Blood Human Chorionic Gonadotropin Research Articles

Elucidation of the role of XBP1 in the progression of complete hydatidiform mole to invasive mole through RNA-seq

ObjectiveA complete hydatidiform mole (CHM) is a common disease and is known to develop post-molar gestational trophoblast neoplasia (GTN). However, the molecular mechanisms underlying the progression of CHM to post-molar GTN remain largely unknown. In this study, we investigated the molecular factors associated with the progression using RNA-seq. MethodsWe included 13 patients with CHM and performed RNA-seq using freshly frozen samples. We identified differentially expressed genes between patients who developed GTN (GTN group) and those who achieved spontaneous remission after uterine evacuation (SR group), and performed pathway analysis. Then, functional analyses were performed on choriocarcinoma (JAR and JEG-3) and CHM (Hmol1-3B and Hmol1-2C) cells. Moreover, we evaluated the in vivo tumorigenicity of XBP1-overexpressed Hmol1-3B cells. ResultsThe gene expression profiles were separated into two groups, and an upstream regulator analysis was performed using 281 differentially expressed genes. We focused on transcription factors and identified that 33 transcription factors were activated in the GTN group. Then, excluding those with low expression levels in clinical samples and cell lines, XBP1 was selected for further analysis. Additionally, XBP1 downregulation significantly decreased the migration and invasive abilities of choriocarcinoma cells, whereas XBP1 overexpression significantly increased the migration and invasive abilities of CHM cells. Furthermore, animal experiments showed that tumor weight and blood human chorionic gonadotropin (hCG) levels were significantly higher in the XBP1-overexpressing Hmol1-3B-bearing mice than those in the control mice. ConclusionRNA-seq identified XBP1 as a key factor in post-molar GTN, suggesting it contributes to the development of post-molar GTN.

Heterotopic pregnancy: a case report of intrauterine hydatidiform mole with tubal pregnancy.

We herein report a rare case of simultaneous intrauterine molar pregnancy and tubal pregnancy. A woman of childbearing age who had never been pregnant underwent an ultrasound examination 70 days after the onset of menopause. She had a history of ovulation induction. The ultrasound findings suggested a partial hydatidiform mole. She was then pathologically confirmed to have a complete hydatidiform mole after uterine suction dilation and curettage. On postoperative day 4, an ultrasound examination before discharge showed an inhomogeneous mass in the left adnexal region with mild lower abdominal pain. On postoperative day 17, the blood human chorionic gonadotropin level did not drop as expected, and a follow-up examination still indicated a mass in the left adnexal region. We were unable to rule out an ectopic hydatidiform mole. Hysteroscopy with laparoscopic exploration of the left adnexal mass and salpingotomy suggested a diagnosis of intrauterine hydatidiform mole combined with left tubal pregnancy.

Tubal superfetation following frozen-thawed single-embryo transfers in two separate cycles: Case report and literature review.

Superfetation is a very rare occurrence. In the context of assisted reproduction, it has been reported only as an intrauterine pregnancy after ovarian stimulation and/or embryo transfer in the presence of an undiagnosed ectopic pregnancy. Here we report a case of a 27-year-old anovulatory patient, gravida 1 para 1, who underwent two frozen-thawed single-blastocyst transfers in separate cycles. The patient reported that 12 days after the first transfer, she had menstrual bleeding and stopped her estradiol and progesterone supplementation without undergoing a blood human chorionic gonadotropin (βhCG) test. At her request, a second cycle was immediately initiated, with endometrial thickness measuring 4 mm. Eleven days after the second transfer, the βhCG value was inappropriately high. A right tubal pregnancy corresponding to 8 gestational weeks was diagnosed. Laparoscopy revealed a prominent right tubal pregnancy in addition to a significantly smaller left tubal pregnancy. The discordant tubal pregnancies were confirmed histologically. To our knowledge, superfetation involving a second ectopic pregnancy coexistent with a first, contralateral ectopic pregnancy consequent to consecutive in vitro fertilization procedures has not previously been described in the medical literature. This case emphasizes the importance of routine βhCG testing after every IVF cycle, even if apparently unsuccessful.

Esketamine use for anesthesia induction in an ectopic pregnancy patient with hemorrhagic shock: a case report

Abstract Background Anesthesia induction is challenging in patients with hemodynamic instability. Esketamine has hypnotic, analgesic, and sympathomimetic effects and is the only anesthetic that can increase sympathetic tension. Therefore, it may be more suitable for patients with hypovolemic shock. Case summary A 40-year-old female patient presented to the emergency department with new-onset abdominal pain and vaginal bleeding for 2 hours. Menstruation of the patient was regular, her self-reported urine pregnancy test was positive half a month earlier, and she had been diagnosed at another hospital 12 days earlier based on a positive blood human chorionic gonadotropin test. Gynecological ultrasonography demonstrated no pregnancy sac in utero, confirming ectopic pregnancy. Emergency laparoscopy for ectopic pregnancy should be performed immediately. We administered esketamine for induction. Conclusion Esketamine-based total intravenous anesthesia results in mild hypotension in ectopic pregnancies with hemorrhagic shock.

Treatment of Placenta Increta With High-Intensity Focused Ultrasound Ablation and Leaving the Placenta in situ: A Multicenter Comparative Study.

ObjectiveTo explore the feasibility of simple high-intensity focused ultrasound (HIFU) ablation for placenta increta.MethodsNinety-five patients after a vaginal delivery were enrolled in this retrospective cohort study, 53 patients were treated with simple HIFU ablation, and 42 patients were treated with HIFU followed by uterine curettage.ResultsAll 95 patients were successfully treated with a single-session HIFU procedure, and in the control group, the necrotic placental tissue was removed with curettage. Vaginal hemorrhage did not occur in either group. The duration of bloody lochia was 25.9 ± 8.6 days in the sHIFU group and 24.2 ± 8.8 days in the control group (P > 0.05). The median serum human chorionic gonadotropin (HCG) level was 3,222 mIU/mL and 2,838 mIU/mL in the sHIFU and control groups, respectively, which decreased and returned to normal within 30 days, and the differences were not significantly on comparing the blood HCG level in the two groups at 7, 15, and 30 days after HIFU (all P > 0.05). Decreased menstrual volume occurred in 85.71% of patients in the control group, which was higher than that in the sHIFU group (23.08%) (χ2 = 6.839, P < 0.001). During 2–8 years of follow-up, six pregnancies occurred in the sHIFU group without any recurrence of placenta increta, three pregnancies occurred in the control group, and one patient developed a repeat placenta increta.ConclusionSimple HIFU treatment is safe and effective for postpartum placenta increta and leaving the placenta in situ. It is a promising option for patients who wish to preserve their fertility and conceive.

Detection and significance of main anchoring villus in early pregnancy.

To find and explore the relationship among the length of the embryo's main anchoring villus and the week of gestation, embryonic crown-rump length (CRL), and maternal blood human chorionic gonadotropin (hCG) during early pregnancy using ultrasound. A total of 108 women with singleton pregnancies underwent ultrasound examination of the fetus during the early months of their pregnancy (5+5 -13+6 weeks of pregnancy). The main anchoring villus was detected using HD-Flow and SlowflowHD mode ultrasound. The detection rate and length of the main anchoring villus were recorded. The correlations among main anchoring villus with gestational weeks, CRL, and blood hCG were obtained. The main anchoring villus was detected in all women (108/108). It could be found throughout the early gestational weeks from as early as 4+6 weeks. The length of the main anchoring villus increased with gestational age, and was positively correlated with CRL and the logarithm of hCG (P<0.05). Our results showed that the detection rate of the main anchoring villus was 100% and the length of the main anchoring villus was correlated with gestational week, CRL, and blood hCG. The main anchoring villus could represent where the embryo implanted.

Analysis of the guidance value of 3D ultrasound in evaluating endometrial receptivity for frozen-thawed embryo transfer in patients with repeated implantation failure.

BackgroundRepeated implantation failure (RIF) is currently believed by some scholars to be mainly related to the poor endometrial receptivity. Three-dimensional (3D) ultrasound, as a noninvasive examination, has attracted the most attention. This paper further discusses whether 3D ultrasound of the endometrial receptivity index has guidance value in the evaluation of pregnancy outcomes in patients with RIF following frozen-thawed embryo transfer.MethodsA total of 79 patients with RIF were retrospectively analyzed. These 79 patients which were confirmed by the transvaginal ultrasonography detection comprised 36 cases of intrauterine pregnancy, which were included in the pregnancy group, and 43 cases with biochemical pregnancy (the HCG in blood or urine is only transient and can be detected by clinical biochemical methods. The pregnancy sac cannot be seen under ultrasound) or negative results of human chorionic gonadotropin (HCG) examination, which were included in the non-pregnancy group. The endometrial thickness, uterine volume, sub-endometrial blood flow type, pulsatility index (PI) and resistance index (RI) of the spiral artery; the RI and PI of the uterine artery; and the peak systolic velocity/end diastolic velocity (S/D) of the two groups were measured and analyzed.Results(I) There were no significant differences in the age, infertility years, body mass index (BMI), anti-Müllerian hormone (AMH), endometrial thickness on the hCG injection day, estradiol (E2), and progesterone (P) between the pregnant and non-pregnant groups (P>0.05). (II) There were no significant differences in the endometrial thickness, uterine volume, and RI and PI of the uterine artery on the day before the implantation between the two groups (P>0.05). (III) There was statistical difference in the sum of the S/D of the two uterine arteries between the two groups (P<0.05) with a cutoff value of 14.47 (P<0.05). (IV) The RI and PI of the spiral artery in the non-pregnancy group were lower than those in the pregnancy group, and the difference was statistically significant (P<0.05). (V) The differences in the endometrial classification and subendometrial blood flow classification between the two groups were statistically significant (P<0.05).ConclusionsUltrasonographic endometrial blood flow classification, spiral artery blood flow parameters, and uterine artery blood flow parameters can be effective indexes for evaluating endometrial receptivity, and they have a certain clinical significance in evaluating the pregnancy outcome of RIF patients after retransplantation.

Ovarian hyperstimulation syndrome following surgical removal of a complete hydatidiform mole: a case report

BackgroundGenerally, ovarian hyperstimulation syndrome develops after superovulation caused by ovulation-inducing drugs in infertile patients. However, ovarian hyperstimulation syndrome associated with natural pregnancy is rare, and most cases of ovarian hyperstimulation syndrome have been associated with a hydatidiform mole.Case presentationWe describe a case of a 16-year-old Japanese girl with a complete hydatidiform mole. The patient was referred for intensive examination and treatment of the hydatidiform mole and underwent surgical removal of the hydatidiform mole at 9 weeks, 5 days of gestation. Histopathological examination revealed a complete hydatidiform mole. The patient’s blood human chorionic gonadotropin level decreased from 980,823 IU/L to 44,815 IU/L on postoperative day 4, and it was below the cutoff level on postoperative day 64. Transvaginal ultrasonography on postoperative day 7 revealed a multilocular cyst measuring 82 × 43 mm in the right ovary and a multilocular cyst measuring 66 × 50 mm in the left ovary. Both ovarian cysts enlarged further. Magnetic resonance imaging on postoperative day 24 revealed that the right multilocular ovarian cyst had enlarged to 10 × 12 cm and that the left multilocular ovarian cyst had enlarged to 25 × 11 cm. Blood examination showed an elevated estradiol level as high as 3482 pg/ml. We diagnosed the patient with bilateral giant multilocular cysts accompanied by ovarian hyperstimulation syndrome because of the rapid increase in the size of the cysts. The patient complained of mild abdominal bloating; however, symptoms such as nausea, vomiting, dyspnea, and abdominal pain were not observed. Therefore, we chose spontaneous observation in the outpatient clinic. The cysts gradually decreased and disappeared on postoperative day 242.ConclusionPhysicians should be aware that ovarian cysts can occur and can increase rapidly after abortion of a hydatidiform mole. However, the ovarian cyst can return to its original size spontaneously even if it becomes huge.

LABORATORY PREDATORS OF SPONTANEOUS PREGNANCY OCCURRENCE IN WOMEN WITH OVARIAN CYSTS AFTER LAPAROSCOPIC TREATMENT OF INFERTILITY

The main goal of treating couples with infertility is achieving pregnancy and successful delivery of the newborn. Laparoscopy is used worldwide for treating patients with infertility due to endometriosis or recurrent functional uni- or bilateral ovarian cysts. In our prospective study we examined 258 women with the diagnosis of benign mass of the ovaries who underwent treatment for infertility at Samara State Clinical Hospital n.a. V.D. Seredavin within the period from November 2015 to December 2017. 54 women with infertility were enrolled in the current study. We divided them into two groups: the first group included patients with endometrioid cysts (n = 20) and the second one included patients diagnosed with functionalovarian cysts (n = 34). Exclusion criteria comprised the tubal factor of infertility, male factor, BMI &gt; 25 of female and other metabolic disorders. Anti-Mullerian hormone (AMH) ng/ml and CA-125 were determined preoperatively. Patients were compatible with age, parity, and duration of infertility. Post-operative levels of AMH were measured on the first cycle after surgery. Postoperatively the patients were followed up for 6 monthsin order to confirm the presence/absence of pregnancy by ultrasound examination and the level of human chorionic gonadotropin in blood. 42,6% of total women enrolled in this study became pregnant within 6 months after surgery. The proportion of pregnancies in the group with treated endometriomas was significantly lower in comparison with the group of functional cysts: 7 patients (35%)in the first groupand 16 patients (47,05%) in the second one, p &lt; 0.007 respectively. We consider post-operative AMH level to be more accurate prognostic tool for predicting results of laparoscopic infertility treatment in women both with ovarian cysts and endometriomas.

The role of tumor size, ultrasonographic findings, and serum tumor markers in predicting the likelihood of malignant testicular histology.

The clinical predictive factors for malignant testicular histology remain unclear because of the low prevalence. Therefore, the aim of this study was to investigate predictors of malignant histology for testicular masses and decide more testis-sparing surgeries before surgery. This retrospective study enrolled 325 consecutive testicular mass patients who underwent radical orchiectomy (310/325) or testicular preserving surgery (15/325) from January 2001 to June 2016. The clinicopathological factors, including tumor diameter, cryptorchidism history, ultrasound findings, serum alpha-fetoprotein, and human chorionic gonadotropin (HCG) levels, were collected retrospectively for statistical analysis. A predictive nomogram was also generated to evaluate the quantitative probability. Among all patients, 247 (76.0%) were diagnosed with a malignant testicular tumor and 78 (24.0%) with benign histology. Larger tumor diameter (per cm increased, hazard ratio [HR] = 1.284, P = 0.036), lower ultrasound echo (HR = 3.191, P = 0.001), higher ultrasound blood flow (HR = 3.320, P < 0.001), and abnormal blood HCG (HR = 10.550, P < 0.001) were significant predictive factors for malignant disease in all testicular mass patients. The nomogram generated was well calibrated for all predictions of malignant probability, and the accuracy of the model nomogram measured by Harrell's C statistic (C-index) was 0.92. According to our data, the proportion of patients who underwent radical orchiectomy for benign tumors (24.0%) was much larger than generally believed (10.0%). Our results indicated that the diameter, ultrasonic echo, ultrasonic blood flow, and serum HCG levels could predict the malignancy in testicular mass patients.

Relationship between thickness and pattern of endometrium and pregnancy rate in in vitro fertilization-intracytoplasmic

Introduction: Assisted reproductive treatment (ART) cycle like in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) is an expensive procedure with low implantation and pregnancy rate. Endometrial pattern and thickness are suggested as the factors of endometrial receptivity and predictors of IVF-ICSI success. The correlation between endometrial pattern and thickness with pregnancy rate in IVF-ICSI cycles was evaluated in this study. Methods: In this study, 150 patients with 150 cycles were included. Ovulation induction was performed by antagonist protocol and in the day of human chorionic gonadotropin (HCG) administration, thickness and pattern of endometrium were measured by transvaginal sonography. Two weeks after embryo transfer, pregnancy rate was defined by blood HCG and the correlation between pregnancy rate with thickness and pattern of endometrium in the day of HCG administration was evaluated. Results: Pregnancy rate in triple line pattern (TLP) was significantly higher than homogenous hypoechoic pattern (P = 0.006). Endometrium thickness was significantly higher in cases of pregnancy (P < 0.001). Sensitivity and specificity of endometrium thickness > 9.5 mm in predicting pregnancy rate was 77.50% and 77.50%, respectively. In addition, the sensitivity and specificity of TLP alone or combined with endometrium thickness were 87.50%, 35.45%, 67.50% and 80.90%, respectively. Conclusion: Thickness and pattern of endometrium both could predict pregnancy occurrence. Having TLP along with endometrium thickness > 9.5 mm, the possibility of pregnancy following IVF-ICSI increases.

WITHDRAWN: The role of tumor size, ultrasonographic findings, and serum tumor markers to predict the likelihood of malignant testicular histology

// Gang Song 1, * , Yu Fan 1, * , Gengyan Xiong 1 , Guangjie Ji 1 , Cong Huang 1 , Yongming Kang 1, 2 , Jinchao Chen 1 , Da Ren 1 , Qun He 1 , He Wang 1 , Gangzhi Shan 1 , Shuqing Li 1 , Zhisong He 1 and Liqun Zhou 1 1 Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China 2 Department of Urology, Suining Central Hospital, Sichuan, China * These authors contributed equally to this work Correspondence to: Gengyan Xiong, email: xgy13537221@163.com Liqun Zhou, email: zhoulqmail@sina.com Keywords: testicular tumor, malignant likelihood, predictive model, urological oncology Received: August 03, 2017 Accepted: November 19, 2017 Published: January 02, 2018 ABSTRACT Background: The clinical predictive factors for malignant testicular histology remain unclear because of the low prevalence. We initiated this study to predict the likelihood of malignant histology for testicular masses and decide more testis-sparing surgeries prior to surgery. Materials and Methods: 325 consecutive testicular mass patients who underwent radical orchiectomy or testicular preserving surgery (15/325) from January, 2001 to June, 2016 were enrolled in our study. We evaluated the predictive role of tumor diameter, cryptorchidism history, ultrasound findings, serum alpha fetoprotein (AFP) and human chorionic gonadotropin (HCG) levels to assess the likelihood of malignant testicular histology. A predictive nomogram was also generated to evaluate the quantitative probability. Results: There were 78 (24.0%) benign and 247 (76.0%) malignant testicular tumor patients in our study cohort. Larger tumor diameter (per centimeter increased, hazard ratio [HR] = 1.284, p = 0.036), lower ultrasound echo (HR = 3.191, p = 0.001), higher ultrasound blood flow (HR = 3.320, p < 0.001) and abnormal blood HCG (HR = 10.550, p < 0.001) were significant predictive factors for malignant disease in all testicular mass patients. In general, the nomogram was well calibrated for all predictions of malignant probability, and the accuracy of the model nomogram measured by Harrell's C statistic (c-index) was 0.92. The main limitation of the study was the retrospective design. Conclusions: According to our data, the proportion of patients who underwent radical orchiectomy for benign tumors (24%) was much larger than generally believed (10%). Our results suggest that the diameter, ultrasonic echo, ultrasonic blood flow and serum HCG levels could predict the malignancy in testicular mass patients.

Retroperitoneal ectopic pregnancy: a case report and review of the literature

BackgroundRetroperitoneal ectopic pregnancy (REP) is an extremely rare type of ectopic pregnancy, with a total of less than 20 cases reported in the English literature. However, failure to recognize REP may result in severe consequences.Case presentationWe report a case of 32-year-old woman with REP. She had amenorrhea, left lower abdominal pain, but no vaginal bleeding. Her urine human chorionic gonadotropin (HCG) test was positive and blood HCG level was 1880 m-international units per milliliter (mIU/mL). Transvaginal ultrasound sonography showed a left adnexal mass. Laparoscopy found an enlarged uterus, normal right uterine tube and ovary, and normal left uterine tube. The left ovary was partly covered by a blood clot, but appeared normal after removing the clot. There was a 10-mm circular peritoneal defect located lateral to the left sacrocervical ligament, anterior to the left ovarian fossa, and next to the lower edge of the left broad ligament. The patient was diagnosed of having REP with the gestational tissues covered by the peritoneum. The REP was removed by laparoscopic surgery. Bleeding was stopped by bipolar coagulation and absorbable hemostatic cellulose. The patient recovered smoothly and was discharged on the next day after surgery. Her blood HCG returned to normal range 29 days after surgery.ConclusionsREP is very rare, but in any suspected case of ectopic pregnancy, caution must be paid to find signs of REP when the common sites of ectopic pregnancy do not have any positive findings.

Clinical observation of tubal pregnancy treated by suspended laparoscope

Objective To compare the efficacy of suspended laparoscope and traditional laparotomy in the treatment of tubal pregnancy.Methods 160 cases of tubal pregnancy were treated by traditional laparotomy (A group,n =100) and suspended laparoscope(B group,n =60).The curative effect was compared between the two groups.Results In group B,the operation time was (45.70 ± 3.76) min,the volume of bleeding during the operation was (29.10 + 6.17) ml,anal exhaust time after operation was (17.70 + 7.75) h,post-operative off-bed time was (23.13 ± 7.55) h,postoperative hospitalization time was (4.52 ± 1.10) d,postoperative pain observed in 12 cases,10 cases had postoperative fever,postoperative poor wound healing in 0 case.Those in group A were (47.01 ± 3.83)min,(40.07 ±6.02)m1,(23.90 ±7.86)h,(27.87 +9.06)h,(6.26 ± 1.14) d,38 cases,35 cases,9 cases,the differences between the two groups were statistically significant(t =2.1101,11.0477,4.8568,3.4022,9.4835,x2 =5.6199、6.1961、4.1521,P ＜0.01).The decline of blood human chorionic gonadotropin had no significant difference between the two groups after operation.Conclusion Suspended laparoscope in treatment of tubal pregnancy is better than traditional laparotomy,it is effective,minimally invasive and safe. Key words: Pregnancy, tubal; Laparoscopy

A case of consistent discrepancies between urine and blood human chorionic gonadotropin measurements

Our laboratory was confronted with two successive urine samples from a single patient which tested positive for human chorionic gonadotropin (hCG) when tested with both qualitative and quantitative assays, combined with no detectable hCG in corresponding plasma samples. Serial dilution and recovery experiments were performed in order to investigate the presence of interfering substances or a high-dose hook effect. The ovarian cysts that were removed from this patient were immunohistochemically stained using polyclonal anti-human hCG antibodies. Furthermore, a urine sample was sent to the USA hCG Reference Service for hCG variant analysis. Dilution and recovery experiments in urine and plasma samples were unremarkable. The biopsy stained negative for human hCG and free β-subunit. hCG isoform analysis in the urine sample revealed that approximately 87.5% of the immunoreactive hCG lacked the β-subunit C-terminal peptide (CTP). We report a rare case in which two successive urine samples test positive for hCG whereas in corresponding plasma samples hCG is undetectable. The majority of the total hCG contained a degraded form of β-subunit that lacks the CTP. This hCG variant, possibly of pituitary origin, is thought to have an extreme fast clearance rate possibly explaining the discordance between the hCG results in urine and plasma samples.

Value of blood AFP and HCG levels in the diagnosis of intracranial germ cell tumors (author's transl)

Plasma α-fetoprotein (AFP) and human chorionic gonadotropin (HCG) concentrations were assayed in patients with intracranial teratomas or germinomas. Plasma AFP was significantly elevated in one patient with a yolk sac tumor, and in four with embryonal carcinomas, while in 14 patients with germinomas, the plasma AFP level was in the normal range. Plasma HCG concentrations were significantly elevated in two patients with embryonal carcinomas and in seven with germinomas. In one patient with a yolk sac tumor, the HCG concentration in CSF was elevated. Pertinent literature was reviewed and it was concluded that AFP is specific to yolk sac tumors and embryonal carcinomas, while HCG is common in all germinal tumors. Blood or CSF AFP and HCG are quite useful for detecting germinal tumors. They are also useful in evaluating the efficacy of the treatment.