OBJECTIVE To evaluate the efficacy， safety and cost-effectiveness of generic drugs and original drugs of voriconazole. METHODS The information of patients who used voriconazole generic drugs selected in National Centralized Drug Procurement （generic drug group） or non-selected original drugs （original drug group） in the treatment of fungal infection was collected from the our hospital. The propensity score matching was carried out to eliminate bias. The comprehensive efficacy was evaluated according to clinical efficacy， image findings and microbiological test， and stratified analysis of different populations was conducted based on fungal species， underlying diseases， etc.， the efficacy of different stratifications was evaluated. Evaluation of safety was performed by using the incidence of adverse reactions. The total cost， defined daily doses （DDDs） and defined daily dose cost （DDDc） were used to evaluate the cost-effectiveness. RESULTS A total of 436 patients were included， and there were 190 patients in each group after matching. In terms of efficacy， the effective rates of voriconazole generic drugs and original drugs were 62.63% and 59.47% （P＝0.528）； in terms of safety， the incidence of adverse reactions caused by generic drugs and original drugs of voriconazole was 13.68% and 7.89%， respectively（P＝0.069）. In terms of cost-effectiveness， the average total cost of generic drugs was 4 636.26 yuan， and that of original drugs was 8 613.20 yuan （P＜0.001）. After the implementation of National Centralized Drug Procurement， replacement rate of generic drugs increased to 87.30%， and DDDc decreased by 59.08%. CONCLUSIONS The efficacy and safety of voriconazole generic drugs are similar to those of original drugs in the treatment of fungal infection， and it is more cost-effective in terms of treatment cost.

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 evaluate the efficacy of neoadjuvant chemoimmunotherapy (NACI) combined with transoral robotic surgery (TORS) in the treatment of locally advanced oropharyngeal squamous cell carcinoma (OPSCC).Methods:This was a retrospective study of 15 patients with locally advanced OPSCC who underwent TORS after neoadjuvant therapy (NAT) at the Department of Otolaryngology-Head and Neck Surgery of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from April 2019 to February 2023. There were 12 males and 3 females, aged 31 to 74 years. Twelve cases were tonsil cancer, and 3 cases were tongue base cancer. There were 11 cases in stage Ⅲ and 4 cases in stage Ⅳ. Two patients received neoadjuvant chemotherapy and 13 patients received NACI, with 2 to 3 cycles, and all patients underwent TORS after multidisciplinary team consultation. The clinicopathological characteristics, surgical outcomes, and oncological results were summarized.Results:All surgeries were successfully completed with negative surgical margins, and no case was required conversion surgery. All patients were fed via nasogastric tubes postoperatively, with a median gastric tube stay of 7 days (range: 2-60 days). No tracheotomy was applied. There were no major complications such as postoperative bleeding. Pathological complete response (pCR) was found in 10 cases (76.9%) among the 13 patients with NACI. The follow-up time was 21 months (range: 10-47 months), and there was no death or distant metastasis. One patient with rT0N3M0 tonsil cancer had local recurrence 5 months after surgery. The 2-year overall survival and 2-year disease-free survival were respectively 100.0% and 93.3% in the 15 patients.Conclusion:NACI combined with TORS provides a safe, effective and minimally invasive treatment for patients with locally advanced oropharyngeal squamous cell carcinoma.

Objective To investigate the sensitization pattern of Blomia tropicalis in patients with aller-gic respiratory disease and the association between Blomia tropicalis with allergic rhinitis and / or asthma. Meth-ods 330 allergic rhinitis and / or asthma patients sensitized with mites were selected in Guangzhou,and sIgE lev-el in the serum of all recruited patients of Blomia tropical,Dermatophagoide pteronyssinus and Dermatophagoide fa-rina was measured. Results The sensitization rate of Blomia tropicalis was significantly lower than that of Derma-tophagoide pteronyssinus and Dermatophagoide farina(P < 0.001,both). 80.0% Patients were sensitized with both three mites,and only 0.3% patients were of monosensitization to Blomia tropicalis. The sIgE of these three mites were significantly positive correlated with each other(P < 0.001),Dermatophagoide pteronyssinus and Derma-tophagoide farina have strong correlation(r = 0.906),Blomia tropicalis has moderate correlation with Dermatopha-goide pteronyssinus and Dermatophagoide farina(r = 0.540 and r = 0.512,respectively). With the increase of Blomia tropicalis sIgE,the severe sensitization rate(sIgE level:class 5~6)of patients sensitized combined Der-matophagoide pteronyssinus or Dermatophagoide farina significantly increased(P < 0.001). The sIgE level of Der-matophagoide pteronyssinus and Dermatophagoide farina in allergic asthma and rhinitis patients were significantly higher than that of patients with rhinitis or asthma alone(P < 0.001),and the sIgE level of Blomia tropicalis in pa-tients with both allergic asthma and rhinitis or with asthma alone were also significantly higher than that of patients with rhinitis alone(P = 0.006 and P = 0.020,respectively). Conclusion The Blomia tropicalis sensitized pa-tients usually sensitize together with Dermatophagoide pteronyssinus or Dermatophagoide farina,and the degree of Blomia tropicalis sensitized in asthma patients are higher.

Objective Comparison of ELISA for detection of Mycoplasmapneumoniae IgM(MP-IgM)and cold agglutination test for early diagnosis of Mycoplasma pneumoniae infection in clinical value. Methods ELISA and cold agglutination test were used to detect 500 cases of serum samples infected with Mycoplasma pneumoniae. Results The positive rate of ELISA(54.8%)was significantly higher than that of cold agglutination(28.4%), and there was significant difference(χ2=71.72,P<0.01).The positive rates of ELISA in Fever 3 days(44.2%), 4~7days(46.4%),8~14 days(71.3%),and 15 days(78.6%)were significantly higher than that of cold aggluti-nation 22.1%,25.4%,35.7%,35.7%.The positive rates were increased with fever days extended.These is no sig-nificant difference(P > 0.05)in 1 ~ 3 days and 4 ~ 7 days,8~14 days and more than 15 days(P > 0.05) by ELISA,while there was a significant difference(P < 0.05)in 8~14 days with 1 ~ 3 days and 4 ~ 7 days. Conclution ELISA of detection MP-IgM should be selected prior in clinical detection,especially in the fever 8~14 days.It can obviously improve the early detection rate of mycoplasma infection and give the most useful value for clinical diagnosis.