核酸代谢 - abuad lms.PPT

* * The advanced gout stage is often referred to as chronic tophaceous gout to indicate the presence of this clinical manifestation, which will remain unresolved in the absence of urate-lowering therapy. Tophi are characterized by solid urate deposits in connective tissues that produce irregular nodularities and joint destruction. In addition, the skin overlying the tophi may become ulcerated and exude a white, chalky material. Shown here are some common sites of tophi, including dermal tophi on the finger, periarticular tophi on the hands, and tophi on the helix of the ear. The patient who was experiencing the intradermal tophi on the knees was diagnosed and treated by multiple generalists and specialists for osteoarthritis. This photo was taken during his self-referred first visit to a rheumatologist and reinforces the point that gout is a disease that is under-recognized.1 The patient with polyarticular involvement of his hands had been misdiagnosed and treated for rheumatoid arthritis for 8 years.2 The tophi exhibited on this slide are clinically apparent, but this may not always be the case, as was seen in the previous case study examples of the tophi that formed in the bone of the knee and the palm of the hand. 1. Patient case study courtesy of Brian Mandell, MD, PhD, Cleveland Clinic. 2. Patient case study courtesy of N. Lawrence Edwards, MD, University of Florida. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * dTMP synthesis at the nucleoside monophosphate level. 5. Regulation of de novo synthesis § 4. 2 Salvage pathway § 4. 3 Antimetabolites of pyrimidine nucleotides Antimetabolites of pyrimidine nucleotides are similar with them of purine nucleotides. 1. Pyrimidine analogs 5-fluorouracil (5-FU) is a analog of thymine. 5-FU 5-FdUMP 5-FUTP dUMP dTMP Synthesis of RNA Destroy structure of RNA 2. Amino acid analogs Azaserine (AS) inhibits the synthesis of CTP. 3. Folic acid a