TB-related technical enquiries received in Japan, 2017-2019

SETTING

Japan, an intermediate TB burden country.

OBJECTIVE

To review TB-related technical enquiries received at the Research Institute of Tuberculosis, Japan, from January 2017 to December 2019.

DESIGN

This was a cohort study.

RESULTS

A total of 2,197 enquiries were analysed. On average, 61.0 enquiries/month (range: 42-81) were received. The enquiry rates were highest for the Yamanashi (4.65/100,000 population) and Ishikawa (4.55) Prefectures, and lowest in the Yamagata (0.46) and Tochigi (0.56) Prefectures. The main organisations the enquirers belonged to were local governments (n = 1,585, 72.1%) and healthcare facilities (n = 307, 14.0%). The enquirers were medical doctors (n = 391, 17.8%), nurses (n = 1,207, 54.9%), other healthcare professionals (n = 57, 2.6%), the general public (n = 168, 7.6%) and others/unknown (n = 374, 17.0%). The most frequent enquiries were about TB diagnosis and treatment (n = 501, 22.8%), including laboratory diagnosis (n = 88, 4.0%), TB treatment in general (n = 93, 4.2%) and management of comorbidities (n = 86, 3.9%), followed by contact investigations (n = 385, 17.5%) and TB in foreigners (n = 344, 15.7%).

CONCLUSION

As the most frequent enquiries were about diagnosis and treatment of TB, the health ministry of Japan should maintain a few specialised TB institutions with TB physicians to provide technical assistance.

The bacteriostatic effect of erythritol on canine periodontal disease-related bacteria

Erythritol helps both prevent and improve periodontal disease and is therefore widely used for dental care in humans. However, only a few studies have investigated the effects of erythritol on periodontal disease in animals. We hypothesized that erythritol could be used to prevent and improve periodontal disease also in canines and investigated the effects of erythritol on canine periodontal disease-related pathogenic bacteria using both in vitro and in vivo methods. The effect of erythritol on the proliferation of Porphyromonas gulae, which is reportedly associated with canine periodontal disease, was investigated in vitro. In addition, a 4-week intervention trial using an external gel preparation containing 5% erythritol was performed in canines with mild periodontal disease; changes in the microbiota around periodontal lesions were investigated using next-generation sequencing and bioinformatics analysis. The growth of P. gulae was significantly suppressed by erythritol in vitro. In the intervention study, the Shannon index, an indicator of the species distribution α-diversity, and the occupancy of several canine periodontal disease - related bacteria ( P. gulae, P. cangingivalis) were significantly decreased in periodontal lesions. Based on the results of in vitro and in vivo studies, we conclude that, as in humans, erythritol has bacteriostatic effects against periodontal disease - related bacteria in canines.

Tuberculosis-related technical enquiries received by a national level institution in Japan, 2014-2016

Background: Japan had a tuberculosis (TB) notification rate of 13.9 per 100 000 population in 2016. Objectives: To characterise TB-related enquiries received by the Research Institute of Tuberculosis, Tokyo, Japan, between January 2014 and December 2016. Design: A descriptive study of the time, place and other attributes of the enquiries. Results: A total of 1864 enquiries were listed for analysis. On average, 51.8 enquiries (range 30-77) were received per month. The enquiry rates were highest for Yamanashi (5.87/100 000) and Kochi (5.77) Prefectures, and lowest in Miyazaki (0.45) and Saga (0.48) Prefectures. Enquirers belonged mostly to local governments (n = 1212, 65%) and health care facilities (n = 386, 21%), and included medical doctors (n = 412, 22%), nurses (n = 926, 50%) and the general public (n = 150, 8.0%). Most enquiries concerned TB diagnosis and treatment (n = 475, 25%), including diagnosis in general (n = 38, 2.0%), laboratory diagnosis (n = 83, 4.5%), anti-tuberculosis treatment in general (n = 62, 3.3%) and the management of comorbidities or adverse events (n = 60, 3.2%), followed by contact investigations (n = 371, 20%). Conclusions: As most enquiries concerned the diagnosis and treatment of TB, the Ministry of Health of Japan should maintain a number of specialised TB institutions with TB clinicians to provide technical assistance.

TPD-TG-MS study of carbonate calcium hydroxyapatite particles

Simultaneous temperature-programmed desorption, mass spectroscopy, and thermogravimetry (TPD-MS-TG) were carried out to explore the evolution process of H2O and CO2 from calcium hydroxyapatite particles containing carbonate ions of 0.1-10.1 mass%. The TPD-MS curves of both H2O and CO2 exhibited two peaks: desorption of H2O and CO2 adsorbed on the particles below 600 degrees C, and liberation of H2O and CO2 in the crystals above 700 degrees C. The increase of carbonate ion content in the particles increased the weight loss in the TPD-TG curves.

Phage typing and DNA-based comparison of strains of enterohemorrhagic Escherichia coli O157 from apparently sporadic infections in Osaka City, Japan, 1996

A marked increase in sporadic cases of enteritis due to enterohemorrhagic Escherichia coli serogroup O157 occurred in Osaka City, Japan, during 1996. To elucidate why the number of cases had increased, the isolates were classified using phage typing, random amplified polymorphic DNA analysis, and pulsed-field gel electrophoresis (PFGE). Fifty-seven percent of the isolates (105/184) belonged to the same phage type (PT-32) and gave the same PFGE pattern; the clone had been isolated during a 3-week period, with a peak on July 15. It was concluded that the majority of the cases identified in July 1996 formed an outbreak, although epidemiological links to a possible common source were not established. The possibility that this outbreak was part of a huge regional outbreak including children at primary schools in Sakai City was discussed.

Preparation and Characterization of Carbonated Barium Hydroxyapatites

Carbonated barium hydroxyapatite (Ba10(PO4)6(OH)2-2x(CO3)x, X = 0.30-0.57, BaHAP) particles with different Ba/P molar ratios were prepared by a wet method. CO2-3 ions were incorporated into OH- sites of a BaHAP lattice during the preparation at high solution pH. The obtained BaHAP particles were well crystallized and showed a high thermostability. On elevating the mixing temperature of H3PO4 and Ba(OH)2 solutions, the mean particle size of BaHAP particles decreased and their specific surface area increased. The amount of CO2 adsorbed irreversibly on BaHAP particles increased with an increase of their Ba/P molar ratio. Copyright 1999 Academic Press.

Adsorption of Bovine Serum Albumin and Lysozyme on Hydrophobic Calcium Hydroxyapatites

The adsorption of bovine serum albumin (BSA) and lysozyme (LSZ) to oleyl phosphate(OP)-grafted calcium hydroxyapatite (OP-CaHAP) with different degrees of hydrophobicity, ranging the number of surface oleyl group per unit nm2 (nO) from 0 to 2.60, was investigated. The pronounced effects of the hydrophobic moiety of adsorbent on protein adsorption were observed. The saturated amount of adsorbed BSA (ns) was increased up to nO = 0.6 by an enlargement of hydrophobic interaction between hydrophobic CaHAP particle and proteins. However, ns decreased at nO >/= 1.3 by increasing the electrostatic repulsive force between negatively charged BSA and OP-CaHAP particles. On the other hand, the ns value of LSZ was continuously increased up to nO = 2.0 and saturated by increasing either the hydrophobic interaction or the electrostatic attraction of positively charged LSZ and negatively charged OP-grafted CaHAPs. The BSA adsorption experiment revealed that the effect of positively charged adsorption sites on the exposed ac or bc crystal faces (C-sites) of the CaHAPs is screened by the OP-groups grafted on their particle surfaces. Copyright 1999 Academic Press.

Epidemiology and properties of heat-stable enterotoxin-producing Escherichia coli serotype O169:H41

Enterotoxigenic Escherichia coli (ETEC) serotype O169:H41 organisms have become the most prevalent ETEC in Japan since the first outbreak in 1991. It was assumed that the outbreaks were due to clonal spread of this new ETEC serotype. The relationship of 32 strains isolated from 6 outbreaks were examined for biotype, antibiotic susceptibility, enterotoxigenicity, protein banding pattern, lipopolysaccharide banding pattern, plasmid analysis, and ribotyping. Further, the strains were examined by haemagglutination, surface hydrophobicity, and the ability to adhere to HEp-2 cells. The present study suggests that the outbreaks were caused by multiple clones of STp-producing O169:H41 since they showed differences in ribotype and outer membrane protein banding patterns. The strains did not agglutinate human or bovine red blood cells in a mannose-resistant manner. They adhered to HEp-2 cells in a manner resembling enteroaggregative E. coli. Five strains were examined by dot-blot tests for the colonization factor antigens CFA/I, CS1, CS2, CS3, CS4, CS5, CS6, CS7, PCFO159, PCFO166 and CFA/III. Although four strains expressed CS6, no structure for CS6 was identified. A strain that the anti-CS6 MAbs did not react with could adhere to HEp-2 cells in mannose resistant manner; thus, it is unlikely that CS6 play an important role in the adhesion to the cells. Electron microscopy studies of the O169:H41 strains suggested that curly fimbriae, a possible new colonization factor, may be playing an important role in the adhesion of the bacteria to HEp-2 cells. In conclusion, outbreaks due to ETEC O169:H41 were caused by multiple clones, and the strains should be examined in detail for a possible new colonization factor.

Preparation and Characterization of Barium-Strontium Hydroxyapatites

Barium-strontium hydroxyapatite solid solutions with different molar ratio Ba/(Ba + Sr) were synthesized by a wet method and characterized by various means. The solid solution particles could be prepared at molar ratios ranging from 0 to 1; however, Ba2+ ions were more difficult to be incorporated into hydroxyapatite crystals compared to Sr2+ ions. With increasing Ba2+ content, the particles grew and finally turned into pure rod-shaped barium hydroxyapatite particles with a size of ca. 0.2 x 2 &mgr;m. The resulting particles were agglomerates consisted of primary fine particles except for strontium hydroxyapatite. The molar ratios (Ba + Sr)/P of all the particles were larger than the stoichiometric ratio of 1.67, suggesting that CO32- ions, OH- ions, and/or H2O molecules substitute for PO43- ions in the crystal lattices. The amount of CO2 adsorbed irreversibly on the particles increased with increasing (Ba + Sr)/P except for strontium hydroxyapatite and fitted a curve with a minimum at a cation/P ratio of ca. 1.56 as well as other HAPs.

Prevalence of Toxocara spp. eggs in sandpits of parks in Osaka city, Japan, with notes on the prevention of egg contamination by fence construction

Toxocara spp. eggs were detected from 30 (75%) out of 40 sandpits of parks, in Osaka city. This prevalence was higher compared to those reported other areas of Japan. Since we examined a large quantity of sample, this could have resulted to higher prevalence. The number of eggs recovered decreased following fence construction around sandpits, but it did not sufficiently prevent the contamination of eggs. Improvement of fence design and education of sandpit users are necessary when contemplating fence construction around sandpits as a measure against contamination with Toxocara spp. eggs.

Evaluation of serotyping, biotyping, plasmid banding pattern analysis, and HEp-2 vacuolation factor assay in the epidemiological investigation of Bacillus cereus emetic-syndrome food poisoning

To assess the value of the plasmid banding patterns, the vacuolation factor (VF) assay, biotyping, and serological typing as epidemiological markers for strains of Bacillus cereus causing emetic-syndrome illness, 43 isolates from five outbreaks and an additional 76 strains isolated in food-poisoning outbreaks caused by other enteric pathogens were examined by these techniques, and the results were compared. Thirty-eight (88%) of the 43 outbreak strains produced vacuolation responses in HEp-2 cells and were all starch-hydrolysis negative. The other 76 strains associated with outbreaks caused by other food-poisoning bacteria gave all negative VF production results except four strains, and 56 (74%) of these strains produced positive reactions in starch hydrolysis tests. Starch hydrolysis emerged as a convenient screen for VF production, because no starch hydrolysis-positive strains produced VF. With the exception of one isolate, all 38 VF-positive isolates from emtic-syndrome outbreaks were serotype H.1. Isolates from four of the five outbreaks revealed identical plasmid banding patterns in each outbreak, whereas only three of eight serotype H.1 strains from the fifth outbreak exhibited indistinguishable plasmid banding patterns. These results suggest that the plasmid banding pattern analysis may be of value in discriminating between isolates of the same serotype, and establishing if an outbreak arises from a common food source. In conclusion, the vacuolation factor assay combined with the plasmid banding patterns proved to be a valuable tool for the epidemiological investigation of emetic-syndrome outbreaks caused by B. cereus. Moreover, these methods are particularly useful for laboratories that do not have ready access to serotyping facilities.

A comparative study of eosinophil isolation by different procedures of CD16-negative depletion

Eosinophils were isolated by the three methods of CD16-negative depletion: 1) magnetic beads, 2) fluorescence-activated cell sorter (FACS), and 3) complement reaction. Their purity, yield, and viability were compared. The second procedure produced well purity and viability (94.65 +/- 1.51% and 94.98 +/- 1.40%, respectively) but low yield of eosinophils (65.47 +/- 2.47%). The viability of cells obtained by the third procedure was not efficient (80.83 +/- 2.85%), while the purity and the yield were efficient (96.23 +/- 1.09% and 90.75 +/- 1.72%, respectively). In conclusion, the magnetic beads method (purity: 98.02 +/- 0.45%, yield: 91.05 +/- 2.43%, viability: 97.57 +/- 0.37%) was the most advantageous of these three procedures. Moreover, in the functional assay, radical oxygen products from eosinophils isolated by the procedure with complement reaction were less than with the magnetic beads or FACS procedures.

Characteristics of bone marrow cells of patients with eosinophilic pneumonia

Bone marrow features were studied to clarify the pathogenesis of peripheral blood eosinophilia in eosinophilic pneumonia. We observed (1) increases in the number of nucleated cells in patients with this disease as compared with that of control subjects (205,944 +/- 104,253 versus 118,154 +/- 76,306) (P < .05); (2) increases in the myelocyte to erythrocyte ratio (6.95 +/- 4.06 versus 4.02 +/- 1.36) (P < .05) mainly due to a marked increase in the eosinophilic series; and (3) an increase in the eosinophilic series with advance in the maturation process, the degree of increase becoming greater with the increase in eosinophilic maturation. These findings suggest that differentiation and maturation of the precursor cells into mature eosinophils were accelerated in the bone marrow in eosinophilic pneumonia by some lymphokines as eosinophilopoietic growth factors.

[A case of interstitial pneumonitis associated with polymyositis complicated by renal cell carcinoma]

A 55-year-old woman was referred to the department of urology in our hospital with left renal tumor, discovered during examinations at another hospital for fever and dyspnea on exertion. Because surgery was difficult due to severe hypoxemia, pulmonary function impairment (restrictive) and bilateral diffuse interstitial shadows on chest X-ray film, the patient was referred to our department. Interstitial pneumonitis was found on transbronchial lung biopsy, and serum GOT, LDH and CPK values were elevated. These symptoms and abnormalities of laboratory data were improved by administration of prednisolone 60 mg/day, and left nephrectomy was performed without any complications. Pathological examination of the surgical specimen showed clear cell carcinoma (Grawitz). Steroid therapy was tapered off and her clinical course was good. Six months after surgery, the patient developed a recurrence of fever, which was not responsive to antibiotics. Polymyositis was diagnosed on the basis of elevated serum GOT, LDH and CPK, electromyogram and muscle biopsy findings and positive anti-Jo-1 antibody. Polymyositis/dermatomyositis is sometimes associated with interstitial pneumonitis or malignant neoplasms, but rarely with both simultaneously. Moreover, renal cell carcinoma is very rare among the malignant neoplasms associated with polymyositis/dermatomyositis, and we therefore report this unusual case.

Possible induction of intercellular adhesion molecule-1 (ICAM-1) expression on endothelial cells by platelet-activating factor (PAF)

We demonstrated that PAF and IL-1 markedly induce ICAM-1 expression on endothelial cells. These findings suggest that PAF not only modulates inflammation by the attraction and activation of eosinophils or by platelet activation, but also intensifies such phenomena by induction of ICAM-1 expression on endothelial cells.

Effects of subminimal inhibitory concentrations of ampicillin on hemagglutination of Escherichia coli

The hemagglutination (HA) activity of Escherichia coli was enhanced by subminimal inhibitory concentrations (sub-MICs) of ampicillin. One half of the MIC of ampicillin caused a bacterial filamentation and diminished bacterial piliation (as observed by light and electron microscopies) as well as an increase of HA activity. HA activity, however, decreased after separation of ampicillin-treated bacteria. These results indicate that the increase in HA activity by ampicillin is mainly due to filament formation.

Upper extremity casting: adjunct treatment for a child with cerebral palsy hemiplegia

A common upper extremity deformity with hemiplegia is pronation contracture of the forearm in association with flexion contracture of the elbow. Early management of the child with hemiplegic cerebral palsy is critical in optimizing overall function. The use of inhibitory upper extremity casting can enhance function and improve arm-hand position. The present paper describes the evaluation process before casting, the goals of each phase of the casting program, and the follow-up.

[Clinical feature of male non-gonorrhoea urethritis and minocycline treatment of Chlamydia or Ureaplasma-infected urethritis]

Thirty-nine male patients with urethritis were studied for gonorrhoea or non-gonorrhoea infections. Only 2 patients were infected with N. gonorrhoeae, the other 37 patients were non-gonorrhoea urethritis (NGU). In 9 of these patients, C. trachomatis was identified and in 6 patients, U. urealyticum was isolated. No chlamydial urethritis was combined with ureaplasma. There was no clinical difference between chlamydia and ureaplasma infection, such as serous urethral discharge or mild pyuria. Minocycline was given orally at the dose of 200 mg daily for 7 to 42 days to these patients. Seven of the 9 patients (78%) with C. trachomatis and 7 of the 6 patients (67%) with U. urealyticum infection showed improvement of subjective and objective symptoms after minocycline. In no case, was an adverse reaction noted. Minocycline was effective in the treatment of both C. trachomatis and U. urealyticum urethral infection.

Effect of diethylstilbestrol diphosphate on activity of 5 alpha-reductase in human prostate

Following the intravenous drip infusion of diethylstilbestrol diphosphate (DES-DP), the diethylstilbestrol (DES) concentrations both in plasma and prostatic tissue obtained from patients with prostatic carcinoma were measured by radioimmunoassay and the effects of DES on the activity of 5 alpha-reductase in the prostate obtained from BPH patients were determined in vitro. Further, the changes in the activity of 5 alpha-reductase in the prostate from the BPH patients who received DES-DP infusion were also determined. The plasma and prostatic tissue concentrations of DES rapidly declined from 2.3 micrograms/ml and 1.6 micrograms/g wet weight 1 h after DES-DP infusion to 0.8 microgram/ml and 0.25 microgram/g wet weight 3 h after DES-DP infusion, respectively, and decreased gradually thereafter until 24 h. In in vitro study progressed by BPH specimens, the 5 alpha-reduction rate was completely inhibited by an addition of 5 x 10(-4) M of DES and the DES concentration on the inhibition rate of 50% was 4 x 10(-5) M. In in vivo study, the mean production rate of 5 alpha-dihydrotestosterone (DHT) in the control specimens of BPH without infusion of DES-DP was 14.0 +/- 3.4 nmol/15 min/mg protein and the production rate of DHT in the DES-DP infused specimens of BPH was 14.7 nmol/15 min/mg protein at 3 h and 15.2 nmol/15 min/mg protein at 12 h after the termination of DES-DP infusion. These results indicated that intravenously administered DES-DP did not act via the inhibition of 5 alpha-reductase in the prostatic cells for producing the clinical effects.

[Clinical experience with oxendolone for treatment of benign prostatic hyperplasia. Clinical efficacy and effects on serum lipid and lipoprotein fraction levels]

Forty-three patients with benign prostatic hyperplasia were treated with weekly i.m. injections of 400 mg oxendolone for 12 weeks. The subjective symptoms were improved in 83% of these patients. Residual urine was decreased significantly and Qmax was increased by this treatment. Serum VLDL level was suppressed significantly, whereas the levels of LDL, total cholesterol, HDL-cholesterol and triglycerides were changed little. Atherosclerotic index and the ratio of (total cholesterol--HDL-cholesterol) to (HDL-cholesterol), was not influenced by the treatment. No severe side-effect was found. These findings suggest that oxendolone is the drug of choice for non-surgical treatment of benign prostatic hyperplasia.

[Combined administration of human chorionic gonadotropin and human menopausal gonadotropin in idiopathic male infertility]

Changes in sex hormone levels, testicular volume and sperm count during hCG/hMG therapy were studied in 44 cases of idiopathic male infertility. These patients were divided into two groups and treated for 12 weeks. In group I, which consisted of 5 cases of azoospermia, 10 cases of severe oligozoospermia (less than 10 X 10(6)/ml) and 12 cases of mild oligozoospermia (10-50 X 10(6)/ml), 1,000 IU of hCG and 75 IU of hMG were both administered once a week. In group II, which consisted of 3 cases of azoospermia, 7 cases of severe oligozoospermia and 7 cases of mild oligozoospermia, 1,000 IU of hCG and 150 IU of hMG were both administered once a week. After 12 weeks, increase in sperm count was observed in 7 cases (26%) in group I and 4 cases (24%) in group II. Pregnancy was ensued in 4 cases in group I. There was no significant changes in testicular volume or sex hormone levels during hCG/hMG therapy.

[Clinical study of male infertility]

A statistical analysis was performed on infertile male patients who visited our urological clinic between Jan. 1976 and Dec. 1981. The incidence of infertile male was 9.9% of the total male out-patients. Age distribution of most of the patients ranged from 25 to 34 years old. Infertile period was most commonly within 5 years after they had married. In semen analysis, the cases of azoospermia and oligozoospermia (less than 50 x 10(6)/ml) accounted for 80% of all the infertile males. Testicular histology showed hypospermatogenesis or "Sertoli cell only" in most patients (more than 84.2%) who received testicular biopsy. Decrease in testicular volume was accompanied by an increase in the serum levels of luteinizing hormone and follicle stimulating hormone, but there was no relationship between testicular volume and testosterone. Most of the patients with a testicular volume of less than 12 ml were azoospermic. This suggests that there may be a suppression of spermatogenesis in small testes.

Androgen receptor in electroresected and cold punch-resected specimens. Usefulness of Kaplan cold punch resectoscope

The measurement of androgen receptor and 5 alpha-dihydrotestosterone (DHT) levels in prostatic carcinoma may be of value in predicting responsiveness to anti-androgenic therapy. A sufficient amount of prostatic carcinoma tissue must be removed for measuring androgen receptor and DHT levels. We have studied the usefulness of Kaplan cold punch-resection compared with electroresection for obtaining tissue in 29 cases of enucleated benign prostatic hyperplasia. DHT level in electroresected specimens was similar to controls. However, following low, moderate, and high-power electroresection an average of total R1881 binding sites (Bmax) of electroresected specimens was reduced to 82.2, 71.9, and 52.1 per cent of corresponding controls, respectively. In contrast, the per cent decrease of Bmax of Kaplan cold punch-resected specimens was only 10 per cent of the control. From our data, Kaplan cold punch-resection of the prostate appears to be a useful tool for obtaining tissue suitable for measuring androgen receptor levels.

[A study on testosterone-estradiol binding globulin (TeBG). I. Purification and some immunological properties of bovine serum TeBG (author's transl)]

Bovine serum TeBG was purified by 17 alpha -carboxyethynyl-17-hydroxy-4-androsten-3-one sepharose 4B affinity chromatography (T-sepharose) and hydroxylapatite column chromatography. The chemical and immunological properties of the purified TeBG were surveyed and the following results were obtained. 1) The procedures yielded 400 microgram of protein from 1 L of bovine serum with an overall purification of about 7,560 fold. 2) The purified TeBG was homogenous and was about 80,000 in molecular weight based on sucrose density gradient ultracentrifugation and polyacrylamide gel electrophoresis. 3) The antibody prepared against the purified bovine TeBG did not cross-react with dog and human sera, suggesting the species specificity of TeBG. 4) 125I-bovine TeBG, labelled by the lactoperoxidase method, had a high binding capacity to the anti-bovine TeGB antibody. These results indicate the applicability of purified TeBG and the antiserum for TeBG RIA.

Stimulation of adenosine 3',5'-monophosphate and sex steroids in the spermatic venous blood after human chorionic gonadotropin injection into human testes

To study the participation of cAMP in the action of gonadotropin on testicular steroidogenesis in the human testis in vivo, we have measured the concentrations of cAMP, testosterone, 5 alpha-dihydrotestosterone, estrone, 17 beta-estradiol, and hCG in the spermatic venous blood of the patients with prostatic cancer after hCG injections into the testis. Five minutes after hCG administration, spermatic cAMP increased to 5 times the pretreated level, and after 30 min, it increased to 20 times the pretreated level. Testosterone increased gradually after hCG injection, and the 2-fold increase was demonstrated at 50 min. Although the pattern of the changes in spermatic 5 alpha-dihydrotestosterone was similar to that of testosterone, a statistically significant increase was not observed after hCG administration. Estrogen production was also stimulated by hCG. These results are consistent with the view that cAMP may participate in the action of hCG upon steroidogenesis in the testis of human beings in vivo, as has previously been observed with rat and human testes in vitro.