The Proliferation Of Vascular Smooth Muscle Cells Depends On Thioredoxin 1 Protein In A Model Of Pulmonary Hypertension

Pulmonary hypertension (PH) is a disease which manifests itself in the lungs of both adults and children. Vascular proliferation and remodeling are the hallmarks of PH and are found mainly in the pulmonary arterial smooth muscle cells (PASMC). The cause of PASMC proliferation and vascular remodeling in PH is poorly understood. Hypoxia, or low oxygen content, underlies many forms of PH. Hypoxia results in alterations in the redox balance of the PASMC. Therefore, the aim of this study was to examine the role of the thioredoxin system, an antioxidant system in the cell, in hypoxia-induced proliferation in PASMC. Protein was isolated from human PASMC which were exposed to either hypoxia (1% O2, 5% CO2, balance N2) or normoxia (21% O2, 5% CO2 and balance N2) to determine the protein levels of thioredoxin 1 and 2 (Trx1 and Trx2), thioredoxin reductase (TrxR), and thioredoxin interacting protein (Txnip), by Western blotting. Proliferation studies were also done by seeding 6 well plates with 10,000 PASMC per well, incubating in either normoxia or hypoxia for 5 days and counting viable cells using trypan blue exclusion. We found that in hypoxia the Trx1 protein levels were significantly greater after 48 and 72 hours of exposure than in PASMC grown in normoxia. We also found that PASMC proliferate more in hypoxia than in normoxia. To determine if Trx1 had a role in hypoxia-induced PASMC proliferation we knocked down Trx1 protein in the PASMC using specific siRNA, and treatment with the Trx1 siRNA completely prevented hypoxia-induced proliferation in PASMC. These findings demonstrate that Trx1 protein is necessary for the hypoxia-induced proliferation of ii PASMC. We speculate that Trx1 may represent a novel therapeutic target for the vascular remodeling that underlies PH

The promotion of sports tourism through the organization of competitions for non-standard cycling track

Материалы XIX Междунар. науч.-техн. конф. студентов, аспирантов и молодых ученых, Гомель, 25–26 апр. 2019 г

Реконструкция электрической части подстанции 35/10 кВ "Велута" и повышение надёжности фрагмента распределительной электрической сети

Background: Globally, at least 2.65 million stillbirths occur every year, of which more than half are during the antepartum period. The proportion of intrapartum stillbirths has substantially declined with improved obstetric care; however, the number of antepartum stillbirths has not decreased as greatly. Attempts to lower this number may be hampered by an incomplete understanding of the risk factors leading to the majority of antepartum stillbirths. We conducted this study in a tertiary hospital in Nepal to identify the specific risk factors that are associated with antepartum stillbirth in this setting. Methods: This case-control study was conducted between July 2012 and September 2013. All women who had antepartum stillbirths during this period were included as cases, while 20 % of all women delivering at the hospital were randomly selected and included as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regression analysis was completed to determine the association between those risk factors and antepartum stillbirth. Results: During the study period, 4567 women who delivered at the hospital were enrolled as referents, of which 62 had antepartum stillbirths and were re-categorized into the case population. In total, there were 307 antepartum stillbirths. An association was found between the following risk factors and antepartum stillbirth: increasing maternal age (aOR 1.0, 95 % CI 1.0-1.1), less than five years of maternal education (aOR 2.4, 95 % CI 1.7-3.2), increasing parity (aOR 1.2, 95 % CI 1.0-1.3), previous stillbirth (aOR 2.6, 95 % CI 1.6-4.4), no antenatal care attendance (aOR 4.2, 95 % CI 3.2-5.4), belonging to the poorest family (aOR 1.3, 95 % CI 1.0-1.8), antepartum hemorrhage (aOR 3.7, 95 % CI 2.4-5.7), maternal hypertensive disorder during pregnancy (aOR 2.1, 95 % CI 1.5-3.1), and small weight-for-gestational age babies (aOR 1.5, 95 % CI 1.2-2.0). Conclusion: Lack of antenatal care attendance, which had the strongest association with antepartum stillbirth, is a potentially modifiable risk factor, in that increasing the access to and availability of these services can be targeted. Antenatal care attendance provides an opportunity to screen for other potential risk factors for antepartum stillbirth, as well as to provide counseling to women, and thus, helps to ensure a successful pregnancy outcome

Factors associated with timing of umbilical cord clamping in tertiary hospital of Nepal.

OBJECTIVE: Delayed umbilical cord clamping (DCC) (≥ 60 s) is recognized to improve iron status and neurodevelopment compared to early umbilical cord clamping. The aim of this study is to identify current umbilical cord clamping practice and factors determining the timing of clamping in a low-resource setting where prevalence of anemia in infants is high. RESULTS: A cross-sectional study design including 128 observations of clinical practice in a tertiary-level maternity hospital in Kathmandu, Nepal. Overall 48% of infants received DCC. The mean and median cord clamping times were 61 ± 33 and 57 (38-79) s, respectively. Univariate analysis showed that infants born during the night shift were five times more likely to receive DCC (OR 5.6, 95% CI 1.4-38.0). Additionally, infants born after an obstetric complication were 2.5 times more likely to receive DCC (OR 2.5, 95% CI 1.2-5.3), and babies requiring ventilation had a 65% lower likelihood of receiving DCC (OR 0.35, 95% CI 0.13-0.88). Despite the existence of standard protocols for cord clamping and its proven benefit, the lack of uniformity in the timing of cord clamping reveals poor translation of clinical guidelines into clinical practice. Clinical trial registration ISRCTN97846009

Validation of the foot length measure as an alternative tool to identify low birth weight and preterm babies in a low-resource setting like Nepal : a cross-sectional study

Background The majority of infants who die in the neonatal period are born with a low birth weight (LBW, <2500 grams), or prematurely (before 37 weeks). Most deaths among these infants could be prevented with simple, low-cost interventions like kangaroo mother care (KMC) or prevention and early identification of infection. It is difficult, however, to determine birth weight and gestational age in community settings, and therefore necessary to find an appropriate alternative screening tool that can identify LBW and preterm infants. Methods This cross-sectional study was conducted at a tertiary hospital in Nepal to compare the validity of using three different foot length measurement methods (plastic ruler, measuring tape, and paper footprint) as screening tools for identifying babies with birth weights <2000 grams or infants born preterm (<37 weeks). LBW was defined as less than 2000 grams because of the implication for use of KMC for these infants. Non-parametric receiver operating characteristics (ROC) analysis was completed to determine which measurement method best predicted LBW and preterm birth. For the method that was the best predictor for each outcome (i.e. highest area under the curve), further analyses were completed to determine sensitivity, specificity, likelihood ratios and predictive values of an operational screening cutoff to predict LBW or preterm birth in this setting. Results Of the 811 infants included in this study, 30 infants had LBW and 54 were born preterm. The plastic ruler was the measurement method with the highest area under the curve, and thus predictive score for estimating both outcomes, so operational cutoffs were identified based on this method. An operational cutoff of 7.2 cm was identified to screen for infants weighing <2000 grams at birth (sensitivity: 75.9%, specificity: 90.3%), and 7.8 cm was determined as the operational cutoff to identify preterm infants (sensitivity: 76.9%, specificity: 53.9%). Conclusions In Nepal, at least in community settings, foot length measurement with a hard ruler may be a valid proxy to identify at-risk infants when birth weight or gestational age is unavailable. Further studies and piloting should be conducted to identify exact cutoffs that can be used within community settings

Level of mortality risk for babies born preterm or with a small weight for gestation in a tertiary hospital of Nepal

Background: Globally, 15 million babies were born prematurely in 2012, with 37.6 % of them in South Asia. About 32.4 million infants were born small for gestational age (SGA) in 2010, with more than half of these births occurring in South Asia. In Nepal, 14 % of babies were born preterm and 39.3 % were born SGA in 2010. We conducted a study in a tertiary hospital of Nepal to assess the level of risk for neonatal mortality among babies who were born prematurely and/or SGA. Methods: This case-control study was completed over a 15-month period between July 2012 and September 2013. All neonatal deaths that occurred during the study period were included as cases and 20 % of women with live births were randomly selected as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regression analyses were conducted to determine the level of risk for neonatal mortality among babies born preterm and/or SGA. Results: During this period, the hospital had an incidence of preterm birth and SGA of 8.1 and 37.5 %, respectively. In the multivariate model, there was a 12-fold increased risk of neonatal death among preterm infants compared to term. Babies who were SGA had a 40 % higher risk of neonatal death compared to those who were not. Additionally, babies who were both preterm and SGA were 16 times more likely to die during the neonatal period. Conclusions: Our study showed that the risk of neonatal mortality was highest when the baby was born both preterm and SGA, followed by babies who were born preterm, and then by babies who were SGA in a tertiary hospital in Nepal. In tertiary care settings, the risk of mortality for babies who are born preterm and/or SGA can be reduced with low-cost interventions such as Kangaroo Mother Care or improved management of complications through special newborn care or neonatal intensive care units. The risk of death for babies who are born prematurely and/or SGA can thus be used as an indicator to monitor the quality of care for these babies in health facility settings

Increased immunization coverage addresses the equity gap in Nepal

Objective To compare immunization coverage and equity distribution of coverage between 2001 and 2014 in Nepal. Methods We used data from the Demographic and Health Surveys carried out in 2001, 2006 and 2011 together with data from the 2014. Multiple Indicator Cluster Survey. We calculated the proportion, in mean percentage, of children who had received bacille Calmette-Guerin (BCG) vaccine, three doses of polio vaccine, three doses of diphtheria-pertussis-tetanus (DPT) vaccine and measles vaccine. To measure inequities between wealth quintiles, we calculated the slope index of inequality (SII) and relative index of inequality (RII) for all surveys. Findings From 2001 to 2014, the proportion of children who received all vaccines at the age of 12 months increased from 68.8% (95% confidence interval, CI: 67.5-70.1) to 82.4% (95% CI: 80.7-84.0). While coverage of BCG, DPT and measles immunization statistically increased during the study period, the proportion of children who received the third dose of polio vaccine decreased from 93.3% (95% CI: 92.7-93.9) to 88.1% (95% CI: 86.8-89.3). The poorest wealth quintile showed the greatest improvement in immunization coverage, from 58% to 77.9%, While the wealthiest quintile only improved from 84.8% to 86.0%. The SII for children who received all vaccines improved from 0.070 (95% CI: 0.061-0.078) to 0.026 (95% CI: 0.013-0.039) and RII improved from 1.13 to 1.03. Conclusion The improvement in immunization coverage between 2001 and 2014 in Nepal can mainly be attributed to the interventions targeting the disadvantaged populations

Risk factors for antepartum stillbirth : a case-control study in Nepal

Background: Globally, at least 2.65 million stillbirths occur every year, of which more than half are during the antepartum period. The proportion of intrapartum stillbirths has substantially declined with improved obstetric care; however, the number of antepartum stillbirths has not decreased as greatly. Attempts to lower this number may be hampered by an incomplete understanding of the risk factors leading to the majority of antepartum stillbirths. We conducted this study in a tertiary hospital in Nepal to identify the specific risk factors that are associated with antepartum stillbirth in this setting. Methods: This case-control study was conducted between July 2012 and September 2013. All women who had antepartum stillbirths during this period were included as cases, while 20 % of all women delivering at the hospital were randomly selected and included as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regression analysis was completed to determine the association between those risk factors and antepartum stillbirth. Results: During the study period, 4567 women who delivered at the hospital were enrolled as referents, of which 62 had antepartum stillbirths and were re-categorized into the case population. In total, there were 307 antepartum stillbirths. An association was found between the following risk factors and antepartum stillbirth: increasing maternal age (aOR 1.0, 95 % CI 1.0-1.1), less than five years of maternal education (aOR 2.4, 95 % CI 1.7-3.2), increasing parity (aOR 1.2, 95 % CI 1.0-1.3), previous stillbirth (aOR 2.6, 95 % CI 1.6-4.4), no antenatal care attendance (aOR 4.2, 95 % CI 3.2-5.4), belonging to the poorest family (aOR 1.3, 95 % CI 1.0-1.8), antepartum hemorrhage (aOR 3.7, 95 % CI 2.4-5.7), maternal hypertensive disorder during pregnancy (aOR 2.1, 95 % CI 1.5-3.1), and small weight-for-gestational age babies (aOR 1.5, 95 % CI 1.2-2.0). Conclusion: Lack of antenatal care attendance, which had the strongest association with antepartum stillbirth, is a potentially modifiable risk factor, in that increasing the access to and availability of these services can be targeted. Antenatal care attendance provides an opportunity to screen for other potential risk factors for antepartum stillbirth, as well as to provide counseling to women, and thus, helps to ensure a successful pregnancy outcome

MOESM1 of Factors associated with timing of umbilical cord clamping in tertiary hospital of Nepal

Additional file 1. Definitions of variables. Definitions of variables (relevant to this study) contained in the structured checklist, and their method of data collection