The first cases of severe pneumonia from a novel coronavirus were reported in Wuhan, China in December 2019. 10 Since then, the virus has been identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 infection causes fevers, cough, dyspnea, myalgias, pharyngitis, diarrhea, pneumonia, acute respiratory distress syndrome, multisystem organ failure, cytokine storm, endothelial damage, and thrombotic events. 2,3,11-13 It has infected over 12 million people and caused over 550 000 deaths across the globe. 1 The case fatality rate is estimated at 2.3% among the entire population. 14 Recent observations show that the majority of pregnant women are asymptomatic or have mild disease based on the criteria proposed by Wu et al. 14-16 Nevertheless, any infection during pregnancy has potential risks. A recent review of obstetric cases found that 3% of pregnant women with SARS-CoV-2 required intensive care. 17 There have also been cases of preterm labor and perinatal death in the setting of maternal SARS-CoV-2 infection. It is uncertain whether the virus can be vertically transmitted from mother to neonate. Given that SARS-CoV-2 causes inflammatory, coagulation, and endothelial changes, investigating placental and fetal involvement during infection is crucial to providing guidance and care to pregnant patients. Coronaviruses are enveloped positive-sense single-stranded RNA viruses that infect both humans and animals. 18 Human coronaviruses typically cause mild upper and lower respiratory infections, although they can present as severe pneumonia or bronchiolitis. 7,18 Gastrointestinal symptoms can also occur with infection. Coronaviruses were believed to have little clinical significance until the 21st century. Since 2002, three novel coronaviruses have been described: SARS-CoV in 2002, Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, and SARS-CoV-2 in 2019. SARS-CoV appears to primarily target ciliated epithelial cells via the angiotension-converting enzyme 2 (ACE2) receptor. ACE2 is expressed in the cardiovascular system, gut tissue, adipose tissue, lungs, kidneys, the placenta, and fetal tissue. 19-21 SARS-CoV-2 also binds to ACE2 in order to enter cells. 19,20,22 The clinical presentation of coronaviruses is likely due to both direct cell injury and host response.

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Necrotizing enterocolitis (NEC) is a severe gastrointestinal complication of prematurity. Using suspension and imaging mass cytometry coupled with single-cell RNA sequencing, we demonstrate severe inflammation in patients with NEC. NEC mucosa could be subtyped by an influx of three distinct neutrophil phenotypes (immature, newly emigrated, and aged). Furthermore, CD16+CD163+ monocytes/Mϕ, correlated with newly emigrated neutrophils, were specifically enriched in NEC mucosa, found adjacent to the blood vessels, and increased in circulation of infants with surgical NEC, suggesting trafficking from the periphery to areas of inflammation. NEC-specific monocytes/Mϕ transcribed inflammatory genes, including TREM1, IL1A, IL1B, and calprotectin, and neutrophil recruitment genes IL8, CXCL1, CXCL2, CXCL5 and had enrichment of gene sets in pathways involved in chemotaxis, migration, phagocytosis, and reactive oxygen species generation. In summary, we identify a novel subtype of inflammatory monocytes/Mϕ associated with NEC that should be further evaluated as a potential biomarker of surgical NEC and a target for the development of NEC-specific therapeutics.

Objective To determine if very early serum hCG, a marker of trophoblast differentiation, is associated with adverse perinatal outcomes in singleton pregnancies. Design Retrospective cohort study Setting University fertility program Patients 360 singleton IVF live births Interventions Serial hCG measurements were used to determine the within-woman slope for hCG (hCG rise). Main Outcomes Measures Primary outcomes included birth weight and gestational age at delivery. Statistical comparisons utilized t-test, chi-square test, and linear and logistic regression as appropriate. Results hCG rise was positively associated with birth weight but not gestational age at delivery. Infant gender, gestational age, and type of embryo transfer ("fresh" vs. frozen/thawed) were significantly associated with birth weight and confounded the associations of interest. hCG rise was slower among subjects delivering an infant with low birth weight (slope: 0.386 ±0.05 vs. 0.407 ±0.06,) or small for gestational age (slope: 0.371 ±0.07 vs. 0.406 ±0.06,). Analysis of hCG rise by quartile showed that, when compared to the first quartile (slowest), subjects with a rate of hCG rise in the fourth quartile (fastest) had a significantly decreased risk of delivering an infant of low birth weight [OR = 0.32, 95% CI (0.11–0.92)]. No relationship was noted between hCG rise and hypertensive disorders of pregnancy. Conclusions Slower, very early first trimester hCG rise is associated with low birth weight but not gestational age at delivery among singleton IVF conceptions. The rate of increase in serum hCG may reflect early trophoblast differentiation and placentation and, possibly, predict subsequent development.

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Objective: Necrotizing enterocolitis (NEC) is characterized by peripheral cell abnormalities, yet few studies have analyzed the complete blood count (CBC) specifically by gestational age (GA). Our objective was to describe GA-specific immune abnormalities in NEC through a comprehensive analysis of the CBC differential.Methods: Using a cohort of 246 infants (177 cases, 69 controls) admitted to neonatal intensive care units at a single institution, we retrospectively analyzed CBCs around illness onset in NEC cases compared with controls. Cases included surgical NEC (S-NEC, 34.5%) and medical NEC (M-NEC, 65.5%). Infants were divided into those born at GA <33 and ≥33 weeks. Differences in CBC values were described as absolute and percent changes at NEC onset from baseline and at antibiotic completion after NEC. We used machine learning algorithms based on the CBC at NEC to generate predictive models for diagnosis.Results: At NEC onset, there was an acute drop in monocytes and lymphocytes along with a rise in bands in S-NEC infants born <33 weeks compared with M-NEC. In comparison, both M-NEC and S-NEC ≥33 weeks had a percent drop in neutrophils at diagnosis compared with controls. At antibiotic completion, monocytes in S-NEC <33 weeks significantly rose compared with M-NEC, yet for S-NEC ≥33 weeks, bands significantly dropped compared with M-NEC. Predictive modeling was able to accurately predict S-NEC from M-NEC and controls.Conclusion: There are discrete leukocyte patterns in NEC based on GA. The CBC at diagnosis may be useful in identifying patients who will require surgery.

In a large healthcare worker cohort, we quantified the association between behaviors and risk of coronavirus disease 2019 (COVID-19) during different pandemic phases, adjusting for prior infection and vaccination. Individual characteristics, including personal concerns, were associated with these behaviors. Public health messaging should target high-risk populations and behaviors as the pandemic evolves.

Establishing the etiology of a retroperitoneal tumor may be difficult due to close proximity of multiple organs. Evaluation of retroperitoneal tumors often leads to surgery, many times to obtain a definitive diagnosis and rule out malignancy. Calcifying fibrous tumors (CFT) are very rare soft tissue tumors occurring most often in young patients. They are most often found arising in the thoracic cavity, mediastinum, abdominal cavity and extremities and usually have a benign clinical course. Macrocscopically, the tumors are well circumscribed and firm with a white-tan appearance. Histologically, CFT comprised a hypocellular proliferation of bland spindle cells, densely hyalinized collagen, chronic lymphoplasmacytic inflammation and dystrophic calcifications. Other considerations in the pathologic differential diagnosis include solitary fibrous tumor and inflammatory myofibroblastic tumor.