The mobile health (mHealth) industry is an enormous global market; however, the dropout or continuance of mHealth is a major challenge that is affecting its positive outcomes. To date, the results of studies on the impact factors have been inconsistent. Consequently, research on the pooled effects of impact factors on the continuance intention of mHealth is limited. Therefore, this study aims to systematically analyze quantitative studies on the continuance intention of mHealth and explore the pooled effect of each direct and indirect impact factor. Until October 2021, eight literature databases were searched. Fifty-eight peer-reviewed studies on the impact factors and effects on continuance intention of mHealth were included. Out of the 19 direct impact factors of continuance intention, 15 are significant, with attitude (β = 0.450; 95% CI: 0.135, 0.683), satisfaction (β = 0.406; 95% CI: 0.292, 0.509), health empowerment (β = 0.359; 95% CI: 0.204, 0.497), perceived usefulness (β = 0.343; 95% CI: 0.280, 0.403), and perceived quality of health life (β = 0.315, 95% CI: 0.211, 0.412) having the largest pooled effect coefficients on continuance intention. There is high heterogeneity between the studies; thus, we conducted a subgroup analysis to explore the moderating effect of different characteristics on the impact effects. The geographic region, user type, mHealth type, user age, and publication year significantly moderate influential relationships, such as trust and continuance intention. Thus, mHealth developers should develop personalized continuous use promotion strategies based on user characteristics.

Mesenchymal stem cells (MSCs) are getting attention in the field of cancer immunotherapy. The main effects of MSCs on tumors are homing and regulation of inflammatory and immune responses. Indeed, cancer immunotherapy has become a promising treatment and MSCs play a potential role in regulating the efficacy of immunotherapy. In addition, MSCs are an ideal carrier for immunomodulatory protein transmission. As such MSCs combined with immunotherapy drugs could act synergistically against tumors, throwing a great impact on cancer therapy. And MSCs may have potential in the treatment of cytokine storm or cytokine release syndrome (CRS). It is assumed that MSCs can form chimeric antigen receptor MSCs (CAR-MSCs). Whether CAR-MSCs can provide a new idea of cancer immunotherapy is unknown. It is a prime time to review the latest progress of MSCs in cancer immunotherapy, in order to clarify to fully understand the role of MSCs in cancer therapy in clinical practice.

Background Sleep disorders are a global challenge, affecting a quarter of the global population. Mobile health (mHealth) sleep apps are a potential solution, but 25% of users stop using them after a single use. User satisfaction had a significant impact on continued use intention. Objective This China-US comparison study aimed to mine the topics discussed in user-generated reviews of mHealth sleep apps, assess the effects of the topics on user satisfaction and dissatisfaction with these apps, and provide suggestions for improving users’ intentions to continue using mHealth sleep apps. Methods An unsupervised clustering technique was used to identify the topics discussed in user reviews of mHealth sleep apps. On the basis of the two-factor theory, the Tobit model was used to explore the effect of each topic on user satisfaction and dissatisfaction, and differences in the effects were analyzed using the Wald test. Results A total of 488,071 user reviews of 10 mainstream sleep apps were collected, including 267,589 (54.8%) American user reviews and 220,482 (45.2%) Chinese user reviews. The user satisfaction rates of sleep apps were poor (China: 56.58% vs the United States: 45.87%). We identified 14 topics in the user-generated reviews for each country. In the Chinese data, 13 topics had a significant effect on the positive deviation (PD) and negative deviation (ND) of user satisfaction. The 2 variables (PD and ND) were defined by the difference between the user rating and the overall rating of the app in the app store. Among these topics, the app’s sound recording function (β=1.026; P=.004) had the largest positive effect on the PD of user satisfaction, and the topic with the largest positive effect on the ND of user satisfaction was the sleep improvement effect of the app (β=1.185; P<.001). In the American data, all 14 topics had a significant effect on the PD and ND of user satisfaction. Among these, the topic with the largest positive effect on the ND of user satisfaction was the app’s sleep promotion effect (β=1.389; P<.001), whereas the app’s sleep improvement effect (β=1.168; P<.001) had the largest positive effect on the PD of user satisfaction. The Wald test showed that there were significant differences in the PD and ND models of user satisfaction in both countries (all P<.05), indicating that the influencing factors of user satisfaction with mHealth sleep apps were asymmetrical. Using the China-US comparison, hygiene factors (ie, stability, compatibility, cost, and sleep monitoring function) and 2 motivation factors (ie, sleep suggestion function and sleep promotion effects) of sleep apps were identified. Conclusions By distinguishing between the hygiene and motivation factors, the use of sleep apps in the real world can be effectively promoted.

Objective We performed a meta-analysis to assess the efficacy and safety of T-DXd in the treatment of HER2-expressing solid tumours. Methods We systematically searched PubMed, Web of Science, Embase and the Cochrane Library and collected studies published before March 17, 2023, on T-DXd for HER2-expressing tumours for a meta-analysis. We performed a subgroup analysis based on the different cancer types and the doses used. Results There were 11 studies including 1349 HER2-expressing patients in this meta-analysis. The pooled ORR was 47.91%, and the pooled DCR was 87.01%. The mPFS and mOS combined were 9.63 and 10.71 months, respectively. The most common adverse reactions in grades 1–2 were decreased appetite (49.3%) and vomiting (43.0%). The netropemia (31.2%) and leukopenia (31.2%) were the most common grade 3 and higher adverse reactions. Subgroup analysis showed that breast cancer had the best ORR and DCR, with 66.96 and 96.52%, respectively. Conclusions Overall, the efficacy of T-DXd in treating HER2-expressing solid tumours is encouraging, especially breast and non-small cell lung cancers, and has an acceptable safety profile. However, concerns remain about potentially serious treatment adverse events (e.g. interstitial lung disease/pneumonia). More well-designed, large-scale randomized controlled trials are needed to demonstrate our study.

The incidence of nasopharyngeal carcinoma (NPC) exhibits marked geographic variation globally and is intimately associated with endemic Epstein-Barr Virus (EBV) infection. Although most patients present with locoregionally-advanced disease, several population-level screening trials using blood-based EBV assays have successfully detected most cases in the asymptomatic period. Given the rarity of NPC, it is uncertain whether screening could be cost-effective, and what the optimal screening program might be. We therefore sought to define the cost-effectiveness of three blood-based screening strategies in high-incidence regions globally, and hypothesized that screening of men and women in both high-incidence and middle-income countries could be costeffective. Materials/Methods: Using incidence data from 340 cancer registries in 69 countries, we selected 42 high-incidence populations in 15 countries with a lifetime NPC incidence exceeding 0.25%. We developed a decision-analytic model comparing three previously-tested annual screening strategies (EBV DNA PCR + endoscopy + MRI, PCR + endoscopy, and ELISA serology + endoscopy) to no screening. Transition probabilities and stage distributions were based upon screening trials. Clinical outcomes were extracted from trial data and the AJCC 8 update, and microcosting was performed using WHO-CHOICE methods. One-way and probabilistic sensitivity analyses were performed to study the impact of age, gender, utilities, and costs. A willingness-to-pay (WTP) threshold was set at twice the local per-capita GDP. Results: Among the 42 selected populations, screening with PCR + endoscopy + MRI, PCR + endoscopy, and ELISA + endoscopy decreased NPC-specific mortality by 62%, 53%, and 72%, respectively. These strategies thereby improved 5-year NPC-specific survival from 74% in an unscreened population to 91%, 89%, and 94%. In the base case scenario, screening with PCR + endoscopy + MRI was cost-effective at the WTP threshold in 40% of selected populations, compared to 38% with PCR + endoscopy and 67% with ELISA + endoscopy. The addition of MRI to PCR was marginally more cost-effective than endoscopy alone, but was associated with small improvements in 5-year NPC-specific survival (2%). Among populations with a lifetime incidence exceeding 0.60%, screening was always cost-effective. Moreover, screening in many middle-income and most high-income countries was also cost-effective. Sensitivity analysis informed the optimal age at first screening in each region, as well as the screening of women. Probabilistic sensitivity analysis was in close agreement with base case analyses. Conclusion: We observed significant reductions in NPC-specific mortality with the use of blood-based screening in high-incidence populations globally. Despite economic differences and the rarity of NPC, these strategies were cost-effective in most high-incidence regions, and could be extended to both adult men and women, generally beginning at age 40.