A case study of community-based distribution and use of Misoprostol and Chlorhexidine in Sokoto State,Nigeria

The United States Agency for International Development/Targeted States High Impact Project supported Sokoto State, Nigeria government in the development of a community-based intervention aimed at preventing post-partum haemorrhage (PPH) and cord infection among women and children, respectively. This paper describes the innovative intervention within the Nigeria health delivery system. It then explains the case study approach to assessing this intervention and summarises findings. Ultimately, the intervention was received well in communities and both drugs were added to the procurement list of all health facilities providing maternity services in the State. Key factors leading to such success include early advocacy efforts at the state-level, broad stakeholder engagement in designing the distribution system, early community engagement about the value of the drugs and concerted efforts to monitor and ensure availability of the drugs. Implementation challenges occurred in some areas, including shortage of community-based health volunteers (CBHVs) and drug keepers, and socio-cultural barriers. To maximise and sustain the effectiveness of such interventions, state government needs to ensure constant drug supply and adequate human resources at the community level, enhance counselling and mobilisation efforts, establish effective quality improvement strategies and implement a strong M&E system.     

新疆地区不同民族中老年急性脑梗死患者血尿酸水平的临床分析

目的探讨新疆维吾尔族及汉族不同年龄段急性脑梗死患者血尿酸水平的变化。方法 190例急性脑梗死患者中,维吾尔族96例,其中40~54岁年龄段28例,55~69岁年龄段31例,≥70岁年龄段37例;汉族94例,其中40~54岁年龄段21例,55~69岁年龄段34例,≥70岁年龄段39例。分别进行同一民族不同年龄段急性脑梗死患者血尿酸的比较及不同民族同一年龄段急性脑梗死患者血尿酸的比较。结果维吾尔族不同年龄段急性脑梗死患者血尿酸水平的差异有统计学意义[F(校正)=17.842,P=0.000]。其中55~69岁年龄段、≥70岁年龄段急性脑梗死患者与40~54岁年龄段急性脑梗死患者血尿酸水平比较,差异有统计学意义(P<0.01);≥70岁年龄段急性脑梗死患者与55~69岁年龄段急性脑梗死患者血尿酸水平比较,差异有统计学意义(P<0.01)。汉族不同年龄段急性脑梗死患者血尿酸水平的差异有统计学意义(F=57.422,P=0.000)。其中≥70岁年龄段急性脑梗死患者与40~54岁年龄段及55~69岁年龄段急性脑梗死患者血尿酸水平比较,差异有统计学意义(P<0.01);而55~69岁年龄段急性脑梗死患者与40~54岁年龄段急性脑梗死患者血尿酸水平比较,差异无统计学意义(P>0.05)。两民族在55~69岁年龄段急性脑梗死患者血尿酸水平的比较,差异有统计学意义(t=34.623,P=0.005);而两民族在40~54、≥70岁年龄段急性脑梗死患者血尿酸水平比较,差异无统计学意义(t=2.387,P=0.252;t=5.098,P=0.412)。结论维吾尔族和汉族急性脑梗死患者随年龄的增长,血尿酸水平增高,且在维吾尔族中发生的年龄更早。     

Respirometric reserve capacity of cumulus cell mitochondria correlates with oocyte maturity

Purpose

Oocyte competence is critical in success of assisted reproduction. Metabolic signaling between oocyte and cumulus cells within the cumulus-oocyte complex procure oocyte development. This study evaluated the relationship between respirometric activity of cumulus cells and maturity of corresponding oocytes.

Methods

In prospective cohort study, 20 women of age 28–42 undergoing IVF procedure were involved. To evaluate oocyte maturity, the cumulus cells from individual oocytes were assessed flow cytometrically by double labeling of cells with mitochondria specific dyes. The respirometric stress analysis using ATPase inhibitor oligomycin was applied to assess mitochondria metabolic abnormalities.

Results

The cumulus cells from each of 327 oocytes were analyzed. The respirometric index of cumulus cells (O′_R) strongly correlates with maternal ovarian reserve, showing to be higher in patients with higher AMH (p <?0.0017). Cumulus cells from immature oocytes had severe mitochondria deficiency, i.e., low O′_R, than those from mature oocytes (p <?0.02). No significant difference in respirometric capacity was found between cumulus cells associated with good vs poor-quality embryos.

Conclusions

The oocyte maturity is potentially related to the mitochondria activity of cumulus cells.

     

Clinical and pathogenetic features of early- and late-onset pre-eclampsia

Background: PE is present in ～2–8% of all pregnant women worldwide. Placental bed disorders at early and late PE have been not carried out yet. However, these studies help to explore details of the pathogenesis of PE, and to optimize the prognosis and obstetric management.

Objective: To identify clinical and morphological differences between early- and late-onset PE based on a comprehensive observation of pregnant women with regard to morphological and immunohistochemical characteristics of the placental bed.

Materials and methods: One hundred fifty patients aged 18–43 years old delivered by cesarean section due to severe PE. The samples of placental bed tissue were studied by morphological and immunohistochemical methods.

Results: The violation of invasion trophoblast, remodeling of spiral arteries were expressed in early onset PE; the degree of compensation of chronic hypoxia tissue in the area of the placental site was typical for late PE and was absent of an early onset PE.

Conclusion: Our studies confirm the need for separation of early- and late-onset PE, being justified in terms of different pathogenetic mechanisms of formation, and therefore the possibility of therapeutic effects, duration of pregnancy prolongation, forecasting, search early diagnostic markers of the disease, and personalized approaches.     

Physiological validation of cell health upon probing with carbon nanotube endoscope and its benefit for single-cell interrogation

New-generation nanoscale devices for single-cell study are intensively being developed. As has been shown, nanodevices are minimally invasive because of their order-of-magnitude smaller size in comparison to conventional glass pipettes. However, in most studies the evaluation of the nanodevice impact on cell health has not extended to their effects on cell metabolic integrity. In this work we evaluated the degree to which the insertion of a carbon-based nanotube endoscope into a cell induces mechanical and biochemical stress, and affects cellular key metabolic systems. The effects of insertion of the nanotube endoscope on cell morphological and physiological modulations were monitored and compared to those of glass micropipettes. We report that nanotube endoscope insertion does not significantly modulate the plasma membrane and actin network. The cell metabolic mechanisms such as energy production and inositol 1,4,5-trisphosphate-dependent calcium signaling remain preserved for prolonged endoscope presence within a cell. FROM THE CLINICAL EDITOR: In this basic science study, the effects of insertion of carbon nanotube endoscope on cell morphological and physiological modulations were monitored and compared to those of glass micropipettes. Nanotube endoscope insertion is truly minimally invasive: it does not significantly modulate the plasma membrane and actin network; the energy production and inositol 1,4,5-trisphosphate-dependent calcium signaling also remain preserved during prolonged endoscope presence within a cell.     

Rapamycin increases oxidative metabolism and enhances metabolic flexibility in human cardiac fibroblasts

Inhibition of mTOR signaling using rapamycin has been shown to increase lifespan and healthspan in multiple model organisms; however, the precise mechanisms for the beneficial effects of rapamycin remain uncertain. We have previously reported that rapamycin delays senescence in human cells and that enhanced mitochondrial biogenesis and protection from mitochondrial stress is one component of the benefit provided by rapamycin treatment. Here, using two models of senescence, replicative senescence and senescence induced by the presence of the Hutchinson-Gilford progeria lamin A mutation, we report that senescence is accompanied by elevated glycolysis and increased oxidative phosphorylation, which are both reduced by rapamycin. Measurements of mitochondrial function indicate that direct mitochondria targets of rapamycin are succinate dehydrogenase and matrix alanine aminotransferase. Elevated activity of these enzymes could be part of complex mechanisms that enable mitochondria to resume their optimal oxidative phosphorylation and resist senescence. This interpretation is supported by the fact that rapamycin-treated cultures do not undergo a premature senescence in response to the replacement of glucose with galactose in the culture medium, which forces a greater reliance on oxidative phosphorylation. Additionally, long-term treatment with rapamycin increases expression of the mitochondrial carrier protein UCP2, which facilitates the movement of metabolic intermediates across the mitochondrial membrane. The results suggest that rapamycin impacts mitochondrial function both through direct interaction with the mitochondria and through altered gene expression of mitochondrial carrier proteins.     

Tumor microenvironment promotes dicarboxylic acid carrier-mediated transport of succinate to fuel prostate cancer mitochondria

Prostate cancer cells reprogram their metabolism, so that they support their elevated oxidative phosphorylation and promote a cancer friendly microenvironment. This work aimed to explore the mechanisms that cancer cells employ for fueling themselves with energy rich metabolites available in interstitial fluids. The mitochondria oxidative phosphorylation in metastatic prostate cancer DU145 cells and normal prostate epithelial PrEC cells were studied by high-resolution respirometry. An important finding was that prostate cancer cells at acidic pH 6.8 are capable of consuming exogenous succinate, while physiological pH 7.4 was not favorable for this process. Using specific inhibitors, it was demonstrated that succinate is transported in cancer cells by the mechanism of plasma membrane Na⁺-dependent dycarboxylic acid transporter NaDC3 (SLC13A3 gene). Although the level of expression of SLC13A3 was not significantly altered when maintaining cells in the medium with lower pH, the respirometric activity of cells under acidic condition was elevated in the presence of succinate. In contrast, normal prostate cells while expressing NaDC3 mRNA do not produce NaDC3 protein. The mechanism of succinate influx via NaDC3 in metastatic prostate cancer cells could yield a novel target for anti-cancer therapy and has the potential to be used for imaging-based diagnostics to detect non-glycolytic tumors.     

14 & 6 Hz positive spikes coinciding with PLEDs

ObjectiveWe describe the coincidence of 14 &; 6 Hz positive spikes with PLEDs in a patient with clonic status epilepticus of the left upper extremity and the persistence of 14 &; 6 Hz positive spikes after cessation of status.MethodsDigital video-EEG recordings were performed using 32-channel EEG equipment (XLTEK, Canada) with all electrodes of the international 10–20 system and additional anterior temporal electrodes in a patient during clonic status epilepticus and 2 months later after cessation of status.ResultsThe initial EEG during clonic status epilepticus showed right hemispheric PLEDs and right lateral temporal 14 &; 6 Hz positive spikes in between the PLEDs. Follow up EEG recording 2 months later after cessation of status revealed an absence of PLEDs, a continuous slowing over the right hemisphere and the occipital background of 7 Hz. Right lateral temporal 14 &; 6 Hz positive spikes were recorded in the same frequency and the same localization as in the previous status EEG.ConclusionsThis case demonstrates that a hemisphere which is in a status epilepticus as clinically reflected by clonic status of the left hand and PLEDs in the EEG is still capable to produce a benign variant pattern like 14 &; 6 Hz positive spikes.SignificanceThe generator of 14 &; 6 Hz positive spikes may still persist despite the presence of severe structural and epileptogenic lesions in the same hemisphere.     

雌、孕激素受体及表皮生长因子受体在EP中的表达和宫腔镜对EP的诊治价值

目的： 探讨雌激素受体（ER）、孕激素受体（PR）、表皮生长因子受体（EGFR）在子宫内膜息肉（EP）中的表达及宫腔镜对EP的诊断和治疗价值.方法： 360例EP患者中56例行经宫颈EP电切术（TCRP）,对30例EP患者息肉组织、息肉旁内膜组织和10例正常子宫内膜中EGFR、ER、PR的表达进行检测,并对各组织间质、腺体中EGFR、ER、PR的表达进行比较. 结果：56例行TCRP的EP患者中,2例病理诊断为高分化子宫内膜腺癌,行全子宫切除术,随访6个月～1年,患者预后良好.宫腔镜手术后3个月随访,除4例患者宫腔底部有轻度粘连外,余患者宫腔形态正常,症状明显改善.（3）子宫息肉组织间质和腺体中ER、PR、EGFR的表达均明显高于息肉旁组织及正常内膜的表达（P〈0.05）;息肉旁内膜组织腺体和间质中ER、PR及间质中EGFR的表达与正常子宫内膜组织差异无统计学意义（P〉0.05）;息肉旁内膜组织腺体EGFR的表达明显高于正常内膜的表达（P〈0.05）;息肉组织腺体ER的表达明显高于间质的表达（P〈0.05）,息肉组织腺体EGFR的表达明显高于间质的表达（P〈0.01）.结论：（1）EP的临床特征以不规则阴道出血为主,绝经期则以绝经后出血为主;（2）EP的发生与EGFR、ER、PR协同作用有关;（3）绝经后妇女体内仍有雌激素持续作用;（4）宫腔镜是EP诊断和治疗的首选方法,切除息肉同时息肉旁内膜也应酌情切除.