[Piriform sinus hamartoma in children: a case report and literature review].

Objective:To investigate the clinical manifestations and treatment of laryngopharynx hamartoma in children. Methods:The clinical data of a child with piriform sinus hamartoma treated in our hospital were analyzed retrospectively. The age, gender, clinical manifestations, auxiliary examination, location of the tumor and surgical methods were analyzed. Results:The patient had a good prognosis after surgery, and no tumor recurrence was found after 1 year of follow-up. Conclusion:Laryngopharynx hamartoma is rare in children. It should be considered in children with laryngeal dysfunction and upper airway obstruction. Complete resection of the tumor is the key to postoperative recurrence.

Co-transport of polystyrene microplastics and kaolinite colloids in goethite-coated quartz sand: Joint effects of heteropolymerization and surface charge modification.

This study investigated the transport behavior of polystyrene microplastics (MPs) in saturated quartz sand and goethite-coated sand in the presence of coexisting kaolinite colloids. Column experiments were conducted under a wide range of solution chemistry conditions, including pH levels of 6.0, 7.0, and 9.0, as well as background Na+ concentrations of 5 mM and 25 mM. We found that: (1) The individual transport of MPs in porous media diminished both with increasing background ion strength and decreasing pH, and its transport ability was significantly dominated by the interactions between MPs and porous media rather than the interplay between MPs, which has been further corroborated by the aggregation stability experiments of MPs particles. (2) MPs had a much lower ability to move through goethite-coated sand columns than quartz sand columns. This is because goethite coating reduces the repulsion energy barriers between porous media and MPs. The increased specific surface area and surface complexity of sand columns after goethite coating should also account for this difference. (3) MPs transport would be subjected to the differentiated impact of co-transported kaolinite colloids in the two types of porous media. The promotion effect of kaolinite colloid on MPs' transport capacity is not significantly affected by background ionic strength changes when quartz sand is served as the porous medium; however, the promotion effect is highly correlated with the background ionic strength when goethite-coated sand is served as the porous medium. In comparison with low background ionic strength conditions, kaolinite colloids under high background ionic strength conditions significantly facilitated MPs transport. This is mainly because under high background ionic conditions, kaolinite colloids are more likely to be deposited on the surface of goethite-covered sand, competing with MPs for the limited deposition sites. The extended Derjaguin-Landau-Verwey-Overbeek (XDLVO) theory is applicable to describe the transport behavior of MPs.

Research Advances on Stem Cell-Derived Extracellular Vesicles Promoting the Reconstruction of Alveolar Bone through RANKL/RANK/OPG Pathway.

Periodontal bone tissue defects and bone shortages are the most familiar and troublesome clinical problems in the oral cavity. Stem cell-derived extracellular vesicles (SC-EVs) have biological properties similar to their sources, and they could be a promising acellular therapy to assist with periodontal osteogenesis. In the course of alveolar bone remodeling, the RANKL/RANK/OPG signaling pathway is an important pathway involved in bone metabolism. This article summarizes the experimental studies of SC-EVs applied for the therapy of periodontal osteogenesis recently and explores the role of the RANKL/RANK/OPG pathway in their mechanism of action. Their unique patterns will open a new field of vision for people, and they will help to advance a possible future clinical treatment.

Advances in air pollution control for vessels in China.

Vessel emissions have contributed a great deal to air quality deterioration in China. Hence, the Chinese government has promulgated a series of stringent emission regulations. It is in this context that vessel emission control technology research is in full swing. In particular, during the 13th Five-Year Plan, the air pollution control technology of vessels has greatly improved. Vessel emission control has followed two main governance routes: source emission reduction and aftertreatment technology. Source control focuses on alternative fuels, with two main directions, the development of new fuels and the modification of existing fuels. Moreover, after-treatment technologies have also been developed, including wet desulfurization technology using seawater or alkaline liquids as wet washing liquids and selective catalytic reduction (SCR) for the control of NOx emission. Due to China's increasingly stringent emissions standards and regulations, work on the development of clean alternative fuels and further upgrading the collaborative application of after-treatment technologies to meet the near-zero-emissions requirements of vessels is still necessary.

Technology development and cost analysis of multiple pollutant abatement for ultra-low emission coal-fired power plants in China.

The implementation of ultra-low emission (ULE) limits (SO2: 35 mg/m3, NOx: 50 mg/m3, PM: 10 mg/m3) promoted the development of flue gas treatment technologies in China. Pollutant control technology development for Chinese coal-fired power plants was summarized and an analysis of the applicability and cost of pollutant control technologies was conducted. Detailed data were collected from 30 ultra-low emission coal-fired units across China. Based on a cost analysis model, the average unit power generation incremental costs were 0.0144 and 0.0095 CNY/(kW·hr) for SO2 and NOx control technologies, respectively. The unit power generation incremental cost of twin spray tower technology was 7.2% higher than that of dual-loop spray tower technology. The effect of key parameters on operating cost was analyzed. The unit power generation incremental cost increased because of increments in the electricity price for SO2 control technology and the price of the reductant in NOx control technology. With high sulfur content or NOx concentration, the unit power generation incremental cost caused by pollutant control increased, whereas the unit pollutant abatement cost decreased. However, the annual operating hours or load increased, thereby leading to a decline in unit power generation incremental cost and unit pollutant abatement cost.

Is simultaneous cranioplasty with cerebrospinal fluid shunts implantation as safe as staged procedures?

Objective: The combination of cranioplasty and ventriculoperitoneal shunt is a therapeutic strategy for patients with hydrocephalus after decompressive craniectomy (DC). However, the efficacies of simultaneous vs. staged surgery in reducing postoperative complications have not been conclusively determined. This was a meta-analysis of relevant studies to assess whether simultaneous surgery significantly reduces postoperative complication risks, compared to staged surgery. Methods: We systematically searched PubMed, Embase, Cochrane, Web of science databases for studies (published by 11 May 2022) comparing patients undergoing concurrent and staged cranioplasty and ventriculoperitoneal shunt. Our main endpoints were; overall postoperative complications, postoperative bleeding, postoperative infection and reoperation. We assessed the pooled data using a random effects model to compare complication rates using odds ratios (ORs) and 95% confidence intervals (CIs). Results: Of the 494 identified studies, 12 were included in our analysis (N = 651 participants). Compared to staged surgery, concurrent surgery increased the relative risk for overall complications (pooled OR: 2.00; 95% CI: 1.10-3.67), however, it did not increase the relative risks for postoperative bleeding, postoperative infection or reoperation. Subgroup analysis revealed that in the Asian population, concurrent surgery increased the relative risks for overall complications (staged vs. concurrent group: OR: 2.41, 95% CI: 1.51-3.83, I 2 = 0.0%) and postoperative infections (staged vs. concurrent group: OR: 2.35, 95% CI: 1.06-5.21, I 2 = 31.8%). Conclusion: Compared to staged surgery, concurrent surgery increases the overall complication rates. However, differences between the two therapeutic approaches in terms of postoperative bleeding, postoperative infection, or reoperation are insignificant. Simultaneous surgery was associated with increased overall post-operative complications and post-operative infection rates in the Asian population.

Self-powered p-CuI/n-GaN heterojunction UV photodetector based on thermal evaporated high quality CuI thin film.

With vacuum thermal evaporation, the CuI film was deposited on quartz and n-GaN substrates, and the morphology, crystalline structure and optical properties of the CuI films were investigated. According to the XRD results, the CuI film preferentially grew along [111] crystal orientation on the GaN epilayer. With Au and Ni/Au ohmic contact electrodes fabricated on CuI and n-GaN, a prototype p-CuI/n-GaN heterojunction UV photodetector strong UV spectral selectivity was created. At 0 V and 360 nm front illumination (0.32 mW/cm2), the heterojunction photodetector displayed outstanding self-powered detection performance with the responsivity (R), specific detectivity (D*), and on/off ratio up to 75.5 mA/W, 1.27×1012 Jones, and ∼2320, respectively. Meanwhile, the p-CuI/n-GaN heterojunction photodetector had excellent atmosphere stability.

Comparison of the Value of Conventional Ultrasound and Contrast-Enhanced Ultrasound-Guided Puncture Biopsy in Different Sizes of Peripheral Pulmonary Lesions.

Objective: To compare the clinical value of contrast-enhanced ultrasound and conventional ultrasound-guided puncture biopsy in peripulmonary lesions of different sizes. Materials and Methods: 110 patients with peripulmonary lesions were randomly divided into two groups: the conventional ultrasound-guided group and the contrast-enhanced ultrasound-guided group. The lesions in the two groups were further divided into two groups according to the size of the lesions, and the tissues taken after puncture biopsy were sent for pathological examination. The pathological results were compared with the postoperative pathological results and other examination results, and the complications were recorded at the same time. Results: In the conventional ultrasound group, the success rate of single puncture was 72.7% and the success rate of puncture was 80.0%; in the contrast group, the success rate of single puncture was 90.9% and the success rate of puncture was 94.6%. The difference between the two groups was statistically significant. There was no significant difference in needle bleeding and pneumothorax between the two groups. In the <30 mm group, there was no significant difference in the success rate of single puncture and the success rate of puncture between the two groups according to the size of the lesions. In the ≥30 mm group, the success rate of single puncture (97.1%) and puncture success rate (97.1%) in the contrast guidance group were higher than those in the conventional ultrasound guidance group (70.3%, 78.4%) and the difference was statistically significant (p < 0.05). Conclusion: Compared with conventional ultrasound, for peripheral pulmonary lesions guided by contrast-enhanced ultrasonography, especially when the maximum diameter of the lesion is ≥ 30 mm, needle biopsy has better guiding significance; for peripheral lung lesions with a maximum diameter of <30 mm, contrast-enhanced ultrasonography is compared with conventional ultrasound guidance. The puncture success rate was not significantly different.

Neck and mediastinal hematoma caused by a foreign body in the esophagus with diagnostic difficulties: A case report.

BACKGROUND: Esophageal foreign body (FB) is a common clinical emergency. Clinically, computed tomography (CT) scans are important in the diagnosis of FBs in the esophagus. Here, we report a case of esophageal perforation and cervical hematoma, caused by a FB, whose uniqueness made rapid diagnosis difficult. CASE SUMMARY: A 42-year-old man was transferred to our hospital with esophageal perforation, which was accompanied by cervical and mediastinal hematoma. CT scans only revealed a black shadow, approximately 2.5 cm in diameter, in the upper esophagus. After multidisciplinary discussion, he was quickly subjected to mediastinal hematoma resection, peripheral nerve compression release, esophageal FB removal and esophagectomy. Eventually, we removed a small crab with a pointed tip from his esophagus. CONCLUSION: This was an unusual case of occurrence of sharp polygonal esophageal FBs caused by a small crab. Rapid diagnosis of this FB was difficult, mainly due to its translucent nature. Occurrence of sharp FBs, with cavities that sometimes only appear as black shadows on CT scans, can easily be mistaken for esophageal lumens. More attention should be paid to such sharp polygonal FBs.

Osteogenic peptides in periodontal ligament stem cell-containing three-dimensional bioscaffolds promote bone healing.

Bone tissue engineering shows great potential in bone regeneration; however, the lack of bone growth factors with high biocompatibility and efficiency is a major concern. Oligopeptides have drawn great attention due to their high biological efficacy, low toxicity, and low molecular weight. The oligopeptide SDSSD promotes the osteogenesis of human periodontal ligament stem cells (hPDLSCs) in vitro. The SDSSD-modified three-dimensional (3D) bioscaffolds promote osteogenesis and bone formation in the subcutaneous pockets of BALB/c nude mice and facilitate bone healing in vivo. Mechanistically, SDSSD promoted bone formation by binding to G protein-coupled receptors and regulating the AKT signaling pathway. 3D-printing bioscaffolds with SDSSD may be potential bone tissue engineering materials for treating bone defects.

Diagnosis and treatment of deep neck abscess due to congenital piriform sinus fistula in children / Diagnóstico e tratamento de abscesso cervical profundo por fístula congênita do seio piriforme em crianças

Abstract Introduction: Congenital piriform sinus fistula is a relatively rare type of disease in clinical practice, most occurring during childhood, but doctors have insufficient knowledge regarding this disease, easily misdiagnosing it. Objectives: This study aimed to identify the characteristics of deep neck abscess due to congenital piriform sinus fistula in children. Methods: We performed a retrospective study of 21 cases from January 2016 to August 2018 in our hospital. The onset age, clinical characteristics, auxiliary examination and clinical treatment of the patients was summarized to analyze the diagnosis, treatment characteristics and prognosis. Results: Children from 11 days to 12 years-old were enrolled, with an average age of 3.5 years. Twenty patients had left congenital piriform sinus fistula and 1 had right congenital piriform sinus fistula. Cervical enhanced computed tomography imaging showed gas-liquid equilibrium or air-shadow in the abscesses in 18 cases, and neck ultrasound demonstrated gas echo in the thyroid region in 10 cases. All patients underwent low temperature plasma to seal the internal fistula and returned to the hospital for electronic laryngoscope and neck ultrasound examination at 3 months, 6 months and 1 year after the surgery. No recurrence occurred in any patient. Conclusion: Congenital piriform sinus fistula is an important cause of deep neck abscess in children. The presence of purulent gas-liquid equilibrium or air shadow in cervical-enhanced computed tomography or ultrasound suggests a high possibility of the presence of an internal fistula, and endoscopic low temperature ablation can be done at the same time as the diagnostic endoscopy.

Resumo Introdução: A fístula congênita do seio piriforme é uma doença relativamente rara na prática clínica; a maioria se manifesta na infância; entretanto, os médicos geralmente têm conhecimento insuficiente sobre essa condição clínica e seu diagnóstico é facilmente feito de forma errônea. Objetivo: Identificar as características do abscesso cervical profundo devido à fístula congênita de seio piriforme em crianças. Método: Estudo retrospectivo de 21 casos de janeiro de 2016 a agosto de 2018 em nosso hospital. Idade de início, características clínicas, exames auxiliares e tratamento clínico dos pacientes foram resumidos para analisar o diagnóstico, as características do tratamento e o prognóstico. Resultados: Foram incluídas crianças de 11 dias a 12 anos, com média de 3,5 anos. Vinte pacientes tinham fístula congênita de seio piriforme no lado esquerdo e um no lado direito; a tomografia computadorizada cervical com contraste mostrava distribuição líquido-gasosa ou sombra aérea nos abscessos em 18 casos. O ultrassom cervical demonstrou eco gasoso na região da tireoide em 10 casos. Todos os pacientes foram submetidos a plasma de baixa temperatura para queimar a fístula interna e retornaram ao hospital para exame com laringoscópio eletrônico e ultrassonografia cervical aos 3 meses, 6 meses e um ano após a cirurgia. Não houve recorrências. Conclusão: A fístula congênita de seio piriforme é uma causa importante de abscesso cervical profundo em crianças. A presença de conteúdo líquido-gasoso purulento ou sombra gasosa na tomografia computadorizada ou no ultrassom cervical sugere uma alta possibilidade da presença de uma fístula interna e a ablação endoscópica a baixa temperatura pode ser feita ao mesmo tempo que a endoscopia diagnóstica.

Deep-ultraviolet photodetector based on pulsed-laser-deposited Cs3Cu2I5 films/n-Si heterojunction.

All-inorganic lead-free perovskite Cs3Cu2I5 thin films were prepared using pulsed laser deposition. Effects of the substrate temperature, laser energy, and laser frequency on the film structure and optoelectronic properties were studied. A heterojunction photodetector based on Cs3Cu2I5/n-Si was constructed, and the deep-ultraviolet photoresponse was obtained. A high Ilight/Idark ratio of 130 was achieved at -1.3V, and the peak response of the heterojunction photodetector was 70.8 mA/W (280 nm), with the corresponding specific detectivity of 9.44×1011cm⋅Hz1/2⋅W-1. Moreover, the device showed good stability after being exposed to air for 30 days.

Correlation between anxiety-depression symptoms and immune characteristics in inpatients with 2019 novel coronavirus in Wuhan, China.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is widely acknowledged as a severe traumatic event, and depression, anxiety, and psychological distress are common in diagnosed patients. However, the correlations of biological indicators with emotion are rarely reported. The primary objective of this study was to explore the dysfunction of immune-inflammatory characteristics in patients with depression-anxiety symptoms. METHODS: We investigated the mental status of inpatients with COVID-19 in Wuhan and compared the differences in cytokines and lymphocytes between patients with and without depression-anxiety symptoms at admission. After two weeks of treatment, we evaluated the mental conditions and measured the cytokines and lymphocytes of the patients with depression and anxiety symptoms and explored the changes and their associations. RESULTS: Approximately half of the patients with COVID-19 had depression and anxiety symptoms, and the symptoms were related to the ratio of CD4+/CD8+ and the level of CD4+T lymphocytes. When compared with patients without depression-anxiety symptoms, CD4+T lymphocytes level was significantly higher in COVID-19 patients with depression-anxiety symptoms. CONCLUSION: This study provided novel evidence regarding the association between depression and anxiety symptoms and immune characteristics, especially CD4+T lymphocyte levels, in COVID-19 patients. We emphasized the importance of paying attention to the dynamic immune process of patients diagnosed with COVID-19 with depression/anxiety.

Clinical characteristics for conservative therapy of pediatric parapharyngeal abscesses / Características clínicas para tratamento conservador em abscessos parafaríngeos pediátricos

Abstract Introduction The role of surgical drainage versus conservative therapy in treating patients with parapharyngeal abscesses is still a theme of debate. Objectives This study aimed to investigate the characteristics associated with good outcomes in pediatric patients with parapharyngeal abscesses treated with conservative therapy. Methods This retrospective chart review was performed on children aged 0.3-14 years with the diagnosis of parapharyngeal abscesses confirmed by computed tomography from January 2013 to March 2018. Patients with a severe upper airway obstruction required early intervention, while those in a stable condition initially received conservative therapy with antibiotics. If the patients appeared unlikely to recover, additional surgical drainage was provided. Multivariate logistic regression models were constructed to investigate the clinical characteristics associated with a good response to conservative therapy. A receiver operating characteristic curve was used to identify the age and abscess size cutoff for predicting a successful response. Results A total of 48 children were included in the study. Patient age, antecedent illness, and abscess size were significantly associated with a response to therapy (Odds Ratio = 1.326, 2.314 and 1.235, respectively). The age cutoff associated with the conservative therapy was 4.2 years (76.9% sensitivity, 68.2% specificity), and the abscess size cutoff associated with the conservative therapy was 23 mm (84.6% sensitivity, 77.3% specificity). Conclusion The findings suggested that younger age, smaller abscess size, and less frequent antecedent illnesses, such as upper respiratory tract infection and lymphadenitis, could predict a successful response to conservative therapy in pediatric patients with parapharyngeal abscesses.

Resumo Introdução O papel da drenagem cirúrgica versus tratamento conservador na abordagem de pacientes com abscessos parafaríngeos ainda é uma questão controversa. Objetivo Investigar as características associadas a um bom desfecho em pacientes pediátricos com abscessos parafaríngeos tratados com terapia conservadora. Método Revisão retrospectiva de prontuários feita em crianças de 14 anos com diagnóstico de abscesso parafaríngeo confirmado por tomografia computadorizada de janeiro de 2013 a março de 2018. Pacientes com obstrução grave das vias aéreas superiores necessitaram de intervenção precoce, enquanto aqueles em estado inicialmente estável receberam tratamento conservador com antibióticos. Se a recuperação dos pacientes parecesse improvável, drenagem cirúrgica adicional era feita. Modelos de regressão logística multivariada foram construídos para investigar as características clínicas associadas a uma boa resposta a terapia conservadora. Uma curva ROC, ou seja, característica de operação do receptor, foi usada para identificar a idade e o tamanho do abscesso com o intuito de prever uma resposta bem-sucedida. Resultados Foram incluídas no estudo 48 crianças. Idade do paciente, doenças respiratórias prévias e comorbidades e tamanho do abscesso foram significantemente associados à resposta terapêutica. (odds ratio = 1.326, 2.314 e 1.235, respectivamente). O ponto de corte da idade associado à terapia conservadora foi de 4,2 anos (sensibilidade de 76,9%, especificidade de 68,2%) e o ponto de corte do tamanho do abscesso associado à terapia conservadora foi de 23 mm (sensibilidade de 84,6%, especificidade de 77,3%). Conclusão Os achados sugerem que idade mais jovem, menor tamanho de abscesso e menor frequência de doença comuns, como infecção do trato respiratório superior e linfadenite, podem prever uma resposta bem-sucedida à terapia conservadora em pacientes pediátricos com abscessos parafaríngeos.

5'-UTR SNP of FGF13 causes translational defect and intellectual disability.

The congenital intellectual disability (ID)-causing gene mutations remain largely unclear, although many genetic variations might relate to ID. We screened gene mutations in Chinese Han children suffering from severe ID and found a single-nucleotide polymorphism (SNP) in the 5'-untranslated region (5'-UTR) of fibroblast growth factor 13 (FGF13) mRNA (NM_001139500.1:c.-32c>G) shared by three male children. In both HEK293 cells and patient-derived induced pluripotent stem cells, this SNP reduced the translation of FGF13, which stabilizes microtubules in developing neurons. Mice carrying the homologous point mutation in 5'-UTR of Fgf13 showed delayed neuronal migration during cortical development, and weakened learning and memory. Furthermore, this SNP reduced the interaction between FGF13 5'-UTR and polypyrimidine-tract-binding protein 2 (PTBP2), which was required for FGF13 translation in cortical neurons. Thus, this 5'-UTR SNP of FGF13 interferes with the translational process of FGF13 and causes deficits in brain development and cognitive functions.

Diagnosis and treatment of deep neck abscess due to congenital piriform sinus fistula in children.

INTRODUCTION: Congenital piriform sinus fistula is a relatively rare type of disease in clinical practice, most occurring during childhood, but doctors have insufficient knowledge regarding this disease, easily misdiagnosing it. OBJECTIVES: This study aimed to identify the characteristics of deep neck abscess due to congenital piriform sinus fistula in children. METHODS: We performed a retrospective study of 21 cases from January 2016 to August 2018 in our hospital. The onset age, clinical characteristics, auxiliary examination and clinical treatment of the patients was summarized to analyze the diagnosis, treatment characteristics and prognosis. RESULTS: Children from 11 days to 12 years-old were enrolled, with an average age of 3.5 years. Twenty patients had left congenital piriform sinus fistula and 1 had right congenital piriform sinus fistula. Cervical enhanced computed tomography imaging showed gas-liquid equilibrium or air-shadow in the abscesses in 18 cases, and neck ultrasound demonstrated gas echo in the thyroid region in 10 cases. All patients underwent low temperature plasma to seal the internal fistula and returned to the hospital for electronic laryngoscope and neck ultrasound examination at 3 months, 6 months and 1year after the surgery. No recurrence occurred in any patient. CONCLUSION: Congenital piriform sinus fistula is an important cause of deep neck abscess in children. The presence of purulent gas-liquid equilibrium or air shadow in cervical-enhanced computed tomography or ultrasound suggests a high possibility of the presence of an internal fistula, and endoscopic low temperature ablation can be done at the same time as the diagnostic endoscopy.

Clinical characteristics for conservative therapy of pediatric parapharyngeal abscesses.

INTRODUCTION: The role of surgical drainage versus conservative therapy in treating patients with parapharyngeal abscesses is still a theme of debate. OBJECTIVES: This study aimed to investigate the characteristics associated with good outcomes in pediatric patients with parapharyngeal abscesses treated with conservative therapy. METHODS: This retrospective chart review was performed on children aged 0.3-14 years with the diagnosis of parapharyngeal abscesses confirmed by computed tomography from January 2013 to March 2018. Patients with a severe upper airway obstruction required early intervention, while those in a stable condition initially received conservative therapy with antibiotics. If the patients appeared unlikely to recover, additional surgical drainage was provided. Multivariate logistic regression models were constructed to investigate the clinical characteristics associated with a good response to conservative therapy. A receiver operating characteristic curve was used to identify the age and abscess size cutoff for predicting a successful response. RESULTS: A total of 48 children were included in the study. Patient age, antecedent illness, and abscess size were significantly associated with a response to therapy (Odds Ratio=1.326, 2.314 and 1.235, respectively). The age cutoff associated with the conservative therapy was 4.2 years (76.9% sensitivity, 68.2% specificity), and the abscess size cutoff associated with the conservative therapy was 23mm (84.6% sensitivity, 77.3% specificity). CONCLUSION: The findings suggested that younger age, smaller abscess size, and less frequent antecedent illnesses, such as upper respiratory tract infection and lymphadenitis, could predict a successful response to conservative therapy in pediatric patients with parapharyngeal abscesses.

Effect of a Text Messaging-Based Educational Intervention on Cesarean Section Rates Among Pregnant Women in China: Quasirandomized Controlled Trial.

BACKGROUND: Consensus exists that appropriate regional cesarean rates should not exceed 15% of births, but China's cesarean rate exceeds 50% in some areas, prompting numerous calls for its reduction. At present, China's 2016 two-child policy has heightened the implications of national cesarean section trends. OBJECTIVE: This study leveraged pervasive cellular phone access amongst Chinese citizens to test the effect of a low-cost and scalable prenatal advice program on cesarean section rates. METHODS: Participants were pregnant women presenting for antenatal care at a clinic in Xi'an, China. Assignment was quasirandomized and utilized factorial assignment based on the expecting mother's birthday. Participants were assigned to one of the following four groups, with each receiving a different set of messages: (1) a comparison group that received only a few "basic" messages, (2) a group receiving messages primarily regarding care seeking, (3) a group receiving messages primarily regarding good home prenatal practices, and (4) a group receiving text messages of all groups. Messages were delivered throughout pregnancy and were tailored to each woman's gestational week. The main outcome was the rates of cesarean delivery reported in the intervention arms. Data analysts were blinded to treatment assignment. RESULTS: In total, 2115 women completed the trial and corresponding follow-up surveys. In the unadjusted analysis, the group receiving all texts was associated with an odds ratio of 0.77 (P=.06), though neither the care seeking nor good home prenatal practice set yielded a relevant impact. Adjusting for potentially confounding covariates showed that the group with all texts sent together was associated with an odds ratio of 0.67 (P=.01). Notably, previous cesarean section evoked an odds ratio of 11.78 (P<.001), highlighting that having a cesarean section predicts future cesarean section in a subsequent pregnancy. CONCLUSIONS: Sending pregnant women in rural China short informational messages with integrated advice regarding both care-seeking and good home prenatal practices appears to reduce women's likelihood of undergoing cesarean section. Reducing clear medical indications for cesarean section seems to be the strongest potential pathway of the effect. Cesarean section based on only maternal request did not seem to occur regularly in our study population. Preventing unnecessary cesarean section at present may have a long-term impact on future cesarean section rates. TRIAL REGISTRATION: ClinicalTrials.gov NCT02037087; https://clinicaltrials.gov/ct2/show/NCT02037087. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2015-011016.

Bone-Targeted Extracellular Vesicles from Mesenchymal Stem Cells for Osteoporosis Therapy.

BACKGROUND: Current drugs used for osteoporosis therapy show strong adverse effects. Stem cell-derived extracellular vesicles (EVs) provide another choice for osteoporosis therapy. Mouse mesenchymal stem cells (mMSCs)-derived EVs promote bone regeneration; however, their clinical application is limited due to non-specific tissue targeting. Alendronate specifically targets bone tissue via hydroxyapatite. Therefore, EVs were combined with alendronate to generate Ale-EVs by "click chemistry" to facilitate EVs targeting bone via alendronate/hydroxyapatite binding. METHODS: Ale-EVs were characterized based on size using dynamic light scattering analysis and morphology was visualized by transmission electron microscopy. Hydroxyapatite affinity of Ale-EVs was detected by flow cytometry. Bone targeting of Ale-EVs was tested by ex vivo fluorescent imaging. Cell viability was assessed by using WST-8 reduction assay kit for testing the ability of Ale-EVs to promote mMSCs proliferation. Alkaline phosphatase experiment was used to detect ability of Ale-EVs to promote differentiation of mouse mesenchymal stem cells in vitro. Western blotting and Q-PCR assay were used to detect the early marker of osteogenic differentiation. Antiosteoporotic effects of Ale-EVs were detected in ovariectomy (OVX)-induced osteoporosis rat model. The safety of the Ale-EVs in vivo was measured by H&E staining and serum markers assay. RESULTS: In vitro, Ale-EVs had high affinity with hydroxyapatite. Also, ex vivo data indicated that Ale-EVs-DiD treatment of mice induced strong fluorescece in bone tissues compared with EVs-DiD group. Furthermore, results suggested that Ale-EVs promoted the growth and differentiation of mouse MSCs. They also protected against osteoporosis in ovariectomy (OVX)-induced osteoporotic rats. Ale-EVs were well tolerated and no side effects were found, indicating that Ale-EVs specifically target bone and can be used as a new therapeutic in osteoporosis treatment. CONCLUSION: We used the Ale-N3 to modify mouse mesenchymal stem cells-derived extracellular vesicles by copper-free "click chemistry" to generate a Ale-EVs system. The Ale-EVs had a high affinity for bone and have great potential for clinical applications in osteoporosis therapy with low systemic toxicity.

[The efficacy of OM85-BV in the treatment of recurrent upper respiratory tract infection with adenoid hypertrophy and the preliminary exploration of potential therapeutic mechanism].

Objective:To observe the efficacy of OM85-BV in the treatment of recurrent upper respiratory tract infection with adenoid hypertrophy and to explore its possible mechanism. Method:Four hundred and forty-eight children with recurrent upper respiratory tract infection and adenoid hypertrophy were collected. Three hundred and twenty-six patients in the control group were treated with conventional drugs, and one hundred and twenty-two patients in the observation group were treated with OM85-BV+conventional drugs, and the treatment lasted 12 weeks. The sleep obstructive symptoms of adenoid hypertrophy were scored according to OSA-18 before and after the treatment respectively（0, 6, 12 weeks）. The symptoms scores and effective rate of treatment between the study and the control group were compared. The patients in the control group and the observation group who were unresponsive to drug treatment received surgery after 12 weeks of drug treatment. The levels of serum IL-2, IL-4, IL-6, IL-10, TNF, IFN-γ and IgE, the ratio of serum CD3, CD4, CD8 in lymphocytes and the ratio of CD4/CD8 were compared between the study and the control group before operation. The levels of HBD-2, IFN-γ, IL-4, IL-6 cytokines in the adenoid were compared between the control group and the observation group. The expression and distribution of adenoid HBD-2, IFN-γ, IL-4, IL-6 were compared between the control group and the observation group. Result:After 12 weeks of treatment, the total effective rate of the observation group was significantly higher than that of the control group, and the improvement of sleep respiratory obstruction symptoms of children with recurrent upper respiratory tract infection and adenoid hypertrophy was also much better than that of the control group. The serum IFN-γ of the observation group was significantly higher than that of the control group, and there was no significant difference in serum IL-2, IL-4, IL-6, IL-10, TNF, IgE between the observation group and the control group. There was no significant difference in serum CD3, CD4, CD8 and CD4/CD8 between the observation group and the control group. In the observation group, the adenoid HBD-2 was significantly higher but IL-4, IFN-γ were significantly lower than that in the control group, and IL-6 had no significant difference compared with the control group. Conclusion:OM85-BV can significantly improve the sleep apnea symptoms but can not rise the level of immune lymphocytes in children with adenoid hypertrophy and recurrent upper respiratory tract infection.OM85-BV can improve the Th1 immune response, enhancing the ability of human body to fight against pathogens and induce the release of HBD-2, increasing the resistance to microorganisms, reducing the bacteria aggregation, weakening the local inflammatory response in adenoids.