Chiral Self-Sorting, Spontaneous Resolution, and Hierarchical Self-Assembly in Metal-Organic Cages.

The ability to collectively program chiral recognition and the hierarchical self-assembly of molecular and supramolecular building blocks into complex higher-order superstructures is a significant goal in supramolecular chemistry. Metal-organic cages are excellent model systems to examine chiral self-sorting and build hierarchical self-assembly. Herein, details on how limiting the conformational flexibility and incorporating hydrogen bonding functional groups in the ligands can influence chiral self-sorting and hierarchical self-assembly of metal-organic cages are reported. The urea-functionalized axially chiral bis-pyridyl ligands afford high-fidelity in chiral self-sorting in Pd2L4 cages, when they have fewer conformations. Ligand L1, with more conformations, affords mixture of heterochiral and homochiral cages (≈70:30). Among them, the heterochiral cage adopts unusual twisted conformation and self-assembles into 2D sheets, linked by anion coordination between urea and nitrate. Ligand L2, with fewer conformations, affords homochiral cages via high-fidelity chiral self-sorting. The choice of counter anions influences further self-sorting in the solid state: racemate with PF6 - and spontaneously resolves conglomerate with BF4 -. Urea-BF4 hydrogen bonding directs hierarchical self-assembly of the Pd2L4 metal-organic cages into super-cubic networks. The study introduces a new approach in hierarchical self-assembly of metal-organic cages into higher-order networks aided by hydrogen bonding anion coordination with functional ligands.

Case report: Rare benign colorectal intussusception due to rectal polyp treated non operatively.

INTRODUCTION AND IMPORTANCE: Intestinal intussusception is rare in adults, involving telescoping of one intestinal segment into another. Commonly associated with colonic lesions, it presents as acute obstruction. Diagnosis relies on CT. We report a rare case of colorectal intussusception due to a polyp, managed by endoscopic polypectomy. CASE PRESENTATION: We present a case of a 74-year-old man with chronic constipation, who presented with acute abdominal pain, vomiting, and cessation of bowel movements. Hemodynamically stable, he had a distended abdomen. We diagnosed acute bowel obstruction secondary to colorectal intussusception via CT scan. Surgery was planned after resuscitation. However, after induction of general anesthesia, the procedure was postponed due to a significant diarrheal episode and resolution of the abdominal distension. A subsequent colonoscopy revealed a 10 mm polyp, which was excised endoscopically. The patient's recovery was smooth, with no recurrence after a one-year follow-up. CLINICAL DISCUSSION: Intestinal intussusception, rare in adults, primarily affects the small intestine but may involve the colon, often associated with organic lesions or postoperative adhesions. While colocolonic intussusceptions, mostly malignant, may stem from benign causes occasionally, symptoms are nonspecific, with common pain. Diagnosis relies on CT scans, with surgery typically required, except in select cases. CONCLUSION: Colorectal intussusception, rare in adults, may necessitate laparotomy. Spontaneous symptom resolution enables conservative management. Clinician awareness is vital to prevent unnecessary and risky surgeries, given its rarity and potential for favorable outcomes sans intervention.

Angina Bullosa Hemorrhagica: A Rare Presentation of Oral Bleeding.

Angina bullosa hemorrhagica (ABH) is a rare condition seen in the oral cavity which is characterized by the presence of single or multiple blood-filled cavities which are generally not associated with any other systemic illness or condition. These lesions tend to rupture spontaneously and lead to epithelial erosions, which heal over the course of a few days without any signs of scarring. The condition is mostly attributed to trauma in the oral cavity, which occurs as a result of sharp metallic crowns or other such metal implants on the teeth or due to chewing hard and crispy food. This report presents a case of a 50-year-old female with no comorbidities who presented with bleeding from the mouth after eating cashew nuts. The case was diagnosed clinically and conservatively managed. The report aims to increase awareness regarding the causes and management of the condition.

Surgical management of secondary acquired cholesteatoma depends on its characteristics.

OBJECTIVE: Cholesteatoma secondary to tympanic perforation, known as "secondary acquired cholesteatoma" may progress slower than a retraction pocket cholesteatoma, with less bone destruction and fewer intracranial complications. However, complete surgical removal remains difficult because the pathological epithelium on the marginal side of the extension is not covered by the subepithelial layer of the cholesteatoma matrix, making the boundary with the middle ear mucosa difficult to identify. Therefore, considering the pathophysiology of secondary acquired cholesteatoma, suitable preoperative evaluation and surgical techniques are required. In this study, we aimed to evaluate (i) the extension of secondary acquired cholesteatoma according to the size and location of tympanic membrane perforation; and (ii) the microscopic surgical outcomes, including the rate of residual cholesteatoma, requirement for specialized surgical management, and changes in hearing. METHODS: This retrospective study included data of cases with secondary acquired cholesteatoma (n = 66; 66 ears of 64 patients, 2 patients had bilateral ear involvement), including those who underwent a staged operation (n = 25). RESULTS: The perforation level of the tympanic membrane was associated with the cholesteatoma extension. When the cholesteatoma extended around the stapes, staged operation was chosen. Six cases of spontaneous resolution of stapes lesions at the time of staged surgery were observed. A significant postoperative improvement in hearing was observed; however, five cases experienced sensorineural hearing loss. CONCLUSION: Surgery, including staged surgery of the stapes lesions, along with careful observation of the perforation, is required in secondary acquired cholesteatoma. For lesions that are visible yet challenging to remove, it is imperative to exercise prudent judgment, taking into account the possibility of spontaneous resolution.

Spontaneous Resolution of Pediatric Varus Ankle Deformity: A Case Report.

Introduction: Distal tibia fractures are a common cause of physeal injuries that can subsequently cause deformity in pediatric populations. Limited literature exists supporting treatment strategies for varus deformities. In this study, we illustrate a unique case of premature physeal closure complicated by development of a varus ankle deformity treated with navigation guided physeal bar resection that spontaneously resolved without the requirement for guided growth. Case Report: A 6-year-old female presented to our clinic after development of a right ankle varus deformity measuring 14°. She had sustained a right Salter Harris type 3 distal tibia fracture 10 months prior and underwent fixation at an external facility. After undergoing navigation guided physeal bar resection, resolution of her deformity occurred without the use of guided growth. Conclusion: Spontaneous resolution of an ankle deformity is possible after a physeal bar resection. However, in these technically demanding procedures, it is important to optimize accuracy and results using preoperative bar mapping and intraoperative three-dimensional navigation.

Spontaneous resolution of proximal humerus sessile osteochondroma: A report of case and literature review.

Key Clinical Message: In managing a child with a solitary osteochondroma, the most advisable course of action involves vigilant observation and regular follow-up, given the potential for spontaneous resolution. Abstract: The most frequent benign cartilage tumors in children are osteochondromas, which develop when the growth plate herniates during bone development. Treatment depends on the symptoms, with asymptomatic cases requiring monitoring and symptomatic patients requiring surgical intervention. Rarely, an asymptomatic osteochondroma may spontaneously disappear. We report the case of a 3-year-old male who presented with left arm swelling and pain due to trauma while playing football. X-rays revealed a proximal humerus posterolateral sessile osteochondroma. After 6 months of observation, the boy tolerated activity and had no pain. Five years later, the osteochondroma was resolved spontaneously both clinically and radiologically. Our study suggests that annual observation of child patients with osteochondroma is more effective than surgical intervention due to the possibility of spontaneous resolution.

Dynamic Stereochemistry of M8 Pd6 Supramolecular Cages Based on Metal-Center Lability for Differential Chiral Induction, Resolution, and Recognition.

A series of isostructural supramolecular cages with a rhombic dodecahedron shape have been assembled with distinct metal-coordination lability (M8 Pd6 -MOC-16, M=Ru2+ , Fe2+ , Ni2+ , Zn2+ ). The chirality transfer between metal centers generally imposes homochirality on individual cages to enable solvent-dependent spontaneous resolution of Δ8 /Λ8 -M8 Pd6 enantiomers; however, their distinguishable stereochemical dynamics manifests differential chiral phenomena governed by the cage stability following the order Ru8 Pd6 >Ni8 Pd6 >Fe8 Pd6 >Zn8 Pd6 . The highly labile Zn centers endow the Zn8 Pd6 cage with conformational flexibility and deformation, enabling intrigue chiral-Δ8 /Λ8 -Zn8 Pd6 to meso-Δ4 Λ4 -Zn8 Pd6 transition induced by anions. The cage stabilization effect differs from inert Ru2+ , metastable Fe2+ /Ni2+ , and labile Zn2+ , resulting in different chiral-guest induction. Strikingly, solvent-mediated host-guest interactions have been revealed for Δ8 /Λ8 -(Ru/Ni/Fe)8 Pd6 cages to discriminate the chiral recognition of the guests with opposite chirality. These results demonstrate a versatile procedure to control the stereochemistry of metal-organic cages based on the dynamic metal centers, thus providing guidance to maneuver cage chirality at a supramolecular level by virtue of the solvent, anion, and guest to benefit practical applications.

Quiste óseo simple de resolución espontánea: reporte de caso y revisión de la literatura / Simple bone cyst of spontaneous resolution: case report and literature review

Introducción: El quiste óseo simple (QOS) es un pseudoquiste intraóseo, de etiología desconocida que representa el 1% de los quistes maxilares. Radiográficamente se observa una imagen radiolúcida de bordes bien definidos, irregulares o festoneados. Su tratamiento consiste en la exploración quirúrgica y curetaje de paredes óseas. En pocas ocasiones se ha descrito resolución espontánea. El propósito de este documento es presentar un caso de QOS de resolución espontánea y realizar una revisión de literatura.Reporte de caso:Mujer de 12 años consulta para evaluación odontológica de rutina. En radiografía panorámica se observa lesión radiolúcida entre raíces de dientes 4.4 y 4.5, de límites bien definidos corticalizados. Se complementó con tomografía computarizada de haz cónico, donde se observó adelgazamiento de tablas óseas. Se realizó un diagnóstico presuntivo de QOS. Se controló a los 3 y 3,5 años observándose hueso de leve mayor densidad que el hueso circundante.Materiales y métodos:Se realizó una revisión de literatura sobre QOS de resolución espontánea en PubMed, Scopus y Web of Science, relacionando los términos libres “simple bone cyst” “spontaneous resolution” “jaws” y sus variantes.Resultados:Se encontraron 13 casos de QOS de resolución espontánea. Las características clínicas y radiográficas de los casos coinciden con la literatura. El 54% de los casos tuvo resolución espontánea en un periodo menor o igual a 5 años.Conclusión:En el presente caso se realizó el seguimiento radiográfico del paciente, demostrando que controlar en el tiempo puede considerarse como tratamiento, ya que la lesión podría resolverse espontáneamente.(AU)

Introduction: Simple bone cyst (SBC) is an intraosseous pseudocyst, of unknown etiology, which represents 1% of maxillary cysts. Radiographically, a radiolucent image with well-defined, irregular or scalloped edges is observed. Treatment consists of surgical exploration and curettage of bone walls. Spontaneous resolution has rarely been described. The purpose of this paper is to present a case of spontaneous resolution of SBC and perform a literature review.Case Report:A 12-year-old woman attends to a routine dental evaluation. Panoramic radiography shows a radiolucent image between roots of teeth 4.4 and 4.5, of well-defined corticated borders. It was complemented with cone-beam computed tomography examination, where thinning of cortical bone was observed. A presumptive diagnosis of SBC was performed. Controls at 3 and 3,5 years were performed and bone of slightly higher density than the surrounding bone was observed.Materials and methods:A literature review on SBC of spontaneous resolution was performed in PubMed, Scopus and Web of Science, relating the free terms “simple bone cyst” “spontaneous resolution” “jaws” and their variants.Results:13 cases of spontaneous resolution of SBC were found. The clinical and radiographic characteristics of the cases coincide with the literature. 54% of cases had spontaneous resolution in a period of 5 years or less.Conclusion:In the case presented, radiographic follow-up of the patient was performed, demonstrating that following-up can be considered as treatment, since the lesion could resolve spontaneously.(AU)

Prognostic factors for spontaneous resolution of an ectopic pregnancy.

OBJECTIVE: To identify factors that can accurately predict the spontaneous resolution of an ectopic pregnancy. STUDY DESIGN: This retrospective cohort analysis was conducted in the Department of Gynecology of a tertiary, university-affiliated medical center. Patients admitted to the center from January 2015 to July 2022 with a tubal ectopic pregnancy who met the criteria for expectant management were included. Beta-human chorionic gonadotropin (ß-hCG) levels were assessed at admission and at subsequent 24-hour intervals. Patients with declining levels were discharged for routine ambulatory ß-hCG follow-up until levels became undetectable. Patients who achieved a successful outcome were designated as the "spontaneous resolution group," while patients who underwent further hospitalization for methotrexate or surgery constituted the" failure group". Demographic, clinical, laboratory, and ultrasound parameters collected at first admission were compared between groups. RESULTS: Among the initial group of 210 eligible patients, 7 were lost to follow-up, 161 achieved spontaneous resolution, and 42 were readmitted for active intervention. Multivariate logistic regression analysis revealed that the last ß-hCG level before discharge (last ß-hCG) and the ratio between ß-hCG at discharge to ß-hCG at admission were the only independent parameters to predict outcomes. Patients with ß-hCG < 650 IU/L at discharge and a decline of 50% or more in ß-hCG level during hospitalization, had a 97% success rate with expectant management. Patients with ß-hCG discharge levels ≥ 1,000 IU/L had a 50% chance of success, regardless of whether their ß-hCG levels had declined. For all other patients, a 76% success rate was found. CONCLUSION: Short-term, serial ß-hCG follow-up at the initial presentation can help predict the spontaneous resolution of an ectopic pregnancy.

Fetal cephalhematoma - an unusual antenatal presentation of a common neonatal scalp swelling posing a diagnostic challenge.

Cephalhematoma is an accumulation of blood in the subperiosteal space. While cephalhematoma is a well-documented postnatal occurrence, antenatal presentation is quite rare. This case report focuses on a rare presentation of fetal scalp swelling in a routine 32-week antenatal scan of a 38-year-old female. The swelling resolved spontaneously after birth. Awareness of this atypical manifestation is crucial for the radiologist to consider it in the differentials and for the obstetrician in providing appropriate prenatal care and avoiding unnecessary drastic interventions. The aim is to elucidate the diagnostic challenges and clinical management of this unique presentation.

Clinicoradiologic Risk Stratification and Outcome Assessment in Symptomatic Intracranial Arachnoid Cyst Managed Over Fifteen Years.

BACKGROUND: Arachnoid cysts (ACs) are developmental anomalies formed by splitting the arachnoid membrane's layers. ACs contribute around 2% of all intracranial space-occupying lesions. ACs are more prevalent in children. Because of varied clinical presentation, there has been a constant need for clinicoradiologic risk stratification with a possible role in outcome prediction. The present study describes the management strategies and outcomes in symptomatic intracranial ACs. METHODS: All biopsy-proven symptomatic patients who underwent surgical management over last 15 years were included in this study (January 2008-December 2022), while those with non-conclusive biopsies were excluded. Patients presenting with acute deterioration were managed in the emergency department with or without cerebrospinal fluid diversion and decompression of the AC. The microsurgical or endoscopic approach was the preferred surgical modality. Postoperative clinicoradiologic improvement was evaluated at 3 months follow-up visit. RESULTS: A total of 108 patients were analyzed in this retrospective observational study. The median age of the patients was 27.5 years (range, 1 to 76 years). Headache was the most typical clinical presentation. Supratentorial ACs (n = 59, 54.6%) were higher than the infratentorial ACs (n = 49, 45.4%). Forty-seven patients belonged to the pediatric age group (<18 years), and seizure was their presenting complaint. In this observational study, there was no statistical difference in operative duration between microsurgical technique versus endoscopic decompression (P= 0.23). CONCLUSIONS: ACs are uncommon brain lesions having a broad spectrum of symptoms. The location and clinical presentation of ACs decide the preferred surgical approach. Individuals in high-risk groups must be treated on priority to achieve long-term relief of symptoms.

Disentangling heterogeneity in contemporary undifferentiated arthritis - A large cohort study using latent class analysis.

OBJECTIVES: Undifferentiated arthritis(UA) is clinically heterogeneous and differs in outcomes ranging from spontaneous resolution to RA-development. Therefore, we hypothesized that subgroups exist within UA and we aimed to identify homogeneous groups based on clinical features, and thereafter to relate these groups to the outcomes spontaneous resolution and RA-development. These outcomes can only be studied in UA-patients in which DMARD-treatment does not influence the natural disease course; these cohorts are scarce. METHODS: We studied autoantibody-negative UA-patients (not fulfilling 1987/2010 RA-criteria, no alternate diagnosis), included in the Leiden Early Arthritis Clinic between 1993 and 2006, when early DMARD-treatment in UA was infrequent. Latent class analysis was used to identify subgroups based on combinations of clinical features. Within these subgroups, test-characteristics were assessed for spontaneous resolution of arthritis and RA-development within 1 year. RESULTS: 310 consecutive UA-patients were studied. Five classes were identified: location and number of swollen joints were most distinguishing. Classes were characterized by: 1) polyarthritis, often symmetric; 2) oligoarthritis, frequently with subacute onset; 3) wrist-monoarthritis, often with subacute onset, increased BMI and without morning stiffness; 4) small-joint monoarthritis, often without increased acute phase reactants, and 5) large-joint monoarthritis, often with subacute onset. Studying the classes in relation to the outcomes revealed that patients without spontaneous resolution (thus having persistent disease) were nearly absent in the classes characterized by monoarthritis (specificity >90%). Additionally, patients who developed RA were infrequent in monoarthritis classes (sensitivity <7%). CONCLUSION: Using a data-driven unsupervised approach, five subgroups within contemporary UA were identified. These have differences in the natural course of disease.

Octa- and Tetradecanuclear Mixed-Valent Vanadium(III/IV) Malates with Triazoles: Gas Adsorptions, Chiral Interface Recognition, and In Situ Decarboxylation.

Spontaneous resolution has been found for a pair of cage-like octanuclear mixed-valent vanadium(III/IV) malate enantiomers [Δ-VIII4VIV4O5(R-mal)6(Hdatrz)6]·44.5H2O (ΔR-1) and [Λ-VIII4VIV4O5(S-mal)6(Hdatrz)6]·38.5H2O (ΛS-1, H3mal = malic acid; Hdatrz = 3,5-diamino-1,2,4-triazole). Their racemic reduced product K7[VIII5VIV3O5(R,S-mal)6(trz)6]·17H2O (2) and tetradecanuclear species K11[VIII3VIV11O11(R,S-mal)12(atrz)6]·45.5H2O (3) (Htrz = 1,2,3-triazole, Hatrz = 3-amino-1,2,4-triazole) have also been obtained. In situ decarboxylation happens for 3-amino-1,2,4-triazole-5-carboxylic acid (H2atrzc) to yield 3-amino-1,2,4-triazole under hydrothermal conditions. Both 1 and 2 show an interesting bicapped-triangular-prismatic {V8O5(mal)6} building block, which further decorates symmetrically with three [VIV2O2(R,S-mal)2]2- units to construct a pinwheel-like {V14}-cluster, 3. Bond valence calculation sum (BVS) analyses manifest that the oxidation states of bicapped V atoms are +3 in 1-3, while the other V atoms in the {V6O5} core are ambiguous between +3 and +4 states with strong electron delocalization. Intriguingly, the triple helical chains in 1 associate in parallel to generate an amine-functionalized chiral polyoxovanadate (POV)-based supramolecular open-framework. The diameter of the interior channel is 13.6 Å, showing preferential adsorption of CO2 over gases N2, H2, and CH4. Importantly, homochiral framework ΔR-1 is capable of performing chiral interface recognition for R-1,3-butanediol (R-BDO) through host-guest interactions, as confirmed by the structural analysis of the host-guest complex ΔR-1·3(R-BDO). There are six R-BDO molecules in the channel of ΔR-1.

Structural Characterization of Zinc(II)/Cobalt(II) Complexes of Chiral N-(Anthracen-9-yl)methyl-N,N-bis(2-picolyl)amine and Evaluation of DNA Photocleavage Activity.

We designed and synthesized a chiral ligand N-(anthracen-9-ylmethyl)-1-(pyridin-2-yl)-N-(pyridin-2-ylmethyl)ethanamine (APPE) DNA photocleavage agent to investigate the effects of chirality of bis(2-picolyl)amine on the DNA photocleavage activity of metal complexes. The structures of ZnII and CoII complexes in APPE were analyzed via X-ray crystallography and fluorometric titration. APPE formed metal complexes with a 1 : 1 stoichiometry in both the crystalline and solution states. Fluorometric titration was used to show that the ZnII and CoII association constants of these complexes (log Kas) were 4.95 and 5.39, respectively. The synthesized complexes were found to cleave pUC19 plasmid DNA when irradiated at 370 nm. The DNA photocleavage activity of the ZnII complex was higher than that of the CoII complex. The absolute configuration of the methyl-attached carbon did not affect DNA cleavage activity and, unfortunately, an achiral APPE derivative without the methyl group (ABPM) was found to perform DNA photocleavage more effectively than APPE. One reason for this may be that the methyl group suppressed the structural flexibility of the photosensitizer. These results will be useful for the design of new photoreactive reagents.

Spontaneous regression of extradural high-flow vascular malformation in spinal arteriovenous metameric syndrome (SAMS): A unique case report.

Background: Spinal arteriovenous metameric syndrome (SAMS) is a rare nonhereditary genetic vascular disorder, involving multiple layers of tissues in the same metameric level. Spontaneous regression of SAMS has never been reported in the medical literature. Case Description: A 42-year-old woman presented with intermittent low back pain for 6 months. Magnetic resonance imaging of the thoracolumbar spine incidentally found clusters of spinal vascular malformations involving spinal cord, vertebral bodies, epidural space, and paraspinal muscles. There was no sign of venous congestion. Magnetic resonance angiography and spinal angiography revealed intradural spinal cord arteriovenous malformation (SCAVM) at the level of T10-11 and extradural high-flow osseous arteriovenous fistula. Due to asymptomatic SAMS and a high risk of anterior spinal arterial compromise during treatment, conservative treatment was considered in our patient. Spinal angiography obtained 8 years after initial angiography demonstrated significant regression of extradural component of SAMS and stable intradural SCAVM. Conclusion: We describe a unique case of SAMS with spontaneous regression of extradural component during a long-term observation period.

Bilateral Spontaneous Resolution of Traumatic Epidural Hematoma: A Case Report and Literature Review.

Epidural hematomas (EDHs) are a neurosurgical emergency characterized by the accumulation of blood in the epidural space surrounding the dura mater. Spontaneous resolution of EDH is an exceptionally rare occurrence, with only 16 cases reported in the medical literature where resolution occurred within 24 hours of onset. In this case report, we present a unique instance of a chronic EDH that spontaneously resolved over a period of seven months. This case adds to the scientific literature by highlighting an extremely prolonged duration of spontaneous EDH resolution, which, to our knowledge, has not been previously documented. A 59-year-old male suffered a head injury following a fall. He presented with a progressively worsening headache and nausea, raising concerns for a potential EDH. A computed tomography (CT) scan confirmed the presence of a large right parietal EDH measuring 58 × 23 × â€‹â€‹â€‹â€‹â€‹â€‹â€‹17 mm and a large left frontoparietal EDH measuring 90 × 20 ×​​​​​​​ 12 mm. These findings were crucial in establishing the primary diagnosis and guiding subsequent interventions. Upon diagnosis of the EDHs, the patient received conservative treatment and was closely monitored. Over a period of seven months, follow-up imaging revealed complete resolution of both EDHs, with restoration of normal midline structures and ventricular sizes. Notably, this represents the longest duration of spontaneous EDH resolution reported in the literature. We attribute this uncommon outcome to the activation of endogenous fibrinolytic pathways, which are responsible for dissolving blood clots and hematomas. In addition, the formation of new collateral blood vessels around the hematoma may help facilitate its resolution. This case underscores the significance of early recognition and vigilant monitoring of EDH cases. While immediate surgical intervention remains essential in most instances, conservative management can be considered in select cases. Our report demonstrates the possibility of spontaneous resolution of EDHs over an extended period, emphasizing the importance of continued observation and appropriate management. By shedding light on this rare occurrence, this case report contributes to the limited existing literature on the topic, providing valuable insights and adding to our understanding of EDH management.

The role of height and weight growth in spontaneous resolution of vesicoureteral reflux.

BACKGROUND: The aim of this study was to investigate the role of height and weight growth in the resolution of primary vesicoureteral reflux (VUR). METHODS: We retrospectively evaluated the data of 74 males and 135 females who were diagnosed with primary VUR. According to the vesicoureteral reflux resolution, patients were divided into two groups. Patients with complete or partial resolution of VUR were included in Group 1 and patients with no resolution of VUR were included in Group 2. Patients were evaluated for weight Z-score, height Z-score and body mass index at the diagnosis and in the follow-up. In addition, age, sex, grade of reflux and laterality were recorded. RESULTS: There were no significant differences between the two groups, according to height Z-score, weight Z-score and body mass index at the diagnosis, in the follow-up and also annual changes of these parameters. In addition, the same parameters did not significantly differ in Groups 1 and 2, between the initial and final evaluations. However, when we evaluate the patients older than 12 months old, weight Z-scores were significantly higher at the final evaluation than at the diagnosis, in Group 1. This significant difference was not detected in Group 2 at the same age. CONCLUSIONS: Although we could not detect the hectic pace of height growth as being important in the prediction of long-term outcomes of VUR, weight growth should be considered to predict the resolution of VUR.

Natural Clearance of Chlamydia trachomatis Infection Is Associated With Distinct Differences in Cervicovaginal Metabolites.

BACKGROUND: Natural clearance of Chlamydia trachomatis in women occurs in the interval between screening and treatment. In vitro, interferon-γ (IFN-γ)-mediated tryptophan depletion results in C. trachomatis clearance, but whether this mechanism occurs in vivo remains unclear. We previously found that women who naturally cleared C. trachomatis had lower cervicovaginal levels of tryptophan and IFN-γ compared to women with persisting infection, suggesting IFN-γ-independent pathways may promote C. trachomatis clearance. METHODS: Cervicovaginal lavages from 34 women who did (n = 17) or did not (n = 17) naturally clear C. trachomatis were subjected to untargeted high-performance liquid chromatography mass-spectrometry to identify metabolites and metabolic pathways associated with natural clearance. RESULTS: In total, 375 positively charged metabolites and 149 negatively charged metabolites were annotated. Compared to women with persisting infection, C. trachomatis natural clearance was associated with increased levels of oligosaccharides trehalose, sucrose, melezitose, and maltotriose, and lower levels of indoline and various amino acids. Metabolites were associated with valine, leucine, and isoleucine biosynthesis pathways. CONCLUSIONS: The cervicovaginal metabolome in women who did or did not naturally clear C. trachomatis is distinct. In women who cleared C. trachomatis, depletion of various amino acids, especially valine, leucine, and isoleucine, suggests that amino acids other than tryptophan impact C. trachomatis survival in vivo.

Bacterial Vaginosis and Spontaneous Clearance of Chlamydia trachomatis in the Longitudinal Study of Vaginal Flora.

BACKGROUND: Up to 26% of urogenital Chlamydia trachomatis infections spontaneously resolve between detection and treatment. Mechanisms governing natural resolution are unknown. We examined whether bacterial vaginosis (BV) was associated with greater chlamydia persistence versus spontaneous clearance in a large, longitudinal study. METHODS: Between 1999 and 2003, the Longitudinal Study of Vaginal Flora followed reproductive-age women quarterly for 1 year. Baseline chlamydia screening and treatment were initiated after ligase chain reaction testing became available midstudy, and unscreened endocervical samples were tested after study completion. Chlamydia clearance and persistence were defined between consecutive visits without chlamydia-active antibiotics (n = 320 persistence/n = 310 clearance). Associations between Nugent score (0-3, no BV; 4-10, intermediate/BV), Amsel-BV, and chlamydia persistence versus clearance were modeled with alternating and conditional logistic regression. RESULTS: Of chlamydia cases, 48% spontaneously cleared by the next visit (310/630). Nugent-intermediate/BV was associated with higher odds of chlamydia persistence (adjusted odds ratio [aOR] = 1.89; 95% confidence interval [CI], 1.30-2.74), and the findings were similar for Amsel-BV (aOR 1.39; 95% CI, .99-1.96). The association between Nugent-intermediate/BV and chlamydia persistence was stronger in a within-participant analysis of 67 participants with both clearance/persistence intervals (aOR = 4.77; 95% CI, 1.39-16.35). BV symptoms did not affect any results. CONCLUSIONS: BV is associated with greater chlamydia persistence. Optimizing the vaginal microbiome may promote chlamydia clearance.

Spontaneous Reperfusion in Patients with Transient ST-Elevation Myocardial Infarction-Prevalence, Importance and Approaches to Management.

Patients with transient ST-elevation myocardial infarction (STEMI) or spontaneous resolution (SpR) of the ST-segment elevation on electrocardiogram could potentially represent a unique group of patients posing a therapeutic management dilemma. In this review, we discuss the potential mechanisms underlying SpR, its relation to clinical outcomes and the proposed management options for patients with transient STEMI with a focus on immediate versus early percutaneous coronary intervention. We performed a structured literature search of PubMed and Cochrane Library databases from inception to December 2020. Studies focused on SpR in patients with acute coronary syndrome were selected. Available data suggest that deferral of angiography and revascularization within 24-48 h in these patients is reasonable and associated with similar or perhaps better outcomes than immediate angiography. Further randomized trials are needed to elucidate the best pharmacological and invasive strategies for this cohort.