Prostaglandin Group Research Articles

Oxytocin Compared With Prostaglandin as First Agent in Prelabor Rupture of Membranes [ID 2683446

INTRODUCTION: Prelabor rupture of membranes (PROM) occurs in 8% of term deliveries. After PROM, induction of labor (IOL) is recommended to decrease risk of intra-amniotic infection and time to delivery. Therefore, finding the safest, most effective way to induce labor in this patient population is important to clinical practice. METHODS: The goal of this investigation is to compare rate of vaginal delivery among patients receiving oxytocin versus prostaglandin as a first-line agent for IOL after PROM. Secondary outcomes include time to vaginal delivery, parity, and cervical dilation. This study involves a secondary analysis of an IRB-approved retrospective chart review investigating cervical ripening in all patients who delivered from 2020 to 2021 at our institution. RESULTS: A total of 365 patients presented with term PROM during the study period. The sample was primarily nulliparous (61.8%) with mean gestational age of 39.1 weeks. More patients in the oxytocin group than the prostaglandin group delivered vaginally (86.2% versus 82%). Patients treated with oxytocin as first agent were found to have faster time to any delivery than prostaglandin as first agent (median 14.9 versus 25.7 hours; P<.001). This result was regardless of parity or whether a cervical exam was documented at time of presentation. CONCLUSION: In our study population, patients induced with oxytocin had a faster time to vaginal delivery without affecting risk of cesarean, regardless of nulliparity status or cervical dilation at time of presentation, supporting a more standard use of oxytocin as a first-line for term PROM IOL.

Double balloon catheter versus vaginal prostaglandins for induction of labor: an observational ambidirectional cohort study

Aim: To compare effectiveness and safety of double balloon catheter and prostaglandins for induction of labor. Methods: an observational ambidirectional cohort study was conducted at a tertiary care university hospital. A total of 666 women with a Bishop score ≤6 requiring labor induction were included. A cohort of 418 patients with double balloon catheter were compared with a retrospective cohort of 248 women induced with prostaglandins, either misoprostol or dinoprostone. Perinatal outcomes were compared between groups, with a p<0.05 considered statistically significant. Results: The cesarean-section rate was 27% in the double balloon group, compared with 27.8% in the prostaglandin group (p=0.352). The mean induction time-to-delivery was longer in the double balloon group as compared to the prostaglandin group (26.6±9.3 hrs vs 19.1±8.6 hrs, p<0.001). Hyperdynamia and umbilical-cord arterial pH<7.1 rates were significantly lower with the mechanical method compared to prostaglandins (p<0.001 and p=0.043, respectively). Other maternal and neonatal outcomes were similar between the groups. Conclusions: Double balloon catheter has similar effectiveness in terms of cesarean-section rate compared to prostaglandins, but with a better safety profile. However, the balloon catheter is associated with a longer time-to-delivery compared to prostaglandins.

Comparison of Different Methods of Induction of Labour Methods; Khyber Pakhtunkhwa Perspective

Objectives: to compare the mechanical, pharmacological or combination of both in induction of labour. Methods: This comparative observational study was conducted in Department of Obs and Gynae, Lady Reading Hospital, from January 2019 to December 2019. In this study all women presenting to labor room with singleton pregnancy and gestational age > 37 weeks and admitted for induction of labor were included. All those women with multiple pregnancies, premature rupture of membrane, malpresentation, and prior Cesareans section were excluded. Total 300 patients were included in the study period, Patients were divided into 4 groups, Group A (mechanical methods), Group B (prostaglandin E2), Group C (mechanical + PGE2), Group D (misoprostol). Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY). Results: In this study 300 patients were included, in mean age of 24.54±12 years, with age range of 16- 40 years. Majority were Primi gravida (167 (55.7%), and 99.7 had poor bishop score. Indication for induction of 109(36.3%) was due to eclampsia / pre-eclampsia, followed by postdate pregnancy 98(32.7%). In majority of cases 123(41%) time from induction to labour was 6-12 hours. prostaglandin group showed good success rate in term of normal vaginal delivery and low adverse effects and good maternal and neonatal outcomes, followed by misoprostol, lowest success rate was recorded in mechanical only group . (p<0.001) Conclusion: Our study concludes that among different methods available for induction of labour, PGE2 is safe, effective and have goof maternal and fetal outcomes Keywords: induction, labour, PGE2, misoprostol

Cervical maturation in breech presentation: Mechanical versus prostaglandin methods

ObjectiveBreech presentation at term accounts for around 5% of births. Few studies have evaluated the effectiveness of different induction methods for breech presentations. We aim to compare the mode of delivery after induction by intra cervical dilatation balloon compared to prostaglandin (PGE2) in breech presentation. We also evaluated the risk factors associated with a failure of induction. MethodsSingle-center retrospective study from January 2000 to December 2020 including all women induced from 36 weeks, breech presentation, with a single pregnancy without contraindication to vaginal delivery and with an unfavorable cervix (Bishop<6). The primary endpoint was the mode of delivery. Failure of induction was defined as the need of a cesarean section. ResultsOne hundred seventy six patients were included, 96 in the balloon group and 80 in the prostaglandin group. The cesarean section rate in the balloon group was not significantly different from the prostaglandin group (34.4% vs. 26.3%, p= 0.24). Fifty percent of the patients in the balloon group required additional maturation with prostaglandins after the balloon was dropped or removed. In our overall population, the factors associated with induction failure were nulliparity (OR= 3.144; CI95%: (1.496-6.661)) and BMI > 30 kg/m2 (OR= 3.15 CI95%: (1,374 - 7,224)). ConclusionMode of delivery after mechanical methods in breech delivery induction appears similar to prostaglandins. However, it should be noted that in half of the cases, additional maturation with prostaglandin was necessary, calling into question the value of the mechanical methods. Factors associated with cesarean were maternal characteristics (nulliparity and BMI > 30 kg/m2) but not induction method.

Differential impact of prostaglandin analogues on agreement of intraocular pressure measurements obtained by Goldmann applanation, rebound, and noncontact tonometry

BackgroundTo evaluate the effect of topical prostaglandin analogues on agreement of IOP measurements obtained by Goldmann applanation tonometry (GAT), rebound tonometry (RBT), and noncontact tonometry (NCT) in eyes with primary open- angle glaucoma (POAG).MethodsIntraocular pressure measurements were obtained using GAT, RBT, and NCT in patients with POAG with or without prostaglandin analogues. The agreement between each tonometry was analysed using Bland-Altman analyses in those with or without prostaglandin analogues. The effect of average IOP on IOP differences was also evaluated.ResultsAmong a total of 86 subjects included in the study, 44 patients were using prostaglandin analogues. The difference in IOP measured by GAT and RBT was marginally greater in those with (GAT-RBT: − 0.94 ± 1.63 mmHg) prostaglandin analogues than in those without (− 0.33 ± 1.22 mmHg, P = 0.06). The difference in IOP measured by GAT and NCT was significantly greater in the prostaglandin group (GAT-NCT: 2.40 ± 2.89 mmHg) than in the group without prostaglandin analogues (0.41 ± 1.63 mmHg, P < 0.01). While there was no significant relationship between the average of all tonometries and the difference between tonometries in those without prostaglandin analogues, both RBT and NCT underestimated IOP relative to GAT at higher IOP in those using prostaglandin analogues.ConclusionIntraocular pressure measured by RBT and NCT was similar to that measured by GAT in those without prostaglandin analogues. RBT overestimated and NCT underestimated IOP compared to GAT in those using prostaglandin analogues.

Cervical ripening for a singleton fetus in breech prensentation at term: Comparison between mechanical and pharmaceutical methods

Although various international professional societies currently recommend trial of vaginal delivery of term fetuses in breech presentation, the question of the method of cervical ripening, when necessary, remains open. ObjectiveTo compare the effectiveness of two methods of cervical ripening for delivery of a singleton fetus in breech presentation at term: a mechanical method (balloon catheter) and a pharmaceutical method (prostaglandins). Study designThis two-center retrospective study reviewed records from 2014 through 2019 in two French maternity units with two different cervical ripening methods for fetuses in breech presentation. The study included all women with cervical ripening for a medical indication with a live singleton fetus in breech presentation ≥ 37 weeks, with an unfavorable cervix. The group treated with a mechanical method was compared with the group receiving a pharmaceutical method. The cesarean delivery rate was the principal outcome, and maternal and neonatal morbidity the secondary outcomes. ResultsWe included 74 women, 19 with mechanical cervical ripening, and 55 with pharmaceutical treatment. The cesarean rate was 57.9% in the balloon catheter group and 40% in the prostaglandin group (P = 0.097) (crude OR =2.06, 95% CI [0.72 – 5.94]; adjusted OR = 2.88, 95% confidence interval [0.52–15.96]), and the postpartum hemorrhage rates 21.1% and 1.8% respectively (P = 0.008). Neonatal morbidity did not differ significantly. ConclusionAlthough the cesarean rate and neonatal morbidity and mortality did not differ significantly between these two methods of cervical ripening, our study lacked power.

Multicentre randomised controlled trial comparing the safety in the first 12h, efficacy and maternal satisfaction of a double balloon catheter and prostaglandin pessary for induction of labour.

To evaluate the safety in the first 12h, efficacy and maternal satisfaction of a double balloon catheter (DBC) with vaginal prostaglandin (PGE) for induction of labour (IOL). We conducted a multicentre randomised controlled study of 420 patients from 1st January 2016 to 31st December 2017 to evaluate the use of DBC in IOL in an Asian population looking at the adverse effects in the first 12h after insertion. Women were assigned randomly to cervical ripening with either a DBC or a prostaglandin pessary. The adverse events in the 12h after DBC or first prostaglandin inserted, the efficacy of a DBC to a prostaglandin in labour induction and maternal satisfaction were evaluated. There were significantly less women with uterine hyperstimulation in the DBC (2 vs 24, p ≤ 0.0001) compared to the prostaglandin group. There were no women with uterine hyperstimulation and non-reassuring foetal status in the DBC while there were 5 women with uterine hyperstimulation and foetal distress in the prostaglandin group. Use of entonox was significantly less in the DBC group (p = 0.009). There were no significant differences in both groups in caesarean section, vaginal deliveries and time to delivery, although significant less time was needed to achieve cervical os dilation more than 4cm in the DBC group (p ≤ 0.0001). Neonatal birth outcomes were similar. Women's pain scores were similar for both methods. 80.1% of women allocated the DBC and 76.8% of women allocated the PGE were keen to recommend their method of induction. Double balloon catheter remains a good alternative method for inducing women in view of a good safety profile with low risk of hyperstimulation and high maternal satisfaction. ClinicalTrials.gov Identifier: NCT02620215.

Increasing conception rate by addition of a second prostaglandin injection in an Ovsynch and progesterone treatment programme for dairy cows not detected in oestrus before the start of the seasonal mating period

ABSTRACT Aims To assess the effect on conception rate to first service, 3- and 6-week in-calf rates, final pregnancy rate and the hazard of pregnancy, of addition of a second prostaglandin (PG) injection 24 hours after the first, in a synchrony programme combining Ovsynch and progesterone in pasture-based dairy cows that had not been detected in oestrus before the start of the seasonal mating period. Methods This prospective, negative-controlled study was conducted using anoestrous cows (n = 1,411) from nine spring-calving dairy herds in the Waikato region of New Zealand. Ovaries of cows not detected in oestrus were examined by transrectal ultrasonography and the presence of a corpus luteum determined. All cows were then treated with an intravaginal progesterone-releasing device and injected I/M with gonadorelin (Day −9). Cows were injected I/M with cloprostenol at device removal (Day −2) and on Day −1 were injected with either water (single PG; n = 720), or cloprostenol (double PG; n = 692). On Day 0 cows were injected again with gonadorelin, unless previously detected in oestrus, and were inseminated on Day 1. Based on dated pregnancy diagnosis by transrectal ultrasonography, cows were categorised as conceiving to first insemination, becoming pregnant in the first 3 or 6 weeks, or becoming pregnant by the end of the mating period. Results Cows in the double PG group had increased conception rate to first service (45.3 (95% CI = 45.1–45.4)% vs. 41.1 (95% CI = 41.0–41.3)%; p < 0.001), 3-week in-calf rate (53.4 (95% CI = 53.6–54.0)% vs. 49.2 (95% CI = 49.0–49.4)%; p < 0.001), and 6-week in-calf rate (67.2 (95% CI = 65.7-68.8)% vs. 63.5 (95% CI = 62.0-65.0)%; p = 0.014) compared to cows in the single PG group. Final pregnancy rate and hazard of pregnancy did not differ between treatment groups (p >0.2). Conclusions Addition of a second PG injection 24 hours after the first, increased conception rate to first service and the proportion of cows pregnant by 3 and 6 weeks after commencement of the mating period. Clinical relevance Improved outcomes can be achieved when treating those cows not detected in oestrus by the start of the seasonal mating period by addition of a second PG injection to the currently recommended treatment protocol for these animals.

Lower Eyelid Horizontal Tightening in Prostaglandin Associated Periorbitopathy.

To determine the effect of chronic topical use of prostaglandin analogs for glaucoma on lower eyelid tension. A prospective case-control study was performed. Lower eyelid tension was measured in a group of glaucoma patients (73 eyelids) using prostaglandin analogs and a paired control group (87 eyelids). Seven glaucoma patients with unilateral use of prostaglandin analogs had the lower eyelid tension of the exposed side compared with the contralateral eyelid. Eyelid tension was digitally measured in photographs in neutral position and after manual downward traction in the center of the eyelid (modified distraction test). Duration of drug exposition, age, use of other topical medication and other prostaglandin-associated periorbitopathy signs as long eyelashes, eyelid hyperemia, eyelid pigmentation, and deepening of upper eyelid sulcus were recorded for analysis. Mean lower eyelid tension in prostaglandin group was significantly higher than in control group: distraction 5.26 mm (SD 1.52) versus 6.80 mm (SD 1.29) (p < 0.001). On the unilateral prostaglandin use intragroup comparison, mean lower eyelid distraction in prostaglandin side was 4.24 mm (SD 1.80) and in control side was 6.79 mm (SD 1.63) (p < 0.012). Beta blocker and carbonic anhydrase inhibitor concomitant use was associated with lower eyelid tension measures in prostaglandin users. Presence of long eyelashes was associated with higher eyelid tension. All other measured variables did not demonstrate interaction with eyelid tension. Chronic topical use of prostaglandin analogs for glaucoma is associated with lower eyelid tightening.

Induction of labor with Foley catheter and risk of subsequent preterm birth: follow-up study of two randomized controlled trials (PROBAAT-1 and -2).

ABSTRACTObjectiveTo evaluate the rate of preterm birth (PTB) in a subsequent pregnancy in women who had undergone term induction using a Foley catheter compared with prostaglandins.MethodsThis was a follow‐up study of two large randomized controlled trials (PROBAAT‐1 and PROBAAT‐2). In the original trials, women with a term singleton pregnancy with the fetus in cephalic presentation and with an indication for labor induction were randomized to receive either a 30‐mL Foley catheter or prostaglandins (vaginal prostaglandin E2 in PROBAAT‐1 and oral misoprostol in PROBAAT‐2). Data on subsequent ongoing pregnancies > 16 weeks’ gestation were collected from hospital charts from clinics participating in this follow‐up study. The main outcome measure was preterm birth < 37 weeks’ gestation in a subsequent pregnancy.ResultsFourteen hospitals agreed to participate in this follow‐up study. Of the 1142 eligible women, 572 had been allocated to induction of labor using a Foley catheter and 570 to induction of labor using prostaglandins. Of these, 162 (14%) were lost to follow‐up. In total, 251 and 258 women had a known subsequent pregnancy > 16 weeks' gestation in the Foley catheter and prostaglandin groups, respectively. There were no differences in baseline characteristics between the groups. The overall rate of PTB in a subsequent pregnancy was 9/251 (3.6%) in the Foley catheter group vs 10/258 (3.9%) in the prostaglandin group (relative risk (RR), 0.93; 95% CI, 0.38–2.24), and the rate of spontaneous PTB was 5/251 (2.0%) vs 5/258 (1.9%) (RR, 1.03; 95% CI, 0.30–3.51).ConclusionIn women with term singleton pregnancy, induction of labor using a 30‐mL Foley catheter is not associated with an increased risk of PTB in a subsequent pregnancy, as compared to induction of labor using prostaglandins. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Effects of topical prostaglandin drops on angiogenesis in an in ovo chick chorioallantoic membrane model

Background To investigate the effects of bimatoprost, latanoprost and travoprost on angiogenesis in the chick chorioallantoic membrane (CAM) model in ovo Materials and methods Fifty fertilized specific-pathogen-free chick eggs were used in this preclinical, prospective, experimental embryo study. Eggs were randomly distributed into 5 groups of ten eggs. Eggs were placed in the incubator after disinfection of their shells with alcohol and monitored appropriate temperature and humidity. On the 3rd day of incubation, a small window was opened on the eggshell. Bimatoprost in group 1, latanoprost in group 2, travoprost in group 3, bevacizumab in group 4, phosphate-buffered-saline (PBS) used in group 5 was applied by injection to CAM. The sterile film was glued onto the broken part of the shell and the eggs were placed in the incubator again. On the 8th day of incubation, eggs were opened and vascular structures on CAMs were examined. Digital photographs were taken, analysed in the ImageJ open source image processing software and differences between groups were evaluated. Thereafter, VEGF (Vascular endothelial growth factor) levels were measured appropriately in the embryo samples. Results All embryos in the prostaglandin groups and the PBS control group were observed to have life signs confirmed by heart rate. In 8 embryos in the bevacizumab group, no life signs were confirmed, while 2 embryos with life signs showed severe hypoplasia. Vascular density, number of vessels and VEGF levels in the bimatoprost, latanoprost and travoprost groups, there were statistically significantly higher than the PBS control group. Conclusion This study demonstrates that topical prostaglandin drops increase angiogenesis in the chick CAM model in ovo.

Effect of Postpartum Routine Intrauterine Treatment on Fertility in Dairy Cows

Bu çalışmada, ineklerde postpartum rutin intrauterin Dimetil Sülfo Oksid (DMSO), DMSO + oksitetrasiklin ve intramuskular PGF2α uygulamalarının fertiliteye etkisini belirlemek amaçlandı. Bu amaçla 150 baş inek rastgele 3 gruba ayrıldı. Vaginal akıntıları ve uterus boyutları 1’den 3’e değişen ölçüde skorlandı. DMSO gurubuna (n=47) postpartum 25-35 gün aralığında ilki, postpartum 40-55 gün aralığında ikincisi olmak üzere iki defa serum fizyolojikle seyreltilen %25’lik DMSO 120 ml intrauterin olarak verildi. Ayrıca PGF2α luteolitik dozda uygulandı. DO grubuna (n=46), postpartum 25-35 gün aralığında ilki, postpartum 40-55 gün aralığında ikincisi olmak üzere iki defa serum fizyolojik ile seyreltilen %25’lik DMSO ve 4 gr oksitetrasiklin 120 ml intrauterin olarak verildi, PGF2α luteolitik dozda uygulandı. PG grubuna (n=42) 25-35 gün aralığında ilki, postpartum 40-55 gün aralığında ikincisi olmak üzere iki defa kas içi PGF2α luteolitik dozda uygulandı. Vaginal akıntı skoru 1 olan ineklerde gebelik başı tohumlama sayısı akıntı skoru 2-3 olanlara göre anlamlı derecede düşük bulundu (p&amp;lt;0.05). Antibiyotik kullanılan grupta gebelik oranları PGF2α ve DMSO kullanımına göre farklılık göstermedi. Erken postpartum dönemde intrauterin antibiyotik kullanımın fertilite parametrelerine etkisinin PGF2α ve DMSO’dan farklı olmadığı sonucuna varıldı. DMSO’nun intrauterin rutin kullanımının oransal olarak fertiliteyi iyileştirdiği ancak daha fazla sayıda inekte çalışılması gerektiği sonucuna varıldı.

Women’s experience of induction of labor using PGE2 as an inpatient versus balloon catheter as an outpatient

ObjectiveInduction of labor (IOL) typically involves cervical priming in an inpatient setting. Outpatient cervical priming may be a safe and cost-effective alternative. However, little is known about women’s preference and the impact of outpatient cervical priming on their healthcare experience. The objective was to compare women’s healthcare experiences following IOL using a balloon catheter and going home, versus prostaglandin (PG) and remaining an inpatient. Study designA randomized controlled trial was undertaken across eight Australian maternity hospitals. Between September 2015 and October 2018, 695 women with uncomplicated term singleton pregnancies were randomized. Of these, 215 and 233 women in the balloon-outpatient and PG-inpatient groups, respectively, received the allocated intervention. The PG group received Dinoprostone gel or controlled-release tape. The balloon group had a double-balloon catheter inserted and went home. Experiential and quality-of-life outcomes were measured via written questionnaire after birth. The primary outcome was a composite neonatal measure. Women’s healthcare experience, health-state (EQ-5D-3 L) and pain scores are reported here. ResultsQuestionnaire data were available for 366 (81.7 %) women enrolled who received their treatment allocation. More women in the balloon-outpatient group reported they would choose IOL next pregnancy (49.2 % vs 38.4 %; p = 0.037) and desire the same method (72.4 % vs 61.1 %; p = 0.022). The balloon-outpatient group experienced higher pain scores at the start of IOL (median (IQR) 3(2−5) vs 2(1−4); p = 0.002) but lower scores at time of rupture of membranes (3(1−5) vs 4(2−6); p = 0.007). The EQ-5D-3 L health-utility index did not differ significantly between the groups (0.77 vs 0.78; p = 0.899). ConclusionsWomen report similar healthcare experiences following balloon-outpatient compared to PG-impatient IOL, but are more likely to desire the same method next pregnancy if IOL is required. If both options are available, then differences in experience should be shared with women, alongside differences in clinical outcomes as part of their decision-making process.

Double-balloon catheter versus prostaglandin for cervical ripening to induce labor after previous cesarean delivery.

To compare the effectiveness of cervical ripening by a mechanical method (double-balloon catheter) and a pharmacological method (prostaglandins) in women with one previous cesarean delivery, an unfavorable cervix (Bishop score < 6), and a singleton fetus in cephalic presentation. This retrospective study, reviewing the relevant records for the years 2013 through 2017, took place in two French university hospital maternity units. This study included women with one previous cesarean delivery, a liveborn singleton fetus in cephalic presentation, and intact membranes, for whom cervical ripening, with unfavorable cervix (Bishop score < 6) was indicated for medical reasons. It compared two groups: (1) women giving birth in a hospital that uses a protocol for mechanical cervical ripening by a double-balloon catheter (DBC), and (2) women giving birth in a hospital that performed pharmacological cervical ripening by prostaglandins. The principal endpoint was the cesarean delivery rate. The secondary outcome measures were maternal and neonatal outcomes. We compared 127 women with prostaglandin ripening to 117 women with DBC. There was no significant difference between the two groups for the cesarean rate (42.5% in the prostaglandin group and 42.7% in the DBC group; p = 0.973; crude OR 1.01 [0.61-1.68]; adjusted OR 1.55 [0.71-3.37]). The median interval between the start of ripening and delivery did not differ between the groups (28.7h in the prostaglandin group vs 25.6h in the DBC group; p = 0.880). Neonatal outcomes did not differ between the groups, either. There was one case of uterine rupture in the prostaglandin group, with no associated maternal or neonatal morbidity. There were no neonatal deaths. The postpartum hemorrhage rate was significantly higher in the DBC group. For cervical ripening for women with one previous cesarean, the choice of a pharmacological or mechanical protocol does not appear to modify the mode of delivery or maternal or neonatal morbidity.

Bronchial-arterial-circulation-sparing Lung Preservation: A New Organ Protection Approach for Lung Transplantation.

Compromised microvasculature resulting from disrupted bronchial arterial circulation appears to trigger chronic lung allograft dysfunction. Maintaining the microvasculature throughout the transplant process could improve the long-term health of transplanted lungs. We recently developed a bronchial-arterial-circulation-sparing (BACS) lung preservation approach and tested whether this approach would decrease microvascular damage and improve allograft function. The lungs of Lewis rats were procured using either the BACS approach, where the bronchial and pulmonary arteries were synchronously perfused; a conventional approach, where only the pulmonary artery was perfused; or a conventional approach with a prostaglandin flush. After 4 hours of cold ischemia, physiologic function and vascular tone of the grafts were evaluated during ex vivo lung perfusion (EVLP), and microvasculature damage was assessed using 2-photon microscopy analysis. Lung function was compared after transplant among the groups. After 4 hours of cold ischemia, the BACS group exhibited significantly higher adenosine triphosphate levels and lower expression of phosphorylated myosin light chain, which is essential for vascular smooth muscle contraction. On EVLP, the BACS and prostaglandin groups showed lower pulmonary vascular resistance and less arterial stiffness. BACS attenuated microvasculature damage in the lung grafts when compared with conventional preservation. After transplantation, the lungs preserved with the BACS approach exhibited significantly better graft function and lower expression of phosphorylated myosin light chain. Our data suggest that BACS lung preservation protects the dual circulation inherent to the lungs, facilitating robust microvasculature in lung grafts after transplantation, leading to better posttransplant outcomes.

Induction of labour using prostaglandin E2 as an inpatient versus balloon catheter as an outpatient: a multicentre randomised controlled trial.

To compare clinical outcomes following induction of labour (IOL) using a balloon catheter and going home, versus prostaglandin (PG) as an inpatient. Randomised controlled trial. Eight Australian maternity hospitals. Women with uncomplicated term singleton pregnancies undergoing IOL for low-risk indications including post-term, advanced maternal age and 'social' reasons. Between September 2015 and October 2018, 347 women were randomised to a balloon outpatient group and 348 to a PG inpatient group. The PG group received Dinoprostone, either 2mg gel or 10mg controlled-release tape. The balloon group had a double-balloon catheter inserted and went home. The primary outcome was a composite neonatal measure comprising nursery admission, intubation/cardiac compressions, acidaemia, hypoxic ischaemic encephalopathy, seizure, infection, pulmonary hypertension, stillbirth or death. Clinical and process outcomes are reported. There were no statistically significant differences in the primary outcome comparing balloon with PG (18.6% versus 25.8%; relative risk=0.77, 95% CI 0.51-1.02; P=0.070), cord arterial pH <7.10 (3.5% versus 9.2%; P=0.072), nursery admissions (12.6% versus 15.5%; P=0.379), neonatal antibiotic use (12.1% versus 17.6%; P=0.103), or mode of birth. Nulliparous women in the balloon group had lower rates of the primary outcome (20.4% versus 31.0%;P=0.032); Parous women were less likely to have an unassisted vaginal birth (77.6% versus 92.3%; P=0.045). Balloon catheters may be a superior method of cervical priming for nulliparous women, whereas this may not be the case for parous women. It is feasible that nulliparous women go home after commencing balloon catheter IOL, and the likelihood of adverse outcomes is low. Multicentre trial shows outpatient induction using balloon catheter is safe and feasible for nulliparous women.

Pulse Waveform Analysis of the Ocular Blood Flow Using Laser Speckle Flowgraphy before and after Glaucoma Treatment.

Although reduction in intraocular pressure (IOP) is the principle of glaucoma treatment, impaired ocular blood flow is believed to play a role in the progression of glaucoma. This study evaluated the effect of glaucoma treatment on pulse waveforms for optic nerve head (ONH) microcirculation in patients with glaucoma. Fifty-one subjects were included on the basis of the glaucoma treatment administered, which involved instillation of prostaglandin (PG) analogs (PG group; n = 28) or trabeculectomy (trabeculectomy group; n = 23). ONH blood flow, represented by the mean blur rate (MBRT) and pulse waveforms, was measured using laser speckle flowgraphy before and 1 and 3 months after treatment. Three months after treatment, IOP exhibited a significant decrease (p < 0.05). Although there was no significant change in MBRT after treatment, the acceleration time index (ATI) significantly decreased (p=0.034) in the PG group. In the trabeculectomy group, there was no significant change in the MBRT after treatment, while fluctuation (p=0.019) and blowout score (BOS) (p=0.036) exhibited significant decrease and increase, respectively. Multiple regression analysis showed that mean deviation was significantly associated with the rate of change in the BOS (p=0.013), age was a significant contributing factor for the rate of change in fluctuation in the trabeculectomy group, reflection was significantly associated with the ATI (p=0.037) in the in the PG group. Both glaucoma treatments can change the pulse waveforms, with MBRT remaining unchanged, and IOP reduction owing to the treatment may contribute to stable blood flow in the tissue area of the ONH. As impaired ocular blood flow plays a role in the progression of glaucomatous damage, it would be beneficial if glaucoma treatment could improve the stability of ONH microcirculation.

Pregnancy-associated glycoproteins (PAGs) and progesterone concentrations in Holstein heifers following two methods of estrus syncronization

Pregnancy-associated glycoproteins (PAGs) and progesterone concentrations were assessed in Holstein heifers 28 days post-insemination, following estrus synchronization with either a double prostaglandin (PG) injection or the ovsynch protocol. Animals between 15 and 20 months of age, with a 3-3.5 BCS, were randomly assigned to three groups: Heifers in the control group (n = 70) were monitored for estrus behaviour for 21 days and inseminated when detected in standing heat; Estrus of heifers in the Ovsynch group (n = 70)) was synchronized following the Ovsynch protocol, and timed artificial insemination was performed 16 h after the completion of treatment; Animals in the PG group (n = 70) received two prostaglandin-F2α injections 11 days apart, were monitored for estrus behaviour for 2-5 days following the last injection, and inseminated when in heat. Serum PAGs and progesterone concentrations were measured in pregnant heifers (control group n = 25; ovsynch group n = 22; PG group n = 21) on day 28 after artificial insemination (AI). Mean serum PAGs concentrations (OD: optical density) were similar between groups (control = 3.37 ± 0.148, Ovsynch = 3.21 ± 0.136, and PG = 3.34 ± 0.143; p &gt; 0.05). However, serum progesterone concentrations were found to be lower in the ovsynch group (4.70 ± 0.17 ng/mL) when compared to the PG (5.34 ± 0.13 ng/mL) or the control (5.37 ± 0.08 ng/mL) groups (p &lt; 0.001). There was no correlation between serum PAGs and progesterone levels at day 28 post-insemination, or between early pregnancy PAGs concentrations and fetal death rates. Further research, including multiple sampling time points throughout gestation, after estrus synchronization protocols is warranted, to determine if there are associated temporal changes in PAGs and progesterone profiles that could impact reproductive parameters in dairy heifers.

Interest of cervical ripening using double balloon catheters for labour induction in term nulliparous women

Objective: To compare the efficiency of double balloon catheters with that of intravaginal prostaglandins alone for the labor induction of unfavourable cervices in term nulliparous women.Methods: 50 nulliparous patients induced with a double balloon device were compared to 53 patients induced using intravaginal prostaglandins alone. The main outcome measure was labour induction failure, characterized by the absence of active labour. The secondary outcome measures were the improvement of the Bishop score, the average durations of ripening and labour induction, the average time to active labour, the need for a second cervical ripening agent, the total dose of prostaglandins used in each group, the use of oxytocins, as well as the rates of vaginal delivery, abnormal foetal heart rate during labour and perinatal maternal infection.Results: The rate of failed labour induction was of 28% in the double balloon group, against 13% in the prostaglandins group. The average durations of ripening and labour induction, as well as the time to active labour were higher in the double balloon group. The improvement of the Bishop score was significantly lower in the double balloon group.Discussion and conclusion: In our study, the use of double balloon catheters does not seem to reduce the rate of failed labour induction in nulliparous women when compared to the use of prostaglandins alone. In addition, it could lengthen the labour induction duration, although more powerful studies would be necessary not to recommend its use for nulliparous women.

Effects of aqueous suppressants and prostaglandin analogues on early wound healing after glaucoma implant surgery

A hypertensive phase frequently develops in the early postoperative period after glaucoma shunt operations. Anti-glaucoma eye drop use is essential when postoperative intraocular pressure (IOP) is not controlled. We investigated whether the use of early topical anti-glaucoma medication affects wound healing following glaucoma tube surgery. Eyes were randomly assigned to receive topical aqueous suppressant (timolol-dorzolamide fixed combination), prostaglandin (PG) analogue (travoprost), or normal saline (control group). First, we observed the effects of topical eye drops on Tenon’s tissue in non-operated eyes in rabbits. Second, we examined the effects of these eye drops on rabbit eyes that underwent Ahmed glaucoma drainage device implantation, including the effects on the histopathological appearance of their blebs. Interleukin-2 in the Tenon’s tissue was elevated in the PG group when compared to the control and aqueous suppressant groups (P = 0.006). In non-operated eyes, IOP was similar among the groups (P = 0.545). After glaucoma implant surgery, the average height of the inner collagenous layer and the average height of the α-SMA-positive blebs were the least in the aqueous suppressant group (P = 0.013, P = 0.001, respectively) at 4 weeks postoperatively. IOP was lower in the aqueous suppressant group than that in the control and PG groups (P = 0.001) following tube surgery. After Ahmed tube surgery, early treatment with aqueous suppressant decreased fibrosis in the bleb, but early treatment with the PG analogues did not.