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.

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.

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.

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.

An important issue facing university education is the adaptation and transformation of freshmen.In order to guide students to adapt to the needs of research-based learning,Jilin University has opened a freshman seminar for all first-year undergraduate students,emphasizing the cultivation of students'thinking patterns and learning abilities.For medical students,it is necessary to ap-ply the learned medical knowledge to clinical problem analysis.Therefore,it is particularly important to cultivate students'integrated thinking from basic to clinical at the beginning of enrollment.In recent years,organ system integration has gradually been carried out in medical schools both domestically and internationally.In the course of integrating the immune system and diseases,the morphology of the immune system is relatively abstract and difficult to observe.In the early stages of enrollment,students still lack the thinking of organ system integration,and the initial stage of immune system integration courses is difficult to carry out.Therefore,we aimed to guide students towards adaptability and academic transformation through freshman seminars,explored the integration of the immune system's organ system as a pathway,and used the BOPPPS teaching model as a means for preliminary exploration.In the freshman seminar,the main focus is on the"morphology and structure-mechanism and function-disease-diagnosis-treatment"of the immune sys-tem,helping students establish a learning mindset that integrates disease diagnosis and treatment based on basic medical courses such as immunology and anatomy.Using BOPPPS to reform the"teaching"of teachers,establishing a student-centered teaching model from six aspects:bridge,objective,pre-assessment,participatory learning,post-assessment and summary,can better guide students to actively think and participate in the entire learning process,focus on the construction of students'fragmented knowledge thinking mode,internalize medical humanities literacy,and improve the quality of medical talent cultivation in colleges and universities.

Objective:To investigate the prognostic value of albumin (ALB), aspartate aminotransferase/alanine aminotransferase ratio (AST/ALT) in patients with acute liver failure (ALF) in hyperacute phase of sepsis which provided the basis for clinical evaluation and prognostic judgment and corresponding treatment options.Methods:A multicenter retrospective cohort study was conducted. Patients with ALF in hyperacute phase of sepsis admitted to Zhoupu Hospital Affiliated to Shanghai Health College, Shanghai Pudong New Area People's Hospital, and Shanghai Oriental Hospital from January 2019 to February 2024 were enrolled. General data such as gender and age of the patients were collected. Lactate dehydrogenase (LDH), liver function indexes [total bilirubin (TBIL), direct bilirubin (DBIL), AST, ALT, AST/ALT, ALB, total protein (TP), globulin (GLB), ALB/GLB ratio (A/G), blood amine, γ-glutamyl transpeptidase (γ-GT)], platelet count (PLT), creatinine, activated partial thromboplastin time (APTT), severity of illness scores [acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), sequential organ failure assessment (SOFA)], serum procalcitonin (PCT), N-terminal pro-brain natriuretic peptide (NT-proBNP), arterial blood lactic acid (Lac) within 24 hours after admission, and whether to use mechanical ventilation, whether to use vasoactive drugs, whether to use artificial liver treatment and prognosis during hospitalization also were collected. The differences of clinical data between patients with different prognosis were compared. The variables with statistically significant differences in univariate analysis were included in multivariate Logistic regression analysis to determine the independent risk factors for death of patients with ALF in hyperacute phase of sepsis during hospitalization. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of ALB and AST/ALT for death of patients with ALF in hyperacute phase of sepsis during hospitalization.Results:A total of 73 patients with ALF in hyperacute phase of sepsis were included, with 22 survived and 51 died during hospitalization and the mortality of 69.86%. Compared with the survival group, the patients in the death group had lower ALB, γ-GT within 24 hours after admission and proportion of artificial liver treatment, and higher AST/ALT, SOFA score, LDH and proportion of use of vasoactive drugs. The differences were statistically significant. Multivariate Logistic regression analysis showed that ALB and AST/ALT were the independent risk factors for death in patients with ALF in hyperacute phase of sepsis during hospitalization [ALB: odds ratio ( OR) = 0.856, 95% confidence interval (95% CI) was 0.736-0.996, P = 0.044; AST/ALT: OR = 2.018, 95% CI was 1.137-3.580, P = 0.016]. ROC curve analysis showed that the area under the curve (AUC) of ALB for predicting in-hospital death in patients with ALF in hyperacute phase of sepsis was 0.760 (95% CI was 0.637-0.884, P < 0.001). When ALB ≤ 29.05 g/L, the sensitivity was 68.2%, and the specificity was 76.5%. The AUC of AST/ALT for predicting in-hospital death in patients with ALF in hyperacute phase of sepsis was 0.764 (95% CI was 0.639-0.888, P < 0.001). When AST/ALT ≥ 1.26, the sensitivity was 59.1%, and the specificity was 90.2%. Conclusions:The lower the ALB level, and the higher the AST/ALT within 24 hours after admission, the worse the prognosis of patients with ALF in hyperacute phase of sepsis. ALB and AST/ALT can be used as clinical indicators to evaluate the severity and prognosis of patients with ALF in hyperacute phase of sepsis.

Objective To explore the value of artificial intelligence(AI)in the diagnosis of pulmonary nodules in terms of consistency and efficiency compared with two radiologists(physician 1 is a chief physician and physician 2 is a deputy chief physician)in the diagnosis of benign and malignant pulmonary nodules using computed tomography(CT).Methods Retrospective analysis of 201 patients with pulmonary nodules confirmed by surgery pathology at Hangzhou Municipal Hospital affiliated to Zhejiang Chinese Medical University from January 2021 to October 2022,including a total of 229 pulmonary nodules,of which 74 were benign and 155 were malignant.The consistency of AI diagnosis with two radiologists was evaluated by weighted Kappa test,and the diagnostic performance of AI with the two radiologists was evaluated by the receiver operating characteristic curve(ROC).Results In the diagnosis of the benign and malignant nature of partial solid nodules,ground-glass nodules,solid nodules,and partial ground-glass and solid plus ground-glass nodules,the consistency between AI and physician 2 was higher than that between AI and physician 1.Additionally,the area under the curve(AUC)of physician 2 was higher than that of AI and physician 1 with statistically significant differences between the AUCs of ground-glass nodules,solid nodules,and partial ground-glass and solid plus ground-glass nodules(P<0.05).In the diagnosis of the benign and malignant nature of partial solid nodules and ground-glass nodules,the AUC of physician 1 was higher than that of AI,but there was no statistically significant difference between the two(P>0.05).In the diagnosis of the benign and malignant nature of solid nodules and partial ground-glass and solid plus ground-glass nodules,the AUC of AI was higher than that of physician 1 with statistically significant differences between the two(P<0.05).In the diagnosis of the benign and malignant nature of ground-glass nodules,solid nodules,and partial ground-glass and solid plus ground-glass nodules,AI's sensitivity(97%,92%,and 94%)was higher than that of physician 1(58%,89%,and 72%)and physician 2(83%,84%,and 85%).Conclusion AI has a certain diagnostic efficacy in the diagnosis of pulmonary nodules malignancy.The overall diagnostic efficacy of the AI system used in this study is between that of physician 1 and physician 2,but its sensitivity is higher than that of the latter two.

Objectives:To investigate the value of metagenomic next-generation sequencing (mNGS) in the diagnosis of Pneumocystis jirovecii pneumonia (PJP) in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) .Methods:The data of 98 patients with suspected pulmonary infection after allo-HSCT who underwent pathogen detection from bronchoalveolar lavage fluid between June 2016 and August 2023 at Nanfang Hospital were analyzed. The diagnostic performance of mNGS, conventional methods, and real-time quantitative polymerase chain reaction (qPCR) for PJP were compared.Results:A total of 12 patients were diagnosed with PJP, including 11 with a proven diagnosis and 1 with a probable diagnosis. Among the patients with a proven diagnosis, 1 was positive by both conventional methods and qPCR, and 10 were positive by qPCR only. Pneumocystis jirovecii was detected by mNGS in all 12 patients. The diagnostic sensitivity of mNGS for PJP was 100%, which was greater than that of conventional methods (8.3%, P=0.001) and similar to that of qPCR (91.6%, P=1.000) . A total of 75% of the patients developed mixed pulmonary infections, and cytomegalovirus and Epstein-Barr virus were the most common pathogens. Mixed infection was detected in eight patients by mNGS and in five patients by qPCR, but not by conventional methods ( P=0.008) . Conclusions:mNGS had good sensitivity for diagnosing PJP after allo-HSCT and was advantageous for detecting mixed infectious pathogens; therefore, mNGS might be an effective supplement to regular detection methods and qPCR.

Objective:To analyze the efficacy of high-throughput hemodialysis (HFHD) therapy on the application of serum ferritin (SF), transferrin saturation (TSAT), ferromodultin (Hepc) and soluble transferrin receptor (sTfR) levels in maintenance hemodialysis (MHD) with renal anemia.Methods:The uremic patients with MHD treatment in the Third People′s Hospital of Hangzhou City from August 2020 to July 2023 were selected as the study object. They were divided into high throughput (30 cases) and low throughput (30 cases) according the treatment methods. The general data; anemia indexes, including red blood cell count (RBC), hemoglobin (Hb), hematocrit (HCT), percentage of reticulocytes (Ret); iron metabolism indexes (SF, TSAT, Hepc and sTfR); inflammations indexes, including β 2-microglobulin (β 2-MG), C-reactive protein (CRP), interleukin-6 (IL-6); renal function indexes, including blood creatinine (SCr), urine creatinine (Cr), blood urea nitrogen (BUN); and adverse reaction were collected. Results:After treatment, the levels of RBC, Hb, HCT, SF and TSAT in the high-throughput group were increased compared with those before treatment: (3.33 ± 0.43) × 10 12/L vs. (2.12 ± 0.24) × 10 12/L, (118.08 ± 11.36) g/L vs. (98.23 ± 8.58) g/L, 0.354 ± 0.030 vs. 0.228 ± 0.037, (486.23 ± 68.22) μg/L vs. (149.34 ± 39.62) μg/L, (36.24 ± 5.82)% vs. (18.72 ± 6.14)%, After treatment, the levels of RBC, Hb, HCT, SF and TSAT in the low-throughput group were increased compared with those before treatment: (2.79 ± 0.32) × 10 12/L vs. (2.19 ± 0.27) × 10 12/L, (111.98 ± 9.07) g/L vs. (97.60 ± 8.33) g/L, 0.330 ± 0.036 vs. 0.214 ± 0.037, (332.73 ± 56.35) μg/L vs. (151.25 ± 39.90) μg/L, (22.23 ± 6.60)% vs. (17.97 ± 5.72)%. In the high-throughput group, after treatment compared with before treatment, Ret, Hepc, sTfR, β 2-MG, CRP, IL-6, SCr, Cr and BUN levels all decreased: (1.02 ± 0.58)% vs.(1.64 ± 0.99)%, (71.56 ± 5.67) μg/L vs. (89.56 ± 7.62) μg/L, (395.07 ± 37.10) μg/L vs. (471.37 ± 41.18) μg/L, (8.38 ± 1.94) μg/L vs. (13.79 ± 2.09) μg/L, (1.07 ± 0.23) mg/L vs. (2.28 ± 0.20) mg/L, (11.40 ± 2.84) ng/L vs. (22.74 ± 6.38) ng/L, (351.54 ± 62.05) μmol/L vs. (530.04 ± 85.06) μmol/L, (6.32 ± 1.49) nmol/L vs. (11.52 ± 2.37) nmol/L, (6.75 ± 1.51) mmol/L vs. (18.37 ± 4.52) mmol/L, compared with before and after treatment in low throughput group, Ret value, Hepc, sTfR, β 2-MG, CRP, IL-6, SCr, Cr and BUN levels decreased: (1.40 ± 0.65)% vs. (1.67 ± 0.78)%, (84.33 ± 7.45) μg/L vs. (88.97 ± 7.79) μg/L, (431.20 ± 37.59) μg/L vs. (459.56 ± 42.22) μg/L, (11.35 ± 1.06) μg/L vs. (14.00 ± 1.90) μg/L, (1.57 ± 0.27) mg/L vs. (2.19 ± 0.23) mg/L, (16..85 ± 3.02) ng/L vs. (23.38 ± 6.17) ng/L, (389.48 ± 67.03) μmol/L vs. (531.02 ± 78.07) μmol/L, (9.80 ± 1.33) nmol/L vs. (11.34 ± 2.18) nmol/L, (7.55 ± 1.21) mmol/L vs. (18.37 ± 4.52) mmol/L, In addition, RBC, Hb, HCT, SF and TSAT levels in high-flux group were higher than those in low-flux group ( P<0.05), while Ret, Hepc, sTfR, β 2-MG, CRP, IL-6, SCr, Cr and BUN levels were lower than those in low-flux group, with statistical significance ( P<0.05). There was no significant difference in the incidence of adverse drug effects between the two groups ( P>0.05). Conclusions:HFHD treatment for patients with renal anemia in MHD has better treatment effect than LFHD, which can effectively correct the anemia state of patients, improve the body iron metabolism response, reduce inflammatory response and improve kidney function, and has certain clinical application value.

Objective To study adverse drug events(ADEs)of busulfan the U.S.Food and Drug Administration Adverse Event Reporting System(FAERS),and to mine the potential ADE signals,so as to provide reference for the safe drug use in clinical practice.Methods Data from the first quarter of 2004 to the first quarter of 2023 were retrieved from the FAERS database,and ADE records for busulfan as a primary suspect drug were obtained through data cleaning and standardization of target drug names.Risk signals for busulfan ADEs were mined based on the reporting odds ratio method,the proportional reporting ratio method,and Medicines and Healthcare Products Regulatory Agency method.The information component method was used to assess the intense of the risk signals.The ADEs were systematically classified according to Medical Dictionary for Regulatory Activities(MedDRA),and two ranking sequence of busulfan ADEs were generated by signal occurrence frequency and signal intense,respectively.Results A total of 20 326 ADE records were collected,involving 5 615 patients with 556 related ADE signals,of which 117 were newly reported as compared to those in the drug instruction of busulfan.Male patients accounted for a higher proportion than female patients(40.71％vs.30.74％).The main population of patients were younger than 18 years old(31.56％).The reports were most reported by physicians(33.71％)and other health professionals(24.35％)as well as pharmacists(23.86％),mainly from the United States(29.69％),Japan(15.78％),and France(11.79％).The top five ADEs in terms of occurrence frequency were busulfan use in unapproved indications,hepatic veno-occlusive disease(HVOD),mucosal inflammation,cytomegalovirus infection,and graft versus host disease.The top five ADEs in terms of signal intense were HVOD,acute graft versus host disease,veno-occlusive disease,graft versus host disease,and chronic graft versus host disease.The ADE signals involves 23 system organ classes.The top three SOCs in terms of the number of ADE signals were infections/infestations,investigations and neoplasms benign/malignant/unspecified(include cysts and polyps).Conclusion When busulfan is used in clinic,attention should be paid to its adverse events in hepatic veno-occlusive disease,infections,graft versus host disease,neurotoxicity,and venous thromboembolism,which are likely to cause serious consequences.The clinical pharmacists can assist clinicians to make prevention plans in case of busulfan ADEs,so as to improve the safety of busulfan use in clinic.