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 evaluate the impact of modified cesarean section techniques on pregnancy outcomes in cases involving placenta accreta spectrum(PAS).Methods A retrospective study was conducted to enroll 176 pregnant women with PAS who underwent cesarean delivery at the First Hospital of Shanxi Medical University between January 2016 and January 2025.Patients who received traditional cesarean delivery before January 17,2021,were assigned to the control group(n=115),while those who underwent a modified cesarean procedure after that date were included in the modified group(n=61).Clinical data,including gestational age,maternal age,gravidity,and intraoperative blood loss,were collected and compared between the two groups.Subsequently,a random forest algorithm was employed to develop a risk prediction model for adverse pregnancy outcomes in patients with PAS.Results In the modified group,only one patient required a hysterectomy(1.64%),which was signifi-cantly lower than the 19 cases observed in the control group(16.52%).The modified group also demonstrated a higher intraoperative diagnosis rate of placenta accreta,along with lower incidences of hemorrhagic shock,disseminated intravascular coagulation,and neonatal asphyxia compared to the control group.However,the proportions of patients undergoing uterine compression sutures and uterine artery ligation were higher in the modified group,with statistically significant differences(P<0.05).Patients were further classified into low-bleeding and high-bleeding subgroups for subgroup analysis.A significant difference in gravidity was observed between the two subgroups(P<0.05),whereas no significant difference was found in the proportion of patients receiving the modified procedure(P>0.05).A predictive model for refractory postpartum hemorrhage was developed with high discriminative ability(AUC=0.938,95%CI:0.917～0.958).Gini coefficient analysis identified gravidity,number of abortions,and ultrasound diagnosis of placenta accreta as key predictors of refractory postpartum hemorrhage(P<0.05).Conclusion Improved cesarean section techniques can effectively reduce intraoperative and postoperative bleeding in cases of PAS,significantly lowering the risk of hysterectomy and thereby improving pregnancy outcomes.

Objective To evaluate the impact of modified cesarean section techniques on pregnancy outcomes in cases involving placenta accreta spectrum(PAS).Methods A retrospective study was conducted to enroll 176 pregnant women with PAS who underwent cesarean delivery at the First Hospital of Shanxi Medical University between January 2016 and January 2025.Patients who received traditional cesarean delivery before January 17,2021,were assigned to the control group(n=115),while those who underwent a modified cesarean procedure after that date were included in the modified group(n=61).Clinical data,including gestational age,maternal age,gravidity,and intraoperative blood loss,were collected and compared between the two groups.Subsequently,a random forest algorithm was employed to develop a risk prediction model for adverse pregnancy outcomes in patients with PAS.Results In the modified group,only one patient required a hysterectomy(1.64%),which was signifi-cantly lower than the 19 cases observed in the control group(16.52%).The modified group also demonstrated a higher intraoperative diagnosis rate of placenta accreta,along with lower incidences of hemorrhagic shock,disseminated intravascular coagulation,and neonatal asphyxia compared to the control group.However,the proportions of patients undergoing uterine compression sutures and uterine artery ligation were higher in the modified group,with statistically significant differences(P<0.05).Patients were further classified into low-bleeding and high-bleeding subgroups for subgroup analysis.A significant difference in gravidity was observed between the two subgroups(P<0.05),whereas no significant difference was found in the proportion of patients receiving the modified procedure(P>0.05).A predictive model for refractory postpartum hemorrhage was developed with high discriminative ability(AUC=0.938,95%CI:0.917～0.958).Gini coefficient analysis identified gravidity,number of abortions,and ultrasound diagnosis of placenta accreta as key predictors of refractory postpartum hemorrhage(P<0.05).Conclusion Improved cesarean section techniques can effectively reduce intraoperative and postoperative bleeding in cases of PAS,significantly lowering the risk of hysterectomy and thereby improving pregnancy outcomes.

Objective To observe the impact of ultrasonic image quality on the consistency of artificial intelligence(Al)assisted diagnosis system and manual measurements of biological indicators of developmental dysplasia of hip(DDH).Methods Hip ultrasonic data of 75 DDH and 345 non-DDH children were retrospectively analyzed,and the quality of ultrasonic images were subjectively scored.An evaluation model of ultrasonic image quality was constructed based on 140 ultrasonic images acquired from 140 cases(group A,containing 25 DDH and 115 non-DDH)using entropy weighting method,the weight of anatomic structures and impact factors related to DDH were obtained.The comprehensive image quality scores of other ultrasonic images acquired from 280 cases(group B,including 50 DDH and 230 non-DDH)were calculated,and the images in group B were classified into grade A,B and C in descending order.The consistency of AI and manual measurements of DDH biological indicators in group B was assessed.Results The weight of each anatomic structure and impact factors of DDH obtained with the model were as follows:The lower edge of iliac branch＞ilium＞glenoid labrum＞bony margin＞femoral head＞motion artifacts.In group B,grade A was observed in 67(9 DDH and 58 non-DDH),grade B was found in 160(26 DDH and 134 non-DDH),while grade C was noticed in 53(15 DDH and 38 non DDH)images.Except for β,femoral head coverage(FHC)and femoral head length diameter,the consistencies between AI and manual measurements of other indicators of DDH were grade A＞B＞C.In group B,AI and manual measurements were more consistent in DDH than in non-DDH cases.Conclusion Ultrasonic image quality affected the consistency between AI and manual measurements of biological indicators of DDH.When image quality was not good enough,further attention should be paid to measurement of FHC and sizes of femoral head.

Purpose To explore the value of contrast-enhanced ultrasound(CEUS)in the differential diagnosis of gallbladder polypoid lesions(GPLs)(diameter≥10 mm).Materials and Methods A prospective enrollment of 229 patients with GPLs who underwent cholecystectomy in 17 hospitals from December 1 2021 to June 30 2024 was conducted to analyze the relationship between general data,conventional ultrasound,CEUS characteristics and the nature of GPLs.Multivariate Logistic regression was employed to identify independent risk factors for neoplastic polyps,the differential diagnostic value of different indicators was compared.Results Among 229 patients with GPLs,there were 108 cases of cholesterol polyps,102 cases of adenoma and 19 cases of gallbladder cancer.Age(Z=-4.476,P<0.001),polyp number(χ2=15.561,P<0.001),diameter(Z=-8.149,P<0.001),echogenicity(χ2=9.241,P=0.010),vascularity(χ2=23.107,P<0.001),enhancement intensity(χ2=47.610,P<0.001),enhancement pattern(χ2=6.468,P=0.011),vascular type(χ2=84.470,P<0.001),integrity of gallbladder wall(χ2=7.662,P=0.006)and stalk width(Z=-9.831,P<0.001)between cholesterol polyps and neoplastic polyps were statistically significant.Age,location,diameter,echogenicity,enhancement pattern,vascular type and stalk width between adenoma and gallbladder cancer were statistically significant(Z=-4.333,-3.902,-5.042,all P<0.05).Multivariate Logistic regression analysis showed that hyper-enhancement,branched vascular type and stalk width were independent risk factors for neoplastic polyps(OR=4.563,5.770,3.075,all P<0.001).The combination of independent risk factors was better than single factor and diameter in the differential diagnosis of cholesterol polyps and neoplastic polyps(all P<0.01).Conclusion CEUS can effectively identify the nature of GPLs and provide a valuable imaging reference for the selection of treatment methods.

Objective:To explore the related factors affecting the prognosis of children with parenteral nutrition-associated cholestasis (PNAC).Methods:Twenty children with PNAC admitted to Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2014 to December 2020 were selected as research objects by retrospective study. According to prognosis, children were divided into good (15 cases) and poor prognosis group (5 cases). Clinical data such as general condition, intravenous nutrition duration, related biochemical examination indexes and main treatment methods of children in the two groups were collected. Spearman correlation analysis was used to quantify the correlation between alanine aminotransferase (ALT) and poor prognosis. Univariate analysis was used to analyze the risk factors affecting the prognosis of children with PNAC, and receiver operating characteristic curve (ROC curve) was drawn to evaluate the predictive value of ALT on the prognosis of children.Results:There were no significant differences in gender, body weight, gestational age, age, feeding mode, duration of intravenous nutrition, direct bilirubin (DBil), aspartate aminotransferase (AST), γ-glutamyltranspeptidase (GGT), total protein (TP), serum albumin (Alb), globulin (GLB), alkaline phosphatase (ALP), platelet count (PLT), white blood cell count (WBC), red blood cell count (RBC), hemoglobin (Hb), lymphocyte count (LYM), urine culture, AST/PLT ratio (APRI) and main treatment methods between the two groups. Total bilirubin (TBil), ALT, neutrophil count (NEU) and monocyte count (MONO) in the good prognosis group were significantly lower than those in the poor prognosis group [TBil (μmol/L): 120.00±48.63 vs. 175.26±29.14, ALT (U/L): 73.25±44.29 vs. 145.30±74.33, NEU (×10 9/L): 2.55±1.29 vs. 5.08±4.10, MONO (×10 9/L): 1.23±0.87 vs. 2.13±0.60, all P < 0.05]. Logistic regression analysis showed that ALT was the risk factor affecting the prognosis of children with PNAC, when ALT increased by 1 U/L, the probability of poor prognosis increased by 3.6% [odds ratio ( OR) = 1.04, 95% confidence interval (95% CI) was 1.00-1.07, P = 0.04]. Spearman correlation analysis showed that the incidence of poor prognosis was positively correlated with ALT ( r = 0.49, P = 0.03). ROC analysis showed that ALT had certain predictive value for the prognosis of children with PNAC [area under ROC cure (AUC) = 0.83, 95% CI was 0.00-1.00, P = 0.03]; when the cut-off value was 121.50 U/L, its sensitivity was 80% and specificity was 93%, suggesting that ALT could be used as the main indicator for clinical prediction of poor prognosis for PNAC. Conclusion:ALT is an independent risk factor of poor prognosis in children with PNAC.

Objective: To explore the effect of neck exercises on improving the shoulder and neck symptoms of senior high school students in Zhuhai. Methods: From February 2019 to July 2019, 805 senior high school students from 20 classes in 10 middle schools in Zhuhai were selected by multi-stage random sampling method, and randomly divided into two groups based on the class. The final observation group consisted of 405 cases and the control group consisted of 400 cases. The observation group was intervened by neck exercise based with isometric contraction exercise for 12 weeks, while the control group was intervened by routine intervention. The changes of VAS, NDI and PSQI were compared before and after the intervention between the two groups, and the subjects who met the diagnosis criteria of cervical spondylosis were analyzed in subgroups. Results: A total of 112 students met the diagnostic criteria of cervical spondylosis, the prevalence rate was 13.9%. among them, 58 cases were diagnosed in the control group and 54 cases in the observation group. After the intervention, the VAS pain level of the observation group was lower than that of the control group (Z=-3.37, P<0.01), and the NDI score was significantly lower than that of the control group (t=-20.05, P<0.01). After the intervention, the PSQI subjective sleep quality, sleep time, sleep efficiency, sleep disorder, daytime dysfunction dimension scores and total scores of the observation group were significantly lower than those of the control group (t=-10.36, -7.66, -12.39, -9.78, -9.06, -11.31, -16.56, P<0.05). Conclusion The incidence of cervical spondylosis is high in senior high school students in Zhuhai. The neck exercise focusing on isometric strengthening can effectively improve the symptoms and sleep quality of cervical vertebrae.

Objective:To investigate the clinical characteristics, treatment effect and prognosis of children with nearly diploid neuroblastoma (NB).Methods:A retrospective analysis of the general clinical characteristics (including age, Gender, risk grouping, location of primary tumor, etc.), laboratory test results, treatment and recent prognosis of NB children with nearly diploidy in bone marrow chromosomes by G-banding technology who admitted to Beijing Children′s Hospital, Capital Medical University from January 2015 to December 2018. Kaplan- Meier method was adopted to calculate survival rate.Univariate analysis was performed using Log- Rank test, and multivariate analysis was conducted with Cox regression model. Results:A total of 43 patients, including 27 males and 16 females, with diagnosis were included, with 14 cases in the hypodiploid group and 29 cases in the hyperdiploid group, and the median age was 35.5 months.The 43 children were all in the high-risk group of International Neuroblastoma Staging System(INSS)-Ⅳ.The primary tumors were mainly located in the retroperitoneal adrenal region (83.7%, 36/43 cases). The largest diameter of the tumors was more than 10 cm (53.5%, 23/43 cases), and often accompanied by 2 or more metastases at the time of consultation.In terms of chromosome karyotype and chromosome karyotype of 14 children in the hypodiploid group was 41-45, the most common karyotype was 45 chromosomes[9 cases(64.3%)]. Among 29 children in the hyperdiploid group of the 47 chromosome karyotypes, 11 cases were common (37.9%). Tumor markers were as follows: neuron enolase (NSE) increased in 41 cases children (95.3%) at first diagnosis, and 25 cases (58.1%)> 370 μg/L; 42 cases (97.7%)had lactate dehydrogenase (LDH). The LDH of children in the hypodiploid group was all> 500 U/L, with 1 case was> 10 000 U/L.Nine cases (20.9%) of MYCN gene were detected by fluorescence in situ hybridization (FISH). Treatment and prognosis: the total course of chemotherapy for 43 patients was 1-12, 19(44.2%) patients received autologous stem cell transplantation, 21 patients (46.5%) received postoperative or autologous radiotherapy or metaiodobenzylguanidine treatment, 28 children developed or relapsed with a median duration of 13.8 months, and 15 cases (34.9%) died.The median follow-up time of the 14 children in the hypodiploid group was 14.9 months (2-38 months), 12 cases progressed or relapsed, and 7 died.The median follow-up of 29 children in the hyperdiploid group was 20.0 months (8.1-51.6 months), with 16 patients progressed or relapsed and 8 cases died. Kaplan- Meier survival analysis illustrated that the 3-year projected event free survival (EFS) rate of 43 children was 18.4%, of which 17.1% were in the hypodiploid group and 29.8% in the hyperdiploid group. Conclusions:Preliminary analysis reveals that children with nearly diploid NB are mostly in the stage Ⅳ high-risk group over the age of 18 months, and 2 or more metastases at the time of consultation.The 3-year estimated EFS of 43 children was 18.4%, and the prognosis was worse in the hypodiploid group.

Objective:To summarize and analyze the results of chromosome karyotype in children with neuroblastoma (NB) with bone marrow metastasis at first diagnosis, and to discuss the clinical significance.Methods:G-banding was applied to the analysis of chromosome karyotype of patients who were regularly treated in the Hematological and Oncology Center in Beijing Children′s Hospital from January 2015 to December 2017, and all the patients were followed up until December 31, 2018.Their clinical features and prognosis were analyzed.Results:(1) There were 120 cases with bone marrow metastasis, including 74 boys and 46 girls, and 98 cases (81.7%) were ≥ 18 months.Among 60 cases with normal chromosome, 56 cases (93.3%) were in International Neuroblastoma Staging System(INSS)-Ⅳ phase, and 4 cases in INSS-Ⅳs phase; there were 2 low-risk (LR) cases, 9 intermediate-risk (MR) cases, and 49 high-risk (HR) cases (81.7%); 7 cases had MYCN gene amplifications.All 60 patients with chromosome abnormalities were in INSS-Ⅳ phase; there was 1 case in MR and 59 cases (98.3%) in HR; 14 cases had MYCN gene amplifications.(2) Among 60 children (50%) with chromosome abnormalities, 4 children had number abnormalities, 14 children had structural abnormalities, and 42 children had both number and structural chromosome abnormalities.Chromosome 21, 10, 11 deletions were the most common in number abnormalities; structural abnormalities involving 11q, 1p, 3p segments had a high incidence.(3) Seventeen cases of children with normal chromosome had tumor progression or recurrence during the 4 to 44-month follow-up period, and 31 cases of children with chromosome abnormalities had tumor progression or recurrence during the 2 to 42-month follow-up period.The 3-year overall survival rate and event-free survival rate of all children were 60.0% and 48.4%, respectively; children in the normal chromosome group had a 3-year overall survival rate of 74.2% and an event-free survival rate of 65.7%; the 3-year overall survival rate and event-free survival rate of children with chromosome abnormalities were 47.5% and 24.9%, respectively.Most children suffering from tumor progression or recurrence had chromosome 10 deletion, and abnormal structure of 11q, 1p, 2p segments. Conclusion:The chromosomal abnormality rate of Nb children's tumor cells is high, but the repetition rate is low, and the individual difference is obvious.The deletion of chromosome 10, abnormal regional structure of 11q, 1p and 2p segments may be poor prognostic factors for NB.Chromosome karyotype analysis of bone marrow samples is feasible, which can provide a basis for more accurate risk stratification and treatment.

Objective To explore the relationship between atrial fibrillation and hip fractures caused by falls in the elderly.Methods All patients aged 65 years or older who underwent surgical treatment for hip fractures caused by falls in our department from January 2015 to December 2017 were enrolled.The relationships of atrial fibrillation as well as chronic medical history with hip fractures were retrospectively analyzed.The control group was matched 1 to 1 by age,sex,and admission time.Chi-square test and Logistic regression analysis were used to calculate the odds ratio (ORvalue) of fractures in patients with atrial fibrillation.Results There was no significant difference in the history of smoking,drinking,diabetes,coronary heart disease,heart failure,chronic kidney disease,chronic obstructive pulmonary disease(COPD),and Parkinson's disease between the two groups.A total of 37 patients had a history of atrial fibrillation in the fracture group,compared to 18 patients with atrial fibrillation in the control group.The incidence of atrial fibrillation in the fracture group and the control group were 9.6％ and 4.7％,respectively,with crude OR=2.18,95％CI(1.32-4.15),P=0.008 and adjusted OR=2.27,95％CI(1.37-5.20),P=0.02.Compared with the control group,the incidence of stroke (x2 =14.06,P ＜ 0.05),osteoporosis (x2 =200.64,P ＜ 0.01) and cognitive impairment(x2 =8.23,P ＜0.01)increased in the fracture group.When classified by age and sex in the fracture group,the incidence of atrial fibrillation had no significant difference between different gender and age subgroups.Conclusions Atrial fibrillation is an independent risk factor for hip fractures caused by falls in the elderly.There is no significant difference in the incidence of atrial fibrillation in hip fracture patients between the different ages(65-74 years,75-84 years,≥of 85 years)and genders.In addition,stroke,osteoporosis,and cognitive impairment increase the risk of hip fractures caused by falls in elderly patients.