OBJECTIVE To provide reference for medical institutions to establish the record management mode and review rules of off-label use of 5-aminolevulinic acid （ALA） in photodynamic therapy based on the level of evidence. METHODS All ALA-containing outpatient prescriptions in the rational drug use system in our hospital from January 1， 2024 to December 31， 2025 were retrospectively collected. Based on the drug instructions， the current status of off-label use of ALA in photodynamic therapy was identified . The relevant studies in Micromedex， PubMed， CNKI， Wanfang Data and other databases were systematically searched as the relevant evidence-based evidence of ALA off-label use. According to the Off-label Drug Use Filing Standard of the hospital，the evidence-based evaluation method was used to evaluate the evidence-based evidence of ALA off-label use and carry out hierarchical management. RESULTS A total of 1 803 effective prescriptions were included， of which 676 （37.49%） were off-label use， distributed in the dermatology department （564 prescriptions，83.43%） and the plastic surgery department （112 prescriptions，16.57%）. All 676 prescriptions were off-indications medication， involving ten types of skin diseases， primarily including moderate to severe acne （39.94%）， skin warts （25.44%）， Bowen’s disease （11.98%）， and others. According to evidence-based evidence，off-label uses such as moderate to severe acne， actinic keratosis， and Bowen’s disease were managed according to the evidence categoryⅠ orⅡ.The uses of extramammary Paget’s disease and rosacea were managed according to the evidence category Ⅲ.The uses of lichen sclerosus and keloids were managed according to the evidence category Ⅳ.The results of evidence-based evaluation showed that 92.01% of off-label use in our hospital had high-level evidence-based support （ evidence category was gradeⅠ-Ⅱ）. CONCLUSIONS Off-label uses supported by high-level evidence， such as moderate to severe acne， skin warts， and Bowen’s disease， can be managed under filing category Ⅰ or Ⅱ. For the use of lichen sclerosus and keloids， evidence-based evidence is insufficient and should be strictly restricted.The vast majority of ALA off-label use in our hospital has sufficient evidence-based basis.

ObjectiveTo investigate the effects of berberine hydrochloride on the expression of urease genes ureA and ureB in Helicobacter pylori （H. pylori） and its biofilm. MethodsThe standard strain 26695 of H. pylori， which was preserved in our laboratory， along with the drug-resistant strains H390， e660， H57， and H389 of H. pylori that were isolated from clinical sources were revived. The minimum inhibitory concentration （MIC） of berberine hydrochloride against the planktonic cells of the aforementioned five strains of H. pylori was determined using the broth dilution method. The combined inhibitory effect of berberine hydrochloride and amoxicillin against the aforementioned four strains of clinically resistant H. pylori was assessed using the checkerboard method. TheMIC of berberine hydrochloride against the biofilms of H. pylori strains 26695 and H390 was determined using the broth dilution method. Planktonic cells and biofilms of the aforementioned H. pylori strains 26695 and H390 were co-incubated with berberine hydrochloride at concentrations of 0.5MIC， MIC， and 2MIC for 2， 8， and 24 hours， respectively. Subsequently， urease activity was measured， and the expression levels of the ureA and ureB genes were detected using RT-qPCR. ResultsBerberine hydrochloride exhibited inhibitory effects against both planktonic cells of the antibiotic-sensitive strain 26695 and the antibiotic-resistant strains H390， e660， H57， and H389 of H. pylori. It also demonstrated inhibitory effects against the biofilms formed by strains 26695 and H390. Furthermore， the combined inhibitory effect of berberine hydrochloride and amoxicillin against antibiotic-resistant strains of H. pylori was either synergistic or additive. Berberine hydrochloride inhibited urease activity in both planktonic cells and biofilms of the H. pylori strains 26695 and H390. Furthermore， berberine hydrochloride downregulated the relative expression levels of the ureA and ureB genes in H. pylori and its biofilms. The relative expression levels of the ureA and ureB genes exhibited a dose- and time-dependent decrease with increasing concentrations of berberine hydrochloride and longer co-incubation times （P<0.05）. ConclusionBerberine hydrochloride inhibits both planktonic cells and biofilms of H. pylori. When combined with amoxicillin， it exerts additive or synergistic effects against H. pylori. Furthermore， by inhibiting urease activity and downregulating the expression of the ureA and ureB genes in H. pylori， berberine hydrochloride contributes to the reduction in growth of both planktonic cells and biofilms.

To investigate the clinical features and peripheral blood immune cell subsets ofelderly (≥60 years old) onset rheumatoid arthritis (EORA) patients.

[Objective] To conduct a retrospective statistical comparison of alanine aminotransferase (ALT) test values in blood donors prior to blood collection, aiming to analyze the objective characteristics of the population with elevated ALT levels (ALT>50 U/L) and provide reference data for adjusting the screening eligibility threshold for ALT. [Methods] The preliminary ALT screening data of 30 341 blood donor samples collected prior to blood donation from three smart blood donation sites at the Shenzhen Blood Center between 2022 and 2023 were extracted and compared with data from a health examination department of a tertiary hospital in Shenzhen (representing the general population, n=24 906). Both datasets were categorized and statistically described. A retrospective analysis was conducted to examine the associations between ALT test results and factors such as donors' gender, age, ethnicity, donation site, donation season, and frequency of blood donation. [Results] The ALT levels in both blood donors and the general population were non-normally distributed. The 95th percentile of ALT values was calculated as 61.4 U/L (male: 67.8 U/L, female: 39.3 U/L) for blood donors and 58.1 U/L (male: 63.7 U/L, female: 51.2 U/L) for the general population. The non-compliance rates (ALT>50 U/L) were 7.65% (2 321/30 341) in blood donors and 7.08% (1 763/24 906) in the general population. There were significant differences (P<0.05) in the ALT failure rate among blood donors based on gender, age, and donation site, but no significant differences (P>0.05) during the blood donation season. There was no statistically significant difference (P>0.05) in the positive rates of four serological markers (HBsAg, anti HCV, HIV Ag/Ab, anti TP) for blood screening pathogens between ALT unqualified and qualified individuals (2.05% vs 1.5%). If the ALT qualification threshold was raised from 50 U/L to 90 U/L, the non qualification rates of male and female blood donors would decrease from 9.82% (2 074/21 125) to 2.23% (471/21 125) and from 2.70% (249/9 216) to 0.75% (69/9 216), respectively. Among the 154 blood donors who donated blood more than 3 times, 88.31% of the 248 ALT test results were in the range of 50-90 U/L. Among them, 9 cases had ALT>130 U/L, and ALT was converted to qualified in subsequent blood donations. [Conclusion] There are differences in the ALT failure rate among blood donors of different genders and ages, and different blood donation sites and operators can also affect the ALT detection values of blood donors. The vast majority of blood donors with ALT failure are caused by transient and non pathological factors. With the widespread use of blood virus nucleic acid testing, appropriately increasing the ALT qualification threshold for blood donors can expand the qualified population and alleviate the shortage of blood sources, and the risk of blood safety will not increase.

OBJECTIVE To explore a new model of intelligent medication education for pharmaceutical outpatient clinics by constructing dynamic HTML web pages through the DeepSeek-V3-0324 large-scale model. METHODS Clinical pharmacists integrated key clinical information such as patients’ basic information， medication history and medication precautions in real time， and generated a standardized medication education list through the DeepSeek-V3-0324 large-scale model and manual review. RESULTS The DeepSeek-V3-0324 large-scale model was applied in the pharmaceutical outpatient clinics to generate a personalized medication education list， which could effectively solve the disunity of pharmacy guidance caused by the lack of standardization of medication education and the difference of individualized experience of pharmacists in the traditional pharmaceutical outpatient clinics in the face of complex cases， and medication errors caused by forgetting or misremembering information among certain special patient populations after receiving medication education. CONCLUSIONS The transformation and application of artificial intelligence technology in pharmaceutical outpatient clinics is an innovation of pharmaceutical outpatient service means， which can provide patients with immediate and personalized medication education and improve the quality of pharmaceutical care. However， it is also necessary to face the lag of database update and the lack of risk management， as well as the lack of diversification of medication education lists.

Objective:To establish the method sterility test for moxifloxacin hydrochloride eye drops.Methods:According to the requirements of Chinese Pharmacopoeia(2020 edition,volume Ⅳ),method suitability test of sterility test for moxifloxacin hydrochloride eye drops that treated with using different flushing fluid and adding neutralizer was performed for membrane-filter procedure.Results:The method was accepted with adding 5 mL 2 mol·L-1 magnesium sulfate solution into the culture media as neutralizer and flushing with 300 mL buff-ered sodium Chloride-Peptone Solution pH 7.0.The test groups grew synchronously with the positive strains while the negative control had no strain growth.Conclusion:The established method is effective and feasible and can be used for the sterility test of moxifloxacin hydrochloride eye drops.

Objective To evaluate the application value of stereotactic robotic surgery driven by a multi scenario AI system in the elderly with severe hypoperfusion in the internal capsule area and minor HTH.Methods A retrospective analysis was conducted on 101 minor HTH patients com-plicated with severe hypoperfusion in the internal capsule area identified by an AI diagnostic sys-tem in our department from January to October 2024.Among them,48 cases who underwent ster-eotactic robotic drainage with AI system support were assigned into the study group,and 53 cases of conventional drug treatment were into the control group.The general clinical data were com-pared between the two group.Improvement rate of rCBF 14 d after treatment,effective rate 90 d after treatment,favorable prognosis rate,and incidence of shunt dependent hydrocephalus were compared between the two groups to evaluate the application value of AI-assisted stereotactic ro-botic surgery in these patients.Results The study group had significantly higher improvement rate of rCBF 14 d after treatment,better effective rate and larger ratio of favorable prognosis 90 d after treatment when compared with the control group(60.4％vs 39.6％,P＜0.05;62.5％vs 41.5％,P＜0.05;64.6％vs 43.4％,P＜0.05).Conclusion Stereotactic robotic assisted drainage driven by multi scenario AI system can significantly improve the prognosis of the elderly minor HTH patients complicated with severe hypoperfusion in the internal capsule area.

Head and neck squamous cell carcinoma(HNSCC)is the most common type of head and neck cancer,and its treatment prognosis remains suboptimal.Although the survival of HNSCC patients has improved with the widespread use of anti-epidermal growth factor receptor(EGFR)monoclonal antibodies and immune checkpoint inhibitors(ICIs),there is still significant room for further improvement.Recent studies have suggested that the combination of anti-EGFR monoclonal antibodies and ICIs offers promising efficacy and safety,earning recommendations from authoritative guidelines such as the National Comprehensive Cancer Network(NCCN)and the Chinese Society of Clinical Oncology(CSCO).However,the application of this combination therapy is still in the early exploratory stage,numerous questions regarding the standardized clinical use of this combination therapy remain unanswered,including the mechanisms of synergy associated with the combination treatment,its therapeutic value in different patient populations,and safety considerations.Committee of Head and Neck Cancer,Chinese Society of Clinical Oncology organized an expert panel to develop"Expert consensus on the combination of anti-EGFR monoclonal antibodies and immune checkpoint inhibitors in the treatment of head and neck squamous cell carcinoma(2025 edition)",based on evidence-based medicine and clinical practice exploration through multiple rounds of discussions.This consensus addressed the mechanisms of the combination of anti-EGFR monoclonal antibodies and ICIs,stratified treatment approaches,applications in special populations,and safety considerations.The consensus has been registered on Practice guideline REgistration for transPAREncy(PREPARE)with the registration number PREPARE-2025CN666.It is hoped that this consensus will provide clearer and more practical guidance for clinicians,further promoting the rational application of this combination therapy in clinical practice and offering more treatment options for HNSCC patients.

Objective:To investigate the current status and challenges of pediatric life support training in China and provide references for improving training quality.Methods:A cross-sectional study was conducted to collect data from pediatric life support training centers across the country，covering basic institutional information，training capacity and training faculty，training program funding，as well as existing challenges and issues.The domestic registry of training centers in 2023 was obtained through the American Heart Association's online platform.After contacting and verifying each center，an online questionnaire was distributed，and the aggregated data were statistically analyzed.Results:A total of 42 institutions participated in the survey，including 19 children's hospitals，14 general hospitals，6 maternal and child health hospitals，2 women and children’s hospitals，and 1 training institution.The distribution of training centers showed a concentration in coastal areas，with the top three provinces/municipalities being Guangdong（7/42，16.7%），Zhejiang（6/42，14.3%），and Shanghai（4/42，9.5%）.As of December 31 2023，the 42 institutions had an annual basic life support（BLS）training volume of 8 587 individuals，the median was 120 (100,200)，and an annual pediatric advanced life support（PALS）training volume of 2 448 individuals，the median was 30 (20,50).Among the 42 institutions，there were 598 BLS instructors and 306 PALS instructors.Among the surveyed institutions，24（24/42，57.1%）reported BLS instructor teams comprising fewer than 10 members，and 33（33/42，78.6%）reported PALS instructor teams comprising fewer than 10.Only 7 centers(7/42,16.7%）reported having dedicated funding support.The top three challenges were：training sessions occupying instructors’personal time（27/42，64.3%），low instructor compensation（16/42，38.1%），and issues with the data submission system（16/42，38.1%）.Conclusion:Pediatric life support training centers in China are primarily children’s hospitals，with a geographical concentration in coastal areas，which is also reflected in the distribution of training scale and instructor resources.Most centers have relatively small training scales and limited instructor capacity，with many instructors conducting training during their personal time.These issues may hinder the implementation and effectiveness of training programs.

Objective:To explore the promotion effect on remineralization of demineralized dentin of urushiol primer applicated in acid-etch-rinse adhesives,and to clarify its impact on the longevity of dentin adhesion.Methods:Ninety-six freshly extracted,caries-free third molars were selected to prepare the dentin specimens.Following acid etching with 37％phosphoric acid gel,the specimens were randomly divided into blank control group,0.3％,0.7％,1.0％,and 1.5％urushiol groups,and positive control group(acetone solvent).The treated samples were placed in modified simulated body fluids for remineralization for 14 and 28 d.Attenuated total reflection Fourier transform infrared spectroscopy(ATR-FTIR)was used to detect the relative mineralization mass of minerals in the dentinal tubules in various groups,and X-ray Diffractometery and Energy Dispersive spectrometer were used to analyze the dentin surface material compositions in various groups.Scanning electron microscope(SEM)was used to observe the surface morphology of the specimens in various groups,Vickers hardness tester was used to measure the microhardness of the dentin surface in various groups,and microtensile strength(μTBS)was used to examine the effect of the bond strengthes in various groups.Results:Compared with blank control group,the conversion rate of adhesive double bonds by primer in positive control group was decreased,but the difference was not significant(P＞0.05);but the conversion rates of adhesive double bonds by primer in 0.3％,0.7％,1.0％,and 1.5％urushiol groups were increased(P＜0.05).The SEM results revealed that at 14 and 28 d,compared with bland control group,a minimal membranous deposit in dentinal tubules was seen in positive control group,minimal mineralization displayed in 0.3％urushiol group,significant deposition of loose mineral particles with blocking the tubule orifices was found in 0.7％urushiol group,noticeable mineral precipitates exhibited in 1.0％urushiol group,and relatively empty dentinal tubules were seen in 1.5％urushiol group.The microhardness results showed that at 14 d after remineralization,compared with blank control group,the microhardness in positive control group showed no significant improvement(P＞0.05),while the differences in 0.3％,0.7％,1.0％and 1.5％urushiol groups were statistically significant(P＜0.05);at 14 d after remineralization compared with positive control group,the microhardness of dertin in 0.7％and 1.0％urushiol groups were increased(P＜0.05);at 28 d after remineralization,compared with blank control and postive control groups,the microhardness in urushiol groups were significantly increased(P＜0.05),espectially in 0.7％to 1.5％urushiol groups(P＜0.05).In the μTBS test,at 14 d after remineralization,compared with postive control group,theμTBS in 0.3％,0.7％,1.0％and 1.5％urushiol groups were increased(P＜0.05);at 28 d after remineralization,the μTBS in blank control group was the lowest;compared with blank control group,there was no significant difference in the μTBS in postive control group(P＞0.05);compared with positive control group,the μTBS in 0.3％,0.7％,1.0％,and 1.5％urushiol groups were increased(P＜0.05),espectially in 0.7％,1.0,and 1.5％urushiol groups(P＜0.05).Conclusion:Natural-derived urushiol,as a novel primer,can pretreat the demineralized dentin substrates,and facilitate collagen cross-linking within the dentin matrix;moreover,it leverages the phenolic hydroxyl groups within its structure to attact calcium and phosphate ions,envelope dentin collagen fibers to promote remineralization,in order to enhance the strength of the resin-dentin bonding interface.