VP-22

Objective: To compare the effectiveness of expectant management (EM), cervical cerclage (CC) and vaginal progesterone (VP) in decreasing the rate of spontaneous preterm birth in twin gestations with midtrimester cervical shortening. Study design: This is a retrospective cohort study comparing pregnancy outcomes of twin gestations with midtrimester cervical shortening, defined as a cervical length (CL) on routine transvaginal ultrasound between 15 weeks 0 days and 24 weeks 6 days gestation of <2.5 cm, managed with either EM, CC or VP. Women were categorized by final management strategy. Primary outcome was gestational age at delivery. Secondary outcomes included latency period (defined as number of weeks between a diagnosis of cervical shortening and delivery), gestational age at delivery <32 weeks, mode of delivery, perinatal death, neonatal birthweight and rate of chorioamnionitis. Subanalysis of women with a CL < 1.5 cm was also performed. Logistic regression was used to identify predictors of delivery <32 weeks, controlling for potential confounders. Results: Between January 2006 and July 2016, 64 pairs of twins with midtrimester cervical shortening were identified, 18 managed with EM (28.1%), 29 CC (45.3%), and 17 VP (26.6%), 52 of which had information regarding delivery outcomes. 90.4% of women delivered prematurely (<37 weeks). Women in the CC group were diagnosed with cervical shortening at a significantly earlier mean gestational age (CC 20.6 ± 1.7 weeks versus EM 22.2 ± 2.9 weeks and VP 22.2 ± 2.0 weeks, p = .02) and had a shorter mean cervical length at the time of diagnosis (CC 1.18 ± 0.7 cm vs. EM 1.56 ± 0.7 and VP 1.95 ± 0.6, p = .002), as compared to those in the EM and VP groups. There was no difference in gestational age at delivery (EM 30.9 ± 5.2 weeks, CC 30.4 ± 4.9 weeks and VP 32.4 ± 4.1 weeks, respectively) or any of the secondary outcomes listed above. Women with a CL <1.5 cm delivered significantly earlier than those with a cervical length ≥1.5 cm (28.4 ± 4.7 weeks vs. 33.2 ± 3.6 weeks, p = .0001). After adjusting for potential confounders, cervical length <1.5 cm, not the management strategy, was the predictor of PTB before 32 weeks in this twin population [AOR 6.56 (95% CI 1.78, 24.20), p = .005]. Conclusion: Twin pregnancies with midtrimester cervical shortening are at high risk for preterm delivery, and outcomes were similar regardless of management strategy. Large prospective trials are needed to evaluate the effect of different management strategies for cervical shortening in twins.

Alphaherpesviruses are zoonotic pathogens that can cause a variety of diseases in humans and animals and severely damage health. Alphaherpesvirus infection is a slow and orderly process that can lie dormant for the lifetime of the host but may be reactivated when the immune system is compromised. All alphaherpesviruses feature a protein layer called the tegument that lies between the capsid and the envelope. Virus protein (VP) 22 is one of the most highly expressed tegument proteins; there are more than 2,000 copies of this protein in each viral particle. VP22 can interact with viral proteins, cellular proteins, and chromatin, and these interactions play important roles. This review summarizes the latest literature and discusses the roles of VP22 in viral gene transcription, protein synthesis, virion assembly, and viral cell-to-cell spread with the purpose of enhancing understanding of the life cycle of herpesviruses and other pathogens in host cells. The molecular interaction information herein provides important reference data.

Protein transduction methods have been developed utilizing the delivery of peptides and proteins into eukaryotic cells by the protein transduction domain (PTD). Initially, the PTD domain was developed from the sequences from HIV-1 TAT, HSV VP-22 and antennapedia homeoprotein. Recently, several novel PTDs were developed and has been used as a valuable strategy for transduction of therapeutic protein. We developed a novel, high efficiency PTD (11 arginine) based on the TAT sequence and used 11R for the regulation of intracellular signal cascades. PTD can deliver proteins and other bioactive compounds and therefore serves as a very useful strategy for the development of therapeutic agents.