Objective To compare the efficacy of percutaneous compression plate (PCCP) and dynamic hip screw (DHS) on intertrochanteric fractures in elderly patients. Methods A literature search was performed in the Cochrane Li-brary, Mdiline, EMbase, CNKI, Wanfang database and other databases. The controlled clinical trials were retrieved, which in-cluded PCCP and DHS treatment for intertrochanteric fractures in elderly patients. A meta-analysis was performed to ana-lyze the efficacy of PCCP and DHS on this kind of fractures in elderly patients. Results In 231 citations initially identified, 11 eligible papers were included in this study, which consisted of a total of 1 100 patients. Results showed that there were shorter operative time (WMD=-12.83,Z=2.54,P=0.01), smaller incision(WMD=-7.43,Z=3.35,P＜0.001), low blood loss during surgery(WMD =-211.41,Z=9.07,P＜ 0.001) and better prognosis in PCCP group than those of DHS group. There was no significant difference in the length of postoperative hospital stay between PCCP and DHS group(WMD=-1.28, Z=0.89, P=0.37). Conclusion The current analysis suggests that the PCCP is better for intertrochanteric fractures in elderly patients.

The aim of this study was to synthesize 1-(5-(hydroxymethyl)-4-methyl-3-oxo-3,4-dihydro-pyrazin-2-yl) guanidine (mucunaguanide),a pyrazinone alkaloid compound extracted from the seed of Stizotobium cochinchinensis.Starting from benzyloxy acetaldehyde,following four steps in reaction including condensation,cyclization,substitution and hydrogenation reaction,mucunaguanide was synthesized with total yield of 27.9％,and purity of more than 97.5％.Structures of all the intermediates and target compound were confirmed by IR,1H NMR and MS.This synthetic process was characterized with raw materials available,simple in operation with much milder reaction conditions,and was an ideal method of synthesis of this compound.

Adenocarcinoma ; metabolism ; pathology ; Adenocarcinoma, Clear Cell ; metabolism ; pathology ; Adult ; Carcinoma, Endometrioid ; metabolism ; pathology ; Cervix Uteri ; metabolism ; pathology ; surgery ; Cyclin-Dependent Kinase Inhibitor p16 ; metabolism ; Diagnosis, Differential ; Electrosurgery ; Endometrial Neoplasms ; metabolism ; pathology ; Female ; Humans ; Hyperplasia ; Keratin-7 ; metabolism ; Mesonephros ; metabolism ; pathology ; surgery ; Neprilysin ; metabolism ; Uterine Cervical Neoplasms ; metabolism ; pathology

OBJECTIVE：To investigate the role of clinical pharmacists on the individualized treatment of children with subglottic Talaromyces marneffei infection. METHODS ：The clinical pharmacists participated in the medication procedure for a case of subglottic T. marneffei infection child . The clinical pharmacists suggested that Budesonide suspension for inhalation should be stopped，according to the subglottic infection pathogen type （T. marneffei ）；Itraconazole oral solution should be chosen and taken orally 2.5 mg/kg，q12 h，and indicators as liver function ，blood potassium should be monitored regularly. However ，as Itraconazole oral solution needed to be applied for temporary purchase ，Itraconazole capsules 2.5 mg/kg，q12 h，p.o.，was administrated temporarily ；clinical pharmacists suggested that Itraconazole capsules should be taken after meal ，and the doctor changed the feeding mode of milk from q 4 h to continuous pumping. After purchased ，Itraconazole oral solution was used instead 2.5 mg/kg，q12 h in fasting state ，and according the clinical pharmacist ’s suggestion ，the doctor changed the nursing method to q 4 h milk pumping. After purchasing and using oral solution instead ，clinical pharmacists suggested taking it at fasting state ；according to the monitoring results and target range （0.5-1 mg/L），oral dose of Itraconazole oral solution was finally adjusted to 8.3 mg/kg， q12 h. In view of the diarrhea during the treatment ，clinical pharmacists suggested to continue the original treatment after considering the effectiveness and importance of the treatment ；at the same time ，discharge medication education should be carried out. RESULTS ： The doctors adopted the suggestions of the clinical pharmacists. The child got a clinical improvement and was discharged after 48 days. CONCLUSIONS ：Clinical pharmacists participate in the treatment of children with T. marneffei infection，timely assist physicians to adjust and improve the medication regimen ，which improve the efficacy and safety of medication for children.

Immune escape is one of the ten hallmarks of tumors， which plays an important role in the occurrence and development of tumors. Immune escape refers to a process where tumor cells remodel and edit the immune system through the model of immune clearance， immune balance， and immune escape to "transform" the immune cells into immunosuppressive cells in the tumor microenvironment， so as to support immune escape. The five-stage evolution is the summary of tumor pathogenesis by professor LI Jie. He believes that the gradual development of tumors follows the core pathogenesis of "deficiency-cold-toxin-obstruction-collapse"， in which "depression" runs through the whole process， and cancer toxin is the key. Based on immune editing， this paper combined phenotypic characteristics of tumor cells with the core pathogenesis of the five-stage evolution of professor LI to reveal the biological basis of malignant tumor five-stage evolution. The results indicate that the prominent change from deficiency to cold is the reduction of immune surveillance and the prominent change from toxin to obstruction is immune escape. The final stage of collapse is the outcome of immune failure. Depression is the booster of tumor immune editing. Therefore， the method of reinforcing the healthy Qi and removing toxins was proposed to regulate the immune editing and cut off the five-stage evolution of tumors. Supplementing Qi and warming Yang can reinforce the healthy Qi and restore immune surveillance. Removing toxins and dredging can reverse toxins and immune escape. The harmonizing method can maintain the dynamic balance of immune cells/immunosuppressive cells. Resolving depression can truncate tumor immune editing. Those methods can provide a certain reference for the treatment based on microscopic syndrome differentiation in traditional Chinese medicine （TCM）. In future studies， it is necessary to further explore the specific mechanism of the regulation of immune editing with the methods of supplementing Qi and warming Yang， removing toxins and dredging， their combination， and resolving depression， so as to find out specific Chinese medicines and targets and provide more sufficient evidence for the regulation of tumor immune editing by TCM.