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Objective This study investigated the clinical outcome of monochorionic diamniotic (MCDA) twins with selective intrauterine growth restriction (sIUGR). Study Design International Peace Maternal and Child Health Hospital of Shanghai ultrasound database was investigated to identify all MCDA delivered from January 2013 to December 2017. After identifying 43 pairs of MCDA twins with sIUGR and 282 pairs of normal MCDA twins, we compared clinical outcomes between the two groups. Results Compared with normal twins, sIUGR fetuses had significantly shorter gestational age at delivery, smaller average birth weight of both twins, more significant intertwin difference in birth weight, lower Apgar scores, and higher intrauterine fetal demise (IUFD) rate, and smaller placental weight. The rate of abnormal umbilical cord insertions and abnormal blood flow in the ductus venosus (DV) and middle cerebral artery (MCA) is significantly higher in the sIUGR group. In addition, the subtype analysis of sIUGR groups indicated the poorest outcomes in type II with no significant difference between type I and III. Conclusion MCDA twins with sIUGR generally exhibited limited clinical outcomes than normal MCDA twins. These limitations are mainly associated with abnormal umbilical cord insertions and blood flow in the DV and MCA. Clinical outcomes differed among the three types of sIUGR, with type II having the worst prognosis and the highest IUFD rate. Key points sIUGR generally exhibited limited clinical outcomes than normal MCDA twins. These limitations are mainly associated with blood flow of the DV and MCA. sIUGR with type II has the worst prognosis and the highest IUFD rate. [ABSTRACT FROM AUTHOR]

A base medium system, generated from a synergistic reaction between Cs2 CO3 and t -BuOK, has been used for the direct carboxylation of imidazoles with CO2 in good yield. Oxygen- and thia-heterocyclic arenes also undergo the carboxylation with CO2 with the same reactivity. Density functional theory calculations show that construction of t -BuOCs in situ is an endothermic process of 38.31 kJ/mol. t -BuOCs can promote the deprotonation of substrates by forming an active C–Cs bond via a rather low HOMO (t -BuOCs)–LUMO (imidazole) gap of 0.28 eV, which favors the electrophilic insertion of CO2 by releasing 94.13 kJ/mol of heat. [ABSTRACT FROM AUTHOR]

A base medium system, generated from a synergistic reaction between Cs2 CO3 and t -BuOK, has been used for the direct carboxylation of imidazoles with CO2 in good yield. Oxygen- and thia-heterocyclic arenes also undergo the carboxylation with CO2 with the same reactivity. Density functional theory calculations show that construction of t -BuOCs in situ is an endothermic process of 38.31 kJ/mol. t -BuOCs can promote the deprotonation of substrates by forming an active C–Cs bond via a rather low HOMO (t -BuOCs)–LUMO (imidazole) gap of 0.28 eV, which favors the electrophilic insertion of CO2 by releasing 94.13 kJ/mol of heat. [ABSTRACT FROM AUTHOR]

Objective  Cystatin C (CysC) references are useful for the monitoring of renal function in neonates. However, the standard CysC references in newborn infants have not been determined. The aim of this study was to establish a useful reference range for CysC in newborns. Study Design  Serum CysC levels were measured in 1,919 blood samples from 1,044 newborns during their first 28 days of life. CysC levels were analyzed for associations between subgroups dichotomized by postnatal age (PA) and gestational age (GA). The serum CysC reference intervals were determined according to the PA and GA. The associations between the serum CysC level and other biochemical parameters as well as perinatal factors were also analyzed. Results  In this study, the mean GA was 35.8 ± 2.9 weeks and the birth weight (BW) was 2,614 ± 697 g. Reference ranges of serum CysC were determined, and a general decreasing trend of CysC levels was observed as the GA increased. CysC levels differed significantly among the PA and GA categories (p  < 0.001). Serum CysC levels were relatively stable throughout the GA range but were impacted by the white blood cell count within the first postnatal 24 hours. Moreover, CysC levels always correlated positively with serum creatinine concentrations (p  < 0.001). Serum Cr levels were influenced by multiple factors, including BW, GA, total bilirubin, direct bilirubin, white blood cell count, C-reactive protein, and blood urea nitrogen. Conclusion  Reference levels of serum CysC should be determined according to the PA and GA. In contrast to Cr, serum CysC is a reliable index for assessing renal function in neonates as it is influenced by very few factors. The CysC reference levels will allow neonatologists to accurately evaluate renal function in the neonatal population. Key Points Cystatin C is a useful marker of the glomerular filtration rate in neonates. A reference range for cystatin C using 1,919 blood samples of 1,044 newborns was determined. In contrast to creatinine, only a few nonrenal factors influence serum cystatin C. [ABSTRACT FROM AUTHOR]

Objective  We aimed to describe changes in cesarean delivery (CD) rates after the change of the one-child policy in China by using the Robson classification in a large Chinese population. Study Design  This retrospective cohort study included 91,015 women who delivered at ≥24 weeks of gestation at a large tertiary obstetric center in Shanghai, China from 2011 to 2016. We analyzed CD rate trend and CD contribution trend in each Robson group. Logistic regression was used to calculate the odds of CD while adjusting for confounding variables. Results  The overall CD rate decreased from 49.0% in 2011 to 40.6% in 2016. In nulliparous women with singleton cephalic term pregnancy and planned CD, the CD contribution rate was reduced significantly from 29.3% in 2011 to 16.4% in 2016 (p  < 0.001). In multiparous with a scarred uterus, the CD contribution rate began to increase from 3.8% in 2011 to 9.1% in 2016 (p  < 0.001). Compared with delivery in 2011, delivery in 2016 was associated with a 37% (adjusted odds ratio [aOR]: 0.63; 95% confidence interval [CI]: 0.60–0.66) reduction in CD. This reduction was observed in both nulliparous women with singleton cephalic term pregnancy (aOR: 0.57; 95% CI: 0.54–0.60), and multiparous women with singleton cephalic term pregnancy without scar (aOR: 0.41; 95% CI: 0.30–0.55). Conclusion  The rate of cesarean delivery in our Chinese population has declined significantly in the past few years. [ABSTRACT FROM AUTHOR]

An efficient approach has been developed for the construction of quinazolin-4(3 H)-ones by the selective anodic dehydrogenative oxidation/cyclization of benzylic chlorides and 2-aminobenzamides. The method features acceptor-free and metal-free dehydrogenation of amines to imines; a subsequent intermolecular addition provides the products in moderate to good yields. [ABSTRACT FROM AUTHOR]

Background Basal ganglia hemorrhage (BGH) is a devastating neurologic disease with high morbidity and mortality, and its management is still controversial. We evaluated the effectiveness of surgical treatments for BGH and investigated computed tomography (CT) imaging features affecting the hematoma evacuation rate (ER) in patients treated with neuroendoscopic surgery. Materials and Methods A total of 104 BGH patients who underwent craniotomy, burr-hole drainage, or neuroendoscopic surgery were analyzed retrospectively. Clinical characteristics, imaging features, and postoperative complications were compared. Univariate and multivariate regression analyses were applied to identify imaging factors associated with ER. Results A significant difference in ER was observed: 78.4% in patients treated with neuroendoscopic surgery, 33.6% in patients treated with burr-hole drainage, and 82.5% in patients treated with craniotomy (p < 0.001). Similar results were observed for operative time (p < 0.001). Five cases (12.5%) of rebleeding were found in patients treated with burr-hole drainage (p = 0.020). No significant difference was found for pneumonia, intracranial infection, gastrointestinal bleeding, hospital mortality, hospital stay, expenses, 3-day Glasgow Coma Scale (GCS) scores after surgery, or GCS at discharge. The CT imaging feature, the island sign (p = 0.004), was observed as an independent factor correlated with lower ER for neuroendoscopic surgery. Conclusions The benefits and drawbacks of surgical treatments confirmed they have their own indications, and neuroendoscopic surgery may be relatively beneficial for BGH treatment. The island sign was an independent factor affecting ER for neuroendoscopic surgery. Therefore, comprehensive assessment of clinical data, especially the island sign, should be performed preoperatively in BGH patients. [ABSTRACT FROM AUTHOR]

13527260-a9557062.mp4 Endoscopic extraction of intrahepatic duct stones with conventional stone retrieval baskets is sometimes difficult [1], especially in patients with surgically altered anatomy [2]. When the left intrahepatic duct stones could not be removed using to this method, we carried out wire-guided cannulation using an improved single-lumen stone extraction basket, in which a hole was made with the tip of a needle (Fig. The removal of the common hepatic duct stones followed the ERCP sequence: intubation to the afferent limb, biliary cannulation, balloon dilation of the distal bile duct, and balloon-assisted stone extraction. [Extracted from the article]

Background Nonunions in the upper extremity are challenging for the reconstructive surgeon. The evolution of microsurgical techniques has allowed for the reliable use of free vascularized bone flaps. Methods In a retrospective study, patients with challenging upper limb nonunions who underwent free vascularized corticocancellous flaps from the medial femoral condyle (MFC) were included. Patient demographics, surgical technique, and outcomes were evaluated. Results Fifteen patients with nonunions of the upper extremity underwent free MFC corticocancellous flap reconstruction. The length of preoperative bone defects ranged from 0.8 to 3 cm, and the mean number of procedure prior to free MFC reconstruction was 1.5. Thirteen patients healed completely in an average of 15 weeks (range, 8-22 weeks). Two patients were lost to follow-up. Only one patient required additional surgery. Functional outcome measures such as Mayo, Disability of Arm, Shoulder, and Hand, and Constant-Murley scores all demonstrated improvement. Conclusion The free vascularized MFC corticocancellous flap can be successfully used for challenging upper extremity nonunions and small bone defects. [ABSTRACT FROM AUTHOR]

A new class of bisthiourea-functionalized molecular clips were designed and synthesized for anion recognition. Clip 1 showed excellent affinity to the biologically relevant fluoride ion in a 1:1 ratio as shown by UV-vis, �H and �9F NMR studies. Moreover, the binding was accompanied with visually noticeable color changes, enabling the compound to act as a colorimetric fluoride sensor. [ABSTRACT FROM AUTHOR]

A variety of N-substituted 3-aminocyclohex-2-enones were converted into the corresponding N-arylated α-iodo enaminones in high yields via concurrent α-iodination and N-arylation mediated by ArI(OAc)2. A mechanism is postulated to account for the reaction differences between the cyclic and the acyclic β-enamin�ones, which undergo predominant α-acetoxylation under the same reaction conditions. [ABSTRACT FROM AUTHOR]

A variety of N-substituted 3-aminocyclohex-2-enones were converted into the corresponding N-arylated ?-iodo enaminones in high yields via concurrent ?-iodination and N-arylation mediated by ArI(OAc) 2. A mechanism is postulated to account for the reaction differences between the cyclic and the acyclic ?-enamin?ones, which undergo predominant ?-acetoxylation under the same reaction conditions. [ABSTRACT FROM AUTHOR]