A case of complete hydatidiform mole with coexistent fetus: conclusive diagnosis of androgenesis of the molar placenta by variation of paternal acrocentric short arms.

A twin pregnancy consisting of complete hydatidiform mole with coexisting fetus is an extremely rare condition. Recent advances in obstetric ultrasonography and cytogenetic analysis have made the prenatal diagnosis of this rare pregnancy possible. Recent literature advocating DNA polymorphism analysis being required for the accurate diagnosis of complete hydatidiform mole with coexisting fetus is discussed. We present a case of complete hydatidiform mole with coexisting fetus terminated at 16 weeks' gestation. After successful termination of the pregnancy with intravaginal gemeprost, androgenesis of the molar placenta was proven by karyotyping analysis only, without DNA polymorphism analysis, because the short arm of chromosome 21 of the paternal allele had the normal variant satellite. To our knowledge, this is the first case report of complete hydatidiform mole with coexisting fetus diagnosed by variation of the acrocentric short arms, followed by termination with intravaginal gemeprost. We describe the clinical course of our case and review some literature concerning complete hydatidiform mole with coexisting fetus.

Spatio-temporal image correlation (STIC) used by general obstetricians is marginally clinically effective compared to 2D fetal echocardiography scanning by experts.

OBJECTIVES: To assess the effectiveness of spatio-temporal image correlation (STIC) used by general obstetricians as compared with 2D scanning. METHODS: As many as 30 pregnant women at 17-21 weeks' gestation were enrolled. 2D ultrasound was performed by a fetal echocardiologist; STIC was performed by a general obstetrician. Time, accuracy of measurement of diameter of great vessels and quality of the pictures obtained by the two methods were compared. RESULTS: The mean time required by 2D ultrasound was significantly shorter than that by STIC (5.2 +/- 1.9 min vs 9.8 +/- 2.7 min; P < 0.001). The measurement of the diameter of the great vessels showed some difference but the mean score of the pictures obtained by both methods were not significantly different. By using 2D ultrasound, acceptable quality pictures were obtained in 51.9, 44.4 and 51.9% of cases for 4-chamber, 5-chamber and 3-vessel views, respectively. Meanwhile by using STIC, the percentages were 77.8, 59.3 and 37%. CONCLUSION: Our study suggested that STIC used by general obstetricians to check normality of fetal cardiac structures at 17-21 weeks' gestation has marginal clinical effectiveness when compared to 2D scanning by a fetal echocardiologist, and should need some improvement before it can be used as a tool to expand a fetal cardiac screening program.

Relationship between human tumor-associated antigen RCAS1 and gestational diabetes mellitus.

PROBLEM: The human tumor-associated receptor-binding cancer antigen expressed on SiSo cells (RCAS1) is considered to play a role in the inhibition of the maternal immune response during pregnancy. The aim of our study was to investigate the expression of RCAS1 protein in the placenta and to compare its concentration in maternal and cord blood sera between normal pregnancies and pregnancies complicated by gestational diabetes mellitus (GDM). METHOD OF STUDY: Samples were obtained from women with GDM (n = 8), women with type 1 DM (n = 5), and healthy term controls (n = 27) after delivery. Placentas were studied by immunohistochemistry, and real-time polymerase chain reaction. For assessment of RCAS1 concentrations in maternal and cord blood sera, enzyme-linked immunosorbent assay was performed. RESULTS: The RCAS1 protein mRNA expression in the placentas of patients with GDM was significantly lower than that in the controls (P = 0.005). The maternal blood RCAS1 protein concentration of the GDM cases was also significantly lower than that in the controls (P = 0.0411), whereas the cord blood RCAS1 protein concentration was significantly higher in the GDM and type 1 DM groups than in the controls (P = 0.0311 and P = 0.0192, respectively). CONCLUSION: The present results suggest that RCAS1 protein might have an important role in the development of GDM.

Level of S100B protein expression in the amnion at various gestational ages in the third trimester of normal pregnancies.

BACKGROUND: S100B protein is a unique calcium-binding protein. Its biological role within the cell populations is not completely defined. Some pathological conditions that develop during pregnancy could affect S100B concentrations in the amniotic fluid, cord blood, and maternal serum. The aim of our study was to assess the correlation between S100B protein expression in the amnion, amniotic fluid and gestational age in the third trimester of uncomplicated pregnancies. METHODS: Amnion, amniotic fluid, maternal peripheral and umbilical cord blood samples were collected from healthy women who delivered at 31-36 weeks (n=17), 37-40 weeks (n=22), and 41-42 weeks (n=21). The expression of S100B in the amnion was assessed by immunohistochemistry and real-time (RT)-PCR, and its concentrations in amniotic fluid, maternal and cord blood sera were determined by ELISA. RESULTS: The S100B protein expression in the amnion and its concentrations in amniotic fluid, maternal and cord blood sera of patients in the third trimester were not significantly different at various gestational ages. CONCLUSIONS: The S100B protein expression in the amnion and the S100B protein concentrations in amniotic fluid, maternal and cord blood do not vary significantly in the third trimester of uncomplicated pregnancies.

Immunisation of male mice with a plasmid DNA vaccine encoding gonadotrophin releasing hormone (GnRH-I) and T-helper epitopes suppresses fertility in vivo.

Immunisation against mammalian gonadotrophin releasing hormone (GnRH-I) linked to large carrier proteins has been shown to disrupt fertility. However, various studies have shown that the carrier protein causes epitope suppression of the hapten response, resulting in short-lived immunoneutralisation, followed by a return of fertility. A range of strategies has been used to resolve this, with limited success. The aim of this study was to construct a plasmid DNA vaccine encoding GnRH-I and T-helper epitopes. A 498 bp long vaccine construct in pcDNA3.1+ was administered to male mice in conjunction with a Hemagglutinating Virus of Japanese Envelop (HVJ-E) vector or in saline solution. The vaccine efficacy was evaluated in terms of GnRH-I specific IgG antibody response, serum testosterone levels, testicular spermatogenesis and the ability to produce offspring. The vaccine appeared to induce higher anti-GnRH-I IgG antibody response and insult the fertility axis, which was characterised by a drop of epididymal sperm counts, reduction of serum testosterone levels, suppressed testicular spermatogenesis and a significant decrease in litter numbers compared to control animals. The end-point vaccine efficacy was much higher in the HVJ-E vector mediated immunisation, than in saline alone.

Post-ischemic hypothermia reduced IL-18 expression and suppressed microglial activation in the immature brain.

Inflammation is an important factor for hypoxia-ischemia (HI) brain injury. Interleukin (IL)-18 is a proinflammatory cytokine which may be a contributor to injury in the immature brain after HI. To investigate the effects of post-HI hypothermia on IL-18 in the developing brain, 7-day-old rats were subjected to left carotid artery ligation followed by 8% oxygen for 60 min and divided into a hypothermia group (rectal temperature 32 degrees C for 24 h) and a normothermia group (36 degrees C for 24 h). The IL-18 mRNA was analyzed with real-time RT-PCR, and the protein level was analyzed by Western blot, and the location and source of IL-18 were assessed by immunohistochemistry. The significant increase of the IL-18 mRNA was observed in the ipsilateral hemispheres of the normothermia group at 24 h and 72 h after HI compared with controls, but the level in the ipsilateral hemispheres of the hypothermia group was significantly reduced at both time points, compared with the normothermia group, respectively. The IL-18 protein level in the ipsilateral hemispheres of the normothermia group significantly increased at 72 h after HI compared with controls, however, the protein level of the hypothermia group was significantly decreased, compared with the normothermia group. IL-18-positive cells were observed throughout the entire cortex, corpus callosum (CC) and striatum in the ipsilateral hemispheres of normothermia group at 72 h after HI, however, little positive cells were observed in the hypothermia group. Double labeling immunostaining found that most of the IL-18-positive cells were colocalized with lectin, which is a marker of microglia. The number of ameboid microglia (AM) in the normothermia group was significantly increased in cortex and CC, compared with the number in controls, but there were very few ramified microglia (RM) in these areas. In contrast, the number of AM in the hypothermia group was significantly decreased in cortex and CC, compared with the number in the normothermia group, and there were no significant differences in the number of AM and RM between the hypothermia group and controls. In conclusion, we found that IL-18 mRNA and the protein level were attenuated by post-HI hypothermia and that post-HI hypothermia may decrease microglia activation in the developing brain.

Mid-second trimester measurement of fetal nasal bone length in the Japanese population.

AIM: We carried out a preliminary study to compare the nasal bone length (NBL) and biparietal diameter/NBL (BPD/NBL) ratio between the Japanese and white populations. METHODS: Three hundred and fifty nine (359) singleton fetuses of healthy Japanese couples were examined from June 2004 to October 2005. NBL was measured by the strict midsagittal section. The reference range of NBL was established from cross-sectional data between 15 and 25 weeks' gestation. RESULTS: The success rate of obtaining reliable NBL was 93% (333/356). There were 330 fetuses (93%) available for constructing a reference range from the population. The median NBL increased from 3.2 mm at 15 weeks' to 7.6 mm at 25 weeks' gestation. The median of BPD/NBL ratio was 9.01. CONCLUSIONS: We demonstrated that NBL was significantly shorter and BPD/NBL was significantly greater in the Japanese population than those in the white and black populations.