The role of YTH domain containing 2 in epigenetic modification and immune infiltration of pan-cancer.

YTH domain containing 2 (YTHDC2) is the largest N6-Methyladenosine (m6 A) binding protein of the YTH protein family and the only member containing ATP-dependent RNA helicase activity. For further analysing its biological role in epigenetic modification, we comprehensively explored YTHDC2 from gene expression, genetic alteration, protein-protein interaction (PPI) network, immune infiltration, diagnostic value and prognostic value in pan-cancer, using a series of databases and bioinformatic tools. We found that YTHDC2 with Missense mutation could cause a different prognosis in uterine corpus endometrial carcinoma (UCEC), and its different methylation level could lead to a totally various prognosis in adrenocortical carcinoma (ACC), cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC), lung squamous cell carcinoma (LUSC) and UCEC. The main molecular mechanisms of YTHDC2 focused on catalytic activity, helicase activity, snRNA binding, spliceosome and mRNA surveillance. Additionally, YTHDC2 was notably correlated with tumour immune infiltration. Moreover, YTHDC2 had a high diagnostic value for seven cancer types and a prognostic value for brain lower grade glioma (LGG), rectum adenocarcinoma (READ) and skin cutaneous melanoma (SKCM). Collectively, YTHDC2 plays a significant role in epigenetic modification and immune infiltration and maybe a potential biomarker for diagnosis and prognosis in certain cancers.

Local Hyperthermia at 44°C Is Effective in Clearing Cervical High-Risk Human Papillomaviruses: A Proof-of-Concept, Randomized Controlled Clinical Trial.

BACKGROUND: Persistent infection by high-risk human papillomavirus (HPV) is the leading cause of cervical intraepithelial neoplasia and cervical carcinoma. Local hyperthermia at 44ºC has been proven efficacious to clear cutaneous or anogenital warts caused by HPV infection. This study aims to assess the effect of hyperthermia at 44ºC on the clearance of high-risk HPV. METHODS: A randomized, patient-blind, sham treatment-controlled trial was conducted in 4 medical centers. We enrolled patients with positive high-risk HPVs and normal or insignificant cytological findings (negative/atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion). Participants were randomly assigned (1:1) to receive either hyperthermia at 44ºC or 37ºC, for 30 minutes in each session. Patients in both groups received treatment once a day for 3 consecutive days, plus 2 more sessions 10 ±â€…3 days later. The primary outcome was clearance rate of HPV 3 months after treatment. RESULTS: After a 3-month follow-up, hyperthermia treatment at 44ºC and 37ºC achieved HPV clearance rates of 85.19% (23/27) and 50% (13/26), respectively (P = .014). There was no significant difference of treatment response between patients with single and multiple type of HPV by 44ºC hyperthermia treatment. There were no significant adverse events recorded during the treatment period in both groups. CONCLUSIONS: Local hyperthermia at 44ºC safely and significantly aids in clearing cervical high-risk HPVs, the effect of which helps halt the progression of cervical transformation and transmission of the virus. CLINICAL TRIALS REGISTRATION: NCT03436251.

Inducing malignant transformation of endometriosis in rats by long-term sustaining hyperestrogenemia and type II diabetes.

This study aimed to induce malignant transformation of endometriosis in Sprague-Dawley rats by hyperestrogenemia and type II diabetes and evaluate its similarity with human disease in biological features. Rats with surgically induced endometriosis were randomized into two groups: those treated with estradiol (5 mg/kg three times/week after surgery), streptozotocin (25 mg/kg, 1 month after surgery), and high carbohydrate-and-fat feed (Es group); and those treated with placebo saline and standard feed (control group). All rats were randomly killed 2, 4, or 8 months after surgery. The endometriosis lesions and the corresponding eutopic endometria were subjected to morphological evaluation, TUNEL, and immunohistochemical analysis for the expressions of proliferating cell nuclear antigen, phosphatase and tensin homolog, phosphorylated protein kinase B, and phosphorylated mammalian target of rapamycin proteins. In the Es group, three cases (6.0%) of endometriosis showed atypical hyperplasia accompanied by simple hyperplastic eutopic endometria, and two cases (4.0%) of endometriosis showed endometrioid carcinoma accompanied by atypical hyperplastic eutopic endometria. In the Es group, the activity of organelles and the expressions of proliferating cell nuclear antigen, phosphorylated protein kinase B, and phosphorylated mammalian target of rapamycin increased, and the level of phosphatase and tensin homolog and TUNEL positivity decreased progressively in the order of endometriosis, atypical endometriosis, and malignant endometriosis. The same tendency was found in the corresponding eutopic endometria. The induced malignant endometriosis showed similarities with human disease in the pathological process and histomorphological and molecular biological features. The method is feasible. The malignant transformations of endometriosis and eutopic endometria may have correlations and similarities, but the former may suffer a higher risk of canceration.

Genome-Wide Microarray Analysis of Long Non-Coding RNAs in Eutopic Secretory Endometrium with Endometriosis.

BACKGROUND/AIMS: Dysregulated long non-coding RNAs (lncRNAs) can lead to the occurrence of various diseases; however, reports of the function of lncRNAs in endometriosis and related studies are scarce. The pathogenesis of endometriosis is still poorly understood. METHODS: Dysregulated lncRNAs and mRNAs between eutopic and normal endometrium (both are late secretory) were analyzed by lncRNA microarray. Eight lncRNAs and mRNA CDK6 were validated using quantitative reverse transcription polymerase chain reaction (qRT-PCR). Bioinformatics prediction was used to investigate the potential function of these differentially expressed lncRNAs. RESULTS: Microarray expression profiling suggests 1277 lncRNAs (488 up- and 789 down-regulated) and 1216 mRNAs (578 up- and 638 down-regulated) were expressed differentially between eutopic and normal endometrium. Pathway analysis and gene ontology (GO) analysis found differently expressed lncRNAs associated with the cell cycle and immune regulation. The relative level of expression of CDK6 and AC002454.1 were obtained by qRT-PCR and the Pearson correlation coefficient was 0.747 (p<0.0001). A coding-noncoding gene co-expression (CNC) network was constructed for these validated lncRNAs. CONCLUSION: These dysregulated lncRNAs might provide information for new biomarkers or novel therapeutic targets of endometriosis. AC002454.1 might induce cell cycle disorder by regulating CDK6 to participate in the pathogenesis of endometriosis.

NDC80 Kinetochore Complex Serves as a Potential Prognostic Predictor and Correlates with Immune Infiltrates in Epithelial Ovarian Cancer Patients.

Purpose: This study focuses on evaluating the prognostic value of the NDC80 kinetochore complex in ovarian cancer (OC) using the Gene Expression Omnibus (GEO) database and the Cancer Genome Atlas (TCGA) database and reveals the relationship between the NDC80 complex and immune infiltrates in OC. Methods: We collected data on NDC80 complex expression levels in both OC tissues and non-OC ovarian tissues from the University of California Santa Cruz Xena and GEO databases. The clinicopathological characteristics correlated with overall survival were analyzed using Cox regression and the Kaplan-Meier method. Gene Ontology analysis, Kyoto Encyclopedia of Genes and Genomes analysis, gene set enrichment analysis and CIBERSORT were performed using data from TCGA database. Immunohistochemical staining was used to verify the higher expression level of NUF2 protein in OC in vitro. Meanwhile, we utilized the Tumor Immune Estimation Resource to analyze the correlation between the NDC80 complex and immunocyte infiltration. Results: The NDC80 complex expression level was prominently higher in OC tissues than in non-OC ovarian tissues and correlated with advanced histologic grade characteristics. Gene expression profiling interactive analysis and the Kaplan-Meier survival curve uncovered a close relationship between high expression of the NDC80 complex and poor overall survival in OC patients. The univariate Cox regression hazard model produced age, pathologic stage, tumor status, primary therapy outcome, SPC24 expression level, and Karnofsky performance score as prognostic factors for OC patients. NDC80 complex expression levels were highly associated with immune cell infiltration, showing NK CD56 bright cells and NK cells with a negative correlation and T helper 2 cells with a positive correlation (P<0.05). Conclusion: These findings provide evidence that an increased expression level of the NDC80 complex is closely associated with the progression of OC and could also serve as a novel target of immunotherapy in OC.

Pituitary apoplexy after surgery for cervical stump adenocarcinoma: A case report and literature review.

Pituitary apoplexy (PA) is an emergency condition caused by sudden hemorrhage or infarction and characterized by sudden sella turcica compression, intracranial hypertension and meningeal stimulation. PA usually occurs secondary to pituitary adenomas and can serve as the initial manifestation of an undiagnosed pituitary adenoma in an individual. In the present study, a case of PA following surgery for cervical stump adenocarcinoma was reported. The patient experienced an abrupt onset of headache and drowsiness on postoperative day 1 (POD1), and developed blurred vision and blepharoptosis of the left eye on POD4. Pituitary MRI confirmed the diagnosis of PA, prompting the initial administration of hydrocortisone to supplement endogenous hormones, followed by trans-sphenoidal resection. At the six-week follow-up, the patient had fully recovered, with only mild residual blurring of vision. Diagnosing PA post-surgery can be a challenging task due to its symptomatic overlap with postoperative complications. The existing literature on PA after surgery was also reviewed, including the symptoms, time of onset, imageological examination, management, potential risk factors and outcome to improve on early detection and individualized treatment in the future.

Therapeutic effects and molecular mechanisms of quercetin in gynecological disorders.

Quercetin is a representative flavonoid that is widely present in fruits, herbs, and vegetables. It is also an important active core component in traditional Chinese medicines. As an important flavonoid, quercetin has various properties and exerts antioxidant, anti-inflammatory, and cardioprotective effects. The public interest in quercetin is increasing, and quercetin has been used to prevent or treat numerous of diseases, such as polycystic ovary syndrome (PCOS), cancer, autoimmune diseases and chronic cardiovascular diseases, in clinical experiments and animal studies due to its powerful antioxidant properties and minimal side effects. Quercetin exerts marked pharmacological effects on gynecological disorders; however, there have been no reviews about the potential health benefits of quercetin in the context of gynecological disorders, including PCOS, premature ovary failure (POF), endometriosis (EM), ovarian cancer (OC), cervical cancer (CC) and endometrial carcinoma (EC). Thus, this review aimed to summarize the biological effects of quercetin on gynecological disorders and its mechanisms.

MiR-136-5p in cancer: Roles, mechanisms, and chemotherapy resistance.

MicroRNAs (miRNAs) have emerged as important regulators of gene expression, and the deregulation of their activity has been linked to the onset and progression of a variety of human malignancies. Among these miRNAs, miR-136-5p has attracted significant attention due to its diverse roles in cancer biology. Mostly, miR-136-5p is downregulated in malignancies. It could inhibit viability, proliferation, migration, invasion and promote apoptosis of tumor cells. This review article provides a comprehensive overview of the current understanding of miR-136-5p in different sorts of human cancers: genital tumors, head and neck tumors, tumors from the digestive and urinary systems, skin cancers, neurologic tumors, pulmonary neoplasms and other cancers by discussing its molecular mechanisms, functional roles, and impact in chemotherapies. In conclusion, miR-136-5p could be a promising new biomarker and potential clinical therapeutic target.

The Predictive Value of PCT and Other Infection Indicators in Postoperative Infection of Epithelial Ovarian Cancer.

Purpose: To study the early predictive value of WBC, CRP and PCT on infectious complications after epithelial ovarian cancer surgery, draw ROC curves, and construct a nomogram prediction model. Patients and Methods: The clinical data of patients with epithelial ovarian cancer in Shengjing Hospital from August 2019 to August 2022 were included. The levels of WBC, CRP and PCT were statistically analyzed on the first, third and fifth days after surgery, and the ROC was plotted. Multivariate logistic regression analysis determined independent influencing factors, individualized nomogram model for predicting the occurrence of postoperative infectious complications was constructed, and the correction curve was used for verification. Results: A total of 116 patients were enrolled. The postoperative test levels of WBC, CRP and PCT were compared between two groups, and the differences on POD3 and POD5 were statistically significant. The ROC area on POD5 was 0.739, 0.838 and 0.804, respectively, better than that on POD3. Among them, CRP has the greatest value; The predicted value of the combined test of WBC, CRP and PCT on POD5 was greater than that of a single index on POD5. The nomogram model on POD5 was constructed, and the ROC analysis showed that it had a good degree of differentiation. Conclusion: WBC, CRP and PCT can effectively predict the occurrence of postoperative infectious complications, among which CRP alone has the greatest diagnostic value on POD5, and the combined test value of the three indicators is higher than that of a single index. The nomogram model constructed by the combined indicators on POD5 can assess the risk individually.

Predicting chorioamnionitis in patients with preterm premature rupture of membranes using inflammatory indexes: a retrospective study.

OBJECTIVE: The prognosis of preterm premature rupture of membranes (PPROM) combined with chorioamnionitis is often unsatisfactory for both mother and newborn. Although tragic outcomes can be avoided if treated early, no effective prediction method for decision-making is available currently. This study aimed to establish an effective method with maternal inflammation indexes to predict preterm premature rupture of membranes with concomitant chorioamnionitis. MATERIALS AND METHODS: This retrospective study examined the data of 206 singleton PPROM cases and 60 normal full-term cases. The PPROM cases included 93 cases of PPROM with chorioamnionitis and 113 cases of PPROM without chorioamnionitis based on clinical manifestations, laboratory examinations, and histopathological diagnosis. Normal full-term cases were included as the control group. Peripheral blood levels of selected inflammatory indicators were observed 12 h after fetal membrane rupture. Associations between selected inflammatory indicators and chorioamnionitis diagnosis were analyzed. RESULTS: Selected factors except for procalcitonin predicted chorioamnionitis in PPROM patients. Combined results of C-reactive protein and white blood cell (WBC) count showed best predictive ability with area under curve, sensitivity, and specificity of 0.702, 60.22%, and 76.11%, respectively. Furthermore including Interleukine-6 and neutrophil count provided similar predictive results. CONCLUSIONS: The best predictive factor combinations for PPROM-CAM were C-reactive protein and white blood cell count. Results of this study provide a useful clinical reference for PPROM-CAM and may improve maternal and infant prognostic outcomes.

Research advances in endometriosis-related signaling pathways: A review.

Endometriosis (EM) is characterized by the existence of endometrial mucosa outside the uterine cavity, which causesinfertility, persistent aches, and a decline in women's quality of life. Both hormone therapies and nonhormone therapies, such as NSAIDs, are ineffective, generic categories of EM drugs. Endometriosis is a benign gynecological condition, yet it shares a number of features with cancer cells, including immune evasion, survival, adhesion, invasion, and angiogenesis. Several endometriosis-related signaling pathways are comprehensively reviewed in this article, including E2, NF-κB, MAPK, ERK, PI3K/Akt/mTOR, YAP, Wnt/ß-catenin, Rho/ROCK, TGF-ß, VEGF, NO, iron, cytokines and chemokines. To find and develop novel medications for the treatment of EM, it is essential to implicitly determine the molecular pathways that are disordered during EM development. Additionally, research on the shared pathways between EM and tumors can provide hypotheses or suggestions for endometriosis therapeutic targets.

Advances in fertility preserving surgery for borderline ovarian tumors.

Borderline ovarian tumor is a tumor with pathomorphological characteristics, biological behavior and prognosis between benign and malignant tumors. Preoperative diagnosis of ovarian cancer is usually based on imaging and tumor markers. Because of the early diagnosis and good prognosis of borderline ovarian tumors, fertility preserving surgery can be selected for patients with borderline ovarian tumors who have not completed fertility. Compared with radical surgery, fertility preserving surgery has a higher recurrence rate, but most of them are not malignant, which will not affect the overall survival rate, and the postoperative fertility rate is also very good. Patients with borderline ovarian tumors, especially those with BOT stage II or above, should get pregnant as soon as possible and be followed up closely for a long time.

Subserous Cystic Adenomyosis: A Case Report and Review of the Literature.

Introduction: Cystic adenomyosis is a rare type of adenomyosis that often occurs in adolescents or women of childbearing age. Due to the few reports of this case, its clinical characteristics have not been clearly established. Case Presentation: We treated a 32-year-old married patient with cystic adenomyosis that reported persistent abdominal pain and massive vaginal bleeding, so an emergency laparotomy was performed. The intraoperative findings and post-operative pathology proved that the diagnosis was correct. The prognosis of the patient is good, and there is no recurrence within 3 months after surgery. Results: Surgery is the most effective way to treat cystic adenomyosis. Ultrasound and magnetic resonance are the most effective auxiliary examinations for diagnosing the disease. Conclusion: Cystic adenomyosis is a sporadic disease. This article summarizes this condition's clinical manifestations, pathological features, diagnosis, treatment, and prognosis by reviewing the existing literature and the case presented in this report. It is noteworthy that early diagnosis and individualized treatment strategies can improve patients' quality of life.

Deep Infiltrating Endometriosis Malignant Invasion of Cervical Wall and Rectal Wall With Lynch Syndrome： A Rare Case Report and Review of Literature.

Background: Malignant transformation of deep infiltrating endometriosis (DIE) invading the cervix and rectum is quite rare, especially in patients combined with Lynch syndrome (LS). We report a rare case of a 49-year-old perimenopausal woman with endometrioid carcinoma arising from the pouch of Douglas, invading the cervix and rectum 1 year after a unilateral salpingo-oophorectomy treatment for ovarian endometriosis. The genetic testing of the patient showed germline mutations in MSH2, which combined with the special family history of colorectal cancer of the patient, was also thought to be associated with LS. We have analyzed the reported cases of DIE malignant transformation over the last 10 years, and reviewed the relevant literature, in order to strengthen the clinical management of patients with endometriosis, particularly patients with DIE, and reveal a possible correlation between malignant transformation of endometriosis and LS. Case Presentation: A 49-year-old perimenopausal woman presented with hypogastralgia, diarrhea, and intermittent fever for more than 1 month. A Transvaginal ultrasound (TVS) showed a cervix isthmus mass, and a magnetic resonance imaging (MRI) showed a mass in pouch of Douglas with high suspicion of malignancy, possibly invading the anterior wall of the rectum. Prior to surgery, the patient performed the ultrasound guided pelvic mass biopsy through the vagina, and the pathology of the mass showed endometrioid carcinoma. The patient received a gynecological-surgical laparotomy and enterostomy, and a histopathology revealed endometrioid carcinoma infiltrating the cervical wall and rectal wall. In the family genetic history of the patient, her mother and two sisters suffered from colorectal cancer, so lesion tissue and blood were taken for genetic testing, which showed a germline mutation in MSH2, with LS being considered. After the surgical treatment, the patient received six courses of paclitaxel-carboplatin chemotherapy. During the course of treatment, bone marrow suppression occurred, but was healed after symptomatic treatment. To date, the patient is generally in good health, and imaging examination showed no evidence of recurrence. Conclusion: The risk of malignant transformation of endometriosis is increased in perimenopause and postmenopause, as DIE is a rare malignant transformation of endometriosis. DIE can invade other adjacent organs and cause poor prognosis, thus, comprehensive gynecological-surgical treatment should be necessary. In addition, if histopathology showed endometrioid carcinoma, the possibility of LS should be considered, and if necessary, immunohistochemical staining and gene detection should be improved to provide follow-up targeted therapy and immunotherapy.

Concurrent Benign Metastasizing Leiomyoma in the Abdominal Wall and Pelvic Cavity: A Case Report and Review of the Literature.

Benign metastatic leiomyoma (BML) is a histologically benign disease with invasive biological behavior. Most patients are women of childbearing age with a history of uterine leiomyoma. The progress of the disease is relatively slow, the prognosis is good, and most patients can survive for a long time. The lung is the common metastatic site, and BML with metastatic lesions outside the lung is very rare. A 37-year-old woman with multiple BML in the abdominal wall and pelvic cavity after uterine leiomyoma surgery was admitted to our hospital. Combined with the clinical data of this case and reviewing the relevant literature, this paper discusses the pathological characteristics, diagnosis, differential diagnosis, and treatment of BML.

Clinical Analysis of 17 Cases of Borderline Ovarian Tumors During Pregnancy.

Objective: The study retrospectively analyzed the clinical characteristics and prognosis of 17 cases of pregnancy complicated by borderline ovarian tumors to provide help for clinical workers. Materials and Methods: The clinicopathological data of 17 patients with ovarian borderline tumors during pregnancy at the Shengjing Hospital of China Medical University from January 2015 to June 2021 were collected and analyzed retrospectively. The average age of the patients was 31.82 years (25-45 years), the average number of pregnancies was 2.06 times (1-6 times), and the average number of births was 0.41 times (0-1 time). Results: Among the 17 patients, 4 were diagnosed in the first trimester, 2 in the second trimester, and 11 in the third trimester. Most of the first symptoms were cysts, cyst enlargement, or cyst rupture. Among them, 3 cases (1 in the first trimester and 2 in the second trimester) continued pregnancy after a conservative operation, 9 cases underwent cesarean section and a conservative operation simultaneously, and the mother and child had a good outcome. Two cases underwent conservative operations and induced abortion, and 1 case underwent an ectopic pregnancy operation at the same time. The prognosis of the patients was good without recurrence. Conclusion: Preoperative diagnosis of borderline ovarian tumors in pregnancy is delayed, and imaging and tumor markers are not specific. The coincidence rate between intraoperative frozen pathology and postoperative paraffin pathology was not high. Borderline tumors are mainly treated by surgery, and the prognosis for mothers and infants is good.

Application of Single-Port Laparoscopic Surgery in Myomectomy.

RESEARCH QUESTION: The use of a power morcellator in laparoscopic myomectomy is a controversial topic. The application of single-port laparoscopy solves this problem, but its safety, efficacy and prognosis are also challenges. The purpose of this study was to compare the clinical application of single-port laparoscopy and traditional three-port laparoscopy in myomectomy. DESIGN: This is a retrospective review of a total of 120 patients who underwent single-port laparoscopic myomectomy (n=60) or traditional three-port laparoscopic myomectomy (n=60), performed between January 2019 to December 2020. The operation time, intraoperative blood loss, specimen removal time, hemoglobin change after operation, postoperative ambulation time, first exhaust time after surgery, the length of hospital stay, pain score on the day, the first day after operation and the satisfaction of abdominal wall scar were evaluated for the surgical outcomes. RESULTS: Compared with the traditional three-port laparoscopic group, the specimen removal time, postoperative ambulation time, first exhaust time after surgery, the length of hospital stay were all shorter, the satisfaction of abdominal wall scar were higher in single-port laparoscopic group. The duration of surgery was longer in single-port laparoscopic group significantly. The differences were statistically significant (P<0.05). The intraoperative blood loss, hemoglobin change after operation, pain score on the day of operation and the first day after operation of the two groups had no differences (P>0.05). CONCLUSIONS: The clinical effect of single-port laparoscopic myomectomy is satisfactory and can be popularized in clinic.

Giant Ovarian Cysts Treated by Single-Port Laparoscopic Surgery: A Case Series.

BACKGROUND: Ovarian cysts are very common diseases of the female reproductive system. Giant ovarian cysts refer to the tumors with diameters greater than 10 cm. In recent years, due to the development of clinical diagnosis, imaging modalities, and the improvement of patients' cognition of the diseases, the occurrence of giant ovarian cysts has become rare. The purpose of this study was to show a new operation method of single-port laparoscopy to treat giant ovarian cysts. METHODS: We report a case series of five patients with giant ovarian cysts who underwent single-port laparoscopic surgery in the gynecology department of the Shengjing Hospital of China Medical University between June 2020 and March 2021. The inclusion criteria were ovarian cysts at least 20 cm in diameter, and cases when the tumor might be malignant were excluded. RESULTS: The patients' mean age was 26.2years. The most common clinical presentation was progressive abdominal distension. Median size of the cysts at imaging was 39.2 cm (range 21-63 cm). All patients underwent single-port laparoscopic surgery, and none of them converted to laparotomy. On final pathological reports, two cysts were serous cystadenomas, and three were mucinous cystadenomas. All patients recovered well and were discharged on time. CONCLUSION: Giant ovarian cysts can be treated by single-port laparoscopic surgery. In addition to the well-known advantages of laparoscopic surgery (e.g., small pelvic interference, fast postoperative recovery), it can also play the role of perfect cosmetic results, which has more advantages for young women.

Predictive Value of HE4 in Platinum-Based Chemotherapy for Ovarian Cancer: A Systematic Review.

OBJECTIVE: To evaluate the value of serum Human epididymis protein 4 (HE4) for predicting the resistance of ovarian cancer (OS) to platinum chemotherapy. METHOD: We searched the MEDLINE (PubMed), EMBASE, Cochrane Central, Web of Science, SCOPUS, and CNKI databases and screened all studies evaluating serum HE4 for predicting OC resistance to treatment with platinum. Two researchers independently evaluated the quality of all eligible original studies using QUADAS-2. RevMan 5.4 was used to compile the quality evaluation form. We also performed a meta-analysis with STATA15.1, and Deek's funnel plots were used to detect any publication bias. RESULTS: Eight studies were included in the final meta-analysis. Our results showed that the sensitivity and specificity of preoperative serum HE4 in predicting the resistance of OC to platinum chemotherapy was 80% and 67%, respectively. The diagnostic odds ratio was 8, and the AUC was 0.78 (95% CI: 0.75-0.82), whereas the pooled sensitivity and specificity of serum HE4 after the third-cycle of chemotherapies for predicting chemoresistance in OC was 86% and 85%, respectively, with a diagnostic odds ratio of 33 and AUC = 0.92 (95% CI: 0.89 - 0.94). CONCLUSION: HE4 may be an effective predictor of platinum-based chemotherapeutic resistance of OC. Serum HE4 levels after the third chemotherapy cycle may be indicative for clinical practice. Further research is needed to validate the significance of HE4 in the long-term management of OC. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, PROSPERO (CRD42021220099).

Drinking habits and water sources with the incidence of cognitive impairment in Chinese elderly population: The Chinese Longitudinal Healthy Longevity Survey.

BACKGROUND: Little was known on whether drinking habits and water sources affected cognitive function. This study aimed to examine the associations of drinking habits and water sources with the incidence of cognitive impairment in the Chinese elderly population. METHODS: Data were drawn from the Chinese Longitudinal Healthy Longevity Survey. All participants aged ≥ 60 years at baseline were potential eligible. Cognitive function was measured using the Chinese version of the Mini-Mental State Examination (CMMSE). Participants with the CMMSE score ≤ 24 were identified as cognitive impairment. Drinking habits included preferring to drink boiled water or un-boiled water. Water sources included well, surface water, spring, and tap water. RESULTS: This study included 18034 participants. Participants drinking un- boiled water were more likely to develop cognitive impairment than those drinking boiled water (P< 0.001; HR: 1.269; and 95% CI: 1.128-1.427). Compared to drinking from a well, drinking from tap water at childhood, around aged 60 years, and present was associated with a lower incidence of cognitive impairment (all P< 0.001; HR: 0.672, 0.735, and 0.765; and 95% CI: 0.540-0.836, 0.686-0.788, and 0.723-0.810, respectively). LIMITATIONS: The underline mechanisms behind the associations of drinking habits and water sources with the incidence of cognitive impairment were not fully explained. CONCLUSIONS: Participants drinking un- boiled water were more likely to develop cognitive impairment. Meanwhile, compared to drinking from a well, drinking from tap water was associated with a lower incidence of cognitive impairment.