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

OBJECTIVES: To study the impact of SURF4 expression level on long-term prognosis of gastric cancer (GC) and biological behaviors of GC cells. METHODS: SURF4 expression level in GC and its association with long-term patient prognosis were analyzed using publicly available databases and in 155 GC patients with low and high SURF4 expressions detected immunohistochemically. The Cox proportional hazard model and Kaplan-Meier survival curves were used to analyze independent prognostic predictors of GC and the 5-year survival rate of the patients with different SURF4 expression levels. Informatics analyses were conducted to explore the correlation of SURF4 expression level with immune cell infiltration in GC, SURF4-related differential genes and their associated pathways. In cultured GC cell line HGC-27, the effects of SURF4 knockdown and overexpression on proliferation, migration, invasion and epithelial-mesenchymal transition (EMT) were investigated. RESULTS: Analysis of GEPIA dataset and immunohistochemical results suggested significant SURF4 overexpression in GC (P<0.05), which was associated with shortened 5-year survival time of the patients (χ²=38.749, P<0.001). The prognosis of GC was closely related to tumor stage T3-4, N2-3, CEA≥5 μg/L and CA19-9≥37 kU/L (P<0.05). SURF4 expression level was negatively correlated with activated B cells, NK cells and CD8⁺ effector memory T cells (P<0.05) and positively correlated with CD4⁺ T cells (P<0.05). GO and KEGG enrichment analysis suggested that SUFR4 may participate in GC carcinogenesis by promoting EMT through the tight junction pathway. In HGC-27 cells, SURF4 overexpression significantly decreased E-cadherin expression, increased N-cadherin expression, inhibited ZO-1 and claudin-1 expressions, and promoted cell proliferation, migration and invasion. CONCLUSIONS SURF4 is highly expressed in GC, and its overexpression is associated with a shortened 5-year survival of the patients possibly by enhancing tumor cell proliferation, migration and invasion via inhibiting tight junction proteins and promoting EMT.
Humans ; Stomach Neoplasms/metabolism* ; Cell Proliferation ; Cell Movement ; Epithelial-Mesenchymal Transition ; Cell Line, Tumor ; Neoplasm Invasiveness ; Prognosis ; Tight Junction Proteins/metabolism* ; Membrane Proteins/metabolism* ; Female ; Male

Objective To analyze the risk factors of ultrasound-guided percutaneous transluminal angioplasty(PTA)for treating thrombotic occlusion of autogenous arteriovenous fistula(AVF).Methods A total of 144 patients with thrombotic occlusion of autologous AVF were retrospectively enrolled and divided into success group(n=114)and failure group(n=30)according to the success of treatment or not.Clinical data and ultrasonic parameters of AVF were compared between groups.A multivariate logistic regression model was constructed to analyze the risk factors of PTA for treating thrombotic occlusion of autologous AVF,and the results were visualized by nomogram.Then receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated to evaluate the predictive efficacy of this model.Results Patients'age,use years of AVF,degree of vascular calcification,the mean Young modulus(Emean),the maximum Young modulus(Emax)and the minimum Young modulus(Emin)were all higher,while the number of venous outflow tracts of AVF was less in failure group than those in success group(all P＜0.05).Moderate to severe calcification of vascular,high Emean of thrombus and 1 venous outflow tract of in AVF were all independent risk factors of ultrasound-guided PTA for treating thrombotic occlusion of autologous AVF(all P＜0.05),and AUC of the obtained model for predicting failure of treatment was 0.969.Conclusion Moderate to severe calcification of vascular,high Emean of thrombus and 1 venous outflow tract of AVF were all independent risk factors of ultrasound-guided PTA for treating thrombotic occlusion of autologous AVF.

[Purpose]To analyze the results of cervical cancer screening among married women of 25～64 years old in Shihezi City from 2021 to 2023,and to explore the risk factors of cervical le-sions.[Methods]The results of cervical cancer screening among married women aged 25～64 years old in Shihezi City from 2021 to 2023 were retrospectively analyzed.The detection rates of common gynecological diseases,cervical cancer and precancerous lesions and human papillo-mavirus(HPV)infection by cervical cytology,colposcopy and cervical biopsy were analyzed.[Re-sults]The HPV infection(mainly single infection)rate was 10.74％.The common gynecological diseases were vaginitis,cervicitis and uterine leiomyoma.The detection rate of cervical cancer was 19.59/105,and the detection rate of cervical precancerous lesions was 308.52/105.Rural resi-dents,HPV 16/18 infection,genital warts were the risk factors for cervical lesions.[Conclusion]Female cervical lesions are significantly correlated with HPV 16/18 infection,genital condyloma acuminatum,particularly for rural residents,and preventive care,early screening and interven-tion should be strengthened for these populations.

[Purpose]To analyze the results of cervical cancer screening among married women of 25～64 years old in Shihezi City from 2021 to 2023,and to explore the risk factors of cervical le-sions.[Methods]The results of cervical cancer screening among married women aged 25～64 years old in Shihezi City from 2021 to 2023 were retrospectively analyzed.The detection rates of common gynecological diseases,cervical cancer and precancerous lesions and human papillo-mavirus(HPV)infection by cervical cytology,colposcopy and cervical biopsy were analyzed.[Re-sults]The HPV infection(mainly single infection)rate was 10.74％.The common gynecological diseases were vaginitis,cervicitis and uterine leiomyoma.The detection rate of cervical cancer was 19.59/105,and the detection rate of cervical precancerous lesions was 308.52/105.Rural resi-dents,HPV 16/18 infection,genital warts were the risk factors for cervical lesions.[Conclusion]Female cervical lesions are significantly correlated with HPV 16/18 infection,genital condyloma acuminatum,particularly for rural residents,and preventive care,early screening and interven-tion should be strengthened for these populations.

Objective To analyze the risk factors of ultrasound-guided percutaneous transluminal angioplasty(PTA)for treating thrombotic occlusion of autogenous arteriovenous fistula(AVF).Methods A total of 144 patients with thrombotic occlusion of autologous AVF were retrospectively enrolled and divided into success group(n=114)and failure group(n=30)according to the success of treatment or not.Clinical data and ultrasonic parameters of AVF were compared between groups.A multivariate logistic regression model was constructed to analyze the risk factors of PTA for treating thrombotic occlusion of autologous AVF,and the results were visualized by nomogram.Then receiver operating characteristic curve was drawn,and the area under the curve(AUC)was calculated to evaluate the predictive efficacy of this model.Results Patients'age,use years of AVF,degree of vascular calcification,the mean Young modulus(Emean),the maximum Young modulus(Emax)and the minimum Young modulus(Emin)were all higher,while the number of venous outflow tracts of AVF was less in failure group than those in success group(all P＜0.05).Moderate to severe calcification of vascular,high Emean of thrombus and 1 venous outflow tract of in AVF were all independent risk factors of ultrasound-guided PTA for treating thrombotic occlusion of autologous AVF(all P＜0.05),and AUC of the obtained model for predicting failure of treatment was 0.969.Conclusion Moderate to severe calcification of vascular,high Emean of thrombus and 1 venous outflow tract of AVF were all independent risk factors of ultrasound-guided PTA for treating thrombotic occlusion of autologous AVF.

Objective To explore the mechanism of lupinol on the proliferation,apoptosis,migration and invasion of lung cancer cells through regulating Notch signaling pathway.Methods Lung cancer cells A549 were cultured in vitro,and the cells were treated with lupeol at concentrations of 0,15,30,and 60 mg/L,with 0 mg/L being the control group and the rese being the lupeol dosage groups,the cells were treated with lupinol at the concentration of 60 mg/L and Notch pathway inhibitor DAPT at the concentration of 10 μmol/L,which was recorded as the lupeol+DAPT group.Cell proliferation changes were detected by MTT;cell apoptosis was detected by flow cytometry;cell migration and invasion were detected by Transwell;protein expression of PCNA,Bcl-2,N-cadherin,E-cadherin,Notch-1 and Hes-1 were detected by Western blot.Results 15,30,60 mg/L lupeol group can significantly inhibit the cell viability,the number of migration cells and invading cells of lung cancer cells,significantly increase the rate of cell apoptosis,and reduce PCNA,N-cadherin,Bcl-2,Hes-1 and Notch-1 expression,increase E-cadherin expression(P＜0.05).Compared with the lupeol group,the lupeol+DAPT group significantly reduced cell viability,the number of migrating cells and invaded cells,increased apoptosis rate,decreased PCNA,Bcl-2,Hes-1,Notch-1 and N-cadherin protein expression,and increased E-cadherin protein expression(P＜0.05).Conclusion Lupinol may inhibit the invasion,migration and proliferation of lung cancer cells through Notch signaling pathway,and induce apoptosis.

Objective To explore the morphological symmetry of the anterior circulation cerebral arteries based on digital subtraction angiography(DSA),and to analyze the value of arterial walking route on the healthy side in guiding catheterization in endovascular treatment for patients with sick-side major artery occlusion of the anterior circulation.Methods A total of 250 consecutive patients who underwent cerebral angiography at the Shengli Oilfield Central Hospital of China between January 2021 and August 2022 were enrolled in this study as angiography group,which was subdivided into youth angiography subgroup(＜50 years),middle-aged angiography subgroup(50-69 years),and elderly angiography subgroup(≥70 years).Other 170 patients with acute occlusion of the anterior circulation vessels,who received emergency mechanical thrombectomy,were collected as thrombectomy group.After successful recanalization,the cerebral angiographic imaging findings of both groups,including the arterial walking route symmetry of bilateral C1 segment,C2-C3 segment,ophthalmic segment,M1 segment proximal to the bifurcation,and M1 segment distal to the bifurcation,were analyzed and compared between the two groups.The recanalization rate and the consistency of bilateral arterial walking route in the thrombectomy group were also analyzed.Results No statistically significant differences in the arterial walking route of the C1 segment,C2-C3 segment,ophthalmic segment,M1 segment proximal to the bifurcation,and M1 segment distal to the bifurcation existed between the left side and right side(all P＞0.05).Ordinary bilateral symmetry was observed in M1 segment proximal to the bifurcation,and excellent bilateral symmetry was observed in all the other segments.There were no statistically significant differences in the bilateral arterial walking route of the C1 segment,C2-C3 segment,ophthalmic segment,M1 segment proximal to the bifurcation,and M1 segment distal to the bifurcation between each other among the three subgroups(all P＞0.05).Ordinary bilateral symmetry of the C1 segment was observed in the youth angiography subgroup,ordinary bilateral symmetry of the M1 segment proximal to the bifurcation was observed in all three subgroups,and excellent bilateral symmetry was observed in all the other segments.In the thrombectomy group the recanalization rate was 95.5％and the consistency rate of bilateral arterial walking route was 89.0％.Conclusion Bilateral symmetry exists in the C1 segment,C2-C3 segment,ophthalmic segment,M1 segment proximal to the bifurcation,and M1 segment distal to the bifurcation of the anterior circulation cerebral arteries.These findings provide a reliable basis of referring healthy-side arterial walking route to guide catheterization in endovascular treatment for mechanical thrombectomy and recanalization of sick-side major artery occlusion of the anterior circulation.(J Intervent Radiol,2024,33:472-478)

As one of the pathogenic mechanisms contained in The Inner Canon of Yellow Emperor （《黄帝内经》）， “disease with latent pathogen induced by a new pathogen” means that the induced new pathogen resulted to a combination of the latent previous pathogen and the new pathogen， which caused the disease. Based on this， it is believed that the change of “nodule-cancer transformation” of pulmonary nodules is actually based on the deficiency of original qi， and the new pathogen induces the latent pathogens like phlegm coagulation， qi stagnation， blood stasis， toxicity， so healthy qi can not drive the pathogens out， and the long-time detention generated into cancerous turbidity， and deve-loped into cancerous tumour at the end. Therefore， based on the three-stage treatment of unformed cancer， dense cancerous toxin， and developed cancer， the clinical practice applied six methods of clearing， expelling， dissipating， tonifying， harmonizing， and transforming， taking into account both the manifestation and root cause， moving the treatment window of pulmonary nodules forward， attacking the pathogens when the toxin was not yet overbearing， supporting the healthy qi before declining， delaying the process of nodules-cancer transformation， and providing ideas for the prevention and treatment of pulmonary nodules “nodule-cancer transformation” in traditional Chinese medicine.