Guiyang Medical University

Despite the proven efficacy of labor epidural analgesia, its utilization in China remains suboptimal, particularly among primiparous women. Providing relevant health education during routine prenatal care appears to be a viable approach. To examine the effects of an online and offline prenatal labor epidural analgesia education program on labor epidural rates in primiparas. A single-blinded, parallel-group randomized controlled trial. A total of 196 couples (primipara and spouse) were recruited from a tertiary hospital in Shenzhen, China. The couples were randomly allocated to the intervention or control groups with usual care only. The intervention comprised a series of web-based educational modules covering fundamental aspects of labor epidural analgesia, such as indications and contraindications, along with four weekly WeChat reminders. Additionally, participants received one group face-to-face education session lasting 30min and one individual consultation of 10-15min. Study outcomes included the rate of labor epidural analgesia, primiparas' intention to use labor epidural analgesia, fear of childbirth, and epidural analgesia-related misconceptions among couples. Data were collected at baseline (T0), immediately post-intervention (T1), and 12weeks post-intervention (T2). The effects of the intervention were evaluated using generalized estimating equation models. The intervention group had a significantly higher labor epidural analgesia rate than the control group after childbirth (P=0.001). Primiparas in the intervention group showed significantly greater improvements in intention to use labor epidural analgesia at T1 (P<0.001) and T2 (P=0.014), compared with the controls. In addition, primiparas in the intervention group demonstrated a significantly greater reduction in misperceptions of labor epidural analgesia at T1 (P<0.001) and T2 (P=0.040) compared with the control group. Decreased primiparas' fear of childbirth and spouses' misperceptions of epidural analgesia were found in the intervention group, but no significant group-by-time effect was detected. The online and offline prenatal labor epidural analgesia education program was effective in increasing labor epidural analgesia rates and in reducing misconceptions about labor epidural analgesia. However, the program had limited effects on reducing primiparas' fear of childbirth and correcting spousal misconceptions about labor epidural analgesia. We recommend that midwives and obstetric nurses provide online-offline labor epidural analgesia education during routine prenatal visits. Chinese Clinical Trial Registry (ChiCTR2400079767).

Current frozen shoulder (FS) therapies present a clinical dilemma: although intra-articular corticosteroids with home exercise provide proven medium-term (3-month) benefits, they lack short-term (<4-week) efficacy for rapid recovery; conversely, manipulative treatments achieve faster outcomes but carry invasiveness risks. These limitations highlight the urgent need for developing and validating novel noninvasive approaches with prompt therapeutic effects. To compare the efficacy and safety of ultrasound-guided tendon surface (UGTS) injection versus manipulation under local anesthesia (MULA) and blind tender point (BTP) injection, all combined with intra-articular injection and home exercise. Randomized controlled trial; Level of evidence, 1. The authors first developed a novel ultrasound-based strategy, which they named "ultrasound-guided tendon surface." Then they conducted a multicenter randomized controlled trial (2019-2022). The primary outcome was 4-week shoulder function assessed by the Beijing Friendship Hospital Scale (BFHS), a modified version of the Constant-Murley Score adapted for Chinese populations with demonstrated validity. Secondary outcomes included (1) short-term (1-month) pain (visual analog scale [VAS]) score, active range of motion (ROM), Evaluation Scale of the Shoulder under Ultrasound (ESSU) score, pain relief, treatment sessions, and cartilage thickness; and (2) long-term (2-year) complete remission rates (tele-follow-up). Among 365 screened patients, 139 were enrolled and randomized to receive UGTS (n = 49), MULA (n = 43), and BTP (n = 47). At the 1-week follow-up visit, the UGTS group showed rapid improvement in BFHS scores compared to both the MULA and BTP groups. These early functional advantages were also indicated by the VAS score, ROM, ESSU score, and pain relief. UGTS achieved faster complete remission (1 month: 59.2% vs 31.0% and 34.9% for BTP and MULA, respectively; 3-month: 79.6% vs 53.2% and 69.8% for BTP and MULA, respectively; P < .05), with remission rates converging by 24 months (P = .216), yet retained early rapid response as its key clinical advantage. UGTS showed no significant impact on articular cartilage thickness. Serial ultrasound monitoring demonstrated no rotator cuff injuries attributable to either the UGTS procedure or prescribed exercises. UGTS combined with intra-articular injection and exercise promotes faster recovery without safety concerns, representing an effective noninvasive first-line option for rapid relief in FS. ChiCTR1900025874 (Chinese Clinical Trial Registry number).

Fluoride (F), an environmental contaminant, is known to induce cardiotoxicity, although the precise molecular mechanisms remain unclear. This study aimed to investigate the role of the SIRT1/PI3K/AKT signaling pathway in F-induced cardiotoxicity and explore the potential protective effects of SIRT1 activation. Human AC16 cardiomyocytes and zebrafish embryos were exposed to increasing concentrations of sodium NaF. Cellular assays were used to assess viability, apoptosis, cell cycle distribution, and oxidative stress. Expression levels of oxidative and inflammatory markers, as well as components of the SIRT1/PI3K/AKT pathway, were analyzed by western blotting, immunofluorescence, and real-time PCR. Zebrafish were evaluated for cardiac developmental abnormalities, apoptosis, and oxidative stress. The SIRT1 agonist SRT1720 was used to evaluate the protective effects of SIRT1 activation. Statistical analysis was performed using SPSS 23 Software and GraphPad Prism7 software, with significant differences evaluated by one-way analysis of variance (ANOVA) and Dunnett's test (p < 0.05). NaF exposure significantly inhibited AC16 cell proliferation, induced G1 phase arrest, and increased apoptosis in a dose-dependent manner. Reactive oxygen species levels were elevated, accompanied by downregulation of antioxidant proteins and upregulation of inflammatory cytokines. NaF markedly suppressed SIRT1, PI3K, and AKT expression while activating FOXO1a. Zebrafish embryos exhibited dose-dependent cardiac malformations, increased apoptosis, and elevated oxidative stress markers. Treatment with SRT1720 restored SIRT1/PI3K/AKT pathway activity, enhanced cell proliferation, reduced apoptosis, and alleviated oxidative and inflammatory responses in both cell and zebrafish models. This study demonstrates that F induces cardiotoxicity by disrupting the SIRT1/PI3K/AKT signaling pathway, leading to increased oxidative stress, inflammation, and apoptosis. Activation of SIRT1 by SRT1720 mitigates these effects, highlighting the protective role of this pathway in F-related cardiac injury. These findings provide mechanistic insights and identify potential molecular targets for the prevention and treatment of fluorosis-associated cardiovascular toxicity.