Total ovarian volume before human chorionic gonadotrophin administration for ovulation induction may predict the hyperstimulation syndrome

Total ovarian volumes were measured before the administrationof HCG in 42 women undergoing treatment for infertility by in-vitrofertilization (IVF) and embryo transfer and considered to havean exaggerated response to stimulation (>20 follicles). Sevenwomen who subsequently developed moderate or severe ovarianhyperstimulation syndrome (OHSS) (n = 7; group 1) were comparedwith 35 matched controls (five matched controls per case; n= 35; group 2) of similar age, number of follicles and durationof infertility who underwent follicular stimulation, oocyterecovery, in-vitro fertilization and embryo transfer duringthe same period but did not develop moderate or severe OHSS.The mean age, duration of infertility and total number of follicleswere similar but the mean total ovarian volume was significantlyhigher in the group of women who developed moderate or severeOHSS compared with controls (271.00 ± 87.00 versus 157.30± 54.20 ml; P < 0.01). We conclude that total ovarianvolume measured before HCG administration is higher in womenwho develop moderate or severe OHSS compared with controls andmay therefore be used as an additional parameter in the preventativestrategy for the ovarian hyperstimulation syndrome.     

Endocrinology: Pituitary down-regulation prior to in-vitro fertilization and embryo transfer: a comparison between a single dose of Zoladex depot and multiple daily doses of Suprefact

In order to further evaluate the endocrinological, embryologicaland clinical efficacy of a single injection of the gonadotrophin-releasinghormone (GnRH) analogue Zoladex (goserelin), 142 women underwentpituitary down-regulation prior to in-vitro fertilization andembryo transfer: 71 with a single injection of Zoladex depot(group I) and 71 matched controls with multiple daily injectionsof Suprefact (buserelin; group II). Ovarian stimulation wasperformed with human menopausal gonadotrophin (HMG) and ovulationinduction with human chorionic gonadotrophin (HCG). HMG andhydroxyprogesterone caproate depot were given for luteal phasesupport. The mean (± SD) age (34.01 ± 4.42 versus34.81 ± 4.00 years), mean total dosage of HMG (61.25± 26.87 versus 56.17 ± 25.18 ampoules), mean dailydosage of HMG (4.74 versus 4.94 ampoules), duration of HMG stimulation(12.91 ± 3.68 versus 11.31 ± 3.46 days) and oestradiolconcentration on the day of HCG (10 082 ± 8007 versus9440 ± 7840 pmol/l) were similar in both groups but themean total number of injections (GnRH and HMG) (13.55 ±3.35 versus 55.37± 31.92) was significantly lower ingroup I. Furthermore, the proportion of women down-regulatedby 2 weeks and pregnancy rate per embryo transfer were significantlyhigher in the Zoladex group, while miscarriage rates were similar.We conclude that a single dose of Zoladex is quicker, more convenientand should be investigated as an equally effective alternativeto mutiple doses of Suprefact for pituitary down-regulationprior to assisted conception. Further studies are required totest the teratogenicity and effectiveness of Zoladex.     

Differential gene expression profiling of cultured neu-transformed versus spontaneously-transformed rat cholangiocytes and of corresponding cholangiocarcinomas

Previously, we described an orthotopic cholangiocarcinoma model based on bile duct inoculation of spontaneously-transformed low grade malignant rat BDE1 cholangiocytes (BDEsp cells) compared to high grade malignant erbB-2/neu- transformed BDE1 cholangiocytes (BDEneu cells) into the livers of syngeneic rats, which closely mimics clinical features of early versus advanced stages of the human cancer. We now used gene expression microarray together with quantitative real-time RT-PCR to profile genes differentially expressed in highly tumorigenic BDEneu cells and corresponding tumors compared to less aggressive tumorigenic BDEsp cells and tumors. Genes identified as being commonly overexpressed in parent BDEneu cells, tumors, and in a BDEneu tumor-derived cholangiocarcinoma cell line included Sox17, Krt20, Erbb2, and Sphk1 when respectively compared to BDEsp cells, tumors, and tumor-derived BDEsp cholangiocarcinoma cells. Muc1 was also prominently overexpressed in BDEneu cells and tumor-derived cholangiocarcinoma cells over that expressed in corresponding BDEsp cell lines. Periostin and tenascin-C, which were produced exclusively by cholangiocarcinoma-associated fibroblastic cells, were each significantly overexpressed in BDEneu tumors compared to BDEsp tumors. Interestingly, amphiregulin was representative of a gene found to be significantly underexpressed in vitro in BDEneu cells compared to BDEsp cells, but significantly overexpressed in BDEneu tumors compared to BDEsp tumors, and correlated with BDEneu cholangiocarcinoma progression in vivo. Our data support a unique animal model that recapitulates important molecular features of human cholangiocarcinoma progression, and may serve as a potentially powerful preclinical platform for identifying and rapidly testing novel molecular targeting strategies for cholangiocarcinoma therapy and/or prevention.     

Mental Health in Women With Traumatic Brain Injury: A Systematic Review on Depression and Hope

The prevalence of traumatic brain injury (TBI) in women has recently increased from 25% to 40%. Current literature inadequately captures challenges women face after injury, including depression. The limited focus on depression is problematic as rates of depression are increasing simultaneously with rates of TBI. A disabling symptom of depression is lack of hope; thus, depression, comorbid with TBI, leads to disability among women. Unfortunately, depression and hope among women with TBI has yet to be systematically examined. The purpose of this systematic review is to examine and synthesize current literature focusing on women with TBI, comorbid with depression, and hope.