The Chinese Pharmacopoeia is the legal technical standard which should be followed during the research, production, use, and administration of drugs. At present, the new edition of the Chinese Pharmacopoeia is planned to be promulgated and implemented. This article summarizes and analyzes the main characteristics and the content of updates and amendments of the Chinese Pharmacopoeia 2025 Edition(Volume Ⅰ), to provide a reference for the correct understanding and accurate implementation the new edition of the pharmacopoeia.

Objective To evaluate the value of high-energetic virtual monoenergetic imaging(MonoE),bone metal artifact reduction(O-MAR),and their combination based on dual-layer detector spectral computed tomography(DLCT)in removing the artifacts caused by lumbar metal implants.Methods Patients who undergone lumbar implant surgery and performed lumbar examination on DLCT after surgery were prospectively selected.MonoE from 100 to 200 keV with an interval of 20 keV were reconstructed.O-MAR and O-MAR combined with MonoE(O-MAR+MonoE)images were also reconstructed.The differences of objective and subjective image quality among the images were compared.Results There were 45 patients included in the study.With the increasing of keV of MonoE,the attenuation of the tissue with low-and high-density artifact on MonoE and O-MAR+MonoE was increased and decreased,respectively.140 keV MonoE was the best sequence for the artifact reduction and the display of soft tissue.200 keV MonoE and its combination with O-MAR showed the best performance in the display of the interface of metal and bone.However,O-MAR+200 keV MonoE had the lowest noise.Conclusion Compared to O-MAR and O-MAR combined with MonoE,high-energetic MonoE shows a good value in the reduction of metal artifacts caused by the lumbar metal implants.

Objective:To investigate the effect of preoperative old muscular calf vein thrombosis on the safety and efficacy of total knee arthroplasty (TKA).Methods:A total of 411 patients with end-stage knee osteoarthritis who underwent primary TKA in the First Affiliated Hospital of Nanjing Medical University from September 2021 to March 2023 were retrospectively analyzed. There were 89 males and 322 females, aged 68.05±5.91 years (range, 50-82 years). The body mass index was 26.8±3.7 kg/m 2 (range, 17.4-39.8 kg/m 2). The group was divided into a preoperative thrombosis group (47 cases) and a preoperative none-thrombosis group (364 cases) according to whether or not there was a combination of old muscular calf vein thrombosis before TKA. The clinical characteristics (location and size) and lower limb swelling were observed, and the American Knee Society (AKS) score, visual analogue scale (VAS) and Villalta score were recorded to compare the differences between the two groups. Results:All patients successfully completed the operation and were followed up for 7.4±1.1 months (range, 6-9 months). Postoperative deep venous thrombosis (DVT) occurred in 96% (45/47) of the patients in the preoperative thrombus group, which was greater than the 38.5% (140/364) in the preoperative none-thrombus group, and the difference was statistically significant (χ 2=55.184, P<0.001). 29% (13/45) of the patients who developed DVT postoperatively in the preoperative thrombus group had DVT located in the main vein, which was greater than the 9% (12/140) in the preoperative none-thrombus group, and the difference was statistically significant (χ 2=12.028, P<0.001). 51% (23/45) of patients with DVT after operation had thrombosis ≥6 mm, which was higher than 34% (47/140) of patients in the preoperative none-thrombus group, and the difference was statistically significant (χ 2=4.454, P=0.035). The rate of thigh swelling on postoperative day 3 was 8.42%±3.50% in the group with preoperative thrombus and 7.80%±4.12% in the preoperative none-thrombus group, and the differences were not statistically significant ( t=-0.995, P=0.320). The rate of calf swelling on postoperative day 3 was 8.14%±3.40% in the preoperative thrombus group, which was greater than the 5.51%±3.45% in the preoperative none-thrombus group, and the difference was statistically significant ( t=-4.923, P<0.001). Postoperative AKS scores were elevated in both groups and were greater than preoperative scores at 3 and 6 months postoperatively, with statistically significant differences ( P<0.05). There was no significant difference in AKS score between the two groups before operation ( P>0.05), and the AKS scores in the preoperative thrombus group were smaller than those in the preoperative none-thrombus group at 3 and 6 months postoperatively, with a statistically significant difference ( P<0.05). Postoperative VAS scores were reduced in both groups and were smaller than preoperative scores at 3 and 6 months postoperatively, with statistically significant differences ( P<0.05). There was no significant difference in preoperative VAS scores between the two groups ( P<0.05), and the VAS scores in the preoperative thrombus group were greater than those in the preoperative none-thrombus group at 3 and 6 months postoperatively, with a statistically significant difference ( P<0.05). The Villalta score of patients with DVT after operation in the preoperative thrombus group was 4.47±2.47 at the last follow-up, which was greater than that of the preoperative none-thrombus group, which was 2.90±1.92, and the difference was statistically significant ( t=-4.395, P<0.001). Conclusion:Preoperative combined old muscular calf vein thrombosis increases the incidence of postoperative DVT and the dangerousness of DVT is higher.

Seizures are a prevalent clinical manifestation during the neonatal period.The majority of neonatal seizures are transient symptoms caused by acute lesions，but in a few cases they are developmental epileptic encephalopathy with neonatal onset.Continuous video-EEG monitoring is the gold standard for diagnosing seizures in newborns,and complex seizures require comprehensive judgment using multi-channel monitoring such as synchronized EMG,blood oxygen,ECG,and respiratory monitoring.In 2021,the International League Against Epilepsy (ILAE) published the updated guidelines for the classification of neonatal seizures,proposing that neonatal seizures cannot be diagnosed if there is only clinical seizure without EEG evidence.Instead,they should be categorized into two types based on the presence of clinical movements and the characteristics of EEG changes during the seizure: electroclinical seizures and electrical seizures.Electroclinical seizures are categorized into motor seizures,non-motor seizures,sequential seizures,and unclassified seizures based on the symptoms exhibited during an attack.In 2023,the ILAE developed evidence-based recommendations for the management of antiseizure medications,discussed the treatment of neonatal seizures based on the latest evidence and emphasized the importance of video EEG in the treatment of neonatal seizures.Phenobarbital remains the first-line antiseizure medication,with phenytoin,levetiracetam,midazolam,or lidocaine as second-line agents.Pyridoxine should be considered for the treatment of neonatal seizures when first- and second-line drugs are ineffective.

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 efficacy and safety of fronto-orbital plasty using premature frontal suture osteotomy with frontoparietal transposition for the treatment of metopic synostosis.Methods:Retrospective analysis was performed on the clinical data of children with metopic synostosis who were treated in the Department of Burns and Plastic Surgery, Children’ s Hospital of Nanjing Medical University from January 2015 to October 2023 with fronto-orbital plasty, which involved premature frontal suture osteotomy with frontoparietal transposition. The frontal and parietal bones were divided into two bones, then the supraorbital bridge was cut off and the premature frontal suture was removed. The parietal bone block was then placed on the upper edge of the orbital bone, followed by the placement of the two pieces of the frontal bone on the upper edge of the parietal bone. Finally, all bone blocks were secured using absorbable plates. Pre-and post-operative CT scans and reconstructions were performed to measure changes in cranial cavity volume, and complications such as cerebrospinal fluid leakage, infection, and recurrence of metopic synostosis were followed up.Results:A total of 5 patients with metopic synostosis were enrolled, 4 males and 1 female, aged 5 to 14 months. The operation time was 4.5 to 5.5 hours, and the intraoperative blood loss was 50 to 150 ml. All patients completed the treatment without serious complications. The cranial cavity volume increased by 48.53 to 172.00 cm 3 after the operation. Follow-up was conducted for 3 to 6 months, and the trigonocephaly was completely improved without any serious complications. Short-term follow-up indicated stable craniofacial morphology. Conclusion:Fronto-orbital plasty using premature frontal suture osteotomy with frontoparietal transposition is an effective and safe treatment for metopic synostosis. The procedure has a low risk of recurrence and complications, and the result are positive. Recurrence was scarce in the short term, and the long-term situation needs to be observed.

Objective:To evaluate the efficacy and safety of fronto-orbital plasty using premature frontal suture osteotomy with frontoparietal transposition for the treatment of metopic synostosis.Methods:Retrospective analysis was performed on the clinical data of children with metopic synostosis who were treated in the Department of Burns and Plastic Surgery, Children’ s Hospital of Nanjing Medical University from January 2015 to October 2023 with fronto-orbital plasty, which involved premature frontal suture osteotomy with frontoparietal transposition. The frontal and parietal bones were divided into two bones, then the supraorbital bridge was cut off and the premature frontal suture was removed. The parietal bone block was then placed on the upper edge of the orbital bone, followed by the placement of the two pieces of the frontal bone on the upper edge of the parietal bone. Finally, all bone blocks were secured using absorbable plates. Pre-and post-operative CT scans and reconstructions were performed to measure changes in cranial cavity volume, and complications such as cerebrospinal fluid leakage, infection, and recurrence of metopic synostosis were followed up.Results:A total of 5 patients with metopic synostosis were enrolled, 4 males and 1 female, aged 5 to 14 months. The operation time was 4.5 to 5.5 hours, and the intraoperative blood loss was 50 to 150 ml. All patients completed the treatment without serious complications. The cranial cavity volume increased by 48.53 to 172.00 cm 3 after the operation. Follow-up was conducted for 3 to 6 months, and the trigonocephaly was completely improved without any serious complications. Short-term follow-up indicated stable craniofacial morphology. Conclusion:Fronto-orbital plasty using premature frontal suture osteotomy with frontoparietal transposition is an effective and safe treatment for metopic synostosis. The procedure has a low risk of recurrence and complications, and the result are positive. Recurrence was scarce in the short term, and the long-term situation needs to be observed.

Objective:To investigate the application and effect of frontal-orbital reconstruction and distraction osteogenesis in the treatment of Crouzon syndrome using three-dimensiond reconstruction mold (3D-RM).Methods:Retrospective analysis was performed on the clinical data of children with Crouzon syndrome who were treated in the Department of Burning and Plastic Surgery, Children’s Hospital of Nanjing Medical University from January 2018 to December 2021. These children were divided into two groups. The study group performed fronto-orbital reconstruction combined with distraction osteogenesis using 3D-RM, while the control group performed the surgery without using 3D-RM. Intraoperative blood loss, operation time, duration of hospital stay, complication rate, cranial index, frontal and orbital retraction rate and postoperative frontal and orbital contour were compared between the two groups. The independent sample t-test was used to compare the differences in intraoperative blood loss, operation duration, hospital stay, postoperative cranial index and fronto-orbital retraction rate between the two groups. The Chi-square test was used to compare the differences in the incidence of postoperative complications between the two groups. Results:The study group included 10 children, including 6 males and 4 females, ranging in age from 9 to 37 months, with an average age of 19 months. In the control group, 8 children were included, including 5 males and 3 females, ranging in age from 8 to 46 months, with an average age of 25 months. The study group was followed up for 12 to 36 months, with an average of 18 months, and the head shape was better improved. The control group was followed up for 12 to 30 months, with an average of 18 months. No serious complications occurred and the head deformity was improved. There were no significant differences in intraoperative blood loss, operation duration, hospital stay, cranial index, fronto-orbital retraction rate and complication rate between the two groups (all P>0.05). The forehead shape of the study group was more symmetrical than that of the control group, the difference was statistically significant ( P<0.05). Conclusion:The effect of frontal orbital reconstruction and distraction osteogenesis using 3D-RM in the treatment of Crouzon syndrome is positive, the head shape and orbit are significantly improved. There were no serious complications after operation. It can play a good auxiliary role in the operation.

Objective:To investigate the application and effect of frontal-orbital reconstruction and distraction osteogenesis in the treatment of Crouzon syndrome using three-dimensiond reconstruction mold (3D-RM).Methods:Retrospective analysis was performed on the clinical data of children with Crouzon syndrome who were treated in the Department of Burning and Plastic Surgery, Children’s Hospital of Nanjing Medical University from January 2018 to December 2021. These children were divided into two groups. The study group performed fronto-orbital reconstruction combined with distraction osteogenesis using 3D-RM, while the control group performed the surgery without using 3D-RM. Intraoperative blood loss, operation time, duration of hospital stay, complication rate, cranial index, frontal and orbital retraction rate and postoperative frontal and orbital contour were compared between the two groups. The independent sample t-test was used to compare the differences in intraoperative blood loss, operation duration, hospital stay, postoperative cranial index and fronto-orbital retraction rate between the two groups. The Chi-square test was used to compare the differences in the incidence of postoperative complications between the two groups. Results:The study group included 10 children, including 6 males and 4 females, ranging in age from 9 to 37 months, with an average age of 19 months. In the control group, 8 children were included, including 5 males and 3 females, ranging in age from 8 to 46 months, with an average age of 25 months. The study group was followed up for 12 to 36 months, with an average of 18 months, and the head shape was better improved. The control group was followed up for 12 to 30 months, with an average of 18 months. No serious complications occurred and the head deformity was improved. There were no significant differences in intraoperative blood loss, operation duration, hospital stay, cranial index, fronto-orbital retraction rate and complication rate between the two groups (all P>0.05). The forehead shape of the study group was more symmetrical than that of the control group, the difference was statistically significant ( P<0.05). Conclusion:The effect of frontal orbital reconstruction and distraction osteogenesis using 3D-RM in the treatment of Crouzon syndrome is positive, the head shape and orbit are significantly improved. There were no serious complications after operation. It can play a good auxiliary role in the operation.

Objective:To observe the clinical characteristics and guideline compliance of chronic obstructive pulmonary disease (COPD) patients with initial triple therapy in real-life world.Methods:This study is a cross-sectional study. The subjects of the study were COPD patients admitted to 13 hospitals in Hunan Province and Guangxi Zhuang Autonomous Region from December 2016 to December 2021. The initial treatment was triple inhaled drugs. The data collected included gender, age, diagnosis, body mass index (BMI), history of acute exacerbation (AE) in the past year, pulmonary function, COPD Assessment Test (CAT) score, modified British Medical Research Council Dyspnea Questionnaire (mMRC), inhaled drugs and other indicators. The characteristics and differences of COPD patients before and after 2020 were analyzed.Results:7 184 patients with COPD were enrolled in this study, including 2 409 COPD patients treated with initial triple therapy, accounting for 33.5%(2 409/7 184). Taking January 1st, 2020 as the cut-off point, 1 825 COPD patients (75.8%) received initial treatment with triple inhaled drugs before 2020 and 584 patients (24.2%) after 2020 were included in this study. Compared with COPD patients before 2020, the COPD patients after 2020 had higher FEV 1% [(40.9±15.5 )% vs (39.3±15.5)%, P=0.040], lower CAT [(15.8±6.5)point vs (17.5±6.2)point, P<0.001], less AE in the past year [1(0, 2)times vs 1(0, 2)times, P=0.001] and higher rate of non-AE [255(43.7%) vs 581(37.1%), P=0.006]. In addition, before 2020, patients with COPD were mainly treated with open triple drugs (1 825/1 825, 100%); after 2020, 306 patients (52.4%) received open triple inhaled drugs, and 278 patients (47.6%) received closed triple inhaled drugs. Conclusions:In real-life world, most of patients with COPD treated with triple therapy have severe lung function, obvious symptoms and high risk of acute exacerbation. The real-world prescribing of triple therapy in patients with COPD does not always reflect recommendations in guidelines and strategies, and overtreatment is common. After 2020, prescribing triple therapy for COPD patients is more positive and worse consistency with guideline.