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 investigate the value of 95% spectral edge frequency (SEF) in identifying the depth of anesthesia in patients with schizophrenia subjected to modified electroconvulsive therapy center.Methods:A total of 195 patients with schizophrenia who received treatment in The Affiliated Kangning Hospital of Wenzhou Medical University in April to December 2020 were included in this study. They were randomly divided into three groups with 65 patients each. Three groups of patients received different doses of anesthesia before undergoing MECT as follows: group A: propofol 1.5 mg/kg, atropine 0.5 mg/kg, succinylcholine chloride 1.0 mg/kg; group B: propofol 2.0 mg/kg, atropine 0.5 mg/kg, succinylcholine chloride 1.0 mg/kg; group C: propofol 2.5 mg/kg, atropine 0.5 mg/kg, succinylcholine chloride 1.0 mg/kg. 95% SEF and bispectral index (BIS) were measured when patients were awake before treatment (T 1), when eyelash reflex disappeared (T 2), at the beginning of electrical stimulation (T 3), at 3 minutes after electrical stimulation (T 4), and when patients were completely awake (T 5) and compared between groups. The incidence of adverse reaction was recorded at 1 day after treatment. Results:At T 1-T 5, 95% SEF in the group A was (28.50 ± 0.87) Hz, (21.49 ± 0.91) Hz, (21.99 ± 0.92) Hz, (28.42 ± 1.29) Hz, (28.40 ± 1.15) Hz respectively, and it was (28.34 ± 0.91) Hz, (18.93 ± 0.86) Hz, (19.05 ± 0.83) Hz, (27.54 ± 0.73) Hz, (28.42 ± 1.21) Hz respectively in group B and (28.26 ± 0.90) Hz, (16.41 ± 0.75) Hz, (16.36 ± 0.75) Hz, (26.58 ± 0.64) Hz, (28.48 ± 1.19) Hz respectively in group C. 95% SEF measured at T 2 ( t = 24.49, 48.60, both P < 0.05), T 3 ( t = 28.47, 54.51, both P < 0.05), and T 4 ( t = 7.61, 15.91, both P < 0.05) in groups B and C were significantly lower than those in group A. 95% SEF measured at T 2 ( t = 24.11, P < 0.05), T 3 ( t = 26.04, P < 0.05) and T 4 ( t = 8.30, P < 0.05) in group C were significantly lower than those in group B. At T 1-T 5, BIS in group A was (94.16 ± 2.07), (55.34 ± 1.93), (56.61 ± 1.84), (76.29 ± 1.94) and (93.84 ± 2.39) respectively, and it was (94.51 ± 2.25), (52.39 ± 1.58), (52.45 ± 1.94), (73.58 ± 2.19), (93.28 ± 2.52) respectively in group B and (93.97 ± 2.16), (50.57 ± 1.96), (51.60 ± 2.03), (69.51 ± 2.12), (93.57 ± 2.66) respectively in group C. BIS values measured at T 2 ( t = 24.49, 48.60, both P < 0.05), T 3 ( t = 28.34, 54.28, both P < 0.05), and T 4 ( t = 7.61, 15.91, both P < 0.05) in groups B and C were significantly lower than those in group A. BIS measured at T 2 ( t = 24.11, P < 0.05), T 3 ( t = 25.93, P < 0.05), and T 4 ( t = 8.30, P < 0.05) in group C were significantly lower than those in group B. Correlation analysis showed that 95% SEF measured at T 2 ( r = 0.65, P < 0.05), T 3 ( r = 0.68, P < 0.05) and T 4 ( r = 0.49, P < 0.05) were positively correlated with BIS measured at corresponding time points. There were no significant differences in duration of electrical stimulation [(61.25 ± 4.32) seconds, (45.19 ± 3.68) seconds, and (27.54 ± 2.54) seconds, F = 1 434.14, P < 0.05], post-onset inhibition index [(87.68 ± 5.82)%, (81.59 ± 5.35)%, (75.27 ± 4.87)%, F = 87.09, P < 0.05], and average seizure energy index [(5 668.38 ± 1 264.01) μV2, (4 555.61 ± 1 058.96) μV2, (3 642.25 ± 792.68) μV2, F = 59.97, P < 0.05] among the three groups. Duration of electrical stimulation ( t = 36.07, 75.71, both P < 0.05), post-onset inhibition index ( t = 9.15, 18.66, both P < 0.05), and average seizure energy index ( t = 8.49, 15.46, both P < 0.05) in groups B and C were significantly lower than those in group A. Duration of electrical stimulation, post-onset inhibition index and average seizure energy index in group C were significantly lower than those in group B ( t = 39.64, 9.50, 6.97, all P < 0.05). BIS was positively correlated with duration of electrical stimulation ( r = 0.68, P < 0.05), post-onset inhibition index ( r = 0.55, P < 0.05) and average seizure energy index ( r = 0.42, P < 0.05). There were no significant differences in the incidences of headache, myalgia, nausea and vomiting among the three groups ( P > 0.05). Conclusion:95% SEF was positively correlated with BIS in patients with schizophrenia. BIS measured at T 2 was positively correlated with effect of modified electroconvulsive therapy center.

Objective To evaluate the analytical performance of four lipoprotein associated phospholipase A2(Lp-PLA2)activity reagents on Beckman AU5800 automatic biochemical analyzer. Methods The remaining serum samples of 214 patients and 140 apparently healthy individuals were collected from March to July 2017 in Peking Union Medical College Hospital.These samples were used for method comparison and reference interval evaluation.According to the guidelines of EP15-A,EP6-A,EP-17 and EP7-P from Clinical and Laboratory Standards Institute(CLSI)standards,the precision, linearity, sensitivity and common interferences(e.g free bilirubin, conjunct bilirubin, hemoglobin and chyle)were assessed.According to EP9-A2,method comparisons of differents regents(Evermed,DiaSys,Hengxiao and Zhongyuan were labeled as A,B,C and D,respectively)were conducted and the differences were estimated at medical decision levels(328U/L,391U/L and 485U/L).Results The precision of four reagents were acceptable.The repeatability(CV%)of A to D were 0.5%-1.7%, 0.7%-3.0%, 0.9%-2.0% and 0.5%-3.3%,respectively.The reproducibility(CV%)were 0.7%-2.9%, 1.4%-3.2%, 1.3%-1.9%and 0.8%-4.1%,respectively.Both of those achievedlaboratory defined quality objective(<5%).The linearity of A to D were 44 -1 992 U/L,39 -1 798 U/L,13 -540 U/L and 75-1 717U/L,respectively.The regression coefficient R2 was between 0.997 and 1.000, and the correlation coefficient(r)was between 0.998 and 1.000.The interference of chyle were acceptable among these four reagents andmet the manufacturer′s requirementsor clinical needs.In a low level of Lp-PLA2,bilirubin had an obvious interferenceonreagent C;B and C were negatively affected when the hemoglobin was 4.5 g/L; and D was positively affected when the hemoglobin was 2.45 g/L.The regression coefficients R2 of A,C,D compared with B were between 0.978 and 0.995,and the correlation coefficients(r)were between 0.989 and 0.998. The expected differences at medical decision levels ranged from -240 U/L to 113 U/L.For A to D,the Lp-PLA2 activity results of 131(93.6%), 140(100%), 82(58.6%), and 128(91.4%)cases were analysed within the manufacturer′s claimed reference intervals.Conclusion The precision and linearity of the four Lp-PLA2 activity detection reagents used in automatic biochemical analyzer are good, but the anti-interference ability needs to be improved.

Objective To investigate the expression of Sema4 D and Ki67 in pancreatic carcinoma and its relationship with clinicopathological features. Methods The expression of Sema4 D and Ki67 in 40 pancreatic carcinoma tissues and 10 adjacent tissues was measured by immunohistochemistry, and its relationship with the clinicopathological features of pancreatic carcinoma was analyzed. Comparison of categorical data between two groups was made by chi-square test. Spearman's rank correlation analysis was used to identify the correlation between these variables. Results Sema4 D and Ki67 were detected in 19 (47. 5％ ) and 18 (45. 0％ ), respectively, of the 40 pancreatic carcinoma tissues, with significantly higher positive rates than the adjacent tissues (χ2= 10. 040 and 10. 000, P = 0. 020 and 0. 022) . The abnormal expression of Sema4 D and Ki67 differed significantly between patients with different tumor stages and between patients with and without lymph node metastasis (χ2= 6. 352, 4. 912, 12. 031, and 6. 465, P = 0. 013, 0. 028, 0. 001, and 0. 025) . Sema4 D expression was positively correlated with Ki67 expression (r = 0. 347, P = 0. 028) . Conclusion The expression of Sema4 D and Ki67 is elevated in pancreatic carcinoma compared with the adjacent tissue. Their expression is positively correlated with each other and is associated with tumor staging and lymph node metastasis.

Objective To explore the recognition of perioperative needs of elderly lung cancer patients from the perspective of doctors and nurses and provide evidence for improving perioperative nursing measures in elderly patients with lung cancer. Methods Totally 17 doctors and nurses were selected by purposive sampling and received face-to-face semi-structural interview during June to September 2016. The data were analyzed with NVivo 8.0 according to Colaizzi's seven-step analysis method to refine the topic. Results The recognition of perioperative needs of elderly patients with lung cancer from the perspective of doctors and nurses could boil down to four topics: the urgent need for the patient's social support system, the need for perioperative nutrition screening, the need for self-care and assistance, and the need for improving doctor-patient communication skills. Conclusions Nursing managers should pay attention to meet the perioperative needs of elderly patients with lung cancer from the perspective of medical workers and put forward appropriate interventions based on their needs in order to improve the perioperative nursing quality of elderly patients with lung cancer.

To adapt to the new challenge of nutrition and food safety as well as to cultivate talents with capacity of innovation and practical application, Dalian Medical University starts to explore a wide range of experimental teaching system:expanding classical confirmatory experiment, offering comprehensive and designing experiment , encouraging students to participate in scientific research , building Internet teaching platform, and initiating community practice service projects. Multiple dimensional and teaching patterns contribute to strengthen basic skills, interest in scientific research, innovation consciousness and practical ability of undergraduate students, which greatly improves their consciousness of social service and responsibility and helps to cultivate the practical professional talents.

Objective To analyze the epidemiological characteristics of measles in the floating population in Daxing District from 2002 to 2015 and to provide a specific guidance for the control and preven-tion of measles. Methods The epidemiological characteristics of measles in the floating population in Dax-ing District were analyzed based on the data collected from Diseases Reporting Information System and Ques-tionnaires for measles cases. Results A total of 1 263 measles cases were reported in the floating population in Daxing District from 2002 to 2015, accounting for 73. 09% of all reported cases in that area. Among the 1 263 measles cases, 1 027 cases (81. 31%) were reported from March to June. The top 5 towns with high incidence of measles were Huangcun, Jiugong, Xihongmen, Yizhuang and Yinghai, from which 80. 29% of measles cases were reported. Age distribution of the measles cases showed that 145 cases were children younger than 8 months, 412 cases were children aged 8 months to 14 years old and the rest 706 cases were a-bove 14 years old. And of all cases, only 224 cases had measles vaccine immunization history. Conclusion It is necessary to maintain the high vaccination rate of 3 doses of measles vaccine by multi-approaches and increase the immunization rate in migrant workers. Moreover, strengthen the surveillance for measles is also an effective way for measles control and elimination.

Objective To investigate the value of ultrasonic diagnosis on cervical lymph nodes metastasis regions and characteristics in thyroid carcinoma.Methods Ultrasound image of 290 patients with thyroid carcinoma were analyzed restrospectively.The cervical lymph node metastasis regions diagnosed by ultrasonography were compared with histopathologic results,and the ultrasound characteristics of metastasis lymph nodes were assessed.Results Among 290 patients,167 cases with cervical lymph node metastasis were comfirmed by pathology (57.6％),and 185 cases were detected by pre-operative ultrasound (63.8％).The region of thyroid carcinoma lymph node metastasis comfirmed by histopathology was most commonly the central region (54.1％),followed by the lateral neck (20.7％).The diagnostic rate of central region lymph node metastatic by pre-operative ultrasound was only 31.7％,which was sharply lower than that of lateral region (57.6％,P ＜0.05).However,the diagnostic specificity (72.8 ％) was apparently higher than lateral region (35.9％,P ＜0.05).The ultrasonic characteristics of metastatic cervical lymph nodes included rounded shape,absence of echogenic hilus,presence of calcitication,hyperechogenicity and cystic change.Conclusions The cervical central region is the predominant region for thyroid carcinoma lymph node metastasis,and ultrasound diagnosis on central region lymph node metastasis possesses positive specificity but negative sensitivity.Improving ultrasound diagnostic accuracy on central lymph nodes metastasis would be of important clinical significance.

Objective To explore the role of endothelial progenitor cells (EPCs)in improving functional recovery and promoting neurogenesis in damaged area of ischemic rat brain by MRI,neurological severity score (NSS),and pathological examinations.Meth-ods EPCs wereseparated,cultured,and identified,ultrasmall superparamagnetic iron oxide(USPIO)particles was used to label EPCs in vitro.Transient middle cerebral arterial occlusion(tMCAO)was successfully performed in 30 adult SD rats.Magnetically labeled cells(the experimental group)and normal saline (the control group)were injected intravenously into the tMCAO rats through the tail vein respectively,then MR imaging and NSS was performed 0 day,2 days,4 days,6 days and 8 days later.At last the paraffin-embedded rat brain tissues were obtained and examed by Prussian blue staining and Measurement of microvessel density.Re-sults EPCs wereseparated,cultured,and identified successfully.MR imaging showed significant low signal intensity at the ischemic area on T2 WI sequence.Prussian blue staining images were corresponding to the EPCs staining in vitro.The NSS and microvessel density in experimental group were significantly higher than in control group.Conclusion EPCs can migrate to the damage zone, improve functional recovery and promote neurogenesis in damaged area of ischemic rat brain,and may be a new source of multipoten-tial stem cells for stroke treatment.

Objective To investigate the value of color Doppler ultrasonography in diagnosis and differential diagnosis of breast sclerosing adenosis (SA).Methods Preoperative sonography in 32 SA,99 invasive ductal carcinoma(IDC),51 ductal carcinoma in situ(DCIS) and 64 fibroadenoma(FA) confirmed by pathology were retrospectively analyzed.Results The average age of SA group was younger than IDC and DCIS groups',but older than FA group's (P ＜0.05).The focal maximum diameter of SA group was the smallest among all(P ＜0.05).All the SA sonograms showed solid hypoechoic lesions,with spiculate margin was less than IDC group and larger than DCIS and FA groups (P ＜0.05).Similar ultrasonic characteristics,such as irregular shape,unclear border,acoustic halos were seen in SA and DCIS groups (P ＞0.05),while IDC group showed the highest rate and FA group had the least(P ＜0.05).SA masses' uneven internal echo,calcification,posterior acoustic attenuation was higher than FA group(P ＜0.05),but less than IDC and DCIS groups(P ＞0.05).Meanwhile,A/T ratios(≥0.7) were higher than DCIS and FA groups,but less than IDC group(P ＞0.05).In addition,SA group had a similar detection rate of the internal blood flow with FA group(P ＞0.05),but less than the IDC and DCIS groups(P ＜0.05).Conelusions Ultrasonography has a significant clinical value in diagnosis and differential breast sclerosing adenosis.