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1.
Mol Cell ; 83(22): 4158-4173.e7, 2023 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-37949068

RESUMO

Sporulating bacteria can retreat into long-lasting dormant spores that preserve the capacity to germinate when propitious. However, how the revival transcriptional program is memorized for years remains elusive. We revealed that in dormant spores, core RNA polymerase (RNAP) resides in a central chromosomal domain, where it remains bound to a subset of intergenic promoter regions. These regions regulate genes encoding for most essential cellular functions, such as rRNAs and tRNAs. Upon awakening, RNAP recruits key transcriptional components, including sigma factor, and progresses to express the adjacent downstream genes. Mutants devoid of spore DNA-compacting proteins exhibit scattered RNAP localization and subsequently disordered firing of gene expression during germination. Accordingly, we propose that the spore chromosome is structured to preserve the transcriptional program by halting RNAP, prepared to execute transcription at the auspicious time. Such a mechanism may sustain long-term transcriptional programs in diverse organisms displaying a quiescent life form.


Assuntos
Bacillus subtilis , Esporos Bacterianos , Esporos Bacterianos/genética , Esporos Bacterianos/metabolismo , Bacillus subtilis/genética , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Fator sigma/genética , Fator sigma/metabolismo , Regiões Promotoras Genéticas , RNA Polimerases Dirigidas por DNA/genética , RNA Polimerases Dirigidas por DNA/metabolismo
2.
Clin Microbiol Rev ; 37(2): e0007123, 2024 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-38656211

RESUMO

SUMMARYMalaria remains one of the biggest health problems in the world. While significant reductions in malaria morbidity and mortality had been achieved from 2000 to 2015, the favorable trend has stalled, rather significant increases in malaria cases are seen in multiple areas. In 2022, there were 249 million estimated cases, and 608,000 malaria-related deaths, mostly in infants and children aged under 5 years, globally. Therefore, in addition to the expansion of existing anti-malarial control measures, it is critical to develop new tools, such as vaccines and monoclonal antibodies (mAbs), to fight malaria. In the last 2 years, the first and second malaria vaccines, both targeting Plasmodium falciparum circumsporozoite proteins (PfCSP), have been recommended by the World Health Organization to prevent P. falciparum malaria in children living in moderate to high transmission areas. While the approval of the two malaria vaccines is a considerable milestone in vaccine development, they have much room for improvement in efficacy and durability. In addition to the two approved vaccines, recent clinical trials with mAbs against PfCSP, blood-stage vaccines against P. falciparum or P. vivax, and transmission-blocking vaccine or mAb against P. falciparum have shown promising results. This review summarizes the development of the anti-PfCSP vaccines and mAbs, and recent topics in the blood- and transmission-blocking-stage vaccine candidates and mAbs. We further discuss issues of the current vaccines and the directions for the development of next-generation vaccines.


Assuntos
Anticorpos Monoclonais , Vacinas Antimaláricas , Vacinas Antimaláricas/imunologia , Humanos , Anticorpos Monoclonais/imunologia , Anticorpos Monoclonais/uso terapêutico , Plasmodium falciparum/imunologia , Malária/prevenção & controle , Malária/imunologia , Malária Falciparum/prevenção & controle , Malária Falciparum/imunologia , Anticorpos Antiprotozoários/imunologia , Proteínas de Protozoários/imunologia , Ensaios Clínicos como Assunto
3.
J Biol Chem ; : 107557, 2024 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-39002668

RESUMO

Glycosylphosphatidylinositol (GPI) anchor protein modification in Plasmodium species is well known and represents the principal form of glycosylation in these organisms. The structure and biosynthesis of GPI anchors of Plasmodium spp. has been primarily studied in the asexual blood stage of P. falciparum and is known to contain the typical conserved GPI structure of EtN-P-Man3GlcN-PI. Here, we have investigated the circumsporozoite protein (CSP) for the presence of a GPI-anchor. CSP is the major surface protein of Plasmodium sporozoites, the infective stage of the malaria parasite. While it is widely assumed that CSP is a GPI-anchored cell surface protein, compelling biochemical evidence for this supposition is absent. Here, we employed metabolic labeling and mass-spectrometry based approaches to confirm the presence of a GPI anchor in CSP. Biosynthetic radiolabeling of CSP with [3H]-palmitic acid and [3H]-ethanolamine, with the former being base-labile and therefore ester-linked, provided strong evidence for the presence of a GPI anchor on CSP, but these data alone were not definitive. To provide further evidence, immunoprecipitated CSP was analyzed for presence of myo-inositol (a characteristic component of GPI anchor) using strong acid hydrolysis and GC-MS for a highly sensitive and quantitative detection. The single ion monitoring (SIM) method for GC-MS analysis confirmed the presence of the myo-inositol component in CSP. Taken together, these data provide confidence that the long-assumed presence of a GPI anchor on this important parasite protein is correct.

4.
J Biol Chem ; 299(12): 105448, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37951305

RESUMO

Bacteria utilize quorum sensing (QS) to coordinate many group behaviors. As such, QS has attracted significant attention as a potential mean to attenuate bacterial infectivity without introducing selective pressure for resistance development. Streptococcus mitis, a human commensal, acts as a genetic diversity reservoir for Streptococcus pneumoniae, a prevalent human pathogen. S. mitis possesses a typical comABCDE competence regulon QS circuitry; however, the competence-stimulating peptide (CSP) responsible for QS activation and the regulatory role of the competence regulon QS circuitry in S. mitis are yet to be explored. We set out to delineate the competence regulon QS circuitry in S. mitis, including confirming the identity of the native CSP signal, evaluating the molecular mechanism that governs CSP interactions with histidine kinase receptor ComD leading to ComD activation, and defining the regulatory roles of the competence regulon QS circuitry in initiating various S. mitis phenotypes. Our analysis revealed important structure-activity relationship insights of the CSP signal and facilitated the development of novel CSP-based QS modulators. Our analysis also revealed the involvement of the competence regulon in modulating competence development and biofilm formation. Furthermore, our analysis revealed that the native S. mitis CSP signal can modulate QS response in S. pneumoniae. Capitalizing on this crosstalk, we developed a multispecies QS modulator that activates both the pneumococcus ComD receptors and the S. mitis ComD-2 receptor with high potencies. The novel scaffolds identified herein can be utilized to evaluate the effects temporal QS modulation has on S. mitis as it inhabits its natural niche.


Assuntos
Percepção de Quorum , Streptococcus mitis , Humanos , Proteínas de Bactérias/metabolismo , Histidina Quinase/metabolismo , Peptídeos/metabolismo , Fenótipo , Regulon , Streptococcus mitis/genética , Streptococcus mitis/metabolismo , Streptococcus pneumoniae/genética , Relação Estrutura-Atividade , Especificidade da Espécie
5.
Neurobiol Dis ; 198: 106538, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38789057

RESUMO

Aging is the main risk factor of cognitive neurodegenerative diseases such as Alzheimer's disease, with epigenome alterations as a contributing factor. Here, we compared transcriptomic/epigenomic changes in the hippocampus, modified by aging and by tauopathy, an AD-related feature. We show that the cholesterol biosynthesis pathway is severely impaired in hippocampal neurons of tauopathic but not of aged mice pointing to vulnerability of these neurons in the disease. At the epigenomic level, histone hyperacetylation was observed at neuronal enhancers associated with glutamatergic regulations only in the tauopathy. Lastly, a treatment of tau mice with the CSP-TTK21 epi-drug that restored expression of key cholesterol biosynthesis genes counteracted hyperacetylation at neuronal enhancers and restored object memory. As acetyl-CoA is the primary substrate of both pathways, these data suggest that the rate of the cholesterol biosynthesis in hippocampal neurons may trigger epigenetic-driven changes, that may compromise the functions of hippocampal neurons in pathological conditions.


Assuntos
Doença de Alzheimer , Colesterol , Hipocampo , Camundongos Transgênicos , Neurônios , Animais , Doença de Alzheimer/metabolismo , Doença de Alzheimer/genética , Hipocampo/metabolismo , Colesterol/biossíntese , Colesterol/metabolismo , Neurônios/metabolismo , Camundongos , Epigenômica , Epigênese Genética , Camundongos Endogâmicos C57BL , Envelhecimento/metabolismo , Envelhecimento/genética , Masculino , Proteínas tau/metabolismo , Proteínas tau/genética
6.
Curr Issues Mol Biol ; 46(6): 5682-5700, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38921011

RESUMO

It is known that sialyllactose (SL) in mammalians is a major source of sialic acid (Sia), which can further form cytidine monophosphate sialic acid (CMP-Sia), and the final product is polysialic acid (polySia) using polysialyltransferases (polySTs) on the neural cell adhesion molecule (NCAM). This process is called NCAM polysialylation. The overexpression of polysialylation is strongly related to cancer cell migration, invasion, and metastasis. In order to inhibit the overexpression of polysialylation, in this study, SL was selected as an inhibitor to test whether polysialylation could be inhibited. Our results suggest that the interactions between the polysialyltransferase domain (PSTD) in polyST and CMP-Siaand the PSTD and polySia could be inhibited when the 3'-sialyllactose (3'-SL) or 6'-sialyllactose (6'-SL) concentration is about 0.5 mM or 6'-SL and 3 mM, respectively. The results also show that SLs (particularly for 3'-SL) are the ideal inhibitors compared with another two inhibitors, low-molecular-weight heparin (LMWH) and cytidine monophosphate (CMP), because 3'-SL can not only be used to inhibit NCAM polysialylation, but is also one of the best supplements for infant formula and the gut health system.

7.
Acta Neuropathol ; 147(1): 94, 2024 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-38833073

RESUMO

A recent large genome-wide association study has identified EGFR (encoding the epidermal growth factor EGFR) as a new genetic risk factor for late-onset AD. SHIP2, encoded by INPPL1, is taking part in the signalling and interactome of several growth factor receptors, such as the EGFR. While INPPL1 has been identified as one of the most significant genes whose RNA expression correlates with cognitive decline, the potential alteration of SHIP2 expression and localization during the progression of AD remains largely unknown. Here we report that gene expression of both EGFR and INPPL1 was upregulated in AD brains. SHIP2 immunoreactivity was predominantly detected in plaque-associated astrocytes and dystrophic neurites and its increase was correlated with amyloid load in the brain of human AD and of 5xFAD transgenic mouse model of AD. While mRNA of INPPL1 was increased in AD, SHIP2 protein undergoes a significant solubility change being depleted from the soluble fraction of AD brain homogenates and co-enriched with EGFR in the insoluble fraction. Using FRET-based flow cytometry biosensor assay for tau-tau interaction, overexpression of SHIP2 significantly increased the FRET signal while siRNA-mediated downexpression of SHIP2 significantly decreased FRET signal. Genetic association analyses suggest that some variants in INPPL1 locus are associated with the level of CSF pTau. Our data support the hypothesis that SHIP2 is an intermediate key player of EGFR and AD pathology linking amyloid and tau pathologies in human AD.


Assuntos
Doença de Alzheimer , Encéfalo , Progressão da Doença , Receptores ErbB , Fosfatidilinositol-3,4,5-Trifosfato 5-Fosfatases , Idoso , Idoso de 80 Anos ou mais , Animais , Feminino , Humanos , Masculino , Camundongos , Doença de Alzheimer/patologia , Doença de Alzheimer/genética , Doença de Alzheimer/metabolismo , Encéfalo/patologia , Encéfalo/metabolismo , Receptores ErbB/genética , Receptores ErbB/metabolismo , Expressão Gênica , Camundongos Transgênicos , Fosfatidilinositol-3,4,5-Trifosfato 5-Fosfatases/genética , Fosfatidilinositol-3,4,5-Trifosfato 5-Fosfatases/metabolismo , Solubilidade , Proteínas tau/metabolismo , Proteínas tau/genética
8.
Chemistry ; 30(12): e202303537, 2024 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-37991931

RESUMO

Site-selective C(sp3 )-H functionalization of unreactive hydrocarbons is always challenging due to its inherited chemical inertness, slightly different reactivity of various C-H bonds, and intrinsically high bond dissociation energies. Here, a site-selective C-H alkylation of naphthoquinone with unactivated hydrocarbons using Mn2 (CO)10 as a catalyst under blue-light (457 nm) irradiation without any external acid or base and pre-functionalization is presented. The selective C-H functionalization of tertiary over secondary and secondary over primary C(sp3 )-H bonds in abundant chemical feedstocks was achieved, and hydroxylation of quinones was realized in situ by employing the developed methodology. This protocol provides a new catalytic system for the direct construction of high-value-added compounds, namely, parvaquone (a commercially available drug used to treat theileriosis) and its derivatives under ambient reaction conditions. Moreover, this operationally simple protocol applies to various linear-, branched-, and cyclo-alkanes with high degrees of site selectivity under blue-light irradiated conditions and could provide rapid and straightforward access to versatile methodologies for upgrading feedstock chemicals. Mechanistic insight by radical trapping, radical scavenging, EPR, and other controlled experiments well corroborated with DFT studies suggest that the reaction proceeds by a radical pathway.

9.
Chemistry ; 30(28): e202400005, 2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38497560

RESUMO

New chiral targets of orientational chirality have been designed and asymmetrically synthesized by taking advantage of N-sulfinyl imine-directed nucleophilic addition/oxidation, Suzuki-Miyaura, and Sonogashira cross-coupling reactions. Orientation of single isomers has been selectively controlled by using aryl/alkynyl levers [C(sp2)-C(sp) axis] and tBuSO2- protecting group on nitrogen as proven by X-ray diffraction analysis. The key structural characteristic of resulting orientational products is shown by remote through-space blocking manner. Seventeen examples of multi-step synthesis were obtained with modest to good chemical yields and complete orientational selectivity.

10.
Chemistry ; 30(6): e202303337, 2024 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-37987541

RESUMO

A photocatalytic domain of doubly decarboxylative Csp 2 -Csp 2 cross coupling reaction is disclosed. Merging iridium and palladium photocatalysis manifested carbon-carbon bonds in a tandem dual-radical pathway. Present catalytic platform efficiently cross-coupled α, ß-unsaturated acids and α-keto acids to afford a variety of α, ß-unsaturated ketones with excellent (E)-selectivity and functional group tolerance. Mechanistically, photocatalyst implicated through reductive quenching cycle whereas cross coupling proceeded over one electron oxidative pallado-cycle.

11.
Chemistry ; 30(32): e202400895, 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38584581

RESUMO

Catalytic cross-coupling between aryl halides and alkynes is considered an extremely important organic transformation (popularly known as the Sonogashira coupling) and it requires a transition metal-based catalyst. Accomplishing such transformation without any transition metal-based catalyst in the absence of any external stimuli such as heat, photoexcitation or cathodic current is highly challenging. This work reports transition-metal-free cross-coupling between aryl halides and alkynes synthesizing a rich library of internal alkynes without any external stimuli. A chemically double-reduced phenalenyl (PLY)-based molecule with the super-reducing property was employed for single electron transfer to activate aryl halides generating reactive aryl radicals, which subsequently react with alkyne. This protocol covers not only various types of aryl, heteroaryl and polyaryl halides but also applies to a large variety of aromatic alkynes at room temperature. With a versatile substrate scope successfully tested on more than 75 entries, this radical-mediated pathway has been explained by several control experiments. All the key reactive intermediates have been characterized with spectroscopic evidence. Detailed DFT calculations have been instrumental in portraying the mechanistic pathway. Furthermore, we have successfully extended this transition-metal-free catalytic strategy for the first time towards solvent-free cross-coupling between solid aryl halide and alkyne substrates.

12.
Chemistry ; 30(6): e202303315, 2024 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-37933814

RESUMO

Catalytic activities of Mn(I) complexes derived from expensive MnBr(CO)5 salt have been explored in various dehydrogenative transformations. However, the reactivity and selectivity of inexpensive high spin Mn(II) complexes are uncommon. Herein, we have synthesized four new Mn(II) complexes and explored switchable alkenylation and alkylation of methyl heteroarenes employing a single Mn(II)catalyst. The developed protocol selectively furnishes a series of functionalized E-heteroarenes and C-alkylated heteroarenes with good to excellent yields. Various medicinally and synthetically useful compounds are successfully synthesized using our developed protocol. Various controls and kinetics experiments were executed to shed light on the mechaism,which reveals that α-C-H bond breaking of alcohol is the slowest step.

13.
Chemistry ; 30(25): e202400010, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38389032

RESUMO

With alkyl halides (I, Br, Cl) as a coupling partner, an electrochemically driven strategy for para-selective C(sp2)-H alkylation of electron-deficient arenes (aryl esters, aldehydes, nitriles, and ketones) has been achieved to access diverse alkylated arenes in one step. The reaction enables the activation of alkyl halides in the absence of sacrificial anodes, achieving the formation of C(sp2)-C(sp3) bonds under mild electrolytic conditions. The utility of this protocol is reflected in high site selectivity, broad substrate scope, and scalable.

14.
Chemistry ; 30(11): e202303626, 2024 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-37997552

RESUMO

Mono α-acylation of acetone has been achieved for the first time by reacting with bench-stable acyl azolium salts under violet-LED light at room temperature. The intermolecular hydrogen atom transfer (HAT) from acetone to triplet state of azolium salts under violet LED irradiation resulted in thermodynamically less favourable (Z)-α,ß-unsaturated ketones with up to 99 : 1 selectivity via C-C bond formation. This compelling protocol access the desired α-C(sp3 )-H acylation product under metal-, ligand- and oxidant-free conditions on a wide range of substrates.

15.
Chemistry ; 30(29): e202400435, 2024 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-38497321

RESUMO

Organoalkali compounds have undergone a far-reaching transformation being a coupling partner to a mediator in unusual organic conversions which finds its spot in the field of sustainable synthesis. Transition-metal catalysis has always been the priority in C(sp3)-H bond functionalization, however alternatively, in recent times this has been seriously challenged by earth-abundant alkali metals and their complexes arriving at new sustainable organometallic reagents. In this line, the importance of MN(SiMe3)2 (M=Li, Na, K & Cs) reagent revived in C(sp3)-H bond functionalization over recent years in organic synthesis is showcased in this minireview. MN(SiMe3)2 reagent with higher reactivity, enhanced stability, and bespoke cation-π interaction have shown eye-opening mediated processes such as C(sp3)-C(sp3) cross-coupling, radical-radical cross-coupling, aminobenzylation, annulation, aroylation, and other transformations to utilize readily available petrochemical feedstocks. This article also emphasizes the unusual reactivity of MN(SiMe3)2 reagent in unreactive and robust C-X (X=O, N, F, C) bond cleavage reactions that occurred alongside the C(sp3)-H bond functionalization. Overall, this review encourages the community to exploit the untapped potential of MN(SiMe3)2 reagent and also inspires them to take up this subject to even greater heights.

16.
Adv Synth Catal ; 366(11): 2489-2494, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38895098

RESUMO

n-Bu4NI/K2S2O8 mediated transformylation from p-anisaldehyde to primary amides is reported. The mechanistic studies suggest the reaction occurs via a single electron transfer pathway. Based on the DFT electronic structure calculations of various reaction pathways, the most plausible mechanism involves the formation of a phenyl radical cation and an arenium ion as the key intermediates. It represents the first example where p-anisaldehyde is employed as a formyl source via a non-metal mediated Csp2-Csp2 bond cleavage.

17.
Ultrasound Obstet Gynecol ; 63(1): 60-67, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-37698345

RESUMO

OBJECTIVE: In-utero repair of an open neural tube defect (ONTD) reduces the risk of developing severe hydrocephalus postnatally. Perforation of the cavum septi pellucidi (CSP) may reflect increased intraventricular pressure in the fetal brain. We sought to evaluate the association of perforated CSP visualized on fetal imaging before and/or after in-utero ONTD repair with the eventual need for hydrocephalus treatment by 1 year of age. METHODS: This was a retrospective cohort study of consecutive patients who underwent laparotomy-assisted fetoscopic ONTD repair between 2014 and 2021 at a single center. Eligibility criteria for surgery were based on those of the Management of Myelomeningocele Study (MOMS), although a maternal prepregnancy body mass index of up to 40 kg/m2 was allowed. Fetal brain imaging was performed with ultrasound and magnetic resonance imaging (MRI) at referral and 6 weeks postoperatively. Stored ultrasound and MRI scans were reviewed retrospectively to assess CSP integrity. Medical records were reviewed to determine whether hydrocephalus treatment was needed within 1 year of age. Parametric and non-parametric tests were used as appropriate to compare outcomes between cases with perforated CSP and those with intact CSP as determined on ultrasound at referral. Logistic regression analysis was performed to assess the predictive performance of various imaging markers for the need for hydrocephalus treatment. RESULTS: A total of 110 patients were included. Perforated CSP was identified in 20.6% and 22.6% of cases on preoperative ultrasound and MRI, respectively, and in 26.6% and 24.2% on postoperative ultrasound and MRI, respectively. Ventricular size increased between referral and after surgery (median, 11.00 (range, 5.89-21.45) mm vs 16.00 (range, 7.00-43.5) mm; P < 0.01), as did the proportion of cases with severe ventriculomegaly (ventricular width ≥ 15 mm) (12.7% vs 57.8%; P < 0.01). Complete CSP evaluation was achieved on preoperative ultrasound in 107 cases, of which 22 had a perforated CSP and 85 had an intact CSP. The perforated-CSP group presented with larger ventricles (mean, 14.32 ± 3.45 mm vs 10.37 ± 2.37 mm; P < 0.01) and a higher rate of severe ventriculomegaly (40.9% vs 5.9%; P < 0.01) compared to those with an intact CSP. The same trends were observed at 6 weeks postoperatively for mean ventricular size (median, 21.0 (range, 13.0-43.5) mm vs 14.3 (range, 7.0-29.0) mm; P < 0.01) and severe ventriculomegaly (95.0% vs 46.8%; P < 0.01). Cases with a perforated CSP at referral had a lower rate of hindbrain herniation (HBH) reversal postoperatively (65.0% vs 88.6%; P = 0.01) and were more likely to require treatment for hydrocephalus (89.5% vs 22.7%; P < 0.01). The strongest predictor of the need for hydrocephalus treatment within 1 year of age was lack of HBH reversal on MRI (odds ratio (OR), 36.20 (95% CI, 5.96-219.12); P < 0.01) followed by perforated CSP on ultrasound at referral (OR, 23.40 (95% CI, 5.42-100.98); P < 0.01) and by perforated CSP at 6-week postoperative ultrasound (OR, 19.48 (95% CI, 5.68-66.68); P < 0.01). CONCLUSIONS: The detection of a perforated CSP in fetuses with ONTD can reliably identify those cases at highest risk for needing hydrocephalus treatment by 1 year of age. Evaluation of this brain structure can improve counseling of families considering fetal surgery for ONTD, in order to set appropriate expectations about postnatal outcome. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.


Assuntos
Hidrocefalia , Meningomielocele , Espinha Bífida Cística , Gravidez , Feminino , Humanos , Espinha Bífida Cística/complicações , Espinha Bífida Cística/diagnóstico por imagem , Espinha Bífida Cística/cirurgia , Estudos Retrospectivos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Encéfalo , Meningomielocele/cirurgia
18.
Artigo em Inglês | MEDLINE | ID: mdl-38308856

RESUMO

Early diagnosis and appropriate management of Cesarean scar pregnancy (CSP) are crucial to prevent severe complications such as uterine rupture, severe hemorrhage and placenta accreta spectrum disorders. In this article, we provide a step-by-step tutorial for the standardized sonographic evaluation of CSP in the first trimester. Practical steps for performing a standardized transvaginal ultrasound examination to diagnose CSP are outlined, focusing on criteria and techniques essential for accurate identification and classification. Key sonographic markers, including gestational sac location, cardiac activity, placental implantation and myometrial thickness, are detailed. The evaluation process is presented according to assessment of the uterine scar, differential diagnosis, detailed CSP evaluation and CSP classification. This step-by-step tutorial emphasizes the importance of scanning in two planes (sagittal and transverse), utilizing color or power Doppler and differentiating CSP from other low-lying pregnancies. The CSP classification is described in detail and is based on the location of the largest part of the gestational sac relative to the uterine cavity and serosal lines. This descriptive classification is recommended for clinical use to stimulate uniform description and evaluation. Such a standardized sonographic evaluation of CSP in the first trimester is essential for early diagnosis and management, helping to prevent life-threatening complications and to preserve fertility. Training sonographers in detailed evaluation techniques and promoting awareness of CSP are critical. The structured approach to CSP diagnosis presented herein is supported by a free e-learning course available online. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

19.
Dig Dis Sci ; 69(7): 2381-2389, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38722411

RESUMO

BACKGROUND: Patients with end-stage renal disease (ESRD) who undergo polypectomy may experience postpolypectomy bleeding. To reduce the risk of delayed postpolypectomy bleeding among the general population, cold snare polypectomy (CSP) is recommended for removing colon polyps smaller than 1 cm. Nevertheless, only few studies have examined the effect of CSP on patients with ESRD. METHODS: We retrospectively analyzed the data of patients with ESRD who underwent colonoscopic polypectomy for polyps larger than 5 mm at a Taiwanese university hospital from January 2014 to January 2023. The main outcome was delayed postpolypectomy bleeding within 30 days. Multivariate analysis was conducted to adjust for major confounders. RESULTS: A total of 557 patients with ESRD underwent colonoscopic polypectomy during the study period: 201 underwent CSP and 356 underwent hot snare polypectomy (HSP). Delayed postpolypectomy bleeding occurred in 27 patients (4.8%). The rate of delayed postpolypectomy bleeding was lower in patients with ESRD who underwent CSP than in those who underwent HSP (1.9% vs. 6.4%, P = 0.022). The percentage of patients who did not experience postpolypectomy bleeding within 30 days after CSP remained lower than that observed after HSP (P = 0.019, log-rank test). Multivariate analysis demonstrated immediate postpolypectomy bleeding and HSP to be independent risk factors for delayed postpolypectomy bleeding. A nomogram prognostic model was used to predict the potential of delayed postpolypectomy bleeding within 30 days in patients with ESRD. CONCLUSIONS: Compared with HSP, CSP is more effective in mitigating the risk of delayed postpolypectomy bleeding in patients with ESRD.


Assuntos
Pólipos do Colo , Colonoscopia , Falência Renal Crônica , Hemorragia Pós-Operatória , Humanos , Falência Renal Crônica/complicações , Estudos Retrospectivos , Pólipos do Colo/cirurgia , Masculino , Feminino , Pessoa de Meia-Idade , Colonoscopia/métodos , Idoso , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Fatores de Risco , Resultado do Tratamento , Taiwan/epidemiologia
20.
Sensors (Basel) ; 24(9)2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38732816

RESUMO

Target detection technology based on unmanned aerial vehicle (UAV)-derived aerial imagery has been widely applied in the field of forest fire patrol and rescue. However, due to the specificity of UAV platforms, there are still significant issues to be resolved such as severe omission, low detection accuracy, and poor early warning effectiveness. In light of these issues, this paper proposes an improved YOLOX network for the rapid detection of forest fires in images captured by UAVs. Firstly, to enhance the network's feature-extraction capability in complex fire environments, a multi-level-feature-extraction structure, CSP-ML, is designed to improve the algorithm's detection accuracy for small-target fire areas. Additionally, a CBAM attention mechanism is embedded in the neck network to reduce interference caused by background noise and irrelevant information. Secondly, an adaptive-feature-extraction module is introduced in the YOLOX network's feature fusion part to prevent the loss of important feature information during the fusion process, thus enhancing the network's feature-learning capability. Lastly, the CIoU loss function is used to replace the original loss function, to address issues such as excessive optimization of negative samples and poor gradient-descent direction, thereby strengthening the network's effective recognition of positive samples. Experimental results show that the improved YOLOX network has better detection performance, with mAP@50 and mAP@50_95 increasing by 6.4% and 2.17%, respectively, compared to the traditional YOLOX network. In multi-target flame and small-target flame scenarios, the improved YOLO model achieved a mAP of 96.3%, outperforming deep learning algorithms such as FasterRCNN, SSD, and YOLOv5 by 33.5%, 7.7%, and 7%, respectively. It has a lower omission rate and higher detection accuracy, and it is capable of handling small-target detection tasks in complex fire environments. This can provide support for UAV patrol and rescue applications from a high-altitude perspective.

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