Risk factors and human chorionic gonadotropin trends in patients with ruptured tubal ectopic pregnancies despite methotrexate treatment

This retrospective cohort study investigates the risk factors and beta-human chorionic gonadotropin (β-hCG) trends in patients with ruptured tubal ectopic pregnancies (EPs) despite methotrexate (MTX) treatment. All patients receiving MTX for sonographically confirmed tubal EPs at our fertility center between 2004 and 2014 were included. Baseline demographics and β-hCG trends of patients with EP rupture after MTX were compared to patients with resolved EPs after MTX. One-hundred-thirty-seven patients with EPs were treated with MTX during the study duration; 27 experienced EP rupture and 110 EP resolution. There was no difference in the baseline demographics or β-hCG levels on the day of MTX between the groups. Patients with ruptured EPs after MTX had higher β-hCG levels on day-4 (1223.9?±?243.5 vs. 1111.2?±?179.7 mIU/mL; p?<?.001) and day-7 (1156.9?±?206.2 vs. 872.4?±?690.2 mIU/mL; p?<?.001). The odds of EP rupture compared to EP resolution was 6.2 (95% CI 2.1–19.1), 13.7 (95% CI 4.8–38.9), and 3.0 (95% CI 1.2–7.2) times higher when the change in β-hCG levels was <5% between day-7 vs. day of MTX, day-7 vs. day-4, and day-4 vs. day of MTX, respectively. Our results demonstrate that ruptured tubal EPs despite MTX have <5% change in β-hCG levels between the day of MTX and day-4 or day-7 after MTX.     

Herpes Simplex virus type 2 myeloradiculitis with a pure motor presentation in a liver transplant recipient

In this case report, we describe the first PCR‐confirmed case of HSV2 myeloradiculitis with a purely motor presentation, occurring in a 68‐year‐old liver transplant recipient. The patient reported ascending weakness with no sensory nor sphincteric symptoms, thereby resembling acute demyelinating inflammatory neuropathy, or Guillain‐Barré syndrome. HSV2 was detected in cerebrospinal fluid by PCR, and the patient was successfully treated with intravenous Acyclovir.     

Correlation between clinical phenotype and electromyographic parameters in amyotrophic lateral sclerosis

Introduction

Even if electromyography (EMG) is routinely used to confirm the diagnosis of amyotrophic lateral sclerosis (ALS), few studies have analysed the correlation between electrophysiological parameters and clinical characteristics of ALS. We assessed if the quantification of active denervation (AD) and chronic denervation (CD) provides clinicians with information about phenotype, disease progression and survival in ALS patients.

Methods

We studied a cohort of 689 ALS patients recording the following parameters: age and site of onset, survival, MRC scale for muscle strength evaluation, burden of upper and lower motor signs as measured with specific scales (PUMNS and LMNS, respectively), ALSFRS-R, progression rate (ΔFS), MITOS and King’s Staging systems (KSS). We performed EMG on 11 muscles, and calculated semiquantitative AD and CD scores for each limb, as well as for the bulbar and spinal regions.

Results

We found a positive correlation between AD and CD scores with LMNS (respectively p = 4.4 × 10^–37 and p = 2.8 × 10^–45) and a negative correlation with MRC (respectively p = 4.5 × 10^–35 and p = 3.0 × 10^–35). Furthermore, patients with higher spinal AD and CD scores had significantly lower ALSFRS-R scores, and higher KSS and MITOS stages. Conversely, only AD was associated to higher ΔFS (p = 1.0 × 10^–6) and shorter survival (p = 1.1 × 10^–5).

Conclusion

Our results confirmed that EMG examination represents not only a diagnostic instrument, but also a prognostic tool. In this context, AD seems to be a reliable predictor of disease’s progression and survival while CD better describes functional disability.

     

Attention and feature integration in the feature inheritance effect

Features of neighboring elements are not processed independently. Often, it is assumed that nearby features are integrated by a (pre-attentive) pooling mechanism. Here, we show that in the feature inheritance effect some features are integrated across space whereas others are not. This result may be partly explained by a very focused spatial attention. Our findings challenge models based on a simple pooling mechanism.     

Red and White Blood Cell Counts Are Associated With Bone Marrow Adipose Tissue,Bone Mineral Density,and Bone Microarchitecture in Premenopausal Women

Bone marrow adipose tissue (BMAT) resides within the bone marrow microenvironment where its function remains poorly understood. BMAT is elevated in anorexia nervosa, a disease model of chronic starvation, despite depletion of other fat depots. In addition to BMAT, the marrow microenvironment also consists of osteoblast and hematopoietic progenitors. BMAT is inversely associated with bone mineral density (BMD) in multiple populations including women with anorexia nervosa, and regulates hematopoiesis in animal models. We hypothesized that BMAT would be associated with circulating populations of hematopoietic cells (red and white blood cells) in humans and performed a post hoc analysis of two studies—a cross-sectional study and a longitudinal study—to investigate this hypothesis. We studied 89 premenopausal women cross-sectionally (median age [interquartile range], 27 [24.5, 31.7] years), including 35 with anorexia nervosa. We investigated associations between red blood cell (RBC) and white blood cell (WBC) counts and BMAT assessed by ¹H-magnetic resonance spectroscopy, BMD assessed by DXA, and bone microarchitecture assessed by HR-pQCT. In addition, we analyzed longitudinal data in six premenopausal women with anorexia nervosa treated with transdermal estrogen for 6 months and measured changes in BMAT and blood cell counts during treatment. Cross-sectionally, BMAT was inversely associated with WBC and RBC counts. In contrast, BMD and parameters of bone microarchitecture were positively associated with WBC and RBC. In women with anorexia nervosa treated with transdermal estrogen for 6 months, decreases in BMAT were significantly associated with increases in both RBC and hematocrit (rho = −0.83, p = 0.04 for both). In conclusion, we show that BMAT is inversely associated with WBC and RBC in premenopausal women, and there is a potential association between longitudinal changes in BMAT and changes in RBC. These associations warrant further study and may provide further insight into the role and function of this understudied adipose depot. © 2020 American Society for Bone and Mineral Research.