OBJECTIVE:To improve the proposal put forward by a hospital on the pharmacoeconomic evaluation of community-acquired pneumonia.METHODS:The domestic pharmacoeconomic evaluation papers on the community-acquired pneumonia were evaluated.The problems lie in the proposal put forward by a hospital on the pharmacoeconomic evaluation of community-acquired pneumonia were analyzed and the measures for its improvement were put forward.RESULTS:The proposal had problems in research angle,determination of sample size,cost calculation,determination of quality of life etc.CONCLUSION:Measures for the improvement of the proposal should be put forward from the aspects of model construction,sample size determination,the design of quality of life table and sensitivity analysis.

Objective To evaluate the efficacy and safety of ultrasonography-guided percutaneous nephrolithotomy(PCNL).Methods Between May 2006 and June 2008,110 patients underwent PCNL by a single urological team at our hospital.The clinical data of the patients were retrospectively reviewed.Of the cases,supracostal access(the 11th intercostal space) was made in 62 patients(supracostal group),and subcostal access was obtained in 48 patients(subcostal group).Forty-five patients in the supracostal group(45/62) and 36 of the subcostal group(36/48) received CT three dimensional reconstruction.Results The stone free rate of the supracostal group was 72.6%(45/62),while that of the subcostal group was 60.4%(29/48;?2=1.818,P=0.178).The mean operation time of the supracostal group was(78.6?5.1) min,while that of the subcostal group was(102.4?7.1) min(t=-20.454,P=0.000).There was one patient in each group received blood transfusion.One patient in the supracostal group had pneumothorax and recovered uneventfully by conservative treatments.Conclusion Ultrasonography-guided PCNL via the supracostal approach is effective and safe with short operation time.

Objective To study the effect of circumferential pulmonary vein isolation(CPVI) guided by Carto-Merge and Lasso catheter for the treatment of atrial fibrillation(AF).Methods Fifty-six drug refractory patients(41 male) with paroxysmal AF were enrolled into this study with a mean age of(58.5?12.7) years.Ostia of pulmonary veins(PVs) were identified by Carto-Merge.Then circumferential pulmonary vein isolation was performed.The endpoint of ablation was abolishment or dissociation of the pulmonary vein potentials(PVPs).Results Mean distance between electroanatomic mapping points and MRI surfaces was(1.79?0.33) mm as a whole in this group.Abolishment or dissociation of PVPs was accomplished in 52 patients(92.9%) during the first procedure.After a mean(18.3?5.7) months of follow up,41 patients(73.2%) maintained sinus rhythm.Ten patients received a second ablation procedure,and 8 were free of atrial tachyarrhythmias after a mean(8.2?6.9) months of the second follow up.No PV stenosis was identified after ablation procedure.Conclusion Combination of Lasso catheters with Carto-Merge to guide the CPVI procedure can confirm the isolation of PVs and lower the incidence of PVs stenosis.

Objective To investigate the immunological reaction mechanism of medicated serum in Zibai Gelatin for SiHa cells of the cervical cancer infected by high risk human papilloma virus (HPV). Methods Through immunohistochemical comparison and the cell culture, and after medicated serum was administrated to SiHa cells of cervical cancer for 24 h, 48 h, and 72 h, optical densities of IL-6, IL-10, CD83 and TNF-αin the same time but different concentrations and different times but the same concentration were observed. Relationships of dose-effect and time-effect between expressions of IL-6, IL-10, CD83 and TNF-α and medicine action were analyzed by calculating average optical density. Results With the increase of medicine concentration and administration time of Zibai Gelatin, the expressions of IL-6 and TNF-αgradually decreased, while the expressions of CD83 and IL-10 gradually increased (P<0.05). Conclusion Zibai Gelatin with medicated serum can inhibit local inflammatory reaction by improving local immunologic function of cervix, which is beneficial to reduce cervix high-risk HPV.

Objective To evaluate the effects of calcitonin and 1, 25 vitamin D on the bone loss in experimental periodontitis in rats. Methods A total of 125 male Wistar rats were randomly allocated to five groups according to the treatments during 8 weeks: normal control (group A, n=25), periodontitis(group B, n=25), calcitonin (group C, prepared in sterile saline at 2 mg/L, and 2μg/kg was administered daily, s.c. , n=25), 1,25 vitamin D (group D, prepared in corn oil daily at a concentration of 2 mg/L, and 2μg/kg was administered daily, p.o. , n=25), 1,25 vitamin D plus calcitonin (group E, n=25). The experimental model of periodontitis was induced by ligating floss around mandibular first molars with orthodontic wires in B,C,D and E groups. Five rats from each group were sacrificed, and the specimens were prepared at 2, 4, 6 and 8-week. The probing depth (PD) and alveolar bone level were observed. The serum bone-specific alkaline phosphatase (BALP) and osteocalcin (OC) were measured by enzyme-linked immunosorbent assay (ELISA) at 8-week in each group. Results The values of PD were significantly lower after 4, 6 and 8 weeks in E group than those of B, C and D groups (P＜0.05). The alveolar bone loss was significantly lower after 6 and 8 weeks in group E compared with that of B, C and D groups (P＜0.05). The serum levels of BALP and OC were significantly higher after 8 weeks in E group than those of B, C and D groups (P＜0.05). Conclusion The present study suggests that 1, 25 vitamin D and calcitonin can partially inhibit the alveolar bone loss induced by periodontitis. Especially, the application of both is more effective than either drug treatment alone.

SUMMARY Intravesical bacillus Calmette-Guérin ( BCG) was a common treatment for non-muscle inva-sive urothelial carcinoma of the bladder. The complication of prostatic abscess was rare. We reported a case of tuberculous prostatic abscess after BCG therapy. A 65-year-old man was diagnosed as bladder cancer and accepted transurethral resection of bladder tumor ( TURBT) treatment. He received a 6-week induction course without any infection complication. Following the second BCG maintenance instillation, he complained of fever and dysuria. Transrectal ultrasound ( TRUS) demonstrated a well-defined complex mass in the right lobe of his prostate. The diagnosis of tuberculous prostatic abscess was considered after excluding other bacterial infection. The patient was treated with an anti-tuberculous regimen of isoniazid, rifampicin, and ethambutol. The symptoms were relieved after 4 weeks of anti-tuberculous therapy. Be-cause of the good response to the medicine, no further aspiration or drainage of prostatic abscess was car-ried out. The anti-tuberculous therapy had to be stopped for serious drug induced liver injury after 6 weeks of anti-tuberculous therapy. Eight weeks later of stopping anti-tuberculous therapy, the follow-up TRUS showed the disappearance of the prostatic abscess and the test of his liver function was normal. Considering the virulence of BCG is weaker than that of common tuberclebacillus, the shorter course of anti-tuberculous therapy maybe an alternative choice, and surgical drainage is not always necessary.

Objective To investigate the effective endodontic irrigation protocols on smear layer removal from curved canals. Methods Forty extracted mandibular first molars with curved mesial root canal were selected and decoronat-ed. Mesiobuccal root canal was instrumented to F3 using handed ProTaper system, and randomly divided into four groups ac-cording to final irrigation protocols: syringe irrigation (group A), #30K file agitation (group B), passive ultrasonic irrigation (PUI, group C) and combination of #30K file agitation and PUI (group D). The ultrasonic file was located within 0.5 mm coro-nal from start of the curvature. All root canals were mesio-distally split, snicked at the start of the curvature and 2 mm apical-ly from the start of the curvature, and divided into three sections. They wereⅠ,ⅡandⅢfrom coronal to apical. The smear layer of each section of root canal was examined under scanning electron microscope (SEM). Results Group D presented small amounts of scattered or thin smear layers and obtained the lowest score at each section of root canal wall. At sectionⅠandⅡ, there was no significant difference in smear layer score between group D and group C. The smear layer scores were both significantly lower in group D and group C than those of group A and group B (P<0.05). At sectionⅢ, the smear layer score was significantly lower in group D than that of group A, group B and group C, and which was significantly lower in group B and group C than that of group A (P<0.05). Conclusion When ultrasonic file was located coronal from the start of the curvature, K file, which was the same size as dimension of apical portion preparation to agitate and PUI can remove smear layer from curved canals efficiently.

Objective: To investigate the position and the size of ureteral stone in patients before treated with ureteroscopic lithotripsy or percutaneous nephrolithotomy (PCNL), as well as the dilatation of ureter caused by stone, which may be helpful for better understanding of pathogenesis of ureteral stone and improvement of the diagnosis and treatment in clinic.Methods: A total of 129 cases with ureteral stone for endourologic lithotripsy in Peking University People''s Hospital from Aug.2016 to Mar.2017 were included for the retrospective review.The CT data of the ureteral stones and the ureteral dilatation were collected, including the position of stone, the transverse and longitudinal diameter of stone, and the transverse diameter of dilated upper ureter and ureteropelvic junction (UPJ).The distribution of ureteral stones and dilatation in different parts of ureter were compared and analyzed.Results: All of the 129 cases of ureteral stone, stones were located at UPJ in 9 cases (7.0%), proximal ureter in 75 (58.0%), ureter crossing external iliac vessel (UEIV) in 6 (4.7%), distal ureter in 26 (20.2%), and ure-terovesical junction (UVJ) in 13 (10.1%).The mean transverse diameter of proximal ureteral stones was greater than that of distal ureteral stones [(8.47±2.36) mm vs.(6.74±1.99) mm, P<0.001], as the same as the mean longitudinal diameter [(11.00±4.41) mm vs.(7.50±4.28) mm, P<0.001].In 114 cases of dilated ureter for stone, the UPJ had a greater transverse diameter compared with the upper ureter [(14.39±6.09) mm vs.(11.45±3.85) mm, P<0.001].Conclusion: The most common location of stone is the proximal ureter in patients for endourologic lithotripsy, as the location in UEIV is rare.Both transverse and longitudinal diameters of stone in proximal ureter are greater than those in distal ureter.For dilated ureter, it is more severe in UPJ than in upper ureter.Traditionally, it is accepted that the stones lodge at 3 sites of natural narrowing in ureter, which may be questioned.

Objective To study whether abnormalities can be detected by MR diffusion tensor imaging (DTI) technology in radiologically isolated syndrome (RIS) patients with normal-appearing white matter (NAWM).Methods Twenty-seven patients who met diagnostic criteria for RIS were collected.Sixteen age-and sex-matched healthy controls with normal neurologic examination findings and no history of neurologic or psychopathic disorders were included.All subjects were examined by both conventional scan and DTI scan on GE Signa 3.0 T MRI.All the images were transmitted to the Advantage Workstation 4.2P and postprocessed using functool software.Anisotropic maps and average diffusion coefficient (ADC) maps were reconstructed.Two ROIs were selected in the genu and splenium of the corpus callosum separately at the trigone of lateral ventricle level.Other 2 ROIs were selected in the anterior and posterior body of the corpus callosum separately at the level of the lateral ventricle body,and 1 ROI was selected in the white matter of bilateral frontal and occipital lobe separately,then the FA and MD values were measured.The diffusion indices (FA and MD)were analysed by SPSS 13.0.Independent-sample t test was performed to examine the group differences in each subregion.Intraclass correlation coefficient analysis was performed to assess the diffusion indices of two measurements in each subregion.Results The ICC of 2 measurements was 0.934-0.989 (P ＜ 0.01),which showed favorable consistency.The FA values were decreased obviously in the genu,anterior and posterior body of the corpus callosum of the RIS patients compared with controls (0.705 ±0.040 vs 0.738 ±0.045,0.632 ±0.043 vs 0.675 ±0.042,0.628 ±0.043 vs 0.666 ± 0.045,t =-3.526,-4.487,-3.890,P ＜0.01),but the FA values of the two groups did not show any significant difference in the splenium,the white matter of the frontal and occipital lobe respectively (t =-1.387,-0.683,-1.243,P ＞0.05).In comparison with controls,the RIS patients had increased MD values in the genu,anterior and posterior body of the corpus callosum.(0.891 ±0.038 vs 0.874 ±0.035,0.839 ± 0.047 vs 0.794 ± 0.031,0.833 ± 0.039 vs 0.792 ± 0.057,t =2.101,5.836,5.146,P ＜ 0.05),but the MD values of the two groups did not show any significant difference in the splenium,the white matter of the frontal and occipital lobe respectively (t =1.671,1.702,1.624,P ＞ 0.05).Conclusion The NAWM abnormalities in the patients with radiologically isolated syndrome could be detected by DTI.

Objectives To investigate the pathogenic mechanism of herpes simplex encephalitis (HSE) and the mecha-nism of action of dexamethasone and acyclovir. Methods 102 male mice were randomly assigned to normal control group, HSV-1 infection group, acyclovir-treated group and combination-treated group. The model of HSE was established by in-tracranial injection of HSV-1 in mice except normal controls. One day after intracranial injection, mice in acyclovir-treated group and combination-treated group were intragastrically administrated with acyclovir, and mice in normal control group and HSV-1 infection group were intragastrically administrated with normal saline. Three days after intracranial injection, mice in combination-treated group were intraperitoneally injected with dexamethasone and mice in other groups were in-traperitoneally injected with normal saline. The neurological injury score and the expressions of IL-2 and IL-10 of the mice brain tissues in each group were compared at 3, 6 and 9 days after model establishment. Results The survival rate of mice was lowest in HSV-1 infection group and highest in combination-treated group (P<0.05). The neurological injury scores at 3, 6 and 9 days were highest in HSV-1 infection group and lowest in the combination-treated group (P<0.05). The changes in brain tissue pathology and HE staining were closely corresponded to the neurological injury scores. At 3, 6 and 9 days, the expression of IL-2 was increased at first and then decreased, but the expression of IL-10 was gradually increased. The expressions of IL-2 and IL-10 were highest in HSV-1 infection group and lowest in combination-treated group. And differ-ences were significant among all groups at each time point (P<0.05) except between combination-treated group and normal control group (P>0.05). Conclusions In comparison with acyclovir monotherapy, combined treatment with dexamethasone and acyclovir for HSE can reduce the expression of IL-2 and IL-10, relieve the clinical symptoms, and increase the survival rate.