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 analyze the institutional and regional differences in influenza vaccination for teachers and students, so as to provide a basis for influenza prevention and control in campus. Methods: Influenza vaccination data for teachers and students in Shandong Province from 2015 to 2024 were collected from Immunization Information Systems. Joinpoint regression models were used to calculate the annual percent change (APC) and average annual percent change (AAPC) in first-dose vaccination rates. Results: The vaccination coverages for the first dose of influenza vaccine among teachers in Shandong Province from 2015 to 2024 were 0.01%, 0.02%, 0.15%, 0.29%, 0.60%, 2.06%, 1.64%, 2.27%, 3.00%, and 2.43%, with a turning point in 2020. For preschools, primary/secondary schools, and higher education institutions, APCs during 2015-2020 were 163.36%, 162.09%, and 174.94%, respectively( P <0.01), declining to 9.53%, 9.92%, and 8.14% during 2020-2024( P >0.05). Corresponding AAPCs were 78.32%, 78.13%, and 81.61%( P <0.01). High, middle, and low GDP regions exhibited APCs of 173.84%, 162.75%, and 136.67% during 2015-2020( P <0.01) and 5.77%, 13.92%, and 11.86% during 2020-2024( P >0.05), with AAPCs of 79.42%, 81.23% , and 69.63%( P <0.01), respectively. Among students, vaccination coverage ranged from 1.59% to 7.20%. Preschool students showed no turning points, with an AAPC of 18.73%( P <0.01). Primary/secondary students had turning points in 2018 and 2022, APCs were -32.59% during 2015-2018( P <0.01), 48.45% during 2018-2022( P <0.01), and -26.25% during 2022-2024( P =0.04), yielding an AAPC of -2.32%( P =0.45). Higher education students had a turning point in 2020, with APCs of 63.27% during 2015-2020( P <0.01) and 4.31% during 2020-2024 ( P =0.77), and the AAPC was 33.79% during 2015-2024 ( P <0.01). High, middle, and low GDP regions for students showed no turning points, with AAPCs of 10.46%( P =0.18), 13.67%( P =0.01), and 10.42%( P = 0.05 ), respectively. Conclusions The influenza vaccination rate among teachers and students in Shandong Province has shown an upward trend from 2015 to 2024, but the overall level is still relatively low. However, continued efforts are needed to enhance health education on influenza and vaccination, to further improve the vaccination rate of teachers and students.

Objective: To investigate the impact of milk and egg supplementation on body composition and bone mineral density of rural primary school students in Yunnan Province, so as to provide a reference for developing targeted nutritional intervention strategies. Methods: In December 2023, a cluster sampling method was adopted to select students from grades one to three in four primary schools each from Jinggu and Shidian countys of Yunnan Province, as the intervention group (662 students). Additionally, two boarding primary schools were selected from each county based on the principle of matching scale and student numbers as the control group (455 students). Starting from April 2023, the intervention group received 200 mL milk and 50 g eggs during the break on school days for 8 months, while the control group maintained their usual diet behavior. Body composition was measured by using bioelectrical impedance analysis, and distal radial bone mineral density was assessed via dual energy X-ray absorptiometry in April and December 2023. The intervention effects were analyzed by using a difference in-differences approach. Results: The final measurements of body fat percentage, skeletal muscle mass and fat free mass of the intervention group and the control group of primary school students were significantly higher than the baseline values, and the net effect of milk and egg intervention on these body composition indicators was not statistically significant ( P >0.05, both before and after adjustment). In contrast, bone mineral density increased significantly by 0.02 g/cm 2 in the intervention group. The net intervention effect on bone mineral density was statistically significant ( β=0.02, 95%CI =0.00-0.04), and remained significant after model adjustment ( β=0.02, 95%CI =0.00-0.04) (both P < 0.05). Subgroup analysis showed statistically significant effects of the intervention among girls ( β=0.02, 95%CI =0.00-0.04), day students ( β=0.04, 95%CI =0.01-0.07), and students with normal nutritional status ( β=0.02, 95%CI =0.00-0.04) (all P <0.05). No significant effect of milk and egg supplementation was observed on body composition indicators (all P <0.05). Conclusions Milk and egg supplementation can improve bone mineral density among rural primary school students in Yunnan Province. It is recommended that rural school aged children should increase intake of milk and eggs to support growth and development.

ObjectiveTo investigate the effects of Jiaohong pills （JHP） and its prescription， Pericarpium Zanthoxyli （PZ） and Rehmanniae Radix （RR） cognitive dysfunction in scopolamine-induced Alzheimer's disease （AD） mice and its mechanism through pharmacodynamic and metabolomics study. MethodThe animal model of AD induced by scopolamine was established and treated with PZ， RG and JHP， respectively. The effects of JHP and its formulations were investigated by open field test， water maze test， object recognition test， avoidance test， cholinergic system and oxidative stress related biochemical test. Untargeted metabolomics analysis of cerebral cortex was performed by ultra-performance liquid chromatography-Quadrupole/Orbitrap high resolution mass spectrometry （UPLC Q-Exactive Orbitrap MS）. ResultThe behavioral data showed that， compared with the model group， the discrimination indexes of the high dose of JHP， PZ and RR groups was significantly increased （P<0.05）. The staging rate of Morris water maze test in the PZ， RR， high and low dose groups of JHP was significantly increased （P<0.05， P<0.01）， the crossing numbers in the PZ， JHP high and low dose groups were significantly increased （P<0.05， P<0.01）； the number of errors in the avoidance test were significantly reduced in the PZ and high-dose JHP groups （P<0.01）， and the error latencies were significantly increased in the JHP and its prescription drug groups （P<0.01）. Compared with the model group， the activities of acetylcholinesterase in the cerebral cortex of the two doses of JHP group and the PZ group were significantly increased （P<0.05， P<0.01）， and the activity of acetylcholinesterase in the high-dose JHP group was significantly decreased （P<0.05）， and the level of acetylcholine was significantly increased （P<0.01）. At the same time， the contents of malondialdehyde in the serum of the two dose groups of JHP decreased significantly （P<0.05， P<0.01）. The results of metabolomics study of cerebral cortex showed that 149 differential metabolites were identified between the JHP group and the model group， which were involved in neurotransmitter metabolism， energy metabolism， oxidative stress and amino acid metabolism. ConclusionJHP and its prescription can antagonize scopolamine-induced cognitive dysfunction， regulate cholinergic system， and reduce oxidative stress damage. The mechanism of its therapeutic effect on AD is related to the regulation of neurotransmitter， energy， amino acid metabolism， and improvement of oxidative stress.

Clinical application of mass spectrometry technology has attracted the attention of clinical laboratory experts due to its high sensitivity, high specificity, and capacities of simultaneous detection of multiple compounds. In recent years, mass spectrometry technology has made significant achievements in the fields of identification of pathogenic microorganism, detection of trace elements and heavy metals, small molecule hormones, vitamins, amino acids, peptides and proteins, as well as therapeutic drug monitoring (TDM) and poisoning drugs screening. In order to further clarify the opportunities and challenges brought by this complex mass spectrometry technology in the field of clinical laboratory, the Chinese Journal of Laboratory Medicine invited experts and scholars of laboratory medicine to share their experience and opinions on related items focusing on the positioning of mass spectrometry technology in the clinical laboratory, the development and improvement of the clinical laboratory by mass spectrometry technology, the challenges of interpreting mass spectrometry test results, the challenges of operating and managing clinical mass spectrometry laboratories, and ways of improving the application of clinical mass spectrometry laboratories with this technology. Agreement was achieved in that the introduction of mass spectrometry technology into the clinical laboratory could bring new directions and opportunities for clinical testing and research, and also is associated with a series of challenges such as the difficulty of sample pretreatment, the high cost and complexity of mass spectrometry technology, the complexity of data processing and interpretation, the lack of standards and norms, and the issue of determining the price of mass spectrometry examinations.

In order to understand the knowledge, attitude and practice (KAP) of vaccination against influenza, pneumonia, human papillomavirus (HPV), herpes zoster (HZ), COVID-19, and hepatitis B among staff of vaccination units in Shandong Province, a sample survey was conducted among 797 staffs of adult vaccination units in 12 counties (cities and districts) of Shandong Province from August to September 2022. The results showed that the respondents had the highest total score of knowledge and attitude for the COVID-19 vaccine, with the M ( Q1, Q3) of 23 (20, 25) and 10 (10, 10), respectively, and had the lowest score of knowledge and attitude for the herpes zoster vaccine, with the M ( Q1, Q3) of 19 (15, 22) and 8 (8, 10), respectively. The vaccine-related knowledge point"vaccine applicable population"had the highest score, with the M (Q1, Q3) of 26 (23, 30). The "contraindications/adverse reactions" and "adverse reaction management" had the lowest score, with the M (Q1, Q3) of 24 (20, 29) and 24 (20, 28), respectively. About 89.71% of respondents received one adult vaccine within two years at least. The principal driver for vaccination of 53.58% of recipients was their understanding of vaccines, which was"it was necessary to receive the vaccine". About 66.00% of respondents who had not received any adult vaccine in the past two years had insufficient awareness of the necessity of vaccination and believed that they were in good health and did not need to receive it. In summary, the staff of adult vaccination units in Shandong Province have a poor understanding of the herpes zoster vaccine in terms of vaccines and a relatively poor understanding of"contraindications/adverse reaction and management"in adult vaccination knowledge points.

Objective:To explore the impact of unidentified injectable fillers on the soft tissue of nasal dorsum and rhinoplasty.Methods:The Plastic Surgery Information System of Xinhua Hospital Affiliated with Dalian University was utilized to conduct an analysis of 62 rhinoplasty patients between 2018 and 2019. Specifically, this included 28 patients with an unidentified history of injectable filler rhinoplasty, encompassing 1 male and 27 females with ages ranging from 19 to 53 years and a mean age of 28.8 years. Additionally, 34 patients underwent primary rhinoplasty, all of whom were female with ages ranging from 19 to 46 years and a mean age of 26.8 years. This study examined the effects of unidentified injectable fillers on the soft tissue of the nasal dorsum by analyzing the excised nasal dorsum under a microscope. Subsequently, statistical methods were performed to assess differences in gender, age, preoperative tip protrusion/nose length, postoperative tip protrusion/nose length, dorsal augmentation modality, and satisfaction, and to investigate the effect of unidentified injectables on the rate of dissatisfaction after rhinoplasty.Results:The histopathological analysis of unidentified injectable fillers removed from the nasal dorsum revealed the presence of mainly gel and granular fillers. The gel fillers, characterized by its pink jelly-like texture, contained unidentified injectable fillers, colorless glue, and were observed to flow out upon cutting. The granular filler, on the other hand, appeared as tough, irregularly shaped tissue similar to caviar. Additionally, evidence of muscle tissue in 5 pathologic sections indicated that the unidentified injectable fillers were injected into or near the dorsal nasal muscles, leading to varying degrees of muscle injuries upon excision. A comparison of 28 rhinoplasty patients with unidentified injectable fillers for nasal dorsal augmentation and 34 patients with primary rhinoplasty showed that 11 females in the former group and 4 females in the latter group were dissatisfied with the results. Statistical analysis demonstrated no significant differences between the two groups in terms of gender ( P=0.452), age ( P=0.219), preoperative tip projection/nasal length ( P=0.681), postoperative tip projection/nasal length ( P=0.105), and nasal dorsum augmentation methods ( P=0.413). However, the initial rhinoplasty group had a lower dissatisfactory rate (4 cases, 11.76%) and the unidentified injectables group had a higher dissatisfactory rate (11 cases, 39.29%), which was statistically significant between the two groups (χ 2=6.341, P=0.012). Conclusions:The presence of unidentified nasal injectable fillers can significantly decrease postoperative satisfactory rates, increase the incidence of dissatisfaction, and have adverse effects on the soft tissues of the nasal dorsum and the overall outcome of the rhinoplasty procedure.

In order to understand the knowledge, attitude and practice (KAP) of vaccination against influenza, pneumonia, human papillomavirus (HPV), herpes zoster (HZ), COVID-19, and hepatitis B among staff of vaccination units in Shandong Province, a sample survey was conducted among 797 staffs of adult vaccination units in 12 counties (cities and districts) of Shandong Province from August to September 2022. The results showed that the respondents had the highest total score of knowledge and attitude for the COVID-19 vaccine, with the M ( Q1, Q3) of 23 (20, 25) and 10 (10, 10), respectively, and had the lowest score of knowledge and attitude for the herpes zoster vaccine, with the M ( Q1, Q3) of 19 (15, 22) and 8 (8, 10), respectively. The vaccine-related knowledge point"vaccine applicable population"had the highest score, with the M (Q1, Q3) of 26 (23, 30). The "contraindications/adverse reactions" and "adverse reaction management" had the lowest score, with the M (Q1, Q3) of 24 (20, 29) and 24 (20, 28), respectively. About 89.71% of respondents received one adult vaccine within two years at least. The principal driver for vaccination of 53.58% of recipients was their understanding of vaccines, which was"it was necessary to receive the vaccine". About 66.00% of respondents who had not received any adult vaccine in the past two years had insufficient awareness of the necessity of vaccination and believed that they were in good health and did not need to receive it. In summary, the staff of adult vaccination units in Shandong Province have a poor understanding of the herpes zoster vaccine in terms of vaccines and a relatively poor understanding of"contraindications/adverse reaction and management"in adult vaccination knowledge points.

OBJECTIVE: To investigate the influence of buried thread nasal augmentation on dorsal soft tissue of nose and revision rhinoplasty. METHODS: A clinical data of 29 patients requesting revision rhinoplasty after buried thread nasal augmentation, who were admitted between July 2017 and July 2019 and met the selection criteria, was retrospectively analyzed. All patients were female with an average age of 26.8 years (range, 18-43 years). The patiens were admitted to the hospital at 3-48 months after buried thread nasal augmentation (median, 15 months). Among them, there were 18 cases of insufficient nasal tip projection, 22 cases of insufficient nasal root projection, 7 cases of threads ectasia, 5 cases of threads exposure, 3 cases of infection, and 10 cases with two or more conditions. There were 9 cases of combined short nose deformity, 1 case of spherical hypertrophy of the nasal tip, 3 cases of deviation of the nasal columella, 3 cases of excessive width of the nasal base, and 1 case of nasal hump. Three infected patients only underwent threads removal and debridement. The rest patients underwent revision rhinoplasty, and the dorsum of the nose was made with polytetrafluoroethylene expansion; the tip of the nose was reshaped by taking autologous rib cartilage and alar cartilage in 16 cases, and by taking autologous septal cartilage and alar cartilage in another 10 cases. The threads and surrounding tissue specimens removed during operation were subjected to histologic observation. Nasal length and nasal tip projection were measured after revision rhinoplasty and the ratio was calculated to evaluate the nasal morphology; patient satisfaction was evaluated using the Likert 5-grade scale. RESULTS: Patients were followed up 12-48 months (mean, 18 months). Inflammation was controlled in 3 patients with infections caused by buried thread nasal augmentation. The remaining 26 patients had satisfactory results immediately after revision rhinoplasty. Before revision rhinoplasty and at 7 days and 6 months after revision rhinoplasty, the nasal length was (4.11±0.34), (4.36±0.25), and (4.33±0.22) cm, respectively; the nasal tip projection was (2.34±0.25), (2.81±0.18), and (2.76±0.15) cm, respectively; and the nasal tip projection/nasal length ratio was 0.57±0.08, 0.65±0.05, and 0.64±0.04, respectively. There were significant differences in the nasal length and the nasal tip projection between time points ( P<0.05). There was a significant difference in the nasal tip projection/nasal length ratio between pre- and post-operation ( P<0.05), but there was no significant difference between 7 days and 6 months after operation ( P>0.05). The Likert score for satisfaction ranged from 1.5 to 5.0 (mean, 4.05). During follow-up period of 26 patients, no nasal prosthesis was exposed, and the shape of the nose was stable, and the nasal skin of 5 patients with exposed threads could be seen with different degrees of scarring; there was no infection, cartilage resorption, and no cartilage deformation, displacement, or exposure. Histological observation showed that absorbable threads were not only absorbed after implantation, but also with the prolongation of time, the inflammatory changes in the surrounding tissues caused by decomposition and absorption of the threads showed a gradual aggravation of the first, the heaviest inflammatory reaction in 6 to 12 months, and then gradually reduce the trend. CONCLUSION After implantation of the absorbable thread into the subcutaneous tissue of the nasal dorsum, the nature of the thread is different from the body's own tissue, which will affect the soft tissue compliance of the nasal dorsum. The degradation and absorption of the thread will stimulate the infiltration of inflammatory cells and the proliferation of fibroblasts in the surrounding tissue and then form scar tissue, which will affect the design and effect of revision rhinoplasty.
Humans ; Female ; Adult ; Male ; Rhinoplasty ; Retrospective Studies ; Reoperation ; Nasal Cartilages ; Nasal Septum ; Cicatrix

Lead poisoning severely threatens human health with its cumulation and durability in the body. The analysis of lead in blood is vital for screening, diagnosis, treatment, and prognostication of lead poisoning and for indirectly monitoring the level of lead in the environment. Although the detection programs are available throughout our country, the accuracy and comparability of the results cannot meet the expectation. A variety of factors can affect the accuracy of blood lead testing. To promote the application of blood lead analysis in clinical trials and reduce the bias of results, a better reference system for blood lead analysis should be established to evaluate the accuracy of traditional methods, promote the standardization of blood lead analysis and achieve accurate blood lead testing.