Efficacy of Kinesio Taping Compared to Other Treatment Modalities in Musculoskeletal Disorders: A Systematic Review and Meta-Analysis.

Kinesio taping is widely used in musculoskeletal conditions. We performed a systematic review and meta-analysis on the efficacy of kinesio taping in musculoskeletal disorders compared to other interventions. Twelve electronic databases were used for systemic search and data relevant to pain and disability were extracted. The protocol was registered in PROSPERO (CRD42018087606). Meta-analysis was performed to compare the efficacy of kinesio taping to other modalities of musculoskeletal disorders. As a result, 36 studies were included in the quantitative analysis. Kinesio taping was found to provide an improvement of both pain and disability when applied to any region of the body. In the first five days of application, kinesio taping significantly reduced the pain in all body regions (SMD = -0.63, 95%CI: -0.87, -0.39). This was also noted after four-to-six weeks of application (SMD = -0.76, 95%CI: -1.07, -0.45). When kinesio taping was used for disability in low back pain patients, it significantly reduced the disability within five days of application (SMD = -0.70, 95%CI: -1.29, -0.11). Finally, kinesio taping has shown an improvement of the disability in all body regions after four-to-six weeks of application (SMD = -0.59, 95%CI: -0.96, -0.22). Our findings support kinesio taping as an adjuvant to other treatments for musculoskeletal disorders. Abbreviations KT = Kinesio taping; MSK = musculoskeletal; SD = standard deviation; CR = conventional rehabilitation; NDI = Neck Disability Index; NPS = Numerical Pain Scale; CTM = Cervical Thrust Manipulation; PIR = Post-isometric muscle relaxation; NPRS Numerical Pain Rating Scale; OA = osteoarthritis; ROM = Range of motion; VAS = visual analogue scale; VAS-W = visual analogue scale-worst pain; VAS-U = visual analogue scale-usual pain; VAS-R = visual analogue scale-resting pain; VAS-A = visual analogue scale-activity pain; VAS-N = visual analogue scale-night pain; NPDS = Neck Pain Disability Scale; QA = Quality assessment.

Burden and mortality of sepsis and septic shock at a high-volume, single-center in Vietnam: a retrospective study.

BACKGROUND: Sepsis and septic shock have high mortality rates and often require a prolonged hospital stay. Patient outcomes may vary according to multiple factors. We aim to determine the prevalence of antimicrobial resistance and factors associated with mortality and hospital stay. METHODS: Clinical and microbiological data of patients with sepsis or septic shock were retrospectively collected for 15 months. Patients with negative blood cultures and patients that did not meet the SEPSIS 3 criteria were excluded. RESULTS: We included 48 septic shock and 28 septic patients (mean APACHE II 20.32 ± 5.61 and mean SOFA 9.41 ± 3.17), with a mean age of 60.5 ± 16.8 years and 56.6% males. WBCs, neutrophils, INR, and fibrinogen levels were significantly associated with mortality. 59.5% of the cultured bacteria were gram-negative (most common E. coli) and 27.8% were gram-positive (most common S. aureus), while 7.6% were other types of bacteria and 5.1% were fungi. Resistance patterns to gram-negative were varying, and resistance to piperacillin/tazobactam, carbapenems, and aminoglycosides were from 60% to 100% (A. baumanii), while they were highly sensitive to Colistin. E. coli was also resistant to ceftriaxone (77.8%) and sulbactam/cefoperazone (44.4%). Resistance rates for Gram-positives were high, from 86% to 100% for oxacillin, while for vancomycin, teicoplanin, and linezolid, they were often low but arrived up to 42.8%. According to our logistic regression analysis, patients over 65 year-old and those who received corticosteroids had a significantly increased risk of in-hospital mortality (OR: 4.0; OR: 4.8). CONCLUSION: Sepsis still poses a significant threat to patients' health, even when positive blood culture results allow the administration of specific antibiotic treatment.

The timing setting in kinetic dengue studies: A systematic review.

Dengue is classified as an endemic infectious disease, which is transmitted by Aedes mosquitos. Kinetic studies, which monitor the viral load of the disease, have been the mainstay for several decades in humanity's quest to control this disease. Our study aims to systematically evaluate the usage of different timing systems in dengue kinetic studies. A search in nine electronic databases and manual search of reference and citation lists were conducted to find relevant studies. A quality assessment using the National Institute of Health tools for observational cohort and cross-sectional studies was performed. The protocol was registered in PROSPERO with number CRD42018086435. As results, among included 87 studies, 71 studies (81.6%) use a timing system which is based on the day of illness onset, of which, 11 studies designate the day of illness onset as "day 0″ (type 1A) while 60 studies designate it as "day 1″ (type 1B). Only ten articles (11.5%) designate the day of defervescence as "day 0″, the day before and after defervescence as "day -1″ and "day +1″, respectively. Four articles (4.6%) use a timing system based on the day of hospital admission. Lastly, two studies (2.3%) designate the day of hemorrhagic manifestation as "day 0″ and two studies (2.3%) designate the day of pharmacological treatment as "day 1″. Therefore, the timing system which designates the day of illness onset as "day 1″ (type 1B) was most commonly used. Inconsistent definitions of "day 0″ and "day 1″ may lead to disparities in results across the studies and may have a negative impact on treatment guidelines implementation.

Hyponatremia in tuberculous meningitis: A systematic review and meta-analysis.

BACKGROUND: Tuberculous meningitis (TBM), manifests as the most severe involvement of the nervous system by Mycobacterium tuberculosis, it has a high mortality rate and a spectrum of systemic and neurological complications that can lead to debilitating or fatal sequelae, whereas hyponatremia is the commonly encountered life-threatening electrolyte disturbance. Thus, our study aimed to determine the prevalence, risk factors and differences in outcomes of hyponatremia in TBM. METHODS: This systematic review was registered in PROSPERO (CRD42018088089). A comprehensive electronic search was conducted through ten databases to find relevant articles. RESULTS: A total of 42 studies were included, 24 case reports and 18 retrospective studies. The prevalence rate of hyponatremia among TBM patients was 52% and the rate of death among those patients was 29%. The meta-regression analysis revealed that there was no significant effect of sodium level on the death rate in TBM patients (P-value = 0.9). Additionally, there was no significant difference in sodium level based on sex, and etiologies of hyponatremia. CONCLUSIONS: Hyponatremia is commonly present in patient with TBM, but it is not significantly correlated to the rate of death. However, it is necessary to treat this potentially life-threatening condition appropriately according to its etiology, further research is needed on its pathophysiology in TBM, its risk factors, and the most appropriate treatment.

Clinical features and outcomes of neonatal dengue at the Children's Hospital 1, Ho Chi Minh, Vietnam.

Objectives Neonatal dengue has been reported in the literature with contradictory findings of clinical characteristics and diagnosis; thereby, misdiagnosis of neonatal dengue has been frequently reported. We aim to delve into the epidemiology, clinical features, and outcomes of neonatal dengue, thus avoid misdiagnosis and obtain early intervention. Study design A retrospective study was conducted at Children's Hospital 1, Ho Chi Minh, Vietnam with laboratory-confirmed dengue in neonates by positive viral antigen nonstructural protein one rapid test (NS1) and positive IgM antibody for dengue by MAC-ELISA. Results We have included 32 neonates in this study with 25% cases were misdiagnosed with neonatal sepsis, and 12.5% cases were misdiagnosed with neonatal immune thrombocytopenia at the beginning. The median time between the first day of the mother's onset of fever and childbirth was -1 days (IQR: -2, 2). The patient's clinical manifestation included: petechiae 87.5% (28/32), pharyngeal mucosal hemorrhage 6.3% (2/32), and hepatomegaly occurred 75% (24/32). In the febrile phase (day of illness 1-3), the mean white blood cell (WBC) counts were 7800 ± 800/mm3 and platelets were 97,111 ± 37,826/mm3. In the critical phase (day of illness 4-6), the mean WBC counts were 13,400 ± 2800/mm3, and platelets were 30,100 ± 5749/mm3. All mothers (100%) had laboratory-confirmed dengue by NS1 positive in the perinatal period. Conclusions The findings emphasize that early diagnosis of neonatal dengue should be based on a history of maternal illness, NS1 rapid test, and clinical presentation such as petechiae, hepatomegaly, and low platelet counts in the febrile phase.

Novel biopolymer-based nanocomposite food coatings that exhibit active and smart properties due to a single type of nanoparticles.

We used nanoparticles which possess simultaneously active (antimicrobial, UV-protective and antioxidant) and smart (temperature sensing) properties. The nanoparticles (2Rh = 450 nm, PDI = 0.118 ± 0.014, ζ-potential = 21 mV and Tg = 8 ± 1 °C) are based on polyethylene glycol (PEG)/methyl cellulose (MC) core with anthocyanidin and sodium acetate, and chitosan/gallotannin-based shell. The core of nanoparticles acts as a temperature indicator, changing its color from colorless into deep purple at 8 °C, while the shell provides antimicrobial (due to chitosan), UV-protective and antioxidant (due to gallotannin) effects. We incorporated these nanoparticles into the chitosan matrix. The coatings demonstrated improved mechanical and barrier properties compared with the pure chitosan coating. The elaborated coatings pronouncedly improve the shelf-life of Ricotta cheese. Moreover, they serve as thermo indicators, which warn about cheese storage at an unacceptable temperature. Thus, we developed new coatings in which all properties are enabled by a single type of nanoparticles.

The association between dengue viremia kinetics and dengue severity: A systemic review and meta-analysis.

In this study, we aim to assess the association of dengue viremia with dengue severity. The study protocol was developed and registered in PROSPERO (CRD42016039864). We searched nine databases to find potential papers. Studies meeting the inclusion criteria were included. We, based our analysis on three outcomes which are disease severity, dengue serotype and disease infection type. Thirty studies with 3316 patients were included. Our analysis revealed that viremia is significantly higher in dengue hemorrhagic fever patients than dengue fever in days 5 to 6. Regarding the serotype of dengue, the maximum viremia titre of serotype 1 was significantly higher than serotype 3 and the viremia in dengue serotype 2 was significantly higher than serotype 4 in days 2 to 4. However, comparison of the daily viremia level between the primary and secondary dengue infection revealed that secondary infection was significantly higher than the primary infection on seventh day and on the eighth day. Viremia is strongly associated with disease severity and type of infection which gave viremia a high indicative power to be used as a clinical predictor. Dengue serotype is also associated with viral load with higher viremia in DENV-2/1.

The best route of administration of lavender for anxiety: a systematic review and network meta-analysis.

BACKGROUND: There is preliminary evidence for lavender as an anxiolytic agent through various routes of administration. Our goal is to elucidate the best route of administration for lavender as a treatment for anxiety. METHODS: Thirteen electronic search engines were systematically scanned for relevant publications. The relevant articles were included after the title and abstract screening followed by the full-text screening. This study included randomized control trials reporting lavender for the treatment of anxiety. The protocol was registered in PROSPERO (CRD42017076711). Frequentist network meta-analysis and Bayesian meta-regression were conducted to report the best treatment modality and the effect of covariates on the effectiveness as an anxiolytic. Treatment arms were ordered according P-scores, where higher P-score indicates better treatment choice. RESULTS: Forty studies were eligible for qualitative analysis, and 32 were included in quantitative analysis. Lavender aromatherapy was the best approach for the treatment of anxiety among other lavender modalities at the first week recording [Standardized Mean Difference (SMD) = -0.57, 95% CI (-1.14-0.01), P-score = 0.72], in addition to achieve at the first time points [SMD = -0, 95% CI (-0.97 ̶ -0.16), P-score = 0.69], compared to placebo; however, lavender massage along with foot bath were found to be the most efficacious for anxiety treatment at the study endpoint [SMD = -1.10, 95% CI = (-7.41 ̶ 5.21), P-score = 0.65]. Furthermore, network meta-regression revealed that the duration of therapy influenced treatment, suggesting Silexan (oral lavender) 80 mg (first rank probability = .116) as the favorable option for anxiety in long-term treatment. CONCLUSIONS: Lavender aromatherapy is, clinically, superior in short-duration, while Silexan (oral lavender) 80 mg is preferable for long-term treatment of anxiety.

Efficacy of kinesio taping in treatment of shoulder pain and disability: a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Kinesio tape is an elastic therapeutic tape used for treating sports injuries and various other disorders. A systematic review and network meta-analysis approach was used to synthesise all related evidence on the clinical effectiveness of kinesio taping for the treatment of shoulder pain. METHODS: A literature search was performed using 10 major databases. Randomised clinical trials reporting usage of kinesio taping for shoulder pain have been included. Quality and risk of bias were assessed using the Cochrane Collaboration's quality assessment tool. Meta-analysis was conducted to calculate standardised mean differences and corresponding 95% confidence intervals (CI). The corresponding 95% CI of pooled effect size were calculated using a fixed-effects or random-effects model based on the level of heterogeneity. In addition, meta-regression was used to assess the influence of underlying shoulder disease on the efficacy of kinesio taping. RESULTS: This systematic review and meta-analysis included 12 studies, with a total of 555 participants. Pairwise comparisons inferred that kinesio taping only showed significant improvement of shoulder pain and disability when combined with exercise. However, kinesio taping did not produce better results than placebo or treatment with steroids. The duration of treatment and underlying shoulder pathology did not influence the efficacy of kinesio taping. CONCLUSION: There is insufficient evidence to support the use of kinesio taping in clinical practice as a treatment for shoulder pain. However, there is limited evidence of its benefit as a complementary treatment in shoulder pain syndromes. CLINICAL TRIAL REGISTRATION NUMBER: PROSPERO CRD42017065881.

Therapeutic efficacy and safety of chamomile for state anxiety, generalized anxiety disorder, insomnia, and sleep quality: A systematic review and meta-analysis of randomized trials and quasi-randomized trials.

This systematic review and meta-analysis aimed to study the efficacy and safety of chamomile for the treatment of state anxiety, generalized anxiety disorders (GADs), sleep quality, and insomnia in human. Eleven databases including PubMed, Science Direct, Cochrane Central, and Scopus were searched to retrieve relevant randomized control trials (RCTs), and 12 RCTs were included. Random effect meta-analysis was performed by meta package of R statistical software version 3.4.3 and RevMan version 5.3. Our meta-analysis of three RCTs did not show any difference in case of anxiety (standardized mean difference = -0.15, 95% CI [-0.46, 0.16], P = 0.4214). Moreover, there is only one RCT that evaluated the effect of chamomile on insomnia and it found no significant change in insomnia severity index (P > 0.05). By using HAM-A scale, there was a significant improvement in GAD after 2 and 4 weeks of treatment (mean difference = -1.43, 95% CI [-2.47, -0.39], P = 0.007), (MD = -1.79, 95% CI [-3.14, -0.43], P = 0.0097), respectively. Noteworthy, our meta-analysis showed a significant improvement in sleep quality after chamomile administration (standardized mean difference = -0.73, 95% CI [-1.23, -0.23], P < 0.005). Mild adverse events were only reported by three RCTs. Chamomile appears to be efficacious and safe for sleep quality and GAD. Little evidence is there to show its effect on anxiety and insomnia. Larger RCTs are needed to ascertain these findings.

Examined and positive lymph nodes counts and lymph nodes ratio are associated with survival in major salivary gland cancer.

BACKGROUND: We aimed to investigate the prognostic role of examined (dissected) lymph nodes (ELNs), negative LNs (NLNs), and positive (metastatic) LNs (PLNs) counts and LN ratio (LNR = PLNs/ELNs×100) in patients with major salivary gland cancer (SGC). METHODS: Data were retrieved for major SGC patients diagnosed between 1988 and 2011 from Surveillance, Epidemiology, and End Results program. RESULTS: We have included 5446 patients with major SGC. Most patients had parotid gland cancer (84.61%). Patients having >18 ELNs, >4 PLNs, and >33.33% LNR were associated with a worse survival. Moreover, older age, male patients, grade IV, distant stage, unmarried patients, submandibular gland cancer, and received chemotherapy but not received surgery were significantly associated with a worse survival. CONCLUSIONS: We demonstrated that patients with >18 ELNs and >4 PLNs counts, and >33.33% LNR were high-risk group patients. We strongly suggest adding the ELNs and PLNs counts and/or LNR into the current staging system.

Efficacy and Safety of Valproic Acid for Spinal Muscular Atrophy: A Systematic Review and Meta-Analysis.

BACKGROUND: Spinal muscular atrophy (SMA) is a neuromuscular disorder classified into four types based on the age of onset of the disease. Early onset is correlated with a higher mortality rate, mainly due to respiratory complications. Valproic acid (VPA) is a histone deacetylase (HDAC) inhibitor that has shown positive results on SMA both in experimental and cohort studies. OBJECTIVES: This systematic review and meta-analysis aimed to investigate the efficacy and safety of VPA in patients with SMA. METHODS: Eleven databases were systematically searched on 30 May 2017 for clinical trials that reported the efficacy and safety of VPA in SMA patients. The primary outcome was the efficacy of VPA in terms of gross motor function and expression of both full-length spinal motor neuron (SMN) gene (FL-SMN) and exon 7-lacking SMN. The secondary outcome was the safety of VPA in terms of reported adverse effects. The protocol was registered at PROSPERO (CRD42017067203). RESULTS: Five of the ten included studies were used in the meta-analysis (n = 126). The overall effect estimate, comparing pre- and post-VPA treatment, regardless of carnitine co-administration and design of the studies, showed significant improvement in gross motor function (standard mean difference [SMD] = 0.302, 95% confidence interval [CI] 0.048-0.556, P = 0.02) using the Hammersmith Functional Motor Scale (HFMS), Modified Hammersmith Functional Motor Scale (MHFMS), and MHFMS-Extend, with no significant heterogeneity. Similarly, in non-randomized controlled studies, the results indicated that there was a significant improvement detected (SMD = 0.335, 95% CI 0.041-0.628, P = 0.025), with no significant heterogeneity. Meanwhile, our results suggest that there was no significant improvement in treatment with co-administered carnitine (SMD = 0.28, 95% CI - 0.02 to 0.581, P = 0.067). No significant differences were found between pre- and post-VPA treatment co-administered with carnitine, in terms of the change in FL-SMN and exon 7-lacking SMN. Qualitative synthesis showed that other motor functions were not improved, while respiratory function test results were contradictory. Regarding the safety of the treatment, a double-blind, randomized, placebo-controlled trial reported no statistically significant differences for adverse events (AEs) between groups. Moreover, most of the included studies reported no serious AEs related to VPA use, although weight gain, gastrointestinal symptoms and respiratory symptoms were notable problems. CONCLUSIONS: Our study suggests that VPA treatment results in an improvement in gross motor functions for SMA patients, but not in other assessments of motor function or, possibly, in respiratory function. Furthermore, VPA appears to be a relatively safe drug, although treatment may be associated with a wide range of AEs (including body weight increase, fatigue, fever, flu-like symptoms, irritability, and pain). Double-blind, randomized, controlled trials are required to confirm these findings.

Crystal structure of (1RS,21SR,22RS,24SR)-28-oxo-24-propyl-8,11,14-trioxa-24,27-di-aza-penta-cyclo[19.5.1.1(22,26).0(2,7).0(15,20)]octa-cosa-2,4,6,15(20),16,18-hexa-ene acetic acid monosolvate.

The title compound, C26H32N2O4(M)·C2H4O2, (I), is the product of the Petrenko-Kritchenko condensation of N-propyl-piperidinone with 1,5-bis-(2-formyl-phen-oxy)-3-oxa-pentane and ammonium acetate. In M, the aza-14-crown-3-ether ring adopts a bowl conformation, with the configuration of the C-O-C-C -O-C-C-O-C polyether chain being t-g ((-))-t-t-g ((+))-t (t = trans, 180°; g = gauche, ±60°). The dihedral angle between the planes of the benzene rings fused to the aza-14-crown-4-ether moiety is 62.75 (5)°. The central piperidinone ring has a boat conformation, whereas the terminal piperidinone ring adopts a chair conformation. The boat conformation of the central piperidinone ring is supported by the bifurcated intra-molecular N-H⋯O hydrogen bond. In the crystal, each solvent mol-ecule is linked to mol-ecule M via strong O-H⋯N hydrogen bonding, forming hydrogen-bonded pairs of mol-ecules, which further inter-act through weak C-H⋯O hydrogen bonds, forming layers parallel to the ac plane.

(1R*,21S*,22R*,24S*)-Methyl ethyl 2-[23-hy-droxy-22,24-diphenyl-8,11,14-trioxa-25-aza-tetra-cyclo-[19.3.1.0(2,7).0(15,20)]penta-cosa-2,4,6,15(20),16,18-hexaen-25-yl]but-2-enedioate.

The title compound, C40H41NO8, is a product of the reduction of the cyclic carbonyl group of the γ-piperidone subunit of the aza-14-crown-4 ether with subsequent re-esterification of its dimethyl butenoate substituent into a monoethyl monomethyl group. The aza-crown macrocycle exhibits a bowl conformation with a dihedral angle of 70.82 (5)° between the benzene rings fused to it. The piperidine ring adopts a chair conformation and the methyl ethyl ethyl-enedi-carboxyl-ate fragment has a cis conformation, with a dihedral angle of 66.51 (7)° between the two carboxyl-ate groups. The ethyl group is disordered over two sites with occupancies of 0.70 (1):0.30 (1). In the crystal, mol-ecules form inversion dimers, via pairs of O-H⋯O hydrogen bonds, that stack along the a axis.

Ethyl 23-benzyl-8,11,14-trioxa-23,28,29-triaza-penta-cyclo-[19.7.1.0(2,7).0(15,20).0(22,27)]nona-cosa-2,4,6,15(20),16,18,21,26-octa-ene-26-carboxyl-ate.

The title compound, C33H35N3O5, is the product of the multicomponent condensation of 1-benzyl-4-eth-oxy-carbonyl-piperidin-3-one with 1,5-bis-(2-formyl-phen-oxy)-3-oxapentane and ammonium acetate. The mol-ecule comprises a penta-cyclic system containing the aza-14-crown-4-ether macrocycle, tetra-hydro-pyrimidine, tetra-hydro-pyridine and two benzene rings. The aza-14-crown-4-ether ring adopts a bowl conformation with a dihedral angle of 62.37 (5)° between the benzene rings. The tetra-hydro-pyrimidine ring has an envelope conformation with the chiral C atom as the flap, whereas the tetra-hydro-pyridine ring adopts a distorted chair conformation. Two amino groups are involved in intra-molecular N-H⋯O hydrogen bonds. In the crystal, weak C-H⋯O hydrogen bonds link the mol-ecules into layers parallel to the ab plane.

meso-(1S*,21R*)-25-Methyl-8,11,14-trioxa-22,24,25-triaza-tetra-cyclo-[19.3.1.0(2,7).0(15,20)]penta-cosa-2,4,6,15(20),16,18-hexa-ene-23-thione chloro-form monosolvate.

The title compound crystallizes as a chloro-form solvate, C(20)H(23)N(3)O(3)S·CHCl(3), with two crystallographically independent units. The independent units have distinctly different inter-action patterns between the aza-crown macrocycle and the chloro-form solvent mol-ecule. In one of them, the chloro-form mol-ecule forms C-H⋯N and Cl⋯H-C hydrogen bonds with the aza-crown macrocycle (as a proton donor and an acceptor, respectively), whereas in the other, one of the chloro-form mol-ecules is bound to the aza-crown macrocycle by an attractive Cl⋯O [3.080 (3) Å] inter-action. The aza-crown macrocycles of different units are structurally similar; the aza-14-crown-3-ether ring adopts a bowl conformation with dihedral angles between the planes of the fused benzene rings of 60.7 (1) and 68.0 (1)°. The triazinane-thione ring in both cases has a sofa conformation. The crystal packing is characterized by N-H⋯S, N-H⋯O, C-H⋯Cl and C-H⋯S hydrogen bonds.

Dimethyl 2-[24-acetyl-28-oxo-8,11,14-trioxa-24,27-diaza-penta-cyclo-[19.5.1.1(22,26).0(2,7).0(15,20)]octa-cosa-2,4,6,15(20),16,18-hexaen-27-yl]but-2-enedioate.

The title compound, C(31)H(34)N(2)O(9), is a product of the Michael addition of the cyclic secondary amine subunit of the (bis-pidino)aza-14-crown-4 ether to dimethyl acetyl-ene-dicarboxyl-ate. The mol-ecule comprises a tricyclic system containing the aza-14-crown-3 ether macrocycle and two six-membered piperidinone rings. The aza-14-crown-3-ether ring adopts a bowl conformation with a dihedral angle between the planes of the fused benzene rings of 51.14 (5)°. The central piperidone ring has a boat conformation, whereas the terminal piperidone ring adopts a chair conformation. The dimethyl ethyl-enedicarboxyl-ate fragment has a cis configuration with a dihedral angle of 56.56 (7)° between the two carboxyl-ate groups. The crystal packing is stabilized by weak C-H⋯O hydrogen bonds.

24-Acetyl-8,11,14-trioxa-24,27-diaza-penta-cyclo-[19.5.1.1(22,26).0(2,7).0(15,20)]octa-cosa-2,4,6,15(20),16,18-hexaen-28-one.

The title compound, C(25)H(28)N(2)O(5), is a product of the Petrenko-Kritchenko condensation of N-acetyl-piperidone with 1,5-bis-(2-formyl-phen-oxy)-3-oxapentane and ammonium acetate. The mol-ecule comprises a fused penta-cyclic system containing an aza-14-crown-3-ether macrocycle, two piperidone and two benzene rings. The aza-14-crown-3-ether ring adopts a bowl conformation. The dihedral angle between the benzene rings fused to the aza-14-crown-4-ether unit is 70.18 (4)°. The central piperidone ring has a boat conformation, whereas the terminal piperidone ring adopts a chair conformation. The conformation of the central piperidone ring is determined by two intra-molecular N-H⋯O hydrogen bonds. In the crystal, mol-ecules are linked by weak C-H⋯O inter-actions into chains along [010].

Dimethyl 2-[22,24-dimethyl-23-oxo-8,11,14-trioxa-25-aza-tetra-cyclo-[19.3.1.0(2,7).0(15,20)]penta-cosa-2,4,6,15(20),16,18-hexaen-25-yl]but-2-enedioate.

The title compound, C(29)H(33)NO(8), is a product of the Michael addition of the cyclic secondary amine subunit of the aza-14-crown-4 ether to dimethyl acetyl-enedicarboxyl-ate. The piperidinone ring exhibits a distorted chair conformation, and the dimethyl ethylenedicarboxylate fragment has a cis configuration with a dihedral angle of 78.96 (5)° between the two carboxyl-ate groups. The crystal packing is stabilized by weak C-H⋯O hydrogen bonds.

Dimethyl 2-[23-oxo-22,24-diphenyl-8,11,14-trioxa-25-aza-tetra-cyclo-[19.3.1.0(2,7).0(15,20)]penta-cosa-2,4,6,15(20),16,18-hexaen-25-yl]but-2-enedioate.

The title compound, C(39)H(37)NO(8), is a product of the Michael addition of the cyclic secondary amine subunit of aza-14-crown-4 ether to dimethyl acetyl-enedicarboxyl-ate. The piperidinone ring exhibits a distorted chair conformation and the dimethyl acetyl-enedicarboxyl-ate fragment has a cis configuration with a dihedral angle of 56.61 (5)° between the two carboxyl-ate groups. The crystal packing is stabilized by the weak C-H⋯O hydrogen bonds.