A comprehensive insight on cognitive behavioral therapy for insomnia in pregnant women: A systematic review and meta-analysis.

BACKGROUND: Cognitive behavioral therapy for insomnia (CBT-I) as a first-line treatment may improve insomnia in pregnant women. The efficacy of the components, modalities, doses, and effectiveness of CBT-I in pregnant women at follow-up remains unclear. OBJECTIVES: To assess the effectiveness of CBT-I in pregnant women and identify effective intervention components, modalities, and doses. DESIGN: Systematic review and meta-analysis. METHODS: Six English databases (PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, CINAHL) and four Chinese databases (CNKI, WanFang Data, SinoMed, and CQVIP) were searched from inception to 10 January 2023. Randomized controlled trials (RCTs) on CBT-I in pregnant women with outcomes of insomnia severity measured by Insomnia Severity Index (ISI) or sleep quality measured by Pittsburgh Sleep Quality Index (PSQI). Two reviewers independently completed records selection, data extraction, and study quality assessment. The fixed-effect or random-effect model was used for pooled analyses. Subgroup analyses were conducted based on different delivery types and intervention duration. The GRADE approach was used to evaluate the certainty of the evidence. Narrative analyses were used when meta-analysis was not appropriate. Mean differences with 95% CIs of insomnia severity and sleep quality scores were the main outcomes (greater scores indicating greater severity). RESULTS: Nine RCTs (N = 978) meeting the inclusion criteria were included. These trials included individual- (n = 6) or group-based (n = 3) interventions, which were conducted via face-to-face (n = 5), digital (n = 3) or telephone and e-mail (n = 1) formats. Six studies stated intervention components specific to pregnant women. CBT-I improved insomnia severity (MD = -2.69, 95% CI: -3.41 to -1.96, P ＜ 0.001, high quality evidence; MD = -3.69, 95% CI: -5.91 to -1.47, P = 0.001, moderate quality evidence) and sleep quality (MD = -2.85, 95% CI: -4.73 to -0.97, P = 0.003, moderate quality evidence; MD = -1.88, 95% CI: -2.89 to -0.88, P ＜ 0.001, moderate quality evidence) immediately after intervention (＜1-month) and at short-term (≥1 month to ＜6 months) follow-up, respectively. Two RCTs reported no effectiveness on insomnia severity at medium-term (≥6 months to＜12 months) follow-up. Only 1 RCT showed reduced insomnia severity at long-term (≥12 months) follow-up. One RCT reported no effectiveness in sleep quality at medium-term follow-up and effectiveness at long-term follow-up was not reported. CONCLUSIONS: Pregnant women may benefit from CBT-I to improve short-term insomnia, but long-term effectiveness is unclear. Rigorous RCTs with long-term follow-ups are warranted.

Attitudes and Barriers to Physical Activity and Exercise Self-Efficacy Among Chinese Pregnant Women: A Cross-Sectional Study.

Background: Most pregnant women do not reach the recommendation for physical activity (PA). As a subcategory of PA, exercise is also essential. Evidence on pregnant women's attitudes and barriers to PA and exercise self-efficacy in China is scarce. Aim: To explore the levels and influencing factors of attitudes and barriers to PA and exercise self-efficacy among pregnant women. Methods: A cross-sectional study of 311 pregnant women was conducted from August to December 2022. Individual characteristics, pregnant women's attitudes toward exercise, barriers to prenatal PA and exercise, and exercise self-efficacy were measured using the self-designed demographic questionnaire, pregnant women's attitudes toward exercise questionnaire, barriers to prenatal PA and exercise questionnaire, and the pregnancy exercise self-efficacy scale, respectively. Results: More than 90% of pregnant women believed exercise benefits themselves and their babies, and 40.8% of pregnant women did not know how to exercise. Women encounter different types of barriers to PA and exercise. Intrapersonal barriers included the proportion of feelings of tiredness (56.6%), low energy (54.7%), lack of interest or motivation (49.2%), feelings of illness and morning sickness (46.6%), and large body weight (43.7%). Interpersonal barriers included pregnant women being advised to avoid PA and exercise (49.2%), lack of clear advice about the intensity and dose of exercise (41.8%), no one to exercise with (38.9%), and lack of advice from healthcare professionals (38.6%). Weather conditions were the most significant environmental barriers (41.2%). The total score of pregnancy exercise self-efficacy was (38.50±7.33). Education level, parity, and attitudes toward exercise independently predict pregnant women's attitudes toward exercise, barriers to prenatal PA and exercise, and exercise self-efficacy, respectively. Conclusion: Pregnant women have a favorable attitude toward exercise and relatively good exercise self-efficacy but lack knowledge of exercise. They face numerous barriers. Medical professionals should encourage pregnant women with lower levels of education to exercise and assist multipara in overcoming obstacles.

Self-Assembly of Glycolipid Epimers: Their Supramolecular Morphology Control and Immunoactivation Function.

Although advances have been made in carbohydrate-based macromolecular self-assembly, harnessing epimers of carbohydrates to perform molecular assembly and further investigating the properties of supramolecular materials remain little explored. Herein, two classes of stereoisomeric glycolipid amphiphiles based on d-N-acetylgalactosamine (GalNAc) are reported, and they can aggregate into ribbon-like structures in the aqueous solution due to amphiphilic property, which allow to obtain glycocalyx-mimicking supramolecular materials. The subtle distinction in glycoside configuration of GalNAc-α-SSA and GalNAc-ß-SSA dictates the different molecular packing in self-assembled structures. Since driven by the distinguishing carbohydrate-carbohydrate interactions, the ribbon-like architectures transform into spherical nanostructures via mixing GalNAc-α-SSA and GalNAc-ß-SSA. The resulting spherical micelles fabricated by blending glycolipid epimers can potentiate the macrophage- and dendritic cell-mediated immune responses in vitro. Such glycolipid epimers will pave the way to create glycocalyx-mimicking immune modulators by incorporating stereochemistry into supramolecular self-assembly.

Spatiotemporal Landscape for the Sophisticated Transformation of Protein Assemblies Defined by Multiple Supramolecular Interactions.

Precise protein assemblies not only constitute a series of living machineries but also provide an advanced class of biomaterials. Previously, we developed the inducing ligand strategy to generate various fixed protein assemblies, without the formation of noncovalent interactions between proteins. Here, we demonstrated that controlling the symmetry and number of supramolecular interactions introduced on protein surfaces could direct the formation of unspecific interactions between proteins and induce various nanoscale assemblies, including coiling nanowires, nanotubes, and nanosheets, without manipulation of the protein's native surfaces. More importantly, these nanoscale assemblies could spontaneously evolve into more ordered architectures, crystals. We further showed that the transformation from the introduced supramolecular interactions to the interactions formed between proteins was crucial for pathway selection and outcomes of evolution. These findings reveal a transformation mechanism of protein self-assembly that has not been exploited before and may provide an approach to generate complex and transformable biomacromolecular self-assemblies.

Nanovaccine Based on a Biepitope Antigen to Potentiate the Immunogenicity of a Neoantigen.

Specific neoantigens are promising candidates for personalized cancer vaccines and immunotherapies, whereas the low immunogenicity and physicochemical variability are the main challenges in clinical trials. Herein, based on the rational design of neoantigens, we developed biepitope nanovaccines via integrating CD4+ with CD8+ T cell epitopes. A class of amphiphilic peptides composed of biepitope and hydrophilic amino acids can form well-defined nanostructures, thus incorporating functional sequences into an artificial platform. Cellular uptake studies demonstrated the enhanced endocytosis of biepitope neoantigens in dendritic cells (DCs). Such designed biepitopes can further stimulate the maturation of DCs, as validated by the upregulation of costimulatory molecules and secreted proinflammatory cytokines, which show the potential ability to prime T cells and evoke specific cellular immunity. The inspiring prophylactic and therapeutic efficacy of biepitope nanovaccines was evaluated in murine colon cancer. In contrast to individual CD8+ T cell epitopes, the rationally designed biepitope nanovaccines can efficiently provoke immune activation and potentiate antitumor immunity both in vitro and in vivo, presenting an alternative strategy for neoantigen vaccines.