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hCG
Kinds of hCG Terms modified by hCG Selected AbstractsSynchronous high-grade squamous intraepithelial lesion and adenocarcinoma in situ of cervix in a young woman presenting with hyperchromatic crowded groups in the cervical cytology specimen: Report of a caseDIAGNOSTIC CYTOPATHOLOGY, Issue 11 2008Nadeem Zafar M.D. Abstract We report a 29-year-old woman who underwent routine gynecologic evaluation at a community clinic and had a cervical sample drawn for liquid-based cytologic evaluation. At cytology, many hyperchromatic crowded groups (HCG) were present, but a consensus could not be established whether the abnormal cells were primarily glandular or squamous with secondary endocervical glandular involvement. An interpretation of atypical endocervical cells, favor neoplastic, was rendered and biopsy advised if clinically appropriate. At biopsy, the cervix contained synchronous squamous cell carcinoma in situ, secondarily involving endocervical glands, and neighboring adenocarcinoma in situ. Immunohistochemistry for Ki-67 and p16INK4A crisply and precisely stained both the lesions, clearly separating them from the adjacent uninvolved mucosa. This case re-emphasizes the challenge associated with accurate evaluation of HCG at cytology, the significance of ancillary testing for surrogate markers of high-risk HPV (HR-HPV) infection, the need for adjunct testing for HPV-DNA in the setting of HCG at cervical cytology, and a recommendation to set up studies to evaluate the role of surrogate markers of HR-HPV infection in cytologic samples with HCG. Diagn. Cytopathol. 2008;36:823,826. © 2008 Wiley-Liss, Inc. [source] Intracytoplasmic sperm injection as a complement to gonadotrophin treatment in infertile men with hypogonadotrophic hypogonadismINTERNATIONAL JOURNAL OF ANDROLOGY, Issue 4 2005BRANKO ZORN Summary In this study we sought to determine whether intracytoplasmic sperm injection (ICSI) could improve the efficacy of treatment with gonadotrophins in gonadotrophin-deficient men in terms of pregnancy. A series of six adult men (aged 26,47 years) with hypogonadotrophic hypogonadism (HH) is reported: four men with prepubertal isolated idiopathic HH (IIHH) and two adult-onset HH, as part of hypopituitarism secondary to surgical treatment of a pituitary tumour. All were azoospermic. To restore spermatogenesis, all received hormonal treatment with intramuscular human menopausal gonadotrophins (HMG) and human chorionic gonadotrophin (HCG) for 2 to 23 months. High basal serum inhibin B was predictive of rapid and complete recovery of spermatogenesis. In the two adult-onset HH, a natural pregnancy was achieved within 3 months. The four men with IIHH underwent ICSI because of poor sperm quality. ICSI using fresh or frozen-thawed ejaculated spermatozoa was performed after 6,23 months of gonadotrophin treatment. ICSI provided good clinical results in terms of fertilization and embryo quality, and resulted in three pregnancies that ended in three term deliveries. In men with oligozoospermia related to prepubertal IIHH, ICSI shortens the hormonal treatment and enhances the chances of pregnancy. [source] Preoperative hCG, and CA 72-4 are prognostic factors in gastric cancerINTERNATIONAL JOURNAL OF CANCER, Issue 6 2004Johanna Louhimo Abstract In gastric cancer, the role of tumour markers in assessment of prognosis is unconfirmed. In our study, we evaluated the prognostic significance of serum tumour markers carcinoembryonic antigen (CEA), CA 19-9, CA 72-4, CA 242 and free , subunit of human chorionic gonadotropin (hCG,) in gastric cancer. Preoperative serum samples were obtained from 146 patients with gastric cancer, including 29 with stage I, 11 with stage II, 42 with stage III and 64 patients with stage IV cancer. Quantitation of CEA, CA 19-9, CA 72-4 and CA 242 in serum was performed with commercial assays. HCG, was measured with an in-house immunofluorometric assay based on monoclonal antibodies specific for the free ,-subunit of hCG. Survival analysis was performed with Kaplan-Meier life-tables and log-rank test, and with multivariate Cox regression analysis. Disease-specific cumulative 2-year survival rate was 40%. Serum levels of CEA, CA 72-4, CA 242 and hCG, showed significant correlation with stage (p<0.027); for CA 19-9 the association was of borderline significance (p=0.056). Of the studied markers, CA 19-9, CA 72-4, CA 242 and hCG, were found to be prognostic factors in univariate analysis (p< 0.022). In multivariate analysis, stage had the statistically most significant association with prognosis followed by hCG,, tumour histology according to the Laurén classification and by CA 72-4. In gastric cancer, tumour markers hCG, and CA 72-4 are independent prognostic factors in addition to stage and histological type of the tumour. © 2004 Wiley-Liss, Inc. [source] Dermatomyositis presenting as panniculitisINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 2 2000Yen-Yu Chao MD A 44-year-old obese woman was transferred to our clinic with a diagnosis of panniculitis. Examination showed multiple, indurated, erythematous, painful nodules and plaques distributed on the shoulders, back, forechest, abdomen, buttock, and bilateral thighs. These skin lesions appeared 2 months previously, measured 5,8 cm, and were tender on palpation. No obvious inducing factor was traced. The lesions seemed unresponsive to treatment with nonsteroidal anti-inflammatory drugs (ibuprofen, 400 mg three times a day) as similar lesions appeared in subsequent visits. Progressive proximal muscle weakness was found 1 month later. She was then admitted via the emergency room because of extensive painful skin plaques and abdominal pain. Diffuse erythematous to violaceous swelling of the face, neck, and shoulder was noted at about the same time ( Fig. 1). A skin biopsy specimen from the nodular lesion showed poikilomatous epidermal changes ( Fig. 2), and marked mononuclear cell infiltration in the dermis and subcutaneous fat ( Fig. 3). Dermatomyositis was considered as the diffuse violaceous facial erythema could be a form of heliotrope eruption, but Gottron's papule was not found. At admission, serum creatinine phosphokinase (CPK) was mildly elevated (436 IU/L; normal range, 20,170 IU/L), but serum asparagine transaminase (AST) and lactate dehydrogenase (LDH) levels were within normal limits (36 IU/L; normal, 11,47 IU/L; and 108 IU/L; normal, 90,280 IU/L, respectively). Antinuclear antibody was 1 : 80 positive with an atypical speckled pattern. Muscle strength was weakest during the first 2 days, about grade 3 by the Medical Research Council (MRC) of Great Britain scale. Gower's sign was positive. An electromyogram showed myopathic changes and a nerve conduction velocity study was normal. Serum enzymes were elevated further on the third day: AST, 55 IU/L; CPK, 783 IU/L with 100% MM form. The diagnosis of dermatomyositis was established. As for the work-up result, anti-dsDNA antibody, anti-ENA antibody, and anti-Jo1 antibody were negative. Tumor marker screen (,-HCG, AFP, CEA, and CA-125), was negative, and rhinolaryngopharyngoscope examination and gynecologic sonography were normal. Figure 1. Diffuse erythematous swelling with subtle violaceous hue extending from the temporal area to the cheeks, neck, and shoulders. The crusted lip ulcers of herpes simplex were also noted Figure 2. Basketweave hyperkeratosis, mild acanthosis, subtle vacuolar degeneration of the basal cells, and melanin incontinence (hematoxylin and eosin, ×400) Figure 3. Heavy mononuclear cells infiltrated in the subcutaneous fat tissue (hematoxylin and eosin, ×100) Pancreatitis was initially suspected because of epigastric pain and tenderness, elevated serum lipase (382 U/L; normal, 23,200 U/L), and amylase (145 U/L; normal, 35,118 U/L). No evidence of pancreatitis could be found in abdominal sonography and abdominal computed tomography (CT), however. The epigastric pain and tenderness subsided soon after admission and the serum pancreatic enzyme level declined on the second day (amylase 69 U/L; lipase, 276 U/L). The patient was then diagnosed with dermatomyositis and treated with prednisolone (120 mg/day). CPK dropped dramatically from 3286 IU/L the day before treatment to 1197 IU/L 3 days after. Panniculitis lessened and the muscle power improved after 1 week of treatment. The disease activity fluctuated even with treatment with prednisolone and the patient often felt listless and weak. The muscle weakness sometimes deteriorated to affect the patient's mobility. Facial erythema and panniculitis-like lesions were found during the worse times. Methotrexate and azathioprine were then added (7.5 mg and 250 mg per week, respectively), but CPK was still mildly elevated (189 IU/L), and the patient still felt ill. Human immune globulin (5%, 500 mL per day, 5 days per month) intravenous infusion was initiated thereafter. There was a dramatic response. Full muscle strength was retained and CPK was within the normal range in the following 6 months with only immune globulin therapy. [source] Unexplained elevated maternal serum ,-HCG concentration and adverse pregnancy outcomePRENATAL DIAGNOSIS, Issue 11 2007Ramesh Ganapathy Abstract Objective To investigate the association between unexplained elevated maternal serum ,-Human chorionic gonadotrophin (HCG) in the second trimester of pregnancy and adverse pregnancy outcome. Methods In a case-controlled study of 3463 women who opted for second-trimester serum screening for Down syndrome, 142 were found to have a serum ,-HCG of ,3.5 multiples of the median (MoM), 56 of whom had a serum ,-HCG of ,5.0 MoM. These women were compared with a control group of women with serum ,-HCG within the 95% confidence interval around the median. Results In the elevated ,-HCG group (,5 MoM) significantly more babies required admission to the special care baby unit (p = 0.02) and were small for gestational age (SGA) (p = 0.03). The mean birth weight was also significantly lower in the group with elevated ,-HCG. Women with a serum ,-HCG of ,5, ,6, ,7 or ,8 MoM were associated with SGA babies in 40, 44, 64 and 86% respectively. All babies born to the six women with ,-HCG of 8.75,24.1 MoM were SGA. Conclusion Increased surveillance is necessary in pregnancies where the maternal serum ,-HCG in the second trimester is inexplicably elevated to ,5 MoM. Copyright © 2007 John Wiley & Sons, Ltd. [source] Extragonadal germ cell tumors: relation to testicular neoplasia and management optionsAPMIS, Issue 1 2003CARSTEN BOKEMEYER An unselected population of 635 consecutive extragonadal GCT patients (EGCT) treated between 1975 through 1996 at 11 cancer centers was retrospectively evaluated for clinical prognosis and biological features of this disease. Five hundred twenty-four patients (83%) had a nonseminomatous GCT, and 104 patients (16%) a seminomatous histology; 341 (54%) patients had a primary mediastinal EGCT, and 283 patients (45%) a retroperitoneal EGCT. Following platinum based induction chemotherapy±secondary surgery, 141 patients (49%) with mediastinal nonseminomas (median follow up period: 19 months) and 144 patients (63%) with retroperitoneal nonseminoma (median follow up period: 29 months) are alive [p=0.0006]. In contrast, the overall survival rate for patients with seminomatous EGCT is 88% with no difference between patients with mediastinal or retroperitoneal tumor location (median follow up period: 49 months). Multivariate analysis revealed nonseminomatous histology, the presence of non-pulmonary visceral metastases, primary mediastinal GCT location, and elevated ,-HCG as independent prognostic factors for shorter survival. Sixteen patients (4.1%) developed a metachronous testicular cancer despite the use of platinum based chemotherapy. The cumulative risk of developing a MTC 10-years after a diagnosis of EGCT was 10.3% (95% CI=4.9 to 15.6%), but higher among patients with nonseminomatous EGCT (14.3%; 95% CI=6.7 to 21.9%) or retroperitoneal EGCT location (14.2%; 95% CI=5.6 to 22.8%) than among patients with seminomatous EGCT (1.4%; 95% CI=0.0 to 4.2) or mediastinal EGCT location (6.2%; 95% CI=0.1 to 12.2). After a median follow-up of 51 months (range=1 to 154 months), all 16 MTC patients were alive without disease. Patients with pure seminomatous EGCT histology have a long term chance of cure of almost 90% irrespective of the primary tumor site. Patients with mediastinal nonseminomas have a five-years survival rate of 45%. This outcome is clearly inferior compared to patients with nonseminomatous retroperitoneal primaries who have a five-year survival rate of 62%. [source] Persistence and malignant sequelae of gestational trophoblastic disease: Clinical presentation, diagnosis, treatment and outcomeAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2010Soo-Keat KHOO Background:, The major concern in gestational trophoblastic disease is management of persistent disease and malignant sequelae. However, prediction of response to treatment is difficult and methods used controversial. Aim and methods:, To evaluate the usefulness of clinical presentation, methods of diagnosis and categorisation of risk in determining clinical outcomes, by analysis of a database of 705 registered patients collected over 30 years. Results:, From the database, there were 97 patients who developed persistent disease and malignant sequelae on the basis of defined criteria , 80.4% had molar pregnancy and 19.6% non-molar pregnancy. Vaginal bleeding was not a common presentation; 59.8% had no clinical symptoms. According to protocol, monitoring by serial human chorion gonadotrophin (HCG) levels followed by imaging screen was used in all patients; histology was also available in 41.2% from hysterectomy and curettage specimens. There were 16 of 76 patients with persisting disease who had metastases (21.1%), and 2 of 20 patients with choriocarcinoma who had an antecedent molar pregnancy (10.0%). Based on five risk factors, 25 patients were categorised as ,high risk' and assigned to receive multi-drug chemotherapy. There were two deaths (2.1% for all malignant sequelae); both were from molar pregnancies. One patient failed to respond and the other suffered a complication of intensive chemotherapy. Conclusion:, Serial HCG levels remain the best monitor to determine therapeutic response. Categorisation of ,high risk' by five factors is useful in treatment. Albeit a small series, clinical outcome is favourable with a five-year survival of 89.7%. [source] Analysis of risk factors for persistent gestational trophoblastic diseaseAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2009Soo-Keat KHOO Setting:, Persistent disease is a serious consequence of molar pregnancies. Its early detection is critical to effective chemotherapy. Therefore, determination of risk becomes an important clinical decision. Objectives:, To determine the relative risk of persistent disease in a cohort of patients with partial and complete molar pregnancies by analysis of five factors derived from a database using multivariate analysis. Results:, Of 686 patients, 78 developed persistent disease which required treatment (rate of 11.3%). Risk was markedly increased when serum human chorionic gonadotrophin (HCG) failed to reach negative by 12 weeks after evacuation [hazard ratio (HR) = 120.78, P < 0.001]. Risk was markedly decreased when the interval from last pregnancy exceeded 12 months (HR = 0.24, P = 0.005). Other factors such as patient's age, stage of gestation and serum HCG level at presentation were not found to be strongly associated with risk of persistent disease. Conclusion:, These findings support the application of the following two factors in risk prediction for molar pregnancies: > 12 weeks to become HCG negative and interval from last pregnancy < 12 months. They will contribute to a greater awareness of persistent disease and assist in early detection and effective chemotherapy. [source] Mechanism of malsegregations at meiosis: premature centromere separation and precocious division in female Chinese hamsters stimulated with gonadotropic hormonesCONGENITAL ANOMALIES, Issue 3 2000Shin-ichi Sonta ABSTRACT, Using female Chinese hamsters stimulated with pregnant mare serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG), we investigated the influence of hormonal stimulation upon meiotic segregation in oocytes. In 1,576 oocytes ovulated spontaneously from 197 non-treated mature females, the number (percentage) of hyperhaploid oocytes with more than 12 (12,14) chromosomes was 16 (1.0%). These cells had no extra single chromatids, but all had extra chromosomes. Single chromatids were seen in 7 (0.4%) cells with a haploid chromosome set. On the other hand, a total of 1,329 and 1,198 second meiotic (MII) oocytes from 64 mature females and 61 immature females stimulated with PMSG and hCG, respectively, were subjected to chromosomal analysis. Single chromatids were seen in 34 (2.6%) and 62 (5.2%) of these oocytes, respectively. Since these chromatids were mostly paired and the sister chromatids existed near each other in many cells, they may have separated from some chromosomes of haploid cells. Compared with the non-treated females, the frequency of cells with single chromatids was significantly greater in oocytes from both mature and immature females stimulated with PMSG and hCG. The number (percentage) of hyperhaploid cells from mature and immature PMSG-hCG-stimulated females, respectively, was 15 (1.1%) and 14 (1.2%), which was not significantly greater than that in non-treated females. Most of these cells had extra whole chromosomes but one oocyte from mature females and one from immature females had an extra single chromatid. These findings indicate that such hormonal stimulation induces premature centromere separation in MII oocytes and precocious division at anaphase I, which can be assumed by the presence of MII cells with extra single chromatids. Considering that no or less hyperhaploid MII oocytes with an extra single chromatid were seen in oocytes from spontaneous ovulation and from artificial ovulation on hormonal stimulation, these findings suggest that the major mechanism of malsegregations at first meiotic (MI) division is not a precocious division but rather, errors such as nondisjunction of homologous chromosomes (dyads). [source] Sex differences in and hormonal regulation of Kv1 potassium channel gene expression in the electric organ: Molecular control of a social signalDEVELOPMENTAL NEUROBIOLOGY, Issue 5 2007W. Preston Few Abstract Electric fish communicate with electric organ (EO) discharges (EODs) that are sexually dimorphic, hormone-sensitive, and often individually distinct. The cells of the EO (electrocytes) of the weakly electric fish Sternopygus possess delayed rectifying K+ currents that systematically vary in their activation and deactivation kinetics, and this precise variation in K+ current kinetics helps shape sex and individual differences in the EOD. Because members of the Kv1 subfamily produce delayed rectifier currents, we cloned a number of genes in the Kv1 subfamily from the EO of Sternopygus. Using our sequences and those from genome databases, we found that in teleost fish Kv1.1 and Kv1.2 exist as duplicate pairs (Kv1.1a&b, Kv1.2a&b) whereas Kv1.3 does not. Using real-time quantitative RT-PCR, we found that Kv1.1a and Kv1.2a, but not Kv1.2b, expression in the EO is higher in high EOD frequency females (which have fast EO K+ currents) than in low EOD frequency males (which have slow EO K+ currents). Systemic treatment with dihydrotestosterone decreased Kv1.1a and Kv1.2a, but not Kv1.2b, expression in the EO, whereas treatment with human chorionic gonadotropin (hCG) increased Kv1.2a but not Kv1.1a or Kv1.2b expression in the EO. Thus, systematic variation in the ratios of Kv1 channels expressed in the EO is correlated with individual differences in and sexual dimorphism of a communication signal. © 2007 Wiley Periodicals, Inc. Develop Neurobiol, 2007 [source] Retrospective study on the efficacy of hCG in an equine artificial insemination programme using frozen semenEQUINE VETERINARY EDUCATION, Issue 6 2000S. Barbacini First page of article [source] Pregnancy rates in mares after a single fixed time hysteroscopic insemination of low numbers of frozen-thawed spermatozoa onto the uterotubal junctionEQUINE VETERINARY JOURNAL, Issue 2 2003L. H. A. MORRIS Summary Reasons for performing study: To compensate for the wide variation in the freezability of stallion spermatozoa, it has become common veterinary practice to carry out repeated ultrasonography of the ovaries of oestrous mares in order to be able to inseminate them within 6,12 h of ovulation with a minimum of 300,500 × 106 frozen-thawed spermatozoa. Furthermore, in order to achieve satisfactory fertility, this requirement for relatively high numbers of spermatozoa currently limits our ability to exploit recently available artificial breeding technologies, such as sex-sorted semen, for which only 5,20 × 106 spermatozoa are available for insemination. Objectives: This study was designed to evaluate and compare the efficacy of hysteroscopic vs. conventional insemination when low numbers of spermatozoa are used at a single fixed time after administration of an ovulation-inducing agent. Methods: In the present study, pregnancy rates were compared in 86 mares inseminated once only with low numbers of frozen-thawed spermatozoa (3,14 × 106) at 32 h after treatment with human chorionic gonadotrophin (hCG), either conventionally into the body of the uterus or hysteroscopically by depositing a small volume of the inseminate directly onto the uterotubal papilla ipsilateral to the ovary containing the pre-ovulatory follicle. Results: Pregnancy rates were similarly high in mares inseminated conventionally or hysteroscopically with 14 × 106 motile frozen-thawed spermatozoa (67% vs. 64%). However, when the insemination dose was reduced to 3 × 106 spermatozoa, the pregnancy rate was significantly higher in the mares inseminated hysteroscopically onto the uterotubal junction compared to those inseminated into the uterine body (47 vs. 15%, P<0.05). Conclusions: When inseminating mares with <10 × 106 frozen-thawed stallion spermatozoa, hysteroscopic uterotubal junction deposition of the inseminate is the preferred method. Potential clinical relevance: Satisfactory pregnancy rates are achievable after insemination of mares with frozen-thawed semen from fertile stallions 32 h after administration of human chorionic gonadotrophin (Chorulon)1. Furthermore, these results were obtained when mares were inseminated with 14 × 106 progressively motile frozen-thawed spermatozoa from 2 stallions of proven fertility. [source] Lunar cycles and reproductive activity in reef fishes with particular attention to rabbitfishesFISH AND FISHERIES, Issue 4 2004Akihiro Takemura Abstract Cues from the moon influence synchrony in growth, feeding, migration, behaviour and reproduction of many reef fishes. Compared with comprehensive studies on the annual and daily activities of fish, few physiological studies have paid attention to the importance of lunar cues in reproductive activities. We review mutual and interesting relationships between fish reproduction and environmental changes induced by the moon, with particular emphasis on the reproductive activity of the rabbitfishes (Siganidae). Rabbitfish species exhibit, in nature, a definitive reproductive season, which differs among the tropical areas. During the reproductive season, synchronous spawning of rabbitfish is associated with a particular lunar phase. The lunar phase used by the respective species is similar in different regions on the earth. Histological observations revealed that gonads develop synchronously towards a peak around the spawning lunar phase, after which the gonads return to spent condition. Concomitant with gonadal development, sex steroid hormones were produced under the influence of gonadotropin (GtH). Injections of human chronic gonadotropin (hCG) to the fish that are undergoing active spermatogenesis accelerated testicular maturation. These results suggest that hormonal response in maturing the gonads in rabbitfish is under the regulation of GtH, and that pituitary secretion of GtH according to the lunar cycle accounts for the lunar rhythm in gonadal development. We speculate that the cues from the moon can be recognized by the higher parts of the hypothalamus,pituitary,gonadal axis. Possible relationships between exogenous environmental factors and the lunar-reproductive rhythm are also discussed. [source] Preoperative hCG, and CA 72-4 are prognostic factors in gastric cancerINTERNATIONAL JOURNAL OF CANCER, Issue 6 2004Johanna Louhimo Abstract In gastric cancer, the role of tumour markers in assessment of prognosis is unconfirmed. In our study, we evaluated the prognostic significance of serum tumour markers carcinoembryonic antigen (CEA), CA 19-9, CA 72-4, CA 242 and free , subunit of human chorionic gonadotropin (hCG,) in gastric cancer. Preoperative serum samples were obtained from 146 patients with gastric cancer, including 29 with stage I, 11 with stage II, 42 with stage III and 64 patients with stage IV cancer. Quantitation of CEA, CA 19-9, CA 72-4 and CA 242 in serum was performed with commercial assays. HCG, was measured with an in-house immunofluorometric assay based on monoclonal antibodies specific for the free ,-subunit of hCG. Survival analysis was performed with Kaplan-Meier life-tables and log-rank test, and with multivariate Cox regression analysis. Disease-specific cumulative 2-year survival rate was 40%. Serum levels of CEA, CA 72-4, CA 242 and hCG, showed significant correlation with stage (p<0.027); for CA 19-9 the association was of borderline significance (p=0.056). Of the studied markers, CA 19-9, CA 72-4, CA 242 and hCG, were found to be prognostic factors in univariate analysis (p< 0.022). In multivariate analysis, stage had the statistically most significant association with prognosis followed by hCG,, tumour histology according to the Laurén classification and by CA 72-4. In gastric cancer, tumour markers hCG, and CA 72-4 are independent prognostic factors in addition to stage and histological type of the tumour. © 2004 Wiley-Liss, Inc. [source] Recent trends in the treatment of testosterone deficiency syndromeINTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2007Bum Sik Hong Abstract: Testosterone deficiency syndrome (TDS) is defined as a clinical and biochemical syndrome associated with advancing age and is characterized by typical symptoms and deficiency in serum testosterone levels. TDS is a result of the interaction of hypothalamo-pituitary and testicular factors. Now, treatment of TDS with testosterone is still controversial due to a lack of large, controlled clinical trials on efficacy. The risks of treatment with testosterone appear to be minimal, although long-term studies on the safety of testosterone therapy are lacking. The aim of the therapy is to establish a physiological concentration of serum testosterone in order to correct the androgen deficiency, relieve its symptoms and prevent long-term sequelae. All of the available products, despite their varying pharmacodynamic and pharmacokinetic profiles, are able to reach this goal. Newer testosterone patches seem not to cause severe skin irritation. Testosterone gels minimize the skin irritation while providing flexibility in dosing and a low discontinuation rate. Oral testosterone undecanoate (TU) is free of liver toxicity. Recent formulation of oral TU markedly increased shelf-live, a major drawback in the older preparation. Producing swings in testosterone levels rising rapidly to the supraphysiological range is not the case with the new injectable long-acting preparation of TU. To be able to rapidly react and stop treatment in cases where side-effects and contraindications are detected, the short-acting transdermal and oral delivery modes have certain advantages. However, there is no evidence that the use of an injectable long-acting TU in men with TDS has limitations in clinical application for this reason. The use of dehydroepiandrosterone is still controversial because of a lack of well designed long-term trials, although some recent studies suggest positive effects on various body systems. Only a few studies have been carried out to investigate the effect of hCG (human chorionic gonadotropin) in TDS with some positive results on various body systems. [source] First-trimester Down syndrome screening in women younger than 35 years old and cost-effectiveness analysis in Taiwan populationJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2009Ching-Yu Chou MD Summary Objectives, Outcome of the first-trimester Down syndrome screening in younger population was less reported before. We present the outcome of this screening in Taiwanese women younger than 35 years old. We also test whether or not the first-trimester Down syndrome screening of women <35 years of age and women >35 years old routinely receiving amniocentesis is cost-effective compared with all pregnant women screened with this test in the setting of increased maternal age. Methods, From 1999 to 2007, the first-trimester Down syndrome screening including nuchal thickness, pregnancy-associated plasma protein A and free ,-hCG are provided to 10 811 singleton women <35 years of age with the cut-off of 1/270. A cost-effectiveness analysis of young women receiving this screening and older women undergo amniocentesis versus all women undergo this screening was performed in Taiwan population from 1987 to 2006, in which advanced age pregnancies increased from 2.8% to 11.6% of total pregnancies. Results, Detection rates of trisomy 21, trisomy 18, Turner syndrome and other chromosome anormalies in women <35 years of age are 87.5% (14/16), 50% (2/4), 80% (8/10) and 63% (12/19), respectively, with a false-positive rate of 5.5% (590/10 811). As advanced age pregnancies reached 11.6%, the average cost per one case averted for all women screened ranged from $77 204 to $98 421, while the cost ranged from $99 647 to $116 433 for only women <35 years of age receiving this screening. Conclusions, In an aging population, the first-trimester Down syndrome screening should be implemented for all pregnant women when it is available. [source] Cost-effectiveness analysis of triple test in second-trimester maternal serum screening for Down's syndrome: an experience from Taiwan with decreasing birth rate but increasing population of old pregnant womenJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2008Hsiao-Lin Hwa PhD Objectives, We intended to assess the cost-effectiveness of adding unconjugated oestriol (uE3) in maternal serum screening for Down's syndrome in Taiwan, where there is a decreasing birth rate but an increasing trend of old women having pregnancies. Methods, We used logistic regressions to estimate the risk of Down's syndrome with maternal age and different combinations of biomarkers. Cost-effectiveness analysis was presented in terms of the average and incremental cost-effectiveness ratios. Sensitivity analyses with different parameters were performed. Results, Given a cut-off point of 1:270 for the confirmation of Down's syndrome with amniocentesis, the average cost per case averted for maternal age above 35 years only, double test [alpha-fetoprotein (AFP) and human chorionic gonadotrophin (hCG)] and triple test (AFP, hCG and uE3) were estimated as $14 561, $42 367 and $37 424. The additional costs per case averted for double test and triple test (compared with maternal age above 35 years) were $135 950 and $77 394, respectively. The additional cost per case averted for triple test was $15 199 compared with double test. Conclusions, The performance of triple test is not only more effective in detecting Down's syndrome cases but also more cost-effective than double test in this study. [source] Risk prediction for Down's syndrome in young pregnant women using maternal serum biomarkers: determination of cut-off risk from receiver operating characteristic curve analysisJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2007Hsiao-Lin Hwa MD PhD Abstract Objective, The aim of this study was to establish a predictive model for Down's syndrome using maternal age as well as maternal serum levels of alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG), and to identify an optimal cut-off risk in women under the age of 35 years to improve sensitivity. Methods, Logistic regression models were utilized to predict fetal Down's syndrome as a function of maternal age and logarithm of levels of AFP as well as hCG using training data of 20 pregnancies with fetal Down's syndrome and 9730 unaffected pregnancies. Validation was performed using data of another nine affected pregnancies and 3496 unaffected pregnancies. Receiver operating characteristic (ROC) curves were plotted. Results, Based on the newly established logistic regression equations, the optimal cut-off risk from the ROC curve analysis was at 1:499, with a 17.8% false-positive rate and a 90.0% sensitivity. A suboptimal cut-off risk was estimated at 1:332, with a 12.0% false-positive rate and an 80% sensitivity. Conclusion, A predictive model for Down's syndrome was developed using logistic regression. By ROC curve analysis and clinical consideration, the cut-off risk for young pregnant women could be determined. [source] Functional reconstruction and synthetic mimicry of a conformational epitope using CLIPSÔ technology,JOURNAL OF MOLECULAR RECOGNITION, Issue 5 2007Peter Timmerman Abstract This paper describes immunization studies with CLIPS-constrained peptides covering only the major part (,3-loop) of a structurally complex antigenic site on human Follicle Stimulating Hormone , -subunit (FSH- ,). In cases where linear and SS-constrained peptides fail, the CLIPS-constrained peptides generate polyclonal antibodies with high neutralizing activity for hFSH. The sera were shown to be specific for hFSH over human Luteinizing Hormone (hLH) and human Chorionic Gonadotropin (hCG). ELISA-competition studies and circular dichroism (CD)-measurements illustrate clearly that activity of the peptides in antibody binding and generation relates directly to precise and appropriate fixation of the peptide conformation. Design of the CLIPS-peptides was entirely based on epitope mapping studies with two neutralizing anti-hFSH mAbs. Both mAbs were shown to bind to a conformational epitope located at the top of the ,1,,3-loop covering the amino acid sequences Y58 -P77 (,3-loop). The results described in this paper show that CLIPS-constrained peptides covering the Y58 -P77 sequence provide the minimally required structural entity necessary to generate reproducibly sera with high hFSH-neutralizing activity. Copyright © 2007 John Wiley & Sons, Ltd. [source] Effect of human chorionic gonadotrophin on in vitro contractions of stimulated detrusor muscle strips of female ratsJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2009Diaa E. E. Rizk Abstract Aims:, We studied the effect of human chorionic gonadotrophin (hCG) on the in vitro detrusor muscle contractions in female rats. Methods:, Two adjacent detrusor muscle strips from the bladder dome of 18 female Wistar rats (230,250 gm) were mounted in an organ bath for the recording of isometric tension. Carbachol (10,9,10,3 M), ,,, methylene adenosine 5,-triphosphate (ATP) (10,9,10,3 M) and potassium chloride (KCl) (10,4,10,3 M) were applied (n = 6 × 3 groups). Concentration-response curves, before and after the addition of hCG (100 iu/mL) or oxybutynin (10,5 M) to either muscle strip, were compared. Results:, All curves were displaced to the right by hCG in a concentration-dependent manner with significant inhibition of contractions induced by carbachol (P < 0.001) and KCl (P = 0.016) but not those induced by ,,,-methylene ATP (P = 0.4). Estimated order of potency of inhibition was carbachol>KCl>,,,-methylene ATP. The overall inhibitory effect of hCG was significantly less than oxybutynin (P < 0.001). Conclusions:, hCG significantly inhibited in vitro detrusor contractions induced by depolarization (KCl) and cholinergic (carbachol) but not purinergic (,,,-methylene ATP) stimulation in a dose-dependent manner in female rats. [source] Effect of insulin on rat ovarian leptin expression by immunohistochemical stainingJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 6 2003Naci Kemal Kuscu Abstract Aim:, Leptin and insulin may interact in regulating ovarian steroid synthesis. The objective of this study was to investigate immunohistochemical staining of leptin in normal rat ovarian tissues and in rats treated with insulin and insulin plus human chorinoic gonadotropin (hCG). Methods:, Paraffin blocks of rat ovarian tissues from a previous study, in which 18 adult, female Wistar rats with an average weight of 250 g were divided into three groups to receive either saline solution, human insulin (2 U/day) or human insulin (2 U/day) plus hCG (4 U/day) for 4 weeks, were used in this study to compare the effects on leptin staining. The results were analysed using a semiquantitative scoring system, such as mild, moderate and strong. Results:, No staining was observed in granulosa cells and theca interna cells of normal ovarian tissues. Theca externa cells had mild staining intensity (+), corpus luteum had moderate (+ +) and stroma had mild (+) staining intensity. Histological structure was impaired in the insulin group, luteinized cells had mild staining, there was no difference in other cell groups. Only theca externa cells of the developing follicles were stained in insulin plus hCG group, luteinized cells again had mild staining. Conclusions: Besides damaging the rat ovarian structure, insulin reduced staining intensity of leptin in luteinized cells. Insulin may stimulate ovarian steroid synthesis not only through its own receptors, but also by acting on the leptin expression of these cells. [source] In-vitro Fertilization and Embryo Transfer and Cellular Immunity: Study on Cytokines and T Lymphocyte subpopulations in IVF-ET CyclesJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2002Mitsutaka Murakami Objectives: To determine whether peripheral T lymphocyte subpopulations and cytokines change during in-vitro fertilization and embryo transfer (IVF-ET) cycles and to evaluate them with regard to pregnancy status and types of infertility. Methods: Peripheral T lymphocyte subpopulations and cytokines in 33 consecutive cycles of IVF-ET were examined. All the women were stimulated with purified FSH and hCG after pituitary suppression with GnRH agonist. Peripheral blood samples were collected before FSH administration, on the day of hCG administration, the day of ET (day 2), day 6 and day 15. We measured plasma estradiol and progesterone levels and plasma interferon-,, interleukin-4 (IL-4), IL-10 and IL-12 levels. Peripheral T lymphocyte subpopulations, T helper type 1 and 2 cells (Th1 and Th2) and T cytotoxic type 1 and 2 cells (Tc1 and Tc2), were analyzed with three-color flowcytometry. Results: There were no changes in the plasma levels of the cytokines or in the proportions of Th1 and Th2 and the proportions of Tc1 and Tc2 in peripheral blood lymphocytes during the IVF-ET cycles. In women with endometriosis, the ratios of Tc1 to CD8+ lymphocytes and the Tc1 to Tc2 ratios before FSH administration were much higher than in women without endometriosis. The ratios of Tc1 to CD8+ lymphocytes were significantly lower in the patients with endometriosis who became pregnant. Conclusions: Peripheral cellular immunity does not change during IVF-ET cycles. In women with endometriosis, the peripheral Tc1 subpopulation is more predominant before ovarian stimulation, suggest- ing that the ratio of Tc1 before ovarian stimulation could be an indicator of fecundity for women with endometriosis. [source] Surgery-related shedding of breast cancer cells as determined by RT-PCR assayJOURNAL OF SURGICAL ONCOLOGY, Issue 4 2003Xi-Chun Hu MD Abstract Background and Objectives Surgery could result in the shedding of cancer cells into the circulation. These cells were investigated with reverse transcriptase-polymerase chain reaction (RT-PCR) assay for cytokeratin 19 (CK19) and ,-subunit of human chorionic gonadotropin (,-hCG). Patients and Methods Peripheral blood was sampled from 49 patients with breast cancer before operation (d,1), 1 day after operation (d1), and 7 days after operation (d7). Total RNA was extracted from peripheral blood mononuclear cells, followed by RT-PCR assay. The products for ,-hCG were digested with Sty I endonuclease. The patients were followed up for a median of 33 months for signs of recurrence and metastasis. Results The results for CK19 at d,1, d1, and d7 were 8.2, 20.4, and 10.2%, respectively. For ,-hCG, the corresponding results were 12.2, 26.5, and 16.3%, respectively. There was a higher positive rate in d1 samples than in d,1 samples for CK19 and ,-hCG (P,<,0.05 and P,=,0.092, respectively). Conversions of signals from being negative to positive were found in all stages. These did not demonstrate a statistical correlation with prognostic factors associated with a poor prognosis. Only two of the five recurrence occurred in the 15 patients with the signal conversions, while the other three occurred in the patients showing no signals in all samples. Conclusions Cancerous breast cells that enter into the blood circulation as a result of an operation are unlikely to be involved in the formation of metastatic deposits. J. Surg. Oncol. 2003;82:228,232. © 2003 Wiley-Liss, Inc. [source] Regulation of prostaglandin synthesis in ovaries of sexually-mature zebrafish (Danio rerio)MOLECULAR REPRODUCTION & DEVELOPMENT, Issue 11 2009Andrea L. Lister This study investigates the regulation of prostaglandin (PG) synthesis in the ovaries of sexually-mature zebrafish (Danio rerio). We examined the ovarian expression of genes within the arachidonic acid (AA) pathway, and the ovarian levels of 17,,20,-dihydroxy-4-pregnen-3-one (17,,20,-P), 17,-estradiol (E2), and PGF2, in spawning and nonspawning fish during the ovulatory cycle. Real-time RT-PCR analysis revealed that the expression levels of cytosolic phospholipase A2 (cpla2) and cyclooxygenases (COX)-2 (ptgs2) in ovarian fragments and in isolated full-grown follicles of spawning fish were highest at 6:00 when ovulation was expected to occur. In nonspawning fish, cpla2 expression levels declined over time while ptgs2 expression displayed the same temporal pattern as in spawning fish. Elevated levels of 17,,20,-P in the spawning fish occurred at 3:30, but there were no changes in the nonspawning fish. In other studies conducted to investigate the hormonal regulation of AA pathway genes, fish exposed via the water for 24 or 96,hr to 17,,20,-P or E2 exhibited reduced ovarian expression levels of COX-1 (ptgs1) and PG E synthase-2 (ptgsl), and E2 reduced the expression of cpla2. Injection of human chorionic gonadotropin (hCG) (100,IU) led to increased expression levels of cpla2 and ptgs2 at 2 and 18,hr post-treatment, but consistently reduced ptgs1 and ptgsl expression. In these fish, ovarian levels of 17,,20,-P were elevated at all time points and PGF2, levels in the hCG-treated group were significantly higher than the control fish at 18,hr. Collectively, these in vivo results suggest that gonadotropins and steroids are involved in the regulation of the AA pathway in ovarian follicles of zebrafish. Mol. Reprod. Dev. 76: 1064,1075, 2009. © 2009 Wiley-Liss, Inc. [source] Adverse effects associated with persistent stimulation of Leydig cells with hCG in vitroMOLECULAR REPRODUCTION & DEVELOPMENT, Issue 11 2009Archana Aggarwal The detrimental effects of persistent stimulation with hCG were investigated in rat Leydig cells in vitro. Significant rise in lipid peroxidation and reactive oxygen species (ROS) with concomitant attenuation in the activities of antioxidant enzymes: superoxide dismutase, catalase, and glutathione- S -transferase was observed. Transcripts for catalase and superoxide dismutase were also depleted. Subsequent to each hCG challenge, the total antioxidant capacity in the target cells also declined significantly (P,<,0.05). There was an increase in cell apoptosis (23%), which was associated with a rise in caspase-3 activity, PARP cleavage, and Fas, FasL, caspase-8 expression. While Bax and Caspase-9 expression remained unchanged, Bcl-2 demonstrated a marked decline. Taken together, the above data indicate that persistent hCG stimulation of Leydig cells induced adverse effects leading to oxidative stress and apoptosis which was channeled primarily through the extrinsic pathway. Mol. Reprod. Dev. 76: 1076,1083, 2009. © 2009 Wiley-Liss, Inc. [source] Impaired cytotrophoblast cell,cell fusion is associated with reduced Syncytin and increased apoptosis in patients with placental dysfunctionMOLECULAR REPRODUCTION & DEVELOPMENT, Issue 1 2008Manuela Langbein Abstract Preeclampsia (PE), Hemolysis Elevated Liver Enzymes and Low Platelets (HELLP)-syndrome, and intrauterine growth restriction (IUGR) are associated with abnormal placentation. In early pregnancy, placental cytotrophoblasts fuse and form multinuclear syncytiotrophoblasts. The envelope gene of the human endogenous retrovirus-W, Syncytin, is a key factor for mediating cell,cell fusion of cytotrophoblasts. This study investigated clinical parameters of PE and HELLP-associated IUGR and analyzed the cell,cell fusion index and ,-human chorionic gonadotropin (,-hCG) secretion of cytotrophoblasts isolated and cultured from placentas of these patients. In addition, we performed absolute quantitation of Syncytin and determined the apoptosis rate in both cultured cytotrophoblasts and placental tissues. Cultured cytotrophoblasts from PE and HELLP-associated IUGR correlated with a pronounced lower cell,cell fusion index, 1.8- and 3.6-fold; less nuclei per syncytiotrophoblast, 1.4- and 2.0-fold; a significantly decreased ,-hCG secretion, 4.3- and 17.2-fold and a reduction of Syncytin gene expression, 8.1 (P,=,0.019) and 222.7-fold (P,=,0.011) compared with controls, respectively. In contrast, a significantly 2.3-fold higher apoptosis rate was observed in cultured PE/IUGR cytotrophoblasts (P,=,0.043). Importantly, Syncytin gene expression in primary placental tissues of PE/IUGR was 5.4-fold lower (P,=,0.047) and in HELLP/IUGR 10.6-fold lower (P,=,0.019) along with a 1.8- and 1.9-fold significant increase in the apoptosis rate compared with controls, respectively. Low Syncytin expression in both cultured cytotrophoblasts and primary tissues from pathological placentas supports an intrinsic placenta-specific deregulation of cell,cell fusion in the formation of syncytiotrophoblasts leading to increased apoptosis. These processes could contribute to the development and severity of PE and HELLP-associated IUGR. Mol. Reprod. Dev. 75: 175,183, 2008. © 2007 Wiley-Liss, Inc. [source] Induction of alpha-caveolin-1 (,CAV1) expression in bovine granulosa cells in response to an ovulatory dose of human chorionic gonadotropinMOLECULAR REPRODUCTION & DEVELOPMENT, Issue 11 2006Mame Nahé Diouf Abstract Caveolins are implicated in endocytosis, cholesterol trafficking and signal transduction. A cDNA fragment corresponding to caveolin-1 (CAV1) was identified in a mRNA profiling expression study in bovine granulosa cells (GC) following human chorionic gonadotropin (hCG)-induced ovulation. Thus, we have characterized CAV1 cDNA and studied its spatio-temporal expression pattern in bovine ovarian follicles. The full-length bovine ,CAV1 cDNA was cloned and encodes a putative 22 kDa protein. Expression of ,CAV1 was studied in bovine GC obtained from follicles at different developmental stages: small follicles (SF: 2,4 mm), dominant follicles (DF), ovulatory follicles (OF: 24 hr post-hCG), and corpus luteum (CL). Semiquantitative RT-PCR analysis showed a 6.5-fold increase in ,CAV1 mRNA in GC of OF versus DF (P,<,0.0001), whereas CAV2 mRNA was increased by only twofold (P,<,0.0007). Temporal expression of ,CAV1 mRNA from OF recovered at 0, 6, 12, 18, and 24 hr after hCG injection showed an 8.5-fold increase of ,CAV1 mRNA after 24 hr compared to 0 hr (P,<,0.0018) whereas no significant variation was detected for CAV2. Immunoblot demonstrated an initial increase in ,CAV1 protein level 12 hr post-hCG, reaching a maximum at 24 hr. Immunohistochemical localization of CAV1 was observed in GC of OF isolated 18 and 24 hr after hCG injection, whereas no signal was detected in GC of DF and SF. The induction of ,CAV1 in GC of OF suggests that ,CAV1 likely contributes to control the increase in membrane signaling that occurs at the time of ovulation and luteinization. Mol. Reprod. Dev. 73: 1353,1360, 2006. © 2006 Wiley-Liss, Inc. [source] Recombinant anti-hCG antibodies retained in the endoplasmic reticulum of transformed plants lack core-xylose and core-,(1,3)-fucose residuesPLANT BIOTECHNOLOGY JOURNAL, Issue 4 2004Rajan Sriraman Summary Plant-based expression systems are attractive for the large-scale production of pharmaceutical proteins. However, glycoproteins require particular attention as inherent differences in the N-glycosylation pathways of plants and mammals result in the production of glycoproteins bearing core-xylose and core-,(1,3)-fucose glyco-epitopes. For treatments requiring large quantities of repeatedly administered glycoproteins, the immunological properties of these non-mammalian glycans are a concern. Recombinant glycoproteins could be retained within the endoplasmic reticulum (ER) to prevent such glycan modifications occurring in the late Golgi compartment. Therefore, we analysed cPIPP, a mouse/human chimeric IgG1 antibody binding to the ,-subunit of human chorionic gonadotropin (hCG), fused to a C-terminal KDEL sequence, to investigate the efficiency of ER retrieval and the consequences in terms of N-glycosylation. The KDEL-tagged cPIPP antibody was expressed in transgenic tobacco plants or Agrobacterium -infiltrated tobacco and winter cherry leaves. N-Glycan analysis showed that the resulting plantibodies contained only high-mannose (Man)-type Man-6 to Man-9 oligosaccharides. In contrast, the cPIPP antibody lacking the KDEL sequence was found to carry complex N-glycans containing core-xylose and core-,(1,3)-fucose, thereby demonstrating the secretion competence of the antibody. Furthermore, fusion of KDEL to the diabody derivative of PIPP, which contains an N-glycosylation site within the heavy chain variable domain, also resulted in a molecule lacking complex glycans. The complete absence of xylose and fucose residues clearly shows that the KDEL-mediated ER retrieval of cPIPP or its diabody derivative is efficient in preventing the formation of non-mammalian complex oligosaccharides. [source] Prediction of adverse pregnancy outcomes by combinations of first and second trimester biochemistry markers used in the routine prenatal screening of Down syndromePRENATAL DIAGNOSIS, Issue 5 2010Tianhua Huang Abstract Objective To investigate the associations between four defined adverse pregnancy outcomes and levels of first and second trimester maternal serum markers focusing in particular on how well combinations of markers predict these adverse outcomes. Methods This was a retrospective review of associations between first and second trimester serum markers and adverse pregnancy outcomes among 141 698 women who underwent prenatal screening for Down syndrome in Ontario, Canada. Detection rates (DR), false positive rates (FPR), and odds ratios were estimated using both single and combinations of markers for the adverse outcomes defined. Results Women with decreased second trimester unconjugated oestriol (uE3), deceased first trimester maternal serum pregnancy-associated plasma protein A (PAPP-A), increased second trimester serum alpha fetoprotein (AFP), or increased second trimester total human chorionic gonadotrophin (hCG) were at greater risk of developing adverse pregnancy outcomes. At a 5% FPR, combinations of these markers predicted at best 33.3% of fetal loss and 31.5% of preterm births (PTB) before 32 weeks of gestation. Conclusion There are significant associations between the levels of first and second trimester serum markers and adverse obstetric outcomes. However, even combinations of these markers can only predict adverse obstetric outcomes with modest accuracy. Copyright © 2010 John Wiley & Sons, Ltd. [source] Association offirst-trimester low PAPP-A levels with preterm birth,,PRENATAL DIAGNOSIS, Issue 4 2010Katherine R. Goetzinger Abstract Objective To determine the association of, and predictive ability of, pregnancy-associated plasma protein A (PAPP-A), free ,-human chorionic gonadotrophin (,-hCG), and nuchal translucency (NT) with preterm birth (PTB). Methods A 5-year retrospective cohort study of women who underwent first-trimester combined screening was performed. Maternal medical, antepartum, and pregnancy outcome data were obtained. PAPP-A and ,-hCG were converted to multiples of the median (MoM), and primary exposure was defined as ,10th percentile MoM for PAPP-A. Secondary exposures were defined as , 90th percentile MoM for ,-hCG and NT values of , 20 and 25 mm. The primary outcome was PTB before 35 weeks and the secondary outcome was PTB before 32 weeks. Univariate, bivariate, multivariate, and receiver,operator analyses were used. Results Of the 2231 patients meeting inclusion criteria with complete outcome data available, 222 had a PAPP-A level ,10th percentile MoM. Abnormally low PAPP-A was associated with an increased risk for PTB < 35 weeks [adjusted odds ratio (aOR) 2.0, 1.0,3.8] and < 32 weeks (aOR 2.7, 1.1,6.4), even after adjusting for prior PTB, tobacco exposure, chronic hypertension, and body mass index. PAPP-A ,10th percentile was not sufficiently predictive of PTB < 35 weeks (area under curve = 0.63, 95% CI 0.53,0.72). Neither abnormally high ,-hCG nor increased NT was associated with an increased risk for PTB. Conclusions PAPP-A ,10th percentile is associated with an increased risk for PTB, but is not sufficiently predictive to be used clinically. Copyright © 2010 John Wiley & Sons, Ltd. [source] | ||||||||||||||||