Vaginal misoprostol versus vaginal dinoprostone for cervical ripening and induction of labour: An individual participant data meta-analysis of randomised controlled trials.

BACKGROUND: Induction of labour (IOL) is common practice and different methods carry different effectiveness and safety profiles. OBJECTIVES: To compare the effectiveness, and maternal and perinatal safety outcomes of IOL with vaginal misoprostol versus vaginal dinoprostone using individual participant data from randomised clinical trials. SEARCH STRATEGY: The following databases were searched from inception to March 2023: CINAHL Plus, ClinicalTrials.gov, Cochrane Pregnancy and Childbirth Group Trial Register, Ovid Embase, Ovid Emcare, Ovid MEDLINE, Scopus and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). SELECTION CRITERIA: Randomised controlled trials (RCTs), with viable singleton gestation, no language restrictions, and all published and unpublished data. DATA COLLECTION AND ANALYSIS: An individual participant data meta-analysis was carried out. MAIN RESULTS: Ten of 52 eligible trials provided individual participant data, of which two were excluded after checking data integrity. The remaining eight trials compared low-dose vaginal misoprostol versus dinoprostone, including 4180 women undergoing IOL, which represents 32.8% of all participants in the published RCTs. Of these, 2077 were assigned to low-dose vaginal misoprostol and 2103 were assigned to vaginal dinoprostone. Compared with vaginal dinoprostone, low-dose vaginal misoprostol had a comparable rate of vaginal birth. Composite adverse perinatal outcomes did not differ between the groups. Compared with vaginal dinoprostone, composite adverse maternal outcomes were significantly lower with low-dose vaginal misoprostol (aOR 0.80, 95% CI 0.65-0.98, P = 0.03, I2 = 0%). CONCLUSIONS: Low-dose vaginal misoprostol and vaginal dinoprostone for IOL are comparable in terms of effectiveness and perinatal safety. However, low-dose vaginal misoprostol is likely to lead to a lower rate of composite adverse maternal outcomes than vaginal dinoprostone.

Clinical effectiveness of a Malaysian-manufactured CAPD product: A randomised trial.

BACKGROUND: We compared the clinical effectiveness of a new peritoneal dialysis (PD) product with polyvinyl chloride-containing tubing (Stay Safe Link®, SSL) with the plastic-free alternative (Stay Safe®, STS) in patients on continuous ambulatory peritoneal dialysis (CAPD). METHOD: A multicentre, parallel, randomised, controlled, open-label, non-inferiority trial was conducted. Adult patients receiving CAPD were randomised in a 1:1 ratio to SSL or STS. The primary outcome was the rate of peritonitis after 1 year of follow-up. RESULTS: A total of 472 subjects were randomised (SSL, n = 233; STS, n = 239). One subject in each group was excluded from the analysis as they withdrew consent before the first dialysis dose. Four hundred and seventy subjects (SSL, n = 232; STS, n = 238) were included in the modified intention-to-treat analysis. Non-inferiority between two groups was established as no significant difference was found in peritonitis rate (incident rate ratio: 0.91, 95% CI: 0.65-1.28). No significant difference was detected in weekly Kt/V (p = 0.58) and creatinine clearance (p = 0.55). However, the average ultrafiltration volume was significantly lower in SSL, with a mean difference of 93 ml (p < 0.01). SSL also demonstrated a 2.57-times higher risk of device defect than STS (95% CI: 1.77-3.75). CONCLUSION: SSL was non-inferior in peritonitis rate compared to plastic-free STS over 1 year in patients requiring CAPD. There was no difference in the delivered dialysis dose, but there was a higher rate of device defects with SSL.

Bitter melon seed oil increases mitochondrial content in gastrocnemius muscle and improves running endurance in sedentary C57BL/6J mice.

The α-eleostearic acid (α-ESA) in bitter melon seed oil (BMSO) is efficiently converted by the body into rumenic acid. The objective of this study was to investigate effects of BMSO on skeletal muscle fiber-type switch and endurance capacity in mice, with or without exercise training. In a 3×2 factorial design, C57BL/6J mice were fed a 30% high-fat diet composed of soybean oil, butter or a 1:1 mixture of BMSO and soybean oil, i.e., SB, BT and BM diets, respectively, and were allocated to be sedentary or undergo exercise (Ex). The Ex groups received a 15-min training regimen on a motorized treadmill 5 times a week. After 3-week intervention, endurance capacity was evaluated (total running time and distance until exhaustion). Mice fed a BM diet had significantly less body fat, with increased muscle percentage and improved endurance capacity. Combining sedentary and Ex groups, mice fed a BM diet ran 33% longer and 50% further than those fed SB, or 25% longer and 36% further than those fed BT (P<.01). The BM-diet-increased gastrocnemius cytochrome c protein and mitochondrial DNA content was more prominent in sedentary than in trained mice. Histochemical staining shows sedentary BM-fed mice had a higher succinate dehydrogenase activity among groups. Based on a reporter assay, rumenic acid, rather than α-ESA itself, activated PPARδ ligand binding domain. We concluded that BMSO improved endurance capacity via stimulation of mitochondrial biogenesis and function, potentially influencing muscle metabolism and fiber-type composition in sedentary mice.

Nanoparticles of Various Degrees of Hydrophobicity Interacting with Lipid Membranes.

Using coarse-grained molecular dynamics simulations, we study the passive translocation of nanoparticles with a size of about 1 nm and with tunable degrees of hydrophobicity through lipid bilayer membranes. We observe a window of translocation with a sharp maximum for nanoparticles having a hydrophobicity in between hydrophilic and hydrophobic. Passive translocation can be identified as diffusive motion of individual particles in a free energy landscape. By combining direct sampling with umbrella-sampling techniques we calculate the free energy landscape for nanoparticles covering a wide range of hydrophobicities. We show that the directly observed translocation rate of the nanoparticles can be mapped to the mean-escape-rate through the calculated free energy landscape, and the maximum of translocation can be related with the maximally flat free energy landscape. The limiting factor for the translocation rate of nanoparticles having an optimal hydrophobicity can be related with a trapping of the particles in the surface region of the membrane. Here, hydrophobic contacts can be formed but the free energy effort of insertion into the brush-like tail regions can still be avoided. The latter forms a remaining barrier of a few kBT and can be spontaneously surmounted. We further investigate cooperative effects of a larger number of nanoparticles and their impact on the membrane properties such as solvent permeability, area per lipid, and the orientation order of the tails. By calculating the partition of nanoparticles at the phase boundary between water and oil, we map the microscopic parameter of nanoparticle hydrophobicity to an experimentally accessibly partition coefficient. Our studies reveal a generic mechanism for spherical nanoparticles to overcome biological membrane-barriers without the need of biologically activated processes.

Mixed brush made of 4-arm stars and linear chains: MD simulations.

We investigate the structural properties of binary polymer brushes, composed of functional 4-armed star polymers and chemically identical linear polymers of different molecular weights. The molecular dynamics simulations confirm recent self-consistent field studies, in which a considerable potential of these systems for the design of switchable surfaces has been claimed. The length of the linear chains serves as a control parameter, which, while passing over a critical value, induces a sharp transition of the molecular conformation. We investigate these transitions at different grafting densities and summarize our findings in a phase diagram. The temperature dependence of the brush structure is investigated in a non-selective solvent, and non-trivial variations of the surface composition are observed. The quantity of these latter effects would be insufficient to build switchable systems, and we argue that a minor quantity of solvent selectivity would suffice to enable the desired feature of an environment-responsive coating.

Reducing HIV-related stigma among health-care professionals: a game-based experiential approach.

Stigmatizing attitudes from health professionals toward people living with HIV (PLHIV) constitute a key barrier to HIV care. Despite considerable progress in HIV stigma-reduction research, we are still searching for effective strategies that can be implemented on a larger scale. To narrow this research gap, the present study investigated a novel cost-effective approach to reducing HIV-related stigma among health professionals. Interactive experiential games were used to help participants gain first-hand experience of potential stressors that PLHIV might encounter. The effectiveness of this game-based experiential approach was compared with that of in vivo contact in reducing HIV-related stigma among students in the health-care fields. Eighty-eight students of health-related programs in Hong Kong were randomly assigned to either the game-based or in vivo contact program. They completed measures of stigmatizing attitudes and HIV/AIDS-related knowledge at pre-program, post-program, and one-month follow-up. Findings showed that the effectiveness of the game-based experiential approach in reducing HIV-related stigma was similar to that of in vivo contact both at post-program and one-month follow-up. Further research is needed to explore the potential value of the game-based approach in reducing HIV stigma among health professionals.

Numerical evidences for a free energy barrier in starlike polymer brushes.

The existence of a free energy barrier, which prohibits the upward motion of retracted molecules into the surface region of starlike polymer brushes, is analyzed through molecular dynamics simulations in good solvent. This barrier emerges at moderate and high grafting densities, as a result of a density-discontinuity at the branching points of the highly stretched starlike molecules. The vertical force profiles of brushes of varying densities are taken with the help of a probe-particle that is gradually moved into the brush, and the results are compared with the density profiles and their negative gradients which generate the local osmotic pressures. Chain expulsion simulations, supported by scaling theory, are conducted to understand the dynamics of individual molecules inside the brushes. We prove that the flip-rates between retracted and extended states, being of relevance for the generation of efficiently switchable, environment-responsive brush layers, are determined by the elastic tension of the stretched molecules.

Interactive virtual reality Wii in geriatric day hospital: a study to assess its feasibility, acceptability and efficacy.

AIM: Rehabilitation using interactive virtual reality Wii (Wii-IVR) was shown to be feasible in patients with different medical problems, but there was no study examining its use in a geriatric day hospital (GDH). The aim of the present study was to test the feasibility, acceptability and efficacy of Wii-IVR in GDH. METHODS: It was a clinical trial with matched historic controls. Patients of a GDH were recruited to participate in Wii-IVR by playing "Wii Fit". Participants used a Wii controller to carry out movements involved in an arm ergometer. Each participant received eight sessions of Wii-IVR in addition to conventional GDH rehabilitation. Feasibility was assessed by the total time receiving Wii-IVR, the percentage of maximal heart rate reserve (%MHR) and Borg perceived exertion scale (BS) after participating in Wii-IVR. %MHR and BS were compared with those after carrying out an arm ergometer for the same duration. Acceptability was assessed by an interviewer-administered questionnaire. Efficacy was assessed by comparing improvements in Functional Independence Measure (FIM) between participants and matched historic controls, who received conventional GDH rehabilitations only. RESULTS: A total of 30 patients completed the study. Participants completed a total of 1941 min of event-free Wii-IVR. The mean %MHR was 15.9% ± 9.9% and the mean BS was 7.9 ± 2.3. There was no significant difference in %MHR and BS between participating in Wii-IVR and arm ergometer. Most participants found Wii-IVR similar to the arm ergometer, and would like to continue Wii-IVR if they had Wii at home. Improvements in FIM of participants were significantly more than that of historic controls. CONCLUSIONS: Wii-IVR in GDH was feasible and most participants accepted it. Participants had more improvements in FIM.