[Clinical study of percutaneous vertebroplasty combined with (125)I seeds implantation in the treatment of patients with thoracic metastatic tumor complicated with posterior vertebral defect].

Objective: To analyze the safety and efficacy of percutaneous vertebroplasty combined with interstitial implantation (125)I of seeds (PVPI) in the treatment of thoracic vertebroplasty with posterior vertebra defect. Methods: A retrospective analysis of the clinical data of 64 patients with thoracic spine metastases admitted to Yunnan Cancer Hospital from November 2017 to May 2019 was conducted, including 32 patients with posterior vertebra defect (experimental group) and 32 cases without (control group). Forty-two vertebral bodies of 32 patients in the experimental group were treated with improved PVPI surgery, which performed with the secondary sealing method and inclined puncture needle injection bone cement rotary filling technology, to reduce leakage. The 54 vertebral bodies of 32 patients in control group underwent PVPI. The two groups of patients were followed up on the second day, one month, three months and six months after the operation, and the short-term efficacy, long-term efficacy and safety indicators of the two groups were compared. Results: All 64 patients successfully completed the surgical treatment. The visual analogue scores and Karnofsky scores of the experimental group and the control group were improved to varying degrees on the second day, 1 month, 3 months and 6 months after the operation. There was no statistically significant difference between the two groups (P>0.05). The amount of bone cement in the experimental group and control group was (2.36±0.20) ml and (2.39±0.17) ml, and the difference was not statistically significant (P=0.482). The amount of (125)I seed implantation was (30.63±0.91) and (32.56±0.68), respectively, the difference was not statistically significant (P=0.925). The partial response rates of the study group and the control group were 81.3% and 87.5%, the stable disease rates were 12.5% and 9.4%, the differences were not statistically significant (P>0.05). The median overall survival (mOS) of the study group was 13 months, and the median progression-free survival (mPFS) was 8 months. The mOS of the control group was 14 months, and the mPFS was 8 months. The differences were not statistically significant (P>0.05). In the experimental group, 6 (14.3%) vertebral bodies had cement leakage, of which 2 (4.8%) were cement leakage at posterior vertebra, 4 (9.5%) were paravertebral cement leakage. Seven (13.0%) paravertebral cement leakage occurred in the control group. There was no significant difference in bone cement leakage between the two groups (P=0.097). Bone cement leakage in both groups did not cause serious complications such as spinal cord injury and paraplegia. Conclusion: The application of PVPI in the treatment of thoracic metastatic tumor patients with posterior vertebra defect can acquire better clinical efficacy and safety through conduction of the improved intraoperative technology and paying more attention to the control of bone cement distribution and other issues.

Outcome of pediatric acquired aplastic anemia: a developing world experience.

INTRODUCTION: Outcome data of children with acquired aplastic anemia (AA) are lacking from the developing world. Here, we describe the same from a centre in North India. METHODS: Retrospective data regarding medical history, physical examination, complete blood count, bone marrow aspirate, and biopsy were retrieved for all children <18 years, with acquired AA admitted between January 2005 and June 2012. In addition, the outcome data after immunosuppressive therapy (IST) or bone marrow transplant (BMT) was obtained. RESULTS: A total of 61 children were diagnosed with AA (Inherited-18 and acquired-43). Among 43 children with acquired AA, 3 had nonsevere and 40 had severe. One patient with nonsevere AA died of sepsis and 2 recovered spontaneously. Of the 40 remaining children with severe AA, 10 refused therapy and 3 died due to severe sepsis prior to any therapy. Five underwent upfront matched sibling donor BMT and one post-IST failure. Four year overall survival (OS) and event free survival (EFS) for children undergoing BMT was 100% and 80 ± 17.9, respectively. Out of 22 treated with IST, 20 were evaluable for response. Seventeen received one course and 3 received two course of IST. The overall response to IST was seen in 14/20 (70%). Only two achieved complete response while remaining 12 had partial response. The 4-year estimated OS and EFS for children treated with IST was 74.4 ± 12.1% and 65.6 ± 12.2. CONCLUSION: Outcomes for children with AA are encouraging in the developing world although barriers like sepsis and treatment abandonment remain. BMT offers faster and complete recovery.

Comparative Study of Inlay and Overlay Cartilage Perichondrium Composite Graft Myringoplasty.

To compare results of inlay and overlay cartilage-perichondrium composite graft myringoplasty. The present study was conducted in the department of otorhinolaryngology, Pt. B. D. Sharma PGIMS, Rohtak. The study was conducted on 40 patients of either sex in age group of 15-50 years having unilateral or bilateral inactive (mucosal) chronic otitis media with dry ear over a period of at least 4 weeks without use of topical or systemic antibiotics after obtaining their informed and written consent. Mean age in group I was 25.25 ± 7.27 years and in group II was 25.95 ± 9.06 years. Maximum number of patients in both groups were in the age group 15-24 years. Out of the total patients, 60% were males and 40% were females. At 6 months post operatively, 95% cases in group I had successful graft take-up compared to 85% cases in group II. However, at long term follow up for 24 months, graft success rate was statistically significant in group I. In group I, 100% graft uptake was seen in large size perforation of 4 and 5 mm along with 2 mm as compared to group II, with 100% graft uptake for only small size perforation of 2 mm. The mean hearing threshold gain was 16.50 ± 5.52 dB in group I as compared to 13.03 ± 6.44 dB in group II. Mean postoperative improvement in air bone (AB) gap of 16.50 ± 5.52 dB was seen in group I as compared to 13.07 ± 6.44 dB seen in group II. The graft take up rate was found to be better in long term with inlay cartilage- perichondrium composite graft myringoplasty technique compared to over lay technique with both the groups showing significant hearing improvement post-operatively. This high success rate for graft uptake and ease to perform under local anaesthesia makes in-lay cartilage perichondrium composite graft myringoplasty technique relatively optimal to use for office based myringoplasty. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03487-w.

Cytogenetic Risk Stratification of B-Acute Lymphoblastic Leukemia and Its Correlation with Other Prognostic Factors.

Purpose of current study was to categorize WHO defined B-Acute Lymphoblastic Leukemia (B-ALL) cases into 3 cytogenetic risk groups (good, intermediate and poor) and to see their correlation with age, NCI risk criteria and treatment response. Clinical and diagnostic details were collected for 78 newly diagnosed B-ALL patients which included bone marrow morphology, flow cytometry immunophenotyping, karyotyping, FISH and RT-PCR. Study cohort comprised 44/78 (56.4%) children including 3 infants and 34/78 (43.6%) adults. Median age for paediatric group was 6 years (3 months-17 years) and for adults was 40.5 years (18 to 75 years). According to NCI risk criteria, excluding infants, 54 (72%) were high risk and 21 (28%) were standard risk. Clonal cytogenetic abnormality was detected in 59/78 cases (75.6%), while 19/78 (24.4%) cases showed normal karyotype. There was significant association of cytogenetic risk groups to age distribution (p value < 0.001) and NCI risk groups (p value < 0.001). There was no significant correlation of CNS involvement with cytogenetic risk groups (p = 0.064). Association of Day 8 steroid response and Day 15 bone marrow status with cytogenetic risk groups was significant (p = 0.006 and p = 0.003 respectively). Post treatment bone marrow status on Day 33 and Day 79 was available for 52 and 42 cases respectively. 9 adults died during induction phase. Day 33 post induction morphological remission was achieved in 51/52 cases (98%) and 1/52 (2.0%) were not in remission. Day 79 post induction morphological remission was achieved in 41/42 cases (98%) and 1/42 (2.0%) were not in remission. Day 33 or End of induction flow MRD (measurable residual disease) was negative in 39/52 (75.0%) patients and positive in 13/52 (25.0%) patients. Day 79 flow MRD was negative in 37/42 (88.1%) and positive in 5/42 (11.9%). Cytogenetic risk groups showed statistically significant Day 33 and Day 79 treatment response (morphologic remission: p = 0.009 and 0.003, flow MRD: p = 0.004 and p = 0.012 respectively). We concluded that cytogenetic risk groups showed statistically significant association with age, NCI risk criteria and treatment response.

Epidemiological, Clinical and Radiological Profile of Patients with Foreign Body Oesophagus: A Prospective Study.

To analyse the patients with foreign body oesophagus in relation to the clinico-radiological and socio-economic profile. The present prospective study was conducted on 100 consecutive patients of all age groups who underwent oesophagoscopy for suspected foreign body ingestion in a tertiary care hospital. The most common age group affected was 0-5 years. The median age was 5 ± 14.37 years. There was preponderance in males as compared to females, male to female ratio was 2.23:1. Majority (70%) of the patients, both males and females, belonged to rural areas. Lower socio-economic group was more commonly affected (54%). The most commonly reported symptom was foreign body sensation (55%) followed by vomiting (54%) and difficulty in swallowing (51%). Foreign body ingestion was witnessed in only 19% cases by the family members. The mean time between ingestion of the foreign body and admission to the hospital was found to be 4.5 h. The majority (97%) of foreign bodies were radio-opaque. The most common site of lodgement was just below the cricopharynx (89%). The most common foreign body retrieved in our series were coins (65%). The majority of foreign bodies (68%) were retrieved in 20-40 min after induction of general anaesthesia. In 99% of the patients we did not encounter any complications. The majority (93%) of the patient's parents/relatives had curiosity to have a glimpse of the foreign body till they actually saw the retrieved foreign body. Foreign body lodgement is more common among children of lower socio-economic strata more so in rural areas. Rigid oesophagoscopy is a safe and effective procedure for removal of the foreign body. Early intervention makes it easier to extract the foreign body without complications.

A study of social status of people with disabilities due to leprosy in desert part of Rajasthan, India.

Leprosy is a stigmatized disease in our society. Ninety-eight disabled leprosy patients were studied in areas of Pokaran CHC and Ramdeora PHC of Jaisalmer district. About ninety-five per cent (94.6%) leprosy patients were found discarded by their life partners due to disabilities. A positive relationship was found between social stigma and deformity due to disease. IEC need to be done at community level also for changing attitude and behaviour towards leprosy patients.

Effect of Supplementation of Fermented Yeast Culture on Hormones and Their Receptors on Exposure to Higher Temperature and on Production Performance after Exposure in Nicobari Chickens.

Heat stress (HS) affects the production performance in chickens and causes economic loss to the producers. Most of the studies have been conducted on and for the welfare of broilers. We still lack information on the physiological parameters being affected during chronic heat stress in layers. To fill this gap, the present study evaluated the effect of heat stress (induced in the chamber) during the prelaying period (21-23 weeks) on plasma levels of the hormones leptin and ghrelin and GH and expression of the respective receptors and heat stress markers. Three groups were considered, one at room temperature (CR) and the other two groups (SH and CH) subjected to heat stress at 39°C for four hours for three weeks (21-23 weeks of age). The SH group (SH) feed was supplemented with fermented yeast culture (FYC, 700 mg/kg), whereas the CH group was devoid of it. After that, all the groups were shifted to shed under natural ambient conditions till 31 weeks of age. Studies were restricted to production performance only. Feed offered without yeast culture (CH group) had a smaller concentration of plasma hormones (P < 0.01) and increased expression fold of the hormone receptors (P < 0.01). Further, the group also presented higher liver AMP kinase enzyme, plasma MDA (malondialdehyde), and cholesterol concentrations. These changes likely explained the decrease in feed intake and the CH group's body weight and further reduced the production performance during the laying period. Supplementation with FYC to birds had an opposite effect on the above-mentioned parameters, reducing HS effects. In summary, supplementation with FYC (700 mg/kg) maintained physiological parameters as in the CR group under HS conditions and negated adverse effects on parameters both before and during laying periods.

A study of treatment seeking behaviour for malaria and its management in febrile children in rural part of desert, Rajasthan, India.

BACKGROUND & OBJECTIVES: For management of malaria, there is a need to give attention on specific group of people like children >5 yr of age in the community. They are unable to explain their feelings about severity of illness and effects of treatment on health and they are dependent on others for their health care, therefore, it is the mother who can seek, obtain, and use medication appropriately. This is directly linked to the level of education, socioeconomic status, timely decision, accessibility of health facility, correct use of drugs and their follow- up. The present study was undertaken with the aim to know the basis on which malaria was recognized and classified and exploring factors involved in the selection of different treatment options in the desert population of Rajasthan. METHODS: Interview and observation techniques were used for data collection in 15 villages of Ramgarh PHC in Jaisalmer district of Rajasthan state, India. A total of 164 mothers were interviewed and observations were made by the investigators in the group discussions who utilized health facility for the febrile children < 5 yr of age. RESULTS: More than 93.3% mothers started taking care at home for their febrile children and watched for improvement on an average up to 72 h. When they thought there was no hope to manage the case at their level, they shifted their febrile children to the nearest health facility such as sub-centre/PHC/private health practitioner. Utilization of health facility was linked with the age of the child, with younger children (<24 months of age) being significantly more likely to be utilized nearby health facility than 24- 59 months children. Children judged as severely ill by their mothers utilized health facility significantly more often than those not thought to be severely ill. Mothers from households where the household heads had a primary or secondary education were more likely to utilize health facility than those household heads having no education. Similarly, mothers from households with moderate or high income utilized health facility more frequently than those with low income. INTERPRETATION & CONCLUSION: The study revealed that mothers usually tried to manage febrile cases at their own level at home for children >5 yr of age. They had gone through different treatment options before utilizing health facilities. There was, on an average three days delay in seeking care in the remote villages of desert part of Rajasthan. To minimize the delay in diagnosis and treatment of malaria among the children >5 yr of age is an urgent need for intervening through IEC programme and trained volunteers for the management of malaria cases at village-level.

Burning Feet, Dilated Heart and Failed Kidneys.

Fabry's disease, X-linked lysosomal storage disease, results from deficient activity of alpha galactosidaseA (α-GalA). Renal manifestation usually begins at third decade of life. We report a 16 year male with initial presentation with end stage renal disease (ESRD) and the diagnosis confirmed by presence of myeloid bodies on electron microscopy of kidney biopsy and low serum α-GalA level.

To Evaluate the Pre and Post Shunt Sensorineural Hearing Loss in Hydrocephalus Patients.

Hydrocephalus means watery head and defined as disturbance of formation, flow, or absorption of cerebrospinal fluid. The clinical presentation of hydrocephalus includes hearing loss especially sensorineural hearing loss (SNHL). Ventriculoperitoneal (VP) shunting is the most commonly performed procedure in these patients. Pure tone audiogram, impedence and BAEPs, were done for preoperative hearing assessment in 20 hydrocephalus patients. Out of 20 patients, 12 cases (60%) had SNHL while, rest 8 (40%) patients had mixed hearing loss. Post VP shunting hearing improvement was observed in 14 patients (70%) whereas it worsened in 30% of patients. The result is even better if shunt is placed at early age.

The Clinicopathological Study of Benign Lesions of Vocal Cords.

Benign vocal lesions are non-malignant growths of abnormal tissue on the vocal cords. The common benign lesions of vocal cord are singer's nodule, polyps, papilloma, polypoidal degeneration and cysts. The aim of this study was to analyze the demographics such as age, sex, occupation, symptomatology, site of involvement. An objective evaluation of voice handicap was done pre and postoperatively using VHI-10 scale to see improvement in patient's symptoms. In this prospective study, a total of 50 cases were selected with benign lesions in regional hospital of India. The pre and post operative assessment for voice handicap was assessed by VHI-10. Chi square test (SPSS 20.0 version) used to analyze result; value of p < 0.05 was taken significant. In this study of 50 patients, the benign lesions were most common in 20-29 age group. Male (70%) outnumbered females (30%). Most common was Vocal polyp (56%), followed by nodule (32%), cyst (10%) and papilloma (2%) respectively. All patients showed improvement after phonosurgery and postoperative speech therapy, being assessed by VHI-10 scale. The benign lesions of vocal cords produces symptoms which can vary from hoarseness to stridor, affect social functioning, work performance. Speech therapy following microlaryngeal surgery forms an essential part of treatment, to avoid recurrence. VHI-10 scale as found to be a useful and convenient tool in measuring patient voice handicap and to see improvement after surgery.

Studying the result of underlay myringoplasty using platelet-rich plasma.

OBJECTIVE: Perforations of the tympanic membrane are treated with various surgical techniques and materials. This study aimed to determine the efficacy of platelet-rich plasma during underlay myringoplasty. METHODS: The study included 40 patients. Autologous platelet-rich plasma was applied in-between temporalis fascia graft and tympanic membrane remnant during underlay myringoplasty in group 1 (n = 20). The outcome was evaluated after three months and compared with group 2 (n = 20), a control group that underwent routine underlay tympanoplasty. RESULTS: After three months' follow up, graft uptake was 95 per cent in group 1 and 85 per cent in group 2 (p < 0.03). Mean hearing threshold gain was 18.62 dB in group 1 and 13.15 dB in group 2. This difference was statistically significant (p < 0.01). CONCLUSION: Platelet-rich plasma, with its ease of preparation technique, availability, low cost, autologous nature and good graft uptake rate, justifies its use in tympanoplasty type I procedures.

In vivo cell-mediated immune, hemagglutination inhibition response, hematological and biochemical values in native vs. exotic chicken breeds.

Birds (364) of both sexes, 11-wk-old, belonging to 2 native (Brown Nicobari and Ghagus) breeds and 1 exotic breed (Dahlem Red) were evaluated for cell-mediated immune response (CMI) by phytohemagglutinin-P (PHA-P), hemagglutination inhibition (HI) assay against Newcastle disease virus (NDV) antigen (LaSota stock virus), flow cytometric analysis of CD8+ cytotoxic T lymphocytes (CTLs), and hematology and biochemical assays. The cutaneous basophil hypersensitivity response PHA-P% increase in wattle thickness (mm) was highest in Ghagus (431.14 ± 22.56) which differed significantly with that of Brown Nicobari (269.1 ± 22.66) and Dahlem Red (218.42 ± 22.30). Sex-wise observation showed that females are having significantly higher response than males. Hemagglutination inhibition test was performed to determine the serum antibodies against Newcastle disease (ND) virus. Brown Nicobari showed highest HI antibody titer than Ghagus and Dahlem Red to similar vaccination program after booster NDV dose. Flow cytometry assay revealed significantly higher CTLs proliferation in Brown Nicobari than Ghagus and Dahlem Red. Moreover, CTLs were found to be higher in control group than the treatment group. Other hematological parameters (103/µL) significant difference was found in white blood cell count between Dahlem Red (38.41 ± 1.03) with that of Brown Nicobari (35.28 ± 1.04) and Ghagus (34.57 ± 1.04) in treatment groups. Same trend was observed in the Lymphocyte treatment group. However, in Granulocyte treatment group, Brown Nicobari (11.04 ± 0.35) was found to be significantly different from Dahlem Red (8.68 ± 0.34) and Ghagus (9.27 ± 0.35). Correlations between body weight at 11 wk of age and CMI, HI, cytotoxic T cell were -0.093, 0.047, and -0.036, respectively. Egg weight was found to be positively correlated with that of chick weight. Serum biochemical values showed that Dahlem Red was having significantly higher creatinine levels compared to Ghagus. Triglycerides level was also significantly higher in Ghagus compared to Dahlem Red. No significant breed effect was observed for alkaline phosphate, aspartate transaminase, and alanine transaminase. Cholesterol and total serum protein levels were significantly higher in Dahlem Red compared to Brown Nicobari.

Sociocultural factors and malaria in the desert part of Rajasthan, India.

BACKGROUND & OBJECTIVES: Malaria is a new emerging problem of Indian Thar Desert. The study was attempted to find out some sociocultural factors associated with malaria transmission in this region and to supplement social solutions to ongoing malaria control efforts in the desert part of Rajasthan. METHODS: Interview technique was used for data collection on pre-tested schedules. In all 30 households (15 from low socioeconomic group and the same number of households from the high socioeconomic group) in a village were selected following systematic random sampling technique. A total of 450 respondents were selected randomly in 15 villages of Jaisalmer district, Rajasthan. RESULTS: One-third of the respondents had neither taken treatment for malaria nor took part in the vector control operations because they did not consider mosquito bites to be harmful and took malaria as a mild disease. Outdoor sleeping habits, sharing bed with children, uneasy and suffocation feeling in using mosquito bednets or any other protective device also contributed to the spread of malaria in the study villages. INTERPRETATION & CONCLUSION: Community should be educated as a whole particularly the low socioeconomic group of people to bring changes in their beliefs, sociocultural and health practices to protect themselves from mosquito bites by using bednets, repellents and other devices, such as wire mesh screening of house doors and windows.

Treatment seeking behaviour of malaria patients in desert part of Rajasthan, India.

Malaria remains to be the most important cause of morbidity and mortality in India and in many other tropical countries with approximately 2 to 3 million new cases arising every year. In spite of arid conditions prevailing in desert part of Rajasthan, malaria is a major public health problem. A longitudinal study on social determinants of malaria has been undertaken in different villages of Ramgarh PHC of Jaisalmer district, Rajasthan. The study aims to know treatment seeking behabiour of malaria patients in the desert communities which is significantly different than the non-desert part of India. Out of 60 villages, 12 villages and 573 malaria patients were selected randomly. Interview technique was used for data collection. Information was recorded on pre-tested schedules. Self diagnosis 423 (73.8%) was more common among the respondents and 443 (77.3%) had taken treatment at home with local herbal remedies as the first treatment action. Desert population was not used to laboratory test for the malaria diagnosis. Symptoms based treatment was practised. They used private and government health facilities for the treatment of malaria. Self diagnosis for malaria was common but practised more by the poorer households. A large part of the population did not complete the full course of malaria treatment as a result drug resistance was more common. They did not use the government health facility as a first step of malaria treatment. There is need for health education with campaign emphasizing the role of mosquitoes in malaria transmission and the need for prompt medical intervention. The use of Government health services for the diagnosis and treatment of malaria by the poor should be encouraged through appropriate information, education and communication (IEC) which on the long run will be more cost effective for desert population under the national malaria control programme.

Assessment of sperm damages during different stages of cryopreservation in water buffalo by fluorescent probes.

The present study was designed to investigate the sperm damages occurring in acrosome, plasma membrane, mitochondrial activity, and DNA of fresh, equilibrated and frozen-thawed buffalo semen by fluorescent probes. The stability of sperm acrosome and plasma membrane stability, mitochondrial activity and DNA status were assessed by fluorescein conjugated lectin Pisum sativum agglutinin, Annexin-V/propidium iodide, JC-1 and TUNEL assay, respectively, under the fluorescent microscope. The damages percentage of acrosome integrity was significantly increased during equilibration and freezing-thawing process. The stability of sperm plasma membrane is dependent on stability of phosphatidylserine (PS) on the inner leaflet of plasma membrane. The frozen-thawed sperm showed externalization of PS leading to significant increase in apoptotic, early necrotic and necrotic changes and lowered high mitochondrial membrane potential as compared with the fresh sperm but all these parameters were not affected during equilibration. However, the DNA integrity was not affected during equilibration and freezing-thawing procedure. In conclusion, the present study revealed that plasma membrane and mitochondria of buffalo sperm are more susceptible to damage during cryopreservation. Furthermore, the use of fluorescent probes to evaluate integrity of plasma and acrosome membranes, as well as mitochondrial membrane potential and DNA status increased the accuracy of semen analyses.

Assessment and clinicopathological correlation of p16 expression in head and neck squamous cell carcinoma.

INTRODUCTION: Oral squamous cell carcinoma is a major cause of death throughout the developed world. It is associated with smoking and alcohol consumption. Human papillomavirus (HPV) type 16 has also been suggested to play a role in etiology of head and neck squamous cell carcinoma (HNSCC). p16 expression is now being used as a surrogate marker of HPV infection in squamous cell carcinoma and provides important prognostic information and future therapy planning. MATERIALS AND METHODS: In this prospective study, total of 75 cases of HNSCC were taken. Tumor grade was determined according to World Health Organization (WHO) criteria. p16 expression was determined by immunohistochemical staining. The obtained results were analyzed and evaluated using Chi-square test (Statistical Package for Social Sciences (SPSS) version 20), value of P <0.05 was taken significant. RESULTS: Out of 75 cases, 78.7% cases were positive for p16 (inclusive of all grades), while 21.3% cases were negative. Expression of p16 was higher in nonsmokers and nonalcohol consumers and significantly associated with paan chewing habit. No significant correlation was seen with history of abnormal sexual habits, but p16 expression was significantly correlated in cases with multiple sexual partners (P = 0.003), with increasing histological grade (P = 0.045) and in cases with lymph node metastasis (P = 0.03). CONCLUSION: As HPV integration with transcription of viral oncoprotein induces overexpression of p16, immunohistochemical expression of p16 can be used as a surrogate marker of HPV. This approach can be implemented in diagnostic laboratories and can provide support for vaccination program in high risk group.

Holoprotein formation of human chorionic gonadotropin: differential trace labeling with acetic anhydride.

The effects of holoprotein formation in human CG (hCG) on the reactivities of several of the individual amino groups of each subunit were investigated by differential trace labeling with [3H]acetic anhydride. The alpha- and beta-subunits were labeled separately, as was hCG, under conditions chosen to ensure that an average of less than one amino group was modified per molecule. Although the beta-subunit contains fewer amino groups than the alpha-subunit, most of the 3H incorporation occurred in beta at the N-terminal region. Chemical and enzymatic cleavage of the subunits enabled us to identify several individual amino groups and, from measurements of the incorporated radioactivity of the free subunits and intact hormone, determine their protection factor, which is a measure of the reactivity and thus of the local environment and changes thereof upon holoprotein formation. Lys51 and Lys91 of alpha were approximately 2-fold more reactive and less reactive, respectively, in the alpha beta complex than in the free subunit. The alpha-amino group of alpha was characterized by comparable reactivities in the heterodimer and free subunit, as was Lys44/Lys45 when analyzed as a pair; the reactivity of alpha-Lys44 was slightly less in the holoprotein than in the free subunit. The alpha-amino group and Lys2 of beta could not be resolved by available cleavage procedures; consequently they were analyzed as a pair and found to be some 2-fold less reactive in the heterodimer than in the free subunit, as was Lys104 of beta. From these results, we can conclude that subunit assembly produces changes in the microenvironments of several amino groups, attributable to steric effects, specific intermolecular interactions, and localized conformational changes. Analysis of these data with reference to the recently determined crystal structure of hydrogen fluoride-treated hCG enabled a distinction to be made of these possibilities for several of the amino groups.