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

In response to the new requirements for course instruction outlined in the revised training program for medical imaging program, this study integrated medical imaging technology courses based on the principle of outcome-oriented education and by leveraging self-developed digital resources, with imaging methods as the entry point. The core elements of the course teaching were re-optimized and reorganized to transcend the temporal and spatial limitations of course delivery, enabling the rational application of diverse teaching methods. This approach facilitated the integration of knowledge across three specialized courses, namely medical imaging physics, medical imaging equipment, and medical imaging examination techniques, and achieved full-dimensional and whole-process teaching evaluation. While reducing the number of hours allocated to theoretical instruction, the teaching objectives were achieved with high quality, providing a reference for the integration of digital technologies into the teaching of medical imaging and related disciplines.

In response to the new requirements for course instruction outlined in the revised training program for medical imaging program, this study integrated medical imaging technology courses based on the principle of outcome-oriented education and by leveraging self-developed digital resources, with imaging methods as the entry point. The core elements of the course teaching were re-optimized and reorganized to transcend the temporal and spatial limitations of course delivery, enabling the rational application of diverse teaching methods. This approach facilitated the integration of knowledge across three specialized courses, namely medical imaging physics, medical imaging equipment, and medical imaging examination techniques, and achieved full-dimensional and whole-process teaching evaluation. While reducing the number of hours allocated to theoretical instruction, the teaching objectives were achieved with high quality, providing a reference for the integration of digital technologies into the teaching of medical imaging and related disciplines.

Acute fatty liver in pregnancy (Acute fatty liver of pregnancy, AFLP) in pregnancy is a relatively rare critical condition in obstetrics, which is difficult to distinguish in the early stages due to the non-specificity of its clinical manifestations. However, early recognition and timely termination of pregnancy is significant for the treatment of AFLP and is crucial to reduce mortality.This paper will report in detail a patient with AFLP at 37 weeks' gestation, mainly presenting with nausea and vomiting for 1 week and yellow skin for 2 days.Due to the relatively long course of the disease, the patient suffered a regrettable result of fetal death after emergency admission, and severe coagulation dysfunction, pulmonary edema, and pancreatitis occurred.The multidisciplinary team from the department of anesthesiology, ICU, hematology, blood transfusion department and so on, actively corrected coagulation disorders and multiple organ injuries in the emergency termination of pregnancy, and the patient had a good prognosis.The importance of early identification for the treatment of AFLP patients can be demonstrated, and the changes of coagulation function can be closely monitored to guide clinical treatment.

Chemical pollution-induced damage to ecosystem function has been a global challenge.The latest"Kunming-Montreal Global Biodiversity Framework"proposed reducing pollution risks to levels harmless to biodiversity and function,placing higher demands on chemical risk management at the ecosystem level.Conventional ecotoxicity tests have focused on single species,only to neglect genetic diversity protection and simplify species interactions.Here,we proposed using environmental RNA(eRNA)and metatranscriptomic analysis to establish a multi-species,multi-biological level chemical pollution ecological risk assessment approach in exposed communities.We reviewed the current status and trends of eRNA in chemical pollution risk assessment and proposed a strategy for bioeffect testing from molecules to communities based on eRNA,constructing ecological risk assessment models for different protection goals.Finally,we summarized the theoretical and technical challenges facing eRNA-based toxicity testing and outlined the future applications of eRNA in capturing real ecological effects of chemical pollution in the field.

Objective To explore the effect and mechanism of uric acid(UA)in regulating the larval growth and development of Drosophila melanogaster.Methods A total of 1350 newly hatched first-instar larvae of wild-type Drosophila melanogaster(W11 18)were collected,and the Drosophila melanogaster model of hyperurice-mia was constructed with a high purine diet.The larvae were assigned into three groups(n=150):control(stand-ard corn meal medium),low-dose adenine(corn meal medium containing 0.05％adenine),and high-dose ad-enine(corn meal medium containing 0.10％adenine),and two parallel groups were set up.The growth and de-velopment of larvae in each group was observed,and the UA and hormone levels were measured.In addition,the expression levels of genes involved in growth and development were determined.Results Compared with the con-trol group,the low-and high-dose adenine groups showed elevated UA levels(both P＜0.001)and prolonged de-velopmental period(P=0.024,P＜0.001).The high-dose adenine group showed decreased survival rate,pupa-tion rate,and eclosion rate and elevated levels of juvenile hormone(JH)and 20-hydroxyecdysone(20E)(all P＜0.001).The PCR results showed that compared with the control group,high-dose adenine upregulated the mRNA levels of reactive oxygen species(ROS),forkhead box O(FOXO),and mammalian target of rapamycin(mTOR)while downregulating the mRNA levels of Sestrin,mTOR complex 1(mTORC1),and AMP-activated protein kinase(all P＜0.001).Conclusion High concentrations of UA may promote the expression of ROS/FOXO/mTORC1/mTOR signaling pathway by regulating the levels of JH and 20E,thereby inhibiting the larval growth and development of Drosophila melanogaster.

Objective To analyze the clinical characteristics and related to risk factors of late-life depression patients with venous thromboembolism in the elderly ward.Methods A retrospective analysis was conducted on 143 hospitalized depression patients(aged≥60 years)including 65 depression patients with VTE(VTE group)and 78 depression patients without VTE(control group)in the elderly ward of Beijing Anding Hospital from January 2023 to September 2023.The clinic and laboratory data was collected such as general demographic information,relevant clinical data,VTE history,personal history,thyroid function,hormone levels,blood lipid levels and D-dimer to analyze and compare the clinical characteristics of two group patients,and Logistic regression was used to analyze the related risk factors of VTE in patients with depression.Results Compared with control group,patients in the VTE group were older[(70.94±5.88)years vs.(68.04±4.92)years,P<0.05],had a higher total HAMD score(26.35±9.28 vs.23.19±5.94,P<0.05),a higher proportion of a history of VTE[13 cases(20.0%)vs.6 cases(7.7%),P<0.05],a higher proportion of bedridden for more than 72 hours[42 cases(64.6%)vs.31 cases(39.7%),P<0.05],lower HDL-C levels[(1.27±0.27)mmol/L vs.(1.39±0.28)mmol/L,P<0.05],and higher levels of D-dimer[1.91(0.82,3.51)mg/L FEU vs.0.48(0.25,0.80)mg/L FEU,P<0.05].Logistic regression analysis showed that total HAMD scores(OR=1.077,P=0.018),history of VTE(OR=4.339,P=0.023),bedridden for more than 72 hours(OR=2.449,P=0.044),and D-dimer level(OR=2.404,P<0.001)were risk factors for hospitalized late-life depression patients with VTE in the elderly ward.Conclusions Depression patients with VTE in the elderly ward have several clinical characteristics including older age,more severe depressive symptoms,lower HDL-C levels,higher D-dimer levels,and higher proportion of a history of VTE and bedridden for more than 72 hours.Depressive symptoms,a history of VTE,bedridden for more than 72 hours,and D-dimer levels may be risk factors for late-life depression patients with VTE in the elderly ward.

Objective:To analyze the current adoption of palliative care by patients with unresectable metastatic colorectal cancer (mCRC) in China.Methods:From 1 March 2023 to 30 June 2023, a questionnaire survey was conducted by random sampling. An exclusive research platform for the Blue Book on Clinical Diagnosis and Treatment of Metastatic Colorectal Cancer. An online questionnaire was sent to medical oncologists (including chief physicians, associate chief physicians, attending physicians and residents) in general hospitals and oncology hospitals in four major regions of East, Central, South and Northeast China. The questionnaire contained 28 questions requesting basic information about doctors, the number of patients with mCRC, the status of treatment from first to fourth line and beyond, points concerning treatment of pain in patients with mCRC, and expectations for the future. A medical team was responsible for the quality control of data collected, whereas statisticians performed the data cleaning and sorting and statistical analysis.Results:A total of 300 clinical questionnaires were collected, including 217 (72%) from doctors in general hospitals and 83 (28%) from doctors in oncology hospitals. Senior physicians (including associate chief physicians and chief physicians) accounted for 65% of the respondents, attending physicians 30%, and residents 5%. Within 3 months (average for each month), 46.4±26.6% patients were diagnosed with recurrent or unresectable mCRC by each physician, 51.6±26.8% of the patients being in cancer hospitals and 44.4±26.3% in general hospitals. One hundred percent of patients receiving first-line treatment received palliative care, as did 80.3% of those receiving second-line treatment, 58.2% of those receiving third-line treatment, and 35.1% of those receiving ≥fourth-line treatment. The primary factor governing selection of first-line treatment was guideline recommendations, whereas comorbidities and the patients' physical status dictated second line to fourth line treatment. Standard first-line treatment was administered to 93.8% of eligible patients, standard second-line treatment to 94.3%; and standard third-line treatment to 73.5%. First-line therapy included targeted therapy in 63.6% of patients and immunotherapy in 2.8%; second-line therapy included targeted therapy in 63.0% of patients and immunotherapy in 2.0%; third-line therapy included targeted therapy in 59.2% of patients and immunotherapy in 2.2%; and fourth-line therapy included targeted therapy in 48.7% of patients and immunotherapy in 3.1%. First-line treatment lasted an average of 9.6 months, second-line treatment 6.7 months, third-line treatment 4.9 months, and fourth-line treatment 3.7 months. More than 70% of the patients maintained a good quality of life after receiving first and second-line treatment and more than 60% of them had ECOG performance scores of 0–1. After receiving third- and fourth-line treatment, 50%–60% of patients maintained a good quality of life and 40%–50% of them maintained ECOG performance scores of 0–1. The survey also revealed that the main deficiencies in treatment were limited effectiveness of third-line treatment, insufficient availability and opportunity for clinical research, popularity of new drugs or new drug combination strategies, and limited channels for participation in multidisciplinary diagnosis and treatment. Clinicians reported looking forward to participating in more clinical research on new drugs, hearing about the experience of experts in the field, and discovery of new targets and new drugs that increased the options for posterior line treatment of colorectal cancer.Conclusions:This report objectively summarizes the current situation, treatment difficulties, and expectations of frontline physicians concerning management of mCRC, thus providing a basis for decision-making and future direction for the diagnosis and research on treatment of mCRC.

Objective:To analyze the current adoption of palliative care by patients with unresectable metastatic colorectal cancer (mCRC) in China.Methods:From 1 March 2023 to 30 June 2023, a questionnaire survey was conducted by random sampling. An exclusive research platform for the Blue Book on Clinical Diagnosis and Treatment of Metastatic Colorectal Cancer. An online questionnaire was sent to medical oncologists (including chief physicians, associate chief physicians, attending physicians and residents) in general hospitals and oncology hospitals in four major regions of East, Central, South and Northeast China. The questionnaire contained 28 questions requesting basic information about doctors, the number of patients with mCRC, the status of treatment from first to fourth line and beyond, points concerning treatment of pain in patients with mCRC, and expectations for the future. A medical team was responsible for the quality control of data collected, whereas statisticians performed the data cleaning and sorting and statistical analysis.Results:A total of 300 clinical questionnaires were collected, including 217 (72%) from doctors in general hospitals and 83 (28%) from doctors in oncology hospitals. Senior physicians (including associate chief physicians and chief physicians) accounted for 65% of the respondents, attending physicians 30%, and residents 5%. Within 3 months (average for each month), 46.4±26.6% patients were diagnosed with recurrent or unresectable mCRC by each physician, 51.6±26.8% of the patients being in cancer hospitals and 44.4±26.3% in general hospitals. One hundred percent of patients receiving first-line treatment received palliative care, as did 80.3% of those receiving second-line treatment, 58.2% of those receiving third-line treatment, and 35.1% of those receiving ≥fourth-line treatment. The primary factor governing selection of first-line treatment was guideline recommendations, whereas comorbidities and the patients' physical status dictated second line to fourth line treatment. Standard first-line treatment was administered to 93.8% of eligible patients, standard second-line treatment to 94.3%; and standard third-line treatment to 73.5%. First-line therapy included targeted therapy in 63.6% of patients and immunotherapy in 2.8%; second-line therapy included targeted therapy in 63.0% of patients and immunotherapy in 2.0%; third-line therapy included targeted therapy in 59.2% of patients and immunotherapy in 2.2%; and fourth-line therapy included targeted therapy in 48.7% of patients and immunotherapy in 3.1%. First-line treatment lasted an average of 9.6 months, second-line treatment 6.7 months, third-line treatment 4.9 months, and fourth-line treatment 3.7 months. More than 70% of the patients maintained a good quality of life after receiving first and second-line treatment and more than 60% of them had ECOG performance scores of 0–1. After receiving third- and fourth-line treatment, 50%–60% of patients maintained a good quality of life and 40%–50% of them maintained ECOG performance scores of 0–1. The survey also revealed that the main deficiencies in treatment were limited effectiveness of third-line treatment, insufficient availability and opportunity for clinical research, popularity of new drugs or new drug combination strategies, and limited channels for participation in multidisciplinary diagnosis and treatment. Clinicians reported looking forward to participating in more clinical research on new drugs, hearing about the experience of experts in the field, and discovery of new targets and new drugs that increased the options for posterior line treatment of colorectal cancer.Conclusions:This report objectively summarizes the current situation, treatment difficulties, and expectations of frontline physicians concerning management of mCRC, thus providing a basis for decision-making and future direction for the diagnosis and research on treatment of mCRC.

Objective To investigate the imaging value and associated clinical features of enhanced CT evaluation of spontaneous portosystemic shunts(SPSS)in patients with cirrhotic portal hypertension.Methods Patients with cirrhosis who attended Panjin Central Hospital from June 2020 to July 2022 were retrospectively collected to evaluate the presence,size and type of spontaneous portal shunts for statistical analysis,and relevant clinical and laboratory indices were recorded.Results A total of 119 patients with liver cirrhosis were included in this study.Total bilirubin level,albumin level,prothrombin time,international normalized ratio,Child-Pugh grade,hepatic encephalopathy,portal vein thrombosis,and renal vein diameter were all statistically significant difference(P<0.05)compared to the three groups of patients in the no-SPSS,SPSS<8mm and SPSS≥8mm groups.Multi-factor logistic analysis could identify Child-Pugh grade C and portal vein thrombosis as independent risk factors for the occurrence of spontaneous splenorenal shunt(SSRS)≥8mm.In the group without SPSS and in the group with SSRS,there was a statistically significant difference(P<0.05).When comparing uric acid values,left gastric vein diameter and left renal vein diameter.Conclusion The presence of SPSS can be detected early by enhancing CT.The presence of SPSS,especially in patients with a diameter greater than or equal to 8mm,is associated with poorer liver function and a greater risk of portal vein thrombosis;the presence of SPSS reflects the patient's cirrhotic state to some extent.