Adjunctive azithromycin prophylaxis protects women from uterine cesarean scar defect: A randomized controlled trial.

INTRODUCTION: Cesarean scar defect (CSD) is a long-term outcome of cesarean section (CS) and associated with numerous gynecological and obstetric problems. Previous studies indicate that infection may be a risk factor for CSD. Adjunctive azithromycin was shown to reduce the risk of postoperative infection in patients undergoing non-elective primary cesarean delivery in labor or after the rupture of membranes compared with standard antibiotic prophylaxis. This study investigated the protective effect of adjunctive azithromycin in combination with single-dose cephalosporin against CSD in women undergoing non-elective cesarean delivery. MATERIAL AND METHODS: A randomized, double-blind, controlled clinical trial was conducted in a University hospital in Shanghai, China. A total of 242 women who underwent their first non-elective CS were randomly assigned to receive 1500 mg cefuroxime sodium plus 500 mg intravenous azithromycin (n = 121; experimental group) or 1500 mg cefuroxime sodium plus a placebo (n = 121; placebo group). The primary outcome was CSD prevalence, as determined by transvaginal ultrasound and saline infusion sonohysterography within 6 months of delivery. Secondary outcomes were changes in infectious indicators (eg hypersensitive C-reactive protein and procalcitonin), postoperative morbidity, and use of postoperative antibiotics. We also examined the operative procedure, pathogenic microorganism cultures, and fetal outcomes. Outcomes were compared between groups with the chi-squared test, Fisher's exact test, or Student's t test. RESULTS: Between May 2018 and May 2021, 121 women were randomized to each arm. Because the sonographic follow up was disrupted by the coronavirus disease 2019 pandemic and strict management policies, we merged the follow-up time points (6 weeks and 6 months) into a single time period (6 weeks to 6 months); 104 and 108 women in the experimental and placebo groups, respectively, completed the first sonographic follow up. CSD was diagnosed by sonography in 34/104 (32.7%) and 50/108 (46.3%) patients in the experimental and placebo groups, respectively (relative risk 0.71, 95% confidence interval 0.50-0.99; p = 0.043). Characteristics of CSD and short-term infection outcomes did not differ between groups. CONCLUSIONS: A single dose of intravenous 500 mg azithromycin adjunctive to single-dose cefuroxime prophylaxis significantly reduced the incidence of CSD in women undergoing non-elective CS.

Constructing a plasma-based Schottky heterojunction for near-infrared-driven photothermal synergistic water disinfection: synergetic effects and antibacterial mechanisms

Developing green and highly efficient water disinfection technique is of great importance to public health. Herein, a near-infrared (NIR) light-triggerable thermo-sensitive defective molybdenum oxide-nitrogen doped carbon (MoO3-x/NCNs) composite was fabricated and applied to water disinfection. With the synergy of photodynamic and photothermal effects, the MoO3-x/NCNs achieve a rapid and effective inactivation of Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) as compared to photocatalytic treatment or thermal catalytic alone. Particularly, MONC-3 with optimal ratio can completely inactivate 7.6 log of E. coli and S. aureus within 60 min and 100 min, respectively. The MONC-3 hybrid exhibits efficient charge separation and migration ability due to the formation of Schottky heterojunction, resulting in the highly enhanced ·O2– (11.34×10-10 M) generation activity. Meanwhile, excellent NIR light absorption and photothermal conversion efficiency (52.6%) of MONC-3 can generate local high temperature to promote photocatalytic reaction rate and destruct the bacterial integrity. The monitoring of cell damage process confirmed the irreversible death of bacteria. Based on density functional theory (DFT) calculation, the antibacterial mechanism and Schottky effect were clarified. This work provides new insights for constructing a water disinfection strategy based on plasma-induced photothermal synergy catalysis.

Genomic monitoring of SARS-CoV-2 uncovers an Nsp1 deletion variant that modulates type I interferon response.

The SARS-CoV-2 virus, the causative agent of COVID-19, is undergoing constant mutation. Here, we utilized an integrative approach combining epidemiology, virus genome sequencing, clinical phenotyping, and experimental validation to locate mutations of clinical importance. We identified 35 recurrent variants, some of which are associated with clinical phenotypes related to severity. One variant, containing a deletion in the Nsp1-coding region (Δ500-532), was found in more than 20% of our sequenced samples and associates with higher RT-PCR cycle thresholds and lower serum IFN-ß levels of infected patients. Deletion variants in this locus were found in 37 countries worldwide, and viruses isolated from clinical samples or engineered by reverse genetics with related deletions in Nsp1 also induce lower IFN-ß responses in infected Calu-3 cells. Taken together, our virologic surveillance characterizes recurrent genetic diversity and identified mutations in Nsp1 of biological and clinical importance, which collectively may aid molecular diagnostics and drug design.