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Concept: Human chorionic gonadotropin


Background An early serum tumor marker ™ decline during chemotherapy was shown to independently predict survival in patients with poor-prognosis disseminated non-seminomatous germ-cell tumors (NSGCTs). The aim of this study was to assess whether a TM decline (TMD) also correlates with the outcome in the salvage setting. Patients and methods Data regarding 400 patients with progressive or relapsed disseminated NSGCTs after first-line chemotherapy prospectively accrued onto two phase III clinical trials were obtained. Serum alpha-fetoprotein (AFP) and/or human chorionic gonadotropin (hCG) were assessed at baseline and after 6 weeks of chemotherapy. A total of 297 patients, 185 and 112 in the training and validation sets, with initially abnormal TMs for whom a change from baseline could be established were used for this analysis. Results An unfavorable decline in either AFP or hCG was predictive of progression-free survival (PFS) [hazard ratio, HR = 2.15, (95% CI 1.48-3.11); P < 0.001; 2-year PFS rate: 50% versus 26%] as was the Lorch prognostic score (LPS). In the multivariate analysis, an unfavorable TMD, stratified based on the LPS, was an independent adverse prognostic factor for PFS and OS. Conclusion An unfavorable TMD during the first 6 weeks after chemotherapy is associated with a poorer outcome in patients with relapsed disseminated NSGCTs.

Concepts: Clinical trial, Cancer, Oncology, Germ cell tumor, Human chorionic gonadotropin, Alpha-fetoprotein, Tumor markers, Tumor marker


A controlled release delivery system helps to overcome the problem of short life of the leutinizing hormone releasing hormone (LHRH) in blood and avoids use of multiple injections to enhance reproductive efficacy. Chitosan- and chitosan-gold nanoconjugates of salmon LHRH of desired size, dispersity and zeta potential were synthesized and evaluated at half the dose rate against full dose of bare LHRH for their reproductive efficacy in the female fish, Whereas injections of both the nanoconjugates induced controlled and sustained surge of the hormones with peak (P<0.01) at 24 hrs, surge due to bare LHRH reached its peak at 7 hrs and either remained at plateau or sharply declined thereafter. While the percentage of relative total eggs produced by fish were 130 and 67 per cent higher, that of fertilised eggs were 171 and 88 per cent higher on chitosan- and chitosan-gold nanoconjugates than bare LHRH. Chitosan nanoconjugates had a 13 per cent higher and chitosan gold preparation had a 9 per cent higher fertilization rate than bare LHRH. Histology of the ovaries also attested the pronounced effect of nanoparticles on reproductive output. This is the first report on use of chitosan-conjugated nanodelivery of gonadotropic hormone in fish.

Concepts: Hormone, Menopause, Luteinizing hormone, Estradiol, Follicle-stimulating hormone, Human chorionic gonadotropin, Gonadotropin, Hormones


Magnetic field (MF) non-ionizing radiation is widespread and everyone is exposed to some degree. This prospective cohort study of 913 pregnant women examined the association between high MF exposure and miscarriage risk. Cox (proportional hazards) regression was used to examine the association. After controlling for multiple other factors, women who were exposed to higher MF levels had 2.72 times the risk of miscarriage (hazard ratio = 2.72, 95% CI: 1.42-5.19) than those with lower MF exposure. The increased risk of miscarriage associated with high MF was consistently observed regardless of the sources of high MF. The association was much stronger if MF was measured on a typical day of participants' pregnancies. The finding also demonstrated that accurate measurement of MF exposure is vital for examining MF health effects. This study provides fresh evidence, directly from a human population, that MF non-ionizing radiation could have adverse biological impacts on human health.

Concepts: Pregnancy, Childbirth, Epidemiology, Human, Electromagnetism, Abortion, Miscarriage, Human chorionic gonadotropin


This is a pilot study to investigate the type and severity of emotional distress in women after early pregnancy loss (EPL), compared with a control group with ongoing pregnancies. The secondary aim was to assess whether miscarriage or ectopic pregnancy impacted differently on the type and severity of psychological morbidity.

Concepts: Psychology, Pregnancy, Obstetrics, Abortion, Miscarriage, Human chorionic gonadotropin, Ectopic pregnancy, Morning sickness


Nausea and vomiting during pregnancy have been associated with a reduced risk for pregnancy loss. However, most prior studies enrolled women with clinically recognized pregnancies, thereby missing early losses.

Concepts: Pregnancy, Childbirth, Clinical trial, Abortion, Miscarriage, Human chorionic gonadotropin, Nausea, Morning sickness


The pituitary gland is present in all vertebrates, from agnathans (jawless vertebrates) to mammals, but not in invertebrates. Reproduction in gnathostomes (jawed vertebrates) is controlled by two pituitary gonadotropins (GTHs), luteinizing hormone and follicle-stimulating hormone, which are part of the pituitary glycoprotein hormone (GPH) family. Hagfishes, which lack both jaws and vertebrae, are considered the most primitive vertebrate known, living or extinct. Accordingly, they are of particular importance in understanding the evolution of the pituitary GPHs and their functions related to vertebrate reproduction. Nevertheless, key elements of the reproductive endocrine system in hagfish have yet to be elucidated. Our current report has revealed the first identification of a functional GPH composed of two subunits that possess gonadotropic action at the pituitary of brown hagfish. It seems most likely that an ancestral GPH gave rise to only one GTH in hagfish pituitary and that multiplicity of GPHs arose later during the early evolution of gnathostomes. This paper briefly summarizes the latest findings on the hagfish GPH from an evolutionary point of view.

Concepts: Luteinizing hormone, Human chorionic gonadotropin, Vertebrate, Chordate, Gnathostomata, Glycoprotein, Hagfish, Agnatha


Aim:  Considering that Ki-67 is a proliferative marker in molar pregnancies and the possible progression of these kinds of pregnancies to gestational trophoblastic neoplasia (GTN), we decided to evaluate the rate of expression of this marker in patients with uneventful hydatidiform moles and GTN. Moreover, we determined the predictive value of this factor for the progression of molar pregnancies to GTN. Methods:  In two groups of patients, including 30 patients with uneventful molar pregnancies and 30 patients with GTN, an immunohistochemical staining technique using the Envision method was performed. To evaluate nuclear immunoreactivity of trophoblastic cells for Ki67 on paraffin sections obtained from molar pregnancy products, the percentage of the stained cells was used. Semi-quantitative evaluation was also performed. Data were analyzed using Mann-Whitney tests and receiver operating characteristic curve analysis. Results:  The expression of Ki67 in cytotrophoblastic and syncytiotrophoblastic cells of patients with GTN was significantly more than for patients with an uneventful molar pregnancy (P < 0.05). We considered a 12.5% cut-off value for Ki67 in cytotrophoblastic cells and a sensitivity of 90%, specificity 93%, positive predictive value of 93.1% and negative predictive value of 90.3% were obtained. Similarly, considering a cut-off value of 6% for Ki67 in syncytiotrophoblastic cells, results of 90% were obtained for all diagnostic indices. Conclusion:  Our findings suggest that expression of the Ki67 oncogene in trophoblastic cells in patients with GTN are found far more frequently than in patients with an uneventful molar pregnancy, and demonstrate a high predictive value of progression to GTN.

Concepts: Oncology, Positive predictive value, Negative predictive value, Obstetrics, Human chorionic gonadotropin, Hydatidiform mole, Trophoblast, Gestational trophoblastic disease


Human pre-ovulatory follicular fluid (FF) contains a higher concentration of melatonin than serum. The aim of this study was to evaluate the effect of melatonin supplementation of culture medium on the clinical outcomes of an in-vitro maturation (IVM) IVF-embryo transfer programme for patients with polycystic ovarian syndrome (PCOS). Melatonin concentrations in the culture media of granulosa cells (GC) or cumulus-oocyte-complexes (COC) were measured and the clinical outcomes after using IVM media with or without melatonin were analysed. In the culture media of GC or COC, melatonin concentrations gradually increased. When human chorionic gonadotrophin priming protocols were used, implantation rates in the melatonin-supplemented group were higher than those of the non-supplemented control group (P<0.05). Pregnancy rates were also higher, although not significantly. The findings suggest that the addition of melatonin to IVM media may improve the cytoplasmic maturation of human immature oocytes and subsequent clinical outcomes. It is speculated that follicular melatonin may be released from luteinizing GC during late folliculogenesis and that melatonin supplementation may be used to improve the clinical outcomes of IVM IVF-embryo transfer. Melatonin is primarily produced by the pineal gland and regulates a variety of important central and peripheral actions related to circadian rhythms and reproduction. Interestingly, human pre-ovulatory follicular fluid contains a higher concentration of melatonin than serum. However, in contrast to animal studies, the direct role of melatonin on oocyte maturation in the human system has not yet been investigated. So, the aim of the study was to evaluate the effect of melatonin supplementation of culture medium on the clinical outcome of an in-vitro maturation (IVM) IVF-embryo transfer programme for PCOS patients. The melatonin concentrations in culture medium of granulosa cells (GC) or cumulus-oocyte-complexes (COC) were measured and the clinical outcomes of IVM IVF-embryo transfer using IVM medium alone or supplemented with melatonin were analysed. In the culture media of GC or COC, the melatonin concentration gradually increased. With human chorionic gonadotrophin priming, the pregnancy and implantation rates in the melatonin-supplemented group were higher than those of the non-supplemented control (P<0.05). Our findings suggest that follicular melatonin is released from luteinizing GC during late folliculogenesis and plays a positive role in oocyte maturation. Therefore, addition of melatonin into IVM medium may improve cytoplasmic maturation of human immature oocytes and subsequent clinical outcomes.

Concepts: Luteinizing hormone, Pineal gland, Human chorionic gonadotropin, Circadian rhythm, Ovulation, Polycystic ovary syndrome, Folliculogenesis, Melatonin


OBJECTIVES: Molar pregnancies, characterized by hydropic change and trophoblast hyperplasia of chorionic villi, are usually sporadic. Second and third molar pregnancies can occur by chance but may be associated with a rare autosomal recessive condition, familial recurrent hydatidiform mole (FRHM). This condition, in which affected women have a predisposition to complete hydatidiform moles (CHM), is not usually diagnosed until women have experienced several CHM when a differential diagnosis is made by demonstrating the CHM are diploid and biparental (BiCHM) in contrast to sporadic CHM which are androgenetic (AnCHM). Our objective was to investigate whether these genetic differences might be reflected in identifiable phenotypic differences between BiCHM and AnCHM that could enable earlier diagnosis of FRHM. STUDY DESIGN: Histopathological features were compared between 27 AnCHM from 17 individuals and 51 BiCHM from 20 families in whom a diagnosis of FRHM was confirmed by the presence of biallelic NLRP7 mutations or pathological variants. RESULTS: A spectrum of morphological features was observed in BiCHM. As a group they show subtle, but consistent, histological differences from typical sporadic AnCHM, with less marked villous trophoblast hyperplasia, extravillous trophoblast fragments, stromal apoptotic debris, budding architecture, cisterns and trophoblastic inclusions. While there are some BiCHM that individually show atypical histological features, the majority are indistinguishable from typical sporadic AnCHM. CONCLUSION: The majority of cases of FRHM cannot be distinguished from sporadic AnCHM on the basis of histopathological features alone. In a minority of cases CHM may demonstrate ‘atypical’ features that raise the possibility of underlying BiCHM requiring further investigation.

Concepts: Pathology, Obstetrics, Anatomical pathology, Human chorionic gonadotropin, Hydatidiform mole, Trophoblast, Differential diagnosis, Gestational trophoblastic disease


The following case report discusses a 21-year-old Hispanic woman who was brought to the emergency room for evaluation because of experiencing acute left-sided hemiparesis with anosognosia. Upon further assessment, the patient was found to have a positive blood test for methamphetamines, positive human chorionic gonadotropin for pregnancy, and a history of patent foramen ovale. Neurological examination of the patient revealed left hemiparesis, dysarthria, and homonymous hemianopsia of the left side with a National Institutes of Health Stroke Scale of 12. Given the patient’s assessment and positive radiological findings of a clot located within the right M1 segmental branch of the middle cerebral artery territory through the use of computed tomography angiography, deployment of intra-arterial thrombolytics within 6 hours of symptom onset was utilized. The patient’s clinical course was complicated by brain swelling requiring intubation. Return of neurological function was assessed with noninvasive and invasive neurological evaluation, which showed full cognitive and physical return of the functional baseline level at discharge.

Concepts: Blood, Myocardial infarction, Medical terms, Stroke, Thrombosis, Human chorionic gonadotropin, Tissue plasminogen activator, Thrombolysis