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

Objective:To assess the association of hemoglobin (Hb) levels with the prevalence of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).Methods:A cross-sectional study. From January 2017 to December 2018, 707 patients with T2DM who were hospitalized in the Department of Internal Medicine of Chu Hsien-I Memorial Hospital & Tianjin Medical University, were included in the study. All patients underwent color photography of the fundus of both eyes with dilated pupils. According to DR diagnostic criteria, patients were divided into DR group and non-DR (NDR) group, with 210 and 497 cases, respectively; DR group was further divided into non-proliferative DR group (NPDR) group and proliferative DR (PDR) group, about 186, 24 cases, respectively. Hb level was detected, single factor analysis of its correlation with DR; logistic regression analysis was used to evaluate the relationship between Hb level and DR risk.Results:The Hb levels of the patients in the NDR group and the DR group were 140.58±17.26 and 132.35±23.48 g/dl; compared with the NDR group, the Hb level of the DR group was significantly lower, and the difference was statistically significant ( t=5.107, P=0.000). In the NDR group, NPDR group, and PDR group, Hb levels of male patients were 149.3±1.01, 142.6±2.35, 132.9±8.44 g/dl, respectively; Hb levels of female patients were 131.7±0.90, 124.0±2.09, 116.8±5.23 g/dl. With the progress of DR, Hb levels of different sexes decreased significantly, and the difference was statistically significant ( P<0.000 1). The results of correlation analysis showed that Hb reduction was an independent risk factor for DR (odds ratio=4.437, 95% confidence interval 2.590-7.603, P<0.000 1). Conclusion:The reduction of Hb in T2DM patients is positively correlated with the severity of DR.

BACKGROUND:Breviscapine has been shown to impact the reproductive capacity in rats with type 2 diabetes mel itus, but few reports concerned its mechanism of action.
OBJECTIVE:To study the effects of breviscapine on proliferating cel nuclear antigen and proto-oncogene c-fos expression in testis of type 2 diabetes mel itus rats.
METHODS:Total y 36 healthy male rats were randomly divided into control group, model group and breviscapine group with 12 rats in each group. In the model group and breviscapine group, rat models of type 2 diabetes mel itus were established by continuous intraperitoneal injection of streptozotocin. Blood glucose reaching 16.7 mmol/L in rats was considered as the standard of model induction. In the control group, rats were given an equal volume of citrate buffer solution by single intraperitoneal injection. In the breviscapine group, rats were administered breviscapine 10 mg/(kg?d) for 4 consecutive weeks by intraperitoneal injection. Rats in the other two groups were injected with an equal volume of physiological saline at the same time point.
RESULTS AND CONCLUSION:After 4 weeks of intervention, serum testosterone testing, immunohistochemistry and PCR results showed that serum testosterone levels, proliferating cel nuclear antigen, c-Fos protein and mRNA expression:control group>breviscapine group>model group (P<0.05);blood glucose concentration:the control group

The in-vitro fertilization and embryo transfer technique has been widely applied in human insemination. The rate of successful insemination is gradual y rising, and the in-vitro fertilization directly determine the insemination outcome.
OBJECTIVE:To evaluate the difference between the two common using insemination methods, microdrop and open, in in-vitro fertilization and embryo development.
METHODS:A randomized study was conducted to compare microdrop and open insemination methods among non-male factor patients undergoing in-vitro fertilization and embryo transfer. A total of 1 175 cases were enrol ed in the research. There were 573 cases in the microdrop group, and 602 cases in open insemination group. The fertilization rate and embryo development in the two groups were compared.
RESULTS AND CONCLUSION:The fertilization failure rate [total fertilization failure rate+low fertilization rate (<25%oocytes fertilized)] in the microdrop insemination group was higher than in the open insemination group (11.9%, 3.3%, P<0.001), while the good quality embryo rate and pregnancy rate did not differ significantly between the two groups (al P>0.05). The open insemination method is a simple insemination method with a lower fertilization failure rate. As the fertilization is a highly complicated process involving many extrinsic and intrinsic factors, further study is needed to confirm the effects of the two insemination methods on in-vitro fertilization outcome.

Objective To estimate the acceptability of nurses for division of labor pattern in China.Methods A total of 1 609 nurses in 3 provinces were investigated by self-made questionnaires.The contents of questionnaires included assignment distribution,the acceptability of current division pattern,and whether current division pattern can arouse working enthusiasm of nurses.Results The proportion of those engaged in not only life nursing but also technical nursing was more than 40％,and those only engaged in life nursing was lower than 5％ in nurses with junior college,college or bachelor education degree.The nurses' acceptability of current division pattern of nursing work was poor,most fairly reasonable and very general.The improvement of working enthusiasm for division of labor pattern at present was also poor.The higher educational background except master,the lower improvement of working enthusiasm.Conclusions The poor nurses' acceptability of division of labor pattern was low and impacted working enthusiasm.It suggested to establish a scientific and reasonable division of labor pattern for improvement of nurse working enthusiasm,and promote the overall development of clinical nursing,nursing management,nursing education and nursing scientific research.