A systematic review of ectopic pregnancy after hysterectomy.

BACKGROUND: An ectopic pregnancy after hysterectomy is a rare but potentially life-threatening event. Women with this condition might not be appropriately investigated, resulting in delays in diagnosis and treatment. OBJECTIVES: To characterize cases of ectopic pregnancy occurring after hysterectomy. SEARCH STRATEGY: PubMed, Embase, Scopus, and Web of Science were searched using the terms "pregnancy, abdominal" or "pregnancy, tubal" or "pregnancy, ectopic" and "hysterectomy" or "post-hysterectomy" or "post hysterectomy." SELECTION CRITERIA: Case reports or case series published in English up to October 10, 2016, were included. Patients were included if the diagnosis was confirmed by definitive tests such as serum or urine ß-human chorionic gonadotropin (ß-hCG) testing, ultrasonography evidence of pregnancy, or histology. DATA COLLECTION AND ANALYSIS: Patient characteristics were extracted via a standard spreadsheet. MAIN RESULTS: A total of 57 patients were included in the analysis. Abdominal pain was the predominant symptom. Implantation in a remaining fallopian tube was common. Most patients were managed surgically. CONCLUSIONS: A high index of suspicion and a low threshold for performing a ß-hCG pregnancy test is recommended in all women presenting with clinical symptoms of ectopic pregnancy, regardless of the hysterectomy status. This could lead to earlier diagnosis and fewer complications.

The Nuclear Receptor, Nor-1, Induces the Physiological Responses Associated With Exercise.

Skeletal muscle remodels metabolic capacity, contractile and exercise phenotype in response to physiological demands. This adaptive remodeling response to physical activity can ameliorate/prevent diseases associated with poor diet and lifestyle. Our previous work demonstrated that skeletal muscle-specific transgenic expression of the neuron-derived orphan nuclear receptor, Nor-1 drives muscle reprogramming, improves exercise endurance, and oxidative metabolism. The current manuscript investigates the association between exercise, Nor-1 expression and the role of Nor-1 in adaptive remodeling. We demonstrate that Nor-1 expression is induced by exercise and is dependent on calcium/calcineurin signaling (in vitro and in vivo). Analysis of fatigue-resistant transgenic mice that express Nor-1 in skeletal muscle revealed increased hypertrophy and vascularization of muscle tissue. Moreover, we demonstrate that transgenic Nor-1 expression is associated with increased intracellular recycling, ie, autophagy, involving 1) increased expression of light chain 3A or LC3A-II, autophagy protein 5, and autophagy protein 12 in quadriceps femoris muscle extracts from Tg-Nor-1 (relative to Wild-type (WT) littermates); 2) decreased p62 expression indicative of increased autophagolysosome assembly; and 3) decreased mammalian target of rapamycin complex 1 activity. Transfection of LC3A-GFP-RFP chimeric plasmid demonstrated that autophagolysosome formation was significantly increased by Nor-1 expression. Furthermore, we demonstrated a single bout of exercise induced LC3A-II expression in skeletal muscle from C57BL/6 WT mice. This study, when combined with our previous studies, demonstrates that Nor-1 expression drives multiple physiological changes/pathways that are critical to the beneficial responses of muscle to exercise and provides insights into potential pharmacological manipulation of muscle reprogramming for the treatment of lifestyle induced chronic diseases.