs and corticosteroids, an interleukin-1 blocker should be considered. In addition to education and a non-pharmacological management approach, urate-lowering therapy (ULT) should be considered from the first presentation of the disease, and serum uric acid (SUA) levels should be maintained atgout. Allopurinol is recommended as first-line ULT and its dosage should be adjusted according to renal function. If the SUA target cannot be achieved with allopurinol, then febuxostat, a uricosuric or combining a xanthine oxidase inhibitor with a uricosuric should be considered. For patients with refractory gout, pegloticase is recommended. These recommendations aim to inform physicians and patients about the non-pharmacological and pharmacological treatments for gout and to provide the best strategies to achieve the predefined urate target to cure the disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  5. [The clinical characteristics, diagnosis and treatment of patients with gout in China].

    Science.gov (United States)

    Luo, H; Fang, W G; Zuo, X X; Wu, R; Li, X X; Chen, J W; Zhou, J G; Yang, J; Song, H; Duan, X J; Lin, X F; Zeng, X W; Zeng, H

    2018-01-01

    Objective: To investigate the demographic characteristics, clinical features, diagnosis and treatment of patients with gout in China. Methods: Clinical data of 6 814 patients with gout from 100 hospitals in 27 provinces, municipalities or autonomous regions in China were collected and analyzed. Results: (1) The ratio of male to female in patients with gout was 14.7∶1. The mean age of onset was (48.8±15.1) years old. Mean serum urate level was (526.7±132.3) μmol/L. Patients' education background was of U-shaped distribution; (2) Hypertension was the most common comorbidity [15.8%(1 079/6 814)], then overweight or obesity [51.9%(3 536/6 814)]; (3) Alcohol and high-purine food intake were dominant triggering factors in men. The diagnosis of gout was made after onset in majority of patients with cardinal symptom arthralgia. Most patients had the disease less than 5 years, and the longer the course, the more flares in the previous year of entry; (4) Febuxostat was the mostly used urate-lowering medication. 20.7%(1 412/6 814), 10.8%(739/6 814) and 3.9%(265/6 814) of patients were followed up in 4 weeks, 12 weeks and 24 weeks after registration, and 18.9%(267/1 412), 29.1%(215/739) and 38.1%(101/265) of them reached the control target of serum urate levels, respectively. After treatment, patients' liver function was not affected, but serum creatinine levels decreased significantly. Conclusions: The proportion of gout patients who reach target serum urate level is very low. Further steps including education and survey need to be carried on.

  6. Associated factors with functional disability and health-related quality of life in Chinese patients with gout: a case-control study.

    Science.gov (United States)

    Fu, Ting; Cao, Haixia; Yin, Rulan; Zhang, Lijuan; Zhang, Qiuxiang; Li, Liren; Gu, Zhifeng

    2017-11-03

    Gout is a painful, inflammatory disease that may cause decreased function and health-related quality of life (HRQoL). Limited study did not take the influence of gout characteristics and anxiety on HRQoL into consideration and there are no studies associated with functional disability in individuals with gout from China. This study aims to investigate the related factors of functional disability and HRQoL in gout patients recruited from China. A total of 226 consecutive gout patients and 232 age- and gender-matched healthy individuals were involved in the study. A series of questionnaires (the Short Form 36 health survey, the Patient Health Questionnaire, the Generalized Anxiety Disorder questionnaire, the 10 cm Visual Analog Scale, and the Health Assessment Questionnaire-Disability Index) were applied. Blood samples were taken to examine the level of serum uric acid. Independent samples t-tests, Chi square tests, U test, Spearman rank correlation, logistic regression modeling, and linear regression were used to analyze the data. After adjusted demographic variables, individuals with gout have poorer HRQoL compared to healthy controls. Univariate tests presented that patients with functional disability had longer disease duration, more frequent flares/last year, more severe total pain, more number of tophi, higher degree of depression and anxiety, with a trend toward diabetes, the treatment of colchicine and corticosteroids use, compared to patients without functional disability. Meanwhile, place of residence, hypertension, DM, disease duration, cardiovascular disease, number of flares/last year, total pain, more number of tophi, presence of tender joints, depression, anxiety, currently using colchicine and corticosteroids were correlated significantly with HRQoL. Additionally, multiple regression analysis identified severe pain, depression, and colchicine use as predictors of functional disability. Cardiovascular disease, total pain, number of flares/last year

  7. Flare continuum

    International Nuclear Information System (INIS)

    Robinson, R.D.

    1985-01-01

    This paper reviews the metre-wave continuum radiation which is related to similar solar emissions observed in the decimetre and centimetre spectral regions. This type of emission, known as Flare Contiuum, is related to the radio bursts of types II and IV. After summarising the history of the phenomenon and reviewing the observational work, the author discusses the various possible radiation mechanisms and their relation to the solar corona, the interplanetary medium and related regions. The theoretical topics covered include the role of high-energy particles, the trapping of such particles, gyro-synchrotron radiation, polarization and plasma interactions. (U.K.)

  8. The genetic basis of hyperuricaemia and gout.

    Science.gov (United States)

    Merriman, Tony R; Dalbeth, Nicola

    2011-01-01

    Gout results from elevated urate concentrations in the blood (hyperuricaemia). When super-saturation of urate is reached, monosodium urate crystals form within the joint. In some individuals, these crystals elicit a painful self-limiting inflammatory response that is characteristic of acute gouty arthritis. The most important cause of hyperuricaemia is reduced excretion of uric acid in the urine. Uric acid excretion is coordinated by a suite of urate transport molecules expressed in the renal collecting tubules, and is a key physiological checkpoint in gout. Other checkpoints in gout are hepatic production of urate, monosodium urate crystal formation, and initiation of the acute inflammatory response. Genome-wide association scans for genes regulating serum urate concentrations have identified two major regulators of hyperuricaemia- the renal urate transporters SLC2A9 and ABCG2. The risk variants at each gene approximately double the risk for gout in people of Caucasian ancestry, with SLC2A9 also resulting in higher risk for gout in people of Polynesian ancestry, a diverse population characterized by a high prevalence of gout. Ongoing genetic association studies are identifying and confirming other genes controlling serum urate concentrations; although genome-wide association studies in gout per se await recruitment of suitable case sample sets. Copyright © 2010 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  9. Gout and Metabolic Syndrome: a Tangled Web.

    Science.gov (United States)

    Thottam, Gabrielle E; Krasnokutsky, Svetlana; Pillinger, Michael H

    2017-08-26

    The complexity of gout continues to unravel with each new investigation. Gout sits at the intersection of multiple intrinsically complex processes, and its prevalence, impact on healthcare costs, and association with important co-morbidities make it increasingly relevant. The association between gout and type 2 diabetes, hypertension, hyperlipidemia, cardiovascular disease, renal disease, and obesity suggest that either gout, or its necessary precursor hyperuricemia, may play an important role in the manifestations of the metabolic syndrome. In this review, we analyze the complex interconnections between gout and metabolic syndrome, by reviewing gout's physiologic and epidemiologic relationships with its major co-morbidities. Increasing evidence supports gout's association with metabolic syndrome. More specifically, both human studies and animal models suggest that hyperuricemia may play a role in promoting inflammation, hypertension and cardiovascular disease, adipogenesis and lipogenesis, insulin and glucose dysregulation, and liver disease. Fructose ingestion is associated with increased rates of hypertension, weight gain, impaired glucose tolerance, and dyslipidemia and is a key driver of urate biosynthesis. AMP kinase (AMPK) is a central regulator of processes that tend to mitigate against the metabolic syndrome. Within hepatocytes, leukocytes, and other cells, a fructose/urate metabolic loop drives key inhibitors of AMPK, including AMP deaminase and fructokinase, that may tilt the balance toward metabolic syndrome progression. Preliminary evidence suggests that agents that block the intracellular synthesis of urate may restore AMPK activity and help maintain metabolic homeostasis. Gout is both an inflammatory and a metabolic disease. With further investigation of urate's role, the possibility of proper gout management additionally mitigating metabolic syndrome is an evolving and important question.

  10. Study for Updated Gout Classification Criteria

    DEFF Research Database (Denmark)

    Taylor, William J; Fransen, Jaap; Jansen, Tim L

    2015-01-01

    OBJECTIVE: To determine which clinical, laboratory, and imaging features most accurately distinguished gout from non-gout. METHODS: We performed a cross-sectional study of consecutive rheumatology clinic patients with ≥1 swollen joint or subcutaneous tophus. Gout was defined by synovial fluid...... (MTP1) joint ever involved (multivariate OR 2.30), location of currently tender joints in other foot/ankle (multivariate OR 2.28) or MTP1 joint (multivariate OR 2.82), serum urate level >6 mg/dl (0.36 mmoles/liter; multivariate OR 3.35), ultrasound double contour sign (multivariate OR 7...

  11. Assessing Elementary Lesions in Gout by Ultrasound

    DEFF Research Database (Denmark)

    Terslev, Lene; Gutierrez, Marwin; Christensen, Robin

    2015-01-01

    OBJECTIVE: To test the reliability of the consensus-based ultrasound (US) definitions of elementary gout lesions in patients. METHODS: Eight patients with microscopically proven gout were evaluated by 16 sonographers for signs of double contour (DC), aggregates, erosions, and tophi in the first......, respectively. The best reliability was seen for erosions (κ 0.74, 95% CI 0.65-0.81) and lowest for aggregates (κ 0.21, 95% CI 0.04-0.37). CONCLUSION: This is the first step to test consensus-based US definitions on elementary lesions in patients with gout. High intraobserver reliability was found when applying...

  12. Genomic Influences on Hyperuricemia and Gout.

    Science.gov (United States)

    Merriman, Tony

    2017-08-01

    Genome-wide association studies (GWAS) have identified nearly 30 loci associated with urate concentrations that also influence the subsequent risk of gout. The ABCG2 Q141 K variant is highly likely to be causal and results in internalization of ABCG2, which can be rescued by drugs. Three other GWAS loci contain uric acid transporter genes, which are also highly likely to be causal. However identification of causal genes at other urate loci is challenging. Finally, relatively little is known about the genetic control of progression from hyperuricemia to gout. Only 4 small GWAS have been published for gout. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Flaring fix: better technologies green flaring

    International Nuclear Information System (INIS)

    Stastny, P.

    2004-01-01

    Recent advances in reducing solution gas flaring and venting are discussed, highlighting the 2002 report of the Clean Air Strategic Alliance (CASA) and its 39 recommendations targeting a 50 per cent reduction in flaring from a 1996 baseline. Much of the improvement to date (62 per cent at the end of 2002 on an annual basis) has come from collecting and sending gas down pipelines for processing, but improvements in technologies such as incineration, in combustion efficiency, and the use of micro-turbines, also helped to make a difference. Improvements in smokeless flares, through the addition of a special flare tip to flare stacks, has similarly contributed to higher combustion efficiency, and further improvements are expected from sonic flare technology currently under development. Expectations are also high for advances in incinerator technology, particularly enclosed burner systems, which almost completely burn flare gas while having no visible flame, smoke or odor

  14. Tophaceous gout in the cervical spine

    Energy Technology Data Exchange (ETDEWEB)

    Cabot, Jonathan [Royal Adelaide Hospital, Department of Orthopaedic Surgery, Adelaide, South Australia (Australia); Mosel, Leigh; Kong, Andrew; Hayward, Mike [Flinders Medical Centre, Department of Medical Imaging, Bedford Park, South Australia (Australia)

    2005-12-01

    Gout is a common metabolic disorder typically affecting the distal joints of the appendicular skeleton. Involvement of the axial skeleton, particularly the facet joints and posterior column of the cervical spine, is rare. This case report highlights such a presentation in a 76-year old female who presented with cervical spine pain following a fall. Her radiological findings were suggestive of a destructive metastatic process. Histological diagnosis confirmed tophaceous gout. (orig.)

  15. Intra-abdominal gout mimicking pelvic abscess

    International Nuclear Information System (INIS)

    Chen, Chia-Hui; Chen, Clement Kuen-Huang; Yeh, Lee-Ren; Pan, Huay-Ban; Yang, Chien-Fang

    2005-01-01

    Gout is the most common crystal-induced arthritis. Gouty tophi typically deposit in the extremities, especially toes and fingers. We present an unusual case of intrapelvic tophaceous gout in a patient suffering from chronic gouty arthritis. CT and MRI of the abdomen and pelvic cavity disclosed calcified gouty tophi around both hips, and a cystic lesion with peripheral enhancement in the pelvic cavity along the course of the iliopsoas muscle. The intra-abdominal tophus mimicked pelvic abscess. (orig.)

  16. International Consensus for ultrasound lesions in gout

    DEFF Research Database (Denmark)

    Gutierrez, Marwin; Schmidt, Wolfgang A; Thiele, Ralf G

    2015-01-01

    OBJECTIVE: To produce consensus-based definitions of the US elementary lesions in gout and to test their reliability in a web-based exercise. METHODS: The process consisted of two steps. In the first step a written Delphi questionnaire was developed from a systematic literature review and expert...... lesions in gout, demonstrated good reliability overall. It constitutes an essential step in developing a core outcome measurement that permits a higher degree of homogeneity and comparability between multicentre studies....

  17. Intra-abdominal gout mimicking pelvic abscess

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Chia-Hui; Chen, Clement Kuen-Huang [Kaohsiung Veterans General Hospital, Department of Radiology, Kaohsiung (Taiwan); National Yang-Ming University, School of Medicine, Taipei (Taiwan); Yeh, Lee-Ren; Pan, Huay-Ban; Yang, Chien-Fang [Kaohsiung Veterans General Hospital, Department of Radiology, Kaohsiung (Taiwan)

    2005-04-01

    Gout is the most common crystal-induced arthritis. Gouty tophi typically deposit in the extremities, especially toes and fingers. We present an unusual case of intrapelvic tophaceous gout in a patient suffering from chronic gouty arthritis. CT and MRI of the abdomen and pelvic cavity disclosed calcified gouty tophi around both hips, and a cystic lesion with peripheral enhancement in the pelvic cavity along the course of the iliopsoas muscle. The intra-abdominal tophus mimicked pelvic abscess. (orig.)

  18. Tophaceous gout in the cervical spine

    International Nuclear Information System (INIS)

    Cabot, Jonathan; Mosel, Leigh; Kong, Andrew; Hayward, Mike

    2005-01-01

    Gout is a common metabolic disorder typically affecting the distal joints of the appendicular skeleton. Involvement of the axial skeleton, particularly the facet joints and posterior column of the cervical spine, is rare. This case report highlights such a presentation in a 76-year old female who presented with cervical spine pain following a fall. Her radiological findings were suggestive of a destructive metastatic process. Histological diagnosis confirmed tophaceous gout. (orig.)

  19. The kidney in hyperuricemia and gout.

    Science.gov (United States)

    Mount, David B

    2013-03-01

    Gout is a painful inflammatory arthritis associated with hyperuricemia, with a prevalence of almost 10 million in the USA. Reduced renal excretion of urate is the underlying hyperuricemic mechanism in the vast majority of gout patients; most of the genes that affect serum urate level (SUA) encode urate transporters or associated regulatory proteins. Acquired influences can also modulate SUA and renal urate excretion, sometimes precipitating acute gout. Coincidentally, the prevalence of renal comorbidities in gout - hypertension, chronic kidney disease (CKD), and nephrolithiasis - is very high. Recent advances in genetics and molecular physiology have greatly enhanced the understanding of renal reabsorption and secretion of filtered urate. Moreover, baseline SUA appears to be set by the net balance of absorption and secretion across epithelial cells in the kidney and intestine. There have also been substantial advances in the management of gout in patients with CKD. The stage is set for an increasingly molecular understanding of baseline and regulated urate transport by the kidney and intestine. The increasing prevalence of gout with CKD will be balanced by an expanding spectrum of therapeutic options for this important disease.

  20. The genetics of hyperuricaemia and gout.

    Science.gov (United States)

    Reginato, Anthony M; Mount, David B; Yang, Irene; Choi, Hyon K

    2012-10-01

    Gout is a common and very painful inflammatory arthritis caused by hyperuricaemia. This review provides an update on the genetics of hyperuricaemia and gout, including findings from genome-wide association studies. Most of the genes that associated with serum uric acid levels or gout are involved in the renal urate-transport system. For example, the urate transporter genes SLC2A9, ABCG2 and SLC22A12 modulate serum uric acid levels and gout risk. The net balance between renal urate absorption and secretion is a major determinant of serum uric acid concentration and loss-of-function mutations in SLC2A9 and SLC22A12 cause hereditary hypouricaemia due to reduced urate absorption and unopposed urate secretion. However, the variance in serum uric acid explained by genetic variants is small and their clinical utility for gout risk prediction seems limited because serum uric acid levels effectively predict gout risk. Urate-associated genes and genetically determined serum uric acid levels were largely unassociated with cardiovascular-metabolic outcomes, challenging the hypothesis of a causal role of serum uric acid in the development of cardiovascular disease. Strong pharmacogenetic associations between HLA-B*5801 alleles and severe allopurinol-hypersensitivity reactions were shown in Asian and European populations. Genetic testing for HLA-B*5801 alleles could be used to predict these potentially fatal adverse effects.

  1. Patients with Gout Treated with Conventional Urate-lowering Therapy: Association with Disease Control, Health-related Quality of Life, and Work Productivity.

    Science.gov (United States)

    Wood, Robert; Fermer, Steve; Ramachandran, Sulabha; Baumgartner, Scott; Morlock, Robert

    2016-10-01

    Implications of inadequate gout control were assessed through health-related quality of life (HRQOL) and work productivity of patients with gout adequately controlled while taking conventional urate-lowering therapy (ULT) for ≥ 3 months vs those whose gout was inadequately controlled. Retrospective data were drawn from the Adelphi Disease Specific Programme (DSP), a cross-sectional survey of patients with gout in France, Germany, the United Kingdom, and the United States. Patients completed these questionnaires: EQ-5D (3L), Patient Reported Outcomes Measurement Information System (PROMIS) Health Assessment Questionnaire (HAQ), and Work Productivity and Activity Impairment. Inadequate control was defined as the most recent serum uric acid (SUA) level > 6 mg/dl (> 360 µmol/l) or ≥ 2 flares in the last 12 months; adequate control as SUA level ≤ 6 mg/dl (≤ 360 µmol/l) and 0 flares. Appropriate statistical tests were used to assess differences between groups. There were 836 (69%) inadequately and 368 (31%) adequately controlled gout cases. Mean age was 61 and 63 years and duration of current ULT was 32 and 57 months, respectively. Patients experiencing inadequate control reported significantly worse functioning and HRQOL, as measured by the EQ-5D (0.790 vs 0.877; difference: -0.087; p work time missed: 4.5% vs 1.3%; impairment while working: 19.1% vs 5.2%; overall work impairment: 20.4% vs 5.6%; activity impairment: 20.3% vs 5.3%; all p quality of life, and work productivity. Gout treatment strategies to improve disease control may lead to improvements in HRQOL and productivity.

  2. Achieving serum urate targets in gout: an audit in a gout-oriented rheumatology practice.

    Science.gov (United States)

    Corbett, Elizabeth J M; Pentony, Peta; McGill, Neil W

    2017-07-01

    To assess the proportion of patients with gout who achieve target serum urate levels, the drug regime required and the reasons for failing to do so. We reviewed the files of all patients with gout who presented to a gout-oriented rheumatology practice between January 2010 and September 2014. Two hundred and thirty patients agreed to commence urate lowering therapy (ULT); 73% achieved their urate target, including 74% with non-tophaceous gout (target ≤ 0.36 mmol/L) and 71% with tophi (target ≤ 0.30 mmol/L). Of the 62 who failed to reach target, in 61 it was due to non-adherence and in one due to inefficacy. Adherence remains the major challenge to successful long-term gout management. © 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  3. Models for stellar flares

    International Nuclear Information System (INIS)

    Cram, L.E.; Woods, D.T.

    1982-01-01

    We study the response of certain spectral signatures of stellar flares (such as Balmer line profiles and the broad-band continuum) to changes in atmospheric structure which might result from physical processes akin to those thought to occur in solar flares. While each physical process does not have a unique signature, we can show that some of the observed properties of stellar flares can be explained by a model which involves increased pressures and temperatures in the flaring stellar chromosphere. We suggest that changes in stellar flare area, both with time and with depth in the atmosphere, may play an important role in producing the observed flare spectrum

  4. Gout

    Science.gov (United States)

    ... OII) Timed Up & Go (TUG) Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) Young Investigators Resources for Doctoral Students/Post-Doctoral Fellows Evidence-Based Practice for Academic Researchers Responsible Data Management in Research Career Planning Treatments Patient ...

  5. Gout

    Science.gov (United States)

    ... which are taken to rid the body of excess fluid in condition like hypertension, edema, and heart disease. Diuretics reduce the amount of uric acid passed in the urine. Drugs with salicylate, such as aspirin. Niacin, a vitamin also known as nicotinic acid. Cyclosporine, a medication ...

  6. New insights into the epidemiology of gout.

    Science.gov (United States)

    Doherty, Michael

    2009-05-01

    Gout is a true crystal deposition disease caused by formation of monosodium urate crystals in joints and other tissues. It is a common inflammatory arthritis that has increased in prevalence in recent decades. Gout normally results from the interaction of genetic, constitutional and environmental risk factors. It is more common in men and strongly age related. A major determinant is the degree of elevation of uric acid levels above the saturation point for urate crystal formation, principally caused by inefficient renal urate excretion. Local joint tissue factors may influence the topography and extent of crystal deposition. Recent studies have provided information on dietary risk factors for gout: higher intakes of red meat, fructose and beer are independently associated with increased risk, whereas higher intakes of coffee, low-fat dairy products and vitamin C are associated with lower risk. Several renal urate transporters have been identified including URAT1 and SLC2A9 (GLUT9) and polymorphisms in these genes are associated with an increased risk of hyperuricaemia and gout. Many drugs influence serum uric acid levels through an effect on renal urate transport. Comorbidities, including the metabolic syndrome and impaired renal function are common in gout patients. The usual initial presentation of gout is with rapidly developing acute inflammatory monoarthritis, typically affecting the first MTP joint. If left untreated it may progress with recurrent acute attacks and eventual development of chronic symptoms and joint damage. New knowledge of the modifiable risk factors for gout can be integrated into the management strategy to optimize long-term patient outcomes.

  7. Hyperuricaemia and gout | Kopke | South African Family Practice

    African Journals Online (AJOL)

    Gout is a painful, inflammatory disease that affects more men than women. The incidence of gout has increased substantially over the past few decades, as evidenced by information from the Rochester project. Some of the risk factors for the development of gout include: increased ethanol intake, high dietary purine ...

  8. Effect of genetic polymorphisms on development of gout.

    Science.gov (United States)

    Urano, Wako; Taniguchi, Atsuo; Inoue, Eisuke; Sekita, Chieko; Ichikawa, Naomi; Koseki, Yumi; Kamatani, Naoyuki; Yamanaka, Hisashi

    2013-08-01

    To validate the association between genetic polymorphisms and gout in Japanese patients, and to investigate the cumulative effects of multiple genetic factors on the development of gout. Subjects were 153 Japanese male patients with gout and 532 male controls. The genotypes of 11 polymorphisms in the 10 genes that have been indicated to be associated with serum uric acid levels or gout were determined. The cumulative effects of the genetic polymorphisms were investigated using a weighted genotype risk score (wGRS) based on the number of risk alleles and the OR for gout. A model to discriminate between patients with gout and controls was constructed by incorporating the wGRS and clinical factors. C statistics method was applied to evaluate the capability of the model to discriminate gout patients from controls. Seven polymorphisms were shown to be associated with gout. The mean wGRS was significantly higher in patients with gout (15.2 ± 2.01) compared to controls (13.4 ± 2.10; p gout. A prediction model for gout that incorporates genetic and clinical factors may be useful for identifying individuals who are at risk of gout.

  9. Treating gout in kidney transplant recipients.

    Science.gov (United States)

    Baroletti, Steven; Bencivenga, Gina Ann; Gabardi, Steven

    2004-06-01

    To review the etiology, treatment, and preventive strategies of hyperuricemia and gout in kidney transplant recipients. Primary literature was obtained via Medline (1966-June 2003). Studies evaluating treatment and prevention of hyperuricemia and gout in kidney transplantation were considered for evaluation. English-language studies were selected for inclusion. Approximately 14,000 kidney transplantations were performed in the United States in 2003, and of those transplant recipients, nearly 13% will experience a new onset of gout. The prevalence of hyperuricemia is even greater. There are several mechanisms by which hyperuricemia and gout develop in kidney transplant recipients. Medication-induced hyperuricemia and renal dysfunction are 2 of the more common mechanisms. Prophylactic and treatment options include allopurinol, colchicine, corticosteroids, and, if absolutely necessary, nonsteroidal antiinflammatory drugs. It is generally recommended to decide whether the risks of prophylactic therapy and treatment outweigh the benefits. Often, the risk of adverse events associated with agents to treat these ailments tends to outweigh the benefits; therefore, treatment is usually reserved for symptomatic episodes of acute gout. Practitioners must also decide if changes in immunosuppressive regimens may be of benefit on a patient-by-patient basis.

  10. Health-related quality of life and treatment satisfaction in patients with gout: results from a cross-sectional study in a managed care setting

    Directory of Open Access Journals (Sweden)

    Khanna PP

    2015-07-01

    differences were: 30.5, gout overall concern; 14.6, gout medication side effects; 22.7, unmet gout treatment needs; 11.5, gout concern during attack (all P<0.05; and 7.9, well-being during attack (NS. Mean difference in SF-12 was -6.6 for physical component summary (P<0.05 and -2.9 for mental component summary (NS. Correlations between several TSQM and GIS scales were moderate.Conclusion: The TSQM and GIS were complementary in evaluating the impact of gout flare on treatment satisfaction and HRQoL. Correlations between the two instruments supported the relationship between treatment satisfaction and HRQoL.Keywords: febuxostat, gout, gouty arthritis, Treatment Satisfaction Questionnaire for Medicine, Gout Impact Scale, SF-12

  11. The safety of treatment options available for gout.

    Science.gov (United States)

    Schlesinger, Naomi

    2017-04-01

    Gout is the most common inflammatory arthritis in humans. Gout treatment includes rapid initiation of anti-inflammatory medications for acute attacks and chronically treating with urate lowering drugs as well as chronic anti-inflammatory prophylaxis. Areas covered: This review aims to provide an overview and discussion of the safety concerns of current treatment options available for gout. Expert opinion: Gout is a curable disease with appropriate treatment. The advent of new therapies provides encouraging opportunities to improve gout management. However, clinicians should be aware of some of the safety concerns of medications used to treat acute and chronic gout. When prescribing medications for gout one has to be mindful of the presence of comorbidities commonly affecting gout patients that may affect drug safety and efficacy, especially in the elderly and in patients treated with multiple drugs. The benefits of gout drugs, usually, outweigh their safety concerns. Studies are needed in gout patients with chronic kidney disease and/or cardiovascular disease, so that escalation of dosing /combination of anti-inflammatory drugs needed to suppress gouty inflammation as well as escalation of dosing/combination of urate lowering drugs needed to achieve target serum urate level will lead to better understanding of gout treatment safety issues.

  12. Magnetic transients in flares

    International Nuclear Information System (INIS)

    Zirin, H.; Tanaka, K.

    1981-01-01

    We present data on magnetic transients (mgtr's) observed in flares on 1980 July 1 and 5 with Big Bear videomagnetograph (VMG). The 1980 July 1 event was a white light flare in which a strong bipolar mgtr was observed, and a definite change in the sunspots occurred at the time of the flare. In the 1980 July 5 flare, a mgtr was observed in only one polarity, and, although no sunspot changes occurred simultaneous with the flare, major spot changes occurred in a period of hours

  13. Elongation of Flare Ribbons

    Energy Technology Data Exchange (ETDEWEB)

    Qiu, Jiong; Longcope, Dana W. [Department of Physics, Montana State University, Bozeman MT (United States); Cassak, Paul A. [Department of Physics and Astronomy, West Virginia University, Morgantown WV (United States); Priest, Eric R. [School of Mathematics and Statistics, University of St. Andrews, Fife KY16 9SS, Scotland (United Kingdom)

    2017-03-20

    We present an analysis of the apparent elongation motion of flare ribbons along the polarity inversion line (PIL), as well as the shear of flare loops in several two-ribbon flares. Flare ribbons and loops spread along the PIL at a speed ranging from a few to a hundred km s{sup −1}. The shear measured from conjugate footpoints is consistent with the measurement from flare loops, and both show the decrease of shear toward a potential field as a flare evolves and ribbons and loops spread along the PIL. Flares exhibiting fast bidirectional elongation appear to have a strong shear, which may indicate a large magnetic guide field relative to the reconnection field in the coronal current sheet. We discuss how the analysis of ribbon motion could help infer properties in the corona where reconnection takes place.

  14. Improvement in the management of gout is vital and overdue: an audit from a UK primary care medical practice

    Science.gov (United States)

    2013-01-01

    Background Gout is estimated to affect 1.4% of adults in the UK. Appropriate and timely management is essential to reduce the risk of further flares, complications, and to reduce cardiovascular disease risk. The British Society for Rheumatology and British Health Professionals in Rheumatology (BSR/BHPR) and the European League Against Rheumatism (EULAR) have published guidance regarding the management of gout, thereby providing standards against which performance can be measured. This audit was designed to assess the extent to which patients diagnosed with gout in one primary care medical practice in North Staffordshire, UK, are managed in accordance with current best practice guidelines, and to identify strategies for improvement where appropriate. Methods Audit criteria were derived from the EULAR and BSR/BHPR guidelines; standards were set arbitrarily, but with consideration of patient comorbidity and other factors which may influence concordance. An electronic search of the practice records was performed to identify adults with a diagnosis of gout. Medical record review with a descriptive analysis was undertaken to assess the extent to which medical management adhered to the predefined standards. Results Of the total ≥18 year-old practice population (n = 8686), 305 (3%) patient records included a diagnosis of gout. Of these, 74% (n = 226) had an electronic record of serum uric acid (SUA), and 11% (n = 34) and 53% (n = 162) a measure of estimated glomerular filtration rate (eGFR) ever and serum glucose since diagnosis respectively. 34% (n = 105) of patients had ever taken urate-lowering therapy with 25% (n = 77) currently prescribed this at the time of data extraction. Dose adjustment and monitoring of treatment according to SUA was found to be inadequate. Provision of lifestyle advice and consideration of comorbidities was also lacking. Conclusions The primary care management of gout in this practice was not concordant with national

  15. Gout and the Risk of Non-vertebral Fracture.

    Science.gov (United States)

    Kim, Seoyoung C; Paik, Julie M; Liu, Jun; Curhan, Gary C; Solomon, Daniel H

    2017-02-01

    Prior studies suggest an association between osteoporosis, systemic inflammation, and pro-inflammatory cytokines such as interleukin (IL)-1 and IL-6. Conflicting findings exist on the association between hyperuricemia and osteoporosis. Furthermore, it remains unknown whether gout, a common inflammatory arthritis, affects fracture risk. Using data from a US commercial health plan (2004-2013), we evaluated the risk of non-vertebral fracture (ie, forearm, wrist, hip, and pelvis) in patients with gout versus those without. Gout patients were identified with ≥2 diagnosis codes and ≥1 dispensing for a gout-related drug. Non-gout patients, identified with ≥2 visits coded for any diagnosis and ≥1 dispensing for any prescription drugs, were free of gout diagnosis and received no gout-related drugs. Hip fracture was the secondary outcome. Fractures were identified with a combination of diagnosis and procedure codes. Cox proportional hazards models compared the risk of non-vertebral fracture in gout patients versus non-gout, adjusting for more than 40 risk factors for osteoporotic fracture. Among gout patients with baseline serum uric acid (sUA) measurements available, we assessed the risk of non-vertebral fracture associated with sUA. We identified 73,202 gout and 219,606 non-gout patients, matched on age, sex, and the date of study entry. The mean age was 60 years and 82% were men. Over the mean 2-year follow-up, the incidence rate of non-vertebral fracture per 1,000 person-years was 2.92 in gout and 2.66 in non-gout. The adjusted hazard ratio (HR) was 0.98 (95% confidence interval [CI] 0.85-1.12) for non-vertebral fracture and 0.83 (95% CI 0.65-1.07) for hip fracture in gout versus non-gout. Subgroup analysis (n = 15,079) showed no association between baseline sUA and non-vertebral fracture (HR = 1.03, 95% CI 0.93-1.15), adjusted for age, sex, comorbidity score, and number of any prescription drugs. Gout was not associated with a risk of non

  16. Sex differences in gout characteristics: tailoring care for women and men.

    Science.gov (United States)

    Harrold, Leslie R; Etzel, Carol J; Gibofsky, Allan; Kremer, Joel M; Pillinger, Michael H; Saag, Kenneth G; Schlesinger, Naomi; Terkeltaub, Robert; Cox, Vanessa; Greenberg, Jeffrey D

    2017-03-14

    To characterize the differences between women and men with gout. We analyzed a US national cohort of gout patients cared for by rheumatologists. Compared with the 1012 men with gout, women with gout (n = 262) were older (71 vs. 61 years, p gout differed with women more often taking diuretics (p gout are markedly different, suggesting a need to tailor treatment recommendations.

  17. Solar Flares: Magnetohydrodynamic Processes

    Directory of Open Access Journals (Sweden)

    Kazunari Shibata

    2011-12-01

    Full Text Available This paper outlines the current understanding of solar flares, mainly focused on magnetohydrodynamic (MHD processes responsible for producing a flare. Observations show that flares are one of the most explosive phenomena in the atmosphere of the Sun, releasing a huge amount of energy up to about 10^32 erg on the timescale of hours. Flares involve the heating of plasma, mass ejection, and particle acceleration that generates high-energy particles. The key physical processes for producing a flare are: the emergence of magnetic field from the solar interior to the solar atmosphere (flux emergence, local enhancement of electric current in the corona (formation of a current sheet, and rapid dissipation of electric current (magnetic reconnection that causes shock heating, mass ejection, and particle acceleration. The evolution toward the onset of a flare is rather quasi-static when free energy is accumulated in the form of coronal electric current (field-aligned current, more precisely, while the dissipation of coronal current proceeds rapidly, producing various dynamic events that affect lower atmospheres such as the chromosphere and photosphere. Flares manifest such rapid dissipation of coronal current, and their theoretical modeling has been developed in accordance with observations, in which numerical simulations proved to be a strong tool reproducing the time-dependent, nonlinear evolution of a flare. We review the models proposed to explain the physical mechanism of flares, giving an comprehensive explanation of the key processes mentioned above. We start with basic properties of flares, then go into the details of energy build-up, release and transport in flares where magnetic reconnection works as the central engine to produce a flare.

  18. New developments in the epidemiology and genetics of gout.

    Science.gov (United States)

    Zaka, Raihana; Williams, Charlene J

    2006-06-01

    The prevalence of gout appears to be rapidly increasing worldwide and is no longer a disorder suffered primarily by over-fed alcohol consumers. Emerging risk factors include longevity, metabolic syndrome, and new classes of pharmacologic agents. In some ethnic populations, no obvious risk factors can explain the high incidence of hyperuricemia and gout, suggesting a genetic liability. Studies to identify genes associated with gout have included families with defects in purine metabolism, as well as families in whom the occurrence of gout is secondary to renal disorders such as juvenile hyperuricemic nephropathy and medullary cystic kidney disease. Case-control studies of isolated aboriginal cohorts suffering from primary gout have revealed several chromosomal loci that may harbor genes that are important to the development and/or progression of gout.

  19. Ophaceous Gout Involving the Whole Spine: An Unusual Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Min Woo; Lee, Ji Hae; Cho, Woo Ho [Dept. of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2012-02-15

    Gout is a relatively common, crystal deposition disease, in which monosodium urate crystals are deposited in joint and periarticular tissues of the extremities. Involvement of the spine is exceedingly rare. Most patients with spinal gout present with symptomatic spinal cord compression. Diffuse involvement of tophi deposition inside the spinal central canal has not been reported. We now present a case of chronic tophaceous gout with extensive spinal involvement that resulted in diffuse spinal cord compression and led to paraplegia.

  20. Ophaceous Gout Involving the Whole Spine: An Unusual Case Report

    International Nuclear Information System (INIS)

    Shin, Min Woo; Lee, Ji Hae; Cho, Woo Ho

    2012-01-01

    Gout is a relatively common, crystal deposition disease, in which monosodium urate crystals are deposited in joint and periarticular tissues of the extremities. Involvement of the spine is exceedingly rare. Most patients with spinal gout present with symptomatic spinal cord compression. Diffuse involvement of tophi deposition inside the spinal central canal has not been reported. We now present a case of chronic tophaceous gout with extensive spinal involvement that resulted in diffuse spinal cord compression and led to paraplegia.

  1. GOUT: THE KING OF DISEASES AND THE DISEASE OF KINGS

    OpenAIRE

    Roberto Marcolongo

    2012-01-01

    Gout is a metabolic disorder caused by hyperuricemia resulting in joints and other tissues deposition of urate crystals. Clinical manifestation includes recurrent attacks of arthritis and accumulation of crystalline deposits called tophi. Gout is considered a progressive disease that, without long-term treatment, can progress to severe tophaceous gout. The disease is increasing in prevalence as a result of changes in diet, lifestyle and environmental factors. Hyperuricemia has a fundamental r...

  2. Intestinal Microbiota Distinguish Gout Patients from Healthy Humans

    Science.gov (United States)

    Guo, Zhuang; Zhang, Jiachao; Wang, Zhanli; Ang, Kay Ying; Huang, Shi; Hou, Qiangchuan; Su, Xiaoquan; Qiao, Jianmin; Zheng, Yi; Wang, Lifeng; Koh, Eileen; Danliang, Ho; Xu, Jian; Lee, Yuan Kun; Zhang, Heping

    2016-01-01

    Current blood-based approach for gout diagnosis can be of low sensitivity and hysteretic. Here via a 68-member cohort of 33 healthy and 35 diseased individuals, we reported that the intestinal microbiota of gout patients are highly distinct from healthy individuals in both organismal and functional structures. In gout, Bacteroides caccae and Bacteroides xylanisolvens are enriched yet Faecalibacterium prausnitzii and Bifidobacterium pseudocatenulatum depleted. The established reference microbial gene catalogue for gout revealed disorder in purine degradation and butyric acid biosynthesis in gout patients. In an additional 15-member validation-group, a diagnosis model via 17 gout-associated bacteria reached 88.9% accuracy, higher than the blood-uric-acid based approach. Intestinal microbiota of gout are more similar to those of type-2 diabetes than to liver cirrhosis, whereas depletion of Faecalibacterium prausnitzii and reduced butyrate biosynthesis are shared in each of the metabolic syndromes. Thus the Microbial Index of Gout was proposed as a novel, sensitive and non-invasive strategy for diagnosing gout via fecal microbiota. PMID:26852926

  3. Triggers of acute attacks of gout, does age of gout onset matter? A primary care based cross-sectional study.

    Science.gov (United States)

    Abhishek, Abhishek; Valdes, Ana M; Jenkins, Wendy; Zhang, Weiya; Doherty, Michael

    2017-01-01

    To determine the proportion of people with gout who self-report triggers of acute attacks; identify the commonly reported triggers, and examine the disease and demographic features associated with self-reporting any trigger(s) of acute attacks of gout. Individuals with gout were asked to fill a questionnaire enquiring about triggers that precipitated their acute gout attacks. Binary logistic regression was used to compute odds ratio (OR) and 95% confidence intervals (CI) to examine the association between having ≥1 self-reported trigger of acute gout and disease and demographic risk factors and to adjust for covariates. All statistical analyses were performed using STATA. 550 participants returned completed questionnaires. 206 (37.5%) reported at least one trigger of acute attacks, and less than 5% reported >2 triggers. Only 28.73% participants reported that their most recent gout attack was triggered by dietary or lifestyle risk factors. The most frequently self-reported triggers were alcohol intake (14.18%), red-meat or sea-food consumption (6%), dehydration (4.91%), injury or excess activity (4.91%), and excessively warm or cold weather (4.36% and 5.45%). Patients who had onset of gout before the age of 50 years were significantly more likely to identify a trigger for precipitating their acute gout attacks (aOR (95%CI) 1.73 (1.12-2.68) after adjusting for covariates. Most people with gout do not identify any triggers for acute attacks, and identifiable triggers are more common in those with young onset gout. Less than 20% people self-reported acute gout attacks from conventionally accepted triggers of gout e.g. alcohol, red-meat intake, while c.5% reported novel triggers such as dehydration, injury or physical activity, and weather extremes.

  4. Midtreatment flare-ups.

    Science.gov (United States)

    Harrington, G W; Natkin, E

    1992-04-01

    It should be apparent that the prompt and effective treatment of midtreatment flare-ups of all types is an essential and integral part of the overall endodontic treatment procedure. The expeditious management of these flare-ups will do much to enhance a positive attitude among patients toward endodontic treatment and to ensure the well-being and comfort of these patients.

  5. Gout: an Asia-Pacific update.

    Science.gov (United States)

    Paul, Binoy J; James, Reeta

    2017-04-01

    Even though, Hippocrates recognized gout as an affection of older men and a product of high living long back in 5th century BC, this painful condition promises to accompany humanity to the 21st century. The incidence is progressively rising and females are also affected in the modern era. There are also regional and ethnic variations in the incidence, the genetics of which is being studied. The recommended best therapy for the acute attacks and long term prophylaxis has improved remarkably in the recent years. However, patients are often treated inadequately and risk factors for their disease are not well explored in daily practice. Although well designed long term studies of current and newer treatment are welcomed, educating doctors especially the primary care physicians who manage majority of gout cases, in optimizing the currently available management options would improve the present care. © 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  6. Flare colours and luminosities

    International Nuclear Information System (INIS)

    Cristaldi, S.; Rodono, M.

    1975-01-01

    Flare colours determined from simultaneous UBV observations made at Catania Observatory and from sequential UBV observations made at McDonald Observatory are presented. They fit fairly well with the theoretical colours computed according to the Gurzadian's (1970) non-thermal model. Only part of the observed flare colours are consistent with the solar type models by Gershberg (1967) and Kunkel (1970). From a B-band patrol of UV Cet-type stars carried out from 1967 to 1972, some quantitative estimates of flare frequencies and luminosities and their average contributions to the stellar radiation are given. The corresponding parameters for the Sun, which were estimated from 'white light' flare activity, are also given for comparison. The Sun and V 1216 Sgr can be regarded as low-activity flare stars of the type found by Kunkel (1973). (Auth.)

  7. Tophaceous Gout simulating infected Ankle Implants

    Directory of Open Access Journals (Sweden)

    Ioannis K

    2016-11-01

    Full Text Available Gout is a well known metabolic disorder characterized by the formation of urate crystals in joints resulting in recurrent attacks of acute inflammatory arthritis following which tophi can occur in joints or subcutaneous tissues. We report a rare localization of gouty tophi in a 52 years old male. The tophi had formed over the stainless steel implant used for the fixation of a lateral malleolus fracture 20 years ago.

  8. Education and non-pharmacological approaches for gout.

    Science.gov (United States)

    Abhishek, Abhishek; Doherty, Michael

    2018-01-01

    The objectives of this review are as follows: to highlight the gaps in patient and physician knowledge of gout and how this might impede optimal disease management; to provide recommended core knowledge points that should be conveyed to people with gout; and to review non-pharmacological interventions that can be used in gout management. MeSH terms were used to identify eligible studies examining patients' and health-care professionals' knowledge about gout and its management. A narrative review of non-pharmacological management of gout is provided. Many health-care professionals have significant gaps in their knowledge about gout that have the potential to impede optimal management. Likewise, people with gout and the general population lack knowledge about causes, consequences and treatment of this condition. Full explanation about gout, including the potential benefits of urate-lowering treatment (ULT), motivates people with gout to want to start such treatment, and there is evidence, albeit limited, that educational interventions can improve uptake and adherence to ULT. Additionally, several non-pharmacological approaches, such as rest and topical ice application for acute attacks, avoidance of risk factors that can trigger acute attacks, and dietary interventions that may reduce gout attack frequency (e.g. cherry or cherry juice extract, skimmed milk powder or omega-3 fatty acid intake) or lower serum uric acid (e.g. vitamin C), can be used as adjuncts to ULT. There is a pressing need to educate health-care professionals, people with gout and society at large to remove the negative stereotypes associated with gout, which serve as barriers to optimal gout management, and to perceive gout as a significant medical condition. Moreover, there is a paucity of high-quality trial evidence on whether certain simple individual dietary and lifestyle factors can reduce the risk of recurrent gout attacks, and further studies are required in this field. © The Author 2018

  9. Central arterial characteristics of gout patients with chronic kidney diseases.

    Science.gov (United States)

    Celik, Gulperi; Yilmaz, Sema; Kebapcilar, Levent; Gundogdu, Ali

    2017-05-01

    The aim of this study was to investigate the relationship between central blood pressure, arterial stiffness parameters and renal function parameters in gout patients with chronic kidney disease (CKD) and without CKD. The study enrolled 48 gout patients and 32 control subjects. Central blood pressure, arterial stiffness parameters and renal function parameters in gout patients were investigated. The vascular measurements were performed with an arteriograph. Of the gout patients, 40.1% had CKD. The 24-h pulse pressure (PP) (P < 0.001), central systolic blood pressure (SBP) (P < 0.001), central diastolic blood pressure (DBP) (P < 0.001), cardiac output (CO) (P < 0.001) and peripheral resistance (P = 0.004) were significantly higher in the all patients with gout compared to healthy control subjects. Moreover, when the gout patients with and without CKD were compared, the gout patients with CKD had higher 24-h PP (P = 0.009), 24-h augmentation index standardized to a heart rate of 75 beats per min (AIx@75) (P < 0.023), daytime PP (P = 0.001), daytime AIx@75 (P = 0.027), and nighttime PP (P = 0.035) than the gout patients without CKD. In our study, gout patients with CKD had worse and more emphasized evidence of arterial stiffness than gout patients without CKD. Further investigations with large sample sizes are needed to evaluate the effect of CKD on the arterial stiffness of gout patients. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  10. Renal filtration function in patients with gout

    Directory of Open Access Journals (Sweden)

    N. N. Kushnarenko

    2016-01-01

    Full Text Available Aim. To study circadian blood pressure (BP profile in patients with gout depending on the presence of arterial hypertension (HT and their relationship to the renal filtration function.Material and methods. Patients with gout (n=87 were included into the study. All the patients underwent ambulatory BP monitoring (ABPM with the assessment of circadian BP profile, determination of uric acid serum levels, glomerular filtration rate (GFR was evaluated by CKD-EPI method. Depending on GFR level, all the patients were divided into 2 groups - with renal dysfunction or without one.Results. ABPM revealed circadian BP dysregulation in 55% of gout patients both with HT and without HT. Chronic kidney disease (CKD was revealed in 72.4% of male patients, with the prevalence in patients with HT (76.6 vs 61%; p<0.001. Correlations between uric acid levels and some ABPM indicators and GFR were determined.Conclusion. Obtained data suggest the contribution of hyperuricemia in disorders of systemic and renal hemodynamics, leading to the early development of CKD.

  11. Unusual radiographic changes of a gout patient

    International Nuclear Information System (INIS)

    Markota, J.

    2004-01-01

    Background. Gout is a metabolic disorder that results in hyperuricemia and accumulation of uric acid crystals (urats) in tissues, especially joint cartilage. The gouty arthritis presents as acute attacks of arthritis leading eventually to chronic gouty arthritis. In 80% of cases it first occurs in the matatarsophalangeal (MTP) joint of the great toe and is more frequent in male population. Case report. We present a case of unusual radiographic changes accompanying gouty arthritis. A 63 year old female complained about swelling of the first MTP joint on the right, right knee, about stiffness of feet and hands' digits and about backache. First symptoms started to appear 30 years ago. In the time of examination radiographs displayed degenerative changes of the majority of presented joints, bilateral sacroiliitis and osseous ankylosis of both insteps. Microscopic examination showed urate crystals in the samples of the synovial fluid aspirated from the knee. The histological findings of the synovial tissue after the synovectomy were also in favour of gouty arthritis. Conclusions. Radiographs are the most important imaging modality in the diagnostic process of gout. However, radiographic differential diagnosis can be difficult, since the findings overlap with other conditions which cause arthritis and osteoarthritis especially in longstanding gout, elderly patients and females. The diagnosis must be often confirmed with the help of laboratory and histological findings. (author)

  12. The genetics of gout: towards personalised medicine?

    Science.gov (United States)

    Dalbeth, Nicola; Stamp, Lisa K; Merriman, Tony R

    2017-05-31

    Over the last decade, there have been major advances in the understanding of the genetic basis of hyperuricaemia and gout as well as of the pharmacogenetics of urate-lowering therapy. Key findings include the reporting of 28 urate-associated loci, the discovery that ABCG2 plays a central role on extra-renal uric acid excretion, the identification of genes associated with development of gout in the context of hyperuricaemia, recognition that ABCG2 variants influence allopurinol response, and the impact of HLA-B*5801 testing in reducing the prevalence of allopurinol hypersensitivity in high-risk populations. These advances, together with the reducing cost of whole genome sequencing, mean that integrated personalised medicine approaches may soon be possible in clinical practice. Genetic data may inform assessment of disease prognosis in individuals with hyperuricaemia or established gout, personalised lifestyle advice, selection and dosing of urate-lowering therapy, and prevention of serious medication adverse effects. In this article, we summarise the discoveries from genome-wide association studies and discuss the potential for translation of these findings into clinical practice.

  13. The efficacy and safety of febuxostat for urate lowering in gout patients ≥65 years of age

    Directory of Open Access Journals (Sweden)

    Jackson Robert L

    2012-03-01

    Full Text Available Abstract Background The incidence of gout rises with increasing age. Management of elderly (≥65 years gout patients can be challenging due to high rates of comorbidities, such as renal impairment and cardiovascular disease, and concomitant medication use. However, there is little data specifically addressing the efficacy and safety of available urate-lowering therapies (ULT in the elderly. The objective of this post hoc analysis was to examine the efficacy and safety of ULT with febuxostat or allopurinol in a subset of elderly subjects enrolled in the CONFIRMS trial. Methods Hyperuricemic (serum urate [sUA] levels ≥ 8.0 mg/dL gout subjects were enrolled in the 6-month, double-blind, randomized, comparative CONFIRMS trial and randomized, 1:1:1, to receive febuxostat, 40 mg or 80 mg, or allopurinol (200 mg or 300 mg based on renal function once daily. Flare prophylaxis was provided throughout the study duration. Study endpoints were the percent of elderly subjects with sUA Results Of 2,269 subjects enrolled, 374 were elderly. Febuxostat 80 mg was significantly more efficacious (82.0% than febuxostat 40 mg (61.7%; p p p = 0.029. In subjects with mild-to-moderate renal impairment, significantly greater ULT efficacy was observed with febuxostat 40 mg (61.6%; p = 0.028 and febuxostat 80 mg (82.5%; p p p = 0.011 groups. Flare rates declined steadily in all treatment groups. Rates of AEs were low and comparable across treatments. Conclusions These data suggest that either dose of febuxostat is superior to commonly prescribed fixed doses of allopurinol (200/300 mg in subjects ≥65 years of age with high rates of renal dysfunction. In addition, in this high-risk population, ULT with either drug was well tolerated. Trial registration clinicaltrials.gov NCT#00430248

  14. Recent big flare

    International Nuclear Information System (INIS)

    Moriyama, Fumio; Miyazawa, Masahide; Yamaguchi, Yoshisuke

    1978-01-01

    The features of three big solar flares observed at Tokyo Observatory are described in this paper. The active region, McMath 14943, caused a big flare on September 16, 1977. The flare appeared on both sides of a long dark line which runs along the boundary of the magnetic field. Two-ribbon structure was seen. The electron density of the flare observed at Norikura Corona Observatory was 3 x 10 12 /cc. Several arc lines which connect both bright regions of different magnetic polarity were seen in H-α monochrome image. The active region, McMath 15056, caused a big flare on December 10, 1977. At the beginning, several bright spots were observed in the region between two main solar spots. Then, the area and the brightness increased, and the bright spots became two ribbon-shaped bands. A solar flare was observed on April 8, 1978. At first, several bright spots were seen around the solar spot in the active region, McMath 15221. Then, these bright spots developed to a large bright region. On both sides of a dark line along the magnetic neutral line, bright regions were generated. These developed to a two-ribbon flare. The time required for growth was more than one hour. A bright arc which connects two ribbons was seen, and this arc may be a loop prominence system. (Kato, T.)

  15. Anti-gout Potential of Malaysian Medicinal Plants

    Directory of Open Access Journals (Sweden)

    Fazleen I. Abu Bakar

    2018-03-01

    Full Text Available Gout is a type of arthritis that causes painful inflammation in one or more joints. In gout, elevation of uric acid in the blood triggers the formation of crystals, causing joint pain. Malaysia is a mega-biodiversity country that is rich in medicinal plants species. Therefore, its flora might offer promising therapies for gout. This article aims to systematically review the anti-gout potential of Malaysian medicinal plants. Articles on gout published from 2000 to 2017 were identified using PubMed, Scopus, ScienceDirect, and Google Scholar with the following keyword search terms: “gout,” “medicinal plants,” “Malaysia,” “epidemiology,” “in vitro,” and “in vivo.” In this study, 85 plants were identified as possessing anti-gout activity. These plants had higher percentages of xanthine oxidase inhibitory activity (>85%; specifically, the Momordica charantia, Chrysanthemum indicum, Cinnamomum cassia, Kaempferia galanga, Artemisia vulgaris, and Morinda elliptica had the highest values, due to their diverse natural bioactive compounds, which include flavonoids, phenolics, tannin, coumarins, luteolin, and apigenin. This review summarizes the anti-gout potential of Malaysian medicinal plants but the mechanisms, active compounds, pharmacokinetics, bioavailability, and safety of the plants still remain to be elucidated.

  16. Anti-gout Potential of Malaysian Medicinal Plants.

    Science.gov (United States)

    Abu Bakar, Fazleen I; Abu Bakar, Mohd F; Rahmat, Asmah; Abdullah, Norazlin; Sabran, Siti F; Endrini, Susi

    2018-01-01

    Gout is a type of arthritis that causes painful inflammation in one or more joints. In gout, elevation of uric acid in the blood triggers the formation of crystals, causing joint pain. Malaysia is a mega-biodiversity country that is rich in medicinal plants species. Therefore, its flora might offer promising therapies for gout. This article aims to systematically review the anti-gout potential of Malaysian medicinal plants. Articles on gout published from 2000 to 2017 were identified using PubMed, Scopus, ScienceDirect, and Google Scholar with the following keyword search terms: "gout," "medicinal plants," "Malaysia," "epidemiology," " in vitro," and " in vivo ." In this study, 85 plants were identified as possessing anti-gout activity. These plants had higher percentages of xanthine oxidase inhibitory activity (>85%); specifically, the Momordica charantia, Chrysanthemum indicum, Cinnamomum cassia, Kaempferia galanga, Artemisia vulgaris , and Morinda elliptica had the highest values, due to their diverse natural bioactive compounds, which include flavonoids, phenolics, tannin, coumarins, luteolin, and apigenin. This review summarizes the anti-gout potential of Malaysian medicinal plants but the mechanisms, active compounds, pharmacokinetics, bioavailability, and safety of the plants still remain to be elucidated.

  17. Gout and hyperuricaemia | Abrahams | South African Medical Journal

    African Journals Online (AJOL)

    Gout is the most common crystal arthritis and its prevalence is rising. It is associated with the metabolic syndrome, and hyperuricaemia may be an independent risk factor for cardiovascular disease. The acute presentation of gout is easily managed, but the underlying cause is seldom addressed. Indications for initiating uric ...

  18. A case of extensive synovial involvement by tophaceous gout | Khan ...

    African Journals Online (AJOL)

    Gout is the most common form of microcrystal arthropathy that results in deposition of uric acid crystals in and around the joints and soft tissues. The most common cause is decreased uric acid clearance by the kidneys. The radiological manifestations of gout are generally well known and have remained unchanged.

  19. Coexistence of gout and rheumatoid arthritis in Nairobi, Kenya ...

    African Journals Online (AJOL)

    Background: There is a widespread belief that gout and RA rarely coexist in the same patient. Given that there is an excess burden of cardiovascular disease in patients with RA, this is compounded by hyperuricemia. The purpose of this study was to describe the clinical profiles of patients with coexistent gout and ...

  20. Racial and Gender Disparities in Patients with Gout

    Science.gov (United States)

    Singh, Jasvinder A.

    2012-01-01

    Gout affects 8.3 million Americans according to NHANES 2007–2008, roughly 3.9% of the U.S. population. Gout has significant impact on physical function, productivity, health-related quality of life (HRQOL) and health care costs. Uncontrolled gout is also associated with significant utilization of emergent care services. Women are less likely to have gout than men, but in the postmenopausal years the gender difference in disease incidence decreases. Compared to Whites, racial/ethnic minorities, especially blacks, have higher prevalence of gout. On the other hand, blacks are less likely to receive quality gout care, leading to a disproportionate morbidity. Women are less likely than men to receive allopurinol, less likely to get joint aspirations for crystal analyses for establishing diagnosis, but those on urate-lowering therapy are as/more likely as men to get serum urate check within 6-months of initiation. While a few studies provide the knowledge related to gender and race/ethnicity disparities in gout, several knowledge gaps exist in gout epidemiology and outcomes differences by gender and race/ethnicity. These should be explored in future studies. PMID:23315156

  1. Menopause, postmenopausal hormone use and risk of incident gout

    NARCIS (Netherlands)

    A.E. Hak (Liesbeth); G.C. Curhan (Gary); F. Grodstein (Francine); H.K. Choi (Hyon)

    2010-01-01

    textabstractObjective: To prospectively study the relation between menopause, postmenopausal hormone use and risk of gout, since female sex hormones have been postulated to decrease gout risk among women. Methods: In the Nurses' Health Study, the association between menopause, age at menopause,

  2. Comparison of measures of functional disability in patients with gout

    NARCIS (Netherlands)

    ten Klooster, Peter M.; Oude Voshaar, Antonius H.; Taal, Erik; van de Laar, Mart A F J

    2011-01-01

    Objective. To compare the measurement properties of the HAQ disability index (HAQ-DI), HAQ-II and short form 36 physical functioning scale (PF-10) in patients with gout. Methods. A cross-sectional sample of 97 patients with gout completed all three measures. Reliability was assessed by examining the

  3. Genetic association of polymorphism rs1333049 with gout.

    Science.gov (United States)

    Wang, Binbin; Meng, Dongmei; Wang, Jing; Liu, Shiguo; Zhou, Sirui; Miao, Zhimin; Han, Lin; Chu, Nan; Zhang, Kun; Ma, Xu; Li, Changgui

    2011-09-01

    We suspect that genes or loci that contribute to coronary artery disease (CAD) may also play a role in the pathogenesis of gout, since hyperuricaemia leads to gout, and serum uric acid (SUA) levels are potential risk factors for CAD. The single nucleotide polymorphism (SNP) rs1333049 (C/G) on chromosome 9p21 has been implicated in previous studies to be associated with CAD. The aim of this study was to evaluate the relationship between this SNP and gout pathogenesis. Nine hundred Chinese Han were recruited for this study (461 gout patients and 439 gout-free individuals). The rs1333049 SNP and surrounding sequences were PCR sequenced. There was a clear link between the rs1333049 genotypic and allelic frequencies between gout cases and controls (χ(2) = 6.81, df = 2, P = 0.033 by genotype; χ(2) = 6.63, df = 1, P = 0.01 by allele). There was a significantly increased risk of gout in carriers of the CC genotype (odds ratio = 1.43, 95% CI 1.07, 1.91). To the best of our knowledge, our findings are the first to establish an association of rs1333049 with gout in a Chinese Han population. Meanwhile, this SNP is homologous to miR-519 and miR-520.

  4. Recent insights into the pathogenesis of hyperuricaemia and gout.

    Science.gov (United States)

    Riches, Philip L; Wright, Alan F; Ralston, Stuart H

    2009-10-15

    Gout is a common rheumatic disease in humans which is characterized by elevation in serum uric acid levels, and deposition of uric acid crystals in the joint. Hyperuricaemia is the primary risk factor for the development of gout and primates have uniquely high levels of serum uric acid due to missense mutations in the uricase gene. Levels of serum uric acid are known to be highly heritable, and mutations in genes which encode enzymes in the purine salvage pathway have long been recognized as rare causes of gout. Until recently, however, little has been known about the genetic determinants of urate metabolism and susceptibility to gout in the general population. Over recent months, a series of large scale genome wide association studies have been performed which have shed new light on the genes which regulate serum uric acid levels and susceptibility to gout. Most of these genes seem to be involved in regulating the renal excretion of uric acid which underscores the importance of reduced urate excretion as opposed to increased endogenous production as a cause of gout. Further work will now be required to investigate the mechanisms by which these genetic variants regulate urate excretion and serum urate levels. However, it seems likely that the genes so far identified will represent new molecular targets for the design of drugs to enhance urate excretion and the genetic variants that predispose to gout might be of value as genetic markers of susceptibility to gout.

  5. Weight loss for overweight and obese individuals with gout

    DEFF Research Database (Denmark)

    Nielsen, Sabrina M; Bartels, Else Marie; Henriksen, Marius

    2017-01-01

    OBJECTIVES: Weight loss is commonly recommended for gout, but the magnitude of the effect has not been evaluated in a systematic review. The aim of this systematic review was to determine benefits and harms associated with weight loss in overweight and obese patients with gout. METHODS: We search...

  6. The evolution of gout (an old lifestyle disease)

    African Journals Online (AJOL)

    the 6th century AD, the role of genetics and the association of gout with an ... NIDDM and cardiovascular disease is a challenge for the 20th century and the future. ... Gout was known among the Egyptians as Podagra (foot pain) as early as.

  7. Flare stars in Pleiades. 5

    International Nuclear Information System (INIS)

    Mirzoyan, L.V.; Chavushyan, O.S.; Erastova, L.K.; Oganyan, G.B.; Melikyan, N.D.; Natsvlishvili, R.Sh.; Tsvetkov, M.K.

    1977-01-01

    The results of photographic observations of stellar flares in the Pleiades region made in the Byurakan and Abastumany astrophysical observatories in 1973-1974 are presented. The observations and revisions of the pictures taken earlier helped to detect 20 new flare stars and 62 repeated flares of flare stars known before. Two-colour photographic and UV observation of 21 flares were carried out. The observation data point to considerable differences in the mean frequency of flares of various flare stars in the Pleiades

  8. Sun and solar flares

    Energy Technology Data Exchange (ETDEWEB)

    McKenna-Lawlor, S. (Saint Patrick' s Coll., Maynooth (Ireland))

    1982-07-01

    The subject is discussed under the headings: the sun's core (thermonuclear reactions, energy transfer from core through radiation zone, convection zone, photosphere, chromosphere and corona); the photosphere (convection, granulation, sunspots, magnetic fields, solar cycle, rotation of the sun); solar variability and paleoclimatic records (correlation of low solar activity with increased /sup 14/C production in atmosphere); the chromosphere and corona (turbulence, temperature, coronal streamers, energy transfer); solar flares (cosmic rays, aurorae, spectra, velocity of flares, prominences, mechanisms of flares); the solar wind.

  9. Solar Features - Solar Flares

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — A solar flare is a short-lived sudden increase in the intensity of radiation emitted in the neighborhood of sunspots. For many years it was best monitored in the...

  10. Proton solar flares

    International Nuclear Information System (INIS)

    Shaposhnikova, E.F.

    1979-01-01

    The observations of proton solar flares have been carried out in 1950-1958 using the extrablackout coronograph of the Crimea astrophysical observatory. The experiments permit to determine two characteristic features of flares: the directed motion of plasma injection flux from the solar depths and the appearance of a shock wave moving from the place of the injection along the solar surface. The appearance of the shock wave is accompanied by some phenomena occuring both in the sunspot zone and out of it. The consistent flash of proton flares in the other groups of spots, the disappearance of fibres and the appearance of eruptive prominences is accomplished in the sunspot zone. Beyond the sunspot zone the flares occur above spots, the fibres disintegrate partially or completely and the eruptive prominences appear in the regions close to the pole

  11. Fibromyalgia Flares: A Qualitative Analysis.

    Science.gov (United States)

    Vincent, Ann; Whipple, Mary O; Rhudy, Lori M

    2016-03-01

    Patients with fibromyalgia report periods of symptom exacerbation, colloquially referred to as "flares" and despite clinical observation of flares, no research has purposefully evaluated the presence and characteristics of flares in fibromyalgia. The purpose of this qualitative study was to describe fibromyalgia flares in a sample of patients with fibromyalgia. Using seven open-ended questions, patients were asked to describe how they perceived fibromyalgia flares and triggers and alleviating factors associated with flares. Patients were also asked to describe how a flare differs from their typical fibromyalgia symptoms and how they cope with fibromyalgia flares. Content analysis was used to analyze the text. A total of 44 participants completed the survey. Responses to the seven open-ended questions revealed three main content areas: causes of flares, flare symptoms, and dealing with a flare. Participants identified stress, overdoing it, poor sleep, and weather changes as primary causes of flares. Symptoms characteristic of flares included flu-like body aches/exhaustion, pain, fatigue, and variety of other symptoms. Participants reported using medical treatments, rest, activity and stress avoidance, and waiting it out to cope with flares. Our results demonstrate that periods of symptom exacerbation (i.e., flares) are commonly experienced by patients with fibromyalgia and symptoms of flares can be differentiated from every day or typical symptoms of fibromyalgia. Our study is the first of its kind to qualitatively explore characteristics, causes, and management strategies of fibromyalgia flares. Future studies are needed to quantitatively characterize fibromyalgia flares and evaluate mechanisms of flares. © 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. Improved flare tip design

    Energy Technology Data Exchange (ETDEWEB)

    Gogolek, P. [Natural Resources Canada, Ottawa, ON (Canada). CANMET Energy Technology Centre

    2004-07-01

    This paper discusses the testing procedures and development of an improved flare tip design. Design objectives included performance equal to or better than utility flares at low wind speed; conversion efficiency; fuel slip; smoking; significant improvement at high wind speed; and no increase in trace emissions. A description of the testing facility of the flare tip was provided, with reference to the fact that the facility allowed for realistic near full scale gas flares in a single-pass flare test facility. Other details of the facility included: an adjustable ceiling; high capacity variable speed fan; sampling ports along working section in stack; windows along working section; and air cooled walls, floor, and ceiling. The fuels used in the flare tip included natural gas, propane, gasoline and inert gases. Details of wind speed, appurtenances and turbulence generating grids were presented, with reference to continuous gas emission measurements. A list of design constraints was provided. Flare performance included wind speed, turbulence and fuel composition. A chart of conversion inefficiencies with a correlation of wind speed and turbulence, fuel flow and pipe size was also presented. Several new tip designs were fabricated for testing, with screening tests for comparison to basic pipe and ranking designs. Significant improvements were found in one of the new designs, including results with 30 per cent propane in fuel. Emissions reduction from 10 to 35 per cent were noted. It was concluded that future work should focus on evaluating improved tip for stability at low wind speeds. Fuel slips are the primary source of emissions, and it was recommended that further research is necessary to improve existing flare tips. tabs, figs.

  13. Tophaceous gout causing lumbar stenosis: A case report.

    Science.gov (United States)

    Lu, Huigen; Sheng, Jianming; Dai, Jiaping; Hu, Xuqi

    2017-08-01

    Gout in the spine is very rare. The clinical symptoms of the spinal gout are various and lack of specificity. The authors report a case of spinal gout causing lumbar stenosis. We never find such wide-invasive spinal gouty lesion in the published studies. A 68-year-old male had low back pain radiating to bilateral lower limbs, accompanying with intermittent claudication that lasted for 3 months and aggravated 5 days ago. Spinal gout, lumbar stenosis. The patient underwent L2-L4 laminectomy, L2/3 L3/4 an d L4/5 discectomy and transforaminal lumbar interbody fusion with pedicle screw fixation. Dual-energy computed tomography detected extensive tophaceous deposits in L1/2 L2/3 L3/4 and L4/5 lumbar discs as well as the posterior column, especially L2-L3 and L4-L5 facet joints. During the surgery, we found a mass of chalky white material at the posterior column of L3 to L5 vertebral bodies, which also involved the intervertebral discs. Pathological examination confirmed the diagnosis of spinal gout. Although spinal gout is thought to be rare, the diagnosis should be considered if the patient had severe back pain and a history of gout. Dual-energy computed tomography is highly recommended for these patients.

  14. Decreased incidence of gout in diabetic patients using pioglitazone.

    Science.gov (United States)

    Niu, Sheng-Wen; Chang, Kai-Ting; Lin, Hugo You-Hsien; Kuo, I-Ching; Chang, Yu-Han; Chen, Yu-Han; Hung, Chi-Chih; Chiu, Yi-Wen; Hwang, Shang-Jyh

    2018-01-01

    The incidence and prevalence of gout are increasing, but the management is poor. Considering the increased prevalence of gout in the diabetic population, this study evaluated the effects of pioglitazone, an insulin resistance inhibitor, on the incidence of gout in the diabetic population. We used data from the National Health Insurance program in Taiwan. The pioglitazone cohort contained 30 100 patients and each patient was age and sex matched with three non-pioglitazone users who were randomly selected from the diabetic population. Cox proportional hazards regression analysis was conducted to estimate the effects of pioglitazone on the incidence of gout in the diabetic population. The incidence of gout was significantly lower in pioglitazone users than in non-pioglitazone users [adjusted hazard ratio (aHR) 0.81 (95% CI 0.78, 0.85)]. The HR for the incidence of gout was lower in both male [aHR 0.80 (95% CI 0.75, 0.85)] and female [aHR 0.83 (95% CI 0.78, 0.88)] pioglitazone users than in non-pioglitazone users. An analysis of three age groups (gout in the diabetic population using pioglitazone was less. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  15. Research progress in the genetics of hyperuricaemia and gout.

    Science.gov (United States)

    Zheng, Min; Ma, Jun-wu

    2016-04-01

    Gout is one of the most common inflammatory arthritis caused by hyperuricaemia, which is affected by both genetic factors and environmental factors. Early researches show that a few of rare monogenic mutations, such as PRPS1 and HPRT1 mutations, lead to abnormal purine anabolism and then cause hyperuricaemia and gout. In recent years, genome-wide association studies (GWAS) have identified dozens of susceptibility loci and/or candidate genes associated with hyperuricemia and gout. Loss-of-function mutations in SLC2A9, SLC22A11, and SLC22A12 cause hereditary hypouricaemia, while their overexpression may increase the reabsorption of uric acid. In contrast, loss-of-function mutations in ABCG2, SLC17A1, and SLC17A3 cause urate underexcretion of renal and intestinal. These variations leading to blood uric acid excretion disorder (excess reabsorption and underexcretion) are the main genetic factors affecting hyperuicemia and gout. Moreover, to some degree, inhibins-activins growth factor system, transcription factors, cytoskeleton and gene-environment interaction can also affect the level of blood uric acid. In addition, two risk genes, RFX3 and KCNQ1, which might impair immune response and lead to functional deficiency of beta cell were recently discovered to influence hyperuiceamia and gout in Han Chinese. This paper systematically reviews genetic studies on hyperuricaemia and gout to improve our understanding of pathogenesis of hyperuricaemia and gout.

  16. NALP3 inflammasome functional polymorphisms and gout susceptibility.

    Science.gov (United States)

    Miao, Zhi-Min; Zhao, Shi-Hua; Yan, Sheng-Li; Li, Chang-Gui; Wang, Yan-Gang; Meng, Dong-Mei; Zhou, Li; Mi, Qing-Sheng

    2009-01-01

    Gout is the most common autoinflammatory arthritis characterized by elevated serum urate and recurrent attacks of intra-articular crystal deposition of monosodium urate (MSU). Although the pathogenesis of gout is still unclear, accumulated studies indicate that genetic factors trigger gout development, including some susceptibility genes that control the production and clearance of urate and lead to hyperuricemia. However, the epidemiological evidence suggests that only less than 10% of hyperuricemia patients develop gout, indicating that other genes unrelated to the urate metabolism may also contribute to the diseases susceptibility. Accumulated evidences have implied that MSU crystal-induced inflammation is a paradigm of innate immunity and that NALP3 inflammasome, an innate immune complex containing NALP3, ASC and CARD-8, is involved in gout development. Recent studies suggest that NALP3 and CARD-8 functional mutations contribute to the development of autoinflammatory diseases including hereditary periodic fever syndrome, arthritis as well as hypertension susceptibility. Taking into account these genetic findings, here we would like to propose a novel hypothesis that functional mutations in NALP3 inflammasome may make NALP3 inflammasome as attractive susceptibility candidates and genetic markers for gout. Further clinical genetic studies need to be performed to confirm the role of NALP3 inflammasome in the etiology of gout.

  17. Identifying flares in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Bykerk, Vivian P; Bingham, Clifton O; Choy, Ernest H

    2016-01-01

    to flare, with escalation planned in 61%. CONCLUSIONS: Flares are common in rheumatoid arthritis (RA) and are often preceded by treatment reductions. Patient/MD/DAS agreement of flare status is highest in patients worsening from R/LDA. OMERACT RA flare questions can discriminate between patients with...... Set. METHODS: Candidate flare questions and legacy measures were administered at consecutive visits to Canadian Early Arthritis Cohort (CATCH) patients between November 2011 and November 2014. The American College of Rheumatology (ACR) core set indicators were recorded. Concordance to identify flares...

  18. Corot's 'gout' and a 'gipsy' girl.

    Science.gov (United States)

    Panush, R B; Caldwell, J R; Panush, R S

    1990-09-05

    Representations of rheumatic disease in art provide insight into artistic expression, help us understand the evolution and perhaps the etiology of rheumatic diseases, and remind us of great contributions by artists in adverse circumstances. We noted hand deformities characteristic of inflammatory arthritis in Jean-Baptiste-Camille Corot's Gipsy Girl With Mandolin (1870 to 1875), National Gallery of Art, Washington, DC. Corot suffered with what probably was gout beginning in 1866. We are unaware that arthritis has been observed in Corot's subjects or that Corot's depiction of arthritis has been appreciated from the perspective of his own rheumatic disease. Examination of other Corot portraits identifies some with blurred hand details consistent with the artist's style and the remainder with normal hands. These observations suggest that the artist portrayed specific anatomic abnormalities in the "Gipsy Girl's" hand, indicating familiarity with inflammatory arthritis. It is speculative whether this was Corot's own or the model's arthritis; we favor the interpretation that Corot's gout was reflected in this particular work. We thus add a new perspective to Corot's Gipsy Girl With Mandolin-a subject with arthritis, a painter knowledgeable about arthritis, and a painting that therefore might be understood at least in part from an appreciation of the artist's specific illness.

  19. How patients with gout become engaged in disease management: a constructivist grounded theory study.

    Science.gov (United States)

    Howren, Alyssa; Cox, Susan M; Shojania, Kam; Rai, Sharan K; Choi, Hyon K; De Vera, Mary A

    2018-06-01

    Prior qualitative research on gout has focused primarily on barriers to disease management. Our objective was to use patients' perspectives to construct an explanatory framework to understand how patients become engaged in the management of their gout. We recruited a sample of individuals with gout who were participating in a proof-of-concept study of an eHealth-supported collaborative care model for gout involving rheumatology, pharmacy, and dietetics. Semistructured interviews were used. We analyzed transcripts using principles of constructivist grounded theory involving initial coding, focused coding and categorizing, and theoretical coding. Twelve participants with gout (ten males, two females; mean age, 66.5 ± 13.3 years) were interviewed. The analysis resulted in the construction of three themes as well as a framework describing the dynamically linked themes on (1) processing the diagnosis and management of gout, (2) supporting management of gout, and (3) interfering with management of gout. In this framework, patients with gout transition between each theme in the process of becoming engaged in the management of their gout and may represent potential opportunities for healthcare intervention. Findings derived from this study show that becoming engaged in gout management is a dynamic process whereby patients with gout experience factors that interfere with gout management, process their disease and its management, and develop the practical and perceptual skills necessary to manage their gout. By understanding this process, healthcare providers can identify points to adapt care delivery and thereby improve health outcomes.

  20. Genome-wide association study of clinically defined gout identifies multiple risk loci and its association with clinical subtypes

    OpenAIRE

    Matsuo, Hirotaka; Yamamoto, Ken; Nakaoka, Hirofumi; Nakayama, Akiyoshi; Sakiyama, Masayuki; Chiba, Toshinori; Takahashi, Atsushi; Nakamura, Takahiro; Nakashima, Hiroshi; Takada, Yuzo; Danjoh, Inaho; Shimizu, Seiko; Abe, Junko; Kawamura, Yusuke; Terashige, Sho

    2015-01-01

    Objective Gout, caused by hyperuricaemia, is a multifactorial disease. Although genome-wide association studies (GWASs) of gout have been reported, they included self-reported gout cases in which clinical information was insufficient. Therefore, the relationship between genetic variation and clinical subtypes of gout remains unclear. Here, we first performed a GWAS of clinically defined gout cases only. Methods A GWAS was conducted with 945 patients with clinically defined gout and 1213 contr...

  1. Imaging tools to measure treatment response in gout.

    Science.gov (United States)

    Dalbeth, Nicola; Doyle, Anthony J

    2018-01-01

    Imaging tests are in clinical use for diagnosis, assessment of disease severity and as a marker of treatment response in people with gout. Various imaging tests have differing properties for assessing the three key disease domains in gout: urate deposition (including tophus burden), joint inflammation and structural joint damage. Dual-energy CT allows measurement of urate deposition and bone damage, and ultrasonography allows assessment of all three domains. Scoring systems have been described that allow radiological quantification of disease severity and these scoring systems may play a role in assessing the response to treatment in gout. This article reviews the properties of imaging tests, describes the available scoring systems for quantification of disease severity and discusses the challenges and controversies regarding the use of imaging tools to measure treatment response in gout. © The Author 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  2. Nonsteroidal anti-inflammatory drugs for treatment of acute gout

    NARCIS (Netherlands)

    van Durme, Caroline M. P. G.; Wechalekar, Mihir D.; Landewé, Robert B. M.

    2015-01-01

    Are nonsteroidal anti-inflammatory drugs (NSAIDs) associated with better outcomes than cyclooxygenase inhibitors, glucocorticoids, IL-1 inhibitors or placebo in the treatment of acute gout? NSAIDs are not significantly associated with a difference in pain reduction compared with cyclooxygenase

  3. Flare stars in Pleiades. 6

    International Nuclear Information System (INIS)

    Mirzoyan, L.V.; Chavushyan, O.S.; Oganyan, G.B.; Ambaryan, V.V.; Garibdzhanyan, A.T.; Melikyan, N.D.; Natsvlishvili, R.Sh.; AN Gruzinskoj SSR, Abastumani. Abastumanskaya Astrofizicheskaya Observatoriya)

    1981-01-01

    The results of photographic observations of stellar flares in the Pleiades region carried out at the Byurakan and Abastumani astrophysical observatories during 1976-1979 are given. On the basis of these observations 17 new flare stars have been found. Total number of all known flare stars in the Pleiades region on 1 June 1980 reached 524, and the number of all flares-1244. The observational data on distribution of flare stars according to the observed flares is satisfactorily represented by the average frequency function introduced by V.A.Ambartsumian. The total number of the flare stars in the Pleiades is of the order of 1100. Using three telescopes, synchronous photographic observations of stellar flares in Pleiades in U, B, V, system are carried out. The colour indices U-B and B-V of stellar flares in periods including the maximum of the flare slightly differ from that of photoelectrically defined for flares of UV Ceti type stars, which testifies the physical relationship of flare stars in Pleiades and in the vicinity of the Sun [ru

  4. Gout in Older Adults: The Atherosclerosis Risk in Communities Study

    Science.gov (United States)

    Burke, Bridget Teevan; Köttgen, Anna; Law, Andrew; Grams, Morgan; Baer, Alan N.; Coresh, Josef

    2016-01-01

    Background: It is unclear whether traditional and genetic risk factors in middle age predict the onset of gout in older age. Methods: We studied the incidence of gout in older adults using the Atherosclerosis Risk in Communities study, a prospective U.S. population–based cohort of middle-aged adults enrolled between 1987 and 1989 with ongoing follow-up. A genetic urate score was formed from common urate-associated single nucleotide polymorphisms for eight genes. The adjusted hazard ratio and 95% confidence interval of incident gout by traditional and genetic risk factors in middle age were estimated using a Cox proportional hazards model. Results: The cumulative incidence from middle age to age 65 was 8.6% in men and 2.5% in women; by age 75 the cumulative incidence was 11.8% and 5.0%. In middle age, increased adiposity, beer intake, protein intake, smoking status, hypertension, diuretic use, and kidney function (but not sex) were associated with an increased gout risk in older age. In addition, a 100 µmol/L increase in genetic urate score was associated with a 3.29-fold (95% confidence interval: 1.63–6.63) increased gout risk in older age. Conclusions: These findings suggest that traditional and genetic risk factors in middle age may be useful for identifying those at risk of gout in older age. PMID:26714568

  5. The role of the NLRP3 inflammasome in gout

    Directory of Open Access Journals (Sweden)

    Sarah R Kingsbury

    2011-03-01

    Full Text Available Sarah R Kingsbury1,2, Philip G Conaghan1,2, Michael F McDermott1,21Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine 2NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UKAbstract: Gout is an inflammatory arthritis characterized by abrupt self-limiting attacks of inflammation caused by precipitation of monosodium urate crystals (MSU in the joint. Recent studies suggest that orchestration of the MSU-induced inflammatory response is dependent on the proinflammatory cytokine IL-1ß, underlined by promising results in early IL-1 inhibitor trials in gout patients. This IL-1-dependent innate inflammatory phenotype, which is observed in a number of diseases in addition to gout, is now understood to rely on the formation of the macromolecular NLRP3 inflammasome complex in response to the MSU 'danger signal'. This review focuses on our current understanding of the NLRP3 inflammasome and its critical role in MSU-crystal induced inflammatory gout attacks. It also discusses the management of treatment-resistant acute and chronic tophaceous gout with IL-1 inhibitors; early clinical studies of rilonacept (IL-1 Trap, canakinumab (monoclonal anti-IL-1ß antibody, and anakinra have all demonstrated treatment efficacy in such patients.Keywords: gout, inflammasome, NLRP3, IL-1

  6. An update on the genetics of hyperuricaemia and gout.

    Science.gov (United States)

    Major, Tanya J; Dalbeth, Nicola; Stahl, Eli A; Merriman, Tony R

    2018-06-01

    A central aspect of the pathogenesis of gout is elevated urate concentrations, which lead to the formation of monosodium urate crystals. The clinical features of gout result from an individual's immune response to these deposited crystals. Genome-wide association studies (GWAS) have confirmed the importance of urate excretion in the control of serum urate levels and the risk of gout and have identified the kidneys, the gut and the liver as sites of urate regulation. The genetic contribution to the progression from hyperuricaemia to gout remains relatively poorly understood, although genes encoding proteins that are involved in the NLRP3 (NOD-, LRR- and pyrin domain-containing 3) inflammasome pathway play a part. Genome-wide and targeted sequencing is beginning to identify uncommon population-specific variants that are associated with urate levels and gout. Mendelian randomization studies using urate-associated genetic variants as unconfounded surrogates for lifelong urate exposure have not supported claims that urate is causal for metabolic conditions that are comorbidities of hyperuricaemia and gout. Genetic studies have also identified genetic variants that predict responsiveness to therapies (for example, urate-lowering drugs) for treatment of hyperuricaemia. Future research should focus on large GWAS (that include asymptomatic hyperuricaemic individuals) and on increasing the use of whole-genome sequencing data to identify uncommon genetic variants with increased penetrance that might provide opportunities for clinical translation.

  7. The Pharmacodynamics, Pharmacokinetics, and Safety of Arhalofenate in Combination with Febuxostat When Treating Hyperuricemia Associated with Gout.

    Science.gov (United States)

    Steinberg, Alexandra S; Vince, Bradley D; Choi, Yun-Jung; Martin, Robert L; McWherter, Charles A; Boudes, Pol F

    2017-03-01

    Arhalofenate (ARH), in development for gout, has uricosuric and anti-flare activities. ARH plus febuxostat (FBX) were evaluated in subjects with gout for serum uric acid (SUA) lowering, drug interaction, and safety. Open phase II trial in gout volunteers (NCT02252835). Cohort 1 received ARH 600 mg for 2 weeks, followed by sequential 1-week co-administration of FBX 80 mg followed by 40 mg. FBX 40 mg was continued alone for 2 weeks. Cohort 2 received ARH 800 mg for 2 weeks, followed by sequential 1-week co-administration of FBX 40 mg followed by 80 mg. FBX 80 mg was continued alone for 2 weeks. SUA, its fractional excretion (FEUA), and plasma oxypurines were assessed. Pharmacokinetics of FBX and ARH were determined alone and in combination for cohort 2. Baseline mean SUA was 9.4 mg/dl for cohort 1 (n = 16) and 9.2 mg/dl for cohort 2 (n = 16). The largest SUA decrease (63%) was observed with ARH 800 mg + FBX 80 mg, with all subjects reaching SUA < 6 mg/dl and 93% < 5 mg/dl. The area under the curve (AUC) (0-t) of ARH acid + FBX/ARH acid was 108%. The AUC (0-t) of FBX + ARH acid/FBX was 87%. As expected, FBX increased oxypurines and increases were unaffected by ARH co-administration. Baseline FEUA were low (3.5%-4.6%) and ARH increased them toward normal without overexcretion of UA. ARH was well tolerated and appeared safe. ARH and FBX lowered SUA by complementary mechanisms. The combination provided greater decreases than each drug alone. The combination was well tolerated and appeared safe. NCT02252835.

  8. Future flare compositions

    NARCIS (Netherlands)

    Lingen, J.L.N. van; Meuken, D.; Hackspik, M.M.; Mäkeläinen, T.; Weiser, V.; Poulson, G.W.

    2014-01-01

    This poster describes the work done within the Category B joint research project under the European Defence Agency (EDA) on Future Flare Compositions [1]. Contributing members were Finland, Germany, United Kingdom and the Netherlands. The program was aimed to identify the technology gaps that apply

  9. Flaring research update

    International Nuclear Information System (INIS)

    Reynen, B.A.

    1999-01-01

    Several studies regarding waste gas flaring have been conducted in an effort to determine the potential health and environmental impacts associated with flaring. Energy source conservation and greenhouse gas emissions reduction are other reasons for studying the issue. A brief outline for each of the following research priorities was given: (1) operating practices, (2) flare performance, focusing on improved combustion efficiency, (3) speciation, addressing the potential effects of incomplete combustion, (4) alternative technologies such as membrane technology, cryogenics and power generation to reduce flare gas volume, (5) improved liquid separation, concentrating on the removal of entrained liquids to improve performance and reduce emissions and (6) fate and transport, including plume modeling, ambient air monitoring, tracking of known toxins, primarily to address concerns of environmental groups.The expectation is that this broad and comprehensive research effort will yield substantive and credible scientific data, lead to cooperation in the research community, reduce emissions, beneficially impact on regulations and standards and gain the support of environmental organizations

  10. Which of Kepler's Stars Flare?

    Science.gov (United States)

    Kohler, Susanna

    2017-12-01

    The habitability of distant exoplanets is dependent upon many factors one of which is the activity of their host stars. To learn about which stars are most likely to flare, a recent study examines tens of thousands of stellar flares observed by Kepler.Need for a Broader SampleArtists rendering of a flaring dwarf star. [NASAs Goddard Space Flight Center/S. Wiessinger]Most of our understanding of what causes a star to flare is based on observations of the only star near enough to examine in detail the Sun. But in learning from a sample size of one, a challenge arises: we must determine which conclusions are unique to the Sun (or Sun-like stars), and which apply to other stellar types as well.Based on observations and modeling, astronomers think that stellar flares result from the reconnection of magnetic field lines in a stars outer atmosphere, the corona. The magnetic activity is thought to be driven by a dynamo caused by motions in the stars convective zone.HR diagram of the Kepler stars, with flaring main-sequence (yellow), giant (red) and A-star (green) stars in the authors sample indicated. [Van Doorsselaere et al. 2017]To test whether these ideas are true generally, we need to understand what types of stars exhibit flares, and what stellar properties correlate with flaring activity. A team of scientists led by Tom Van Doorsselaere (KU Leuven, Belgium) has now used an enormous sample of flares observed by Kepler to explore these statistics.Intriguing TrendsVan Doorsselaere and collaborators used a new automated flare detection and characterization algorithm to search through the raw light curves from Quarter 15 of the Kepler mission, building a sample of 16,850 flares on 6,662 stars. They then used these to study the dependence of the flare occurrence rate, duration, energy, and amplitude on the stellar spectral type and rotation period.This large statistical study led the authors to several interesting conclusions, including:Flare star incidence rate as a a

  11. Efeitos agudos do exercício físico prolongado: avaliação após ultramaratona de 24 horas Acute effects of prolonged physical exercise: evaluation after a twenty-four-hour ultramarathon

    Directory of Open Access Journals (Sweden)

    Daniela Guinther Passaglia

    2013-01-01

    Full Text Available FUNDAMENTO: As consequências e os riscos do exercício físico contínuo por períodos prolongados não estão esclarecidos. OBJETIVO: Avaliar os efeitos do exercício prolongado em participantes de uma ultramaratona de 24 horas. MÉTODOS: Vinte corredores foram selecionados para avaliação, um dia antes e imediatamente após a prova em que os corredores devem percorrer a maior distância em 24 horas. Foram obtidos dados clínicos, laboratoriais e ecocardiográficos. RESULTADOS: A distância média percorrida foi de 140,3 ± 18,7 km. Os corredores apresentaram redução do peso corpóreo (p BACKGROUND: The consequences and risks of prolonged physical exercise are not well established. OBJECTIVE: To evaluate the effects of prolonged physical exercise on the participants of a 24-hour ultramarathon race. METHODS: Twenty male runners were selected for evaluation a day before and immediately after the race, where the athletes had to cover the most distance in 24 hours. Clinical, laboratory and echocardiographic data were obtained at both evaluations. RESULTS: Mean distance covered was 140.3 ± 18.7 km. Runners showed weight loss (p < 0.001 and decrease in systolic (p < 0.001 and diastolic (p = 0.004 blood pressure. Hematological changes were compatible with the physiological stress. Plasma levels of creatine phosphokinase strikingly increased post-race (163.4 ± 56.8 vs. 2978.4 ± 1921.9 U/L; p < 0.001 and was inversely correlated with distance covered: those who covered the longest distances showed the lowest CPK levels (Pearson r = 0.69, p = 0.02. After the race, 2 runners showed a slight increase in Troponin levels. One of them also had simultaneous decrease in left ventricular ejection fraction (coronary artery disease was subsequently ruled out. Basal echocardiography assessment had shown LV hypertrophy in one and increased left atrial volume in five runners. After the race, there was a decrease in E/A ratio (p < 0.01. CONCLUSION: Prolonged physical exercise is associated with metabolic and cardiovascular alterations. Cardiac abnormalities found in our study suggest that cardiac fatigue may occur in this specific race modality. The long-term effect of these alterations, while maintaining the routine practice of prolonged strenuous physical activity, is still unknown.

  12. Efeitos agudos do exercício físico prolongado: avaliação após ultramaratona de 24 horas Acute effects of prolonged physical exercise: evaluation after a twenty-four-hour ultramarathon

    Directory of Open Access Journals (Sweden)

    Daniela Guinther Passaglia

    2012-01-01

    Full Text Available FUNDAMENTO: As consequências e os riscos do exercício físico contínuo por períodos prolongados não estão esclarecidos. OBJETIVO: Avaliar os efeitos do exercício prolongado em participantes de uma ultramaratona de 24 horas. MÉTODOS: Vinte corredores foram selecionados para avaliação, um dia antes e imediatamente após a prova em que os corredores devem percorrer a maior distância em 24 horas. Foram obtidos dados clínicos, laboratoriais e ecocardiográficos. RESULTADOS: A distância média percorrida foi de 140,3 ± 18,7 km. Os corredores apresentaram redução do peso corpóreo (p BACKGROUND: The consequences and risks of prolonged physical exercise are not well established. OBJECTIVE: To evaluate the effects of prolonged physical exercise on the participants of a 24-hour ultramarathon race. METHODS: Twenty male runners were selected for evaluation a day before and immediately after the race, where the athletes had to cover the most distance in 24 hours. Clinical, laboratory and echocardiographic data were obtained at both evaluations. RESULTS: Mean distance covered was 140.3 ± 18.7 km. Runners showed weight loss (p < 0.001 and decrease in systolic (p < 0.001 and diastolic (p = 0.004 blood pressure. Hematological changes were compatible with the physiological stress. Plasma levels of creatine phosphokinase strikingly increased post-race (163.4 ± 56.8 vs. 2978.4 ± 1921.9 U/L; p < 0.001 and was inversely correlated with distance covered: those who covered the longest distances showed the lowest CPK levels (Pearson r = 0.69, p = 0.02. After the race, 2 runners showed a slight increase in Troponin levels. One of them also had simultaneous decrease in left ventricular ejection fraction (coronary artery disease was subsequently ruled out. Basal echocardiography assessment had shown LV hypertrophy in one and increased left atrial volume in five runners. After the race, there was a decrease in E/A ratio (p < 0.01. CONCLUSION: Prolonged physical exercise is associated with metabolic and cardiovascular alterations. Cardiac abnormalities found in our study suggest that cardiac fatigue may occur in this specific race modality. The long-term effect of these alterations, while maintaining the routine practice of prolonged strenuous physical activity, is still unknown.

  13. Monitorização eletrocardiográfica ambulatorial por 24-horas em cães com cardiomiopatia dilatada idiopática Twenty-four-hour ambulatory electrocardiographic monitoring in dogs with idiopathic dilated cardiomyopathy

    Directory of Open Access Journals (Sweden)

    F.L. Yamaki

    2007-12-01

    Full Text Available Caracterizou-se monitorização eletrocardiográfica ambulatorial por 24 horas (ou monitorização Holter em cães com cardiomiopatia dilatada idiopática, visando principalmente à detecção de arritmias ventriculares não detectadas pela eletrocardiografia convencional (de repouso. Para tanto, avaliaram-se 40 pacientes com diagnóstico de cardiomiopatia dilatada idiopática, por meio de exame físico e mensuração indireta da pressão arterial, além de exames eletrocardiográfico, ecocardiográfico, radiográfico de tórax e da monitorização Holter. Extra-sístoles ventriculares foram detectadas, por monitorização Holter, em 97,5% dos animais e taquicardia ventricular, em 45%. Não houve correlação entre o número de extra-sístoles ventriculares e a fração de encurtamento. Considerando as manifestações clínicas, apenas houve associação entre presença de taquicardia ventricular e histórico de síncopes. Conclui-se que a incidência de arritmias ventriculares em cães com cardiomiopatia dilatada idiopática é bastante alta, sendo a taquicardia ventricular relativamente freqüente, ocorrendo mais sob a forma não sustentada.This study aimed to characterize 24-hour ambulatory electrocardiographic monitoring (Holter monitoring in dogs with idiopathic dilated cardiomyopathy. Physical examination and indirect (Doppler blood pressure measurement, and also electrocardiography, thoracic radiography, echocardiography, and 24-hour ambulatory electrocardiographic exams were performed in 40 dogs with idiopathic dilated cardiomyopathy. Ventricular extrasystoles were detected in 97.5% of the animals, and ventricular tachycardia in 45%. No correlation between the number of ventricular extrasystoles and the shortening fraction was observed. Concerning the clinical symptoms, there was only association between the presence of ventricular tachycardia and past report of syncope. It was concluded that the incidence of ventricular arrhythmias is high in dogs with dilated cardiomyopathy, being ventricular tachycardia, mostly non-sustained, relatively frequent.

  14. Familial aggregation of gout and relative genetic and environmental contributions: a nationwide population study in Taiwan

    OpenAIRE

    Kuo, Chang-Fu; Grainge, Matthew J.; See, Lai-Chu; Yu, Kuang-Hui; Luo, Shue-Fen; Valdes, Ana M.; Zhang, Weiya; Doherty, Michael

    2015-01-01

    OBJECTIVE: To examine familial aggregation of gout and to estimate the heritability and environmental contributions to gout susceptibility in the general population. \\ud \\ud METHODS: Using data from the National Health Insurance (NHI) Research Database in Taiwan, we conducted a nationwide cross-sectional study of data collected from 22 643 748 beneficiaries of the NHI in 2004; among them 1 045 059 individuals had physician-diagnosed gout. We estimated relative risks (RR) of gout in individual...

  15. GWAS of clinically defined gout and subtypes identifies multiple susceptibility loci that include urate transporter genes

    OpenAIRE

    Nakayama, Akiyoshi; Nakaoka, Hirofumi; Yamamoto, Ken; Sakiyama, Masayuki; Shaukat, Amara; Toyoda, Yu; Okada, Yukinori; Kamatani, Yoichiro; Nakamura, Takahiro; Takada, Tappei; Inoue, Katsuhisa; Yasujima, Tomoya; Yuasa, Hiroaki; Shirahama, Yuko; Nakashima, Hiroshi

    2016-01-01

    Objective A genome-wide association study (GWAS) of gout and its subtypes was performed to identify novel gout loci, including those that are subtype-specific. Methods Putative causal association signals from a GWAS of 945 clinically defined gout cases and 1213 controls from Japanese males were replicated with 1396 cases and 1268 controls using a custom chip of 1961 single nucleotide polymorphisms (SNPs). We also first conducted GWASs of gout subtypes. Replication with Caucasian and New Zeala...

  16. Interphalangeal joint involvement of the big toe in gout: a rare presentation.

    Science.gov (United States)

    Dobson, Michael; Alwahab, Yasir; Fazal, Muhammad A

    2012-01-01

    Atypical presentation of gout can cause diagnostic dilemmas. We report a case of gout that presented with an expansile lytic lesion involving the interphalangeal joint of the hallux, lack of a history of gout, and an associated solitary lung nodule. Magnetic resonance imaging showed an expansile destructive bony lesion with soft-tissue involvement suggestive of a possible bony metastasis. A needle biopsy was performed, and histopathologic features were diagnostic of chronic tophaceous gout.

  17. Improvement in Diagnosis and Treat-to-Target Management of Hyperuricemia in Gout: Results from the GEMA-2 Transversal Study on Practice.

    Science.gov (United States)

    Perez Ruiz, Fernando; Sanchez-Piedra, Carlos A; Sanchez-Costa, Jesus T; Andrés, Mariano; Diaz-Torne, Cesar; Jimenez-Palop, Mercedes; De Miguel, Eugenio; Moragues, Carmen; Sivera, Francisca

    2018-06-01

    The objective of the study was to evaluate changes regarding main European League Against Rheumatism (EULAR) recommendations on diagnosis and treatment of gout compared to a previous assessment. The GEMA-2 (Gout Evaluation and MAnagement) is a transversal assessment of practice for gout by rheumatologists. Main outcome variables were improvement of the previous GEMA assessment regarding the rate of crystal-proven diagnosis and that reaching therapeutic serum urate target below 6 mg/dl at last visit. Other management variables (prophylaxis, treatment of flares, lifestyle change advice) were also evaluated along with general characteristics. The sample was powered to include at least 483 patients for up to 50% change. Data on management of 506 patients were retrieved from 38 out of 41 rheumatology units that participated in the previous GEMA audit. Crystal-proved diagnosis rate increased from 26% to 32% (31% improvement) and was higher in gout-dedicated practices; ultrasonography contributed to diagnosis in less than 1% of cases. Therapeutic serum urate at last visit improved from 41% to 64% of all patients (66% of patients on urate-lowering medications), in any case over 50% improvement from the previous assessment. The use of any urate-lowering medication available was not prescribed as per label dosing in patients who failed to achieve target serum urate. Clinical inertia to increase doses of either allopurinol or febuxostat was still present in clinical practice. Over 50% improvement in targeting therapeutic serum urate has been observed, but clinical inertia is still present. Diagnosis is still mostly clinically based, ultrasonography not being commonly contributive. Menarini España.

  18. GWAS of clinically defined gout and subtypes identifies multiple susceptibility loci that include urate transporter genes

    NARCIS (Netherlands)

    Nakayama, A.; Nakaoka, H.; Yamamoto, K.; Sakiyama, M.; Shaukat, A.; Toyoda, Y.; Okada, Y.; Kamatani, Y.; Nakamura, T.; Takada, T.; Inoue, K.; Yasujima, T.; Yuasa, H.; Shirahama, Y.; Nakashima, H.; Shimizu, S.; Higashino, T.; Kawamura, Y.; Ogata, H.; Kawaguchi, M.; Ohkawa, Y.; Danjoh, I.; Tokumasu, A.; Ooyama, K.; Ito, T.; Kondo, T.; Wakai, K.; Stiburkova, B.; Pavelka, K.; Stamp, L.K.; Dalbeth, N.; Sakurai, Y.; Suzuki, H; Hosoyamada, M.; Fujimori, S.; Yokoo, T.; Hosoya, T.; Inoue, I.; Takahashi, A.; Kubo, M.; Ooyama, H.; Shimizu, T.; Ichida, K.; Shinomiya, N.; Merriman, T.R.; Matsuo, H.; Andres, M; Joosten, L.A.; Janssen, M.C.H.; Jansen, T.L.; Liote, F.; Radstake, T.R.; Riches, P.L.; So, A.; Tauches, A.K.

    2017-01-01

    OBJECTIVE: A genome-wide association study (GWAS) of gout and its subtypes was performed to identify novel gout loci, including those that are subtype-specific. METHODS: Putative causal association signals from a GWAS of 945 clinically defined gout cases and 1213 controls from Japanese males were

  19. Topacheous gout as a rare cause of spinal stenosis in the lumbar region. Case report.

    LENUS (Irish Health Repository)

    Kelly, Joseph

    2012-02-03

    Despite the fact that gout is a common metabolic disorder, because its involvement of the axial skeleton is rare the diagnosis is often delayed, even in patients with long-standing gout who present with neurological deficits. The authors report the case of a woman with a history of extensive gout, emphasizing the clinical, radiological, and pathological features of a lumbar spinal stenosis.

  20. Exploring current and potential roles of Australian community pharmacists in gout management: a qualitative study.

    Science.gov (United States)

    Counsell, Allyce B; Nguyen, Amy D; Baysari, Melissa T; Kannangara, Diluk R W; McLachlan, Andrew J; Day, Richard O

    2018-05-09

    Gout is an increasingly prevalent form of inflammatory arthritis. Although effective treatments for gout exist, current management is suboptimal due to low medication adherence rates and treatments that are non-concordant with guidelines. Medications are the mainstay and most effective form of gout management. Thus, there is potential for community pharmacists to play an important primary health care role in gout management, however their current role and their potential to improve management of gout treatment is currently unclear. The purpose of the study is to explore the views of Australian pharmacists on their roles in gout management and to identify factors influencing their involvement in gout management. A convenience sample of community pharmacists were invited to participate using a snowballing recruitment strategy. Semi-structured, face-to-face interviews were conducted with 15 pharmacists of varying age, gender and pharmacy experience. Interviews focused on pharmacists' experiences of managing gout, interactions with people living with gout and their perceived roles and responsibilities in gout management. Interviews were transcribed verbatim and independently analysed by two reviewers to identify themes. The main role of pharmacists reported in gout management was providing patient education. The greatest facilitator to pharmacists involvement in gout management was identified to be pharmacists' good understanding of gout and its management. Barriers to pharmacists involvement were identified to be difficulties in monitoring adherence to gout medications, low priority given to gout in the pharmacy compared to other chronic health conditions, and lack of specific training and/or continuing education in gout prevention and management. Pharmacists can expand their primary health care role in gout management, particularly in the area of ongoing provision of education to people living with gout and in monitoring medication adherence in patients. However, a

  1. Dynamics of flare sprays

    International Nuclear Information System (INIS)

    Tandberg-Hanssen, E.; Hansen, R.T.

    1980-01-01

    During solar cycle No. 20 new insight into the flare-spray phenomenon has been attained due to several innovations in solar optical-observing techniques (higher spatial resolution cinema-photography, tunable pass-band filters, multi-slit spectroscopy and extended angular field coronographs). From combined analysis of 13 well-observed sprays which occured between 1969-1974 we conclude that (i) the spray material originates from a preexisting active region filament which undergoes increased absorption some tens of minutes prior to the abrupt chromospheric brightening at the 'flare-start', and (ii) the spray material is confined within a steadily expanding, loop-shaped (presumably magnetically controlled) envelope with part of the material draining back down along one or both legs of the loop. (orig.)

  2. Chromosphere flare models

    International Nuclear Information System (INIS)

    Avrett, E.H.; Kurucz, R.L.; Machado, M.E.; NASA, Marshall Space Flight Center, Huntsville, AL)

    1985-01-01

    Further calculated results based on the F1 and F2 chromospheric models of Machado et al. (1980) are presented in addition to results from a model with enhanced temperatures relative to the weak-flare model F1 in the upper photosphere and low chromosphere, and from a model with enhanced temperatures relative to the strong flare model F2 in the upper chromosphere. The coupled equations of statistical equilibrium and radiative transfer for H, H(-), He I-II, C I-IV, Si I-II, Mg I-II, Fe, Al, O I-II, Na, and Ca II are solved, and the overall absorption and emission of radiation by lines throughout the spectrum are determined by means of a reduced set of opacities taken from a compilation of over 10 million lines. Semiempirical models show that the white light flare continuum may arise by extreme chromospheric overheating, as well as by an enhancement of the minimum temperature region. 34 references

  3. CLINICAL CHARACTERISTICS OF GOUT: A HOSPITAL CASE SERIES

    Directory of Open Access Journals (Sweden)

    GUN SC

    2011-01-01

    Full Text Available Introduction: Gout is an increasingly common medical problem. The traditional risk factors of male sex and high red meat or alcohol consumption have been joined with newer risks such as increased life expectancy, and the metabolic syndrome (hypertension, diabetes, dyslipidaemia, truncal obesity. Methods: This was a retrospective study to determine the epidemiology, clinical features, associated conditions as well as renal related conditions in existing gout patients followed-up in Rheumatology outpatient clinic, Hospital Tuanku Ja’afar, Seremban. Results: Over a three month period, we identified 54 gouty patients on our follow-up, the majority being male, Malay ethnicity, withthe age of onset in the third and fourth decades of life. Commonly associated risk factors were hypertension, hyperlipidaemia and obesity. However, underlying history of diabetes mellitus, alcohol consumption, and family history were not commonly associated with gout in our group of patients. Half of our patients had at least two or more joints involvement. About half of the patients with tophaceous gout had renal impairment. Conclusion: Our series of gout patients highlight the high prevalence of cardiovascular risk factors. The high prevalence of tophi and renal impairment is a cause for concern.

  4. Gout on CT of the feet: A symmetric arthropathy

    International Nuclear Information System (INIS)

    Doyle, Anthony J.; Boyer, Lucinda; Dong, Jing; Dalbeth, Nicola; McQueen, Fiona; Rome, Keith; Frecklington, Mike

    2016-01-01

    The aim of this study was to assess the distribution of bone erosions in the feet of patients with gout using CT and thereby to test the hypothesis that gout is an asymmetric arthropathy. CT scans of both feet were obtained from 25 patients with chronic gout. CT scans were scored for bone erosion using a semi-quantitative method based on the rheumatoid arthritis MRI scoring system (RAMRIS). CT bone erosion was assessed at 22 bones in each foot (total 1,100 bones) by two independent radiologists. Symmetry was assessed by two methods: (i) comparing right and left foot scores for each patient; and (ii) calculating the proportion of paired joints with or without erosions. Observer agreement was excellent (intra-class correlation coefficient 0.92). In the group overall, the difference in scores between the feet was not significant (Student's t-test P = 0.8). In 17 of 25 patients, the difference in erosion scores between the two feet was less than the inter-observer difference. In 24 of 25 patients, the proportion of paired joints was greater than 0.5, indicating symmetric disease. Erosive disease from gout is, in fact, a symmetric process in our patient group. This finding is contrary to the established view of gout as an asymmetric arthritis and lends new insight into the behaviour of this common disease.

  5. Gout - a guide for the general and acute physicians.

    Science.gov (United States)

    Abhishek, Abhishek; Roddy, Edward; Doherty, Michael

    2017-02-01

    Gout is the most prevalent inflammatory arthritis and affects 2.5% of the general population in the UK. It is also the only arthritis that has the potential to be cured with safe, inexpensive and well tolerated urate-lowering treatments, which reduce serum uric acid by either inhibiting xanthine oxidase - eg allopurinol, febuxostat - or by increasing the renal excretion of uric acid. Of these, xanthine oxidase inhibitors are used first line and are effective in 'curing' gout in the vast majority of patients. Gout can be diagnosed on clinical grounds in those with typical podagra. However, in those with involvement of other joints, joint aspiration is recommended to demonstrate monosodium urate crystals and exclude other causes of acute arthritis, such as septic arthritis. However, a clinical diagnosis of gout can be made if joint aspiration is not feasible. This review summarises the current understanding of the pathophysiology, clinical presentation, investigations and treatment of gout. © Royal College of Physicians 2017. All rights reserved.

  6. Xanthine oxidoreductase and its inhibitors: relevance for gout.

    Science.gov (United States)

    Day, Richard O; Kamel, Bishoy; Kannangara, Diluk R W; Williams, Kenneth M; Graham, Garry G

    2016-12-01

    Xanthine oxidoreductase (XOR) is the rate-limiting enzyme in purine catabolism and converts hypoxanthine to xanthine, and xanthine into uric acid. When concentrations of uric acid exceed its biochemical saturation point, crystals of uric acid, in the form of monosodium urate, emerge and can predispose an individual to gout, the commonest form of inflammatory arthritis in men aged over 40 years. XOR inhibitors are primarily used in the treatment of gout, reducing the formation of uric acid and thereby, preventing the formation of monosodium urate crystals. Allopurinol is established as first-line therapy for gout; a newer alternative, febuxostat, is used in patients unable to tolerate allopurinol. This review provides an overview of gout, a detailed analysis of the structure and function of XOR, discussion on the pharmacokinetics and pharmacodynamics of XOR inhibitors-allopurinol and febuxostat, and the relevance of XOR in common comorbidities of gout. © 2016 The Author(s). published by Portland Press Limited on behalf of the Biochemical Society.

  7. Interleukin-1beta gene polymorphisms in Taiwanese patients with gout.

    Science.gov (United States)

    Chen, Man-Ling; Huang, Chung-Ming; Tsai, Chang-Hai; Tsai, Fuu-Jen

    2005-04-01

    The purpose of this study was to examine whether interleukin-1 beta (IL-1beta) promoter and exon 5 gene polymorphisms are markers of susceptibility or clinical manifestations in Taiwanese patients with gout. The study included 196 patients in addition to 103 unrelated healthy control subjects living in central Taiwan. From genomic DNA, polymorphisms of the gene for IL-1beta promoter and IL-1beta exon 5 were typed. Allelic frequencies were compared between the two groups, and the relationship between allelic frequencies and clinical manifestations of gout was evaluated. No significant differences were observed in the allelic frequencies of the IL-1beta promoter between patients with gout and healthy control subjects. Additionally, we did not detect any association of the IL-1beta promoter genotype with the clinical and laboratory profiles of gout patients. However, there was a significant difference between the two groups in terms of hypertriglyceridemia (P=0.0004, chi(2)=12.52, OR 7.14, 95%CI 0.012-0.22). There was also a significant difference in the genotype of IL-1beta exon 5 polymorphism between patients with and without hypertriglyceridemia. Results of the present study suggest that polymorphisms of the IL-1beta promoter and IL-1beta exon 5 are not related to gout patients in central Taiwan.

  8. Flares on a Bp Star

    Science.gov (United States)

    Mullan, D. J.

    2009-09-01

    Two large X-ray flares have been reported from the direction of a magnetic B2p star (σ Ori E). Sanz-Forcada et al. have suggested that the flares did not occur on the B2p star but on a companion of late spectral type. A star which is a candidate for a late-type flare star near σ Ori E has recently been identified by Bouy et al. However, based on the properties of the flares, and based on a recent model of rotating magnetospheres, we argue that, rather than attributing the two flares to a late-type dwarf, it is a viable hypothesis that the flares were magnetic phenomena associated with the rotating magnetosphere of the B2p star itself.

  9. FLARES ON A Bp STAR

    International Nuclear Information System (INIS)

    Mullan, D. J.

    2009-01-01

    Two large X-ray flares have been reported from the direction of a magnetic B2p star (σ Ori E). Sanz-Forcada et al. have suggested that the flares did not occur on the B2p star but on a companion of late spectral type. A star which is a candidate for a late-type flare star near σ Ori E has recently been identified by Bouy et al. However, based on the properties of the flares, and based on a recent model of rotating magnetospheres, we argue that, rather than attributing the two flares to a late-type dwarf, it is a viable hypothesis that the flares were magnetic phenomena associated with the rotating magnetosphere of the B2p star itself.

  10. New gout test: enhanced ex vivo cytokine production from PBMCS in common gout patients and a gout patient with Kearns-Sayre syndrome

    NARCIS (Netherlands)

    Jansen, T.L.; Berendsen, D.; Crisan, T.O.; Cleophas, M.C.; Janssen, M.C.; Joosten, L.A.

    2014-01-01

    Monosodium urate (MSU) monohydrate crystals synergize with various toll-like receptor (TLR) ligands to induce interleukin-(IL)-1beta production. Data are shown from a young male with mitochondriopathy in Kearns-Sayre syndrome (KSS) who developed gout and underwent urate-lowering therapy (ULT) versus

  11. Association Between Gout and Incident Type 2 Diabetes Mellitus: A Retrospective Cohort Study.

    Science.gov (United States)

    Tung, Yi-Ching; Lee, Su-Shin; Tsai, Wen-Chan; Lin, Gau-Tyan; Chang, Hsin-Wen; Tu, Hung-Pin

    2016-11-01

    We investigated the association between gout and the risk of type 2 diabetes mellitus. Population-based representative insurance (outpatient and inpatient) claims data of 29,765 patients with gout and 59,530 controls without gout (1:2 case:control ratio) between 1998 and 2010 in Taiwan were identified. The association between gout and type 2 diabetes was evaluated using the Cox proportional hazards model. Moreover, the combined effects of sex and incident gout on the risk of type 2 diabetes were estimated. In total, 3940 patients (13.24%) with gout and 6334 controls (10.64%) developed type 2 diabetes in the follow-up period. Multivariate analyses revealed a significant association between gout and type 2 diabetes. Compared with the control group, the adjusted hazard ratios (95% confidence intervals) for type 2 diabetes were 1.62 (1.54-1.70) in men, 1.97 (1.81-2.14) in women, and 1.70 (1.62-1.77) overall. The multiplicative interaction was β = 0.18 and P = .0001, suggesting a positive interaction between sex and incident gout. Moreover, compared with men without gout, a significantly higher risk of type 2 diabetes was noted in women without gout (adjusted relative risk [95% confidence interval], 1.17 [1.10-1.24]), men with gout (1.11 [1.06-1.16]), and women with gout (1.47 [1.37-1.57]) (P for interaction = .0058). Gout is a strong and independent risk factor for type 2 diabetes, and female patients with gout are at a higher risk of type 2 diabetes than are male patients with gout. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. The evolution of flaring and non-flaring active regions

    Science.gov (United States)

    Kilcik, A.; Yurchyshyn, V.; Sahin, S.; Sarp, V.; Obridko, V.; Ozguc, A.; Rozelot, J. P.

    2018-06-01

    According to the modified Zurich classification, sunspot groups are classified into seven different classes (A, B, C, D, E, F and H) based on their morphology and evolution. In this classification, classes A and B, which are small groups, describe the beginning of sunspot evolution, while classes D, E and F describe the large and evolved groups. Class C describes the middle phase of sunspot evolution and the class H describes the end of sunspot evolution. Here, we compare the lifetime and temporal evolution of flaring and non-flaring active regions (ARs), and the flaring effect on ARs in these groups in detail for the last two solar cycles (1996 through 2016). Our main findings are as follows: (i) Flaring sunspot groups have longer lifetimes than non-flaring ones. (ii) Most of the class A, B and C flaring ARs rapidly evolve to higher classes, while this is not applicable for non-flaring ARs. More than 50 per cent of the flaring A, B and C groups changed morphologically, while the remaining D, E, F and H groups did not change remarkably after the flare activity. (iii) 75 per cent of all flaring sunspot groups are large and complex. (iv) There is a significant increase in the sunspot group area in classes A, B, C, D and H after flaring activity. In contrast, the sunspot group area of classes E and F decreased. The sunspot counts of classes D, E and F decreased as well, while classes A, B, C and H showed an increase.

  13. Gout: a review of non-modifiable and modifiable risk factors

    Science.gov (United States)

    MacFarlane, Lindsey A.; Kim, Seoyoung C.

    2014-01-01

    Gout is a common inflammatory arthritis triggered by the crystallization of uric acid within the joints. Gout affects millions worldwide and has an increasing prevalence. Recent research has been carried out to better qualify and quantify the risk factors predisposing individuals to gout. These can largely be broken into non-modifiable risk factors such as sex, age, race, and genetics, and modifiable risk factors such as diet and lifestyle. Increasing knowledge of factors predisposing certain individuals to gout could potentially lead to improved preventive practices. This review summarizes the non-modifiable and modifiable risk factors associated with development of gout. PMID:25437279

  14. Acute Gout Following Dermofasciectomy in a Patient With Dupuytren Disease.

    Science.gov (United States)

    Cochrane, Elliott; Harper, Rosalyn

    2017-01-01

    A 62-year-old man underwent uncomplicated dermofasciectomy of the right little finger. In the week after surgery, he presented with erythema, tenderness, reduced range of movement, and a chalklike discharge from the suture line. Investigations revealed a raised serum urate level accompanied with a borderline rise in inflammatory markers. A diagnosis of acute gout was made. The patient was managed with nonsteroidal anti-inflammatory drugs. Clinicians should consider the diagnosis of gout when patients present after surgery with redness, pain, and swelling and also consider measuring urate levels before surgery and initiating colchicine prophylaxis when there is a known diagnosis of gout before surgery. Accurate diagnosis may prevent unnecessary antibiotic use. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  15. Actovegin administration in patients with ulcerated gout tophuses

    Directory of Open Access Journals (Sweden)

    M S Eliseev

    2005-01-01

    Full Text Available Objective. To study actovegin efficacy in the treatment of chronic skin ulcers due to ulceration of tophuses in pts with chronic tophaceous gout. Materials and methods. 6 pts with chronic tophaceous gout aged 52 to 77 years with disease duration from 6 to 20 years with longstanding persisting skin ulcers due to tophuses ulceration were included. In addition to allopuri- nol, steroid and nonsteroidal anti-inflammatory drugs they were treated with actovegin 20% intravenously and local applications of 2% actovegin gel. Clinical examination was performed before and after the course of therapy- Results. Two from six pts showed healing of single chronic ulcers to the end of the treatment course. In the remaining pts ulcer count and size decrease was achieved. Conclusion. Actovegin administration in combined therapy of chronic skin ulcers in pts with chronic tophaceous gout promoted healing of the defects in all cases.

  16. Weight loss for overweight and obese individuals with gout

    DEFF Research Database (Denmark)

    Nielsen, Sabrina M; Bartels, Else Marie; Henriksen, Marius

    2017-01-01

    OBJECTIVES: Weight loss is commonly recommended for gout, but the magnitude of the effect has not been evaluated in a systematic review. The aim of this systematic review was to determine benefits and harms associated with weight loss in overweight and obese patients with gout. METHODS: We searched...... six databases for longitudinal studies, reporting the effect of weight loss in overweight/obese gout patients. Risk of bias was assessed using the tool Risk of Bias in Non-Randomised Studies of Interventions. The quality of evidence was assessed using the Grading of Recommendations Assessment......, Development and Evaluation. RESULTS: From 3991 potentially eligible studies, 10 were included (including one randomised trial). Interventions included diet with/without physical activity, bariatric surgery, diuretics, metformin or no intervention. Mean weight losses ranged from 3 kg to 34 kg. Clinical...

  17. Key barriers to gout care: a systematic review and thematic synthesis of qualitative studies.

    Science.gov (United States)

    Rai, Sharan K; Choi, Hyon K; Choi, Sally H J; Townsend, Anne F; Shojania, Kam; De Vera, Mary A

    2018-04-17

    Gout care remains highly suboptimal, contributing to an increased global disease burden. To understand barriers to gout care, our aim was to provide a systematic review and thematic synthesis of qualitative studies worldwide reporting provider and patient perspectives and experiences with management. We conducted a mapped search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Social Sciences Citation Index databases and selected qualitative studies of provider and patient perspectives on gout management. We used thematic synthesis to combine the included studies and identify key themes across studies. We included 20 studies that reported the experiences and perspectives of 480 gout patients and 120 providers spanning five different countries across three continents. We identified three predominant provider themes: knowledge gaps and management approaches; perceptions and beliefs about gout patients; and system barriers to optimal gout care (e.g. time constraints and a lack of incentives). We also identified four predominant themes among gout patients: limited gout knowledge; interactions with health-care providers; attitudes towards and experiences with taking medication; and practical barriers to long-term medication use. Our systematic review of worldwide literature consistently identified gaps in gout knowledge among providers, which is likely to contribute to patients' lack of appropriate education about the fundamental causes of and essential treatment approaches for gout. Furthermore, system barriers among providers and day-to-day challenges of taking long-term medications among patients are considerable. These factors provide key targets to improve the widespread suboptimal gout care.

  18. Clinical features of gout in a cohort of Italian patients

    Directory of Open Access Journals (Sweden)

    M.A. Cimmino

    2011-06-01

    Full Text Available Objective: To assess the clinical characteristics of gout and its diagnostic approach in a group of Italian patients. Methods: In a retrospective analysis, we evaluated 72 consecutive gouty patients examined in the years 2000-2007.We recorded demographic data, family history, comorbidities and disease characteristics (seasonality of the attacks, joints affected, serum uric acid concentration, and treatment. Result: 63/72 (87.5% patients were men and 9 women, with mean age 61.9±13.7 years. 8/72 (11.1% patients reported a familial history of gout. The first attack occurred mainly in the months of June, July and December. The first metatarsophalangeal joint was affected in 59.7% of patients and the hand in 25%. Treatment changed over the follow- up period, with a decreased use of NSAIDs (p<0.0001 and an increased use of colchicine (p=0.015 and allopurinol (p<0.0001. In 9 (12.5% patients, joint aspiration was performed and monosodium urate crystals were found in synovial fluid or tophi. 42/72 (58.3% patients fulfilled a minimum of 6 clinical criteria of the American College of Rheumatology, necessary for gout diagnosis. 47/72 (65.3% patients, met the EULAR recommendations and had an 82% probability of being affected by gout. Conclusions: The diagnosis of gout is not always easy because of its changing clinical spectrum. Identification of MSU crystals in joint aspirates was obtained only in a minority of patients. In this setting the diagnosis with gout was often based on the observation of an acute intermittent monoarthritis involving mainly the first metatarsophlangeal joint, associated with hyperuricaemia and responsive to colchicine.

  19. Adherence to gout management recommendations of Chinese patients.

    Science.gov (United States)

    Sheng, Feng; Fang, Weigang; Zhang, Bingqing; Sha, Yue; Zeng, Xuejun

    2017-11-01

    Though efficacious and affordable treatments for gout are widely available, gout is still not well controlled in many countries of the world including China.To investigate patient adherence to gout management recommendations and potential barriers in Chinese male gout patients, a survey was carried out by telephone interview in male patients registered in the gout clinic at Peking Union Medical College Hospital. Adherence to dietary and medication recommendations was measured by a food frequency questionnaire and proportion of cumulative time adherent to chemical urate-lowering therapy (ULT), respectively. Dietary adherence was defined as consumption of alcohol, seafood and animal organs less than once per month, and reduced red meat after dietary counseling. Medication adherence was defined as ULT ≥80% of time in the past 12 months for patients with indications. Logistic regression models were used to identify patient characteristics associated with management adherence. Reasons for nonadherence were also sought by open-end questions.Dietary and medication adherence were 44.2% and 21.9%, respectively. Older age (odds ratio [OR] 7.90, 95% confidence interval [CI] 2.49-25.04 for age ≥60), higher serum uric acid (sUA) levels (OR 3.53, 95% CI 1.42-8.75 for the highest quartile), and tophi (OR 2.31, 95% CI 1.12-4.77) were associated with dietary adherence independently, while tophi (OR 14.05, 95% CI 2.67-74.08) and chronic kidney disease (OR 16.66, 95% CI 2.63-105.37) were associated with medication adherence independently. Reasons that patients reported for nonadherence to medication included remission after treatment (35.3%), concerns for potential side effects (22.7%), insufficient patient education (8.7%), and adverse events (8.2%).Patient adherence to gout management recommendations is poor in China. Older age, increased disease burden, and specific comorbidities were associated with management adherence.

  20. Gout in immigrant groups: a cohort study in Sweden.

    Science.gov (United States)

    Wändell, Per; Carlsson, Axel C; Li, Xinjun; Gasevic, Danijela; Ärnlöv, Johan; Holzmann, Martin J; Sundquist, Jan; Sundquist, Kristina

    2017-05-01

    Our aim was to study the association between country of birth and incidence of gout in different immigrant groups in Sweden. The study population included the whole population of Sweden. Gout was defined as having at least one registered diagnosis in the National Patient Register. The association between incidence of gout and country of birth was assessed by Cox regression, with hazard ratios (HRs) and 95% confidence intervals (95% CI), using Swedish-born individuals as referents. All models were conducted in both men and women, and the full model was adjusted for age, place of residence in Sweden, educational level, marital status, neighbourhood socio-economic status and co-morbidities. The risk of gout varied by country of origin, with highest estimates, compared to Swedish born, in fully adjusted models among men from Iraq (HR 1.82, 95% CI 1.54-2.16), and Russia (HR 1.69, 95% CI 1.26-2.27), and also high among men from Austria, Poland, Africa and Asian countries outside the Middle East; and among women from Africa (HR 2.23, 95% CI 1.50-3.31), Hungary (HR 1.98, 95% CI 1.45-2.71), Iraq (HR 1.76, 95% CI 1.13-2.74) and Austria (HR 1.70, 95% CI 1.07-2.70), and also high among women from Poland. The risk of gout was lower among men from Greece, Spain, Nordic countries (except Finland) and Latin America and among women from Southern Europe, compared to their Swedish counterparts. The increased risk of gout among several immigrant groups is likely explained by a high cardio-metabolic risk factor pattern needing attention.

  1. Gout in Older Adults: The Atherosclerosis Risk in Communities Study.

    Science.gov (United States)

    Burke, Bridget Teevan; Köttgen, Anna; Law, Andrew; Grams, Morgan; Baer, Alan N; Coresh, Josef; McAdams-DeMarco, Mara A

    2016-04-01

    It is unclear whether traditional and genetic risk factors in middle age predict the onset of gout in older age. We studied the incidence of gout in older adults using the Atherosclerosis Risk in Communities study, a prospective U.S. population-based cohort of middle-aged adults enrolled between 1987 and 1989 with ongoing follow-up. A genetic urate score was formed from common urate-associated single nucleotide polymorphisms for eight genes. The adjusted hazard ratio and 95% confidence interval of incident gout by traditional and genetic risk factors in middle age were estimated using a Cox proportional hazards model. The cumulative incidence from middle age to age 65 was 8.6% in men and 2.5% in women; by age 75 the cumulative incidence was 11.8% and 5.0%. In middle age, increased adiposity, beer intake, protein intake, smoking status, hypertension, diuretic use, and kidney function (but not sex) were associated with an increased gout risk in older age. In addition, a 100 µmol/L increase in genetic urate score was associated with a 3.29-fold (95% confidence interval: 1.63-6.63) increased gout risk in older age. These findings suggest that traditional and genetic risk factors in middle age may be useful for identifying those at risk of gout in older age. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. Bilateral olecranon bursitis – A rare clinical presentation of gout

    Directory of Open Access Journals (Sweden)

    Betul Sargın

    2018-04-01

    Full Text Available Background: Gout is the most common form of crystal arthropathy. Monoarthritis affecting the first metatarsophalangeal joint is the common initial presentation. Bilateral olecranon bursitis is a rare presentation of gout. Aim of the work: To describe the clinical features of bilateral olecranon bursitis as an initial presentation of gout. Case report: A 62-year old male patient presented to the rheumatology clinic , Adnan Menderes University with sudden bilateral elbow pain and swelling for three months . Swellings gradually increased to the size of a golf ball with minimal restriction in the elbow extension (170°. He didn’t have arthritis in the elbows. The patient had medical history of heart failure and chronic obstructive pulmonary disease and medications received included acetylsalicylic acid and diuretics. Blood tests revealed elevated serum uric acid (12.6 mg/dL, with normal renal function tests, erythrocyte sedimentation rate (ESR 43 mm/h and C-reactive protein (CRP 8.8 mg/L. Rheumatoid factor and hepatitis markers were negative. Diagnostic bursal aspiration excluded septic bursitis and under polarized microscopy monosodium urate (MSU crystals were identified with typical negative birefringence. A diagnosis of gout was established. ESR and CRP were normalized after diclofenac potassium (100 mg and colchicine (1.5 mg. Allopurinol 300 mg was added when his joint pain was relieved. Conclusion: This is the first gout case initially presenting with bilateral olecranon bursitis. Bursal fluid analysis is important in such atypical presentation to look for MSU crystals and establish a diagnosis. Keywords: Olecranon bursitis, Gout, Crystal arthropathy, Monosodium urate

  3. Modern Therapy for Gout through the Prism of Efficacy and Safety

    Directory of Open Access Journals (Sweden)

    I.Yu. Golovach

    2015-04-01

    Full Text Available The modern data on the treatment of such common condition as gout were presented in this article. Gout management covers and unites two directions: firstly, adequate treatment of acute gout episodes and, secondly, a steady decline in serum urate level below 360 µmol/l (6 mg/dl or lower in some cases to prevent recurrences and to promote resorption of tophi. The therapeutic possibilities in acute gout episode include nonsteroidal anti-inflammatory drugs, colchicine and glucocorticoids; in the treatment of chronic gout, allopurinol is widely used. The efficacy and safety of innovative drugs in the treatment of gout — febuxostat and interleukin-1 inhibitors were shown. It is underlined that the main problems of gout treatment are related to long-term safety and comorbidities.

  4. Cost-effectiveness analysis of allopurinol versus febuxostat in chronic gout patients: a U.S. payer perspective.

    Science.gov (United States)

    Gandhi, Pranav K; Gentry, William M; Ma, Qinli; Bottorff, Michael B

    2015-02-01

    Gout is a chronic inflammatory condition associated with poor urate metabolism. Xanthine oxidase inhibitors such as allopurinol and febuxostat are recommended to reduce uric acid levels and to prevent gout attacks in adult patients. Under budget-driven constraints, health care payers are faced with the broader challenge of assessing the economic value of these agents for formulary placement. However, the economic value of allopurinol versus febuxostat has not be assessed in patients with gout over a 5-year time period in the United States. To evaluate the cost-effectiveness of allopurinol versus febuxostat in adult patients with gout over a 5-year time period from a U.S. health care payer's perspective. A Markov model was developed to compare the total direct costs and success of serum uric acid (sUA) level reduction associated with allopurinol and febuxostat. Treatment success was defined as patient achievement of a sUA level less than  6 mg/dL (0.36 mmol/L) at 6 months. Event probabilities were based on published phase III randomized clinical trials and included long-term sequelae from open-label extension studies. A hypothetical cohort of 1,000 adult gout patients with sUA levels of ≥ 8 mg/dL (0.48 mmol/L) who had received either allopurinol 300 mg or febuxostat 80 mg at model entry transitioned among the 4 health states defined by treatment success, treatment failure and switch, treatment dropout, and death. The length of each Markov cycle was 6 months. Costs were gathered from the RED BOOK, Medicare fee schedules, Healthcare Cost and Utilization Project's Nationwide Inpatient Sample, and for a limited number of inputs, expert consultation. Direct costs included treatment drug costs, costs for prophylaxis drugs, diagnostic laboratory tests, and the treatment and management of acute gout flare. Resource utilization was based on clinical evidence and expert consultation. All costs were inflated to 2014 U.S. dollars and were discounted at 3% in the base case

  5. Solar Flares and Their Prediction

    Science.gov (United States)

    Adams, Mitzi L.

    1999-01-01

    Solar flares and coronal mass ejection's (CMES) can strongly affect the local environment at the Earth. A major challenge for solar physics is to understand the physical mechanisms responsible for the onset of solar flares. Flares, characterized by a sudden release of energy (approx. 10(exp 32) ergs for the largest events) within the solar atmosphere, result in the acceleration of electrons, protons, and heavier ions as well as the production of electromagnetic radiation from hard X-rays to km radio waves (wavelengths approx. = 10(exp -9) cm to 10(exp 6) cm). Observations suggest that solar flares and sunspots are strongly linked. For example, a study of data from 1956-1969, reveals that approx. 93 percent of major flares originate in active regions with spots. Furthermore, the global structure of the sunspot magnetic field can be correlated with flare activity. This talk will review what we know about flare causes and effects and will discuss techniques for quantifying parameters, which may lead to a prediction of solar flares.

  6. How flares can be understood

    International Nuclear Information System (INIS)

    Severny, A.B.

    1977-01-01

    Specific features of the flare phenomenon which are important for understanding of flares are the following: (1) Fine structure of visible emission of flares, especially at the very beginning and in the pre-flare active region. This structure can be seen also in later stages of development as bright points, some of which exist from the flare beginning (Babin's observations at Crimea, 1972-1976). (2) Turbulent motion with velocities up to 250-300 km s -1 as can be estimated from broadening of emission lines. (3) Predominantly red asymmetry of emission lines in the explosive phase and during further development of flares. (4) 'Supersonic' velocities and supergravitational accelerations of separate moving masses of the flare plasma. (5) The appearance of flares in areas with high grad H, exceeding 0.1 G km -1 which is equivalent to regions of electric currents > approximately 10 11 A. (6) Strong variations of net magnetic flux through the active region, as it follows from Meudon, Crimean, and Sacramento Peak (Rust's) observations. (Auth.)

  7. Parameterization of solar flare dose

    International Nuclear Information System (INIS)

    Lamarche, A.H.; Poston, J.W.

    1996-01-01

    A critical aspect of missions to the moon or Mars will be the safety and health of the crew. Radiation in space is a hazard for astronauts, especially high-energy radiation following certain types of solar flares. A solar flare event can be very dangerous if astronauts are not adequately shielded because flares can deliver a very high dose in a short period of time. The goal of this research was to parameterize solar flare dose as a function of time to see if it was possible to predict solar flare occurrence, thus providing a warning time. This would allow astronauts to take corrective action and avoid receiving a dose greater than the recommended limit set by the National Council on Radiation Protection and Measurements (NCRP)

  8. Clinical Characteristics of Gout: A Hospital Case Series

    OpenAIRE

    Mohd, A; Gupta, E das; Loh, YL; Gandhi, C; D’Souza, B; Gun, SC

    2011-01-01

    Introduction: Gout is an increasingly common medical problem. The traditional risk factors of male sex and high red meat or alcohol consumption have been joined with newer risks such as increased life expectancy, and the metabolic syndrome (hypertension, diabetes, dyslipidaemia, truncal obesity).

  9. Some historical remarks on microcrystalline arthritis (gout and chondrocalcinosis

    Directory of Open Access Journals (Sweden)

    G. Pasero

    2012-01-01

    Full Text Available The history of microcrystalline arthritis only began in 1961 when Daniel McCarty and Joseph Lee Hollander demonstrated the presence of sodium monourate crystals in the synovial fluid of gouty patients. However, gout is a historical disease, thanks to the descriptions of Hippocrates, Caelius Aurelianus, Soranus of Ephesus and Araeteus of Cappadocia. The relationship between hyperuricemia and gout was first documented in the nineteenth century by Alfred Baring Garrod, who demonstrated deposits of uric acid crystals on a linen thread held dipped in acidified blood (the so-called “thread method”. Gout has always been considered a prerogative of the moneyed classes (arthritis divitum, and history is full of famous gouty personalities, including kings, emperors, popes, commanders, politicians, artists, writers, philosophers and scientists. Another form of microcrystalline arthritis, chondrocalcinosis, was identified as being a rheumatic disorder different from gout in the 1960s. As a specific clinical entity, it was first identified in 1958 by Dušan Žitnˇan and Štefan Sit’aj in a few Slovak families.

  10. Tophaceous Gout: a tragic course for a preventable disease

    Directory of Open Access Journals (Sweden)

    Filipa Farinha

    2015-07-01

    Full Text Available A 66-year-old man, with a history of chronic tophaceous gout since the age of 30, presented with multiple tophi and significant deformity of all fingers that caused substantial function loss. Due to osteomyelitis refractory to antimicrobial therapy, he underwent disarticulation of several fingers. Finally, both his hands were amputated.

  11. Lesinurad for the treatment of hyperuricaemia in people with gout.

    Science.gov (United States)

    Robinson, Philip C; Dalbeth, Nicola

    2017-12-01

    Gout is a common form of inflammatory arthritis caused by deposition of monosodium urate crystals. The central strategy for effective long-term management of gout is serum urate lowering. Current urate-lowering drugs include both xanthine oxidase inhibitors and uricosuric agents. Lesinurad is a URAT1 inhibitor that selectively inhibits urate rebsorption at the proximal renal tubule. Lesinurad 200mg daily in combination with a xanthine oxidase is approved for urate-lowering therapy in patients with gout. Areas covered: The published literature was searched using Pubmed and additional information was obtained from publically available regulatory documents. Pre-clinical data and clinical trials of lesinurad are described. Serum urate-lowering efficacy and effects on other clinical endpoints are discussed. Adverse event data, focusing on renal safety are also presented. Expert opinion: Lesinurad is an effective urate-lowering drug that has a generally acceptable safety profile when used at 200mg daily dosing in combination with a xanthine oxidase inhibitor. The recent approval of fixed dose combination pills of lesinurad with allopurinol is an important step in improving adherence and reducing risk of renal adverse events. It remains to be seen if this therapy will provide additional benefit for gout management above improved use of widely available generic therapies.

  12. Case report 539: Tophaceous gout of the patella

    International Nuclear Information System (INIS)

    Walot, I.; Staple, T.W.

    1989-01-01

    Anteroposterior, lateral, and skyline radiographs of a man's left knee and patella showed extensive destructive changes in the lateral half of the patella and a partially calcified adjacent soft tissue mass. The articular cartillages were moderately calcified, but the cartilage space was normal. A joint effusion was present. The diagnosis is: Tophaceous gout of the patella. (orig./GDG)

  13. NEW OPPORTUNITIES FOR CORRECTION OF HYPERURICEMIA IN GOUT

    Directory of Open Access Journals (Sweden)

    Svetlana Evgenyevna Myasoedova

    2009-01-01

    Full Text Available An open-labeled study of the efficiency and tolerability of the herbal preparation Urisan used for one month in 21 male gout patients has revealed that the agent has moderate antihyperurecemic activity, no adverse reactions, and excellent or good tolerability in the appraisal by physicians and patients.

  14. The evolution of gout (an old lifestyle disease) | Omole | South ...

    African Journals Online (AJOL)

    Background: Few diseases that confront the 21st century clinician have documented history which dates back to early human era. Methods: We reviewed how the understanding of the aetiogenesis, symptomatology, diagnosis and treatment of gout including myths have evolved and discussed the implications thereof.

  15. Estimation of Serum Uric Acid in Cases of Hyperuriceamia and Gout

    Directory of Open Access Journals (Sweden)

    R K Pokharel

    2011-03-01

    Full Text Available Introduction: Gout is crystal deposit arthritis and is an ancient disease. The biologic precursor to gout is hyperuricaemia. The prevalence of hyperuricaemia and gout has an increasing trend all over the world including the developing countries. The purpose of this study is to estimate serum uric acid level in hyperuricaemic and gout patients attending a medical college hospital. Methods: A consecutive 150 hyperuricaemics and 150 gout patients attending Tribhuwan University Teaching Hospital from June to September 2005 were included in this study. The serum uric acid level was measured by the enzymatic (PAP- Uricase method. The patients with acute gout were interviewed and relevant information was obtained. Results: Males comprised 84 % of gout cases. Hyperuricaemia was common in both sexes. The mean age for gout was 47.49 and 56.65 years in males and females respectively. The mean age for the first gout attack was 42.1 ± 14.0 years. Family history was positive in 22 % of cases. The overall mean serum uric acid level in hyperuricaemics was 7.2 ± 0.7 mg/dL and 8.4 ± 1.1 mg/dL in acute gout (p 0.0001. The mean serum uric acid level was signifi cantly (p 0.0001 high among males both at the asymptomatic phase and at acute gout. Gout was more common in non-vegetarians (95 % and alcoholics (65.3 %. Serum uric acid level was inversely related with the amount of daily water intake (p 0.0001. Conclusions: Serum uric acid level is signifi cantly high among the male gouty arthritic patients. However, it is also high among asymptomatic hyperuricaemic cases of both sexes. Keywords: asymptomatic hyperuricaemia, gout, serum uric acid level.

  16. The Obesity Paradox in Recurrent Attacks of Gout in Observational Studies: Clarification and Remedy

    Science.gov (United States)

    Nguyen, Uyen-Sa D. T.; Zhang, Yuqing; Louie-Gao, Qiong; Niu, Jingbo; Felson, David T.; LaValley, Michael P.; Choi, Hyon K.

    2016-01-01

    Objective Obesity is strongly associated with incident gout risk; its association with risk of recurrent gout attacks has been null or weak, constituting an obesity paradox. We sought to demonstrate and overcome the methodologic issues associated with the obesity paradox for risk of recurrent gout attacks. Methods Using the MRFIT database, we decomposed the total effect of obesity into its direct and indirect (i.e., mediated) effects using marginal structural models. We also estimated the total effect of BMI change from baseline among incident gout patients. Results Of 11,816 gout-free subjects at baseline, we documented 408 incident gout cases, with 132 developing recurrent gout attacks over a 7-year follow-up. The adjusted odds ratio (OR) for incident gout among obese individuals was 2.6, while that for recurrent gout attacks among gout patients was 0.98 (i.e., the obesity paradox). These ORs correlated well with the ORs for the indirect and direct effects of obesity on risk of recurrent gout attacks (i.e., 2.83 and 0.98, respectively). Compared with no BMI change, the OR of losing vs. gaining >5% of baseline BMI was 0.61 and 1.60 for recurrent gout attacks, respectively (P for trend gout attacks is explained by the absence of the direct effect, which is often measured in conventional analyses and misinterpreted as the intended total effect of interest. In contrast, the BMI change analysis correctly estimated the intended total effect of BMI, and revealed a dose-response relationship. PMID:27331767

  17. Gout Can Increase the Risk of Receiving Rotator Cuff Tear Repair Surgery.

    Science.gov (United States)

    Huang, Shih-Wei; Wu, Chin-Wen; Lin, Li-Fong; Liou, Tsan-Hon; Lin, Hui-Wen

    2017-08-01

    Gout commonly involves joint inflammation, and clinical epidemiological studies on involved tendons are scant. Rotator cuff tears are the most common cause of shoulder disability, and surgery is one of the choices often adopted to regain previous function. To investigate the risk of receiving rotator cuff repair surgery among patients with gout and to analyze possible risk factors to design an effective prevention strategy. Cohort study; Level of evidence, 3. The authors studied a 7-year longitudinal follow-up of patients from the Taiwan Longitudinal Health Insurance Database 2005 (LHID2005). This included a cohort of patients who received a diagnosis of gout during 2004-2008 (gout cohort) and a cohort matched by propensity scores (control cohort). A 2-stage approach that used the National Health Interview Survey 2005 was used to obtain missing confounding variables from the LHID2005. The crude hazard ratio (HR) and adjusted HR were estimated between the gout and control cohorts. The gout and control cohorts comprised 32,723 patients with gout and 65,446 people matched at a ratio of 1:2. The incidence of rotator cuff repair was 31 and 18 per 100,000 person-years in the gout and control cohorts, respectively. The crude HR for rotator cuff repair in the gout cohort was 1.73 (95% confidence interval [CI], 1.23-2.44; P gout cohort. Further analysis revealed that the adjusted HR was 1.73 (95% CI, 1.20-2.50; P gout who did not take hypouricemic medication and 2.70 (95% CI, 1.31-5.59; P gout aged 50 years or younger. Patients with gout, particularly those aged 50 years or younger and without hypouricemic medication control, are at a relatively higher risk of receiving rotator cuff repair surgery. Strict control of uric acid levels with hypouricemic medication may effectively reduce the risk of rotator cuff repair.

  18. ALPK1 genetic regulation and risk in relation to gout.

    Science.gov (United States)

    Ko, Albert Min-Shan; Tu, Hung-Pin; Liu, Tze-Tze; Chang, Jan-Gowth; Yuo, Chung-Yee; Chiang, Shang-Lun; Chang, Shun-Jen; Liu, Yu-Fan; Ko, Allen Min-Jen; Lee, Chien-Hung; Lee, Chi-Pin; Chang, Chung-Ming; Tsai, Shih-Feng; Ko, Ying-Chin

    2013-04-01

    The present study investigated whether single nucleotide polymorphisms (SNPs) in the alpha-protein kinase 1 (ALPK1) gene are associated with gout in aboriginal and Han Chinese Taiwanese. A total of 1351 aborigines from the community (511 cases and 840 controls) and 511 Han people from hospital (104 cases and 407 controls) were recruited. SNPs in potentially functional regions of the 38 genes within 4q25 were identified and genotypes determined by direct sequencing. Quantitation of blood ALPK1 mRNA expression levels and luciferase assay of gout-associated rs231253 pGL3-SNP constructs cotransfected with hsa-miR-519e were examined. We found that ALPK1 gene was the most determinant of gout. Three SNPs of rs11726117 M861T [C], rs231247 [G] and rs231253 [G] were most associated with gout risk [odd ratios (OR) ≥1.44, P ≤ 3.78 × 10(-6)) in aborigines. A replication set using Han people had risk at rs11726117 and rs231247 (OR ≥1.72, P ≤ 4.08 × 10(-3)). From pooled analysis (Breslow-Day test, P > 0.33) assuming an additive model, each increasing copy of the risk allele of rs11726117 [C], rs231247 [G] and rs231253 [G] showed significantly elevated OR for gout ≥1.42 (P ≥ 1.53 × 10(-6)). Consistently, the composite homozygous of linked 3 SNPs (versus wild-type, OR = 1.83, P = 8.21 × 10(-4)) had strong associations with ALPK1 mRNA expression. Luciferase showed reduced hybridization between hsa-miR-519e and construct carrying gout-associated rs231253 [G] than the wild-type [C] (P = 6.19 × 10(-4)). Our study found that a newly identified ALPK1 gene can effectively interfere with microRNA target recognition and modulates the mRNA expression; and the varying distribution of the implicated SNPs among cases and controls in the two studied populations suggests a significant role in gout susceptibility.

  19. Flare Seismology from SDO Observations

    Science.gov (United States)

    Lindsey, Charles; Martinez Oliveros, Juan Carlos; Hudson, Hugh

    2011-10-01

    Some flares release intense seismic transients into the solar interior. These transients are the sole instance we know of in which the Sun's corona exerts a conspicuous influence on the solar interior through flares. The desire to understand this phenomenon has led to ambitious efforts to model the mechanisms by which energy stored in coronal magnetic fields drives acoustic waves that penetrate deep into the Sun's interior. These mechanisms potentially involve the hydrodynamic response of the chromosphere to thick-target heating by high-energy particles, radiative exchange in the chromosphere and photosphere, and Lorentz-force transients to account for acoustic energies estimated up to at 5X10^27 erg and momenta of order 6X10^19 dyne sec. An understanding of these components of flare mechanics promises more than a powerful diagnostic for local helioseismology. It could give us fundamental new insight into flare mechanics themselves. The key is appropriate observations to match the models. Helioseismic observations have identified the compact sources of transient seismic emission at the foot points of flares. The Solar Dynamics Observatory is now giving us high quality continuum-brightness and Doppler observations of acoustically active flares from HMI concurrent with high-resolution EUV observations from AIA. Supported by HXR observations from RHESSI and a broad variety of other observational resources, the SDO promises a leading role in flare research in solar cycle 24.

  20. A concise history of gout and hyperuricemia and their treatment

    Science.gov (United States)

    2006-01-01

    First identified by the Egyptians in 2640 BC, podagra (acute gout occurring in the first metatarsophalangeal joint) was later recognized by Hippocrates in the fifth century BC, who referred to it as 'the unwalkable disease'. The term is derived from the Latin word gutta (or 'drop'), and referred to the prevailing medieval belief that an excess of one of the four 'humors' – which in equilibrium were thought to maintain health – would, under certain circumstances, 'drop' or flow into a joint, causing pain and inflammation. Throughout history, gout has been associated with rich foods and excessive alcohol consumption. Because it is clearly associated with a lifestyle that, at least in the past, could only be afforded by the affluent, gout has been referred to as the 'disease of kings'. Although there is evidence that colchicine, an alkaloid derived from the autumn crocus (Colchicum autumnale), was used as a powerful purgative in ancient Greece more than 2000 years ago, its first use as a selective and specific treatment for gout is attributed to the Byzantine Christian physician Alexander of Tralles in the sixth century AD. Uricosuric agents were first used at the end of the 19th century. In the modern era, nonsteroidal anti-inflammatory drugs are usually the drugs of choice for treating acute gout. Perhaps the most important historical advance in the treatment of hyperuricemia was the development of xanthine oxidase inhibitors, which are effective in reducing plasma and urinary urate levels and have been shown to reverse the development of tophaceous deposits. PMID:16820040

  1. An update on the genetic architecture of hyperuricemia and gout.

    Science.gov (United States)

    Merriman, Tony R

    2015-04-10

    Genome-wide association studies that scan the genome for common genetic variants associated with phenotype have greatly advanced medical knowledge. Hyperuricemia is no exception, with 28 loci identified. However, genetic control of pathways determining gout in the presence of hyperuricemia is still poorly understood. Two important pathways determining hyperuricemia have been confirmed (renal and gut excretion of uric acid with glycolysis now firmly implicated). Major urate loci are SLC2A9 and ABCG2. Recent studies show that SLC2A9 is involved in renal and gut excretion of uric acid and is implicated in antioxidant defense. Although etiological variants at SLC2A9 are yet to be identified, it is clear that considerable genetic complexity exists at the SLC2A9 locus, with multiple statistically independent genetic variants and local epistatic interactions. The positions of implicated genetic variants within or near chromatin regions involved in transcriptional control suggest that this mechanism (rather than structural changes in SLC2A9) is important in regulating the activity of SLC2A9. ABCG2 is involved primarily in extra-renal uric acid under-excretion with the etiological variant influencing expression. At the other 26 loci, probable causal genes can be identified at three (PDZK1, SLC22A11, and INHBB) with strong candidates at a further 10 loci. Confirmation of the causal gene will require a combination of re-sequencing, trans-ancestral mapping, and correlation of genetic association data with expression data. As expected, the urate loci associate with gout, although inconsistent effect sizes for gout require investigation. Finally, there has been no genome-wide association study using clinically ascertained cases to investigate the causes of gout in the presence of hyperuricemia. In such a study, use of asymptomatic hyperurcemic controls would be expected to increase the ability to detect genetic associations with gout.

  2. Solar neighbourhood flare stars - a review

    International Nuclear Information System (INIS)

    Kunkel, W.E.

    1975-01-01

    The review concentrates on 'astronomical' aspects of flare activity, such as where, and under what circumstances flare activity is found in the solar vicinity. Non-classical activity is briefly described (without regard for completeness) and the influence of detection effects on flare observations is treated. Flare stars discovered during the last four years are described and flare activity of local dMe stars is compared. The BY Draconis syndrome is discussed followed by some remarks about rotation. Pleiades flare activity is compared to that of the solar neighbourhood and evidence for the evolution of flare activity in stars is examined. (Auth.)

  3. The sun and solar flares

    International Nuclear Information System (INIS)

    McKenna-Lawlor, S.

    1982-01-01

    The subject is discussed under the headings: the sun's core (thermonuclear reactions, energy transfer from core through radiation zone, convection zone, photosphere, chromosphere and corona); the photosphere (convection, granulation, sunspots, magnetic fields, solar cycle, rotation of the sun); solar variability and paleoclimatic records (correlation of low solar activity with increased 14 C production in atmosphere); the chromosphere and corona (turbulence, temperature, coronal streamers, energy transfer); solar flares (cosmic rays, aurorae, spectra, velocity of flares, prominences, mechanisms of flares); the solar wind. (U.K.)

  4. The association between the polymorphism rs2231142 in the ABCG2 gene and gout risk: a meta-analysis.

    Science.gov (United States)

    Lv, Xiaofei; Zhang, Yuan; Zeng, Fangfang; Yin, Aihua; Ye, Ning; Ouyang, Haimei; Feng, Dan; Li, Dan; Ling, Wenhua; Zhang, Xiaozhuang

    2014-12-01

    Gout is a common metabolic disorder with high heritability. We tried to explore the association between rs2231142 and gout. We searched "rs2231142 or Q141K and gout" in four databases and scholar searching website until 1 June, 2013 and included data from 52,010 participants in meta-analysis and subgroup analysis. The T allele of rs2231142 was associated with increased gout susceptibility (odds ratio [OR] [95 % confidence interval (95 % CI)] = 1.73 [1.55-1.91], P gout risk in Caucasians with OR (95 % CI) = 1.68 (1.50-1.87), P gout.

  5. Transient magnetic field changes in flares

    International Nuclear Information System (INIS)

    Patterson, A.; Zirin, H.

    1981-01-01

    Magnetic changes have been detected with the videomagnetograph (VMG) at Big Bear during two large flares on 1979 November 5. Two kinds of changes were detected in both flares: a decrease in satellite field strength near the locus of the flare and the appearance of strong transient fields during the peak of the flare. We explain why we believe that the observed effects are real and not instrumental and discuss their significance for flare studies

  6. The Budget Impact of Increased Use of Febuxostat in the Management of Gout: A US Health Plan Managed Care Pharmacy and Medical Costs Perspective.

    Science.gov (United States)

    Smolen, Lee J; Gahn, James C; Mitri, Ghaith; Shiozawa, Aki

    2016-07-01

    Gout is a chronic disease characterized by the deposition of urate crystals in the joints and throughout the body, caused by an excess burden of serum uric acid (sUA). The study estimates pharmacy and medical cost budgetary impacts of wider adoption by US payers of febuxostat, a urate-lowering therapy (ULT) for the treatment of gout. A US payer-perspective budget impact model followed ULT patients from a 1,000,000-member plan over 3 years. The current market share scenario, febuxostat (6%) and ULT allopurinol (94%), was compared with an 18% febuxostat market share. Data were implemented from randomized controlled trials, census and epidemiologic studies, and real-world database analyses. An innovation was the inclusion of gout-related chronic kidney disease costs. Cost results were estimated as annual and cumulative incremental costs, expressed as total costs, cost per member per month, and cost per treated member per month. Clinical results were also estimated. Increasing the febuxostat market share resulted in a 6.3% increase in patients achieving the sUA target level of <6.0 mg/dL and a 1.4% reduction in gout flares during the 3-year period. Total cost increased 1.4%, with a 49.9% increase in ULT costs, a 1.4% reduction in flare costs, a 1.2% reduction in chronic kidney disease costs, and a 2.8% reduction in gout care costs. The cumulative incremental costs were $1,307,425 in the first year, $1,939,016 through the second year, and $2,092,744 through the third year. By the third year, savings in medical costs offset most of the increase in treatment costs. Impacts on cumulative cost per member per month and cumulative cost per treated member per month followed the same pattern, with the highest impact in the first year and cumulative impacts declining during the 3-year period. The cumulative cost per member per month impact was estimated as $0.109, $0.081, and $0.058 and the cumulative cost per treated member per month impact was estimated as $12.416, $9.207, and

  7. Solar Features - Solar Flares - Patrol

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The H-alpha Flare Patrol identifies time periods each day when the sun is being continuously monitored by select ground-based solar observatories.

  8. Flare stars and Pascal distribution

    International Nuclear Information System (INIS)

    Muradian, R.

    1994-07-01

    Observed statistics of stellar flares are described by Pascal or Negative Binomial Distribution. The analogy with other classes of chaotic production mechanisms such as hadronic particle multiplicity distributions and photoelectron counts from thermal sources is noticed. (author). 12 refs

  9. Solar flares at submillimeter wavelengths

    Czech Academy of Sciences Publication Activity Database

    Krucker, S.; Gimenez de Castro, C.G.; Hudson, H. S.; Trottet, G.; Bastian, T.S.; Hales, A.S.; Kašparová, Jana; Klein, K. L.; Kretzschmar, M.; Luethi, T.; Mackinnon, A.; Pohjolainen, S.; White, S.M.

    2013-01-01

    Roč. 21, č. 1 (2013), 58/1-58/45 ISSN 0935-4956 Institutional support: RVO:67985815 Keywords : Sun * flares * radio observations Subject RIV: BN - Astronomy, Celestial Mechanics, Astrophysics Impact factor: 13.312, year: 2013

  10. Citric acid treatment of chronic nonhealing ulcerated tophaceous gout with bursitis.

    Science.gov (United States)

    Nagoba, Basavaraj S; Punpale, Ajay; Poddar, Ashok; Suryawanshi, Namdev M; Swami, Ganesh A; Selkar, Sohan P

    2013-12-01

    The ulceration associated with gout tophi is very difficult to treat because of impaired and halted local inflammatory response resulting from the gout treatment regimen. We report chronic nonhealing tophaceous gout with bursitis in an 80-year-old male, not responding to conventional treatment modality for months together. This nonhealing ulcer was treated successfully with local application of 3% citric acid ointment for 22 days.

  11. Gout after living kidney donation: Correlations with demographic traits and renal complications

    Science.gov (United States)

    Lam, Ngan N.; Garg, Amit X.; Segev, Dorry L.; Schnitzler, Mark A.; Xiao, Huiling; Axelrod, David; Brennan, Daniel C.; Kasiske, Bertram L.; Tuttle-Newhall, Janet E.; Lentine, Krista L.

    2015-01-01

    Background The demographic and clinical correlates of gout after living kidney donation are not well described. Methods Using a unique database that integrates national registry identifiers of U.S. living kidney donors (1987-2007) with billing claims from a private health insurer (2000-2007), we identified post-donation gout based on medical diagnosis codes or pharmacy fills for gout therapies. The frequencies and demographic correlates of gout after donation were estimated by Cox regression with left- and right-censoring. We also compared rates of renal diagnoses among donors with and without gout, matched 1:3 by age, sex, and race. Results The study sample of 4,650 donors included 13.1% African-Americans. By seven years, African-Americans were almost twice as likely to develop gout as Caucasian donors (4.4% vs. 2.4%; adjusted hazard ratio, aHR, 1.8; 95% confidence interval, CI, 1.0–3.2). Post-donation gout risk also increased with older age at donation (aHR per year 1.05) and was higher in men (aHR 2.80). Gout rates were similar in donors and age- and sex-matched general non-donors (rate ratio 0.86, 95% CI 0.66–1.13). Compared to matched donors without gout, donors with gout had more frequent renal diagnoses, reaching significance for acute kidney failure (rate ratio 12.5; 95% CI 1.5–107.0), chronic kidney disease (rate ratio 5.0; 95% CI 2.1–11.7), and other disorders of the kidney (rate ratio 2.2; 95% CI 1.2–4.2). Conclusion Donor subgroups at increased risk of gout include African-Americans, older donors, and men. Donors with gout have a higher burden of renal complications after demographic adjustment. PMID:25896309

  12. Risk of incident diabetes in patients with gout: a cohort study

    Science.gov (United States)

    Kim, Seoyoung C.; Liu, Jun; Solomon, Daniel H.

    2015-01-01

    Background Patients with hyperuricemia or gout often have metabolic syndrome. Few prospective studies examined the risk of incident diabetes mellitus (DM) in patients with gout, and no data exist whether the DM risk in gout differs by sex. Methods Using data from a US commercial insurance plan (2003–2012), we conducted a cohort study to examine the overall and sex-specific incidence rate (IR) of DM in patients aged ≥40 years with gout compared to those with osteoarthritis. Incident DM was defined based on a diagnosis of DM and a dispensing for anti-diabetic drugs. We tested the sex-specific effect of gout on DM risk. Results The study cohort consisted of 54,075 gout and 162,225 osteoarthritis patients, matched on age, sex and index date. The mean age was 56.2 years and 84.8% were men. Over a mean follow-up of 1.9 years, the IR of DM was 1.91 per 100 person-years in gout and 1.12 per 100 person-years in osteoarthritis patients. After adjusting for age, comorbidities, medications, and health care utilization, gout was associated with an increased risk of DM (hazard ratio [HR] 1.45, 95%CI 1.37–1.54) for both sexes. The impact of gout on the risk of incident DM was greater in women (HR 1.78, 95%CI 1.51–2.09) than men (HR 1.41, 95%CI 1.33–1.50) with a significant interaction between sex and gout (p=0.0009). Conclusion Gout was associated with an increased risk of developing DM compared with osteoarthritis after adjusting for potential confounders, and the risk associated with gout was higher among women than men. PMID:25332119

  13. On the possible cyclic recurrence of flare activity of flare stars in the pleiades

    International Nuclear Information System (INIS)

    Mirzoyan, L.V.; Oganyan, G.V.

    1977-01-01

    The flare activity of flare stars in Pleiades is investigated. It is shown that according to flare statistics only one half of the probable Pleiades members with low luminosities have flare activity throughout the observation period. Two assumptions are suggested to explain this contradiction with the concept on the evolutionary importance of the flare star phase which all the dwarf stars go through: cyclic nature of the flare activity and large dispersion in flare activity phase durations for equally luminous stars. Certain evidences to support cyclic flare activity assumption are adduced

  14. Effects of multiple genetic loci on the pathogenesis from serum urate to gout.

    Science.gov (United States)

    Dong, Zheng; Zhou, Jingru; Jiang, Shuai; Li, Yuan; Zhao, Dongbao; Yang, Chengde; Ma, Yanyun; Wang, Yi; He, Hongjun; Ji, Hengdong; Yang, Yajun; Wang, Xiaofeng; Xu, Xia; Pang, Yafei; Zou, Hejian; Jin, Li; Wang, Jiucun

    2017-03-02

    Gout is a common arthritis resulting from increased serum urate, and many loci have been identified that are associated with serum urate and gout. However, their influence on the progression from elevated serum urate levels to gout is unclear. This study aims to explore systematically the effects of genetic variants on the pathogenesis in approximately 5,000 Chinese individuals. Six genes (PDZK1, GCKR, TRIM46, HNF4G, SLC17A1, LRRC16A) were determined to be associated with serum urate (P FDR  gene, SLC17A4, contributed to the development of gout from hyperuricemia (OR = 1.56, P FDR  = 3.68E-09; OR = 1.27, P FDR  = 0.013, respectively). Also, HNF4G is a novel gene associated with susceptibility to gout (OR = 1.28, P FDR  = 1.08E-03). In addition, A1CF and TRIM46 were identified as associated with gout in the Chinese population for the first time (P FDR  gout and suggests that urate-associated genes functioning as urate transporters may play a specific role in the pathogenesis of gout. Furthermore, two novel gout-associated genes (HNF4G and SLC17A4) were identified.

  15. Identification of rs671, a common variant of ALDH2, as a gout susceptibility locus.

    Science.gov (United States)

    Sakiyama, Masayuki; Matsuo, Hirotaka; Nakaoka, Hirofumi; Yamamoto, Ken; Nakayama, Akiyoshi; Nakamura, Takahiro; Kawai, Sayo; Okada, Rieko; Ooyama, Hiroshi; Shimizu, Toru; Shinomiya, Nariyoshi

    2016-05-16

    Gout is a common disease resulting from hyperuricemia. Recently, a genome-wide association study identified an association between gout and a single nucleotide polymorphism (SNP) rs2188380, located on an intergenic region between MYL2 and CUX2 on chromosome 12. However, other genes around rs2188380 could possibly be gout susceptibility genes. Therefore, we performed a fine-mapping study of the MYL2-CUX2 region. From 8,595 SNPs in the MYL2-CUX2 region, 9 tag SNPs were selected, and genotyping of 1,048 male gout patients and 1,334 male controls was performed by TaqMan method. Eight SNPs showed significant associations with gout after Bonferroni correction. rs671 (Glu504Lys) of ALDH2 had the most significant association with gout (P = 1.7 × 10(-18), odds ratio = 0.53). After adjustment for rs671, the other 8 SNPs no longer showed a significant association with gout, while the significant association of rs671 remained. rs671 has been reportedly associated with alcohol drinking behavior, and it is well-known that alcohol drinking elevates serum uric acid levels. These data suggest that rs671, a common functional SNP of ALDH2, is a genuine gout-associated SNP in the MYL2-CUX2 locus and that "A" allele (Lys) of rs671 plays a protective role in the development of gout.

  16. Genetic architecture for susceptibility to gout in the KARE cohort study.

    Science.gov (United States)

    Shin, Jimin; Kim, Younyoung; Kong, Minyoung; Lee, Chaeyoung

    2012-06-01

    This study aimed to identify functional associations of cis-regulatory regions with gout susceptibility using data resulted from a genome-wide association study (GWAS), and to show a genetic architecture for gout with interaction effects among genes within each of the identified functions. The GWAS was conducted with 8314 control subjects and 520 patients with gout in the Korea Association REsource cohort. However, genetic associations with any individual nucleotide variants were not discovered by Bonferroni multiple testing in the GWAS (P>1.42 × 10(-7)). Genomic regions enrichment analysis was employed to identify functional associations of cis-regulatory regions. This analysis revealed several biological processes associated with gout susceptibility, and they were quite different from those with serum uric acid level. Epistasis for susceptibility to gout was estimated using entropy decomposition with selected genes within each biological process identified by the genomic regions enrichment analysis. Some epistases among nucleotide sequence variants for gout susceptibility were found to be larger than their individual effects. This study provided the first evidence that genetic factors for gout susceptibility greatly differed from those for serum uric acid level, which may suggest that research endeavors for identifying genetic factors for gout susceptibility should not be heavily dependent on pathogenesis of uric acid. Interaction effects between genes should be examined to explain a large portion of phenotypic variability for gout susceptibility.

  17. Investigation on the association between NLRP3 gene polymorphisms and susceptibility to primary gout.

    Science.gov (United States)

    Wang, L F; Ding, Y J; Zhao, Q; Zhang, X L

    2015-12-09

    We conducted a case-control study to investigate the association between 3 common NALP3 polymorphisms (rs10754558, rs7512998, and rs12137901) and the susceptibility to primary gout. A total of 320 patients with primary gout and 320 controls were included in this study. The genotyping of NALP3 rs10754558, rs7512998, and rs12137901 were conducted by polymerase chain reaction-restriction fragment length polymorphism. Comparison analysis showed that primary gout patients were more likely to have higher body mass index, prevalence of hypertension, blood glucose, triglycerides, urea nitrogen, and uric acid (P gene polymorphisms and the risk of primary gout.

  18. A comparative study between clinical grading of anterior chamber flare and flare reading using the Kowa laser flare meter.

    Science.gov (United States)

    Konstantopoulou, Kallirroi; Del'Omo, Roberto; Morley, Anne M; Karagiannis, Dimitris; Bunce, Catey; Pavesio, Carlos

    2015-10-01

    To assess the accuracy of standard clinical grading of aqueous flare in uveitis according to the Standardization of Uveitis Nomenclature consensus, and compare the results with the readings of the laser flare meter, Kowa 500. Two examiners clinically graded the flare in 110 eyes. The flare was then measured using the Kowa laser flare meter. Twenty-nine eyes were graded as anterior chamber flare +2; for 18 of these, the clinicians were in agreement, the rest differed by the order of one grade. The range of the laser flare meter for these eyes was 5.2-899.1 photons/ms. The median value was 41.4. Seventy-four eyes were graded with flare +1. Agreement was established in 51 of these eyes. Disagreement for the rest was again by the order of 1, and the flare meter range was 1.1-169.9 photons/ms, median value 18.4. For the clinical measure of flare 0, the clinicians disagreed on three out of five eyes. The flare meter readings ranged from 2.5 to 14.1 photons/ms, median value 9.9. Only two eyes were graded with flare +3 and there was one step disagreement on both of them. We found little evidence of association between the flare readings and intraocular pressure or age. Our findings suggest that clinical evaluation of aqueous flare is subjective. Compared with the Kowa laser flare meter's numeric readings, the discrepancies observed indicate that clinical grading is an approximate science. The laser flare meter provides an accurate, reproducible, non-invasive assessment of aqueous flare that can prove valuable in research and clinical decisions.

  19. The spine and polytopic hyperostoses in gout and hyperuricemia

    International Nuclear Information System (INIS)

    Stepan, J.; Svab, V.; Susta, A.; Kolar, J.; Cap, F.; Karlova Universita, Prague

    1983-01-01

    Investigations were made on a total of 92 patients with gout and hyperuricemia. 30% had no clinical signs of spinal involvement. The remaining 70% were examined radiologically and by xeroradiography. Examination revealed signs of erosion of vertebral bodies, spondylodiscitis, osteopenia, manifestations of Forestier's disease and changes on sacroiliac joints. In 52% of subjects there were polytopic hyperostoses including an increased incidence of calcifications around the large joints and periostal appositions at the periphery, particularly on the finger and toe tips. The hypothesis was raised that massive calcifications and manifestations of hyperostosis and ossification of the ligaments and tendons (osteodesmoses) in gout may correlate with a latent glycide metabolism disorder like in Forestier's disease. (orig.)

  20. Gout Initially Mimicking Rheumatoid Arthritis and Later Cervical Spine Involvement

    Directory of Open Access Journals (Sweden)

    Eduardo Araújo Santana Nunes

    2014-01-01

    Full Text Available Gout is clinically characterized by episodes of monoarthritis, but if not treated properly, it can lead to a chronic polyarthritis, which may eventually mimic rheumatoid arthritis (RA. We present the case of a 59-year-old man, with a history of symmetrical polyarthritis of the large and small joints with later development of subcutaneous nodules, which was initially misdiagnosed as RA, being treated with prednisone and methotrexate for a long period of time. He complained of occipital pain and paresthesia in his left upper limb, and computed tomography (CT and magnetic resonance imaging (MRI revealed the presence of an expansive formation in the cervical spine with compression of the medulla. He was admitted for spinal decompressive surgery and the biopsy specimen demonstrated a gouty tophus. Chronic gout can mimic RA and rarely involves the axial skeleton, and thus its correct diagnosis and the implementation of adequate therapy can halt the development of such damaging complications.

  1. SIGNIFICANCE OF DIET AND DIETARY SUPPLEMENTS IN GOUT

    Directory of Open Access Journals (Sweden)

    A E Il'ina

    2008-01-01

    Full Text Available The paper discusses a role of a diet and therapy with the herbal complex Urisan in patients with gout. It is noted that the agent based on herbal components may be used in addition to drug therapy and diet in seasonal hyperuricuria, hyperuricemia observed after heavy strenuous and athletic activity, meat overeating, and alcohol abuse. Urisan may be recommended in subsiding gouty inflammation as a bridge to the use of allopurinol.

  2. Gout and subsequent erectile dysfunction: a population-based cohort study from England.

    Science.gov (United States)

    Abdul Sultan, Alyshah; Mallen, Christian; Hayward, Richard; Muller, Sara; Whittle, Rebecca; Hotston, Matthew; Roddy, Edward

    2017-06-06

    An association has been suggested between gout and erectile dysfunction (ED), however studies quantifying the risk of ED amongst gout patients are lacking. We aimed to precisely determine the population-level absolute and relative rate of ED reporting among men with gout over a decade in England. We utilised the UK-based Clinical Practice Research Datalink to identify 9653 men with incident gout age- and practice-matched to 38,218 controls. Absolute and relative rates of incident ED were calculated using Cox regression models. Absolute rates within specific time periods before and after gout diagnosis were compared to control using a Poisson regression model. Overall, the absolute rate of ED post-gout diagnosis was 193 (95% confidence interval (CI): 184-202) per 10,000 person-years. This corresponded to a 31% (hazard ratio (HR): 1.31 95%CI: 1.24-1.40) increased relative risk and 0.6% excess absolute risk compared to those without gout. We did not observe statistically significant differences in the risk of ED among those prescribed ULT within 1 and 3 years after gout diagnosis. Compared to those unexposed, the risk of ED was also high in the year before gout diagnosis (relative rate = 1.63 95%CI 1.27-2.08). Similar findings were also observed for severe ED warranting pharmacological intervention. We have shown a statistically significant increased risk of ED among men with gout. Our findings will have important implications in planning a multidisciplinary approach to managing patients with gout.

  3. Presence of Gout is Associated With Increased Prevalence and Severity of Knee Osteoarthritis

    Science.gov (United States)

    Howard, Rennie G.; Samuels, Jonathan; Gyftopoulos, Soterios; Krasnokutsky, Svetlana; Leung, Joseph; Swearingen, Christopher J.; Pillinger, Michael H.

    2015-01-01

    Background Gout and osteoarthritis (OA) are the most prevalent arthritides, but their relationship is neither well established nor well understood. Objectives We assessed whether a diagnosis of gout or asymptomatic hyperuricemia (AH) is associated with increased prevalence/severity of knee OA. Methods 119 male patients ages 55–85 were sequentially enrolled from the primary care clinics of an urban VA hospital, assessed and categorized into 3 groups: gout (ACR Classification Criteria), AH ([serum urate] ≥ 6.8 mg/dL, no gout), and control ([serum urate] gout). 25 patients from each group subsequently underwent formal assessment of knee OA presence and severity (ACR Clinical/Radiographic Criteria, Kellgren-Lawrence (KL) grade). Musculoskeletal ultrasound was used to detect monosodium urate (MSU) deposition at the knees and 1st metatarsophalangeal (MTP) joints. Results 68.0% of gout, 52.0% of AH, and 28.0% of age-matched control subjects had knee OA (gout vs. control, P=0.017). Odds ratio for knee OA in gout vs. controls was 5.46 prior to, and 3.80 after adjusting for BMI. Gout subjects also had higher KL grades than controls (P=0.001). Subjects with sonographically-detected MSU crystal deposition on cartilage were more likely to have OA than those without (60.0 vs 27.5%, P=0.037), with crystal deposition at the 1st MTP joints correlating most closely with OA knee involvement. Conclusion Knee OA was more prevalent in gout patients vs. controls, and intermediate in AH. Knee OA was more severe in gout patients vs. controls. PMID:25710856

  4. GWAS of clinically defined gout and subtypes identifies multiple susceptibility loci that include urate transporter genes.

    Science.gov (United States)

    Nakayama, Akiyoshi; Nakaoka, Hirofumi; Yamamoto, Ken; Sakiyama, Masayuki; Shaukat, Amara; Toyoda, Yu; Okada, Yukinori; Kamatani, Yoichiro; Nakamura, Takahiro; Takada, Tappei; Inoue, Katsuhisa; Yasujima, Tomoya; Yuasa, Hiroaki; Shirahama, Yuko; Nakashima, Hiroshi; Shimizu, Seiko; Higashino, Toshihide; Kawamura, Yusuke; Ogata, Hiraku; Kawaguchi, Makoto; Ohkawa, Yasuyuki; Danjoh, Inaho; Tokumasu, Atsumi; Ooyama, Keiko; Ito, Toshimitsu; Kondo, Takaaki; Wakai, Kenji; Stiburkova, Blanka; Pavelka, Karel; Stamp, Lisa K; Dalbeth, Nicola; Sakurai, Yutaka; Suzuki, Hiroshi; Hosoyamada, Makoto; Fujimori, Shin; Yokoo, Takashi; Hosoya, Tatsuo; Inoue, Ituro; Takahashi, Atsushi; Kubo, Michiaki; Ooyama, Hiroshi; Shimizu, Toru; Ichida, Kimiyoshi; Shinomiya, Nariyoshi; Merriman, Tony R; Matsuo, Hirotaka

    2017-05-01

    A genome-wide association study (GWAS) of gout and its subtypes was performed to identify novel gout loci, including those that are subtype-specific. Putative causal association signals from a GWAS of 945 clinically defined gout cases and 1213 controls from Japanese males were replicated with 1396 cases and 1268 controls using a custom chip of 1961 single nucleotide polymorphisms (SNPs). We also first conducted GWASs of gout subtypes. Replication with Caucasian and New Zealand Polynesian samples was done to further validate the loci identified in this study. In addition to the five loci we reported previously, further susceptibility loci were identified at a genome-wide significance level (pgout cases, and NIPAL1 and FAM35A for the renal underexcretion gout subtype. While NIPAL1 encodes a magnesium transporter, functional analysis did not detect urate transport via NIPAL1, suggesting an indirect association with urate handling. Localisation analysis in the human kidney revealed expression of NIPAL1 and FAM35A mainly in the distal tubules, which suggests the involvement of the distal nephron in urate handling in humans. Clinically ascertained male patients with gout and controls of Caucasian and Polynesian ancestries were also genotyped, and FAM35A was associated with gout in all cases. A meta-analysis of the three populations revealed FAM35A to be associated with gout at a genome-wide level of significance (p meta =3.58×10 -8 ). Our findings including novel gout risk loci provide further understanding of the molecular pathogenesis of gout and lead to a novel concept for the therapeutic target of gout/hyperuricaemia. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  5. Common variant of ALPK1 is not associated with gout: a replication study.

    Science.gov (United States)

    Chiba, Toshinori; Matsuo, Hirotaka; Sakiyama, Masayuki; Nakayama, Akiyoshi; Shimizu, Seiko; Wakai, Kenji; Suma, Shino; Nakashima, Hiroshi; Sakurai, Yutaka; Shimizu, Toru; Ichida, Kimiyoshi; Shinomiya, Nariyoshi

    2015-01-01

    Gout is one of the most kinds of common inflammatory arthritis as a consequence of hyperuricemia. Alpha-protein kinase 1 (ALPK1) gene locates in a gout-susceptibility locus on chromosome 4q21-31, and encodes ALPK1 protein which plays a pivotal role in the phosphorylation of myosin 1. In the previous genetic study of Taiwanese populations, 3 single nucleotide polymorphisms (SNPs), rs11726117, rs231247 and rs231253, in ALPK1 gene were reported to have a significant association with gout. However, no replication study has been performed to confirm this association. Therefore, we first conducted a replication study with clinically defined gout patients in a different population. Linkage disequilibrium (LD) analyzes of the 3 SNPs in ALPK1 revealed that these SNPs are in strong LD in a Japanese population. Among the 3 SNPs of ALPK1, rs11726117 (M861T) is the only missense SNP. Therefore, rs11726117 was genotyped in a Japanese population of 903 clinically defined gout cases and 1,302 controls, and was evaluated for a possible association with gout. The minor allele frequencies of rs11726117 were 0.26 and 0.25 in the case and control groups, respectively. The association analysis has not detected a significant association between rs11726117 and gout susceptibility in a Japanese population (p = 0.44). Because ABCG2, a major causative gene for gout, also locates in the gout-susceptibility locus on chromosome 4q, these findings suggest that among genes in a gout-susceptibility locus, not ALPK1 but ABCG2 could be important as a gout-susceptible gene.

  6. Monoamine oxidase A gene polymorphisms and enzyme activity associated with risk of gout in Taiwan aborigines.

    Science.gov (United States)

    Tu, Hung-Pin; Ko, Albert Min-Shan; Wang, Shu-Jung; Lee, Chien-Hung; Lea, Rod A; Chiang, Shang-Lun; Chiang, Hung-Che; Wang, Tsu-Nai; Huang, Meng-Chuan; Ou, Tsan-Teng; Lin, Gau-Tyan; Ko, Ying-Chin

    2010-02-01

    Taiwanese aborigines have a high prevalence of hyperuricemia and gout. Uric acid levels and urate excretion have correlated with dopamine-induced glomerular filtration response. MAOs represent one of the major renal dopamine metabolic pathways. We aimed to identify the monoamine oxidase A (MAOA, Xp11.3) gene variants and MAO-A enzyme activity associated with gout risk. This study was to investigate the association between gout and the MAOA single-nucleotide polymorphisms (SNPs) rs5953210, rs2283725, and rs1137070 as well as between gout and the COMT SNPs rs4680 Val158Met for 374 gout cases and 604 controls. MAO-A activity was also measured. All three MAOA SNPs were significantly associated with gout. A synonymous MAOA SNP, rs1137070 Asp470Asp, located in exon 14, was associated with the risk of having gout (P = 4.0 x 10(-5), adjusted odds ratio 1.46, 95% confidence intervals [CI]: 1.11-1.91). We also showed that, when compared to individuals with the MAOA GAT haplotype, carriers of the AGC haplotype had a 1.67-fold (95% CI: 1.28-2.17) higher risk of gout. Moreover, we found that MAOA enzyme activity correlated positively with hyperuricemia and gout (P for trend = 2.00 x 10(-3) vs. normal control). We also found that MAOA enzyme activity by rs1137070 allele was associated with hyperuricemia and gout (P for trend = 1.53 x 10(-6) vs. wild-type allele). Thus, our results show that some MAOA alleles, which have a higher enzyme activity, predispose to the development of gout.

  7. Upstream petroleum industry flaring guide : review draft

    International Nuclear Information System (INIS)

    1999-03-01

    The Alberta requirements and expectations for upstream petroleum flaring are presented. Flaring is associated with a wide range of energy activities including oil and gas well drilling and well completion operations. The guide incorporates the recommendations made to the Alberta Energy and Utilities Board (EUB) in June 1998 by the multi-stakeholder Clean Air Strategic Alliance (CASA) on associated or solution gas flaring. Additional requirements which address flaring issues not covered in the CASA report are also included in this guide. The Guide requires a 15 per cent reduction in solution gas flare volume by the end of year 2000 from the 1996 baseline, and a 25 per cent reduction by the end of 2001. The Guide prescribes new flare performance requirements for all flares, within three years for existing solution gas flares, five years for flares at other existing permanent facilities. It sets personal consultation and public notification requirements for new and existing solution gas batteries, and new sulphur recovery requirements for facilities not covered by existing EUB regulations. The Guide also addresses the question of conflict resolution to deal with flaring concerns, the release of flaring and venting data, the proposed reduction of flare limits, progress towards minimizing requirements for electricity generators using otherwise flared gas, annual reporting to the EUB, and management framework review in 2001

  8. Survey Definitions of Gout for Epidemiologic Studies: Comparison With Crystal Identification as the Gold Standard

    NARCIS (Netherlands)

    Dalbeth, N.; Schumacher, H.R.; Fransen, J.; Neogi, T.; Jansen, T.L; Brown, M.; Louthrenoo, W.; Vazquez-Mellado, J.; Eliseev, M.; McCarthy, G.; Stamp, L.K.; Perez-Ruiz, F.; Sivera, F.; Ea, H.K.; Gerritsen, M.; Scire, C.A.; Cavagna, L.; Lin, C.; Chou, Y.Y.; Tausche, A.K.; Rocha Castelar-Pinheiro, G. da; Janssen, M; Chen, J.H.; Cimmino, M.A.; Uhlig, T.; Taylor, W.J.

    2016-01-01

    OBJECTIVE: To identify the best-performing survey definition of gout from items commonly available in epidemiologic studies. METHODS: Survey definitions of gout were identified from 34 epidemiologic studies contributing to the Global Urate Genetics Consortium (GUGC) genome-wide association study.

  9. The effect of control and self-medication of chronic gout in a developing country.

    NARCIS (Netherlands)

    Darmawan, John; Rasker, Johannes J.; Nuralim, Hendri

    2003-01-01

    Objective:: We describe a 10 year observation of the effect of control of hyperuricemia compared with self-medication alone in patients with chronic gout. Methods: We studied 299 consecutively self-referred Malayo-Polynesian men with chronic gout, mean age 35 ± 14.3 SD years. Subjects comprised 228

  10. Gout, not induced by diuretics? A case-control study from primary care.

    NARCIS (Netherlands)

    Janssens, H.; Lisdonk, E.H. van de; Janssen, M.; Hoogen, H.J.M. van den; Verbeek, A.L.M.

    2006-01-01

    BACKGROUND: It is taken for granted that diuretics may induce gout, but there is a general lack of evidence on this topic. OBJECTIVES: To determine the incidence of gout in patients who use diuretics, taking into account concurrent hypertension and cardiovascular diseases. METHODS: A case-control

  11. Tophaceous gout of the first costochondral junction in a heart transplant patient

    International Nuclear Information System (INIS)

    Chang, Patrick C.; Seeger, Leanne L.; Motamedi, Kambiz; Chan, Jessica B.

    2006-01-01

    We report the case of a 49-year-old man with a 10-year history of gout, who presented with a painful left first costochondral junction mass. A computed tomography (CT)-guided biopsy of the mass revealed foreign body giant cell reaction and crystalline deposition consistent with tophaceous gout. (orig.)

  12. Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray

    Energy Technology Data Exchange (ETDEWEB)

    Rettenbacher, Thomas; Ennemoser, Sybille; Weirich, Harald [Innsbruck Medical University, Department of Radiology, Innsbruck (Austria); Ulmer, Hanno [Innsbruck Medical University, Department of Medical Statistics, Informatics, and Health Economics, Innsbruck (Austria); Hartig, Frank; Klotz, Werner; Herold, Manfred [Innsbruck Medical University, Department of Internal Medicine, Innsbruck (Austria)

    2008-03-15

    The aim was to compare X-ray and ultrasound (US) in diagnosing gout. In a prospective study, 105 consecutive patients with clinical suspicion of gout underwent conventional X-ray und high-resolution US in order to help in arriving at a definite diagnosis. X-ray findings suggestive of gout included soft-tissue opacifications with densities between soft tissue and bone, articular and periarticular bone erosions, and osteophytes at the margins of opacifications or erosions. US findings suggestive of gout included bright stippled foci and hyperechoic soft-tissue areas. Fifty-five patients had a definite diagnosis of gout (102 involved sites), 31 patients were diagnosed as having another disease (59 involved sites), and 19 patients were excluded from the study because a definite diagnosis could not be established. X-ray suggested gout with a sensitivity of 31% (32/102) and a specificity of 93% (55/59), whereas US suggested gout with a sensitivity of 96% (98/102) and a specificity of 73% (43/59). US was much more sensitive than conventional X-ray but less specific. Our data show that US often provided additional diagnostic information in patients with clinical suspicion of gout when laboratory findings and X-ray results were negative or inconclusive and should therefore be used in these cases. (orig.)

  13. Tophaceous gout of the first costochondral junction in a heart transplant patient

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Patrick C.; Seeger, Leanne L.; Motamedi, Kambiz [David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA (United States); Chan, Jessica B. [David Geffen School of Medicine at UCLA, Department of Pathology, Los Angeles, CA (United States)

    2006-09-15

    We report the case of a 49-year-old man with a 10-year history of gout, who presented with a painful left first costochondral junction mass. A computed tomography (CT)-guided biopsy of the mass revealed foreign body giant cell reaction and crystalline deposition consistent with tophaceous gout. (orig.)

  14. Sensitivity and specificity of ultrasonographic features of gout in intercritical and chronic phase.

    Science.gov (United States)

    Das, Shyamashis; Ghosh, Alakendu; Ghosh, Parasar; Lahiri, Debasish; Sinhamahapatra, Pradyot; Basu, Kaushik

    2017-07-01

    This study aimed to assess the sensitivity and specificity of ultrasonographic features of gout in intercritical and chronic stages and compared ultrasonographic features of gout between patients with persistent high serum uric acid (SUA) and patients with low SUA. Adult patients with gout confirmed by demonstration of monosodium urate crystals were recruited, if they were in intercritical or chronic stage clinically. Ultrasonographic examination of the first metatarsophalangeal joints (MTPJs) and the knee joints of both sides were done by a blinded rheumatologist trained in musculoskeletal ultrasound. Sixty-two patients with gout and 30 control subjects were examined. The double contour sign (DCS) was found in 71 (57.3%) first MTPJs and tophi were found in 54 (43.5%) first MTPJs. DCS was present in 43 (69.4%) gout patients but none in the control group (P gout patients were 69.4% (56.4-80.4%) and 100% (88.3-100%), respectively, while of tophi they were 66.1% (53-77.7%) and 100% (88.3-100%), respectively. The sensitivity of DCS increased to 100% in high the SUA subgroup (SUA ≥ 7 mg/dL). The low SUA (SUA gout subgroup showed significantly higher occurrence of erosions (40%) and tophi (50%) in first MTP joints than the control group. MSUS is useful for diagnosis of gout in intercritical or chronic stages, especially in patients with persistently high SUA level. © 2016 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  15. A Case of Mitral Valve Tophus in a Patient with Severe Gout Tophaceous Arthritis

    Directory of Open Access Journals (Sweden)

    Atooshe Rohani

    2012-01-01

    Full Text Available A few cases of cardiac valve tophi have been reported in literature. In this case report, the echocardiographic characteristics of the hyperechoic mass in the posterior leaflet mitral valve, intact mitral valve ring, and the occurrence of severe tophaceous gout arthritis suggested the diagnosis of a gout tophus on the mitral valve.

  16. A rare cause of spinal cord compression: imaging appearances of gout of the cervical spine

    International Nuclear Information System (INIS)

    Dharmadhikari, R.; Hide, I.G.; Dildey, P.

    2006-01-01

    Gout is a metabolic disorder typically affecting the peripheral joints, more commonly in males. Spinal involvement is uncommon and is usually associated with hyperuricemia. We present the imaging findings of a case of spinal gout in a female patient with no previous history of hyperuricaemia, involving multiple spinal segments. (orig.)

  17. A rare cause of spinal cord compression: imaging appearances of gout of the cervical spine

    Energy Technology Data Exchange (ETDEWEB)

    Dharmadhikari, R.; Hide, I.G. [Freeman Hospital, Department of Radiology, High Heaton, Newcastle-upon-Tyne (United Kingdom); Dildey, P. [Freeman Hospital, Department of Pathology, High Heaton, Newcastle-upon-Tyne (United Kingdom)

    2006-12-15

    Gout is a metabolic disorder typically affecting the peripheral joints, more commonly in males. Spinal involvement is uncommon and is usually associated with hyperuricemia. We present the imaging findings of a case of spinal gout in a female patient with no previous history of hyperuricaemia, involving multiple spinal segments. (orig.)

  18. Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray

    International Nuclear Information System (INIS)

    Rettenbacher, Thomas; Ennemoser, Sybille; Weirich, Harald; Ulmer, Hanno; Hartig, Frank; Klotz, Werner; Herold, Manfred

    2008-01-01

    The aim was to compare X-ray and ultrasound (US) in diagnosing gout. In a prospective study, 105 consecutive patients with clinical suspicion of gout underwent conventional X-ray und high-resolution US in order to help in arriving at a definite diagnosis. X-ray findings suggestive of gout included soft-tissue opacifications with densities between soft tissue and bone, articular and periarticular bone erosions, and osteophytes at the margins of opacifications or erosions. US findings suggestive of gout included bright stippled foci and hyperechoic soft-tissue areas. Fifty-five patients had a definite diagnosis of gout (102 involved sites), 31 patients were diagnosed as having another disease (59 involved sites), and 19 patients were excluded from the study because a definite diagnosis could not be established. X-ray suggested gout with a sensitivity of 31% (32/102) and a specificity of 93% (55/59), whereas US suggested gout with a sensitivity of 96% (98/102) and a specificity of 73% (43/59). US was much more sensitive than conventional X-ray but less specific. Our data show that US often provided additional diagnostic information in patients with clinical suspicion of gout when laboratory findings and X-ray results were negative or inconclusive and should therefore be used in these cases. (orig.)

  19. Epidermal growth factor gene is a newly identified candidate gene for gout

    Science.gov (United States)

    Han, Lin; Cao, Chunwei; Jia, Zhaotong; Liu, Shiguo; Liu, Zhen; Xin, Ruosai; Wang, Can; Li, Xinde; Ren, Wei; Wang, Xuefeng; Li, Changgui

    2016-01-01

    Chromosome 4q25 has been identified as a genomic region associated with gout. However, the associations of gout with the genes in this region have not yet been confirmed. Here, we performed two-stage analysis to determine whether variations in candidate genes in the 4q25 region are associated with gout in a male Chinese Han population. We first evaluated 96 tag single nucleotide polymorphisms (SNPs) in eight inflammatory/immune pathway- or glucose/lipid metabolism-related genes in the 4q25 region in 480 male gout patients and 480 controls. The SNP rs12504538, located in the elongation of very-long-chain-fatty-acid-like family member 6 gene (Elovl6), was found to be associated with gout susceptibility (Padjusted = 0.00595). In the second stage of analysis, we performed fine mapping analysis of 93 tag SNPs in Elovl6 and in the epidermal growth factor gene (EGF) and its flanking regions in 1017 male patients gout and 1897 healthy male controls. We observed a significant association between the T allele of EGF rs2298999 and gout (odds ratio = 0.77, 95% confidence interval = 0.67–0.88, Padjusted = 6.42 × 10−3). These results provide the first evidence for an association between the EGF rs2298999 C/T polymorphism and gout. Our findings should be validated in additional populations. PMID:27506295

  20. Epidermal growth factor gene is a newly identified candidate gene for gout.

    Science.gov (United States)

    Han, Lin; Cao, Chunwei; Jia, Zhaotong; Liu, Shiguo; Liu, Zhen; Xin, Ruosai; Wang, Can; Li, Xinde; Ren, Wei; Wang, Xuefeng; Li, Changgui

    2016-08-10

    Chromosome 4q25 has been identified as a genomic region associated with gout. However, the associations of gout with the genes in this region have not yet been confirmed. Here, we performed two-stage analysis to determine whether variations in candidate genes in the 4q25 region are associated with gout in a male Chinese Han population. We first evaluated 96 tag single nucleotide polymorphisms (SNPs) in eight inflammatory/immune pathway- or glucose/lipid metabolism-related genes in the 4q25 region in 480 male gout patients and 480 controls. The SNP rs12504538, located in the elongation of very-long-chain-fatty-acid-like family member 6 gene (Elovl6), was found to be associated with gout susceptibility (Padjusted = 0.00595). In the second stage of analysis, we performed fine mapping analysis of 93 tag SNPs in Elovl6 and in the epidermal growth factor gene (EGF) and its flanking regions in 1017 male patients gout and 1897 healthy male controls. We observed a significant association between the T allele of EGF rs2298999 and gout (odds ratio = 0.77, 95% confidence interval = 0.67-0.88, Padjusted = 6.42 × 10(-3)). These results provide the first evidence for an association between the EGF rs2298999 C/T polymorphism and gout. Our findings should be validated in additional populations.

  1. Performance of Ultrasound in the Diagnosis of Gout in a Multi-Center Study

    DEFF Research Database (Denmark)

    Ogdie, Alexis; Taylor, William J; Neogi, Tuhina

    2017-01-01

    OBJECTIVES: To examine the performance of ultrasound for the diagnosis of gout using presence of monosodium urate (MSU) crystals as the gold standard. METHODS: We analyzed data from the Study for Updated Gout Classification Criteria (SUGAR), a large, multi-center observational cross-sectional stu...

  2. Performance of gout definitions for genetic epidemiological studies: analysis of UK Biobank.

    Science.gov (United States)

    Cadzow, Murray; Merriman, Tony R; Dalbeth, Nicola

    2017-08-09

    Many different combinations of available data have been used to identify gout cases in large genetic studies. The aim of this study was to determine the performance of case definitions of gout using the limited items available in multipurpose cohorts for population-based genetic studies. This research was conducted using the UK Biobank Resource. Data, including genome-wide genotypes, were available for 105,421 European participants aged 40-69 years without kidney disease. Gout definitions and combinations of these definitions were identified from previous epidemiological studies. These definitions were tested for association with 30 urate-associated single-nucleotide polymorphisms (SNPs) by logistic regression, adjusted for age, sex, waist circumference, and ratio of waist circumference to height. Heritability estimates under an additive model were generated using GCTA version 1.26.0 and PLINK version 1.90b3.32 by partitioning the genome. There were 2066 (1.96%) cases defined by self-report of gout, 1652 (1.57%) defined by urate-lowering therapy (ULT) use, 382 (0.36%) defined by hospital diagnosis, 1861 (1.76%) defined by hospital diagnosis or gout-specific medications and 2295 (2.18%) defined by self-report of gout or ULT use. Association with gout at experiment-wide significance (P genetic epidemiological studies of gout.

  3. Polymorphisms of uric transporter proteins in the pathogenesis of gout in a Chinese Han population.

    Science.gov (United States)

    Wan, W; Xu, X; Zhao, D B; Pang, Y F; Wang, Y X

    2015-03-30

    In this study, we analyzed single nucleotide polymorphisms (SNP) in urate transporter genes to examine the pathogenesis of gout. We conducted a 1:1-matched case-control study that included 110 patients with acute gout attacks as the patient group and 110 healthy age- and gender-matched subjects as the control group. Clinical parameters were recorded and blood biochemistry tests were conducted for both groups. Multivariate logistic regression analysis was used to analyze the data. Hyperuricemia, hypercholesterolemia, and hypertriglyceridemia were found to be the main risk factors for the onset of gout, with relative risks of 29.2 (P 0.05). The risk factors of gout were hyperuricemia, hypercholesterolemia, hypertriglyceridemia, and the T/T genotype of the rs2231142 locus in the ABCG2 gene; expression of the G/G genotype may be a protective factor against gout development.

  4. Performance of classification criteria for gout in early and established disease

    DEFF Research Database (Denmark)

    Taylor, William J; Fransen, Jaap; Dalbeth, Nicola

    2016-01-01

    OBJECTIVES: To compare the sensitivity and specificity of different classification criteria for gout in early and established disease. METHODS: This was a cross-sectional study of consecutive rheumatology clinic patients with joint swelling in which gout was defined by presence or absence...... of monosodium urate crystals as observed by a certified examiner at presentation. Early disease was defined as patient-reported onset of symptoms of 2 years or less. RESULTS: Data from 983 patients were collected and gout was present in 509 (52%). Early disease was present in 144 gout cases and 228 non.......3%/84.4% and 86.4%/63.6%. Criteria not requiring synovial fluid analysis had sensitivity and specificity of less than 80% in early and established disease. CONCLUSIONS: Existing classification criteria for gout have sensitivity of over 80% in early and established disease but currently available criteria that do...

  5. What's an Asthma Flare-Up?

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Asthma Flare-Ups KidsHealth / For Parents / Asthma Flare-Ups ... español ¿Qué es una crisis asmática? What Are Asthma Flare-Ups? Keeping asthma under control helps kids ...

  6. Design alternatives, components key to optimum flares

    International Nuclear Information System (INIS)

    Cunha-Leite, O.

    1992-01-01

    A properly designed flare works as an emissions control system with greater than 98% combustion efficiency. The appropriate use of steam, natural gas, and air-assisted flare tips can result in smokeless combustion. Ground flare, otherwise the elevated flare is commonly chosen because it handles larger flow releases more economically. Flaring has become more complicated than just lighting up waste gas. Companies are increasingly concerned about efficiency. In addition, U.S. Occupational Safety and Health Administration (OSHA) and U.S. Environmental Protection Agency (EPA) have become more active, resulting in tighter regulations on both safety and emissions control. These regulations have resulted in higher levels of concern and involvement in safety and emissions matters, not to mention smoke, noise, glare, and odor. This first to two articles on flare design and components looks at elevated flares, flare tips, incinerator-type flares, flare pilots, and gas seals. Part 2 will examine knockout drums, liquid-seal drums, ignition systems, ground flares, vapor recovery systems, and flare noise

  7. Instant CloudFlare starter

    CERN Document Server

    Dickey, Jeff

    2013-01-01

    Get to grips with a new technology, understand what it is and what it can do for you, and then get to work with the most important features and tasks. Written as a practical guide, CloudFlare Starter will show you all you need to know in order to effectively improve your online presence in a multitude of different ways. ""Instant CloudFlare Starter"" is a practical yet accessible guide for website owners looking to optimize their site for optimum security and maximum performance.

  8. Patients’ knowledge and beliefs concerning gout and its treatment: a population based study

    Directory of Open Access Journals (Sweden)

    Harrold Leslie R

    2012-09-01

    Full Text Available Abstract Background For patients to effectively manage gout, they need to be aware of the impact of diet, alcohol use, and medications on their condition. We sought to examine patients’ knowledge and beliefs concerning gout and its treatment in order to identify barriers to optimal patient self-management. Methods We identified patients (≥18 years of age cared for in the setting of a multispecialty group practice with documentation of at least one health care encounter associated with a gout diagnosis during the period 2008–2009 (n = 1346. Patients were sent a questionnaire assessing knowledge with regard to gout, beliefs about prescription medications used to treat gout, and trust in the physician. Administrative electronic health records were used to identify prescription drug use and health care utilization. Results Two hundred and forty patients returned surveys out of the 500 contacted for participation. Most were male (80%, white (94%, and aged 65 and older (66%. Only 14 (6% patients were treated by a rheumatologist. Only a minority of patients were aware of common foods known to trigger gout (e.g., seafood [23%], beef [22%], pork [7%], and beer [43%]. Of those receiving a urate-lowering medication, only 12% were aware of the short-term risks of worsening gout with initiation. These deficits were more common in those with active as compared to inactive gout. Conclusion Knowledge deficits about dietary triggers and chronic medications were common, but worse in those with active gout. More attention is needed on patient education on gout and self-management training.

  9. ABCG2 contributes to the development of gout and hyperuricemia in a genome-wide association study.

    Science.gov (United States)

    Chen, Chung-Jen; Tseng, Chia-Chun; Yen, Jeng-Hsien; Chang, Jan-Gowth; Chou, Wen-Cheng; Chu, Hou-Wei; Chang, Shun-Jen; Liao, Wei-Ting

    2018-02-16

    Although many genome-wide association studies (GWASs) of hyperuricemia or gout have been reported, the related genetic factors and the mechanisms from hyperuricemia to gouty attack remain unclear. This study aimed to identify genetic factors and pathogenesis of gout from hyperuricemia by genome-wide association study (GWAS). 747 gout patients, 747 hyperuricemia and 2071 age-matched controls were recruited and analyzed with Affymetrix 650 K chip to find the related genetic variants. The functions of the related genes were investigated in an endothelial cell (EC) with urate crystal stimulation. The GWAS results showed 36 SNPs to be strongly associated with gout compared to controls (all p-values gene had significant associations between gout and controls, between gout and hyperuricemia, and between hyperuricemia and controls (all p-values gene contributed to hyperuricemia but also gout, and that it was involved in the inflammation dysregulation via augmented IL-8 release in EC.

  10. Energy Release in Solar Flares,

    Science.gov (United States)

    1982-10-01

    Plasma Research, Stanford University P. Kaufmanu CRAA/CNPq -Conseiho lacional de Desenvolvimento Cientifico e Tecnologico, Slo Paulo, SP, Brasil D.F...three phases of energy release in solar flares (Sturrock, 1980). However, a recent article by Feldman e a.. (1982) points to a significant

  11. Thermal Fronts in Solar Flares

    Czech Academy of Sciences Publication Activity Database

    Karlický, Marian

    2015-01-01

    Roč. 814, č. 2 (2015), 153/1-153/7 ISSN 0004-637X R&D Projects: GA ČR GAP209/12/0103 Institutional support: RVO:67985815 Keywords : plasmas * Sun flares * radio radiation Subject RIV: BN - Astronomy, Celestial Mechanics, Astrophysics Impact factor: 5.909, year: 2015

  12. Solar Flare Aimed at Earth

    Science.gov (United States)

    2002-01-01

    At the height of the solar cycle, the Sun is finally displaying some fireworks. This image from the Solar and Heliospheric Observatory (SOHO) shows a large solar flare from June 6, 2000 at 1424 Universal Time (10:24 AM Eastern Daylight Savings Time). Associated with the flare was a coronal mass ejection that sent a wave of fast moving charged particles straight towards Earth. (The image was acquired by the Extreme ultaviolet Imaging Telescope (EIT), one of 12 instruments aboard SOHO) Solar activity affects the Earth in several ways. The particles generated by flares can disrupt satellite communications and interfere with power transmission on the Earth's surface. Earth's climate is tied to the total energy emitted by the sun, cooling when the sun radiates less energy and warming when solar output increases. Solar radiation also produces ozone in the stratosphere, so total ozone levels tend to increase during the solar maximum. For more information about these solar flares and the SOHO mission, see NASA Science News or the SOHO home page. For more about the links between the sun and climate change, see Sunspots and the Solar Max. Image courtesy SOHO Extreme ultaviolet Imaging Telescope, ESA/NASA

  13. The Crab Nebula flaring activity

    Energy Technology Data Exchange (ETDEWEB)

    Montani, G., E-mail: giovanni.montani@frascati.enea.it [ENEA – C.R, UTFUS-MAG, via Enrico Fermi 45, I-00044 Frascati (RM) (Italy); Dipartimento di Fisica, Università di Roma “Sapienza”, p.le Aldo Moro 5, I-00185 Roma (Italy); Bernardini, M.G. [INAF – Osservatorio Astronomico di Brera, via Bianchi 46, I-23807 Merate (Italy)

    2014-12-12

    The discovery made by AGILE and Fermi of a short time scale flaring activity in the gamma-ray energy emission of the Crab Nebula is a puzzling and unexpected feature, challenging particle acceleration theory. In the present work we propose the shock-induced magnetic reconnection as a viable mechanism to explain the Crab flares. We postulate that the emitting region is located at ∼10{sup 15} cm from the central pulsar, well inside the termination shock, which is exactly the emitting region size as estimated by the overall duration of the phenomenon ∼1 day. We find that this location corresponds to the radial distance at which the shock-induced magnetic reconnection process is able to accelerate the electrons up to a Lorentz factor ∼10{sup 9}, as required by the spectral fit of the observed Crab flare spectrum. The main merit of the present analysis is to highlight the relation between the observational constraints to the flare emission and the radius at which the reconnection can trigger the required Lorentz factor. We also discuss different scenarios that can induce the reconnection. We conclude that the existence of a plasma instability affecting the wind itself as the Weibel instability is the privileged scenario in our framework.

  14. [Historical Study of the Etymological Form and Translational Process of Gout (Tongfeng,)].

    Science.gov (United States)

    Cho, Jae-Heung; Jung, Jae Young

    2015-08-01

    This study aims to address questions regarding the translation of 'gout' into 'tongfeng ()' in East Asia. To this end, the formation process of the origins, 'gout' from Western medicine and 'tongfeng' from Oriental medicine, and the translational process were investigated through the relevant records and literature dating from the 16th century on. Symptoms associated with gout were originally mentioned in ancient Egypt and various terminologies were used to refer to gout, such as podagra, cheiragra and gonogra. The word 'gout', which is derived from Latin, was used for the first time in the 13th century. The reason for this linguistic alteration is thought to be the need for a comprehensive term to cover the various terms for gout in symptomatic body parts, since it can occur concurrently in many joints. However, it took hundreds of years before gout was independently established as a medical term. In oriental medicine, terms describing diseases with features similar to gout include bibing (), lijiefeng (), baihufeng () and tongfeng (). Among them, the concept of 'tongfeng' has been established since the Jin and Yuan dynasties. The cause, prevention and various treatments for tongfeng were proposed throughout the Ming and Qing dynasties. The early translation of gout and tongfeng in East Asia, respectively, is estimated to have occurred in the 18th century. The first literature translating gout in China was 'An English and Chinese Vocabulary in the Court Dialect (yinghua yunfu lijie, )'. From the publication of this book until the late 19th century, gout was translated into an unfamiliar Chinese character 'Jiu feng jiao ()', likely because the translation was done mostly by foreign missionaries at the time, and they created a new word on the basis of Western medicine instead of researching and translating similar diseases in oriental medicine. In Japan, the first book translating gout was 'A Pocket Dictionary of the English and Japanese Language (Eiwa taiyaku

  15. Flare observation by the satellite 'Hinotori'

    International Nuclear Information System (INIS)

    Tanaka, Toshio

    1981-01-01

    The satellite ''Hinotori'' makes 5 rounds a day and is doing flare observation. The total observation days amounted to 94 days. Among the observed flares, the quiet mode flares were picked up from the reproduced data. The plot of the time variation of flares was obtained for four energy bands, HXM-1 (17 to 40 keV), HXM2 - 7 (over 40 keV), FLM-L (1 to 5 keV) and FLM-H (5 to 12 keV). At present, the judge of flares is made by using hard X-ray of the HXM-1 plot. False signals were completely removed. A large percentage of big flares was collected by Hinotori, eleven X-class flares were recorded. The operation status of ''Hinotori'' has been in good condition. The spin frequency has increased with a constant rate. (Kato, T.)

  16. Formulation of colchicine ointment for the treatment of acute gout.

    Science.gov (United States)

    Maduri, Sairam; Atla, Venkateshwar Reddy

    2012-11-01

    In spite of being the fastest acting drug available for the control of an acute gout attack, colchicine is generally considered a last alternative in gout therapy. This is mainly due to the severe adverse effects associated with its administration through the enteral and parenteral routes, as well as its high risk/benefit ratio. The preparation of dosage forms of colchicine that can be administered by alternative routes is therefore a beneficial exercise. Among the formulable substitute dosage forms of colchicine, its ointment seems to be the best option available due to its ability to deliver the drug transdermally as well as its ease of preparation and evaluation. In this study, we prepared and tested 0.2% and 0.5% colchicine ointments for their effectiveness in delivering colchicine transdermally. Colchicine ointment was prepared using a self-formulated water-in-oil type of emulsion ointment base, with the colchicine dissolved in the water portion of the ointment base. In vitro drug release studies were carried out using the Franz diffusion test apparatus and an ultraviolet (UV)-visible spectrophotometer was used to quantify the drug in the samples. Rabbits were used as test animals for in vivo studies and the blood samples were analysed using the UV-visible spectrophotometer. Colchicine was found to be well-absorbed transdermally, although absorption was not 100%. No side effects were associated with its 0.2% formulation. Ointments containing colchicine in low concentrations may be a feasible and effective treatment option for the prevention and treatment of acute gout attacks.

  17. Statistical study of spatio-temporal distribution of precursor solar flares associated with major flares

    Science.gov (United States)

    Gyenge, N.; Ballai, I.; Baranyi, T.

    2016-07-01

    The aim of the present investigation is to study the spatio-temporal distribution of precursor flares during the 24 h interval preceding M- and X-class major flares and the evolution of follower flares. Information on associated (precursor and follower) flares is provided by Reuven Ramaty High Energy Solar Spectroscopic Imager (RHESSI). Flare list, while the major flares are observed by the Geostationary Operational Environmental Satellite (GOES) system satellites between 2002 and 2014. There are distinct evolutionary differences between the spatio-temporal distributions of associated flares in about one-day period depending on the type of the main flare. The spatial distribution was characterized by the normalized frequency distribution of the quantity δ (the distance between the major flare and its precursor flare normalized by the sunspot group diameter) in four 6 h time intervals before the major event. The precursors of X-class flares have a double-peaked spatial distribution for more than half a day prior to the major flare, but it changes to a lognormal-like distribution roughly 6 h prior to the event. The precursors of M-class flares show lognormal-like distribution in each 6 h subinterval. The most frequent sites of the precursors in the active region are within a distance of about 0.1 diameter of sunspot group from the site of the major flare in each case. Our investigation shows that the build-up of energy is more effective than the release of energy because of precursors.

  18. KEPLER FLARES. II. THE TEMPORAL MORPHOLOGY OF WHITE-LIGHT FLARES ON GJ 1243

    Energy Technology Data Exchange (ETDEWEB)

    Davenport, James R. A.; Hawley, Suzanne L.; Johnson, Emily C.; Peraza, Jesus; Jansen, Tiffany C.; Larsen, Daniel M. [Department of Astronomy, University of Washington, P.O. Box 351580, Seattle, WA 98195 (United States); Hebb, Leslie [Department of Physics, Hobart and William Smith Colleges, 300 Pulteney Street, Geneva, NY 14456 (United States); Wisniewski, John P.; Malatesta, Michael; Keil, Marcus; Silverberg, Steven M.; Scheffler, Matthew S.; Berdis, Jodi R. [HL Dodge Department of Physics and Astronomy, University of Oklahoma, 440 W Brooks Street, Norman, OK 73019 (United States); Kowalski, Adam F. [NASA Goddard Space Flight Center, Code 671, Greenbelt, MD 20771 (United States); Hilton, Eric J., E-mail: jrad@astro.washington.edu [Universe Sandbox, 911 E. Pike Street #333, Seattle, WA 98122 (United States)

    2014-12-20

    We present the largest sample of flares ever compiled for a single M dwarf, the active M4 star GJ 1243. Over 6100 individual flare events, with energies ranging from 10{sup 29} to 10{sup 33} erg, are found in 11 months of 1 minute cadence data from Kepler. This sample is unique for its completeness and dynamic range. We have developed automated tools for finding flares in short-cadence Kepler light curves, and performed extensive validation and classification of the sample by eye. From this pristine sample of flares we generate a median flare template. This template shows that two exponential cooling phases are present during the white-light flare decay, providing fundamental constraints for models of flare physics. The template is also used as a basis function to decompose complex multi-peaked flares, allowing us to study the energy distribution of these events. Only a small number of flare events are not well fit by our template. We find that complex, multi-peaked flares occur in over 80% of flares with a duration of 50 minutes or greater. The underlying distribution of flare durations for events 10 minutes and longer appears to follow a broken power law. Our results support the idea that sympathetic flaring may be responsible for some complex flare events.

  19. KEPLER FLARES. II. THE TEMPORAL MORPHOLOGY OF WHITE-LIGHT FLARES ON GJ 1243

    International Nuclear Information System (INIS)

    Davenport, James R. A.; Hawley, Suzanne L.; Johnson, Emily C.; Peraza, Jesus; Jansen, Tiffany C.; Larsen, Daniel M.; Hebb, Leslie; Wisniewski, John P.; Malatesta, Michael; Keil, Marcus; Silverberg, Steven M.; Scheffler, Matthew S.; Berdis, Jodi R.; Kowalski, Adam F.; Hilton, Eric J.

    2014-01-01

    We present the largest sample of flares ever compiled for a single M dwarf, the active M4 star GJ 1243. Over 6100 individual flare events, with energies ranging from 10 29 to 10 33 erg, are found in 11 months of 1 minute cadence data from Kepler. This sample is unique for its completeness and dynamic range. We have developed automated tools for finding flares in short-cadence Kepler light curves, and performed extensive validation and classification of the sample by eye. From this pristine sample of flares we generate a median flare template. This template shows that two exponential cooling phases are present during the white-light flare decay, providing fundamental constraints for models of flare physics. The template is also used as a basis function to decompose complex multi-peaked flares, allowing us to study the energy distribution of these events. Only a small number of flare events are not well fit by our template. We find that complex, multi-peaked flares occur in over 80% of flares with a duration of 50 minutes or greater. The underlying distribution of flare durations for events 10 minutes and longer appears to follow a broken power law. Our results support the idea that sympathetic flaring may be responsible for some complex flare events

  20. Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout.

    Science.gov (United States)

    White, William B; Saag, Kenneth G; Becker, Michael A; Borer, Jeffrey S; Gorelick, Philip B; Whelton, Andrew; Hunt, Barbara; Castillo, Majin; Gunawardhana, Lhanoo

    2018-03-29

    Cardiovascular risk is increased in patients with gout. We compared cardiovascular outcomes associated with febuxostat, a nonpurine xanthine oxidase inhibitor, with those associated with allopurinol, a purine base analogue xanthine oxidase inhibitor, in patients with gout and cardiovascular disease. We conducted a multicenter, double-blind, noninferiority trial involving patients with gout and cardiovascular disease; patients were randomly assigned to receive febuxostat or allopurinol and were stratified according to kidney function. The trial had a prespecified noninferiority margin of 1.3 for the hazard ratio for the primary end point (a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or unstable angina with urgent revascularization). In total, 6190 patients underwent randomization, received febuxostat or allopurinol, and were followed for a median of 32 months (maximum, 85 months). The trial regimen was discontinued in 56.6% of patients, and 45.0% discontinued follow-up. In the modified intention-to-treat analysis, a primary end-point event occurred in 335 patients (10.8%) in the febuxostat group and in 321 patients (10.4%) in the allopurinol group (hazard ratio, 1.03; upper limit of the one-sided 98.5% confidence interval [CI], 1.23; P=0.002 for noninferiority). All-cause and cardiovascular mortality were higher in the febuxostat group than in the allopurinol group (hazard ratio for death from any cause, 1.22 [95% CI, 1.01 to 1.47]; hazard ratio for cardiovascular death, 1.34 [95% CI, 1.03 to 1.73]). The results with regard to the primary end point and all-cause and cardiovascular mortality in the analysis of events that occurred while patients were being treated were similar to the results in the modified intention-to-treat analysis. In patients with gout and major cardiovascular coexisting conditions, febuxostat was noninferior to allopurinol with respect to rates of adverse cardiovascular events. All-cause mortality and

  1. Fructose malabsorption in people with and without gout: A case-control study.

    Science.gov (United States)

    Batt, Caitlin; Fanning, Niamh; Drake, Jill; Frampton, Christopher; Gearry, Richard B; Stamp, Lisa K

    2017-10-01

    Higher fructose intake has been associated with hyperuricaemia and gout. Some individuals malabsorb fructose in the small intestine. The aims of this study were to determine the rate of fructose malabsorption and the effects of gout and fructose malabsorption on serum urate in people with and without gout. A total of 100 people with gout (cases) were age and gender matched with one control without gout. After a low fructose diet, fructose malabsorption was measured using a hydrogen and methane breath test with a 35g fructose load. In a subgroup of 35 cases and 35 controls, serum urate response to the fructose load over 240 minutes was measured. There was no significant difference in the rate of fructose malabsorption between cases and controls (48% vs. 52%; p = 0.67). Cases had a significantly lower mean (SEM) serum urate cumulative incremental concentration from baseline-240 minutes (iAUC 0-240 ) compared to controls 0.97 (0.56) vs. 4.78 (0.55); p gout. Allopurinol inhibits the increase in serum urate induced by a fructose load suggesting that people with gout receiving allopurinol may not need to restrict dietary intake of fructose. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Alteration in plasma free amino acid levels and its association with gout.

    Science.gov (United States)

    Mahbub, M H; Yamaguchi, Natsu; Takahashi, Hidekazu; Hase, Ryosuke; Amano, Hiroki; Kobayashi-Miura, Mikiko; Kanda, Hideyuki; Fujita, Yasuyuki; Yamamoto, Hiroshi; Yamamoto, Mai; Kikuchi, Shinya; Ikeda, Atsuko; Kageyama, Naoko; Nakamura, Mina; Ishimaru, Yasutaka; Sunagawa, Hiroshi; Tanabe, Tsuyoshi

    2017-03-16

    Studies on the association of plasma-free amino acids with gout are very limited and produced conflicting results. Therefore, we sought to explore and characterize the plasma-free amino acid (PFAA) profile in patients with gout and evaluate its association with the latter. Data from a total of 819 subjects (including 34 patients with gout) undergoing an annual health examination program in Shimane, Japan were considered for this study. Venous blood samples were collected from the subjects and concentrations of 19 plasma amino acids were determined by high-performance liquid chromatography-electrospray ionization-mass spectrometry. Student's t-test was applied for comparison of variables between patient and control groups. The relationships between the presence or absence of gout and individual amino acids were investigated by logistic regression analysis controlling for the effects of potential demographic confounders. Among 19 amino acids, the levels of 10 amino acids (alanine, glycine, isoleucine, leucine, methionine, phenylalanine, proline, serine, tryptophan, valine) differed significantly (P gout. The observed significant changes in PFAA profiles may have important implications for improving our understanding of pathophysiology, diagnosis and prevention of gout. The findings of this study need further confirmation in future large-scale studies involving a larger number of patients with gout.

  3. An optimal ultrasonographic diagnostic test for early gout: A prospective controlled study.

    Science.gov (United States)

    Norkuviene, Eleonora; Petraitis, Mykolas; Apanaviciene, Indre; Virviciute, Dalia; Baranauskaite, Asta

    2017-08-01

    Objective To identify the optimal sites for classification of early gout by ultrasonography. Methods Sixty patients with monosodium urate crystal-proven gout (25 with early gout [≤2-year symptom duration], 35 with late gout [>2-year symptom duration], and 36 normouricemic healthy controls) from one centre were prospectively evaluated. Standardized blinded ultrasound examination of 36 joints and the triceps and patellar tendons was performed to identify tophi and the double contour (DC) sign. Results Ultrasonographic sensitivity was lower in early than late gout. Binary logistic regression analysis showed that two ultrasonographic signs (tophi in the first metatarsophalangeal joint [odds ratio, 16.46] and the DC sign in the ankle [odds ratio, 25.18]) significantly contributed to the final model for early gout diagnosis (sensitivity and specificity of 84% and 81%, respectively). The inter-reader reliability kappa value for the DC sign and tophi was 0.712. Conclusions Four-joint investigation (both first metatarsophalangeal joints for tophi and both ankles for the DC sign) is feasible and reliable and could be proposed as a screening test for early ultrasonographic gout classification in daily practice.

  4. Investigation of serum biomarkers in primary gout patients using iTRAQ-based screening.

    Science.gov (United States)

    Ying, Ying; Chen, Yong; Zhang, Shun; Huang, Haiyan; Zou, Rouxin; Li, Xiaoke; Chu, Zanbo; Huang, Xianqian; Peng, Yong; Gan, Minzhi; Geng, Baoqing; Zhu, Mengya; Ying, Yinyan; Huang, Zuoan

    2018-03-21

    Primary gout is a major disease that affects human health; however, its pathogenesis is not well known. The purpose of this study was to identify biomarkers to explore the underlying mechanisms of primary gout. We used the isobaric tags for relative and absolute quantitation (iTRAQ) technique combined with liquid chromatography-tandem mass spectrometry to screen differentially expressed proteins between gout patients and controls. We also identified proteins potentially involved in gout pathogenesis by analysing biological processes, cellular components, molecular functions, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways and protein-protein interactions. We further verified some samples using enzyme-linked immunosorbent assay (ELISA). Statistical analyses were carried out using SPSS v. 20.0 and ROC (receiver operating characterstic) curve analyses were carried out using Medcalc software. Two-sided p-values gout than in controls (p=0.023). iTRAQ technology was useful in the selection of differentially expressed proteins from proteomes, and provides a strong theoretical basis for the study of biomarkers and mechanisms in primary gout. In addition, TBB4A protein may be associated with primary gout.

  5. Tumor necrosis factor-alpha and interleukin-4 gene polymorphisms in Chinese patients with gout.

    Science.gov (United States)

    Chen, M-L; Tsai, F-J; Tsai, C-H; Huang, C-M

    2007-01-01

    The purpose of this study was to examine whether polymorphisms of interleukin-4 (IL-4) (promoter-590 and intron 3) and tumor necrosis factor-alpha (TNF-alpha) promoter-308 genes are markers of susceptibility to or clinical manifestations of gout in Taiwanese patients. The study included 196 Taiwanese patients with gout and 103 unrelated healthy control subjects living in central Taiwan. Polymorphisms of the IL-4 (promoter-590 and intron 3) and TNF-alpha (promoter-308) genes were typed from genomic DNA. Allelic frequencies and carriage rates were then compared between gout patients and control subjects. The correlation between allelic frequencies, carriage rates and clinical manifestations of gout were evaluated. No significant differences were observed in the allelic frequencies and carriage rates of the IL-4 (promoter-590 and intron 3) and TNF-alpha gene polymorphisms between patients with gout and healthy control subjects. Furthermore, the IL-4 (promoter-590 and intron 3) and TNF-alpha genotypes were not found to be associated with the clinical and laboratory profiles in gout patients. However, there was a significant difference in the TNF-alphapolymorphism genotype between patients with and without hypertriglyceridemia (P=0.001, xi2=11.47, OR=10.3, 95%CI=3.57-29.7). The results of our study suggest that polymorphisms of the IL-4 (promoter-590 and intron 3) and TNF-alpha promoter-308 genes are not related to gout in Chinese patients in Taiwan.

  6. Genetics of hyperuricemia and gout: implications for the present and future.

    Science.gov (United States)

    George, Ronald L; Keenan, Robert T

    2013-02-01

    Gout is the most common inflammatory arthropathy and occurs in the setting of elevated serum urate levels. Gout is also known to be associated with multiple comorbidities including cardiovascular disease and the metabolic syndrome. Recent advances in research have increased our understanding and improved our knowledge of the pathophysiology of gout. Genome-wide association studies have permitted the identification of several new and common genetic factors that contribute to hyperuricemia and gout. Most of these are involved with the renal urate transport system (the uric acid transportasome), generally considered the most influential regulator of serum urate homeostasis. Thus far, SCL22A12, SCL2A9, and GLUT9 have been found to have the greatest variation and most influence on serum urate levels. However, genetics are only a part of the explanation in the development of hyperuricemia and gout. As results have been mixed, the role of known urate influential genes in gout's associated comorbidities remains unclear. Regardless, GWAS findings have expanded our understanding of the pathophysiology of hyperuricemia and gout, and will likely play a role in the development of future therapies and treatment of this ancient disease.

  7. Coffee consumption and risk of incident gout in women: the Nurses' Health Study.

    Science.gov (United States)

    Choi, Hyon K; Curhan, Gary

    2010-10-01

    Coffee is one of the most widely consumed beverages in the world and may affect the risk of gout via various mechanisms, but prospective data on the relation between coffee intake and the risk of incident gout are limited. Over a 26-y period, we prospectively examined the relation between coffee intake and risk of incident gout in 89,433 female participants in the Nurses' Health Study. We assessed the consumption of coffee, decaffeinated coffee, tea, and total caffeine in participants every 2-4 y through validated questionnaires. We used a supplementary questionnaire to ascertain whether participants met the survey criteria of the American College of Rheumatology for gout. During the 26 y of follow-up, we documented 896 confirmed incident cases of gout. There was an inverse association between higher coffee intake and the risk of gout. The multivariate relative risks (RRs) for incident gout according to coffee-consumption categories [ie, 0, 1-237, 238-947, and ≥948 mL coffee/d (237 mL = one 8-ounce cup)] were 1.00, 0.97, 0.78 (95% CI: 0.64, 0.95), and 0.43 (95% CI: 0.30, 0.61; P for trend coffee, the multivariate RRs according to consumption categories (0, 1-237, and ≥237 mL decaffeinated coffee/d) were 1.00, 1.02, and 0.77 (95% CI: 0.63, 0.95; P for trend = 0.02), respectively. There was an inverse association between total caffeine from all sources and the risk of gout; the multivariate RR of the highest quintile compared with the lowest quintile was 0.52 (95% CI: 0.41, 0.68; P for trend coffee consumption is associated with a lower risk of incident gout in women.

  8. Maori experiences and perceptions of gout and its treatment: a kaupapa Maori qualitative study

    Directory of Open Access Journals (Sweden)

    Te Karu L

    2013-09-01

    Full Text Available INTRODUCTION: The prevalence of gout among Maori is one of the highest in the world. This study explores the perceptions, understanding and treatment of gout among Maori. METHODS: A qualitative general inductive approach was used, guided by kaupapa Maori principles. Participants included 12 Maori aged 48-79 years with gout. Semi-structured interviews were undertaken, taped and transcribed. Themes were identified from transcripts. FINDINGS: Participants described overwhelming sufferance due to gout, which was sometimes considered inevitable. All participants believed or had been informed that gout is caused by food and/or drink. This led to feelings of self-blame and blame from partners and employers. Whanau (family were a resource for information and a support when independence was limited. Rongoa (traditional medicine played a role in the lives of rural but not urban participants. Many reported stoicism, putting up with pain and putting others before themselves, as the 'Maori way'. Medicines used for gout management were predominantly non-steroidal anti-inflammatory drugs, colchicine and prednisone, with allopurinol only playing a role late in the disease. Medications were often poorly understood and consequently improperly used. Relationships with health professionals were important, but cultural, financial and time barriers impaired access and understanding. Gout had a huge, negative impact on the lives of participants. CONCLUSION: The quality of lives of many people with gout could be improved by better understanding through educational campaigns for health professionals and the community. Culturally sensitive health care systems and a paradigm shift in gout management and early preventive treatment are needed.

  9. Relation of temperature and humidity to the risk of recurrent gout attacks.

    Science.gov (United States)

    Neogi, Tuhina; Chen, Clara; Niu, Jingbo; Chaisson, Christine; Hunter, David J; Choi, Hyon; Zhang, Yuqing

    2014-08-15

    Gout attack risk may be affected by weather (e.g., because of volume depletion). We therefore examined the association of temperature and humidity with the risk of recurrent gout attacks by conducting an internet-based case-crossover study in the United States (in 2003-2010) among subjects with a diagnosis of gout who had 1 or more attacks during 1 year of follow-up. We examined the association of temperature and humidity over the prior 48 hours with the risk of gout attacks using a time-stratified approach and conditional logistic regression. Among 632 subjects with gout, there was a significant dose-response relationship between mean temperature in the prior 48 hours and the risk of subsequent gout attack (P = 0.01 for linear trend). Higher temperatures were associated with approximately 40% higher risk of gout attack compared with moderate temperatures. There was a reverse J-shaped relationship between mean relative humidity and the risk of gout attacks (P = 0.03 for quadratic trend). The combination of high temperature and low humidity had the greatest association (odds ratio = 2.04, 95% confidence interval: 1.26, 3.30) compared with moderate temperature and relative humidity. Thus, high ambient temperature and possibly extremes of humidity were associated with an increased risk of gout attack, despite the likelihood that individuals are often in climate-controlled indoor environments. © The Author 2014. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. Value of ultrasonography in the diagnosis of gout in patients presenting with acute arthritis.

    Science.gov (United States)

    Pattamapaspong, Nuttaya; Vuthiwong, Withawat; Kanthawang, Thanat; Louthrenoo, Worawit

    2017-06-01

    To evaluate the value of ultrasonographic features of crystal deposition for diagnosing gout in patients presenting with acute arthritis. Ultrasound scanning of the most inflamed joint was performed on 89 consecutively enrolled patients with acute arthritis. Two radiologists independently reviewed the ultrasound images, and a consensus was achieved with a third radiologist when the interpretations of four key ultrasound features of gout differed. Arthrocentesis and crystal analysis using compensated polarized light microscopy of aspirates are considered the gold standards for gout diagnosis. Fifty-three (60%) patients had gout, whereas the remaining 36 (40%) had non-gout arthritis. The mean serum uric acid level was 7.1 mg/dl in patients with gout and 4.7 mg/dl in patients with non-gout arthritis. Three US features differed significantly (p non-gout arthritis: the double contour sign (42 vs. 8%, respectively), intra-articular aggregates (58 vs. 8%), and tophi (40 vs. 0%). No statistically significant differences in detecting intra-tendinous aggregates (32 vs. 17%, p = 0.14) were observed. The sensitivity and specificity of the double contour sign were 42 and 92%, respectively; those of the intra-articular aggregates were 58 and 92%; and those of tophi were 40 and 100%. The positive predictive values for these three features ranged from 88 to 100%, whereas the negative predictive values ranged from 52 to 60%. When the prevalence is high, these three ultrasound features may be a useful adjunct in the diagnosis of acute gout, particularly when specialized microscopic techniques are not available.

  11. Arterial hypertension and gout: the current state of the problem (literature review

    Directory of Open Access Journals (Sweden)

    Kuzmina A.P.

    2017-12-01

    Full Text Available An important aspect of the family doctor's work is the management of patients with comorbid pathology. Pathogenetic mechanisms of interrelation, as well as the bi-directionality of the association of arterial hypertension and gout are actively studied. By data analysis of literature, in many developed countries of the world there are shortcomings in the management of patients with gout at the primary stage. There is a need to improve the quality of management and prescription of combinations of basic therapy drugs for the treatment of patients with hypertension in combination with gout at the primary stage.

  12. Development of Preliminary Remission Criteria for Gout Using Delphi and 1000Minds® Consensus Exercises

    DEFF Research Database (Denmark)

    de Lautour, Hugh; Taylor, William J; Adebajo, Ade

    2016-01-01

    OBJECTIVES: The aim of this study was to establish consensus for potential remission criteria for use in clinical trials of gout. METHODS: Experts (n=88) in gout from multiple countries were invited to participate in a web-based questionnaire study. Three rounds of Delphi consensus exercises were...... months (51%) and one year (49%). In the discrete choice experiment, there was a preference towards 12 months as a timeframe for remission. CONCLUSION: These consensus exercises have identified domains and provisional definitions for gout remission criteria. Based on the results of these exercises...

  13. Functional non-synonymous variants of ABCG2 and gout risk.

    Science.gov (United States)

    Stiburkova, Blanka; Pavelcova, Katerina; Zavada, Jakub; Petru, Lenka; Simek, Pavel; Cepek, Pavel; Pavlikova, Marketa; Matsuo, Hirotaka; Merriman, Tony R; Pavelka, Karel

    2017-11-01

    Common dysfunctional variants of ATP binding cassette subfamily G member 2 (Junior blood group) (ABCG2), a high-capacity urate transporter gene, that result in decreased urate excretion are major causes of hyperuricemia and gout. In the present study, our objective was to determine the frequency and effect on gout of common and rare non-synonymous and other functional allelic variants in the ABCG2 gene. The main cohort recruited from the Czech Republic consisted of 145 gout patients; 115 normouricaemic controls were used for comparison. We amplified, directly sequenced and analysed 15 ABCG2 exons. The associations between genetic variants and clinical phenotype were analysed using the t-test, Fisher's exact test and a logistic and linear regression approach. Data from a New Zealand Polynesian sample set and the UK Biobank were included for the p.V12M analysis. In the ABCG2 gene, 18 intronic (one dysfunctional splicing) and 11 exonic variants were detected: 9 were non-synonymous (2 common, 7 rare including 1 novel), namely p.V12M, p.Q141K, p.R147W, p.T153M, p.F373C, p.T434M, p.S476P, p.D620N and p.K360del. The p.Q141K (rs2231142) variant had a significantly higher minor allele frequency (0.23) in the gout patients compared with the European-origin population (0.09) and was significantly more common among gout patients than among normouricaemic controls (odds ratio = 3.26, P gout (42 vs 48 years, P = 0.0143) and a greater likelihood of a familial history of gout (41% vs 27%, odds ratio = 1.96, P = 0.053). In a meta-analysis p.V12M exerted a protective effect from gout (P gout. Non-synonymous allelic variants of ABCG2 had a significant effect on earlier onset of gout and the presence of a familial gout history. ABCG2 should thus be considered a common and significant risk factor for gout. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  14. Identification of rs671, a common variant of ALDH2, as a gout susceptibility locus

    OpenAIRE

    Sakiyama, Masayuki; Matsuo, Hirotaka; Nakaoka, Hirofumi; Yamamoto, Ken; Nakayama, Akiyoshi; Nakamura, Takahiro; Kawai, Sayo; Okada, Rieko; Ooyama, Hiroshi; Shimizu, Toru; Shinomiya, Nariyoshi

    2016-01-01

    Gout is a common disease resulting from hyperuricemia. Recently, a genome-wide association study identified an association between gout and a single nucleotide polymorphism (SNP) rs2188380, located on an intergenic region between MYL2 and CUX2 on chromosome 12. However, other genes around rs2188380 could possibly be gout susceptibility genes. Therefore, we performed a fine-mapping study of the MYL2-CUX2 region. From 8,595 SNPs in the MYL2-CUX2 region, 9 tag SNPs were selected, and genotyping ...

  15. Common variant of ALPK1 is not associated with gout: a replication study

    OpenAIRE

    Chiba, Toshinori; Matsuo, Hirotaka; Sakiyama, Masayuki; Nakayama, Akiyoshi; Shimizu, Seiko; Wakai, Kenji; Suma, Shino; Nakashima, Hiroshi; Sakurai, Yutaka; Shimizu, Toru; Ichida, Kimiyoshi; Shinomiya, Nariyoshi

    2014-01-01

    Gout is one of the most kinds of common inflammatory arthritis as a consequence of hyperuricemia. Alpha-protein kinase 1 (ALPK1) gene locates in a gout-susceptibility locus on chromosome 4q21?31, and encodes ALPK1 protein which plays a pivotal role in the phosphorylation of myosin 1. In the previous genetic study of Taiwanese populations, 3 single nucleotide polymorphisms (SNPs), rs11726117, rs231247 and rs231253, in ALPK1 gene were reported to have a significant association with gout. Howeve...

  16. Epidermal growth factor gene is a newly identified candidate gene for gout

    OpenAIRE

    Lin Han; Chunwei Cao; Zhaotong Jia; Shiguo Liu; Zhen Liu; Ruosai Xin; Can Wang; Xinde Li; Wei Ren; Xuefeng Wang; Changgui Li

    2016-01-01

    Chromosome 4q25 has been identified as a genomic region associated with gout. However, the associations of gout with the genes in this region have not yet been confirmed. Here, we performed two-stage analysis to determine whether variations in candidate genes in the 4q25 region are associated with gout in a male Chinese Han population. We first evaluated 96 tag single nucleotide polymorphisms (SNPs) in eight inflammatory/immune pathway- or glucose/lipid metabolism-related genes in the 4q25 re...

  17. Effects of multiple genetic loci on the pathogenesis from serum urate to gout

    OpenAIRE

    Zheng Dong; Jingru Zhou; Shuai Jiang; Yuan Li; Dongbao Zhao; Chengde Yang; Yanyun Ma; Yi Wang; Hongjun He; Hengdong Ji; Yajun Yang; Xiaofeng Wang; Xia Xu; Yafei Pang; Hejian Zou

    2017-01-01

    Gout is a common arthritis resulting from increased serum urate, and many loci have been identified that are associated with serum urate and gout. However, their influence on the progression from elevated serum urate levels to gout is unclear. This study aims to explore systematically the effects of genetic variants on the pathogenesis in approximately 5,000 Chinese individuals. Six genes (PDZK1, GCKR, TRIM46, HNF4G, SLC17A1, LRRC16A) were determined to be associated with serum urate (P FDR?

  18. Genetic variation in WDR1 is associated with gout risk and gout-related metabolic indices in the Han Chinese population.

    Science.gov (United States)

    Liu, L J; Zhang, X Y; He, N; Liu, K; Shi, X G; Feng, T; Geng, T T; Yuan, D Y; Kang, L L; Jin, T B

    2016-04-28

    Gout is the most common form of inflammatory arthritis affecting men, and current evidence suggests that genetic factors contribute to its progression. As a previous study identified that WD40 repeat protein 1 (WDR1) is associated with gout in populations of European descent, we sought to investigate its relationship with this disease in the Han Chinese population. We genotyped six WDR1 single nucleotide polymorphisms in 143 gout cases and 310 controls using Sequenom MassARRAY technology. The SPSS 16.0 software was used to perform statistical analyses. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by unconditional logistic regression, with adjustments for age and gender. In an analysis using an allelic model, we identified that the minor alleles of rs3756230 (OR = 0.64, 95%CI = 0.450-0.911, P = 0.013) and rs12498927 (OR = 1.377, 95%CI = 1.037-1.831, P = 0.027) were associated with gout risk. In addition, we found that the "A/A" genotype of rs12498927 was associated with increased risk of gout under codominant (OR = 2.22, 95%CI = 1.12- 4.40, P = 0.042) and recessive models (OR = 2.24, 95%CI = 1.20-4.17, P = 0.012). We also determined the "A/G" genotype of rs12498927 to be significantly associated with higher urea levels in gout patients (P = 0.017). Our data shed new light on the association between genetic variations in the WDR1 gene and gout susceptibility in the Han Chinese population.

  19. The Effects of Flare Definitions on the Statistics of Derived Flare Distrubtions

    Science.gov (United States)

    Ryan, Daniel; Dominique, Marie; Seaton, Daniel B.; Stegen, Koen; White, Arthur

    2016-05-01

    The statistical examination of solar flares is crucial to revealing their global characteristics and behaviour. However, statistical flare studies are often performed using standard but basic flare detection algorithms relying on arbitrary thresholds which may affect the derived flare distributions. We explore the effect of the arbitrary thresholds used in the GOES event list and LYRA Flare Finder algorithms. We find that there is a small but significant relationship between the power law exponent of the GOES flare peak flux frequency distribution and the algorithms’ flare start thresholds. We also find that the power law exponents of these distributions are not stable but appear to steepen with increasing peak flux. This implies that the observed flare size distribution may not be a power law at all. We show that depending on the true value of the exponent of the flare size distribution, this deviation from a power law may be due to flares missed by the flare detection algorithms. However, it is not possible determine the true exponent from GOES/XRS observations. Additionally we find that the PROBA2/LYRA flare size distributions are clearly non-power law. We show that this is consistent with an insufficient degradation correction which causes LYRA absolute irradiance values to be unreliable. This means that they should not be used for flare statistics or energetics unless degradation is adequately accounted for. However they can be used to study time variations over shorter timescales and for space weather monitoring.

  20. Tibialis Posterior Tenosynovitis: A Unique Musculoskeletal Manifestation of Gout.

    Science.gov (United States)

    Shupper, Peter; Stitik, Todd P

    2018-02-01

    Extra-articular manifestations of gout can present in several ways, including tenosynovitis. We present a rare case of acute tibialis posterior gouty tenosynovitis. An 82-year-old man with a history of well-controlled gout presented with acute onset of left ankle pain, occurring without inciting event. The medial ankle was slightly erythematous with moderate dorsal-medial swelling and mild dorsal-lateral swelling, with severe tenderness to palpation over the medial retro-malleolar region. Range of motion and manual muscle testing were pain limited throughout. Ultrasound examination revealed a left posterior tibialis tendon sheath tenosynovitis with effusion and overlying soft tissue edema. Tendon sheath aspirate revealed sodium urate crystals and a white blood cell count of 6400/μL. Tendon sheath injection with a mixture of 1% lidocaine and dexamethasone 4 mg resulted in symptom resolution. Repeat ultrasound examination demonstrated no evidence of tibialis posterior tendon sheath effusion. This case is unique not only because acute gouty posterior tibialis tenosynovitis is very rare, particularly in a normouricemic individual, but also because the sonographic evidence of gouty infiltration into the posterior tibialis tendon and overlying subcutaneous tissue considerably aided in arriving at the correct diagnosis in a timely manner.

  1. Deep Flare Net (DeFN) Model for Solar Flare Prediction

    Science.gov (United States)

    Nishizuka, N.; Sugiura, K.; Kubo, Y.; Den, M.; Ishii, M.

    2018-05-01

    We developed a solar flare prediction model using a deep neural network (DNN) named Deep Flare Net (DeFN). This model can calculate the probability of flares occurring in the following 24 hr in each active region, which is used to determine the most likely maximum classes of flares via a binary classification (e.g., ≥M class versus statistically predict flares, the DeFN model was trained to optimize the skill score, i.e., the true skill statistic (TSS). As a result, we succeeded in predicting flares with TSS = 0.80 for ≥M-class flares and TSS = 0.63 for ≥C-class flares. Note that in usual DNN models, the prediction process is a black box. However, in the DeFN model, the features are manually selected, and it is possible to analyze which features are effective for prediction after evaluation.

  2. Search for relation between flares and photometric variability outside of flares in EV Lac

    International Nuclear Information System (INIS)

    Rojzman, G.Sh.

    1984-01-01

    The observations of the flare star EV Lac in July-September 1981 have confirmed the existence of photometric variability outside the flares during the night. It was found that, as a rule, a slow increase of brightness in U and B bands during 1-2 hours preceded the flares. It is suggested that the variability outside the flares is the result of the variability of chpomospheric emission lines and continuum that are emitted by the chromospheric preflare formations

  3. Dwarf Star Erupts in Giant Flare

    Science.gov (United States)

    2005-01-01

    This movie taken by NASA'S Galaxy Evolution Explorer shows one of the largest flares, or star eruptions, ever recorded at ultraviolet wavelengths. The star, called GJ 3685A, just happened to be in the Galaxy Evolution Explorer's field of view while the telescope was busy observing galaxies. As the movie demonstrates, the seemingly serene star suddenly exploded once, then even more intensely a second time, pouring out in total about one million times more energy than a typical flare from our Sun. The second blast of light constituted an increase in brightness by a factor of at least 10,000. Flares are huge explosions of energy stemming from a single location on a star's surface. They are caused by the brief destruction of a star's magnetic fields. Many types of stars experience them, though old, small, rapidly rotating 'red dwarfs' like GJ 3685A tend to flare more frequently and dramatically. These stars, called flare stars, can experience powerful eruptions as often as every few hours. Younger stars, in general, also erupt more often. One of the reasons astronomers study flare stars is to gain a better picture and history of flare events taking place on the Sun. A preliminary analysis of the GJ 3685A flare shows that the mechanisms underlying stellar eruptions may be more complex than previously believed. Evidence for the two most popular flare theories was found. Though this movie has been sped up (the actual flare lasted about 20 minutes), time-resolved data exist for each one-hundredth of a second. These observations were taken at 2 p.m. Pacific time, April 24, 2004. In the still image, the time sequence starts in the upper left panel, continues in the upper right, then moves to the lower left and ends in the lower right. The circular and linear features that appear below and to the right of GJ 3685A during the flare event are detector artifacts caused by the extreme brightness of the flare.

  4. [Clinical characteristics and renal uric acid excretion in early-onset gout patients].

    Science.gov (United States)

    Li, Q H; Liang, J J; Chen, L X; Mo, Y Q; Wei, X N; Zheng, D H; Dai, L

    2018-03-01

    Objective: To investigate clinical characteristics and renal uric acid excretion in early-onset gout patients. Methods: Consecutive inpatients with primary gout were recruited between 2013 and 2017. The patients with gout onset younger than 30 were defined as early-onset group while the others were enrolled as control group. Clinical characteristics and uric acid (UA) indicators were compared between two groups. Results: Among 202 recruited patients, the early-onset group included 36 patients (17.8%). Compared with control group, the early-onset group presented more patients with obesity [13 patients (36.1%) vs. 22 patients (13.3%), Pgout early onset. Conclusion: The gout patients with early-onset younger than 30 present high serum and glomerular load of uric acid which might be due to obesity and relative under-excretion of renal uric acid.

  5. Tophaceous Gout in an Anorectic Patient Visualized by Dual Energy Computed Tomography (DECT)

    DEFF Research Database (Denmark)

    Christensen, Heidi Dahl; Sheta, Hussam; Birger Morillon, Melanie

    2016-01-01

    BACKGROUND Gout is characterized by deposition of uric acid crystals (monosodium urate) in tissues and fluids. This can cause acute inflammatory arthritis. The 2015 ACR/EULAR criteria for the diagnosis of gout include dual energy computed tomography (DECT)-demonstrated monosodium urate crystals...... known to have anorexia nervosa. During our clinical examination, we detected plenty of tophi on both hands, but no swollen joints. The diagnosis of gout was made by visualizing crystals in a biopsy from a tophus. The first line of treatment was allopurinol, the second line was rasburicase...... and soft tissue. CONCLUSIONS DECT is an imaging modality useful to assess urate crystal deposits at diagnosis of gout and could be considered during treatment evaluation. Lack of adherence to treatment should be considered when P-urate values vary significantly and when DECT scans over years persistently...

  6. Diagnostic Arthrocentesis for Suspicion of Gout Is Safe and Well Tolerated

    DEFF Research Database (Denmark)

    Taylor, William J; Fransen, Jaap; Dalbeth, Nicola

    2016-01-01

    OBJECTIVE: To determine the frequency of adverse events of diagnostic arthrocentesis in patients with possible gout. METHODS: Consecutive patients underwent arthrocentesis and were evaluated at 6 weeks to determine adverse events. The 95% CI were obtained by bootstrapping. RESULTS: Arthrocentesis...

  7. Solar flares through electric current interaction

    International Nuclear Information System (INIS)

    De Jager, C.

    1988-01-01

    The fundamental hypothesis by Alfven and Carlqvist (1967) that solar flares are related to electrical currents in the solar chromosphere and low corona is investigated in the light of modern observations. The authors confirm the important role of currents in solar flares. There must be tens of such current loops (flux threads) in any flare, and this explains the hierarchy of bursts in flares. The authors summarize quantitative data on energies, numbers of particles involved and characteristic times. A special case is the high-energy flare: this one may originate in the same way as less energetic ones, but it occurs in regions with higher magnetic field strength. Because of the high particle energies involved their emission seats live only very briefly; hence the area of emission coincides virtually with the seat of the instability. These flares are therefore the best examples for studying the primary instability leading to the flare. Finally, the authors compare the merits of the original Alfven-Carlqvist idea (that flares originate by current interruption) with the one that they are due to interaction (reconnection) between two or more fluxthreads. The authors conclude that a final decision cannot yet by made, although the observed extremely short time constants of flare bursts seem to demand a reconnection-type instability rather than interruption of a circuit

  8. Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies.

    Science.gov (United States)

    Nielsen, Sabrina M; Bartels, Else M; Henriksen, Marius; Wæhrens, Eva E; Gudbergsen, Henrik; Bliddal, Henning; Astrup, Arne; Knop, Filip K; Carmona, Loreto; Taylor, William J; Singh, Jasvinder A; Perez-Ruiz, Fernando; Kristensen, Lars E; Christensen, Robin

    2017-11-01

    Weight loss is commonly recommended for gout, but the magnitude of the effect has not been evaluated in a systematic review. The aim of this systematic review was to determine benefits and harms associated with weight loss in overweight and obese patients with gout. We searched six databases for longitudinal studies, reporting the effect of weight loss in overweight/obese gout patients. Risk of bias was assessed using the tool Risk of Bias in Non-Randomised Studies of Interventions. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation. From 3991 potentially eligible studies, 10 were included (including one randomised trial). Interventions included diet with/without physical activity, bariatric surgery, diuretics, metformin or no intervention. Mean weight losses ranged from 3 kg to 34 kg. Clinical heterogeneity in study characteristics precluded meta-analysis. The effect on serum uric acid (sUA) ranged from -168 to 30 μmol/L, and 0%-60% patients achieving sUA target (gout attacks. Two studies indicated dose-response relationship for sUA, achieving sUA target and gout attacks. At short term, temporary increased sUA and gout attacks tended to occur after bariatric surgery. The available evidence is in favour of weight loss for overweight/obese gout patients, with low, moderate and low quality of evidence for effects on sUA, achieving sUA target and gout attacks, respectively. At short term, unfavourable effects may occur. Since the current evidence consists of a few studies (mostly observational) of low methodological quality, there is an urgent need to initiate rigorous prospective studies (preferably randomised controlled trials). PROSPERO, CRD42016037937. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  9. Comorbidities in patients with gout prior to and following diagnosis: case-control study

    Science.gov (United States)

    Kuo, Chang-Fu; Grainge, Matthew J; Mallen, Christian; Zhang, Weiya; Doherty, Michael

    2016-01-01

    Objectives To determine the burden of comorbidities in patients with gout at diagnosis and the risk of developing new comorbidities post diagnosis. Methods There were 39 111 patients with incident gout and 39 111 matched controls identified from the UK Clinical Practice Research Data-link. The risk of comorbidity before (ORs) and after the diagnosis of gout (HRs) were estimated, adjusted for age, sex, diagnosis year, body mass index, smoking and alcohol consumption. Results Gout was associated with adjusted ORs (95% CIs) of 1.39 (1.34 to 1.45), 1.89 (1.76 to 2.03) and 2.51 (2.19 to 2.86) for the Charlson index of 1–2, 3–4 and ≥5, respectively. Cardiovascular and genitourinary diseases, in addition to hyperlipidaemia, hypothyroidism, anaemia, psoriasis, chronic pulmonary diseases, osteoarthritis and depression, were associated with a higher risk for gout. Gout was also associated with an adjusted HR (95% CI) of 1.41 (1.34 to 1.48) for having a Charlson index ≥1. Median time to first comorbidity was 43 months in cases and 111 months in controls. Risks for incident comorbidity were higher in cardiovascular, genitourinary, metabolic/endocrine and musculoskeletal diseases, in addition to liver diseases, hemiplegia, depression, anaemia and psoriasis in patients with gout. After additionally adjusting for all comorbidities at diagnosis, gout was associated with a HR (95% CI) for all-cause mortality of 1.13 (1.08 to 1.18; pgout have worse pre-existing health status at diagnosis and the risk of incident comorbidity continues to rise following diagnosis. The range of associated comorbidities is broader than previously recognised and merits further evaluation. PMID:25398375

  10. Case report 536: Chronic tophaceous gout in a 17-year-old male

    International Nuclear Information System (INIS)

    Garagiola, D.M.; Braunstein, E.M.; Clark, S.A.; Colyer, R.A.

    1989-01-01

    We have presented a case of gout with destructive arthritis of the first metatarsophalangeal joint in a seventeen year old boy. The diagnosis was not suspected due to the patient's age and the presentation as an expanding lesion of the base of the phalanx. Renal insufficiency may have contributed to the early onset of the disease, but even in chronic renal failure secondary gout is rare. (orig./GDG)

  11. Hyperthyroid and Hypothyroid Status Was Strongly Associated with Gout and Weakly Associated with Hyperuricaemia

    Science.gov (United States)

    See, Lai-Chu; Kuo, Chang-Fu; Yu, Kuang-Hui; Luo, Shue-Fen; Chou, I-Jun; Ko, Yu-Shien; Chiou, Meng-Jiun; Liu, Jia-Rou

    2014-01-01

    Objectives The aim of this study was to estimate the risk of hyperuricaemia and gout in people with hypothyroid or hyperthyroid status. Methods This study analyzed data from individuals who participated in health screening programs at Chang Gung Memorial Hospital in northern Taiwan (2000–2010). Participants were categorized as having euthyroid, hypothyroid, or hyperthyroid status according to their thyroid-stimulating hormone (TSH) levels. Multinomial logistic regression models were used to calculate the odds ratios (95% CI) for hyperuricaemia and gout in participants with thyroid dysfunction compared to euthyroid participants. Results A total of 87,813 (euthyroid, 83,502; hypothyroid, 1,460; hyperthyroid, 2,851) participants were included. The prevalence of hyperuricaemia was higher in hyperthyroid subjects (19.4%) than in euthyroid subjects (17.8%) but not in hypothyroid subjects (19.3%). The prevalence of gout was significantly higher in both hypothyroid (6.0%) and hyperthyroid (5.3%) subjects than in euthyroid subjects (4.3%). In men, hypothyroid or hyperthyroid status was not associated with hyperuricaemia. However, hypothyroid or hyperthyroid status was associated with ORs (95% CI) of 1.47 (1.10–1.97) and 1.37 (1.10–1.69), respectively, for gout. In women, hypothyroid status was not associated with hyperuricaemia or gout. However, hyperthyroid status was associated with ORs (95% CI) of 1.42 (1.24–1.62) for hyperuricaemia and 2.13 (1.58–2.87) for gout. Conclusions Both hyperthyroid and hypothyroid status were significantly associated with gout and weakly associated with hyperuricaemia. A thyroid function test for gout patients may by warranted. PMID:25486420

  12. Metabolic characteristics and renal dysfunction in 65 patients with tophi prior to gout.

    Science.gov (United States)

    Lu, Chuan-Chin; Wu, Shyi-Kuen; Chung, Wei-Sheng; Lin, Liang-Hung; Hung, Ta-Wei; Yeh, Chih-Jung

    2017-08-01

    Tophi typically occur many years after uncontrolled gout. Therefore, their development before gout remains unusual. Such patients might exhibit some characteristic differences compared with typical tophaceous gout patients. In this study, 65 tophaceous gout patients with tophi as the first sign of gout (tophi-first group) were enrolled. Their clinical characteristics were compared with those of 1421 patients whose tophi occurred after gout (tophi-after group). Compared with the tophi-after group, the tophi-first group had a significantly higher percentage of female patients and patients with elderly onset of disease and a lower percentage of patients with a positive family history; these patients had lower body mass indices, serum urate levels, and estimated glomerular filtration rates (eGFRs). Female sex and negative family history were identified as the principal determinants of tophi development before gout. The decreasing eGFR among the tophi-first group was not due to the group per se but was a result of older age, longer tophi duration, and hyperuricemia. The most common site of initial tophi occurrence in both groups was the toe. In the tophi-first group, the occurrence rates for initial tophi sites were significantly higher at the finger but were lower at the ankle. The tophi-first group exhibited distinct characteristics of age, gender, family history, BMI, serum urate levels, and initial tophi site. This group had fewer comorbidities but similar renal dysfunction compared with the tophi-after group. Thus, patients presenting with tophi should be treated promptly, even if they have no history of gout symptoms.

  13. Tophaceous gout in an amputation stump in a patient with chronic myelogenous leukemia

    International Nuclear Information System (INIS)

    Chung, Christine B.; Mohana-Borges, Aurea; Pathria, Mini

    2003-01-01

    Gout is a common rheumatologic disorder that can have an unusual clinical presentation. This case report describes the development of a gouty tophus at a site of remote traumatic forearm amputation in a patient with chronic myelogenous leukemia (CML). It further addresses the imaging characteristics of tophaceous gout as well as the differential diagnostic considerations as regards both the imaging findings and the clinical presentation. (orig.)

  14. Electroacupuncture Alleviates Pain Responses and Inflammation in a Rat Model of Acute Gout Arthritis

    Directory of Open Access Journals (Sweden)

    Wenxin Chai

    2018-01-01

    Full Text Available Acute gout arthritis is one of the most painful inflammatory conditions. Treatments for gout pain are limited to colchicine, nonsteroidal anti-inflammatory drugs, and corticosteroids, which oftentimes result in severe adverse effects. Electroacupuncture (EA has been proved to be effective in relieving many inflammatory pain conditions with few side effects. Here, we aim to investigate the therapeutic potentials of EA on pain and inflammation of a rat model of acute gout arthritis and underlying mechanisms. We found that 2/100 Hz EA produced the most robust analgesic effect on mechanical hyperalgesia of acute gout arthritis rat model compared with 2 and 100 Hz. EA produced similar analgesic effect compared with indomethacin. 2/100 Hz EA also significantly alleviates the ongoing pain behavior, thermal hyperalgesia, and ankle edema. Locally applied μ and κ-opioid receptor antagonists but not adenosine A1 receptor antagonist significantly abolished the analgesic effect of EA. Locally applied μ and κ-opioid receptor agonists produced significant antiallodynia on acute gout arthritis rats, mimicking EA. Furthermore, 2/100 Hz EA upregulated β-endorphin expression in inflamed ankle skin tissue. Our results demonstrated, for the first time, that EA can be used for relieving acute gout arthritis with effect dependent on peripheral opioid system and comparable with the one obtained with indomethacin.

  15. Cost of illness and determinants of costs among patients with gout.

    Science.gov (United States)

    Spaetgens, Bart; Wijnands, José M A; van Durme, Caroline; van der Linden, Sjef; Boonen, Annelies

    2015-02-01

    To estimate costs of illness in a cross-sectional cohort of patients with gout attending an outpatient rheumatology clinic, and to evaluate which factors contribute to higher costs. Altogether, 126 patients with gout were clinically assessed. They completed a series of questionnaires. Health resource use was collected using a self-report questionnaire that was cross-checked with the electronic patient file. Productivity loss was assessed by the Work Productivity and Activity Impairment Questionnaire, addressing absenteeism and presenteeism. Resource use and productivity loss were valued by real costs, and annual costs per patient were calculated. Factors contributing to incurring costs above the median were explored using logistic univariable and multivariable regression analysis. Mean (median) annual direct costs of gout were €5647 (€1148) per patient. Total costs increased to €6914 (€1279) or €10,894 (€1840) per patient per year when adding cost for absenteeism or both absenteeism and presenteeism, respectively. Factors independently associated with high direct and high indirect costs were a positive history of cardiovascular disease, functional limitations, and female sex. In addition, pain, gout concerns, and unmet gout treatment needs were associated with high direct costs. The direct and indirect costs-of-illness of gout are primarily associated with cardiovascular disease, functional limitations, and female sex.

  16. Identification of low-frequency variants associated with gout and serum uric acid levels

    DEFF Research Database (Denmark)

    Sulem, Patrick; Gudbjartsson, Daniel F; Walters, G Bragi

    2011-01-01

    We tested 16 million SNPs, identified through whole-genome sequencing of 457 Icelanders, for association with gout and serum uric acid levels. Genotypes were imputed into 41,675 chip-genotyped Icelanders and their relatives, for effective sample sizes of 968 individuals with gout and 15......,506 individuals for whom serum uric acid measurements were available. We identified a low-frequency missense variant (c.1580C>G) in ALDH16A1 associated with gout (OR = 3.12, P = 1.5 × 10(-16), at-risk allele frequency = 0.019) and serum uric acid levels (effect = 0.36 s.d., P = 4.5 × 10(-21)). We confirmed...... the association with gout by performing Sanger sequencing on 6,017 Icelanders. The association with gout was stronger in males relative to females. We also found a second variant on chromosome 1 associated with gout (OR = 1.92, P = 0.046, at-risk allele frequency = 0.986) and serum uric acid levels (effect = 0...

  17. The management of gout in different clinical specialties in Turkey: a patient-based survey.

    Science.gov (United States)

    Öztürk, Mehmet Akif; Mercan, Rıdvan; Gök, Kevser; Onat, Ahmet Mesut; Kısacık, Bünyamin; Kimyon, Gezmiş; Balkarlı, Ayşe; Kaya, Arif; Çobankara, Veli; Balcı, Mehmet Ali; Pamuk, ÖmerNuri; Yıldırım Çetin, Gözde; Sayarlıoğlu, Mehmet; Şenel, Soner; Tezcan, Mehmet Engin; Küçük, Adem; Üreten, Kemal; Şahin, Şafak; Tufan, Abdurrahman

    2016-12-01

    Although gout is potentially curable, the management of this disease is often suboptimal. In this study, we investigated the treatment of gout in Turkey and also compared the management approaches to gout in different clinical specialties. Three hundred and nineteen consecutive patients (mean age 58.60 ± 12.8 years; 44 females, 275 males) were included in this multicenter study. A standardized form was generated to collect data about the patient's first admission to health care, the specialty of the doctor first diagnosed the gout, the treatment options for gout including attack management, patient referral, chronic treatment including medical treatment, and life style modifications. Forty patients were referred to another center without any treatment (12.8 %), and referral rate is most common among the primary care physicians (28.8 %). Colchicine was more commonly used for attack prophylaxis than allopurinol. Ninety-two patients had never been treated with allopurinol (28.8 %). Allopurinol prescription was less common among the primary care physicians and orthopedists, and highest among the rheumatologists. Recommendation of diet and life style modifications was less common among the primary care physicians and orthopedists, and highest among the rheumatologists. The rates of life style modification recommendation and long-term allopurinol prescription were 83.7 and 77.6 %, respectively, among the rheumatologists. Both acute and chronic management of gout is suboptimal in Turkey especially among the primary care physicians and orthopedists. Moreover, chronic treatment is even suboptimal among rheumatologists.

  18. rs3806268 of NLRP3 gene polymorphism is associated with the development of primary gout.

    Science.gov (United States)

    Deng, Jianping; Lin, Wen; Chen, Yunpeng; Wang, Xin; Yin, Zhong; Yao, Chunhong; Liu, Tangbing; Lv, Yonghong

    2015-01-01

    The aim of the present study was to investigate the association between seven functional SNPs in NALP3 gene and the susceptibility to primary gout. A total of 247 patients with primary gout and 247 controls were selected in this study. Genotyping of NALP3 rs4612666, rs3806268, rs12239046, rs10754558, rs7512998, rs12137901 and rs12565738 was performed using the Sequenom MassARRAY platform. Comparison analysis showed that primary gout patients were more likely to have a higher body mass index, DBP, SBP, TG, urea nitrogen and uric acid (P gout when compared with the AA genotype (OR=1.83, 95% CI=1.03-3.26). However, no significant associations were identified for the remaining SNPs. In conclusion, we found a significant association between rs3806268 in NLRP3 gene and the risk of primary gout in a Chinese population. Further clinical and genetic studies are required to investigate the mechanisms underlying the association between NALP3 polymorphisms and the development of primary gout.

  19. Associations between interleukin and interleukin receptor gene polymorphisms and risk of gout.

    Science.gov (United States)

    Liu, Shiguo; Zhou, Zheng; Wang, Can; Guo, Mingzhen; Chu, Nan; Li, Changgui

    2015-09-24

    Gout is a self-limiting, auto-inflammatory arthritis induced by the deposition of monosodium urate crystals in the synovial fluid and periarticular tissues. The aim of this study was to investigate the associations between genetic variants in the interleukin (IL) and interleukin receptor (ILR) genes IL-33, IL-1RL1, IL-23R, and signal transducer and activator of transcription 4 (STAT4) and susceptibility to gout in Chinese Han male individuals. The genetic distributions of rs3939286 in IL-33, rs13015714 in IL-1RL1, rs10889677 in IL-23R, and rs7574865 in STAT4 were detected in 1100 men with gout and 1227 ethnically matched controls, using Taqman allelic discrimination real-time polymerase chain reaction (PCR). Differences in these polymorphisms between the groups were investigated using χ(2) tests. The genotype-phenotype relationship among gout patients was tested by analysis of variance. There was a significant difference in genotypic frequencies of IL-23R rs10889677 between gout patients and controls (χ(2) = 81.386, P gout in Chinese Han male individuals. However, further studies in other ethnic groups are needed to confirm these results.

  20. The renal urate transporter SLC17A1 locus: confirmation of association with gout.

    Science.gov (United States)

    Hollis-Moffatt, Jade E; Phipps-Green, Amanda J; Chapman, Brett; Jones, Gregory T; van Rij, Andre; Gow, Peter J; Harrison, Andrew A; Highton, John; Jones, Peter B; Montgomery, Grant W; Stamp, Lisa K; Dalbeth, Nicola; Merriman, Tony R

    2012-04-27

    Two major gout-causing genes have been identified, the urate transport genes SLC2A9 and ABCG2. Variation within the SLC17A1 locus, which encodes sodium-dependent phosphate transporter 1, a renal transporter of uric acid, has also been associated with serum urate concentration. However, evidence for association with gout is equivocal. We investigated the association of the SLC17A1 locus with gout in New Zealand sample sets. Five variants (rs1165196, rs1183201, rs9358890, rs3799344, rs12664474) were genotyped across a New Zealand sample set totaling 971 cases and 1,742 controls. Cases were ascertained according to American Rheumatism Association criteria. Two population groups were studied: Caucasian and Polynesian. At rs1183201 (SLC17A1), evidence for association with gout was observed in both the Caucasian (odds ratio (OR) = 0.67, P = 3.0 × 10-6) and Polynesian (OR = 0.74, P = 3.0 × 10-3) groups. Meta-analysis confirmed association of rs1183201 with gout at a genome-wide level of significance (OR = 0.70, P = 3.0 × 10-8). Haplotype analysis suggested the presence of a common protective haplotype. We confirm the SLC17A1 locus as the third associated with gout at a genome-wide level of significance.

  1. Associations between interleukin and interleukin receptor gene polymorphisms and risk of gout

    Science.gov (United States)

    Liu, Shiguo; Zhou, Zheng; Wang, Can; Guo, Mingzhen; Chu, Nan; Li, Changgui

    2015-01-01

    Gout is a self-limiting, auto-inflammatory arthritis induced by the deposition of monosodium urate crystals in the synovial fluid and periarticular tissues. The aim of this study was to investigate the associations between genetic variants in the interleukin (IL) and interleukin receptor (ILR) genes IL-33, IL-1RL1, IL-23R, and signal transducer and activator of transcription 4 (STAT4) and susceptibility to gout in Chinese Han male individuals. The genetic distributions of rs3939286 in IL-33, rs13015714 in IL-1RL1, rs10889677 in IL-23R, and rs7574865 in STAT4 were detected in 1100 men with gout and 1227 ethnically matched controls, using Taqman allelic discrimination real-time polymerase chain reaction (PCR). Differences in these polymorphisms between the groups were investigated using χ2 tests. The genotype-phenotype relationship among gout patients was tested by analysis of variance. There was a significant difference in genotypic frequencies of IL-23R rs10889677 between gout patients and controls (χ2 = 81.386, P < 0.001). However, there were no significant differences in distributions of the other polymorphisms between the groups. Our results revealed that the rs10889677 variant in IL-23R may be involved in the development of gout in Chinese Han male individuals. However, further studies in other ethnic groups are needed to confirm these results. PMID:26399911

  2. The Rising Prevalence and Incidence of Gout in British Columbia, Canada: Population-Based Trends from 2000-2012

    Science.gov (United States)

    Rai, Sharan K.; Aviña-Zubieta, J. Antonio; McCormick, Natalie; De Vera, Mary A.; Shojania, Kam; Sayre, Eric C.; Choi, Hyon K.

    2016-01-01

    Objectives Gout is increasingly recognized as the most common form of inflammatory arthritis worldwide; however, no Canadian data on the disease burden of gout are available. We estimated the prevalence, incidence, prescription patterns, and comorbidity burden of gout in an entire Canadian province (British Columbia [BC]) over the last decade. Methods We utilized PopulationData BC, a province-wide database, to estimate temporal trends in the prevalence and incidence of gout from 2000-2012, as well as according to age category. Annual estimates were age-sex-standardized using 2012 as the reference. We also examined annual trends in prescription patterns of common gout medications and assessed the comorbidity burden among gout patients in 2012. Results The 2012 prevalence of gout was 3.8% among the overall population, and the incidence rate was 2.9 per 1,000 person-years. Both gout prevalence and incidence increased substantially over the study period. This burden additionally increased according to age category, affecting over 8% of those ages 60-69 years in 2012. Approximately 22% of gout patients received a prescription for urate-lowering therapy (ULT), which remained stable over the study period, while colchicine and oral glucocorticoid use both increased modestly. By 2012, 72%, 52%, and 18% of prevalent gout patients had been diagnosed with hypertension, hyperlipidemia, and diabetes, respectively. Conclusions The burden of gout in BC, Canada, is substantial, and both the prevalence and incidence have increased over the past decade, while prescription of ULT remains low. These data support the need to improve gout prevention and care. PMID:28040245

  3. Observations of vector magnetic fields in flaring active regions

    Science.gov (United States)

    Chen, Jimin; Wang, Haimin; Zirin, Harold; Ai, Guoxiang

    1994-01-01

    We present vector magnetograph data of 6 active regions, all of which produced major flares. Of the 20 M-class (or above) flares, 7 satisfy the flare conditions prescribed by Hagyard (high shear and strong transverse fields). Strong photospheric shear, however, is not necessarily a condition for a flare. We find an increase in the shear for two flares, a 6-deg shear increase along the neutral line after a X-2 flare and a 13-deg increase after a M-1.9 flare. For other flares, we did not detect substantial shear changes.

  4. The thermal phase of solar flares

    International Nuclear Information System (INIS)

    Hirayama, Tadashi

    1979-01-01

    This paper is described on the observation of the flares, and then the numerical simulation on the structural change in the corona and the chromosphere during the flare is briefly discussed. Most of the flares occur on the active region where the density and the electron temperature are higher than those in the quiet region. The temperature and density increase after the flare started. The temperature of the pre-flare chromosphere is about 6000 K, and it rises during the flare. The temperature of the transition region is about 10 5 K, and the gas pressure increases more than one order of magnitude during the flare. Sometimes, the flaring in the photosphere is observed. Large amount of mass ejected at the time of the flare is observed. Most probable energy source of the flare is the magnetic energy contained in the form of electric current. Liberation of this energy into the corona is discussed in this paper. It is assumed that a column of unit area is standing vertically in the corona, the top being closed. A hydrostatic model of the corona-chromosphere is constructed, in which the heat source is assumed to be in the corona. As the results of calculation, it can be said that the temperature of the flaring corona does not depend upon the liberated energy, the density in the corona increases proportionally to the energy, and particles are supplied from the chromosphere with the upward velocity of about 100 km/s. The gas pressure of the transition region can become up to three orders of magnitude larger. All these are consistent with the observation. Extension of this calculation is also performed. (Kato, T.)

  5. Ultrasound Characteristics of the Achilles Tendon in Tophaceous Gout: A Comparison with Age- and Sex-matched Controls.

    Science.gov (United States)

    Carroll, Matthew; Dalbeth, Nicola; Allen, Bruce; Stewart, Sarah; House, Tony; Boocock, Mark; Frampton, Christopher; Rome, Keith

    2017-10-01

    To investigate the frequency and distribution of characteristics of the Achilles tendon (AT) in people with tophaceous gout using musculoskeletal ultrasound (US). Twenty-four participants with tophaceous gout and 24 age- and sex-matched controls without gout or other arthritis were recruited. All participants underwent a greyscale and power Doppler US examination. The AT was divided into 3 anatomical zones (insertion, pre-insertional, and proximal to the mid-section). The following US characteristics were assessed: tophus, tendon echogenicity, tendon vascularity, tendon morphology, entheseal characteristics, bursal morphology, and calcaneal bone profile. The majority of the participants with tophaceous gout were middle-aged men (n = 22, 92%) predominately of European ethnicity (n = 14, 58%). Tophus deposition was observed in 73% (n = 35) of tendons in those with gout and in none of the controls (p gout compared to controls. High prevalence of entheseal calcifications, calcaneal bone cortex irregularities, and calcaneal enthesophytes were observed in both gout participants and controls, without differences between groups. Intratendinous structural damage was rare. Hyperechoic spots were significantly more common at the insertion compared to the zone proximal to the mid-section (p gout. Despite crystal deposition, intratendinous structural changes are infrequent. Many characteristics observed in the AT in people with tophaceous gout, particularly at the calcaneal enthesis, are not disease-specific.

  6. A common variant of MAF/c-MAF, transcriptional factor gene in the kidney, is associated with gout susceptibility.

    Science.gov (United States)

    Higashino, Toshihide; Matsuo, Hirotaka; Okada, Yukinori; Nakashima, Hiroshi; Shimizu, Seiko; Sakiyama, Masayuki; Tadokoro, Shin; Nakayama, Akiyoshi; Kawaguchi, Makoto; Komatsu, Mako; Hishida, Asahi; Nakatochi, Masahiro; Ooyama, Hiroshi; Imaki, Junko; Shinomiya, Nariyoshi

    2018-01-01

    Gout is a multifactorial disease characterized by acute inflammatory arthritis, and it is caused as a consequence of hyperuricemia. A recent meta-analysis of genome-wide association studies has newly identified the relationship between serum uric acid (SUA) levels and rs889472, a single nucleotide polymorphism of musculoaponeurotic fibrosarcoma oncogene (MAF/c-MAF). However, it remained unclear whether rs889472 is associated with gout susceptibility. In the present study, we investigate the association between c-MAF rs889472 and gout in Japanese male population. We genotyped 625 male patients who were clinically diagnosed as gout and 1221 male control subjects without hyperuricemia or a history of gout by TaqMan method. As a result, the major allele (C), which reportedly increases SUA levels, had a higher frequency in the gout cases (58.8%) than in the controls (55.0%). A logistic regression analysis showed a significant association between rs889472 and gout (p = 0.029, odds ratio = 1.17; 95% confidence interval 1.02-1.34). C-MAF is reported as a pivotal transcriptional factor in the development and differentiation of renal proximal tubular cells. Because urate is mainly regulated in renal proximal tubular cells, c-MAF may have an important role in urate regulation in the kidney and influence not only SUA but also gout susceptibility. Our finding shows that rs889472 of c-MAF is associated with gout susceptibility.

  7. SLC2A9 and ZNF518B polymorphisms correlate with gout-related metabolic indices in Chinese Tibetan populations.

    Science.gov (United States)

    Zhang, X Y; Geng, T T; Liu, L J; Yuan, D Y; Feng, T; Kang, L L; Jin, T B; Chen, C

    2015-08-19

    Current evidence suggests that heredity and metabolic syndrome contribute to gout progression. SLC2A9 and ZNF518B may play a role in gout progression in different populations, but no studies have focused on the Tibetan Chinese population. In this study, we determined whether variations in these 2 genes were correlated with gout-related indices in Chinese-Tibetan gout patients. We detected 6 single nucleotide polymorphisms in SLC2A9 and ZNF518B in 319 Chinese Tibetan gout patients. One-way analysis of variance was used to evaluate the polymorphisms' effects on gout based on mean serum levels of metabolism indicators. Polymorphisms in SLC2A9 and ZNF518B affected multiple risk factors related to gout development. Significant differences in serum triglyceride levels and high-density lipoprotein-cholesterol level were detected between different genotypic groups with SLC2A9 polymorphisms rs13129697 (P = 0.022), rs4447863 (P = 0.018), and rs1014290 (P = 0.045). Similarly in ZNF518B, rs3217 (P = 0.016) and rs10016022 (P = 0.046) were associated with high creatinine and glucose levels, respectively. This study is the first to investigate and identify positive correlations between SLC2A9 and ZNF518B gene polymorphisms and metabolic indices in Tibetan gout patients. We found significant evidence indicating that genetic polymorphisms affect gout-related factors in Chinese Tibetan populations.

  8. Purine biosynthesis de novo by lymphocytes in gout

    International Nuclear Information System (INIS)

    Kamoun, P.; Chanard, J.; Brami, M.; Funck-Brentano, J.L.

    1978-01-01

    A method of measurement in vitro of purine biosynthesis de novo in human circulating blood lymphocytes is proposed. The rate of early reactions of purine biosynthesis de novo was determined by the incorporation of [ 14 C]formate into N-formyl glycinamide ribonucleotide when the subsequent reactions of the metabolic pathway were completely inhibited by the antibiotic azaserine. Synthesis of 14 C-labelled N-formyl glycinamide ribonucleotide by lymphocytes was measured in healthy control subjects and patients with primary gout or hyperuricaemia secondary to renal failure, with or without allopurinol therapy. The average synthesis was higher in gouty patients without therapy than in control subjects, but the values contained overlap the normal range. In secondary hyperuricaemia the synthesis was at same value as in control subjects. These results are in agreement with the inconstant acceleration of purine biosynthesis de novo in gouty patients as seen by others with measurement of [ 14 C]glycine incorporation into urinary uric acid. (author)

  9. Multiple Tophaceous Gout of Hand with Extensor Tendon Rupture

    Directory of Open Access Journals (Sweden)

    Haruki Tobimatsu

    2017-01-01

    Full Text Available A 45-year-old man presented with painless subcutaneous masses bilaterally on his hands and loss of motion or contracture of the fingers. Initially, drug therapy to reduce the serum uric acid was administered and was expected to reduce the tophi. However, during observation at the clinic, spontaneous rupture of an extensor tendon occurred, and surgical repair of the tendon and resection of the masses were performed. Surgical exploration of the right hand showed hypertrophic white-colored crystal deposits that both surrounded and invaded the extensor digitorum communis of the index finger, which was ruptured. Histopathologic examination of the specimen demonstrated findings consistent with gouty tophi. Tophaceous gout can induce a rupture of tendons during clinical observation, and surgical resection of the tophi might be needed to prevent ruptures.

  10. Diagnostics of solar flare reconnection

    Directory of Open Access Journals (Sweden)

    M. Karlický

    2004-01-01

    Full Text Available We present new diagnostics of the solar flare reconnection, mainly based on the plasma radio emission. We propose that the high-frequency (600-2000 MHz slowly drifting pulsating structures map the flare magnetic field reconnection. These structures correspond to the radio emission from plasmoids which are formed in the extended current sheet due to tearing and coalescence processes. An increase of the frequency drift of the drifting structures is interpreted as an increase of the reconnection rate. Using this model, time scales of slowly drifting pulsating structure observed during the 12 April 2001 flare by the Trieste radiopolarimeter with high time resolution (1 ms are interpreted as a radio manifestation of electron beams accelerated in the multi-scale reconnection process. For short periods Fourier spectra of the observed structure have a power-law form with power-law indices in the 1.3-1.6 range. For comparison the 2-D MHD numerical modeling of the multi-scale reconnection is made and it is shown that Fourier spectrum of the reconnection dissipation power has also a power-law form, but with power-law index 2. Furthermore, we compute a time evolution of plasma parameters (density, magnetic field etc in the 2-D MHD model of the reconnection. Then assuming a plasma radio emission from locations, where the 'double-resonance' instability generates the upper-hybrid waves due to unstable distribution function of suprathermal electrons, we model radio spectra. Effects of the MHD turbulence are included. The resulting spectra are compared with those observed. It is found, that depending on model parameters the lace bursts and the decimetric spikes can be reproduced. Thus, it is shown that the model can be used for diagnostics of the flare reconnection process. We also point out possible radio signatures of reconnection outflow termination shocks. They are detected as type II-like herringbone structures in the 200-700 MHz frequency range. Finally

  11. Active Longitude and Solar Flare Occurrences

    Science.gov (United States)

    Gyenge, N.; Ludmány, A.; Baranyi, T.

    2016-02-01

    The aim of the present work is to specify the spatio-temporal characteristics of flare activity observed by the Reuven Ramaty High Energy Solar Spectroscopic Imager (RHESSI) and the Geostationary Operational Environmental Satellite (GOES) in connection with the behavior of the longitudinal domain of enhanced sunspot activity known as active longitude (AL). By using our method developed for this purpose, we identified the AL in every Carrington Rotation provided by the Debrecen Photoheliographic Data. The spatial probability of flare occurrence has been estimated depending on the longitudinal distance from AL in the northern and southern hemispheres separately. We have found that more than 60% of the RHESSI and GOES flares is located within +/- 36^\\circ from the AL. Hence, the most flare-productive active regions tend to be located in or close to the active longitudinal belt. This observed feature may allow for the prediction of the geo-effective position of the domain of enhanced flaring probability. Furthermore, we studied the temporal properties of flare occurrence near the AL and several significant fluctuations were found. More precisely, the results of the method are the following fluctuations: 0.8, 1.3, and 1.8 years. These temporal and spatial properties of the solar flare occurrence within the active longitudinal belts could provide us with an enhanced solar flare forecasting opportunity.

  12. A Bayesian method for detecting stellar flares

    Science.gov (United States)

    Pitkin, M.; Williams, D.; Fletcher, L.; Grant, S. D. T.

    2014-12-01

    We present a Bayesian-odds-ratio-based algorithm for detecting stellar flares in light-curve data. We assume flares are described by a model in which there is a rapid rise with a half-Gaussian profile, followed by an exponential decay. Our signal model also contains a polynomial background model required to fit underlying light-curve variations in the data, which could otherwise partially mimic a flare. We characterize the false alarm probability and efficiency of this method under the assumption that any unmodelled noise in the data is Gaussian, and compare it with a simpler thresholding method based on that used in Walkowicz et al. We find our method has a significant increase in detection efficiency for low signal-to-noise ratio (S/N) flares. For a conservative false alarm probability our method can detect 95 per cent of flares with S/N less than 20, as compared to S/N of 25 for the simpler method. We also test how well the assumption of Gaussian noise holds by applying the method to a selection of `quiet' Kepler stars. As an example we have applied our method to a selection of stars in Kepler Quarter 1 data. The method finds 687 flaring stars with a total of 1873 flares after vetos have been applied. For these flares we have made preliminary characterizations of their durations and and S/N.

  13. X-ray Emission from Solar Flares

    Indian Academy of Sciences (India)

    2016-01-27

    Jan 27, 2016 ... Solar flares; X-ray detectors; X-ray line emission and continuum; break energy; microflares. Abstract. Solar X-ray Spectrometer (SOXS), the first space-borne solar astronomy experiment of India was designed to improve our current understanding of X-ray emission from the Sun in general and solar flares in ...

  14. FLARES AND THEIR UNDERLYING MAGNETIC COMPLEXITY

    International Nuclear Information System (INIS)

    Engell, Alexander J.; Golub, Leon; Korreck, Kelly; Siarkowski, Marek; Gryciuk, Magda; Sylwester, Janusz; Sylwester, Barbara; Cirtain, Jonathan

    2011-01-01

    SphinX (Solar PHotometer IN X-rays), a full-disk-integrated spectrometer, observed 137 flare-like/transient events with active region (AR) 11024 being the only AR on disk. The Hinode X-Ray Telescope (XRT) and Solar Optical Telescope observe 67 of these events and identified their location from 12:00 UT on July 3 through 24:00 UT 2009 July 7. We find that the predominant mechanisms for flares observed by XRT are (1) flux cancellation and (2) the shearing of underlying magnetic elements. Point- and cusp-like flare morphologies seen by XRT all occur in a magnetic environment where one polarity is impeded by the opposite polarity and vice versa, forcing the flux cancellation process. The shearing is either caused by flux emergence at the center of the AR and separation of polarities along a neutral line or by individual magnetic elements having a rotational motion. Both mechanisms are observed to contribute to single- and multiple-loop flares. We observe that most loop flares occur along a large portion of a polarity inversion line. Point- and cusp-like flares become more infrequent as the AR becomes organized with separation of the positive and negative polarities. SphinX, which allows us to identify when these flares occur, provides us with a statistically significant temperature and emission scaling law for A and B class flares: EM = 6.1 x 10 33 T 1.9±0.1 .

  15. Offshore production flares: a PETROBRAS review

    Energy Technology Data Exchange (ETDEWEB)

    Pagot, Paulo R.; Burmann, Clovis P.; Araujo, Paulo Bento de; Motomura, Tsukasa [PETROBRAS S.A., Rio de Janeiro, RJ (Brazil)

    2008-07-01

    The purpose of the present work is to briefly present the offshore flare system technological evolution and the main design criteria for flare and its supporting structure. In order to perform the aimed task, this work was divided into two parts: the first part presents the technological evolution of the offshore production flares and the second one discusses the flare system designing criteria. The evolution of the technology associated to the offshore production flares is organized by the authors just dividing the history in four chronological phases. Each phase is defined by the predominant use of the, by the time, most up-to-date technological alternative and it will be described with the help of sketches, drawings, photographs, data and information about the platforms where such technologies were applied. The second part of the present work discusses the dimensional criteria, interesting aspects and flaws of the offshore flare systems in two different fields, which are: definition of the flare system capacity; and flow and thermal design of the flare system. (author)

  16. 40 CFR 63.987 - Flare requirements.

    Science.gov (United States)

    2010-07-01

    ... specified in paragraphs (b)(3)(i) through (iv) of this section. (i) Method 22 of appendix A of part 60 shall...) cross sectional area of the flare tip. (iv) Flare flame or pilot monitors, as applicable, shall be..., ultra-violet beam sensor, or infrared sensor) capable of continuously detecting that at least one pilot...

  17. Fast electrons in small solar flares

    International Nuclear Information System (INIS)

    Lin, R.P.

    1975-01-01

    Because approximately 5-100 keV electrons are frequently accelerated and emitted by the Sun in small flares, it is possible to define a detailed characteristic physical picture of these events. The review summarizes both the direct spacecraft observations of non-relativistic solar electrons, and observations of the X-ray and radio emission generated by these particles at the Sun and in the interplanetary medium. These observations bear on the basic astrophysical process of particle acceleration in tenuous plasmas. It is found that in many small solar flares the approximately 5-100 keV electrons accelerated during flash phase constitute the bulk of the total flare energy. Thus the basic flare mechanism in these flares essentially converts the available flare energy into fast electrons. These electrons may produce the other flare electromagnetic emissions through their interactions with the solar atmosphere. In large proton flares these electrons may provide the energy to eject material from the Sun and to create a shock wave which could then accelerate nuclei and electrons to much higher energies. (Auth.)

  18. New flare stars in the Pleiade. 3

    International Nuclear Information System (INIS)

    Parsamyan, Eh.S.

    1976-01-01

    The flare stars in the Pleiads were investigated. The observations were carried out from the second part of 1972 to the beginning of 1973. Data on 9 new and 9 repeat flares are given. The new data are compared with those obtained previously

  19. Solar flare irradiation records in Antarctic meteorites

    International Nuclear Information System (INIS)

    Goswami, J.N.

    1981-01-01

    Observations of solar flare heavy nuclei tracks in eight Antartic meteorite samples are reported. Two of these were interior specimens from an L-3 chondrite which contained track-rich grains (olivine) indicating their exposure to solar flare irradiation before compaction of the meteorite. Preliminary noble gas data also indicate the presence of solar-type gases. (U.K.)

  20. Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study

    Science.gov (United States)

    Kuo, Chang-Fu; Grainge, Matthew J; Mallen, Christian; Zhang, Weiya; Doherty, Michael

    2015-01-01

    Objectives To describe trends in the epidemiology of gout and patterns of urate-lowering treatment (ULT) in the UK general population from 1997 to 2012. Methods We used the Clinical Practice Research Datalink to estimate the prevalence and incidence of gout for each calendar year from 1997 to 2012. We also investigated the pattern of gout management for both prevalent and incident gout patients. Results In 2012, the prevalence of gout was 2.49% (95% CI 2.48% to 2.51%) and the incidence was 1.77 (95% CI 1.73 to 1.81) per 1000 person-years. Prevalence and incidence both were significantly higher in 2012 than in 1997, with a 63.9% increase in prevalence and 29.6% increase in incidence over this period. Regions with highest prevalence and incidence were the North East and Wales. Among prevalent gout patients in 2012, only 48.48% (95% CI 48.08% to 48.89%) were being consulted specifically for gout or treated with ULT and of these 37.63% (95% CI 37.28% to 38.99%) received ULT. In addition, only 18.6% (95% CI 17.6% to 19.6%) of incident gout patients received ULT within 6 months and 27.3% (95% CI 26.1% to 28.5%) within 12 months of diagnosis. The management of prevalent and incident gout patients remained essentially the same during the study period, although the percentage of adherent patients improved from 28.28% (95% CI 27.33% to 29.26%) in 1997 to 39.66% (95% CI 39.11% to 40.22%) in 2012. Conclusions In recent years, both the prevalence and incidence of gout have increased significantly in the UK. Suboptimal use of ULT has not changed between 1997 and 2012. Patient adherence has improved during the study period, but it remains poor. PMID:24431399

  1. Familial aggregation of gout and relative genetic and environmental contributions: a nationwide population study in Taiwan.

    Science.gov (United States)

    Kuo, Chang-Fu; Grainge, Matthew J; See, Lai-Chu; Yu, Kuang-Hui; Luo, Shue-Fen; Valdes, Ana M; Zhang, Weiya; Doherty, Michael

    2015-02-01

    To examine familial aggregation of gout and to estimate the heritability and environmental contributions to gout susceptibility in the general population. Using data from the National Health Insurance (NHI) Research Database in Taiwan, we conducted a nationwide cross-sectional study of data collected from 22 643 748 beneficiaries of the NHI in 2004; among them 1 045 059 individuals had physician-diagnosed gout. We estimated relative risks (RR) of gout in individuals with affected first-degree and second-degree relatives and relative contributions of genes (heritability), common environment shared by family members and non-shared environment to gout susceptibility. RRs for gout were significantly higher in individuals with affected first-degree relatives (men, 1.91 (95% CI 1.90 to 1.93); women, 1.97 (95% CI 1.94 to 1.99)) and also in those with affected second-degree relatives (men, 1.27 (95% CI 1.23 to 1.31); women, 1.40 (95% CI 1.35 to 1.46)). RRs (95% CIs) for individuals with an affected twin, sibling, offspring, parent, grandchild, nephew/niece, uncle/aunt and grandparent were 8.02 (6.95 to 9.26), 2.59 (2.54 to 2.63), 1.96 (1.95 to 1.97), 1.93 (1.91 to 1.94), 1.48 (1.43 to 1.53), 1.40 (1.32 to 1.47), 1.31 (1.24 to 1.39), and 1.26 (1.21 to 1.30), respectively. The relative contributions of heritability, common and non-shared environmental factors to phenotypic variance of gout were 35.1, 28.1 and 36.8% in men and 17.0, 18.5 and 64.5% in women, respectively. This population-based study confirms that gout aggregates within families. The risk of gout is higher in people with a family history. Genetic and environmental factors contribute to gout aetiology, and the relative contributions are sexually dimorphic. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. Case report 445: Bilateral acromioclavicular gouty arthritis with pseudo-tumor of the outer end of the right clavicle: Saturnine gout

    International Nuclear Information System (INIS)

    Podgorski, M.R.; Ibels, L.S.; Webb, J.; Royal North Shore Hospital, St. Leonards

    1987-01-01

    An example of extensive, bilateral, distal clavicular erosion due to tophaceous saturnine gout is discussed, including the differential diagnosis of such lesions. The importance of unrecognized chronic lead nephropathy apparently causing primary gout is emphasized. (orig.)

  3. Case report 445: Bilateral acromioclavicular gouty arthritis with pseudo-tumor of the outer end of the right clavicle: Saturnine gout

    Energy Technology Data Exchange (ETDEWEB)

    Podgorski, M.R.; Ibels, L.S.; Webb, J.

    1987-10-01

    An example of extensive, bilateral, distal clavicular erosion due to tophaceous saturnine gout is discussed, including the differential diagnosis of such lesions. The importance of unrecognized chronic lead nephropathy apparently causing primary gout is emphasized.

  4. Energetic Particle Estimates for Stellar Flares

    Science.gov (United States)

    Youngblood, Allison; Chamberlin, Phil; Woods, Tom

    2018-01-01

    In the heliosphere, energetic particles are accelerated away from the Sun during solar flares and/or coronal mass ejections where they frequently impact the Earth and other solar system bodies. Solar (or stellar) energetic particles (SEPs) not only affect technological assets, but also influence mass loss and chemistry in planetary atmospheres (e.g., depletion of ozone). SEPs are increasingly recognized as an important factor in assessing exoplanet habitability, but we do not yet have constraints on SEP emission from any stars other than the Sun. Until indirect measurements are available, we must assume solar-like particle production and apply correlations between solar flares and SEPs detected near Earth to stellar flares. We present improved scaling relations between solar far-UV flare flux and >10 MeV proton flux near Earth. We apply these solar scaling relations to far-UV flares from exoplanet host stars and discuss the implications for modeling chemistry and mass loss in exoplanet atmospheres.

  5. Models of spots and flares

    International Nuclear Information System (INIS)

    Mullan, D.J.

    1983-01-01

    Laboratory experiments in recent years have shown that there are many more ways to drive a plasma out of equilibrium than to preserve equilibrium. In that sense, it is perhaps easier to understand why flares should occur in a stellar atmosphere than why a long-lived feature such as a dark spot should persist. The author summarizes work on the equilibrium structure of cool spots in the sun and stars. Since spots involve complex interactions between convective flows and magnetic fields, he needs to refer to observations for help in identifying the dominant processes which should enter into the modelling. His summary therefore begins by discussing certain relevant properties of spots in the solar atmosphere. The next sections deal with the magnetic fields in spots, the stability of spots, spot cooling and missing flux. The author concludes that spots should be viewed not simply as cool areas, but rather as engines which do the work of converting the energy of convective flows into flare-compatible form. (Auth.)

  6. The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: prospective cohort study.

    Science.gov (United States)

    Rai, Sharan K; Fung, Teresa T; Lu, Na; Keller, Sarah F; Curhan, Gary C; Choi, Hyon K

    2017-05-09

    Objective  To prospectively examine the relation between the Dietary Approaches to Stop Hypertension (DASH) and Western diets and risk of gout (ie, the clinical endpoint of hyperuricemia) in men. Design  Prospective cohort study. Setting  The Health Professionals Follow-up Study. Participants  44 444 men with no history of gout at baseline. Using validated food frequency questionnaires, each participant was assigned a DASH dietary pattern score (based on high intake of fruits, vegetables, nuts and legumes, low fat dairy products, and whole grains, and low intake of sodium, sweetened beverages, and red and processed meats) and a Western dietary pattern score (based on high intake of red and processed meats, French fries, refined grains, sweets, and desserts). Main outcome measure  Risk of incident gout meeting the preliminary American College of Rheumatology survey criteria for gout, adjusting for potential confounders, including age, body mass index, hypertension, diuretic use, and alcohol intake. Results  During 26 years of follow-up, 1731 confirmed cases of incident gout were documented. A higher DASH dietary pattern score was associated with a lower risk for gout (adjusted relative risk for extreme fifths 0.68, 95% confidence interval 0.57 to 0.80, P value for trend dietary pattern score was associated with an increased risk for gout (1.42, 1.16 to 1.74, P=0.005). Conclusion  The DASH diet is associated with a lower risk of gout, suggesting that its effect of lowering uric acid levels in individuals with hyperuricemia translates to a lower risk of gout. Conversely, the Western diet is associated with a higher risk of gout. The DASH diet may provide an attractive preventive dietary approach for men at risk of gout. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  7. Potential contribution of the neurodegenerative disorders risk loci to cognitive performance in an elderly male gout population.

    Science.gov (United States)

    Han, Lin; Jia, Zhaotong; Cao, Chunwei; Liu, Zhen; Liu, Fuqiang; Wang, Lin; Ren, Wei; Sun, Mingxia; Wang, Baoping; Li, Changgui; Chen, Li

    2017-09-01

    Cognitive impairment has been described in elderly subjects with high normal concentrations of serum uric acid. However, it remains unclear if gout confers an increased poorer cognition than those in individuals with asymptomatic hyperuricemia. The present study aimed at evaluating cognitive function in patients suffering from gout in an elderly male population, and further investigating the genetic contributions to the risk of cognitive function.This study examined the cognitive function as assessed by Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) in 205 male gout patients and 204 controls. The genetic basis of these cognitive measures was evaluated by genome-wide association study (GWAS) data in 102 male gout patients. Furthermore, 7 loci associated with cognition in GWAS were studied for correlation with gout in 1179 male gout patients and 1848 healthy male controls.Compared with controls, gout patients had significantly lower MoCA scores [22.78 ± 3.01 vs 23.42 ± 2.95, P = .023, adjusted by age, body mass index (BMI), education, and emotional disorder]. GWAS revealed 7 single-nucleotide polymorphisms (SNPs) associations with MoCA test at a level of conventional genome-wide significance (P gout in further analysis (all P > .05).Elderly male subjects with gout exhibit accelerated decline in cognition performance. Several neurodegenerative disorders risk loci were identified for genetic contributors to cognitive performance in our Chinese elderly male gout population. Larger prospective studies of the cognitive performance and genetic analysis in gout subjects are recommended.

  8. Analysis of polymorphisms in the promoter region and protein levels of interleukin-6 gene among gout patients.

    Science.gov (United States)

    Tsai, P-C; Chen, C-J; Lai, H-M; Chang, S-J

    2008-01-01

    To explore the associations between the polymorphisms and protein levels of interleukin-6 (IL-6) gene and gout disease. A total of 120 male gout patients and 184 healthy controls were enrolled. Each patient was matched with 1-2 gout-free controls by age within three years. Four polymorphisms in the promoter of IL-6 gene, including -597G/A, -572C/G, -373A(m)T(n), and -174G/C, and the IL-6 levels were analyzed. The clinical characteristics and biochemical markers in plasma were measured, including age of gout onset, duration of gout history, tophus number, gout attack frequency, uric acid, total cholesterol, triglycerides and creatinine. The mean IL-6 level for gout patients was 9.80 (+/-11.76 pg/ml) which showed no significant difference from the controls (7.06+/-7.58 pg/ml, p=0.230). When the IL-6 levels were dichotomized according to the median value (5 pg/ml), there were significantly higher proportions of the gout patients (59.66%) than controls (44%) with high IL-6 levels (OR=1.88, 95% CI=1.17-3.02, p=0.008). Unique genotype was found at polymorphisms -174G/C and -597G/A. Neither the polymorphisms -572C/G nor -373A(m)T(n) in the genotype or allele distributions showed a significant association related to clinical characteristics, biochemical markers, IL-6 levels or gout disease (all p>0.05). Those with gout disease have greater proportions of high IL-6 levels in plasma than controls, and there is no significant association between the four polymorphisms in the promoter region of IL-6 gene and gout disease.

  9. Burden of gout in the Nordic region, 1990-2015: findings from the Global Burden of Disease Study 2015.

    Science.gov (United States)

    Kiadaliri, A A; Uhlig, T; Englund, M

    2018-01-29

    To explore the burden of gout in the Nordic region, with a population around 27 million in 2015 distributed across six countries. We used the findings of the 2015 Global Burden of Diseases study to report prevalence and disability associated with gout in the Nordic region. From 1990 to 2015, the number of prevalent gout cases rose by 30% to 252 967 [95% uncertainty interval (UI) 223 478‒287 288] in the Nordic region. In 2015, gout contributed to 7982 (95% UI 5431‒10 800) years lived with disability (YLDs) in the region, an increase of 29% (95% UI 24‒35%) from 1990. While the crude YLD rate of gout increased by 12.9% (95% UI 7.8‒18.1%) between 1990 and 2015, the age-standardized YLD rate remained stable. Gout was ranked as the 63rd leading cause of total YLDs in the region in 2015, with the highest rank in men aged 55-59 years (38th leading cause of YLDs). The corresponding rank at the global level was 94. Of 195 countries studied, four Nordic countries [Greenland (2nd), Iceland (12th), Finland (14th), and Sweden (15th)] were among the top 15 countries with the highest age-standardized YLD rate of gout. The burden of gout is rising in the Nordic region. Gout's contribution to the total burden of diseases in the region is more significant than the global average. Expected increases in gout burden owing to population growth and ageing call for stronger preventive and therapeutic strategies for gout management in Nordic countries.

  10. Relevant aspects of imaging in the diagnosis and management of gout.

    Science.gov (United States)

    De Avila Fernandes, Eloy; Bergamaschi, Samuel Brighenti; Rodrigues, Tatiane Cantarelli; Dias, Gustavo Coelho; Malmann, Ralff; Ramos, Germano Martins; Monteiro, Soraya Silveira

    Gout is an inflammatory arthritis characterized by the deposition of monosodium urate crystals in the synovial membrane, articular cartilage and periarticular tissues leading to inflammation. Men are more commonly affected, mainly after the 5th decade of life. Its incidence has been growing with the population aging. In the majority of the cases, the diagnosis is made by clinical criteria and synovial fluid analysis, in search for monosodium urate crystals. Nonetheless, gout may sometimes have atypical presentations, complicating the diagnosis. In these situations, imaging methods have a fundamental role, aiding in the diagnostic confirmation or excluding other possible differential diagnosis. Conventional radiographs are still the most commonly used method in gout patients' evaluation; nevertheless, this is not a sensitive method, since it detect only late alterations. In the last years, there have been several advances in imaging methods for gout patients. Ultrasound has shown a great accuracy in the diagnosis of gout, identifying monosodium urate deposits in the synovial membrane and articular cartilage, in detecting and characterizing tophi and in identifying tophaceous tendinopathy and enthesopathy. Ultrasound has also been able to show crystal deposition in patients with articular pain in the absence of a classical gout crisis. Computed tomography is an excellent method for detecting bone erosions, being useful in spine involvement. Dual-energy CT is a new method able to provide information about the chemical composition of tissues, with high accuracy in the identification of monosodium urate deposits, even in the early stages of the disease and in cases of difficult characterization. Magnetic resonance imaging is useful in the evaluation of deep tissues not accessible by ultrasound. Besides the diagnosis, with the emergence of new drugs that aim to reduce tophaceous burden, imaging methods have become useful tools in monitoring the treatment of patients with

  11. The unclosing premature mortality gap in gout: a general population-based study.

    Science.gov (United States)

    Fisher, Mark C; Rai, Sharan K; Lu, Na; Zhang, Yuqing; Choi, Hyon K

    2017-07-01

    Gout, the most common inflammatory arthritis, is associated with premature mortality. Whether this mortality gap has improved over time, as observed in rheumatoid arthritis (RA), is unknown. Using an electronic medical record database representative of the UK general population, we identified incident gout cases and controls between 1999 and 2014. The gout cohort was divided based on year of diagnosis into early (1999-2006) and late (2007-2014) cohorts. We compared the mortality rates and HRs, adjusting for potential confounders between the cohorts. We conducted sensitivity analyses among patients with gout who received at least one prescription for urate-lowering therapy, which has been found to have a validity of 90%. In both cohorts, patients with gout showed similar levels of excess mortality compared with their corresponding comparison cohort (ie, 29.1 vs 23.5 deaths/1000 person-years and 23.0 vs 18.8 deaths/1000 person-years in the early and late cohorts, respectively). The corresponding mortality HRs were 1.25 (95% CI 1.21 to 1.30) and 1.24 (95% CI 1.20 to 1.29), and the multivariable HRs were 1.10 (95% CI 1.06 to 1.15) and 1.09 (95% CI 1.05 to 1.13), respectively (both p values for interaction >0.72). Our sensitivity analyses showed similar findings (both p values for interaction >0.88). This general population-based cohort study indicates that the level of premature mortality among patients with gout remains unimproved over the past 16 years, unlike RA during the same period. This unclosing premature mortality gap calls for improved management of gout and its comorbidities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  12. Patients with gout differ from healthy subjects in renal response to changes in serum uric acid.

    Science.gov (United States)

    Liu, Sha; Perez-Ruiz, Fernando; Miner, Jeffrey N

    2017-03-01

    Our objectives were to determine whether a change in serum uric acid (sUA) resulted in a corresponding change in the fractional excretion of uric acid (FEUA) and whether the renal response was different in patients with gout versus healthy subjects. FEUA was calculated from previously published studies and four new phase I studies in healthy subjects and/or patients with gout before and after treatment to lower or raise sUA. Treatments included xanthine oxidase inhibitors to lower sUA as well as infusion of uric acid and provision of a high-purine diet to raise sUA. Plots were created of FEUA versus sUA before and after treatment. For the phase I studies, percent change in FEUA per mg/dL change in sUA was calculated separately for healthy subjects and patients with gout, and compared using Student's t test. Analysis of previously published data and the new phase I clinical data indicates that changing sUA by a non-renal mechanism leads to a change in FEUA. The magnitude of change is greater in subjects with higher baseline FEUA versus patients with gout. Healthy subjects excrete more urate than do patients with gout at physiological urate-filtered load; this difference disappears when the urate-filtered load is decreased to ∼5000mg/24hours. These observations are consistent with a less saturated urate reabsorption system in patients with gout versus healthy subjects, resulting in elevated retention of uric acid. Further investigation could lead to the discovery of mechanisms responsible for the etiology of hyperuricemia/gout. Copyright © 2016 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  13. The rate of adherence to urate-lowering therapy and associated factors in Chinese gout patients: a cross-sectional study.

    Science.gov (United States)

    Yin, Rulan; Cao, Haixia; Fu, Ting; Zhang, Qiuxiang; Zhang, Lijuan; Li, Liren; Gu, Zhifeng

    2017-07-01

    The aim of this study was to assess adherence rate and predictors of non-adherence with urate-lowering therapy (ULT) in Chinese gout patients. A cross-sectional study was administered to 125 gout patients using the Compliance Questionnaire on Rheumatology (CQR) for adherence to ULT. Patients were asked to complete the Treatment Satisfaction Questionnaire for Medication version II, Health Assessment Questionnaire, Confidence in Gout Treatment Questionnaire, Gout Knowledge Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and 36-Item Short Form Health Survey. Data were analyzed by independent sample t test, rank sum test, Chi-square analysis as well as binary stepwise logistic regression modeling. The data showed that the rate of adherence (CQR ≥80%) to ULT was 9.6% in our investigated gout patients. Adherence was associated with functional capacity, gout-related knowledge, satisfaction with medication, confidence in gout treatment and mental components summary. Multivariable analysis of binary stepwise logistic regression identified gout-related knowledge and satisfaction of effectiveness with medication was the independent risk factors of medication non-adherence. Patients unaware of gout-related knowledge, or with low satisfaction of effectiveness with medication, were more likely not to adhere to ULT. Non-adherence to ULT among gout patients is exceedingly common, particularly in patients unaware of gout-related knowledge, or with low satisfaction of effectiveness with medication. These findings could help medical personnel develop useful interventions to improve gout patients' medication adherence.

  14. Identifying core domains to assess flare in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Bartlett, Susan J; Hewlett, Sarah; Bingham, Clifton O

    2012-01-01

    For rheumatoid arthritis (RA), there is no consensus on how to define and assess flare. Variability in flare definitions impairs understanding of findings across studies and limits ability to pool results. The OMERACT RA Flare Group sought to identify domains to define RA flares from patient...

  15. Solar flare leaves sun quaking

    Science.gov (United States)

    1998-05-01

    Dr. Alexander G. Kosovichev, a senior research scientist from Stanford University, and Dr. Valentina V. Zharkova from Glasgow (United Kingdom) University found the tell-tale seismic signature in data on the Sun's surface collected by the Michelson Doppler Imager onboard the Solar and Heliospheric Observatory (SOHO) spacecraft immediately following a moderate-sized flare on July 9, 1996. "Although the flare was a moderate one, it still released an immense amount of energy," said Dr. Craig Deforest, a researcher with the SOHO project. "The energy released is equal to completely covering the Earth's continents with a yard of dynamite and detonating it all at once." SOHO is a joint project of the European Space Agency and NASA. The finding is reported in the May 28 issue of the journal Nature, and is the subject of a press conference at the spring meeting of the American Geophysical Union in Boston, Mass., May 27. The solar quake that the science team recorded looks much like ripples spreading from a rock dropped into a pool of water. But over the course of an hour, the solar waves traveled for a distance equal to 10 Earth diameters before fading into the fiery background of the Sun's photosphere. Unlike water ripples that travel outward at a constant velocity, the solar waves accelerated from an initial speed of 22,000 miles per hour to a maximum of 250,000 miles per hour before disappearing. "People have looked for evidence of seismic waves from flares before, but they didn't have a theory so they didn't know where to look," says Kosovichev. Several years ago Kosovichev and Zharkova developed a theory that can explain how a flare, which explodes in space above the Sun's surface, can generate a major seismic wave in the Sun's interior. According to the currently accepted model of solar flares, the primary explosion creates high-energy electrons (electrically charged subatomic particles). These are funneled down into a magnetic flux tube, an invisible tube of magnetic

  16. A New Paradigm for Flare Particle Acceleration

    Science.gov (United States)

    Guidoni, Silvina E.; Karpen, Judith T.; DeVore, C. Richard

    2017-08-01

    The mechanism that accelerates particles to the energies required to produce the observed high-energy impulsive emission and its spectra in solar flares is not well understood. Here, we propose a first-principle-based model of particle acceleration that produces energy spectra that closely resemble those derived from hard X-ray observations. Our mechanism uses contracting magnetic islands formed during fast reconnection in solar flares to accelerate electrons, as first proposed by Drake et al. (2006) for kinetic-scale plasmoids. We apply these ideas to MHD-scale islands formed during fast reconnection in a simulated eruptive flare. A simple analytic model based on the particles’ adiabatic invariants is used to calculate the energy gain of particles orbiting field lines in our ultrahigh-resolution, 2.5D, MHD numerical simulation of a solar eruption (flare + coronal mass ejection). Then, we analytically model electrons visiting multiple contracting islands to account for the observed high-energy flare emission. Our acceleration mechanism inherently produces sporadic emission because island formation is intermittent. Moreover, a large number of particles could be accelerated in each macroscopic island, which may explain the inferred rates of energetic-electron production in flares. We conclude that island contraction in the flare current sheet is a promising candidate for electron acceleration in solar eruptions. This work was supported in part by the NASA LWS and H-SR programs..

  17. Temporal and Periodic Variations of Sunspot Counts in Flaring and Non-Flaring Active Regions

    Science.gov (United States)

    Kilcik, A.; Yurchyshyn, V.; Donmez, B.; Obridko, V. N.; Ozguc, A.; Rozelot, J. P.

    2018-04-01

    We analyzed temporal and periodic variations of sunspot counts (SSCs) in flaring (C-, M-, or X-class flares), and non-flaring active regions (ARs) for nearly three solar cycles (1986 through 2016). Our main findings are as follows: i) temporal variations of monthly means of the daily total SSCs in flaring and non-flaring ARs behave differently during a solar cycle and the behavior varies from one cycle to another; during Solar Cycle 23 temporal SSC profiles of non-flaring ARs are wider than those of flaring ARs, while they are almost the same during Solar Cycle 22 and the current Cycle 24. The SSC profiles show a multi-peak structure and the second peak of flaring ARs dominates the current Cycle 24, while the difference between peaks is less pronounced during Solar Cycles 22 and 23. The first and second SSC peaks of non-flaring ARs have comparable magnitude in the current solar cycle, while the first peak is nearly absent in the case of the flaring ARs of the same cycle. ii) Periodic variations observed in the SSCs profiles of flaring and non-flaring ARs derived from the multi-taper method (MTM) spectrum and wavelet scalograms are quite different as well, and they vary from one solar cycle to another. The largest detected period in flaring ARs is 113± 1.6 days while we detected much longer periodicities (327± 13, 312 ± 11, and 256± 8 days) in the non-flaring AR profiles. No meaningful periodicities were detected in the MTM spectrum of flaring ARs exceeding 55± 0.7 days during Solar Cycles 22 and 24, while a 113± 1.3 days period was detected in flaring ARs of Solar Cycle 23. For the non-flaring ARs the largest detected period was only 31± 0.2 days for Cycle 22 and 72± 1.3 days for the current Cycle 24, while the largest measured period was 327± 13 days during Solar Cycle 23.

  18. CLINICAL IMPLICATION OF FATTY ACID CHANGES IN PATIENTS WITH PRIMARY GOUT ASSOCIATED WITH ARTERIAL HYPERTENSION

    Directory of Open Access Journals (Sweden)

    N. N. Kushnarenko

    2015-12-01

    Full Text Available Aim. To study blood levels of non-esterified fatty acids (NEFAs and adenyl nucleotides, and fatty acids levels in lipids of erythrocyte membranes in patients with primary gout associated with arterial hypertension (HT. Material and methods. 175 male patients with primary gout were included in the study. According to 24-hour blood pressure (BP monitoring results patients were split into two groups: 74 patients with normal BP (group 1 and 101 patients with HT (group 2. 29 healthy age-comparable subjects were included into control group. Uric acid, total NEFAs and glycerol blood levels were studied in all patients. Adenyl nucleotides (ATP , ADP and AMP levels were determined in erythrocytes. Higher fatty acid levels were specified in lipids of erythrocyte membranes, including the following acids: myristinic (С14:0, palmitinic (С16:0, stearic (С18:0, pentadecanic (С15:0, heptadecanic (С17:0, pentadecenic (С15:1, heptadecenic (С17:1, palmitooleic (С16:1, oleic (С18:1, linoleic (С18:2ω6, α-linolenic (С18:3ω3, γ-linolenic (С18:3ω6, dihomo-γ-linolenic (С20:3ω6, arachidonic (С20:4ω6, eicosapentaenoic (С20:5ω3, and docosapentaenoic (С22:5ω3. Results and discussion. Hypertensive patients with gout demonstrated higher NEFAs blood level and greater changes in ATP-ADP-AMP system than normotensive gout patients and healthy subjects as well as 2.2 and 3.7 times higher NEFAs/ATP ratio, respectively. In hypertensive patients with primary gout the composition of fatty acids in erythrocyte membranes lipids changed due to increase in saturated fatty acids amount and decrease in unsaturated fatty acids amount, at that monoenic acid levels increased while polyenic acid levels decreased in unsaturated acids composition. Hypertensive patients with gout shown 1.3 and 2.5 times less levels of ω-3 poly-unsaturated fatty acids (PUFA than normotensive gout patients and healthy subjects, respectively. At the same time ω-6 PUFA levels changed in

  19. Difficulties and Mistakes in the Management of the Patient with Gout

    Directory of Open Access Journals (Sweden)

    S.A. Trypilka

    2016-10-01

    Full Text Available The issues of the most frequent mistakes and difficulties in the early gout diagnosis and further patient management are discussed in the article. It is known that the diagnosis of gout is made in the first year of the disease only in 1/4 ca­ses, on the average 7–8 years pass until the disease is revealed. Only in one out of 4–5 cases gout is correctly verified in early stages. The reasons of the late diagnostics are the features of the course of gout with periods of absence of a symptom (intermittent gout, diagnostic errors at the first patient encounter, early conduction of X-ray examination without revealing the typical signs of the disease, the lack of joint puncture and verification of uric acid crystals in the synovial fluid. Ano­ther cause of diagnostic errors is the determination of the level of uric acid in the blood serum during acute attack. Late diagnosis of gout leads to a series of further diagnostic and tactical mistakes. First of all, this includes the prescription of non-steroidal anti-inflammatory drugs and glucocorticoids without the correct diagnosis. Current recommendations for the management of patients with gout emphasize that the use of glucocorticoids to treat gout is possible only for short cour­ses, their long-term use is not allowed due to the high risk of side effects in this group of patients, who often have comorbidities. Another tactical error is the prescription of urate-lowering drugs in the period of acute arthritis without dose titration and without prescription of anti-inflammatory therapy. The paper presents a clinical case of the late diagnosis of gout involving inefficient treatment with the long-term use of glucocorticoids and absence of administration of urate-lowering drugs resulting in serious side effects — development of diabetes mellitus and hypertension. A detailed analysis of the clinical errors is conducted; recommendations on the rational tactics in this case are presented.

  20. Tophaceous gout of the lumbar spine in a renal transplant patient: a case report and literature review

    International Nuclear Information System (INIS)

    Thornton, Frank J.; Torreggiani, William C.; Brennan, Paul

    2000-01-01

    Tophaceous gout of the spine is rare. We report the case of a 27-year-old male, renal transplant recipient, who presented with an acute onset of lower back pain. Radiological, biochemical and histo-pathological findings confirmed a diagnosis of tophaceous gout of the lumbar spine. We present the case history with the radiological findings and discuss the literature

  1. THE COURSE OF GOUTY ARTHRITIS ACCORDING TO THE KHABAROVSK CITY RHEUMATOLOGY ROOMAND THE EFFECTIVENESS OF GOUT SCHOOL

    Directory of Open Access Journals (Sweden)

    Faina Sergeyevna Zharskaya

    2010-01-01

    Full Text Available The past decade is marked by a rise in the detection rates of gout. The paper gives data on its incidence, risk factors, the frequency of diagnostic errors, the specific features of the course of male gouty arthritis, and the effectiveness of Gout school activities

  2. Association of three genetic loci with uric acid concentration and risk of gout: a genome-wide association study

    NARCIS (Netherlands)

    A. Dehghan (Abbas); A. Köttgen (Anna); Q. Yang (Qiong Fang); S.J. Hwang; W.H.L. Kao (Wen); F. Rivadeneira Ramirez (Fernando); E.A. Boerwinkle (Eric); D. Levy (Daniel); A. Hofman (Albert); B.C. Astor (Brad); E.J. Benjamin (Emelia); P. Tikka-Kleemola (Päivi); J.C.M. Witteman (Jacqueline); J. Coresh (Josef); C.S. Fox (Caroline)

    2008-01-01

    textabstractBackground: Hyperuricaemia, a highly heritable trait, is a key risk factor for gout. We aimed to identify novel genes associated with serum uric acid concentration and gout. Methods: Genome-wide association studies were done for serum uric acid in 7699 participants in the Framingham

  3. Common Variants in LRP2 and COMT Genes Affect the Susceptibility of Gout in a Chinese Population.

    Science.gov (United States)

    Dong, Zheng; Zhao, Dongbao; Yang, Chengde; Zhou, Jingru; Qian, Qiaoxia; Ma, Yanyun; He, Hongjun; Ji, Hengdong; Yang, Yajun; Wang, Xiaofeng; Xu, Xia; Pang, Yafei; Zou, Hejian; Jin, Li; Wang, Jiucun

    2015-01-01

    Gout is a common inflammation disease resulting from an increase in serum uric acid. Nearly 70% of uric acid is excreted via the kidneys. To date, evidence for an association between genetic loci and gout is absent, equivocal or not replicated. Our study aims to test variants in two genes abundantly expressed in the kidney, LRP2 and COMT, for their association with uric acid and gout. In total, 1318 Chinese individuals were genotyped for rs2544390 in LRP2 and rs4680 in COMT. These LRP2 and COMT gene polymorphisms showed no significant effect on uric acid (P = 0.204 and 0.188, separately); however, rs2544390 in LRP2 did influence uric acid levels in individuals with BMI ≥ 25 (P = 0.009). In addition, the allele frequency distributions of the two loci showed a significant difference between gout patients and healthy controls. A missense variation in rs4680 (G > A) decreased the risk of gout (OR = 0.77, P = 0.015), whereas the T allele of rs2544390 was associated with gout pathogenesis risk (OR = 1.26, P = 0.020). The present study provides the first evidence for an association between COMT and gout. Rs2544390 in LRP2 only influenced uric acid levels in individuals with BMI ≥ 25, which might explain the discrepant results among previous studies. In addition, we are the first to identify the association between LRP2 and gout in a Chinese population and to confirm this association in Asians.

  4. Gout: will the "King of Diseases" be the first rheumatic disease to be cured?

    Science.gov (United States)

    Singh, Jasvinder A

    2016-11-11

    Gout is the most common inflammatory arthritis in adults in the Western world. Characterized by hyperuricemia and the effects of acute and chronic inflammation in joints and bursa, gout leads to an agonizing, chronically painful arthritis. Arthritis can also be accompanied by urate nephropathy and subcutaneous urate deposits (tophi). Exciting new developments in the last decade have brought back the focus on this interesting, crystal-induced chronic inflammatory condition. New insights include the role of NALP3 inflammasome-induced inflammation in acute gout, the characterization of diagnostic signs on ultrasound and dual-energy computed tomography imaging modalities, the recognition of target serum urate less than 6 mg/day as the goal for urate-lowering therapies, and evidence-based treatment guidelines. A better understanding of disease mechanisms has enabled drug discovery - three new urate-lowering drugs have been approved in the last decade, with several more in the pipeline. We now recognize the important role that environment and genetics play in the causation of gout. A focus on the cardiac, renal, and metabolic comorbidities of gout will help translational research and discovery over the next decade.

  5. A re-look at an old disease: A multimodality review on gout

    Energy Technology Data Exchange (ETDEWEB)

    Dhanda, S., E-mail: sunitadhanda63@gmail.com [Department of Diagnostic Imaging, National University Hospital (Singapore); Jagmohan, P.; Tian, Q.S. [Department of Diagnostic Imaging, National University Hospital (Singapore)

    2011-10-15

    Gout, the most common form of microcrystalline arthropathy has always interested radiologists. The diagnosis of gout is primarily based on clinical and laboratory findings; however, it has well known and characteristic radiographic manifestations. Radiographs remain the examination of choice in the diagnosis of joint involvement. Plain radiographs are less sensitive to early changes in gout than other imaging techniques. Recently, magnetic resonance imaging (MRI), ultrasound (US), and computed tomography (CT) have demonstrated an increasing role in early diagnosis of gouty arthritis, for assessing the extent of soft-tissue involvement and as problem-solving tools for diagnostically difficult cases. Cross-sectional imaging can also be used for guiding needle aspirations in patients with an acute attack of gout, which may simulate an infective process clinically. This pictorial review illustrates the main imaging features of gout on radiographs, MRI, CT, and ultrasound with the aim of helping the radiologist to make a confident diagnosis in radiographically typical cases and to serve as a problem-solving tool in cases that present a diagnostic dilemma.

  6. Genome-wide association analysis identifies three new risk loci for gout arthritis in Han Chinese

    Science.gov (United States)

    Li, Changgui; Li, Zhiqiang; Liu, Shiguo; Wang, Can; Han, Lin; Cui, Lingling; Zhou, Jingguo; Zou, Hejian; Liu, Zhen; Chen, Jianhua; Cheng, Xiaoyu; Zhou, Zhaowei; Ding, Chengcheng; Wang, Meng; Chen, Tong; Cui, Ying; He, Hongmei; Zhang, Keke; Yin, Congcong; Wang, Yunlong; Xing, Shichao; Li, Baojie; Ji, Jue; Jia, Zhaotong; Ma, Lidan; Niu, Jiapeng; Xin, Ying; Liu, Tian; Chu, Nan; Yu, Qing; Ren, Wei; Wang, Xuefeng; Zhang, Aiqing; Sun, Yuping; Wang, Haili; Lu, Jie; Li, Yuanyuan; Qing, Yufeng; Chen, Gang; Wang, Yangang; Zhou, Li; Niu, Haitao; Liang, Jun; Dong, Qian; Li, Xinde; Mi, Qing-Sheng; Shi, Yongyong

    2015-01-01

    Gout is one of the most common types of inflammatory arthritis, caused by the deposition of monosodium urate crystals in and around the joints. Previous genome-wide association studies (GWASs) have identified many genetic loci associated with raised serum urate concentrations. However, hyperuricemia alone is not sufficient for the development of gout arthritis. Here we conduct a multistage GWAS in Han Chinese using 4,275 male gout patients and 6,272 normal male controls (1,255 cases and 1,848 controls were genome-wide genotyped), with an additional 1,644 hyperuricemic controls. We discover three new risk loci, 17q23.2 (rs11653176, P=1.36 × 10−13, BCAS3), 9p24.2 (rs12236871, P=1.48 × 10−10, RFX3) and 11p15.5 (rs179785, P=1.28 × 10−8, KCNQ1), which contain inflammatory candidate genes. Our results suggest that these loci are most likely related to the progression from hyperuricemia to inflammatory gout, which will provide new insights into the pathogenesis of gout arthritis. PMID:25967671

  7. Fructose-induced aberration of metabolism in familial gout identified by 31P magnetic resonance spectroscopy

    International Nuclear Information System (INIS)

    Seegmiller, J.E.; Dixon, R.M.; Kemp, G.J.; Rajagopalan, B.; Radda, G.K.; Angus, P.W.; McAlindon, T.E.; Dieppe, P.

    1990-01-01

    The hyperuricemia responsible for the development of gouty arthritis results from a wide range of environmental factors and underlying genetically determined aberrations of metabolism. 31 P magnetic resonance spectroscopy studies of children with hereditary fructose intolerance revealed a readily detectable rise in phosphomonoesters with a marked fall in inorganic phosphate in their liver in vivo and a rise in serum urate in response to very low doses of oral fructose. Parents and some family members heterozygous for this enzyme deficiency showed a similar pattern when given a substantially larger dose of fructose. Three of the nine heterozygotes thus identified also had clinical gout, suggesting the possibility of this defect being a fairly common cause of gout. In the present study this same noninvasive technology was used to identify the same spectral pattern in 2 of the 11 families studied with hereditary gout. In one family, the index patient's three brothers and his mother all showed the fructose-induced abnormality of metabolism, in agreement with the maternal inheritance of metabolism, in agreement with the maternal inheritance of the gout in this family group. The test dose of fructose used produced a significantly larger increment in the concentration of serum urate in the patients showing the changes in 31 P magnetic resonance spectra than in the other patients with familial gout or in nonaffected members, thus suggesting a simpler method for initial screening for the defect

  8. Genetic variants in two pathways influence serum urate levels and gout risk: a systematic pathway analysis.

    Science.gov (United States)

    Dong, Zheng; Zhou, Jingru; Xu, Xia; Jiang, Shuai; Li, Yuan; Zhao, Dongbao; Yang, Chengde; Ma, Yanyun; Wang, Yi; He, Hongjun; Ji, Hengdong; Zhang, Juan; Yuan, Ziyu; Yang, Yajun; Wang, Xiaofeng; Pang, Yafei; Jin, Li; Zou, Hejian; Wang, Jiucun

    2018-03-01

    The aims of this study were to identify candidate pathways associated with serum urate and to explore the genetic effect of those pathways on the risk of gout. Pathway analysis of the loci identified in genome-wide association studies (GWASs) showed that the ion transmembrane transporter activity pathway (GO: 0015075) and the secondary active transmembrane transporter activity pathway (GO: 0015291) were both associated with serum urate concentrations, with P FDR values of 0.004 and 0.007, respectively. In a Chinese population of 4,332 individuals, the two pathways were also found to be associated with serum urate (P FDR  = 1.88E-05 and 3.44E-04, separately). In addition, these two pathways were further associated with the pathogenesis of gout (P FDR  = 1.08E-08 and 2.66E-03, respectively) in the Chinese population and a novel gout-associated gene, SLC17A2, was identified (OR = 0.83, P FDR  = 0.017). The mRNA expression of candidate genes also showed significant differences among different groups at pathway level. The present study identified two transmembrane transporter activity pathways (GO: 0015075 and GO: 0015291) were associations with serum urate concentrations and the risk of gout. SLC17A2 was identified as a novel gene that influenced the risk of gout.

  9. Genome-wide association analysis identifies three new risk loci for gout arthritis in Han Chinese.

    Science.gov (United States)

    Li, Changgui; Li, Zhiqiang; Liu, Shiguo; Wang, Can; Han, Lin; Cui, Lingling; Zhou, Jingguo; Zou, Hejian; Liu, Zhen; Chen, Jianhua; Cheng, Xiaoyu; Zhou, Zhaowei; Ding, Chengcheng; Wang, Meng; Chen, Tong; Cui, Ying; He, Hongmei; Zhang, Keke; Yin, Congcong; Wang, Yunlong; Xing, Shichao; Li, Baojie; Ji, Jue; Jia, Zhaotong; Ma, Lidan; Niu, Jiapeng; Xin, Ying; Liu, Tian; Chu, Nan; Yu, Qing; Ren, Wei; Wang, Xuefeng; Zhang, Aiqing; Sun, Yuping; Wang, Haili; Lu, Jie; Li, Yuanyuan; Qing, Yufeng; Chen, Gang; Wang, Yangang; Zhou, Li; Niu, Haitao; Liang, Jun; Dong, Qian; Li, Xinde; Mi, Qing-Sheng; Shi, Yongyong

    2015-05-13

    Gout is one of the most common types of inflammatory arthritis, caused by the deposition of monosodium urate crystals in and around the joints. Previous genome-wide association studies (GWASs) have identified many genetic loci associated with raised serum urate concentrations. However, hyperuricemia alone is not sufficient for the development of gout arthritis. Here we conduct a multistage GWAS in Han Chinese using 4,275 male gout patients and 6,272 normal male controls (1,255 cases and 1,848 controls were genome-wide genotyped), with an additional 1,644 hyperuricemic controls. We discover three new risk loci, 17q23.2 (rs11653176, P=1.36 × 10(-13), BCAS3), 9p24.2 (rs12236871, P=1.48 × 10(-10), RFX3) and 11p15.5 (rs179785, P=1.28 × 10(-8), KCNQ1), which contain inflammatory candidate genes. Our results suggest that these loci are most likely related to the progression from hyperuricemia to inflammatory gout, which will provide new insights into the pathogenesis of gout arthritis.

  10. A re-look at an old disease: A multimodality review on gout

    International Nuclear Information System (INIS)

    Dhanda, S.; Jagmohan, P.; Tian, Q.S.

    2011-01-01

    Gout, the most common form of microcrystalline arthropathy has always interested radiologists. The diagnosis of gout is primarily based on clinical and laboratory findings; however, it has well known and characteristic radiographic manifestations. Radiographs remain the examination of choice in the diagnosis of joint involvement. Plain radiographs are less sensitive to early changes in gout than other imaging techniques. Recently, magnetic resonance imaging (MRI), ultrasound (US), and computed tomography (CT) have demonstrated an increasing role in early diagnosis of gouty arthritis, for assessing the extent of soft-tissue involvement and as problem-solving tools for diagnostically difficult cases. Cross-sectional imaging can also be used for guiding needle aspirations in patients with an acute attack of gout, which may simulate an infective process clinically. This pictorial review illustrates the main imaging features of gout on radiographs, MRI, CT, and ultrasound with the aim of helping the radiologist to make a confident diagnosis in radiographically typical cases and to serve as a problem-solving tool in cases that present a diagnostic dilemma.

  11. Radio imaging of solar flares using the very large array - New insights into flare process

    Science.gov (United States)

    Kundu, M. R.; Schmahl, E. J.; Vlahos, L.; Velusamy, T.

    1982-01-01

    An interpretation of VLA observations of microwave bursts is presented in an attempt to distinguish between certain models of flares. The VLA observations provide information about the pre-flare magnetic field topology and the existence of mildly relativistic electrons accelerated during flares. Examples are shown of changes in magnetic field topology in the hour before flares. In one case, new bipolar loops appear to emerge, which is an essential component of the model developed by Heyvaerts et al. (1977). In another case, a quadrupole structure, suggestive of two juxtaposed bipolar loops, appears to trigger the flare. Because of the observed diversity of magnetic field topologies in microwave bursts, it is believed that the magnetic energy must be dissipated in more than one way. The VLA observations are clearly providing means for sorting out the diverse flare models.

  12. Implications of NRL/ATM solar flare observations on flare theories

    International Nuclear Information System (INIS)

    Cheng, C.C.; Spicer, D.S.

    1975-01-01

    During the Skylab mission, many solar flares were observed with the NRL XUV spectroheliogram in the wavelength region from 150 to 650 A. Because of its high spatial resolution (approximately 2ins.) the three-dimensional structures of the flare emission regions characterized by temperatures from 10 4 K to 20 x 10 6 K can be resolved. Thus the spatial relationship between the relatively cool plasma and the hot plasma components of a flare, and the associated magnetic field structure can be inferred. The implications for various flare models are discussed. (Auth.)

  13. Influences of misprediction costs on solar flare prediction

    Science.gov (United States)

    Huang, Xin; Wang, HuaNing; Dai, XingHua

    2012-10-01

    The mispredictive costs of flaring and non-flaring samples are different for different applications of solar flare prediction. Hence, solar flare prediction is considered a cost sensitive problem. A cost sensitive solar flare prediction model is built by modifying the basic decision tree algorithm. Inconsistency rate with the exhaustive search strategy is used to determine the optimal combination of magnetic field parameters in an active region. These selected parameters are applied as the inputs of the solar flare prediction model. The performance of the cost sensitive solar flare prediction model is evaluated for the different thresholds of solar flares. It is found that more flaring samples are correctly predicted and more non-flaring samples are wrongly predicted with the increase of the cost for wrongly predicting flaring samples as non-flaring samples, and the larger cost of wrongly predicting flaring samples as non-flaring samples is required for the higher threshold of solar flares. This can be considered as the guide line for choosing proper cost to meet the requirements in different applications.

  14. Interaction of the GCKR and A1CF loci with alcohol consumption to influence the risk of gout.

    Science.gov (United States)

    Rasheed, Humaira; Stamp, Lisa K; Dalbeth, Nicola; Merriman, Tony R

    2017-07-05

    Some gout-associated loci interact with dietary exposures to influence outcome. The aim of this study was to systematically investigate interactions between alcohol exposure and urate-associated loci in gout. A total of 2792 New Zealand European and Polynesian (Māori or Pacific) people with or without gout were genotyped for 29 urate-associated genetic variants and tested for a departure from multiplicative interaction with alcohol exposure in the risk of gout. Publicly available data from 6892 European subjects were used to test for a departure from multiplicative interaction between specific loci and alcohol exposure for the risk of hyperuricemia (HU). Multivariate adjusted logistic and linear regression was done, including an interaction term. Interaction of any alcohol exposure with GCKR (rs780094) and A1CF (rs10821905) influenced the risk of gout in Europeans (interaction term 0.28, P = 1.5 × 10 -4 ; interaction term 0.29, P = 1.4 × 10 -4 , respectively). At A1CF, alcohol exposure suppressed the gout risk conferred by the A-positive genotype. At GCKR, alcohol exposure eliminated the genetic effect on gout. In the Polynesian sample set, there was no experiment-wide evidence for interaction with alcohol in the risk of gout (all P > 8.6 × 10 -4 ). However, at GCKR, there was nominal evidence for an interaction in a direction consistent the European observation (interaction term 0.62, P = 0.05). There was no evidence for an interaction of A1CF or GCKR with alcohol exposure in determining HU. These data support the hypothesis that alcohol influences the risk of gout via glucose and apolipoprotein metabolism. In the absence of alcohol exposure, genetic variants in the GCKR and A1CF genes have a stronger role in gout.

  15. Gout in Duke Federico of Montefeltro (1422-1482): a new pearl of the Italian Renaissance.

    Science.gov (United States)

    Fornaciari, Antonio; Giuffra, Valentina; Armocida, Emanuele; Caramella, Davide; Rühli, Frank J; Galassi, Francesco Maria

    2018-01-01

    The article examines the truthfulness of historical accounts claiming that Renaissance Duke Federico of Montefeltro (1422-1482) suffered from gout. By direct paleopathological assessment of the skeletal remains and by the philological investigation of historical and documental sources, primarily a 1461 handwritten letter by the Duke himself to his personal physician, a description of the symptoms and Renaissance therapy is offered and a final diagnosis of gout is formulated. The Duke's handwritten letter offers a rare testimony of ancient clinical self-diagnostics and Renaissance living-experience of gout. Moreover, the article also shows how an alliance between historical, documental and paleopathological methods can greatly increase the precision of retrospective diagnoses, thus helping to shed clearer light onto the antiquity and evolution of diseases.

  16. Up-titration of allopurinol in patients with gout.

    Science.gov (United States)

    Jennings, Claudine G; Mackenzie, Isla S; Flynn, Rob; Ford, Ian; Nuki, George; De Caterina, Raffaele; Riches, Philip L; Ralston, Stuart H; MacDonald, Thomas M

    2014-08-01

    European League against Rheumatism (EULAR) gout management guidelines recommend achieving a target urate level titration in achieving the EULAR target levels. The Febuxostat versus Allopurinol Streamlined Trial (FAST) is an ongoing multi-centre study comparing the cardiovascular safety of febuxostat and allopurinol (target recruitment: 5706 patients). Recruited patients were already taking allopurinol and the protocol required up-titration of daily allopurinol dose, in 100 mg increments, to achieve the EULAR urate target level prior to randomisation. We reviewed pre-randomisation data from the first 400 recruited and subsequently randomised FAST patients. Of 400 patients, 144 (36%) had urate levels ≥357 µmol/L at screening and required allopurinol up-titration. Higher urate levels were significantly associated with lower allopurinol dose, male sex, increased BMI, increased alcohol intake and diuretic use. Mean fall in urate levels after a single 100-mg dose increase was 71 µmol/L. The number of up-titrations required ranged from one to five (median = 1) with 65% of patients controlled after one 100-mg up-titration. Overall, 97% of up-titrated patients achieved target urate levels with median final allopurinol dose of 300 mg daily. Side effects and complications of up-titration were minimal. Overall, 36% of FAST patients were not at target urate levels and required up-titration. Allopurinol up-titration was effective in achieving urate target levels and was generally well tolerated by patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Can we explain atypical solar flares?

    Science.gov (United States)

    Dalmasse, K.; Chandra, R.; Schmieder, B.; Aulanier, G.

    2015-02-01

    Context. We used multiwavelength high-resolution data from ARIES, THEMIS, and SDO instruments to analyze a non-standard, C3.3 class flare produced within the active region NOAA 11589 on 2012 October 16. Magnetic flux emergence and cancellation were continuously detected within the active region, the latter leading to the formation of two filaments. Aims: Our aim is to identify the origins of the flare taking the complex dynamics of its close surroundings into account. Methods: We analyzed the magnetic topology of the active region using a linear force-free field extrapolation to derive its 3D magnetic configuration and the location of quasi-separatrix layers (QSLs), which are preferred sites for flaring activity. Because the active region's magnetic field was nonlinear force-free, we completed a parametric study using different linear force-free field extrapolations to demonstrate the robustness of the derived QSLs. Results: The topological analysis shows that the active region presented a complex magnetic configuration comprising several QSLs. The considered data set suggests that an emerging flux episode played a key role in triggering the flare. The emerging flux probably activated the complex system of QSLs, leading to multiple coronal magnetic reconnections within the QSLs. This scenario accounts for the observed signatures: the two extended flare ribbons developed at locations matched by the photospheric footprints of the QSLs and were accompanied with flare loops that formed above the two filaments, which played no important role in the flare dynamics. Conclusions: This is a typical example of a complex flare that can a priori show standard flare signatures that are nevertheless impossible to interpret with any standard model of eruptive or confined flare. We find that a topological analysis, however, permitted us to unveil the development of such complex sets of flare signatures. Movies associated to Figs. 1, 3, and 9 are only available at the CDS via

  18. Laser flare photometry in clinical practice

    Directory of Open Access Journals (Sweden)

    Yury S Astakhov

    2016-06-01

    Full Text Available Laser flare photometry (LFP is the only quantitative and objective method for the evaluation of aqueous flare. There are numerous opportunities to use LFP in clinical practice, and they are discussed in the paper. It is especially helpful in management of uveitis patients, because it allows estimating the correct diagnosis, managing the patient during the treatment with noninvasive method and predicting relapses and complications.

  19. Physics of Coupled CME and Flare Systems

    Science.gov (United States)

    2016-12-21

    AFRL-RV-PS- AFRL-RV-PS- TR-2016-0162 TR-2016-0162 PHYSICS OF COUPLED CME AND FLARE SYSTEMS K. S. Balasubramaniam, et al. 21 December 2016 Final...30 Sep 2016 4. TITLE AND SUBTITLE Physics of Coupled CME and Flare Systems 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 61102F...objectives for this task were: (i) derive measureable physical properties and discernible structural circumstances in solar active regions that

  20. Modelling blazar flaring using a time-dependent fluid jet emission model - an explanation for orphan flares and radio lags

    Science.gov (United States)

    Potter, William J.

    2018-01-01

    Blazar jets are renowned for their rapid violent variability and multiwavelength flares, however, the physical processes responsible for these flares are not well understood. In this paper, we develop a time-dependent inhomogeneous fluid jet emission model for blazars. We model optically thick radio flares for the first time and show that they are delayed with respect to the prompt optically thin emission by ∼months to decades, with a lag that increases with the jet power and observed wavelength. This lag is caused by a combination of the travel time of the flaring plasma to the optically thin radio emitting sections of the jet and the slow rise time of the radio flare. We predict two types of flares: symmetric flares - with the same rise and decay time, which occur for flares whose duration is shorter than both the radiative lifetime and the geometric path-length delay time-scale; extended flares - whose luminosity tracks the power of particle acceleration in the flare, which occur for flares with a duration longer than both the radiative lifetime and geometric delay. Our model naturally produces orphan X-ray and γ-ray flares. These are caused by flares that are only observable above the quiescent jet emission in a narrow band of frequencies. Our model is able to successfully fit to the observed multiwavelength flaring spectra and light curves of PKS1502+106 across all wavelengths, using a transient flaring front located within the broad-line region.

  1. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative

    Science.gov (United States)

    Neogi, Tuhina; Jansen, Tim L Th A; Dalbeth, Nicola; Fransen, Jaap; Schumacher, H Ralph; Berendsen, Dianne; Brown, Melanie; Choi, Hyon; Edwards, N Lawrence; Janssens, Hein J E M; Lioté, Frédéric; Naden, Raymond P; Nuki, George; Ogdie, Alexis; Perez-Ruiz, Fernando; Saag, Kenneth; Singh, Jasvinder A; Sundy, John S; Tausche, Anne-Kathrin; Vaquez-Mellado, Janitzia; Yarows, Steven A; Taylor, William J

    2015-01-01

    Objective Existing criteria for the classification of gout have suboptimal sensitivity and/or specificity, and were developed at a time when advanced imaging was not available. The current effort was undertaken to develop new classification criteria for gout. Methods An international group of investigators, supported by the American College of Rheumatology and the European League Against Rheumatism, conducted a systematic review of the literature on advanced imaging of gout, a diagnostic study in which the presence of monosodium urate monohydrate (MSU) crystals in synovial fluid or tophus was the gold standard, a ranking exercise of paper patient cases, and a multi-criterion decision analysis exercise. These data formed the basis for developing the classification criteria, which were tested in an independent data set. Results The entry criterion for the new classification criteria requires the occurrence of at least one episode of peripheral joint or bursal swelling, pain, or tenderness. The presence of MSU crystals in a symptomatic joint/bursa (ie, synovial fluid) or in a tophus is a sufficient criterion for classification of the subject as having gout, and does not require further scoring. The domains of the new classification criteria include clinical (pattern of joint/bursa involvement, characteristics and time course of symptomatic episodes), laboratory (serum urate, MSU-negative synovial fluid aspirate), and imaging (double-contour sign on ultrasound or urate on dual-energy CT, radiographic gout-related erosion). The sensitivity and specificity of the criteria are high (92% and 89%, respectively). Conclusions The new classification criteria, developed using a data-driven and decision-analytic approach, have excellent performance characteristics and incorporate current state-of-the-art evidence regarding gout. PMID:26359487

  2. Cardiovascular risk of patients with gout seen at rheumatology clinics following a structured assessment.

    Science.gov (United States)

    Andrés, Mariano; Bernal, José Antonio; Sivera, Francisca; Quilis, Neus; Carmona, Loreto; Vela, Paloma; Pascual, Eliseo

    2017-07-01

    Gout-associated cardiovascular (CV) risk relates to comorbidities and crystal-led inflammation. The aim was to estimate the CV risk by prediction tools in new patients with gout and to assess whether ultrasonographic carotid changes are present in patients without high CV risk. Cross-sectional study. Consecutive new patients with crystal-proven gout underwent a structured CV consultation, including CV events, risk factors and two risk prediction tools-the Systematic COronary Evaluation (SCORE) and the Framingham Heart Study (FHS). CV risk was stratified according to current European guidelines. Carotid ultrasound (cUS) was performed in patients with less than very high CV risk. The presence of carotid plaques was studied depending on the SCORE and FHS by the area under the curve (AUC) of receiver operating curves. 237 new patients with gout were recruited. CV stratification by scores showed a predominance of very high (95 patients, 40.1%) and moderate (72 patients, 30.5%) risk levels. cUS was performed in 142 patients, finding atheroma plaques in 66 (46.5%, 95% CI 37.8 to 54.2). Following cUS findings, patients classified as very high risk increased from 40.1% up to 67.9% (161/237 patients). SCORE and FHS predicted moderately (AUC 0.711 and 0.683, respectively) the presence of atheroma plaques at cUS. The majority of patients presenting with gout may be at very high CV risk, indicating the need for initiating optimal prevention strategies at this stage. Risk prediction tools appear to underestimate the presence of carotid plaque in patients with gout. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  3. Role of chicken astrovirus as a causative agent of gout in commercial broilers in India.

    Science.gov (United States)

    Bulbule, N R; Mandakhalikar, K D; Kapgate, S S; Deshmukh, V V; Schat, K A; Chawak, M M

    2013-01-01

    Several outbreaks of gout were reported in commercial broilers in India during 2011 and 2012, causing up to 40% mortality in the birds. Gross and histopathological observations confirmed gout. Quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) analysis from kidney samples of gout-affected birds indicated the presence of chicken astrovirus (CAstV) in 41.7% of cases and a mixed infection of CAstV and avian nephritis virus (ANV) in 36.4% of cases. CAstV isolated from gout-affected kidneys by inoculating embryonated specific pathogen free (SPF) eggs showed dwarfing in embryos and a cytopathic effect in chicken embryo kidney cells. Inoculation of 1-day-old SPF and broiler chicks with CAstVs caused gout and mortality between 4 and 10 days post inoculation. Virus isolation and qRT-PCR analysis showed the presence of only CAstV in inoculated chicks. Sequence analysis of capsid genes indicated a major group of Indian CAstVs that displayed 92.0 to 99.2% intergroup amino acid identity and 83.9 to 90.4% identity with subgroup Bi CAstVs of UK origin. We designated this group Indian Bi. Analysis of the partial polymerase amino acid sequences of our isolates indicated two groups of CAstVs (Indian 1 and 2) that displayed 90.2 to 95.5% amino acid identity between them. We thus report for the first time that, in addition to infectious bronchitis virus and ANV, CAstVs are a causative agent of gout.

  4. Mapping patients' experiences from initial symptoms to gout diagnosis: a qualitative exploration.

    Science.gov (United States)

    Liddle, Jennifer; Roddy, Edward; Mallen, Christian D; Hider, Samantha L; Prinjha, Suman; Ziebland, Sue; Richardson, Jane C

    2015-09-14

    To explore patients' experiences from initial symptoms to receiving a diagnosis of gout. Data from in-depth semistructured interviews were used to construct themes to describe key features of patients' experiences of gout diagnosis. A maximum variation sample of 43 UK patients with gout (29 men; 14 women; age range 32-87 years) were recruited from general practices, rheumatology clinics, gout support groups and through online advertising. Severe joint pain, combined with no obvious signs of physical trauma or knowledge of injury, caused confusion for patients attempting to interpret their symptoms. Reasons for delayed consultation included self-diagnosis and/or self-medication, reluctance to seek medical attention, and financial/work pressures. Factors potentially contributing to delayed diagnosis after consultation included reported misdiagnosis, attacks in joints other than the first metatarsophalangeal joint, and female gender. The limitations in using serum uric acid (SUA) levels for diagnostic purposes were not always communicated effectively to patients, and led to uncertainty and lack of confidence in the accuracy of the diagnosis. Resistance to the diagnosis occurred in response to patients' beliefs about the causes of gout and characteristics of the people likely to be affected. Diagnosis prompted actions, such as changes in diet, and evidence was found of self-monitoring of SUA levels. This study is the first to report data specifically about patients' pathways to initial consultation and subsequent experiences of gout diagnosis. A more targeted approach to information provision at diagnosis would improve patients' experiences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Modelling emissions from natural gas flaring

    Directory of Open Access Journals (Sweden)

    G. Ezaina Umukoro

    2017-04-01

    Full Text Available The world today recognizes the significance of environmental sustainability to the development of nations. Hence, the role oil and gas industry plays in environmental degrading activities such as gas flaring is of global concern. This study presents material balance equations and predicts results for non-hydrocarbon emissions such as CO2, CO, NO, NO2, and SO2 etc. from flaring (combustion of 12 natural gas samples representing composition of natural gas of global origin. Gaseous emission estimates and pattern were modelled by coding material balance equations for six reaction types and combustion conditions with a computer program. On the average, anticipated gaseous emissions from flaring natural gas with an average annual global flaring rate 126 bcm per year (between 2000 and 2011 in million metric tonnes (mmt are 560 mmt, 48 mmt, 91 mmt, 93 mmt and 50 mmt for CO2, CO, NO, NO2 and SO2 respectively. This model predicted gaseous emissions based on the possible individual combustion types and conditions anticipated in gas flaring operation. It will assist in the effort by environmental agencies and all concerned to track and measure the extent of environmental pollution caused by gas flaring operations in the oil and gas industry.

  6. New Results from the Flare Genesis Experiment

    Science.gov (United States)

    Rust, D. M.; Bernasconi, P. N.; Eaton, H. A.; Keller, C.; Murphy, G. A.; Schmieder, B.

    2000-05-01

    From January 10 to 27, 2000, the Flare Genesis solar telescope observed the Sun while suspended from a balloon in the stratosphere above Antarctica. The goal of the mission was to acquire long time series of high-resolution images and vector magnetograms of the solar photosphere and chromosphere. Images were obtained in the magnetically sensitive Ca I line at 6122 Angstroms and at H-alpha (6563 Angstroms). The FGE data were obtained in the context of Max Millennium Observing Campaign #004, the objective of which was to study the ``Genesis of Solar Flares and Active Filaments/Sigmoids." Flare Genesis obtained about 26,000 usable images on the 8 targeted active regions. A preliminary examination reveals a good sequence on an emerging flux region and data on the M1 flare on January 22, as well as a number of sequences on active filaments. We will present the results of our first analysis efforts. Flare Genesis was supported by NASA grants NAG5-4955, NAG5-5139, and NAG5-8331 and by NSF grant OPP-9615073. The Air Force Office of Scientific Research and the Ballistic Missile Defense Organization supported early development of the Flare Genesis Experiment.

  7. Lyman continuum observations of solar flares

    Science.gov (United States)

    Machado, M. E.; Noyes, R. W.

    1978-01-01

    A study is made of Lyman continuum observations of solar flares, using data obtained by the EUV spectroheliometer on the Apollo Telescope Mount. It is found that there are two main types of flare regions: an overall 'mean' flare coincident with the H-alpha flare region, and transient Lyman continuum kernels which can be identified with the H-alpha and X-ray kernels observed by other authors. It is found that the ground level hydrogen population in flares is closer to LTE than in the quiet sun and active regions, and that the level of Lyman continuum formation is lowered in the atmosphere from a mass column density .000005 g/sq cm in the quiet sun to .0003 g/sq cm in the mean flare, and to .001 g/sq cm in kernels. From these results the amount of chromospheric material 'evaporated' into the high temperature region is derived, which is found to be approximately 10 to the 15th g, in agreement with observations of X-ray emission measures.

  8. Neutrophil: Lymphocyte Ratio and Mean Platelet Volume in Patients with Gout

    Directory of Open Access Journals (Sweden)

    Ayse Balkarli

    2016-09-01

    Full Text Available Aim: Gout is a clinical syndrome with increased uric acid concentration, which is caused by inflammatory response against monosodium urate (MSU crystals. In gout, neutrophils are involved in inflammatory response and neutrophil activation is dependent on local cytokine production. Mean platelet volume (MPV and neutrophillymphocyte ratio (NLR are considered as inflammatory markers in several diseases and it is reported that they may have prognostic significance. Inthe current literature, there is no study evaluating MPV and NLR in gout. In this retrospective study, we investigated the role of MPV and NLR in determining inflammation in gout disease. Material and Method: In this retrospective study, 106 patients with gout (91 men and 15 women meeting the inclusion criteria based on patient records and 148 age- and sex-matched healthy controls (128 men and 20 women were included. Laboratory data during attacks (group I and intercritical period (group II were collected for the patient group. Results: Mean age was 59.46±12.93 years in the patient group and 59.00±11.33 years in the control group. Age at first attack was 52.00±12.77 years and mean time interval between first 2 attacks was 6.00±5.52 months. There was tophus in 9 patients (8.5% and family history of gout in 17 patients (16.0%. Compared to groupII (intercritical period and the control, no significant difference in MPV levels was found in groupI (during attack. MPV was similar among the three groups. C-reactive protein (CRP and erythrocyte sedimentation rate (ESR were found to be significantly higher in group I compared to group II. There was significant difference in NLR among three groups. When classified according to the presence of tophus, it was seen that MPV and NLR were similar in both groups. Discussion: The finding of increased NLR during attacks and intercritical period show that patients with gout are subjected to chronic inflammation. Thus, NLR can be a simple, inexpensive

  9. Solar and stellar flares and their impact on planets

    Science.gov (United States)

    Shibata, Kazunari

    Recent observations of the Sun revealed that the solar atmosphere is full of flares and flare-like phenomena, which affect terrestrial environment and our civilization. It has been established that flares are caused by the release of magnetic energy through magnetic reconnection. Many stars show flares similar to solar flares, and such stellar flares especially in stars with fast rotation are much more energetic than solar flares. These are called superflares. The total energy of a solar flare is 1029 - 1032 erg, while that of a superflare is 1033 - 1038 erg. Recently, it was found that superflares (with 1034 - 1035 erg) occur on Sun-like stars with slow rotation with frequency once in 800 - 5000 years. This suggests the possibility of superflares on the Sun. We review recent development of solar and stellar flare research, and briefly discuss possible impacts of superflares on the Earth and exoplanets.

  10. Effect of flow parameters on flare stack generator noise

    International Nuclear Information System (INIS)

    Dinn, T.S.

    1998-01-01

    The SoundPLAN Computer Noise Model was used to determine the general effect of flare noise in a community adjacent to a petrochemical plant. Tests were conducted to determine the effect of process flow conditions and the pulsating flame on the flare stack generator noise from both a refinery flare and process flare. Flaring under normal plant operations, the flaring of fuel gas and the flaring of hydrogen were the three conditions that were tested. It was shown that the steam flow rate was the determining factor in the flare stack generated noise. Variations in the water seal level in the flare line surge tank increased or decreased the gas flowrate, which resulted in a pulsating flame. The period and amplitude of the pulsating noise from the flare stacks was determined by measuring several parameters. Flare stack noise oscillations were found to be greater for the process flare than for the refinery flare stack. It was suggested that minimizing the amount of steam fed to the flare and improving the burner design would minimize noise. 2 tabs., 6 figs

  11. Feasibility of flare gas reformation to practical energy in Farashband gas refinery: no gas flaring.

    Science.gov (United States)

    Rahimpour, Mohammad Reaza; Jokar, Seyyed Mohammad

    2012-03-30

    A suggested method for controlling the level of hazardous materials in the atmosphere is prevention of combustion in flare. In this work, three methods are proposed to recover flare gas instead of conventional gas-burning in flare at the Farashband gas refinery. These methods aim to minimize environmental and economical disadvantages of burning flare gas. The proposed methods are: (1) gas to liquid (GTL) production, (2) electricity generation with a gas turbine and, (3) compression and injection into the refinery pipelines. To find the most suitable method, the refinery units that send gas to the flare as well as the required equipment for the three aforementioned methods are simulated. These simulations determine the amount of flare gas, the number of GTL barrels, the power generated by the gas turbine and the required compression horsepower. The results of simulation show that 563 barrels/day of valuable GTL products is produced by the first method. The second method provides 25 MW electricity and the third method provides a compressed natural gas with 129 bar pressure for injection to the refinery pipelines. In addition, the economics of flare gas recovery methods are studied and compared. The results show that for the 4.176MMSCFD of gas flared from the Farashband gas refinery, the electricity production gives the highest rate of return (ROR), the lowest payback period, the highest annual profit and mild capital investment. Therefore, the electricity production is the superior method economically. Copyright © 2012 Elsevier B.V. All rights reserved.

  12. The diagnostic usefulness of densitometric examinations and radioisotopic indexes of bone metabolism and muscle perfusion in gout

    International Nuclear Information System (INIS)

    Tryniszewski, W.; Gadzicki, M.; Gorska-Chrzastek, M.; Maziarz, Z.; Rysz, J.

    2010-01-01

    Background: Gout affects joints and other organs and often impairs the body asymptomatically. The aim of this study was to determine to what extent gout correlates with the changes in bone system and muscle perfusion. The influence of gout on bone mineralization, bone metabolism and muscle perfusion were assessed. The correlation between these and the diagnostic usefulness of the methods applied are discussed. The study included 44 patients (ages 38 - 67) including 7 women (ages 59 - 67). Seventeen of the examined men were 35 -45 years of age. Of the 44 total patients, 5 were normal weight (11 %), 29 (66 %) were overweight and 10 (23 %) were obese. The disease duration was 5 - 10 years. Material/Methods: The patients were examined for gout by specialists. Biochemical and hormonal blood tests were performed on parameters that influence bone mineralization and rotation, and muscle perfusion. BMD, T-score and Z-score of femoral bone neck were obtained, and muscle perfusion was assessed. With own methods and programs the bone metabolism and muscle perfusion indicators were assigned. Results: In patients with gout, a decrease in BMD, together with the slowing of metabolic processes, was observed. When BMD increased, a decreased perfusion was observed. A strong positive correlation was observed between BMD and IBM (indicator of bone metabolism), and between BMI and the perfusion indicator. Improved perfusion caused the BMD and IBM to increase. IBM and BMD define the size of the disturbances and are important clinical parameters. Conclusions: The bone metabolism disorder, osteopenia and osteoporosis may be caused by the destructive influence of gout on the bone system. In patients with gout, bone mineralization and IBM disturbances occur much earlier than in those without gout. The increase of IBM reflects the pace of the metabolic processes in the bone system. These methods complete the diagnostics of bone systems in patients with gout. (authors)

  13. Functional polymorphisms of the ABCG2 gene are associated with gout disease in the Chinese Han male population.

    Science.gov (United States)

    Zhou, Danqiu; Liu, Yunqing; Zhang, Xinju; Gu, Xiaoye; Wang, Hua; Luo, Xinhua; Zhang, Jin; Zou, Hejian; Guan, Ming

    2014-05-22

    Gout is a common type of arthritis that is characterized by hyperuricemia, tophi and joint inflammation. Genetic variations in the ABCG2 gene have been reported to influence serum uric acid levels and to participate in the pathogenesis of gout, but no further data have been reported in the Han Chinese population. Peripheral blood DNA was isolated from 352 male patients with gout and 350 gout-free normal male controls. High-resolution melting analysis and Sanger sequencing were performed to identify the genetic polymorphisms V12M, Q141K and Q126X in the ABCG2 gene. Genotype and haplotype analyses were utilized to determine the disease odds ratios (ORs). A prediction model for gout risk using ABCG2 protein function was established based on the genotype combination of Q126X and Q141K. For Q141K, the A allele frequency was 49.6% in the gout patients and 30.9% in the controls (OR 2.20, 95% confidence interval (CI): 1.77-2.74, p=8.99×10⁻¹³). Regarding Q126X, the T allele frequency was 4.7% in the gout patients and 1.7% in the controls (OR 2.91, 95% CI: 1.49-5.68, p=1.57×10⁻³). The A allele frequency for V12M was lower (18.3%) in the gout patients than in the controls (29%) (OR 0.55, 95% CI 0.43-0.71, p=2.55×10⁻⁶). In the order of V12M, Q126X and Q141K, the GCA and GTC haplotypes indicated increased disease risk (OR=2.30 and 2.71, respectively). Patients with mild to severe ABCG2 dysfunction accounted for 78.4% of gout cases. The ABCG2 126X and 141K alleles are associated with an increased risk of gout, whereas 12M has a protective effect on gout susceptibility in the Han Chinese population. ABCG2 dysfunction can be used to evaluate gout risk.

  14. Improved Gout Outcomes in Primary Care Using a Novel Disease Management Program: A Pilot Study.

    Science.gov (United States)

    Bulbin, David; Denio, Alfred E; Berger, Andrea; Brown, Jason; Maynard, Carson; Sharma, Tarun; Kirchner, H Lester; Ayoub, William T

    2018-02-13

    To pilot a primary care gout management improvement intervention. Two large primary care sites were selected: one underwent the intervention, the other, a control, underwent no intervention. The intervention consisted of: engagement of intervention site staff, surveys of provider performance improvement preferences, and onsite live and enduring online education. Electronic Health Record reminders were constructed. Both the intervention and control sites had 3 quality measures assessed monthly: percent of gout patients treated with urate lowering therapy, percent of treated patients monitored with serum urate, and percent of treated patients at target serum urate ≤ 6.0 mg/dl. The intervention site providers received monthly reports comparing their measures against their peers. By 6 months, the intervention site significantly improved all 3 gout performance measures. Percentage treated increased from 54.4 to 61.1%, OR 1.19 (95% CI 1.08, 1.31 and p-value management program can significantly improve primary care gout management performance. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  15. Olecranon bursitis as initial presentation of gout in asymptomatic normouricemic patients

    NARCIS (Netherlands)

    Emad, Yasser; Ragab, Yasser; El Shaarawy, Nashwa; Rasker, Johannes J.

    2014-01-01

    Background Acute bursitis is a less frequent presentation of gout, especially in normouricemic subjects compared to the typical pattern of acute gouty arthritis. Aim of the work The aim of the current case reports is to describe the clinical and the magnetic resonance imaging features of acute gouty

  16. Step wise approach of gout in the rheumatology ward of Point-G ...

    African Journals Online (AJOL)

    Background: Worldwide, the numbers of gout cases are increasing due to behaviour changes and socio economic factors. Although this can be a global health problem according to data reported from industrialized countries, there are limited reports on the disease burden in low and middle income countries like Mali where ...

  17. [Gout not induced by diuretics in a case-control study in general practice

    NARCIS (Netherlands)

    Janssens, H.; Lisdonk, E.H. van de; Janssen, M.; Hoogen, H.J.M. van den; Verbeek, A.L.M.

    2007-01-01

    OBJECTIVE: To determine the relation between diuretics and the development of gout, taking into account the possible confounding by hypertension and cardiovascular diseases. DESIGN: Case-control study. METHOD: With the aid of the data on morbidity and medication from the electronic medical files ofa

  18. THE HERBAL COMPLEX URISAN IS THE HELP TO A PHYSICIAN TREATING A PATIENT WITH GOUT

    Directory of Open Access Journals (Sweden)

    I I Polskaya

    2009-01-01

    Full Text Available The paper gives the data of an open-labeled study of the efficacy and safety of the herbal preparation Urisan in gout. There is a decrease in the serum level of uric acid during Urisan therapy that has shown a good tolerability and a high adherence.

  19. Retinal complications of gout: a case report and review of the literature.

    Science.gov (United States)

    Jiang, Ying; Brenner, Jason E; Foster, William J

    2018-01-19

    There have been few reported findings of posterior segment complications of gout. While exudative lesions, an increased risk of macular degeneration, and vascular occlusions have been previously reported, to our knowledge, refractile macular lesions have not been reported in a patient with chronic uncontrolled gout. Highly refractile, crystal-like lesions were found in the macula of a 62 year old male patient with chronically uncontrolled gout. The lesions appeared at the termination of retinal arterioles and were located at the level of the retinal pigment epithelium. The lesions did not stain with fluorescein and were associated with larger areas geographic atrophy. Review of the patient's blood tests revealed well-controlled vasculopathic risk factors. Fundus appearance and best-corrected visual acuity remained stable over 12 months of follow-up during which the uric acid levels were well controlled. Retinopathy may be associated with chronically uncontrolled gout and patients with visual complaints should undergo a dilated examination in addition to the typical anterior segment slit-lamp exam.

  20. Population-specific association between ABCG2 variants and tophaceous disease in people with gout.

    Science.gov (United States)

    He, Wendy; Phipps-Green, Amanda; Stamp, Lisa K; Merriman, Tony R; Dalbeth, Nicola

    2017-03-07

    Tophi contribute to musculoskeletal disability, joint damage and poor health-related quality of life in people with gout. The aim of this study was to examine the role of SLC2A9 and ABCG2 variants in tophaceous disease in people with gout. Participants (n = 1778) with gout fulfilling the 1977 American Rheumatism Association (ARA) classification criteria, who were recruited from primary and secondary care, attended a detailed study visit. The presence of palpable tophi was recorded. SLC2A9 rs11942223, ABCG2 rs2231142 and ABCG2 rs10011796 were genotyped. Data were analysed according to tophus status. Compared to participants without tophi, those with tophi were older, had longer disease duration and higher serum creatinine, and were more likely to be of Māori or Pacific (Polynesian) ancestry. SLC2A9 rs11942223 was not associated with tophi. However, the risk alleles for both ABCG2 single nucleotide polymorphisms (SNPs) were present more frequently in those with tophi (OR (95% CI) 1.24 (1.02-1.51) for rs2231142 and 1.33 (1.01-1.74) for rs10011796, p gout.

  1. Interactions between tenocytes and monosodium urate monohydrate crystals: implications for tendon involvement in gout.

    Science.gov (United States)

    Chhana, Ashika; Callon, Karen E; Dray, Michael; Pool, Bregina; Naot, Dorit; Gamble, Greg D; Coleman, Brendan; McCarthy, Geraldine; McQueen, Fiona M; Cornish, Jillian; Dalbeth, Nicola

    2014-09-01

    Advanced imaging studies have demonstrated that urate deposition in periarticular structures, such as tendons, is common in gout. The aim of this study was to investigate the effects of monosodium urate monohydrate (MSU) crystals on tenocyte viability and function. The histological appearance of tendons in joints affected by advanced gout was examined using light microscopy. In vitro, colorimetric assays and flow cytometry were used to assess cell viability in primary rat and primary human tenocytes cultured with MSU crystals. Real-time PCR was used to determine changes in the relative mRNA expression levels of tendon-related genes, and Sirius red staining was used to measure changes in collagen deposition in primary rat tenocytes. In joint samples from patients with gout, MSU crystals were identified within the tendon, adjacent to and invading into tendon, and at the enthesis. MSU crystals reduced tenocyte viability in a dose-dependent manner. MSU crystals decreased the mRNA expression of tendon collagens, matrix proteins and degradative enzymes and reduced collagen protein deposition by tenocytes. These data indicate that MSU crystals directly interact with tenocytes to reduce cell viability and function. These interactions may contribute to tendon damage in people with advanced gout. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. Ultrasound as an Outcome Measure in Gout. A Validation Process by the OMERACT Ultrasound Working Group

    DEFF Research Database (Denmark)

    Terslev, Lene; Gutierrez, Marwin; Schmidt, Wolfgang A

    2015-01-01

    OBJECTIVE: To summarize the work performed by the Outcome Measures in Rheumatology (OMERACT) Ultrasound (US) Working Group on the validation of US as a potential outcome measure in gout. METHODS: Based on the lack of definitions, highlighted in a recent literature review on US as an outcome tool...

  3. Radio-flaring Ultracool Dwarf Population Synthesis

    Energy Technology Data Exchange (ETDEWEB)

    Route, Matthew, E-mail: mroute@purdue.edu [Department of Astronomy and Astrophysics, the Pennsylvania State University, 525 Davey Laboratory, University Park, PA 16802 (United States)

    2017-08-10

    Over a dozen ultracool dwarfs (UCDs), low-mass objects of spectral types ≥M7, are known to be sources of radio flares. These typically several-minutes-long radio bursts can be up to 100% circularly polarized and have high brightness temperatures, consistent with coherent emission via the electron cyclotron maser operating in approximately kilogauss magnetic fields. Recently, the statistical properties of the bulk physical parameters that describe these UCDs have become described adequately enough to permit synthesis of the population of radio-flaring objects. For the first time, I construct a Monte Carlo simulator to model the population of these radio-flaring UCDs. This simulator is powered by Intel Secure Key (ISK), a new processor technology that uses a local entropy source to improve random number generation that has heretofore been used to improve cryptography. The results from this simulator indicate that only ∼5% of radio-flaring UCDs within the local interstellar neighborhood (<25 pc away) have been discovered. I discuss a number of scenarios that may explain this radio-flaring fraction and suggest that the observed behavior is likely a result of several factors. The performance of ISK as compared to other pseudorandom number generators is also evaluated, and its potential utility for other astrophysical codes is briefly described.

  4. Numerical simulation of a sour gas flare

    Energy Technology Data Exchange (ETDEWEB)

    Chambers, A. [Alberta Research Council, Devon, AB (Canada)

    2008-07-01

    Due to the limited amount of information in the literature on sour gas flares and the cost of conducting wind tunnel and field experiments on sour flares, this presentation presented a modelling project that predicted the effect of operating conditions on flare performance and emissions. The objectives of the project were to adapt an existing numerical model suitable for flare simulation, incorporate sulfur chemistry, and run simulations for a range of conditions typical of sour flares in Alberta. The study involved the use of modelling expertise at the University of Utah, and employed large eddy simulation (LES) methods to model open flames. The existing model included the prediction of turbulent flow field; hydrocarbon reaction chemistry; soot formation; and radiation heat transfer. The presentation addressed the unique features of the model and discussed whether LES could predict the flow field. Other topics that were presented included the results from a University of Utah comparison; challenges of the LES model; an example of a run time issue; predicting the impact of operating conditions; and the results of simulations. Last, several next steps were identified and preliminary results were provided. Future work will focus on reducing computation time and increasing information reporting. figs.

  5. A study of flare stars in the taurus region

    International Nuclear Information System (INIS)

    Khodzhaev, A.S.

    1986-01-01

    The results are given of a search for flare stars in the region of the dark clouds in Taurus together with the results of photometric, H /sub alpha/ -spectroscopic, and statistical investigations of them. Photographic observations during 1980-1984 revealed 92 new flare stars, 13 of which were found to be known Orion variables with 16 repeated flares of 13 previously known flare stars. Their apparent distribution is considered. The question of whether the flare stars belong to a dark cloud is discussed. A comparative analysis of the flare stars in the Taurus region and other aggregates is made. The Hertzsprung-Russell (V, B - V) and two-color (U - B, B - V) diagrams for the flare stars are similar to the corresponding diagrams constructed for star clusters and associations (Pleiades, Orion, etc.). The total number of flare stars in the region of the dark clouds in Taurus is estimated at ≥ 500

  6. Gas Flaring: Carbon dioxide Contribution to Global Warming ...

    African Journals Online (AJOL)

    PROF HORSFALL

    emissions resulting from high consumption of fossil fuels. Flaring been a ... method of analysis showed that carbon dioxide from gas flaring constitute 1% of the total ... Although of these, methane is potentially the most .... in some gas plants.

  7. Frequency distribution function of stellar flares in the Orion association

    International Nuclear Information System (INIS)

    Parsamian, E.S.

    1981-01-01

    The temporal distributions of flare stars in the Orion association and the numbers of stars with different flare frequencies are determined by means of Ambartsumian's (1978) method, which uses the chronology of discovery of 'first' flares and the chronology of confirmations, i.e., the temporal distributions of 'repeated' flares. It is shown that flare stars with high flare frequency (not greater than 1000 hours) in the Pleiades are basically stars of low luminosity with M(U) not less than 13m. Two independent methods of determining the number of flare stars in the aggregates confirm that there are about 1.5 times more flare stars in the Orion association than in the Pleiades

  8. Reliability and sensitivity of the self-report of physician-diagnosed gout in the campaign against cancer and heart disease and the atherosclerosis risk in the community cohorts.

    Science.gov (United States)

    McAdams, Mara A; Maynard, Janet W; Baer, Alan N; Köttgen, Anna; Clipp, Sandra; Coresh, Josef; Gelber, Allan C

    2011-01-01

    gout is often defined by self-report in epidemiologic studies. Yet the validity of self-reported gout is uncertain. We evaluated the reliability and sensitivity of the self-report of physician-diagnosed gout in the Campaign Against Cancer and Heart Disease (CLUE II) and the Atherosclerosis Risk in the Community (ARIC) cohorts. the CLUE II cohort comprises 12,912 individuals who self-reported gout status on either the 2000, 2003, or 2007 questionnaires. We calculated reliability as the percentage of participants reporting having gout on more than 1 questionnaire using Cohen's κ statistic. The ARIC cohort comprises 11,506 individuals who self-reported gout status at visit 4. We considered a hospital discharge diagnosis of gout or use of a gout-specific medication as the standard against which to calculate the sensitivity of self-reported, physician-diagnosed gout. of the 437 CLUE II participants who self-reported physician-diagnosed gout in 2000, and subsequently answered the 2003 questionnaire, 75% reported gout in 2003 (κ = 0.73). Of the 271 participants who reported gout in 2000, 73% again reported gout at the 2007 followup questionnaire (κ = 0.63). In ARIC, 196 participants met the definition for gout prior to visit 4 and self-reported their gout status at visit 4. The sensitivity of a self-report of physician-diagnosed gout was 84%. Accuracy was similar across sex and race subgroups, but differed across hyperuricemia and education strata. these 2 population-based US cohorts suggest that self-report of physician-diagnosed gout has good reliability and sensitivity. Thus, self-report of a physician diagnosis of gout is appropriate for epidemiologic studies.

  9. Diagnostic accuracy of dual-energy computed tomography in patients with gout: A meta-analysis.

    Science.gov (United States)

    Lee, Young Ho; Song, Gwan Gyu

    2017-08-01

    This study aimed to evaluate the diagnostic performance of dual-energy computed tomography (DECT) for patients with gout. We searched the Medline, Embase, and Cochrane Library databases, and performed a meta-analysis on the diagnostic accuracy of DECT in patients with gout. A total of eight studies including 510 patients with gout and 268 controls (patients with non-gout inflammatory arthritis) were available for the meta-analysis. The pooled sensitivity and specificity of DECT were 84.7% (95% confidence interval [CI]: 81.3-87.7) and 93.7% (93.0-96.3), respectively. The positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 9.882 (6.122-15.95), 0.163 (0.097-0.272), and 78.10 (31.14-195.84), respectively. The area under the curve of DECT was 0.956 and the Q * index was 0.889, indicating a high diagnostic accuracy. Some between-study heterogeneity was found in the meta-analyses. However, there was no evidence of a threshold effect (Spearman correlation coefficient = 0.419; p = 0.035). In addition, meta-regression showed that the sample size, study design, and diagnostic criteria were not sources of heterogeneity, and subgroup meta-analyses did not change the overall diagnostic accuracy. Our meta-analysis of published studies demonstrates that DECT has a high diagnostic accuracy and plays an important role in the diagnosis of gout. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Allopurinol use and the risk of acute cardiovascular events in patients with gout and diabetes.

    Science.gov (United States)

    Singh, Jasvinder A; Ramachandaran, Rekha; Yu, Shaohua; Curtis, Jeffrey R

    2017-03-14

    Few studies, if any, have examined cardiovascular outcomes in patients with diabetes and gout. Both diabetes and gout are risk factors for cardiovascular disease. The objective of this study was to examine the effect of allopurinol on the risk of incident acute cardiovascular events in patients with gout and diabetes. We used the 2007-2010 Multi-Payer Claims Database (MPCD) that linked health plan data from national commercial and governmental insurances, representing beneficiaries with United Healthcare, Medicare, or Medicaid coverage. In patients with gout and diabetes, we assessed the current allopurinol use, defined as a new filled prescription for allopurinol, as the main predictor of interest. Our outcome of interest was the occurrence of the first Incident hospitalized myocardial infarction (MI) or stroke (composite acute cardiovascular event), after which observations were censored. We employed multivariable-adjusted Cox proportional hazards models that simultaneously adjusted for patient demographics, cardiovascular risk factors and other medical comorbidities. We calculated hazard ratios [HR] (95% confidence intervals [CI]) for incident composite (MI or stroke) acute cardiovascular events. We performed sensitivity analyses that additionally adjusted for the presence of immune diseases and colchicine use, as potential confounders. There were 2,053,185 person days (5621.3 person years) of current allopurinol use and 1,671,583 person days (4576.5 person years) of prior allopurinol use. There were 158 incident MIs or strokes in current and 151 in prior allopurinol users, respectively. Compared to previous allopurinol users, current allopurinol users had significantly lower adjusted hazard of incident acute cardiovascular events (incident stroke or MI), with an HR of 0.67 (95% CI, 0.53, 0.84). Sensitivity analyses, additionally adjusted for immune diseases or colchicine use, confirmed this association. Current allopurinol use protected against the occurrence

  11. Genetic Analysis of IL-17 Gene Polymorphisms in Gout in a Male Chinese Han Population.

    Science.gov (United States)

    Zhou, Zheng; Li, Xinde; Li, Hua; Guo, Mingzhen; Liu, Shiguo; Li, Changgui

    2016-01-01

    Interleukin (IL)-17 is a proinflammatory cytokine mainly secreted by activated T helper 17 cells and involved in inflammatory immune responses. This study aimed to investigate the association between IL-17 variants as well as serum IL-17 levels with gout in male Chinese Han individuals. A total of 1,101 male gout patients and 1,239 ethic-matched controls were enrolled. Genetic distributions of three variants (rs2275913 in IL-17A, rs763780 in IL-17F, and rs4819554 in IL-17RA) were detected by real-time polymerase chain reaction using the Taqman probe method. The plasma concentrations of IL-17A and IL-17F were measured in 228 gout patients and 198 controls that came from above samples by an enzyme-linked immunosorbent assay. No significant differences were observed in the genetic distribution of these polymorphisms between cases and controls (rs2275913: χ2 = 0.15, p = 0.928 by genotype, χ2 = 0.14, p = 0.711 by allele; rs763780: χ2 = 2.24, p = 0.326 by genotype, χ2 = 0.26, p = 0.609 by allele; rs4819554: χ2 = 1.79, p = 0.409 by genotype, χ2 = 1.46, p = 0.227 by allele). Levels of serum IL-17A and IL-17F were significantly decreased in gout patients (both pgout patients between different genotypic carriers of rs2275913 and rs763780 regarding serum IL-17A and IL-17F levels (p>0.05). Although the genetic variants in IL-17 we studied in this research do not appear to be involved in the development of gout in male Chinese Han individuals, the IL-17 cytokine family may participate in gouty inflammation in an undefined way, which requires further validation.

  12. Flaring red dwarf stars: news from Crimea

    International Nuclear Information System (INIS)

    Gershberg, Roald E

    1998-01-01

    Important phenomena are briefly described which have recently been discovered in the Crimean studies of flaring red dwarf stars believed to be the most common type of variable stars in the Galaxy. These phenomena include (i) long-lived radiation from a blueshifted component in the ionized-helium λ 4686 A emission line in the active state of one such star, (ii) a long-lived absorption component in the stellar flare light curves with a lifetime exceeding that of the conventional flare emission, and (iii) solarcycle-like activity periodicity of the star EV Lac, whose mass is only 0.3 solar masses. In theoretical terms, a red dwarf star spot model is constructed which, in contrast to the commonly accepted model, agrees well with the solar spot picture. (physics of our days)

  13. Flaring red dwarf stars: news from Crimea

    Energy Technology Data Exchange (ETDEWEB)

    Gershberg, Roald E [Crimean Astrophysical Observatory, Nauchnyi, Crimea (Ukraine)

    1998-08-31

    Important phenomena are briefly described which have recently been discovered in the Crimean studies of flaring red dwarf stars believed to be the most common type of variable stars in the Galaxy. These phenomena include (i) long-lived radiation from a blueshifted component in the ionized-helium {lambda} 4686 A emission line in the active state of one such star, (ii) a long-lived absorption component in the stellar flare light curves with a lifetime exceeding that of the conventional flare emission, and (iii) solarcycle-like activity periodicity of the star EV Lac, whose mass is only 0.3 solar masses. In theoretical terms, a red dwarf star spot model is constructed which, in contrast to the commonly accepted model, agrees well with the solar spot picture. (physics of our days)

  14. Solar flare loops observations and interpretations

    CERN Document Server

    Huang, Guangli; Ji, Haisheng; Ning, Zongjun

    2018-01-01

    This book provides results of analysis of typical solar events, statistical analysis, the diagnostics of energetic electrons and magnetic field, as well as the global behavior of solar flaring loops such as their contraction and expansion. It pays particular attention to analyzing solar flare loops with microwave, hard X-ray, optical and EUV emissions, as well as the theories of their radiation, and electron acceleration/transport. The results concerning influence of the pitch-angle anisotropy of non-thermal electrons on their microwave and hard X-ray emissions, new spectral behaviors in X-ray and microwave bands, and results related to the contraction of flaring loops, are widely discussed in the literature of solar physics. The book is useful for graduate students and researchers in solar and space physics.

  15. Endodontic flare-ups: a prospective study.

    Science.gov (United States)

    Alves, Vanessa de Oliveira

    2010-11-01

    The objective of this prospective clinical study was to evaluate the incidence of flare-ups (pain and/or swelling requiring endodontic interappointment and emergency treatment) and identify the risk factors associated with their occurrence in patients who received endodontic treatment from June 2006 to June 2007 at the endodontics clinic of the São Paulo Dental Association (APCD), Jardim Paulista branch, São Paulo, Brazil. The incidence of flare-ups was 1.71% out of 408 teeth that had received endodontic therapy. Statistical analysis using the chi-squared test (P flare-up rate and the presence of a periradicular radiolucency. Copyright © 2010 Mosby, Inc. All rights reserved.

  16. KEPLER FLARES. I. ACTIVE AND INACTIVE M DWARFS

    Energy Technology Data Exchange (ETDEWEB)

    Hawley, Suzanne L.; Davenport, James R. A.; Kowalski, Adam F.; Wisniewski, John P.; Deitrick, Russell; Hilton, Eric J. [Department of Astronomy, University of Washington, Box 351580, Seattle, WA 98195 (United States); Hebb, Leslie, E-mail: slhawley@uw.edu [Department of Physics, Hobart and William Smith Colleges, 300 Pulteney Street, Geneva, NY 14456 (United States)

    2014-12-20

    We analyzed Kepler short-cadence M dwarf observations. Spectra from the Astrophysical Research Consortium 3.5 m telescope identify magnetically active (Hα in emission) stars. The active stars are of mid-M spectral type, have numerous flares, and have well-defined rotational modulation due to starspots. The inactive stars are of early M type, exhibit less starspot signature, and have fewer flares. A Kepler to U-band energy scaling allows comparison of the Kepler flare frequency distributions with previous ground-based data. M dwarfs span a large range of flare frequency and energy, blurring the distinction between active and inactive stars designated solely by the presence of Hα. We analyzed classical and complex (multiple peak) flares on GJ 1243, finding strong correlations between flare energy, amplitude, duration, and decay time, with only a weak dependence on rise time. Complex flares last longer and have higher energy at the same amplitude, and higher energy flares are more likely to be complex. A power law fits the energy distribution for flares with log E{sub K{sub p}}> 31 erg, but the predicted number of low-energy flares far exceeds the number observed, at energies where flares are still easily detectable, indicating that the power-law distribution may flatten at low energy. There is no correlation of flare occurrence or energy with starspot phase, the flare waiting time distribution is consistent with flares occurring randomly in time, and the energies of consecutive flares are uncorrelated. These observations support a scenario where many independent active regions on the stellar surface are contributing to the observed flare rate.

  17. KEPLER FLARES. I. ACTIVE AND INACTIVE M DWARFS

    International Nuclear Information System (INIS)

    Hawley, Suzanne L.; Davenport, James R. A.; Kowalski, Adam F.; Wisniewski, John P.; Deitrick, Russell; Hilton, Eric J.; Hebb, Leslie

    2014-01-01

    We analyzed Kepler short-cadence M dwarf observations. Spectra from the Astrophysical Research Consortium 3.5 m telescope identify magnetically active (Hα in emission) stars. The active stars are of mid-M spectral type, have numerous flares, and have well-defined rotational modulation due to starspots. The inactive stars are of early M type, exhibit less starspot signature, and have fewer flares. A Kepler to U-band energy scaling allows comparison of the Kepler flare frequency distributions with previous ground-based data. M dwarfs span a large range of flare frequency and energy, blurring the distinction between active and inactive stars designated solely by the presence of Hα. We analyzed classical and complex (multiple peak) flares on GJ 1243, finding strong correlations between flare energy, amplitude, duration, and decay time, with only a weak dependence on rise time. Complex flares last longer and have higher energy at the same amplitude, and higher energy flares are more likely to be complex. A power law fits the energy distribution for flares with log E K p > 31 erg, but the predicted number of low-energy flares far exceeds the number observed, at energies where flares are still easily detectable, indicating that the power-law distribution may flatten at low energy. There is no correlation of flare occurrence or energy with starspot phase, the flare waiting time distribution is consistent with flares occurring randomly in time, and the energies of consecutive flares are uncorrelated. These observations support a scenario where many independent active regions on the stellar surface are contributing to the observed flare rate

  18. THE FLARE-ONA OF EK DRACONIS

    International Nuclear Information System (INIS)

    Ayres, Thomas R.

    2015-01-01

    EK Draconis (HD 129333: G1.5 V) is a well-known young (50 Myr) solar analog. In 2012, Hubble Space Telescope returned to EK Dra to follow up a far-ultraviolet (FUV) SNAPshot visit by Cosmic Origins Spectrograph (COS) two years earlier. The brief SNAP pointing had found surprisingly redshifted, impulsively variable subcoronal “hot-line” emission of Si iv 1400 Å (T ∼ 8 × 10 4 K). Serendipitously, the 2012 follow-on program witnessed one of the largest FUV flares ever recorded on a sunlike star, which again displayed strong redshifts (downflows) of 30–40 km s −1 , even after compensating for small systematics in the COS velocity scales, uncovered through a cross-calibration by Space Telescope Imaging Spectrograph (STIS). The (now reduced, but still substantial) ∼10 km s −1 hot-line redshifts outside the flaring interval did not vary with rotational phase, so cannot be caused by “Doppler imaging” (bright surface patches near a receding limb). Density diagnostic O iv] 1400 Å multiplet line ratios of EK Dra suggest n e ∼ 10 11 cm −3 , an order of magnitude larger than in low-activity solar twin α Centauri A, but typical of densities inferred in large stellar soft X-ray events. The self-similar FUV hot-line profiles between the flare decay and the subsequent more quiet periods, and the unchanging but high densities, reinforce a long-standing idea that the coronae of hyperactive dwarfs are flaring all the time, in a scale-free way; a flare-ona if you will. In this picture, the subsonic hot-line downflows probably are a byproduct of the post-flare cooling process, something like “coronal rain” on the Sun. All in all, the new STIS/COS program documents a complex, energetic, dynamic outer atmosphere of the young sunlike star

  19. Two-phase Heating in Flaring Loops

    Science.gov (United States)

    Zhu, Chunming; Qiu, Jiong; Longcope, Dana W.

    2018-03-01

    We analyze and model a C5.7 two-ribbon solar flare observed by the Solar Dynamics Observatory, Hinode, and GOES on 2011 December 26. The flare is made of many loops formed and heated successively over one and half hours, and their footpoints are brightened in the UV 1600 Å before enhanced soft X-ray and EUV missions are observed in flare loops. Assuming that anchored at each brightened UV pixel is a half flaring loop, we identify more than 6700 half flaring loops, and infer the heating rate of each loop from the UV light curve at the footpoint. In each half loop, the heating rate consists of two phases: intense impulsive heating followed by a low-rate heating that is persistent for more than 20 minutes. Using these heating rates, we simulate the evolution of their coronal temperatures and densities with the model of the “enthalpy-based thermal evolution of loops.” In the model, suppression of thermal conduction is also considered. This model successfully reproduces total soft X-ray and EUV light curves observed in 15 passbands by four instruments GOES, AIA, XRT, and EVE. In this flare, a total energy of 4.9 × 1030 erg is required to heat the corona, around 40% of this energy is in the slow-heating phase. About two-fifths of the total energy used to heat the corona is radiated by the coronal plasmas, and the other three fifth transported to the lower atmosphere by thermal conduction.

  20. Recurrent flares in active region NOAA 11283

    Science.gov (United States)

    Romano, P.; Zuccarello, F.; Guglielmino, S. L.; Berrilli, F.; Bruno, R.; Carbone, V.; Consolini, G.; de Lauretis, M.; Del Moro, D.; Elmhamdi, A.; Ermolli, I.; Fineschi, S.; Francia, P.; Kordi, A. S.; Landi Degl'Innocenti, E.; Laurenza, M.; Lepreti, F.; Marcucci, M. F.; Pallocchia, G.; Pietropaolo, E.; Romoli, M.; Vecchio, A.; Vellante, M.; Villante, U.

    2015-10-01

    Context. Flares and coronal mass ejections (CMEs) are solar phenomena that are not yet fully understood. Several investigations have been performed to single out their related physical parameters that can be used as indices of the magnetic complexity leading to their occurrence. Aims: In order to shed light on the occurrence of recurrent flares and subsequent associated CMEs, we studied the active region NOAA 11283 where recurrent M and X GOES-class flares and CMEs occurred. Methods: We use vector magnetograms taken by HMI/SDO to calculate the horizontal velocity fields of the photospheric magnetic structures, the shear and the dip angles of the magnetic field, the magnetic helicity flux distribution, and the Poynting fluxes across the photosphere due to the emergence and the shearing of the magnetic field. Results: Although we do not observe consistent emerging magnetic flux through the photosphere during the observation time interval, we detected a monotonic increase of the magnetic helicity accumulated in the corona. We found that both the shear and the dip angles have high values along the main polarity inversion line (PIL) before and after all the events. We also note that before the main flare of X2.1 GOES class, the shearing motions seem to inject a more significant energy than the energy injected by the emergence of the magnetic field. Conclusions: We conclude that the very long duration (about 4 days) of the horizontal displacement of the main photospheric magnetic structures along the PIL has a primary role in the energy release during the recurrent flares. This peculiar horizontal velocity field also contributes to the monotonic injection of magnetic helicity into the corona. This process, coupled with the high shear and dip angles along the main PIL, appears to be responsible for the consecutive events of loss of equilibrium leading to the recurrent flares and CMEs. A movie associated to Fig. 4 is available in electronic form at http://www.aanda.org

  1. An essay on sunspots and solar flares

    International Nuclear Information System (INIS)

    Akasofu, S.-I.

    1984-01-01

    The presently prevailing theories of sunspots and solar flares rely on the hypothetical presence of magnetic flux tubes beneath the photosphere and the two subsequent hypotheses, their emergence above the photosphere and explosive magnetic reconnection, converting magnetic energy carried by the flux tubes for solar flare energy. In this paper, attention is paid to the fact that there are large-scale magnetic fields which divide the photosphere into positive and negative (line-of-sight) polarity regions and that they are likely to be more fundamental than sunspot fields, as emphasized most recently by McIntosh. A new phenomenological model of the sunspot pair formation is then constructed by considering an amplification process of these large-scale fields near their boundaries by shear flows, including localized vortex motions. The amplification results from a dynamo process associated with such vortex flows and the associated convergence flow in the large-scale fields. This dynamo process generates also some of the familiar ''force-free'' fields or the ''sheared'' magnetic fields in which the magnetic field-aligned currents are essential. Upward field-aligned currents generated by the dynamo process are carried by downward streaming electrons which are expected to be accelerated by an electric potential structure; a similar structure is responsible for accelerating auroral electrons in the magnetosphere. Depending on the magnetic field configuration and the shear flows, the current-carrying electrons precipitate into different geometrical patterns, causing circular flares, umbral flares, two-ribbon flares, etc. Thus, it is suggested that ''low temperature flares'' are directly driven by the photospheric dynamo process. (author)

  2. Solar flare impulsivity and its relationship with white-light flares and with CMEs

    Science.gov (United States)

    Watanabe, K.; Masuda, S.

    2017-12-01

    There are many types of classification in solar flares. One of them is a classification by flare duration in soft X-rays; so-called impulsive flare and long duration event (LDE). Typically, the duration of an impulsive flare is shorter than 1 hour, and that of an LDE is longer than 1 hour. These two types of flare show different characteristics. In soft X-rays, impulsive flares usually have a compact loop structure. On the other hand, LDEs show a large-scale loop, sometimes a large arcade structure. In hard X-rays (HXRs), the difference appears clear, too. The former shows a strong and short-time (10 minutes) emissions and show a large coronal source. These facts suggest that HXR observation becomes one of a good indicator to classify solar flares, especially for the study on the particle acceleration and the related phenomena. However, HXR data do not always exist due to the satellite orbit and the small sensitivity of HXR instruments. So, in this study, based on the concept of the Neupert effect (Neupert, 1968), we use soft X-ray derivative data as the proxy of HXR. From this data, we define impulsivity (IP) for each flare. Then we investigate solar flares using this new index. First we apply IP index to white-light flare (WLF) research. We investigate how WL enhancement depends on IP, then it is found that WLF tend to have large IP values. So the flare impulsivity (IP) is one of the important factors if WL enhancement appears or not in a solar flare. Next we investigate how CME itself and/or its physical parameters depend on IP index. It has been believed that most of CMEs are associated with LDEs, but we found that there is only a weak correlation between the existence of CME and IP index. Finally, we also search for the relationship between WLF and CME as a function of IP and discuss the physical condition of WLF.

  3. Statistical Distributions of Optical Flares from Gamma-Ray Bursts

    International Nuclear Information System (INIS)

    Yi, Shuang-Xi; Yu, Hai; Wang, F. Y.; Dai, Zi-Gao

    2017-01-01

    We statistically study gamma-ray burst (GRB) optical flares from the Swift /UVOT catalog. We compile 119 optical flares, including 77 flares with redshift measurements. Some tight correlations among the timescales of optical flares are found. For example, the rise time is correlated with the decay time, and the duration time is correlated with the peak time of optical flares. These two tight correlations indicate that longer rise times are associated with longer decay times of optical flares and also suggest that broader optical flares peak at later times, which are consistent with the corresponding correlations of X-ray flares. We also study the frequency distributions of optical flare parameters, including the duration time, rise time, decay time, peak time, and waiting time. Similar power-law distributions for optical and X-ray flares are found. Our statistic results imply that GRB optical flares and X-ray flares may share the similar physical origin, and both of them are possibly related to central engine activities.

  4. Statistical Distributions of Optical Flares from Gamma-Ray Bursts

    Energy Technology Data Exchange (ETDEWEB)

    Yi, Shuang-Xi [College of Physics and Engineering, Qufu Normal University, Qufu 273165 (China); Yu, Hai; Wang, F. Y.; Dai, Zi-Gao, E-mail: fayinwang@nju.edu.cn [School of Astronomy and Space Science, Nanjing University, Nanjing 210093 (China)

    2017-07-20

    We statistically study gamma-ray burst (GRB) optical flares from the Swift /UVOT catalog. We compile 119 optical flares, including 77 flares with redshift measurements. Some tight correlations among the timescales of optical flares are found. For example, the rise time is correlated with the decay time, and the duration time is correlated with the peak time of optical flares. These two tight correlations indicate that longer rise times are associated with longer decay times of optical flares and also suggest that broader optical flares peak at later times, which are consistent with the corresponding correlations of X-ray flares. We also study the frequency distributions of optical flare parameters, including the duration time, rise time, decay time, peak time, and waiting time. Similar power-law distributions for optical and X-ray flares are found. Our statistic results imply that GRB optical flares and X-ray flares may share the similar physical origin, and both of them are possibly related to central engine activities.

  5. X-ray Emission Characteristics of Flares Associated with CMEs ...

    Indian Academy of Sciences (India)

    tics of solar flares and their relationship with the dynamics of CMEs have ... lation between X-ray peak intensity of the flares with linear speed as well ... shear angle (θ1, measured at the flare onset), the final shear angle (θ2, measured at the.

  6. Solar flares as harbinger of new physics

    CERN Document Server

    Zioutas, K; Semertzidis, Y.; Papaevangelou, T.; Georgiopoulou, E.; Gardikiotis, A.; Dafni, T.; Tsagri, M.; Semertzidis, Y.; Papaevangelou, T.; Dafni, T.

    2011-01-01

    This work provides additional evidence on the involvement of exotic particles like axions and/or other WISPs, following recent measurements during the quietest Sun and flaring Sun. Thus, SPHINX mission observed a minimum basal soft X-rays emission in the extreme solar minimum in 2009. The same scenario (with ~17 meV axions) fits also the dynamical behaviour of white-light solar flares, like the measured spectral components in the visible and in soft X-rays, and, the timing between them. Solar chameleons remain a viable candidate, since they may preferentially convert to photons in outer space.

  7. Impulsive phase of solar flares: theory

    International Nuclear Information System (INIS)

    Mackinnon, A.L.

    1986-01-01

    The paper reviews the theoretical interpretation of impulsive phase phenomena in solar flares. The impulsive phase is defined to be that period of approx. 10 - 100s duration, during which the flare radiative output undergoes its most rapid, dramatic increase and decrease. The interpretation of the various impulsive phase radiation signatures are examined, including the i) hard x-ray emission, ii) radio emission, iii) UV, Hα and white light emissions and iv) gamma-ray emission. The acceleration mechanisms are discussed with respect to candidate acceleration mechanisms, and the synthesis of the theory and observations. (UK)

  8. [Association of ABCG2 gene C421A polymorphism and susceptibility of primary gout in Han Chinese males].

    Science.gov (United States)

    Li, Fa-gui; Chu, Yi; Meng, Dong-mei; Tong, Ya-wen

    2011-12-01

    To assess the association between a C421A single nucleotide polymorphism (SNP) in exon 5 of ATP-binding cassette, sub-family G (WHITE), member 2 (ABCG2) gene and susceptibility of primary gout in Han Chinese males. For 200 male patients with primary gout and 235 controls, the genotype of C421A locus was analyzed by PCR and direct sequencing. Blood glucose, uric acid, total cholesterol, triglycerides, creatinine and urea nitrogen was measured by an automatic biochemical analyzer. Compared with the controls, there was a higher frequency for AA genotype and A allele of the rs2231142 SNP in gout patients (22.5% vs. 8.5% by genotype; 44.9% vs. 32.3% by allele). The association with gout reached significance (chi-square =15.91, Pgout patients were significantly higher than those of controls (Pgout in Han Chinese males.

  9. Genome-wide association study of clinically defined gout identifies multiple risk loci and its association with clinical subtypes.

    Science.gov (United States)

    Matsuo, Hirotaka; Yamamoto, Ken; Nakaoka, Hirofumi; Nakayama, Akiyoshi; Sakiyama, Masayuki; Chiba, Toshinori; Takahashi, Atsushi; Nakamura, Takahiro; Nakashima, Hiroshi; Takada, Yuzo; Danjoh, Inaho; Shimizu, Seiko; Abe, Junko; Kawamura, Yusuke; Terashige, Sho; Ogata, Hiraku; Tatsukawa, Seishiro; Yin, Guang; Okada, Rieko; Morita, Emi; Naito, Mariko; Tokumasu, Atsumi; Onoue, Hiroyuki; Iwaya, Keiichi; Ito, Toshimitsu; Takada, Tappei; Inoue, Katsuhisa; Kato, Yukio; Nakamura, Yukio; Sakurai, Yutaka; Suzuki, Hiroshi; Kanai, Yoshikatsu; Hosoya, Tatsuo; Hamajima, Nobuyuki; Inoue, Ituro; Kubo, Michiaki; Ichida, Kimiyoshi; Ooyama, Hiroshi; Shimizu, Toru; Shinomiya, Nariyoshi

    2016-04-01

    Gout, caused by hyperuricaemia, is a multifactorial disease. Although genome-wide association studies (GWASs) of gout have been reported, they included self-reported gout cases in which clinical information was insufficient. Therefore, the relationship between genetic variation and clinical subtypes of gout remains unclear. Here, we first performed a GWAS of clinically defined gout cases only. A GWAS was conducted with 945 patients with clinically defined gout and 1213 controls in a Japanese male population, followed by replication study of 1048 clinically defined cases and 1334 controls. Five gout susceptibility loci were identified at the genome-wide significance level (pgenes (ABCG2 and SLC2A9) and additional genes: rs1260326 (p=1.9×10(-12); OR=1.36) of GCKR (a gene for glucose and lipid metabolism), rs2188380 (p=1.6×10(-23); OR=1.75) of MYL2-CUX2 (genes associated with cholesterol and diabetes mellitus) and rs4073582 (p=6.4×10(-9); OR=1.66) of CNIH-2 (a gene for regulation of glutamate signalling). The latter two are identified as novel gout loci. Furthermore, among the identified single-nucleotide polymorphisms (SNPs), we demonstrated that the SNPs of ABCG2 and SLC2A9 were differentially associated with types of gout and clinical parameters underlying specific subtypes (renal underexcretion type and renal overload type). The effect of the risk allele of each SNP on clinical parameters showed significant linear relationships with the ratio of the case-control ORs for two distinct types of gout (r=0.96 [p=4.8×10(-4)] for urate clearance and r=0.96 [p=5.0×10(-4)] for urinary urate excretion). Our findings provide clues to better understand the pathogenesis of gout and will be useful for development of companion diagnostics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. Potential contribution of the neurodegenerative disorders risk loci to cognitive performance in an elderly male gout population

    Science.gov (United States)

    Han, Lin; Jia, Zhaotong; Cao, Chunwei; Liu, Zhen; Liu, Fuqiang; Wang, Lin; Ren, Wei; Sun, Mingxia; Wang, Baoping; Li, Changgui; Chen, Li

    2017-01-01

    Abstract Cognitive impairment has been described in elderly subjects with high normal concentrations of serum uric acid. However, it remains unclear if gout confers an increased poorer cognition than those in individuals with asymptomatic hyperuricemia. The present study aimed at evaluating cognitive function in patients suffering from gout in an elderly male population, and further investigating the genetic contributions to the risk of cognitive function. This study examined the cognitive function as assessed by Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) in 205 male gout patients and 204 controls. The genetic basis of these cognitive measures was evaluated by genome-wide association study (GWAS) data in 102 male gout patients. Furthermore, 7 loci associated with cognition in GWAS were studied for correlation with gout in 1179 male gout patients and 1848 healthy male controls. Compared with controls, gout patients had significantly lower MoCA scores [22.78 ± 3.01 vs 23.42 ± 2.95, P = .023, adjusted by age, body mass index (BMI), education, and emotional disorder]. GWAS revealed 7 single-nucleotide polymorphisms (SNPs) associations with MoCA test at a level of conventional genome-wide significance (P gene (Padjusted = 4.2 × 10−9, Padjusted = 4.7 × 10–9) at 14q22. The next best signal was in RELN gene (rs155333, Padjusted = 1.3 × 10–8) at 7q22, while the other variants at rs17458357 (Padjusted = 3.98 × 10–8), rs2572683 (Padjusted = 8.9 × 10–8), rs12555895 (Padjusted = 2.6 × 10–8), and rs3764030 (Padjusted = 9.4 × 10–8) were also statistically significant. The 7 SNPs were not associated with gout in further analysis (all P > .05). Elderly male subjects with gout exhibit accelerated decline in cognition performance. Several neurodegenerative disorders risk loci were identified for genetic contributors to cognitive performance in our

  11. Lack of association of -607 C/A and -137 G/C polymorphisms in interleukin 18 gene with susceptibility to gout disease in Chinese Han male population.

    Science.gov (United States)

    Li, Changgui; Yuan, Ying; Wang, Xinfeng; Han, Lin; Chu, Nan; Wang, Hui; Liu, Shiguo

    2012-06-01

    To identify association of IL18-607 C/A and -137 G/C polymorphism with susceptibility to gout in Chinese Han male population, We evaluate the genetic contribution of the IL18-607 C/A and -137 G/C polymorphism in 202 gout male patients and 493 gout-free control of Chinese Han population by allele-specific polymerase chain reaction assay. Our results reveal no significant association between the polymorphisms -607C/A and -137G/C in IL18 with gout. Our study might suggest that -607 C/A and -137 G/C polymorphisms in the promoter of IL18 are not associated with susceptibility to gout and thus do not play a major role in the development of gout in the Chinese Han male population.

  12. The ABCG2 gene Q141K polymorphism contributes to an increased risk of gout: a meta-analysis of 2185 cases.

    Science.gov (United States)

    Qiu, Ya; Liu, Hua; Qing, Yufeng; Yang, Min; Tan, Xiaoyao; Zhao, Mingcai; Lin, Monica; Zhou, Jingguo

    2014-09-01

    Individual genetic association studies examining the relationship between the ABCG2 gene polymorphisms and gout have yielded inconsistent results. This study aims to evaluate the association between the ABCG2 gene variants and gout using meta-analysis. Relevant studies were identified by searching databases extensively. The odds ratio (OR) was calculated using a random-effect or fixed-effect model. A Q statistic was used to evaluate homogeneity, and Egger's test and funnel plot were used to assess publication bias. Subgroup analyses on ethnicities and sex were also performed. A total of 7 studies, including 2185 gout patients and 8028 controls from 5 countries or regions, were included and identified for the current meta-analysis. It was found that the A allele or AA genotype of the ABCG2 Q141K polymorphism (rs2231142) had an increased risk of gout in the general population (A allele, p gout (p gout.

  13. Time-trends, Predictors and Outcome of Emergency Department Utilization for Gout: A Nationwide U.S. Study

    Science.gov (United States)

    Singh, Jasvinder A.; Yu, Shaohua

    2016-01-01

    Objective To assess gout-related emergency department (ED) utilization/charges and discharge disposition. Methods We used the U.S. National ED Sample (NEDS) data to examine the time-trends in total ED visits and charges and ED-related hospitalizations with gout as the primary diagnosis. We assessed multivariable-adjusted predictors of ED charges and hospitalization for gout-related visits using the 2012 NEDS data. Results There were 180,789, 201,044 and 205,152 ED visits in years 2009, 2010 and 2012 with gout as the primary diagnosis, with total ED charges of $195, $239 and $287 million, respectively; these accounted for 0.14-0.16% of all ED visits. Mean/median 2012 ED charges/visit were $1,398/$956. Of all gout-related ED visits, 7.7% were admitted to the hospital in 2012. Mean/median length of hospital stay was 3.9/2.6 days and mean/median inpatient charge/admission was $22,066/$15,912 in 2012. In multivariable-adjusted analyses, older age, female gender, highest income quartile, being uninsured, metropolitan residence, Western U.S. hospital location, heart disease, renal failure, congestive heart failure (CHF), hypertension, diabetes, osteoarthritis and chronic obstructive pulmonary disease (COPD) were associated with higher ED charges. Older age, Northeast location, Metropolitan teaching hospital, higher income quartile, heart disease, renal failure, CHF, hyperlipidemia, hypertension, diabetes, COPD, and osteoarthritis were associated with higher odds where as self-pay insurance status was associated with lower odds of hospitalization following an ED visit for gout. Conclusions Absolute ED utilization and charges for gout increased over time, but relative utilization remained stable. Modifiable comorbidity factors associated with higher gout-related utilization should be targeted to reduce morbidity and healthcare utilization. PMID:27134260

  14. WDR1 and CLNK gene polymorphisms correlate with serum glucose and high-density lipoprotein levels in Tibetan gout patients.

    Science.gov (United States)

    Lan, Bing; Chen, Peng; Jiri, Mutu; He, Na; Feng, Tian; Liu, Kai; Jin, Tianbo; Kang, Longli

    2016-03-01

    Current evidence suggests heredity and metabolic syndrome contributes to gout progression. Specifically, the WDR1 and CLNK genes may play a role in gout progression in European ancestry populations. However, no studies have focused on Chinese populations, especially Tibetan individuals. This study aims to determine whether variations in these two genes correlate with gout-related indices in Chinese-Tibetan gout patients. Eleven single-nucleotide polymorphisms in the WDR1 and CLNK genes were detected in 319 Chinese-Tibetan gout patients and 318 controls. We used one-way analysis of variance to evaluate the polymorphisms' effects on gout based on mean serum levels of metabolism indicators, such as albumin, glucose (GLU), triglycerides, cholesterol, high-density lipoproteins (HDL-C), creatinine, and uric acid, from fasting venous blood samples. All p values were Bonferroni corrected. Polymorphisms of the WDR1 and CLNK genes affected multiple risk factors for gout development. Significant differences in serum GLU levels were detected between different genotypic groups with WDRI polymorphisms rs4604059 (p = 0.005) and rs12498927 (p = 0.005). In addition, significant differences in serum HDL-C levels were detected between different genotypic groups with the CLNK polymorphism rs2041215 (p = 0.001). Polymorphisms of CLNK also affected levels of albumin, triglycerides, and creatinine. This study is the first to investigate and identify positive correlations between WDR1 and CLNK gene polymorphisms in Chinese-Tibetan populations. Our findings provide significant evidence for the effect of genetic polymorphisms on gout-related factors in Chinese-Tibetan populations.

  15. Common Variants in LRP2 and COMT Genes Affect the Susceptibility of Gout in a Chinese Population.

    Directory of Open Access Journals (Sweden)

    Zheng Dong

    Full Text Available Gout is a common inflammation disease resulting from an increase in serum uric acid. Nearly 70% of uric acid is excreted via the kidneys. To date, evidence for an association between genetic loci and gout is absent, equivocal or not replicated. Our study aims to test variants in two genes abundantly expressed in the kidney, LRP2 and COMT, for their association with uric acid and gout. In total, 1318 Chinese individuals were genotyped for rs2544390 in LRP2 and rs4680 in COMT. These LRP2 and COMT gene polymorphisms showed no significant effect on uric acid (P = 0.204 and 0.188, separately; however, rs2544390 in LRP2 did influence uric acid levels in individuals with BMI ≥ 25 (P = 0.009. In addition, the allele frequency distributions of the two loci showed a significant difference between gout patients and healthy controls. A missense variation in rs4680 (G > A decreased the risk of gout (OR = 0.77, P = 0.015, whereas the T allele of rs2544390 was associated with gout pathogenesis risk (OR = 1.26, P = 0.020. The present study provides the first evidence for an association between COMT and gout. Rs2544390 in LRP2 only influenced uric acid levels in individuals with BMI ≥ 25, which might explain the discrepant results among previous studies. In addition, we are the first to identify the association between LRP2 and gout in a Chinese population and to confirm this association in Asians.

  16. Tubular urate transporter gene polymorphisms differentiate patients with gout who have normal and decreased urinary uric acid excretion.

    Science.gov (United States)

    Torres, Rosa J; de Miguel, Eugenio; Bailén, Rebeca; Banegas, José R; Puig, Juan G

    2014-09-01

    Primary gout has been associated with single-nucleotide polymorphisms (SNP) in several tubular urate transporter genes. No study has assessed the association of reabsorption and secretion urate transporter gene SNP with gout in a single cohort of documented primary patients with gout carefully subclassified as normoexcretors or underexcretors. Three reabsorption SNP (SLC22A12/URAT1, SLC2A9/GLUT9, and SLC22A11/OAT4) and 2 secretion transporter SNP (SLC17A1/NPT1 and ABCG2/BRCP) were studied in 104 patients with primary gout and in 300 control subjects. The patients were subclassified into normoexcretors and underexcretors according to their serum and 24-h urinary uric acid levels under strict conditions of dietary control. Compared with control subjects, patients with gout showed different allele distributions of the 5 SNP analyzed. However, the diagnosis of underexcretor was only positively associated with the presence of the T allele of URAT1 rs11231825, the G allele of GLUT9 rs16890979, and the A allele of ABCG2 rs2231142. The association of the A allele of ABCG2 rs2231142 in normoexcretors was 10 times higher than in underexcretors. The C allele of NPT1 rs1165196 was only significantly associated with gout in patients with normal uric acid excretion. Gout with uric acid underexcretion is associated with transporter gene SNP related mainly to tubular reabsorption, whereas uric acid normoexcretion is associated only with tubular secretion SNP. This finding supports the concept of distinctive mechanisms to account for hyperuricemia in patients with gout with reduced or normal uric acid excretion.

  17. Dependence of absolute magnitudes (energies) of flares on the cluster age containing flare stars

    International Nuclear Information System (INIS)

    Parsamyan, Eh.S.

    1976-01-01

    Dependences between Δmsub(u) and msub(u) are given for the Orion, NGC 7000, Pleiades and Praesepe aggregations. Maximum absolute values of flares have been calculated for stars with different luminosities. It has been shown that the values of flares can be limited by a straight line which gives the representation on the distribution of maximum values of amplitudes for the stars with different luminosities in an aggregation. Presented are k and m 0 parameters characterizing the lines fot the Orion, NGC 7000, Pleiades and Praesepe aggregation and their age T dependence. From the dependence between k (angular coefficient of straight lines) and lgT for the aggregation with known T the age of those aggregation involving a great amount of flaring stars can be found. The age of flaring stars in the neighbourhood of the Sun has been determined. The age of UV Ceti has been shown by an order to exceed that of the rest stars

  18. The rs7517847 polymorphism in the IL-23R gene is associated with gout in a Chinese Han male population.

    Science.gov (United States)

    Liu, Shiguo; He, Hongmei; Yu, Renchao; Han, Lin; Wang, Can; Cui, Ying; Li, Changgui

    2015-05-01

    Gout is a polygenic auto-inflammatory disease, in which inflammation plays an important role in disease pathogenesis. The cytokine interleukin (IL)-23 promotes inflammation and helps to guide inflammatory cells, while studies have shown that the IL-23R gene is associated with susceptibility to several immune-related diseases. This study aimed to determine whether the IL-23R rs7517847 (G/T) polymorphism is associated with gout in a Chinese Han male population. We recruited 400 patients with gout and 582 gout-free controls. After obtaining blood samples for DNA extraction, genotyping of the rs7517847 polymorphism was performed by fluorescence-based quantitative PCR using TaqMan probes. An association analysis was carried out using the χ(2) test. A genotype-phenotype analysis was also conducted. Both genotypic and allelic frequencies of rs7517847 differed significantly between gout patients and controls (χ(2) = 6.792, df = 2, P = 0.034 by genotype; χ(2) = 4.202, df = 1, P = 0.04 by allele). IL-23R may be associated with gout in a Chinese Han male population, although our findings should be confirmed using larger sample sizes and other independent populations.

  19. The polymorphism -863C/A in tumour necrosis factor-alpha gene contributes an independent association to gout.

    Science.gov (United States)

    Chang, S-J; Tsai, P-C; Chen, C-J; Lai, H-M; Ko, Y-C

    2007-11-01

    To investigate the associations between polymorphisms in the promoter of the tumour necrosis factor-alpha (TNF-alpha) gene and gout. The polymorphisms -308G/A and -863C/A in the TNF-alpha gene were determined in 106 gout patients and 159 healthy controls among male Taiwanese using the Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method. The biochemical markers, including Glutamic-oxaloacetic transaminase (GOT), Glutamic-pyruvic transaminase (GPT), uric acid, creatinine, total cholesterol (TC), triglycerides (TG), body mass index (BMI) and hypertension, as well as alcohol consumption were measured. The gout patients had 9.43% (10/106) with genotype AA at polymorphism -863C/A showing a significantly higher fraction than controls (0.63%; 1/159, P gout patients had significantly higher portions of abnormal GOT, GPT, creatinine, TC, TG, alcohol consumption, hypertension and hyperuricaemia than controls (P 0.05). After adjustment by a stepwise logistic regression method, the hyperuricaemia, creatinine, GPT, TG and alcohol consumption as well as genotype AA at polymorphism -863C/A were found to be significantly associated with gout. The genotype AA at polymorphism -863C/A in a recessive model showed a significant association with developing gout independent of hyperuricaemia, abnormal creatinine, higher TG, GPT and alcohol consumption.

  20. Photospheric Magnetic Field Properties of Flaring versus Flare-quiet Active Regions. II. Discriminant Analysis

    Science.gov (United States)

    Leka, K. D.; Barnes, G.

    2003-10-01

    We apply statistical tests based on discriminant analysis to the wide range of photospheric magnetic parameters described in a companion paper by Leka & Barnes, with the goal of identifying those properties that are important for the production of energetic events such as solar flares. The photospheric vector magnetic field data from the University of Hawai'i Imaging Vector Magnetograph are well sampled both temporally and spatially, and we include here data covering 24 flare-event and flare-quiet epochs taken from seven active regions. The mean value and rate of change of each magnetic parameter are treated as separate variables, thus evaluating both the parameter's state and its evolution, to determine which properties are associated with flaring. Considering single variables first, Hotelling's T2-tests show small statistical differences between flare-producing and flare-quiet epochs. Even pairs of variables considered simultaneously, which do show a statistical difference for a number of properties, have high error rates, implying a large degree of overlap of the samples. To better distinguish between flare-producing and flare-quiet populations, larger numbers of variables are simultaneously considered; lower error rates result, but no unique combination of variables is clearly the best discriminator. The sample size is too small to directly compare the predictive power of large numbers of variables simultaneously. Instead, we rank all possible four-variable permutations based on Hotelling's T2-test and look for the most frequently appearing variables in the best permutations, with the interpretation that they are most likely to be associated with flaring. These variables include an increasing kurtosis of the twist parameter and a larger standard deviation of the twist parameter, but a smaller standard deviation of the distribution of the horizontal shear angle and a horizontal field that has a smaller standard deviation but a larger kurtosis. To support the

  1. Transport and containment of plasma, particles and energy within flares

    Science.gov (United States)

    Acton, L. W.; Brown, W. A.; Bruner, M. E. C.; Haisch, B. M.; Strong, K. T.

    1983-01-01

    Results from the analysis of flares observed by the Solar Maximum Mission (SMM) and a recent rocket experiment are discussed. Evidence for primary energy release in the corona through the interaction of magnetic structures, particle and plasma transport into more than a single magnetic structure at the time of a flare and a complex and changing magnetic topology during the course of a flare is found. The rocket data are examined for constraints on flare cooling, within the context of simple loop models. These results form a basis for comments on the limitations of simple loop models for flares.

  2. Flare stars of the Orion Nebula - spectra of an outburst

    International Nuclear Information System (INIS)

    Carter, B.D.; O'Mara, B.J.; Ross, J.E.

    1988-01-01

    For the first time, detailed, time-resolved spectra of a flare event of an Orion cluster flare star are presented. These spectra, covering ∼ λλ3600-4600, were obtained by using the Anglo-Australian Telescope with a fibre coupler to simultaneously monitor 23 flare stars in the region of the Orion Nebula. The flare spectra reveal continuous emission which filled in the photospheric Ca I 4226 A absorption, and hydrogen Balmer, Ca II H and K, He I 4026 A and He I 4471 A line emission. Overall, the spectral behaviour indicates similarities to strong outbursts of the classical dMe flare stars. (author)

  3. Second-stage acceleration in solar flares

    International Nuclear Information System (INIS)

    Mullan, D.J.

    1976-01-01

    A model proposed by Chevalier and Scott to account for cosmic ray acceleration in an expanding supernova remnant is applied to the case of a shock wave injected into the solar corona by a flare. Certain features of solar cosmic rays can be explained by this model. (orig.) [de

  4. A clarification on endodontic flare-ups.

    Science.gov (United States)

    Morse, D R; Esposito, J V

    1990-09-01

    In an article on endodontic flare-ups by Robert J. Matusow, our research and publications are discussed. Since we found what we consider to be distortions and misinterpretations of our work, it was decided to clarify the apparent discrepancies found in Matusow's article.

  5. Endodontic cellulitis 'flare-up'. Case report.

    Science.gov (United States)

    Matusow, R J

    1995-02-01

    Endodontic cellulitis involves facial swelling which can vary from mild to severe and can occur as a primary case or a flare-up following initial treatment of asymptomatic teeth with periapical lesions. The microbial spectrum in primary cases involves a significant mixture of anaerobic and facultative aerobic microbes, chiefly streptococci. In a previous study, cultures from flare-up cases, utilizing the same anaerobic techniques as in primary cases, revealed an absence of obligate anaerobes and an 80 per cent incidence of facultative aerobic streptococci. These cases also revealed a significant time lapse from onset of symptoms to the cellulitis phase. No sex or age factors were noted in the primary or flare-up cases. The purpose of this case report is to restate a traditional theory, namely, the alteration of the oxidation/reduction potential (Eh), as a major factor for endodontic cellulitis flare-ups; to confirm the pathogenic potential of oral facultative streptococci; and that asymptomatic endodontic lesions tend to exist with mixed aerobic/anaerobic microbial flora.

  6. Hybrid simulations of chromospheric HXR flare sources

    Czech Academy of Sciences Publication Activity Database

    Moravec, Z.; Varady, Michal; Kašparová, Jana; Kramoliš, D.

    2016-01-01

    Roč. 337, č. 10 (2016), s. 1020-1023 ISSN 0004-6337. [Dynamic Sun - Exploring the Many Facets of Solar Eruptive Events. Potsdam, 26.10.2015-29.10.2015] Institutional support: RVO:67985815 Keywords : Sun * chromosphere * flares Subject RIV: BN - Astronomy, Celestial Mechanics, Astrophysics Impact factor: 0.916, year: 2016

  7. 40 CFR 65.147 - Flares.

    Science.gov (United States)

    2010-07-01

    ..., equal to or less than 122 meters per second (400 feet per second) if the net heating value of the gas... section, less than the velocity, V max, and less than 122 meters per second (400 feet per sec), where the... standard cubic meter (300 British thermal units per standard cubic foot) or greater if the flare is steam...

  8. Sugar Sweetened Beverage Consumption among Adults with Gout or Type 2 Diabetes.

    Directory of Open Access Journals (Sweden)

    Rinki Murphy

    Full Text Available Current guidelines for the management of type 2 diabetes and gout recommend that people with these conditions limit their sugar sweetened beverage (SSB intake. We examined self-reported SSB intake among New Zealand adults with gout or type 2 diabetes, including those on hemodialysis.1023 adults with gout and 580 adults (including 206 receiving hemodialysis with type 2 diabetes, participated in this study of between 2009 and 2012. Participants completed an interviewer-administered SSB intake question "how many sugar sweetened drinks (including fruit juice, but not including diet drinks, do you normally drink per day?" SSB consumption was recorded as a circled number 0, 1, 2, 3, 4, 5, or >5, cans or large glasses (300 mL per day.Consuming one or more SSB per day was reported by 64% (622/1023 of subjects with gout, 49% (176/374 with type 2 diabetes without dialysis, and 47% (96/206 with diabetes on dialysis. Consuming four or more SSBs per day was reported by 18% (179/1023, 9% (31/374 and 9% (18/206, respectively. Such high consumers of SSB were characterized after multivariable analysis to be more likely to be male (adjusted odds ratio (OR 1.8; 95% confidence interval 1.1-2.9, younger in age (40 vs 65 years: 1.6; 1.1-2.3, current smoker (5.2; 2.7-10.1, obese (BMI 41 vs 26 kg/m(2: 1.4; 1-1.9, and report Māori (1.8; 1.2-2.8 or Pacific (1.6; 1.1-2.5 ancestry, compared to Caucasian. People with gout were more likely to report heavy SSB intake compared to people with diabetes (OR 2.4, 95% CI 1.5-3.9. Heavy SSB consumption reported by people with diabetes was similar if they did or did not require dialysis.A high proportion of patients with gout and type 2 diabetes, including those on haemodialysis, are not responding to health messages to abstain from SSB consumption.

  9. Racial differences in health-related quality of life and functional ability in patients with gout.

    Science.gov (United States)

    Singh, Jasvinder A; Bharat, Aseem; Khanna, Dinesh; Aquino-Beaton, Cleopatra; Persselin, Jay E; Duffy, Erin; Elashoff, David; Khanna, Puja P

    2017-01-01

    To compare the health-related quality of life (HRQOL) and the functional ability by race in patients with gout. In a 9-month prospective cohort multicentre study, patients with gout self-reported race, dichotomized as Caucasian or African American (others excluded). We calculated HRQOL/function scores adjusted for age, study site and college education for Short Form-36 (SF-36; generic HRQOL), Gout Impact Scale (GIS; disease-specific HRQOL) and HAQ-disability index (HAQ-DI; functional ability). Longitudinally adjusted scores were computed using multivariable mixed-effect regression models with a random patient effect and fixed sequential visit effect (3-monthly visits). Compared with Caucasians (n = 107), African Americans (n = 60) with gout were younger (61.1 vs 67.3 years) and had higher median baseline serum urate (9.0 vs 7.9 mg/dl) (P gout had worse HRQOL scores on three SF-36 domains, the mental component summary (MCS) and two of the five GIS scales than Caucasians [mean (se); P ⩽ 0.02 for all]: SF-36 mental health, 39.7 (1.1) vs 45.2 (0.9); SF-36 role emotional, 42.1 (4.2) vs 51.4 (4.2); SF-36 social functioning, 36.0 (1.1) vs 40.0 (0.9) (P = 0.04); SF-36 MCS, 43.2 (3.1) vs 50.0 (3.2); GIS unmet treatment need, 37.6 (1.6) vs 31.5 (1.4); and GIS concern during attacks, 53.3 (3.7) vs 47.4 (3.7). Differences between the respective HAQ-DI total scores were not statistically significant; 0.98 (0.1) vs 0.80 (1.0) (P = 0.11). Racial differences in SF-36 mental health, role emotional and MCS scales exceeded, and for HAQ-DI approached, the minimal clinically important difference thresholds. African Americans with gout have significantly worse HRQOL compared with Caucasians. Further research is necessary in the form of studies targeted at African Americans on how best to improve these outcomes. Published by Oxford University Press on behalf of the British Society for Rheumatology 2016. This work is written by US Government employees and is in the public domain in the

  10. The radiographic and MRI features of gout referred as suspected soft tissue sarcoma: a review of the literature and findings from 27 cases

    Energy Technology Data Exchange (ETDEWEB)

    Upadhyay, Neil [Imperial College Healthcare NHS Trust, Imaging Department, London (United Kingdom); Saifuddin, Asif [The Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom)

    2014-09-24

    Gout has been termed the ''great mimicker'', for its ability to resemble other pathological conditions. Whilst the typical imaging features of gout are well described, there is a relative paucity of literature describing more challenging cases of gout, where a malignant tumour has been considered in the differential diagnosis. The aim of this article is to provide an overview of the radiographic and MRI features of 27 cases of gout that were initially referred to our centre as suspected soft tissue sarcoma, alongside a review of the literature. (orig.)

  11. The radiographic and MRI features of gout referred as suspected soft tissue sarcoma: a review of the literature and findings from 27 cases

    International Nuclear Information System (INIS)

    Upadhyay, Neil; Saifuddin, Asif

    2015-01-01

    Gout has been termed the ''great mimicker'', for its ability to resemble other pathological conditions. Whilst the typical imaging features of gout are well described, there is a relative paucity of literature describing more challenging cases of gout, where a malignant tumour has been considered in the differential diagnosis. The aim of this article is to provide an overview of the radiographic and MRI features of 27 cases of gout that were initially referred to our centre as suspected soft tissue sarcoma, alongside a review of the literature. (orig.)

  12. Flare Characteristics from X-ray Light Curves

    Science.gov (United States)

    Gryciuk, M.; Siarkowski, M.; Sylwester, J.; Gburek, S.; Podgorski, P.; Kepa, A.; Sylwester, B.; Mrozek, T.

    2017-06-01

    A new methodology is given to determine basic parameters of flares from their X-ray light curves. Algorithms are developed from the analysis of small X-ray flares occurring during the deep solar minimum of 2009, between Solar Cycles 23 and 24, observed by the Polish Solar Photometer in X-rays (SphinX) on the Complex Orbital Observations Near-Earth of Activity of the Sun-Photon (CORONAS- Photon) spacecraft. One is a semi-automatic flare detection procedure that gives start, peak, and end times for single ("elementary") flare events under the assumption that the light curve is a simple convolution of a Gaussian and exponential decay functions. More complex flares with multiple peaks can generally be described by a sum of such elementary flares. Flare time profiles in the two energy ranges of SphinX (1.16 - 1.51 keV, 1.51 - 15 keV) are used to derive temperature and emission measure as a function of time during each flare. The result is a comprehensive catalogue - the SphinX Flare Catalogue - which contains 1600 flares or flare-like events and is made available for general use. The methods described here can be applied to observations made by Geosynchronous Operational Environmental Satellites (GOES), the Reuven Ramaty High Energy Solar Spectroscopic Imager (RHESSI) and other broad-band spectrometers.

  13. WHITE-LIGHT FLARES ON CLOSE BINARIES OBSERVED WITH KEPLER

    International Nuclear Information System (INIS)

    Gao, Qing; Xin, Yu; Liu, Ji-Feng; Zhang, Xiao-Bin; Gao, Shuang

    2016-01-01

    Based on Kepler data, we present the results of a search for white light flares on 1049 close binaries. We identify 234 flare binaries, of which 6818 flares are detected. We compare the flare-binary fraction in different binary morphologies (“detachedness”). The result shows that the fractions in over-contact and ellipsoidal binaries are approximately 10%–20% lower than those in detached and semi-detached systems. We calculate the binary flare activity level (AL) of all the flare binaries, and discuss its variations along the orbital period ( P orb ) and rotation period ( P rot , calculated for only detached binaries). We find that the AL increases with decreasing P orb or P rot , up to the critical values at P orb ∼ 3 days or P rot ∼ 1.5 days, and thereafter the AL starts decreasing no matter how fast the stars rotate. We examine the flaring rate as a function of orbital phase in two eclipsing binaries on which a large number of flares are detected. It appears that there is no correlation between flaring rate and orbital phase in these two binaries. In contrast, when we examine the function with 203 flares on 20 non-eclipse ellipsoidal binaries, bimodal distribution of amplitude-weighted flare numbers shows up at orbital phases 0.25 and 0.75. Such variation could be larger than what is expected from the cross section modification.

  14. MOST OBSERVATIONS OF OUR NEAREST NEIGHBOR: FLARES ON PROXIMA CENTAURI

    Energy Technology Data Exchange (ETDEWEB)

    Davenport, James R. A. [Department of Physics and Astronomy, Western Washington University, 516 High Street, Bellingham, WA 98225 (United States); Kipping, David M. [Department of Astronomy, Columbia University, 550 West 120th Street, New York, NY 10027 (United States); Sasselov, Dimitar [Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, Cambridge, MA 02138 (United States); Matthews, Jaymie M. [Department of Physics and Astronomy, University of British Columbia, 6224 Agricultural Road, Vancouver, BC V6T 1Z1 (Canada); Cameron, Chris [Department of Mathematics, Physics and Geology, Cape Breton University, 1250 Grand Lake Road, Sydney, NS B1P 6L2 (Canada)

    2016-10-01

    We present a study of white-light flares from the active M5.5 dwarf Proxima Centauri using the Canadian microsatellite Microvariability and Oscillations of STars . Using 37.6 days of monitoring data from 2014 to 2015, we have detected 66 individual flare events, the largest number of white-light flares observed to date on Proxima Cen. Flare energies in our sample range from 10{sup 29} to 10{sup 31.5} erg. The flare rate is lower than that of other classic flare stars of a similar spectral type, such as UV Ceti, which may indicate Proxima Cen had a higher flare rate in its youth. Proxima Cen does have an unusually high flare rate given its slow rotation period, however. Extending the observed power-law occurrence distribution down to 10{sup 28} erg, we show that flares with flux amplitudes of 0.5% occur 63 times per day, while superflares with energies of 10{sup 33} erg occur ∼8 times per year. Small flares may therefore pose a great difficulty in searches for transits from the recently announced 1.27 M {sub ⊕} Proxima b, while frequent large flares could have significant impact on the planetary atmosphere.

  15. Field Measurements of Black Carbon Yields from Gas Flaring.

    Science.gov (United States)

    Conrad, Bradley M; Johnson, Matthew R

    2017-02-07

    Black carbon (BC) emissions from gas flaring in the oil and gas industry are postulated to have critical impacts on climate and public health, but actual emission rates remain poorly characterized. This paper presents in situ field measurements of BC emission rates and flare gas volume-specific BC yields for a diverse range of flares. Measurements were performed during a series of field campaigns in Mexico and Ecuador using the sky-LOSA optical measurement technique, in concert with comprehensive Monte Carlo-based uncertainty analyses. Parallel on-site measurements of flare gas flow rate and composition were successfully performed at a subset of locations enabling direct measurements of fuel-specific BC yields from flares under field conditions. Quantified BC emission rates from individual flares spanned more than 4 orders of magnitude (up to 53.7 g/s). In addition, emissions during one notable ∼24-h flaring event (during which the plume transmissivity dropped to zero) would have been even larger than this maximum rate, which was measured as this event was ending. This highlights the likely importance of superemitters to global emission inventories. Flare gas volume-specific BC yields were shown to be strongly correlated with flare gas heating value. A newly derived correlation fitting current field data and previous lab data suggests that, in the context of recent studies investigating transport of flare-generated BC in the Arctic and globally, impacts of flaring in the energy industry may in fact be underestimated.

  16. Study on the flare stars in the Taurus region

    International Nuclear Information System (INIS)

    Khodzhaev, A.S.

    1986-01-01

    The results of the search of flare stars and their photometric, Hsub(α)-spectroscopic and statistical study in the Taurus are presented. By means of photographic observations carried out during 1980-1984, 92 new flare stars were discovered, 13 of which are known Orion Population variables, and 16 repeated flare-ups among 13 known flare stars. Spatial distribution of these stars was considered and the problem of their membership was discussed. Comparative analysis of the data of flare stars in the Taurus with that of other systems has been carried out. The Herzsprung-Russel and two-colour (U-B, B-V) diagrams for the Taurus flare stars are similar to the diagrams of stellar clusters and associations (Pleiades, Orion etc.). The estimated total number of flare stars in this region is larger than 500

  17. Management of routine solution gas flaring in Alberta

    International Nuclear Information System (INIS)

    1998-01-01

    Alberta's Clean Air Strategic Alliance (CASA) shares decision-making responsibilities with the Government of Alberta for strategic aspects of air quality. In 1997, the Alliance established the Flaring Project Team to develop recommendations that address potential and observed impacts associated with flaring, with particular focus on 'upstream solution gas' flaring. The upstream industry explores for, acquires, develops, produces and markets crude oil and natural gas. Essentially, solution gas at upstream sites is 'co-produced' during crude oil production. The project team was established to collect and summarize information on flaring and its impacts and to develop recommendations for short-term actions to minimize the practice of routine flaring of solution gas. Another goal of the team is to develop a research strategy to better understand flaring emissions and their effects on human, animal and environmental health. The team is working on developing long-term strategies for actions to address the gas flaring issue. 5 refs., 1 tab., 7 figs

  18. Motion of matter in flare loops of the solar disc

    International Nuclear Information System (INIS)

    Xu Ao-ao

    1987-01-01

    By using the optical observation data of a Class 3B double-ribbon flare obtained on July 14, 1980 at the Yunan Observatory, and the x-ray result from the SMM satellite for the same flare, the law of motion of matter in the flare loops of the solar disc is discussed. First, the solar disc positions from the Hα and x-ray images for the flare were compared, and the altitude of the flare loop was determined according to projection effects. Second, the line-of-sight velocity distribution in the region of flare activity due to the falling of matter in the flare loop was estimated theoretically. The result agreed with the observed data

  19. Microbial causes of endodontic flare-ups.

    Science.gov (United States)

    Siqueira, Jose F

    2003-07-01

    Inter-appointment flare-up is characterized by the development of pain, swelling or both, following endodontic intervention. The causative factors of flare-ups encompass mechanical, chemical and/or microbial injury to the pulp or periradicular tissues. Of these factors, microorganisms are arguably the major causative agents of flare-ups. Even though the host is usually unable to eliminate the root canal infection, mobilization and further concentration of defence components at the periradicular tissues impede spreading of infection, and a balance between microbial aggression and host defences is commonly achieved. There are some situations during endodontic therapy in which such a balance may be disrupted in favour of microbial aggression, and an acute periradicular inflammation can ensue. Situations include apical extrusion of infected debris, changes in the root canal microbiota and/or in environmental conditions caused by incomplete chemo-mechanical preparation, secondary intraradicular infections and perhaps the increase in the oxidation-reduction potential within the root canal favouring the overgrowth of the facultative bacteria. Based on these situations, preventive measures against infective flare-ups are proposed, including selection of instrumentation techniques that extrude lesser amounts of debris apically; completion of the chemo-mechanical procedures in a single visit; use of an antimicrobial intracanal medicament between appointments in the treatment of infected cases; not leaving teeth open for drainage and maintenance of the aseptic chain throughout endodontic treatment. Knowledge about the microbial causes of flare-ups and adoption of appropriate preventive measures can significantly reduce the incidence of this highly distressing and undesirable clinical phenomenon.

  20. The classification of flaring states of blazars

    Science.gov (United States)

    Resconi, E.; Franco, D.; Gross, A.; Costamante, L.; Flaccomio, E.

    2009-08-01

    Aims: The time evolution of the electromagnetic emission from blazars, in particular high-frequency peaked sources (HBLs), displays irregular activity that has not yet been understood. In this work we report a methodology capable of characterizing the time behavior of these variable objects. Methods: The maximum likelihood blocks (MLBs) is a model-independent estimator that subdivides the light curve into time blocks, whose length and amplitude are compatible with states of constant emission rate of the observed source. The MLBs yield the statistical significance in the rate variations and strongly suppresses the noise fluctuations in the light curves. We applied the MLBs for the first time on the long term X-ray light curves (RXTE/ASM) of Mkn 421, Mkn 501, 1ES 1959+650, and 1ES 2155-304, more than 10 years of observational data (1996-2007). Using the MLBs interpretation of RXTE/ASM data, the integrated time flux distribution is determined for each single source considered. We identify in these distributions the characteristic level, as well as the flaring states of the blazars. Results: All the distributions show a significant component at negative flux values, most probably caused by an uncertainty in the background subtraction and by intrinsic fluctuations of RXTE/ASM. This effect concerns in particular short time observations. To quantify the probability that the intrinsic fluctuations give rise to a false identification of a flare, we study a population of very faint sources and their integrated time-flux distribution. We determine duty cycle or fraction of time a source spent in the flaring state of the source Mkn 421, Mkn 501, 1ES 1959+650 and 1ES 2155-304. Moreover, we study the random coincidences between flares and generic sporadic events such as high-energy neutrinos or flares in other wavelengths.