Background:Twin pregnancies continue to increase worldwide;however,the current clinical prenatal evaluation for the intrauterine growth of twins still relies on the growth standards of singletons.We attempted to estab...Background:Twin pregnancies continue to increase worldwide;however,the current clinical prenatal evaluation for the intrauterine growth of twins still relies on the growth standards of singletons.We attempted to establish a set of fetal biometric references for Chinese twin pregnancies,stratified by chorionicity and conception mode as spontaneously conceived monochorionic diamniotic(SC-MCDA),spontaneously conceived dichorionic diamniotic(SC-DCDA),and assisted reproductive technology dichorionic diamniotic(ART-DCDA)twins.Methods:From 2016 to 2019,the ultrasonographic fetal biometric measurements were longitudinally collected in pregnant women,including fetal weight,biparietal diameter,head circumference,abdominal circumference,femur length,and humerus length.The linear mixed models were used to test the difference of growth patterns between groups,and the growth curve of each biometric parameter was modeled by a generalized additive model for location scale and shape.Results:A total of 929 twin pregnant women and 2019 singleton pregnant women,met the inclusion criteria.Among twin pregnancies,148 were SC-MCDA,215 were SC-DCDA,and 566 were ART-DCDA twins.Overall,SC-DCDA twins grew faster than SC-MCDA twins,while slower than ART-DCDA twins(all P<0.05),and all of the three groups showed significant differences comparing with singletons,especially during the third trimester.Hence,the customized fetal growth charts of each fetal biometric parameter were,respectively,constructed for SC-MCDA,SC-DCDA,and ART-DCDA twins.Conclusions:The fetal biometric trajectories demonstrated characteristic patterns according to chorionicity and conception mode.To fill the gap,we modeled fetal biometric parameters for Chinese SC-MCDA,SC-DCDA,and ART-DCDA twin pregnancies,hoping to provide a reference for the further establishment of fetal growth reference values for Chinese twin fetuses.展开更多
Objective:Ultrasound determination of chorionicity is poor in early pregnancy in China.In an effort to increase the accuracy rate of prompt chorionicity determination,clinical training was provided to primary care phy...Objective:Ultrasound determination of chorionicity is poor in early pregnancy in China.In an effort to increase the accuracy rate of prompt chorionicity determination,clinical training was provided to primary care physicians.This study assesses the effects of implementing clinical guidelines on chorionicity determination.Methods:A multi-centered cohort study was conducted between January 2014 and June 2017 in 12 hospitals without fetal medicine centers.In 2014,the obstetricians and ultrasound physicians were trained in clinical practice and ultrasound examination relating to chorionicity determination.Linear and binary regression analyses were conducted to identify the effects of introducing the new protocols,including the diagnosis rate of chorionicty and perinatal outcomes,taking the data from 2014 as a baseline.Pregnancy outcomes were additionally adjusted for maternal age.Results:During the period of this study,3,599 twin pregnancies from 12 centers were enrolled,and a total of 2,998 twin pregnancies were extracted.The rate of overall chorionicity determination,including antenatal and postpartum diagnosis,increased successively from 49.5% in 2014 to 93.5% in 2017(P<0.0001).The rate of ultrasonic chorionicity diagnosis before 14 weeks increased from 25.2% in 2014 to 65.0% in 2017(P<0.0001).These changes were associated with decreasing incidence of preterm birth,a lower risk of stillbirth,whether for one(P=0.0456 in 2016)or two fetuses(P=0.0470 in 2016;P=0.0042 in 2017)and a decreased rate of admission to neonatal intensive care unit(43.0% in 2014,37.4% in 2017;P=0.0032).Conclusions:The implementation of a clinical practice guideline improved both overall and early chorionicity determinations.Regular training workshops of antenatal care are recommended to further promote capability in clinical diagnosis and treatment.展开更多
Dear Editor,We present a modified surgical technique to verify the chorion layer of the human amniotic membrane(hAM)in treating retinal detachment(RD)with vitrectomy.RD patients with pathological myopia where the tear...Dear Editor,We present a modified surgical technique to verify the chorion layer of the human amniotic membrane(hAM)in treating retinal detachment(RD)with vitrectomy.RD patients with pathological myopia where the tear is located within the posterior pole choroidal atrophy area are difficult to treat.Surgical procedures such as laser treatments,diathermy,cryopexy applications or long-term silicone oil endotamponade may not only be ineffective but also harmful in these cases^([1]).Amniotic membrane transplantation(AMT)is an effective technique in case of RD recurrences to seal retinal holes over high myopic chorioretinal atrophy^([2]).展开更多
BACKGROUND Gastrointestinal bleeding due to metastasis of an invasive mole to the small intestine is very rare.Most reported cases of metastatic invasive mole are diagnosed after surgery,and lack rich illustrations,wh...BACKGROUND Gastrointestinal bleeding due to metastasis of an invasive mole to the small intestine is very rare.Most reported cases of metastatic invasive mole are diagnosed after surgery,and lack rich illustrations,which leads to insufficient understanding by clinicians,misdiagnosis,and unnecessary surgeries.CASE SUMMARY A 22-year-old female patient presented with bloody stool and elevated human chorionic gonadotropin.The transvaginal gynecological ultrasound ruled out pregnancy.Upper gastrointestinal endoscopy and colonoscopy were performed,but no bleeding focus was detected.The contrast-enhanced computed tomography was unremarkable.The capsule endoscopy suggested jejunal protuberant lesions with dark red blood clots.Therefore,oral single-balloon enteroscopy was performed,and two connected protuberant lesions were detected,with blood clot traces and local ulceration.The enteroscopic biopsy revealed trophoblastic cells with a probable diagnosis of trophoblastic tumor.The patient underwent surgical resection of the diseased jejunum.Intraoperative endoscopy was performed,and the findings were the same as those of the small intestine endoscopy.The postoperative pathology confirmed the preoperative diagnosis of invasive mole.CONCLUSION In non-pregnant women with elevated human chorionic gonadotropin and gastrointestinal bleeding,metastatic trophoblastic neoplasia should be considered.展开更多
Neonatal hypoxic-ischemic encephalopathy is often associated with permanent cerebral palsy,neurosensory impairments,and cognitive deficits,and there is no effective treatment for complications related to hypoxic-ische...Neonatal hypoxic-ischemic encephalopathy is often associated with permanent cerebral palsy,neurosensory impairments,and cognitive deficits,and there is no effective treatment for complications related to hypoxic-ischemic encephalopathy.The therapeutic potential of human placental chorionic plate-derived mesenchymal stem cells for various diseases has been explored.However,the potential use of human placental chorionic plate-derived mesenchymal stem cells for the treatment of neonatal hypoxic-ischemic encephalopathy has not yet been investigated.In this study,we injected human placental chorionic plate-derived mesenchymal stem cells into the lateral ventricle of a neonatal hypoxic-ischemic encephalopathy rat model and observed significant improvements in both cognitive and motor function.Protein chip analysis showed that interleukin-3 expression was significantly elevated in neonatal hypoxic-ischemic encephalopathy model rats.Following transplantation of human placental chorionic plate-derived mesenchymal stem cells,interleukin-3 expression was downregulated.To further investigate the role of interleukin-3 in neonatal hypoxic-ischemic encephalopathy,we established an in vitro SH-SY5Y cell model of hypoxic-ischemic injury through oxygen-glucose deprivation and silenced interleukin-3 expression using small interfering RNA.We found that the activity and proliferation of SH-SY5Y cells subjected to oxygen-glucose deprivation were further suppressed by interleukin-3 knockdown.Furthermore,interleukin-3 knockout exacerbated neuronal damage and cognitive and motor function impairment in rat models of hypoxic-ischemic encephalopathy.The findings suggest that transplantation of hpcMSCs ameliorated behavioral impairments in a rat model of hypoxic-ischemic encephalopathy,and this effect was mediated by interleukin-3-dependent neurological function.展开更多
BACKGROUND Epithelioid trophoblastic tumor(ETT)is an extremely rare malignant gestational trophoblastic neoplasm commonly presenting with abnormal vaginal bleeding,abdominal pain,and increased human chorionic gonadotr...BACKGROUND Epithelioid trophoblastic tumor(ETT)is an extremely rare malignant gestational trophoblastic neoplasm commonly presenting with abnormal vaginal bleeding,abdominal pain,and increased human chorionic gonadotropin(hCG).This study reported a case of uterine ETT with the main manifestation being increased hCG.CASE SUMMARY A 39-year-old female was referred to the Ningbo Maternal and Child Hospital of China in December 2022,complaining of increased hCG levels for 1 month.Magnetic resonance imaging revealed gestational trophoblastic tumor,and hysteroscopic electrotomy and curettage of intrauterine hyperplasia were performed.The patient was diagnosed with uterine ETT through postoperative pathological examination and immunohistochemical results.Total laparoscopic hysterectomy and bilateral salpingectomy were performed,and hCG levels returned to normal.The patient was without recurrence during the postoperative 3-month follow-up.CONCLUSION This study reported a case of uterine ETT with the main manifestation being increased hCG,highlighting that ETT should be considered in the presence of abnormal hCG.A total laparoscopic hysterectomy is recommended.展开更多
Background: Prenatal diagnosis is the process of evaluating the presence of disease or potential disease in the fetus, this enables families to be better prepared before the birth of the baby. There are non-invasive p...Background: Prenatal diagnosis is the process of evaluating the presence of disease or potential disease in the fetus, this enables families to be better prepared before the birth of the baby. There are non-invasive prenatal diagnosis procedures and invasive prenatal diagnosis procedures. The invasive prenatal diagnosis procedures are CVS (chorionic villus sampling) and amniocentesis. The American College of Obstetricians and Gynecologists states that invasive diagnostic testing should be available to all women, regardless of age or risk. Objective: To determine the indications, outcome and results of diagnostic invasive prenatal procedures. Study setting: The obstetrics and Gynecology Department in Salmaniya Medical Complex in Kingdom of Bahrain. Study design: Retrospective descriptive study. Study subjects and Methods: This retrospective descriptive study was conducted on 175 pregnant women who underwent invasive prenatal procedures (CVS and amniocentesis) between January 2013 and December 2018 at SMC in Kingdom of Bahrain. All medical records of the participants were reviewed and entered the study. According to the implemented procedures, medical records were categorized into two chorionic villus sampling (CVS) and amniocentesis groups. The study subject will include indications of the procedures which are advanced maternal age, hematological disorders, genetic disorders, metabolic disorders, abnormal structural findings in fetal ultrasound and previous child with aneuploidy. In addition, the study will address the complications, outcome and results of procedures. Results: About half of our indications of the procedures were due to hematological disorders (47.6%) followed by abnormal structural findings in fetal ultrasound (30.1%) then genetic disorders (15.7%), metabolic disorders (4.8%) and advanced maternal age (1.8%). Regarding complications of the procedure;threatened miscarriage or loss of pregnancy within 3 weeks was (2.3%), amniotic fluid leakage (0.7%), abdominal cramps (0.7%) and Insufficient or contaminated sample (6.2%). Regarding outcome of the pregnancy, our results showed that the loss of pregnancy was (4.8%), intrauterine fetal death or still birth was (13.9%), live birth was (63.9%), preterm delivery was (7.8%), preterm premature rupture of membrane (PPROM) was (1.8%), limbs reduction was (0.0%). Termination of pregnancy outside the country was (7.8%) of chorionic villus sampling and amniocentesis. Conclusion: CVS and amniocentesis are useful outpatient procedures to detect diagnosis or to assess whether a patient is at increased risk of having an affected fetus and that will minimize the psychological impact on the patient and to provide a proper antenatal care to the pregnant women by her obstetrician and follow up to the baby by pediatrician. In this study it was observed that most of the patients who underwent the procedure were couples either carrier or affected to sickle cell disease or Beta thalassemia.展开更多
An ectopic pregnancy (EP) is defined as any pregnancy that occurs outside the uterine cavity. The most common site of ectopic pregnancy is the fallopian tube. The goal of this retrospective study is to address medical...An ectopic pregnancy (EP) is defined as any pregnancy that occurs outside the uterine cavity. The most common site of ectopic pregnancy is the fallopian tube. The goal of this retrospective study is to address medical and conservative surgical management of unruptured fallopian tube EP as an effective manner to preserve tubes to prevent secondary infertility. This study was conducted between January 1, 2010, and April 30, 2024, in Ponni Hospital, Madurai. It included 319 women, out of 6248 pregnant women diagnosed with ectopic pregnancy by using an Inexecreen kit, trans-abdominal scan, trans-vaginal scan, and doubling of beta-human chorionic gonadotropin (β-HCG) in 48 hours and Magnetic Resonance Imaging (MRI). Medical and conservative surgical management were given to those patients effectively. Out of 319 patients, 62 patients (19.4%) had a ruptured ectopic pregnancy and underwent surgical treatment;257 patients (80.6%) had an unruptured ectopic pregnancy. The conservative medical management was provided to 257 patients. Out of 257 patients, 235 patients were treated by injecting methotrexate and folic acid rescue when the criteria were met. 14 patients had salpingostomy and injection methotrexate (Inj. Methotrexate) and inj. Prostaglandin F2 alpha was administered into the tubal wall to preserve tubes. 8 patients had a live ectopic pregnancy;for those patients, Inj. Methotrexate was injected into the gestational sac through ultrasound guidance. 225 out of 257 patients reached out to us to seek fertility treatment;the remaining 32 patients were not seeking fertility. All fertility-seeking patients had successful pregnancies. We lost follow-up of 12 patients in this study. Out of 213 patients who came for fertility treatment, a 76.1% success rate was achieved with live birth, the recurrent ectopic pregnancy rate was 13.6%, the miscarriage and stillbirth rates were 10.3%. 32 patients, who were not seeking fertility, had quality life without surgical scars for ectopic pregnancy and cost-effective treatment. 25 patients out of 32 had laparoscopic sterilization later, and 7 patients followed temporary contraception as per our advice. This clinical data was retrieved from medical records.展开更多
Purpose: The purpose of this study was to investigate the impact of maternal, fetal and obstetric parameters in twin pregnancies due to chorionicity, perinatal morbidity and early neonatal mortality. Methods: Early ne...Purpose: The purpose of this study was to investigate the impact of maternal, fetal and obstetric parameters in twin pregnancies due to chorionicity, perinatal morbidity and early neonatal mortality. Methods: Early neonatal outcome parameters were retrospectively analysed in 240 twin pregnancies (51 monochorionic [MC], 189 dichorionic [DC] twins) over a 7.5 years period. Beside chorionicity, we focused on risk factors affecting perinatal morbidity and early neonatal outcome in the overall study cohort and subgroups 1) late preterm and 2) pregnancies conceived by artificial fertilization (IVF/ICSI). Mixed effects logistic regression models were used for multivariate risk analyses. Results: MC vs DC pregnancies showed significantly lower birth weights (p 25% and amniotic inflammation (amniotic infection syndrome [AIS]). A gestational age >36 completed weeks was accompanied by a decrease of early neonatal complications展开更多
Male factor contributes to 50%-60% of overall infertility but is solely responsible in only 20% of couples. Although most male factor infertility is ascertained from an abnormal semen analysis, other male factors can ...Male factor contributes to 50%-60% of overall infertility but is solely responsible in only 20% of couples. Although most male factor infertility is ascertained from an abnormal semen analysis, other male factors can be contributory especially if the sample returns normal. Male infertility can be due to identifiable hormonal or anatomical etiologies that may be reversible or irreversible. This manuscript will highlight existing guidelines and our recommendations for hormone evaluation for male infertility and empiric therapies including multivitamins, estrogen receptor modulators （clomiphene）, estrogen conversion blockers （anastrozole）, and hormone replacement.展开更多
Cell-based regenerative medicine is of growing interest in biomedical research. The role of stem cells in this context is under intense scrutiny and may help to define principles of organ regeneration and develop inno...Cell-based regenerative medicine is of growing interest in biomedical research. The role of stem cells in this context is under intense scrutiny and may help to define principles of organ regeneration and develop innovative therapeutics for organ failure. Utilizing stem and progenitor cells for organ replacement has been conducted for many years when performing hematopoietic stem cell transplantation. Since the first successful transplantation of umbilical cord blood to treat hematological malignancies, non-hematopoietic stem and progenitor cell populations have recently been identified within umbilical cord blood and other perinatal and fetal tissues. A cell population entitled mesenchymal stromal cells (MSCs) emerged as one of the most intensely studied as it subsumes a variety of capacities: MSCs can differentiate into various subtypes of the mesodermal lineage, they secrete a large array of trophic factors suitable of recruiting endogenous repair processes and they are immunomodulatory.Focusing on perinatal tissues to isolate MSCs, we will discuss some of the challenges associated with these cell types concentrating on concepts of isolation and expansion, the comparison with cells derived from other tissue sources, regarding phenotype and differentiation capacity and finally their therapeutic potential.展开更多
Gestational trophoblastic neoplasia(GTN) is a rare tumor that originates from pregnancy that includes invasive mole, choriocarcinoma(CCA), placental site trophoblastic tumor and epithelioid trophoblastic tumor(PSTT/ET...Gestational trophoblastic neoplasia(GTN) is a rare tumor that originates from pregnancy that includes invasive mole, choriocarcinoma(CCA), placental site trophoblastic tumor and epithelioid trophoblastic tumor(PSTT/ETT). GTN presents different degrees of proliferation, invasion and dissemination, but, if treated in reference centers, has high cure rates, even in multi-metastatic cases.The diagnosis of GTN following a hydatidiform molar pregnancy is made according to the International Federation of Gynecology and Obstetrics(FIGO)2000 criteria: four or more plateaued human chorionic gonadotropin(hCG)concentrations over three weeks; rise in hCG for three consecutive weekly measurements over at least a period of 2 weeks or more; and an elevated but falling hCG concentrations six or more months after molar evacuation. However,the latter reason for treatment is no longer used by many centers. In addition,GTN is diagnosed with a pathological diagnosis of CCA or PSTT/ETT. For staging after a molar pregnancy, FIGO recommends pelvic-transvaginal Doppler ultrasound and chest X-ray. In cases of pulmonary metastases with more than 1cm, the screening should be complemented with chest computed tomography and brain magnetic resonance image. Single agent chemotherapy, usually Methotrexate(MTX) or Actinomycin-D(Act-D), can cure about 70% of patients with FIGO/World Health Organization(WHO) prognosis risk score ≤ 6(low risk), reserving multiple agent chemotherapy, such as EMA/CO(Etoposide,MTX, Act-D, Cyclophosphamide and Oncovin) for cases with FIGO/WHO prognosis risk score ≥ 7(high risk) that is often metastatic. Best overall cure rates for low and high risk disease is close to 100% and > 95%, respectively. The management of PSTT/ETT differs and cure rates tend to be a bit lower. The early diagnosis of this disease and the appropriate treatment avoid maternal death,allow the healing and maintenance of the reproductive potential of these women.展开更多
Primary gastric choriocarcinoma is a rapidly growing neoplasm with an average survival of several months in untreated patients.Gastrectomy with lymph node dissection followed by chemotherapy is the treatment of choice...Primary gastric choriocarcinoma is a rapidly growing neoplasm with an average survival of several months in untreated patients.Gastrectomy with lymph node dissection followed by chemotherapy is the treatment of choice.Regimens used for gastric adenocarcinoma are usually selected.However,median survival remains less than six months.In this case report,we describe a case of primary gastric choriocarcinoma with a clinical complete response to multidisciplinary treatment including surgery,chemotherapy,and radiofrequency ablation(RFA).The patient was originally referred for general malaise.Esophagogastroduodenoscopy demonstrated a large tumor occupying the fornix,and total gastrectomy with lymph node dissection was performed.Seven days later,multiple liver metastatic recurrences with high serum levels of beta-human chorionic gonadotropin(β-hCG) were recognized.Chemotherapy with a gonadal choriocarcinoma regimen consisting of etoposide,methotrexate,actinomycin D,cyclophosphamide,and vincristine(EMA/CO),was initiated.After three cycles,serum β-hCG decreased markedly and the tumors disappeared.Six months later,multiple lung metastatic recurrences were found.After one cycle of EMA/CO,only one nodule remained.Computed tomography-guided RFA was performed for this oligometastatic tumor.The patient has been alive with no evidence of disease for 10 years after the initial diagnosis.To the best of our knowledge,this patient with recurrent primary gastric choriocarcinoma has achieved the longest survival.The present case is the first report of choriocarcinoma metastatic to the lung successfully treated with RFA.From our retrospective analysis of recurrent or unresectable primary gastric choriocarcinoma,we propose that gonadal choriocarcinoma regimens can be considered as first-line for primary gastric choriocarcinoma.展开更多
By using human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG), fairly good clinical therapeutic efficacy has been obtained in the treatment of infertility. However, difficulties are brought about...By using human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG), fairly good clinical therapeutic efficacy has been obtained in the treatment of infertility. However, difficulties are brought about due to the ovarian hyperstimulation syndrome (OHSS) easily induced by these two drugs. Therefore,展开更多
This paper was aimed to study the minimum dose of human chorionic gonadotropin （hCG） to effectively trigger maturation of oocytes and prevent ovarian hyperstimulation syndrome （OHSS） in a series of hyper-responder...This paper was aimed to study the minimum dose of human chorionic gonadotropin （hCG） to effectively trigger maturation of oocytes and prevent ovarian hyperstimulation syndrome （OHSS） in a series of hyper-responders treated with a long gonadotropin releasing hormone agonist （GnRHa） proto- col. Six women at high risk of developing severe OHSS in a long GnRHa protocol were enrolled into this study. Serum hormone levels on the day of and after hCO administration, antral follicle count, oo- cyte retrieval number and quality were determined. In total, 6 women aged between 29 and 36 years and at risk of developing severe OHSS, received 2000 U hCG Five of them were treated with coasting for 1 day and the rest one for 4 days. The mean number of oocytes collected was 19 （range 14-27） and the fertilization rate per collected oocyte was 72.81%. Of the 6 women in the study, only one cancelled em- bryos transfer and all embryos were frozen, and then she delivered two health boys on term in the sub- sequent frozen-thawed embryo transfer （FET） cycle. Pregnancies and births were achieved in 3 patients out of 5 in vitro fertilization-embryo transfer （IVF-ET） cycles. No woman developed moderate or severe OHSS. Triggering with 2000 U hCG is feasible to prevent OHSS in unpredicted hyper-responders undergoing IVF in a long GnRHa protocol.展开更多
An increasing number of young and middle-aged men are seeking treatment for symptoms related to deficient levels of androgens （hypogonadism） including depression, loss of libido, erectile dysfunction, and fatigue. T...An increasing number of young and middle-aged men are seeking treatment for symptoms related to deficient levels of androgens （hypogonadism） including depression, loss of libido, erectile dysfunction, and fatigue. The increase in prevalence of testosterone supplementation in general and anabolic steroid-induced hypogonadism specifically among younger athletes is creating a population of young men who are uniquely impacted by the testicular end-organ negative consequences of exogenous steroid use. Exogenous testosterone therapy can alter the natural regulation of the hypothalamic-pituitary-gonadal axis leading to impaired spermatoganesis with azoospermia being a serious possible result, thus rendering the individual infertile. For men of reproductive age who suffer from hypogonadal symptoms, preservation of fertility is an important aspect of their treatment paradigm. Treatment with human chorionic gonadotropin （hCG） has shown the ability not only to reverse azoospermia brought on by testosterone supplementation therapy but also to help maintain elevated intratesticular testosterone levels. In addition, selective estrogen receptor modulators, often used with hCG have been shown both to elevate total testosterone levels and to maintain spermatogenesis in hypogonadal men.展开更多
Klinefelter syndrome （KS） is a hypergonadotropic hypogonadism characterized by a 47, XXY karyotype. The risk of testicular cancer in KS is of interest in relation to theories about testicular cancer etiology general...Klinefelter syndrome （KS） is a hypergonadotropic hypogonadism characterized by a 47, XXY karyotype. The risk of testicular cancer in KS is of interest in relation to theories about testicular cancer etiology generally; nevertheless it seems to be low. We evaluated the need for imaging and serum tumor markers for testicular cancer screening in KS. Participants were 40 consecutive KSpatients, enrolled from December 2009 to January 2013. Lactate dehydrogenase （LDH）, alpha-fetoprotein （AFP）, and beta-human chorionic gonadotrophin subunit （^-HCG） serum levels assays and testicular ultrasound （US） with color Doppler, were carried out at study entry, after 6 months and every year for 3 years. Abdominal magnetic resonance （MR） was performed in KS when testicular US showed micro-calcifications, testicular nodules and cysts. Nearly 62% of the KS had regular testicular echotexture, 37.5% showed an irregular echotexture and 17.5% had micro-calcifications and cysts. Eighty seven percent of KS had a regular vascular pattern, 12.5% varicocele, 12.5% nodules 〈1 cm, but none had nodules 〉1 cm. MR ruled out the diagnosis of cancer in all KS with testicular micro calcifications, nodules and cysts. No significant variations in LDH, AFP, and ^-HCG levels and in US pattern have been detected during follow-up. We compared serum tumor markers and US pattern between KS with and without cryptorchidism and no statistical differences were found. We did not find testicular cancer in KS, and testicular US, tumor markers and MR were, in selected cases, useful tools for correctly discriminating benign from malignant lesions.展开更多
As one of the earliest markers for predicting pregnancy outcomes, human chorionic gonadotropin(h CG) values have been inconclusive on reliability of the prediction after frozen and fresh embryo transfer(ET). In this r...As one of the earliest markers for predicting pregnancy outcomes, human chorionic gonadotropin(h CG) values have been inconclusive on reliability of the prediction after frozen and fresh embryo transfer(ET). In this retrospective study, patients with positive h CG(day 12 after transfer) were included to examine the h CG levels and their predictive value for pregnancy outcomes following 214 fresh and 1513 vitrified-warmed single-blastocyst transfer cycles. For patients who got clinical pregnancy, the mean initial h CG value was significantly higher after frozen cycles than fresh cycles, and the similar result was demonstrated for patients with live births(LB). The difference in h CG value existed even after adjusting for the potential covariates. The area under curves(AUC) and threshold values calculated by receiver operator characteristic curves were 0.944 and 213.05 m IU/m L for clinical pregnancy after fresh ET, 0.894 and 399.50 m IU/m L for clinical pregnancy after frozen ET, 0.812 and 222.86 m IU/m L for LB after fresh ET, and 0.808 and 410.80 m IU/mL for LB after frozen ET with acceptable sensitivity and specificity, respectively. In conclusion, single frozen blastocyst transfer leads to higher initial h CG values than single fresh blastocyst transfer, and the initial h CG level is a reliable predictive factor for predicting IVF outcomes.展开更多
基金grants from the National Natural Science Foundation of China(Nos.81673183,81874266,and 81971401)the Clinical Guidance Project of Shanghai Science and Technology Commission(No.164119622800).
文摘Background:Twin pregnancies continue to increase worldwide;however,the current clinical prenatal evaluation for the intrauterine growth of twins still relies on the growth standards of singletons.We attempted to establish a set of fetal biometric references for Chinese twin pregnancies,stratified by chorionicity and conception mode as spontaneously conceived monochorionic diamniotic(SC-MCDA),spontaneously conceived dichorionic diamniotic(SC-DCDA),and assisted reproductive technology dichorionic diamniotic(ART-DCDA)twins.Methods:From 2016 to 2019,the ultrasonographic fetal biometric measurements were longitudinally collected in pregnant women,including fetal weight,biparietal diameter,head circumference,abdominal circumference,femur length,and humerus length.The linear mixed models were used to test the difference of growth patterns between groups,and the growth curve of each biometric parameter was modeled by a generalized additive model for location scale and shape.Results:A total of 929 twin pregnant women and 2019 singleton pregnant women,met the inclusion criteria.Among twin pregnancies,148 were SC-MCDA,215 were SC-DCDA,and 566 were ART-DCDA twins.Overall,SC-DCDA twins grew faster than SC-MCDA twins,while slower than ART-DCDA twins(all P<0.05),and all of the three groups showed significant differences comparing with singletons,especially during the third trimester.Hence,the customized fetal growth charts of each fetal biometric parameter were,respectively,constructed for SC-MCDA,SC-DCDA,and ART-DCDA twins.Conclusions:The fetal biometric trajectories demonstrated characteristic patterns according to chorionicity and conception mode.To fill the gap,we modeled fetal biometric parameters for Chinese SC-MCDA,SC-DCDA,and ART-DCDA twin pregnancies,hoping to provide a reference for the further establishment of fetal growth reference values for Chinese twin fetuses.
基金supported by the Shanghai Key Program of Clinical Science and Technology Innovation(17411950500,17411950501,18511105602)National Science Foundation of China(81741047,81971411)+2 种基金Shanghai Medical Center of Key Programs for Female Reproductive Diseases(2017ZZ01016)National Key Basic Research Plan of China(973 Plan)(2015CB943300)The Major Program of the National 13th Five-Year Plan of China(2016YFC1000400).
文摘Objective:Ultrasound determination of chorionicity is poor in early pregnancy in China.In an effort to increase the accuracy rate of prompt chorionicity determination,clinical training was provided to primary care physicians.This study assesses the effects of implementing clinical guidelines on chorionicity determination.Methods:A multi-centered cohort study was conducted between January 2014 and June 2017 in 12 hospitals without fetal medicine centers.In 2014,the obstetricians and ultrasound physicians were trained in clinical practice and ultrasound examination relating to chorionicity determination.Linear and binary regression analyses were conducted to identify the effects of introducing the new protocols,including the diagnosis rate of chorionicty and perinatal outcomes,taking the data from 2014 as a baseline.Pregnancy outcomes were additionally adjusted for maternal age.Results:During the period of this study,3,599 twin pregnancies from 12 centers were enrolled,and a total of 2,998 twin pregnancies were extracted.The rate of overall chorionicity determination,including antenatal and postpartum diagnosis,increased successively from 49.5% in 2014 to 93.5% in 2017(P<0.0001).The rate of ultrasonic chorionicity diagnosis before 14 weeks increased from 25.2% in 2014 to 65.0% in 2017(P<0.0001).These changes were associated with decreasing incidence of preterm birth,a lower risk of stillbirth,whether for one(P=0.0456 in 2016)or two fetuses(P=0.0470 in 2016;P=0.0042 in 2017)and a decreased rate of admission to neonatal intensive care unit(43.0% in 2014,37.4% in 2017;P=0.0032).Conclusions:The implementation of a clinical practice guideline improved both overall and early chorionicity determinations.Regular training workshops of antenatal care are recommended to further promote capability in clinical diagnosis and treatment.
文摘Dear Editor,We present a modified surgical technique to verify the chorion layer of the human amniotic membrane(hAM)in treating retinal detachment(RD)with vitrectomy.RD patients with pathological myopia where the tear is located within the posterior pole choroidal atrophy area are difficult to treat.Surgical procedures such as laser treatments,diathermy,cryopexy applications or long-term silicone oil endotamponade may not only be ineffective but also harmful in these cases^([1]).Amniotic membrane transplantation(AMT)is an effective technique in case of RD recurrences to seal retinal holes over high myopic chorioretinal atrophy^([2]).
文摘BACKGROUND Gastrointestinal bleeding due to metastasis of an invasive mole to the small intestine is very rare.Most reported cases of metastatic invasive mole are diagnosed after surgery,and lack rich illustrations,which leads to insufficient understanding by clinicians,misdiagnosis,and unnecessary surgeries.CASE SUMMARY A 22-year-old female patient presented with bloody stool and elevated human chorionic gonadotropin.The transvaginal gynecological ultrasound ruled out pregnancy.Upper gastrointestinal endoscopy and colonoscopy were performed,but no bleeding focus was detected.The contrast-enhanced computed tomography was unremarkable.The capsule endoscopy suggested jejunal protuberant lesions with dark red blood clots.Therefore,oral single-balloon enteroscopy was performed,and two connected protuberant lesions were detected,with blood clot traces and local ulceration.The enteroscopic biopsy revealed trophoblastic cells with a probable diagnosis of trophoblastic tumor.The patient underwent surgical resection of the diseased jejunum.Intraoperative endoscopy was performed,and the findings were the same as those of the small intestine endoscopy.The postoperative pathology confirmed the preoperative diagnosis of invasive mole.CONCLUSION In non-pregnant women with elevated human chorionic gonadotropin and gastrointestinal bleeding,metastatic trophoblastic neoplasia should be considered.
基金supported by the National Natural Science Foundation of China,No.82001604Guizhou Provincial Higher Education Science and Technology Innovation Team,No.[2023]072+1 种基金Guizhou Province Distinguished Young Scientific and Technological Talent Program,No.YQK[2023]040Guizhou Provincial Basic Research Program(Natural Science),No.ZK[2021]-368(all to LXiong),and Zunyi City Innovative Talent Team Training Plan,No.[2022]-2.
文摘Neonatal hypoxic-ischemic encephalopathy is often associated with permanent cerebral palsy,neurosensory impairments,and cognitive deficits,and there is no effective treatment for complications related to hypoxic-ischemic encephalopathy.The therapeutic potential of human placental chorionic plate-derived mesenchymal stem cells for various diseases has been explored.However,the potential use of human placental chorionic plate-derived mesenchymal stem cells for the treatment of neonatal hypoxic-ischemic encephalopathy has not yet been investigated.In this study,we injected human placental chorionic plate-derived mesenchymal stem cells into the lateral ventricle of a neonatal hypoxic-ischemic encephalopathy rat model and observed significant improvements in both cognitive and motor function.Protein chip analysis showed that interleukin-3 expression was significantly elevated in neonatal hypoxic-ischemic encephalopathy model rats.Following transplantation of human placental chorionic plate-derived mesenchymal stem cells,interleukin-3 expression was downregulated.To further investigate the role of interleukin-3 in neonatal hypoxic-ischemic encephalopathy,we established an in vitro SH-SY5Y cell model of hypoxic-ischemic injury through oxygen-glucose deprivation and silenced interleukin-3 expression using small interfering RNA.We found that the activity and proliferation of SH-SY5Y cells subjected to oxygen-glucose deprivation were further suppressed by interleukin-3 knockdown.Furthermore,interleukin-3 knockout exacerbated neuronal damage and cognitive and motor function impairment in rat models of hypoxic-ischemic encephalopathy.The findings suggest that transplantation of hpcMSCs ameliorated behavioral impairments in a rat model of hypoxic-ischemic encephalopathy,and this effect was mediated by interleukin-3-dependent neurological function.
文摘BACKGROUND Epithelioid trophoblastic tumor(ETT)is an extremely rare malignant gestational trophoblastic neoplasm commonly presenting with abnormal vaginal bleeding,abdominal pain,and increased human chorionic gonadotropin(hCG).This study reported a case of uterine ETT with the main manifestation being increased hCG.CASE SUMMARY A 39-year-old female was referred to the Ningbo Maternal and Child Hospital of China in December 2022,complaining of increased hCG levels for 1 month.Magnetic resonance imaging revealed gestational trophoblastic tumor,and hysteroscopic electrotomy and curettage of intrauterine hyperplasia were performed.The patient was diagnosed with uterine ETT through postoperative pathological examination and immunohistochemical results.Total laparoscopic hysterectomy and bilateral salpingectomy were performed,and hCG levels returned to normal.The patient was without recurrence during the postoperative 3-month follow-up.CONCLUSION This study reported a case of uterine ETT with the main manifestation being increased hCG,highlighting that ETT should be considered in the presence of abnormal hCG.A total laparoscopic hysterectomy is recommended.
文摘Background: Prenatal diagnosis is the process of evaluating the presence of disease or potential disease in the fetus, this enables families to be better prepared before the birth of the baby. There are non-invasive prenatal diagnosis procedures and invasive prenatal diagnosis procedures. The invasive prenatal diagnosis procedures are CVS (chorionic villus sampling) and amniocentesis. The American College of Obstetricians and Gynecologists states that invasive diagnostic testing should be available to all women, regardless of age or risk. Objective: To determine the indications, outcome and results of diagnostic invasive prenatal procedures. Study setting: The obstetrics and Gynecology Department in Salmaniya Medical Complex in Kingdom of Bahrain. Study design: Retrospective descriptive study. Study subjects and Methods: This retrospective descriptive study was conducted on 175 pregnant women who underwent invasive prenatal procedures (CVS and amniocentesis) between January 2013 and December 2018 at SMC in Kingdom of Bahrain. All medical records of the participants were reviewed and entered the study. According to the implemented procedures, medical records were categorized into two chorionic villus sampling (CVS) and amniocentesis groups. The study subject will include indications of the procedures which are advanced maternal age, hematological disorders, genetic disorders, metabolic disorders, abnormal structural findings in fetal ultrasound and previous child with aneuploidy. In addition, the study will address the complications, outcome and results of procedures. Results: About half of our indications of the procedures were due to hematological disorders (47.6%) followed by abnormal structural findings in fetal ultrasound (30.1%) then genetic disorders (15.7%), metabolic disorders (4.8%) and advanced maternal age (1.8%). Regarding complications of the procedure;threatened miscarriage or loss of pregnancy within 3 weeks was (2.3%), amniotic fluid leakage (0.7%), abdominal cramps (0.7%) and Insufficient or contaminated sample (6.2%). Regarding outcome of the pregnancy, our results showed that the loss of pregnancy was (4.8%), intrauterine fetal death or still birth was (13.9%), live birth was (63.9%), preterm delivery was (7.8%), preterm premature rupture of membrane (PPROM) was (1.8%), limbs reduction was (0.0%). Termination of pregnancy outside the country was (7.8%) of chorionic villus sampling and amniocentesis. Conclusion: CVS and amniocentesis are useful outpatient procedures to detect diagnosis or to assess whether a patient is at increased risk of having an affected fetus and that will minimize the psychological impact on the patient and to provide a proper antenatal care to the pregnant women by her obstetrician and follow up to the baby by pediatrician. In this study it was observed that most of the patients who underwent the procedure were couples either carrier or affected to sickle cell disease or Beta thalassemia.
文摘An ectopic pregnancy (EP) is defined as any pregnancy that occurs outside the uterine cavity. The most common site of ectopic pregnancy is the fallopian tube. The goal of this retrospective study is to address medical and conservative surgical management of unruptured fallopian tube EP as an effective manner to preserve tubes to prevent secondary infertility. This study was conducted between January 1, 2010, and April 30, 2024, in Ponni Hospital, Madurai. It included 319 women, out of 6248 pregnant women diagnosed with ectopic pregnancy by using an Inexecreen kit, trans-abdominal scan, trans-vaginal scan, and doubling of beta-human chorionic gonadotropin (β-HCG) in 48 hours and Magnetic Resonance Imaging (MRI). Medical and conservative surgical management were given to those patients effectively. Out of 319 patients, 62 patients (19.4%) had a ruptured ectopic pregnancy and underwent surgical treatment;257 patients (80.6%) had an unruptured ectopic pregnancy. The conservative medical management was provided to 257 patients. Out of 257 patients, 235 patients were treated by injecting methotrexate and folic acid rescue when the criteria were met. 14 patients had salpingostomy and injection methotrexate (Inj. Methotrexate) and inj. Prostaglandin F2 alpha was administered into the tubal wall to preserve tubes. 8 patients had a live ectopic pregnancy;for those patients, Inj. Methotrexate was injected into the gestational sac through ultrasound guidance. 225 out of 257 patients reached out to us to seek fertility treatment;the remaining 32 patients were not seeking fertility. All fertility-seeking patients had successful pregnancies. We lost follow-up of 12 patients in this study. Out of 213 patients who came for fertility treatment, a 76.1% success rate was achieved with live birth, the recurrent ectopic pregnancy rate was 13.6%, the miscarriage and stillbirth rates were 10.3%. 32 patients, who were not seeking fertility, had quality life without surgical scars for ectopic pregnancy and cost-effective treatment. 25 patients out of 32 had laparoscopic sterilization later, and 7 patients followed temporary contraception as per our advice. This clinical data was retrieved from medical records.
文摘Purpose: The purpose of this study was to investigate the impact of maternal, fetal and obstetric parameters in twin pregnancies due to chorionicity, perinatal morbidity and early neonatal mortality. Methods: Early neonatal outcome parameters were retrospectively analysed in 240 twin pregnancies (51 monochorionic [MC], 189 dichorionic [DC] twins) over a 7.5 years period. Beside chorionicity, we focused on risk factors affecting perinatal morbidity and early neonatal outcome in the overall study cohort and subgroups 1) late preterm and 2) pregnancies conceived by artificial fertilization (IVF/ICSI). Mixed effects logistic regression models were used for multivariate risk analyses. Results: MC vs DC pregnancies showed significantly lower birth weights (p 25% and amniotic inflammation (amniotic infection syndrome [AIS]). A gestational age >36 completed weeks was accompanied by a decrease of early neonatal complications
文摘Male factor contributes to 50%-60% of overall infertility but is solely responsible in only 20% of couples. Although most male factor infertility is ascertained from an abnormal semen analysis, other male factors can be contributory especially if the sample returns normal. Male infertility can be due to identifiable hormonal or anatomical etiologies that may be reversible or irreversible. This manuscript will highlight existing guidelines and our recommendations for hormone evaluation for male infertility and empiric therapies including multivitamins, estrogen receptor modulators （clomiphene）, estrogen conversion blockers （anastrozole）, and hormone replacement.
基金Supported by Research Funds of the German Federal Ministry of Education and Research (01GN0531 and 01GN0939)Proj-ect Commissioned by the European Community ("CASCADE"HEALTH-F5-2009-223236).
文摘Cell-based regenerative medicine is of growing interest in biomedical research. The role of stem cells in this context is under intense scrutiny and may help to define principles of organ regeneration and develop innovative therapeutics for organ failure. Utilizing stem and progenitor cells for organ replacement has been conducted for many years when performing hematopoietic stem cell transplantation. Since the first successful transplantation of umbilical cord blood to treat hematological malignancies, non-hematopoietic stem and progenitor cell populations have recently been identified within umbilical cord blood and other perinatal and fetal tissues. A cell population entitled mesenchymal stromal cells (MSCs) emerged as one of the most intensely studied as it subsumes a variety of capacities: MSCs can differentiate into various subtypes of the mesodermal lineage, they secrete a large array of trophic factors suitable of recruiting endogenous repair processes and they are immunomodulatory.Focusing on perinatal tissues to isolate MSCs, we will discuss some of the challenges associated with these cell types concentrating on concepts of isolation and expansion, the comparison with cells derived from other tissue sources, regarding phenotype and differentiation capacity and finally their therapeutic potential.
文摘Gestational trophoblastic neoplasia(GTN) is a rare tumor that originates from pregnancy that includes invasive mole, choriocarcinoma(CCA), placental site trophoblastic tumor and epithelioid trophoblastic tumor(PSTT/ETT). GTN presents different degrees of proliferation, invasion and dissemination, but, if treated in reference centers, has high cure rates, even in multi-metastatic cases.The diagnosis of GTN following a hydatidiform molar pregnancy is made according to the International Federation of Gynecology and Obstetrics(FIGO)2000 criteria: four or more plateaued human chorionic gonadotropin(hCG)concentrations over three weeks; rise in hCG for three consecutive weekly measurements over at least a period of 2 weeks or more; and an elevated but falling hCG concentrations six or more months after molar evacuation. However,the latter reason for treatment is no longer used by many centers. In addition,GTN is diagnosed with a pathological diagnosis of CCA or PSTT/ETT. For staging after a molar pregnancy, FIGO recommends pelvic-transvaginal Doppler ultrasound and chest X-ray. In cases of pulmonary metastases with more than 1cm, the screening should be complemented with chest computed tomography and brain magnetic resonance image. Single agent chemotherapy, usually Methotrexate(MTX) or Actinomycin-D(Act-D), can cure about 70% of patients with FIGO/World Health Organization(WHO) prognosis risk score ≤ 6(low risk), reserving multiple agent chemotherapy, such as EMA/CO(Etoposide,MTX, Act-D, Cyclophosphamide and Oncovin) for cases with FIGO/WHO prognosis risk score ≥ 7(high risk) that is often metastatic. Best overall cure rates for low and high risk disease is close to 100% and > 95%, respectively. The management of PSTT/ETT differs and cure rates tend to be a bit lower. The early diagnosis of this disease and the appropriate treatment avoid maternal death,allow the healing and maintenance of the reproductive potential of these women.
文摘Primary gastric choriocarcinoma is a rapidly growing neoplasm with an average survival of several months in untreated patients.Gastrectomy with lymph node dissection followed by chemotherapy is the treatment of choice.Regimens used for gastric adenocarcinoma are usually selected.However,median survival remains less than six months.In this case report,we describe a case of primary gastric choriocarcinoma with a clinical complete response to multidisciplinary treatment including surgery,chemotherapy,and radiofrequency ablation(RFA).The patient was originally referred for general malaise.Esophagogastroduodenoscopy demonstrated a large tumor occupying the fornix,and total gastrectomy with lymph node dissection was performed.Seven days later,multiple liver metastatic recurrences with high serum levels of beta-human chorionic gonadotropin(β-hCG) were recognized.Chemotherapy with a gonadal choriocarcinoma regimen consisting of etoposide,methotrexate,actinomycin D,cyclophosphamide,and vincristine(EMA/CO),was initiated.After three cycles,serum β-hCG decreased markedly and the tumors disappeared.Six months later,multiple lung metastatic recurrences were found.After one cycle of EMA/CO,only one nodule remained.Computed tomography-guided RFA was performed for this oligometastatic tumor.The patient has been alive with no evidence of disease for 10 years after the initial diagnosis.To the best of our knowledge,this patient with recurrent primary gastric choriocarcinoma has achieved the longest survival.The present case is the first report of choriocarcinoma metastatic to the lung successfully treated with RFA.From our retrospective analysis of recurrent or unresectable primary gastric choriocarcinoma,we propose that gonadal choriocarcinoma regimens can be considered as first-line for primary gastric choriocarcinoma.
文摘By using human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG), fairly good clinical therapeutic efficacy has been obtained in the treatment of infertility. However, difficulties are brought about due to the ovarian hyperstimulation syndrome (OHSS) easily induced by these two drugs. Therefore,
文摘This paper was aimed to study the minimum dose of human chorionic gonadotropin （hCG） to effectively trigger maturation of oocytes and prevent ovarian hyperstimulation syndrome （OHSS） in a series of hyper-responders treated with a long gonadotropin releasing hormone agonist （GnRHa） proto- col. Six women at high risk of developing severe OHSS in a long GnRHa protocol were enrolled into this study. Serum hormone levels on the day of and after hCO administration, antral follicle count, oo- cyte retrieval number and quality were determined. In total, 6 women aged between 29 and 36 years and at risk of developing severe OHSS, received 2000 U hCG Five of them were treated with coasting for 1 day and the rest one for 4 days. The mean number of oocytes collected was 19 （range 14-27） and the fertilization rate per collected oocyte was 72.81%. Of the 6 women in the study, only one cancelled em- bryos transfer and all embryos were frozen, and then she delivered two health boys on term in the sub- sequent frozen-thawed embryo transfer （FET） cycle. Pregnancies and births were achieved in 3 patients out of 5 in vitro fertilization-embryo transfer （IVF-ET） cycles. No woman developed moderate or severe OHSS. Triggering with 2000 U hCG is feasible to prevent OHSS in unpredicted hyper-responders undergoing IVF in a long GnRHa protocol.
文摘An increasing number of young and middle-aged men are seeking treatment for symptoms related to deficient levels of androgens （hypogonadism） including depression, loss of libido, erectile dysfunction, and fatigue. The increase in prevalence of testosterone supplementation in general and anabolic steroid-induced hypogonadism specifically among younger athletes is creating a population of young men who are uniquely impacted by the testicular end-organ negative consequences of exogenous steroid use. Exogenous testosterone therapy can alter the natural regulation of the hypothalamic-pituitary-gonadal axis leading to impaired spermatoganesis with azoospermia being a serious possible result, thus rendering the individual infertile. For men of reproductive age who suffer from hypogonadal symptoms, preservation of fertility is an important aspect of their treatment paradigm. Treatment with human chorionic gonadotropin （hCG） has shown the ability not only to reverse azoospermia brought on by testosterone supplementation therapy but also to help maintain elevated intratesticular testosterone levels. In addition, selective estrogen receptor modulators, often used with hCG have been shown both to elevate total testosterone levels and to maintain spermatogenesis in hypogonadal men.
文摘Klinefelter syndrome （KS） is a hypergonadotropic hypogonadism characterized by a 47, XXY karyotype. The risk of testicular cancer in KS is of interest in relation to theories about testicular cancer etiology generally; nevertheless it seems to be low. We evaluated the need for imaging and serum tumor markers for testicular cancer screening in KS. Participants were 40 consecutive KSpatients, enrolled from December 2009 to January 2013. Lactate dehydrogenase （LDH）, alpha-fetoprotein （AFP）, and beta-human chorionic gonadotrophin subunit （^-HCG） serum levels assays and testicular ultrasound （US） with color Doppler, were carried out at study entry, after 6 months and every year for 3 years. Abdominal magnetic resonance （MR） was performed in KS when testicular US showed micro-calcifications, testicular nodules and cysts. Nearly 62% of the KS had regular testicular echotexture, 37.5% showed an irregular echotexture and 17.5% had micro-calcifications and cysts. Eighty seven percent of KS had a regular vascular pattern, 12.5% varicocele, 12.5% nodules 〈1 cm, but none had nodules 〉1 cm. MR ruled out the diagnosis of cancer in all KS with testicular micro calcifications, nodules and cysts. No significant variations in LDH, AFP, and ^-HCG levels and in US pattern have been detected during follow-up. We compared serum tumor markers and US pattern between KS with and without cryptorchidism and no statistical differences were found. We did not find testicular cancer in KS, and testicular US, tumor markers and MR were, in selected cases, useful tools for correctly discriminating benign from malignant lesions.
文摘As one of the earliest markers for predicting pregnancy outcomes, human chorionic gonadotropin(h CG) values have been inconclusive on reliability of the prediction after frozen and fresh embryo transfer(ET). In this retrospective study, patients with positive h CG(day 12 after transfer) were included to examine the h CG levels and their predictive value for pregnancy outcomes following 214 fresh and 1513 vitrified-warmed single-blastocyst transfer cycles. For patients who got clinical pregnancy, the mean initial h CG value was significantly higher after frozen cycles than fresh cycles, and the similar result was demonstrated for patients with live births(LB). The difference in h CG value existed even after adjusting for the potential covariates. The area under curves(AUC) and threshold values calculated by receiver operator characteristic curves were 0.944 and 213.05 m IU/m L for clinical pregnancy after fresh ET, 0.894 and 399.50 m IU/m L for clinical pregnancy after frozen ET, 0.812 and 222.86 m IU/m L for LB after fresh ET, and 0.808 and 410.80 m IU/mL for LB after frozen ET with acceptable sensitivity and specificity, respectively. In conclusion, single frozen blastocyst transfer leads to higher initial h CG values than single fresh blastocyst transfer, and the initial h CG level is a reliable predictive factor for predicting IVF outcomes.
