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Objective:To improve the clinical differential diagnosis ability of rheumatoid arthritis (RA) complicated with gout and septic arthritis (SA).Methods:The clinical characteristics, diagnosis, and treatment of one RA patient with hyperuricemia and recurrent swelling and pain in right shoulder were reported and discussed.Results:A patient, with a history of RA for 10 years, hyperuricemia for 8 years, recurrent swelling and pain in right shoulder for 1 year. RA, gout, and SA were diagnosed before, and the response was poor after symptomatic treatment. In recent 1 month, the symptom was aggravated with the formation of fistula on the right shoulder. The laboratory tests for tuberculosis T cell interferon release test (IGRA) and tuberculin (PPD) test were negative, and the CD4 + cell count decreased. The comprehensive analysis of the imaging with right shoulder showed MSU deposition on right shoulder, with bone erosion, bone destruction, bone marrow edema, joint effusion, and multiple sites of connective tissue involvement (synovial bursa, tendon sheath, tendon, and muscle) GeneXpert MTB/RIF (GeneXpert), metagenomic next-generation sequencing (mNGS) of puncture fluid and joint fluid culture prompted Mycobacterium tuberculosis complex group. He was finally diagnosed with RA, gout, and osteoarticular tuberculosis (OAT). Symptoms were relieved after symptomatic treatment. Conclusion:RA patients with hyperuricemia have recurrent single arthritis. In addition to considering for gout, the presence of OAT should also be considered. The immune functional status of the patient and drug used may interfere with the interpretation of immune function tests. It is necessary to integrate the clinical characteristics of patients, a variety of imaging examinations, and etiological detection to confirm the diagnosis and avoid misdiagnosis.
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Objective To study the prevalence of chronic kidney disease(CKD) and risk factors among adults received examina-tion in Yongchuan district of Chongqing .Methods 10 280 residents(older than 18 years) were selected ,who had health examina-tion in the Yongchuan Affiliated Hospital ,Chongqing Medical University ,Yongchuan Hospital of Traditional Chinese Medicine and Yongchuan people's hospital from January 2012 to December 2013 .Patients with CKD were identified by the examination dates .All of them were conducted with a questionnaire survey ,physical examination ,and renal damage and related risk indicator factors moni-toring for more than 3 months .Results Eligible dates of 10 021 subjects were enrolled in the study .The prevalence of albuminuria was 5 .1% ,hematuria in 8 .3% ,reduced renal function in 1 .4% .The CKD population prevalence rate was 15 .7% ,and the recogni-tion was 6 .4% .The Logistic regression model showed that hyperuricemia ,nephrolithiasis ,diabetes mellitus ,hypertension ,obesity and age contributed to the development of CKD .Conclusion The prevalence of chronic kidney disease is 15 .7% and the recognition is 6 .4% in urban healthy examination population of Yongchuan .Independent risk factors associated with CKD are hyperuricemia , nephrolithiasis ,diabetes mellitus ,hypertension ,obesity and age .
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The TCM acupuncture education for foreign students is complicated and technical work.The writer discusses the modern teaching methods recently to aim directly at the problems in the traditional teaching methods in foreign students education,analyzes and compares the connotation and teaching mode of these teaching methods,and at last puts forward that we should choose correct teaching method according to the actuality to improve the teaching quality for foreign students in TCM acupuncture.