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Background: The pathophysiological mechanism underlying pregnancy complications is not entirely known. Although it is currently impossible to predict the occurrence of redox imbalance, it is possible to identify women with a high or medium risk of developing this disease prior to a negative outcome by non-invasive diagnostic methods. The Aim: This study aimed to examine the possible role of the parameter of oxidative stress (OS) measured in early pregnancy in the screening/treatment of obesity and its complications during pregnancy. Methods: This research was designed as a prospective observational cross-sectional clinical study which included 40 non-obese and 31 obese pregnant women between 11 and 13 g.w. who were managed in the Department of Obstetrics, University Clinical Center Kragujevac in Serbia. We collected anthropometric and clinical indicators, maternal and pregnancy factors, and measured prooxidative parameters from blood samples. Results: We observed significantly increased levels of the superoxide anion radical, hydrogen peroxide and the index of lipid peroxidation in the Obese group in comparison with the Non-Obese group and significantly decreased bioavailability of nitrites in the Obese group in comparison with the Non-Obese group. Conclusions: The determination of systemic parameters of OS in early pregnancy could be a good methodological approach in the screening/treatment of obesity during pregnancy and this approach should be followed for the screening of endothelial dysfunction in pregnancy which needs further monitoring and/or treatment. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to collect information on human chorionic gonadotrophin (hCG) laboratory testing and reporting in women with gestational trophoblastic disease (GTD), to assess the associated challenges, and to offer perspectives on hCG testing harmonisation. Design: Information was collected from laboratories by electronic survey (SurveyMonkey) using a questionnaire designed by members of the European Organisation for the Treatment of Trophoblastic Disease (EOTTD) hCG working party. Participants: The questionnaire was distributed by the EOTTD board to member laboratories and their associated scientists who work within the GTD field. Setting: The questionnaire was distributed and accessed via an online platform. Methods: The questionnaire consisted of 5 main sections. These included methods used for hCG testing, quality procedures, reporting of results, laboratory operational aspects, and non-GTD testing capability. In addition to reporting these survey results, examples of case scenarios which illustrate the difficulties faced by laboratories providing hCG measurement for GTD patient management were described. The benefits and challenges of using centralised versus non-centralised hCG testing were discussed alongside the utilisation of regression curves for management of GTD patients. Results: Information from the survey was collated and presented for each section and showed huge variability in responses across laboratories even for those using the same hCG testing platforms. An educational example was presented, highlighting the consequence of using inappropriate hCG assays on clinical patient management (Educational Example A), along with an example of biotin interference (Educational Example B) and an example of high-dose hook effect (Educational Example C), demonstrating the importance of knowing the limitations of hCG tests. The merits of centralised versus non-centralised hCG testing and use of hCG regression curves to aid patient management were discussed. Limitations: To ensure the survey was completed by laboratories providing hCG testing for GTD management, the questionnaire was distributed by the EOTTD board. It was assumed the EOTTD board held the correct laboratory contact, and that the questionnaire was completed by a scientist with in-depth knowledge of laboratory procedures. Conclusions: The hCG survey highlighted a lack of harmonisation of hCG testing across laboratories. Healthcare professionals involved in the management of women with GTD should be aware of this limitation. Further work is needed to ensure an appropriate, quality-assured laboratory service is available for hCG monitoring in women with GTD. [ABSTRACT FROM AUTHOR]

Copyright of Jurnal Veteriner is the property of Fakultas Kedokteran Hewan, Universitas Udayana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Backgrounds: The immunomodulatory properties of human chorionic gonadotrophin (hCG) have been identified to be critical for successful pregnancy. However, the effects of hCG on peripheral γδT cells during early pregnancy have not been reported previously. Methods: We cocultured the purified γδT cells and peripheral blood mononuclear cells (PBMCs) with early pregnancy‐relevant hCG concentrations and investigated the changes in the immune functional characteristics of γδT cells via flow cytometry assays. Results: The ratios of CD69+ and IL‐10+ γδT cells were increased in early pregnant women compared to nonpregnant women. γδT cells expressed low levels of the mannose receptor (CD206) instead of the classical hCG/LH receptor for hCG. The direct treatment of purified γδT cells with early pregnancy‐relevant hCG concentrations may have no significant effects on their immune functions. Interestingly, when PBMCs were treated with the same broad range of hCG concentrations, the ratios of CD69+ and IL‐10+ γδT cells to total γδT cells were significantly increased. Conclusion: Certain early pregnancy‐relevant hCG concentrations could enhance the ratios of peripheral CD69+ and IL‐10+ γδT cells, contributing to the activation of γδT cells and immunological tolerance during early pregnancy. However, these affects may not be strongly mediated by direct ligand–receptor interactions and they may highly depend on immune microenvironment. Our novel observations propose a perspective into the endocrine‐immune dialog that exists between the fetus and maternal immune cells. [ABSTRACT FROM AUTHOR]

Objective: Human choriogonadotrophin (hCG) treatment of gonadotrophin‐deficient infertile men uses hCG of urinary (uhCG) or recombinant (rhCG) origin, but these treatments have not been compared nor are there studies defining rhCG dosing in men. Design: hCG products were studied in randomized cross‐over single‐dose studies of standard (Study 1, 1500 IU and 62.5 µg, respectively) or high (Study 2, 5000 IU and 250 µg) dose and a multi‐dose population pharmacology study of hCG use. Participants: Eight (Study 1) and seven (Study 2) volunteers in cross‐over and 52 gonadotrophin‐deficient men in the multi‐dose study Measurements: In cross‐over studies, serum testosterone (T), dihydrotestosterone (DHT) and estradiol by liquid chromatography‐mass spectrometry (LCMS) and serum hCG, LH, FSH, SHBG and T (observational study) by immunoassays. Results: After standard and high‐dose injection, serum hCG and testosterone responses had similar timing and peak concentrations except for a mildly lower early (<48 h) serum testosterone with uhCG. In the multi‐dosing study, both hCGs had similar pharmacokinetics (pooled half‐life 5.8 days, p <.001), while serum testosterone concentrations were stable after injection and did not differ between hCG products. Bench testing verified that 20% of pens from 4/10 individuals were used inappropriately. Conclusions: Although hCG pharmacokinetics are not formally bioequivalent, the similar pharmacodynamic effects on serum testosterone indicate that at the doses tested both hCGs provide comparable clinical effects. The starting dose of rhCG for treating gonadotrophin‐deficient men should be 62.5 µg (6 clicks) of the rhCG pen. [ABSTRACT FROM AUTHOR]

Quantitative human chorionic gonadotropin (hCG) measurements are used to manage women classified with a pregnancy of unknown location (PUL). Two point of care testing (POCT) devices that quantify hCG are commercially available. We verified the i-STAT 1 (Abbott) and the AQT 90 FLEX (Radiometer) prior to use in PUL triage. Tests for precision, external quality assurance (EQA), correlation, hook effect and recovery were undertaken alongside a POCT usability assessment during this prospective multi-center verification. Coefficients of variation ranged between 4.0 and 5.1 % for the three i-STAT 1 internal quality control (IQC) solutions and between 6.8 and 7.3 % for the two AQT IQC solutions. Symmetric differences in POCT EQA results when compared with laboratory and EQA stock values ranged between 3.2 and 24.5 % for the i-STAT 1 and between 3.3 and 36.9 % for the AQT. Correlation coefficients (i-STAT 1: 0.96, AQT: 0.99) and goodness of fit curves (i-STAT 1: 0.92, AQT: 0.99) were excellent when using suitable whole blood samples. An hCG hook effect was noted with the i-STAT 1 between 572,194 and 799,089 IU/L, lower than the hook effect noted with the AQT, which was between 799,089 and 1,619,309 IU/L. When hematocrit concentration was considered in sample types validated for use with each device, hCG recovery was 108 % with the i-STAT 1 and 98 % with the AQT. The i-STAT 1 scored lower on usability overall (90/130) than the AQT (121/130, p<0.001, Mann-Whitney). Both hCG POCT devices were verified for use in clinical practice. Practical factors must also be considered when choosing which device to use in each unit. [ABSTRACT FROM AUTHOR]

Background: Gallbladder carcinoma (GBC) producing human chorionic gonadotrophin (HCG) is an extremely rare and highly invasive tumor with a poor prognosis. This unfavorable clinical outcome is partly due to the aggressive nature of the tumor and its insensitivity to chemotherapy. Case presentation:We herein report a case of primary GBC producing HCG with liver metastases in a 58-year-old woman. The patient presented with a markedly elevated b-HCG level and a mass in the gallbladder with multiple liver metastases. A definitive diagnosis was obtained after a needle biopsy of the liver metastases, showing poorly differentiated carcinoma with large-scale necrosis and strong positivity of immunostaining for HCG in tumor cells. The patient received chemotherapy (gemcitabine plus capecitabine) combined with carrellizumab, an immune checkpoint inhibitor (ICI). Pathological complete response was achieved after eight courses of combined therapy, which was confirmed by pathological analysis of resected specimens. After surgery, two courses of chemotherapy plus ICIs were adopted again. Complete response remained for approximately 1 year up to the present. Tumor tissue was collected to perform immunostaining of PD-L1, whole-exome sequencing, and RNA-seq. Low-TMB (1.51 mut/Mb), MSS, and high PD-L1 expression (TPS ≥ 50%) were observed in the tumor. Besides, the dominant types of infiltrating immune cells were macrophage and CD4+ T cells. Compared to other gallbladder adenocarcinoma without HCG, the proportion of M1 macrophage was at a higher level and the gene sets of MYC targets v1 and PI3K/AKT/mTOR signaling were highly expressed in our case. To the best of our knowledge, this is the first case report of complete remission of HCG-producing gallbladder carcinoma with liver metastases after chemotherapy combined with an immune checkpoint inhibitor. Furthermore, this is also the first report that described the tumor genetic feature and tumor immune microenvironment atlas of HCG-producing GBC. Conclusion: chemotherapy plus an immune checkpoint inhibitor may provide a potentially curative option for gallbladder carcinoma with HCG production. [ABSTRACT FROM AUTHOR]

Background: Urothelial carcinomais the most common urological malignancy and following prostate and lung cancer, it is the third most common carcinoma in male population. Objective: The main aim of this study was to determine the expression of beta hCG in different grades of human urothelial carcinoma in our population. Methods: The study was conducted in Pathology Department of Faisalabad Medical University, Faisalabad, between 2018-2020.Sections were taken on frosted slides for H& E, and on lysine coated slides for IHC.H& E and IHC were performed according to protocols. Results: Out of the 65 tumor studied, 35(54%) were graded as low and 30(46%) were graded as high. In 35 low grade tumors 4(11%) were muscle invasive and 31(89%) were non-invasive and in 30 high grade tumors, 24(80%) were found to be muscle invasive and only 6(20) were non muscle invasive. Out of 65 specimens, 52 (80%) cases were found to be positive for beta hCG while only 13(20%) were found to be negative of 35 low grade tumors, 27(77%) tumors were stained positive for beta hCG and 8(23%) were negative. Of 30 high grade tumors 25(83%) tumors were stained positive for beta hCG and 5 (17%) were negative. Chi-square test was applied showed that there was no significant association between tumor grade and beta hCG expression. Conclusion: The immunohistochemical expression of beta hCG is positive in majority of low and high grade urothelial carcinoma but it may not be utilized as a marker for prognostic determination. [ABSTRACT FROM AUTHOR]

This study was designed to assess the effects of the GnRH agonist gonadorelin and human chorionic gonadotrophin, during a timed artificial insemination program, on the fertility of lactating dairy cows during the warm and cold seasons of the year. Cows were treated intramuscularly with GnRH-agonist (Day 0) and PGF2a (Day 7), followed by either GnRH-agonist (GPG treatment; 38 animals) or hCG (GPH treatment; 26 animals) on Day 9. All cows were fixed-time inseminated (TAI) 16-22 h after the end of treatment. In this study, replacing the Day 9 dose of GnRH with a dose of hCG may result in an increase in the cumulative pregnancy rate (46.6% vs. 25%, P = 0.05) but not the pregnancy rate (26.6% vs. 18.8%, P > 0.05) in heat-stressed cows (THI > 70). However, in cold season, no effects were observed in the pregnancy rates or cumulative pregnancy rates of the examined cows. This finding indicates that hCG therapy in TAI programs may mitigate the negative effects of heat stress on dairy cows reproduction. This tendency can be explained also by some studies that have shown that hCG can significantly reduce the number of small luteal cells while increasing the number of large luteal cells as the corpus luteum gets bigger in diameter, area, and volume. [ABSTRACT FROM AUTHOR]

Background: This study aims to study whether the change of endometrial thickness between the day of human chorionic gonadotrophin (HCG) administration and the day of embryo transfer (ET) has any effect on ectopic pregnancy (EP) rate following fresh in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Methods: This study retrospectively analyzed 3134 patients who underwent fresh IVF/ICSI ET, including 3022 intrauterine, 112 ectopic cycles. Multiple logistic regression analysis and stratified analysis were used to study the effect of endometrial compaction after HCG administration on EP in patients with non-thin endometrium after adjusting for confounding factors. Results: After adjusting for confounders, multiple logistic regression analysis found that the risk of EP in the compaction group was significantly lower than that in the non-compaction group (OR = 0.49; 95% CI: 0.31–0.78; P = 0.0023). The results of the stratified analysis demonstrated the EP rate in patients with an endometrial thickness ≥ 8 mm on the day of ET; the compaction group significantly reduced the incidence of EP (OR = 0.49; 95% CI: 0.31–0.79; P = 0.0036). In patients with an endometrial thickness ≥ 8 mm on the day of ET, the incidence of EP had no statistical significance in two group (OR = 1.02; 95% CI: 0.18–5.88; P = 9790). Conclusion(s): In patients with non-thin endometrium, endometrial thickness compaction from the day of HCG to the ET day reduced the risk of EP significantly. [ABSTRACT FROM AUTHOR]

Background: GnRHa and hCG are both used for oocyte maturation and ovulation triggering. However, GnRHa have a shorter half-life than hCG, which leads to luteal phase deficiency. Letrozole (LE) has been found to improve the luteal function. Thus, the choice of triggering strategy can be different in intrauterine insemination (IUI) cycles using LE and human menopausal gonadotropin (HMG). The aim of this study was to compare the pregnancy and neonatal outcomes of patients triggered with GnRHa versus hCG versus dual trigger in LE-IUI cycles. Methods: This retrospective cohort study included 6,075 LE-HMG IUI cycles between January 2010 and May 2021 at a tertiary-care academic medical center in China. All cycles were divided into three groups according to different trigger strategies as hCG trigger group, GnRHa trigger group and dual trigger group. The primary outcome was clinical pregnancy rate. Logistic regression analysis was performed to explore other risk factors for clinical pregnancy rate. Results: No significant difference was observed in clinical pregnancy rate between hCG, GnRHa and dual trigger cycles in LE-HMG IUI cycles (P = 0.964). The miscarriage rate was significantly lower in the GnRHa trigger group, and higher in the dual trigger group, compared with the hCG group (P = 0.045). Logistic analysis confirmed that triggering strategy was associated with miscarriage (aOR:0.427, 95%CI: 0.183–0.996, P = 0.049; aOR:0.298, 95%CI: 0.128–0.693, P = 0.005). No significant differences were observed regarding neonatal outcomes between the three groups. Conclusions: Our findings suggested that both GnRHa and dual trigger can be used to trigger ovulation in LE-HMG IUI cycles, but dual trigger must be used with caution. [ABSTRACT FROM AUTHOR]

Adrenocortical tumor (ACT) is a rare malignant tumor which usually present with Cushing syndrome and virilization. Paraneoplastic syndromes (PNS) due to neoplasms can occur with peptides or cytokines secreted by the tumor. Here, we report a 13-month-old-male presented with severe masculinization. He had signs of precocious puberty with enlarged testicles, very high testosterone levels but low levels of gonadotrophins, and elevated β-hCG. He underwent a left nephrectomy. The histopathological evaluation revealed a diagnosis of adrenocortical neoplasm. The levels of androgens and β-hCG normalized after the resection of tumor, and the clinical findings improved within few months. We report the first pediatric patient with peripheral precocious puberty due to an ACT that secretes β-hCG as PNS. A β-hCG secreting ACT can cause severe virilization due to increased gonadal androgens stimulated by β-hCG as well as due to increased adrenal androgens from the tumor. [ABSTRACT FROM AUTHOR]

Objective: To determine the positive predictive value of beta Human Chorionic Gonadotrophin in early second trimester for predicting pregnancy induced hypertension. Study Design: Cross-sectional study. Place and Duration of Study: Department of Obstetrics and Gynaecology Combined Military Hospital, Lahore, from Jun 2017 to Nov 2017. Methodology: A total of 214 female pregnant patients met the criteria for inclusion in this study. Patients with beta human chorionic gonadotrophin (βHcg) levels ≥2 MoM were followed at 22, 26, 30 and 34 weeks of gestation. Blood pressure was monitored. Pregnancy induced hypertension (PIH) was labelled after 20 weeks (as per dating scan) of gestation in patients who did not have proteinuria (≥300 mg 24 hour urine sample) and had a systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg (blood pressure readings taken at two separate points in time four hours apart). Results: Patients ranged between 18-35 years of age, with the mean age being 27.3 ± 4.3 years. Mean gestational age was observed to be 15.6 ± 1.8 weeks. Mean BMI was 23.8 ± 3.2 kg/m² . Out of 214 patients, 30 patients (14%) had beta human chorionic gonadotrophin level >2 MoM. Out of these 30 patients, 25 patients (83.3%) developed PIH. There were 100 primigravida (46.7%) and 114 multigravidas (53.3%). Beta human chorionic gonadotrophin in predicting pregnancy induced hypertension showed sensitivity of 96.1%, a specificity of 97.3%, with a PPV 83.3%, a NPV 99.4% and diagnostic accuracy of 97.2%. Conclusion: Pregnant women with beta human chorionic gonadotrophin levels >2 MoM at 13-18 weeks gestation were at an increased risk of developing pregnancy induced hypertension. [ABSTRACT FROM AUTHOR]

A novel surface-enhanced Raman scattering (SERS) immunoassay method based on tyramine signal amplification (TSA) technology triggering the formation of enzyme repeats on an enzyme-linked immunosorbent assay (ELISA) was designed for highly sensitive detection of human chorionic gonadotropin (hCG) using enzymatic biocatalytic precipitation toward o-phenylenediamine (OPD). Initially, a horseradish peroxidase (HRP)-labeled hCG antibody was fixed by the double antibody sandwich method, and then a tyramine-HRP conjugate was used to form HRP repeats by triggering the immobilized HRP on ELISA with the aid of H2O2. In the presence of the target hCG, the HRP repeats carried by the sandwich immune complex catalyzed the oxidation of OPD to produce product molecules with different structures, resulting in changes in the SERS fingerprint spectrum. The analytical performance of the SERS immunoassay was studied in detail using SERS spectral characterization. Under the optimum conditions, the immunosensor displayed a working range from 1 IU L−1 to 16 IU L−1 with a detection limit (LOD) of 0.17 IU L−1 relative to the target hCG. Compared to the traditional SERS immunosensor, a higher detection sensitivity can be obtained. Therefore, this work provides a new strategy for hCG detection and inspiration for the construction of sensitive and efficient immunosensors. [ABSTRACT FROM AUTHOR]

Level of βhCG and the presence of any uterine mass of hydatidiform mole need a careful review or monitoring in order to prevent metastasis, provide an early treatment and avoid unnecessary chemotherapy. A 36-year old fifth gravida patient who had a missed abortion was diagnosed as having a molar pregnancy with beta human chorionic gonadotrophin (βhCG) level of 509,921 IU/L. Her lung field was clear and she underwent suction and curettage (S & C) procedure. However, after six weeks, AA presented to the emergency department with a massive bleeding, although her βhCG level had decreased to 65,770 IU/L. A trans-abdominal ultrasound indicated the presence of an intra-uterine mass (3.0 × 4.4 cm). Nevertheless, her βhCG continued to show a declining trend (8,426 IU/L). AA was advised to undergo a chemotherapy but she refused, citing preference for alternative medicine like herbs instead. She opted for an "at own risk" (AOR) discharge with scheduled follow up. Subsequently, her condition improved with her βhCG showing a downward trend. Surprisingly, at six months post S & C, her βhCG ameliorated to 0 IU/L with no mass detected by ultrasound. Brucea javanica fruits, Pereskia bleo and Annona muricata leaves can potentially be useful alternatives to chemotherapy and need further studies. [ABSTRACT FROM AUTHOR]

We investigated whether human chorionic gonadotrophin (hCG), rather than porcine luteinising hormone (pLH), could induce ovulation in the tammar wallaby (Notamacropus eugenii) after priming with pregnant mare serum gonadotrophin (PMSG). pLH is effective, but is more expensive and supply is problematic. On Day 0 pouch young were removed (RPY) and 5 mg kg-1 of bromocriptine mesylate was administered to all non-pregnant wallabies (n = 12) to reactivate an oestrous cycle. On Day 20 RPY each female received 20IU PMSG i.m. and three days later (Day 23 RPY), the Single-Dose group (n = 6) received 500IU of hCG suspended in oil at 0900 hours, and the Multi-Dose group (n = 6) received 500IU of hCG at 0900, 1230 and 1630 hours. From Day 25 to Day 28 RPY copulatory plugs were observed in the Single-Dose (n = 4 of 6; Day 25.3 to 28.3 RPY) and Multi-Dose (n = 5 of 6; Day 25 to 28 RPY) groups. Autopsy on Day 31 RPY revealed that all females had reactivated, and despite all having large preovulatory follicles (4-6 mm) in both ovaries, no ovulations or embryos were observed. We conclude that hCG is not an effective source of exogenous LH for the induction of ovulation in the tammar wallaby. [ABSTRACT FROM AUTHOR]

In this study, we conducted a retrospective single-centre study of 1664 singleton pregnancies derived from frozen-thawed blastocyst transfer between January 2017 and December 2018. Analysis showed that there were 596 early pregnancy losses and 1068 ongoing pregnancies. We compared serum HCG (human chorionic gonadotophin) concentrations on days 12, 14, 19, and 21, between the pregnancy loss group and the ongoing pregnancy group. The cut-off level of HCG at each time point was calculated to predict pregnancy outcome. Joint analysis of two single HCG levels taken one week apart was carried out to improve predictive accuracy. The levels of HCG at four time points were significantly lower in the early pregnancy loss group than in the ongoing pregnancy group. According to the area under ROC (receiver operating characteristic curve) curves, all levels of HCG taken at four time points showed good ability to predict the outcome of pregnancy. The joint analysis of two single HCG levels taken one week apart further improved the accuracy of prediction. What is already known on this subject? Multiple studies have shown that the maternal level of serum HCG is the best parameter for predicting the course of pregnancy. What do the results of this study add? The levels of HCG on days 12, 14, 19 and 21 were significantly lower in the early pregnancy loss group than in the group of ongoing pregnancies. According to the area under ROC curves, all levels of HCG taken at four time points showed a good ability to predict the outcome of pregnancy. What are the implications of these findings for clinical practice and/or further research? The joint analysis of two single HCG levels, taken one week apart, further improved the accuracy of prediction. [ABSTRACT FROM AUTHOR]

Purpose: To study whether the change of endometrial thickness (EMT) between the day of human chorionic gonadotrophin (hCG) administration and the day of embryo transfer has any impact on pregnancy outcome in fresh in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Methods: This single-center retrospective cohort study included 2620 patients undergoing their first consecutive autologous IVF/ICSI cycles from January 2003 to December 2012. Patients were categorized into three groups based on the percentage change of post-hCG EMT: > 10% decrease, ± 10% plateau and > 10% increase. The primary outcome was live birth rate. Results: Live birth rates were similar in the EMT decrease, plateau and increase groups (27.4% [174/635], 29.7% [300/1010] and 27.6% [269/975]; P = 0.649). Compared with the plateau group, both EMT decrease (crude odds ratio [cOR] 0.89, 95% confidence interval [CI] 0.72–1.11) and increase (cOR 0.90, 95% CI 0.74–1.10) on the day of transfer did not affect the likelihood of live birth. The non-significant association was maintained after controlling for major confounding factors, with the adjusted OR being 0.92 (95% CI 0.73–1.16) and 0.92 (95% CI 0.75–1.13) for the decrease and increase groups, respectively. Conclusion: EMT change after hCG administration did not provide significant prognostic information for pregnancy outcome in fresh IVF/ICSI cycles. This finding should offer reassuring information for patients with decreased EMT on the day of embryo transfer while questioning the necessity of EMT re-measurement prior to transfer as a routine practice. [ABSTRACT FROM AUTHOR]

Background: Placenta is a temporary endocrine organ formed during pregnancy, which produces hormones important in the maintenance of a healthy pregnancy. hCG is the first one of these hormone that is measured in pregnancy test and used in the follow up of adverse pregnancy outcome, Alpha fetoprotein is a major plasma protein produced by the yolk sac and the fetal liver during fetal development. Aim of study: to study relationship between gestational complications and levels of maternal serum HCG and AFP and determine whether the semarkers are effective predictors adverse pregnancy outcomes. Patients & Methods: Prospective cohorts study in AlDiwaniyah maternity and pediatrics teaching hospital. We enrolled a total of 230 women at 14-23 gestational weeks and measurement of maternal serum HCG & AFP were done, of those with normal HCG & AFP formed (group l), group 2 involved women with elevated AFP, group 3 with elevated HCG & group 4 involved women with elevated both HCG & AFP. Follow up weekly of the patients for the development of adverse pregnancy outcome. Results: A significant relationship between adverse pregnancy outcomes and abnormal elevation of HCG & AFP levels in the second trimester. In group 2 the patients developed higher rate of preterm labour & pre-eclampsia compared with the group 1. In group 3 with raised HCG the rate of pre-eclampsia & IUGR development were higher than group 1. In group 4 with elevated both HCG & AFP higher incidence of pre-eclampsia & placental abruption, with a specificity (p<0.001). Conclusion: In the second trimester unexplained high AFP and HCG rates related to adverse maternal and perinatal outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Gynecological Endocrinology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Human chorionic gonadotrophin (hCG) is the first specific molecule synthesized by the embryo. hCG RNA is transcribed as early as the eight-cell stage, and the blastocyst produces the protein before its implantation. hCG in the uterine microenvironment binds with its cognate receptor, luteinizing hormone/choriogonadotropin receptor (LHCGR), on the endometrial surface. This binding stimulates leukemia inhibitory factor (LIF) production and inhibits interleukin-6 (IL-6) production by epithelial cells of the endometrium. These effects ensure essential help in the preparation of the endometrium for initial embryo implantation. hCG also effects angiogenic and immunomodulatory actions as reported in many articles by our laboratories and other ones. By stimulating angiogenesis and vasculogenesis, hCG provides the placenta with an adequate maternal blood supply and optimal embryo nutrition during the invasion of the uterine endometrium. The immunomodulatory properties of hCG are numerous and important for programming maternal immune tolerance toward the embryo. The reported effects of hCG on uterine NK, Treg, and B cells, three major cell populations for the maintenance of pregnancy, demonstrate the role of this embryonic signal as a crucial immune regulator in the course of pregnancy. Human embryo rejection for hCG-related immunological reasons has been studied in different ways, and a sufficient dose of hCG seems to be necessary to maintain maternal tolerance. Different teams have studied the addition of hCG in patients suffering from recurrent miscarriages or implantation failures. hCG could also have a beneficial or a negative impact on autoimmune diseases during pregnancy. In this review, we will discuss the immunological impacts of hCG during pregnancy and if this hormone might be used therapeutically. [ABSTRACT FROM AUTHOR]

Human chorionic gonadotrophin (hCG) is largely used to confirm pregnancy. Yet evidence shows that longitudinal hCG profiles are distinguishable between healthy and failing pregnancies. We retrospectively fitted a joint longitudinal-survival model to data from 127 (85 healthy and 42 failing pregnancies) US women, aged 18–45, who were attempting to conceive, to quantify the association between longitudinally measured urinary hCG and early miscarriage. Using subject-specific predictions, obtained uniquely from the joint model, we investigated the plausibility of adaptively monitoring early pregnancy outcomes based on updating hCG measurements. Volunteers collected daily early morning urine samples for their menstrual cycle and up to 28 days post day of missed period. The longitudinal submodel for log hCG included a random intercept and slope and fixed linear and quadratic time terms. The survival submodel included maternal age and cycle length covariates. Unit increases in log hCG corresponded to a 63.9% (HR 0.36, 95% CI 0.16, 0.47) decrease in the risk of miscarriage, confirming a strong association between hCG and miscarriage. Outputted conditional survival probabilities gave individualised risk estimates for the early pregnancy outcomes in the short term. However, longer term monitoring would require a larger sample size and prospectively followed up data, focusing on emerging extensions to the joint model, which allow assessment of the specificity and sensitivity. [ABSTRACT FROM AUTHOR]

Background Human chorionic gonadotrophin is a marker of early pregnancy. This study sought to determine the possibility of being able to distinguish between healthy and failing pregnancies by utilizing patient-associated risk factors and daily urinary human chorionic gonadotrophin concentrations. Methods Data were from a study that collected daily early morning urine samples from women trying to conceive (n = 1505); 250 of whom became pregnant. Data from 129 women who became pregnant (including 44 miscarriages) were included in these analyses. A longitudinal model was used to profile human chorionic gonadotrophin, a Cox proportional hazards model to assess demographic/menstrual history data on the time to failed pregnancy, and a two-stage model to combine these two models. Results The profile for log human chorionic gonadotrophin concentrations in women suffering miscarriage differs to that of viable pregnancies; rate of human chorionic gonadotrophin rise is slower in those suffering a biochemical loss (loss before six weeks, recognized by a rise and fall of human chorionic gonadotrophin) and tends to plateau at a lower log human chorionic gonadotrophin in women suffering an early miscarriage (loss six weeks or later), compared with viable pregnancies. Maternal age, longest cycle length and time from luteinizing hormone surge to human chorionic gonadotrophin reaching 25 mIU/mL were found to be significantly associated with miscarriage risk. The two-stage model found that for an increase of one day in the time from luteinizing hormone surge to human chorionic gonadotrophin reaching 25 mIU/mL, there is a 30% increase in miscarriage risk (hazard ratio: 1.30; 95% confidence interval: 1.04, 1.62). Conclusion Rise of human chorionic gonadotrophin in early pregnancy could be useful to predict pregnancy viability. Daily tracking of urinary human chorionic gonadotrophin may enable early identification of some pregnancies at risk of miscarriage. [ABSTRACT FROM AUTHOR]

Objective: To compare effectiveness of spontaneous ovulation monitored by urinary luteinising hormone (LH) versus induced ovulation by administration of human chorionic gonadotrophin (hCG) in couples undergoing gonadotrophin-stimulated intrauterine insemination (IUI).Design: Randomised controlled trial.Setting: University-level infertility unit.Population: Couples with unexplained infertility, mild endometriosis, mild male factor infertility and polycystic ovarian syndrome.Methods: Couples were randomised to an LH group (Group A), in which urinary LH was measured daily to detect spontaneous ovulation, or an hCG group (Group B), in which urinary hCG was administered as a trigger.Main Outcome Measures: Clinical pregnancy rate. Secondary outcomes - ongoing pregnancy, live birth, multiple pregnancy and miscarriage rates.Results: A total of 392 couples were randomised with 196 in each arm. The clinical pregnancy rate per woman randomised was 14/196 (7.1%) in the LH arm versus 15/196 (7.6%) in the hCG arm (P = 0.847, which was not statistically significant). Similarly, the ongoing pregnancy rates [13/196 (6.6%) versus 14/196 (7.1%); P = 0.84] and the live birth rates [13/196 (6.6%) versus 14/196 (7.1%); P = 0.84] between the two groups did not show any significant difference. The duration of stimulation and gonadotrophin dosage also did not differ significantly between the two methods.Conclusion: There was no significant difference in clinical pregnancy rates when urinary LH and hCG trigger were compared as methods to time insemination in women undergoing gonadotropin-stimulated IUI.Tweetable Abstract: A randomised controlled study showing similar effectiveness between two different methods of timing IUI. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effect of booster dose of human chorionic gonadotropin (HCG) on the unruptured follicles in non-in vitro fertilization/intracytoplasmic sperm injection cycles. Setting and design: This randomized controlled multicenter study was conducted at Tanta and Zagazig University hospitals in the period from August 1, 2018 to January 1, 2021. Patients and methods: Enrolled patients (n=160) who had unruptured mature Graafian follicle 48 hours after intramuscular (IM) 10,000 IU HCG dose. Patients were allocated randomly into intervention group and control group. In the intervention group, another booster dose (10,000 IU of HCG) was given IM, whereas in the control group, 1 mL normal saline was given IM. Study outcomes: Ovulation and pregnancy rates. Results: The number of cases who had follicular rupture was similar to those in the control group. The incidence of luteinized unruptured follicle (LUF) was nearly similar in both groups. No significant differences were noticed regarding pregnancy rates in both groups. Conclusion: Booster dose of HCG for unruptured follicles has no benefit in ovulation triggering nor in the prevention of LUF syndrome. There was no significant difference in pregnancy rates in both groups. [ABSTRACT FROM AUTHOR]

Plasma gelsolin (pGSN), a protein primarily involved in clearance of circulating actin filaments, is an upcoming novel biomarker. Its level changes in multiple disease and injury conditions, attributable mainly to its consumption during actin clearance; the endogenous regulation of its expression, however, remains elusive as well as unexplored. Here, we are reporting the first isolation of the promoter region of pGSN gene and investigation of its transcriptional regulation during pregnancy (a natural process associated with a well-programmed injury course of parturition). Interestingly, two of the pregnancy-related hormones, human chorionic gonadotrophin (hCG) and progesterone, significantly upregulated pGSN promoter activity in muscle cells. This action of both hormones was found to mediate through their respective cellular receptors and involved a contribution of multiple signaling pathways including those of protein kinase A, protein kinase C, epidermal growth factor receptor and prostaglandin-endoperoxidase synthase 2 in the case of hCG-mediated upregulation. This novel upregulation was further supported by elevated levels of endogenous pGSN transcripts as well as secreted protein upon hormonal treatments of muscle cells compared with untreated controls. A participation of pGSN promoter cis-elements, capable of interacting with endogenous transcription factors, Ap1, Sp1, and p300, was also observed during this hormonal upregulation. Additionally, the augmented pGSN levels observed in pregnant mice compared with the control animals further supported an upregulation of this protein during pregnancy, implicating vital role(s) played by pGSN during this period in mammals. [ABSTRACT FROM AUTHOR]

Background: The clinical implication of the increased serum progesterone level on the day of HCG administration in assisted reproduction treatment (ART) is still controversial. The current study aimed to compare the predictive value of serum progesterone on day of HCG administration / metaphase II oocyte (P/MII) ratio on IVF/ ICSI outcome to serum progesterone (P) level alone and the ratio of serum progesterone/estradiol level (P/E2) ratio in prediction of pregnancy rates after ART. Material & methods: Two hundred patients admitted to the IVF/ICSI program at Minia IVF center in Egypt in the period from October 2016 to May 2018 were included in this study. Serum Progesterone (P) and Estradiol (E2) levels were estimated on the day of HCG administration. The ratio between serum P and the number of MII oocytes (P/MII ratio) was calculated and the predictive values of the three parameters (P, P/E2 ratio and P/MII ratio) in prediction of cycle outcomes were measured. Results: P/ MII oocyte ratio was significantly lower in patients who attained clinical pregnancy (n = 97) as compared with those who couldn't whilst there was no significant difference in P and P/E2 ratio between the two groups. Using a cut off value of 0.125, the sensitivity and specificity of progesterone/ MII ratio in prediction of no pregnancy in IVF/ICSI were 75.7 and 77.1% respectively with the area under The Receiver operating curve (ROC-AUC) = 0.808. The respective values of the ROC-AUC for the P and P/E2 ratio were 0.651 and 0.712 with sensitivity and specificity of 71.2 and 73.5%for P level and of 72.5 and 75.3% for P/E2 ratio. Implantation or clinical pregnancy rates were significantly different between patients with high and low P/MII ratio irrespective of day of embryo transfer (day 3 or 5). Conclusions: In patients with normal ovarian response, serum progesterone on day of HCG / MII oocyte ratio can be a useful predictor of pregnancy outcomes and in deciding on freezing of all embryos for later transfer instead of high progesterone level alone. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Pediatric Surgery is the property of Journal of Clinical Pediatric Surgery Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The majority of studies which investigate the predicted power of Human chorionic gonadotropin (hCG) levels to the occurrence of Gestational trophoblastic neoplasia (GTN) considered the effect of a single measurement of hCG or used classical statistical methods without considering the endogenous marker. The aim of this study is to investigate the association between weekly measurements of ß-hCG with time to GTN occurring, using a robust Bayesian joint modeling. Methods: Data of 201 women with a molar pregnancy were considered for this retrospective cohort study. After the first measurement of ß-hCG in 48 hours post evacuation of mole, the other titration was performed on a weekly basis until three consecutive normal titers. The association between serial measurements of ß-hCG and risk of GTN occurring were assessed by the classic and Bayesian joint modeling and in separate analysis the mixed linear effect and Cox-PH model were used. Results: The mean age (SD) of participants was 26.6 (6.55) year. The GTN was occurred among 14.9% of patients. The association parameter using Bayesian approach was estimated as 1.30 (95% CI: 0.44 to 2.20) which showed one unit increase in the log ß-hCG corresponds to the 2.80-times increase in the hazard for the occurrence of GTN (Hazard Ratio: 2.80, 95% CI: 1.55 to 8.98). Conclusions: Findings of this study revealed that weekly measurements of ß-hCG are an important and reliable biomarker to early detection of developing of molar pregnancy to persistent GTN. [ABSTRACT FROM AUTHOR]

Background: Clinically during ICSI, controlled ovarian stimulation (COS) is a famous way to increase the number of mature oocytes picked up. This method must be asseeed with a substantial danger of ovarian hyper stimulation syndrome (OHSS), which occurred if follicular induction is very strong. Along with multifollicular growth, COS is also resulting in increased serum concentration of estradiol (E2) that in turn may has effect on the receptivity of the endometrium. The high serum E2 concentration through COS may resulting either with an increased chance of pregnancy or an impaired reproductive score secondary to change in endometrial receptivity. Aim of the study: to assess the impact of thickness of the endometrium at the day of hCG administration on the winning of intracytoplasmic sperm injection (ICSI) cycles. Patients and method: A retrospective study in which 235 women who were undergo one time of ICSI cycle were evaluated in this retrospective study, All patients were treated with gonadotrophin agonist either short or long protocol. The patients were according to endometrial thickness they were categorized into three groups I (<7mm), II (7-14mm), and group III (>14mm). Results: the rate of clinical pregnancy was increased ingroup II (7-14mm) than other two groups depending on endometrial thickness measurement. Conclusion: endometrial thickness 7-14mm is associated with higher rate of clinical pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the levels of hyperglycosylated human chorionic gonadotropin (hCG-H) secreted from balanced and unbalanced human embryos. Methods: Single-step culture media samples from 155 good quality embryos, derived from 90 good prognosis patients undergoing intracytoplasmic sperm injection (ICSI), were collected on the fifth day of embryo cultivation. All embryos were tested by next-generation sequencing (NGS) technique. The hCG-H levels in the culture media were evaluated by ELISA kit (Cusabio Biotech, CBS-E15803h) according to the manufacturer's instructions. Statistical analysis was performed using SPSS v.21 (IBM Corp., Armonk, NY, USA). Results: The NGS analysis revealed that 36% of the embryos (n = 56) were balanced, and 64% of the embryos were unbalanced (n = 99). The presence of hCG-H was confirmed in all embryo culture media samples but was absent in the negative control. In addition, hCG-H concentration was significantly higher in the culture media from unbalanced embryos compared with the balanced ones (0.72 ± 0.30 mIU/ml vs. 0.62 ± 0.12 mIU/ml, p = 0.02, respectively). Furthermore, the mean levels of hCG-H were significantly increased in the samples from embryos with multiple abnormalities. Finally, the highest levels of hCG-H were expressed from embryos with monosomy of chromosome 11 (1.28 ± 0.04 mIU/ml) and those with trisomies of chromosomes 21 (2.23 mIU/ml) and 4 (1.02 ± 0.35 mIU/ml). Conclusion: Our results suggest that chromosomal aberrations in human embryos are associated with an increased secretion of hCG-H. However, hCG-H concentration in embryo culture media as a single biomarker is not sufficient for an accurate selection of balanced embryos. [ABSTRACT FROM AUTHOR]

Copyright of Fudan University Journal of Medical Sciences is the property of Fudan University Journal of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Bisphenol AF (BPAF) has been shown to inhibit testicular steroidogenesis in male rats. However, the precise mechanisms related to the toxic effects of BPAF on reproduction remain poorly understood. In the present study, a mouse Leydig tumor cell line (mLTC‐1) was used as a model to investigate the mechanism of steroidogenic inhibition and to identify the molecular target of BPAF. Levels of progesterone and the concentration of cyclic adenosine monophosphate (cAMP) in cells exposed to BPAF were detected, and expression of key genes and proteins in steroid biosynthesis was assessed. The results showed that BPAF exposure decreased human chorionic gonadotrophin (hCG)‐stimulated progesterone production in a dose‐dependent manner. The 24‐h IC50 (half maximal inhibitory concentration) value for BPAF regarding progesterone production was 70.2 µM. A dramatic decrease in cellular cAMP concentration was also observed. Furthermore, BPAF exposure inhibited expression of genes and proteins involved in cholesterol transport and progesterone biosynthesis. Conversely, the protein levels of steroidogenic acute regulatory protein (StAR) were not altered, and those of progesterone were still decreased upon 22R‐hydroxycholesterol treatment of cells exposed to higher doses of BPAF. Together, these data indicate that BPAF exposure inhibits progesterone secretion in hCG‐stimulated mLTC‐1 cells by reducing expression of scavenger receptor class B type I (SR‐B1) and cytochrome P450 (P450scc) due to the adverse effects of cAMP. However, StAR might not be the molecular target in this process. [ABSTRACT FROM AUTHOR]

We report on a label-free immunosensor based on graphene field effect transistors (G-FETs) for the ultrasensitive detection of Human Chorionic Gonadotrophin (hCG), as an indicator of pregnancy and related disorders, such as actopic pregnancy, choriocarcinoma and orchic teratoma. Pyrene based bioactive ester was non-covalently anchored onto the graphene channel in order to retain the sp² lattice. The G-FET transfer characteristics showed repeatable and reliable responses in all surface modifying steps using a direct current (DC) readout system. The hCG concentration gradient showed a detection limit of ~1 pgmL-1. The proposed method facilitates the cost-effective and viable production of graphene point-of-care devices for clinical diagnosis. [ABSTRACT FROM AUTHOR]

While the global use of in vitro‐produced embryos in dairy cattle is on the rise, several technical aspects of embryo transfer procedures have not yet been optimized. This study compares the effects of inducing ovulation using human chorionic gonadotropin (hCG) versus gonadotropin‐releasing hormone (GnRH) at the end of a 5‐day progesterone(P4)‐based protocol for oestrous synchronization on the pregnancy rate of lactating dairy cow recipients of in vitro‐produced embryos. Fresh embryos were transferred on Day‐seven post‐oestrus to ovulating cows receiving GnRH or hCG (groups GnRH and hCG, n = 60 each). Pregnancy was diagnosed by ultrasound on Day 28 post‐oestrus. Forty‐nine cows became pregnant: 16 in GnRH (26.7%) and 33 in hCG (55%). Taking GnRH‐treated cows as reference, the odds ratio for pregnancy of hCG‐treated cows was 3.3 (p =.002). In conclusion, hCG treatment given at the end of a 5‐day P4‐based protocol for oestrous synchronization improved the pregnancy rate in lactating dairy cows receiving an in vitro‐produced embryo. [ABSTRACT FROM AUTHOR]

Background: Differences in human chorionic gonadotrophin (hCG) results provided by the commercial immunoassays reflect the heterogeneity of antibodies and the use of suboptimal standards. As a consequence, the principal forms of hCG and metabolites are differentially detected and the hCG tests are not suited for the same clinical applications. Conflicting results are available in the literature regarding which hCG variants are recognized by the Roche Elecsys hCG + β test. The aim of our study was to compare the hCG concentrations provided by the Siemens Immulite 2000 test and the Roche test as well as to assess the concordance between both assays.Methods: In this purpose, 152 samples obtained from women and 44 samples from men were analysed by both tests during the follow-up of pregnancy termination, gestational trophoblastic disease and malignancies. The intermediate precision of the Roche test was also investigated on a pool with a low hCG concentration.Results and Conclusions: The hCG concentrations measured with the Roche test were slightly lower compared with the Siemens assay; mean biases of -34.2% and -8% were respectively obtained for hCG values ≤100 UI/L and higher than 100 UI/L. The overall agreement between both assays was 96.1% for women and 97.7% for men. By using an upper reference limit of 3.2 UI/L for women and 1.6 UI/L for men, the Roche test demonstrated a respective concordance of 98.7% and 100%. This test also yielded an excellent precision with a coefficient of variation of 2.8% at a mean hCG concentration of 7 UI/L. [ABSTRACT FROM AUTHOR]

Uterine fibroids are the most common gynecologic benign tumors. Studies supporting a strong pregnancy-related growth of leiomyomas generally claimed a crucial role of sex steroid hormones. However, sex steroids are unlikely the unique actors involved as estrogen and progesterone achieve a pick serum concentration in the last trimester while leiomyomas show a typical increase during the first trimester. Given the rapid exponential raise in serum human Chorionic Gonadotrophin (hCG) at the beginning of gestation, we conducted a review to assess the potential role of hCG in the striking growth of leiomyomas during initial pregnancy. Fibroid growth during initial pregnancy seems to correlate to the similar increase of serum hCG levels until 12 weeks of gestation. The presence of functional Luteinizing Hormone/human Chorionic Gonadotropin (LH/hCG) receptors was demonstrated on leiomyomas. In vitro treatment of leiomyoma cells with hCG determines an up to 500% increase in cell number after three days. Expression of cyclin E and cyclin-dependent kinase 1 was significantly increased in leiomyoma cells by hCG treatment. Moreover, upon binding to the receptor, hCG stimulates prolactin secretion in leiomyoma cells, promoting cell proliferation via the mitogen-activated protein kinase cascade. Fibroid enlargement during initial pregnancy may be regulated by serum hCG. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to investigate a series of patients with sustained low-level elevated human chorionic gonadotrophin (hCG) and explore the management of these patients. Methods A total of 47 patients with persistent low levels of hCG were selected for analysis between January 2002 and January 2014 at the Women's Hospital of Zhejiang University, Hangzhou, China. Data were retrospectively reviewed for patient characteristics, therapeutic strategies, and follow-ups. We compared the characteristics of patients who were and were not eventually considered to have malignancies. Results Among the 47 patients, 17 with persistent low-level elevated hCG and no detectable lesions were considered to have no active malignancy. Fifteen of the 17 patients had hCG levels that returned to normal range by the end of follow-up, while the remaining two did not. The other 30 patients were eventually diagnosed as having active malignancies due to detected lesions or increasing elevation of hCG. A large proportion of these patients were diagnosed with placental site trophoblastic tumor or epithelioid trophoblastic tumor. Conclusion For patients with persistent low-level elevated hCG, frequent follow-up rather than any therapy is recommended. Treatment was considered effective and safe once diagnosis of active malignancy was confirmed. [ABSTRACT FROM AUTHOR]

A two year old boy presented with precocious puberty associated with hepatoblastoma. Serum concentrations of beta human chorionic gonadotrophin and alpha-fetoprotein were raised. An aggressive chemotherapeutic regimen resulted in useful palliation and interesting changes in the beta human chorionic gonadotrophin and alpha-fetoprotein concentrations. In contrast to a previous report, the ultrastructure of the tumour showed frequent Golgi apparatus but no other electron dense membrane bound vesicles. [ABSTRACT FROM PUBLISHER]

Background: Ovarian hyperstimulation syndrome is usually an iatrogenic and potentially life-threatening disease. It develops following ovulation induction and use of in vitro fertilization techniques. A 32-year-old primigravida Ethiopian woman presented at 15 weeks gestation with a history of progressive bilateral leg swelling and abdominal pain of 2 weeks duration. She had triplet pregnancy and conceived through in vitro fertilization. She was managed in intensive care unit.Conclusion: Patients with multiple pregnancy following in vitro fertilization conception can have ovarian hyperstimulation syndrome as late as 15 weeks gestation. Hence, frequent follow-up should be continued to detect early signs of OHSS to avoid further complications and need of intensive care unit care. [ABSTRACT FROM AUTHOR]

Serum chromogranin A is the most useful general and prognostic tumour marker available for neuroendocrine tumour (NET) patients. The role of other tumour markers is less clear. In order to determine the diagnostic and prognostic value of serum alpha-fetoprotein (AFP) and human chorionic gonadotrophin-beta (hCGbeta) in NETs, a database containing biochemical, histological, and survival data on 360 NET patients was constructed. This data was statistically assessed, using Statistical Package for the Social Sciences, to determine the utility of commonly measured tumour markers with particular emphasis on AFP and hCGbeta. Alpha-fetoprotein and hCGbeta were raised in 9.5 and 12.3% of patients respectively and jointly raised in 9.1% of patients in whom it was measured. Alpha-fetoprotein levels associated strongly and positively with tumour grade, serum CgA and hCGbeta levels, and worse survival. Human chorionic gonadotrophin-beta levels also associated strongly and positively with serum CgA and AFP levels, and worsening survival. Alpha-fetoprotein and hCGbeta are elevated in high-grade NETs, with a rapidly progressive course and poorer survival. They also correlate with chromogranin-A, which is known to be a marker of tumour burden and to have prognostic value. Thus AFP and hCGbeta are clinically important in NETs and when elevated are poor prognostic markers. [ABSTRACT FROM AUTHOR]