Bone, Brain, Heart study protocol: A resilient nested, tripartite prospective cohort study of the role of estrogen depletion on HIV pathology

PURPOSE

We describe the rationale for and design of an innovative, nested, tripartite prospective observational cohort study examining whether relative estrogen insufficiency-induced inflammation amplifies HIV-induced inflammation to cause end organ damage and worsen age-related co-morbidities affecting the neuro-hypothalamic-pituitary-adrenal axis (Brain), skeletal (Bone), and cardiovascular (Heart/vessels) organ systems (BBH Study).

METHODS

The BBH parent study is the Multicenter AIDS Cohort/Women's Interagency HIV Study Combined Cohort Study (MWCCS) with participants drawn from the Atlanta MWCCS site. BBH will enroll a single cohort of n = 120 women living with HIV and n = 60 HIV-negative women, equally distributed by menopausal status. The innovative multipart nested study design of BBH, which draws on data collected by the parent study, efficiently leverages resources for maximum research impact and requires extensive oversight and management in addition to careful implementation. The presence of strong infrastructure minimized BBH study disruptions due to changes in the parent study and the COVID-19 pandemic.

CONCLUSION

BBH is poised to provide insight into sex and HIV associations with the neuro-hypothalamic-pituitary-adrenal axis, skeletal, and cardiovascular systems despite several major, unexpected challenges.

Nested and multipart prospective observational studies, flaming fiasco or efficiently economical?: The Brain, Bone, Heart case study

BACKGROUND

Collecting new data from cross-sectional/survey and cohort observational study designs can be expensive and time-consuming. Nested (hierarchically cocooned within an existing parent study) and/or Multipart (≥ 2 integrally interlinked projects) study designs can expand the scope of a prospective observational research program beyond what might otherwise be possible with available funding and personnel. The Brain, Bone, Heart (BBH) study provides an exemplary case to describe the real-world advantages, challenges, considerations, and insights from these complex designs. MAIN: BBH is a Nested, Multipart study conducted by the Specialized Center for Research Excellence (SCORE) on Sex Differences at Emory University. BBH is designed to examine whether estrogen insufficiency-induced inflammation compounds HIV-induced inflammation, leading to end-organ damage and aging-related co-morbidities affecting the neuro-hypothalamic-pituitary-adrenal axis (brain), musculoskeletal (bone), and cardiovascular (heart) organ systems. Using BBH as a real-world case study, we describe the advantages and challenges of Nested and Multipart prospective cohort study design in practice. While excessive dependence on its parent study can pose challenges in a Nested study, there are significant advantages to the study design as well. These include the ability to leverage a parent study's resources and personnel; more comprehensive data collection and data sharing options; a broadened community of researchers for collaboration; dedicated longitudinal research participants; and, access to historical data. Multipart, interlinked studies that share a common cohort of participants and pool of resources have the advantage of dedicated key personnel and the challenge of increased organizational complexity. Important considerations for each study design include the stability and administration of the parent study (Nested) and the cohesiveness of linkage elements and staff organizational capacity (Multipart).

CONCLUSION

Using the experience of BBH as an example, Nested and/or Multipart study designs have both distinct advantages and potential vulnerabilities that warrant consideration and require strong biostatistics and data management leadership to optimize programmatic success and impact.

MR Imaging Features of Middle Cranial Fossa Encephaloceles and Their Associations with Epilepsy

BACKGROUND AND PURPOSE

Middle cranial fossa encephaloceles are an increasingly recognized cause of epilepsy; however, they are also often encountered on neuroimaging in patients with no history of seizure. We characterized the MR imaging features of middle cranial fossa encephaloceles in seizure and nonseizure groups with the hope of uncovering features predictive of epileptogenicity.

MATERIALS AND METHODS

Seventy-seven patients with middle cranial fossa encephaloceles were prospectively identified during routine clinical practice of neuroradiology at a tertiary care hospital during an 18-month period. Thirty-five of 77 (45%) had a history of seizure, 20/77 (26%) had temporal lobe epilepsy, and 42/77 (55%) had no history of seizures. Middle cranial fossa encephalocele features on MR imaging were characterized, including depth, area, number, location, presence of adjacent encephalomalacia, and degree of associated parenchymal morphologic distortion. MR imaging features were compared between the seizure and nonseizure groups.

RESULTS

No significant difference in MR imaging features of middle cranial fossa encephaloceles was seen when comparing the seizure and nonseizure groups. Comparison of just those patients with temporal lobe epilepsy (n = 20) with those with no history of seizure (n = 42) also found no significant difference in MR imaging features.

CONCLUSIONS

Anatomic MR imaging features of middle cranial fossa encephaloceles such as size, number, adjacent encephalomalacia, and the degree of adjacent parenchymal morphologic distortion may not be useful in predicting likelihood of epileptogenicity.

Crystal structures and solution behavior of paramagnetic divalent transition metal complexes (Fe, Co) of the sterically encumbered tridentate macrocycles 1,4,7-R3-1,4,7-triazacyclononane: coordination numbers 5 (R = i-Pr) and 6 (R = i-Bu)

The coordination chemistry of the sterically hindered macrocyclic triamines, 1,4,7-R3-1,4,7-triazacyclononane (R = i-Pr, i-Pr3tacn, and R = i-Bu, i-Bu3tacn) with divalent transition metals has been investigated. These ligands form a series of stable novel complexes with the triflate salts MII(CF3SO3)2 (M = Fe, Co, or Zn) under anaerobic conditions. The complexes Fe(i-Pr3tacn)(CF3SO3)2 (2), [Co(i-Pr3tacn)(SO3CF3)(H2O)](CF3SO3) (3), [Co(i-Pr3tacn)(CH3CN)2](BPh4)2 (4), Zn(i-Pr3tacn)(CF3SO3)2 (5), [Fe(i-Bu3tacn)(CH3CN)2(CF3SO3)](CF3SO3) (6), Fe(i-Bu3tacn)-(H2O)(CF3SO3)2 (7), and Co(i-Bu3tacn)(CF3SO3)2 (8) have been isolated. The behavior of these paramagnetic complexes in solution is explored by their 1H NMR spectra. The solid-state structures of four complexes have been determined by X-ray single-crystal crystallography. Crystallographic parameters are as follows. 2: C17H33F6FeN3O6S2, monoclinic, P2(1)/n, a = 10.895(1) A, b = 14.669(1) A, c = 16.617(1) A, beta = 101.37(1) degrees, Z = 4. 3: C17H35CoF6N3O7S2, monoclinic, P2(1)/c, a = 8.669(2) A, b = 25.538(3) A, c = 12.4349(12) A, beta = 103.132(13) degrees, Z = 4. 6: C24H45F6FeN5O6S2, monoclinic, P2(1)/c, a = 12.953(6) A, b = 16.780(6) A, c = 15.790(5) A, beta = 96.32(2) degrees, Z = 4. 7: C20H41F6FeN3O7S2, monoclinic, C2/c, a = 22.990(2) A, b = 15.768(2) A, c = 17.564(2) A, beta = 107.65(1) degrees, Z = 8. The ligand i-Pr3tacn leads to complexes in which the metal ions are five-coordinate, while it's isobutyl homologue affords six-coordinate complexes. This difference in the stereochemistries around the metal center is attributed to steric interactions involving the bulky alkyl appendages of the macrocycles.

Spin-state variation in solid state and solution of mononuclear iron(II) 1,4,7-trimethyl-1,4,7-triazacyclonane complexes

The series of mononuclear iron(II) complexes with the tridentate macrocycle Me3tacn have been prepared (Me3tacn = 1,4,7-trimethyl-1,4,7-triazacyclonane). A purple, spin-crossover complex [Fe(Me3tacn)(MeCN)3](CF3-SO3)2 (1-OTf) forms in acetonitrile but readily loses MeCN ligands to form a colorless high-spin complex Fe(Me3tacn)(OTf)2 (2). The BPh4- salt of 1 is stable to loss of MeCN and remains purple even under a vacuum. Methylene chloride solutions of Fe(OTf)2 and Me3tacn afford crystals of [Fe(Me3tacn)(MeCN)2(OTf)](OTf) (3). Crystallization of 1-OTf in the presence of water affords a colorless high-spin complex, Fe(Me3tacn)(H2O)(CF3-SO3)2 (4), that exists as a pair of molecules bridged by hydrogen bonds between the coordinated water and the two bound triflate anions of the inversion-related partner. The crystallographic parameters are the following. 1-BPh4: C63H70B2Fe, monoclinic, P2(1)/c, a = 18.360(1) A, b = 11.761(1) A, c = 25.754(2) A, beta = 90.72(1) degrees, Z = 4. 3: C16H29Cl2F6FeN5O6S2, triclinic group P1, a = 8.500(1) A, b = 11.421(2) A, c = 15.677(2) A, alpha = 92.23(1) degrees, beta = 94.79(1) degrees, gamma = 97.03(1) degrees, Z = 2. 4: C20H18F6FeN4O6S2, monoclinic, P2(1)/n, a = 11.253(3) A, b = 12.624(5) A, c = 14.683(5) A, beta = 94.02(2) degrees, Z = 4. Variable temperature visible spectra and 1H NMR spectra of solutions of both 1-OTf and 1-BPh4 exhibit low-spin, high-spin crossover behavior, whereas 2, 3, and 4 remain high-spin in solution. The extensive role of coordinated triflate as a terminal and/or bridging ligand as well as a counteranion is demonstrated by variable temperature 19F NMR spectra.

Spin-state variation in solid state and solution of mononuclear iron(II) 1,4,7-trimethyl-1,4,7-triazacyclonane complexes

The series of mononuclear iron(II) complexes with the tridentate macrocycle Me3tacn have been prepared (Me3tacn = 1,4,7-trimethyl-1,4,7-triazacyclonane). A purple, spin-crossover complex [Fe(Me3tacn)(MeCN)3](CF3-SO3)2 (1-OTf) forms in acetonitrile but readily loses MeCN ligands to form a colorless high-spin complex Fe(Me3tacn)(OTf)2 (2). The BPh4- salt of 1 is stable to loss of MeCN and remains purple even under a vacuum. Methylene chloride solutions of Fe(OTf)2 and Me3tacn afford crystals of [Fe(Me3tacn)(MeCN)2(OTf)](OTf) (3). Crystallization of 1-OTf in the presence of water affords a colorless high-spin complex, Fe(Me3tacn)(H2O)(CF3-SO3)2 (4), that exists as a pair of molecules bridged by hydrogen bonds between the coordinated water and the two bound triflate anions of the inversion-related partner. The crystallographic parameters are the following. 1-BPh4: C63H70B2Fe, monoclinic, P2(1)/c, a = 18.360(1) A, b = 11.761(1) A, c = 25.754(2) A, beta = 90.72(1) degrees, Z = 4. 3: C16H29Cl2F6FeN5O6S2, triclinic group P1, a = 8.500(1) A, b = 11.421(2) A, c = 15.677(2) A, alpha = 92.23(1) degrees, beta = 94.79(1) degrees, gamma = 97.03(1) degrees, Z = 2. 4: C20H18F6FeN4O6S2, monoclinic, P2(1)/n, a = 11.253(3) A, b = 12.624(5) A, c = 14.683(5) A, beta = 94.02(2) degrees, Z = 4. Variable temperature visible spectra and 1H NMR spectra of solutions of both 1-OTf and 1-BPh4 exhibit low-spin, high-spin crossover behavior, whereas 2, 3, and 4 remain high-spin in solution. The extensive role of coordinated triflate as a terminal and/or bridging ligand as well as a counteranion is demonstrated by variable temperature 19F NMR spectra.

Tetranuclear manganese carboxylate complexes with a trigonal pyramidal metal topology via controlled potential electrolysis

Controlled potential electrolysis (CPE) procedures are described that provide access to complexes with a [Mn4(mu 3-O)3(mu 3-O2CR)]6+ core (3MnIII,MnIV) and a trigonal pyramidal metal topology, starting from species containing the [Mn4(mu 3-O)2]8+ core (4MnIII). [Mn4O2(O2CMe)6(py)2(dbm)2] (6): triclinic, P1, a = 10.868(3) A, b = 13.864(3) A, c = 10.625(3) A, alpha = 108.62(1) degrees, beta = 118.98(1) degrees, gamma = 89.34(2) degrees, V = 1307 A3, Z = 1, T = -131 degrees C, R (Rw) = 3.24 (3.70)%. [Mn4O2(O2CPh)6(py)(dbm)2] (8): monoclinic, P2(1)/c, a = 14.743(6) A, b = 15.536(8) A, c = 30.006(13) A, beta = 102.79(1) degrees, V = 6702 A3, Z = 4, T = -155 degrees C, R (Rw) = 4.32 (4.44)%. Both 6 and 8 contain a [Mn4O2]8+ core; 8 only has one py group, the fourth MnIII site being five-coordinate. (NBun4)[Mn4O2(O2CPh)7(dbm)2] (10) is available from two related procedures. CPE of 10 at 0.65 V vs ferocene in MeCN leads to precipitation of [Mn4O3(O2CPh)4(dbm)3] (11); similarly, CPE of 6 at 0.84 V in MeCN/CH2Cl2 (3:1 v/v) gives [Mn4O3(O2CMe)4(dbm)3] (12). Complex 11: monoclinic, P2(1)/n, a = 15.161(3) A, b = 21.577(4) A, c = 22.683(5) A, beta = 108.04(3) degrees, V = 7056 A3, Z = 4, T = -100 degrees C, R (wR2) = 8.63 (21.80)%. Complex 12: monoclinic, P2(1)/n, a = 13.549(2) A, b = 22.338(4) A, c = 16.618(2) A, beta = 103.74(1) degrees, V = 4885 A3, Z = 4, T = -171 degrees C, R (Rw) = 4.63 (4.45)%. Both 11 and 12 contain a [Mn4(mu 3-O)3(mu-O2CR)] core with a Mn4 trigonal pyramid (MnIV at the apex) and the RCO2- bridging the MnIII3 base. However, in 11, the carboxylate is eta 2,mu 3 with one O atom terminal to one MnIII and the other O atom bridging the other two MnIII ions, whereas in 12 the carboxylate is eta 1,mu 3, a single O atom bridging three MnIII ions. Variable-temperature, solid-state magnetic susceptibility studies on 11 and 12 show that, for both complexes, there are antiferromagnetic exchange interactions between MnIII/MnIV pairs, and ferromagnetic interactions between MnIII/MnIII pairs. In both cases, the resultant ground states of the complex is S = 9/2, confirmed by magnetization vs field studies in the 2.00-30.0 K and 0.50-50 kG temperature and field ranges, respectively.

A copper(I) oxygenation precursor in the entatic state: two isomers of a copper(I) compound of a rigid tetradentate ligand

Oxygenation of [CuI(L1)(NC-CH3)]+ (L1 = dimethyl 2,4-bis(2-pyridinyl)-3,7-diazabicyclo-[3.3.1]-nonane-9-on-1,5-dicarboxylate) leads to a relatively stable mu-peroxo-dicopper(II) product. The stability of this type of oxygenation product has been shown before to be the result of the square pyramidal geometry of L1; preorganization by a dinucleating ligand has been shown to increase the stability of the mu-peroxo-dicopper(II) compound. The structural data presented here indicate that destabilization of the copper(I) precursor is another important factor. There are two isomers of [CuI(L1)(NCCH3)]+; one is yellow, and the other is red. X-ray crystallography indicates that one pyridinyl donor is not coordinated in the yellow compound and that the red compound is 5-coordinate. In the light of the X-ray structure of the metal-free ligand and that of the corresponding copper(II) compound, it emerges that the ligand cavity is well suited for copper(II), whereas the copper(I) compounds are highly strained. This is supported by 1H NMR spectra of the copper(I) species where a fast dynamic process leads to line broadening and by electrochemical data, which indicate that the copper(II) products are exceptionally stable. Also presented are structural (copper(II)), electrochemical, and spectroscopic data (1H NMR, copper(I)) of the derivative [Cu(L2)(X)]n+ with a methyl substituent at the alpha-carbon atom of the two coordinated pyridinyl groups (L2 = dimethyl 2,4-bis(2-pyridinyl-6-methyl)-3,7-diazabicyclo-[3.3.1]-nonane-9-on-1,5-dicarboxylate). There are two structural forms of [CuII(L2)(X)]n+ (X = NCCH3, Cl), which depend on the steric demand of the fifth donor X. For both, van der Waals repulsion leads to a destabilization of the copper(II) products, and this is also evident from an increase in the reduction potential (-110 mV vs. -477 mV, Ag/AgNO3).

A comparison of two skin preps used in cardiac surgical procedures

Postoperative surgical site infections contribute significantly to increased patient morbidity and mortality rates and unnecessary hospital costs. Effective and efficient preoperative patient skin preparation is an important perioperative nursing intervention that decreases the number of wound contaminants and reduces the risks for postoperative surgical site infections. This study examined the effectiveness and time and material costs of two preoperative patient skin prep methods (ie, isopropyl alcohol prep/iodophor-impregnated adhesive drape method, iodophor scrub and paint prep/plain adhesive drape method). The isopropyl alcohol prep/iodophor-impregnated adhesive drape method clinically was as effective as the iodophor scrub and paint prep/plain adhesive drape method, more cost-effective when time and materials were compared, and less cost-effective when materials alone were compared. To make appropriate decisions about the use of preoperative patient skin prep methods, perioperative nurse managers and staff members need to examine and determine whether costs in time or materials have the greater impact on their surgical settings.

The Synthesis and Structure of Encapsulating Ligands: Properties of Bicyclic Hexamines

Template syntheses based on tris (ethane-1,2-diamine)cobalt(III) lead to cobalt(III) complexes of cage hexamines of the ' sarcophagine ' type ( sarcophagine = sar = 3,6,10,13,16,19- hexaazabicyclo [6.6.6] icosane ) rapidly and in high yield. Reduction of these species to their cobalt(II) forms enables the ligands to be removed in concentrated acids at elevated temperatures, and in hot aqueous solutions containing excess cyanide ion. The free sarcophagine and 1,8-diaminosarcophagine [(NH2)2sar or diamsar] ligands are strong bases, accepting up to four and five protons, respectively, in aqueous solution. In chloride medium, I = 1.0, at 298 K, pK1 = 11.95, pK2 = 10.33, pK3 = 7.17, pK4 ≈ 0 for sarcophagine , and pK1 = 11.44, pK2 = 9.64, pK3 = 6.49, pK4 = 5.48, pK5 ≈ 0 for diaminosarcophagine , with very similar values being found for triflate medium. Crystal structure determinations for both free bases, the chloride, sulfate, perchlorate and nitrate salts of diamsar , the complex of zinc chloride with sar, and the magnesium nitrate complex with diamsar show remarkably small variations in the cavity defined by the bicyclic ligands, though relatively subtle bond length and bond angle changes can be rationalized in terms of the effects of proton and metal ion binding. Exhaustive methylation of sarcophagine produces the highly lipophilic, hexatertiary base hexamethylsarcophagine , which, in the solid state, adopts quite different conformations and nitrogen-atom configurations to those of sar itself. All the ligands rapidly form metal ion complexes of generally exceptional kinetic and thermodynamic stability.