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BackgroundMobile health (mHealth) interventions offer great potential to reach large populations and improve public health. However, high attrition rates threaten evaluation and implementation of mHealth intervention studies. ObjectiveWe explored factors associated with attrition of study participants in an mHealth randomized controlled trial (RCT) evaluating an intervention to reduce unintentional child injury risk in China. MethodsThe cluster RCT compared two groups of an app-based intervention for caregivers of 3-6–year-old children (Bao Hu San). The intervention group received unintentional child injury and parenting education, whereas only parenting education was implemented in the control group. The trial included 2920 study participants in Changsha, China, and lasted 6 months. Data on participant engagement (using the app) were collected electronically throughout the 6-month period. Associations between participant attrition and demographic characteristics, and between attrition and intervention engagement were tested and quantified separately for the intervention and control groups using the adjusted odds ratio (aOR) based on generalized linear mixed models. ResultsIn total, 2920 caregivers from 20 eligible preschools participated, with 1510 in the intervention group and 1410 in the control group. The 6-month attrition rate differed significantly between the two groups (P

BackgroundWith the growing popularity of mobile health technology, app-based interventions delivered by smartphone have become an increasingly important strategy toward injury prevention. ObjectiveThis study aimed to develop a framework supporting the design of an app-based intervention to prevent unintentional injury, targeted for caregivers of Chinese children aged 0 to 6 years. MethodsA theory-based mixed-method study, including focus groups and Web-based quantitative survey, was performed. Adult caregivers who care for children aged 0 to 6 years and own a smartphone were recruited into 2 sequential stages of research. First, focus groups were conducted among the caregivers at community health care centers and preschools from December 2015 to March 2016. Focus groups (8-10 participants per group) explored awareness, experiences, and opinions of caregivers toward using an app to prevent unintentional injury among children. Second, based on the focus groups findings, a Web-based quantitative survey was designed and distributed to caregivers in November 2016; it collected information on specific needs for the app-based intervention. Thematic analysis and quantitative descriptive analyses were performed. ResultsIn total, 12 focus groups were completed, involving 108 caregivers. Most participants expressed a strong desire to learn knowledge and skills about unintentional child injury prevention and held positive attitudes toward app-based interventions. Participants expressed multiple preferences concerning the app-based intervention, including their contents, functions, interactive styles, installation and registration logistics, and privacy protection and information security. Following the focus groups, 1505 caregivers completed a WeChat-based quantitative survey, which generated roughly similar results to those of focus groups and added numerical metrics concerning participants’ preferences on what to learn, when to learn it, and how to learn it. A detailed framework was established involving 5 components: (1) content design, (2) functional design, (3) interactive style, (4) installation and registration logistics, and (5) privacy protection and information security, and 15 specific requirements. ConclusionsWe developed a framework that can be used as a guide to design app-based interventions for parents and caregivers, specifically for unintentional injury prevention of children aged 0 to 6 years.

Abstract A two-way fifth-generation (5G) new radio (NR) free-space optical (FSO)-hollow-core fibre (HCF)-underwater wireless optical communication (UWOC) converged systems with a red/green/blue (R/G/B) 3-wavelengths and spatial light modulator (SLM)-based beam-tracking scheme is practically built. It is the first to practically build a two-way FSO-HCF-UWOC converged system with high-speed and long-distance optical wireless-wired-underwater wireless communication characteristics. It shows a 5G NR FSO-HCF-UWOC convergence from drone or buildings to undersea, using R/G/B 3-wavelengths and an SLM as a demonstration. The R/G/B 3-wavelengths are used to enhance the downstream and upstream aggregate transmission rates. An SLM with electrical comparator is used to adjust the laser beam and mitigate laser beam misalignment caused by drone movement or ocean flow. Over a hybrid of 1-km FSO, 10-m HCF, and 10.44-m ocean water-air-ocean water medium, downstream/upstream 5G-millimeter-wave (MMW) 9.1-Gb/s/24-GHz signals are transmitted with satisfactorily low bit error rates and error vector magnitudes, as well as distinct constellations. This demonstrated that the 5G NR FSO-HCF-UWOC converged system exhibits promising potential as it advances the scenario implemented by the 5G-MMW signals over FSO, HCF, and UWOC convergence, paving the way for high-speed and long-distance communications across diverse media.

Abstract Background The pathogenesis of osteoarthritis (OA) involves the progressive degradation of articular cartilage. Exosomes derived from mesenchymal stem cells (MSC-EXOs) have been shown to mitigate joint pathological injury by attenuating cartilage destruction. Optimization the yield and therapeutic efficacy of exosomes derived from MSCs is crucial for promoting their clinical translation. The preconditioning of MSCs enhances the therapeutic potential of engineered exosomes, offering promising prospects for application by enabling controlled and quantifiable external stimulation. This study aims to address these issues by employing pro-inflammatory preconditioning of MSCs to enhance exosome production and augment their therapeutic efficacy for OA. Methods The exosomes were isolated from the supernatant of infrapatellar fat pad (IPFP)-MSCs preconditioned with a pro-inflammatory factor, TNF-α, and their production was subsequently quantified. The exosome secretion-related pathways in IPFP-MSCs were evaluated through high-throughput transcriptome sequencing analysis, q-PCR and western blot analysis before and after TNF-α preconditioning. Furthermore, exosomes derived from TNF-α preconditioned IPFP-MSCs (IPFP-MSC-EXOsTNF−α) were administered intra-articularly in an OA mouse model, and subsequent evaluations were conducted to assess joint pathology and gait alterations. The expression of proteins involved in the maintenance of cartilage homeostasis within the exosomes was determined through proteomic analysis. Results The preconditioning with TNF-α significantly enhanced the exosome secretion of IPFP-MSCs compared to unpreconditioned MSCs. The potential mechanism involved the activation of the PI3K/AKT signaling pathway in IPFP-MSCs by TNF-α precondition, leading to an up-regulation of autophagy-related protein 16 like 1(ATG16L1) levels, which subsequently facilitated exosome secretion. The intra-articular administration of IPFP-MSC-EXOsTNF−α demonstrated superior efficacy in ameliorating pathological changes in the joints of OA mice. The preconditioning of TNF-α enhanced the up-regulation of low-density lipoprotein receptor-related protein 1 (LRP1) levels in IPFP-MSC-EXOsTNF−α, thereby exerting chondroprotective effects. Conclusion TNF-α preconditioning constitutes an effective and promising method for optimizing the therapeutic effects of IPFP-MSCs derived exosomes in the treatment of OA. Graphical Abstract

Abstract Background Percutaneous endovascular aneurysm repair (PEVAR) is the definitive therapy of choice for abdominal aortic aneurysms worldwide. However, current literature regarding the anatomic changes in the common femoral artery (CFA) post-PEVAR is sparse and contradictory, and a significant proportion of these studies did not control for the potential confounding effects of ethnicity. Thus, this study aims to investigate the anatomical effects of PEVAR on the CFA using an Asian study cohort. Methods Between January 2019 and September 2023, the records of 113 patients who received PEVAR were reviewed. Groins with previous surgical interventions were excluded. The most proximate pre- and postoperative CT angiography of patients receiving PEVAR via the Perclose ProGlide™ Suture-Mediated Closure System were retrospectively analysed for changes in both the CFA inner luminal diameter (ID) and outer diameter (OD), the latter also encompassing the arterial walls. Access site complications within 3 months post-PEVAR were also recorded per patient. Results One hundred seventeen groins from 60 patients were included in this study, with 1 report of pseudoaneurysm. The CFA ID exhibited a 0.167 mm decrease (p-value = 0.0403), while the OD decreased by 0.247 mm (p-value = 0.0107). This trend persisted when the data was separately analysed with the common cardiovascular risk factors of diabetes mellitus, hypertension and hyperlipidaemia. Conclusion Our analysis demonstrated a statistically significant decrease in the CFA diameters post-PEVAR. However, the percentage changes were below established flow-limiting values, as reflected by the single access site complication reported. Hence, our findings give confidence in the safety profile of this procedure, even with the reported smaller baseline CFA lumen size in Asians. Moving forward, similar longer-term studies should be considered to characterise any late postoperative effects. Graphical Abstract

Joint diseases greatly impact the daily lives and occupational functioning of patients globally. However, conventional treatments for joint diseases have several limitations, such as unsatisfatory efficacy and side effects, necessitating the exploration of more efficacious therapeutic strategies. Mesenchymal stem cell (MSC)-derived EVs (MSC-EVs) have demonstrated high therapeutic efficacyin tissue repair and regeneration, with low immunogenicity and tumorigenicity. Recent studies have reported that EVs-based therapy has considerable therapeutic effects against joint diseases, including osteoarthritis, tendon and ligament injuries, femoral head osteonecrosis, and rheumatoid arthritis. Herein, we review the therapeutic potential of various types of MSC-EVs in the aforementioned joint diseases, summarise the mechanisms underlying specific biological effects of MSC-EVs, and discuss future prospects for basic research on MSC-EV-based therapeutic modalities and their clinical translation. In general, this review provides an in-depth understanding of the therapeutic effects of MSC-EVs in joint diseases, as well as the underlying mechanisms, which may be beneficial to the clinical translation of MSC-EV-based treatment.The translational potential of this article: MSC-EV-based cell-free therapy can effectively promote regeneration and tissue repair. When used to treat joint diseases, MSC-EVs have demonstrated desirable therapeutic effects in preclinical research. This review may supplement further research on MSC-EV-based treatment of joint diseases and its clinical translation.

Abstract Background To compare the difference of postoperative anastomotic leakage (AL) rate between neoadjuvant chemoradiotherapy (NCRT) with pembrolizumab and NCRT group, and investigate the risk factors of developing AL for locally advanced esophageal squamous cell cancer (ESCC). Materials and methods The GF was contoured on the pretreatment planning computed tomography and dosimetric parameters were retrospectively calculated. Univariate and multivariate logistic regression analysis was performed to determine the independent risk predictors for the entire cohort. A nomogram risk prediction model for postoperative AL was established. Results A total of 160 ESCC patients were included for analysis. Of them, 112 were treated with NCRT with pembrolizumab and 44 patients with NCRT. Seventeen (10.6%) patients experienced postoperative AL with a rate of 10.7% (12/112) in NCRT with pembrolizumab and 11.4% (5/44) in NCRT group. For the entire cohort, mean, D50, Dmax, V5, V10 and V20 GF dose were statistically higher in those with AL (all p

Abstract Objective To determine the prevalence of and risk factors for overweight and obese among Chinese children and adolescents. Methods This analytical cross-sectional study included 16,640 children and adolescents aged 6–18 years across four provinces of China in 2016. Physical characteristics and responses to questionnaires were analyzed. Body Mass Index (BMI) and the prevalence of overweight and obesity were calculated. Results Among children and adolescents, the overall prevalence of overweight and obesity in 2016 in four regions of China was 27.2% and 29.6%, respectively. Among different stages and sexes, the highest prevalence of obesity (15.8%) was observed in adolescent boys. From childhood to adolescence, the obesity rate among boys increased by 0.7% (from 15.1% to 15.8%), while the obesity rate among girls decreased by 0.9% (from 10.8% to 9.9%). Children and adolescents who were overweight or obese had significantly higher systolic blood pressures, larger waist circumferences and larger hip sizes than those with a normal BMI. Logistic regression analyses identified thirteen factors associated with overweight or obesity in children and adolescents. Conclusions Our results indicate that the prevalence of overweight and obesity is high among children and adolescents, especially among male adolescents in four regions of China. A suitable intervention program should not only help parents understand the serious risk of childhood obesity but also, more importantly, help to encourage a healthy lifestyle among children and adolescents.

Abstract Background Kawasaki disease (KD) is a pyretic ailment predominantly observed in children aged below 5 years. There is currently a dearth of precise markers for timely identification of incomplete Kawasaki disease (IKD). It is imperative to develop updated, comprehensive, and evidence-based guidelines to effectively direct clinical practice. Methods The guideline development group comprised individuals with diverse expertise in both content and methodology and carried out an extensive exploration of the following digital repositories: CNKI, VIP, Wanfang Data, UpToDate, BMJ, Clinical Evidence, National Guideline Clearinghouse, Joanna Briggs Institute Library, Cochrane Library, and PubMed. The entire period from the establishment of these databases until January 1, 2024 was covered. To evaluate IKD, systematic reviews and randomised controlled trials were assessed using the risk of prejudice instrument specified in the Cochrane Handbook, along with the evidence robustness framework established by the GRADE group. The recommendations were formulated based on the findings, considering the evidence strength. After several iterations of expert consensus, the relevant professional committees in China endorsed the ultimate guideline. Results These guidelines address clinical questions regarding the classification and definition of KD, diagnosis of IKD, treatment during the acute phase of IKD, and follow-up of IKD. Conclusions To provide healthcare professionals with guidance and decision-making bases for the diagnosis and treatment of IKD in China, 13 recommendations were formulated based on expert consensus and evidence of best practices.

Abstract Background Achilles tendon is vital in maintaining the stability and function of ankle joint. It is quite difficult to achieve the structural and functional repair of Achilles tendon in tissue engineering. Methods A tissue-engineered tendon micro-tissue was prepared using rat tail tendon extracellular matrix (TECM) combined with rat adipose stem cells (ADSCs) to repair Achilles tendon injuries. The TECM was prepared by repeated freezing and thawing. The in vitro characteristics of TECM and its effect on ADSCs proliferation were detected. This tissue-engineered tendon micro-tissue for Achilles tendon repair in vivo was evaluated based on general characteristics, gait analysis, ultrasound findings, histological analysis, and biomechanical testing. Results The results showed that the TECM scaffold had good biocompatibility for ADSCs. At 2 weeks post-surgery, collagen types I and III and tenomodulin expression were higher, and vascular endothelial growth factor expression was lower in the micro-tissue group than other groups. At 4 and 8 weeks post-surgery, the results of histological analysis and ultrasound findings showed that the repaired tendon tissue was smooth and lustrous, and was arranged regularly and evenly in the micro-tissue group. Gait analysis confirmed that better motor function recovery was noted in micro-tissue group than other groups. In addition, the mechanical properties of the repaired tendon tissue in micro-tissue group were better than other groups. Conclusion Tissue-engineered tendon micro-tissue fabricated by TECM and ADSCs has good biocompatibility and can promote structural and functional repair of tendon in vivo. This composite biomaterial has broad application prospects in tissue engineering.

Abstract Background Previous observational studies have reported that systemic inflammatory regulators are related to the development of chronic kidney disease (CKD); however, whether these associations are causal remains unclear. The current study aimed to investigate the potential causal relationships between systemic inflammatory regulators and CKD and kidney function. Method We performed bidirectional two-sample Mendelian randomization (MR) analyses to infer the underlying causal associations between 41 systemic inflammatory regulators and CKD and kidney function. The inverse-variance weighting (IVW) test was used as the primary analysis method. In addition, sensitivity analyses were executed via the Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) test and the weighted median test. Results The findings revealed 12 suggestive associations between 11 genetically predicted systemic inflammatory regulators and CKD or kidney function in the forward analyses, including 4 for CKD, 3 for blood urea nitrogen (BUN), 4 for eGFRcrea and 1 for eGFRcys. In the other direction, we identified 6 significant causal associations, including CKD with granulocyte-colony stimulating factor (GCSF) (IVW β = 0.145; 95% CI, 0.042 to 0.248; P = 0.006), CKD with stem cell factor (SCF) (IVW β = 0.228; 95% CI, 0.133 to 0.323; P = 2.40 × 10− 6), eGFRcrea with SCF (IVW β =-2.90; 95% CI, -3.934 to -1.867; P = 3.76 × 10− 8), eGFRcys with GCSF (IVW β =-1.382; 95% CI, -2.404 to -0.361; P = 0.008), eGFRcys with interferon gamma (IFNg) (IVW β =-1.339; 95% CI, -2.313 to -0.366; P = 0.007) and eGFRcys with vascular endothelial growth factor (VEGF) (IVW β =-1.709; 95% CI, -2.720 to -0.699; P = 9.13 × 10− 4). Conclusions Our findings support causal links between systemic inflammatory regulators and CKD or kidney function both in the forward and reverse MR analyses.

We present six case studies from a comprehensive mass range (1-109 M⊙) of astrophysical objects, each of which possess jets, emit high-energy gamma radiation and in some instances spatially identifiable ultra-high-energy cosmic rays (UHECRs). All sources are strong candidates for UHECR emission, if not already known to emit them. We surmise that wakefield acceleration in conjunction with the magnetorotational instability of the accretion disc explains both structural properties of the jets and details in their emission signals, such as correlations in neutrino and gamma-ray bursts, and in the case of blazars, anticorrelations in flux and spectral index. Furthermore, our model predicts an upper bound for the energy of UHECRs emitted from a source given the mass of its central compact object and total jet luminosity. To provide context for our model predictions, we quantitatively compare them with observational data, however, we have not accounted for the GZK limit and assumed universal values for several model parameters (e.g. jet-spreading index, p) that likely differ between sources. Since the accretion and acceleration mechanisms are independent of mass, aside from determining maximum values, blazars (∼109 M⊙), radio galaxies (∼ 108 M⊙), Seyfert galaxies (∼ 106 M⊙ ), starburst galaxies (∼ 103 M⊙ ), even microquasars (1-10 M⊙) interestingly exhibit the same physics. Other radiation bands, such as X-ray, ultraviolet, or radio, may harbour additional information, but we chose not to focus on them for brevity. However, such an endeavour may open the door to a new multimessenger approach for understanding these objects.

Introduction Simulation-based learning is essential for health care providers to prepare for rare obstetric emergencies, such as severe trauma and maternal cardiac arrest. These situations demand rapid and prompt actions, often testing the skill of emergency physicians. Resuscitative hysterotomy (RH), a critical procedure in maternal cardiac arrest, requires technical expertise, coordination, and anatomical knowledge. The high cost of commercial trainers and complex existing models restricts accessibility. This resource introduces a low-cost anatomically accurate RH task trainer and assesses its effectiveness in improving skills and confidence among trainee emergency physicians. Methods A 20-minute-long case scenario depicted the resuscitation of a pregnant trauma patient with tension pneumothorax and uterine rupture, culminating in maternal cardiac arrest necessitating RH. Residents performed RH on the task trainer under faculty guidance. Feedback followed the Pendleton model, and an online questionnaire gauged the residents’ experiences. Results Thirty emergency medicine residents participated in the simulation. The questionnaire revealed positive responses, confirming the session's relevance and enhancement of clinical skills and confidence. Discussion Our results underscore the RH task trainer's critical role in improving residents’ skills and confidence during obstetric trauma simulations. Its realism and effectiveness were notably well received. Future refinements aim to augment fidelity while preserving affordability and integrating regular reinforcement sessions. This innovative educational approach equips health care professionals to respond adeptly to rare and challenging obstetric emergencies, ultimately elevating outcomes for mothers and infants during critical situations.

Abstract Harmonic generation and utilization are significant topics in nonlinear science. Although the progress in the microwave region has been expedited by the development of time‐modulated metasurfaces, one major issue of these devices is the strong entanglement of multiple harmonics, leading to criticism of their use in frequency‐division multiplexing (FDM) applications. Previous studies have attempted to overcome this limitation, but they suffer from designing complexity or insufficient controlling capability. Here a new space‐time‐coding metasurface (STCM) is proposed to independently and precisely synthesize not only the phases but also the amplitudes of various harmonics. This promising feature is successfully demonstrated in wireless space‐ and frequency‐division multiplexing experiments, where modulated and unmodulated signals are simultaneously transmitted via different harmonics using a shared STCM. To illustrate the advantages, binary frequency shift keying (BFSK) and quadrature phase shift keying (QPSK) modulation schemes are respectively implemented. Behind the intriguing functionality, the mechanism of the space‐time coding strategy and the analytical designing method are elaborated, which are validated numerically and experimentally. It is believed that the achievements can potentially propel the time‐vary metasurfaces in the next‐generation wireless applications.

BackgroundThe purpose of this real-world study was to investigate the risk factors for developing recurrence among patients with pathological T1-3N0 breast cancer (BC) treated with breast-conserving surgery (BCS) followed by whole breast irradiation alone (WBI) and identify those clinically high-risk BCs who could benefit from regional nodal irradiation (RNI).Materials and methodsFemale BC patients treated at Shanghai Ruijin hospital from 2009 to 2016 were retrospectively reviewed. The disease-free survival (DFS), breast cancer specific survival (BCSS) and overall survival (OS) were estimated by the Kaplan-Meier method, and survival differences were compared with the log-rank test. Univariate and multivariate analysis was performed using Cox proportional hazards regression analysis. An external validation was conducted by using SEER database.ResultsA total of 622 BC patients treated with BCS+WBI alone were included. With a median follow-up of 82 months, the 7-year OS, BCSS and DFS for the entire cohort was 97%, 99% and 91%, respectively. Multivariable Cox analysis indicated that tumor size (p=0.006), tumor location (p=0.033), lymphovascular invasion (LVI) status (p=0.0028) and Ki-67 index (p=0.051) were independent risk factors for DFS. A scoring system was developed using these four factors and the 7-year DFS and OS were 97% and 96% for patients with 0-1 risk factors, 95% and 82% for patients with ≥2 risk factors (p

Gliomas are primary tumors that originate in the central nervous system. The conventional treatment options for gliomas typically encompass surgical resection and temozolomide (TMZ) chemotherapy. However, despite aggressive interventions, the median survival for glioma patients is merely about 14.6 months. Consequently, there is an urgent necessity to explore innovative therapeutic strategies for treating glioma. The foundational study of regulated cell death (RCD) can be traced back to Karl Vogt’s seminal observations of cellular demise in toads, which were documented in 1842. In the past decade, the Nomenclature Committee on Cell Death (NCCD) has systematically classified and delineated various forms and mechanisms of cell death, synthesizing morphological, biochemical, and functional characteristics. Cell death primarily manifests in two forms: accidental cell death (ACD), which is caused by external factors such as physical, chemical, or mechanical disruptions; and RCD, a gene-directed intrinsic process that coordinates an orderly cellular demise in response to both physiological and pathological cues. Advancements in our understanding of RCD have shed light on the manipulation of cell death modulation - either through induction or suppression - as a potentially groundbreaking approach in oncology, holding significant promise. However, obstacles persist at the interface of research and clinical application, with significant impediments encountered in translating to therapeutic modalities. It is increasingly apparent that an integrative examination of the molecular underpinnings of cell death is imperative for advancing the field, particularly within the framework of inter-pathway functional synergy. In this review, we provide an overview of various forms of RCD, including autophagy-dependent cell death, anoikis, ferroptosis, cuproptosis, pyroptosis and immunogenic cell death. We summarize the latest advancements in understanding the molecular mechanisms that regulate RCD in glioma and explore the interconnections between different cell death processes. By comprehending these connections and developing targeted strategies, we have the potential to enhance glioma therapy through manipulation of RCD.

The present study stresses how leadership quality and educational practices affect student outcomes through the way teacher attitudes and behavior are expressed in Pakistani educational institutions. The quantitative data for this study were collected via random sampling from investors in different cities of Pakistan. A simple random sampling technique was adopted recruiting 1000 teachers from different levels of educational institutions in various areas of Pakistan for data analysis. Therefore, the study considered several factors to ensure that a representative sample, which reflects the large population of Pakistan’s teachers, was taken, allowing for more accurate generalizations based on the study findings. The Partial Least Squares (PLS) method was employed to analyze the data gathered for this study. The latter concluded that educational practices and leadership grades play a significant role in improving student learning. It emphasized the relationship between educational institution management, teachers’ mindsets and actions, and student learning results. These relationships can enhance educational outcomes, leadership development, and teacher preparation. Implications include policy considerations, teacher pedagogical training, leadership skills, and pursuing a more student-centered and holistic educational approach.