Update knowledge on cervical cancer incidence and prevalence in Asia

Effect of laparoscopic-assisted transvaginal hysterectomy on wound complications in patients with early stage cervical cancer: A meta-analysis

Laparoscopic-assisted vaginal radical hysterectomy (LARVH) and abdominal radical hysterectomy (ARH) have been widely applied to treat cervical carcinoma. But LARVH and ARH have not been fully investigated in treating cervical carcinoma after injury associated with injury. This research is intended to provide an up-to-date basis for comparing LARVH with ARH in early stage cervical carcinoma. Comparison between LARVH and ARH in cervical carcinoma was carried out through a combination of related research. Eligible articles from databases such as PubMed and Embase were screened using an established search strategy. This report covered the results of LARVH versus ARH in cervical carcinoma. The average difference and the 95% confidence interval (CI) were used for the combination of consecutive variables. The combination of categorical variables was performed with the odds ratio (OR) 95% confidence interval. Through the identification of 1137 publications, eight of them were chosen to be analysed. Among them, 363 were treated with LARVH and 326 were treated with ARH. Eight trials showed that LARVH was associated with a reduced risk of postoperative wound infection than ARH (OR, 0.23; 95% CI, 0.1-0.55, p = 0.0009). Five trials showed that there was no difference in the risk of postoperative bleeding after surgery (OR, 1.17; 95% CI, 0.42-3.29, p = 0.76). We also did not differ significantly in the duration of the surgery (OR, 1.79; 95% CI, -6.58 to 10.15, p = 0.68). So, the two surgical methods differ significantly only in the risk of postoperative wound infection.

Nurses and doctors 's awareness and knowledge towards treatment and care of cervical cancer patients: a cross-sectional study

AIM

The present study aimed to investigate healthcare professionals' perceptions and experiences in caring for cervical cancer patients. The present study was also designed to assess the healthcare professionals' attitudes toward cervical cancer screening and its prevention.

METHODS

A cross-sectional quantitative descriptive study was conducted, and 540 participants (240 nurses and 300 doctors), from different hospitals of Pakistan have been selected and interviewed.

RESULTS

Data was collected using structured questionnaires and SPSS was used to statistically analyze the data. Participants in the present study are questioned with respect to age, gender, and work experience. The mean age of the participants is 35 years. Among them, 41% of participants are < 35 years of age and 59% are > 35 years of age. In the case of gender, 22% of participants are males and 78% are females. 47% of the participants have work experience < 20 years and 53% have work experience > 20 years. Data from the present study showed that most of the nurses are less educated (basic education of middle and matric degree) with a simple diploma in nursing and midwifery. Nurses and doctors do not have any knowledge/experience of the patient's psychological counselling. Participants are also questioned with respect to HPV vaccination, 39% of nurses and 62% of doctors are vaccinated. The difference in vaccination frequency of participants was observed as statistically significant (p < 0.0001). In the case of treatment modalities, doctors have statistically more knowledge about the pap smear (p < 0.0001), cervical biopsy (p < 0.0001), colposcopy (p < 0.0001), and visual application after acetic acid application (p < 0.0001) compared to nurses. Data analysis showed that Pap smear was performed significantly higher in married females compared to unmarried (p < 0.0001).

CONCLUSION

our study provides a comprehensive and in-depth perspective of the nurses and doctors for cervical cancer patients. Cervical cancer prevalence is increasing due to inadequate knowledge and awareness among healthcare professionals. Improvement can be brought about by the regular use of treatment modalities in unmarried females also.

Neuroendocrine Carcinoma of Cervix: A Case Series

Cervical cancer is the second most common cause of cancer-related mortality in women globally. Neuroendocrine carcinomas are among the rarest and least studied histopathological types of cervical cancers, accounting for 1.4% of all cervical cancers. Neuroendocrine carcinomas of the cervix (NECCs) are aggressive tumors that can be associated with several high-risk features such as early lymphovascular invasion and multiple systemic metastases, at early stages. Here, we present a case series of five patients with NECC who have been diagnosed and managed at a tertiary care hospital in coastal Andhra Pradesh, South India. Using the hospital records, we made a list of patients with NECC who were diagnosed by histopathological findings between 2019 and 2022. Details regarding their demographic variables, presenting complaints, staging, and treatment given were noted down using a pre-defined proforma.

Epidemiology and survival of cervical cancer in Iran based on national cancer registry data (2008-2014)

Background

Cervical cancer (CC) is the third most commonly diagnosed cancer and the fourth leading cause of cancer death in females worldwide, associated with the incidence of human papillomavirus (HPV) infection. The CC incidence is low in Iran, ranking 11th among cancers. This study aimed to estimate the survival rate of CC and the reasons for its low survival rate based on the data retrieved from the Iranian National Cancer Registry System.

Methods

In this retrospective cohort study, data for patients diagnosed with CC from 2008 to 2014 were collected and analyzed. The Kaplan-Meier method was used for survival analysis based on epidemiological and clinical factors.

Results

A total of 5,304 women were diagnosed from March 10, 2008 to March 9, 2014 and 2,423 patients were followed. The mean age of the cases was 51.91 years, and 65.91% were alive. The 5- and 10-year survival rates were 58% and 50%, respectively, with no difference between younger cases with SCC or AC but better survival rates for older patients with SCC.

Conclusions

As a preventable disease, CC is related to biological factors and geographical and sociodemographic indices. Geographical, cultural, and religious behaviors affect the CC incidence and survival. In Iran, the 5-year survival rate ranges from 34% to 70% among different geographic regions. Hence, effective screening based on cultural and sociodemographic issues is recommended.

Novel Insight of CircRNAs in Cervical Cancer: Potential Biomarkers and Therapeutic Target

Cervical cancer (CC) is a prominent cancer around the globe, with a high incidence, and fatality rate. Numerous recent investigations have shown that various non-coding RNAs are associated with the progression of CC. Circular RNAs, a novel class of non-coding RNAs, have a single chain covalent closed-loop structure and are involved in cell growth and other physiological processes. These dysregulated circRNAs seem to have environment-specific functions. They have been demonstrated in certain studies to have a dual involvement in oncogene production and tumor inhibition in different cell settings. Simultaneously, some evidence indicates that circRNAs are abnormally expressed in CC and contributes to its progression. Thus, the distinctive expression profile of circRNAs is associated with the diagnosis, prognosis, and treatment outcomes of CC. We summarized numerous CC-specific circles and their function in revealing the molecular processes of carcinogenesis and progression in CC in this review. Taken together, these data suggest that circRNA may be used as an early detection biomarker and potential therapeutic target in patients with CC.

Bioinformatics Analysis Highlights Five Differentially Expressed Genes as Prognostic Biomarkers of Cervical Cancer and Novel Option for Anticancer Treatment

Cervical cancer is one of the most common gynecological malignancies and is related to human papillomavirus (HPV) infection, especially high-risk type HPV16 and HPV18. Aberrantly expressed genes are involved in the development of cervical cancer, which set a genetic basis for patient prognosis. In this study, we identified a set of aberrantly expressed key genes from The Cancer Genome Atlas (TCGA) database, which could be used to accurately predict the survival rate of patients with cervical squamous cell carcinoma (CESC). A total of 3,570 genes that are differentially expressed between normal and cancerous samples were analyzed by the algorithm of weighted gene co-expression network analysis (WGCNA): 1,606 differentially expressed genes (DEGs) were upregulated, while 1,964 DEGs were downregulated. Analysis of these DEGs divided them into 7 modules including 76 hub genes. Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) enrichment analysis revealed a significant increase of genes related to cell cycle, DNA replication, p53 signaling pathway, cGMP-PKG signaling pathway, and Fanconi anemia (FA) pathway in CESC. These biological activities are previously reported to associate with cervical cancer or/and HPV infection. Finally, we highlighted 5 key genes (EMEMP2, GIMAP4, DYNC2I2, FGF13-AS1, and GIMAP1) as robust prognostic markers to predict patient’s survival rate (p = 3.706e-05) through univariate and multivariate regression analyses. Thus, our study provides a novel option to set up several biomarkers for cervical cancer prognosis and anticancer drug targets.

Long coding RNA CCAT2 enhances the proliferation and epithelial-mesenchymal transition of cervical carcinoma cells via the microRNA-493-5p/CREB1 axis

Cervical cancer (CC) is one of the most common malignancies among women. It has been demonstrated that long coding RNAs (lncRNAs) play a crucial role in CC. The purpose of this study was to investigate the role of the colon cancer associated transcript 2 (CCAT2) lncRNA in CC and elucidate its possible mechanisms of action. The expression of CCAT2, the miR-493-5p microRNA (miRNA), and mRNA was detected using qRT-PCR. Cell viability, proliferation, and migration and invasion were determined using the MTT, colony formation, and transwell assays, respectively. The interactions between miR-493-5p and CCAT2 or cAMP response element-binding protein 1 (CREB1) were verified using the luciferase and RNA pull-down assays. The effects of CCAT2 knockdown on in vivo tumor growth were determined using tumor xenografts and immunohistochemistry assays. The expression of CCAT2 was upregulated in CC cells and tissues. However, the knockdown of CCAT2 inhibited the proliferation and epithelial-mesenchymal transition (EMT) of CC cells in vitro and suppressed tumor growth in vivo. Mechanistically, CCAT2 functions as a competing endogenous RNA (ceRNA) to upregulate the expression of CREB1 by binding to miR-493-5p. The overexpression of CREB1 or downregulation of miR-493-5p antagonized the effect of CCAT2 knockdown on the proliferation and EMT of CC cells. The knockdown of CCAT2 suppressed the aggressiveness of CC via the miR-493-5p/CREB1 axis. Therefore, CCAT2 is likely to be a promising therapeutic target for CC.

Exploring the barriers to Pap smear test in Iranian women: a qualitative study

BACKGROUND

Cervical cancer is one of the most frequent types of cancer in females. The Pap smear is one of the most essential ways of diagnosing and screening for this malignancy, and any failure can be caused by a number of causes. The current study sought to investigate barriers to Pap smear in Iranian women.

METHOD

This qualitative content analysis study was conducted in Iran in 2019. Data was gathered through focus groups and individual semi-structured interviews with 32 women and health professionals. The interviewees were chosen using a combination of purposive and theoretical sampling. The data was then analyzed using the content analysis approach developed by Graneheim and Lundman. Guba and Lincoln's criteria for establishing trustworthiness were explored.

RESULTS

Data analysis resulted in the identification of four primary categories, seventeen subcategories, and 186 original concepts. The main categories include weakness of health system, difficult accessibility, low health literacy, and socio-cultural factors.

CONCLUSION

By informing women about the necessity and importance of Pap smear, providing the conditions, facilities, and equipment to facilitate the testing process, and paying more attention to cultural and social factors in cervical cancer and Pap smear planning, interventions, and policies, barriers to Pap testing can be eliminated.

The effect of educational program based on beliefs, subjective norms and perceived behavior control on doing pap-smear test in sample of Iranian women

Objective

Cervical cancer is considered treatable as long as it is detected early and managed effectively. Pap smear test is a screening tool that plays an important role in the early detection, prevention and can prevent any early cervical cell changes from becoming cancer. This study aims to survey the effect of educational programs based on beliefs, subjective norms, and perceived behavior control on doing the pap-smear test in a sample of Iranian women.

Materials and methods

This experimental interventional study was performed on 300 women admitted to Fasa City, Fars Province, Iran health centers in 2018–2019. A questionnaire consisting of demographic information, knowledge, Health Belief Model, and Theory of Planned Behavior constructs were used to measure on doing of Pap smear test in women before and after 6 months’ educational intervention.

Results

The results revealed that 6 months after the intervention, 108 women (72%) in the experimental group and only 9 women (6%) in the control group received the Pap smear test.

Conclusions

The current research results revealed that education based on the combination of the health Belief model and theory of planned behavior might be promoting participation and an increasing rate of receiving Pap smear tests in women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01419-w.

Low level of knowledge about cervical cancer among Ethiopian women: a systematic review and meta-analysis

Introduction

Cervical cancer is one of the leading causes of malignancies among women in Ethiopia. Knowing the disease could empower women to make an informed decision regarding participation with cervical cancer prevention strategies. There is scarcity of compiled data in the field. Therefore, this systematic review aimed to provide an overview of knowledge about cervical cancer among Ethiopian women.

Methods

We conducted a systematic review of peer-reviewed articles on the knowledge of cervical cancer. Articles were systematically searched using comprehensive search strings from PubMed/Medline, SCOPUS, and grey literature from Google Scholar. Two reviewers assessed study eligibility, extracted data, and the risk of bias independently. Meta-analysis was performed using STATA v 14 to pool the overall knowledge of the women about cervical cancer.

Results

We included 26 articles published between 2013 and 2020 covering a total of 14,549 participants. All the included articles had good methodological quality. The proportion of participants who had heard of cervical cancer varied from 4.6 to 87.7% with the pooled estimate at 56% (95% CI: 47–66). Similarly, the proportion of participants who knew that HPV is the main cause of cervical cancer lied between 0 and 49.7% with the pooled result at 21% (95% CI: 13–30). Likewise, the pooled prevalence to identify at least one risk factor, one symptom of cervical cancer and ever heard of cervical cancer screening was gauged at 52% (95% CI: 39–64), 43% (95% CI: 26–60), and 39% (95% CI: 24–55), respectively. The overall pooled prevalence of good knowledge about cervical cancer was at 43% (95% CI: 33–53). On top of this, the prevalence of previous screening practice among the participants was at 14% (95% CI: 9–20).

Conclusions

Knowledge about cervical cancer among Ethiopian women is quite poor. Therefore, health education to provide sufficient and unbiased information about HPV and cervical cancer in general is required to the public.

Development and Validation of Questionnaire to Assess Knowledge about Cervical Cancer among Women Aged 20 to 65 years in Oman

OBJECTIVE

This study aimed to develop and validate a questionnaire to assess awareness of cervical cancer, its risk factors, and methods of prevention among Arabic-speaking women aged 20 years and over.

METHODS

The study took place at primary healthcare institutions, Al Buraimi Governorate, Oman, between November 2018 to February 2019. In phase I, seventy items concerning cervical cancer and its prevention were generated through a literature review. In phase 2, the questionnaire was validated through calculating the content validity index (CVI) for both item level (I-CVI) and the scale level (S-CVI), in this phase a shortened English questionnaire of 55 items was formed, then rigorously translated to the Arabic language in phase III. The questionnaire was tested for reliability in two stages: A pilot and a large field test in phase IV.

RESULTS

A total of 55 out of 70 items formed the final version of the questionnaire. The final instrument had an S-CVI/Ave of 0.92. The questionnaire called the Knowledge in Cervical Cancer and Prevention Methods 55-items (KCCPM-55). The Cronbach alpha coefficient was 0.940 for the whole questionnaire, and ranged between 0.57 to 0.93 for each of the domains. Test-retest reliability was examined in a subsample of the total participants sample (r = 0.769, p < 0.001).

CONCLUSION

The KCCPM-55 has been successfully developed in the Arabic language and found to be a valid and reliable instrument for assessing the level of knowledge about cervical cancer and prevention methods among women aged 20 to 65 years in Oman.

Viral nanoparticles for drug delivery, imaging, immunotherapy, and theranostic applications

Viral nanoparticles (VNPs) encompass a diverse array of naturally occurring nanomaterials derived from plant viruses, bacteriophages, and mammalian viruses. The application and development of VNPs and their genome-free versions, the virus-like particles (VLPs), for nanomedicine is a rapidly growing. VLPs can encapsulate a wide range of active ingredients as well as be genetically or chemically conjugated to targeting ligands to achieve tissue specificity. VLPs are manufactured through scalable fermentation or molecular farming, and the materials are biocompatible and biodegradable. These properties have led to a wide range of applications, including cancer therapies, immunotherapies, vaccines, antimicrobial therapies, cardiovascular therapies, gene therapies, as well as imaging and theranostics. The use of VLPs as drug delivery agents is evolving, and sufficient research must continuously be undertaken to translate these therapies to the clinic. This review highlights some of the novel research efforts currently underway in the VNP drug delivery field in achieving this greater goal.

COX-2-PGE2-EPs in gynecological cancers

PURPOSE

Nonsteroidal anti-inflammatory drugs (NSAIDs) and selective COX-2 inhibitors (COXibs) inhibit the progression of endometrial cancer, ovarian cancer and cervical cancer. However, concerning the adverse effects of NSAIDs and COXibs, it is still urgent and necessary to explore novel and specific anti-inflammation targets for potential chemoprevention. The signaling of cyclooxygenase 2-prostaglandin E₂-prostaglandin E₂ receptors (COX-2-PGE₂-EPs) is the central inflammatory pathway involved in the gynecological carcinogenesis.

METHODS

Literature searches were performed to the function of COX-2-PGE₂-EPs in gynecological malignancies.

RESULTS

This review provides an overview of the current knowledge of COX-2-PGE₂-EPs signaling in endometrial cancer, ovarian cancer and cervical cancer. Many studies demonstrated the upregulated expression of the whole signaling pathway in gynecological malignancies and some focused on the function of COX-2 and cAMP-linked EP2/EP4 and EP3 signaling pathway in gynecological cancer. By contrast, roles of EP1 and the exact pathological mechanisms have not been completely clarified. The studies concerning EP receptors in gynecological cancers highlight the potential advantage of combining COX enzyme inhibitors with EP receptor antagonists as therapeutic agents in gynecological cancers.

CONCLUSION

EPs represent promising anti-inflammation biomarkers for gynecological cancer and may be novel treatment targets in the near future.

Knowledge, awareness, and practices of cervical cancer, its risk factors, screening, and prevention among women in Karachi, Pakistan

BACKGROUND

Cervical cancer has a high mortality rate worldwide; in Pakistan it kills more than 7000 women every year. Prevention is possible through vaccination against human papilloma virus, the causative agent of cervical cancer, or by screening for premalignant lesions through routine Pap smear tests. We have studied the knowledge and practices regarding cervical cancer, its risk factors, screening and prevention and the role of human papilloma virus vaccination and Pap smear testing, among young women of Karachi.

METHODS

Information was gathered using a modified version of Cervical Cancer Awareness Measure Toolkit version 2.1 from 384 women aged 15 to 50 with no medical background attending outpatient clinics of AKUH, Karachi. Data entry was done through EpiData and analysis was done using SPSS version 22.0.

RESULTS

Our respondents' mean age was 30 (±7.6) years. Out of the 61.2% of women who had heard about cervical cancer, 47.0% had heard about Pap smear test and among them, 73% had gotten a Pap test. A total of 25.5% of women out of the 61.2%, knew that a vaccine existed for prevention and out of them only 9.8% had vaccinated against human papilloma virus.

CONCLUSION

Majority of women in our study belonged to a higher socioeconomic class and were mostly educated but their knowledge and practices regarding prevention and screening of cervical cancer were poor. This reflects that the knowledge levels as a whole would be considerably lower in the city's general population.

Knowledge, Perception, and Prevention Practices Related to Human Papillomavirus-based Cervical Cancer and Its Socioeconomic Correlates Among Women in Karachi, Pakistan

Background

Cervical carcinoma is a widespread disease of the female genital tract, for which human papillomavirus (HPV) is an utmost risk factor. Of the total global burden, the majority is endured by the developing nations of the world, mainly due to inadequate knowledge regarding the disease and ineffective measures taken for its prevention, early detection, and screening. Hence, our study aimed to determine the level of knowledge, general attitudes and perception, and prevention practices related to HPV-based cervical cancer and its socioeconomic correlates among women in Karachi, Pakistan.

Methods

A cross-sectional, questionnaire-based study was conducted by approaching 450 females in the out-patient department (OPD) of a tertiary care hospital in Karachi, Pakistan from June 2019 to November 2019. The modified Kuppuswamy socioeconomic scale 2018 was deployed to assess the socioeconomic status of participants, while the knowledge score of the participants was determined based on the original Bloom's cut off point. The analysis was conducted using Statistical Package for Social Sciences (SPSS) version 24.0 (IBM Corp., Armonk, NY). Descriptive statistics were used to present the knowledge, attitude, and practice level of respondents. The respondents’ knowledge, attitude, and practice scores were compared across socioeconomic and demographic variables using the chi-square test.

Results

Of the 388 females interviewed, 199 (51.3%) were aware of the term cervical cancer, and 68 (34.2%) knew about Pap smear as a screening test; only 80 (40.2%) women were familiar with HPV vaccination as prophylaxis against cervical cancer. The practice of screening and prevention was found to be remarkably low (2.1% and 1.8% respectively). Socioeconomic status and education level had a significant association with knowledge of cervical cancer. Although around 64% of participants had poor knowledge, 308 (79.4%) demonstrated a favorable attitude as they were willing to know more about screening and preventive practices regarding cervical carcinoma.

Conclusion

The majority of the participants had insufficient overall knowledge about cervical cancer, HPV, Pap smear test, and HPV vaccination, highlighting the need for mass education through health professionals and media. In addition, the government authorities should provide screening services and vaccination against HPV free of cost to promote early detection of lesions and prophylaxis against this deadly disease.

Comparison of Diagnostic Methods in Detection of Squamous Cell Abnormalities in Iranian Women with Abnormal Pap's Smear Test and Associated Demographic and Issues

Background & Objective

Premalignant lesions of cervix have increased dramatically in recent years. Early diagnosis and management of abnormalities have an effective role in preventing the invasion of the disease and also in timely treatment. This study aimed to compare diagnostic methods in the detection of squamous cell abnormalities with abnormal Pap smear test.

Methods

This cross-sectional study was performed on 1000 women with abnormal Pap smears in 2007-2018. Sampling was performed with simple method. All samples were subjected to an immediate assessment of colposcopy and histopathology if suspected. The checklist included demographic information as well as symptoms, cytopathology, colposcopy and histopathology findings. Data analysis was performed using descriptive and statistical analysis (P<0.05).

Results

A significant relationship between histopathology and Pap smear findings was found (P=0.009), also there was a significant correlation between histopathology and colposcopy findings (P=0.001). However, there was no significant relationship between clinical symptoms and histopathology findings (p=0.8). Sensitivity , specificity , positive and negative predictive value of Pap smear were 43%, 65.9%, 75.4%, 32.2% and of colposcopy were 74.7%, 39.5%, 75%, 39.1%, and of clinical symptoms were 72.6%, 28.1%, 71.1%, 29.7%, respectively.

Conclusion

Pap smear findings have the appropriate diagnostic accuracy in comparison with colposcopy and histopathology findings for screening and diagnosis of squamous intra-epithelial lesions. Also, there was higher sensitivity of colposcopy compared with Pap smear to detect cervical lesions. Therefore, it is advisable to use these methods simultaneously.

Trends in Cervical Cancer Mortality in Brazilian Women who are Screened and Not Screened

Objective:

This study aimed to analyze the trend in cervical cancer (ICD C53) mortality in Brazilian regions in women who are who are screened and not screened from 1996 to 2015.

Methods:

An epidemiological study, of time series of mortality from cervical cancer performed in 90,856 women under 24 years old (343 women), between 25 and 64 years old (32,703 women), and over 65 years old (10,909 women). The data from this research were collected from the DATASUS, from the SIM Health Surveillance Secretariat files, captured through TABNET selecting the resident population by gender and age group and ICD 10 C53 from 1996 to 2015.

Results:

Among women, 43.8% were white, and 76% had less than eight years of formal education. Polynomial regression showed an increasing trend in cervical cancer mortality in Brazil for women aged 15 - 24 years (p=0.01). Between 25 - 64 and 65 years or older it remained constant, but high (p=0.07; 0.99). The Northeast region pointed a growing trend in women aged 15 to 24 (p=0.01), 25 to 64 years (p=0.01) and 65 or older (p=0.001). The Northeast presented the highest average growth per year. In the Southeast, South and Midwest regions, decreasing trends were observed despite the high rates. The Joinpoint regression showed a 95% confidence interval, and that mortality from cervical cancer in the North region increased throughout the period analyzed. an increasing trend was observed from 1996 to 1998, whereas in the Midwest region, the trend remained stable throughout the period analyzed. The Federal District presented an upward trend from 1996 to 2015. In Brazil, an upward trend was observed throughout the whole period analyzed.

Conclusions:

Cervical cancer mortality in younger women is becoming more predominant, in addition to the high rate observed for women aged 65 or older.

Elastic Net-Based Identification of a Multigene Combination Predicting the Survival of Patients with Cervical Cancer

Background

The objective of the present study was to identify prognostication biomarkers in patients with cervical cancer.

Material/Methods

Survival related genes were identified in The Cancer Genome Atlas (TCGA) cervical cancer study, and they were included into an elastic net regularized Cox proportional hazards regression model (CoxPH). The genes that their coefficients that were not zero were combined to build a prognostication combination. The prognostication performance of the multigene combination was evaluated and validated using Kaplan-Meier curve and univariate and multivariable CoxPH model. Meanwhile, a nomogram was built to translate the multigene combination into clinical application.

Results

There were 37 survival related genes identified, 9 of which were integrated to build a multigene combination. The area under the curve (AUC) of receiver operating characteristic (ROC) curve at 1-year, 3-year, 5-year, and 7-year in the training set were 0.757, 0.744, 0.799, and 0.854, respectively, and the multigene combination could stratify patients into significantly different prognostic groups (hazard ratio [HR]=0.2223, log-rank P<0.0001). Meanwhile, the corresponding AUCs in the test set was 0.767, 0.721, 0.735, and 0.703, respectively, and the multigene combination could classify patients into different risk groups (HR=0.3793, log-rank P=0.0021). The multigene combination could stratify patients with early stage and advanced stage into significantly different survival groups in the training set and test set. The prognostication performance of the multigene combination was better compared with 3 existing prognostic signatures. Finally, a multigene containing nomogram was developed.

Conclusions

We developed a multigene combination which could be treated as an independent prognostic factor in cervical cancer and be translated into clinical application.

MicroRNA-449a Is Downregulated in Cervical Cancer and Inhibits Proliferation, Migration, and Invasion

INTRODUCTION

Cervical cancer is one of the most common malignant tumors among women in the world. MicroRNA-449a (miR-449a) has been identified as a tumor suppressor gene in various cancers. Our present study aimed to explore the biological role of miR-449a in cervical cancer.

METHODS

The expression of miR-449a in cervical cancer tissues and cell lines was detected using real-time quantitative PCR. Kaplan-Meier survival analysis and a Cox regression assay were used to identify the prognostic significance of miR-449a in cervical cancer. A CCK-8 assay and a Transwell assay were performed to determine the impact of miR-449a on the proliferation, migration, and invasion of cervical cancer cells.

RESULTS

The expression of miR-449a was decreased in both cervical cancer tissues and cell lines. The decreased expression of miR-449a was significantly associated with lymph node metastasis, differentiation, and FIGO stage, as well as with poor survival. In vitro, transfection of miR-449a mimic into cervical cancer cells inhibited cell proliferation, migration, and invasion.

CONCLUSION

All of the results revealed that miR-449a functions as a suppressor gene and inhibits cell proliferation, migration, and invasion in cervical cancer. In addition, it may serve as a prognostic biomarker for cervical cancer.

Effects of Notch Signaling Pathway in Cervical Cancer by Curcumin Mediated Photodynamic Therapy and Its Possible Mechanisms in Vitro and in Vivo

Curcumin, as a high effect and low toxicity anti-cancer drug and photosensitiser, has synergistic and complementary effects with photodynamic therapy (PDT). However, due to its unclear mechanism, PDT's application and efficacy were limited. Notch signaling pathway, which is highly correlates with carcinogenesis and development of cervical cancer, could be a potential therapeutic targets to improve the effectiveness of PDT. Therefore, in this study, we explored the effects of Notch signaling pathway in cervical cancer by curcumin mediated PDT with/without Notch receptor blocker (DAPT), and hope to elucidate its mechanism. Firstly, the effect on the proliferation of cervical cancer Me180 cells were detected with MTT assay, and apoptosis were detected with Annexin V-FITC/PI combined with flow cytometry. Secondly, after establishment of nude mice model, dividing the experimental animals into model group, curcumin PDT group, simple DAPT group, and curcumin-PDT+DAPT group, and analyzing tumor volume changes as well as HE staining in each group. mRNA and protein expression of gene Notch-1 and its downstream NF-κB and VEGF were observed with RT-PCR, immunohistochemical staining and Western-blot with/without inhibition of Notch signaling pathway by DAPT, both in vivo and in vitro experiments. We found both DAPT and curcumin-PDT can inhibit the proliferation and induce apoptosis of cervical cancer cell. The two have synergistic effect in vitro and in vivo. This effect can effectively block the conduction of Notch signaling pathway, which is associated with down-regulation of the expression of Notch1 and NF-κB. Notch signaling pathway could be one of the targets of curcumin-PDT photodynamic therapy.

Overexpression of mircoRNA-137 inhibits cervical cancer cell invasion, migration and epithelial-mesenchymal transition by suppressing the TGF-β/smad pathway via binding to GREM1

Background

Accumulating evidence has highlighted the tumor suppressive roles of microRNA (miRNAs) in cervical cancer (CC). In the present study, we aim to delineate the functional relevance of microRNA-137 (miR-137) in influencing epithelial-mesenchymal transition (EMT), and other CC cell biological activities via the TGF-β/smad pathway by binding to GREM1.

Methods

Microarray analysis was initially adopted to predict the differentially expressed genes and the miRNAs related to CC, followed by the measurement of the expression patterns of GREM1, EMT-related factors in the CC tissues and the adjacent tissues. Dual luciferase reporter gene assay was conducted to determine the relationship between miR-137 and GREM1. Gain-of- and loss-of-function experiments were conducted to characterize the effects of miR-137 and GREM1 on the colony formation, proliferation, apoptosis, migration, and invasion of CC cells in vitro, and the tumorigenicity of the CC cells in nude mice. The TGF-β/smad pathway was subsequently blocked with si-TGF-β to investigate its involvement.

Results

Reduced miR-137 expression and increased GREM1 expression were predicted in CC, which was subsequently observed in the CC tissues and cells. Notably, GREM1 was a target gene of miR-137. The overexpressed miR-137 was found to inhibit EMT, cell proliferation, colony formation, invasion, migration and tumorigenesis in nude mice. In addition, miR-137 was noted to inhibit the activation of the TGF-β/smad pathway by binding to GREM1. The silencing of TGF-β1 was shown to reverse the effects induced by downregulated expression of miR-137.

Conclusions

This study suggests that upregulated miR-137 suppresses the tumor progression in CC via blocking the TGF-β/smad pathway by binding to and negatively regulating GREM1.

Carbazole Derivatives as Antiviral Agents: An Overview

Keywords: carbazole; tetrahydrocarbazole; antiviral agents.

Evaluation of the thermal stability and the protective efficacy of spray-dried HPV vaccine, Gardasil® 9

High-risk human papillomavirus (HPV) types are responsible for nearly all cases of cervical cancers. Cervarix® and Gardasil® 9 are the current prophylactic vaccines available that protect against the majority of HPVs associated with cancer. Although these vaccines are highly effective, HPV vaccine implementation has been slow, particularly in low-and-middle income countries. Major barriers to the widespread availability of the HPV vaccines is its cost and the requirement for continuous refrigeration (2-8°C). Here, we used spray drying along with stabilizing excipients to formulate a thermostable Gardasil® 9 vaccine. We evaluated the immunogenicity and protective efficacy of the vaccine in mice immediately after spray drying and following storage for three months at 4°C, 25°C, and 40°C. The immunogenicity studies were performed using Gardasil® 9 as a whole antigen, and not individual HPV types, for ELISA. At the dose tested, the spray dried vaccine conferred protection against HPV following storage at temperatures up to 40°C. In addition to the spray-dried vaccine, our studies revealed that the Gardasil® 9 vaccine, as currently marketed, may be stored and transported at elevated temperatures for up to 3 months without losing efficacy, especially against HPV16. This study is critical, as a thermostable vaccine will decrease vaccine cost associated with cold-chain maintenance and could increase vaccine access and coverage, especially in remote regions of the world.

Effect of Multiple Vaccinations with Tumor Cell-Based Vaccine with Codon-Modified GM-CSF on Tumor Growth in a Mouse Model

Ectopic expression of codon-modified granulocyte-macrophage colony-stimulating factor (cGM-CSF) in TC-1 cells (TC-1/cGM-CSF), a model cell line for human papillomavirus (HPV)-infected cervical cancer cells, increased the expression level of GM-CSF and improved the efficacy of tumor cell-based vaccines in a cervical cancer mouse model. The number of vaccine doses required to induce a long-term immune response in a cervical cancer mouse model is poorly understood. Here, we investigated one, three, and five doses of the irradiated TC-1/cGM-CSF vaccine to determine which dose was effective in inducing a greater immune response and the suppression of tumors. Our findings showed that three doses of irradiated TC-1/cGM-CSF vaccine elicited slower tumor growth rates and enhanced survival rates compared with one dose or five doses of irradiated TC-1/cGM-CSF vaccine. Consistently, mice vaccinated with three doses of irradiated TC-1/cGM-CSF vaccine exhibited stronger interferon gamma (IFN-γ) production in HPV E7-specific CD8⁺ T cells and CD4⁺ T cells. A higher percentage of natural killer cells and interferon-producing killer dendritic cells (IKDCs) appeared in the splenocytes of the mice vaccinated with three doses of irradiated TC-1/cGM-CSF vaccine compared with those of the mice vaccinated with one dose or five doses of irradiated TC-1/cGM-CSF vaccine. Our findings demonstrate that single or multiple vaccinations, such as five doses, with irradiated TC-1/cGM-CSF vaccine suppressed the immune response, whereas three doses of irradiated TC-1/cGM-CSF vaccine elicited a greater immune response and subsequent tumor suppression.

microRNA-802 inhibits cell proliferation and induces apoptosis in human cervical cancer by targeting serine/arginine-rich splicing factor 9

microRNAs (miRNAs) play crucial roles in cancer development and progression by targeting mRNAs for degradation and/or translational repression. microRNA-802 (miR-802) has been reported as a tumor suppressor and its deregulation is observed in various human cancers. However, the prognostic value of miR-802 and its underlying mechanisms involved in human cervical cancer are poorly investigated. The purposes of this study were to explore the role of miR-802 in cervical cancer and to clarify the regulation of serine/arginine-rich splicing factor 9 (SRSF9) by miR-802. Here, we found that miR-802 was downregulated in both cervical cancer tissues and cell lines. Transfection of a miR-802 mimic into cervical cancer cells inhibited their proliferation and colony formation, and promoted cell cycle arrest at the G0/G1 phase and cell apoptosis. In addition, we found that miR-802 could directly target the 3'-untranslated region of SRSF9 and suppress SRSF9 expression. Rescue experiments revealed that overexpression of SRSF9 partially reversed the inhibition effect of miR-802 in cervical cancer cells. Overall, these findings demonstrate that miR-802 functions as a tumor suppressor in cervical cancer by targeting SRSF9, suggesting that miR-802 might serve as a potential therapeutic target in cervical cancer.