This article introduces an overview of management system for conflict of interest of the European Pharmacopoeia Commission (EPC) and the United States Pharmacopoeia Convention (USP). The EPC and USP have standardized the management system for conflict of interest in drug standard work in multiple management documents, such as the Guide for the Work, Code of Practice for the Work, Form for Declaration of Interests and Confidentiality Undertaking of the EPC, bylaws, Rules and Procedures of the Council of Experts, Code of Ethics, Standards of Conduct of the USP, in order to ensure the transparency and fairness of drug standard development, improve the credibility and rigor of drug standards. This article introduces the management system for conflict of interest of the EPC and USP, providing reference for the improvement of relevant management systems of the Chinese Pharmacopoeia Commission.

Background Results of genetic testing for antipsychotic drugs can guide the rational use of drugs in clinical practice and help improve the clinical symptoms of patients with schizophrenia.However,there is currently limited evidence in China regarding the impact of genetic testing results on medication adherence,social function and drug side effects of antipsychotic drug treatment.Objective To explore the improvement of clinical symptoms,medication adherence and social function in patients with schizophrenia under the guidance of antipsychotic drug gene testing results and examine the safety of drug treatment,so as to provide references for ifor precise treatment of schizophrenia patients.Methods Patients with acute schizophrenia who received hospitalization at Dazhou Minkang Hospital from July 2019 to August 2021 as well as met the diagnostic criteria of the International Classification of Diseases,tenth edition(ICD-10)were selected as research subjects(n=144).Based on random number table,subjects were divided into study group and control group,with 72 cases in each group.Control group received drug treatment based on the doctor's clinical experience,while study group received drug treatment based on the results of gene testing for antipsychotic drug.Both treatments lasted for 12 weeks.At baseline as well as 2,4,8 and 12 weeks after treatment,Positive and Negative Syndrome Scale(PANSS),8-item Morisky Medication Adherence Scale(MMAS-8),Social Functional Rating Scale(SFRS)and Treatment Emergent Symptom Scale(TESS)were adopted for assessment.Result Time effect and group effect of the reducing rate of PANSS,MMAS-8 and SFRS scores in the groups were statistically significant(Ftime=95.251,6.650,14.101,Fgroup=38.055,58.175,128.221,P<0.01).The interaction effect of the reduction rates of MMAS-8 scores in two groups was statistically significant(Finteraction=5.837,P<0.01).The group effect and interaction effect of the severity scores of drug side effects and patient pain scores in two groups were statistically significant(Fgroup=7.553,81.533,Finteraction=8.693,9.322,P<0.01).Conclusion In terms of improving clinical symptom relief,medication adherence,social function and drug side effects,medication for patients with schizophrenia guided by genetic testing of antipsychotic drugs may be more effective than that relying on medication based on clinical experience.

Objective To observe the effect of flurbiprofen axetil on lung oxygenation function,re-spiratory mechanics and pulmonary complications in patients undergoing thoracoscopic right lung lobectomy with endobronchial blockers during one-lung ventilation(OLV).Methods Sixty patients scheduled for elective thoracoscopic right lung lobectomy with endobronchial blockers for OLV,25 males and 35 females,aged 35-64 years,BMI 18-28 kg/m2,ASA physical status Ⅰ or Ⅱ,were randomly allocated into two groups:the flurbiprofen axetil group(group F)and the control group(group C),30 patients in each group.In group F,flurbiprofen axeil 1.0 mg/kg was injected intravenously 15 minutes before anesthesia induction,while group C was not treated.Blood gas analysis was performed in 2 ml of radial artery 20 minutes before anesthesia induction(T0),30 minutes(T1)and 60 minutes(T2)after OLV,and 15 minutes(T3)after two lung ventilation,then oxygenation index(OI)was calculated respectively and SpO2 was recorded.Pa-rameters of lung mechanics were monitored at T1 and T2 including peak airway pressure(Ppeak),airway platform pressure(Pplat),dynamic lung compliance(Cdyn),and ratio of null lumen volume to tidal vol-ume(VD/VT).The incidence of hypoxemia and the number of remedial cases during OLV were recorded.The postoperative transfer to ICU and complications such as atelectasis,acute lung injury and pneumonia within 72 hours after surgery were recorded.Results Compared with group C,SpO2 at T1,PaO2 and OI at T1—T3,and Cdyn at T1 and T2 were significantly increased in group F(P＜0.05),Ppeak and VD/VT at T1 and T2,Pplat at T2 were significantly decreased in group F(P＜0.05).There were no hypoxemia and remedies occurred during OLV and no patients were transferred to ICU after surgery,no atelectasis,acute lung injury,and pneumonia occurred within 72 hours after surgery between the two groups.Conclusion For patients undergoing OLV with endobronchial blockers undergoing thoracoscopic right lung lobectomy,in-travenous flurbiprofen axetil before induction of anesthesia can help improve lung oxygenation and optimize respiratory parameters during one lung ventilation.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To evaluate the effect of low-dose esketamine for postoperative analgesia on the postoperative depression in patients with gastrointestinal tumors.Methods:This study was a prospective randomized controlled trial. Eighty patients, aged 18-64 yr, with a body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective radical resection of the gastrointestinal tumor under general anesthesia from June to November 2023 in our hospital, were divided into 2 groups ( n=40 each) using a random number table method: esketamine group (group E) and control group (group C). Each patient received postoperative patient-controlled intravenous analgesia(PCIA). The PCIA solution in group E contained esketamine 0.5 mg/kg, dezocine 0.5 mg/kg, dexmetomidine 1.5 μg/kg and flurbiprofen ester 100 mg in 100 ml of normal saline. The PCIA solution in group C contained dezocine 0.5 mg/kg, dexmetomidine 1.5 μg/kg and flurbiprofen ester 100 mg in 100 ml of normal saline. The Hospital Anxiety and Depression Scale (HADS) was used to assess the patients′ anxiety and depression at 1 day before operation (T 0) and 2 days after operation (T 1). The Quality of Recovery-15 scale was used to evaluate the early postoperative recovery quality. Visual analog scale scores, the pressing times of patient-controlled analgesia and the number of rescue analgesia were recorded within 2 days after operation. The occurrence of drug-related adverse reactions was also recorded. Results:Seventy-eight patients were finally included, with 39 cases in group E and 39 cases in group C. Compared with group C, the postoperative HADS-depression scale score and incidence of depression were significantly decreased, the Quality of Recovery-15 scale score was increased, the visual analog scale scores were decreased ( P<0.05), and no significant changes were found in the postoperative HADS-anxiety scale score and incidence of anxiety, the pressing times of patient-controlled analgesia and the number of rescue analgesia in group E ( P>0.05). Visual hallucination was found at 1 day after operation in one patient and relieved at 2 days after operation in group E. There was no significant difference in the incidence of postoperative dizziness, nausea and vomiting between the two groups ( P>0.05). Conclusions:Postoperative analgesia with 0.5 mg/kg esketamine can alleviate postoperative depressive symptoms, enhance the efficacy of analgesia and improve the early postoperative recovery quality in patients with gastrointestinal tumors.

Objective:To evaluate the efficacy of remimazolam for induction of anesthesia in patients with colorectal cancer.Methods:This was a prospective study. Eighty-two patients scheduled for elective colon and rectal tumor surgery under general anesthesia from June to November 2023 at our hospital, aged 18-80 yr, with body mass index of 18.5-28.0 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ, were divided into 2 groups ( n=41 each) using a random number table method: propofol group (group P) and remimazolam group (group R). Propofol 1.5 mg/kg was intravenously injected in group R and remimazolam 0.3 mg/kg was intravenously injected in group P. When the bispectral index (BIS) value≤60, sufentanil 0.5 μg/kg and cisatracurium 0.2 mg/kg were intravenously injected in both groups. Heart rate and mean arterial pressure were recorded before induction of anesthesia (T 0), 3 min after induction (T 1), immediately after intubation (T 2), and 5 min after tracheal intubation (T 3). The occurrence of hypotension, hypertension, tachycardia and bradycardia during induction, use of vasoactive drugs, and injection pain were recorded. The time to loss of consciousness, time from the beginning of administration to BIS value ≤60, time from the beginning of administration to tracheal intubation, occurrence of BIS value > 60 immediately after intubation and rescue sedation were recorded. Results:Eighty patients were finally included, with 40 in group P and 40 in group R. Compared with group P, the heart rate and mean arterial pressure were significantly increased at T 1 and T 2, the incidence of hypotension and bradycardia was decreased, and the time from the beginning of administration to BIS value ≤60 was prolonged ( P<0.05), and no statistically significant changes were found in the other parameters in group R ( P>0.05). Conclusions:Remimazolam 0.3 mg/kg can be safely and effectively used for anesthesia induction and provides better efficacy in maintaining hemodynamic stability when compared with propofol 1.5 mg/kg in patients with colorectal cancer.

Objective:To study the application of 3D printing technology in multi-center fenestrated/branched endovascular repair (F/B-EVAR) for endovascular repair of abdominal aortic diseases.Methods:From Feb 2018 to Mar 2023, The clinical and followup data of 316 cases of abdominal aortic lesions undergoing repair with F/B-EVAR at 69 medical centers nationwide using 3D printing technology to guide physician-modified stent graft were retrospectively analyzed.Results:The mean follow-up time of the patients was 23 months (2-60 months), and 24 cases were lost to follow up, the follow-up rate was 92.4% (292/316), the mean postoperative hospitalization time was (8.2±4.9) days. A total of 944 main abdominal branch arteries were reconstructed. Intraoperative reconstruction of 11 branches failed, with a success rate of 98.8% (933/944). Within 30 days after surgery, 8 patients died (2.5%), and 6 patients died during follow-up, a total of 14 patients died (4.4%). There were 11 cases (3.5%) of spinal cord ischemia and no patient suffered from permanent paraplegia. There were 19 patients (6.0%) with postoperative renal function injury. Internal leakage was found in 26 patients, and the rate of internal leakage was 8.2%.Conclusion:3D printing technology can accurately locate the location of branch arteries, simplifing the surgical process, shortening the learning curve , and improving clinical efficacy.

Objective:To investigate a new method for the reconstruction of hemifacial microsomia by sagittal osteotomy of the affected mandibular outer cortex combined with bone graft of mandibular outer cortex from healthy side.Methods:From March 2006 to March 2023, the clinical data of patients with hemifacial microsomia admitted to the Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences were analyzed retrospectively. Preoperative diagnosis and surgical design were performed based on clinical manifestations and imaging findings. All cases were operated under general anesthesia. The affected mandibular outer cortex was previously split by an intraoral approach, and then the mandibular outer cortex of appropriate shape and size on the healthy side was harvested and grafted into the split bone space according to the preoperative design, following by internal rigid fixation. Complications, facial appearance improvement, and patient satisfaction were followed up. Photographs were taken preoperative, immediately postoperative and at the long-term(last) postoperative follow-up, and the severity of the deformity was analyzed. CT data from preoperative, immediate postoperative, and long-term follow-up visits were imported into Surgicase Proplan medical three-dimensional image workstation in Dicom format. The mandible was reconstructed using Segmentation, and the thickness of the mandible was measured during pre-operative, immediate post-operative and long-term follow-up visits. Anova with repeated measurement design was used to compare measurements and LSD test was used for multiple comparisons. The Kruskal-Wallis rank sum test were used to statistically analyze malformation severity. P< 0.05 is considered statistically significant. Results:A total of 39 patients were included in this study, including 13 females and 26 males, with an average age of (22.21±4.57) years (15-27 years). All patients were followed up for an average of (45.56±39.41) months (6-153 months) after surgery. The grafted mandibular outer cortex grows well with the adjacent bone tissue, and the mandibular angle and mandibular body are significantly wider. Of the 39 cases, 1 developed an infection 1 year after surgery, the titanium plate was exposed, and the patient healed after debridement and removal of the immobilizing splint. The facial appearance of the other patients improved significantly. Preoperative, immediate postoperative and long term follow up of mandibular thickness measurements were compared in pairs, and the differences were statistically significant (all P<0.05). The patient’s appearance satisfaction score: the preoperative score was [2.0(1.5, 2.0)] points, the immediate postoperative score was [4.0(4.0, 4.0)] points, the score of the last postoperative follow up was [4.0(4.0, 4.0)] points. There was statistical difference in satisfaction among the three groups ( P<0.01). The preoperative scores were compared with the scores of the immediate postoperative and the last postoperative follow-up respectively, and the differences were statistically significant( P<0.01). There was no statistical significance in satisfaction between the immediate postoperative score and the score of the last postoperative follow up ( P>0.05). Conclusion:The sagittal splitting osteotomy of the mandibular outer cortex is consistent with the features of mandibular anatomy, and provides a good condition for the grafting and healing of autogenous bone. Removing the outer cortex of the mandible on the healthy side not only increases the thickness of the affected side, but also decreases the width of the angle of the mandible on the healthy side, so as to effectively correct the asymmetric deformity of the mandible. The method is simple, with few complications and good results, and is one of the ideal treatments to correct hemofacial microsomia.

Objective:To investigate a new method for the reconstruction of hemifacial microsomia by sagittal osteotomy of the affected mandibular outer cortex combined with bone graft of mandibular outer cortex from healthy side.Methods:From March 2006 to March 2023, the clinical data of patients with hemifacial microsomia admitted to the Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences were analyzed retrospectively. Preoperative diagnosis and surgical design were performed based on clinical manifestations and imaging findings. All cases were operated under general anesthesia. The affected mandibular outer cortex was previously split by an intraoral approach, and then the mandibular outer cortex of appropriate shape and size on the healthy side was harvested and grafted into the split bone space according to the preoperative design, following by internal rigid fixation. Complications, facial appearance improvement, and patient satisfaction were followed up. Photographs were taken preoperative, immediately postoperative and at the long-term(last) postoperative follow-up, and the severity of the deformity was analyzed. CT data from preoperative, immediate postoperative, and long-term follow-up visits were imported into Surgicase Proplan medical three-dimensional image workstation in Dicom format. The mandible was reconstructed using Segmentation, and the thickness of the mandible was measured during pre-operative, immediate post-operative and long-term follow-up visits. Anova with repeated measurement design was used to compare measurements and LSD test was used for multiple comparisons. The Kruskal-Wallis rank sum test were used to statistically analyze malformation severity. P< 0.05 is considered statistically significant. Results:A total of 39 patients were included in this study, including 13 females and 26 males, with an average age of (22.21±4.57) years (15-27 years). All patients were followed up for an average of (45.56±39.41) months (6-153 months) after surgery. The grafted mandibular outer cortex grows well with the adjacent bone tissue, and the mandibular angle and mandibular body are significantly wider. Of the 39 cases, 1 developed an infection 1 year after surgery, the titanium plate was exposed, and the patient healed after debridement and removal of the immobilizing splint. The facial appearance of the other patients improved significantly. Preoperative, immediate postoperative and long term follow up of mandibular thickness measurements were compared in pairs, and the differences were statistically significant (all P<0.05). The patient’s appearance satisfaction score: the preoperative score was [2.0(1.5, 2.0)] points, the immediate postoperative score was [4.0(4.0, 4.0)] points, the score of the last postoperative follow up was [4.0(4.0, 4.0)] points. There was statistical difference in satisfaction among the three groups ( P<0.01). The preoperative scores were compared with the scores of the immediate postoperative and the last postoperative follow-up respectively, and the differences were statistically significant( P<0.01). There was no statistical significance in satisfaction between the immediate postoperative score and the score of the last postoperative follow up ( P>0.05). Conclusion:The sagittal splitting osteotomy of the mandibular outer cortex is consistent with the features of mandibular anatomy, and provides a good condition for the grafting and healing of autogenous bone. Removing the outer cortex of the mandible on the healthy side not only increases the thickness of the affected side, but also decreases the width of the angle of the mandible on the healthy side, so as to effectively correct the asymmetric deformity of the mandible. The method is simple, with few complications and good results, and is one of the ideal treatments to correct hemofacial microsomia.

Objective To investigate the clinical application of 3D printed bolus with specific density in breast cancer radiotherapy,and to evaluate its effects on dose distribution and positioning.Methods Forty post-mastectomy patients undergoing intensity-modulated radiotherapy were randomly enrolled for 3D printed bolus(n=20)and conventional bolus(n=20),and all patients were fixed in the supine position using styrofoam.Conventional positioning was performed based on in-room lasers and body markers,with daily Catalyst HD optical surface monitoring combined with weekly CBCT verification.The absolute dose,patients'skin surface dose,surgical incision,planned field,target area doses(VCTV50Gy,VPTV50Gy)and organs-at-risk doses in patients with different boluses were recorded,and the conformity index and homogeneity index were calculated,and the setup errors using CBCT and Catalyst HD were also analyzed.Results The difference in absolute dose between different boluses was trivial,but the skin surface dose with 3D printed bolus was significantly higher than with conventional bolus[(54.83±0.44)Gyvs(54.43±0.51)Gy,P<0.05].Patients with 3D printed boluses had a higher conformity index than with conventional boluses(0.69±0.04 vs 0.65±0.02).For different boluses,there was no significant difference in VCTV50 Gy,while the VPTV50 Gy and organs-at-risk doses were lower in those with 3D printed bolus than conventional boluses(P<0.05),with heart Vmean of 9.68%±3.24%vs11.43%±3.60%.In patients with 3D printed boluses,both planned field arrangement and surgical incision affected the target doses,and the doses of the target area without an internal breast wrap was greater than those with internal breast wrap(P<0.05).When the field was not wrapped around the internal breast,the surgical incisions only affected VPTV50 Gy,and the VPTV50 Gy was greater with the transverse fusiform incision than with the oblique vertical incision(P<0.05),which were 95.58%±0.51%vs95.44%±0.71%.The optical monitoring accuracies with different boluses differed only in the left-right direction(P<0.05),with(0.08±0.57)cm and(-0.15±0.46)cm for 3D printed and conventional boluses.Conclusion Compared with conventional bolus,3D printed bolus can improve dose distribution and optical monitoring accuracy.The surgical incision and planned field arrangement under 3D-printed bolus would exert effects on target doses.