Ggnbp2 Is Essential for Pregnancy Success via Regulation of Mouse Trophoblast Stem Cell Proliferation and Differentiation.

The Ggnbp2 null mutant embryos died in utero between Embryonic Days 13.5 to 15.5 with dysmorphic placentae, characterized by excessive nonvascular cell nests consisting of proliferative trophoblastic tissue and abundant trophoblast stem cells (TSCs) in the labyrinth. Lethality of Ggnbp2 null embryos was caused by insufficient placental perfusion as a result of remarkable decreases in both fetal and maternal blood vessels in the labyrinth. These defects were accompanied by a significant elevation of c-Met expression and phosphorylation and its downstream effector Stat3 activation. Knockdown of Ggnbp2 in wild-type TSCs in vitro provoked the proliferation but delayed the differentiation with an upregulation of c-Met expression and an enhanced phosphorylation of c-Met and Stat3. In contrast, overexpression of Ggnbp2 in wild-type TSCs exhibited completely opposite effects compared to knockdown TSCs. These results suggest that loss of GGNBP2 in the placenta aberrantly overactivates c-Met-Stat3 signaling, alters TSC proliferation and differentiation, and ultimately compromises the structure of placental vascular labyrinth. Our studies for the first time demonstrate that GGNBP2 is an essential factor for pregnancy success acting through the maintenance of a balance of TSC proliferation and differentiation during placental development.

Novices outperform experienced laparoscopists on virtual reality laparoscopy simulator.

BACKGROUND AND OBJECTIVES: Virtual reality has been poorly studied among gynecologic surgeons. The aim of this study was to evaluate whether performance on the Minimally Invasive Surgery Trainer-Virtual Reality (MIST-VR) laparoscopic trainer reflects laparoscopic experience among gynecologic surgeons and trainees. METHODS: Twenty-six medical students, residents, and attending gynecologic surgeons completed a MIST-VR training program. A new simulated task was then presented to each participant, who repeated the task until proficiency was reached. RESULTS: Attending physicians performed poorly when compared with medical students, requiring more than twice the number of attempts to reach proficiency (Mann-Whitney P<0.01). Among medical students and residents, there was an association between years of live laparoscopy experience and poor simulator performance (Spearman r P=0.01). CONCLUSION: Increased operating room experience and age were associated with worsening simulator performance. Several potential explanations for this trend are discussed, including lack of tactile and contextual feedback. Caution should be exercised when considering current virtual reality simulator technology as a measure of experience or ability among gynecologic surgeons.

Turner mosaicism (45,X/46,XX) diagnosed in a young woman subsequent to low oocyte maturity and failed ICSI.

OBJECTIVE: To report a case of Turner mosaicism with low oocyte maturity during ICSI. DESIGN: Retrospective case report. SETTING: Academic tertiary medical center. PATIENT(S): A 28-year-old patient with 7-year history of primary unexplained infertility. INTERVENTION(S): Four cycles of ICSI. MAIN OUTCOME MEASURE(S): Oocyte quality; fertilization, cleavage, and implantation rates; and live births during ICSI cycles; as well as patient karyotype were obtained. RESULT(S): Over four cycles of ICSI, 111 oocytes were harvested, a high follicular response, but 68% were immature (germinal vesicles or metaphase I). Additionally, seven embryos were transfered, but none implanted. Owing to this unusual response in a young healthy woman, maternal karyotype was performed, which demonstrated 17% Turner mosaicism. CONCLUSION(S): This is, to our knowledge, the first reported case of excellent ovarian response but marked oocyte immaturity in a young woman with Turner mosaicism. The implications of sex chromosome aneuploidy on fertility and the significance of low oocyte maturity are discussed.