Off-label drug use,being urgent and rational under certain circumstances,has existed in clinical practice all the time.While the academic community is divided on this issue,resolving the balance between ensuring the safety of medicines for the public and the availability of medicines for certain groups of the population remains a major concern of the society,but to favour either side is to neglect the defence of the rights of the other side.The implementation of"Law on Practicing Doctors of the People's Republic of China"brings new opportunities and requirements for off-label drug use.With the causes and ethical certification of off-label drug use as a starting point,it holds to the premise of strictly controlling the applicable conditions of off-label drug use and brings forward countermeasures of laws and regulations for the following three aspects:the realization of legal involvement and cohesion of off-label drug use,the issue of unified standards for evidence-based medicine and the encouragement of updating and replacing drug specifications.

Off-label drug use,being urgent and rational under certain circumstances,has existed in clinical practice all the time.While the academic community is divided on this issue,resolving the balance between ensuring the safety of medicines for the public and the availability of medicines for certain groups of the population remains a major concern of the society,but to favour either side is to neglect the defence of the rights of the other side.The implementation of"Law on Practicing Doctors of the People's Republic of China"brings new opportunities and requirements for off-label drug use.With the causes and ethical certification of off-label drug use as a starting point,it holds to the premise of strictly controlling the applicable conditions of off-label drug use and brings forward countermeasures of laws and regulations for the following three aspects:the realization of legal involvement and cohesion of off-label drug use,the issue of unified standards for evidence-based medicine and the encouragement of updating and replacing drug specifications.

Objective To evaluate the clinical outcome of kidney transplantation from donation after brain death(DBD)donors complicated with acute kidney injury(AKI).Methods Clinical data of 216 DBD donors were retrospectively analyzed,and they were divided into the AKI group(n=69)and control group(n=147)according to the Kidney Disease:Improving Global Outcomes(KDIGO)guidelines.Donors in the AKI group were further divided into the KDIGO stage 1 and stage 2-3 subgroups.One hundred and thirty-five recipients were assigned into the AKI group and 288 recipients in the control group.Postoperative recovery of renal function and clinical outcomes of the recipients were recorded.The risk factors of delayed graft function(DGF)were identified.Results The highest serum creatinine(Scr)level,Scr level before procurement,the highest blood sodium level and blood sodium level before procurement in the AKI group were higher than those in the control group.The application duration of vasopressors in the AKI group was longer than that in the control group.In the AKI group,the amount of fluid resuscitation within 48 h was higher,the HCO3-level at admission was lower,and the incidence of diabetes insipidus and hypotension was higher than those in the control group.The highest Scr level and the Scr level before procurement in KDIGO stage 2-3 donors were significantly higher than those in KDIGO stage 1 counterparts(all P＜0.05).Compared with the control group,the incidence of DGF and acute rejection was higher,the proportion of continuous renal replacement therapy was higher,the Scr level within postoperative 90 d was higher,and the urine amount within postoperative 3 d was less than those of recipients in the AKI group.Compared with KDIGO stage 1 recipients,KDIGO stage 2-3 recipients had higher Scr levels at postoperative 3,4,5 and 15 d,and less urine amount at postoperative 2 d(all P＜0.05).Univariate analysis showed that donor age,the highest Scr level,the highest blood sodium level and the amount of fluid resuscitation within 48 h were the risk factors for DGF in recipients after kidney transplantation.Multivariate analysis showed that donor age was the independent risk factor for DGF in recipients after kidney transplantation(all P＜0.05).Conclusions For the application of DBD donors complicated with AKI,active organ maintenance should be performed to alleviate AKI.It exerts no effect upon graft function and survival rate at postoperative 6 months,which may achieve equivalent efficacy as non-AKI donors and may be used as a source of extended criteria donor kidneys.

Off-label drug use,being urgent and rational under certain circumstances,has existed in clinical practice all the time.While the academic community is divided on this issue,resolving the balance between ensuring the safety of medicines for the public and the availability of medicines for certain groups of the population remains a major concern of the society,but to favour either side is to neglect the defence of the rights of the other side.The implementation of"Law on Practicing Doctors of the People's Republic of China"brings new opportunities and requirements for off-label drug use.With the causes and ethical certification of off-label drug use as a starting point,it holds to the premise of strictly controlling the applicable conditions of off-label drug use and brings forward countermeasures of laws and regulations for the following three aspects:the realization of legal involvement and cohesion of off-label drug use,the issue of unified standards for evidence-based medicine and the encouragement of updating and replacing drug specifications.

Off-label drug use,being urgent and rational under certain circumstances,has existed in clinical practice all the time.While the academic community is divided on this issue,resolving the balance between ensuring the safety of medicines for the public and the availability of medicines for certain groups of the population remains a major concern of the society,but to favour either side is to neglect the defence of the rights of the other side.The implementation of"Law on Practicing Doctors of the People's Republic of China"brings new opportunities and requirements for off-label drug use.With the causes and ethical certification of off-label drug use as a starting point,it holds to the premise of strictly controlling the applicable conditions of off-label drug use and brings forward countermeasures of laws and regulations for the following three aspects:the realization of legal involvement and cohesion of off-label drug use,the issue of unified standards for evidence-based medicine and the encouragement of updating and replacing drug specifications.

Off-label drug use,being urgent and rational under certain circumstances,has existed in clinical practice all the time.While the academic community is divided on this issue,resolving the balance between ensuring the safety of medicines for the public and the availability of medicines for certain groups of the population remains a major concern of the society,but to favour either side is to neglect the defence of the rights of the other side.The implementation of"Law on Practicing Doctors of the People's Republic of China"brings new opportunities and requirements for off-label drug use.With the causes and ethical certification of off-label drug use as a starting point,it holds to the premise of strictly controlling the applicable conditions of off-label drug use and brings forward countermeasures of laws and regulations for the following three aspects:the realization of legal involvement and cohesion of off-label drug use,the issue of unified standards for evidence-based medicine and the encouragement of updating and replacing drug specifications.

Off-label drug use,being urgent and rational under certain circumstances,has existed in clinical practice all the time.While the academic community is divided on this issue,resolving the balance between ensuring the safety of medicines for the public and the availability of medicines for certain groups of the population remains a major concern of the society,but to favour either side is to neglect the defence of the rights of the other side.The implementation of"Law on Practicing Doctors of the People's Republic of China"brings new opportunities and requirements for off-label drug use.With the causes and ethical certification of off-label drug use as a starting point,it holds to the premise of strictly controlling the applicable conditions of off-label drug use and brings forward countermeasures of laws and regulations for the following three aspects:the realization of legal involvement and cohesion of off-label drug use,the issue of unified standards for evidence-based medicine and the encouragement of updating and replacing drug specifications.

Off-label drug use,being urgent and rational under certain circumstances,has existed in clinical practice all the time.While the academic community is divided on this issue,resolving the balance between ensuring the safety of medicines for the public and the availability of medicines for certain groups of the population remains a major concern of the society,but to favour either side is to neglect the defence of the rights of the other side.The implementation of"Law on Practicing Doctors of the People's Republic of China"brings new opportunities and requirements for off-label drug use.With the causes and ethical certification of off-label drug use as a starting point,it holds to the premise of strictly controlling the applicable conditions of off-label drug use and brings forward countermeasures of laws and regulations for the following three aspects:the realization of legal involvement and cohesion of off-label drug use,the issue of unified standards for evidence-based medicine and the encouragement of updating and replacing drug specifications.

Off-label drug use,being urgent and rational under certain circumstances,has existed in clinical practice all the time.While the academic community is divided on this issue,resolving the balance between ensuring the safety of medicines for the public and the availability of medicines for certain groups of the population remains a major concern of the society,but to favour either side is to neglect the defence of the rights of the other side.The implementation of"Law on Practicing Doctors of the People's Republic of China"brings new opportunities and requirements for off-label drug use.With the causes and ethical certification of off-label drug use as a starting point,it holds to the premise of strictly controlling the applicable conditions of off-label drug use and brings forward countermeasures of laws and regulations for the following three aspects:the realization of legal involvement and cohesion of off-label drug use,the issue of unified standards for evidence-based medicine and the encouragement of updating and replacing drug specifications.

To summarize the nursing care of a patient with hypovolemic hypematrium encephalopathy after cardiac surgery.Nursing focus:indwelling gastric tube to trans gastrointestinal combined with intravenous fluid therapy;implementing fluid management strategy with right heart protection as the core;the electrolyte changes should be closely monitored and the rate of sodium reduction should be strictly controlled;paying attention to the state of neurological function and carrying out rehabilitation training as soon as possible.After active treatment and nursing care,the patient recovered and was discharged from hospital on the 28th day after surgery.