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

Background/Aims: The aim of this study was to analyze the chronological changes in postoperative complications in surgical ulcerative colitis patients over the past decade in China and to investigate the potential parameters that contributed to the changes. Methods: Ulcerative colitis patients who underwent surgery during 2008–2017 were retrospectively enrolled from 13 hospitals in China. Postoperative complications were compared among different operation years. Risk factors for complications were identified by logistic regression analysis. Results: A total of 446 surgical ulcerative colitis patients were analyzed. Fewer short-term complications (24.8% vs. 41.0%, P=0.001) and more laparoscopic surgeries (66.4% vs. 25.0%, P<0.001) were found among patients who received surgery during 2014–2017 than 2008–2013. Logistic regression suggested that independent protective factors against short-term complications were a higher preoperative body mass index (odds ratio [OR], 0.870; 95% confidence interval [CI], 0.785–0.964; P=0.008), laparoscopic surgery (OR, 0.391; 95% CI, 0.217–0.705; P=0.002) and elective surgery (OR, 0.213; 95% CI, 0.067–0.675; P=0.009). The chronological decrease in short-term complications was associated with an increase in laparoscopic surgery. Conclusions Our data revealed a downward trend of short-term postoperative complications among surgical ulcerative colitis patients in China during the past decade, which may be due to the promotion of minimally invasive techniques among Chinese surgeons.

OBJECTIVE To establish a quantitative analysis method for the quality control components in Tenghuang jiangu capsules， and predict the possible action mechanism of the quality control components. METHODS Seven key quality control components in Tenghuang jiangu capsules were quantitatively analyzed by UHPLC-Q-Orbitrap HRMS. The “component-target” network was constructed based on network pharmacology， and the Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment analysis and gene ontology （GO） function enrichment analysis were further conducted to find the key signaling pathways. RESULTS The average contents of succinic acid， hyperoside， gallic acid， kaempferol， naringin， naringenin and protocatechuic acid in 20 batches of Tenghuang jiangu capsules were 520.92， 67.67， 129.48， 4.74， 397.45， 5.66 and 376.62 μg/g， respectively. The results of network pharmacology showed that the 62 key target genes of the quality control components of the drug included AKT1， TNF， VEGFA， MMP9， PTGS2， etc. They were mainly enriched in cytokine receptor interaction， nuclear factor， tumor necrosis factor， interleukin 17， rheumatoid arthritis， Toll-like receptor and other signal pathways， involving inflammatory reaction， signal transduction， protein phosphorylation and other biological processes， kytoplasm， cell membrane and other cell components， as well as enzyme activity， energy activity and other molecular functions. CONCLUSIONS The established UHPLC- Q-Orbitrap HRMS method can be used for the quantitative analysis of the quality control components of Tenghuang jiangu capsule. Its quality control components may be mapped to inflammatory pathways related to bone diseases such as rheumatoid arthritis and Toll-like receptors through AKT1， TNF， VEGFA and other key targets， so as to play a therapeutic role.

Objective To evaluate the effect of percutaneous coronary intervention (PCI) on anxiety and depression among patients with coronary heart disease (CHD). Methods A total of 600 CHD patients were divided into the stent group (n = 400) and the non-stent group (n = 200) according to stent implantation during coronary angiography, and 400 cases in the stent group were further divided into the intervention group (n = 200) and the non-intervention group (n = 200) according to post-stenting psychological interventions. The anxiety and depression were scored using self-rating anxiety and depression scales 1 day after admission, 1 day after PCI and at discharge from hospital, and the anxiety and depression scores were compared at different time points. Results The mean age, sex ratio, hemoglobin, total cholesterol, triglyceride, high-density lipoprotein cholesteroland low-density lipoprotein cholesterol levels were comparable among the three groups (P > 0.05). There were no significant differences among the three groups in terms of anxiety or depression scores one day after admission (P > 0.05). One day after PCI, the anxiety and depression scores were significantly higher among CHD patients in the intervention and non-intervention groups than in the non-stent group (P < 0.05), and the anxiety (t = 11.21, P < 0.01; t = 9.96, P < 0.01) and depression scores (t = 8.56, P < 0.01; t = 6.73, P < 0.01) were significantly higher in the intervention and non-intervention groups one day after PCI than one day after admission. At discharge from hospital, there were significant differences among the three groups in terms of anxiety and depression scores (P < 0.05), and the anxiety (t = 21.57, P < 0.01; t = 15.77, P < 0.01) and depression scores (t = 24.33, P < 0.01; t = 15.01, P < 0.01) were significantly higher in the intervention and non-intervention groups at discharge from hospital than one day after PCI, while the anxiety and depression scores were significantly lower among CHD patients in the intervention group than in the non-intervention group (P < 0.05). Conclusion The anxiety and depression are aggravated among CHD patients after PCI, and psychological interventions may alleviate the anxiety and depression.

Psoriasis is characterized by abnormal proliferation of keratinocytes, as well as infiltration of immune cells into the dermis and epidermis, causing itchy, scaly and erythematous plaques of skin. The understanding of this chronic inflammatory skin disease remains unclear and all available treatments have their limitations currently. Here, we showed that IMMH002, a novel orally active S1P modulator, desensitized peripheral pathogenic lymphocytes to egress signal from secondary lymphoid organs and thymus. Using different psoriasis animal models, we demonstrated that IMMH002 could significantly relieve skin damage as revealed by PASI score and pathological injure evaluation. Mechanistically, IMMH002 regulated CD3 T lymphocytes re-distribution by inducing lymphocytes' homing, thus decreased T lymphocytes allocation in the peripheral blood and skin but increased in the thymus. Our results suggest that the novel S1P agonist, IMMH002, exert extraordinary capacity to rapidly modulate T lymphocytes distribution, representing a promising drug candidate for psoriasis treatment.

Objective To compare the efficacy of heparin and bivalirudin in patients with acute coronary syndrome undergoing emergency percutaneous coronary intervention ( PCI ) .Methods A total of 90 patients with acute coronary syndrome were included in this study .They were divided into the study group and control group according to the requirements of random envelope method ,45 cases in each group .The study group received bivalirudin during PCI,the control group was given heparin .The Fbg,APTT,TT and PT were detected in the two groups ,and the inci-dence of adverse reactions ( heart failure , cardiac death , platelet reduction , hemorrhage of digestive tract ) was analyzed.Results After treatment,there were no statistically significant differences between the two groups in various blood coagulation indicators (all P>0.05).The incidence rate of adverse events of the study group was 4.44％, which was significantly lower than 24.44％of the control group ,and the difference was statistically significant (χ2 =7.28,P<0.05).Conclusion Application of heparin and bivalirudin in PCI has similar efficacy ,but the safety of bivalirudin is higher ,which is worthy of clinical promotion .

Objective To analyze the clinical effects of allogenic acellular dermal matrix (ADM) treatment for diabetic foot ulcer (DFU) with meta-analysis.Methods Databases including PubMed,Cochrance Library,Embase,and OVID EBM Reviews were searched using key words " diabetic foot,diabetic ulcer,diabetic wound,acellular dermal matrix,acellular dermal regenerative tissue matrix,acellular regenerative tissue matrix,AlloDerm,SureDerm,KaroDerm,Graftjacket,Hyalomatrix PA,and Hyalograft 3D",and Chinese Biological Abstracts,Chinese Journals Full-text Database,VIP Database,and Wanfang Database were searched using key words in Chinese version”糖尿病足,糖尿病足溃疡,异体脱细胞真皮基质,真皮基质”to obtain the published trials of allogenic ADM treatment for DFU from January 1990 to July 2015,and then meta-analysis was used to analyze the trials.The measurement indexes were wound contraction rate,wound healing rate,complete epithelization time of wound,and complication rate.Meta-analysis was conducted by RevMan 5.2 statistical software.Results A total of 5 trials involving 426 DFU patients were included,with 224 patients in group ADM who received allogenic ADM treatment and 202 patients in conventional treatment group (CT) who received conventional moist treatment.There was no statistically significant difference between group ADM and group CT in wound contraction rate,with mean difference 20.34 (with 95％ confidence interval-25.27-65.94,P =0.38).The wound healing rate of patients in group ADM was higher than that in group CT,with relative risk (RR) 1.90 (with 95％ confidence interval 1.29-2.80,P ＜0.01).There was no statistically significant difference between group ADM and group CT in complete epithelization time of wound,with mean difference 1.20 (with 95％ confidence interval-2.93-0.52,P =0.17).The complication rate of patients in group ADM was lower than that in group CT,RR =0.54 (with 95％ confidence interval 0.38-0.76,P ＜ 0.001).Publication bias might exist in wound contraction rate,wound healing rate,complete epithelization time of wound,and complication rate.Conclusions Compared with conventional moist treatment,allogenic ADM treatment can accelerate wound healing and reduce complication rate in patients with DFU.