Cesarean scar pregnancy managed with local and systemic methotrexate: A single center case series.

OBJECTIVE: To report the efficacy of combined systemic and local methotrexate treatment for cesarean scar pregnancy and review data from selected, similar case series. STUDY DESIGN: A retrospective case series of 12 patients with cesarean scar pregnancy treated in a university hospital between 2014 and 2018. The intervention was combined treatment of systemic and local methotrexate. RESULTS: Twelve patients were treated with combined systemic and local methotrexate. Clinical characteristics, clinical course and treatment efficacy were evaluated. Mean gestational age at diagnosis was 7.5 weeks (range 5.9-9.1). ßhCG levels at diagnosis ranged from 1581 to 345,427 U/L with a mean of 77,795 U/L. All 12 patients were successfully treated without surgical intervention and with no significant side-effects. Mean hospitalization duration was 9 days (5.8-12.6) and mean time to normalization of ßhCG levels was 98 days (63-132). CONCLUSIONS: Treatment of cesarean scar pregnancy with a combination of systemic and local methotrexate was effective and safe. Although the treatment course tends to be longer than with other modalities, this protocol offers excellent success rates, with fertility preservation and few complications.

The experience-description gap and the role of the inter decision interval.

Previous research highlights four distinct contributors to the experience-description gap (the observation that people exhibit oversensitivity to rare events in decisions from description and the opposite bias in decisions from experience). These contributors include the nature of small samples, the mere presentation effect, the belief that the environment is dynamic, and overgeneralization from decisions based on estimated risks. This chapter reviews this research and highlights the role of a fifth contributor to the experience-description gap. Three new experiments demonstrate that long deliberation before the decisions increases the weighting of rare events. The increase, however, is not large. People tend to underweight rare events in decisions from experience even after a forced deliberation period of 7.8s. This pattern was documented in pure decisions from experience and when the subjects could rely on both description and experience. In addition, the results show that the existence of inter decisions delay does not increase the weighting of rare events when the subjects are asked to perform a distraction task during the delay. Distraction reduces the weighting of rare events.

Plexin-B1, glycodelin and MMP7 expression in the human fallopian tube and in the endometrium.

BACKGROUND: To study the expression of Plexin-B1, Glycodelin, and MMP7 during the menstrual cycle in the endometrium and in the fallopian tube. METHODS: The research included women undergoing hysterectomy, tubal sterilization or salpingo-oophoerectomy. Total RNA from endometrial and fallopian tube tissues was extracted using a total RNA isolation kit. Semi-quantitative RT-PCR was performed to examine mRNA relative expression. RESULTS: Plexin-B1 expression in the endometrium was significantly higher on days 19 - 23 compared to days 12 - 14 (1.166 +/- 0.42 versus 0.523 +/- 0.299), P < 0.005. In the fallopian tube the level of plexin-B1 did not change significantly throughout the menstrual cycle. Glycodelin expression was significantly higher on days 19 - 23 compared with days 12-14, both in the endometrium (0.819 +/- 0.564 versus 0.072 +/- 0.343, P < 0.05) and the fallopian tube (0.796 +/- 0.196 versus 0.329 +/- 0.398, P < 0.05). Although the level of MMP7 secretion was the highest in the secretory phase the difference from the proliferative phase did not reach statistical significance, neither in the endometrium nor in the fallopian tube. This could result from a lack of power. CONCLUSIONS: In the endometrium, both Glycodelin and Plexin-B1 are exhibiting a cyclic pattern suggesting a possible steroid regulation and a role in endometrial receptivity.