Beyond boundaries: The therapeutic potential of exosomes in neural microenvironments in neurological disorders.

Neurological disorders are a diverse group of conditions that can significantly impact individuals' quality of life. The maintenance of neural microenvironment homeostasis is essential for optimal physiological cellular processes. Perturbations in this delicate balance underlie various pathological manifestations observed across various neurological disorders. Current treatments for neurological disorders face substantial challenges, primarily due to the formidable blood-brain barrier and the intricate nature of neural tissue structures. These obstacles have resulted in a paucity of effective therapies and inefficiencies in patient care. Exosomes, nanoscale vesicles that contain a complex repertoire of biomolecules, are identifiable in various bodily fluids. They hold substantial promise in numerous therapeutic interventions due to their unique attributes, including targeted drug delivery mechanisms and the ability to cross the BBB, thereby enhancing their therapeutic potential. In this review, we investigate the therapeutic potential of exosomes across a range of neurological disorders, including neurodegenerative disorders, traumatic brain injury, peripheral nerve injury, brain tumors, and stroke. Through both in vitro and in vivo studies, our findings underscore the beneficial influence of exosomes in enhancing the neural microenvironment following neurological diseases, offering promise for improved neural recovery and management in these conditions.

Launching continuous kangaroo mother care through participatory action research in Iran.

BACKGROUND: This study describes the launching of a unit for continuous kangaroo mother care (KMC) in a teaching hospital (Taleghani) in Iran. METHODS: We used a participatory three-stage action research approach to establish a unit for continuous KMC: design (needs identification and planning for change); implementation (and reflection); and evaluation (and institutionalization). As part of the design and implementation stages, individual and focus group interviews were conducted with mothers, physicians, nurses, other healthcare personnel and policy makers. The evaluation was done by means of a standardized tool specifically developed for monitoring progress with the implementation of KMC. RESULTS: Four themes relating to potential barriers to implementation emerged from the analysis of the staff interviews, namely barriers associated with the mother, the father, the physician and the health system. Mothers' experiences of barriers were grouped into five themes: personal discomfort, fear, healthcare provider attitudes and actions, infrastructure constraints and family matters. An implementation progress score of 27.05 out of 30 was achieved, indicating that the continuous KMC unit was on the path to institutionalization. Some of the gaps identified related to policies on resource allocation, the discharge and follow-up system, and the transportation of infants in the KMC position. CONCLUSION: The study findings indicated that participatory action research is a suitable method for studying the establishment of a continuous KMC unit. When action research is practiced, there is a prospect of turning knowledge into action in the real world.

KMC by surrogate can have an effect equal to KMC by mother in improving the nutritional behavior and arterial oxygen saturation of the preterm infant: results of a controlled randomized clinical trial.

BACKGROUND: The aim of this study was to investigate the effect of kangaroo mother care (KMC) by mother and her surrogate on nutritional behavior and physiological function of preterm neonates. METHOD: This study was a randomized, controlled clinical trial conducted on 70 preterm infants admitted to the NICU. For the neonates of the intervention group, KMC was performed (by mother and surrogate) 3 times a day and the neonates of the control group received KMC by the mother 3 times a day for up to 4 days and 60 minutes each time. The primary outcome was to compare the effect of KMC by mother and surrogate on the feeding behavior measured by preterm infant breastfeeding behavior scale (PIBBS), and the secondary outcome was to compare the effect of KMC by mother and surrogate on physiological outcomes. RESULT: The score of the PIBBS in both groups increased significantly during 4 days, this difference was not significant between the groups. [Adjusted mean difference (95% Confidence interval), 0.66 (- 2.36 to 1.03), P = 0.438]. Within the group, among the physiological functions, only O2 saturation had significantly increased during the study. This increase, however, was not statistically different between the two groups. [Adjusted mean difference (95% Confidence interval), 0.102 (- 0.68 to 0.88), P = 0.761]. CONCLUSION: When the mother is unable to provide this type of care, it can be provided by the surrogate that is as effective as the mother in improving arterial oxygen saturation and the feeding behavior of the preterm neonates. TRIAL REGISTRATION: IRCT20150424021917N10 . Registered 22/04/ 2020.

Development a coordination polymer based nanosensor for phenobarbital determination in exhaled breath condensate.

In this study, a fluorometric probe based on luminol-terbium coordination polymer nanoparticles (luminol-Tb CP NPs) is validated for the quantification of phenobarbital in the exhaled breath condensate collected from expiratory circuit of the mechanical ventilator (MVEBC). It relies on the coordination of phenobarbital to luminol-Tb CP NPs which casing an aggregation-induced fluorescence enhancement of probe owing to the increasing the system rigidity and the decreasing the nonradiative decay rate. As the increase in response intensity is proportional to phenobarbital amount, a method is offered for its determination in MVEBC. This method presents a linear relationship with phenobarbital concentration in the range of 0.1-10.0 mg.L-1 with a limit of detection of 0.024 mg.L-1 and the relative standard deviation of 3.6%. The proposed method is used in MVEBC of the pre-term newborn babies receiving phenobarbital under mechanical ventilator.

Effect of Vaginal Delivery on Lactose Content of Human Milk.

OBJECTIVE: The macronutrients of human milk are considered essential nutritional sources in the first few months of a newborn's life. The present study aimed to investigate the effect of delivery mode on the macronutrients of human milk. METHODS: This retrospective cohort study was conducted on 102 women who gave birth by cesarean section or vaginal delivery between September 2019 and November 2019. The participants were requested to provide their milk samples on day 15 ± 1 after childbirth. RESULTS: There were no significant differences between the two groups (cesarean and vaginal delivery) regarding the sociodemographic characteristics and intake of fat, carbohydrate, protein, and energy. The lactose level was significantly higher in women who gave birth by vaginal delivery (adjusted mean difference, 1.2 (95 % CI 0.02- 1.82)). For other macronutrients, there were no statistically significant differences between the two groups. CONCLUSION: The vaginal delivery might influence the mature milk lactose level.

Short-term Outcomes of Launching Mother's Milk Bank in Neonatal Intensive Care Unit: A Retrospective Study.

BACKGROUND: The WHO and UNICEF have suggested pasteurized donor milk (PDM) as the best alternative for infants who do not receive enough milk from their mothers. Objective: This study aimed to assess the short-term outcomes of launching the first mother's milk bank in North-West of Iran. METHODS: The present retrospective study included 366 premature infants (181 pre-launch and 185 post-launch) who were hospitalized in Al-Zahra Hospital of Tabriz, Iran. The study included infants with birth weight ˂2000 g and/or gestation age ˂32 weeks who were born before and after the launch of mother's milk bank. Frequency of necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), late onset sepsis (LOS) and mortality rate were compared. Data were analyzed using SPSS 23 with the chi-square test, Fisher exact test, independent t test, and logistic regression test. RESULTS: In total, NEC grade ≥2 was reported in 9 cases; 8 cases (4.41%) in pre-launch and one case (0.54%) in post-launch (adjusted OR=0.091; 95% CI=0.010 to 0.849, P=0.035). ROP was reported in 21 cases in two groups. Nineteen cases (10.5%) belonged to the pre-launch group and 2 cases (3.7%) to the post-launch group (adjusted OR=0.105; 95% CI=0.022 to 0.488, P=0.004). LOS was also found in 17 cases (9.39%) in the pre-launch group and 4 cases (2.16%) in the post-launch period, suggesting a significant difference between the two groups (adjusted OR=0.297; 95%CI=0.089 to 0.995, P=0.049). There was no significant difference in mortality of infants during hospitalization between the two groups (P=0.789); however, it was decreased from 15 to 8. CONCLUSION: Launching the human milk bank significantly improved the outcomes of premature infants.

Maintaining human milk bank services throughout the COVID-19 pandemic: A global response.

If maternal milk is unavailable, the World Health Organization recommends that the first alternative should be pasteurised donor human milk (DHM). Human milk banks (HMBs) screen and recruit milk donors, and DHM principally feeds very low birth weight babies, reducing the risk of complications and supporting maternal breastfeeding where used alongside optimal lactation support. The COVID-19 pandemic has presented a range of challenges to HMBs worldwide. This study aimed to understand the impacts of the pandemic on HMB services and develop initial guidance regarding risk limitation. A Virtual Collaborative Network (VCN) comprising over 80 HMB leaders from 36 countries was formed in March 2020 and included academics and nongovernmental organisations. Individual milk banks, national networks and regional associations submitted data regarding the number of HMBs, volume of DHM produced and number of recipients in each global region. Estimates were calculated in the context of missing or incomplete data. Through open-ended questioning, the experiences of milk banks from each country in the first 2 months of the pandemic were collected and major themes identified. According to data collected from 446 individual HMBs, more than 800,000 infants receive DHM worldwide each year. Seven pandemic-related specific vulnerabilities to service provision were identified, including sufficient donors, prescreening disruption, DHM availability, logistics, communication, safe handling and contingency planning, which were highly context-dependent. The VCN now plans a formal consensus approach to the optimal response of HMBs to new pathogens using crowdsourced data, enabling the benchmarking of future strategies to support DHM access and neonatal health in future emergencies.

The Therapeutic Applications of Exosomes in Different Types of Diseases: A Review.

Exosomes are nano-sized vesicles secreted by nearly all cells and have received massive attention recently. In addition to their roles in pathophysiological processes and diagnostic evaluations, recently, several studies have applied exosomes to design novel therapeutic applications. Exosomes can be derived from a variety of cells and tissues and based on the source, they can carry different native contents such as DNAs, non-coding small RNAs, mRNAs, and proteins. They can also be engineered by adding desirable agents including specific biomolecules or drugs. Both forms can be therapeutically used for delivering their cargoes to the target cells and desirably alter their functions. The present study aimed to provide a comprehensive review of the various studies which applied exosomes as a therapeutic tool in the treatment of different types of diseases including cancer, cardiovascular, neurologic, psychiatric, liver, and kidney diseases.

The Role of Infant Sex on Human Milk Composition.

Objective: Human milk (HM) is the most necessary and complete food for infants and their survival. It is a dynamic system influenced by different factors such as the sex of the infant. The study of the factors affecting the composition of mother's milk can provide us better insight into the nutritional needs of infants with different sex and improve the nutrition of babies who do not have access to HM. This study aimed to study the effects of infant sex on mother's milk composition. Methods: Sixty-one mother's milk samples were collected from mothers with female or male infants and divided into two (32 sons, 29 daughters) groups. The samples were analyzed by the Lacto-Scan milk analyzer and the obtained data were compared between the groups. Results: The results showed that the mean fat content in the milk samples of mothers with female infants (daughters group) (3.42 ± 1.80%) was significantly (p = 0.029) higher than that in mothers with male infants (sons group) (2.53 ± 1.18%). However, the sons group had higher (p = 0.024) levels of salts (0.76 ± 0.14%) compared with the daughters group (0.67 ± 0.18%). There was no significant (p > 0.05) difference in other indices between the groups. Conclusions: The sex of the infant is one of the important factors affecting the composition of mother's milk. The difference in the composition of mother's milk may reflect the differences in metabolic substrate needed for optimal growth and development in female and male infants.

Neonatal Intensive Care Unit Nurses' Perceptions and Knowledge of Newborn Individualized Developmental Care and Assessment Program: A Multicenter Study.

BACKGROUND: The newborn individualized developmental care and assessment program (NIDCAP) is a new multifaceted approach, which is developmentally and functionally supportive of health especially in premature newborns at the neonatal intensive care unit (NICU). This study is designed for assessing the knowledge and perception of nurses as the most important members of the multidisciplinary team of NIDCAP about this program. MATERIALS AND METHODS: This cross-sectional study was conducted on 120 nurses working in the NICUs of Alzahra, Taleghani, and Children hospitals affiliated to the educational and treatment centers of Tabriz University of Medical Sciences as well as 29 Bahman Hospital affiliated to Tabriz Social Security Organization in 2016 using census sampling method. Three questionnaires were employed to collect demographic data and to explore the nurses' perceptions and knowledge of the NIDCAP program. RESULTS: Findings of the study indicated that the mean (SD) nurses' knowledge and perception scores for NIDCAP were 71.83 (1.64) and 76.80 (0.79), respectively. In the terms of knowledge, significant differences were found with regard to being married (t = -2.39, p < 0.019), having an MSc degree (t = -2.14, p = 0.034), and employment experience (t = -3.38, p = 0.001). However, there was no significant relationship between perception and demographic variables (p > 0.05), nor was there any significant relationship between perception and knowledge (p = 0.275). CONCLUSIONS: The results of this study showed that the majority of nurses participating in the study had high knowledge about NIDCAP.

The effects of enteral artificial amniotic fluid-containing erythropoietin on short term outcomes of preterm infants.

Hosseini M, Azampour H, Raeisi S, Behtari M, Valizadeh H, Saboohi R. The effects of enteral artificial amniotic fluid-containing erythropoietin on short term outcomes of preterm infants. Turk J Pediatr 2019; 61: 392-398. Necrotizing Enterocolitis (NEC) is a common devastating gastrointestinal disease, which usually develops in premature infants. Erythropoietin (EPO) as a hematopoietic hormone produced by the kidney can also be naturally found in amniotic fluid and breast milk. There is some evidence that supports the contribution of EPO in the prevention of inflammation and intestinal tissue repair. This study was aimed to determine if oral administration of artificial amniotic fluid with or without EPO would protect preterm infants against NEC and improve the certain neonatal outcomes. In this study, 150 preterm infants with gestational age 28 weeks or less and birth weight 1250 grams or less were enrolled. The infants were divided randomly into 3 groups: 1) Control group (n=50) with routine feeding protocol without any administration; 2) Amniotic fluid group (n=50) with 5mL/kg synthetic amniotic fluid; 3) EPO group (n=50) with RhuEPO dissolved in the synthetic amniotic fluid. The administrations of the study solution were started 3 days after the birth and were continued for 3 weeks (21 days). The infants in the study groups were followed up until discharge and the frequency of NEC, mortality, and other complications of the disease among the groups were compared. The mortality rate in preterm infants of the amniotic fluid and EPO groups were significantly lower than in the control group (p=0.027). We couldn`t find any significant differences in the frequency of NEC and other complications among the three study groups. The administration of synthetic amniotic fluid (with or without EPO) in preterm infants may decrease the mortality rate. Use of EPO in synthetic amniotic fluid did not affect the frequency of NEC.

Evaluation of the Freeze-Thawing Method in Reducing Viral Load of Cytomegalovirus in Breast Milk of Mothers of Preterm Infants.

BACKGROUND: The aim of this study was to evaluate the freeze-thawing method in reducing viral load of cytomegalovirus (CMV) in breast milk of mothers of preterm infants. MATERIALS AND METHODS: In this study, 169 nursing mothers of preterm infants were evaluated serologically for CMV infection. We found 29 (17.15%) nursing mothers who had serologic evidence of CMV infections consistent with recent infection (N = 2, IgG + IgM +) or prior infection (N = 27 IgG + IgM-). Two to 6 weeks after delivery, breast milk of seropositive mothers (N = 29) was evaluated for CMV load by real-time polymerase chain reaction (PCR) before and after freezing at -20°C for 72 hours. All preterm infants with milk results positive for DNA particles of CMV (N = 25) were followed up for signs and symptoms of CMV infection until 3 months of age, together with urine testing for CMV by real-time PCR. RESULTS: Examination of breast milk by real-time PCR of the seropositive mothers showed 25 of them with CMV DNA particles in their breast milk. After freezing and thawing, we found virus DNA in 4 of 25 (16%) of the breast milk samples and there was no CMV DNA particles in 21 (84%) of them. In these samples, mean viral load before freezing was 76.04 ± 34.08 copies/µL (20-135.00 copies/µL) and after freezing it was 6.75 ± 4.34 copies/µL (0.00-13.00 copies/µL). Freezing showed a significant decrease in viral load of the samples (p = 0.001). CONCLUSION: The study showed that the freeze-thawing method is an effective method in reducing the CMV load in breast milk samples.

The effects of an educational and supportive relactation program on weight gain of preterm infants.

INTRODUCTION: Re-establishing breastfeeding (relactation) is necessary in preterm infants who are deprived of breastfeeding due to hospitalized in the neonatal intensive care unit (NICU). Although NICU nurses train mothers about breastfeeding and relactation to some degree, there exists a lack of support or evaluation for restarting breastfeeding. The present study tried to determine the effects of an educational and supportive relactation program on weight gain of preterm infants. METHODS: This clinical trial study was performed on 60 preterm infants with mean gestational age of 29 weeks hospitalized in NICU of Alzahra Hospital (Tabriz, Iran). The infants were evaluated in two groups of 30. The mothers of infants in the control group received routine training and support about relactation while the intervention group received routine training as well as the designed educational and supportive relactation program including breast pumping, increasing milk agents and kangaroo mother care. Daily follow-up was conducted by the researcher. All the infants were weighed by a co-researcher. RESULTS: On the 14(th) day of the study, the mean (SD) weight of infants in the control and intervention groups was 1666.67 (136.08) and 1765.86 (156.96) g, respectively. CONCLUSION: Providing mothers with support from the medical team and training on relactation and kangaroo mother care can lead to better weight gain of the low birth weight premature infants.