OBJECTIVE To formulate the Expert Consensus on the Implementation and Management of Drug Selection for Centralized Volume-Based Procurement in Medical Institutions of Guangxi （hereinafter referred to as the “ Consensus ”）， and to provide decision-making support and practical guidance for the drug selection and management of centralized volume-based procurement （hereinafter referred to as “centralized procurement”） drugs in medical institutions at all levels in Guangxi. METHODS A systematic review was conducted on the materials from previous batches of centralized procurement implemented in Guangxi. A comprehensive search was carried out for drug-related works and books， along with a systematic collation of guidelines on drug selection， expert consensus on centralized procurement， and policy documents. Through three rounds of specialized seminars， combined with existing evidence-based data and the practical drug selection experiences of medical institutions at various levels， this Consensus was formulated after thorough discussion and successive rounds of revision. RESULTS & CONCLUSIONS The Consensus systematically outlines the three key stages in the implementation of centralized procurement in medical institutions： procurement volume reporting， confirmation of agreed procurement volume， and procurement and usage implementation. It proposes drug selection strategies for centralized procurement bas ed on multiple dimensions， including specifications， dosage forms， packaging materials， fill volume， and manufacturing enterprises. In response to practical challenges encountered in the selection process， corresponding countermeasures are proposed， such as establishing a regularized information reserve mechanism， strengthening information technology support， and implementing categorized selection approaches. The Consensus advocates for medical institutions to construct an integrated “policy， data， and quality” decision-making system to promote full-cycle management of centralized procurement. This Consensus will provide scientific and practical guidance for medical institutions at all levels in Guangxi in the drug selection of centralized procurement， facilitating the smooth implementation and sustainable development of centralized procurement policies at the institutional level.

Objective To investigate the prognostic differences among pure urothelial carcinoma,squamous-differentiated urothelial carcinoma,and pure squamous cell carcinoma,so as to provide reference for postoperative risk stratification.Methods The clinical data of bladder cancer patients who visited the Department of Urology,Peking University First Hospital and underwent radical cystectomy during Jan.2005 and Jun.2024 were retrospectively analyzed.Patients were categorized into the pure urothelial carcinoma group(n=725),squamous-differentiated urothelial carcinoma group(n=189),and pure squamous cell carcinoma group(n=36).General characteristics,surgical approaches,pathological staging,muscle invasion status,and lymph node positivity were compared among the three groups.Kaplan-Meier survival curves were plotted,and prognostic differences among the groups were compared after 1∶1 propensity score matching between each pair.Independent risk factors of prognosis were identified with Cox multivariable regression.Results The pure squamous cell carcinoma group had a higher proportion of female patients(50.00％vs.25.24％vs.22.75％,P=0.002 4).Compared with the pure urothelial carcinoma group,the other two groups demonstrated higher proportions of stage Ⅲ+Ⅳ,higher rates of muscle invasion,and higher lymph node positivity,with the pure squamous cell carcinoma group showing the highest overall staging(69.45％vs.58.20％vs.29.38％,P＜0.000 1).Kaplan-Meier analysis showed that squamous-differentiated urothelial carcinoma group and pure squamous cell carcinoma group had significantly worse survival than the pure urothelial carcinoma group(P＜0.05),while the former two groups exhibited similar outcomes(P=0.85).After propensity score matching,postoperative survival curves among the three groups were not significantly different(all P＞0.05).In multivariable Cox proportional hazards models adjusting for confounders,prognosis was primarily associated with age,muscle invasion,and lymph-node positivity(P＜0.05);pathological subtype was not an independent predictor of postoperative survival.Conclusion In a cohort of non-metastatic patients undergoing radical cystectomy,pure squamous cell carcinoma and squamous-differentiated urothelial carcinoma presented with higher clinical and pathological staging and poorer unadjusted prognosis compared with pure urothelial carcinoma.However,postoperative survival did not differ significantly among the three groups in the same clinicopathological conditions.

Objective To analyze cases of Langerhans cell histiocytosis(LCH)initially presenting with hemophagocytic lymphohistiocytosis(HLH)in order to enhance clinicians'awareness and avoid misdiagnosis or missed diagnosis.Methods Clinical characteristics of two cases of LCH with HLH as the initial symptom cases were retrospectively collected and analyzed.Results Both patients were male and admitted with"fever and bicytopenia".The physical examination revealed scattered rashes and hepatosplenomegaly.Based on the laboratory results,HLH was initially considered in both children.In case 1,the underlying disease was not immediately identified,but a skin biopsy later confirmed LCH.The patient's symptoms improved with LCH-directed therapy;however,a secondary pulmonary infection triggered progressive hemophagocytosis,which was successfully controlled after adding HLH treatment.In Case 2,HLH treatment initially stabilized the fever.After a skin biopsy confirmed LCH,combined LCH therapy was administered,and the symptoms improved.Both patients received regular chemotherapy according to the CCHG-LCH-2019 protocol.During follow-up,Case 1 developed a BRAF gene mutation and was treated with oral trametinib in addition to chemotherapy.As of the latest follow-up,both patients remained in stable condition.Conclusion Children with HLH and accompanied by a rash should actively search for the underlying cause.A skin biopsy should be performed promptly to clarify the diagnosis.Once the diagnosis is confirmed,active treatment is necessary,a single treatment approach should be avoided,and timely assessment of the condition should be conducted to achieve personalized treatment.

Objective To investigate the distribution and antimicrobial resistance profiles of clinically isolated Haemophilus influenzae and Moraxella catarrhalis in hospitals across China from 2015 to 2021,and provide evidence for rational use of antimicrobial agents.Methods Data of H.influenzae and M.catarrhalis strains isolated from 2015 to 2021 in CHINET program were collected for analysis,and antimicrobial susceptibility testing was performed by disc diffusion method or automated systems according to the uniform protocol of CHINET.The results were interpreted according to the CLSI breakpoints in 2022.Beta-lactamases was detected by using nitrocefin disk.Results From 2015 to 2021,a total of 43 642 strains of Haemophilus species were isolated,accounting for 2.91％of the total clinical isolates and 4.07％of Gram-negative bacteria in CHINET program.Among the 40 437 strains of H.influenzae,66.89％were isolated from children and 33.11％were isolated from adults.More than 90％of the H.influenzae strains were isolated from respiratory tract specimens.The prevalence of β-lactamase was 53.79％in H.influenzae strains.The H.influenzae strains isolated from children showed higher resistance rate than the strains isolated from adults.Overall,779 strains of H.influenzae did not produce β-lactamase but were resistant to ampicillin(BLNAR).Beta-lactamase-producing strains showed significantly higher resistance rates to these antimicrobial agents than the β-lactamase-nonproducing strains.Of the 16 191 M.catarrhalis strains,80.06％were isolated from children and 19.94％isolated from adults.M.catarrhalis strains were mostly susceptible to both amoxicillin-clavulanic acid and cefuroxime,evidenced by resistance rate lower than 2.0％.Conclusions The emergence of antibiotic-resistant H.influenzae due to β-lactamase production poses a challenge for clinical anti-infective treatment.Therefore,it is very important to implement antibiotic resistance surveillance for H.influenzae and guide rational antibiotic use.All local clinical microbiology laboratories should actively improve antibiotic susceptibility testing and strengthen antibiotic resistance surveillance for H.influenzae.

Objective To explore the effect and mechanism of Slc1a2 overexpression on cognitive dysfunction in sleep-deprived mice.Methods A total of 130 mice were divided into five groups:normal sleep(NS),NS+ov-Slc1a2,sleep deprivation(SD),SD+ov-NC,and SD+ov-Slc1a2,with 26 mice in each group.The SD mice model was established using an automatic system based on a rotating rod,and overexpress Slc1a2 adenovirus was injected into the prefrontal cortex(PFC).Immunofluorescence and Western blotting were used to detect the expression of Slc1a2 in the mouse PFC.Electrophysiological tests were used to evaluate non-rapid eye movement(NREM)sleep time,rapid eye movement(REM)sleep time,and wakefulness time in mice.Real-time quantitative PCR was used to detect the expression of glutamate(Glu)and gamma-aminobutyric acid(GABA)metabolic enzymes in the mouse PFC.Whole-cell patch-clamp recording was used to detect the frequency and amplitude of miniature excitatory postsynaptic currents(mEPSC)in mouse PFC.Immunofluorescence was used to detect the proportion of GABA-positive cells in the mouse PFC.The C11-BODIPY fluorescent probe was used to detect lipid reac-tive oxygen species(ROS)levels in mouse PFC.Commercial kits were used to detect Fe2+and malondialdehyde(MDA)levels in the mouse PFC.Cognitive function in mice was evaluated using the open field,novel object recognition,and Y-maze tests.Results Compared with the NS group,the NREM sleep time,REM sleep time,central area stay time,recognition index,and novel wall selection index increased significantly,while wakefulness time decreased significantly in the NS+ov-Slc1a2 group(all P＜0.05).The percentage of Slc1a2+GFAP+cells,expression of Slc1a2 protein,expression of Glul,Slc6a1,and Abat mRNA,frequency and amplitude of mEPSC,and proportion of GABA-positive cells in the PFC increased significantly,whereas lipid ROS,Fe2+,and MDA levels decreased significantly(all P＜0.05).Compared with the NS group,the NREM sleep time,REM sleep time,central area stay time,recognition index,and novel wall selection index of the SD group and the SD+ov-NC group were significantly decreased,whereas wakefulness time was significantly increased(all P＜0.05).The percentage of Slc1a2+GFAP+cells,expression of Slc1a2 protein,expression of Glul,Slc6a1,and Abat mRNA,frequency and amplitude of mEPSC,and proportion of GABA-positive cells in the mouse PFC decreased significantly,whereas lipid ROS,Fe2+,and MDA levels increased significantly(all P＜0.05).Compared with the SD and SD+ov-NC groups,the NREM sleep time,REM sleep time,central area stay time,recognition index,and novel wall selection index of the SD+ov-Slc1a2 group increased significantly,whereas the wakeful-ness time decreased significantly(all P＜0.05).The percentage of Slc1a2+GFAP+cells,the expression of Slc1a2 protein,the expression of Glul,Slc6a1,and Abat mRNA,the frequency and amplitude of mEPSC,and the proportion of GABA-positive cells in the mouse PFC increased significantly,whereas lipid ROS,Fe2+,and MDA levels decreased significantly(all P＜0.05).Conclusion Ectopic overexpres-sion of Slc1a2 in the PFC can improve sleep disorders in SD mice,reduce the damage caused by SD to excitatory synaptic transmission and GABAergic neuron function in the PFC,and alleviate cognitive impairment and anxiety-like behavior in these mice.Its mechanism may be related to the improvement of Glu/GABA metabolic imbalance in the PFC and inhibition of ferroptosis.

Objective To measure the three-dimensional(3D)motion of the knee joint in healthy people and patients after total knee arthroplasty(TKA).Methods The coordinate system for the tibia and femur of the knee joint was established,and the marking points were pasted at the bone landmarks.Then the 3D motion of human knee joint was measured by biplane high-speed photogrammetry,and the data were processed according to the coordinate transformation.Results The peak values of adduction and abduction,internal and external rotation,internal and external translation,and proximal and distal movement of the artificial knee joint were larger than those of the healthy knee joint(P<0.05),but there was no statitistic difference in posterior displacement between the artificial and healthy knee joints(P=0.05).Conclusions By measuring the knee joint motion,not only the difference in knee joint motion between the healthy volunteers and TKA patients was revealed,but also the effectiveness of biplane high-speed photography in knee joint kinematic measurement was demonstrated.

Objective To discuss the efficacy and safety of AcoStream mechanical thrombectomy(AMT)system in treating high risk acute pulmonary embolism(APE),and to analyze the risk factors associated with postoperative recurrence of pulmonary embolism(PE).Methods A total of 137 patients with APE,who were admitted to Bingzhou Medical University Hospital Yantai Affiliated hospital from January 2018 to April 2023,were collected.The patients were divided into AMT group(receiving AMT treatment,n=76)and catheter-directed thrombolysis group(CDT group,n=61).The preoperative risk,surgical core indicators,perioperative and follow-up results,and incidence of adverse events were compared between the two groups.One month after treatment,the risk factors for PE recurrence in the AMT group were analyzed.Results Compared with the CDT group,in the AMT group the preoperative risk stratification of pulmonary embolism was higher,the patients were older,the cardiac function grade was higher,the intraoperative used urokinase dose was less,and the postoperative hospital stay was shorter;the differences in the above indexes between the two groups were statistically significant(all P＜0.05).During follow-up period of one month,the difference in the recurrence of pulmonary embolism between the two groups was statistically significant(P=0.026).Logistic regression analysis revealed that pre-operative NT-proBNP was the risk factor for PE recurrence at one month after AMT treatment(OR=1.001,95％CI:1.000-1.001).Conclusion AMT technique carries high efficacy for removing thrombus in different pulmonary artery segments,which is suitable for the treatment of APE.While reducing the bleeding amount,AMT technique will not increase the time spent for operation,besides,it has excellent advantages in improving the right heart function and in ensuring clinical safety.

Objective To investigate the effects of physical activity and disease burden on self-ef-ficacy and quality of life in patients with inflammatory bowel disease(IBD).Methods A total of 312 IBD patients were selected by convenience sampling method.General information of patients was col-lected.Self-efficacy[Chronic Disease Management Self-Efficacy Scale(CDM-SES)],physical activi-ty[International Physical Activity Questionnaire-Short Form(IPAQ-SF)],disease burden[Inflamma-tory Bowel Diseases Disk(IBD-disk)Scale]and quality of life[Inflammatory Bowel Disease Ques-tionnaire(IBDQ)]were assessed in IBD patients.The chain-mediating effects of physical activity and disease burden on self-efficacy and quality of life in IBD patients were analyzed.Results There were statistically significant differences in self-efficacy of IBD patients with different ages,body mass index(BMI),places of residence,marital status,educational background and disease stages(P＜0.05);there were statistically significant differences in physical activity among IBD patients with different gen-der,age,place of residence,marital status,education background,disease stage and whether to use biological agents(P＜0.05);there were statistically significant differences in the disease burden of IBD patients with different BMI,place of residence,marital status,education background,payment method and disease stage(P＜0.05);there were statistically significant differences in the quality of life of IBD patients with different ages,places of residence,marital status,education levels,pay-ment methods,disease stages and whether to use biological agents(P＜0.05).The quality of life of IBD patients was positively correlated with self-efficacy and physical activity(r=0.605,0.482,P＜0.01),and negatively correlated with disease burden and disease stage(r=-0.550,-0.362,P＜0.01).Physical activity and disease burden partially mediated between self-efficacy and quality of life in IBD patients.Conclusion IBD patients exhibited moderate levels of self-effi-cacy,low levels of physical activity,and high disease burdens.Clinical healthcare professionals should actively take measures to improve patients'self-efficacy and physical activity levels to reduce disease burden.

Objective To analyze the effect of Callicarpa nudiflora on wound healing and phos-phatidylinositol-3-kinase/protein kinase B/mammalian target of rapamycin(PI3K/AKT/mTOR)path-way by regulating M2 macrophage polarization in rats with diabetic foot ulcer.Methods A total of 40 rats were selected,with 10 rats in control group(topical application of saline),and the remaining 30 were used to establish rat model of diabetic foot ulcer.Ultimately,27 rats were successfully mod-eled and divided into model group(topical application of saline),Callicarpa nudiflora group(topi-cal application of Callicarpa nudiflora),and Callicarpa nudiflora combined with inhibitor group(topical application of Callicarpa nudiflora combined with CD206 inhibitor,a marker protein of M2 macrophages),with 9 rats in each group.The wound healing rate,levels of basic fibroblast growth factor(bFGF)and vascular endothelial growth factor(VEGF),relative expression levels of induc-ible nitric oxide synthase(iNOS),CD16/32,CD206,PI3K,AKT and mTOR as well as mRNA ex-pression levels of PI3K,AKT and mTOR were compared among groups.Results On the 3rd,7th and 14th days after intervention,compared with the control group,the wound healing rate,VEGF,bFGF,relative expression level of CD206,relative expression of PI3K,AKT and mTOR at mRNA and protein levels were significantly decreased while the relative expression levels of iNOS and CD16/32 were significantly increased in all other groups(P＜0.05);compared with the model group,the Callicarpa nudiflora group and the Callicarpa nudiflora combined with inhibitor group showed significant increased wound healing rate,VEGF,bFGF,relative expression level of CD206,and relative expression of PI3K,AKT and mTOR at mRNA and protein levels,and significant de-creased relative expression levels of iNOS and CD16/32(P＜0.05);compared with the Callicarpa nudiflora group,the Callicarpa nudiflora combined with inhibitor group showed significant decreased wound healing rate,VEGF,bFGF,relative expression level of CD206,and relative expression of PI3K,AKT and mTOR at mRNA and protein levels,and significant increased relative expression levels of iNOS and CD16/32(P＜0.05).Conclusion Callicarpa nudiflora can promote M2 mac-rophage polarization,increase wound healing rate and levels of VEGF and bFGF in rats with diabetic foot ulcer,and activate the PI3K/AKT/mTOR signaling pathway.

ObjectiveTo investigate the influence of entecavir （ETV） versus tenofovir alafenamide fumarate （TAF） on renal function in previously untreated patients with chronic hepatitis B （CHB）. MethodsA retrospective analysis was performed for the clinical data of 167 previously untreated CHB patients who received ETV or TAF treatment for at least 48 weeks at the outpatient service of Department of Infectious Diseases in The First Affiliated Hospital of Nanchang University from September 2019 to November 2023， and according to the antiviral drug used， they were divided into ETV group with 117 patients and TAF group with 50 patients. In order to balance baseline clinical data， propensity score matching （PSM） was used for matching and analysis at a ratio of 2∶1， and the two groups were compared in terms of estimated glomerular filtration rate （eGFR） and the incidence rate of abnormal renal function at week 48. According to eGFR at week 48， the patients were divided into normal renal function group and abnormal renal function group. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The multivariate Logistic regression analysis was used to investigate the influencing factors for abnormal renal function， and the receiver operating characteristic （ROC） curve was used to assess the performance of each indicator in predicting abnormal renal function. The Kaplan-Meier method was used to analyze the cumulative incidence rate of abnormal renal function， and the log-rank test was used for comparison. The analysis of variance with repeated measures was used to compare the dynamic changes of eGFR during antiviral therapy in CHB patients. ResultsAfter PSM matching， there were 100 patients in the ETV group and 50 patients in the TAF group. There were no significant differences in baseline clinical data between the ETV group and the TAF group （all P>0.05）， with an eGFR level of 112.29±9.92 mL/min/1.73 m² in the ETV group and 114.72±12.15 mL/min/1.73 m² in the TAF group. There was a reduction in eGFR from baseline to week 48 in both groups， and compared with the TAF group at week 48， the ETV group had a significantly lower eGFR （106.42±14.12 mL/min/1.73 m² vs 112.25±13.44 mL/min/1.73 m²， t=-2.422， P=0.017） and a significantly higher incidence rate of abnormal renal function （17.00% vs 4.00%， χ²=5.092， P=0.024）. After the patients were divided into normal renal function group with 131 patients and abnormal renal function group with 19 patients， the univariate analysis showed that there were significant differences between the two groups in age （Z=-2.039， P=0.041）， treatment drug （ETV/TAF） （χ²=5.092， P=0.024）， and baseline eGFR level （t=4.023， P<0.001）， and the multivariate Logistic regression analysis showed that baseline eGFR （odds ratio ［OR］=0.896， 95% confidence interval ［CI］： 0.841 — 0.955， P<0.001） and treatment drug （OR=5.589， 95%CI： 1.136 — 27.492， P=0.034） were independent influencing factors for abnormal renal function. Baseline eGFR had an area under the ROC curve of 0.781 in predicting abnormal renal function in CHB patients， with a cut-off value of 105.24 mL/min/1.73 m²， a sensitivity of 73.68%， and a specificity of 82.44%. The Kaplan-Meier curve analysis showed that the patients with baseline eGFR≤105.24 mL/min/1.73 m² had a significantly higher cumulative incidence rate of abnormal renal function than those with baseline eGFR>105.24 mL/min/1.73 m² （χ²=22.330， P<0.001）， and the ETV group had a significantly higher cumulative incidence rate of abnormal renal function than the TAF group （χ²=4.961， P=0.026）. With the initiation of antiviral therapy， both the ETV group and the TAF group had a significant reduction in eGFR （F=5.259， P<0.001）， but the ETV group only had a significant lower level of eGFR than the TAF group at week 48 （t=-2.422， P=0.017）； both the baseline eGFR≤105.24 mL/min/1.73 m² group and the baseline eGFR>105.24 mL/min/1.73 m² group had a significant reduction in eGFR （F=5.712， P<0.001）， and there was a significant difference in eGFR between the two groups at baseline and weeks 12， 24， 36， and 48 （t=-13.927， -9.780， -8.835， -9.489， and -8.953， all P<0.001）. ConclusionFor CHB patients initially treated with ETV or TAF， ETV antiviral therapy has a higher risk of renal injury than TAF therapy at week 48.