A randomized controlled trial of low-dose aspirin for the prevention of preeclampsia in women at high risk in China.

BACKGROUND: Low-dose aspirin has been the most widely studied preventive drug for preeclampsia. However, guidelines differ considerably from country to country regarding the prophylactic use of aspirin for preeclampsia. There is limited evidence from large trials to determine the effect of 100 mg of aspirin for preeclampsia screening in women with high-risk pregnancies, based on maternal risk factors, and to guide the use of low-dose aspirin in preeclampsia prevention in China. OBJECTIVE: The Low-Dose Aspirin in the Prevention of Preeclampsia in China study was designed to evaluate the effect of 100 mg of aspirin in preventing preeclampsia among high-risk pregnant women screened with maternal risk factors in China, where preeclampsia is highly prevalent, and the status of low-dose aspirin supply is commonly suboptimal. STUDY DESIGN: We conducted a multicenter randomized controlled trial at 13 tertiary hospitals from 11 provinces in China between 2016 and 2019. We assumed that the relative reduction in the incidence of preeclampsia was at least 20%, from 20% in the control group to 16% in the aspirin group. Therefore, the targeted recruitment number was 1000 participants. Women were randomly assigned to the aspirin or control group in a 1:1 allocation ratio. Statistical analyses were performed according to an intention-to-treat basis. The primary outcome was the incidence of preeclampsia, diagnosed along with a systolic blood pressure of ≥140 mm Hg or a diastolic blood pressure of ≥90 mm Hg after 20 weeks of gestation, with a previously normal blood pressure (systolic blood pressure of <140 mm Hg and diastolic blood pressure of <90 mm Hg), and complicated by proteinuria. The secondary outcomes included maternal and neonatal outcomes. Logistic regression analysis was used to determine the significance of difference of preeclampsia incidence between the groups for both the primary and secondary outcomes. Interaction analysis was also performed. RESULTS: A total of 1000 eligible women were recruited between December 2016 and March 2019, of which the final 898 patients were analyzed (464 participants in the aspirin group, 434 participants in the control group) on an intention-to-treat basis. No significant difference was found in preeclampsia incidence between the aspirin group (16.8% [78/464]) and the control group (17.1% [74/434]; relative risk, 0.986; 95% confidence interval, 0.738-1.317; P=.924). Likewise, adverse maternal and neonatal outcomes did not differ significantly between the 2 groups. Meanwhile, the incidence of postpartum hemorrhage between the 2 groups was similar (6.5% [30/464] in the aspirin group and 5.3% [23/434] in the control group; relative risk, 1.220; 95% confidence interval, 0.720-2.066; P=.459). We did not find any significant differences in preeclampsia incidence between the 2 groups in the subgroup analysis of the different risk factors. CONCLUSION: A dosage of 100 mg of aspirin per day, initiated from 12 to 20 gestational weeks until 34 weeks of gestation, did not reduce the incidence of preeclampsia in pregnant women with high-risk factors in China.

Prenatal assessment and pregnancy outcomes of foetal low-lying conus medullaris using 3D ultrasound.

OBJECTIVES: This study aims to follow up on low-lying conus medullaris (CM) cases and explore the correlation between the CM location and the final prognosis.  METHODS: We retrospectively collected 37 cases diagnosed with low-lying CM during pregnancy in the Peking University First Hospital from January 2019 to December 2020. The location of CM was confirmed by 3D ultrasonography, and clinical data, including postnatal outcomes, were recorded. When the conus medullaris was below L3 (excluding L3), it was diagnosed as low-lying conus medullaris, regardless of gestational age. The short-term postnatal outcome included assessment of symptoms and signs of motor and sensory neuron dysfunction. RESULTS: The average gestational weeks of low-lying diagnosis was between 23 and 24 weeks. Among 37 cases, nine (24.3%) were complicated with spine dysraphism (3 cases of open spina bifida, 6 cases of tethered cord syndrome). Apart from 7 cases of pregnancy termination, the remaining 30 live births had a good prognosis in the short term, though 5 out of 6 cases of tethered cord syndrome underwent surgical release. The mean location of cases of open spinal dysraphism (n = 3) and those of closed dysraphism/tethered cord syndrome (n = 6) was at Lumber vertebra 5 (L5) and between L5 and Sacral vertebra 1 (S1), respectively, which showed statistical significance compared with the postnatally normal group. When we set Lumber 4.25 as the cut-off value to predict the diagnosis of spine dysraphism (mainly involving open spinal dysraphism and closed spinal dysraphism/tethered cord syndrome), the sensitivity was 66.7. At the same time, the specificity was 96%, along with the area under the curve (AUC) at 0.877. CONCLUSION: The second trimester finding of low CM is associated with spinal defects, mainly open spinal dysraphism and closed spinal dysraphism/tethered cord syndrome. Careful assessment of the fetal spine should be considered especially when the location of CM is lower than L4.

Simpson-Golabi-Behmel syndrome in one of the Dichorionic-diamniotic twin: a case report and literature review.

BACKGROUND: Simpson-Golabi-Behmel syndrome (SGBS) is a rare X-linked overgrowth syndrome. The main clinical manifestations are overgrowth and multiple malformations. CASE PRESENTATION: A 38-year-old Chinese woman was pregnant with dichorionic-diamniotic (DCDA) twins after in-vitro fertilization. Series of ultrasound examinations indicated that the measurements (abdominal circumference and estimated foetal weight) of one twin were significantly greater than those of the other one. The genetic testing results of the larger baby indicated of Simpson-Golabi-Behmel syndrome. CONCLUSION: SGBS is difficult to diagnose due to different clinical manifestations. Clinicians need to be more aware of typical SGBS's clinical findings and choose genetic testing methods individually to improve its prenatal diagnosis.

A case of fetal isolated ventricular noncompaction with TNNT2 gene mutation and literature review.

BACKGROUND: Ventricular noncompaction (VNC) is a cardiomyopathy characterized by overdeveloped ventricular trabeculaes and deep recess, which has been rarely reported. CASE PRESENTATION: A 29-year-old Chinese pregnant woman with no obvious fetal abnormality in regular prenatal examination during first and second trimester. However, at 32 weeks of gestation, both obstetric growth scan and fetal echocardiogram revealed an enlarged heart with grid-like changes at the apical region. Eventually, the genetic and autopsy findings indicated the deceased infant with VNC. CONCLUSION: Isolated VNC could be detected prenatally, even during the late pregnancy. Fetuses suspected of VNC should be offered genetic tests.

The effect of family-based intervention for adults with diabetes on HbA1c and other health-related outcomes: Systematic review and meta-analysis.

AIMS AND OBJECTIVES: To evaluate the effectiveness of family-based intervention for adults with diabetes on glycosylated haemoglobin and other health-related outcomes. BACKGROUND: The impact of family-based intervention on adults with diabetes has been evaluated in various studies, but there is uncertainty about their effect on health-related outcomes for adults with diabetes. DESIGN: A systematic review and meta-analysis of randomised controlled trials. METHODS: A review was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Six relevant databases were searched from inception to 5 March 2021. Heterogeneity between studies was quantified by using Higgins' I2 test. Sensibility and subgroup analyses were used to explore potential heterogeneity. RESULTS: The review included 23 studies (3,114 participants). Family-based intervention had a significant effect on improving glycosylated haemoglobin levels, body mass index, blood pressure, fasting glucose, diabetes self-care, diabetes self-efficacy, diabetes distress and positive family support. Non-significant results were obtained for blood lipid, body weight, depression and negative family support. In particular, subgroup analyses indicated that family-based intervention in Asian regions was more effective in improving glycosylated haemoglobin levels than in other areas. CONCLUSION: Family-based intervention may improve diabetes control, diabetes self-care, psychological well-being and positive family support in adults with diabetes and is especially effective in Asian regions. Given the limitations in current studies, further studies are recommended to combine family theory with family-based intervention, and to examine the effectiveness of such intervention for family members. RELEVANCE TO CLINICAL PRACTICE: This review and meta-analysis provides evidence that family-based intervention can improve positive family support, which has a good effect on diabetes control and psychological well-being in adults with diabetes, and it is especially effective in Asian regions. Findings suggested that unreinforced participation by family members and integrating flexible strategies into family-based intervention may be equally effective.

Surgical Masks for Protection of Health Care Personnel Against Covid-19: Results from an Observational Study.

PURPOSE: The aim of the study was to describe the use of masks among health care personnel (HCP) exposed to index cases of coronavirus disease 2019 (COVID-19), and to evaluate any association with infection rate. METHODS: We did a retrospective, observational study of HCP at Zhongnan Hospital of Wuhan University for the management of COVID-19 (before person-to-person transmission was official confirmed, no additional protection was provided). A questionnaire was given to all staff listed on the roster in the clinical regions providing care for index patients with COVID-19. All participants were surveyed regarding hand-washing and use of surgical masks and gloves and were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Data were analysed (Student's t test and Pearson χ2 test) for an association between infection and use of personal protective equipment. RESULTS: Exposure of a total of 299 non-infected and 30 infected staff was confirmed. None of the 149 staff who reported use of all three preventative measures (hand-washing and use of gloves and masks) became infect-ed. In contrast, all 30 of the staff who became infected had omitted at least one of the measures. Fewer staff who wore surgical masks (P=0.000003) became infected compared with those who did not. Infections rates were significantly lower in HCP from the internal medicine departments, as these personnel generally wore masks. CONCLUSION: An association was found between SARS-CoV-2 infection of HCP and the non-use of masks when working with index cases in clinical settings. We recommend that all HCP follow the strict instructions for prevention and treatment of nosocomial infection during intimate contact with COVID-19, especially staff from surgical departments.

Arrayed microfluidic chip for detection of circulating tumor cells and evaluation of drug potency.

Circulating tumor cells (CTCs) from peripheral blood of cancer patients are considered as one of the most promising pharmacodynamic (PD) biomarkers due to its non-invasive property in disease diagnosis and prognosis. However, the detection of extremely low number of CTCs in patient blood requires methods with high sensitivity and accuracy. We fabricated an arrayed geometrically enhanced mixing (GEM) chip with a "dislocation herringbone" layout based on cell immunoaffinity. By optimizing the injection and rinsing flow rate, an average cell capture rate of 87.02% and an average capture purity of 99.58% were achieved using the human lung adenocarcinoma cell lines H1975. In addition, we determined the specificity, precision, accuracy, and detection limit of our chip. The results demonstrated the chip was stable, accurate and reliable for the "liquid biopsy" of lung cancer cells using the peripheral blood of patients. Our chip can also be used to evaluate the potency of different drugs against tumor cells in parallel due to the presence of four independent microchannels.

PI3K signaling pathways modulated white spot syndrome virus (WSSV) replication in Procambarus clarkii.

The PI3K/AKT signaling pathway is commonly exploited to regulate viral replication and affect the fate of infected cells. In the present study, a PI3K-specific inhibitor (LY294002) was employed to pretreat crayfish to evaluate the effects of PI3K/AKT signaling pathway in WSSV replication. The results showed that the WSSV copy numbers in crayfish pretreated with LY294002 were significantly lower than those in Tris-HCl pretreatment crayfish on the sixth and tenth day after WSSV infection. In semigranular cells, the apoptosis rates were up-regulated on the third day post-WSSV infection, and a significantly lower proportion of apoptosis cells were observed in LY294002-pretreatment group. The expression level of Bax, Bax inhibitor-1 and lectin mRNA in haemocytes of crayfish were increased after WSSV infection. After the secondary stimulation with Tris-HCl, the Bax expression level in LY294002-pretreatment crayfish was significantly higher than that of crayfish pretreated with Tris-HCl on the third or sixth day, but the Toll and lectin mRNA expression decreased significantly on the third, sixth and tenth day. The Bax mRNA expression levels in LY294002-WSSV group were significantly higher than those in Tris-HCl-WSSV group on the third and tenth day. The Bax inhibitor-1 mRNA expression levels in LY294002-WSSV group were significantly lower than those in Tris-HCl-WSSV crayfish on the third day. These results together indicated that the hosts PI3K/AKT signaling pathway play positive roles in WSSV replication through the balance between host cell apoptois and innate immune responses. This information is helpful to further understand the role of PI3K/AKT signaling pathway on WSSV replication in Decapoda crustaceans.

IL-17A Promotes Initiation and Development of Intestinal Fibrosis Through EMT.

BACKGROUND: Intestinal fibrosis is a common complication of Crohn's disease (CD). Its exact mechanism is still unclear, and effective treatments to control or reverse the fibrosis process are unavailable. Epithelial-mesenchymal transition (EMT) may promote intestinal fibrosis by increasing deposition of extracellular matrix protein. IL-17A is a pro-inflammatory cytokine, and it has been shown as a profibrotic factor as its association with fibrosis of multiple organs was reported. AIMS: To assess the roles of IL-17A and EMT in the initiation and development of intestinal fibrosis and to verify the potential inductive effect of IL-17A on EMT. METHODS: In this study, we evaluated the expression of IL-17A and EMT-related genes in colonic mucosal biopsy tissues of CD patients and control individuals. Then, we examined the changes of EMT-related genes and fibrosis-related genes of IEC-6 cells which cultured for 72 h under increasing concentrations of IL-17A or with TGF-ß1, to verify the potential inductive effect of IL-17A on EMT in vitro. We blocked the IL-17A of the mouse model of TNBS-induced experimental intestinal colitis and fibrosis to further verify the potential inductive effect of IL-17A on EMT in vivo. RESULTS: We found the occurrence of EMT and high-level expression of IL-17A in intestinal mucosa of CD patients. Using IEC-6 cells, we showed that IL-17A may induce EMT in intestinal epithelial cells that come with reduced E-cadherin expression and increased expression of vimentin, snail, and α-SMA. We further found that anti-IL-17A treatment alleviated intestinal fibrosis through reducing EMT in mouse intestine. CONCLUSIONS: Our study confirmed the involvement of IL-17A in the development of intestinal fibrosis through inducing EMT.

Caffeic acid reduces cutaneous tumor necrosis factor alpha (TNF-α), IL-6 and IL-1ß levels and ameliorates skin edema in acute and chronic model of cutaneous inflammation in mice.

Caffeic acid (3,4-dihydroxycinnamic acid, CA) has been reported to have anti-inflammatory activity in animal models. However, the mechanisms underlying the anti-inflammatory effects of CA in skin inflammation are only partially understood. The present study was designed to investigate the effects and mechanisms of CA on acute and chronic skin inflammation in mice and the effect of CA in keratinocytes in vitro. The results showed that topical treatment with CA inhibited 12-O-tetradecanoyl-phorbol-13-acetate (TPA)-induced skin edema in a dose-dependent manner, leading to substantial reductions in skin thickness and tissue weight, neutrophil-mediated myeloperoxidase activity, and various histopathological indicators. The CA treatment also significantly reduced the mRNA and protein levels of tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6) and IL-1ß at the application site, and the TNF-α production, the TNF-α-induced IL-6 and IL-1ß production, and TNF-α-induced nuclear factor-kappa B (NF-κB) activation in human keratinocytes in vitro. Furthermore, CA was effective at reducing inflammatory damage induced by chronic TPA exposure. These results demonstrate that CA has anti-inflammatory activities in both acute and chronic contact dermatitis models via blockade of the mRNA and protein synthesis of these cytokines and neutrophil-mediated myeloperoxidase activity, and can target inflammatory mediators specifically in the keratinocytes. Taken together, the present results suggest that CA might be a therapeutic agent against inflammatory skin diseases.

MICDnet: Multimodal information processing networks for Crohn's disease diagnosis.

Crohn's disease (CD) is a chronic inflammatory disease with increasing incidence worldwide and unclear etiology. Its clinical manifestations vary depending on location, extent, and severity of the lesions. In order to diagnose Crohn's disease, medical professionals need to comprehensively analyze patients' multimodal examination data, which includes medical imaging such as colonoscopy, pathological, and text information from clinical records. The processes of multimodal data analysis require collaboration among medical professionals from different departments, which wastes a lot of time and human resources. Therefore, a multimodal medical assisted diagnosis system for Crohn's disease is particularly significant. Existing network frameworks find it hard to effectively capture multimodal patient data for diagnosis, and multimodal data for Crohn's disease is currently lacking. In addition,a combination of data from patients with similar symptoms could serve as an effective reference for disease diagnosis. Thus, we propose a multimodal information diagnosis network (MICDnet) to learn CD feature representations by integrating colonoscopy, pathology images and clinical texts. Specifically, MICDnet first preprocesses each modality data, then uses encoders to extract image and text features separately. After that, multimodal feature fusion is performed. Finally, CD classification and diagnosis are conducted based on the fused features. Under the authorization, we build a dataset of 136 hospitalized inspectors, with colonoscopy images of seven areas, pathology images, and clinical record text for each individual. Training MICDnet on this dataset shows that multimodal diagnosis can improve the diagnostic accuracy of CD, and the diagnostic performance of MICDnet is superior to other models.

Improvement in Microstructure and Properties of 304 Steel Wire Arc Additive Manufacturing by the Micro-Control Deposition Trajectory.

In this study, the GMAW welding torch was controlled by a stepping motor to achieve a periodic swing. By controlling the swing speed, a micro-variable deposition path was obtained, which was called the micro-control deposition trajectory. The influence of the micro-control deposition trajectory on the arc characteristics, microstructure, and mechanical properties of 304 steel wire arc additive manufacturing was studied. The results showed that the micro-control deposition process was affected by the swing arc and the deposition trajectory and that the arc force was dispersed over the whole deposition layer, which effectively reduced the welding heat input. However, the arc centrifugal force increased with the increase in the swing speed, which easily caused instability of the arc and large spatter. Compared with common thin-walled deposition, the deposition width of micro-control thin-walled deposition components was increased. In addition, the swinging arc had a certain stirring effect on the molten pool, which was conducive to the escape of the molten pool gas and refinement of the microstructure. Below, the interface of the deposition layer, the microstructure of the common thin-walled deposition components, and the micro-control thin-walled deposition components were composed of lathy ferrite and austenite. Compared with the common deposition, when the swing speed increased to 800 °/s, the microstructure consisted of vermicular ferrite and austenite. The tensile strength and elongation of the micro-control thin-walled deposition components are higher than those of the common thin-walled deposition components. The tensile fracture mechanism of the common thin-walled deposition components and the micro-control thin-walled deposition components was the ductile fracture mechanism.

Thymoquinone: An Effective Natural Compound for Kidney Protection.

Kidney disease is a common health problem worldwide. Acute or chronic injuries may interfere with kidney functions, eventually resulting in irreversible kidney damage. A number of recent studies have shown that the plant-derived natural products have an extensive potential for renal protection. Thymoquinone (TQ) is an essential compound derived from Nigella Sativa (NS), which is widely applied in the Middle East as a folk medicine. Previous experiments have demonstrated that TQ has a variety of potential pharmacological effects, including anti-oxidant, antibacterial, antitumor, immunomodulatory, and neuroprotective activities. In particular, the prominent renal protective efficacy of TQ has been demonstrated in both in vivo and in vitro experiments. TQ can prevent acute kidney injuries from various xenobiotics through anti-oxidation, anti-inflammatory, and anti-apoptosis effects. In addition, TQ exhibited significant pharmacological effects on renal cell carcinoma, renal fibrosis, and urinary calculi. The essential mechanisms involve scavenging ROS and increasing anti-oxidant activity, decreasing inflammatory mediators, inducing apoptosis, and inhibiting migration and invasion. The purpose of this review is to conclude the pharmacological effects and the potential mechanisms of TQ in renal protection, shedding new light on the exploration of medicinal phyto-protective agents targeting kidneys.

Long noncoding RNA PSMA3-AS1 functions as a competing endogenous RNA to promote gastric cancer progression by regulating the miR-329-3p/ALDOA axis.

LncRNA PSMA3-AS1 functions as an oncogene in several cancers, including ovarian cancer, lung cancer, and colorectal cancer. However, its role in gastric cancer (GC) progression remains unclear. In this study, the levels of PSMA3-AS1, miR-329-3p, and aldolase A (ALDOA) in 20 paired human GC tissues and adjacent nontumorous tissues were measured by real-time PCR. GC cells were transfected with recombinant plasmid carrying full-length PSMA3-AS1 or shRNA targeting PSMA3-AS1. The stable transfectants were selected by G418. Then, the effects of PSMA3-AS1 knockdown or overexpression on GC progression in vitro and in vivo were evaluated. The results showed that PSMA3-AS1 was highly expressed in human GC tissues. Stable knockdown of PSMA3-AS1 significantly restrained proliferation/migration/invasion, enhanced cell apoptosis, and induced oxidative stress in vitro. Tumor growth and matrix metalloproteinase expression in tumor tissues were markedly inhibited, while oxidative stress was enhanced in nude mice after stable PSMA3-AS1 knockdown. Additionally, PSMA3-AS1 negatively regulated miR-329-3p while positively regulated ALDOA expression. MiR-329-3p directly targeted ALDOA-3'UTR. Interestingly, miR-329-3p knockdown or ALDOA overexpression partially attenuated the tumor-suppressive effects of PSMA3-AS1 knockdown. Conversely, PSMA3-AS1 overexpression exhibited the opposite effects. PSMA3-AS1 promoted GC progression by regulating the miR-329-3p/ALDOA axis. PSMA3-AS1 might serve as a promising and effective target for GC treatment.

Long noncoding RNA MIAT regulates TP53 ubiquitination and expedites prostate adenocarcinoma progression by recruiting TBL1X.

Despite recent advances in cancer immunotherapy, their efficacy for treating patients with prostate adenocarcinoma (PRAD) is low due to complex immune evasion mechanisms. However, the function of long non-coding RNA (lncRNAs) in immune evasion has not been fully clarified. This study aimed to expound the role of myocardial infarction-associated transcript (MIAT), a lncRNA significantly upregulated in three PRAD-associated datasets, in immune evasion and try to reveal the potential mechanism. MIAT was highly expressed in PRAD tissues and predicted poor prognosis, and suppression of MIAT inhibited the malignant biological behavior of PRAD cells. Moreover, the depletion of MIAT promoted the immune response of CD8+ T cells and hampered the immune evasion of PRAD cells. In addition, MIAT downregulated TP53 protein expression by recruiting transducin beta-like protein 1X (TBL1X) for ubiquitination modification. Silencing of TP53 or overexpression of TBL1X was enough to abate the tumor suppressive effects of MIAT knockdown in vitro and in vivo. Our results provide evidence for a novel regulation mechanism of CD8+ T cells in PRAD and MIAT may serve as a potential therapeutic target in PRAD.

Mucosal esophageal carcinoma following endoscopic submucosal dissection with giant gastric metastasis: A case report and review of literature.

BACKGROUND: Esophageal carcinoma is a highly aggressive digestive cancer responsible for a notable proportion of cancer-related deaths worldwide. Its elevated metastatic rate contributes to a poor prognosis in affected patients. In this case review, we aim to summarize the metastatic characteristics of intramural gastric metastasis (IGM) in mucosal esophageal squamous carcinoma. CASE SUMMARY: A 56-year-old man was admitted to our hospital because of a dry cough with an esophageal sensation for one year. Endoscopic examination revealed a 2.0 cm 1.0 cm, superficial esophageal squamous cell carcinoma, and the patient underwent endoscopic submucosal dissection (ESD). Fifteen months after ESD, positron emission tomography/computed tomography revealed that the metabolism of the stomach cardia wall had increased slightly. However, the mucosa of the gastric cardia was smooth under gastroendoscopy. Two years after ESD, endoscopic examination revealed a giant gastric cardia carcinoma, while the esophageal mucosa was smooth, and no advanced cancer was found. A biopsy of the gastric cardia indicated squamous-cell carcinoma. The patient received immunochemotherapy and radiotherapy for esophageal cancer for 8 mo and is currently under follow-up. CONCLUSION: Early-stage esophageal carcinoma with IGM is rare. Despite the ESD of the primary lesion, IGM may still occur and should be closely monitored after ESD.

Effects of digital sleep interventions on sleep and psychological health during the COVID-19 pandemic: A systematic review and meta-analysis.

BACKGROUND: Various digital sleep interventions have been implemented to address sleep and psychological complications during the coronavirus disease 2019 (COVID-19) pandemic. However, the characteristics and effectiveness of digital sleep interventions on sleep and psychological outcomes for people with sleep problems during the COVID-19 pandemic are unknown. METHODS: The protocol of this systematic review and meta-analysis was registered on PROSPERO (ID: CRD42022325662), seven databases were searched from December 2019 to June 2023. Reference lists from digital sleep reviews were also identified and selected. Two reviewers independently screened eligible articles and extracted data. Quality appraisal was undertaken by two independent reviewers using the Cochrane Risk-of-Bias Tools. Data synthesis was conducted using fixed- or random-effects model based on the results of the heterogeneity test. RESULTS: A total of 20 studies were identified, including nine randomised controlled trials (RCTs) and 11 non-RCTs, involving 3860 participants. Meta-analyses showed that digital sleep interventions significantly improve sleep quality, insomnia, and depression during the COVID-19 pandemic. Subgroup analysis showed that interventions of more than four weeks, healthcare workers as participants, and relaxation therapies may have the advantage of improving sleep quality. Most non-RCTs supported the efficacy of digital sleep interventions on sleep and psychological health. CONCLUSION: Digital sleep interventions during the COVID-19 pandemic had significant effectiveness in improving sleep and psychological outcomes for people with sleep problems. More structured and personalised digital sleep interventions should be designed, and other diverse digital technologies could be used to improve sleep and psychological disorders.

Maternal and Offspring Cardiovascular Function following Pregnancy with Hypertensive Disorder.

BACKGROUND: Hypertensive disorders of pregnancy (HDP) have been associated with increased cardiovascular risk for the mother and her offspring. However, it remains unknown whether cardiovascular changes are present in the postpartum period. METHODS: This was a cross-sectional study of women with singleton pregnancies. We recruited 33 women (20 following preeclampsia and 13 following gestational hypertension) and an equal number of women with uncomplicated pregnancy. Conventional and more advanced echocardiographic modalities such as speckle tracking were used to assess maternal and offspring cardiac function at 3-9 months postpartum. RESULTS: In women with HDP compared to those without, there was higher mean arterial pressure (mean 92.3 (SD 7.3) vs. 86.8 (8.3) mmHg, p = 0.007), left-ventricular mass indexed for body-surface area (64.5 (10.5) vs. 56.8 (10.03), p < 0.003), and E/e' (3.6 (0.8) vs. 3.1 (0.9), p = 0.022). There were no significant differences between groups in maternal left-ventricular systolic-functional indices and in offspring cardiac function between groups. CONCLUSIONS: At 3-9 months postpartum, mothers with HDP had higher blood pressure, higher left-ventricular mass, and reduced left-ventricular diastolic function. However, in their offspring, cardiac function was preserved. These findings suggest that mothers who experienced an HDP would benefit from cardio-obstetric follow-up in the postpartum period.

Chromosomal abnormalities and structural defects in fetuses with increased nuchal translucency at a Chinese tertiary medical center.

Objectives: To explore the pregnancy outcomes of fetuses with increased NT thickness. Methods: This was a retrospective study of fetuses with increased NT (≥95th centile) at 11-14 weeks of gestation between January 2020 and November 2020. Results: Among 264 fetuses with increased NT, the median of CRL and NT was 61.2 mm and 2.41 mm. Among them, 132 pregnancy women chose invasive prenatal diagnosis (43 cases of chorionic villus sampling (CVS), 89 cases of amniocentesis). Eventually, 16 cases of chromosomal abnormalities were discovered, including 6 cases (6.4%) of trisomy 21, 4 cases (3%) of trisomy 18, 1 case (0.8%) of 45, XO, 1 case (0.8%) of 47, XXY and 4 cases (3.03%) of CNV abnormalities. The major structural defects included hydrops (6.4%), cardiac defects (3%), and urinary anomalies (2.7%). The incidences of chromosomal abnormalities and structural defects in the NT < 2.5 mm group were 1.3 and 6%, while the incidences were 8.8 and 28.9% in the NT≥2.5 group. Conclusion: Increased NT was associated with high risk of chromosomal abnormalities and structural anomalies. Chromosomal abnormalities and structural defects could be detected when NT thickness was between 95th centile and 2.5 mm.

Prospective comparison of extracorporeal shock wave lithotripsy and ureteroscopy in distal ureteral stones.

The optimal treatment modality of distal ureteral stones is controversial. Therefore, we conducted a prospective study to evaluate the efficacy, safety, and cost of early second shock wave lithotripsy (SWL) sessions versus ureterorenoscopy (URS) in patients with distal ureteral stones. This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent SWL or URS for distal ureteral stones were enrolled in this study. The stone-free rate (SFR), secondary treatment rate, complications, and costs were recorded. Propensity-score matching (PSM) analysis was also performed. A total of 1023 patients were included, of whom 68.4% (700) were treated with SWL and 31.6% (323) with URS. Based on PSM, SWL had an equivalent SFR (87.4% vs. 84.9%, P = 0.325) at one month after SWL and secondary treatment rate (10.7% vs.10.8%, P = 0.958) when compared with URS. Complications were rare and comparable between the SWL and URS groups (6.0% vs. 5.9%, P > 0.05), while the incidence of ureteral injuries (i.e., perforations) was higher in the URS group compared with the SWL group (1.3% vs. 0%, P = 0.019). The hospital stay was significantly shorter (1 day vs. 2 days, P < 0.001) and the costs considerably less (2000 RMB vs. 25,030 RMB; P < 0.001) in the SWL group compared with the URS group. This prospective study demonstrated that early second SWL sessions had equivalent efficacy in addition to reduced complication rates and costs compared with URS in patients with distal ureteral stones. Our findings may help guide clinical decision making.