Mycophenolic acid (MPA), the active moiety of both mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS), serves as a primary immunosuppressant for maintaining solid organ transplants. Therapeutic drug monitoring (TDM) enhances treatment outcomes through tailored approaches. This study aimed to develop an evidence-based guideline for MPA TDM, facilitating its rational application in clinical settings. The guideline plan was drawn from the Institute of Medicine and World Health Organization (WHO) guidelines. Using the Delphi method, clinical questions and outcome indicators were generated. Systematic reviews, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence quality evaluations, expert opinions, and patient values guided evidence-based suggestions for the guideline. External reviews further refined the recommendations. The guideline for the TDM of MPA (IPGRP-2020CN099) consists of four sections and 16 recommendations encompassing target populations, monitoring strategies, dosage regimens, and influencing factors. High-risk populations, timing of TDM, area under the curve (AUC) versus trough concentration (C₀), target concentration ranges, monitoring frequency, and analytical methods are addressed. Formulation-specific recommendations, initial dosage regimens, populations with unique considerations, pharmacokinetic-informed dosing, body weight factors, pharmacogenetics, and drug‍-‍drug interactions are covered. The evidence-based guideline offers a comprehensive recommendation for solid organ transplant recipients undergoing MPA therapy, promoting standardization of MPA TDM, and enhancing treatment efficacy and safety.
Mycophenolic Acid/administration & dosage* ; Drug Monitoring/methods* ; Humans ; Organ Transplantation ; Immunosuppressive Agents/administration & dosage* ; Delphi Technique

Objective:To understand the attitudes toward sexual health education and its correlates among community-based older adults in Shanghai, China.Methods:From June 2020 to December 2022, a cross-sectional survey was conducted among community residents aged ≥50 in Shanghai through multi-stage sampling. The estimated sample size was 735. The questionnaire included sociodemographic characteristics, health characteristics, and history of sexual health education. The multivariable logistic regression model was used to assess the correlates of attitudes toward sexual health education among community-based older adults.Results:A total of 824 participants (489 males and 335 females) with age of (65.1±8.1) years were included, whose main age distribution was 60-69 years (45.3%). The prevalence of supporting sexual health education among older adults was 49.4% (45.2% of men and 55.5% of women). Males (a OR=0.61, 95% CI: 0.44-0.83), aged 70 years and older (a OR=0.62, 95% CI: 0.40-0.94), urban residents (a OR= 2.54, 95% CI: 1.81-3.58), self-reported very good or excellent health status (a OR=1.64,95% CI: 1.04-2.58), having depressive symptoms (a OR=0.37,95% CI: 0.15-0.85), and having a history of sexual health education (a OR=8.64 ,95% CI: 4.62-17.70) were associated with their attitude toward sexual health education. Conclusions:The proportion of community-based older adults in Shanghai who support sexual health education was not high. Their attitudes toward sexual health education were associated with their self-reported health status, depressive symptoms, and history of sex education. Health professionals and institutions should focus on community-based older adults with key characteristics and tailor interventions to promote the willingness to receive sexual health education among older adults in China and to promote the popularity of sexual health education in this population.

Objective:To understand the sexually active status among community-based older adults aged ≥50 years in Tianjin, China, and to explore the potential correlates.Methods:A cross-sectional survey using multistage sampling among community-based older adults aged ≥50 was conducted between June 2020 and December 2022. The estimated sample size was 735. The survey collected questionnaire information through face-to-face interviews with investigators, including sociodemographic, health, and sexual lifestyle characteristics. The multivariable logistic regression model was used to assess correlates of sexually active status.Results:A total of 776 study participants (510 males and 266 females) were included, whose major age distribution was 50-59 years (45.9%). The overall sexual activity prevalence of the participants was 45.6%. Older age (60-69: a OR=0.67, 95% CI: 0.45-0.99; ≥70: a OR=0.12, 95% CI: 0.07-0.21), being male (a OR=1.93, 95% CI: 1.32-2.82), living in urban area (a OR=0.18, 95% CI: 0.12-0.28), living with spouse/married (a OR=2.80, 95% CI: 1.41-5.58), living alone (a OR=0.51, 95% CI: 0.27-0.96), having difficulty climbing stairs or walking (a OR=0.55, 95% CI: 0.31-0.97), having chronic diseases (one chronic disease: a OR=0.55, 95% CI: 0.36-0.85; two or more chronic diseases: a OR=0.53, 95% CI: 0.33-0.84) were associated with sexually active status among older adults. Conclusions:Many community-based older adults remained sexually active. There was an association between physical health and sexually active status among community-based older adults. Incorporating sexual health services into healthcare services for community-based older adults could be advocated, with a concurrent emphasis on enhancing the awareness and competence of providing sexual health services among community-based healthcare workers.

Objective:To investigate the utilization of sexual health services among community-based older adults in Chongqing and explore its potential correlates.Methods:A cross-sectional survey using multistage sampling among community-based older adults aged ≥50 years was conducted in Chongqing between June 2020 and December 2022. A questionnaire including information on demographic characteristics, general health, sexual health status, and sexual health services utilization was collected. Sexual health and reproductive services utilization was defined as having ever been tested for human immunodeficiency virus (HIV), or having had a male/gynecological reproductive health examination in the past year. Logistic regression was used to examine the correlates of the utilization of sexual health services.Results:A total of 794 community-based older adults participated in the study (482 were male, and 312 were female). The mean age was (62.8±8.2) years. The proportion of HIV testing was 18.0%, and the proportion of reproductive health examination was 10.1% among community-based older adults. The results of multivariate logistic regression analysis showed that the age group of 60-69 years (a OR=0.37, 95% CI: 0.18-0.76), female (a OR=11.34, 95% CI: 5.71-22.52), monthly income ≥5 000 yuan (a OR=3.05, 95% CI: 1.01-9.27), being sexual activity (a OR=4.99, 95% CI: 2.23-11.15) was significantly associated with had a reproductive health examination in the past year. Conclusions:The proportion of sexual health services utilization among older adults was low. Older sexual health education should be further strengthened, the close relationship between older adults should be correctly guided and dealt with, and the sexual health services suitable for the older population should be formulated.

Objective:To understand the current status of condom use and its correlates among community-based older adults in Chongqing, China.Methods:Cross-sectional study based on a multistage sampling method was conducted in Chongqing from June 2020 to December 2022. The estimated sample size was 735. Through face-to-face interviews, the investigators collected the sociodemographic characteristics, sexual behavior characteristics, awareness of AIDS prevention knowledge, etc. A multivariable logistic regression model was used to explore the correlates of condom use during the last sexual behavior among the participants. Results:A total of 761 participants were included in this study, with 476 males and 285 females, whose average age was (63.8±8.2) years old, mainly in the age group of 60-69 years (44.5%). Among the participants, the rate of condom use during the last sexual behavior was 9.7%. The multivariable logistic regression analysis indicated that correlates of condom use during the last sexual behavior included urban household registration (a OR=2.34, 95% CI: 1.12-4.89), monthly income of 1 000-4 999 Yuan, and 5 000 Yuan and above (a OR=4.49, 95% CI: 1.31-15.41; a OR=16.33, 95% CI: 4.30-62.00), self-assessed sexual behavior risk as very risky/relatively risky (a OR=3.97, 95% CI: 1.40-11.31), awareness of AIDS prevention knowledge (a OR=0.36, 95% CI: 0.21-0.62). Conclusions:The rate of condom use among community-based older adults in Chongqing is low. Comprehensive intervention measures should be taken in combination with the characteristics and needs of community-based older adults to improve awareness of AIDS prevention knowledge and perception of AIDS risk and promote condom use among this population.

Cholesterol is an important precursor of many endogenous molecules. Disruption of cholesterol homeostasis can cause many pathological changes, leading to liver and cardiovascular diseases. CYP1A is widely involved in cholesterol metabolic network, but its exact function has not been fully elucidated. Here, we aim to explore how CYP1A regulates cholesterol homeostasis. Our data showed that CYP1A1/2 knockout (KO) rats presented cholesterol deposition in blood and liver. The serum levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and total cholesterol were significantly increased in KO rats. Further studies found that the lipogenesis pathway (LXRα-SREBP1-SCD1) of KO rats was activated, and the key protein of cholesterol ester hydrolysis (CES1) was inhibited. Importantly, lansoprazole can significantly alleviate rat hepatic lipid deposition in hypercholesterolemia models by inducing CYP1A. Our findings reveal the role of CYP1A as a potential regulator of cholesterol homeostasis and provide a new perspective for the treatment of hypercholesterolemia.

Objective To explore the clinical application of analgesic and amnestic anesthesia during gastroscope.Methods 120 patients underwent gastroscopy in our hospital were randomly divided into conscious amnesia,analgesia group(experimental group)and painless gastroscopy group(observation group).Induction time recording blood pressure(BP),heart rate(HR)changes,observed gastroscopy procedure and postoperative condition.Results Two groups of patients with BP and HR in each time period,there were no significant differences between them(P＞0.05),and the recovery time of the experimental group(1.43±2.67)min was significantly lower than that of the control group(5.34±0.82)min,propofol total experimental group(34.45±11.12)mg was significantly lower than the control group(92.53±13.67)mg,the difference was significant(P＜0.05),and the experimental group the adverse reaction ratio was significantly lower than the observation group,the difference was significant(P＜0.05).Conclusion Analgesic and amnestic anesthesia during gastroscope had good controllability,fewer adverse reactions,worthy of clinical application.

Objective To document the impact of conversion to mycophenolate mofetil (MMF)at different time points after transplantation on the renal function of renal function.Methods A longterm,multicenter,non-interventional and observational study was done.Two cohorts were included:One was Switch cohort (340 cases) including renal allograft recipients who switched to MMF at least 6 months after renal transplantation and followed up for 4 years after switch; The other was Stay cohort (123 cases),including renal allograft recipients who received MMF treatment after transplantation and followed up for 4 years after enrollment.Results GFR values of patients in Switch cohort was significantly increased after switch,and the change in GFR slope was 3.1 mL· min-1 · year-1 (P＜0.01).GFR values of patients in Stay cohort kept steady before and after enrollment,and the change in GFR slope was 0.44 mL·min-1 ·year-1 (P＞0.05).Statistically significant difference in the onset time of GFR decline (defined as 20％ decline from the baseline) was observed among subgroups within Switch cohort (P＜0.01),but there was no significant difference among subgroups within Stay cohort (P＞0.05).Stay cohort was 12％ higher than in Switch cohort every year.Conclusion Conversion to MMF ＞6 months or even many years after transplantation can obviously improve the renal function of recipients.The earlier conversion can benefit improvement of the renal function.

Objective To investigate the therapeutic effects of haploidentical hematopoietic stem-cell transplantation (Haplo-PBSCT) for acute myeloid leukemia in first relapse after complete remission by standard induction chemotherapy. Methods Eighty-nine cases of AML in first relapse after complete remission by standard DA/Hi-Ara-C regimens induction chemotherapy were evaluated retrospectively. Fiftythree cases were grafted by haplo-PBSCT and 26 cases were treated with iDA/Mid-Ara-C or MA/ Mid- Ara-C agents. Results The second remission rate in haplo-PBSCT group and continuous chemotherapy group was 86. 7 % (46/53 cases) and 38. 1% (9/23 cases) respectively (P＜0. 01). Survival postprogression (SPP) at 36th month was 43. 4 % (23/53 cases) in haplo-PBSCT group and 11.5 % (3/26 cases) in continuous chemotherapy group (P ＜ 0. 05). Conclusion Haplo-PBSCT could significantly increase the second remission rate and prolong the survival time of patients with acute myeloid leukernia in first relapse after complete remission by standard induction chemotherapy.

BACKGROUND: Hepatic myelopathy results from liver disease, which lacks of effective cure method. Liver transplantation has attempted to cure this disease; however, the long-term therapeutic effect is rarely reported. OBJECTIVE: To explore the long-term therapeutic effect of liver transplantation in patients with hepatic myelopathy. METHODS: The clinical data of 2 patients with hepatic myelopathy, who underwent orthotopic liver transplantation, in August 2002 and November 2004, at the 309 Hospital of Chinese PLA, were analyzed retrospectively. The time of follow-up was 18 and 43 months, respectively. The muscle strength of double lower limbs in 2 patients was assessed prior to and after operation. RESULTS AND CONCLUSION: Two patients recovered well at 4 weeks after transplantation, the clinical symptom and physical signs of patients were improved obviously, the blood routine examination and other biochemical index were normal,and the function of transplanted kidney was normal. Two patients discharged at 6 weeks after transplantation. Patient 1 could stand for a long time at months 6 after transplantation, walked slowly with the supporter after 12 months and without the supporter at 43 months. The muscular strength of two lower limbs was grade 4. And the liver function was normal. Patients 2 could move his lower limbs in bed at months 6 after transplantation, walked with the supporter at 18 months. The muscular strength of two lower limbs was grade 3. The liver function was normal. It demonstrated that liver transplantation is beneficial to control hepatic myelopathy and recover muscular strength of two lower limbs. It is a newly developed, effective curing method for treating hepatic myelopathy. However, the numbers were small with short time observation, thus, the long-term therapeutic effect still need to be explored.