Emerging biomarkers for improving pregnancy planning in multiple sclerosis

Background

Patient disability, relapse rate, and age are used for family planning in multiple sclerosis (MS). However, the need for more accurate biomarkers is widely recognized. We aimed to explore the influence of age on neurofilament light chain (sNfL), which reflects acute inflammation; glial fibrillary acidic protein (GFAP), associated with disability progression independent of relapses; and anti-Müllerian hormone (AMH), reflecting ovarian reserve, to provide a tailored family planning strategy.

Methods

This case-control study included 95 MS patients and 61 healthy control women (HCW). sNfL and GFAP levels were measured using a sensitive single-molecule array assay. AMH levels were measured by the automated Elecsys® Anti-Müllerian Hormone Assay.

Results

We observed no significant differences in AMH values between MS patients and the control group within any of the age-matched categories. Age exhibited a negative correlation with AMH values in both groups, as expected. Nevertheless, our findings suggest a slight tendency toward reduced ovarian reserve in MS patients (rho MS patients = -0.67, p < 0.0001; rho HCW = -0.43, p = 0.0006). Interestingly, among the 76 MS participants under 40 years old, we identified ten individuals (13.1%) with AMH levels below 0.7 ng/ml, indicative of a low ovarian reserve, and an additional six individuals (7.8%) with AMH levels between 0.7 ng/ml and 0.9 ng/ml, suggesting a potential risk of premature ovarian failure. Conversely, sNfL and GFAP levels in the MS group exhibited high variability but showed no significant association with age intervals.

Conclusion

We found no significant differences in AMH, sNfL or GFAP values between MS patients and the control group within any of the age-matched categories. The assessment of AMH, sNFL and GFAP levels at MS onset facilitates personalized therapeutic and family planning strategies for childbearing-age women.

Epidemiology of malignant melanoma, worldwide incidence, and etiologic factors

Malignant melanoma is increasing at an alarming rate, exceeding that of any other cancer in the United States today. Genetic susceptibility and exposure to ultraviolet radiation are thought to be the two most important risk factors for development of the neoplasm. While genetic factors cannot be altered, minimizing exposure to ultraviolet light, especially intermittent intense type, and photoprotective measures may significantly reduce the development of this ominous cutaneous malignancy.

Malignant melanoma: differential diagnosis of the pigmented lesion

Familiarity with the clinical signs of malignant melanoma can result in earlier recognition and thus potentially decrease both patient morbidity and mortality. Unfortunately, several cutaneous tumors, both benign and malignant, have clinical similarities to this neoplasm, often making the correct diagnosis difficult. The purpose of this paper is to discuss the clinical characteristics of the different types of malignant melanoma and those lesions that mimic this ominous malignancy. Furthermore, diagnostic clues to help delineate between these various pigmented lesions are provided.