case study 2 biochemistry

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Case Studies: Biochemistry

All biochemistry cases.

Dystrophin Stability and Cardiomyopathy

By Richard J. Kwak, Joyce A. Horton, Zyan Davis, Kristy J. Wilson

A Bioinformatic Investigation of a Mysterious Meningoencephalitis

By Sari Matar, Dyan Anore, Basma Galal, Shawn Xiong

Diabetic Ketoacidosis Upon Diagnosis

By Ali Chaari, Aisha Kafoud

Can Stem Cells Bring Magic to Medicine?

By Ashleigh Garrett, Joni H. Ylostalo

Not the NMR You Are Thinking of

By Shawn Xiong

Is p53 a Smoking Gun?

By Michèle I. Shuster, Joann Mudge, Meghan Hill, Katelynn James, Gabriella A. DeFrancesco, Maria P. Chadiarakou, Anitha Sundararajan

Liam’s Head Injury

By Melody J. Neumann, Michelle B. French, Franco A. Taverna

Metabolic Mayhem

By Theresa L. Beaty

Life in the Fat Lane

By Scott J. Donnelly

Atkins or Ammonia?

By Stephanie Dingwall, Tammy Nguyen

Case Studies in Clinical Biochemistry

• Undergraduate Medicine

Research output : Book/Report › Book

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• https://books.google.co.uk/books?id=r11OMwEACAAJ

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T1 - Case Studies in Clinical Biochemistry

AU - Murphy, M.J.

AU - Srivastava, R.

AU - Gaw, Allan

N2 - Clinical Biochemistry is about patients - how we investigate their signs and symptoms, how we diagnose their illnesses and how we treat them. In this book the authors present a series of clinical cases, all based on real patients, and invite the reader to answer key questions using their knowledge and experience of each topic. Each case and its questions are accompanied by the authors' detailed answers, which can be found by simply turning the page. As such, it is an ideal revision aid for those studying Medicine, Nursing and Biomedical Sciences and for those preparing for post-graduate membership examinations.Case Studies in Clinical Biochemistry by Michael Murphy, Rajeev Srivastava and Allan Gaw was published in 2012. The book was incorporated in its entirety into the online sixth edition of Tietz: Fundamentals of Clinical Chemistry and Molecular Diagnostics - the 'bible' for clinical chemists everywhere.

AB - Clinical Biochemistry is about patients - how we investigate their signs and symptoms, how we diagnose their illnesses and how we treat them. In this book the authors present a series of clinical cases, all based on real patients, and invite the reader to answer key questions using their knowledge and experience of each topic. Each case and its questions are accompanied by the authors' detailed answers, which can be found by simply turning the page. As such, it is an ideal revision aid for those studying Medicine, Nursing and Biomedical Sciences and for those preparing for post-graduate membership examinations.Case Studies in Clinical Biochemistry by Michael Murphy, Rajeev Srivastava and Allan Gaw was published in 2012. The book was incorporated in its entirety into the online sixth edition of Tietz: Fundamentals of Clinical Chemistry and Molecular Diagnostics - the 'bible' for clinical chemists everywhere.

SN - 9780956324245

BT - Case Studies in Clinical Biochemistry

PB - SA Press

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A case‐based learning approach to online biochemistry labs during COVID ‐19

Dylan thibaut.

1 Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando Florida, USA

Kersten T. Schroeder

With biochemistry forced to transition to remote‐teaching online, the cooperative active learning and problem‐solving normally in labs have been limited. With little ability to perform experiments with laboratory equipment, determining how to mimic the qualities integral to these labs in an online environment is necessary. We propose one possible solution to provide online labs: short case‐based learning activities.

Case‐based learning (CBL) has shown successful results in improving student achievement, facilitating retention of information, and increasing positive perception towards biochemistry courses. 1 , 2 , 3 Though creation of biochemistry cases has been discussed in a step‐by‐step guide before, instructions on how to translate cases to online‐only instruction is necessary. One must begin first with a learning objective in mind, keep cases concise to only one or a few paragraphs, and encourage student cooperation for cases to work effectively. 4 We suggest using current online conference tools which separate students into groups. These small groups can communicate via voice chat and text with the teacher attached to monitor their work. Students in each group can work on cases using a shared document online which the instructor has access to, making cooperative learning possible. This shared document can then be turned in via a web link.

One example case idea for biochemistry is described in the next paragraph, where students are trying to figure out the identity of unknown amino acids. Instructors may ask each group to identify possible amino acids for every band and what evidence they have to support their hypothesis. Note that the case study is written to promote inquiry, a vital component of case studies, in that the five unknown amino acids cannot be identified without synthesizing the information from the three experiments described (e.g. multiple amino acids have similar isoelectric points, similar molecular weights and similar properties).

Biochemistry case : Three students test a mixture of five unknown amino acids using different biochemistry laboratory techniques to figure out what is in the mixture. Student 1 performed isoelectric focusing by placing the mixture at pH 7 and waited for changes. Four bands appeared with the following isoelectric points: Band 1: 11, Band 2: 9.5; Band 3: 5, Band 4: 3. Student 2 performed a native gel. Using the location of the bands, molecular weight per mole was determined. These g/mole results are as follows: Band 5: 240, Band 6: 174, Band 7: 147, Band 8: 146, Band 9: 133. Student 3 performed sodium dodecyl sulfate–polyacrylamide gel electrophoresis (SDS–PAGE). This student obtained similar results to Student 2; however, the student observed the band at 240 disappear, instead seeing a thicker band much further down the gel. See Figure ​ Figure1 1 for how to approach creating a CBL activity.

Scheme for how to approach creating a case‐based learning (CBL) activity

After personally using a CBL biochemistry curriculum online, it is important that instructors know that it was a challenge initially but became easier with experience. Groups of five students seem to work best online and approximately 10 questions should be given. Questions should ideally apply concepts to real‐world situations and slowly develop from simple to complex.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

Thibaut D, Schroeder KT. A case‐based learning approach to online biochemistry labs during COVID‐19 . Biochem Mol Biol Educ . 2020; 48 :484–485. 10.1002/bmb.21408 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

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2023-24 General Bulletin

Biochemistry, BS

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Program Overview

The field of biochemistry encompasses an extremely broad and ever-growing variety of topics focused on studying  biomedically-relevant problems from a molecular point of view .  Biochemists make fundamental discoveries that provide a platform for understanding life, from the study of individual proteins and nucleic acids to control of gene expression in entire tissues.  This research contributes directly to the development of therapies for health issues such as metabolic disorders, cancer, and infectious diseases.

The Biochemistry Department in the School of Medicine offers majors leading to BA and BS degrees, as well as a minor.  Biochemical studies prepare students well:  for medical or other professional schools; for top graduate programs; for research or technical positions in industry (e.g. biotechnology, pharmaceutical) or academia; and for a variety of careers in which biomedical knowledge is crucial (e.g. finance, consulting, media, intellectual property, education).

Research in faculty laboratories is required and is a strength of the major.  Both majors require BIOC 391  and students present their research during their last semester in BIOC 393  as a written thesis and a presentation at the Biochemistry Capstone Retreat. 

Both the BA and BS programs offer five optional concentrations which are defined by their required courses:  Cancer Biology, Infectious Disease, Metabolism, Computational Health Science, and Research Honors.

Learning Outcomes

• Students will understand the central biochemical mechanisms that are important in human biology and medicine.
• Students will learn biochemical approaches that align with the understanding of normal physiology and disease.
• Students will understand that macromolecular structure determines function and regulation.
• Students will learn that energy is required by and transformed in biological systems
• Students will understand the molecular basis of information storage and flow within and between cells.
• Students will learn that scientific discovery requires objective measurement, quantitative analysis and clear communication.
• Students will learn the value and application of experiential learning to the practice of research.

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For undergraduate policies and procedures, please review the Undergraduate Academics section of the General Bulletin.

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Undergraduate students may participate in accelerated programs toward graduate or professional degrees. For more information and details of the policies and procedures related to accelerated studies, please visit the Undergraduate Academics section of the General Bulletin.

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Students seeking to complete this major and degree program must meet the  general requirements for bachelor's degrees  and the  Unified General Education Requirements . Students completing this program as a  secondary major  while completing another undergraduate degree program do not need to satisfy the  school-specific requirements  associated with this major.

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Biochemistry majors who have excellent academic records may be awarded Biochemistry Undergraduate Honors. To graduate with departmental honors in biochemistry, a student must satisfy the following requirements:

1.  A grade point average of at least 3.6

2.  A minimum of 6 credit hours of undergraduate research  BIOC 391  in one laboratory

3.  A BIOC 393 capstone report approved by the Undergraduate Education Committee of the department on the basis of the quality of the research, the written report, and an oral presentation. An acceptable report:

a.  Should follow a standard journal format

b.  Should demonstrate the student’s understanding of the research area, experimental techniques, goals and implications of the project

c.  Should show that the student has advanced their knowledge of the applicable techniques and the underlying scientific concepts.

4.  Using all or part of the capstone research, the student must be a co-author on a manuscript either submitted, in press, or published in a peer reviewed journal.

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Cancer biology concentration requirements:, infectious disease concentration requirements:, metabolism concentration requirements:, computational health science concentration requirements:, research honors concentration requirements:, sample plan of study.

Unified General Education Requirement .

Selected students may be invited to take CHEM 323  or  CHEM 324

Selected students may be invited to take PHYS 123  and  PHYS 124 in place of PHYS 121  and  PHYS 122 .

BS students must take two of the three Biochemistry core courses: BIOC 312 , BIOC 334 , or BIOC 350 . For BS  students who take all three courses, one course can serve as a technical elective.

3 credit hours of BIOC 391 are required; an additional 3 credit hours of BIOC 391 are highly recommended. Students should consult their academic advisers about the elective parts of the curriculum.

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Biochemistry

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Biochemistry quiz, core and foundation learning, biochemistry: acute kidney injury case study 1.

Learn what blood results should be reviewed, why they are important and the impact of medicines when a patient has an acute kidney injury (AKI).

This case study forms part of the Biochemistry learning gateway . On this learning gateway page, you will find a range of learning resources which aim to increase your knowledge, skills, and confidence in relation to biochemistry.

1h:00m (for events this includes pre and post event learning)

Biochemistry: Drug induced liver injury case study 2

Learn how to recognise abnormal liver function test results, how to explain this physiologically and the appropriate action to take when abnormal results are due to medicines.

Biochemistry: Iron deficiency anaemia case study 3

Learn how to recognise abnormal biochemistry results, make recommendations on treatments for iron deficiency anaemia and monitoring requirements.

Core and foundation learning continued

Biochemistry: primary hyperthyroidism case study 4.

Learn what blood results should be reviewed when assessing a patient's thyroid function, describe how these blood results differ when a patient has a thyroid disorder and interpret a patient's blood results to recommend interventions for their medicines.

Biochemistry: Type 2 diabetes: blood glucose and cholesterol case study 5

Learn what the monitoring requirements, and targets associated with HbA1c and cholesterol results, are for people with type 2 diabetes, interpret those results accurately, and develop strategies to support patients in achieving their targets.

Biochemistry: Bacterial infection case study 6

Learn to recognise abnormal inflammatory markers, understand how you can use these to monitor an infection, and describe the appropriate action to take when a patient has a bacterial infection and their condition is not improving despite treatment.

Biochemistry: Hyperparathyroidism case study 7

The aim of this piece of learning is to support you to become more confident with biochemistry results and managing medicines in relation to those results. We have a series of case studies on different topics to help put your learning into practice.

Learning Outcomes:

• interpret abnormal bone profile results
• describe the role of parathyroid hormone in calcium and phosphate homeostasis
• explain how prolonged high parathyroid hormone levels can lead to bone disease.

Biochemistry: Coagulation case study 8

On completion of all aspects of this learning programme you should be able to:

• list the relevant blood results you would review when you identify a patient at risk of a DVT
• explain why these are important for assessing coagulation
• interpret a patient’s blood results and use to provide guidance for recommended management of coagulation disorders.

Biochemistry: Cardiac markers case study 9

• describe what troponin is
• explain to a patient why troponin levels are measured
• interpret a patients troponin results to determine if someone has had a myocardial infarction
• interpret brain natriuretic peptide (BNP) levels to determine if someone has heart failure.

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Biochemistry: section 1.

The aim of this e-learning programme is to provide learners with a basic awareness of important blood tests and how to interpret them in order to support the diagnosis and management of patients. Section 1 covers full blood count, inflammatory markers and coagulation.

There are three sections which make up this learning programme. To access the other sections, select the links below:

Section 2 covers chronic disease markers, urea and electrolytes and liver function tests.

Section 3 covers thyroid function tests, bone function tests and therapeutic drug monitoring.

Please note: this e-learning programme has been developed and provided by the Welsh Centre for Pharmacy Professional Education (WCPPE). Users should recognise that this programme may refer to Welsh policies and organisations. CPPE does not maintain control over the accuracy and currency of this programme.

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• explain the importance of laboratory testing in diagnostics and patient monitoring
• demonstrate understanding of the theoretical basis of and varied approach to investigation and monitoring of interventions
• advise on the appropriate treatment of patients with abnormal test results
• recognise the drugs that require therapeutic drug monitoring.

Biochemistry: Section 2

The aim of this e-learning programme is to provide learners with a basic awareness of important blood tests and how to interpret them in order to support the diagnosis and management of patients. Section 2 covers chronic disease markers, urea and electrolytes and liver function tests.

Section 1 covers full blood count, inflammatory markers and coagulation.

Biochemistry: Section 3

The aim of this e-learning programme is to provide learners with a basic awareness of important blood tests and how to interpret them in order to support the diagnosis and management of patients. Section 3 covers thyroid function tests, bone function tests and therapeutic drug monitoring.

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Case study: Biochemistry without borders: a case study utilising infographics

Affiliations.

• 1 School of Life and Health Sciences, University of Roehampton, London SW15 4JD, U.K.
• 2 Natural Sciences Department, Hostos Community College, CUNY, NY 10451, U.S.A.
• PMID: 35411387
• DOI: 10.1042/EBC20210040

The present paper addresses a case study on the implementation of an online learning exercise utilising infographics in undergraduate Biochemistry and General Chemistry courses at the University of Roehampton (UoR) and Hostos Community College (HCC) of the City University of New York (CUNY). Students at UoR were asked to create infographics on topics related to the four major classes of biomolecules: carbohydrates, lipids, proteins and nucleic acids, and these infographics were shared with HCC students in an active learning exercise which incorporated peer evaluation and feedback. We highlight the various teaching and learning strategies, as well as the challenges related to the implementation of digital tools, in the educational process during the COVID-19 pandemic to maintain student engagement and active learning. Student feedback revealed positive learning gains on biochemistry concepts related to the four biomolecules. The exercise was viewed favourably by students, with learners indicating the acquisition of digital skills to effectively represent and visualise their understanding of biochemical concepts and explain these processes to peers.

Keywords: Biochemistry; Communication; General Chemistry; Infographics; Internet and Web-based learning; Undergraduate.

© 2022 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society.

• Biochemistry / education
• Data Visualization

• Research article
• Open access
• Published: 01 April 2024

Hyperuricemia as an independent risk factor for achilles tendon rupture in male: a case–control study

• Dongliang Chen 1 ,
• Jinwei Liu 1 ,
• Zhaohui Zhu 1 ,
• Zengfang Zhang 1 ,
• Deheng Liu 1 &
• Liangxiao Zheng 1  

Journal of Orthopaedic Surgery and Research volume  19 , Article number:  215 ( 2024 ) Cite this article

41 Accesses

Metrics details

To study the correlation between achilles tendon rupture (ATR) and hyperuricemia, also verify the known risk factors for ATR.

A retrospective review of 488 subjects was performed (182 with Achilles tendon rupture, 306 controls with ankle sprains). Demographic variables and risk factors for rupture were tabulated and compared. The baseline data and related indicators were compared, and the risk factors of ATR were analyzed by constructing a binary logistic regression model.

Univariate logistic analysis showed that BMI, smoking, and hyperuricemia were risk factors for the development of ATR (OR = 1.65, 95%CI 1.13–2.42, P  = 0.01; OR = 1.47, 95%CI 1.00–2.24, P  < 0.05; OR = 2.85, 95%CI 1.84–4.42, P  < 0.01). Multifactorial analysis showed that BMI ≥ 25 kg/m 2 , smoking, and hyperuricemia were independent risk factors for the development of ATR (OR = 1.66, 95%CI 1.11–2.49, P  = 0.01; OR = 2.15, 95%CI 1.28–3.60, P  < 0.01; OR = 3.06, 95%CI 1.92–4.89, P  < 0.01). Among the blood biochemical indicators, total cholesterol (TC) and uric acid (UA) were independent risk factors for the occurrence of ATR (OR = 1.54, 95% CI 1.12–2.12, P  = 0.01; OR = 1.01, 95% CI 1.01–1.01, P  < 0.01).

Our study confirmed that, as in previous results, higher BMI, smoking, and total cholesterol are risk factors for ATR, Hyperuricemia may contribute to the development of ATR, and adjunctive tests for TC and UA in the blood biochemistry may be helpful in predicting the risk of ATR.

Introduction

Achilles tendon ruptures (ATR) are a common injury associated with exercise, with an incidence ranging from 5 to 50 cases per 100,000 person-years and appearing to be on the rise in recent decades [ 1 , 2 , 3 ]. Achilles tendon rupture can severely impair mobility and affect normal activity and movement [ 4 , 5 , 6 ]. In general, this damage is more common in male aged between 40 and 50 years old. In fact, the ratio of male injuries to female injuries ranged between 2:1 and 12:1 [ 5 ]. Preventing the occurrence of ATR becomes an important option to reduce the health risks in this population.

Several risk factors for ATR have been identified in previous studies, including age, sex, body mass index (BMI), race, smoking status, use of fluoroquinolones, topical and oral corticosteroids, previous achilles tendinopathy, blood type, and intensity of participation in competitive sports [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Hyperuricemia is defined as a serum uric acid level greater than 6.8 mg/dL (0.40 μmol/L), and less than 20% of patients with hyperuricemia are estimated to develop gout attacks [ 14 ]. Hyperuricemia can cause cellular and metabolic distress [ 15 ], leading to degeneration of the tendon extracellular matrix and subclinical inflammation. Interestingly, subclinical tendon inflammation and structural damage have been observed in patients with asymptomatic hyperuricemia [ 16 ], with previous literature reporting patellar tendon intimal lesions in 12% of hyperuricemia patients and achilles tendinopathy in 15% of hyperuricemic patients, compared to only 1.9% of normouricemic subjects. Based on the hypothesis that ATR is the result of acute trauma to a chronically degenerative tendon [ 17 ]. ATR is more prevalent in patients with hyperuricemia than people with normal uric acid, we thus hypothesize that there may be a potential correlation between ATR and hyperuricemia.

The objective of this study was to investigate the relationship between ATR and hyperuricemia in male and to explore the risk factors associated with the development of ATR, while verifying some previous risk factors. Provide valuable information for clinical study of ATR and its preventive measures.

Materials and methods

This retrospective cross-sectional cohort study included 182 male patients diagnosed with achilles tendon rupture (ATR) and a control group of 306 male patients with ankle fractures, who were seen at the Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, between January 2014 and July 2022. Inclusion criteria for the ATR group were: (1) 18 to 70-year-old male patients with ATR and complete clinical data, without other coexisting injuries. Exclusion criteria were: (1) insufficient data to calculate body mass index (BMI) or unclear epidemiological data; (2) open Achilles tendon rupture; (3) systemic or local use of steroids or quinolones. The control group selected patients with ankle injury admitted during the same period, we chosen ankle sprains as the control group because the physicians participating in this study easily identified such patients due to the close site of injury. Furthermore, ankle sprains occur in all ages and are therefore considered a reasonable representative of the general population. Exclusion criteria: There was no previous history of acute ATR, and the same exclusion criteria were used as in the ATR group.

Variables and data sources

Data for the study were collected using a questionnaire that included variables such as demographic data (age and gender), harmful habits (smoking and drinking), use of uricotelic drugs, past medical history, family medical history, medical conditions, and medication. Additionally, information on endocrine and cardiovascular diseases, as well as specific diseases such as diabetes mellitus, hypertension, and coronary heart disease, were recorded.

Detection methods

Blood specials were collected from patients after at least 10 h of rest and fasting in the morning. Measurements of triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), glucose (GLU) and lipoprotein levels were performed using a fully automated biochemical analyzer (Modular 7600, Hitachi, Tokyo, Japan). Furthermore, the levels of high-density lipoprotein (HDL-C), apolipoproteins A1 (APO-A1), apolipoprotein B (APO-B), and uric acid (UA) were also measured.

Statistical analysis

A descriptive analysis was conducted on all variables. IBM SPSS Statistics (version 26, R26.0.0.2, IBM, Chicago, USA) was utilized for statistical analysis. Continuous variables with normal distribution were represented as mean ± standard deviation and analyzed using t-tests or one-way ANOVA. Categorical variables were presented as frequencies [n (%)] and analyzed using the χ 2 test to determine differences between the two groups. Logistic regression was used to analyze risk factors for ATR, with adjustment made for other confounding factors. Sample size was calculated to determine the number of subjects required to demonstrate equivalence of mean UA in ATR and control cohorts using the two one-sided t-test (TOST) method for equivalence testing, with a = 0.05 and b = 0.20. With data obtained from 182 ATR patients, sample size analysis indicated that 306 controls would achieve 80% power. All assays were two-tailed, and statistical significance was indicated by P  < 0.05.

Clinical information

The clinical data of ATR patients and control subjects are shown in Table  1 . The results of the univariate analysis showed that among the included subjects, the proportions of BMI, smokers, and hyperuricemia patients in ATR patients were significantly higher than those in the control group, and the differences were statistically significant ( P  < 0.05). There was no significant difference in the proportion of patients with age, hypertension, coronary heart disease, drinking and hypertension between ATR group and the control group ( P  > 0.05).

Analysis of risk factors for the occurrence of ATR

Univariate logistic regression and multivariate logistic regression were used to analyze the risk factors for the occurrence of ATR, and the results were shown in Tables  2 and 3 . Univariate logistic analysis showed that BMI, smoking, and hyperuricemia were risk factors for the developmalet of ATR (OR = 1.65, 95%CI 1.13–2.42, P  = 0.01; OR = 1.47, 95%CI 1.00–2.24, P  < 0.05; OR = 2.85, 95%CI. 1.84–4.42, P  < 0.01). Multifactorial analysis showed that BMI ≥ 25 kg/m 2 , smoking and hyperuricemia were independent risk factors for the developmalet of ATR (OR = 1.66, 95%CI 1.11–2.49, P  = 0.01; OR = 2.15, 95%CI 1.28–3.60, P  < 0.01; OR = 3.06, 95%CI 1.92–4.89, P  < 0.01).

Correlation between blood biochemical levels and ATR

We analyzed the correlation between blood biochemical parameters and the occurrence of ATR. The result of univariate logistic regression analysis showed that TG, TC, LDL-C, UA, GLU, APO-A1, APO-B were risk factors for the occurrence of ATR ( P  < 0.05, Table  4 ). The result of multivariate logistic regression showed that TC and UA were independent risk factors for the occurrence of ATR (OR = 1.54, 95% CI 1.12–2.12, P  = 0.01; OR = 1.01, 95% CI 1.01–1.01, P  < 0.01) (Table  5 ).

The results of ROC analysis showed that the area under the curve (AUC) for both TC and UA diagnosis alone and in combination was > 0.6, with a higher sensitivity for UA diagnosis alone and a higher specificity for TC diagnosis in combination with UA (Fig.  1 , Table  6 ).

The receiver operating characteristic (ROC) of TC, UA and the combination of the them for the diagnosis of ATR. TC, total cholesterol. UA, uric acid

This case control study has found that hyperuricemia is an autonomous risk factor for ATR in the male Chinese population. The analysis of blood biochemical test results showed a considerable difference in uric acid values between the two groups. To date, Studies on the association between hyperuricemia and ATR in male were scarce. Therefore, this research sets an important precedent and plays a crucial role in the prevention and treatment of ATR in exercise active male aged around 40 years old. In order for the conclusions of this study to be considered valid, it is important that the sample demonstrate similarities in risk factors for ATR as compared to previously published studies. This study sample accurately represents the general population of ATR in coastal China, with predominantly male individuals suffering primarily exercise-related injuries. Additionally, TC is a significant risk factor, and other known risk factors, such as smoking, tend to increase the risk of ATR.

Hyperuricemia, a disorder characterized by abnormal purine metabolism, has been found to have an impact on tendons, although its significance in this regard is often underestimated and not fully comprehended [ 15 , 18 ]. Although evidence linking hyperuricemia to tendinopathy is limited, it is more evident that crystal deposition in and around tendons during gout attacks can cause cell death. Dodds et al. [ 19 ] found that 30 patients with ATR had significantly higher uric acid levels when compared to healthy controls. Additionally, Beskin reported a 14% incidence of gout in 42 consecutive patients with ATR [ 20 ].The precise mechanism by which Achilles tendon injury occurs remains unclear, although restricted blood supply and degenerative changes are generally believed to be the primary causes [ 7 , 21 ]. In a retrospective study investigating the relationship between tendon pathologies and uric acid levels, Abate et al. [ 15 ] found that elevated serum uric acid levels disrupt proteoglycan metabolism, which is the underlying cause of tendon injury. Recent research evidence suggests that asymptomatic hyperuricemia may be a predisposition of ATR by impeding the normal functions of tendon stem/progenitor cells (TSPCs) [ 22 ]. There is also research evidence that MSU crystals directly interact with tenocytes to reduce cell viability and function [ 23 ]. Andia I et al. found that urate crystals caused pro-inflammatory response drives the progression of tendinopathy [ 24 ]. An MRI study of 45 cases of Achilles tendon rupture by Bäcker HC et al. [ 25 ] confirmed that was evidence of diffuse degeneration in each achilles tendon. Achilles tendon degeneration or tendinopathy can lead to the mechanical failure of the achilles tendon. Based on this analysis, it was hypothesized that an increase in uric acid levels caused secondary ATR due to Achilles tendinopathy. However, there is no direct evidence to confirm the causal relationship between the increase in uric acid levels, Achilles tendinopathy and ATR, and further studies are needed to provide more comprehensive data and pathological findings.

Several limitations are associated with this study. Firstly, the retrospective survey design used in this comparative study only provides a relevant basis and cannot confirm the causal relationship, which warrants confirmation through a prospective investigation study conducted on a large sample size of natural populations in the community. Secondly, the relatively small number of ATR cases prohibit subsequent subgroup analysis, particularly with regards to other factors contributing to ATR, such as congenital malformation factors like Haglund malformation that could be associated with ATR. Thirdly, due to the fluctuation of serum uric acid levels and sex differences, we only analyzed admitted fasting blood of male patients, and the lack of follow-up review results also limits the scope of the study. Fourth, the survey area is in the coastal region and may have a higher incidence of hyperuricemia, which is another limitation of this study. Fifth, since the duration of hyperuricemia cannot be determined at the time of diagnosis, there is a lack of data on the duration of hyperuricemia in patients with ATR in this study, and it remains unclear whether patients with longer hyperuricemia duration are more prone to tendon rupture. Sixth, there is an absence of histological data regarding tendon tissue, which will be the main focus of this aspect of the study in future clinical research.

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LZ designed the study protocol. JL and ZhZ collected and analyzed the clinical data of patients. DC wrote the first draft of the manuscript. ZZ and DL provided revision for intellectual content and final approval. The authors read and approved the final manuscript of the manuscript.

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Chen, D., Liu, J., Zhu, Z. et al. Hyperuricemia as an independent risk factor for achilles tendon rupture in male: a case–control study. J Orthop Surg Res 19 , 215 (2024). https://doi.org/10.1186/s13018-024-04698-9

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7.5: Case Study- Balancing Acts in Pharmacological Synthesis

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Introduction: Chemical equations are the language through which chemists communicate the subtleties of chemical reactions. In pharmacological research, where the synthesis of new drug molecules is both an art and a science, balancing these equations is crucial. This case study explores the importance of balancing chemical equations in the synthesis of new drugs and how this relates to enzyme kinetics in the body.

Scenario: In the high-tech research laboratory of Apex Pharmaceuticals, a team of researchers, including Dr. Sophie Lee, is on the verge of a breakthrough. They have developed a promising new drug molecule that could potentially treat a rare genetic disorder. However, before they can move forward with production and trials, they must first balance the chemical equation for the synthesis reaction of the drug to ensure the process is efficient, cost-effective, and yields the correct product in the desired quantities.

The Art of Balancing Equations: Dr. Lee and her team meticulously account for each atom of the reactants and products, adhering to the law of conservation of mass. They adjust coefficients to balance the number of atoms on both sides of the equation, a step that is critical for the synthesis process to proceed correctly and safely.

Case Study Questions:

• Why is balancing chemical equations important in drug synthesis?
• How do reaction rates relate to enzyme kinetics?

Hands-On Classroom Activities:

• Synthesis Lab: In the "Synthesis Lab" activity, students will engage in the synthesis of aspirin and are required to balance the chemical equation for this reaction. This exercise is designed to connect their understanding of chemical reactions and stoichiometry with the practical aspects of drug synthesis and pharmaceutical chemistry.
• Enzyme Kinetics Experiment: During the "Enzyme Kinetics Experiment," students will conduct investigations into reaction rates by observing enzyme-catalyzed reactions. They will then be tasked with relating their observations to the principles of balancing chemical equations, thereby enhancing their understanding of the role of enzymes in biological reactions and the importance of precise chemical equations in biochemistry.

Conclusion: For Dr. Lee and her team at Apex Pharmaceuticals, the balancing of chemical equations is not just a necessary step in the synthesis of new drug molecules—it is a critical process that affects every stage from design to delivery. It ensures that each synthesis step is predictable and controllable, which is vital for the safe and effective production of pharmaceuticals. Moreover, by understanding the principles of enzyme kinetics and reaction rates, researchers can better anticipate how a drug will perform in vivo, ultimately leading to more effective treatments with fewer side effects. The meticulous balancing of chemical equations thus stands as the cornerstone of successful drug development and patient care.