RESUMEN
STUDY DESIGN: Cross-sectional. OBJECTIVES: The objective of the study was to determine and report agreement in fracture risk stratification of adults with spinal cord injury (SCI) using (1) Canadian Association of Radiologists and Osteoporosis Canada (CAROC) and Canadian Fracture Risk Assessment (FRAX) tools with and without areal bone mineral density (aBMD) and (2) SCI-specific fracture thresholds. SETTING: Tertiary rehabilitation center, Ontario, Canada. METHODS: Community-dwelling adults with chronic SCI (n=90, C2-T12, AIS A-D) consented to participation. Femoral neck aBMD values determined 10-year fracture risk (CAROC and FRAX). Knee-region aBMD and distal tibia volumetric BMD values were compared to SCI-specific fracture thresholds. Agreements between CAROC and FRAX risk stratifications, and between fracture threshold risk stratification, were assessed using prevalence- and bias-adjusted Kappa statistics (PABAK). RESULTS: CAROC and FRAX assessment tools showed moderate agreement for post-menopausal women (PABAK=0.56, 95% confidence interval (CI): 0.27, 0.84) and men aged ⩾50 years (PABAK=0.51, 95% CI: 0.34, 0.67), with poor agreement for young men and pre-menopausal women (PABAK⩽0). Excellent agreement was evident between FRAX with and without aBMD in young adults and in those with motor incomplete injury (PABAK=0.86-0.92). In other subgroups, agreement ranged from moderate to substantial (PABAK=0.41-0.73). SCI-specific fracture thresholds (Eser versus Garland) showed poor agreement (PABAK⩽0). CONCLUSION: Fracture risk estimates among individuals with SCI vary substantially with the risk assessment tool. Use of SCI-specific risk factors to identify patients with high fracture risk is recommended until a validated SCI-specific tool for predicting fracture risk is developed.
Asunto(s)
Algoritmos , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico , Medición de Riesgo , Traumatismos de la Médula Espinal/complicaciones , Adulto , Factores de Edad , Densidad Ósea , Enfermedad Crónica , Estudios Transversales , Femenino , Fracturas Óseas/epidemiología , Humanos , Rodilla/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/lesiones , Estudios Prospectivos , Factores Sexuales , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/tratamiento farmacológico , Traumatismos de la Médula Espinal/epidemiologíaRESUMEN
Concise syntheses of the Ergot alkaloids rugulovasine A (3a), rugulovasine B (3b), and setoclavine (2) have been completed by strategies that feature inter- and intramolecular vinylogous Mannich reactions as the key steps. Thus, the first synthesis of 3a,b commenced with the conversion of the known indole 17 into 24 via the addition of the furan 22 to the iminium ion 21, which was generated in situ from the aldehyde 19. Cyclization of 24 by a novel S(RN)1 reaction followed by removal of the N-benzyl group furnished a mixture (1:2) of 3a and 3b. In an alternative approach to these alkaloids, the biaryl 35 was reduced with DIBAL-H to give an intermediate imine that underwent spontaneous cyclization via an intramolecular vinylogous Mannich addition to provide 36a,b. N-Methylation of the derived benzyl carbamates 37a,b followed by global deprotection gave a mixture (2:1) of rugulovasines A and B (3a,b). Setoclavine (2) was then prepared from the biaryl 41 using a closely related intramolecular vinylogous Mannich reaction to furnish the spirocyclic lactones 42a,b. These lactones were subsequently transformed by hydride reduction and reductive methylation into the ergoline derivatives 43a,b, which were in turn converted into 2 by deprotection and solvolytic 1,3-rearrangement of the allylic hydroxyl group.
Asunto(s)
Alcaloides/síntesis química , Alcaloides de Claviceps/síntesis química , Indoles/síntesis química , Alcaloides/química , Química Orgánica/métodos , Alcaloides de Claviceps/química , Indicadores y Reactivos , Indoles/química , Espectroscopía de Resonancia Magnética , Conformación Molecular , Estructura Molecular , Micotoxinas/síntesis química , Micotoxinas/químicaRESUMEN
Transplacental hemorrhage is reportedly detectable by erythrocytes containing fetal hemoglobin-F in the maternal circulation. The procedure in the present study is based on the premise that fetal hemoglobin is not eluted from red cells in blood smears by an acid buffer, whereas adult hemoglobin is removed. Erythrocytes containing hemoglobin-F were observed in blood smears of both virgin and pregnant BALB/c mice, but the relative number of these cells in the maternal blood increased during pregnancy, reached a peak around the time of parturition, and decreased thereafter. In BALB/c females pregnant by DBA/2 males, the relatively large numbers of acid-resistant erythrocytes in maternal blood were related to the maternal unresponsiveness to DBA/2 allografts. The fetal derivation of at least a fraction of these cells was suggested by the apparent activity of fetal immunogens in the maternal circulation. The blood of peripartum BALB/c mice multiparous by DBA/2 males was injected into normal, nonimmune BALB/c mice. The blood recipients were later challenged with an allotransplantable DBA/2 tumor. A low degree of immunity was indicated by a decreased size of tumor implants. Attempts to demonstrate vertical transmission of immune suppression from mothers to progeny were negative. These findings indicate that transplacental hemorrhage is a potential source of antigens involved in the induction of specific maternal unresponsiveness.