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OBJECTIVE: To evaluate the relative cost-effectiveness of starting antenatal fetal surveillance at 32 vs. 36 weeks, in medication-treated gestational diabetes. METHODS: We performed a 2017-2022 retrospective cohort study of patients with medication-treated GDM who underwent BPPs. Patients diagnosed before 24 weeks, those delivered before 32 weeks, and those without BPPs or delivery data were excluded. Demographic and outcome data were abstracted by chart review. We performed a cost-effectiveness analysis regarding two outcomes: stillbirth, and decision to alter delivery timing following abnormal BPPs. RESULTS: A total of 652 pregnancies were included. Patients were 49% privately insured, 25% publicly insured, and 26% uninsured. We assumed that each BPP cost $145. In total, 1,284 BPPs occurred after 36 weeks, costing $186,180, and 2,041 BPPs occurred between 32 and 36 weeks, costing an additional $295,945. Twelve deliveries resulted from abnormal BPPs, all after 36 weeks. No stillbirths occurred. The cost to attempt to avoid one stillbirth was $40,177 across all patients. In our sample, starting surveillance at 36 weeks would have theoretically avoided all stillbirths, with cost savings per avoided stillbirth of $51,572 for privately insured patients, $14,123 for publicly insured patients, and $17,799 for patients without insurance. CONCLUSION: Based on this population with no stillbirths and no BPPs dictating delivery before 36 weeks, surveillance after 36 weeks may be safe and cost-effective. Our findings reflect opportunities for shared decision making and potential practice change, with greatest impact for low socioeconomic status patients and those without insurance.
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Análise Custo-Benefício , Diabetes Gestacional , Humanos , Feminino , Gravidez , Diabetes Gestacional/tratamento farmacológico , Diabetes Gestacional/economia , Estudos Retrospectivos , Adulto , Idade Gestacional , Diagnóstico Pré-Natal/economia , Diagnóstico Pré-Natal/métodos , Natimorto/epidemiologia , Natimorto/economia , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/métodosRESUMO
[FeFe] hydrogenases demonstrate remarkable catalytic efficiency in hydrogen evolution and oxidation processes. However, susceptibility of these enzymes to oxygen-induced degradation impedes their practical deployment in hydrogen-production devices and fuel cells. Recent investigations into the oxygen-stable (Hinact) state of the H-cluster revealed its inherent capacity to resist oxygen degradation. Herein, we present findings on Cl- and SH-bound [2Fe-2S] complexes, bearing relevance to the oxygen-stable state within a biological context. A characteristic attribute of these complexes is the terminal Cl-/SH- ligation to the iron center bearing the CO bridge. Structural analysis of the t-Cl demonstrates a striking resemblance to the Hinact state of DdHydAB and CbA5H. The t-Cl/t-SH exhibit reversible oxidation, with both redox species, electronically, being the first biomimetic analogs to the Htrans and Hinact states. These complexes exhibit notable resistance against oxygen-induced decomposition, supporting the potential oxygen-resistant nature of the Htrans and Hinact states. The swift reductive release of the Cl-/SH-group demonstrates its labile and kinetically controlled binding. The findings garnered from these investigations offer valuable insights into properties of the enzymatic O2-stable state, and key factors governing deactivation and reactivation conversion. This work contributes to the advancement of bio-inspired molecular catalysts and the integration of enzymes and artificial catalysts into H2-evolution devices and fuel-cell applications.
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Research on tooth regeneration using human-induced pluripotent stem cells (hiPSCs) is valuable for autologous dental regeneration. Acquiring mesenchymal and epithelial cells as a resource for dental regeneration is necessary because mesenchymal-epithelial interactions play an essential role in dental development. We reported the establishment of hiPSCs-derived dental epithelial-like cell (EPI-iPSCs), but hiPSCs-derived dental mesenchymal stem cells (MSCs) have not yet been reported. This study was conducted to establish hiPSCs-derived MSCs and to differentiate them into dental cells with EPI-iPSCs. Considering that dental MSCs are derived from the neural crest, hiPSCs were induced to differentiate into MSCs through neural crest formation to acquire the properties of dental MSCs. To differentiate hiPSCs into MSCs through neural crest formation, established hiPSCs were cultured and differentiated with PA6 stromal cells and differentiated hiPSCs formed neurospheres on ultralow-attachment plates. Neurospheres were differentiated into MSCs in serum-supplemented medium. Neural crest-mediated MSCs (NC-MSCs) continuously showed typical MSC morphology and expressed MSC markers. After 8 days of odontogenic induction, the expression levels of odontogenic/mineralization-related genes and dentin sialophosphoprotein (DSPP) proteins were increased in the NC-MSCs alone group in the absence of coculturing with dental epithelial cells. The NC-MSCs and EPI-iPSCs coculture groups showed high expression levels of amelogenesis/odontogenic/mineralization-related genes and DSPP proteins. Furthermore, the NC-MSCs and EPI-iPSCs coculture group yielded calcium deposits earlier than the NC-MSCs alone group. These results indicated that established NC-MSCs from hiPSCs have dental differentiation capacity with dental epithelial cells. In addition, it was confirmed that hiPSCs-derived dental stem cells could be a novel cell source for autologous dental regeneration.
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Células-Tronco Pluripotentes Induzidas , Células-Tronco Mesenquimais , Humanos , Diferenciação Celular , Transição Epitelial-Mesenquimal , Técnicas de Cocultura , Células CultivadasRESUMO
Once tooth development is complete, odontoblasts and their progenitor cells in the dental pulp play a major role in protecting tooth vitality from external stresses. Hence, understanding the homeostasis of the mature pulp populations is just as crucial as understanding that of the young, developing ones for managing age-related dentinal damage. Here, it is shown that loss of Cpne7 accelerates cellular senescence in odontoblasts due to oxidative stress and DNA damage accumulation. Thus, in Cpne7-null dental pulp, odontoblast survival is impaired, and aberrant dentin is extensively formed. Intraperitoneal or topical application of CPNE7-derived functional peptide, however, alleviates the DNA damage accumulation and rescues the pathologic dentin phenotype. Notably, a healthy dentin-pulp complex lined with metabolically active odontoblasts is observed in 23-month-old Cpne7-overexpressing transgenic mice. Furthermore, physiologic dentin was regenerated in artificial dentinal defects of Cpne7-overexpressing transgenic mice. Taken together, Cpne7 is indispensable for the maintenance and homeostasis of odontoblasts, while promoting odontoblastic differentiation of the progenitor cells. This research thereby introduces its potential in oral disease-targeted applications, especially age-related dental diseases involving dentinal loss.
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Senilidade Prematura , Camundongos , Animais , Polpa Dentária , Senescência Celular/genética , Odontoblastos , Diferenciação Celular/genética , Camundongos TransgênicosRESUMO
The high-performance Y6-based nonfullerene acceptors (NFAs) feature a C-shaped A-DA'D-A-type molecular architecture with a central electron-deficient thiadiazole (Tz) A' unit. In this work, we designed and synthesized a new A-D-A-type NFA, termed CB16, having a C-shaped ortho-benzodipyrrole-based skeleton of Y6 but with the Tz unit eliminated. When processed with nonhalogenated xylene without using any additives, the binary PM6:CB16 devices display a remarkable power conversion efficiency (PCE) of 18.32% with a high open-circuit voltage (Voc) of 0.92 V, surpassing the performance of the corresponding Y6-based devices. In contrast, similarly synthesized SB16, featuring an S-shaped para-benzodipyrrole-based skeleton, yields a low PCE of 0.15% due to the strong side-chain aggregation of SB16. The C-shaped A-DNBND-A skeleton in CB16 and the Y6-series NFAs constitutes the essential structural foundation for achieving exceptional device performance. The central Tz moiety or other A' units can be employed to finely adjust intermolecular interactions. The single-crystal X-ray structure reveals that ortho-benzodipyrrole-embedded A-DNBND-A plays an important role in the formation of a 3D elliptical network packing for efficient charge transport. Solution structures of the PM6:NFAs detected by small- and wide-angle X-ray scattering (SWAXS) indicate that removing the Tz unit in the C-shaped skeleton could reduce the self-packing of CB16, thereby enhancing the complexing and networking with PM6 in the spin-coating solution and the subsequent device film. Elucidating the structure-property-performance relationships of A-DA'D-A-type NFAs in this work paves the way for the future development of structurally simplified A-D-A-type NFAs.
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The self-assembly of tetrarhenium metallacycles [{Re(CO)3}2(µ-dhaq)(µ-N-N)]2 (3a, N-N = 1,3-bis(1-butylbenzimidazol-2-yl)benzene; 3b, N-N = 1,3-bis(1-octylbenzimidazol-2-yl)benzene), (H2-dhaq = 1,4-dihydroxy-9,10-anthraquinone) and [{Re(CO)3}2(µ-thaq)(µ-N-N)]2 (4, N-N = 1,3-bis(1-butylbenzimidazol-2-yl)benzene), (H2-thaq = 1,2,4-trihydroxy-9,10-anthraquinone) under solvothermal conditions is described. The metallacycles 3a,b and 4 underwent aggregation-induced emission enhancement (AIEE) in THF upon the incremental addition of water. TEM images revealed that metallacycle 3a in a 60% aqueous THF solution formed rectangular aggregates with a wide size distribution, while a 90% aqueous THF solution resulted in the formation of a mixture of nanorods and amorphous aggregates due to rapid and abrupt aggregation. UV-vis and emission spectral profiles supported the formation of nanoaggregates of metallacycles 3a,b and 4 upon the gradual addition of water to a THF solution containing metallacycles. Further studies indicated that these nanoaggregates were excellent probes for the sensitive and selective detection of nitro group containing picric acid (PA) derivatives as well as antibiotics.
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The strong tendency to stack in the solid state and rich luminescence for the Pt(II) complexes makes them potential candidates as new mechanochromic materials and sensing applications. Six mononuclear complexes [Pt(ppy)(O4NCS2)] (1), [Pt(bpy)(O4NCS2)]ClO4 (2), [Pt(ppy)(O5NCS2)] (3), [Pt(phen)(O4NCS2)]ClO4·CH3OH (5a), [Pt(phen)(O4NCS2)]ClO4 (5b), and [Pt(phen)(O5NCS2)]ClO4 (6a), one dinuclear complex [Pt2(phen)2(NaO5NCS2)2(ClO4)3]ClO4 (6b), and one one-dimensional (1-D) coordination polymer {[Pt2(bpy)2(NaO5NCS2)2(ClO4)2](ClO4)2}n (4) were synthesized by reacting [Pt(ppy)Cl]2, Pt(bpy)Cl2, and Pt(phen)Cl2 (ppy = 2-phenylpyridine, bpy = 2,2'-bipyridine, and phen = 1,10-phenanthroline) with (1-aza-15-crown-5)dithiocarbamate (O4NCS2) or (1-aza-18-crown-6)dithiocarbamate (O5NCS2), respectively, which have been isolated and structurally characterized by X-ray diffraction. Neutral complexes 1 and 3 contain no intermolecular Pt(II)···Pt(II) contact, whereas cationic complexes 2, 5a, 5b, and 6a with ClO4- as counteranions show alternative intermolecular Pt(II)···Pt(II) contacts of 3.535/4.091, 3.480/5.001, 3.527/4.571, and 3.446/4.987 Å in the solid state, respectively. Interestingly, complex 4 forms a 1-D coordination polymer through coordination between the encapsulated Na+ ions inside the azacrown ether rings of O5NCS2 and ClO4- anions with respective intra- and intermolecular Pt(II)···Pt(II) contacts of 3.402 and 3.847 Å in crystal lattices, whereas a dinuclear complex 6b was surprisingly formed and also connected by the encapsulated Na+ ions and ClO4- anions with alternative intra- and intermolecular Pt(II)···Pt(II) contacts of 3.650 and 3.677/4.4.372 Å, respectively. Upon excitation, complexes 1 and 3 showed similar vibronic luminescence at 507, 534, and 502, 532 nm, respectively, and the other complexes 2 and 4-6 showed broad luminescence with maxima at 537-567 nm. The B3LYP/LanL2DZ calculation was carried out and used to clarify their excited-state properties. In addition, the powder samples for complexes 1-4 almost showed no energy shift for the luminescence and significantly those of complexes 5-6 exhibited the mechanochromic luminescence upon grinding. It is noted that complexes 5a and 6a only showed minor red shifts (i.e., from 544 to 556 nm for complex 5a and from 551 to 565 nm for complex 6a), whereas complex 6b exhibited a remarkable red shift from 558 to 603 nm upon grinding. Besides, their luminescence reversibility was also examined toward various solvents.
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The pursuit of di-coordinate boron radical has been continued for more than a half century, and their stabilization and structural characterization remains a challenge. Here we report the isolation and structural characterization of a linear di-coordinate boron radical cation, achieved by stabilizing the two reactive atomic orbitals of the central boron atom by two orthogonal π-donating and π-accepting functionalities. The electron deficient radical cation undergoes facile one-electron reduction to borylene and binds Lewis base to give heteroleptic tri-coordinate boron radical cation. The co-existence of half-filled and empty p orbitals at boron also allows the CO-regulated electron transfer to be explored. As the introduction of CO promotes the electron transfer from a tri-coordinate neutral boron radical to a boron radical cation, the removal of CO under vacuum furnishes the reverse electron transfer from borylene to yield a solution consisting of two boron radicals.
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The reaction of potassium (aza-15-crown-5)dithiocarbamate (KO4NCS2) and (Me2S)AuCl gave the dinuclear complex [Au(O4NCS2)]2, which underwent structural transformation upon heating to rearrange into the hexanuclear complex [Au(O4NCS2)]6. Under similar reaction conditions, KO4NCS2 reacted with AgNO3 or [Cu(CH3CN)4]ClO4 to give the 1-D coordination polymer [Ag(O4NCS2)]n (1) and the tetranuclear complex [Cu(O4NCS2)]4 (2), respectively. It is noted that upon heating a similar structural transformation process occurs from tetranuclear complex 2 to the octanuclear complex [Cu(O4NCS2)]8 (2'), connected by a weak Cuâ¯S contact of 2.846 Å, and it has been isolated and corroborated by powder and single-crystal X-ray diffraction studies as well. Moreover, a variety of MO4NCS2 salts (M = Li+, Na+, K+ and Rb+) were used to react with AgNO3 to construct a series of coordination architectures: [LiAg(O4NCS2)2(µ-H2O)0.5]2 (3), {Na[Ag(O4NCS2)2]}n (4), {K[Ag(O4NCS2)2]}n (5) and {Rb[Ag(O4NCS2)2]}n (6). The smallest Li+ ion only coordinates with four oxygen atoms from the same azacrown ether ring and one H2O molecule, leading to a 1-D hydrogen-bonded chain with another azacrown ether ring for complex 3. The larger Na+ ion coordinates with seven oxygen atoms from two different crown ether rings, leading to a 1-D chain for complex 4. However, the largest K+ and Rb+ ions constitute a 1-D framework, except that each metal ion coordinates with eight oxygen atoms from two different crown ether rings, featuring a 1-D helical chain for complexes 5 and 6. Hence, the different sizes of alkaline metal ions exert a dramatic effect on the structural motifs of complexes 3-6. Remarkably, the dithiocarbamate moieties adopt µ2-bridging ([Au(O4NCS2)]2 and [Au(O4NCS2)]6), µ3- and µ4-bridging (1-2) and chelate forms (3-6) in the structural backbones.
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Complexos de Coordenação , Éteres de Coroa , Complexos de Coordenação/química , Íons , OxigênioRESUMO
A dimeric dithiolate-bridged species, [Fe(NO)(PS2)]2 (1) containing two {FeNO}7 units, can be isolated by treating [Fe(CO)2(NO)2] with PS2H2 (PS2H2 = bis(2-dimercaptophenyl)phenylphosphine). Crystallographic studies reveal the syn-configuration of NO units and the bridging thiolates in the butterfly shape of the 2Fe2S core. Addition of PPh3 to the solution of dinuclear 1 leads to the formation of mononuclear {FeNO}7 [Fe(NO)(PS2)(PPh3)] (2) that shows electrochemical responses similar to those of 1. One-electron reduction of 1 with Cp*2Co or KC8 results in the isolation of thiolate-bridged bimetallic DNIC, [(PS2)Fe(µ-PS2)Fe(NO)2]- ([3]-), confirmed by several spectroscopies including single-crystal X-ray diffraction studies. The bimetallic DNIC [3]- is a rare example obtained from the one-electron reduction of a dinuclear Fe-NO {FeNO}7 model complex. With the assistance of redox behaviors of 2, electrochemical studies imply that the reduction of 1 leads to the formation of a mononuclear {FeNO}8 [Fe(NO)(PS2)(THF)]- intermediate, which involves disproportionation or NO- transfer to yield [3]-. Based on IR data and magnetic properties, the electronic structure of [3]- can be described as a FeII/{Fe(NO)2}9 state. Isolation of the {Fe(NO)2}9 moiety coordinated by the Fe ancillary complex lends strong support to the NO scrambling behavior in the effectiveness of the activity of flavodiiron nitric oxide reductases (FNORs).
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Ferro , Óxido Nítrico , Cristalografia por Raios X , Compostos Ferrosos , Ferro/química , Óxido Nítrico/química , Oxirredutases/químicaRESUMO
The straightforward preparation of N-coordinated ruthenium triazolato complexes by [3 + 2] cycloaddition reactions of a ruthenium azido complex [Ru]-N3 (1, [Ru] = (η5-C5H5)(dppe)Ru, dppe = Ph2PCH2CH2PPh2) with a series of terminal phenylacetylenes is reported. The reaction products, N(2)-bound ruthenium 4-aryl-1,2,3-triazolato complexes such as [Ru]N3C2H(4-C6H4CN) (2), [Ru]N3C2H(4-C6H4CHO) (3), [Ru]N3C2H(4-C6H4F) (4), [Ru]N3C2H(Ph) (5) and [Ru]N3C2H(4-C6H4CH3) (6) were produced from 4-ethynylbenzonitrile, 4-ethynylbenzaldehyde, 1-ethynyl-4-fluorobenzene, phenylacetylene and 4-ethynyltoluene, respectively, at 80 °C or above under an atmosphere of air. To the best of our knowledge, this is the first example of the preparation of N-coordinated ruthenium aryl-substituted 1,2,3-triazolato complexes by the [3 + 2] cycloaddition of a metal-coordinated azido ligand and a terminal aryl acetylene, less electron-deficient terminal aryl alkynes. All of the compounds have been fully characterized and the structures of complexes 2, 3, 5 and 6 were confirmed by single-crystal X-ray diffraction analysis. Each compound participates in non-covalent aromatic interactions in the solid-state structure which can be favorable in the binding of DNA/biomolecular targets and has shown great potential in the development of biologically active anticancer drugs.
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Molybdenum trioxide (MoO3) with a theoretical specific capacity of 1117 mA h g-1 is widely considered a promising anode material for lithium-ion batteries. However, the irreversible conversion reactions, low electrical conductivity, and detrimental volume expansion upon Li intercalation between the one-dimensional layered structures of MoO3 hinder its practical implementation. Herein, we report a facile synthetic protocol that allows surficial modification by replacing the terminal and bridging oxo groups of molybdenum oxide clusters. Successful organoimido functionalization resulted in a large cathodic shift in Mo(VI/V) reduction by 0.6 V, pronounced electronic communication between the organic moiety and the metal-oxide unit, and significant increase in electrical conductivity (80-100 Ω interfacial charge-transfer resistance). Combined with the enlarged active surface area due to the structural hindrance induced by the organic functionality, the steady specific capacity of the organoimido-modified molybdenum oxide clusters was greater than 1200 mA h g-1 at 900 mA g-1 at the end of 360 cycles, where the best value of 1653 mA h g-1 was achieved for the nitroaniline-substituted species. The steady capacity of 480 mA h g-1 was achieved in the fast charge-discharge process (3000 mA g-1) over 1400 cycles. The results indicate that the surficial modification of metal oxides with organo moieties using our facile synthetic method has broad application potential for metal oxides to be used as high-capacity electrode materials in the future.
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An intriguing stereoselective visible-light photocatalysis of dihydroquinoxalinone derivatives has been realized via cyclization with or without the solvolysis cascade. The reactions provided the polycyclic ring structures with efficient formation of multiple bonds and with high stereoselectivity. X-ray crystallography unequivocally determined the structures of five polycyclic products.
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First total synthesis of ulodione A has been achieved via the key-step reactions of DIPEA-promoted dialkytion of 1,3-cyclopentadione with a bromonitroolefin and DABCO promoted/catalytic semipinacol-like ring-expansion rearrangement, with regioselective transformation of the nitrocyclohexane intermediates to their cyclopentenone counterparts via a sequence of reactions in a one-pot operation. Structures of six products were unequivocally established by X-ray crystallography.
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Piperazinas , Alquilação , Catálise , Estrutura MolecularRESUMO
Two ligand ratio-dependent supramolecular networks, [Cd(2,2'-bpym)1.5(BDC)]·0.5(2,2'-bpym)·5H2O (1) and [Cd(2,2'-bpym)0.5(BDC)(H2O)3] (2), (BDC2- = dianion of terephthalic acid and 2,2'-bpym = 2,2'-bipyrimidine) have been synthesized and structurally characterized by the single-crystal X-ray diffraction method. Structural determination reveals that compound 1 is a two-dimensional (2D) layered metal-organic framework (MOF) constructed via the bridges of Cd(II) ions with 2,2'-bpym and BDC2- ligands, and compound 2 is a zero-dimensional (0D) 2,2'-bpym-bridged di-Cd(II) monomeric complex. When the thermally dehydrated powders of 1 (at 100 °C) were immersed into water solution, most of the dehydrated powders of 1 underwent structural transformation back to rehydrated 1, but very little amounts of the dehydrated powders of 1 were decomposed to light-brown crystals of 2 or colorless crystals of a new coordination polymer (CP), [Cd(2,2'-bpym)(BDC)(H2O)]·3H2O (3), with its one-dimensional (1D) zigzag chain-like framework being constructed via the bridges of Cd(II) ions with the BDC2- ligand. Structural analysis reveals that all 3D supramolecular networks of 1-3 are further constructed via strong intermolecular interactions, including hydrogen bonds and π-π stacking interactions. Compounds 1 and 2 both exhibit significant water vapor hysteresis isotherms, and their cyclic water de-/adsorption behavior accompanied with solid-state structural transformation has been verified by de-/rehydration TG analyses and powder X-ray diffraction (PXRD) measurements.
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We report herein on the crystal structure and magnetic studies of a three-dimensional (3D) Ni(II)-chromate coordination polymer, [Ni(CrO4)(bpym)(H2O)]n (1; bpym = 5,5'-bipyrimidin), prepared by self-assembly of Ni(II) and chromate ions with a multi-N donor auxiliary ligands, bpym, through hydrothermal processes. The structure of 1 is composed of Ni(II)-CrO4 layers with [Ni3(µ3-CrO4)] triangular motifs, in which the Ni(II) centers are bridged by O':O':O':µ3-CrO42- anions, and the resulting layers are further connected by twisted trans-µ2-N,N'-bpym auxiliary ligands to form a 3D pillar-layered network with an hms topology. The magnetic properties of compound 1 were illustrated by variable field and temperature magnetic susceptibility measurements. The findings reveal that compound 1 shows intralayer ferromagnetic interactions within Ni(II)-CrO4 layers, and furthers the 3D antiferromagnetic ordering in the resulting of interlayer antiferromagnetic couplings with a Néel temperature (TN) of 5.6 K. In addition, compound 1 shows the field-induced metamagnetic behavior at temperature below the TN.
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Background: Patients undergoing surgical treatment for solid tumors are at risk for development of secondary lymphedema due to intraoperative lymphatic vessel injury. The damaged lymphatic vessels fail to adequately regenerate and lymphatic obstruction leads to fluid and protein accumulation in the interstitial space and chronic lymphedema develops as a result. There are currently no effective pharmacological agents that reduce the risk of developing lymphedema or treat pre-existing lymphedema, and management is largely palliative. The present study investigated the efficacy of various 9-cis retinoic acid (9-cis RA) dosing strategies in reducing postsurgical lymphedema by utilizing a well-established mouse tail lymphedema model. Methods and Results: Short-duration treatment with 9-cis RA did not demonstrate a significant reduction in postoperative tail volume, nor an improvement in lymphatic clearance. However, long-term treatment with 9-cis RA resulted in decreased overall tail volume, dermal thickness, and epidermal thickness, with an associated increase in functional lymphatic clearance and lymphatic vessel density, assessed by LYVE-1 immunostaining, compared with control. These effects were seen at the site of lymphatic injury, with no significant changes observed in uninjured sites such as ear skin and the diaphragm. Conclusions: Given the reported results indicating that 9-cis RA is a potent promoter of lymphangiogenesis and improved lymphatic clearance at sites of lymphatic injury, investigation of postoperative 9-cis RA administration to patients at high risk of developing lymphedema may demonstrate positive efficacy and reduced rates of postsurgical lymphedema.
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Vasos Linfáticos , Linfedema , Camundongos , Humanos , Animais , Duração da Terapia , Vasos Linfáticos/patologia , Alitretinoína/farmacologia , Linfangiogênese , Linfedema/patologia , Modelos Animais de DoençasRESUMO
OBJECTIVE: To compare vaginal progesterone to cerclage in preventing preterm birth and adverse perinatal outcomes in women with a singleton gestation, incidentally found sonographic cervical length of <15 mm, and no history of preterm birth. STUDY DESIGN: A retrospective cohort study was conducted on 68 women who delivered at the University of Kansas Health System with a singleton gestation found to have a cervical length <15 mm on transvaginal ultrasound and no history of preterm birth. Women treated with vaginal progesterone (n = 29) were compared to women who underwent cerclage placement (n = 39). The primary outcome was preterm birth at <34 weeks of gestation. Secondary outcomes include preterm birth at <37 and <28 weeks of gestation and neonatal morbidities. RESULTS: Of the 268 patients who had a cervical length of <15 mm on transvaginal ultrasound, 68 participants met inclusion criteria and were included in the final analysis. Twenty-nine participants received vaginal progesterone and 39 participants received cervical cerclage. The average cervical length at initiation of therapy was greater in the progesterone cohort versus cerclage cohort, respectively (10.5 vs. 8.0 mm, p < .01). All other baseline characteristics were similar between groups, including no difference in average gestational age at initiation of therapy (21.6 vs. 21.5 weeks, p = .87). Average latency after therapy did not differ between groups (100 vs. 92.7 days p = .43). The incidence of preterm birth at <37 weeks (OR = 1.49, 95% CI = 0.57-3.93), <34 weeks (OR = 1.47, 95% CI = 0.52-4.18), and <28 weeks (OR = 1.90, 95% CI = 0.45-8.07), did not differ significantly between groups. Additionally, no difference in neonatal morbidity was detected. CONCLUSION: At our institution, we found no difference between vaginal progesterone and cerclage in the average latency period or risk of preterm birth among women with an incidental short cervix of <15 mm and no history of preterm birth, despite the significantly shorter initial cervical length in the cerclage group. These findings suggest either vaginal progesterone or cerclage could be used to reduce the risk of preterm birth among this high-risk population.
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Cerclagem Cervical , Nascimento Prematuro , Recém-Nascido , Feminino , Humanos , Gravidez , Progesterona , Colo do Útero/diagnóstico por imagem , Colo do Útero/cirurgia , Gestantes , Estudos Retrospectivos , Administração Intravaginal , Nascimento Prematuro/prevenção & controleRESUMO
A camphorsulfonic acid-mediated one-pot tandem consecutive approach was developed to synthesize functionalized indole and 2-quinolone derivatives from the Ugi four-component reaction by switching solvents. A reaction of the Ugi adduct in an aprotic solvent undergoes 5-exo-trig cyclization to form an indole ring. In a protic solvent, however, the Ugi adduct undergoes an alkyne-carbonyl metathesis reaction to form a 2-quinolone ring.
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INTRODUCTION: Mothers with a short cervix have been shown to have increased risk of spontaneous preterm delivery (PTD) and newborn morbidity. Those who require an ultrasound-indicated cerclage experience the highest rates of morbidity. Inflammation has been linked to a short cervix, and it has been linked to pregnancies affected by small for gestational age (SGA) newborns. To date, there are no studies that have investigated an association between a short cervix, with or without an ultrasound-indicated cerclage, and a SGA newborn. METHODS: This was a case-control study examining all pregnancies with a transvaginal cervical length <25 mm found at their second trimester anatomy scan. Cases were subdivided into those who received an ultrasound-indicated cerclage (Group 1, n = 52) and those who did not (Group 2, n = 139). Controls were defined as pregnancies with a transvaginal cervical length >25 mm with no cerclage (Group 3, n = 186) whose due date was within 2 months of the case pregnancy. Each short cervix case was matched with a control from group 3 in a 1:1 ratio. The primary outcome was birthweight <10% (SGA). Unadjusted data was analyzed with simple odds ratios. A logistic regression was used to control for confounding variables and provide an adjusted odds ratios (aOR). RESULTS: The incidence of SGA among cases overall (group 1 + group 2) was 13.6% (26/191). In group 3, the SGA incidence was 4.3% (8/186). The adjusted odds ratio (aOR) for a SGA infant was significant, 2.8 (95% CI 1.2, 6.6). Subgroup analysis showed that Group 1 had an increased risk for an SGA infant [aOR 4.9 (95% CI 1.8, 13.7)], but Group 2 did not show a significant finding [aOR 2.3 (95% CI 0.9, 5.7)]. CONCLUSION: Pregnancies complicated by a short cervical length <25mm, with or without a cerclage, were associated with an increased risk for a SGA newborn. Most of this significance was due to the pregnancies which received an ultrasound-indicated cerclage for a mid-trimester short cervix.