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Off-label drug use represents a reasonable need for diagnosis and treatment in some cases, but it faces potential risks with drug safety and legal challenges. However, there was no guideline on how to manage the off-label drug use in China. Therefore, Peking Union Medical College Hospital, in cooperation with Evidence-based Medicine Center of Lanzhou University, established a working group and an expert group consisting of multidisciplinary group of experts to develop the Management Guideline for the Off-label Use of Drugs in China (2021). The Guideline is guided by the Law on Doctors of the People's Republic of China and the World Health Organization Guideline Development Manual. This is the first management guideline on the off-label use of drugs, aiming to improve the stakeholders' understanding of this topic and establish a standardized management procedure in China. This guideline has determined nine questions and proposed a total of twenty-three recommendations. The English version of the guideline was published in September 2022. This paper offers a detailed interpretation of the key points of the guidelines in order to provide suggestions and references for the management of off-label drug use.

With the implementation of the Law on Doctors of the People's Republic of China on March 1, 2022, off-label use of drugs has been included into the legislation for the first time. The Law on Doctors of the People's Republic of China stipulates: 'In the absence of effective or better treatment approaches and other special circumstances, after obtaining the informed consent of the patient/guardian/entrusted agent, the clinician can undertake a usage not specified in the drug instruction if supported with evidence. Medical institutions are suggested to establish a management system to review the suitability of prescriptions and medications and strictly standardize the medication behavior of clinicians'. In view of this, Peking Union Medical College Hospital has established the management system for off-label drug use based on evidence-based methods, with the aim to strengthen its management and rational use in our hospital. The measures for off-label drug use have been formulated to safeguard the doctors' legitimate rights, as well as to strictly standardize practicing behavior. Contingency plans have been established for risk prevention and control to protect the patients' rights and escort the off-label use of drugs. Hierarchical management based on the patients' needs and the types of evidence sources for off-label medication use have been adopted to improve its feasibility.

Electrocatalytic nitrate reduction is a promising approach to remove harmful nitrate and produce ammonia in aqueous media. Here, we demonstrate how 3D printed polymer electrodes can be electroless plated with a bimetallic NiCu alloy film suitable for sustained nitrate‐to‐ammonia reduction. Characterization by powder X‐ray diffraction, X‐ray photoelectron spectroscopy, scanning/transmission electron microscopy and energy‐dispersive X‐ray spectroscopy indicate that the electrode has a two‐layer structure consisting of polymer/ coating layer of metal alloys. The composite electrode shows high‐performance in the nitrate‐to‐ammonia electroreduction, giving NH3 Faradaic efficiencies of up to 83 % and NH3 yield rates up to 860 μg/(h cm2) at −0.38 V vs. RHE. We show that the electrode can easily be integrated into a Zn‐nitrate battery, giving a power density of 3.8 mW cm−2 with continuous NH3 production. The system combines three productive outputs, that is removal of nitrate pollutants, synthesis of valuable ammonia and generation of "green" electricity. [ABSTRACT FROM AUTHOR]

Using the multi-physical field simulation software COMSOL, the acoustic characteristics of the multilayer sound absorbing material straight-through perforated pipe muffler are studied by the finite element method. The results show that the finite element calculation of the multilayer sound absorbing material straight-through the perforated pipe muffler agrees well with the experimental measurement results. The reliability of the finite element method for studying the acoustic performance of the straight-through perforated pipe muffler with multilayer sound absorbing materials is shown. Furthermore, the influence of some structural parameters of porous sound absorbing material and micro-perforated plate on the acoustic performance of the multilayer sound absorbing material straight-through perforated pipe muffler is analyzed. The muffler based on multilayer sound absorbing material is different from the traditional muffler. After applying the multilayer sound absorbing material to the straight-through perforated pipe muffler, the transmission loss value greatly increases, which provides new ideas and directions for future research on the muffler. [ABSTRACT FROM AUTHOR]

The multilayer impedance composite sound absorption structure of the new muffler is proposed by combining the microporous plate structure with the resonant sound absorption structure of the porous material. Firstly, the acoustic impedance and acoustic absorption coefficient of the new muffler structure are calculated by acoustic electric analogy method, and then the noise attenuation is calculated. When the new muffler structure parameters change, the relationship among the noise frequency, the sound absorption coefficient and the noise attenuation is calculated by using MATLAB. Finally, the calculated results are compared with the experimental data to verify the correctness of the theoretical calculation. The variation of resonance peak, resonance frequency and attenuation band width of each structural parameter is analyzed by the relation curve. The conclusion shows that it is feasible to use multilayer sound absorbing materials as the body structure of the new muffler. And the influence relationship between the change of various parameters of the sound absorption structure with the sound absorption coefficient and noise attenuation is obtained. [ABSTRACT FROM AUTHOR]