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 Previous studies found that high temperature and heatwave increase the risk of traffic injuries. The complex road conditions in Yunnan Province result in frequent traffic accidents. However, there is limited evidence on the correlation between heatwave and traffic injuries in Yunnan Province. Objective To assess the association between heatwave events and traffic injuries, to estimate its disease burden, and to identify relevant sensitive groups. Methods We collected data on traffic injury cases and concurrent meteorological information from four surveillance sites in Yunnan Province, China: Dali, Lufeng, Zhaoyang, and Qilin from May to September each year from 2015 to 2023. Traffic injury cases refer to patients who visited the outpatient or emergency departments of local surveillance hospitals for the first time due to traffic injuries. Meteorological data were derived from the fifth generation atmosphericreanalysis dataset of the global climate provided by the European Centre for Medium-Range Weather Forecasts. A time-stratified case-crossover design combined with distributed lag non-linear model was used to analyze the association between short-term exposure to heatwave and traffic injuries. We also conducted subgroup analyses by sex, age, occupation, injury cause, activity at the time of injury occurrence, and severity of injury. Results A total of 34764 traffic injury surveillance cases were included in the analysis. The risk of traffic injuries occurred during heatwave was 1.13 times (95%CI: 1.07, 1.20) greater than those occurred during non-heatwave, and 2.64% (95%CI: 1.49%, 3.73%) of traffic injuries were attributed to heatwave exposure throughout the study period. The results of stratified analysis showed greater impacts of heatwave on the risk of traffic injuries in female [odds ratio (OR)=1.17, attributable fraction (AF)=3.23%], people aged 15-64 years (OR=1.13, AF=2.68%), farmers/workers (OR=1.22, AF=4.07%), people with non-motor vehicle traffic injuries (OR=1.17, AF=3.24%), people who were driving or riding when injuries occurred (OR=1.12, AF=2.43%), and people with minor injuries (OR=1.18, AF=3.49%) ( P<0.05). Longer duration [excess risk (ER)=0.99%] and greater intensity (ER=4.12%) of heatwave had greater impacts on the risk of traffic injuries (P<0.05). Conclusion Heatwave events are associated with an increased risk of traffic injuries. Female, people aged 15-64, farmers/workers, people with non-motor vehicle traffic injuries, those injured while driving/riding a vehicle, and people with minor injuries are particularly vulnerable. The findings suggest that targeted mitigation and adaptation measures should be taken to address the risk of traffic injuries associated with extreme climate events.

Objective To explore the construction of α-1,3-galactosyltransferase (GGTA1) gene-knockout (GTKO) Diannan miniature pigs and the kidney xenotransplantation from pigs to rhesus macaques, and to assess the effectiveness of GTKO pigs. Methods The GTKO Diannan miniature pigs were constructed using the CRISPR/Cas9 gene-editing system and somatic cell cloning technology. The phenotype of GTKO pigs was verified through polymerase chain reaction, Sanger sequencing and immunofluorescence staining. Flow cytometry was used to detect antigen-antibody (IgM) binding and complement-dependent cytotoxicity. Kidney xenotransplantation was performed from GTKO pigs to rhesus macaques. The humoral immunity, cellular immunity, coagulation and physiological indicators of the recipient monkeys were monitored. The function and pathological changes of the transplanted kidneys were analyzed using ultrasonography, hematoxylin-eosin staining, immunohistochemical staining and immunofluorescence staining. Results Single-guide RNA (sgRNA) targeting exon 4 of the GGTA1 gene in Diannan miniature pigs was designed. The pGL3-GGTA1-sgRNA1-GFP vector was transfected into fetal fibroblasts of Diannan miniature pigs. After puromycin selection, two cell clones, C59# and C89#, were identified as GGTA1 gene-knockout clones. These clones were expanded to form cell lines, which were used as donor cells for somatic cell nuclear transfer. The reconstructed embryos were transferred into the oviducts of trihybrid surrogate sows, resulting in 13 fetal pigs. Among them, fetuses F04 and F11 exhibited biallelic mutations in the GGTA1 gene, and F04 had a normal karyotype. Using this GTKO fetal pig for recloning and transferring the reconstructed embryos into the oviducts of trihybrid surrogate sows, seven surviving piglets were obtained, all of which did not express α-Gal epitope. The binding of IgM from the serum of rhesus monkey 20# to GTKO pig PBMC was reduced, and the survival rate of GTKO pig PBMC in the complement-dependent cytotoxicity assay was higher than that of wild-type pig. GTKO pig kidneys were harvested and perfused until completely white. After the left kidney of the recipient monkey was removed, the pig kidney was heterotopically transplanted. Following vascular anastomosis and blood flow restoration, the pig kidney rapidly turned pink without hyperacute rejection (HAR). Urine appeared in the ureter 6 minutes later, indicating successful kidney transplantation. The right kidney of the recipient was then removed. Seven days after transplantation, the transplanted kidney had good blood flow, the recipient monkey's serum creatinine level was stable, and serum potassium and cystatin C levels were effectively controlled, although they increased 10 days after transplantation. Seven days after transplantation, the levels of white blood cells, lymphocytes, monocytes and eosinophils in the recipient monkey increased, while platelet count and fibrinogen levels decreased. The activated partial thromboplastin time, thrombin time and prothrombin time remained relatively stable but later showed an upward trend. The recipient monkey survived for 10 days. At autopsy, the transplanted kidney was found to be congested, swollen and necrotic, with a small amount of IgG deposition in the renal tissue, and a large amount of IgM, complement C3c and C4d deposition, as well as CD68⁺ macrophage infiltration. Conclusions The kidneys of GTKO Diannan miniature pigs may maintain normal renal function for a certain period in rhesus macaques and effectively overcome HAR, confirming the effectiveness of GTKO pigs for xenotransplantation.

Objective To develop GTKO (α-1,3-galactosyltransferase gene-knockout, GTKO)/hCD55 (human CD55) gene-edited xenotransplant donor pigs and verify their function. Methods In this study, CRISPR (clustered regularly interspaced short palindromic repeats)/Cas9 (CRISPR-associated nuclease 9), PiggyBac transposon technology and somatic cell nuclear transfer technology were used to construct GTKO/hCD55 gene-edited Diannan miniature pigs. The phenotype and function of GTKO/hCD55 pigs were analyzed by Sanger sequencing, real-time fluorescence quantitative PCR, flow cytometry, immunofluorescence, bisulfite sequencing, antigen-antibody binding assays, and complement-dependent cytotoxicity assays. Results After transfection of PX458 and PiggyBac gene editing vectors into wild-type fetal pig fibroblasts, 48 single-cell colonies were obtained through puromycin drug screening. Two single-cell colonies were selected for somatic cell nuclear transfer, resulting in two fetal pigs at 33 days of gestation. The GGTA1(α-1,3-galactosyltransferase) genotypes of fetal pig F01 were -17 bp and wild type (WT), while the GGTA1 genotypes of fetal pig F02 were -26 bp/+2 bp and -3 bp. The hCD55 mRNA expression levels of both fetal pigs were significantly higher than those of WT pigs (P＜0.01). The fetal pig F02 was selected as the donor cell source for recloning, 11 surviving piglets were obtained, all identified as GTKO/hCD55 gene-edited pigs. These pigs showed absence of α-Gal antigen expression, but weak or no expression of hCD55 was observed. Methylation analysis of the hCD55 gene's CpG island showed hypermethylation in kidney tissue lacking hCD55 expression, whereas it was not methylated or partially methylated in kidney tissue expressing hCD55. Moreover, codon optimization of the CpG island of the hCD55 gene to reduce CG content could achieve stable expression of the hCD55 gene. In addition, antigen-antibody binding experiment showed that the amount of human IgM binding to GTKO/hCD55 gene-edited pig fibroblasts was significantly lower than that of WT pigs (P＜0.01). Complement-dependent cytotoxicity experiment showed that the survival rate of fibroblasts in GTKO/hCD55 pigs was significantly higher than that in WT pigs (P＜0.01). Conclusion This study demonstrates the successful generation of GTKO/hCD55 gene-edited xenotransplant donor pigs. Methylation-induced gene silencing of the hCD55 gene can be effectively avoided by reducing the CG content of the CpG island through codon optimization. This study provides a reference for the development of xenotransplant donor pigs and guides subsequent research on xenotransplantation.

Adolescent idiopathic scoliosis(AIS)is a complex three-dimensional deformity involving coronal,sagittal,and axial planes,with a prevalence that should not be overlooked.With advancements in technology and in-depth research,an increasing number of hospitals and physicians are exploring standardized diagnostic and treatment approaches for AIS.Comprehensive and in-depth understanding is required for AIS,including its etiology,screening and diagnosis,classification,assessment and examination,treatment options,exploration of current focus,and evaluation of quality of life.Such understanding ensures that the diagnostic and treatment are scientific,standardized,and timely.Based on the principles of evidence-based medicine,a consensus on the diagnosis and treatment of AIS is reached after multiple discussions among spinal surgery experts,aiming to provide reference and guidance for clinical practice.

Objective To explore the correlation between the pulmonary artery diameter(PAD),PAD/aortic diameter(AOD),right ventricular diameter(RVD),RVD/left ventricular diameter(LVD)measured on pulmonary artery CT angiography(CTPA)cross-sectional images and the degree of embolism,cardiac biomarkers in patients with medium-to-high risk acute pulmonary embolism(APE).Methods The clinical data of 53 patients with medium-to-high risk APE,who received interventional treatment at the Putian Municipal First Hospital of China From January 2021 to December 2023,were retrospectively analyzed.The PAD,PAD/AOD,RVD,and RVD/LVD were measured on CTPA cross-sectional images.The correlations of the above indexes with CT embolism index(CTEI),N terminal pro B type natriuretic peptide(NT-proBNP),and cardiac troponin Ⅰ(cTnⅠ)were analyzed.Results A weak-moderate positive correlation existed between PAD,RVD,RVD/LVD and CTEI(r=0.506,r=0.310,r=0.452 respectively,P＜0.001,P=0.024,P=0.001 respectively),while no correlation existed between PAD/AOD and CTEI(r=0.247,P=0.075).Compared with the NT-proBNP negative group,in the NT-proBNP positive group the values of PAD,PAD/AOD and RVD/LVD were higher(all P＜0.05),and there was no statistically significant difference in RVD value between the two groups(P＞0.05).A weak-moderate positive correlation existed between NT-proBNP and PAD,PAD/AOD,RVD,RVD/LVD(r=0.454,r=0.326,r=0.302,r=0.405 respectively,P=0.001,P=0.017,P=0.028,P=0.003 respectively).There were no statistically significant differences in PAD,PAD/AOD,RVD and RVD/LVD values between the cTnⅠ negative group and the cTnI positive group(all P＞0.05).No correlation existed between cTnⅠ and PAD,PAD/AOD,RVD,RVD/LVD(r=0.188,r=0.042,r=-0.021,r=0.139 respectively,and P=0.195,P=0.772,P=0.884,P=0.342 respectively).Conclusion CTPA cross-sectional quantitative indicators are helpful in evaluating the embolism degree of APE and right heart function,but it cannot be used to assess myocardial injury.

Aiming to provide the foundation for the quality evaluation， in this paper， a comprehensive examination of historical materia medica， medical books and modern literature was conducted to systematically compile and verify the naming， origin and quality of Stalactitum， combined with the phase analysis of 20 batches of samples. The investigation indicates that before the Qing dynasty， Stalactitum was often referred to as Shizhongru， and there are other aliases such as Xuzhong， Xiashi and Huangshisha. In addition， there are some homologous mixed names such as Konggongnie， Yinnie， Ruchuang， Ruhua， but Zhongrushi is more commonly used. The descriptions of Stalactitum in ancient materia medica align with modern carbonate mineral calcite， slightly conical or cylindrical in shape， mostly white， grey and yellow in colour， often with a hole in the centre， and has a calcium carbonate content of 95% or more. Historical quality assessments include phrases such as gooseneck tube， cicada wing， bright and white， and brightness， the gloss is the most crucial feature. Modern evaluations encompass features like white color， hollow interior， brightness， multiple layers of patterns， and cross-sectional mask spark-like luminosity. Under the scanning electron microscope， Stalactitum showed obvious layered characteristics and uniform particle size， while the OS Balanophylliae was irregular. By comparing the characteristics and micro-features of Stalactitum from different batches， along with X-ray diffraction（XRD） and determination of calcium carbonate， the phase composition of different batches of Stalactitum was roughly similar， all of them were dominated by calcite， with magnesium calcite as an additional ingredient， the content of CaCO₃ was relatively higher for those with brightness and a lot of spark-like luminosity， which were key features of its quality evaluation， the white color could be used as a quality reference， and layered patterns and papillary bulge could be used as a medicinal material identification feature， which were basically consistent with the results of herbal textual research. This study can provide a reference for the quality evaluation of mineral medicines， and can better guide their clinical use and rational utilization of resources.

Objective:To explore the optimal index of rotational displacement of femoral neck fractures by modeling the axial rotational displacement of femoral neck fractures after reduction and based on X-ray projections.Methods:Six dry human femur specimens, comprising 2 males and 4 females, were utilized in the study. Design and manufacture a proximal femur ortholateral and oblique X-ray casting jigs and mounts. The femoral neck fracture was modeled on the femoral specimen, with Pauwells 30°, 50°, and 70° models (2 each) made according to Pauwells typing. The fractures were manually repositioned with residual anterior 20°, 40° and 60° axial rotational displacements. Each fracture model was projected at different angles (pedicled 40°, pedicled 20°, vertical 0°, cephalad 20°, and cephalad 40°), and the trabecular angle and Garden's alignment index of the model were measured to observe the imaging characteristics of the fracture line on the medial oblique and lateral oblique radiographs.Results:In the presence of a 20° and 40° anterior rotational displacement following reduction of a femoral neck fracture, the trabecular angle in the rotationally displaced group was not significantly different from that of the anatomically repositioned group in various projection positions. However, when a residual rotational displacement of 60° was present, the trabeculae appeared blurred at most projection angles in the Pauwells 30° and 50° models, failing to measure trabecular angles. In the Pauwells 70° fracture model, the trabecular angle in the rotational displacement group was significantly different from that in the anatomical reduction group. In anteroposterior radiographs, when the anterior rotation displacement was 60° in the Pauwells 70° group, Garden's contralateral index showed an unsatisfactory restoration (150°, 142°), whereas all rotationally displaced models in the Pauwells 30° and Pauwells 50° groups had a Garden's contralateral index of >155°, which achieved an acceptable restoration. In lateral radiographs, all rotational displacement models with Garden's alignment index>180° failed to achieve acceptable repositioning, and the larger the Pauwells angle the greater the Garden's alignment index at the same rotational displacement. In the internal oblique position with a bias towards the foot side, the image showed partial overlap between the femoral head and the shaft, making it difficult to assess the quality of the reduction. Conversely, when projected cephalad, the femoral neck appeared longer, particularly at a projection angle of 40° cephalad, allowing for clear observation of the fracture line and the anatomy of the proximal femur. The trabeculae were not well visualized in the external oblique position.Conclusion:There are limitations in applying the trabecular angle to assess the axial rotational displacement of the femoral head after reduction of femoral neck fractures. The Pauwells 70° with residual rotational anterior displacement of 60° was the only way to detect axial rotational displacement of the femoral head on anteroposterior radiographs Garden's alignment index. For the determination of axial rotational displacement of the femoral head, the Garden's alignment index on lateral radiographs provides higher reliability.

Objective:To propose a method to measure the femoral anteversion angle based on the three-dimensional model of femur.Methods:From January 2019 to December 2023, a total of 50 patients (100 femurs) with patellar instability who underwent full-length CT examination of both lower limbs in Tianjin Hospital were retrospectively analyzed, including 16 males and 34 females, aged 28.5±11.9 years (range, 16-57 years). All patients underwent CT examination of both lower limbs, and the imaging data were imported into Mimics 21.0 software as DICOM format files. The femur was extracted by the threshold segmentation function, and the 3D model of the femur was reconstructed by appropriate trimming and smoothing. Three-dimensional models of the femur from 30 patients (60 femurs) were selected and imported into 3-matic 13.0 software for labeling of anatomical points and drawing of axes. The angle between the axis of the distal femur and the axis of the proximal femur was the femoral anteversion angle. Two observers positioned the spatial coordinates of the intercondylar fossa apex, the greater trochanter apex, the center of the femoral head, the femoral through-condylar axis and the posterior condylar tangent marker points on a 3D model of the femur to compare the differences between the groups. The femoral anteversion angles measured by different three-dimensional measurement methods were compared with the clinically reported femoral anteversion angles.Results:The difference between the femoral head center and intercondylar fossa apex coordinate data of 30 patients (60 femurs) measured by the two observers was not statistically significant ( P>0.05), whereas the data for the Y-axis coordinate of the greater trochanter apex were 25.77±23.21 and 22.08±25.73, respectively, and the difference was statistically significant ( t=2.906, P=0.017). The difference between the data of femoral through condylar and posterior condylar tangential coordinates of 30 patients (60 femurs) measured by the two observers was not statistically significant ( P>0.05). Using the femoral mechanical axis as the projection direction, the angle between the transcondylar axis and the posterior condylar tangent line was 5.97°±2.02° (range, 1.48°-12.08°). The anterior tilt of the femur measured by the two observers in the femoral neck cylinder fitting method was 23.35°±7.45° and 24.94°±9.01°, respectively, and the difference was statistically significant ( t=-2.147, P=0.040). The anterior inclination of the femur measured by the two observers in the femoral head ball enlargement method was 24.63°±7.66° and 25.12°±8.84°, the difference was not statistically significant ( t=-0.820, P=0.419). Using the femoral head ball expansion method to locate the proximal femoral axis, two observers measured the anterior tilt angle of the femur in 50 patients (100 femurs) according to the method described above, which was 23.30°±9.41° and 23.57°±9.97°, respectively, without a statistically significant difference ( t=-0.664, P=0.508), both smaller than the 29.56°±8.74° measured based on two-dimensional images in the imaging report, and the difference was statistically significant ( P<0.05). Conclusion:The femoral anteversion angle measured by the angle between the axis of the femoral condyle and the axis of the femoral neck based on the three-dimensional model is accurate and effective, and the measured value is smaller than that based on the two-dimensional images in clinical practice.

Objective To investigate the feasibility,safety and efficacy of transcatheter drug-loaded microsphere embolization(DLME)in treating patients with advanced bladder cancer with bleeding(ABCB).Methods A total of 26 ABCB patients who underwent DLME for tumor supply arteries were retrospectively selected.The postoperative efficacy and related complications were observed.The recurrence of hematuria and survival situation were followed up.Results All 26 surgeries achieved success with a technical success rate of 100.0％.There were 21 cases(80.8％)of bilateral bladder artery embolism and 5 cases(19.2％)of unilateral bladder artery embolism.Three days after the operation,24 patients(92.3％)had hematuria remission.And the other two patients(7.7％)had no hematuria remission,they were relieved after interventional embolization again.Compared with that before operation,the blood transfusion rate,blood transfusion volume,hematocrit and hemoglobin at one week after operation were significantly improved(P＜0.05).One month after the last intervention,there were 2 cases of complete response,19 cases of partial response,3 cases of stable disease,and 2 cases of progressive disease.The objective remission rate was 80.8％,and the disease control rate was 92.3％.Compared with that before operation,the T stage was significantly improved at one month after operation(P＜0.05).No patients had severe complications such as ectopic embolism.After follow-up for 3-36 months,5 cases(19.2％)had a recurrence of hematuria.Conclusion Transcatheter DLME is feasible,safe,and effective in the treatment of patients with ABCB.It is an optional,minimally invasive palliative measure.