Objective To observe the clinical curative effect of tripterygium polyglycoside combined with cozaar in elderly patients with IgA nephropathy (IgAN) and its influence on expressions of TGF-β1,PAI-1 and VEGF.Methods Eighty elderly patients with IgA nephropathy in Jiaxing Hospital of Armed Police Zhejiang Corps from April 2011 to January 2016 were selected and randomly divided into the control group and observation group,40 cases in each group.The two groups received the routine treatment of chronic basic diseases and took oral cozaar.On this basis the observation group took tripterygium polyglycoside for continuous 12 months.Urine protein,serum creatinine (Scr),blood urea nitrogen (BUN),plasma Alb,urine TGF-β1,PAI-1 and VEGF levels before treatment and at 3,6,12 months after treatment were compared between the two groups.The occurrence situation of adverse reactions was recorded.Results The 24 h urinary protein levels at 3,6,12 months after treatment in the two groups were decreased,moreover the 24 h urine protein level at each time point in the observation group was lower than that in the control group,the difference was statistically significant (P<0.05).The levels of Scr,BUN,urine TGF-β1,PAI-1 and VEGF after treatment in the two groups were decreased compared with before treatment,while the Alb level was increased compared with before treatment,moreover the levels of Scr,BUN,urine TGF-β1,PAI-1 and VEGF in the observation group were lower than those in the control group,while the Alb level was higher than that in the control group,the difference was statistically significant (P<0.05).The observation group appeared 2 cases of leukopenia,1 case of liver dysfunction and no serious adverse reactions occurred.Conclusion Tripterygium polyglycoside combined with cozaar has a significant therapeutic effect on elderly patients with IgAN,can significantly reduce urinary protein and protect renal function,moreover its clinical use is safer.Its efficacy may be related to reducing the expression levels of TGF-β1,PAI-1 and VEGF.

The mandibular first premolar has complicated morphology of root canal, it has more variation which increases the incidence of multiple root canals. A successful root canal therapy not only need strict cleaning, disinfection and filling, but also need a correct understanding of root canal morphology and anatomy. Otherwise there might be a risk of missing canals that resulting the failure of the therapy. Also crown closure is one of the successful elements of root canal therapy. This is a case report accompanied by a review of the literature that shows the unusual anatomy of the mandibular first molar with three roots and three root canals.

Signal transducer and activator of transcription 3 (STAT3) is a signal transcription protein that exists in the cytoplasm. The abnormal activation of STAT3 is closely related to cell proliferation, differentiation, and canceration. It has abnormal expression in cancer stem cells such as breast cancer, pancreatic cancer, lymphoma, and lung cancer. Therefore, inhibiting the abnormal expression of STAT3 has become a new approach for antitumor therapy.

BACKGROUND: There is no report on the treatment of suppurative discitis with posterior microendoscopic discectomy, antibiotic artificial bone implantation and one-stage percutaneous pedicle screw fixation. OBJECTIVE: To evaluate the clinical effectiveness of posterior microendoscopic debridement, antibiotic artificial bone implantation and one-stage percutaneous pedicle screw fixation for pyogenic spondylodiscitis. METHODS: Thirty-one patients with suppurative discitis admitted at the Department of Spinal Surgery, the First Affiliated Hospital of Guangzhou Medical University from January 2014 to December 2017, including 17 males and 14 females, aged 28-78 years, were included. All the patients underwent posterior microendoscopic lesion clearance and antibiotic artificial bone grafting and one-stage percutaneous pedicle screw fixation. The erythrocyte sedimentation rate and C-reactive protein levels were detected at postoperative follow-up. The Visual Analog Scale and the Japanese Orthopaedic Association scores were used for detection. RESULTS AND CONCLUSION: (1) All the surgical operations of the 31 patients were successfully completed and all patients had immediate relief of low back pain and lower extremity radiation pain. They were able to move ground wearing a waistband at 1-4 days postoperatively. (2) Thirty-one patients were followed up for 9-18 months. All patients had a significant decrease in C-reactive protein and erythrocyte sedimentation rate at 1 week after surgery, and C-reactive protein and erythrocyte sedimentation rate were in the normal range at 1, 3, and 6 months postoperatively. (3) The Visual Analog Scale scores of all patients at 1 week of follow-up were significantly lower than those before surgery (P < 0.05) , and the Japanese Orthopaedic Association scores were significantly higher than those before surgery (P < 0.05) . (4) In the follow-up examination of CT and MRI, there was no recurrence, pseudoarticular formation or internal fixation loosening. (5) These results suggest that posterior microendoscopic discectomy, antibiotic artificial bone implantation combined with one-stage percutaneous pedicle screw fixation for treating suppurative discitis can result in little trauma, few bleeding and rapid pain relief, and patients can move to the ground early. The operation method has a good clinical effect.

Objective To establish the chemical synthesis of the active ingredient rosavin of Rhodiola rosea. Methods β-D-pentaacetylglucose, 1-hydroxy-2,3,4-triacetylarabinose and cinnamyl alcohol were used as starting materials. The target compound was prepared by 1-position selective of β-D-pentaacetylglucose deacetylation, glycosylation reaction, glucose 6-OH selective protection and deprotection and other 8-step reactions. Results The target product, rosavage, was successfully obtained with high yield. The structure was confirmed by ESI-MS, ¹H-NMR and ¹³C-NMR. The protection of 6-OH with high selectivity and high yield of tert-butyldiphenyl chlorosilane played a vital role in the synthesis process,. Conclusion The synthetic route has the advantages of simple operation, high yield, and good safety.

OBJECTIVE: To analyze the current status of diagnosis and management of acute appendicitis (AA) in China. METHODS: Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary. RESULTS: A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001). CONCLUSIONS The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.
Acute Disease ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Appendectomy ; Appendicitis ; diagnosis ; therapy ; China ; Female ; Health Care Surveys ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult