This prospective cohort study aims to explore the mechanisms by examining the independent and sequential mediation effects of internalized weight stigma, breastfeeding difficulties, and breastfeeding self-efficacy in the relationship between pre-pregnancy overweight/obesity and exclusive breastfeeding at 6 months postpartum. In Nanjing, China, 296 primiparous women were stratified by pre-pregnancy body mass index (BMI) into two groups: pre-pregnancy overweight/obese (n = 146) and normal BMI (n = 150). Data were collected via questionnaires during the antenatal period and at 6 months postpartum. Women with pre-pregnancy overweight/obesity reported significantly higher levels of internalized weight stigma (M = 30.73, SD = 5.71) compared to their normal-weight counterparts (M = 22.42, SD = 3.75). Path analysis with bias‑corrected bootstrapping was used to test mediation, adjusting for baseline covariates. The study confirmed a negative correlation between pre-pregnancy overweight/obesity and exclusive breastfeeding at 6 months postpartum. Significant indirect paths were identified from pre-pregnancy overweight/obesity to exclusive breastfeeding at 6 months postpartum via internalized weight stigma, breastfeeding difficulties, and breastfeeding self-efficacy. A significant serial indirect path through breastfeeding difficulties and self-efficacy was also identified. This study highlights the critical mediating roles of internalized weight stigma, breastfeeding difficulties, and breastfeeding self-efficacy in the relationship between pre-pregnancy overweight/obesity and exclusive breastfeeding. The findings provide healthcare professionals with evidence-based targets for intervention, emphasizing the need to address weight stigma in prenatal care and enhance breastfeeding support strategies. Future studies in more diverse populations are warranted to confirm generalizability. Trial Registration: Registered at the Chinese Clinical Trial Registry (registry number: ChiCTR2200057038), trial registration date February 26, 2022.

Background:Antepartum depression is a common mental health issue. This study aimed to develop a tool to predict antepartum depression risk and contribute to improving the screening rate of antepartum depression. Methods:This study used a prospective design, including a total of 1,701 mid-pregnancy women, who were followed up until late pregnancy. We comprehensively incorporate predictors from biological, psychological, demography, and obstetrics. Several machine learning algorithms (logistic regression, random forest, support vector machine and extreme gradient boosting) were used to predict antepartum depression. Predictive variables were screened using the least absolute shrinkage and selection operator (LASSO). The models were built based on 70% of the training set and evaluated on the remaining 30% test set using metrics such as accuracy, precision, sensitivity, specificity, F1 score, and area under the receiver operating characteristic curve (AUC). We also ranked the importance of the variables. Results:LASSO was used to select the nine variables (out of a total of 42). The importance ranking of the nine variables is as follows: psychological resilience, rumination, stress, social support, body image satisfaction during pregnancy, preparation for neonatal parenting, low-density lipoprotein cholesterol, work status and relationship with parents. The logistic regression achieved 68% accuracy, 25.6% precision, 68.7% sensitivity, 68.4% specificity, 37.3% F1-score, and 76% AUC in the test set. The random forest achieved 66.1% accuracy, 24.1% precision, 68.5% sensitivity, 65.7% specificity, 35.6% F1-score, and 75.4% AUC in the test set. The support vector machine achieved 65.1% accuracy, 23% precision, 65.7% sensitivity, 65.1% specificity, 34.1% F1-score, and 70.1% AUC in the test set. The extreme gradient boosting achieved 86.8% accuracy, 57.8% precision, 15.7% sensitivity, 98.1% specificity, 24.7% F1-score, and 71.8% AUC in the test set. Conclusion:The antepartum depression risk prediction model developed in this study has moderate discriminative ability, which helps achieve early identification and classification management of risk, and provides a basis for targeted interventions.

Postnatal depression (PND) increases the risk of neurodevelopmental impairments in offspring, yet the underlying mechanisms remain elusive. Here, we identify an intergenerational signaling pathway through which maternal psychological state is encoded in breastmilk microRNAs (miRNAs) and transmitted to offspring via breastmilk small extracellular vesicles (sEVs). Using cross-fostering models, we demonstrate that maternal depression disrupts the maturation of newborn neurons in the offspring hippocampal dentate gyrus (DG), leading to cognitive deficits and depressive-like behaviors. Strikingly, gastric administration of PND-derived breastmilk sEVs to healthy pups recapitulates these neurodevelopmental phenotypes. Mechanistically, PND-induced miRNAs are packaged into breastmilk sEVs and delivered to infant brain, where they suppress mGluR8 expression in supramammillary nucleus (SuM) neurons projecting to the DG. This presynaptic mGluR8 deficiency dysregulates glutamate release, triggers aberrant synaptic transmission and calcium overload, and ultimately drives a pathological “high-frequency, low amplitude” neuronal activation pattern that compromises the functional integration of newborn neurons into hippocampal circuits. Critically, inhibiting sEV secretion from the mammary gland or sequestering the culprit miRNAs within offspring SuM neurons rescues these neurodevelopmental deficits. Together, these findings establish breastmilk sEV miRNAs as an epigenetic vector that translates maternal psychological state into maladaptive programming of offspring brain circuitry and behavior.

Postnatal depression (PND) increases the risk of neurodevelopmental impairments in offspring, yet the underlying mechanisms remain elusive. Here, we identify an intergenerational signaling pathway whereby maternal psychological state is encoded in breastmilk microRNAs (miRNAs) and transmitted to offspring via breastmilk small extracellular vesicles (sEVs). Using cross-fostering models, we demonstrate that maternal depression disrupts offspring hippocampal dentate gyrus (DG) newborn neuron maturation, causing cognitive deficits and depressive-like behaviors. Strikingly, gastric administration of PND-derived breastmilk sEVs to healthy pups recapitulates these neurodevelopmental phenotypes. Mechanistically, PND-induced miRNAs are packaged into breastmilk sEVs and delivered to infant brain, where they suppress mGluR8 expression in supramammillary nucleus (SuM) neurons projecting to the DG. This presynaptic mGluR8 deficiency dysregulates glutamate release, triggers aberrant synaptic transmission and calcium overload, and ultimately drives a pathological “high-frequency, low amplitude” neuronal activation pattern that compromises the functional integration of newborn neurons into hippocampal circuits. Critically, inhibiting sEV secretion from the mammary gland or sequestering the culprit miRNAs within offspring SuM neurons rescues these neurodevelopmental deficits. These findings not only uncover a novel mechanism underlying PND-related offspring neurodevelopmental impairments, but also provide a promising therapeutic target for clinical intervention of intergenerational transmission of maternal mental disorders.

Background: To analyze the latent profiles and influencing factors of psychological capital of midwives, and to explore the core competencies of midwives with different profiles. Methods: From July 5 to July 19, 2024, a cross-sectional study was conducted using convenience sampling to recruit 965 midwives from Jiangsu Province, China. The Demographics Questionnaire, Positive Psycap Questionnaire, and Midwife Core Competency Scale were used for investigation. Data analysis was performed using latent profile analysis, univariate analysis, multinomial logistic regression analysis, and the Kruskal-Wallis H-test. Results: The psychological capital of midwives can be classified into three profiles: low psychological capital - balanced group (C1) (56.37%), medium psychological capital - low tenacity group (C2) (21.97%), and high psychological capital - balanced group (C3) (21.66%). Compared to C1, midwives working in general hospitals were more likely to belong to C2 (aORs = 1.820, 95%CI: 1.213- 2.729, P < 0.01) and C3 (aORs = 1.665, 95%CI: 1.117- 2.481, P < 0.05). Compared to C2, midwives with 0- 5 years of working experience were more likely to belong to C1 (aORs = 0.117, 95%CI: 0.022- 0.612, P < 0.05) and C3 (aORs = 8.334, 95%CI: 1.295- 53.645, P < 0.05). Compared to C3, midwives with a junior college degree were more likely to belong to C1 (aORs = 0.643, 95%CI: 0.416- 0.994, P < 0.05). C1 showed statistically lower scores of core competency compared to C2 and C3 (P < 0.05), while no significant difference was observed between C2 and C3 (P > 0.05). Conclusion: This study revealed heterogeneity in the psychological capital of midwives. Targeted interventions, such as Psychological Capital Intervention (PCI) strategies, should be primarily applied to the C1 group to enhance their self-efficacy, optimism, hope, and core competency levels. Concurrently, the emotional contagion and role-modeling effects of the C3 group should be leveraged. When resources permit, efforts should also be made to improve the tenacity level of the C2 group.

BACKGROUND:Perinatal loss is a profoundly distressing experience for parents and can lead to long-term psychological challenges. Midwifery students often encounter bereaved parents during clinical placements but frequently feel unprepared to provide adequate support. Identifying the key factors that influence their competence in bereavement care is essential for enhancing training effectiveness and care quality. METHODS:This is a cross-sectional study. An online survey was administered to 215 final-year midwifery students from 10 institutions in Jiangsu Province in August 2024. Both regression analysis and fuzzy-set Qualitative Comparative Analysis (fsQCA) were used to identify the core influencing factors. RESULTS:Regression analysis revealed that Professional Meaning and Knowledge Development (Bereavement Care Knowledge) and Workload Influences (Organisational Support) were significantly associated with perceived competence. FsQCA identified Supporting Degree (Organisational Support), Competence and Resource Awareness (Self-Awareness), and Deficiency and Learning Awareness (Self-Awareness) as key configurations associated with high competence, outlining two distinct pathways: the Inadequate External Support Path and the Adequate External Support Path. CONCLUSIONS:This study underscores the critical role of organisational support, self-awareness, and bereavement care knowledge in shaping midwifery students' competence. Training programs should be tailored to institutional contexts, integrating these elements to better prepare students for perinatal bereavement care.

AIM:To systematically identify instruments assessing clinical nurse preceptor competence, evaluate their methodological quality and measurement properties and provide recommendations for instrument selection in clinical and research practice. BACKGROUND:Clinical nurse preceptors are experienced nurses who guide and support nursing students and nurses undertaking clinical training at different career stages. They play a vital role in clinical education and professional development. Numerous instruments have been developed to assess clinical nurse preceptor competence; however, a comprehensive systematic evaluation based on the COSMIN guideline is still lacking. DESIGN:A systematic review was conducted in accordance with the COSMIN guideline. METHODS:Six English databases and two Chinese databases were searched to identify studies involving instruments used to assess clinical nurse preceptor competence. Two reviewers independently conducted study selection, data extraction and literature appraisal. Methodological quality was evaluated using the COSMIN Risk of Bias checklist and measurement properties were synthesized according to COSMIN criteria. RESULTS:18 studies involving 16 instruments were included. Three instruments received Category C, while the others were classified as Category B. CONCLUSIONS:Among Category B instruments, the revised Nursing Student Mentors' Competence Instrument (MCI), the core competence tool for clinical nursing teachers and the Core Competence Scale for Nursing Preceptors of Undergraduate Students showed high-quality evidence for sufficient structural validity and internal consistency and were provisionally recommended for use. Future studies should further refine and evaluate these instruments, emphasizing cross-cultural validity, measurement error and responsiveness in line with COSMIN guidelines.

BACKGROUND:Persistently low fertility and rapid population aging have increased concern regarding subsequent childbearing in China. Although fertility intentions have been widely examined, the multidimensional pressure experienced by parous women when considering another child remains insufficiently understood. METHODS:An online cross-sectional survey was conducted from January to June 2025 among 2097 parous women aged 18-49 years across 21 provinces and four municipalities in China. Subsequent fertility pressure was assessed using a validated 24-item scale. Guided by Becker's quantity-quality trade-off theory and the socio-ecological framework, hierarchical multiple linear regression was conducted by entering variables in four blocks: demographic characteristics, family and caregiving factors, socioeconomic and structural factors, and psychological and cultural factors. RESULTS:The mean subsequent fertility pressure score was 118.17 ± 23.41, indicating that women experienced pressure across multiple economic, occupational, health, childcare, child-development, and family-relationship domains. Higher fertility pressure was associated with poorer self-rated health, having more existing children, maternal primary caregiving, the absence of affordable childcare, lower personal and household income, smaller housing area, lower self-perceived social status, lower subjective wellbeing, more frequent Internet use, a lower ideal number of children, and weaker endorsement of lineage continuation. Compared with government-provided childcare, market-based childcare was also associated with higher pressure. Greater partner participation in housework and having only daughters rather than only sons were associated with lower pressure. The final model explained 26.3% of the variance in fertility pressure (Adjusted R2 = 0.253). CONCLUSIONS:Subsequent fertility pressure among parous women is a socially embedded experience shaped by physical capacity, cumulative caregiving demands, gendered household labor, material security, childcare provision, psychological resources, and fertility values. Policies should prioritize stable and affordable public childcare, a sustained redistribution of unpaid care through father-specific leave and paternal involvement, targeted economic and housing assistance, maternal health and mental health support, and protection of women's reproductive autonomy.

ABSTRACT Pre‐pregnancy overweight or obesity delays the onset of lactogenesis II, posing an early barrier to achieving optimal infant nutrition and long‐term health. However, the underlying pathophysiological mechanisms remain incompletely elucidated. This prospective cohort study conducted in China aimed to delineate the distinct pathways through which pre‐pregnancy overweight/obesity, compared to normal body mass index (BMI), leads to delayed lactogenesis II. Guided by an expanded biopsychosocial framework, we enrolled and stratified 296 primiparous women into pre‐pregnancy overweight/obese (n = 146) and normal BMI (n = 150) groups. Data on biological, psychological, social, and infant‐related factors were collected prospectively at prenatal, delivery, and one‐week postpartum stages. Structural equation modeling was used to identify and compare the mediating pathways between the two groups. Results demonstrated that the association between pre‐pregnancy overweight/obesity and delayed lactogenesis II was primarily mediated through four distinct pathways: biological (e.g., breastfeeding difficulties: β = 0.203, 95% CI: 0.144−0.265, p < 0.001), psychological (e.g., internalized weight stigma: β = 0.095, 95% CI: 0.016−0.181, p = 0.026), social (e.g., reduced pro‐breastfeeding practices: β = 0.076, 95% CI: 0.017−0.144, p = 0.019), and infant‐related (e.g., higher formula intake: β = 0.114, 95% CI: 0.047−0.195, p = 0.003). This study validates the expanded biopsychosocial model by elucidating the distinct pathways through which pre‐pregnancy overweight/obesity contributes to delayed lactogenesis II. These findings underscore the necessity for clinical practice to move beyond a purely biological focus and advocate for a paradigm shift in clinical support towards integrated, multi‐faceted interventions tailored to this vulnerable population. Trial Registration This study was registered at the Chinese Clinical Trial Registry (registry number: ChiCTR2200057038). The trial was registered on February 26, 2022.

BACKGROUND:Little is known about the influencing factors of psychological birth trauma (PBT) among postpartum women in China. METHODS:A multicenter cross-sectional survey was conducted from April to June 2023 among 2230 women within one year postpartum by convenience sampling. The measurement tools were selected based on the classical ABC-X model. PBT (factor X) was assessed using the Psychological Birth Trauma Assessment Scale. Data on predictors were collected from three aspects, including birth events (factor A), women's coping resources (factor B), and perception of birth events (factor C). Univariate analysis, correlation analysis, and multivariate linear regression analysis were performed to identify the influencing factors of PBT. RESULTS:Multivariate linear regression analysis results showed that induced labor onset (β' = 0.086, P < .001), preterm birth (β' = 0.049, P = .001), instrumental vaginal delivery (β' = 0.031, P = .039), neuroticism (β' = 0.229, P < .001), and negative cognitions of birth events (β' = 0.375, P < .001) were risk factors for PBT among postpartum women in China. Perceived social support (β' = -0.175, P < .001) and nursing support (β' = -0.117, P < .001) were protective factors. These factors accounted for 52.5 % of explained variances in PBT. CONCLUSIONS:Multifaceted influencing factors of PBT were identified based on the ABC-X model. Such efforts seem to provide information for identifying women at high risk of PBT and formulating interventions aimed at preventing or reducing PBT and its associated adverse consequences. Additional well-designed studies are required to validate our findings and deepen the understanding of this topic.

To identify profiles of psychosocial characteristics among pregnant women with antepartum depression, and to investigate the association between these profiles and the severity of antepartum depression. A total of 448 women with antepartum depression were recruited using convenience sampling from one hospital in China. Data were collected from June to October 2023 using a self-report questionnaire. Firstly, latent profile analysis was used to identify psychosocial profiles across a wide range of negative psychosocial characteristics (anxiety, stress, susceptibility personality traits and rumination) and positive psychosocial characteristics (psychological resilience, social support, self-efficacy and family function). We then explored differences in demographic and obstetric characteristics between different profiles and the relationship between profiles and the severity of antepartum depression by conducting univariate analysis and multinomial logistic regression analysis. This study identified three distinct psychosocial profiles among women with antepartum depression: “Well-adjusted” (54.7

Several individuals with depressive symptoms either do not seek help or delay treatment. This study elucidates the effects of various interventions on help-seeking behaviours, key intermediate indicators of behaviour (intentions, attitudes, subjective norms, and perceived behavioural control), and stigma. Six databases were searched from their inception to January 2024. Two researchers independently conducted study selection, data extraction, and quality appraisal. Data were analysed using Review Manager 5.4 software and STATA 18.0 software. Thirteen studies were included, encompassing seven types of interventions: positive emotion infusion, information support intervention, mental contrasting with implementation intentions, self-perspective interventions, telephone care management, health information feedback, and depression follow-up monitoring. Existing interventions did not improve help-seeking behaviour in individuals with depressive symptoms (OR = 1.67, 95

Background:Fear of childbirth is a common psychological problem among women during the perinatal period. It not only affects the physical and mental health of the mother, but also has an impact on the health of the fetus. Studies have shown that fear of childbirth has a significant positive predictive effect on prenatal depression. However, there are few studies exploring the underlying mechanism between fear of childbirth and depression. Methods:Childbirth Attitude Questionnaire, Social Support Rating Scale, Rumination Scale and Edinburgh Postpartum Depression Scale were used to measure 2765 Chinese pregnant women. Results:Fear of childbirth had a positive predictive effect on prenatal depression (β = 0.11, t = 15.63, P < 0.001); rumination played a partial mediating role in the influence of fear of childbirth on prenatal depression, with an indirect effect value of 0.05; social support not only moderated the impact pathway of childbirth fear on rumination (β = -0.01, t = -2.26, P < 0.01), but also moderated the impact pathway of rumination on prenatal depression (β = -0.01, t = -2.12, P < 0.01). Conclusion:Rumination mediated the relationship between fear of childbirth and prenatal depression, and social support had a moderating effect on the first and second half of the mediation model.

PROBLEM:The effectiveness of pelvic floor muscle training is limited by insufficient human resource and low adherence to the exercise. BACKGROUND:Group-based pelvic floor muscle training provides a possible way to implement pelvic floor muscle training for more women. However, the feasibility and effectiveness of group-based pelvic floor muscle training still needs to be evaluated. AIM:This study aimed to co-design a group-based programme to facilitate adherence to pelvic floor muscle training in pregnant women. METHODS:The study involved a systematic review, a survey, behaviour change theory identification and stakeholder engagement to co-design the programme. FINDINGS:The stakeholders discussed the barriers and mapped them to the capability, opportunity, motivation and behaviour model. The main barriers are increased cost and time for receiving the pelvic floor muscle training supervision and lack of knowledge about the importance of doing pelvic floor muscle training. Six intervention functions were identified to facilitate behaviour change in pregnant women. Then, 18 behaviour change techniques were identified and used to develop a facilitated group-based pelvic floor muscle training programme for pregnant women. DISCUSSION:This study has shown the importance of addressing barriers to adhere to the resulting programme. However, how to ensure the pregnant women to attend the sessions still need to be discussed. CONCLUSIONS:Through the use of the behaviour change wheel approach, this paper describes a transparent process of translating current evidence and theoretical understanding to the co-design of a complex intervention to improve adherence to a group-based pelvic floor muscle training programme. REGISTRATION:This study has been registered with ClinicalTrials.gov under NCT05242809.

Background Autoimmune modulators (Aire) mediate immune tolerance by inducing expression of tissue-restricted antigen (TRA) in thymic medullary epithelial cells. However, the function of Aire in peripheral B cells remains unknown. We aimed to investigate whether Aire is expressed in human peripheral B cells and how its expression is regulated. Methods Human thymus tissues were collected and firstly, islet-specific autoantibodies and insulinogen c-peptide were determined by luciferase immunoprecipitation (LIPS). Secondly, Aire expression in peripheral blood lymphocytes was identified by flow cytometry, Western Blot and immunofluorescent staining. Then, immunofluorescent staining was performed on cells cultured in vitro and surgically resected tissues. Meanwhile, Aire promoter methylation. Finally, insulinogen expression was quantified by reverse transcription qPCR and IF staining. Data were compared by Mann-Whitney U test between groups. Results Aire was expressed in CD19+ B cells but not in CD3+ cells, and the expression of Aire in B cells was much lower than that in thymus. Induction of Aire expression under BCR activation in B cells. The level of Aire expression in peripheral B cells of patients with T1D and healthy subjects showed no difference in Aire expression level between the two groups. Conclusions Aire expression in peripheral B cells may play a role in peripheral immune tolerance and protection of islet β-cell function in T1D patients.

Objective:Perinatal depression has become a global public health problem, which not only harms the health of mothers and their offspring, but also increases the socio-economic burden, so early intervention is urgent. Music intervention is a low-cost and safe intervention method. This study endeavored to systematically integrate and quantitatively evaluate the effectiveness of music intervention for perinatal depression. Methods:PubMed, Embase, Web of Science and Cochrane Library were searched systematically. The search period was up to September 1, 2024. The included studies were summarized and analyzed. Results:A total of 1375 articles were obtained through preliminary search, and 13 of them were finally included. The effect of music intervention on perinatal depression was better than that of the control group (SMD = -0.53, 95%CI (-0.81, -0.26), p ＜ 0.05). Music intervention had no significant effect on alleviating anxiety (SMD = -0.47, 95%CI (-0.63, -0.31), p ＞ 0.05). However, the heterogeneity of the included studies was significant. Conclusions:This study indicated that music intervention had a significant effect on alleviating perinatal depression, but the effect on anxiety was not significant. However, the results were highly heterogeneous, and large-scale, multi-center, and long-term studies are needed in the future to confirm this.

Background: Perinatal depression (PND) is a common mental health problem, and eHealth interventions may provide a strategy for alleviating PND. Aim: This meta-analysis aimed to determine the effect of eHealth interventions on PND. Methods: Six databases were searched to retrieve published randomized controlled trials (RCTs) on the effect of eHealth interventions on PND. A meta-analysis was performed on the data of these studies using a random effects model. Results: A total of 21 RCTs were included in the meta-analysis, which revealed that eHealth interventions significantly reduced antenatal depression (WMD = -1.64, 95 % CI [-2.92, -0.35], P = .013), postpartum depression (SMD = -0.41, 95 % CI [-0.52, -0.29], P < .001), anxiety (SMD = -0.39, 95 % CI [-0.51, -0.28], P < .001), stress (WMD = -2.93, 95 % CI [-4.58, -1.27], P = .001), and improved self-efficacy (SMD = 0.42, 95 % CI [0.21, 0.63], P < .001) compared with the control group. However, eHealth interventions did not significantly improve social support (SMD = 0.27, 95 % CI [-0.01, 0.56], P = .058). For antenatal depression, significant subgroup differences were observed in the digital platform and material presentation format. In addition, for postpartum depression, significant subgroup differences were found in the type of therapy. Conclusions: The meta-analysis results suggest that eHealth interventions can relieve depression, anxiety, and stress symptoms and improve self-efficacy in perinatal women. However, these interventions did not improve social support. Additional high-quality studies on eHealth interventions in PND are needed to validate these results.

BACKGROUND:Perinatal depression has become a global public health issue with a high prevalence rate. Multiple studies have confirmed the effectiveness of music intervention. Still, the current form of offline intervention ignores issues such as convenient transportation and the stigma of diseases that pregnant women are concerned about, resulting in poor adherence. This randomized controlled study will evaluate the impact of music intervention on depression, anxiety, and stress in perinatal women through the WeChat application. In addition, the usability of the WeChat application and the adherence of PND women will also be evaluated. METHODS:This randomized, open, single-center parallel controlled trial randomly divided 110 women with perinatal depression who met the inclusion criteria into a smartphone-based music intervention group and usual care group in a 1:1 ratio. The main outcome measures will consist of EPDS and WeChat application usability score. The secondary outcome measures will consist of GAD-7, CPSS, and Knowledge-Attitude-Practice questionnaire scores. DISCUSSION:This study will test the effectiveness of music intervention based on the WeChat application for perinatal depression and the usability of the WeChat application, to provide practical guidance for perinatal mental health care. TRIAL REGISTRATION:This protocol was registered at the Chinese Clinical Trials.gov (Identifier: ChiCTR2400088924) on August 29, 2024.

Due to glioblastoma (GBM) being the most intractable brain tumor, the continuous improvement of effective treatment methods is indispensable. The combination of siRNA-based gene therapy and chemotherapy for GBM treatment has now manifested great promise. Herein, Gint4. T-siHDGF chimera-capped mesoporous silica nanoparticles (MSN) encapsulating chemotherapy drug temozolomide (TMZ), termed as TMSN@siHDGF-Gint4.T, is developed to co-deliver gene-drug siHDGF and TMZ for synergistic GBM therapy. TMSN@siHDGF-Gint4.T possesses spherical nucleic acid-like architecture that can improve the enzyme resistance of siHDGF and increase the blood-brain barrier (BBB) permeability of the nanovehicle. The aptamer Gint4. T of chimera endows the nanovehicle with GBM cell-specific binding ability. When administered systemically, TMSN@siHDGF-Gint4.T can traverse BBB and enter GBM cells. In the acidic lysosome environment, the cleavage of benzoic-imine bond on MSN surface leads to an initial rapid release of chimera, followed by a slow release of TMZ encapsulated in MSN. The sequential release of siHDGF and TMZ first allows siHDGF to exert its gene-silencing effect, and the downregulation of HDGF expression further enhances the cytotoxicity of TMZ. In vivo experimental results have demonstrated that TMSN@siHDGF-Gint4.T significantly inhibits tumor growth and extends the survival time of GBM-bearing mice. Thus, the as-developed TMSN@siHDGF-Gint4.T affords a potential approach for the combination treatment of GBM.

BACKGROUND:Perinatal depression is a global public health problem that seriously affects the health of perinatal women. This study evaluated the pooled uptake rate of interventions among women who screened positive for perinatal depression to provide a basis for clinical intervention. METHODS:We systematically searched four databases (PubMed, Embase, Cochrane Library and Web of Science) from the establishment of the database to May 1, 2023. All included studies were used to derive the pooled uptake rate. We also performed meta-regression and subgroup analysis to explore the potential sources of heterogeneity using STATA 17.0. RESULTS:Of 15024 retrieved articles, only 41 met the inclusion criteria. The overall uptake rate was 55 % (95 % CI 43-67 %). Meta-regression and subgroup analyses both showed that the uptake rate in high-income countries 57 % (95 % CI 50-65 %) was higher than that in low and middle-income countries 37 % (95 % CI 18-56 %). LIMITATIONS:First, only English publications were included. Therefore, articles in other languages were likely missed. Second, of the 41 studies included, there were only six randomized controlled trials, with limited quality of evidence. Third, we could not adequately explain the source of heterogeneity because there were too many mediating variables, although further subgroup and sensitivity analysis were performed. CONCLUSIONS:About a half of women did not receive interventions after screening positive, and the uptake rate of interventions in high-income countries was higher than that in low and middle-income countries.