Can serum human epididymis protein 4 (HE4) support the decision to refer a patient with an ovarian mass to an oncology hospital?

INTRODUCTION: The value of serum human epididymis protein 4 (HE4) in guiding referral decisions in patients with an ovarian mass remains unclear, because the majority of studies investigating HE4 were performed in oncology hospitals. However, the decision to refer is made at general hospitals with a low ovarian cancer prevalence. We assessed accuracies of HE4 in differentiating benign or borderline from malignant tumors in patients presenting with an ovarian mass at general hospitals. METHOD: Patients with an ovarian mass were prospectively included between 2017 and 2021 in nine general hospitals. HE4 and CA125 were preoperatively measured and the risk of malignancy index (RMI) was calculated. Histological diagnosis was the reference standard. RESULTS: We included 316 patients, of whom 195 had a benign, 39 had a borderline and 82 had a malignant ovarian mass. HE4 had the highest AUC of 0.80 (95%CI 0.74-0.86), followed by RMI (0.71, 95%CI 0.64-0.78) and CA125 (0.69, 95%CI 0.62-0.75). Clinical setting significantly influenced biomarker performances. Applying age-dependent cut-off values for HE4 resulted in a better performance than one cut-off. Addition of HE4 to RMI resulted in a 32% decrease of unnecessary referred patients, while the number of correctly referred patients remained the same. CONCLUSION: HE4 is superior to RMI in predicting malignancy in patients with an ovarian mass from general hospitals. The addition of HE4 to the RMI improved HE4 alone. Although, there is still room for improvement, HE4 can guide referral decisions in patients with an ovarian mass to an oncology hospital.

PCR assessment of Chlamydia trachomatis infection of semen specimens processed for artificial insemination.

In order to ascertain the microbiological quality of stored semen specimens processed for artificial insemination by a donor (AID), we developed a PCR assay targeting the chlamydial plasmid to detect Chlamydia trachomatis in semen. The lower limit of detection of this assay corresponded to 2.5 to 5 elementary bodies per microl of semen. A total of 669 cryopreserved ejaculates from 97 asymptomatic donors were tested for C. trachomatis infection. Twelve ejaculates, originating from four donors, were found to be positive, indicating a 4% prevalence of C. trachomatis infection among the donor population studied. Cross-contamination between the cryopreserved specimens in the storage container was studied by typing using sequence analysis of PCR-amplified omp1 genes of the strains. Two donors were infected with serovar E, one was infected with serovar F, and one was infected with serovar K. For two donors, the duration of C. trachomatis positivity could be assessed. One donor donated C. trachomatis-positive semen for at least 4 successive months, and the other did so for at least 16 months. The occurrence of C. trachomatis infection in cryopreserved donor semen indicates that ejaculates from donors not tested for a C. trachomatis infection just prior to donation should be tested for infection by a direct test such as the PCR described here. Direct testing of semen specimens will detect not only donors with an active infection but also C. trachomatis-infected ejaculates already stored and will thus improve the microbiological quality of AID, since discrepancies in the presence of C. trachomatis in urine and semen specimens have been reported.

Maternal and perinatal outcome after expectant management of the HELLP syndrome compared with pre-eclampsia without HELLP syndrome.

OBJECTIVE: To compare maternal and perinatal outcome of pregnancies complicated by pregnancy induced hypertension and HELLP syndrome with the outcome of pregnancies complicated by pre-eclampsia only. DESIGN: It was a retrospective cohort study. Fifty one patients with pregnancy induced hypertension and HELLP syndrome were matched with 51 pre-eclamptic patients according to parity and gestational age on admission in hospital. Management was expectant, treatment only symptomatic and delivery was mainly effectuated because of fetal condition. RESULTS: There was no maternal mortality in either group; maternal morbidity was more frequent in the HELLP group. Immediate intervention within a few hours of admission because of fetal distress more often occurred in the HELLP group. In both groups 41 children (80%) are still alive, with one major handicapped child in each group. Logistic regression analysis identified gestational age on admission and antihypertensive treatment on admission as significant contributors to perinatal mortality or major handicap. Whether the patient belonged to the HELLP group or the pre-eclamptic group had no influence on outcome. CONCLUSION: Expectant management of pregnancy induced hypertension with HELLP syndrome and pre-eclampsia without HELLP syndrome results in similar maternal and perinatal outcome. Perinatal outcome is strongly influenced by gestational age and the severity of hypertension as expressed by the need of antihypertensive treatment, irrespective of the underlying syndrome.