Characteristics and health consequences of adolescent sexual assault at Police General Hospital, Thailand.

OBJECTIVE: To describe the characteristic and epidemiology ofadolescent sexual assaults and to compare health consequences between adolescent and adult victims. MATERIAL AND METHOD: Retrospective review of sexual assault victims records of those who were examined in sexual assault program in Police General Hospital between January 1 and December 31, 2012. RESULTS: There were 335 cases ofadolescents sexual assault victims. Most of them were in junior high school (62.4%). Most adolescent sexual assaults were committed by boyfriends (50.3%) and acquaintance/friends (14.7%). The most common place for the assaults was the offender's residence (52.9%). Delayed medical evaluation was common. Only 49.4% attended medical evaluation within 72 hours. Adolescent victims had a higher pregnancy rate than adult victims (9.0% vs. 3.6%), but lower rate of non-genital injuries (14.6% vs. 36.3%). Only labia minora injury of adolescent was significantly lower than adult (9.3% vs. 17.5%) among genital injuries. Hepatitis B infection rate of adolescent was lower than adult (1.2% vs. 4.5%), whereas other types of infection were not different. CONCLUSION: Thai adolescents had set the unique assault characteristic different from adult victims. Adolescent victims were mainly assaulted by boyfriends at assailant's residence, with higher pregnancy rate than other international reports. Promote education to adolescences is highly recommended to decrease cases of rape and rape-related pregnancy in female adolescent.

Natural selection of human embryos: decidualizing endometrial stromal cells serve as sensors of embryo quality upon implantation.

BACKGROUND: Pregnancy is widely viewed as dependent upon an intimate dialogue, mediated by locally secreted factors between a developmentally competent embryo and a receptive endometrium. Reproductive success in humans is however limited, largely because of the high prevalence of chromosomally abnormal preimplantation embryos. Moreover, the transient period of endometrial receptivity in humans uniquely coincides with differentiation of endometrial stromal cells (ESCs) into highly specialized decidual cells, which in the absence of pregnancy invariably triggers menstruation. The role of cyclic decidualization of the endometrium in the implantation process and the nature of the decidual cytokines and growth factors that mediate the crosstalk with the embryo are unknown. METHODOLOGY/PRINCIPAL FINDINGS: We employed a human co-culture model, consisting of decidualizing ESCs and single hatched blastocysts, to identify the soluble factors involved in implantation. Over the 3-day co-culture period, approximately 75% of embryos arrested whereas the remainder showed normal development. The levels of 14 implantation factors secreted by the stromal cells were determined by multiplex immunoassay. Surprisingly, the presence of a developing embryo had no significant effect on decidual secretions, apart from a modest reduction in IL-5 levels. In contrast, arresting embryos triggered a strong response, characterized by selective inhibition of IL-1beta, -6, -10, -17, -18, eotaxin, and HB-EGF secretion. Co-cultures were repeated with undifferentiated ESCs but none of the secreted cytokines were affected by the presence of a developing or arresting embryo. CONCLUSIONS: Human ESCs become biosensors of embryo quality upon differentiation into decidual cells. In view of the high incidence of gross chromosomal errors in human preimplantation embryos, cyclic decidualization followed by menstrual shedding may represent a mechanism of natural embryo selection that limits maternal investment in developmentally impaired pregnancies.

Natural selection of human embryos: impaired decidualization of endometrium disables embryo-maternal interactions and causes recurrent pregnancy loss.

BACKGROUND: Recurrent pregnancy loss (RPL), defined as 3 or more consecutive miscarriages, is widely attributed either to repeated chromosomal instability in the conceptus or to uterine factors that are poorly defined. We tested the hypothesis that abnormal cyclic differentiation of endometrial stromal cells (ESCs) into specialized decidual cells predisposes to RPL, based on the observation that this process may not only be indispensable for placenta formation in pregnancy but also for embryo recognition and selection at time of implantation. METHODOLOGY/PRINCIPAL FINDINGS: Analysis of mid-secretory endometrial biopsies demonstrated that RPL is associated with decreased expression of the decidual marker prolactin (PRL) but increased levels of prokineticin-1 (PROK1), a cytokine that promotes implantation. These in vivo findings were entirely recapitulated when ESCs were purified from patients with and without a history of RPL and decidualized in culture. In addition to attenuated PRL production and prolonged and enhanced PROK1 expression, RPL was further associated with a complete dysregulation of both markers upon treatment of ESC cultures with human chorionic gonadotropin, a glycoprotein hormone abundantly expressed by the implanting embryo. We postulated that impaired embryo recognition and selection would clinically be associated with increased fecundity, defined by short time-to-pregnancy (TTP) intervals. Woman-based analysis of the mean and mode TTP in a cohort of 560 RPL patients showed that 40% can be considered "superfertile", defined by a mean TTP of 3 months or less. CONCLUSIONS: Impaired cyclic decidualization of the endometrium facilitates implantation yet predisposes to subsequent pregnancy failure by disabling natural embryo selection and by disrupting the maternal responses to embryonic signals. These findings suggest a novel pathological pathway that unifies maternal and embryonic causes of RPL.