Effects of maternal anxiety and depression during pregnancy in Chinese women on children's heart rate and blood pressure response to stress

Psychological disturbances, including anxiety and depression, are common during human pregnancy. Our objective was to determine whether these maternal disturbances influence cardiovascular responses of the offspring. The psychological status of 231 pregnant women was determined. Offspring (216) of these women were subsequently exposed to a video challenge stress when aged 7-9 years. Heart rate (HR) and blood pressure (BP) of the children were determined at rest, in response to video stress and during subsequent recovery. Children's resting and stress-induced increases in HR (bpm), systolic (SBP, mm Hg) and diastolic (DBP, mm Hg) BP were all greater in children whose mothers reported anxiety during pregnancy. Values (mean±s.d.) for resting HR, SBP and DBP were 75.15±5.87, 95.37±2.72 and 66.39±4.74 for children whose mothers reported no anxiety and an average of 81.62±6.71, 97.26±2.90 and 68.86±2.82 for children whose mothers reported anxiety at any level. Respective values for stress-induced increments in HR, SBP and DBP were 14.83.±2.14, 16.41±1.97 and 12.72±2.69 for children whose mothers reported no anxiety and 17.95±3.46, 18.74±2.46 and 14.86±2.02 for children whose mothers reported any level of anxiety. Effects of maternal depression were less consistent. The effects of maternal anxiety remained in multivariate analyses, which also included children's birth weight. The results indicate a long-term influence of maternal psychological status during pregnancy on the cardiovascular responses to stress among offspring. These effects may contribute to prenatal influences on subsequent health of the offspring.

Activation of p38 MAPK in the rostral ventromedial medulla by visceral noxious inputs transmitted via the dorsal columns may contribute to pelvic organ cross-sensitization in rats with endometriosis

Whether visceral organ cross-sensitization is involved in endometriosis-associated pain remains elusive. Previous studies have shown that visceral noxious stimuli may trigger a cascade of signal transductions in the rostral ventromedial medulla (RVM) via the spinal dorsal column (DC) pathway and the RVM plays a critical role in the descending control of visceral nociception. In the current study, we hypothesized that the p38 mitogen-activated protein kinase (MAPK) activation in the RVM by noxious visceral inputs from ectopic growths via the DC was involved in the development of pelvic organ cross-sensitization in established endometriosis. A rat model of experimental endometriosis was established. To examine ectopic growths-to-colon cross-sensitization, graded colorectal distention (CRD) was performed and abdominal withdrawal reflex (AWR) scores were recorded in female rats at 8weeks after the uterine or fat (control) auto-transplantation. Western blot study was carried out to examine the phosphorylated form and the total level of p38 MAPK protein in the RVM. Our results showed that lesions of bilateral DCs immediately following uterine or fat auto-transplantation in female rats significantly attenuated the later development of ectopic growths-to-colon cross-sensitization and the increased p38 MAPK activation in the RVM, as compared to sham DC lesions. Furthermore, intra-RVM microinjection of a p38 MAPK inhibitor (SB 203580), but not vehicle, in female rats with established endometriosis significantly attenuated ectopic growths-to-colon cross-sensitization and the increased activation of p38 MAPK in the RVM. These findings suggest that the noxious inputs from ectopic growths may activate p38 MAPK in the RVM via the DC, which may contribute to the development of ectopic growths-to-colon cross-sensitization in established endometriosis.

Cyclic mechanical stress modulates neurotrophic and myelinating gene expression of Schwann cells

OBJECTIVES

This study aimed to investigate the response of Schwann cells to cyclic compressive and tensile stresses of different durations of stimulation.

MATERIALS AND METHODS

RSC96 cells were subjected to cyclic tensile stress or compressive stress; for either, cells in five groups were treated for 0, 1, 2, 24 and 48 h respectively. Enzyme-linked immunosorbent assay was conducted to detect secretion of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 and neurotrophin-4 in the culture medium. Real-time PCR was conducted to quantify mRNA expression of neurotrophins including NGF, BDNF, neurotrophin-3 and neurotrophin-4, and myelin-related genes including Sox10, Krox20, neuregulin 1, NCAM, N-cadherin, P0, MAG and MBP. Immunofluorescent staining was performed to visualize Krox20 and F-actin in the tensile groups.

RESULTS

Within 24 h, cells treated with cyclic tensile stress expressed and secreted significantly more BDNF, while cyclic compression down-regulated BDNF expression. Cells treated with both tensile and compressive stress down-regulated expression of NRG1, NCAM, Krox20 and Sox10 at all time points. Expression of N-cadherin was not affected by either stretch or compression. F-actin was down-regulated by tensile stress.

CONCLUSIONS

Both tensile and compressive loading down-regulated expression of several important myelin-related Schwann cells genes and thus facilitated demyelination. Tensile stress meanwhile promoted secretion of BDNF by Schwann cells within 24 h, which may contribute to maintenance and repair of damaged axons. These effects of mechanical stress might have been mediated by the actin cytoskeleton.

Sevoflurane inhibits neurogenesis and the Wnt-catenin signaling pathway in mouse neural progenitor cells

Recent population studies suggest that children who receive anesthesia and surgery could be at an increased risk for developing learning disabilities. The underlying reason for this clinical observation is largely unknown. Whether undergoing anesthesia contributes to learning disability development, or if the need for anesthesia and surgery is a marker for other unidentified factors that contribute to the development of learning disabilities, remains to be determined. Neurogenesis, regulated by the Wnt-catenin signaling pathway, has been shown to be involved in learning and memory, and sevoflurane is the most commonly used inhalation anesthetic in children. We therefore set out to determine the effects of sevoflurane on neurogenesis and the Wnt-catenin signaling pathway in mouse neural progenitor cells (NPCs) using immunofluorescence and Western blot analysis. Here we show for the first time that 4.1%, but not 2.0%, sevoflurane reduced mouse NPC proliferation, increased Glycogen synthase kinase-3β(GSK-3β) levels, and decreased levels of β-Catenin in mouse NPCs. The GSK-3β inhibitor Lithium attenuated the sevoflurane-induced reduction in mouse NPC proliferation. The data suggest that sevoflurane may reduce neurogenesis through the Wnt-catenin signaling pathway. These findings would promote further studies to investigate the effects of anesthesia on neurogenesis and function of learning and memory, as well as the underlying mechanisms in vitro and in vivo. Ultimately these efforts would lead to safer anesthesia care and better postoperative outcomes in children.

Practice variations in the conduct of hypothermic circulatory arrest for adult aortic arch repair: focus on an emerging European paradigm

INTRODUCTION

Hypothermic circulatory arrest for adult aortic arch repair is still high-risk. Despite decades of clinical experience, significant practice variations exist around the world. These practice variations in hypothermic circulatory arrest may offer multiple opportunities to improve practice. The hypothesis of this study was that the current conduct of adult hypothermic circulatory arrest in Europe has significant variations that might suggest opportunities for risk reduction.

METHODS

An adult hypothermic circulatory arrest questionnaire was developed and then administered at thoracic aortic sessions at international conferences during 2010 in Beijing and Milan. The data was collected, abstracted and analyzed.

RESULTS

The majority of the 105 respondents were anesthesiologists based in Europe and China. The typical adult aortic arch repair in Europe was with hypothermic circulatory arrest at moderate hypothermia utilizing bilateral antegrade cerebral perfusion, typically monitored with radial arterial pressure and cerebral oximetry. Brain temperature was frequently measured at distal locations. The preferred neuroprotective agents were steroids, propofol and thiopental.

CONCLUSIONS

The opportunities for outcome improvement in this emerging European paradigm of tepid adult aortic arch repair include nasal/tympanic temperature measurement and adoption of unilateral antegrade cerebral perfusion monitored with radial artery pressure and cerebral oximetry. The publication of an evidence-based consensus would enhance these practice-improvement opportunities.

Isoflurane facilitates synaptic NMDA receptor endocytosis in mice primary neurons

Inhalation anesthetic isoflurane has been reported to induce caspase activation and accumulation of β-amyloid (Aβ), however, the down-stream consequences of these effects are largely unknown. Isoflurane has also been shown to impair learning and memory, however, the up-stream mechanisms of these effects remain largely to be determined. Facilitation of synaptic NMDA receptor endocytosis can reduce synaptic function, leading to learning and memory impairment. We therefore set out to determine the effects of isoflurane on synaptic NMDA receptor endocytosis. Primary neurons from wild-type and Alzheimer's disease transgenic mice were treated with 2% isoflurane for six hours. Synaptic surface levels of NMDA receptor 2B (NR2B) and NR2B internalization were determined by surface and cleavable biotinylation assay, western blot analysis and immunofluorescence. Here we show that isoflurane can induce caspase-3 activation, increase levels of β-site amyloid precursor protein-cleaving enzyme and cause accumulation of Aβ in the primary neurons. Isoflurane facilitates synaptic NR2B endocytosis as evidenced by reducing surface NR2B levels, increasing NR2B internalization, and decreasing the ratio of synaptic surface NR2B to synapsin in mice primary neurons. Moreover, caspase activation inhibitor Z-VAD and γ-secretase inhibitor L-685,458 attenuated the isoflurane-facilitated NR2B endocytosis. These results suggest that isoflurane induces caspase activation and Aβ accumulation, leading to facilitation of synaptic NMDA receptor endocytosis, which potentially serve as the upstream mechanism of the isoflurane-induced impairment of learning and memory. These findings will encourage further studies to determine the underlying mechanism by which isoflurane and other anesthetics promote Alzheimer's disease neuropathogenesis and induce cognitive dysfunction.

Osteogenic differentiation of adipose-derived stem cells prompted by low-intensity pulsed ultrasound

OBJECTIVES

Based on in vivo studies, low-intensity pulsed ultrasound (LIPUS) stimulation has been widely used in the clinic for advancing bone growth during healing of non-union alignment, fractures and other osseous defects. In this study, we have investigated osteogenic differentiation of adipose stem cells (ASCs) regulated by LIPUS, and also in a preliminarily manner, we have discussed diverse effects of different duty ratio parameters.

MATERIALS AND METHODS

Mouse adipose stem cells were isolated and osteogenically induced. Then they were treated with LIPUS for 10 min/day for 3 days, 5 days and 7 days, respectively. Finally, effects of LIPUS on osteogenic differentiation of the ASCs were analysed by real-time PCR, western blotting and immunofluorescence.

RESULTS

Our data indicated that LIPUS promoted mRNA levels of runt-related transcription factor 2, osteopontin and osterix in the presence of osteo-induction medium; moreover, protein levels of runt-related transcription factor 2 and osteopontin were upregulated.

CONCLUSIONS

We successfully demonstrated that LIPUS enhanced osteogenesis of ASCs, specially at the duty ratio of 20%.

Low-intensity pulsed ultrasound induced enhanced adipogenesis of adipose-derived stem cells

OBJECTIVE

The aim of this study was to investigate effects of low-intensity pulsed ultrasound (LIPUS) on differentiation of adipose-derived stem cells (ASCs), in vitro.

MATERIALS AND METHODS

Murine ASCs were treated with LIPUS for either three or five days, immediately after adipogenic induction, or delayed for 2 days. Expression of adipogenic genes PPAR-γ1, and APN, was examined by real-time PCR. Immunofluorescence (IF) staining was performed to test for PPAR-γ at the protein level.

RESULTS

Our data revealed that specific patterns of LIPUS up-regulated levels of both PPAR-γ1 and APN mRNA, and PPAR-γ protein.

CONCLUSIONS

In culture medium containing adipogenic reagents, LIPUS enhanced ASC adipogenesis.

Surgical incision induces phosphorylation of AMPA receptor GluR1 subunits at Serine-831 sites and GluR1 trafficking in spinal cord dorsal horn via a protein kinase Cγ-dependent mechanism

Spinal α-amino-3-hydroxy-5-methy-4-isoxazole propionate (AMPA) receptor plays an important role in acute pain induced by surgical tissue injuries. Our previous study has shown that the enhanced phosphorylation of AMPA receptor GluR1 subunits at Serine-831 sites by protein kinase C (PKC) in the spinal cord dorsal horn is involved in post-surgical pain hypersensitivity. However, which isoforms of PKC are responsible for the phosphorylation of AMPA receptor GluR1 subunits at Serine-831 sites remains to be established. In the present study, using an animal model of postoperative pain, we found that surgical tissue injuries enhanced the membrane translocation level of PKCγ, but not PKCα, βI, and βII, and induced the trafficking of GluR1, but not GluR2 into neuronal plasma membrane. Intrathecal (i.t.) pretreatment of small interfering RNA targeting PKCγ to reduce the PKCγ expression in the spinal cord significantly attenuated the pain hypersensitivity and inhibited the phosphorylation of AMPA receptor GluR1 subunits at Serine-831 sites as well as GluR1 membrane trafficking. Our study indicates that the surgical incision-induced phosphorylation of AMPA receptor GluR1 subunits at Serine-831 sites and GluR1 trafficking are regulated by a PKCγ-dependent mechanism.

Current conduct of deep hypothermic circulatory arrest in China

INTRODUCTION

Deep hypothermic circulatory arrest for adult aortic arch repair is still associated with significant mortality and morbidity. Furthermore, there is still significant variation in the conduct of this complex perioperative technique. This variation in deep hypothermic circulatory arrest practice has not been adequately characterized and may offer multiple opportunities for outcome enhancement. The hypothesis of this study was that the current practice of adult deep hypothermic circulatory arrest in China has significant variations that might offer therapeutic opportunities for reduction of procedural risk.

METHODS

An adult deep hypothermic circulatory arrest questionnaire was developed and then administered at a thoracic aortic session at the International Cardiothoracic and Vascular Anesthesia Congress convened in Beijing during 2010. The data was abstracted and analyzed.

RESULTS

The majority of the 56 respondents were anesthesiologists based in China at low-volume deep hypothermic circulatory arrest centers. The typical aortic arch repair had a prolonged deep hypothermic circulatory arrest time at profound hypothermia. The target temperature for deep hypothermic circulatory arrest was frequently measured distal to the brain. The most common perfusion adjunct was antegrade cerebral perfusion, typically monitored with radial arterial pressure and cerebral venous oximetry. The preferred neuroprotective agents were steroids and propofol.

CONCLUSIONS

The identified opportunities for outcome improvement in this delineated deep hypothermic circulatory arrest model include nasal/tympanic temperature measurement and routine cerebral perfusion, preferably with unilateral antegrade cerebral perfusion monitored with radial artery pressure and cerebral oximetry. Development and dissemination of an evidence-based consensus would enhance these practice-improvement opportunities.

Effect of greyscale liquid crystal displays of different resolutions on observer performance during detection of small solitary pulmonary nodules

OBJECTIVE

The aim of this study was to evaluate the effect of monochrome liquid crystal displays (LCDs) with different resolutions on observer performance during detection of small solitary pulmonary nodules.

METHODS

Chest images of digital radiography were selected online from the hospital's picture archiving and communication system. Of the 164 images selected, small solitary non-calcified pulmonary nodules were present in 63 images and absent in 101 images. Observer performance was assessed among 3 extremely experienced, 3 very experienced and 3 moderately experienced radiologists, who independently interpreted these images on 2, 3 and 5 megapixel greyscale LCDs. A five-point confidence level rating scale was used to represent the presence of nodules: definite absence, probable absence, indetermination, probable presence and definite presence. The observers were requested to rank each image on the given display according to the presence of the pulmonary nodule. Observer performance was analysed in terms of receiver operating characteristics (ROCs).

RESULTS

The areas under the ROC curves which represented the observer performance for the 2, 3 and 5 megapixel LCDs were found to be 0.705, 0.722 and 0.764, respectively, for the extremely experienced radiologists; 0.687, 0.712 and 0.721, respectively, for the very experienced radiologists; and 0.689, 0.696 and 0.711, respectively, for the moderately experienced radiologists. These differences were not statistically significant.

CONCLUSION

The observer performances for detection of small solitary non-calcified pulmonary nodules by radiologists with varying degrees of experience were comparable between the 2, 3 and 5 megapixel monochrome LCDs.