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

With the progress of science and technology and the increase of clinical demand, medical robots have developed rapidly and played a important role in promoting the medical cause. Service robot is a branch of medical robot, which is mainly oriented to medical service and assistance needs, and has been applied in many medical scenarios and achieved demonstration effects. This research first describes the development of medical service robots, and then summarizes the key technologies and clinical applications of robots. Finally, it points out the challenges and directions that medical service robots face at present, and puts forward prospects for their further development in the medical field.
Robotics ; Technology

Objective:To evaluate the value of 99Tc m-methoxyisobutylisonitrile(MIBI) SPECT/CT imaging for the identification of dystonic muscles in patients with primary cervical dystonia (PCD). Methods:A total of 10 patients with PCD (3 males, 7 females, age (47.3±9.9) years) and 10 healthy subjects (4 males, 6 females, age (43.5±9.4) years; control group) between August 2019 and October 2021 in China-Japan Friendship Hospital were enrolled prospectively. All subjects underwent 99Tc m-MIBI SPECT/CT scan. The SUV max of 8 bilateral representative muscles, including rectus capitis posterior major, obliquus capitis inferior, splenius capitis, semispinalis, sternocleidomastoid, trapezius, musculus scalenus muscle and levator scapulae were evaluated in control group. In PCD group, muscles with abnormal uptake were determined. ROI was drawn and SUV max was measured. Independent-sample t test was used to analyze the differences of SUV max between normal and abnormal muscles. The detecting rates of neck MRI and SPECT/CT for abnormal muscles were analyzed by χ2 test. Results:Normal muscles of healthy subjects showed mild symmetrical radioactivity distribution, with the SUV max of 1.10±0.19. A total of 60 muscles with abnormal uptake in 10 patients were found, including 7 rectus capitis posterior major, 10 obliquus capitis inferior, 8 splenius capitis, 8 semispinalis, 10 sternocleidomastoid, 5 trapezius, 3 musculus scalenus muscle and 9 levator scapulae. The SUV max of muscles with abnormal uptake was 1.81±0.43, which was higher than that of normal muscles ( t=17.05, P<0.001). Only 30 pieces abnormal hypertrophy muscle were found by neck MRI, and the detecting rate was much lower than that of SPECT/CT (18.75%(30/160) vs 37.50%(60/160); χ2=28.03, P<0.001). Conclusion:99Tc m-MIBI SPECT/CT may be a useful method for identifying dystonic muscles and a guide to precision therapy in patients with PCD.

Objective:To explore the mechanism of highly expressed primary cilia in tibial growth plate chondrocytes accelerating chondrocytes differentiation in young rats with chronic renal failure (CRF).Methods:Forty male 4-week-old SD rats weighing (98±3) g were randomly divided into control group (intragastric administration with distilled water, n=20) and CRF group (intragastric administration with adenine suspension 150 mg·kg -1·d -1, n=20). All the young rats were sacrificed after continuous gavage for 6 weeks. The length of the growth plate was measured with histological sections. Immunofluorescence (IF) was used to detect the expression rate of primary cilia and the level of β-catenin, the key protein of Wnt/β-catenin signaling pathway in tibial growth plate chondrocytes. Chondrocytes isolated from growth plate in two groups were cultured in vitro to P3 generation, and the expression rate of primary cilia in chondrocytes, the levels of Indian hedgehog (IHH) and glycogen synthase kinase 3β (GSK3β) were detected by IF. Co-immunoprecipitation was used to detect the relationship between IHH and GSK3β. Results:Compared with the control group, the relative length of the growth plate was shorter in histological sections [(0.51±0.11) vs (1.00±0.08), t=16.11, P<0.001], the expression rate of primary cilia was higher [(26.3±5.5)% vs (7.6±1.9)%, t=14.37, P<0.001], and the level of β-catenin increased [(7.1±2.0) scores vs (3.6±1.0) scores, t=7.10, P<0.001] in CRF group. In vitro, the expression rate of primary cilia was higher in CRF group chondrocytes [(31.4±8.2)% vs (12.5±3.1)%, t=9.64, P<0.001] than that in control group. The level of IHH in CRF group increased than that in control group [(1 360±270) vs (310±84), t=16.61, P<0.001]. There was no significant difference in GSK3β level of chondrocytes between the two groups [(850±195) vs (780±140), t=1.30, P=0.200]. There was a direct interaction between IHH and GSK3β in CRF group chondrocytes. Conclusions:The expression levels of primary cilia and related protein IHH increase in tibial growth plate chondrocytes of CRF young rats. The IHH protein plays a direct interaction with GSK3β protein, Wnt/β-catenin signaling pathway antagonist, which leads to the activation of Wnt/β-catenin signaling pathway and final accelerated differentiation of chondrocytes. The rapid differentiation of chondrocytes causes the closing trend of growth plate.

With the advancement and development of life science and technology,many problems in liver surgery have been solved,and the surgical procedures of liver surgery have been continuously developed and the indications for surgery have been continuously expanded.Benign and malignant lesions and even donor liver can be performed under laparoscopy.The indications for laparoscopic liver resection are expanding,from superficial liver resection to a wider range of anatomical resection.At the same time of technological advancement,along with the development of the humanistic spirit,liver resection is not only the removal of lesions,but the pursuit of rehabilitation,which is "the best rehabilitation with minimal trauma".Laparoscopic liver resection has been greatly developed due to the spread of the concept of "precise medicine".

Objective:To explore the current situation of obtaining high quality and efficient medical service in clinical application of mobile tele-consultation terminal about cell phone. Methods: The technical basis of mobile teleconsultation terminal of cell phone and its application status in domestic and abroad were analyzed. This method was compared with other tele-consultation method at service, mode and cost and other aspects.Results: In the clinical application, mobile tele-consultation terminal about cell phone has many positive roles and advantages, for example, it could enhance the level of diagnosis and treatment for doctor who work in district and community, and resolve medical burden for patients, and promote grading diagnosis and treatment.Conclusion:The mobile tele-consultation terminal can obtain high quality and efficient medical service by investing lower capital. And with the continuous development of the network tele-consultation technique, satellite consultation technique and mobile terminal consultation of cell phone in future, they will further enhance the hospital medical service ability.

Objective To establish the training objective systems for undergraduates in mili-tary clinical medicine in order to promote the educational reform of military medicine, and to improve the quality of talents training in military medical universities. Methods Literature analysis was made to determine the initial military clinical medical undergraduate training objectives, and a questionnaire was given to experts, on-the-job military doctors, medical graduates to know the real requirements of military doctors' position. A total of 455 valid questionnaires were collected. Then the questionnaire results were discussed and summarized by the method of expert discussion. Finally,. Delphi method was used to determine the ultimate training objective system. Results The ultimate training objective system of military undergraduate clinical medicine contains two aspects, eight fields and sixty-one standards objective systems. Conclusion Organically fusing military medical knowledge, ability and professional quality requirement into two levels and eight modules and clearly understanding the standards and requirements of each module are significantly systematic, advanced and operable, which has important reference value and guiding significance to both the military medical colleges and uni-versities and the local universities.

Objective To investigate the predictable value of susceptibility weighted imaging (SWI)in hemorrhagic transforma-tion (HT)of ischemic stroke.Methods 48 patients with ischemic stroke were involved.The presence and features of HT on CT, T1 WI,DWI and SWI were observed,as well as the distribution and signal features of cerebral microbleeds (CMBs),abnormal visi-bility of venules on SWI sequence.The correlation between those imaging findings and HT were analyzed.Results HT was detected in 19 of 48 patients (39.6%).The sensibility of T1 WI,DWI,SWI in detecting HT were 68.4%,36.8%,100%,respectively.HT was significantly associated with abnormal visibility of venules within the infarction region.The incidence of HT greatly increased with the aggravation of CMBs.Conclusion SWI can be a sensitive predictor for HT,and it’s helpful in making clinical strategy for ischemic stroke.

Objective To observe the efficacy and safety of different initial doses of nebulized budesonide inhalation (BI) in infants and young children with moderate to severe asthma exacerbations.Methods A multi-center,parallel controlled clinical trial was performed during Sep 2008 to Apr 2010 in three hospitals,which were Department of Pediatrics,Shanghai Jiaotong University Affiliated Shanghai First People's Hospital,Department of Pediatrics,Shanghai Jiaotong University School of Medicine Affiliated Xinhua Hospital,and Department of Respiratory,Fudan University Affiliated Children's Hospital.One hundred and fifty children aged 6 to 36 month with moderate to severe asthma exacerbations were randomly divided into two groups.The high-starting-dose group was treated with a dose of 1 mg nebulized BI every 8 h for 2 days,while the conventional-starting-dose group was treated with a dose of 0.5 mg cvcry 8 h for 4 days.The terbutaline sulfate aerosol liquid was administered with a dose of 2.5 mg each time as needed.The primary outcome measures were severity scores,which were assessed at admission (0 h),and 8 h,16 h,24 h,48 h,72 h after treatment separately.The secondary outcome measures included the use of β2 receptor agonist,the systemic use of corticosteroids,average length of hospital stay and total cost.The data was analyzed with SPSS 13.0.Results (1) The clinical severity scores were significantly decreased at all time points after treatment in both groups (P ＜ 0.05).Compared with conventional starting-dose of BI,high starting-dose of 3.25 ± 1.82,P ＜ 0.01).(2) The terbutaline doses and the systemic corticosteroids do-ses were significantly reduced in high-starting-dose group compared with conventional-starting-dose group [(16.27 ± 12.99) mg vs (22.90 ± 18.27) mg,P ＜ 0.05 ; (4.54 ± 18.18) mg vs (11.16 ± 21.34) mg,P ＜ 0.05).The average length of hospital stay and the total cost of the two groups showed no significant differences (P ＞ 0.05).(3) There were no side effects associated with BI.Conclusion Compared with conventional treatment,high-starting-dose of BI can control symptoms fast and reduce the use of systemic corticosteroid without any side effects.BI improved symptoms more quickly at 8 h (2.87 ± 1.60 vs 4.48 ± 2.24,P ＜ 0.01) and 16 h (2.48 ± 1.56 vs

The present paper was aimed to study the relationship between the pneumonia clinical features and the pathogens of pneumonia in children by making use of association rules based on the clinical data of 6 300 cases of pneumonia. Through software analysis, the different association relationship can be obtained between different clinical features of pneumonia in children, such as gender, age and region, etc., and the pathogens of pneumonia. For example, children of different sex with the same pathogen showed different association relationships. Due to the different association relationships between the pneumonia clinical features and the pathogens of pneumonia in children of Guangzhou area, different methods in prevention and treatment of children's pneumonia should be adopted according to actual condition, in order to achieve the best results.
Adolescent ; Age Factors ; Bronchopneumonia ; epidemiology ; microbiology ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Incidence ; Infant ; Male ; Pneumonia ; epidemiology ; microbiology ; Pneumonia, Mycoplasma ; epidemiology ; microbiology ; Pneumonia, Viral ; epidemiology ; microbiology ; Sex Factors ; Software