Cognitive markers of dementia risk in middle-aged women with bilateral salpingo-oophorectomy prior to menopause
NEUROBIOLOGY OF AGING
Authors: Gervais, Nicole J.; Au, April; Almey, Anne; Duchesne, Annie; Gravelsins, Laura; Brown, Alana; Reuben, Rebekah; Baker-Sullivan, Elizabeth; Schwartz, Deborah H.; Evans, Kelly; Bernardini, Marcus Q.; Eisen, Andrea; Meschino, Wendy S.; Foulkes, William D.; Hampson, Elizabeth; Einstein, Gillian
Abstract
Oophorectomy prior to menopause is associated with late-life dementia. Memory decline may start within 6 months after oophorectomy in middle-aged women, suggested by lower verbal and working memory performance. Unknown is whether such changes persist beyond 6 months, and whether they are reversed by estradiol. Short-term benefits of estradiol on verbal memory following oophorectomy were observed in one study, but longer term effects remain unknown. In the present study, middle-aged BRCA1/2 mutation carriers with early oophorectomy at least 1 year prior to study onset were tested on verbal and working memory with results stratified by (1) current estradiol use (n = 22) or (2) no history of estradiol use (n = 24), and compared to age-matched premenopausal controls (n = 25). Both memory abilities were adversely affected by oophorectomy, but only working memory was maintained by estradiol. Estrogen metabolite levels correlated with working memory, suggesting a role for estradiol in preserving this ability. Memory decline appears to persist after early oophorectomy, particularly for women who do not take estradiol. (C) 2020 Elsevier Inc. All rights reserved.
How do the M4 and M6 models perform in an Australian pregnancy of unknown location population?
AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY
Authors: Ooi, Sara; De Vries, Bradley; Ludlow, Joanne
Abstract
Background The diagnosis of a pregnancy of unknown location (PUL) is made when there is an elevated serum beta human chorionic gonadotropin (beta hCG) and no pregnancy on transabdominal and transvaginal ultrasound. Most of these pregnancies end as intra-uterine pregnancies or unsuccessful pregnancies and can be safely managed expectantly. However, up to 20% of these women will have an ectopic pregnancy. Several mathematical models, including the M4 and M6 protocols, have been developed using biochemical markers to triage PUL presentations. This rationalises numbers of tests and visits made without compromising safety and allowing timely intervention. Aims We aimed to externally validate the M4 and M6 models in an Australian tertiary early pregnancy assessment service (EPAS). Materials and Methods We performed a retrospective single-centre cohort study across five years. Our study population included all women attending our EPAS with a PUL who had at least two serum beta hCG levels and one progesterone level measured. The M4 and M6 models were retrospectively applied. Results Of the 360 women in the study population, there were 26 confirmed ectopic pregnancies (7.2%) and six persisting PULs (2%). The M4 model had a sensitivity and specificity of 72%. The M6P model had a sensitivity of 91% and specificity of 63%. The M6P misclassified two ectopic pregnancies into the low-risk group, compared with seven in the M4 model. Conclusions The M6P model has the highest sensitivity of the three models and a negative predictive value of 99%. These numbers are comparable to the original United Kingdom population. Further prospective validation is planned.