OBJECTIVE:To study the drug price administration models in some developed countries,so as to provide ref?erence information for establishing drug price administration model in China.METHODS:The comparative method and crite?rion method were adopted to study the published literature.RESULTS&CONCLUSION:Although different countries have carried out different models,they still have similarity in some policies.Therefore,we should pay attention to learn the advan?tages in different drug administration models.

Objective To investigate the early diagnosis and treatment of pneumocystosis after renal transplantation. Methods The clinical data of 6 cases of renal transplant recipients from 2000-2001 who developed pneumocystosis were discussed. Results Six patients were diagnosed as having pneumocystosis and subjected to the treatment of SMZ_ CO (SMZ 60-70 mg/kg daily, TMP 12-14 mg/kg daily) for 3 weeks. Immunosuppressive regimene was regulated. Except one case died due to abandonment of treatment, the remaining 5 cases were cured and had normal renal function. Conclusion The diagnosis of pneumocystosis was established by visualization of pathogen in bronchialveolar lavage (BAL) samples. SMZ_ CO is still the most commonly used drug for pneumocystosis at present and administration for individual is important because of its renal toxicity. The dosage of immunosuppressive agent for each patient with pneumocystosis must be adjusted.

Actinin ; genetics ; Adolescent ; Adult ; Asian Continental Ancestry Group ; genetics ; Athletes ; Athletic Performance ; China ; Ethnic Groups ; genetics ; Female ; Humans ; Male ; Polymorphism, Genetic ; Young Adult

Objective To compare the effect of occupy effects of tumor in situ before surgery(OETS) and after neurosurgery (ANS) on neuroendocrine dysfunction and grading of neuroendocrine function in children with craniopharyngioma. Methods The grading evaluation criteria of neuroendocrine dysfunction in children with craniopharyngioma were drew up according to references and the endocrine feedback principle. Based on these grading evaluation criteria, the clinical date of 227 cases of children with craniopharyngioma who underwent neurosurgical treatment were retrospectively studied. These children were divided into pre-pubertal group (167 cases) and pubertal group (60 cases). The neuroendocrine impairment status before and after the surgery were evaluated separately. Results Among 227 children with craniopharyngioma, after the surgery, the incidence of the hypothalamus-pituitary-thyroid dysfunction increased from 16.74%(38/227) to 67.40%(153/227), the incidence of the hypothalamus-pituitary-adrenal gland dysfunction increased from 14.54%(33/227) to 44.49%(101/227), and the the incidence of pituitary function impairment increased from 17.62%(40/227) to 21.15%(48/227). Meanwhile, the incidence of body temperature dysregulation, sleeping disorder, personality abnormality and cognitive abnormality all increased after the surgery. The scoring and grading on neuroendocrine dysfunction in pre-pubertal group were increased after the surgery (Z=-5.20, P<0.01; Z=-4.94, P<0.01,). The scoring and grading on neuroendocrine dysfunction in pubertal group were increased after the surgery( Z=-4.10, P<0.01;Z=-4.25, P<0.01). Conclusions Both the mass effect of tumor in situ of craniopharyngioma and the neurosurgical treatment can be harmful to the neuroendocrine function. Even though the surgery can remove the mass effect of tumor in situ in the saddle area, it can increase the level of grading of neuroendocrine dysfunction. The status of neuroendocrine dysfunction can be evaluated by the grading evaluation criteria of neuroendocrine dysfunction in children with craniopharyngioma, which then provides an effective evaluation tool for the reconstruction and rehabilitation of neuroendocrine function.

ObjectiveTo investigate the action mechanism of CD20 lymphocyte infiltration in the renal allograft biopsy with chronic allograft nephropathy (CAN).MethodsCAN cases confirmed by renal biopsy within 2 years after renal transplantation served as study subjects. By using immunohistochemistry,the deposition of C4d and the CD20-positive lymphocytes infiltration in the renal grafts were examined.The clinical follow-up data were analyzed.ResultsForty-four cases of CAN were enrolled in the study, including 13 cases (29.5％ ) of CD20-positive lymphocytes infiltration,and 31cases (70.5％ )of CD20-negative lymphocytes infiltration. CD20-positive lymphocytes in biopsy showed nodular and scattered lymphocytes infiltration.There were 5 (26.3％)cases of CAN Ⅰ,4 cases (25.0％) of CAN Ⅱ,and 4 (44.4％) of CAN Ⅲ in CD20-positive group.There was no statistically significant difference between the only CAN group and CAN with AR group in CD20-positive rate.Immunohistochemical staining showed there were 12 cases (27.3％) with C4d linear deposition in peritubular capillary endothelial cells (PTC).C4d positive rate had no significant difference among the CAN classifications. There was no significant relationship between C4d deposition and CD20-positive lymphocytic infiltration.The average serum creatinine in CD20-negtive group and CD20-posigtive group was 140.8 ± 22.0 and 183.5 ± 25.5μmol/L before biopsy,and 165.6 ± 37.6 and 242.2 ± 59.1 μmol/L one year after biopsy.The average serum creatinine level in CD20-positive group was higher than in CD20-negtive group before and after biopsy.ConclusionProgressive chronic humoral immunity is high risk in the process of CAN. The CD20-positive lymphocyte infiltration has no relevance with CAN grade and C4d deposition in PTC,but is associated with circulating antibody PRA and allograft long-term outcome. Pathogenetic mechanism may not contribute to chronic humoral immune,but B cells presenting donor antigens,are recognized and activated by T cells as antigen-presenting cells.

ObjectiveTo compare the clinical effectiveness and adverse effects following low doses versus traditional doses of amphotericin B liposome (L-AmB) in the treatment of patients with invasive pulmonary fungal infections (IPFI) after renal transplantation.MethodsA total of 26 postrenal transplantation patients with IPFI between Jan. 2005 and Mar. 2011in Zhujiang hospital received L-AmB treatment identified low doses group (0.2-0.5 mg·kg-1·d-1,n =19) or traditional doses group (1-5 mg· kg-1,d-1,n =7) were reviewed.ResultsThe treatment duration in low doses group and traditional doses group was 20.3 +12.7 and19.3 ±13.2 days respectively (P＞0.05).The effective rate in low doses group and traditional doses group was 84.2％ and 57.1％ respectively (P＞0.05).The overall dosage was significantly less in the low doses group (414.7 ± 241.7 mg) than in the traditional doses group (1158.8 ± 928.0 mg) (P＜0.05).The incidence of adverse effect was significantly lower in the low doses group than in the traditional doses group (21.1％ vs.85.7％,P＜0.05).ConclusionThe effectiveness of low doses of L-AmB protocol in the treatment of IPFI postrenal transplantation patients was similar to that of traditional doses of L-AmB protocol,but the incidence of adverse effects in low doses of L-AmB protocol was significantly lower.

Objective To investigate the effect of C4d deposition in peritubular capillary (PTC)in chronic allograft nephropathy (CAN) on prognosis and intervention of renal transplantation recipients. Methods All the cases who received the renal graft biopsy due to diagnosis of CAN from January 2000 to August 2008, and had the 2-year follow-up data were included in the study. The clinical data were analyzed according to the C4d deposition in PTC. Results Among 86 cases 39 cases were C4d positive (C4d+ group) and the remaining 47 cases were negative (C4d group). There was no significant difference in sex, age, donor source, transplant times, time after biopsy, the panel reactive antibodies (PRA) level between two groups (P＞0. 05). Before intervention, there was no significant difference in serum creatinine (Scr) and 24 h urinary protein between two groups (P＞0. 05). At the end of 2-year followed-up period, graft loss rate and urinary protein levels in C4d+group were significantly higher than in C4d- group (P＜0. 05). Before intervention, the incidence of blood lipid disorder and hypertension was higher in C4d- group (P ＜ 0. 05 ), but no significant difference was found in uric acid and blood sugar levels (P＞0. 05). At the end of 2-year followed-up period, there was no significant difference in blood glucose, uric acid, blood pressure and lipid profile (eliminating renal lost cases) between two groups (P＞0. 05). Conclusion The patients with CAN and C4d+ means the involvement of chronic humoral rejection and have poor clinical results. Effective intervention against humoral immune response can improve renal allograft survival.

Objective To investigate the expression and significance of platelet membrane glyco- proteins and antiplatelet antibody in patients with anaphylactoid purpura.Methods Forty-five patients with anaphylactoid purpura were divided into three groups according to their clinical manifestations,15 in dermal purpura group,18 in mixed group and 12 in nephritis group.The expression of CD62P,CD63 and CD41 in these 45 patients was detected by flow cytometry.The level of antiplatetlet antibody was analysed by ELISA with monoclonal antibody as the probe.Results The percentage of CD62P,CD63 and the level of an- tiplatelet antibody in patients in acute phase were significantly higher than those in regressive phase and those in normal control.Neither of the expression of CD62P,CD63 and CD41,nor the level of antiplatetlet antibody in nephritis group was significantly different from that in the mixed group.Compared with dermal purpura group,the percentage of CD62P was significantly higher in the nephritis group and mixed group. There was no significant difference in CD41 expression among all groups.Conclusion Abnormal humoral immunity exists in anaphylactoid purpura.The activation of platelet could be closely related to the progress of anaphylactoid purpura.CD62P and CD63 could be considered as an index for monitoring of symptoms, determination of prognosis and predicting the outcome in anaphylactoid purpura.

AIM: To determine the association between subfoveal choroidal thickness before therapy and therapeutic activity in diabetic macular edema.
METHODS: The current study was a retrospective study, which included 32 patients ( 32 eyes ) diagnosed with diabetic retinopathy and macular edema. All the patients were firstly treated with intravitreal injections of ranibizumab. Main outcome measures were included the subfoveal choroidal thickness, central macular thickness and best-corrected visual acuity ( BCVA) at preoperation and postoperative visit at 3mo.
RESULTS: After 3 monthly intravitreal injections of ranibizumab, the BCVA was significantly higher than that before therapy and accompanied with significantly reduced thickness of subfoveal choroid and central fovea of macula. Spearman analysis was revealed that a greater baseline subfoveal choroidal thickness was associated with a better BCVA (rs=0. 544, P=0. 036).
CONCLUSION:In the therapy of intravitreal injections of ranibizumab on diabetic macular edema, there seems to be a better BCVA in the patients with a greater baseline subfoveal choroidal thickness. Therefore, baseline subfoveal choroidal thickness may be a useful predictor for the therapy of diabetic macular edema.

AIM:To assess changes of tear film function in patients after pterygium excision combined with amniotic membrane transplantation.
METHODS:Totally 126 patients with pterygium excision with amniotic membrane transplantation from January 2011 to November 2013 were entered in the study. The tear breakup time ( BUT) , the Schirmer I test ( SⅠt) and tear ferning test ( TFT ) were elevated in the patients before and after pterygium excision combined with amniotic membrane transplantation. The examnation times were 1d before surgey, 1wk, 1, 2mo after surgery. Operation eyes were studied group, while opposite healthy eyes as control group.
RESULTS: Compared with the control group, BUT and TFT were significantly different in the eyes with pterygium (P<0. 05); However, no obvious difference was detected in the results of SⅠt (P>0. 05). The results of BUT and TFT at 1mo after surgery in study group were significantly better than 1wk (P<0. 05), while no significant difference compared with 2mo (P>0. 05); The tear film stability in the study group at 1wk after surgery was still inferior to the control group (P<0. 05) and there was no significant difference at 1, 2mo after surgery (P all>0. 05). SⅠt results did not differ between the different examination times(P>0. 05).
CONCLUSION:Tear film stability was broken in the eyes with pterygium. Pterygium excision combined with amniotic membrane transplantation can obviously restore the tear film function into normal state, and the tear film function could reach steady-state 1mo after surgery.