Hypoxic Air Inhalation and Ischemia Interventions Both Elicit Preconditioning Which Attenuate Subsequent Cellular Stress In vivo Following Blood Flow Occlusion and Reperfusion

Cross-adaptation from heat stress to hypoxia: A systematic review and exploratory meta-analysis

Cross-adaptation (CA) refers to the successful induction of physiological adaptation under one environmental stressor (e.g., heat), to enable subsequent benefit in another (e.g., hypoxia). This systematic review and exploratory meta-analysis investigated the effect of heat acclimation (HA) on physiological, perceptual and physical performance outcome measures during rest, and submaximal and maximal intensity exercise in hypoxia. Database searches in Scopus and MEDLINE were performed. Studies were included when they met the Population, Intervention, Comparison, and Outcome criteria, were of English-language, peer-reviewed, full-text original articles, using human participants. Risk of bias and study quality were assessed using the COnsensus based Standards for the selection of health status Measurement INstruments checklist. Nine studies were included, totalling 79 participants (100 % recreationally trained males). The most common method of HA included fixed-intensity exercise comprising 9 ± 3 sessions, 89 ± 24-min in duration and occurred within 39 ± 2 °C and 32 ± 13 % relative humidity. CA induced a moderate, beneficial effect on physiological measures at rest (oxygen saturation: g = 0.60) and during submaximal exercise (heart rate: g = -0.65, core temperature: g = -0.68 and skin temperature: g = -0.72). A small effect was found for ventilation (g = 0.24) and performance measures (peak power: g = 0.32 and time trial time: g = -0.43) during maximal intensity exercise. No effect was observed for perceptual outcome measures. CA may be appropriate for individuals, such as occupational or military workers, whose access to altitude exposure prior to undertaking submaximal activity in hypoxic conditions is restricted. Methodological variances exist within the current literature, and females and well-trained individuals have yet to be investigated. Future research should focus on these cohorts and explore the mechanistic underpinnings of CA.

Two are better than one? The impact of lay birth companions on childbirth experiences and PTSD

Although continuous support during childbirth is recommended by the World Health Organization (WHO) and has well-established benefits, the practice is still not routinely implemented in all maternity settings. We studied the possible effect of an additional lay companion (other than the partner) on childbirth experience and postpartum post-traumatic stress disorder (PTSD). Two hundred and forty-six women, who gave birth in maternity wards of a large tertiary health center in Israel, responded to questionnaires in person at 1-4 days (Demographic questions and the childbirth experience questionnaire) and on-line at 8-10 weeks postpartum (City Birth Trauma Scale). Obstetric data were taken from the medical files. Women who were accompanied by their partners and an additional companion were lower in birth-related PTSD symptoms (M = 1.17, SD = 2.61) than women accompanied by only their partner (M = 1.53, SD = 2.79) (F(2, 240) = 4.0, p < 0.05). Women who had a single companion (M = 1.44, SD = 2.61) showed more birth-related PTSD symptoms than women who had two or more companions (M = 1.17, SD = 2.52) (F(1, 241) = 6.4, p < 0.05). In addition, women who had a single companion were higher in general PTSD symptoms (M = 3.91, SD = 4.73) than women who had two or more companions (M = 2.31, SD = 4.29) (F(1, 241) = 4.2, p < 0.05). No differences were found in childbirth experiences of women with single or multiple companions. Allowing more than one lay companion (other than the partner) may be a simple cost-effective way of providing beneficial support in all birth settings, promoting respectful maternity care and reducing childbirth-related PTSD levels and by that future psychopathology sequela.

Postpartum depression and postpartum post-traumatic stress disorder: prevalence and associated factors

BACKGROUND

Despite the increased global interest from researchers in postpartum depression (PPD) and postpartum post-traumatic stress disorder (PP-PTSD), studies of PPD in China have shown a wide range of variability. Indeed, the prevalence and risk factors for PP-PTSD have received little attention in China.

AIM

To determine the prevalence of PPD and PP-PTSD in China, and to examine the relationships between a range of sociodemographic, pregnancy-related, and newborn-related variables, and PPD and PP-PTSD.

METHODS

A cross-sectional study involving 1136 women who returned to the obstetrics clinic for routine postpartum examination were enrolled. The sociodemographic, pregnancy-related, and newborn-related characteristics were collected. Social support, and PPD and PP-PTSD symptoms were measured by the Perceived Social Support Scale (PSSS), the Edinburgh Postnatal Depression Scale (EPDS), and the Perinatal Post-traumatic Stress Questionnaire (PPQ).

RESULTS

The prevalence rates of PPD and PP-PTSD symptoms were 23.5 and 6.1%, respectively. A multivariate model showed that the presence of PP-PTSD was the strongest risk factor for PPD symptoms and vice versa. Other risk factors for PPD included low sleep quality, low social support and newborn's incubator admission. In terms of PP-PTSD symptoms, risk factors included the presence of PPD symptoms, non-Han ethnicity, and low social support, while having one child was a protective factor.

CONCLUSIONS

This study addressed some gaps in the literature and provided a better understanding of PPD and PP-PTSD in China, which may contribute to early detection and intervention. Attention should be paid to women who are most susceptible to PPD and/or PP-PTSD, including those with low social support, low sleep quality, newborn's incubator admission, non-Han ethnicity, and women with siblings.

Post-traumatic stress disorder following childbirth

BACKGROUND

Childbirth experience could be complicated and even traumatic. This study explored the possible risk factors for post-traumatic stress disorder following childbirth (PTSD-FC) in mothers and partners.

METHODS

Through a cross-sectional online survey biographical, medical, psychological, obstetrical and trauma history data were collected. The PTSD-FC, postnatal depression, social support, and perceived mother-infant bond in 916 mothers and 64 partners were measured through self-reported psychometric assessments.

RESULTS

Our findings highlight the possible impact of several risk factors such as emergency childbirth, past traumatic experiences and distressing events during childbirth on PTSD-FC. The difficulties in mother-infant bond and the postpartum depression were highly associated with the total score of PTSD-FC symptoms for mothers. While for partners, post-partum depression was highly associated with the total score of PTSD-FC.

CONCLUSIONS

Our study demonstrated significant links between psychological, traumatic and birth-related risk factors as well as the perceived social support and the possible PTSD following childbirth in mothers and partners. Given that, a specific attention to PTSD-FC and psychological distress following childbirth should be given to mothers and their partners following childbirth.

Effects of a psychological nursing intervention on prevention of anxiety and depression in the postpartum period: a randomized controlled trial

BACKGROUND

Anxiety and postpartum depression are the most common psychological problems in women after delivery. Cognitive behavior intervention has been reported to have an effect in the therapy of postpartum depression. This research aimed to investigate whether cognitive behavior intervention could prevent the pathogenesis of postpartum depression in primiparous women.

METHODS

In this randomized controlled trial, primiparous women who were prone to postpartum depression were recruited. Participates in the control group received routine postpartum care and those in the intervention group received both routine postpartum care and cognitive behavior intervention. Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Edinburgh Postpartum Depression Scale (EPDS) and Pittsburgh Sleep Quality Index (PSQI) were evaluated before and after the intervention.

RESULTS

In the intervention group, the post-intervention scores of HAMA, HAMD, EPDS and PSQI were all significantly lower than the baseline scores (p = 0.034, p = 0.038, p = 0.004, p = 0.014, respectively). The proportion of participants with postpartum depression in the intervention group (11.5%) was significantly lower than the control group (24.3%) after the 6-week intervention. Participants in the intervention group were significantly more satisfied with the care than those in the control group (p = 0.032).

CONCLUSION

This research provided evidence that cognitive behavioral intervention in postpartum period could alleviate anxiety and depression in primiparous women, and inhibit the pathogenesis of postpartum depression. Trial registry This clinical trial was registered in the Chinese Clinical Trial Registry (ChiCTR2000040076).

Association of sexual assault history with traumatic childbirth and subsequent PTSD

Although childbirth-related posttraumatic stress (CB-PTSD) has received recognition, how sexual assault (SA) history influences obstetrical and traumatic stress outcomes remains unclear. Six hundred eighty-three women provided information about their childbirth and mental health. Obstetric complications and unplanned cesareans were more prevalent among women with SA history. They also had higher rates of probable CB-PTSD and were two times more likely to have premature deliveries than women without SA history. Screening women for history of sexual trauma is warranted to optimize birth outcomes.

Perception of childbirth experiences of Japanese women in Bali, Indonesia: a qualitative study

Background

Maternal healthcare services in Indonesia have seen dramatic improvements over the past 25 years and yet there is still room for improvement. The perception, by the women, of the perinatal care provided, is a vital input to further improving these services. This study examines how the perinatal care provided is experienced by Japanese women in Bali, using an interview survey.

Methods

We conducted semi-structured interviews, from August to October 2017, with 14 Japanese women living in Badung Regency and Denpasar City in Bali Province, Indonesia to report their perception of the perinatal care they experienced during their pregnancies. The interview guide included among others, the reasons for choosing specific (perinatal care) health facilities and their satisfaction with their experience of using the antenatal, delivery, and postnatal care services. The data were analysed using the qualitative content analysis method.

Results

From the interview data, 12 categories across five themes were extracted. Participants reported experiencing various concerns during their pregnancies such as difficulty in obtaining perinatal care related information. From the beginning of their pregnancies, participants gradually established trusting relationships with midwives, but in many situations, they were disappointed with their childbirth experiences, as they felt that the care provided was not woman-centred. Through their own efforts and with the support of family members and other Japanese residents, many women were able to eventually regard their childbirth experiences as positive. Nevertheless, some women could not overcome their negative impressions even years after childbirth.

Conclusions

Participants desired close attention and encouragement from nurses and midwives. Our results suggest that Japanese women in Bali expected a woman-centred perinatal care and active support from nursing/midwifery staff during their pregnancies and postnatal care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-020-03466-x.

Exosomal circHIPK3 Released from Hypoxia-Pretreated Cardiomyocytes Regulates Oxidative Damage in Cardiac Microvascular Endothelial Cells via the miR-29a/IGF-1 Pathway

Background/Aims

Circular RNAs (circRNAs) are a class of endogenous noncoding RNAs that regulate gene expression in eukaryotes. Recently, exosomes from cardiomyocytes (CMs) have been found to facilitate cell proliferation and survival by transporting various bioactive molecules, including circRNA. However, the functions of exosomal circRNAs are not clear. The present research is aimed at determining whether circHIPK3 released from hypoxia-pretreated CMs is transferred into cardiac microvascular endothelial cells (CMVECs) by exosomes and becomes functionally active in the CMVECs under oxidative stress conditions.

Methods

Quantitative polymerase chain reactions were conducted to detect the expression pattern of circHIPK3 in CMVECs under oxidative stress. Annexin V-FITC/propidium iodide (PI) staining assays, TUNEL assays, ROS assays, and Western blot analysis were conducted to detect the role of exosomal circHIPK3 in CMVEC function in vitro. Luciferase activity assays and RNA immunoprecipitation studies were conducted in vitro to reveal the mechanism of circHIPK3-mediated CMVEC function.

Results

circHIPK3 expression was significantly upregulated in hypoxic exosomes (HPC-exos) compared with normoxic exosomes (Nor-exos). Moreover, HPC-exos induced stronger antioxidant effects than Nor-exos. The silencing or overexpression of circHIPK3 changed CMVEC survival under oxidative conditions in vitro. Furthermore, circHIPK3 silencing in HPC-exos abrogated the protective effects of HPC-exos in CMVECs, as shown by increased levels of apoptosis, ROS, MDA, and proapoptotic proteins. circHIPK3 acted as an endogenous miR-29a sponge to sequester and inhibit miR-29a activity, which led to increased IGF-1 expression. The ectopic expression of miR-29a mimicked the effect of circHIPK3 silencing in CMVECs in vitro.

Conclusions

circHIPK3 in HPC-exos plays a role in CMVECs under oxidative conditions through miR-29a-mediated IGF-1 expression, leading to a decrease in oxidative stress-induced CMVECs dysfunction. These data suggest that the exosomal circRNA in CMs is a potential target to control CMVECs dysfunction under oxidative conditions.

The childbirth experience: obstetric and psychological predictors in Italian primiparous women

BACKGROUND

The experience of childbirth crucially impacts a mother's psychological well-being and the mother-infant relationship. It is recognised that negative births can be linked to different forms of discomfort, both for the mother as well as for the infant. This prospective longitudinal study aimed to study the effect of obstetric and psychological variables on women's subjective experience of childbirth.

METHODS

111 primiparous Italian women completed a set of questionnaires at 38-40 weeks of pregnancy (Time 1) and 1-5 days after childbirth (Time 2). Sociodemographic and obstetric information were collected. Data about the childbirth were obtained from the mother's ward birth records. Women completed the Wijma Delivery Expectancy/Experience Questionnaire both before and after childbirth.

RESULTS

The subjective experience of birth was significantly predicted by the duration of the expulsive phase (β = .26; p < .05), the use of epidural analgesia (β = .21;  p< .05) and by fear of birth (β = .21; p < .05). The effect of mode of birth and duration of the dilatation phase on women's birth experience was not found.

CONCLUSIONS

In our study, neither instrumental childbirth nor caesarean section have a significant effect on women's birth experience. Instead, both a longer expulsion phase and epidural analgesia contribute to the negative experience. Moreover, the higher the fear of birth, the worse the women's emotional experience. These findings confirmed the role of obstetric and psychological variables on birth experience. More investigation about this topic could be useful to develop specific interventions to prepare women for birth.

Childhood adversity and sleep are associated with symptom severity in perinatal women presenting for psychiatric care

This study leverages psychiatric intake data from treatment-seeking perinatal women aiming to explore the understudied associations between childhood adversity, sleep quality, and severity of perinatal mental illness in this population. The sample is 578 perinatal women presenting for initial evaluation to a university-based perinatal psychiatry clinic. At intake, we collected demographics, adverse childhood experiences (ACEs), sleep quality, and diagnosis and symptom severity of depression, anxiety, and posttraumatic stress disorder (PTSD). Clinician-rated diagnoses showed that 65% of women met criteria for major depression, 23% for generalized anxiety disorder and 4% for PTSD; almost 30% of women had childhood adversity and 98.2% reported poor perinatal sleep quality. Regression analyses revealed differential associations between ACEs and sleep quality and perinatal mood symptoms; ACEs were significantly associated with pregnancy and postpartum PTSD, whereas sleep quality was associated with perinatal depression and generalized anxiety. Screening for ACEs and sleep quality during perinatal intake has high clinical utility, as these two factors significantly contribute to symptom severity across peripartum.

Acquired Resilience: An Evolved System of Tissue Protection in Mammals

This review brings together observations on the stress-induced regulation of resilience mechanisms in body tissues. It is argued that the stresses that induce tissue resilience in mammals arise from everyday sources: sunlight, food, lack of food, hypoxia and physical stresses. At low levels, these stresses induce an organised protective response in probably all tissues; and, at some higher level, cause tissue destruction. This pattern of response to stress is well known to toxicologists, who have termed it hormesis. The phenotypes of resilience are diverse and reports of stress-induced resilience are to be found in journals of neuroscience, sports medicine, cancer, healthy ageing, dementia, parkinsonism, ophthalmology and more. This diversity makes the proposing of a general concept of induced resilience a significant task, which this review attempts. We suggest that a system of stress-induced tissue resilience has evolved to enhance the survival of animals. By analogy with acquired immunity, we term this system 'acquired resilience'. Evidence is reviewed that acquired resilience, like acquired immunity, fades with age. This fading is, we suggest, a major component of ageing. Understanding of acquired resilience may, we argue, open pathways for the maintenance of good health in the later decades of human life.

miR‑133b‑5p contributes to hypoxic preconditioning‑mediated cardioprotection by inhibiting the activation of caspase‑8 and caspase-3 in cardiomyocytes

In a previous study using a microRNA (miRNA/miR) microarray assay, we demonstrated that miR-133b-5p was upregulated in response to hypoxic preconditioning (HPC). The present study was designed to investigate the role of the miR‑133b‑5p in HPC‑induced cardioprotection and the underlying mechanisms involving caspase‑8 and caspase‑3 apoptotic signaling. Adult rats were subjected to myocardial ischemia/reperfusion (I/R) injury with or without ischemic preconditioning (IPC), and the level of miR‑133b‑5p in myocardium was measured. Neonatal rat cardiomyocytes were isolated and subjected to hypoxia/reoxygenation (H/R) injury, with or without HPC. miR‑133b‑5p antagomir was transfected into the cardiomyocytes to observe whether it could block HPC‑induced cardioprotection. Cellular injury was evaluated by detecting cell viability, lactate dehydrogenase (LDH) activity and apoptotic rate. Reverse transcription‑quantitative polymerase chain reaction was used to measure the level of miR‑133b‑5p. The activation of caspase‑8 and caspase‑3 were measured by western blot analysis to detect the cleaved fragments as well as a colorimetric assay. Following myocardial I/R injury, the expression of miR‑133b‑5p was decreased in myocardium, while this decrease was restored by IPC. HPC protected neonatal rat cardiomyocytes against H/R injury by increasing cell viability, while reducing LDH release and cell apoptosis. These protective effects were coupled with the upregulation of miR‑133b‑5p. However, the knockdown of miR‑133b‑5p in the cardiomyocytes blocked HPC‑mediated cardioprotection as reflected by the aggravation of cell injury and apoptosis. HPC upregulated miR‑133b‑5p level was markedly suppressed by the antagomir. In addition, the cleavage and activities of caspase‑8 and caspase‑3 were inhibited by HPC while reversed by knockdown of miR‑133b‑5p. Upregulation of miR‑133b‑5p contributes to HPC‑mediated cardioprotection in cardiomyocytes, and the mechanism may be associated with inhibition of caspase‑8 and caspase‑3 apoptotic signaling.