Metformin is a potent inhibitor of endometrial cancer cell proliferation—implications for a novel treatment strategy

Obesity and diabetes are strong risk factors that drive the development of type I endometrial cancers. Recent epidemiological evidence suggests that metformin may lower cancer risk and reduce rates of cancer deaths among diabetic patients. In order to better understand metformin's anti-tumorigenic potential, our goal was to assess the effect of metformin on proliferation and expression of key targets of metformin cell signaling in endometrial cancer cell lines

Indicadores de sustentabilidad para la pesquería de curvina golfina Cynoscion othonopterus en el Alto Golfo de California

The Upper Gulf of California and Colorado River Delta is a zone which is immersed in an ecological, economic, political and social conflict. That is because of the Totoaba Totoaba macdonaldi illegal fishing and the Vaquita Phocoena sinus potential extinction. This issue has driven to ban all the region's fisheries with the exception of the Gulf corvina Cynoscion othonopterus which is the only of the finfish species with operating license. Therefore, the main objetive was to evaluate the fishery's health condition through the Froese sustainability indicators in Upper Gulf of California during 2008, 2013, 2014 and 2015 fishing seasons. The results showed that the Gulf corvina annual production ratio showed fluctuations, highlighting in the 2012-2016 period, when the whole fishing captures with the exception of 2014, surpassed the established quota by the National Institute of Fishery (Instituto Nacional de Pesca). The size-at-maturity were: 2008= L50: 502 mm (IC= 490-514 mm), 2013= L50: 559 mm (IC= 544-576 mm), 2014= L50: 499 mm (IC= 476-518 mm), and 2015= L50: 480 mm (IC= 445-510 mm). Based on the sustainability indicators, it is demonstrated that the Gulf corvina fishery is directed towards the organisms of greater length (mega-spawners). Finally it is concluded that Gulf corvina currently shows problems of over-exploitation and therefore its exploitation is not sustainable. This suggests the need to make adjustments and updates to current management measures.El Alto Golfo de California y Delta del Río Colorado es un área que se encuentra inmersa en un conflicto ecológico, económico, político y social debido a la pesca ilegal de totoaba Totoaba macdonaldi y la posible extinción de vaquita marina Phocoena sinus. Esto último ha provocado el cierre de todas las pesquerías en la región salvo la de curvina golfina Cynoscion othonopterus la cual es la única especie con permiso de explotación. Por lo tanto, el objetivo principal fue evaluar el estado de salud de la pesquería mediante los indicadores de sustentabilidad de Froese en el Alto Golfo de California durante las temporadas de pesca 2008, 2013, 2014 y 2015. Los resultados mostraron que la producción anual de curvina golfina presenta fluctuaciones, resaltando el periodo 2012-2016, donde las capturas totales con excepción de 2014, sobrepasaron la cuota de captura establecida por el Instituto Nacional de la Pesca. La longitud de madurez para los años estudiados fueron: 2008= L50: 502 mm (IC= 490-514 mm), 2013= L50: 559 mm (IC= 544-576 mm), 2014= L50: 499 mm (IC= 476-518 mm), y 2015= L50: 480 mm (IC= 445-510 mm). Con base en los indicadores de sustentabilidad, se demuestra que la pesquería de curvina golfina está dirigida hacia los organismos de mayor longitud (mega-reproductores). Se concluye que actualmente la curvina golfina manifiesta problemas de sobreexplotación y por ende su aprovechamiento no es sustentable. Esto sugiere la necesidad realizar ajustes y actualizaciones a las actuales medidas de manejo

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Dramatic clinical response following dabrafenib and trametinib therapy in a heavily pretreated low grade serous ovarian carcinoma patient with a BRAF V600E mutation

Low grade serous ovarian cancer (LGSOC) is a slowly growing, relatively chemoresistant neoplasm that is associated with a more favorable prognosis, especially compared to the disease's high-grade serous counterpart. We recount a case involving a 47-year-old, heavily pretreated LGSOC patient who presented with an elevated CA-125 of 1047 U/mL during her recent course of pemetrexed therapy. Thereafter, she underwent molecular profiling, which revealed a BRAF V600E mutation; accordingly, the patient was administered dabrafenib and trametinib combination therapy, a regimen that resulted in a precipitous decline of her CA-125 to 35 U/mL following the 6th cycle. The patient's favorable response to BRAF and MEK 1/2 inhibitor therapy underscores the significance of molecular profile testing and the use of targeted therapy regardless of tissue origin, especially in cases for whom standard management is limited or ineffective. Keywords: Low grade serous ovarian cancer, BRAF mutation, Dabrafenib, Trametini

The Impact of an Enhanced Recovery After Surgery Program on Patients Treated for Gynecologic Cancer in the Community Hospital Setting.

OBJECTIVES: The purpose of this study was to compare the outcomes of gynecologic oncology patients treated in the community hospital setting either under the auspices of an enhanced recovery after surgery (ERAS) protocol or in accordance with physician discretion. METHODS: We retrospectively evaluated a series of consecutive gynecologic oncology patients who were managed via open surgery in coincident with an ERAS pathway from January 2015 to December 2016. They were compared with a historical open surgery cohort who was treated from November 2013 to December 2014. The primary clinical end points encompassed hospital length of stay, hospital costs, and patient readmission rates. RESULTS: There were 86 subjects accrued in the ERAS group and 91 patients in the historical cohort. The implementation of ERAS occasioned a greater than 3-day mean reduction in hospital stay (8.04 days for the historical group vs 4.88 days for the ERAS subjects; CONCLUSIONS: The results from our investigation suggest that adhering to an ERAS protocol confers beneficial hospital length of stay and hospital cost outcomes, without compromising patient readmission rates. Additional investigation scrutinizing the impact of ERAS enactment with more defined study variables in a larger, randomized setting is warranted

The incidence of occult malignancy following uterine morcellation: A ten-year single institution experience retrospective cohort study.

INTRODUCTION: When the Food and Drug Administration (FDA) initially reported on the parlous incidence (0.28%) of occult malignancy identified following uterine power morcellation, investigations thereafter documented their particular experience with this surgical procedure. Nevertheless, the precise risk of identifying a sarcoma following uterine morcellation remains indeterminate, primarily due to varying study patient risk factors, diagnostic criteria and operative approach. METHOD: We retrospectively evaluated subjects who underwent an endoscopic hysterectomy and uterine power morcellation for the treatment of a presumptive, benign indication from January 2006 until December 2015. The primary outcome was the incidence of an occult malignancy. Secondarily, we were interested in characterizing the patients\u27 specific clinical (age, menopausal status, body mass index (BMI)) risk factors within the context of a confirmed malignant or pre-malignant pathology. RESULTS: We identified 281 patients who underwent endoscopic surgery that incorporated uterine morcellation. During the study period, one subject was ultimately diagnosed with a uterine leiomyosarcoma; the overall incidence of occult malignancy was 0.36%. There were also 3 cases of uterine premalignant disease on final pathology (2 patients had complex hyperplasia with or without atypia and 1 subject was diagnosed with a smooth muscle tumor of uncertain malignant potential (an incidence of 1.1%)). We were unable to establish any relationship between patient age, uterine weight, menopausal status or BMI and the incidence of a malignant or pre-malignant pathology (P \u3e 0.05). CONCLUSION: The rate of occult malignancy in the present investigation was similar to previously documented studies and that which has been reported by the FDA. Additional study of methods in which to enhance preoperative work-up and mitigate the surgical risk for tumor cell dissemination is warranted

The MEMORY Study: MulticentEr study of Minimally invasive surgery versus Open Radical hYsterectomy in the management of early-stage cervical cancer: Survival outcomes.

OBJECTIVE: The Laparoscopic Approach to Cervical Cancer (LACC) trial found that minimally invasive radical hysterectomy compared to open radical hysterectomy compromised oncologic outcomes and was associated with worse progression-free survival (PFS) and overall survival (OS) in early-stage cervical carcinoma. We sought to assess oncologic outcomes at multiple centers between minimally invasive (MIS) radical hysterectomy and OPEN radical hysterectomy. METHODS: This is a multi-institutional, retrospective cohort study of patients with 2009 FIGO stage IA1 (with lymphovascular space invasion) to IB1 cervical carcinoma from 1/2007-12/2016. Patients who underwent preoperative therapy were excluded. Squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinomas were included. Appropriate statistical tests were used. RESULTS: We identified 1093 cases for analysis-715 MIS (558 robotic [78%]) and 378. OPEN procedures. The OPEN cohort had more patients with tumors \u3e2 cm, residual disease in the hysterectomy specimen, and more likely to have had adjuvant therapy. Median follow-up for the MIS and OPEN cohorts were 38.5 months (range, 0.03-149.51) and 54.98 months (range, 0.03-145.20), respectively. Three-year PFS rates were 87.9% (95% CI: 84.9-90.4%) and 89% (95% CI: 84.9-92%), respectively (P = 0.6). On multivariate analysis, the adjusted HR for recurrence/death was 0.70 (95% CI: 0.47-1.03; P = 0.07). Three-year OS rates were 95.8% (95% CI: 93.6-97.2%) and 96.6% (95% CI: 93.8-98.2%), respectively (P = 0.8). On multivariate analysis, the adjusted HR for death was 0.81 (95% CI: 0.43-1.52; P = 0.5). CONCLUSION: This multi-institutional analysis showed that an MIS compared to OPEN radical hysterectomy for cervical cancer did not appear to compromise oncologic outcomes, with similar PFS and OS

Agreement in the assessment of metastatic spine disease using scoring systems

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