non-EP Group Research Articles

The association between endometrial polyps and insulin resistance from the expression of PI3K and AKT proteins perspective

BackgroundInsulin resistance (IR) induces hyperinsulinemia, which activates downstream signaling pathways such as the phosphatidylinositol-3-kinase/protein kinase B (PI3K/AKT) pathway, ultimately leading to abnormal proliferation and apoptosis of endometrial cells. This is thought to be a key pathogenic mechanism underlying the development of endometrial polyps (EP). This study aims to investigate the relationship between IR and the development of EP, the expression levels of downstream signaling molecules, including PI3K and AKT, and related laboratory parameters were examined.MethodsA total of 100 patients who visited the gynecology outpatient clinic of Zhongda Hospital affiliated with Southeast University from May 2021 to March 2023 and were diagnosed with abnormal endometrial echoes by vaginal ultrasound and underwent hysteroscopic diagnostic curettage were enrolled in this study. General data and relevant hematological indicators were compared, and intraoperative specimens were obtained for pathological examination. Possible factors influencing the development of endometrial polyps were analyzed using Pearson correlation analysis and logistic regression analysis.ResultsIn terms of body mass index, waist circumference, fasting insulin, insulin resistance index, serum total testosterone, and free testosterone index, women of childbearing age in the endometrial polyp group had higher values than those in the non-polyp group, while sex hormone-binding globulin in the endometrial polyp group was lower than that in the non-polyp group, and the differences were statistically significant (P < 0.05). The expression scores and mRNA expression levels of PI3K and AKT proteins were higher in the EP group than in the non-EP group (p < 0.05). Pearson correlation analysis showed a positive correlation between HOMA-IR and the expression scores of PI3K and AKT proteins (p < 0.01).ConclusionsInsulin resistance and abnormal activation of the phosphatidylinositol 3-kinase/protein kinase B signaling pathway may be potential pathogenic mechanisms for the development of endometrial polyps.

Macular hole with epiretinal proliferation: diagnostic value of en-face optical coherence tomography and clinical characteristics.

To elucidate the clinical features and surgical outcomes of full-thickness macular hole (FTMH) with epiretinal proliferation (EP) diagnosed by both en-face and B-mode optical coherence tomography (OCT). This retrospective cohort study classified idiopathic FTMHs into two groups, based on B-scan and en-face OCT imaging: FTMH with EP (EP group) and without EP (non-EP group). The preoperative features, as well as postoperative outcomes up to 12months, were compared between the two groups. Among 318 eyes of idiopathic FTMH that met the inclusion criteria, 59 eyes (18.6%) were in the EP group, and others were in the non-EP group. In 9 eyes (15.3%) out of the EP group, EP was not detected in the preoperative B-mode OCT but was identified through the en-face OCT. Baseline features showed a higher male proportion (47.5% vs. 27.8%, P = 0.005) and a lower incidence of vitreofoveal traction (P < 0.001) in the EP group than in the non-EP group. The EP group showed worse visual recovery than the non-EP group (- 0.23 vs. - 0.41 logarithm of the minimum angle of the resolution at 12months, P = 0.001). The en-face OCT enhances diagnostic accuracy of EP in FTMH eyes, especially in the case with smaller extent of EP. Eyes with FTMH with EP showed a worse visual recovery than FTMH without EP.

Gut microbiota and acylcarnitine metabolites connect the beneficial association between equol and adiposity in adults: a prospective cohort study

Many studies have investigated the effects of soy isoflavones on weight control, but few have focused on the role of equol, a gut-derived metabolite of daidzein with greater bioavailability than other soy isoflavones. This study examined the association of equol production with obesity and explored the mediating roles of equol-related gut microbiota and microbial carnitine metabolites. This 6.6-y prospective study included 2958 Chinese adults (2011 females and 947 males) aged 60.6±6.0 y (mean±SD) at baseline. Urinary equol and isoflavones were measured using HPLC-tandem MS. BMI, percentage fat mass (%FM), and serum triglycerides (TGs) were assessed every 3 y. Metagenomics sequencing and assessment of carnitine metabolites in feces were performed in a subsample of 897 participants. Urinary equol, but not daidzein and genistein, was independently and inversely associated with the obesity-related indicators of BMI, %FM, and a biomarker (TGs). Equol producers (EPs) had lower odds of adiposity conditions and a reduced risk of 6.6-y obesity progression than non-EPs among total participants. Gut microbial analyses indicated that EPs had higher microbiome species richness (P=3.42×10-5) and significantly different β-diversity of gut microbiota compared with the non-EP group (P=0.001), with 20 of 162 species differing significantly. EPs (compared with non-EPs) had higher abundances of Alistipes senegalensis and Coprococcus catus but lower abundances of Ruminococcus gnavus (false discovery rate<0.05). Among the 7 determined fecal acylcarnitine metabolites, palmitoylcarnitine, oleylcarnitine 18:1, and stearylcarnitine were inversely associated with EPs but positively correlated with obesity conditions and progression. Path analyses indicated that the beneficial association between equol and obesity might be mediated by gut microbiota and decreased production of 3 acylcarnitines in feces. This study suggests a beneficial association between equol and obesity, mediated by the gut microbiome and acylcarnitines, in adults.This trial was registered at clinicaltrials.gov as NCT03179657.

The role of SK3 in progesterone-induced inhibition of human fallopian tubal contraction

BackgroundNormal motor activity of the fallopian tube is critical for human reproduction, and abnormal tubal activity may lead to ectopic pregnancy (EP) or infertility. Progesterone has an inhibitory effect on tubal contraction; however, the underlying mechanisms remain unclear. Small-conductance calcium-activated K+ channel 3 (SK3) is abundantly expressed in platelet-derived growth factor receptor α positive (PDGFRα+) cells and was reported to be important for the relaxation of smooth muscle. The present study aims to explore the expression of SK3 in the human fallopian tube and its role in progesterone-induced inhibition of tubal contraction.MethodsWe collected specimens of fallopian tubes from patients treated by salpingectomy for EP (EP group) and other benign gynecological diseases (Non-EP group). The expression of SK3 was detected by quantitative real-time polymerase chain reaction, western blot, immunocytochemistry, and immunohistochemistry analyses. Isometric tension experiments were performed to investigate the role of SK3 in progesterone-induced inhibition of tubal contraction.ResultsThe baseline amplitude and frequency of human fallopian tube contraction were both statistically lower in the EP group compared with the non-EP group. The expression levels of SK3 in different portions of fallopian tubes from the non-EP group were significantly higher than in those from the EP group. Progesterone had an inhibitory effect on tubal contraction, mainly on the amplitude, in both groups, and SK3 as well as other calcium-activated K+ channels may be involved. SK3-expressing PDGFRα (+) cells were detected in the human fallopian tube.ConclusionsThe expression of SK3 is lower in the EP group, and SK3 is involved in the progesterone-induced inhibition of human fallopian tube contraction.

Pulmonary eosinophilia may indicate onset stage of allergic bronchopulmonary aspergillosis

BackgroundAllergic bronchopulmonary aspergillosis (ABPA) and chronic eosinophilic pneumonia (CEP) both display peripheral eosinophilia as well as pulmonary infiltration, together described as pulmonary eosinophilia, and differentiation is sometimes problematic. This study therefore examined the distinctions between ABPA with and without CEP-like shadows.MethodsThis retrospective cohort study from a single center included 25 outpatients (median age, 65 years) with ABPA diagnosed between April 2015 and March 2019, using criteria proposed by the International Society of Human and Animal Mycology (ISHAM), which focuses on positive specific IgE for Aspergillus fumigatus. Patients were assigned to either the eosinophilic pneumonia (EP) group or Non-EP group, defined according to findings on high-resolution computed tomography (HRCT). The EP group included patients with HRCT findings compatible with CEP; i.e., the presence of peripheral consolidation (p-consolidation) or ground-glass opacities (GGO), with no evidence of high-attenuation mucus. The Non-EP group comprised the remaining patients, who showed classical findings of ABPA such as mucoid impaction. Differences between the groups were analyzed.ResultsBaseline characteristics, frequency of a history of CEP (EP, 50% vs. Non-EP, 26%) and tentative diagnosis of CEP before diagnosis of ABPA (67% vs. 16%) did not differ significantly between groups. Although elevated absolute eosinophil count and Aspergillus-specific immunoglobulin E titers did not differ significantly between groups, the Non-EP group showed a strong positive correlation between these values (R = 0.7878, p = 0.0003). The Non-EP group displayed significantly higher levels of the fungal marker beta-D glucan (median, 11.7 pg/ml; interquartile range, 6.7–18.4 pg/ml) than the EP group (median, 6.6 pg/ml; interquartile range, 5.2–9.3 pg/ml). Both groups exhibited frequent recurrence of shadows on X-rays but no cases in the EP group had progressed to the Non-EP group at the time of relapse.ConclusionsThe ABPA subgroup with imaging findings resembling CEP experienced frequent recurrences, as in typical ABPA. In pulmonary eosinophilia, even if there are no shadows indicating apparent mucous change, the Aspergillus-specific immunoglobulin E level is important in obtaining an accurate diagnosis and in the selection of appropriate therapies for this type of ABPA.

Classification of emphysematous pancreatitis and its relation to prognosis.

Emphysematous pancreatitis (EP) is a subtype of infectious pancreatic necrosis (IPN). It is characterized by the accumulation of gas inside or around the pancreatic necrotic tissue. This study aims to investigate the relation between classification and prognosis of EP, and to provide guidance for clinical diagnosis and treatment of IPN. A prospective cohort of 228 cases of IPN from January 2010 to June 2020 in the Department of General Surgery of Xiangya Hospital, Central South University were analyzed. Among them, 120 cases without peritoneal/retroperitoneal surgical intervention before admission were included. The 120 cases of IPN were classified into the EP group and the non-EP group. The general clinical information and results of pathogenic microorganism between the EP and the non-EP group were compared. EP patients were divided into early-EP (within 2 weeks of onset) and late-EP (after 2 weeks of onset) according to the presence timing of air bubble sign, and they were divided into extensive-EP and common-EP according to the distribution characteristics of bubble sign. The clinical characteristics between the survivors and non-survivors of both IPN and EP were compared. Among the 120 IPN patients, 25 (20.8%) were EP patients and 95 (79.2%) were non-EP patients. According to the classifications, 8 were early-EP (32.0%) and 17 were late-EP (68.0%); 15 were common-EP (60.0%) and 10 were extensive-EP (40.0%). There was no significant difference in gender, age, etiology, and mortality between the EP group and the non-EP group (all P>0.05). The percentage of Escherichia coli infection in the EP group was significantly higher than that in non-EP group (52.0% vs 16.5%, P<0.05). Among the 120 IPN patients, 35 died (IPN non-survivors) and 85 patients survived (IPN survivors). The mortality rate of IPN was 29.2%. There was no significant difference in gender, age, and etiology between the IPN non-survivors and the IPN survivors (all P>0.05). The proportion of severe patients in IPN non-survivors was significantly higher than that in the IPN survivors (97.1% vs 54.1%, P<0.05). Among the 25 cases of EP, 8 died (EP non-survivors) and 17 survived (EP survivors). The mortality rate of EP was 32.0%. There was no significant difference in gender, age, etiology, and time from gas detected to surgical intervention between the EP non-survivors and the EP survivors (all P>0.05). The proportion of early-EP and extensive-EP in the EP non-survivors was significantly higher than that in the EP survivors (both P<0.05). The mortality was up to 100% in the early- and extensive-EP patients. All of the EP non-survivors were severe patients, while 58.8% of the EP survivors were moderate or severe patients, the difference was statistically significant (P<0.05). All of the EP survivors underwent step-up surgical treatment strategy. Air bubble sign is not associated with the prognosis of IPN. Early- and extensive-EP often indicate worse prognosis. Aggressive surgical intervention based on step-up approach should be considered with priority.

Evaluation of short- and long-term outcomes following laparoscopic surgery for colorectal cancer in elderly patients aged over 80years old: a propensity score-matched analysis.

It remains controversial whether the advantages of laparoscopic surgery for colorectal cancer (CRC) are beneficial in elderly patients (EP, age ≥ 80years). The present study aimed to evaluate whether age itself is an independent risk factor for laparoscopic surgery by comparing short- and long-term outcomes between non-EP and EP groups. We retrospectively analyzed 730 consecutive patients with stage I-III CRC who had undergone elective surgery between 2010 and 2017, using propensity score-matched analysis. Median follow-up was 49months. After matching, we enrolled 228 patients. In the matched cohort, estimated operative time, estimated blood loss, lymph node dissection ≥ D3, number of lymph nodes harvested < 12, conversion rate, multivisceral resection rate, postoperative complication rate, and length of postsurgical stay were similar between the two groups. Before matching, compared with the non-EP group, the EP group had significantly shorter overall survival (OS) (p < 0.01), cancer-specific survival (CSS) (p < 0.01), recurrence-free survival (RFS) (p < 0.01), and higher frequency of local recurrence (LR) (p = 0.01); however, there was no significant difference in terms of incidence of LR or CSS between the two groups in the matched cohort. Prior to matching, multivariate analysis identified age ≥ 80years as an independent prognostic factor for OS (p < 0.01), CSS (p < 0.01), and RFS (p = 0.01); however, after matching, age ≥ 80years was not an independent poor prognostic factor for OS or CCS. Laparoscopic surgery offers a safe, effective option for CRC in EP aged ≥ 80years.

Factors associated with the incidence of ectopic pregnancy in women undergoing assisted reproductive treatment.

BackgroundEctopic pregnancy (EP) is a common complication in women undergoing assisted reproductive treatment, but the underlying causes for this remain unclear. This study aimed to explore factors affecting the incidence of EP in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).MethodsThis was a retrospective study on the incidence of EP in IVF/ICSI cycles between January 1, 2013 and December 31, 2017. Patient age, infertility diagnosis (tubal factor or not), primary or secondary infertility, type of cycle (frozen-thawed or fresh), type of embryo(s) transferred (cleavage embryo or blastocyst), number of embryos transferred (one, two, or three), previous history of EP, and endometrial combined thickness were analyzed to explore their relationships with the incidence of EP. Based on clinical typing results, the patients were divided into an EP group or a non-EP group. Categorical variables were analyzed using Chi-squared test or Fisher exact test. Logistic regression analysis was performed to explore their associations with the incidence of EP.ResultsThe percentage of patients with primary infertility in EP group was significantly lower than that in non-EP group (31.3% vs. 46.7%, χ2 = 26.032, P < 0.001). The percentage of patients with tubal infertility in EP group was also significantly higher than that in non-EP group (89.2% vs. 63.6%, χ2 = 77.410, P < 0.001). The percentages of patients with transfer of cleavage-stage embryo or blastocyst (91.4% vs. 84.4%, χ2 = 10.132, P = 0.001) and different endometrial combined thickness (ECT) (χ2 = 18.373, P < 0.001) differed significantly between EP and non-EP groups. For patients who had a previous history of one to four EPs, the percentage of patients undergoing transfer of a cleavage-stage embryo was significantly higher in EP group than that in non-EP group (92.2% vs. 77.6%, χ2 = 13.737, P < 0.001). In multivariate logistic regression analysis, tubal infertility was strongly associated with EP (adjusted odds ratio: 3.995, 95% confidence interval: 2.706–5.897, P < 0.001).ConclusionsIn IVF/ICSI cycles, transfer of a blastocyst-stage embryo, especially for patients with a previous history of EP, reduced the rate of EP. Tubal infertility was strongly associated with EP.

Diagnostic performance of using effervescent powder for detection and grading of esophageal varices by multi-detector computed tomography

PurposeTo investigate the effect of using effervescent powder (EP) on the efficacy of multi-detector computed tomography (MDCT) in detection and grading of esophageal varices in cirrhotic patients by considering endoscopy as the gold standard. Materials and methodsNinety-two cirrhotic patients undergoing biphasic liver MDCT followed by upper gastrointestinal endoscopy within 4 weeks of MDCT were prospectively evaluated. The patients were divided into two groups before MDCT. The first group (n=50) received effervescent powder (EP) before and during MDCT procedure and the second group did not receive (n=42). The presence, size and grade of the esophageal varices were evaluated. MDCT findings were compared with endoscopic results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of MDCT with EP and without EP were calculated and compared. Correlations between the grades of the varices for each group based on MDCT imaging and endoscopic grading were also evaluated. ResultsThe sensitivity, specificity, accuracy, PPV, and NPV of MDCT were 100%, 88%, 96%, 94%, and 100%, respectively, in the EP group, whereas they were 76%, 67%, 74%, 89%, and 43%, respectively, in the non-EP group. Correlations between the grades of the esophageal varices on MDCT and endoscopy were significant in both groups (r=0.94, p<0.001 for EP group and r=0.70, p<0.001 for non-EP group). ConclusionDuring periodic CT scanning of cirrhotic patients, use of EP increases the success rate of MDCT for detection and grading of esophageal varices.

Effect of intestinal production of equol on menopausal symptoms in women treated with soy isoflavones

Objective: To evaluate the effect of soy isoflavones on menopausal symptoms in women who do and who do not produce equol, a daidzein metabolite. Method: A randomized, double-blind, placebo-controlled clinical trial was conducted over 6 months with 96 healthy menopausal women. After taking take 135 mg of isoflavones daily for 1 week, the women in the study group were assigned to the equol-producing (EP) or the non-EP group according to the presence or absence of equol in their urine. Menopausal symptoms were evaluated using a modified Kupperman Index. Result: Compared with the placebo group, the scores for hot flashes and excessive sweating were significantly reduced after 3 months, and the scores for weakness, palpitations, limb paresthesia, and total symptoms after 6 months, in the EP group only. Conclusions: Isoflavone supplementation improves menopausal symptoms only in women with the ability to produce equol.

47 CHROMATIN AND CYTOSKELETAL REORGANIZATION OF RABBIT OOCYTES AFTER CUMULUS CELL NUCLEAR TRANSFER

It has been reported that a preincubation of the reconstructed oocytes prior to activation treatment might enhance the efficiency of nuclear reprogramming after somatic cell nuclear transfer in many species. The objectives of this study were to evaluate chromatin and cytoskeletal reorganization of nuclear-transferred rabbit oocytes before activation treatment. Sexually mature New Zealand White rabbits (6-month-old) were superovulated by six consecutive injections of FSH (0.4 mg) at 12-h intervals, followed by a single hCG (200-IU) injection. Mature oocytes were collected by flushing the oviducts 14–15 h post-hCG treatment. Cumulus cells were introduced into enucleated oocytes by piezo-driven microinjection. The reconstructed oocytes were randomly allocated to two treatment groups, with or without electric pulses (EP, 2 kV cm−1), and the progressive changes of the chromatin and cytoskeleton were examined by immunocytochemical staining at 0, 2, and 4 h after EP. The oocytes (n = 59) without successful enucleation served as the control, in which 30 out of 59 oocytes were electrically pulsed. After immunocytochemical staining, the proportions of reconstructed oocytes possessing dense chromatin decreased from 0 to 4 h (40-0% vs. 82-9%, respectively) in both groups, but only the oocytes without EP showed a significant reduction (P &lt; 0.05). In contrast, the proportions of reconstructed oocytes with spread chromatin increased significantly from 0 to 4 h in both groups (20–95% vs. 5–82%, respectively; P &lt; 0.05). The oocytes at 0 h after EP had the greatest percentage (35%) of normal chromosome alignment on the spindle compared to the other EP groups. The EP treatment also caused significant increase of the cytasters in both the reconstructed (5 to 45%, P &lt; 0.05) and the control oocytes (20 to 78%) at 0 h. These changes were recovered at 2 h after EP, but the proportions of cytasters in the reconstructed oocytes increased to 59% in the non-EP group and 81% in EP group at 4 h after EP. The percentages of reconstructed oocytes with multiple spindles increased from 0 to 27% and 43% in EP and non-EP groups, respectively. These results demonstrated that EP changed the proportions of chromatin configurations from the condensed form to normal alignment on the metaphase plate. The extended preincubation period for the reconstructed oocytes prior to activation treatment might increase the incidences of chromatin and spindle abnormalities of the reconstructed rabbit embryos.

556. Toward the Development of Electroporation for Delivery of DNA Vaccines to Humans

The objectives of this study were: 1) to evaluate the potency of plasmid DNA vaccines encoding two different HIV antigens in Rhesus macaques when delivered intramuscularly with electroporation (EP), and 2) to develop EP electrodes and pulse conditions suitable for human clinical applications. Two groups of monkeys (n=5) were immunized with DNA vaccines encoding HIV Gag and an oligomeric form of HIV Env by three subsequent i.m. injections at weeks 0, 4, and 14. In one group (EP group), injection was followed by six EP pulses delivered with a 6-needle array electrode at a nominal field strength of 233V/cm (Widera et al., J. Immunol. 164, 4635–40, 2000). All animals received a boost with rSF2 Gag protein (week 29) and rSF162 Env protein (weeks 38 and 75). During the DNA priming period (up to week 29) the EP group showed faster onset, higher peak titers (>100-fold for Gag) and longer duration of the antibody response than the non-EP group. Protein boosts restored (Gag) or enhanced (Env) peak Ab titers obtained after the third DNA immunization. Cell-mediated responses were also consistently stronger with EP. Helper T cell responses were measured by a lymphoproliferation assay (LPA) and intracellular cytokine staining (ICS). Anti-Gag LPA responses in animals given EP produced stable stimulation indices (SIs) of 12–19 throughout the DNA priming period, compared with a maximum SI of 5 without EP. For Env the corresponding SIs were 8 –10 vs. a maximum of 4. Also, IFN-gamma production in CD4 T cells, as measured by ICS, was 5 to 9-fold higher in the EP group during the entire DNA priming period for Gag, compared with a 2 to 5-fold increase for Env. Cytolytic T cell activity (CTL response) was measured after in vitro culture of PBMC. EP treatment modestly increased the response rate to anti-Gag CTL (20 vs. 13 cumulative responses). However, anti-Env CTLs were markedly enhanced by EP (16 vs. 2 cumulative responses), with 3 out of 5 animals consistently responding throughout the DNA priming period, vs. only one animal responding transiently in the non-EP group. These data demonstrate that in vivo EP is effective at increasing the potency of DNA vaccines against two different HIV antigens in Rhesus by triggering faster, stronger and longer antibody, helper T cell and CTL responses. Naked DNA injection, although effective in rodents, is known to be ineffective in non-human primates. Since EP is a physical delivery system that consistently results in significantly increased immune responses in a spectrum of species from mice to monkeys, it is reasonable to hypothesize that EP could enable effective DNA vaccination in humans as well. In order to make EP more patient-friendly, we developed EP instrumentation and pulse conditions more compatible with routine clinical applications than those used for the treatments described above. We reduced the number of needle electrodes from 6 to 4, reduced electrode toxicity, and limited the number of pulses to two. Under these clinically superior conditions, gene expression levels and antibody responses in rabbits were unaffected. This encourages further non-human primate studies in preparation for clinical trials.

Effects of the Clarion Electrode Positioning System on auditory thresholds and comfortable loudness levels in pediatric patients with cochlear implants.

To evaluate the effects of using the Electrode Positioning System on psychophysical auditory thresholds, most comfortable loudness levels, and electric auditory brainstem response (EABR) thresholds in children with the Clarion version 1.2 cochlear implant. Retrospective analysis. Academic tertiary care center. Clinical records of a series of 25 children who received the Clarion version 1.2 cochlear implant at the University of Minnesota, Minneapolis, between January 1997 and August 1999 were examined. Measures evaluated were psychophysical thresholds (T-levels) and most comfortable loudness levels (M-levels) obtained at the 3-month posthookup audiologic evaluation and EABR thresholds obtained during implant surgery. Relevant threshold measures were available for 24 patients, 11 of whom had received the Clarion spiral electrode and electrode positioner (EP group) and 13 of whom had received the spiral electrode without positioner (non-EP group). The 3 measures (T-levels, M-levels, and EABR thresholds) were compared across groups. In addition, EABR thresholds were compared with T-levels and M-levels within groups. Mean T-levels and M-levels were significantly lower for the EP group than for the non-EP group, and interpatient variability for these measures was considerably smaller in the EP group. Electric auditory brainstem response thresholds were not significantly different for EP vs non-EP patients; however, EABR data were available for only a few non-EP patients. Use of the electrode positioner results in lower T-levels and M-levels in children with the Clarion version 1.2 cochlear implant, consistent with results of previous studies in adults, and reduces across-patient variability for these measures. It is unclear from the present data whether use of the electrode positioner systematically reduces intraoperative EABR thresholds.

The utility of maternal creatine kinase in the evaluation of ectopic pregnancy

This investigation was designed to evaluate the utility of maternal creatine phosphokinase (CPK) in predicting the presence of an ectopic pregnancy (EP) in an emergency department (ED) setting. Twenty-one patients with the diagnosis of EP were randomly matched (1:1) with pregnant patients who subsequently ruled-out for EP. Serum CPK values at presentation were compared between the groups using two-tailed ANOVA, odds ratio, and frequency tables were generated using our a priori hypothesis that a serum CPK of > 70 mIU/dL may be useful as a predictor of EP. The mean serum CPK was 118mIU/dL in the EP group and 64 mIU/dL in the non-EP group (P < .0031). Controlling for age, race, and gestational age, there was an association between elevated serum CPK and EP in our study population (with an odds ratio of 6.5). The categorical evaluation (with 95% confidence interval [CI]) of CPK (>70 mIU/dL) as a predictor of EP follows: sensitivity − 100% (80.8 to 100); specificity − 61.9% (38.7 to 81); PV(+) − 72.4% (52.5 to 88.6); PV(−) − 100% (71.7 to 100). We therefore conclude that a CPK level > 70 mIU/dL may serve as an important adjuvant diagnostic tool in ruling-out EP. (Am J Emerg Med 2000;18:695-697.

Serum amylase levels in ectopic pregnancy

Thirty-four women with abdominal complaints and a positive pregnancy test were evaluated for possible ectopic pregnancy (EP). Serum amylase levels were obtained as part of the diagnostic workup to note any correlation of enzyme levels with the presence of EP. Thirteen individuals (30%) were subsequently diagnosed as having an EP, and serum amylase levels in all of these patients were within normal limits, averaging 81 U L . There was no statistically significant difference in amylase levels between the EP group and the non-EP group ( P = .70). Serum amylase levels cannot reliably predict the presence of EP and should not be used as a screening or diagnostic test for this disorder.