Alpha smooth muscle actin (α-SM actin) in normal human ovaries,in ovarian stromal hyperplasia and in ovarian neoplasms

An immunohistochemical investigation of alpha-smooth muscle actin (alpha-SM actin) using the monoclonal anti-alpha-SM-1 antibody was carried out in 15 normal ovaries, in three ovaries with stromal hyperplasia and in 27 neoplastic ovaries. In selected cases the pattern of actin isoforms was examined by means of 2 D-gel electrophoresis. In addition, the tissues were stained for vimentin and desmin. In normal ovaries alpha-SM actin was found in the inner cortex and in the theca externa. In ovarian stromal hyperplasia expression of alpha-SM actin was minimal or absent. In primary and metastatic epithelial tumors there was positive stromal staining for alpha-SM actin, especially in the vicinity of epithelial elements. This tended to be more widespread in malignant neoplasms. Thecomas did not express alpha-SM-actin and could thus be differentiated from leiomyomas which stained intensely for alpha-SM actin. Only focal stromal staining of alpha-SM actin was observed in granulosa and germ cell tumors. In all the tissues studied blood vessels were strongly positive for alpha-SM actin. Desmin, although present in the stroma of most of the specimens, was less abundant than alpha-SM actin. We concluded that alpha-SM actin is a component of the normal human ovary where it may contribute to the contractility of its stroma. Its absence in the normal outer cortex and theca interna, and in stromal hyperplasia and thecoma implies that sex hormones do not constitute a stimulus for alpha-SM actin production in the ovary. Among neoplasms it is most widely represented in the stroma of epithelial tumors in which it may reflect stromal stimulation mediated by neoplastic epithelium.     

Remission of Diabetes Mellitus during Pregnancy

Two cases are reported in which a remission of diabetes was sustained throughout pregnancy. This seemed to be due in part to improved β-cell function consequent on restoration of normoglycaemia before pregnancy, and in part to an increase in insulin sensitivity during pregnancy, which in the first case disappeared very rapidly after delivery.     

A Simple Immunologic Test for Pregnancy

Experience with a latex agglutination-inhibition slide test for human chorionic gonadotrophin which allows pregnancy to be diagnosed in three minutes is described. Among 350 tests performed, 115 were in patients who presented with some complication of a presumed pregnancy, and 132 patients presented diagnostic problems in which pregnancy was to be ruled out. Clinical follow-up confirmed the accuracy of the test and its usefulness in the management of such clinical problems. In addition, among 48 patients with normal pregnancy between 42 and 120 days in duration, the only false-negative test was in one patient who was exactly 42 days from her last normal menstrual period.     

Failed medical management in ovarian pregnancy despite favorable prognostic factors--a case report

Primary ovarian pregnancy is a rare form of ectopic pregnancy that must be demonstrated with use of 4 Spiegelberg criteria. It is usually diagnosed at laparotomy or laparoscopy, although it may resemble a hemorrhagic corpus luteum. Successful conservative management of ovarian pregnancy with methotrexate has been reported only occasionally. This may be partly because of the rarity of this condition and partly because when medical treatment is successful, the patient does not need to undergo laparotomy or laparoscopy, and an occasional ovarian pregnancy may have been diagnosed as a tubal pregnancy. We present a case of ovarian pregnancy (diagnosed at laparotomy) for which initial medical management with methotrexate failed despite favorable prognostic factors. Whether the unusual location (ovary) could have contributed toward treatment failure is unknown.     

A mathematical model of pregnancy recognition in mammals

In this paper we develop a mathematical model of the luteal phase of the reproductive cycle in mammals with the aim to generate a systems understanding of pregnancy recognition. Pregnancy recognition is initiated by the production of interferon tau (IFNτ) by the growing conceptus. This ensures that the maternal corpus luteum (CL) remains viable to secrete progesterone, which is critical for providing a uterine microenvironment suitable for embryonic growth. Our mathematical model describes the interactions among the CL, the reproductive hormones and the hormone receptors in the uterus. It also characterises the complex interactions amongst the uterine oestrogen, progesterone and oxytocin receptors that control the sensitivity of the uterus to oestrogen, progesterone and oxytocin, respectively. The model is represented by a dynamical system and exhibits qualitative features consistent with the known experimental results in sheep. A key factor identified was a time-dependent threshold for the IFNτ signal below which the presence of the embryo might not be recognised and thus pregnancy would likely fail. Furthermore, the model indicated that if the IFNτ signal is later than around day 13 of the cycle, then pregnancy will not be recognised irrespective of the IFNτ concentration. The thresholds in the concentration and time of the IFNτ signal is a screening mechanism whereby only embryos of sufficient quality are able to prevent luteolysis (i.e. regression of the CL). The effect of progesterone secretion rate from the CL on pregnancy recognition was investigated. The model suggests that if the secretion rate is low then the initiation of the IFNτ signal is delayed, which in turn compromises the likelihood of a pregnancy being recognised by the CL. Furthermore, pregnancy recognition does not occur below a critical threshold in the progesterone secretion rate. In summary, the model can be used to identify the most favourable conditions for pregnancy recognition.     

Delayed surgical treatment for a traumatic bilateral cervical facet joint dislocation using a posterior-anterior approach: a case report

Introduction

Advanced abdominal (extrauterine) pregnancy is a rare condition with high maternal and fetal morbidity and mortality. Because the placentation in advanced abdominal pregnancy is presumed to be inadequate, advanced abdominal pregnancy can be complicated by pre-eclampsia, which is another condition with high maternal and perinatal morbidity and mortality. Diagnosis and management of advanced abdominal pregnancy is difficult.

Case presentation

We present the case of a 33-year-old African woman in her first pregnancy who had a full-term advanced abdominal pregnancy and developed gross ascites post-operatively. The patient was successfully managed; both the patient and her baby are apparently doing well.

Conclusion

Because most diagnoses of advanced abdominal pregnancy are missed pre-operatively, even with the use of sonography, the cornerstones of successful management seem to be quick intra-operative recognition, surgical skill, ready access to blood products, meticulous post-operative care and thorough assessment of the newborn.     

妊娠期家兔子宫内膜的鞘糖脂表达

 妊娠期家兎子宫内膜的神经节苷脂(Gls)的含量明显低于动情期的,而中性鞘糖脂(NGSL)的含量则以妊娠中、晚期的最高,动情期最低。鞘糖脂组成变化最显著的是妊娠早期,由动情期到早孕GM_3从28.0％增加到52.7％,CMH.CDH由未测出分别增加到29.2％和21.9％,而糖链复杂的组分GD_3,GTlb和CPH的百分含量则明显减少,到妊娠中、晚期、短糖链组分逐渐减少,而复杂糖链组分渐增。中期妊娠内膜的(GIs)以GD_3为主要组分,占45％,明显高于其它各期。NGSL在妊娠中、晚期CPH增高达70％,与动情期水平相当。结果提示,妊娠期间子宫内膜的鞘糖脂含量与组成均发生明显变化,这些变化可能与子宫功能密切相关。特别是早孕对的变化,推测与子宫内膜和胚泡的识别,粘连特性的获得有关。     

Biochemical interactions between blastocyst and endometrium in the large domestic animals

In pigs, the blastocyst begins to elongate from a sphere to a long filamentous thread around day 10.5 of pregnancy. At about this time the endometrium secretes large quantities of protein into the uterine lumen. The synthesis of this material which is believed to be required for nutritional support of the conceptus is under the control of progesterone. The release of secretory protein appears to be triggered by the production of estrogens by the elongating blastocyst. Blastocyst estrogens are also involved in the phenomenon of maternal recognition of pregnancy in swine, and their interaction with the maternal system, by a mechanism as yet unknown, prevents a return to reproductive cyclicity. Maternal recognition of pregnancy in the sheep and cow occurs at around the time of blastocyst elongation. Here estrogens do not appear to be involved, and protein products secreted by the conceptus have been implicated. One product of the sheep, ovine trophoblast protein-1, which is produced only during a brief period (days 13–21) of pregnancy, has been purified. It appears to be a hormone whose target tissue is the uterine endometrium.     

MANAGEMENT OF VARICOSE VEINS DURING PREGNANCY

The incidence of recurrences after radical venous operations done during pregnancy or where pregnancy has occurred subsequently is much higher than it is in cases in which pregnancy is not a factor. These discouraging results are due to increased venous pressure, obstruction to the venous drainage of the lower extremities and hormonal factors. The management of varicose veins during pregnancy should be by conservative means consisting of proper elastic support, elevation of the extremities at night and during rest periods in the day, avoiding static dependency of the legs, and control of body weight. In event of venous stasis and severe symptoms of varicosis that cannot be controlled by conservative measures, limited surgical intervention is indicated. This should consist of high ligation and division of the involved venous trunk and the immediate tributaries. Radical extirpation of varicose veins should be reserved until further pregnancy is not contemplated.     

Consequences of the number and spacing of pregnancies on outcome,and of pregnancy outcome on spacing

Abstract

This study is based on 3,098 once‐married women in Abderdeen, Scotland, who had a total of 10,825 pregnancies, which resulted in wastages of 285 infant deaths, 173 stillbirths, 712 involuntary abortions, and 200 voluntary terminations. Wastage varies by pregnancy number, particularly after the third pregnancy. There is, however, a selective factor operating here in that women who have a wastage are more likely to continue on to the next higher pregnancy number, and those who have a wastage at one pregnancy number are more likely to have a wastage at the next pregnancy outcome also. Wastage tends to be cumulative. Women who enter the reproductive cycle at the younger ages have a larger number of pregnancies and a higher wastage rate than women who postpone their first pregnancy until the older ages. Women who experience a wastage at any given pregnancy number are not only more likely to have another pregnancy, but they do so over a shorter time interval than those whose last pregnancy resulted in a live birth. Except for terminations, wastage is highest among women who closely space their pregnancy     

妊娠期乳腺癌的治疗进展

妊娠期乳腺癌是一种特殊类型的乳腺癌。妊娠对乳腺癌的生物学行为可能的影响及诊疗措施对胎儿的影响,使得妊娠期乳腺癌的临床表现、诊断和治疗等有其特殊性。由于妊娠相关的乳腺的生理改变,妊娠期乳腺癌的诊断极具挑战性,导致诊断延误非常普遍。妊娠期乳腺癌患者的治疗策略需要多学科专家一起参与决定,在考虑胎儿安全性的同时尽量与非妊娠乳腺癌患者的标准治疗一致。妊娠期间都可以安全的行乳腺手术。妊娠第一孕期和第二孕期早期可以考虑放疗,但要注意检测胎儿暴露的放射剂量。研究证据越来越支持14孕周后可以安全的行化疗。曲妥单抗和他莫昔芬有潜在的胎儿毒性,不推荐用于妊娠期患者。     

The size of the corpus luteum during pseudopregnancy and pregnancy in the rat.

The corpus luteum in mature Sprague Dawley rats was weighted at the various stages of pseudopregnancy and pregancy. The average size of these corpora lutea was 1.0 +/- 0.10 mg, 1.61 +/- 0.69 mg, 1.90 +/- 0.25 mg, 3.69 +/- 0.36 mg, and 4.37 +/- 0.50 mg on day 2 of diestrus, on days 10-15 of psuedopregnancy, on days 9-10, 14, and 20 of pregnancy, respectively. The fact that the average size of the corpus luteum on days 10-15 of pseudopregnancy was larger than that on day 2 of diestrus is thought to drive from prolonged exposure of the corpus luteum to prolactin. The average size of the corpus luteum on days 9-10 of pregnancy had a tendency to be larger than that on days 10-15 of pseudopregnancy and this seems to demonstrate that the placenta secreted placental lactogen by this stage of pregnancy. The average size of the corpus luteum on day 14 of pregnancy was larger than that on days 9-10 of pregnancy. This phenomenon might be attributed to the presence of large amounts of placental lactogen secreted from the placenta between days 10 and 14 of pregnancy. Furthermore, it was noted that the size of the corpus luteum on day 20 of pregnancy was larger than that of day 14, which suggests that further secretion of placental lactogen continued after day 14 of pregnancy. As there was a remarkable decrease in the number of fetuses on day 20 of pregnancy when overiectomy was performed on day 14 of pregnancy, the ovary was considered indispensable in maintaining pregnancy in the rat.     

Glycodelin protein and mRNA is downregulated in human first trimester abortion and partially upregulated in mole pregnancy.

Glycodelin (Gd) is a major reproductive glycoprotein and a mediator for immunomodulatory effects directed to cellular, humoral, and innate immunity. Human pregnancy depends on a diversity of physiological processes including modulation of the maternal immunosystem. We evaluated the expression of Gd protein and mRNA in first trimester decidual tissue of normal pregnancies and spontaneous abortion and hydatidiform moles. Furthermore, in vitro experiments on endometrial cancer cells to analyze the effect of human chorionic gonadotropin (hCG) on Gd regulation were performed. In decidual tissue of abortion patients, Gd expression was significantly decreased compared with normal gestation, which was confirmed by in situ hybridization. In mole pregnancy, an upregulation of Gd in the first 8 weeks of pregnancy was present. Gd is a main product of decidual tissue in the first trimester of human pregnancy. Reduced Gd expression in abortive pregnancy could lead to an increased activation of the maternal immunosystem, thus causing rejection of the developing fetus. Moreover, Gd expression in endometrial cancer cells in vitro could be stimulated by addition of hCG. Therefore, we speculate that hCG could be one of the factors regulating Gd expression because hCG is downregulated in women with abortion and upregulated in mole pregnancy. In addition, we found a positive feedback loop in Gd and hCG expression in human pregnancy.     

Diabetes Insipidus in Pregnancy: Etiology,Evaluation, and Management

ObjectiveTo review the approach to a patient with diabetes insipidus during pregnancy.MethodsThis review examines the normal physiology of water homeostasis, the related changes that occur during pregnancy, and the pathophysiology of diabetes insipidus in pregnancy. Associated complications, evaluation, and management are discussed.ResultsDiabetes insipidus can complicate up to 1 in 30000 pregnancies. Diabetes insipidus during pregnancy has a variety of causes, some that predate the pregnancy and others that begin during gestation. Polyuria and polydipsia can occur or be exacerbated in women with overt or subclinical central or nephrogenic diabetes insipidus. These women have either decreased central secretory reserve or impaired renal responsiveness to vasopressin. In addition, women can experience diabetes insipidus de novo in pregnancy through the actions of placental vasopressinase, which causes accelerated degradation of vasopressin. This form of diabetes insipidus may be associated with increased complications of pregnancy, including preeclampsia. Management of central diabetes insipidus and transient diabetes insipidus of pregnancy can be achieved with 1-deamino-8-D-arginine vasopressin (desmopressin acetate) (DDAVP), a vasopressin analogue. Nephrogenic diabetes insipidus is typically resistant to both DDAVP and vasopressin and underlying causes should be addressed.ConclusionsIncreased awareness of diabetes insipidus in pregnancy may lead to early diagnosis and appropriate treatment that will reduce the risks of maternal and fetal morbidity. Overall, growing experience with DDAVP has shown that it is a safe and effective treatment for diabetes insipidus caused by a variety of factors. (Endocr Pract. 2009;15:377-382)     

The cardiovascular paradox of pregnancy

Despite widespread accessibility to prenatal care, little is known on the mechanisms initiating early maternal adaptation to pregnancy. Moreover, preeclampsia and intrauterine growth retardation remain the most frequent and serious complications of pregnancy. Recent studies, both in humans and in laboratory animals, have shown that very early events in gestation may be important determinants for the continuation of healthy pregnancy. Certain of these early adaptations appear to be linked to the corpus luteum of pregnancy, as ovarian steroid hormones (especially progesterone) would set the basic hemodynamic conditions, more specifically, generalized vasodilation. This new hemodynamic setup initiates a vicious cycle in which the renin - angiotensin - aldosterone system is activated, together with the resetting of the control of antidiuretic hormone secretion relative to plasma osmolality. This leads to a gradual and substantial increase in plasma volume and a parallel increase in cardiac function (both heart rate and stroke volume) with the goal of maintaining blood pressure in the face of the generalised vasodilation. This includes the creation of a functional arterio-venous shunt represented by the utero-placental circulation. By the end of the first trimester, the decrease in peripheral vascular resistance is marked relative to the increase in cardiac output, resulting in a significant decrease in blood pressure that will be maintained until the third trimester. It is proposed that in preeclampsia, these very early events (vasodilation - increased plasma volume) fail to occur, resulting in an absence of the usual decrease in blood pressure, which is normally seen in the second trimester of pregnancy, and hypertension in the third trimester. Experimental animals, especially the rat, are suitable models to study this early maternal adaptation to pregnancy, since both endocrine and hemodynamic changes appear to be similar to humans.     

Evidence for a role of progesterone in the control of uterine ornithine decarboxylase in the pregnant hamster

Changes in uterine ornithine decarboxylase (ODC) activity throughout pregnancy and the importance of progesterone in the regulation of this enzyme during the early post-implantation period have been studied in the hamster. Soon after implantation, from day 5 to day 6 of pregnancy, ODC activity rapidly increased. It reached a plateau on day 7, then abruptly fell on day 8 and remained low until the end of pregnancy. DL-alpha-difluoromethyl-ornithine (DFMO), an irreversible inhibitor of ODC, induced pregnancy termination as a consequence of the reduction of uterine ODC activity. When pregnancy arrest was induced by removing endogenous progesterone by administration of prostaglandin F2 alpha (PGF2 alpha) or by ovariectomy, the ODC rise was completely abolished, and exogenous progesterone was able to entirely counteract this effect on the enzyme activity and the termination of pregnancy. These results suggest that progesterone play a significant role in the rise of uterine ODC activity, which appears to be essential for the early post-implantation events needed for pregnancy maintenance.     

Mating Increases Neuronal Tyrosine Hydroxylase Expression and Selectively Gates Transmission of Male Chemosensory Information in Female Mice

Exposure to chemosensory signals from unfamiliar males can terminate pregnancy in recently mated female mice. The number of tyrosine hydroxylase-positive neurons in the main olfactory bulb has been found to increase following mating and has been implicated in preventing male-induced pregnancy block during the post-implantation period. In contrast, pre-implantation pregnancy block is mediated by the vomeronasal system, and is thought to be prevented by selective inhibition of the mate’s pregnancy blocking chemosignals, at the level of the accessory olfactory bulb. The objectives of this study were firstly to identify the level of the vomeronasal pathway at which selective inhibition of the mate’s pregnancy blocking chemosignals occurs. Secondly, to determine whether a post-mating increase in tyrosine hydroxylase-positive neurons is observed in the vomeronasal system, which could play a role in preventing pre-implantation pregnancy block. Immunohistochemical staining revealed that mating induced an increase in tyrosine-hydroxylase positive neurons in the arcuate hypothalamus of BALB/c females, and suppressed c-Fos expression in these neurons in response to mating male chemosignals. This selective suppression of c-Fos response to mating male chemosignals was not apparent at earlier levels of the pregnancy-blocking neural pathway in the accessory olfactory bulb or corticomedial amygdala. Immunohistochemical staining revealed an increase in the number of tyrosine hydroxylase-positive neurons in the accessory olfactory bulb of BALB/c female mice following mating. However, increased dopamine-mediated inhibition in the accessory olfactory bulb is unlikely to account for the prevention of pregnancy block to the mating male, as tyrosine hydroxylase expression did not increase in females of the C57BL/6 strain, which show normal mate recognition. These findings reveal an association of mating with increased dopaminergic modulation in the pregnancy block pathway and support the hypothesis that mate recognition prevents pregnancy block by suppressing the activation of arcuate dopamine release.     

Diagnosis of pregnancy in the ewe at mid-gestation

Detection of the pregnancy-specific antigen, chorionic somatomammotrophin in serum was applied to the diagnosis of pregnancy in a commercial-type flock of 286 sheep 70 days after joining with rams. At the time of testing the ewes were between Days 47 and 70 of pregnancy. Based upon lambing results, the positive diagnoses were 97% correct. However, the accuracy in diagnosing non-pregnancy, which rose from 85% when all the ewes (Day 47–70) were considered to 99% after Day 55, suggest that some pregnant ewes whose stage of pregnancy was earlier than Day 55 were not being detected and were wrongly designated non-pregnant. This pregnancy test can be successfully used from Day 55, although a correct prediction of pregnancy was made in 40 ewes between Days 47 and 54.     

Baseline and stress-induced glucocorticoids during reproduction in the variable flying fox, Pteropus hypomelanus (Chiroptera: Pteropodidae)

Baseline and stress-responsive glucocorticoid (GC) levels were assessed during early pregnancy, late pregnancy, and lactation in female variable flying foxes (Pteropus hypomelanus) and in males over the same time period. Animals were maintained in a breeding colony in captivity. High levels of both cortisol and corticosterone were detected, with total plasma GC levels being among the highest documented in vertebrates (up to 3000 ng/ml in individual animals, with cortisol being the primary GC, accounting for approximately 78% of total GCs), and significantly greater in males than in females. Plasma levels of cortisol and corticosterone showed nearly identical profiles within each sex, with the exception of females in late pregnancy, in which corticosterone, but not cortisol, increased significantly. Baseline levels of plasma cortisol were highest in September (when pups were between 1 and 2 months of age) in both sexes, which may be related to the approaching onset of the mating period. There was a continuum in the magnitude of the response to stress (handling and sampling) over time in females, with the greatest stress response in early pregnancy, a dampened response during late pregnancy, and no significant stress response during lactation. Surprisingly, males failed to exhibit elevated GCs after this stress, but did have significant stress-induced hyperglycemia and suppression of plasma testosterone levels. This may be due to their high (perhaps maximal) baseline levels, which suggests that being in a breeding group was chronically stressful for males.