OBJECTIVE To investigate the implementation effects of the national centralized drug volume-based procurement policy （abbreviated as “national centralized procurement policy”） in Guangxi Zhuang Autonomous Region prefecture， and to provide a reference for the future centralized drug procurement work of the medical institution. METHODS Drug procurement data before and after policy implementation were included in the study. The six secondary indicators （such as availability， affordability， and drug safety） and eighteen third-level indicators （such as completion rate of agreed purchase volume， affordability level， drug revenue proportion） were introduced， guided by the policy objectives and issues of concern to policy beneficiaries. Descriptive statistics was adopted to analyze the data before and after policy implementation （in 2019 and 2020） in terms of differences and change trends. RESULTS In terms of accessibility， the participation rate of medical institutions in Guangxi Zhuang Autonomous Region was 92.55%， the proportion of diseases involved and median completed procurement rate were 40.16%， and 287.82% respectively， and the total centralized delivery rate was 97.20%. In terms of affordability， the total reduction amplitude in drug price was 74.80% from 2019 to 2022； the charge for medicine per capita in hospitalization， the proportion of medicine used for outpatient service and hospitalization， decreased by 17.61%， 10.22%， and 20.10% in order； the burden levels on medical fares for patients were all below 1 in addition to chronic diseases， and anti-tumor drugs. In terms of the impact on medicine， the ratio of adverse drug reaction event cases in 2022 was 66.00%， an increase of 1.29% compared to the previous； since the implementation of the policy， 12 drugs from local pharmaceutical enterprises from Guangxi Zhuang Autonomous Region had passed the consistency evaluation， and the market concentration rate of the top 8 pharmaceutical companies was less than 20.00%. In terms of the impact on healthcare and medical insurance， the public medical institutions achieved generic substitution for originator drugs mostly until 2022； about 9.12% of drugs that were non- centrally purchased in the same category were used； 63.39% of people under investigation did not show a need for a second dressing change； drug expenditure decreased by 2.459 billion yuan. CONCLUSIONS The national centralized procurement policy achieves a significant effect in Guangxi Zhuang Autonomous Region. On the other hand， attention should be paid to these suggestions as follows: expanding the category of drugs used in clinic， conducting clinically comprehensive evaluation of selected drugs， and improving reasonable allocation strategy， etc.

Objective:To explore the development status, research hotspots, and frontiers of low value care (LVC) de-implementation in foreign countries.Methods:The literature on LVC de-implementation included in the Web of Science core collection from 1995 to 2023 was electronically searched. Excel software was used to organize literature. CiteSpace software was used to visually analyze the authors, institutions, countries, journals, co-citation status, and key terms included in the literature.Results:A total of 576 articles were included. The overall number of articles published from 1995 to 2023 showed an increase, with the highest in 2022 (150 articles). The top 10 research institutions with publication volume and centrality> 0.10 were the Harvard University and the United States Department of Veterans Affairs. Compared with other journals, Archives of Internal Medicine, Anesthesiology and American Review of Respiratory Disease had the highest number of indexed literature. The journals with a co-citation frequency greater than 50 and centrality>0.10 were Archives of Internal Medicine, The American Journal of Medicine, British Medical Journal and Annals of Internal Medicine. In addition to the key terms searched for in this study, the key terms frequently cited greater than 30 times in 576 articles were "impact" "management" "outcome" "health" "quality" "health care", and "guidelines". The clusters in keyword clustering analysis that extend the timeline to the past 5 years were "value based care" and "low value care". The analysis of burst words showed that the forefront was the accurate identification of LVC in clinical practice and the intervention strategies for LVC de-implementation. Conclusions:Through the analysis of key terms and burst terms, it is found that in recent years, research topics in this field focus on the relationship between LVC and medical insurance expenditures, the influencing factors of de-implementation, tools (checklists or manuals) for identifying LVC, clinical intervention pathways, de-implementation of different types of LVC, and evaluation of the effectiveness of de-implementation. In the future, domestic research needs to strengthen international cooperation and exchange, explore and construct a suitable implementation path for LVC in China, accurately formulate LVC lists and intervention strategies, optimize nursing measures, improve the effective utilization of medical resources, and provide effective and high-quality nursing services for patients.

Objective To analyze the administrative penalties for radiation diagnosis and treatment in Xuzhou, China, 2018—2021, investigate the key illegal behaviors in radiation diagnosis and treatment, and provide a basis for effective supervision with targeted measures. Methods A total of 142 cases of administrative penalties were analyzed for the year of the case, the undertaker, the basic information of the subjects, the amount of penalty, and the specific illegal facts. Results From 2018 to 2021, the case number of administrative penalties for radiation diagnosis and treatment in Xuzhou was relatively stable. The cases were mainly undertaken by the municipal health supervision institution, while the number of cases handled by basic-level health supervision institutions was increasing. The administrative penalties were mainly imposed on persons and primary or non-classified medical institutions. Common illegal behaviors included occupational health management of radiation workers and personal protection during medical exposure. Conclusion We should focus on strengthening the publicity and supervision of personal protection in occupational health management and medical exposure, continue to improve the law enforcement ability of basic-level radiation health supervisors, develop a standardized management system for radiation diagnosis and treatment, innovate the supervision mode and radiation hazard notification mode, promote the “Internet + ” informatization supervision, and recommend to improve and revise radiation-related laws and regulations.

Objective To investigate the effect of Echinococcus granulosus cyst fluid(EgCF) on the cytoskeletal rearrangement and phagocytosis and the migration of macrophages induced by lipopolysaccharide(LPS). Methods Peritoneal macrophages of C57BL/6 mice were isolated and cultured in vitro, and divided into control group and LPS group and LPS combined with EgCF group. After 48 hours of treatment, filamentous actin (F-actin) changes were observed with rhodamine-labelled phalloidin staining and fluorescence microscopy; Transwell^TM chamber was used to test cell migration ability and flow cytometry to test cell phagocytosis. After 1 hour of treatment, PI3K and AKT, phosphorylated AKT (p-AKT), Rac1, guanosine triphospho-Rac1 (GTP-Rac1), WASP and Arp2 protein expressions were detected with Western blot analysis. Results Compared with the control group, after LPS stimulation, macrophages were deformed significantly; pseudopodia increased; actin cytoskeleton increased and was more distributed in pseudopodia; the ability of migration and phagocytosis were significantly improved, and the expression of PI3K, p-AKT, GTP-Rac1, WASP and Arp2 proteins significantly increased. EgCF treatment caused cell shrinkage and disappearance of pseudopodia protrusions of LPS-activated cells, and led to the reduced phagocytic and migratory of cells; the protein expression of PI3K, p-AKT, GTP-Rac1, WASP and Arp2 decreased significantly compared with the LPS group. Conclusion LPS induces the migration and enhances phagocytosis of macrophages while EgCF inhibits these effects, which is related to actin cytoskeleton rearrangement.
Mice ; Animals ; Lipopolysaccharides/pharmacology* ; Echinococcus granulosus/metabolism* ; Proto-Oncogene Proteins c-akt ; Cyst Fluid/metabolism* ; Mice, Inbred C57BL ; Macrophages/metabolism* ; Phagocytosis ; Actins/metabolism* ; Phosphatidylinositol 3-Kinases/metabolism* ; Guanosine Triphosphate/pharmacology*

ObjectiveTo investigate the association between ZJU index and the onset of nonalcoholic fatty liver disease （NAFLD） in the Uygur population and the value of ZJU index in predicting the risk of NAFLD. MethodsThe Uighur community of The 51st Regiment of The Third Division of Xinjiang Kashgar Corps was selected as the investigation site， and the Uygur residents who lived in this area and had an age of >18 years were selected as subjects. Follow-up studies were conducted in 2019， 2020， and 2021， and the investigation of outcomes was completed in June to August of 2021. Finally 10 597 subjects were enrolled for analysis. The Kruskal-Wallis H test was used for comparison of continuous variables between groups， and the chi-square test was used for comparison of categorical variables between groups. The subjects were divided into Q1-Q4 groups according to the level of ZJU index. The Kaplan-Meier curve was used to predict the incidence rate of NAFLD， and the Cox regression model was used to analyze the association between ZJU index and the risk of NAFLD； the area under the ROC curve （AUC） was used to evaluate the value of ZJU index in predicting the risk of NAFLD. ResultsDuring the median follow-up time of 4.92 years， the incidence rate of NAFLD was 9.4% （992/10 597） among the study population. After adjustment for multiple factors， there was a significant increase in the risk of NAFLD with the increase in ZJU index， with a hazard ratio of 2.55 （95% confidence interval ［CI］： 1.60‍ — ‍4.06）， 7.32 （95%CI： 4.78‍ — ‍11.20）， and 21.74 （95%CI： 14.32‍ — ‍33.00）， respectively （all P_trend<0.001）. The ROC curve showed that ZJU index had a higher value in predicting NAFLD （AUC=0.816）， and the male subgroup had a significantly higher predictive accuracy of ZJU index than the female subgroup （AUC： 0.829 vs 0.809）. ConclusionZJU index is a predictive factor for the onset of NAFLD in the Uygur population in rural areas of Xinjiang and has a good value in predicting the risk of NAFLD.

Hepatic cystic echinococcosis (HCE) is a global public health problem. At present, the research of echinococcosis mainly focuses on etiology, epidemiology, immunology, imaging and treatment programs, while ignoring the systematic study of its natural decline and death course. The popularization of modern imaging examination methods enable researchers to obtain the clinical data of HCE in different stages, with different imaging features and pathological states. Based on CT imaging features and clinical practice, the authors discuss the natural decline and death course of HCE, in order to provide new ideas for its diagnosis and treatment.

Objective:To investigate the feasibility of anthocyanins(C3G)antioxidant inhibition of autophagy to al-leviate epilepsy.Methods:Seventy-five SD rats were randomly divided into 5 groups:Control group,pentetrazole(PTZ)group,hydrogen peroxide(H2O2)intervention group,3-methyladenine(3-MA)intervention group,and C3G intervention group.The seizure grade,latency,and frequency were documented.Electroencephalography was employed to detect abnormal electrical discharges in the brain across.Patch clamp technique was utilized to measure action poten-tials in hippocampal neurons for each group.The concentration of 4-hydroxynonenoic(4-HNE)hippocampus was deter-mined using a specific kit.Ultrastructural alterations in hippocampal neurons were examined through electron microsco-pyissl staining was performed to assess neuronal damage within the hippocampus.Immunohistochemical staining and Western Blot were conducted to evaluate expression levels of 15-LOX,GPX4,and LC3 proteins within the hippocampus of rats.Results:Compared with the control group,the PTZ group was completely ignited and the modeling was success-ful.Compared with other epilepsy groups,the seizure grade of C3G group decreased,abnormal discharge decreased,latency increased,hippocampal neuron excitability decreased,nishi content increased,4-HNE content,15-LOX expression and LC3Ⅱ/LC3Ⅰ ratio decreased,but GPX4 expression increased(P＜0.05).Conclusion:The oxidative stress induced by epilepsy can induce excessive autophagy of neurons,and C3G can alleviate the occurrence and devel-opment of epilepsy by anti-oxidation and inhibition of autophagy.

Ameloblastoma is a relatively common benign tumor that occurs in the dental epithelial tissues, which is characterized with local infiltration and growth, high-risk recurrence and metastasis, etc. At present, radical osteotomy is the main treatment of ameloblastoma, whereas it yields high recurrence rate and causes multiple postoperative complications such as facial and functional deformities, etc. For inoperable patients, non-surgical interventions, such as radiotherapy, chemotherapy and molecule-targeted therapy, are urgently needed to improve prognosis and retain organs. This article summarizes the current status and research progresses on non-surgical treatment of ameloblastoma, aiming to provide evidence for individualized treatment of ameloblastoma.

Objective:To identify the biotypes of blood culture positive Brucella in patients with acute brucellosis in Xinjiang Uygur Autonomous Region (hereinafter referred to as Xinjiang), and to learn about the clinical characteristics of these patients. Methods:Among the 30 patients diagnosed with acute brucellosis in First Affiliated Hospital, School of Medicine, Shihezi University from January 2019 to July 2021, the positive strains of blood culture Brucella of 12 patients with acute brucellosis were used to identify the biotype by AMOS-PCR. Then the general and clinical data of the 12 patients were collected, including demographic characteristics, epidemiological characteristics, clinical characteristics, laboratory tests, treatment and prognosis. Results:AMOS-PCR results showed that all 12 strains were Brucella melitensis. Among the 12 patients, 9 were males and 3 were females, all of whom had a clear history of livestock contact, and the onset time was concentrated in April to September. All 12 patients showed fever, followed by headache and dizziness (9/12), weakness (8/12), digestive symptoms (8/12), hyperhidrosis (7/12), lumbago and backache (6/12), and arthralgia (6/12). One patient was complicated with pleural effusion and pericardial effusion. One patient was complicated with pleural effusion, pelvic effusion and ascites. Only ascites occurred in 2 patients. Liver function was abnormal in 3 patients, lactate dehydrogenase increased in 6 patients, and blood creatinine decreased in 9 patients. Among the 12 patients, 10 patients were treated with rifampicin combined with doxycycline. The other 2 patients were treated with levofloxacin and doxycycline, supplemented by symptomatic treatment with hepatoprotective drugs due to impaired liver function. After discharge, the patients received out-of-hospital oral anti-infectious drugs for 1-2 courses (6 weeks each course), and all indicators returned to normal at 6 months and 12 months after discharge. Conclusions:All the 12 patients with acute brucellosis in Xinjiang are infected with Brucella melitensis. In addition to the common clinical features, patients are characterized by decreased creatinine and increased lactate dehydrogenase. The standardized anti- Brucella treatment is still the main treatment strategy.

Objective:Ameloblastoma (AM) is a rare tumor derived from dental epithelial tissues, which is prone to recurrence and infiltration. This study aims to identify the prognostic factors of AM.Methods:207 ameloblastoma patients were screened from the SEER database. A Cox regression model and nomogram were constructed to evaluate the factors on the overall survival. Clinical data of 61 patients admitted to Hunan Cancer Hospital were retrospectively analyzed. The independent factors of recurrence rate were analyzed by the Cox regression model.Results:The results on the SEER database showed that age, tumor size, type of surgery, radiotherapy were important prognostic factors of the overall survival. The nomogram was constructed and the C-index was equaled to 0.821, indicating this model was moderately accurate. The receiver operating characteristic (ROC) curve demonstrated that the area under the ROC curve (AUC) at 1, 3, 5, and 10 years were 0.852, 0.869, 0.856, and 0.879, indicating this model had relatively high sensitivity and specificity. Kaplan- Meier survival analysis suggested that overall survival in the high-risk group was significantly lower than that in the low-risk group ( P<0.001). Based on retrospective analysis, clinical symptoms and type of surgery were the independent factors of the local recurrence rate. Kaplan- Meier survival analysis found the recurrence rate of facial swelling and pain was lower compared to those of other symptoms. Compared with the palliative surgery, radical surgery could decrease the recurrence rate. Conclusions:Age, tumor size, type of surgery, and radiotherapy may be important factors of the overall survival. Type of surgery and clinical symptoms are probably the independent factors of the recurrence rate.