Metformin plus megestrol acetate compared with megestrol acetate alone as fertility-sparing treatment in patients with atypical endometrial hyperplasia and well-differentiated endometrial cancer: a randomised controlled trial.

OBJECTIVE: To assess the efficacy of metformin in megestrol acetate (MA)-based fertility-sparing treatment for patients with atypical endometrial hyperplasia (AEH) and endometrioid endometrial cancer (EEC). DESIGN: A randomised, single-centre, open-label, controlled trial conducted between October 2013 and December 2017. SETTING: Shanghai OBGYN Hospital of Fudan University, China. POPULATION: A total of 150 patients (18-45 years old) with primary AEH or well-differentiated EEC were randomised into an MA group (n = 74) and an MA plus metformin group (n = 76). METHODS: Patients with AEH or EEC were firstly stratified, then randomised to receive MA (160 mg orally, daily) or MA (160 mg orally, daily) plus metformin (500 mg orally, three times a day). MAIN OUTCOMES AND MEASURES: The primary efficacy parameter was the cumulate complete response (CR) rate within 16 weeks of treatment (16w-CR rate); the secondary efficacy parameters were 30w-CR rate and adverse events. RESULTS: The 16w-CR rate was higher in the metformin plus MA group than in the MA-only group (34.3 versus 20.7%, odds ratio [OR] 2.0, 95% confidence interval [CI] 0.89-4.51, P = 0.09) but the difference was more significant in 102 AEH patients (39.6 versus 20.4%, OR 2.56, 95% CI 1.06-6.21, P = 0.04). This effect of metformin was also significant in non-obese (51.4 versus 24.3%, OR 3.28, 95% CI 1.22-8.84, P = 0.02) and insulin-sensitive (54.8 versus 28.6%, OR 3.04, 95% CI 1.03-8.97, P = 0.04) subgroups of AEH women. No significant result was found in secondary endpoints. CONCLUSION: As a fertility-sparing treatment, metformin plus MA was associated with a higher early CR rate compared with MA alone in AEH patients. TWEETABLE ABSTRACT: For AEH patients, metformin plus MA might be a better fertility-sparing treatment to achieve a higher early CR rate compared with MA alone.

Expression of nestin in ovarian serous cancer and its clinicopathologic significance.

OBJECTIVE: Nestin has been found to be overexpressed in several human malignancies. The primary goal of this research was to investigate whether nestin expression correlates with the occurrence and development of ovarian cancer. PATIENTS AND METHODS: Expression of nestin was evaluated by immunohistochemistry in 315 cases of various epithelial ovarian lesions as well as 52 cases of normal ovarian epithelia. The association between nestin expression and various clinical pathological parameters was analysed. RESULTS: Immunohistochemical results showed that the positive correlation of nestin expression gradually increased from benign and borderline to malignant ovarian tumours. Nestin overexpression was associated with more advanced International Federation of Gynaecology and Obstetrics stage and higher histological grade in serous adenocarcinoma. Nestin expression was significantly associated with chemoresistance. However, there was no significant correlation between nestin expression and the age and level of CA125 in patients. CONCLUSIONS: We propose that nestin expression might contribute to the initiation, promotion, and progression of serous ovarian carcinoma; nestin expression is associated with poor chemoresponse. It could be a potential therapeutic target in patients with epithelial ovarian carcinoma.

[Chemical constituents in volatile oil from fruits of Alpinia oxyphylla Miq].

OBJECTIVE: To study the chemical constituents in the volatile oil from fruits of Alpinia oxyphylla. METHOD: Using GC-MS to identify the constituents. RESULT AND CONCLUSION: Sixty-four compounds were identified on the basis of GC-MS, the main ones being p-cymene, valence, linalool, myrtenal, alpha-pinene, beta-pinene, furopelargone A and terpinen-4-ol. Three sesquiterpenes valencene, nootkanone and nootkanol have been isolated from the CHCl3 extract as check, of these 64 identified compounds linalyl oxide, valencene, bakkenolide A, furopelargone A and 3-hydroxycalamenene are reported for the first time.

Annonaceous acetogenins of the seeds from Annona muricata.

Muricatenol (1) is a new C37 non-THF ring acetogenin with four hydroxyls and one isolated double bond in the long aliphatic chain. 2,4-cis-Gigantetrocinone (2) and 2,4-trans-gigantetrocinone (3) have been isolated as their acetates by preparative TLC. 2,4-trans-Isoannonacin-10-one (4) and 2,4-trans-isoannonacin (5) have been isolated as only 2,4-trans-form for the first time (no cis-form). Also four known acetogenins, gigantetrocin-A (6), gigantetrocin-B (7), annomontacin (8), gigantetronenin (9) and a mixture of N-fatty acyl tryptamines have been isolated (10). Their structures have been established on the basis of spectral analyses. The CHCl3 fraction of the seeds showed strong antitumor activities.

[Studies on the chemical constituents of Annona muricata].

Annonaceous acetogenin (or polyketide) is a kind of potential antineoplastic agents from Annonaceae plants. Two new acetogenins, Muricatalicin (I) and muricatalin (VI), a mesitoate of a new acetogenin, annonacin-B mesitoate (Vb), and three known acetogenins, annonacin (II), annonacin-A (III) and annonacin-10-one (IV) have been isolated from Annona muricata L. The structures and relative stereochemistry of I, VI and Vb were elucidated on the basis of spectral analysis and examination of their acetates and/or mesitoate.

[Giant-cell tumor of the sacrum: an analysis of 10 cases].

Giant-cell tumor of the sacrum is rare. There were only a few reports of large series in the literature. From 1960-1988 a total of ten cases giant-cell tumor of the sacrum were treated in our Department. The average age of the patients was 34 years (with range of 19-49 years). The lesions located in the proximal parts of the sacrums in 8 cases, and in S3-5 in another 2 cases. of 10, 7 were treated with en bloc resection or subtotal resection. of the sacrum, and followed by irradiation in 5 of 7 cases (with range of 2000r-4500r). All the 7 cases were followed up without any evidence of local recurrence or distant metastases. The average follow-up period was 10.3 years (with range of 1.5-27.5 years). The rectal, bladder and sexual function were normal or restored. The other 3 cases, biopsied in 2, partially resected in 1, died less than one year after diagnosis. Comparing the died group with the survival group, we concluded that early diagnosis and thorough excision of the tumor are the two decisive factors for a favorable prognosis.