Background In both the general population and people with multiple sclerosis (PwMS), physical exercise is associated with improved mental well-being. Moreover, there is evidence of the possible protection of physical activity against disease progression in multiple sclerosis (MS). However, the question arises if acute or regular exercise has any impact on the immune system in PwMS. To answer this question, we performed a systematic review and meta-analysis on both plasma and serum cytokine levels (IL-6 and TNF-α) before and after acute and regular exercise among PwMS and compared to healthy controls. Method We performed an online search via PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane Library till September 2021 to identify original studies on IL-6 and TNF-α changes after acute and regular exercise in PwMS and controls. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 11 original studies were included in the meta-analysis. Sensitivity analyses were used to identify the origins of heterogeneity. R 4.0.4 was used to perform the meta-analysis of IL-6 and TNF-α levels before and after acute and regular exercise in PwMS, compared to controls. This study does not qualify for a clinical trial number. Results IL-6 levels did neither increase nor decrease after acute and regular exercise in PwMS, and compared to controls (pre- vs. post-intervention: Standardized Mean Difference (SMD) -0.09, 95% CI [−0.29; 0.11], p-value = 0.37, PwMS vs. Control: SMD −0.08, 95% CI [−0.33; 0.16], p-value = 0.47). In PwMS, TNF-α levels decreased after regular exercise and when TNF-α levels of both acute and regular exercise were pooled (pre- vs. post-intervention: SMD −0.51, 95% CI [-0.91; 0.11], p-value = 0.01, PwMS vs. Control: SMD −0.23, 95% CI [−0.66; 0.18], p-value = 0.26). TNF-α levels did neither increase nor decrease after acute and regular exercise in PwMS, when compared to controls. Conclusion This systematic review and meta-analysis show that exercise does not lead to significant changes in peripheral levels of IL-6 in PwMS in contrast to the observed response in healthy subjects and other medical contexts. However, regular exercise had a specific anti-inflammatory effect on blood TNF-α levels in PwMS. It remains to be investigated why PwMS display this different exercise-induced pattern of cytokines.

Background: Monitoring fetal movement is a simple and effective approach to assessing fetal well-being. Among other issues, the maternal perception of altered (not just reduced) fetal movements remains a complex issue. This study aimed to report a case of fetal demise following the increased fetal movements in the third trimester of pregnancy. Case Presentation: A 32-year-old woman in 34th week of her first pregnancy attended the emergency room while she had no chief complaint of fetal movement from the previous night; the fetus was examined, but no fetal heart rate was detected. She had reported an increased perception of fetal movements in the earlier week. Her maternal history, as well as her labs and obstetrics data, were normal. Despite the normal appearance of the fetus and placenta, the triple loops of tied nuchal cord was abnormal. Conclusions: Increased fetal movement (IFM) was a controversial finding, and earlier studies had questioned its safety. Therefore, any fetal movement alteration may have had clinical and fateful importance. Thus, it was recommended that further prospective studies should be conducted in order to clarify the association between IFM patterns and pregnancy adverse outcomes.

Background: Cervical insufficiency occurs in the second trimester. Herein, we report a successful term pregnancy in a woman with glucose intolerance and a history of cervical insufficiency after two consecutive preterm deliveries in the second trimester. Case Presentation: We present a 35-year-old woman, G3P2L0, with a history of two preterm deliveries in the second trimester. In the second pregnancy, vaginal cerclage at the 18th gestational week did not prevent premature delivery. Following two pregnancies with borderline fasting blood sugar (FBS) results, we decided to further evaluate the gestational diabetes mellitus (GDM) state with a two-hour postprandial (2 hpp) glucose test and glucose tolerance test (GTT). By impaired 2 hpp and GTT results, an insulin regimen was started with subsequent vaginal cerclage in the third pregnancy. She delivered a healthy 2,750-g girl at 38 weeks of gestation by tight blood sugar control. Conclusions: More attention should be paid to evaluating glucose intolerance in pregnancy, especially in patients with cervical insufficiency. Blood glucose control in these patients can probably improve pregnancy outcomes.

Background The objective of this study is to quantitatively compare the diagnostic value of conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) in differentiating the histopathological features and subtypes of breast cancer. Materials and Methods There were 98 patients with breast cancer studied by multiple b value DWIs and DKIs grouped according to their molecular prognostic factors. Entropy and histogram derived parameters of volumetric ADC values, true diffusivity (Dt), pseudo-diffusion coefficient (Dp), perfusion fraction (f), mean kurtosis (MK), and mean diffusivity (MD) maps were calculated using voxel based analysis for the whole lesion volume. The diagnostic efficacy of various diffusion parameters for predicting both molecular prognostic factors (Hormone-Receptor (HR, ER or PR positive), HER2 and ki67) and breast cancer subtypes were compared. Diagnostic performance was evaluated using the univariate and multivariate logistic regressions, ROC analysis, multivariate backward logistic regression, analysis of covariance (ANCOVA) and partial eta squared (ηp2) estimation. Results HR- positive tumors had significantly lower median ADC values (P= < 0.001, Bonferroni adjusted significance < 0.002) than HR- negative tumors. HER-2 positive tumors had significantly higher mean ADC values and last ADC quartile (P< 0.001, univariate regression: OR=99.3, 14.2, AUC=0.79, 0.73, P<0.001) than HER-2 negative tumors. High ki67 tumors had significantly lower last ADC quartile (P< 0.001) than tumors with low ki67 index. Luminal B subtype had significantly lower mean ADC, median ADC (OR=0.011, AUC=0.78, P<0.001) and last ADC Quartile (P< 0.001, Bonferroni adjusted significance < 0.001), HER-2 subtype had significantly higher mean ADC, median ADC and last ADC Quartile (P< 0.001, (OR=129.2, 32.1, 78.7, univariate regression, P<0.001, AUC=0.94, 82, 89, P<0.001) and triple negative subtype showed significantly lower MD (P< 0.001, univariate regression: OR=0.02, AUC=0.73, P=0.002) than other tumor subtypes. ANCOVA analyses found a significant association between mean ADC and luminal HER2 (ηp2=0.86, P< 0.001) after adjusting for molecular prognostic factors. Conclusion The use of diffusion imaging with multiple b values will be beneficial for the classification of breast cancers.