Prognostic impact of erythropoietin-stimulating agent use during front-line chemotherapy in patients with ovarian cancer: A Korean multicenter cohort study

OBJECTIVE

To evaluate whether treatment with erythropoiesis-stimulating agents (ESAs) for chemotherapy-induced anemia affects progression-free survival (PFS) in patients receiving front-line chemotherapy following surgery for ovarian cancer (OC).

METHODS

We retrospectively reviewed all consecutive patients who received front-line chemotherapy after surgery between 2013 and 2019 at six institutions. The patients were divided according to the use of ESAs during front-line chemotherapy. The primary endpoint was PFS. The secondary endpoint was the occurrence of thromboembolism. Propensity score matching (PSM) analysis was used to compare survival between matched cohorts.

RESULTS

Overall, 2147 patients (433 receiving ESA and 1714 for no-ESA) were identified, with a median follow-up of 44.0 months. The ESA group showed a significantly higher proportion of stage III/IV disease (81.8% vs 61.1%; P < 0.001) and postoperative gross residual disease (32.3% vs 21.2%; P < 0.001) than the no-ESA group. In the multivariable Cox regression analysis, the use of ESAs did not affect PFS (adjusted hazard ratio, 1.03; 95% confidence interval [CI]: 0.89-1.20; P = 0.661). The incidence of thromboembolism was 10.2% in the ESA group and 4.6% in the no-ESA group (adjusted odds ratio, 6.58; 95% CI: 3.26-13.28; P < 0.001). When comparing the well-matched cohorts after PSM, PFS did not differ between the ESA (median PFS 23.5 months) and no-ESA groups (median PFS 22.2 months) (P = 0.540, log-rank test).

CONCLUSIONS

The use of ESAs during front-line chemotherapy did not negatively affect PFS in patients with OC after surgery but increased the risk of thromboembolism.

The Expression and Amplification of HER2 Has a Significant Impact on the Prognosis of Endometrial Carcinoma in Korean Patients

Objective: The purpose of this study was to analyze the protein overexpression and gene amplification of HER2 in endometrial carcinoma (EC) and to evaluate its role as a prognostic factor in Korean women. Methods: A tissue microarray (TMA) was constructed from samples from 191 patients with diverse histologic types of EC. HER2 protein expression and gene amplification status were analyzed using immunohistochemistry (IHC) and silver in situ hybridization (SISH), respectively. All patients were treated and followed up at a single tertiary medical center in Seoul, Korea, between July 2009 and October 2020. Results: In terms of histological type, among the 191 EC patients, 157 had endometrioid carcinoma, nine had uterine serous papillary carcinoma (USPC), one had clear cell carcinoma, one had squamous cell carcinoma, eight had mixed carcinoma, and 15 had uterine carcinosarcoma (UC). HER2 protein overexpression was observed in eight of the 191 (4.2%) EC patients; of these patients, five had IHC scores of 2+, and three had IHC scores of 3+. The HER2 overexpression rates of USPC, UC, and endometrioid carcinomas were 33.3%, 26.6%, and 0.6%, respectively. HER2 protein overexpression was significant in USPC and UC tissues (p < 0.000) and was associated with poor overall survival (OS) (p < 0.001). HER2 gene amplification was confirmed in seven of 184 patients (3.8%), including three patients with USPC and four patients with UC. OS was significantly shorter in patients who had HER2 amplification (p < 0.001). On multivariate analysis, HER2 expression and HER2 amplification were statistically significantly associated with worse OS (p = 0.006). However, HER2 expression without amplification was not statistically associated with OS (p = 0.993). Conclusions: HER2 protein overexpression and gene amplification are significantly correlated with shorter OS in Korean women. HER2 can be considered an important predictor of survival outcomes in EC patients.

Major clinical research advances in gynecologic cancer in 2023: a tumultuous year for endometrial cancer

In the 2023 series, we summarized the major clinical research advances in gynecologic oncology based on communications at the conference of Asian Society of Gynecologic Oncology Review Course. The review consisted of 1) Endometrial cancer: immune checkpoint inhibitor, antibody drug conjugates (ADCs), selective inhibitor of nuclear export, CDK4/6 inhibitors WEE1 inhibitor, poly (ADP-ribose) polymerase (PARP) inhibitors. 2) Cervical cancer: surgery in low-risk early-stage cervical cancer, therapy for locally advanced stage and advanced, metastatic, or recurrent setting; and 3) Ovarian cancer: immunotherapy, triplet therapies using immune checkpoint inhibitors along with antiangiogenic agents and PARP inhibitors, and ADCs. In 2023, the field of endometrial cancer treatment witnessed a landmark year, marked by several practice-changing outcomes with immune checkpoint inhibitors and the reliable efficacy of PARP inhibitors and ADCs.

Impact of resident participation on surgical outcomes in laparoscopically assisted vaginal hysterectomy

OBJECTIVE

To compare surgical outcomes in patients with benign diseases who underwent laparoscopically assisted vaginal hysterectomy (LAVH) to determine the association between surgical outcomes and resident participation in the gynecologic field.

METHODS

A single-center retrospective study was conducted of patients diagnosed with benign gynecologic diseases who underwent LAVH between January 2010 and December 2015. Clinicopathologic characteristics and surgical outcomes were compared between the resident involvement and non-involvement groups. The primary endpoint was the 30-day postoperative morbidity. Observers were propensity matched for 17 covariates for resident involvement or non-involvement.

RESULTS

Of the 683 patients involved in the study, 165 underwent LAVH with resident involvement and 518 underwent surgery without resident involvement. After propensity score matching (157 observations), 30-day postoperative morbidity occurred in 6 (3.8%) and 4 (2.5%) patients in the resident involvement and non-involvement groups, respectively (P = 0.501). The length of hospital stay differed significantly between the two groups: 5 days in the resident involvement group and 4 days in the non-involvement group (P < 0.001). On multivariate analysis, Charlson Comorbidity Index >2 (odds ratio [OR] 8.01, 95% confidence interval [CI] 2.68-23.96; P < 0.001), operative time (OR 1.02, 95% CI 1.01-1.03; P < 0.001), and estimated blood loss (OR 1.00, 95% CI 1.00-1.00; P < 0.001) were significantly associated with 30-day morbidity, but resident involvement was not statistically significant.

CONCLUSION

There was no significant difference in the 30-day morbidity rate when residents participated in LAVH. These findings suggest that resident participation in LAVH may be a viable approach to ensure both residency education and patient safety.

Metabolomics Reveals Rubiadin Accumulation and the Effects of Methyl Jasmonate Elicitation in Damnacanthus major Calli

Callus suspension techniques have been considered attractive for improving bioactive metabolite productivity; methyl jasmonate (MeJA) is a widely used elicitor for stimulating synthetic pathways. In this study, a multivariate analysis-based metabolomics approach was employed to investigate the primary and specialized metabolites in the leaves, unelicited calli, and 100 or 200 μM MeJA elicited calli of Damnacanthus major. Rubiadin, a powerful anthraquinone with various therapeutic properties, was only identified in D. major calli, accumulating in a MeJA elicitation concentration-dependent manner. Callus cultures also contained high levels of amino acids, sugars, and phenolic compounds, indicating energy metabolism and metabolic adaptation responses for proliferation and stabilization. Regarding MeJA application, elicited calli contained higher amounts of quinic acid, kaempferol, and glucose with lower amounts of sucrose and raffinose than those in the unelicited control, which were closely related to protective mechanisms against MeJA. Moreover, excessive elicitation increased the asparagine, fructose, and raffinose levels and decreased the glucose and sucrose levels, which was ascribed to increased activation of the aminoacyl-tRNA biosynthesis pathway and wider utilization of glucose than of fructose after sucrose degradation. These results will be useful for optimizing plant cell culture techniques to achieve high production rates for valuable specialized metabolites.

Therapeutic Efficacy of YM155 to Regulate an Epigenetic Enzyme in Major Subtypes of RCC

Renal cell carcinoma (RCC) is the most common type of kidney cancer and includes more than 10 subtypes. Compared to the intensively investigated clear cell RCC (ccRCC), the underlying mechanisms and treatment options of other subtypes, including papillary RCC (pRCC) and chromogenic RCC (chRCC), are limited. In this study, we analyzed the public databases for ccRCC, pRCC, and chRCC and found that BIRC5 was commonly overexpressed in a large cohort of pRCC and chRCC patients as well as ccRCC and was closely related to the progression of RCCs. We investigated the potential of BIRC5 as a therapeutic target for these three types of RCCs. Loss and gain of function studies showed the critical role of BIRC5 in cancer growth. YM155, a BIRC5 inhibitor, induced a potent tumor-suppressive effect in the three types of RCC cells and xenograft models. To determine the mechanism underlying the anti-tumor effects of YM155, we examined epigenetic modifications in the BIRC5 promoter and found that histone H3 lysine 27 acetylation (H3K27Ac) was highly enriched on the promoter region of BIRC5. Chromatin-immunoprecipitation analysis revealed that H3K27Ac enrichment was significantly decreased by YM155. Immunohistochemistry of xenografted tissue showed that overexpression of BIRC5 plays an important role in malignancy in RCC. Furthermore, high expression of P300 was significantly associated with the progression of RCC. Our findings demonstrate the P300-H3K27Ac-BIRC5 cascade in three types of RCC and provide a therapeutic path for future research on RCC.

Risk of adverse obstetric outcomes in patients with a history of endometrial cancer: A nationwide population-based cohort study

OBJECTIVE

To evaluate adverse obstetric outcomes in women with a history of endometrial cancer (EC).

DESIGN

Population-based cohort study.

SETTING

The Korean National Health Insurance (KNHI) claims database.

POPULATION

Women who gave birth between 2009 and 2016, with a history of EC prior to pregnancy.

METHODS

The KNHI database was used to compare obstetric outcomes of women with and without a history of EC, using the ICD-10 codes. Multivariable logistic regression models were used to determine the associations between a history of EC and adverse obstetric outcomes.

MAIN OUTCOMES MEASURES

Adverse obstetric outcomes.

RESULTS

Overall, 248 and 3 335 359 women with and without a history of EC, respectively, gave birth. When adjusted for age, primiparity and comorbidities, an increased risk of multiple gestations (odds ratio [OR] 4.925, 95% confidence interval [CI] 3.394-7.147), caesarean delivery (OR 2.005, 95% CI 1.535-2.62) and preterm birth (OR 1.941, 95% CI 1.107-3.404) was observed among women with a history of EC. We were unable to demonstrate significant differences in the risk of pre-eclampsia, gestational diabetes, vacuum delivery, placenta praevia, placenta accreta spectrum, placental abruption and postpartum haemorrhage between the groups. In the sensitivity analyses excluding multiple gestations, an increased risk of preterm birth was not observed among women with a history of EC (OR 1.276, 95% CI 0.565-2.881).

CONCLUSIONS

There is no convincing evidence of an increased risk of adverse obstetric outcomes among women with a history of EC. Our findings would be useful in counselling of patients with EC who are undergoing fertility-sparing treatment.

Effect of α1D-adrenoceptor blocker for the reduction of ureteral contractions

PURPOSE

Urolithiasis is a common urinary tract disease with growing prevalence. Alpha1-adrenoceptors (α1-ARs) are abundant in ureteral smooth muscle, distributed with different α1-AR subtypes. α1D-AR is the most widely distributed in the ureter. However, the effect of α1D-AR blockade on ureteric contraction remains unknown.

MATERIALS AND METHODS

We dissected smooth muscle tissues (3 mm×3 mm) from the rat bladder and human ureter, tied silk strips on both tissue ends, and measured contraction in an organ bath chamber. Contraction activity in ureteral smooth muscle cells (USMCs) was immunocytochemically examined using primary rat and human USMC cultures.

RESULTS

Using the organ bath system, we determined the inhibitory effects of silodosin, tamsulosin, and naftopidil. Naftopidil significantly decreased contractility of rat bladder tissue; similar results were observed in human ureteral tissue. To confirm ex vivo experimental results in vitro , we examined the phosphorylation of myosin light chain (MLC), a marker of contractility, in a primary human USMC culture. The examined drugs decreased phospho-MLC levels in human USMCs; however, naftopidil profoundly increased MLC dephosphorylation.

CONCLUSIONS

We studied the effects of naftopidil, an α1D-AR inhibitor, on the ureter. Compared with alpha-blockers, naftopidil significantly relaxed ureteral smooth muscle. Therefore, naftopidil could be an effective therapy for patients with ureteral stones.

Proliferation and Metabolic Profiling of Cynanchum wilfordii Adventitious Roots Using Explants from Different Cultivation Methods

Cynanchum wilfordii root is used in traditional herbal medicine owing to its various pharmacological activities. However, C. wilfordii roots are misused owing to their morphological similarities with C. auriculatum. Adventitious root (AR) culture can prevent such misuse, and the selection of plant materials is an important procedure for producing high-quality ARs. This study aimed to compare the proliferation and metabolic profiles of C. wilfordii ARs in two types of explants from different cultivation methods (either cultivated in open field (ECF) or cultivated on a heap of C. wilfordii (ECH)). After 4 weeks of culture, the proliferation rate and number and length of secondary ARs were determined, and 3/4 Murashige and Skoog (MS) salt medium, 4.92 μM indole-3-butyric acid (IBA), and 5% sucrose were suggested as the best proliferation conditions for ARs originating from both ECF and ECH. Through metabolic profiling, ARs from ECH were found to show higher accumulation patterns for flavonoids, polysaccharides, hydroxyacetophenones, aromatic amino acids, and mono-unsaturated fatty acids, which were ascribed to the activation of flavonoid biosynthesis, the phenylpropanoid pathway, and fatty acid desaturase, stimulated by abiotic stresses. In contrast, ARs from ECF had higher levels of TCA cycle intermediates, amino acids in the aspartate-glutamate pathway, and saturated and polyunsaturated fatty acids, indicating energy metabolism and plant development. Overall, the current study provided information on the optimal conditions for inducing C. wilfordii ARs with higher amounts of bioactive compounds.

Indwelling urinary catheter assembled with lidocaine-loaded polymeric strand for local sustained alleviation of bladder discomfort

Indwelling urinary catheters (IUCs) are used in clinical settings to assist detrusor contraction in hospitalized patients. However, an inserted IUC often causes catheter-related bladder discomfort. To resolve this, we propose an IUC coupled with local, sustained release of an anesthetic drug, lidocaine. For this, a thin strand composed of poly (lactic-co-glycolic acid) and lidocaine was separately prepared as a drug delivery carrier, which was then wound around the surface of the IUC to produce the drug-delivery IUC. Our results revealed that the drug-delivery IUC could exert the pain-relief effects for up to 7 days when placed in the bladder of living rats. Cystometrogram tests indicated that the drug-delivery IUC could significantly relieve bladder discomfort compared with the IUC without lidocaine. Furthermore, the expression of pain-related inflammatory markers, such as nerve growth factor, cyclooxygenase-2, and interleukin-6 in the biopsied bladder tissues was significantly lower when the drug-delivery IUC was used. Therefore, we conclude that an IUC simply assembled with a drug-loaded polymer strand can continuously release lidocaine to allow for the relief of bladder discomfort during the period of IUC insertion.

Electroantennogram responses of mediterranean fruit fly,Ceratitis capitata (Diptera: Tephritidae) to trimedlure and itstrans isomers

Electroantennograms (EAGs) of unmated laboratory-reared male and femaleCeratitis capitata (Wiedemann) were recorded in response to the attractant trimedlure [tert-butyl 4(and 5)-chloro-trans-2-methylcyclohexane-1-carboxylate] and its fourtrans isomers. For both sexes, the magnitude of the EAG response was relatively low as compared to other previously tested compounds (i.e., plant volatiles). Dosage-response curves generated for all TML isomers revealed that flies responded to increasing dosages over a relatively narrow range (two to three log steps). Responses for both sexes peaked at ca. 10 μg dose for all isomers. Antennal response in males was greatest to the C isomer followed by the B1, A, and B2 isomers, while responses of females were greatest for the A isomer followed by B1, C, and B2. Both sexes exhibited a long recovery period for the response potential to return to baseline at doses above 1 μg for all of the isomers tested, except for B2. The low EAG sensitivity to trimedlure and the apparent EAG selectivity to the C isomer in males are discussed in relation to the known field attractancy of males to the C, A, B1, and B2 isomers.

Attraction of female mediterranean fruit flies to the five major components of male-produced pheromone in a laboratory flight tunnel

Attraction and pheromonal activity of five major identified components of the male-produced sex pheromone of the Mediterranean fruit flyCeratitis capitata to virgin laboratory-reared females was assessed in a laboratory flight tunnel. Dual-choice competitive assays were run to establish a baseline response of virgin females to live male pheromone, individual components, and an ensemble of all five compounds alone (air control) and competitively against one another. Approximately 50% of the females released in the tunnel were captured on leaf models emitting pheromonal odors from five live males. Over 37% of released females responded to an ensemble of five major identified components presented in individual capillaries. Response of females to individual components was less than 10%. Competitive assays showed the live male-produced pheromone to be more attractive than either the five major component ensemble (FMCE) or individual components. Further research is likely to identify other male-produced compounds with pheromonal activity that could improve development of a pheromone-based trap for monitoring Mediterranean fruit fly populations.

Potential of "lure and kill" in long-term pest management and eradication of invasive species

"Lure and kill" technology has been used for several decades in pest management and eradication of invasive species. In lure and kill, the insect pest attracted by a semiochemical lure is not "entrapped" at the source of the attractant as in mass trapping, but instead the insect is subjected to a killing agent, which eliminates affected individuals from the population after a short period. In past decades, a growing scientific literature has been published on this concept. This article provides the first review on the potential of lure and kill in long-term pest management and eradication of invasive species. We present a summary of lure and kill, either when used as a stand-alone control method or in combination with other methods. We discuss its efficacy in comparison with other control methods. Several case studies in which lure and kill has been used with the aims of long-term pest management (e.g., pink bollworm, Egyptian cotton leafworm, codling moth, apple maggot, biting flies, and bark beetles) or the eradication of invasive species (e.g., tephritid fruit flies and boll weevils) are provided. Subsequently, we identify essential knowledge required for successful lure and kill programs that include lure competitiveness with natural odor source; lure density; lure formulation and release rate; pest population density and risk of immigration; and biology and ecology of the target species. The risks associated with lure and kill, especially when used in the eradication programs, are highlighted. We comment on the cost-effectiveness of this technology and its strengths and weaknesses, and list key reasons for success and failure. We conclude that lure and kill can be highly effective in controlling small, low-density, isolated populations, and thus it has the potential to add value to long-term pest management. In the eradication of invasive species, lure and kill offers a major advantage in effectiveness by its being inverse density dependent and it provides some improvements in efficacy over related control methods. However, the inclusion of insecticides or sterilants in lure and kill formulations presents a major obstacle to public acceptance.

Can ménage-a-trois be used for controlling insects?

We propose a new cross-species disruption approach that might be capable of interrupting mating of one species that uses another insect species as the mercenary agent. We argue that insects treated with a sufficiently powerful attractant for a second species might interfere with mating of one or both species, for example, by leading males astray in pursuit of the false trails created by suitably dosing individuals of the first species. Our reciprocal test systems used (1) methyl eugenol, an attractant for male oriental fruit flies (Bactrocera dorsalis), applied to melon flies (B. cucurbitae) and (2) cuelure, a lure for male melon flies, applied to B. dorsalis. There was no mortality 1 week after either attractant was applied to individual flies at doses up to 100 ng, which was effective in attracting insects in a field cage and in the field. In wind tunnel choice tests, 100 ng of either lure topically applied to tethered flies attracted fruit fly males of the second species, which exhibited prolonged bouts of physically disruptive behaviors including chasing and bumping. In small cages, treatment of males did not reduce mating of either species, with one group of three (ménage) per cage. However, in large field cages with multiple pairs of both species present, there was a significant reduction in the mating of melon flies resulting from methyl eugenol applied to males compared to untreated controls. The treatment of oriental fruit flies with cuelure also reduced their mating to a lesser extent. These results do not yet provide the practical proof of this new concept for pest management, but other model systems may be more appropriate. This work is novel in presenting attractants on a moving target, in this case, another insect species.

Field attraction of Mediterranean fruit fly, Ceratitis capitata (Wiedemann) to synthetic stereoselective enantiomers of the ceralure B1 isomer

Stereoselectively synthesized enantiomers of ethyl cis-5-iodotrans-2-methylcyclohexane-1-carboxylate (ceralure B1), a potent lure for male Mediterranean fruit flies, were tested in the laboratory and the field against laboratory reared sterile flies. The (-)-ceralure B1 enantiomer was significantly more attractive than the (+)-ceralure B1 antipode. Dose-response studies of the above compounds demonstrated that (-)-ceralure B1 and to a lesser extent, racemic ceralure B1, captured consistently more male flies than trimedlure, the current male attractant used in detection programs. Longevity tests demonstrated that, over a three-week period, both (-)-ceralure B1 and racemic ceralure B1 caught significantly more flies than trimedlure. The synthesis of specific enantiomers of ceralure B1 shows great promise as a male attractant that could replace trimedlure for detection and delimitation in action programs aimed at this exotic pest.

Implication of SAR of male medfly attractants in insect olfaction

Medfly (Ceratitis capitata) males are strongly attracted by different compounds, not described as pheromones. The best attractants reported are (+)-alpha-copaene, a sesquiterpene of natural source and (-)-ceralure-B1, a non-natural iodinated cyclohexane ester. Although their origin, atomic composition, chemical and physical properties are rather different, they show similar attraction to medflies. The question of why these compounds, act behaviorally in the same way, has been never addressed in research papers. We show here for the first time that these compounds have quite similar stereochemistry, water accessible surfaces, certain local dipole moments and, to some extent, similar octanol/water partition coefficient (log P). When seven carbons, one oxygen and one iodine belonging to (-)-ceralure-B1 are selectively chosen based on topological homology with (+)-alpha-copaene and are overlaid with nine corresponding carbons of (+)-alpha-copaene, the RMS is 0.367 A. This represents a high degree of steric resemblance. Local dipole moments and charges are similar in those regions where the molecules show topological homologies. Thus, we hypothesize that these two molecules could interact with the same male medfly's odorant receptor(s). The implications of this result in future research in insect olfaction is discussed.