The Analgesic Effect of a Transdermal Lappaconitine Patch Combined With Ibuprofen Suspension for Children After Adenoidectomy and Tonsillectomy: A Randomized Clinical Trial.

PURPOSE: To study the analgesic effects and side effects of a transdermal lappaconitine (TLA) patch, ibuprofen suspension (IS), and TLA combined with IS (TLACIS) after adenoidectomy and tonsillectomy. DESIGN: Prospective, randomized clinical trial. METHODS: The patients were randomized into three groups defined by different analgesic drug regimens: the TLA group, the IS group, and the TLACIS group. Pain scores at 2, 12, and 24 hours after surgery and adverse-event reports within the first postoperative week were collected. RESULTS: Ultimately, this study included 102 cases in the TLA group, 101 cases in the IS group, and 101 cases in the TLACIS group. At 2 hours after surgery, the pain scores of the TLA and the TLACIS groups were both significantly lower than that of the IS group (all P < .05). At 12 and 24 hours after surgery, the pain score of the TLACIS group was significantly lower than those of the TLA and IS groups (all P < .05); furthermore, the pain score of the IS group was significantly lower than that of the TLA group (P < .05). Within 1 week after the operation, there was no significant difference in the incidence of adverse events. CONCLUSIONS: The addition of a TLA patch can speed the onset of analgesia. In terms of analgesic effects, IS alone is more advantageous than TLA alone, while the combination of TLA and IS has the best analgesic effect. No significant differences were found in the incidence of adverse events among the three regimens.

The levels of women's awareness, experience, acceptability and preference for Vaginal Human Papillomavirus (HPV) self-sampling in three provinces of China: a cross-sectional study.

BACKGROUND: The primary screening technique for precancerous lesions and cervical cancer is human papillomavirus (HPV) testing, and HPV self-sampling has been shown to be consistent with clinician sampling in terms of the accuracy of the results and may improve cervical cancer screening rates. The aim of this study was to understand the level of awareness, experience, acceptability, and preference for vaginal HPV self-sampling among women in Jiangsu, Zhejiang, and Shanghai, China, and to analyze the possible influencing factors to determine the feasibility of implementing self-sampling. METHODS: Overall, 1793 women were included in the data analysis. A self-administered questionnaire was utilized. In addition to descriptive analysis, univariate and multivariate analyses were used to explore the associations between sociodemographic features, history of cervical cancer screening, and the level of awareness, experience, acceptability, and preference for HPV self-samples. RESULTS: The participants' level of awareness of and experience with HPV self-sampling were moderate. A total of 88.8% of participants rated the acceptability as "high", and self-sampling was preferred by 64.2% of them for cervical cancer screening. People aged 45 to 54 years showed a preference for both clinician sampling(OR = 1.762 (1.116-2.163)) and self-sampling (OR = 1.823 (1.233-2.697)). Those who had graduated from high school or above (OR = 2.305 (1.517-3.503), OR = 2.432 (1.570-3.768), OR = 3.258 (2.024-5.244)) preferred clinician-sampling, and those with a bachelor's degree or above (OR = 1.664 (1.042-2.657)) preferred self-sampling. Middle- and high-income individuals showed no preference for either sampling method (OR < 1). CONCLUSIONS: HPV self-sampling is widely accepted, but awareness, experience and preferences need to be improved. These results may help to adjust public health strategies for the early inclusion of HPV self-sampling as a screening method in national initiatives to prevent cervical cancer.

Carbon dioxide laser therapy for the management of genitourinary syndrome of menopause: A meta­analysis of randomized controlled trials.

Genitourinary symptoms of menopause (GSM) affect ~50% of women after menopause. Recently, CO2 laser therapy has been used for managing GSM but without high quality evidence. The present review assessed the effectiveness of CO2 laser therapy in the management of GSM. PubMed, Embase, Web of Science, CENTRAL and Scopus databases were searched for randomized controlled trials (RCTs), published up to June 30, 2023, comparing CO2 laser and sham laser treatments for GSM management. The outcomes of interest included Female Sexual Function Index (FSFI), Vaginal Health Index (VHI) and visual analog scale (VAS) for dyspareunia, dryness, burning, itching and dysuria. A total of seven RCTs were included in the review and meta-analysis, with 6/7 studies using three sessions of laser therapy, 4-8 weeks apart. Meta-analysis demonstrated no statistically significant difference in FSFI [mean difference (MD), -1.48; 95% CI, -5.85, 2.89; I2=45%] and VHI scores (MD, -0.18; 95% CI, -1.66, 1.31; I2 =72%) between laser and control groups. Meta-analysis also demonstrated no statistically significant difference in VAS scores for dyspareunia (MD, -1.63; 95% CI; -4.06, 0.80; I2=91%), dryness (MD, -1.30; 95% CI, -3.14, 0.53; I2=75%), burning (MD, -0.76; 95% CI, -2.03; 0.51 I2=56%), itching (MD, -0.28; 95% CI, -0.95, 0.38; I2=0%) and dysuria (MD, 0.15; 95% CI, -0.37, 0.67; I2=23%) between the groups. The included RCTs had low risk of bias. In conclusion, meta-analyses of high-quality sham-controlled RCTs indicated that CO2 may not have any beneficial effect on GSM. Limited data and high heterogeneity in meta-analyses in this area of research are important limitations that need to be addressed by future RCTs.

[Clinical analysis of 102 cases of pediatric vocal fold nodules].

Objective:To evaluate the impact of vocal fold nodules on the quality of life of children, and to compare the efficacy between conservative management（voice hygiene education, etc.） and laryngeal microsurgery. Methods:A retrospective study was performed on 102 children with vocal fold nodules, who received treatment in Children's Hospital of Fudan University during the period from January 2020 to December 2022. According to the regime, the patients were divided into conservative management group and surgical treatment group; Cases are divided into pre-school age group （2-5 years old） and school-age group （6-12 years old） based on age. The pediatric voice-related quality of life （pVRQOL） was used to evaluate the impact of vocal fold nodules on the quality of life of children and differences in efficacy between two treatment regimens. Results:The pVRQOL scores of vocal fold nodule grades 1, 2, and 3 were 91.58±8.17, 78.87±12.49, 72.50±12.08, respectively. There were statistical differences between grade 1 and grade 2, and between grade 2 and grade 3. There were statistical differences between grade 1 grade 2, grade 2 and grade 3 （P<0.001）, suggesting that the higher the rating of vocal cord nodules, the lower the pVRQOL score of patients was. The pVRQOL score of the school-age group was 69.83±11.11, which is lower than that of the preschool group（87.59±8.63）, and the difference was statistically significant （P=0.042）. Vocal fold nodules had a significant impact on the pVRQOL score of school-age children. In the conservative management group, the pVRQOL scores before and after treatment were 83.99±12.66 and 87.26±9.58, respectively, and there was significant difference between the two groups（P=0.046）. Indirect voice therapy such as voice hygiene education could improve children's pVRQOL scores and was more effective for school-age children（P<0.001）. The microsurgical treatment had a more significant improvement in the pVRQOL score of children. Conclusion:The higher the rating of vocal fold nodules, the greater the impact on the quality of life of patients. Vocal fold nodules had a greater impact on the quality of life of school-age children than that of preschool children. Voice hygiene education could improve the quality of life of children, which was more evident in the school-age group. Compared with voice hygiene therapy, laryngeal microsurgery had a more significant effect on improving the pVRQOL score of patients. It is recommended to undergo laryngeal microsurgery for the treatment of vocal fold nodules for the requirement of improving the quality of life related to voice. During the 6-month follow-up period after surgery in this study, the short-term efficacy of laryngeal microsurgery in treating vocal cord nodules in children is clear, but the long-term efficacy needs further research.

[New progress in the surgical treatment of laryngeal cyst in infants and children].

Laryngeal cyst is a cystic lesion occurring in the laryngeal cavity. Large laryngeal cyst in infants and young children can cause laryngeal wheezing and other upper airway obstruction symptoms. In severe cases, it can be even life-threatening and requires timely surgical treatment. Currently, there is a lack of unified clinical treatment strategy for this disease.This article summarizes the surgical methods, the advantages and disadvantages of various surgical methods for laryngeal cysts in recent years. It is recommended that needle aspiration, partial cyst wall resection, radical cyst dissection, transoral robotic surgery or external approach cyst resection should be selected through full communication and evaluation to clarify the extent of the lesion scope and the advantages and disadvantages of surgery.

Experience and acceptability for HPV self-sampling among women in Jiangsu province, China: a cross-sectional survey.

This aim of this study was to investigate women's knowledge about HPV along with their experience and acceptability of self-sampling in Jiangsu province, China. A total of 862 women aged 25-63 years old from Jiangsu province who purchased an HPV self-sampling test kit were invited to complete a questionnaire designed by the authors. Participants had high acceptability for HPV self-sampling with a mean score of 4.2 (95% [CI], 4.1-4.22) out of 5 points. 27% of participants preferred clinician-sampling, 33% preferred self-sampling, other 40% expressed no preference. Women with good knowledge about HPV and with a good experience with HPV self-sampling were more acceptable for self-sampling (P < 0.05). The biggest concern about HPV self-sampling of the participants includes 'specimens' spoilage', 'incorrect sampling', 'can't get results in time', and so on. HPV self-sampling can be used to improve cervical cancer screening coverage and participation rates in China.

Cancer screening and can be an alternative primary screening for cervical cancer.•What the results of this study add? This study adds new findings about Chinese women's experience and acceptability of HPV self-sampling. We found that most women had high acceptability for HPV self-sampling in Jiangsu province, China, and high knowledge about HPV as well as good•What is already known on this subject? HPV self-sampling testing was proven to be useful for improving the uptake rate of cervical experience of self-sampling can improve the acceptability for self-sampling in women.•What the implications are of these findings for clinical practice and/or further research? Further research should assess the acceptability of women with less education or who never screened.

[Pediatric tracheotomy: clinical analysis of 95 cases with different etiology].

Objective:To disscuss the changes in indications, surgical opportunity and post-operative management of pediatric tracheotomy. Methods:Retrospective cohort study of pediatric patients undergoing tracheostomy between January 2016 and December 2020 at Children's Hospital of Fudan University. Ninety-five patients were divided into four groups according to their primary indication. Group A: neuromuscular disease（n=36, 37.9%）, Group B: congenital abnormality（n=30, 31.6%）, Group C: accidental injury（n=15, 15.8%）, Group D: tumor（n=14, 14.7%）. Results:By the comparison between four groups, children in group A had higher incidence of Severe pneumonia（47.2%）, higher usage of mechanical ventilation（97.2%）, longer hospitalization days（=84.9 days） and higher rate of Ventilator dependence（66.7%）; children in group B had higher rate of emergency surgery（4.2%）, lower age（median age 2 months） and lower usage of mechanical ventilation（30.0%）; Mortality of the children in group D was the highest（42.9%）. In the recent five years, we saw a increasing tendency in the proportion of group A（28.6%, 35.0%, 38.5%, 44.4%, 43.5%）, and a decreasing tendency of group B（57.1%, 30.0%, 38.5%, 33.3%, 21.7%）. On discharge, 50.5% of children（48 of 95）spontaneously breathe with the tracheos tomy in situ, 29.5% of children（28 of 95）had ventilator-dependence, tracheostomy decannulation was successful in 6.3% of children （6 of 95） and all-cause mortality was 13.7% （13 of 95）. Conclusion:Most paediatric tracheotomies were performed due to chronic underlying diseases. Pediatric tracheostomy should be considered as a long-term intervention in many children. Earlier tracheotomy can shorten the duration of post-tracheotomy mechanical ventilation in several conditions.

Effect of the Concentration of SrAl2O4: Eu2+and Dy3+ (SAO) on Characteristics and Properties of Environment-Friendly Long-Persistent Luminescence Composites from Polylactic Acid and SAO.

We report luminous polylactic acid (PLA) composite prepared via a solvent casting method using different amounts of phosphor strontium aluminate (SrAl2O4: Eu2+ and Dy3+) (SAO). The reason for doing this is that the changes of fluorescence and mechanical properties in the composites with different SAO contents can be directly evaluated. The SAO particles should have a variety of excellent characteristics in the PLA matrix, among which dispersibility and compatibility are particularly important; so, they can be modified by 3-aminopropyltriethoxysilane (APS) to achieve the target characteristics. The results showed that the fluorescence and mechanical properties were affected by SAO addition. The mechanical properties significantly improved with 5 wt% SAO; further, addition had no impact. And the emission band of fluorescence and phosphorescence is just at the peak of 524 nm. The composites with 15 wt% SAO have the best fluorescence properties. The fluorescence decreased with further doping. Fluorescence decay curves with various amounts of SAO particles show a similar tendency as pure SAO particles; the speed of decrease in afterglow intensity was higher for the first 30 min. In addition, the detailed morphological scanning and study by scanning electron microscope (SEM) showed that the particles had good adhesion to the matrix. In conclusion, the concentration of SAO into the PLA matrix impacts the fluorescence and mechanical properties of a SAO/PLA composite material.

Apparent homozygosity for a novel splicing variant in EPS8 causes congenital profound hearing loss.

Autosomal recessive deafness-102 (DFNB102), a new profound prelingual non-syndromic hearing loss, is caused by mutations in the EPS8 gene. To date, only three such consanguineous families with three different homozygous variants in EPS8 have been reported. Here, we report the fourth case from a non-consanguineous Chinese family, an 11-month-old male infant presented with congenital profound non-syndromic hearing loss. Trio whole-exome sequencing initially identified the patient with a novel seemingly homozygous splicing variant NM_004447.5: c.1435-2A > T in intron 14 of the EPS8 gene and was inherited from his father; further CNVs analysis identified a novel 65.9 kb intragenic deletion and was inherited from his mother. The deletion is covering intron 14 that could account for the apparent homozygosity of the patient. In vitro splicing assay showed the variant c.1435-2A > T creates a new donor site at position c.1443, which is predicted to produce a stop codon after 14 additional amino acids (p.His479Cysfs*14). Furthermore, quantitative allele-specific expression assay showed that relative EPS8 gene expression in the patient significantly decreased (0-fold for the wild-type transcript and 0.25-0.27-fold for the mutant transcript) compared to the control (P < 0.05), indicating the pathogenicity of the identified variants. Overall, our study provides additional evidence that EPS8 is a causative gene for DFNB102 and highlights the clinical utility of simultaneous analysis of CNVs and SNVs to avoid potential errors in the diagnosis and interpretation of patients with apparent homozygosity.

Recessive LOXHD1 variants cause a prelingual down-sloping hearing loss: genotype-phenotype correlation and three additional children with novel variants.

BACKGROUND: Biallelic mutations in LOXHD1 have been identified as the cause of DFNB77 (deafness, autosomal recessive 77). It is a new progressive, severe-to-profound, and late-onset nonsyndromic sensorineural hearing loss (NSHL), and is highly heterogeneous genetically and phenotypically. This study aimed to provide an additional three cases of DFNB77. METHODS: We presented three unrelated children diagnosed with prelingual mild-to-severe NSHL, and their audiograms showed mild hearing loss at 250 Hz before downsloping to a moderate-to-severe degree. Trio whole-exome sequencing (WES) was conducted to identify the pathogenic variants. Additionally, we reviewed the literature to further analyze the relationships between the genotype and audiology phenotype of LOXHD1. RESULTS: Six novel possible pathogenic LOXHD1 variants were identified, including three missense, one nonsense, and two splicing variants. The literature review showed that 68.5% of patients with DFNB77 onset before five years old; Most variants (62%) were associated with a down-sloping audiogram of mild-to-moderate hearing loss at low frequencies (200Hz, 500Hz), particularly variants in the protein domain of PLAT 9. We found that compared with homozygous LOXHD1 variants, individuals with heterozygous compound variants had a significantly milder phenotype, especially individuals carrying one missense and one splicing or bi-allelic missense variants (P < 0.05). Audiometric analysis at different ages showed that the hearing loss degree was aggravated at all frequencies by increasing age. CONCLUSIONS: We report three children with prelingual NSHL carrying six novel LOXHD1 variants. Furthermore, our work indicates that DFNB77 may be milder than previously reported and recommends considering the genotype combination and mutation location of LOXHD1 and race-specificity in DFNB77 molecular diagnoses and management.

[Use of balloon catheter dilation and bioabsorbable steroid-releasing sinus implants in pediatric chronic rhinosinusitis].

Objective:To evaluate the effect of use of balloon catheter dilation （BCD） with bioabsorbable steroid-releasing sinus implants in pediatric chronic rhinosinusitis（PCRS）. Method:A retrospective study was performed of 49 children with failed medical therapy, who underwent surgery, and children all accepted adenoidectomy.77 sides of sinus were performed with balloon catheter dilation sinuplasty. They were divided into two groups：the balloon group and the balloon with implant group. The balloon group included 26 cases, 16 cases of which accepted balloon catheter dilation sinuplasty of both maxillary sinuses, and 10 cases of which accepted one side. The balloon with implant group included 23 cases,12 cases of which accepted balloon catheter dilation sinuplasty of both maxillary sinuses plus positioning of bioabsorbable steroid-releasing sinus implants, and 11 cases of which accepted one side. VAS and SN-5 scales were completed by children and their parents to evaluate subjective symptoms. Children all accepted CT of sinus and CT score （Lund-Mackey） was completed by a doctor. We use the SPSS 23.0 with the way of Repeated measures ANOVA to analyze the data between two groups, aiming to identify the effect of the operation manners. Result:The procedures were successful in all patients in the balloon with implant group. No complications happened. No sinus implants moving and no detachment. In the balloon with implant group, VAS score declined from 6.9 before operation to 2.0 of six months after operation and SN-5 score declined from 2.397 to 1.376 and CT score of one side of operation declined from 9.628 to 1.314. VAS score, SN-5 score and CT score of the balloon with implant group all declined significantly after operation. The remission rate of the VAS and SN-5 score in the balloon with implant group were 100% and 95% respectively. The SN-5 score data of patients in two groups with SN-5 score <2.5 before operation was analyzed. There was no statistical significance between the data of two groups before operation（P=0.199）, and there was no statistical significance between the data decline of SN-5 score of two groups after operation （F=2.336，P=0.14）. The data of patients in two groups with SN-5 score ≥2.5 before operation was analyzed. There was no statistical significance between the data of two groups before operation（P=0.628）, and, after operation, there was statistical significance between the data decline of SN-5 score of two groups （F=13.861，P=0.001）.It meant the balloon with implant group declined more. The CT score data of patients in two groups with CT score （3-8） before operation was analyzed. There was no statistical significance between the data of two groups before operation（P=0.411）,and there was no statistical significance between the data decline of CT score of two groups after operation（F=1.108，P=0.300）.The data of patients in two groups with CT score （9-12） before operation was analyzed. There was no statistical significance between the data of two groups before operation（P=0.792）, and, after operation, there was statistical significance between the data decline of CT score of two groups （F=13.059，P＝0.001）. It meant the balloon with implant group declined more. Conclusion:In our study, the use of balloon catheter dilation （BCD） with bioabsorbable steroid-releasing sinus implants made a clinical curative effect in the treatment of PCRS with failed medical therapy, and it was safety. In severe PCRS patients, balloon catheter dilation （BCD） with bioabsorbable steroid-releasing sinus implants was more effective than the use of balloon catheter sinuplasty （BCS） alone.

Novel heterozygous GATA3 and SLC34A3 variants in a 6-year-old boy with Barakat syndrome and hypercalciuria.

BACKGROUND: Barakat syndrome is an autosomal dominant disorder characterized by the triad of hypoparathyroidism, sensorineural deafness, and renal anomalies and is caused by mutations in GATA3 gene. SLC34A3 is the cause gene of hypophosphatemic rickets with hypercalciuria, and heterozygous carriers may have milder clinical symptoms. The aim of this study was to identify the underlying genetic cause of a patient who initially presented with renal failure, hypercalciuria, kidney stone, and bilateral sensorineural deafness. METHODS: A 6-year-old boy with complex clinical presentations was investigated. Comprehensive medical evaluations were performed including auditory function tests, endocrine function tests, metabolic studies, and imaging examinations. Molecular diagnoses were analyzed by trio whole-exome sequencing. RESULTS: One novel de novo deleterious variant (c. 324del) of the GATA3 gene was identified in the patient. The patient can be diagnosed with Barakat syndrome. In addition, one novel variant (c. 589A>G) of the SLC34A3 gene was detected, which was inherited from the father. This heterozygous variant can explain the hypercalciuria and kidney stone that occurred in both the patient and his father. CONCLUSION: This study provides a special case which is phenotype-driven dual diagnoses, and the two novel variants can parsimoniously explain the complex clinical presentations of this patient.

Systematic elucidation of the mechanism of geraniol via network pharmacology.

BACKGROUND: Geraniol is an acyclic monoterpene alcohol, which is extracted from the ethereal oils of aromatic plants. A systematic analysis of its mechanism of action has not yet been carried out. METHODS: In this study, the druggability of geraniol was assessed via Traditional Chinese Medicine Systems Pharmacology Database (TCMSP), and the potential targets of geraniol were identified using the Comparative Toxicogenomics Database (CTD). Additionally, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed using WebGestalt. Drug-target-pathway networks were constructed using Cytoscape to give a visual view. RESULTS: Our findings showed that geraniol has superb druggability with 38 putative identified target genes. GO, KEGG, and network analyses revealed that these targets were associated with cancer, inflammatory immunoreactions, and other physiological processes. CONCLUSION: Geraniol is predicted to target multiple proteins and pathways that shape a network which can exert systematic pharmacological effects.

Geraniol suppresses proinflammatory mediators in phorbol 12-myristate 13-acetate with A23187-induced HMC-1 cells.

BACKGROUND: Geraniol is a monoterpene alcohol that has anti-fungal, anti-cancer and anti-nociceptive properties, but its anti-allergic rhinitis (AR) property is unclear. METHODS: In this study, the anti-inflammatory role and its possible mechanisms of geraniol in human mast cell line (HMC-1) cells stimulated by inflammatory trigger phorbol 12-myristate 13-acetate plus A23187 (PMACI), as well as in ovalbumin (OVA)-induced AR mice models were investigated. RESULTS: PMACI results in a significant increase in the production of proinflammatory cytokines, such as TNF-α, IL-1ß, MCP-1, IL-6 and as well as histamine. Geraniol was found to inhibit both TNF-α, IL-1ß and IL-6 protein and mRNA expressions at concentrations of 40, 80, 160 µM. In OVA-induced AR models, geraniol treatment was able to suppress AR biomarkers (OVA-specific IgE and IL-1ß as well as histamine) and nasal rub scores. Interestingly, p38, a member of the mitogen-activated protein kinase (MAPK) signaling family, was found to be increasingly hypophosphorylated as geraniol dose was increased. Similar decreases in the nuclear level of p65, a member of the nuclear factor kappa B (NF-κB) signaling pathway, were also observed. CONCLUSION: Our data highlights that the anti-inflammatory properties of geraniol on AR-related markers in activated HCM-1 cells and OVA-induced AR models may be mediated through the regulation of the MAPK/NF-κB signaling pathway.

Pregnancy after fertility-sparing surgery for borderline ovarian tumors.

OBJECTIVE: To investigate the ability to conceive and the factors affecting chances of pregnancy among patients with borderline ovarian tumors (BOTs) treated with fertility-sparing surgery. METHODS: A retrospective study included nulliparous patients aged 40years or younger who had undergone fertility-sparing surgery for BOTs between January 2005 and June 2012 at a center in Fuzhou, China. Identified patients were followed up by telephone or mail between March 15 and June 30, 2013. Patients who had already been pregnant and those who had not but had discontinued contraception for more than 1year were included in final analyses. RESULTS: Among 23 included patients, 17 (74%) had become pregnant within the mean follow-up period of 48.2months. The frequencies of previous infertility, sequelae of pelvic inflammatory disease, and endometriosis were all higher in the nonpregnant group than in the pregnant group (P≤0.021 for all). More women in the nonpregnant group that in the pregnant group had BOTs of stage II or worse, but the difference was nonsignificant (P=0.059). CONCLUSION: Fertility-sparing surgery in young patients with BOTs is associated with a good pregnancy rate. However, the tumor stage and coexisting infertility factors are important considerations in selecting the optimal surgical approach.