Tacrolimus is a crucial therapeutic drug for preventing immune rejection after solid organ transplantation in children. Due to the narrow treatment window and significant individual variability， personalized treatment is often required. In recent years， with the promotion of therapeutic drug monitoring technology， individualized treatment models based on tacrolimus drug concentration have developed rapidly. This article reviews the research progress of individualized dosing models for tacrolimus in children both domestically and internationally over the past decade. It includes dose simulation methods based on population pharmacokinetics， physiologically based pharmacokinetics， machine learning， and multiple linear regression. The characteristics of each model and its application in pediatric individualized dosing are analyzed and summarized. Additionally， the current development status of decision support systems for individualized tacrolimus dosing is introduced.

Objective: To examine the application of multi-disciplinary treatment (MDT) in the diagnosis and management of recurrence and metastasis of adenoid cystic carcinoma (ACC) of the palate, as well as the treatment of concurrent massive palatal bleeding. This article aimed to provide references for the diagnosis and treatment of patients with advanced oral cancer, along with strategies for managing massive hemorrhage. Methods: This article reported on the MDT process for a patient diagnosed with ACC of the left upper palate, who experienced skull base recurrence and lung metastasis following surgery and radiotherapy. The case was further complicated by massive palatal hemorrhage. Additionally, the article analyzed patients with ACC recurrence and significant hemorrhage in the context of relevant literature. The patient was a 36-year-old female with ACC located in the left palate, initially diagnosed at clinical stage T3N0M0 in 2013. She underwent an extensive resection of the palatal lesion, followed by radioactive 125I seed implantation, which was guided by a radiotherapy planning system (TPS) and a digital guide. The patient was monitored for four years post-surgery, during which no signs of tumor recurrence were observed. However, at the fifth year of follow-up, the patient developed recurrence with lung metastasis, classified as T4N0M1. Following a multidisciplinary consultation involving the oral and maxillofacial surgery, radiotherapy, medical oncology, and thoracic surgery, the patient underwent a procedure comprising left subtotal maxillary resection, autologous free flap transplantation, and thoracoscopic resection of pulmonary metastases. After surgery, the patient received 60 Gy of radiotherapy and was orally administered Anlotinib hydrochloride capsules to suppress tumor growth. After 31 months of follow-up, the patient reported experiencing slight bleeding in the mouth. A craniomaxillofacial CT scan revealed that the tumor had grown aggressively, resulting in destruction of the skull base. Consequently, the patient was admitted to the hospital. On the second day of admission, she experienced a sudden episode of oral bleeding. Despite the application of pressure, the bleeding continued unabated. An emergency tracheotomy was performed to relieve the obstruction of the patient’s respiratory tract, and a red blood cell suspension was transfused to address the hemorrhagic shock. Following an urgent consultation with the vascular interventional surgery department, super-selective embolization was promptly employed to effectively halt the bleeding and achieve rapid vascular occlusion. An individualized treatment plan was developed under MDT, incorporating postoperative radiotherapy, targeted therapies, and immunotherapy to manage the tumor. Results: Through the MDT model, the patient successfully achieved emergency hemostasis, and normal vital signs were restored. With the addition of radiotherapy and immune-targeted drug treatment, tumor progression was effectively controlled, leading to an improved quality of life for the patient, who successfully survived for 129 months with the tumor by July 2024. A review of the relevant literature indicated that MDT offered significant advantages in the management of adenoid cystic carcinoma. In selecting surgical methods, the team administering MDT could comprehensively evaluate factors such as the patient’s age, physical condition, tumor location, size, and extent of invasion to develop a personalized treatment plan. Radical surgical resection was a common treatment option for ACC. Postoperative tissue defects could be restored to their corresponding functions and aesthetic appearance through autologous tissue reconstruction, utilizing techniques such as peroneal myocutaneous flaps or iliac myocutaneous flaps, or by the implantation of artificial materials. In complex cases involving positive margins, recurrence, and metastasis, the MDT model employed interdisciplinary collaboration to devise a comprehensive treatment plan that may have included re-operation, radiotherapy, and chemotherapy, with the aim of minimizing the risk of ACC recurrence and controlling distant metastasis. Massive bleeding resulting from advanced oral cancer presented a complex medical challenge, influenced by various risk factors such as tumor type, metastasis, treatment options, and the patient’s overall condition. Early identification of bleeding risks, along with strategies to mitigate the adverse effects of bleeding on disease progression—through supportive care, medical treatment, surgical intervention, and interventional therapy—could significantly enhance patients’ quality of life. Conclusion The MDT model can provide comprehensive, precise, and personalized treatment plans for patients with advanced oral cancer and massive hemorrhage and improve the effectiveness of treatment strategies.

With the rapid development of mobile internet technology, mobile health application (mHealth APP) are increasingly widely used in the field of health management and have been proven to play an important role in the management of chronic diseases. Solid organ transplant recipients face complex health management needs after surgery, including postoperative follow-up, medication management, prevention and treatment of complications and comorbidities, and lifestyle adjustment. mHealth APP can provide solid organ transplant recipients with convenient self-management tools. Although some progress has been made in this field, there are still many challenges, such as insufficient user experience, technological dependence, and data security risks. Therefore, this article discusses the development process, main functions and current application status of mHealth APP, and analyzes its advantages in improving the self-management ability of solid organ transplant recipients, promoting doctor-patient communication and reducing the incidence of complications. At the same time, based on the practical experience of author’s team in developing the “TransMate” mHealth APP, we propose the directions that mHealth APPs should focus on in the future, in order to provide more effective support and services for the health management of solid organ transplant recipients.

Background Hypertension is one of the chronic diseases with the highest prevalence in China, and a history of hypertension may potentially exacerbate hearing loss. Investigating the association between long-term blood pressure trends and hearing thresholds could contribute to hearing protection efforts for occupationally noise-exposed populations. Objective By investigating hearing thresholds and blood pressure levels among occupationally noise-exposed workers in an urban rail transit enterprise, and conducting a comprehensive analysis of the association between long-term blood pressure changes and hearing thresholds, to provide data references for health management strategies targeting occupationally noise-exposed workers. Methods Workers exposed to occupational noise at a rail transit enterprise were enrolled as study subjects and underwent pure-tone audiometry. Group-based trajectory modeling was employed to identify blood pressure trajectories. Categorical data were compared using chi-square tests, while normally distributed continuous variables were analyzed via t-tests and analysis of variance (ANOVA). Generalized linear mixed models (GLMMs) were subsequently applied toexamine associations between these trajectory groups and high-frequency hearing thresholds. Results Among 2 002 occupationally noise-exposed workers, the median (P₂₅, P₇₅) age was 32 (28, 35) years, with a median (P₂₅, P₇₅) working tenure of 7 (3, 10) years. In 2019, the positive hypertension rate was 9.04%, with a mean systolic blood pressure (SBP) of (122.97±11.60) mmHg and a mean diastolic blood pressure (DBP) of (76.37±9.02) mmHg. The hearing loss prevalence was 10.1%, showing bilateral high-frequency average hearing thresholds of (17.18±8.71) dB and speech-frequency average thresholds of (13.79±3.46) dB. Three distinct trajectory groups were identified for both SBP and DBP. Compared with other trajectory groups, the high-stable DBP group exhibited significantly higher hearing loss prevalence (χ²=6.34, P=0.042) and elevated high-frequency hearing thresholds (all Ps<0.05). Specifically, within the 30-39 age subgroup, the moderate-stable DBP group demonstrated 1.96 dB lower high-frequency thresholds than the high-stable group [β(95%CI): −1.96 (−3.61, −0.32), P=0.020]. Conclusion Among occupationally noise-exposed workers in a municipal rail transit enterprise, DBP trajectories demonstrated a positive association with high-frequency hearing thresholds. Notably, in young and middle-aged occupationally noise-exposed populations, DBP may exert a more critical influence than SBP on the progression of hearing loss.

Background At present, the practice of pulmonary rehabilitation for pneumoconiosis in China is in a primary stage. The basis for formulating an individualized comprehensive pulmonary rehabilitation plan is still insufficient, which is one of the factors limiting the development of community-level rehabilitation work. Objective To formulate an exercise prescription based on maximum heart rate measured by cardiopulmonary exercise test (CPET), conduct an individualized comprehensive pulmonary rehabilitation program with the exercise prescription for patients with stable pneumoconiosis, and evaluate its role in improving exercise endurance and quality of life, thus provide a basis for the application and promotion of pulmonary rehabilitation. Methods A total of 68 patients were recruited from the Occupational Disease Prevention Hospital of Jinneng Holding Coal Industry Group Co., Ltd. from April to August 2022 , and were divided into an intervention group and a control group by random number table method, with 34 cases in each group. All the pneumoconiosis patients participated in a baseline test. The control group was given routine drug treatment, while the intervention group received multidisciplinary comprehensive pulmonary rehabilitation treatment on the basis of routine drug treatment, including health education, breathing training, exercise training, nutrition guidance, psychological intervention, and sleep management, whose exercise intensity was determined according to the maximum heart rate provided by CPET. The rehabilitation training lasted for 24 weeks. Patients were evaluated at registration and the end of study respectively. CPET was used to measure peak oxygen uptake per kilogram (pVO₂/kg), anaerobic threshold (AT), carbon dioxide equivalent of ventilation (EqCO₂), maximum metabolic equivalent (METs), and maximum work (W_max). The modified British Medical Research Council Dyspnea Questionnaire (mMRC), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI), Chronic Obstructive Pulmonary Disease Assessment Test (CAT), and Short Form of Health Survey (SF-36) were used to evaluate the potential effect of the comprehensive pulmonary rehabilitation program. Results Among the included 68 patients, 63 patients were having complete data, then 31 cases were assigned in the control group and 32 cases in the interventional group. Before the intervention, there was no significant difference in pVO₂/kg, AT, EqCO₂, METs, or W_max between the two groups (P>0.05). At the end of the trail, the indicators like pVO₂/kg [(19.81±2.38) mL·(min·kg)⁻¹], AT [(14.48±2.33) mL·(min·kg)⁻¹], METs (5.64±0.69), and W_max [(85.25±14) W] of patients in the intervention group were all higher than those [(13.90±2.37) mL·(min·kg)⁻¹, (11.70±1.94) mL·(min kg)⁻¹, (3.97±0.70), and (61.77±14.72) W, respectively] in the control group (P<0.001); there was no significant difference in EqCO₂ between the two groups (P=0.083). Before the trial, there was no significant difference in mMRC, SAS, SDS, PSQI, or CAT scores between the two groups (P>0.05). At the end of the trail, the mMRC score (1.16±0.57), SAS score (27.93±2.12), SDS score (26.48±1.44), PSQI score (1.08±0.88), and CAT score (4.34±3.28) of patients in the intervention group were lower than those [(2.03±0.83), (35.87±6.91), (34.23±6.65), (5.37±3.03), and (13.87±7.53), respectively] in the control group (P<0.001). The SF-36 scores of bodily pain (94.13±10.72), general health (87.50±5.68), vitality (95.31±5.53), mental health (99.88±0.71), and health changes (74.22±4.42) in the intervention group were higher than those [(71.87±32.72), (65.81±15.55), (74.52±16.45), (86.97±16.56), and (29.84±13.50), respectively] in the control group (P<0.001), and no significant difference was found in social functioning and role emotional scores (P>0.05). Conclusion Comprehensive pulmonary rehabilitation can increase the oxygen intake and exercise endurance of pneumoconiosis patients, ameliorate dyspnea symptoms, elevate psychological state and sleep quality, and improve the quality of life.

Objective: To compare the relative effectiveness of different exercise modalities on inhibitory control in children with attention deficit hyperactivity disorder (ADHD), so as to provide an evidence based basis for the development of effective exercise prescriptions. Methods: The databases of China National Knowledge Internet (CNKI), Pubmed, Web of Science, Embase, and Cochrane were searched to screen the literature of randomized controlled trials of exercise interventions for inhibitory control in children with ADHD up to December 31, 2022. The Cochrane risk of bias assessment tool was used for methodological quality assessment, and Stata 17.0 software was used for network Meta analysis, standardized mean difference ( SMD ) and 95% CI were used as the effect indicators to compare the difference in effect between interventions and rank the effect. Results: Twenty two papers with a total of 1 134 participants aged 6-14.5 years were finally included. Network Meta analysis showed that the impact effects of physical and mental exercises [ SMD (95% CI )=1.08(0.50-1.66)], cognition+exercise [ SMD (95% CI ) =0.81(0.13-1.48)], and ball games [ SMD (95% CI )= 1.54(0.99-2.09)] were significantly superior to that of control group, and the ball games had a significantly better effect than single aerobic exercise [ SMD (95% CI )=1.02(0.20-1.84)], and combined exercises [ SMD (95% CI )=1.08( 0.28 -1.88)]( P < 0.05 ). The results of surface under the cumulative ranking (SUCRA) showed that ball games might be the best means to improve inhibitory control in children with ADHD(SUCRA=95.3). Conclusion It is recommended to appropriately increase ball sports in sports activities to more effectively improve the inhibitory control of children with ADHD.

Objective To compare the clinical efficacy of abdominal ultrasound-guided endoscopic retrograde appendicitis therapy(ERAT)with laparoscopic appendectomy(LA)for acute uncomplicated appendicitis using propensity score matching.Methods The clinical data of 441 patients with acute uncomplicated appendicitis admitted to the Third People's Hospital of Yunnan Province from March 2020 to April 2023 were collected.The cases were classified based on the differences in surgical method and divided into the ERAT group(n = 30)and LA group(n = 411).The clinical efficacy of patients was compared between the two groups after reducing confounding bias by propensity score matching(PSM).Results After PSM,a total of 30 pairs of patients in the two groups were successfully matched,and the baseline data of the two groups met the requirements for comparability.At 24 hours after the operation,the ERAT group exhibited lower white blood cells,neutrophil counts,and C-reactive protein levels compared to the LA group,and these differences were statistically significant(P<0.05).There was no significant difference in the operation time and total effective rate between the ERAT group and the LA group(P>0.05).However,the ERAT group had lower intraoperative blood loss and shorter pain relief time compared to the LA group,and these differences were statistically significant(P<0.05).Conclusion Abdominal ultrasound-guided endoscopic retrograde appendicitis treatment is an effective,safe,and feasible technique with good prospects for the treatment of acute uncomplicated appendicitis.

Objective To evaluate the maturity and metabolic status of heterotopic ossification(HO)by single-photon emission computed tomography(SPECT)/CT fusion bone imaging.Methods The clinical and SPECT/CT fusion bone imaging data of 57 patients with HO confirmed by pathology or follow-up were analyzed retrospectively.HO was graded by CT,and the characteristics of radioactive concentration of HO were analyzed.Results Of 57 cases,single lesion in 52 cases,and multiple lesions in 5 cases,with a total of 63 lesions,mostly located in the hip joint(55.6%,35/63)and thigh(19.0%,12/63).There were 41 lesions in the middle stage and 22 lesions in the late stage.In the visual evaluation of SPECT/CT fusion bone imaging,the middle stage lesions were mostly clumps or flakes,with moderate or high radioactive concentration(75.6%,31/41),furthermore,the concentration range was larger than or equal to the total or limited range of CT ossification(21/41,50.1%),with high concentration mainly located in the mixed areas of ossification density.The concentration of the late stage lesions was mostly non-radioactive(72.7%,16/22).Conclusion SPECT/CT fusion bone imaging can show the range,degree and maturity of HO radioactive concentration,and can accurately locate the area with osteoblastic activity,which provides scientific basis for the selection of surgical timing.

Objective To present a pharmaceutical care case of a pediatric patient with nephrotic syndrome developing tacrolimus-inducedposterior reversible encephalopathy syndrome(PRES)during tacrolimus treatment,and to accumulate experience for the treatment and pharmaceutical services of related diseases.Methods Clinical pharmacists conduct an analysis and evaluation of the correlation of drug-induced PRES caused by tacrolimus in a pediatric patient.Simultaneously,regarding the latest evidence-based information,they propose optimized drug therapy recommendations and provide personalized pharmaceutical services.Results After treatment with antispasmodics,blood pressure control,intracranial pressure reduction,and tapering of tacrolimus,the clinical symptoms of the child improved.Follow-up cranial MRI demonstrated partial absorption of abnormal signals in the brain,and the lesions were significantly smaller than before.Conclusion For tacrolimus-related PRES,clinical pharmacists can enhance the long-term safety and effectiveness of patient medication through aspects such as choosing antihypertensive drugs,adjusting treatment plans based on drug concentration monitoring,and implementing targeted pharmaceutical monitoring and educatio.

Objective:To explore the application value of optical surface monitoring system (OSMS) volume rendering technique (VRT) body surface imaging in intensity-modulated radiotherapy for thoracic tumors.Methods:A retrospective case series study was performed. The clinical data of 65 patients with thoracic tumors treated with intensity-modulated radiotherapy at Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from September 2021 to October 2022 were retrospectively analyzed. In the first treatment,after cone-beam computed tomography (CBCT) scan and correction, VRT body surface images were obtained by using OSMS. In subsequent treatment, the VRT image was used as the benchmark and the 6-dimensional bed was automatically positioned to record the 6-dimensional bed positioning value. The CBCT scan was performed to record the translation and rotation errors of left-right direction (X-axis), head-foot direction (Y-axis) and front-rear direction (Z-axis). After the calibration of the 6-dimensional automatic bed shifting, the new real-time deltas (RTD) value of digital imaging and communications in medicine (DICOM) body surface image was recorded, and the new VRT image was obtained. CBCT registration error value was defined as VRT image-guided setup error. The sum of CBCT registration error value and moving bed movement value was defined as the body surface marker line-guided setup error. The sum of CBCT registration error value and the recorded DICOM image RTD value was defined as the theoretical error of DICOM image-guided setup. The advantages and disadvantages of VRT image, body surface marker line and DICOM image-guided setup were compared and analyzed.Results:There were 42 males and 23 females in 65 patients with thoracic tumors, and the age [ M ( Q1, Q3)] was 58 years (51 years, 64 years). The linear errors [ M ( Q1, Q3)] of VRT image-guided setup in X, Y and Z axes were 0.6 mm (0.3 mm, 1.2 mm), 1.2 mm (0.5 mm, 2.4 mm) and 1.1 mm (0.5 mm, 1.9 mm); and the rotational errors were 0.4° (0.1°, 0.7°), 0.4° (0.1°, 0.6°) and 0.4° (0.2°, 0.6°). The linear errors of the marker line-guided setup were 1.6 mm (0.9 mm, 2.6 mm), 2.2 mm (1.1 mm, 3.8 mm) and 1.0 mm (0.4 mm, 1.8 mm); and the rotational errors were 0.7° (0.3°, 1.2°), 0.5° (0.2°, 0.8°) and 0.5° (0.2°, 0.8°). The linear errors of the DICOM image-guided positioning were 1.1 mm (0.6 mm, 1.9 mm), 2.1 mm (1.0 mm, 3.4 mm) and 1.3 mm (0.6 mm, 3.1 mm), and the rotational errors were 0.6° (0.2°, 1.1°), 0.7° (0.3°, 1.1°), 0.7° (0.2°, 1.1°). Compared with the marker line-guided setup, except for Z-axis linear error ( P = 0.218), the VRT-guided setup errors were low (all P < 0.001). Compared with the DICOM imaging-guided setup, the VRT image-guided setup linear error and rotational error in X-, Y- and Z-axis were low (all P < 0.01). Conclusions:VRT image-guided setup is superior to traditional body surface marker setup and DICOM imaging setup; OSMS VRT body surface imaging can effectively improve the setup accuracy and stability of intensity-modulated radiotherapy for thoracic tumors, and reduce the setup errors.