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

Breast cancer is the most common malignant tumor among women, and early diagnosis, coupled with optimized treatment strategies is crucial for improving the prognosis. In recent years, with the advancement of nanotechnology, manganese-based nanomaterials have shown potential in various aspects of early breast cancer diagnosis, drug delivery, and tumor treatment. Compared to other nanomaterials, manganese-based nanomaterials exhibit excellent biocompatibility and have become a significant focus in the research of breast cancer diagnosis and treatment.

Objective:To evaluate the efficacy and safety of gold micrhenedle radiofrequency and other photoelectric methods in the treatment of facial acne depression scar by using a meta-analysis.Methods:From January 2015 to August 2022, gold microneedles and radio frequence for treatment of facial acne depression scar of randomized controlled trial were retrieved from CNKI, Wanfang Database, VIP, China Biomedical Literature Service System, PubMed database, Cochrane Library and Embase database, including 12 papers. There were 6 Chinese and 6 English literatures, with a sample size of 612 cases.Results:Gold microneedling radio-frequency showed better efficacy in the treatment of facial acne depression scar ( P<0.05). After subgroup analysis, the effective rate in the observation group was higher than that in the control group after 4 treatments, and the difference was statistically significant ( P<0.05). Clinical acne scarring assessment scale, pain score and recovery time had statistically significant difference ( P<0.05). Conclusions:Gold microneedling radiofrequency alone or in collaboration with other photoelectricity in the treatment of acne depression scar has short rest period, slight pain, and obvious improvement of scar effect. However, the improvement effect on icicle depression scar is limited.

Objective: To develop a simplified Rating Questionnaire of Social Ecological Risks in Adolescents and to evaluate the reliability and predictive validity of the brief questionnaire, so as to provide data and evidence support for building the evaluation system of cumulative social ecological risk exposure. Methods: A large cross sectional was conducted in eight areas, including Shenzhen, Zhengzhou, Xuzhou, Nanchang, Shenyang, Taiyuan, Kunming and Chongqing, from October to December 2021. A total of 22 868 adolescents were included in the analysis. Data on healthy behaviors from 10 838 adolescents from Shenyang, Taiyuan, Kunming, Chongqing were used for item selection, based on factor analysis, validity and reliability evaluation. The data from Shenzhen, Zhengzhou, Xuzhou, Nanchang, including 12 030 adolescents, were used to define the partition values of the brief questionnaire, and evaluate the predictive validity. Results: The brief questionnaire containing 25-item were developed by analyzing and choosing all items of original questionnaire, and covered seven dimensions including individual, family, school, community, policy, time and culture. The cumulative contribution rate of variance was 54.95%, the Cronbach coefficient was 0.79, and the split half coefficient was 0.70. Participants in the higher risk group had significantly higher risk of smoking ( OR =4.05, 95% CI = 2.78 -5.92), drinking ( OR =3.47, 95% CI =2.86-4.19), suicidal ideation ( OR =8.85, 95% CI =7.68-10.21), suicidal plans ( OR = 8.85, 95% CI =7.27-10.78), suicidal attempt ( OR = 8.86 , 95% CI =6.67-11.78) than individual in the lower risk group ( P < 0.05). After stratified by gender, the above positive correlations still remained significant( P <0.05). Conclusion The brief questionnaire, with good reliability and predictive validity, could be widely applicated in the further researches on social ecological risk factors.

Objective To investigate the genetic diversity and genetic differentiation of different geographical isolates of Gohieria fusca.. Methods G. fusca isolates were sampled from Wuhu (WH), Bengbu (BB) and Bozhou cities (BZ) of Anhui Province and Jiaxing City of Zhejiang Province (JX). Mitochondrial cytochrome b (Cytb) and ribosomal internal transcribed spacer (ITS) genes were amplified in WH, BB, BZ and JX isolates of G. fusca using PCR assay. The gene sequences were edited and aligned using the software Chromas 2 and DNASTAR 1.00, and the haplotype, haplotype diversity (Hd) and nucleotide polymorphism (Pi) of each isolate were calculated using the software DnaSP 5.10.00. The genetic differentiation among isolates (F_st) and gene flow value (N_m) were estimated using the software MEGA 10.2, and a phylogenetic tree was built. Tests of neutrality and analysis of molecular variance (AMOVA) were performed using the software Arlequin 3.1 and a haplotype network was built based on the Median-Joining network using the software Network 10.2. Results PCR assay showed that the sizes of the Cytb and ITS genes were 372 bp and 1 301 to 1 320 bp, respectively. All four isolates of G. fusca presented high genetic diversity based on mitochondrial Cytb and ITS genes (Hd = 0.804, Pi = 0.006 91). AMOVA showed genetic differentiation among geographical isolates of G. fusca (F_st = 0.202 40, P < 0.05), and the genetic variation was mainly caused by intra-population variations (79.76%). Gene flow analysis showed a high level of gene flow among G. fusca isolates (N_m > 1). Tests of neutrality based on Cytb gene measured a Tajima’s D value of −1.796 31 (P < 0.05) and a Fu’s FS value of −3.293 98 (P < 0.05) in WH isolate of G. fusca, indicating population expansion in WH isolate of G. fusca. Haplotype network analysis and phylogenetic analysis revealed no remarkable geographical distribution pattern among different geographical isolates of G. fusca. All four isolates of G. fusca presented high genetic diversity (Hd = 0.985, Pi = 0.011 97). AMOVA showed moderate level of genetic differentiation between four isolates (F_st = 0.104 62, P < 0.05). The tests of neutrality based on ITS genes measured a Tajima’s D value of −6.088 20 and a Fu’s FS value of −1.935 99 (both P > 0.05) in the whole isolate of G. fusca, indicating no obviously population expansion. Conclusions The four geographical isolates of G. fusca have high genetic diversity and remarkable genetic differentiation. Since a high level of gene flow is detected among different geographical isolates of G. fusca, no obvious geographical distribution pattern of G. fusca is found.

Objective:To construct an evaluation index system of teaching quality in medical schools.Methods:The text entry analysis was used to construct the index entry pool. The thematic group discussions were used to determine the preliminary index system. The Delphi method was used to further select the index. Finally, the analytic hierarchy process was used to determine the index weight and perform consistency test. EpiData 3.2 was used to build database, and MATLAB was used for statistical analysis and solving judgment matrix.Results:The index framework was established by attitude, content, method and effect, which was refined into 10 secondary indicators and 20 tertiary indicators such as passing on knowledge, knowledge mastering, and so on. The consistency test coefficients of each layer was less than 0.1.Conclusion:The method of constructing the indicator system is scientific, and the selection of indicators is in line with the current medical education reform, which has certain feasibility and guiding significance.

Objective To explore the relationship between metabolic syndrome(MS) and corrected QT(QTc) interval prolongation.Methods A total of 1 260 participants having electrocardiogram examinations,aged over 18 years old from June 2015 to June 2016 were included and divided into the MS group and non-MS group.QTc was calculated according to the Bazett formula.The Logistic regression model was established for exploring the association between MS and QTc.Results There were 63 cases of QTc interval prolongation in the MS group,however,40 cases in the non-MS group(P＜0.01).In the unadjusted model,MS was a risk factor of QTc interval prolongation[OR =6.36,95 ％ CI(2.34,8.67),P＜ 0.01].After further adjusting confounders,MS was still correlated with QTc interval prolongation[OR =4.11,95 ％ CI(2.09,7.13,P＜ 0.01].In the study of the relationship between the MS groups with QTc interval prolongation,after adjusting confoundingfactors,only abdominal obesity[OR=2.76,95％ CI(1.43,7.56),P＜0.01] and hypertriglyceridemia[OR=1.75,95％CI(1.22,4.31),P=0.013)] were closely correlated with QTc interval prolongation.Conclusion MS is an independent risk factor of QTc interval prolongation.It is especially important to strengthen the management of blood lipid and abdominal circumference.

This study was aimed to observe the influence of β-sitosterol (BSS) on estrogen receptor (ER) positive the human breast cancer cell line T47D and to study its mechanisms. ER antagonist ICI182 780 was employed to observe the influence on the proliferation. Proliferations of T47D cells influenced by different concentrations of BSS were analyzed by MTT assay. Cell cycle analyses were examined by flow cytometry. The protein expression of cyclin D1 was measured by western blot analysis and cyclin D1 mRNA was quantified by real-time PCR assay. The results showed that BSS in high dose exhibited significant inhibitory effects that were partly antagonized by ICI182 780 and decreased the proliferative index on T47D cells. However, BSS in low dose obviously promoted the proliferation that was completely inhibited by ICI182 780 and increased the proliferative index on T47D cells. The mRNA and protein levels of cyclin D1 were increased in low-dose BSS. The effect was blocked by ICI182 780. It was concluded that BSS in low concentration had phytoestrogenic effect by up-regulating the expression of cyclin D1 via ER pathway.

This study was aimed to investigate effects of Er-Xian (EX) decoction in follicular granulosa cell apoptosis in chemotherapy-induced premature ovarian failure (POF) of rats. SD rats were randomly divided into the normal group, model group, positive group and EX decoction group. Intraperitoneal injection of cisplatin was used in the establishment of chemotherapy-induced POF rat model. Intragastric administration of corresponding medication was give to each group for four weeks. The general conditions of rats were observed. The serum contents of E2, FSH, LH and Pro were determined. The ovarian tissue morphology was observed. Granulosa cell apoptosis was analyzed by TUNEL. The expressions of BAX, Bcl-2 and VEGF protein were detected by immunohistochemistry. The results showed that in the model group, the body weight decreased with disordered estrous cycle. After treatment, the weight gained, and the estrous cycle recovered. Compared with the normal group, in the model group, E2 decreased, FSH and LH levels increased. There was no significant difference in the content of progesterone among different groups. Detection of TUNEL showed that the positive expression in the model group was increased compared with the normal group (P < 0.05). The positive expression of EX decoction group was reduced compared to the positive group (P < 0.05). Compared with the normal group, the expression of BAX was obviously increased and Bcl-2 was decreased in the model group. After EX decoction treatment, the expression of BAX was decreased and the Bcl-2 was increased compared to the model group. The expression of VEGF protein in the model group was obviously less than that in the normal group. It was concluded that cisplatin can induce follicular granulosa cell apoptosis, and cause premature ovarian function recession. EX decoction can adjust the content of different hormones in serum, alter expression of apoptosis related protein to reduce the damage of cisplatin on ovarian follicular development, in order to promote follicular development, improve and enhance the ovarian function.

Aim To study the effect of ginsenoside F1 on the enzyme activity and expression of gene of CYP3 A4 through activation of pregnane X receptor ( PXR ) . Methods With different concentrations of ginsenoside F1 treated on LS174T cells, the expression of CYP3A4 mRNA was determined by Q-PCR, and the enzyme activity was measured by P450-GloTM CYP3A4 assay according to the manufacturer′s instructions, fur-ther PXR-CYP3 A4 stable translation HepG2 cell lines were used to test ginsenoside F1 activates PXR by re-porter gene screening assay. Results The results re-vealed that the levels of CYP3 A4 gene and protein ex-pression were significantly increased by ginsenoside F1 in a concentration-dependent manner. At the same time, reporter gene screening showed that ginsenoside F1 could also enhance the transcriptional activity of PXR. Conclusion Ginsenoside F1 can significantly up-regulate the gene expression and enzyme activity of CYP3A4 via the PXR-CYP3A4 pathway.