Zunyi 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).

Localized delivery of molecular hydrogen (H2) in bone tissue engineering remains largely unexplored, despite its potent antioxidative and anti-inflammatory properties. In this study, we present a multifunctional collagen membrane reinforced with micro-magnesium wires coated with metal-phenolic networks (Col-MMW), designed for guided bone regeneration (GBR). The embedded magnesium wires provide mechanical reinforcement, enhancing the membrane's structural integrity and space-maintaining capability during early healing. Concurrently, magnesium degradation enables sustained, site-specific release of H2 and magnesium ions (Mg2+), offering a synergistic strategy to modulate the osteoimmune environment. Col-MMW attenuates intracellular reactive oxygen species (ROS) and reprograms cellular metabolism from glycolysis toward oxidative phosphorylation, thereby activating the nuclear factor erythroid 2-related factor 2 (NRF-2)-mediated redox balance pathway and suppressing nuclear factor kappa B (NF-κB) pathway-driven inflammation. This osteoimmunometabolic reprogramming leads to a significant reduction in inflammatory responses. In vivo studies, including rat subcutaneous implantation and calvarial defect models, demonstrated that the immunoregulatory effects of Col-MMW significantly promoted osteogenesis. By integrating mechanical reinforcement with localized metabolic and immune modulation, Col-MMW redefines the design paradigm of GBR membranes. These findings highlight Col-MMW as a next-generation biomaterial that combines structural integrity with targeted osteoimmunomodulation, addressing the unmet need for intelligent biomaterials for bone repair.

Sepsis-associated acute kidney injury (SA-AKI) is a severe pediatric condition often requiring red blood cell transfusion, yet its transfusion risk factors remain unclear. This study investigated the incidence, temporal trends, and determinants of transfusion in children with SA-AKI. Using the U.S. Nationwide Inpatient Sample (2010-2019), pediatric patients (< 18years) with SA-AKI were identified by ICD-9/10 codes. Demographic, hospital, comorbidity, and complication data were compared and then analyzed using multivariate logistic regression to identify independent risk factors for transfusion. Among 7,521 children with SA-AKI, 30.17% received transfusions. The annual transfusion rate declined from 45.6% (2010) to 21.6% (2019). Independent risk factors included younger age, Black/Hispanic/Asian race, higher comorbidity burden, teaching hospital admission, elective admission, and Northeast hospital location. Specific comorbidities (coagulopathy, disseminated intravascular coagulation, lymphoma, fluid/electrolyte disorders, neurological disorders, and solid tumor without metastasis) and complications (continuous trauma ventilation, acute respiratory failure, gastrointestinal bleeding, thrombocytopenia, septic shock, hepatic insufficiency) significantly increased transfusion likelihood. Protective factors included chronic pulmonary disease, uncomplicated diabetes, paralysis, and urinary tract infection. Pediatric SA-AKI transfusion rates have markedly decreased over the past decade. Risk factors reflect disease severity and acute complications, while certain chronic conditions appear protective. These findings highlight the complexity of transfusion decision-making in SA-AKI and may inform strategies to optimize transfusion practices.