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

A child aged 5 years with pulmonary arterial hypertension was admitted to the First Affiliated Hospital of Xiamen University in December 2017. A truncated mutation in the bone morphogenetic protein receptor 2 (BMPR2) gene [Chr2(GRCh37):g.203395656delA] was detected, which might be responsible for the disease and the diagnosis of hereditary pulmonary arterial hypertension (HPAH) was confirmed. Genetic testing revealed that the child′s father also carried the same mutation in BMPR2 gene, but no gene mutation was detected in child′s mother and young brother; however, no HPAH was developed in child′s father and other family members. The child was treated with targeted drugs for pulmonary arteries with poor response, and died in April 2019. Later, the child′s mother accidentally became pregnant. Gene sequencing test of the amniotic fluid showed that the fetus also carried the BMPR2 gene mutation; the pregnancy was terminated after genetic counseling. HPAH has the clinical characteristics of early onset, rapid progression, and poor prognosis, and the BMPR2 gene mutation is an important pathogenic factor. For HPAH patients with unknown etiology, particularly for pediatric patients, genetic testing is recommended to identify the cause and to make an appropriate clinical management plan.

Objective:To determine the incidence of acute focal bacterial nephritis (AFBN) in children with febrile urinary tract infections (UTI) and to identify associated risk factors.Methods:A retrospective cohort study included 181 children hospitalized with febrile UTI at Fujian Children′s Hospital from April 2021 to September 2023. Demographic data, clinical manifestations, and laboratory findings were collected. Patients were categorized into AFBN group and non-AFBN group based on AFBN diagnosis. The incidence of AFBN within this febrile UTI cohort was determined. The diagnostic value for pre-antibiotic blood white blood cell (WBC) count and C-reactive protein (CRP) level, along with post-treatment fever duration and pyuria duration for AFBN was evaluated using the area under curve (AUC) of the receiver operating characteristic (ROC).Results:The cohort comprised 181 children with febrile UTI (100 boys and 81 girls), age of 0.6 (0.3, 1.0) years. Eleven patients (6.1%) were diagnosed with AFBN. For predicting AFBN, the AUC was 0.71 (95% CI 0.55-0.85, P=0.026) for pre-antibiotic WBC count and 0.80 (95% CI 0.71-0.90, P=0.001) for pre-antibiotic CRP level, with optimal cutoff values of 16.0×10 9/L and 80.1 mg/L, respectively. For post-treatment parameters, the AUC was 0.79 (95% CI 0.69-0.92, P=0.001) for fever duration and 0.84 (95% CI 0.72-0.97, P<0.001) for pyuria duration, with optimal cutoff values of 1.9 d and 5.5 d, respectively. The combination of pre-antibiotic WBC count >16.0×10 9/L and CRP>80.1 mg/L yielded a sensitivity of 0.73 and a specificity of 0.86 for AFBN prediction. Similarly, the combination of post-treatment fever duration ≥2 d and pyuria duration >5 d demonstrated a sensitivity of 0.82 and specificity of 0.88. Conclusions:AFBN incidence was 6.1% in this cohort of children with febrile UTI. AFBN should be highly suspected in febrile UTI children presenting with either a pre-antibiotic WBC count >16.0×10 9/L and CRP >80.1 mg/L, or a post-treatment fever duration ≥2 d and pyuria duration >5 d.

Organic ultraviolet absorbers (OUVs) have been widely used in personal care products and industrial products due to their unique physicochemical properties. However, with the advancement of science and technology and the deepening of research, the potential risks of OUVs have gradually emerged. They have been proven to be persistent, bioconcentrated and potential endocrine disruptors that may pose a threat to human health. In recent years, some OUVs have been widely detected in environmental and human samples worldwide, and the concentration of detection has been increasing year by year, which has attracted extensive attention both domestically and internationally. This article summarizes the research results of OUVs exposure in recent years from two aspects: external environmental exposure and internal human exposure, aiming to provide a valuable reference for the subsequent research on human exposure and health risk assessment of OUVs.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Organic ultraviolet absorbers (OUVs) have been widely used in personal care products and industrial products due to their unique physicochemical properties. However, with the advancement of science and technology and the deepening of research, the potential risks of OUVs have gradually emerged. They have been proven to be persistent, bioconcentrated and potential endocrine disruptors that may pose a threat to human health. In recent years, some OUVs have been widely detected in environmental and human samples worldwide, and the concentration of detection has been increasing year by year, which has attracted extensive attention both domestically and internationally. This article summarizes the research results of OUVs exposure in recent years from two aspects: external environmental exposure and internal human exposure, aiming to provide a valuable reference for the subsequent research on human exposure and health risk assessment of OUVs.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

A child aged 5 years with pulmonary arterial hypertension was admitted to the First Affiliated Hospital of Xiamen University in December 2017. A truncated mutation in the bone morphogenetic protein receptor 2 (BMPR2) gene [Chr2(GRCh37):g.203395656delA] was detected, which might be responsible for the disease and the diagnosis of hereditary pulmonary arterial hypertension (HPAH) was confirmed. Genetic testing revealed that the child′s father also carried the same mutation in BMPR2 gene, but no gene mutation was detected in child′s mother and young brother; however, no HPAH was developed in child′s father and other family members. The child was treated with targeted drugs for pulmonary arteries with poor response, and died in April 2019. Later, the child′s mother accidentally became pregnant. Gene sequencing test of the amniotic fluid showed that the fetus also carried the BMPR2 gene mutation; the pregnancy was terminated after genetic counseling. HPAH has the clinical characteristics of early onset, rapid progression, and poor prognosis, and the BMPR2 gene mutation is an important pathogenic factor. For HPAH patients with unknown etiology, particularly for pediatric patients, genetic testing is recommended to identify the cause and to make an appropriate clinical management plan.

Objective:To determine the incidence of acute focal bacterial nephritis (AFBN) in children with febrile urinary tract infections (UTI) and to identify associated risk factors.Methods:A retrospective cohort study included 181 children hospitalized with febrile UTI at Fujian Children′s Hospital from April 2021 to September 2023. Demographic data, clinical manifestations, and laboratory findings were collected. Patients were categorized into AFBN group and non-AFBN group based on AFBN diagnosis. The incidence of AFBN within this febrile UTI cohort was determined. The diagnostic value for pre-antibiotic blood white blood cell (WBC) count and C-reactive protein (CRP) level, along with post-treatment fever duration and pyuria duration for AFBN was evaluated using the area under curve (AUC) of the receiver operating characteristic (ROC).Results:The cohort comprised 181 children with febrile UTI (100 boys and 81 girls), age of 0.6 (0.3, 1.0) years. Eleven patients (6.1%) were diagnosed with AFBN. For predicting AFBN, the AUC was 0.71 (95% CI 0.55-0.85, P=0.026) for pre-antibiotic WBC count and 0.80 (95% CI 0.71-0.90, P=0.001) for pre-antibiotic CRP level, with optimal cutoff values of 16.0×10 9/L and 80.1 mg/L, respectively. For post-treatment parameters, the AUC was 0.79 (95% CI 0.69-0.92, P=0.001) for fever duration and 0.84 (95% CI 0.72-0.97, P<0.001) for pyuria duration, with optimal cutoff values of 1.9 d and 5.5 d, respectively. The combination of pre-antibiotic WBC count >16.0×10 9/L and CRP>80.1 mg/L yielded a sensitivity of 0.73 and a specificity of 0.86 for AFBN prediction. Similarly, the combination of post-treatment fever duration ≥2 d and pyuria duration >5 d demonstrated a sensitivity of 0.82 and specificity of 0.88. Conclusions:AFBN incidence was 6.1% in this cohort of children with febrile UTI. AFBN should be highly suspected in febrile UTI children presenting with either a pre-antibiotic WBC count >16.0×10 9/L and CRP >80.1 mg/L, or a post-treatment fever duration ≥2 d and pyuria duration >5 d.

Objective:To investigate the strategy of using tissue flaps for repairing scalp defects with exposed skull wounds.Methods:This study was a retrospective observational study. From January 2019 to December 2023, 18 patients (13 males and 5 females, aged 17-59 years) with different scalp defect combined with skull exposure area (hereafter referred to as scalp defect area) who met the inclusion criteria were admitted to Guangzhou Red Cross Hospital of Jinan University. After debridement, the scalp defect area was 1 cm×1 cm to 25 cm×25 cm. For patients with scalp defect area < 9 cm 2 and good local conditions of the surrounding scalp, local flaps with area of 2 cm×2 cm-5 cm×5 cm were used for wound repair. The wound in the donor site of the flap was pulled together and sutured. If the suture tension was large, the skin graft from the head was taken and transplanted for wound repair. For patients with scalp defect area > 9 cm 2 and ≤1/4 of the total scalp area, expanded flaps with area of 5 cm×3 cm-12 cm×12 cm were used for wound repair. The wound in the donor site of the flap was pulled together and sutured directly. For patients with scalp defect area >1/4 and ≤1/2 of the total scalp area, free transplantation of anterolateral thigh flaps with area of 9 cm×7 cm-29 cm×14 cm were used for wound repair. The wound in the donor site of the flap was sutured in layers, and the skin graft from the ipsilateral thigh was transplanted for repair if the tension was large. For patients with scalp defect area >1/2 of the total scalp area, free greater omental flap (28 cm×23 cm-29 cm×26 cm in area) transplantation and thigh skin graft were used for wound repair. The abdominal incision caused by cutting the greater omental flap was sutured directly. The types of tissue flaps were recorded during operation. After operation, the survival of tissue flaps and skin graft in the recipient sites was observed, and the wound healing of flap donor sites/abdominal incision caused by cutting the greater omental flap was observed. During follow up, the survival of tissue flaps and the scar hyperplasia of flap donor site/abdominal incision caused by cutting the greater omental flap were observed. At the last follow-up, the skull necrosis was evaluated by computed tomography scan. Results:For the scalp defect with exposed skull wounds in this group of cases, 4 cases were repaired with local flaps, of which 2 cases were repaired with V-Y advancement flaps, and 2 cases were repaired with local double-pedicle vault stone flaps. The flaps survived completely after operation. Five cases were repaired with expanded flaps, of which 1 patient was implanted with 2 skin and soft tissue expanders, and 4 patients were implanted with 1 skin and soft tissue expander. The expanded flaps survived completely after operation. Seven cases were repaired with free transplantation of anterolateral thigh flaps. After operation, the flap in 6 cases survived, and the distal end of the flap was necrotic in 1 case, and the wound healed well after debridement and suture. Two cases were repaired with free transplantation of greater omental flaps and thigh skin graft, and the greater omental flap and skin graft in the recipient site survived well after operation. After operation, the wound of flap donor site/abdominal incision caused by cutting the greater omental flap healed well. During follow-up, all tissue flaps survived well without skull exposure; the scar hyperplasia of flap donor site/abdominal incision caused by cutting the greater omental flap was not obvious. At the last follow-up, computed tomography scan showed that all patients had no skull necrosis.Conclusions:According to the size of scalp defect, local flap, expanded flap, free anterolateral thigh flap, and free greater omental flap+skin graft are selected successively from small to large to repair the wounds, and the effect is good, which is worthy of clinical promotion.