Effects of thymosin ß4-derived peptides on migration and invasion of ovarian cancer cells.

BACKGROUND: Thymosin ß4 (Tß4) is a highly conserved actin binding protein associated with the metastatic potential of tumor cells by stimulating cell migration. The role of Tß4 and its derived fragment peptides in migration of ovarian cancer cells has not been studied. OBJECTIVE: To analyze the effects of Tß4 and its derived fragment peptides on ovarian cancer cell migration and invasion, we applied Tß4 and three Tß4-derived synthetic peptides to SKOV3 ovarian cancer cells. METHOD: The migration and invasion of SKOV3 cells treated with Tß4(1-43), Tß4(1-15), Tß4(12-26), Tß4(23-), and untreated control were analyzed by in vitro migration and invasion assay with transwell plate. Cell proliferation assay was conducted to identify the effect of Tß4 and its derived peptide on SKOV3 cell proliferation. The expression of Tß4 related proteins related with cell proliferation was analyzed by Western blot after treatment with Tß4 and its derived peptides. RESULTS: Cell migration and invasion were significantly increased in Tß4 peptide-treated SKOV3 cells compared with untreated control. All three Tß4-derived fragment peptides including those without an actin binding site significantly stimulated migration and invasion of SKOV3 cells. Tß4 and its derived peptide significantly stimulated SKOV3 cell proliferation and up-regulated the expression of RACK-1 protein. CONCLUSIONS: The Tß4 peptide and all of its derived fragment peptides including those without an actin binding motif stimulate migration and invasion of SKOV3 ovarian cancer cells. All peptides significantly increased RACK-1 expression and cell proliferation of SKOV3 cells. These results suggest that Tß4 stimulates migration and invasion of SKOV3 cells by stimulation of cell proliferation through up-regulation of RACK-1 protein.

Analysis of KAP1 expression patterns and human endogenous retrovirus Env proteins in ovarian cancer.

BACKGROUND: Human endogenous retroviruses (HERVs) constitute around 8% of the human genome and have important roles in human health and disease, including cancers. Previous studies showed that HERV envelope (Env) proteins are highly expressed in cancer tissues and co-related with cancer progression. KAP1 has been reported to play a key role in regulating retrotransposons, including HERV-K, through epigenetic silencing. OBJECTIVE: The relationship between KAP-1 and HERV Envs expressions was analyzed only in tumor cell lines and has not yet been studied in cancer tissues. In this study, we analyzed the expression patterns and relationship between KAP1 and HERV Env proteins in ovarian cancer tissues. METHOD: The expression patterns of KAP-1 and HERV Env proteins, including HERV-K and HERV-R, were analyzed in ovarian cancer tissue microarrays that contained 80 surgical specimens, including normal ovary and malignant ovarian cancers. RESULTS: The expression of HERV-R Env and KAP1 proteins is significantly higher in ovarian cancer compared with normal ovary tissues. However, the expression of HERV-K Env did not change significantly in cancer tissues. The expression patterns of HERV-K Env and HERV-R Env significantly increased in early stages of cancer and KAP1 expression was higher in certain stage and types of cancers. However, the expression of HERV-K Env, HERV-R Env, and KAP1 did not change in different age groups. The correlation between the expression of KAP1 and HERV-Env, including HERV-K and HERV-R, was not significantly correlated. CONCLUSIONS: The results of this study showed that there was no significant correlation between the expression of KAP1 and HERV Env proteins in ovarian cancer tissues, unlike studies with cell lines in vitro. These results suggest that the actual expression of HERV Env proteins in ovarian cancer tissues may be regulated through various complex factors as well as KAP1.

Correlation of constitutive photomorphogenic 1 (COP1) and p27 tumor suppressor protein expression in ovarian cancer.

BACKGROUND: Constitutive photomorphogenic 1 (COP1) is an E3 ubiquitin ligase that regulates important target proteins for cell growth including p27. The tumor suppressor p27 negatively regulates the cell cycle by inhibiting cyclin-dependent kinase. COP1 negatively regulates p27 stability by mediating its nuclear export and degradation. OBJECTIVE: Even if COP1 and p27 are tightly related and have significant roles in tumor progression, the expression patterns and relationship of both proteins in cancer have not yet been studied. METHOD: We analyzed the expression patterns and relationship between COP1 and p27 using an ovarian cancer tissue microarray by dual immunofluorescence analysis. RESULTS: The expression levels of COP1 and p27 proteins were not significantly different between ovarian cancer tissue and normal control tissue. Other clinical data including age, tumor type, tumor grade, and stage were not significantly related to expression of the two proteins. The co-relationship between COP1 and p27 proteins was significantly high (Pearson correlation coefficient 0.79, p = 8.65 × 10-22). CONCLUSIONS: Our results demonstrate that while the expression levels of COP1 and p27 are highly correlated, they are not significantly related to cancer progression in ovarian cancer.

Characteristics of Dapagliflozin Responders: A Longitudinal, Prospective, Nationwide Dapagliflozin Surveillance Study in Korea.

INTRODUCTION: Sodium glucose co-transporter 2 (SGLT2) inhibitors, such as dapagliflozin, have demonstrated favorable effects in patients with type 2 diabetes (T2D). However, there are limited reports in the literature regarding the glucose-lowering effects of SGLT2 inhibitors in actual clinical settings. METHODS: The post-marketing surveillance data from a longitudinal prospective study of 2007 patients with T2D who were prescribed dapagliflozin (10 mg/day) were analyzed (ClinicalTrials.gov, NCT02252224). RESULTS: After 12 weeks of dapagliflozin treatment, glycated hemoglobin (HbA1c) and body mass index were significantly decreased (P < 0.001) from 8.1 ± 1.3% to 7.5 ± 1.2% and from 28.1 ± 4.4 to 27.6 ± 4.2 kg/m2, respectively. Both body weight and HbA1c were reduced in 67.7% of patients, and HbA1c was lowered in 75.1%. Younger age, male sex, shorter diabetes duration, higher baseline HbA1c and estimated glomerular filtration rate (eGFR), and having dapagliflozin as add-on therapy were associated with stronger HbA1c reductions after dapagliflozin use (all P < 0.05). Moreover, subgroup analysis of eGFR of subjects with renal hyperfiltration (eGFR ≥ 120 ml/min/1.73 m2) showed the largest reduction in glucose level (% change, - 9.5; 95% CI - 6.8 to - 12.3 for HbA1c; P < 0.001). Multivariable logistic regression analysis showed that recent T2D diagnosis and higher HbA1c at baseline in patients who received an add-on regimen of dapagliflozin were statistically significantly associated with a dapagliflozin response (all P < 0.05). CONCLUSIONS: Dapagliflozin provides benefits for glycemic control and body weight. Patients in a relatively early stage of the course of diabetes with renal hyperfiltration might be more suitable for and gain maximal benefit from dapagliflozin treatment. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT02252224. FUNDING: AstraZeneca.

Effectiveness and safety of exenatide in Korean patients with type 2 diabetes inadequately controlled with oral hypoglycemic agents: an observational study in a real clinical practice.

BACKGROUND: Randomized clinical trials have shown the efficacy and safety of short-acting exenatide in patients with type 2 diabetes mellitus (T2DM). The aim of this observational study was to investigate the effectiveness and safety of exenatide twice a day in Korean patients with T2DM who are suboptimally controlled with oral hypoglycemic agents. METHODS: This study was a post hoc analysis of multi-center (71 centers), prospective, observational, single-arm, post-marketing study of short-acting exenatide 5 to 10 µg twice a day from March 2008 to March 2014 and analyzed those who finished the follow-up over 20 weeks of medication. Changes of hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and body weight values before and after exenatide treatment were analyzed. Adverse events and adverse drug reactions were estimated in patients who were treated with exenatide at least once and for whom follow-up for safety has been completed. RESULTS: After 20 weeks treatment with exenatide, mean HbA1c and body weight were significantly reduced from 8.4% to 7.7% and from 83.4 kg to 80.2 kg, respectively (both p < 0.001). Subjects with higher baseline glucose and HbA1c levels showed an independent association with a greater reduction in glucose level. In addition, short duration of diabetes less than 5 years was an independent predictor for the improvement in glucose level. The majority of study subjects showed a reduction in both body weight and glucose level (63.3%) after exenatide treatment. In terms of safety profile, exenatide treatment was generally well-tolerated and the incidence of severe adverse event was rare (0.8%). The gastrointestinal side effects were most common and hypoglycemia was reported in 1.7% of subjects. CONCLUSION: In real clinical practice, 20 weeks treatment with short-acting exenatide was well tolerated and showed a significant body weight and glucose reduction in Korean patients with T2D who are suboptimally controlled with oral hypoglycemic agents. TRIAL REGISTRATION: ClinicalTirals.gov , number NCT02090673 , registered 14 February 2008.

Discovery and characterization of small molecules targeting the DNA-binding ETS domain of ERG in prostate cancer.

Genomic alterations involving translocations of the ETS-related gene ERG occur in approximately half of prostate cancer cases. These alterations result in aberrant, androgen-regulated production of ERG protein variants that directly contribute to disease development and progression. This study describes the discovery and characterization of a new class of small molecule ERG antagonists identified through rational in silico methods. These antagonists are designed to sterically block DNA binding by the ETS domain of ERG and thereby disrupt transcriptional activity. We confirmed the direct binding of a lead compound, VPC-18005, with the ERG-ETS domain using biophysical approaches. We then demonstrated VPC-18005 reduced migration and invasion rates of ERG expressing prostate cancer cells, and reduced metastasis in a zebrafish xenograft model. These results demonstrate proof-of-principal that small molecule targeting of the ERG-ETS domain can suppress transcriptional activity and reverse transformed characteristics of prostate cancers aberrantly expressing ERG. Clinical advancement of the developed small molecule inhibitors may provide new therapeutic agents for use as alternatives to, or in combination with, current therapies for men with ERG-expressing metastatic castration-resistant prostate cancer.

Intravenous Delivery of Xenon Incorporated in Thermosensitive Nano-Emulsions for Anesthesia.

Xenon anesthesia has several advantages over conventional anesthetics, however, it has not been widely used in clinical sites, since the cost and minimum alveolar concentration were higher than conventional inhalational anesthetics. The purpose of this study was to develop an optimum vehicle for stable intravenous delivery of xenon with sufficient concentration. Thermosensitive lipid based nano-emulsions (TS-LE) were prepared by blending medium chain triglyceride, polyethylene glycol-15-hydroxystearate, D-α tocopherol polyethylene glycol succinate and Poloxamer 188. Three folds higher xenon was loaded in TS-LE when it was prepared under 5.5 atm of xenon pressure compared to that under 1 atm of xenon pressure at 22 °C (11.4±0.7 vs. 3.82±0.34 mg/ml). Poloxamer 188 conferred thermosensitive viscosity and outer rigid structure on TS-LE, and the properties led to the enhanced stability of xenon compared to usual lipid emulsion. Induction of anesthesia was investigated by monitoring loss of forepaw righting reflex (LORR) in rats. The ED50 for LORR was 131.9 mg/kg and the anesthesia was maintained for 65.3±7.1 sec at a dose of 179 mg/kg in rats. When it is considered that TS-LE stably loads enough concentration of xenon for the induction of therapeutically sufficient anesthesia, TS-LE may be regarded as a promising candidate for intravenous xenon delivery.

Expression of Interactive Genes Associated with Apoptosis and Their Prognostic Value for Ovarian Serous Adenocarcinoma.

BACKGROUND: Malignant ovarian tumor is one of the leading causes of worldwide cancer death. It is usually characterized by insidious onset and late diagnosis because of the absence of symptoms, allowing ovarian cancer cases to progress rapidly and become unresectable. The tumor suppressor, p53, plays an important role in regulating cell cycles and apoptosis. p53 is regulated by several molecules, and it interacts with other apoptotic proteins. OBJECTIVES: To compare the prognosis of ovarian serous carcinoma and evaluate the expression of DNA-PKcs, Akt3, GSK-3ß, and p53 in cancerous cells. MATERIAL AND METHODS: DNA-PKcs, Akt3, GSK-3ß, and p53 expression levels were scored using immunohistochemistry staining of tissue samples from 132 women with ovarian serous adenocarcinoma. Expression was confirmed by real-time RT-PCR. Analyses were stratified by age, tumor grades, cancer stages and serum CA 125 levels. RESULTS: Significant differences in DNA-PKcs, Akt3, and p53 expression were observed between participants with different stages and tumor grades of ovarian serous adenocarcinoma. DNA-PKcs and p53 expression increased along with increasing tumor grade. Meanwhile, DNA-PKcs, Akt3, and p53 expression increased along with increasing cancer stage, and with a decrease in 5-year overall survival rate. CONCLUSIONS: This study shows that elevated expression of DNA-PKcs, Akt3, and p53 in ovarian serous adenocarcinoma tissues are an indication of more advanced disease and worse prognosis.

Detection of angiogenic factors in midtrimester amniotic fluid and the prediction of preterm birth.

OBJECTIVE: We investigated whether the level of vascular endothelial growth factor (VEGF), placental growth factor (PlGF), and soluble VEGF receptor-1 (sFlt-1) in midtrimester amniotic fluid of preterm birth have different values compared with term delivery. MATERIALS AND METHODS: Our participants were 86 pregnant women who had undergone amniocentesis from 16 to 19 weeks of gestation. Forty-three cases were women with preterm delivery, and the other 43 cases were matched women with full-term delivery. Stored amniotic fluid was investigated after the delivery. The levels of VEGF, PlGF, and sFlt-1 were measured by enzyme-linked immunosorbent assay and Western blot. RESULTS: The levels of VEGF and PlGF in the preterm group were significantly higher than in the control group (30.48 ± 8.57 pg/mL vs. 26.06 ± 8.24 pg/mL and 28.83 ± 7.83 pg/mL vs. 25.35 ± 8.26 pg/mL, respectively) (p = 0.017 and 0.048, respectively). In terms of sFlt-1, the levels were decreased in the preterm group (10,478.51 ± 4012.56 pg/mL vs. 12,544.05 ± 4140.96 pg/mL) (p = 0.021). CONCLUSION: This study explains that elevated levels of VEGF and PlGF, suggestive of angiogenesis and tendency of inflammation at midtrimester, are predictive of preterm delivery, and their availability is maximized by downregulation of sFlt-1.

Accuracy of three dimensional ultrasound and treatment outcomes of intrauterine adhesion in infertile women.

OBJECTIVE: To determine the accuracy and usefulness of three-dimensional transvaginal ultrasound (3D-TVUS) in diagnosing intrauterine adhesion (IUA) and to evaluate treatment outcomes associated with fertility. MATERIALS AND METHODS: IUA patients (110) underwent hysteroscopy to definitively diagnose and treat adhesiolysis. Morphologic characteristics of endometrium suggesting IUA, such as marginal irregularity, thinning, defects, obliteration, fibrosis, and calcification, were identified and recorded by 3D-TVUS. The sensitivity of 3D-TVUS findings and the attainment of postoperative fertility were evaluated prospectively. The clinical records were followed up for 2 years for obstetrical outcomes and analyzed. RESULTS: On comparing the findings of 3D-TVUS with those of hysteroscopy in 110 patients, 45 (88.23%) patients were confirmed as IUA by hysteroscopy among 51 (46.36%) patients, with one finding in 3D-TVUS; 42 (97.67%) patients were confirmed among 43 (39.09%) patients with two findings; and 16 (100%) patients were confirmed among 16 (14.55%) patients with over three findings. A pregnancy rate of eight out of 47 (17.02%) was achieved in patients who desired fertility. CONCLUSION: 3D-TVUS assessment of the uterus provides an accurate depiction of adhesion and extent of cavity damage in patients with suspected IUA.

Altered Colonic Bacterial Fermentation as a Potential Pathophysiological Factor in Irritable Bowel Syndrome.

OBJECTIVES: Dysbiosis leading to abnormal intestinal fermentation has been suggested as a possible etiological mechanism in irritable bowel syndrome (IBS). We aimed to investigate the location and magnitude of altered intestinal bacterial fermentation in IBS and its clinical subtypes. METHODS: IBS patients who satisfied the Rome III criteria (114) and 33 healthy controls (HC) were investigated. Intestinal fermentation was assessed using two surrogate measures: intestinal intraluminal pH and fecal short-chain fatty acids (SCFAs). Intraluminal pH and intestinal transit times were measured in the small and large bowel using a wireless motility capsule (SmartPill) in 47 IBS and 10 HC. Fecal SCFAs including acetate, propionate, butyrate, and lactate were analyzed by capillary gas chromatography in all enrolled subjects. Correlations between intestinal pH, fecal SCFAs, intestinal transit time, and IBS symptom scores were analyzed. RESULTS: Colonic intraluminal pH levels were significantly lower in IBS patients compared with HC (total colonic pH, 6.8 for IBS vs. 7.3 for HC, P=0.042). There were no differences in total and segmental pH levels in the small bowel between IBS patients and HC (6.8 vs. 6.8, P=not significant). The intraluminal colonic pH differences were consistent in all IBS subtypes. Total SCFA level was significantly lower in C-IBS patients than in D-IBS and M-IBS patients and HC. The total SCFA level in all IBS subjects was similar with that of HC. Colonic pH levels correlated positively with colon transit time (CTT) and IBS symptoms severity. Total fecal SCFAs levels correlated negatively with CTT and positively with stool frequency. CONCLUSIONS: Colonic intraluminal pH is decreased, suggesting higher colonic fermentation, in IBS patients compared with HC. Fecal SCFAs are not a sensitive marker to estimate intraluminal bacterial fermentation.

Bone Density in Patients with Cervical Cancer or Endometrial Cancer in comparison with Healthy Control; According to the stages.

OBJECTIVE: To evaluate the bone mineral density (BMD) in the lumbar spine and femur in postmenopausal women with cervical cancer and endometrial cancer without bone metastasis in comparison with that in healthy control postmenopausal women, and to assess the loss of BMD according to the cancer stage. MATERIALS AND METHODS: We analyzed the BMD of the lumbar spine and femur using dual-energy X-ray absorptiometry (DXA) in 218 patients with cervical cancer, 85 patients with endometrial cancer, and 259 healthy controls. The serum levels of calcium (Ca), phosphorus (P), osteocalcin (OSC), and total alkaline phosphatase (ALP), and urine deoxypyridinoline(DPL) were measured in all participants. RESULTS: Age, body mass index, parity, and time since menopause were not significantly different between the three groups. Serum Ca level was higher in the cervical cancer group (p = 0.000), however, urine DPL was lower in endometrial cancer group (p = 0.000). The T-scores of basal BMD at the second and fourth lumbar vertebra (L2, L4) were significantly lower in patients with cervical cancer (p = 0.038, 0.000, respectively) compared to those in the healthy control groups. Additionally, the incidence of osteoporosis and osteopenia basal status of bone mass was significantly higher in patients with cervical cancer compared to that in controls (p = 0.016). No differences in basal BMD of the lumbar spine and femur were observed between patients with cervical cancer according to their stages. CONCLUSION: Our results suggest that postmenopausal women with cervical cancer have a lower BMD and are at increased risk of osteoporosis in the lumbar spine before receiving anticancer treatment compared with postmenopausal women with endometrial cancer.

Diagnostic utility of three-dimensional power Doppler ultrasound for postmenopausal bleeding.

OBJECTIVES: We evaluated the role of three-dimensional power Doppler ultrasound (3D PD-US) to detect endometrial lesions in women with postmenopausal endometrial bleeding. MATERIALS AND METHODS: In this prospective observational study, from January 2009 to November 2012, we recruited 225 postmenopausal women with postmenopausal uterine bleeding who met the study criteria. Women who had hematologic disease, chronic medical diseases, or nonuterine pelvic diseases were excluded. Prior to endometrial biopsy, the patients underwent a baseline transvaginal ultrasound screening. The vascular indices and endometrial volumes were calculated with 3D PD-US and compared with the endometrial histopathology. RESULTS: Among the endometrial histopathologic findings of 174 women, atrophic endometrium was the most common finding (30.5%). Endometrial malignancy was confirmed in 28 cases (16.1%), and endometrial hyperplasia was diagnosed in 17 cases (9.8%). The prevalence of endometrial cancer was high in patients who had endometrial thickness >9.5 mm (p < 0.001) and volume greater than 4.05 mL (p < 0.001). For the endometrial carcinoma only, the cutoff values of vascular index, flow index, and vascular flow index for predicting malignancy were 13.070, 12.610, and 3.764, respectively. For endometrial hyperplasia, endometrial thickness and vascular flow index were significant findings. CONCLUSION: Endometrial vasculature and volume can be obtained using 3D PD-US. The diagnostic usefulness of 3D PD-US for endometrial diseases is promising in women with postmenopausal endometrial bleeding.

Do Endometrial Movements Affect The Achievement of Pregnancy during Intrauterine Insemination?

BACKGROUND: This study was aimed to assess the effect of endometrial movements on pregnancy achievement in intrauterine insemination (IUI) cycles. MATERIALS AND METHODS: The population of this observational study was composed of unexplained infertility couples undergoing first-time IUI with clomiphene citrate between September 2010 and October 2011. Not only endometrial movements, but also thickness, volume, pattern, and echogenic change of endometrium were analyzed prospectively in prediction of pregnancy. RESULTS: The total number of 241 cycles of IUI with 49 intrauterine pregnancies (20.3%) was analyzed. Pregnancy was not related to endometrial thickness and endometrial volume, but significantly related to endometrial movements associated with the number of contraction, strong movement, cervicofundal direction, and hyperechoic change (p<0.05). Pregnant group showed higher cervicofundal movement rate (89.8 vs. 75.5%). CONCLUSION: For IUI cycles stimulated by clomiphene citrate in unexplained infertility women, endometrial movements on the day of IUI could be a predictor of pregnancy.

Absolute monocyte and lymphocyte count prognostic score for patients with gastric cancer.

AIM: To measure the prognostic significance of absolute monocyte count/absolute lymphocyte count prognostic score (AMLPS) in patients with gastric cancer. METHODS: We retrospectively examined the combination of absolute monocyte count (AMC) and absolute lymphocyte count (ALC) as prognostic variables in a cohort of 299 gastric cancer patients who underwent surgical resection between 2006 and 2013 and were followed at a single institution. Both AMC and ALC were dichotomized into two groups using cut-off points determined by receiving operator characteristic curve analysis. An AMLPS was generated, which stratified patients into three risk groups: low risk (both low AMC and high ALC), intermediate risk (either high AMC or low ALC), and high risk (both high AMC and low ALC). The primary objective of the study was to validate the impact of AMLPS on both disease-free survival (DFS) and overall survival (OS), and the second objective was to assess the AMLPS as an independent prognostic factor for survival in comparison with known prognostic factors. RESULTS: Using data from the entire cohort, the most discriminative cut-off values of AMC and ALC selected on the receiver operating characteristic curve were 672.4/µL and 1734/µL for DFS and OS. AMLPS risk groups included 158 (52.8%) patients in the low-risk, 128 (42.8%) in the intermediate-risk, and 13 (4.3%) in the high-risk group. With a median follow-up of 37.2 mo (range: 1.7-91.4 mo), five-year DFS rates in the low-, intermediate-, and high-risk groups were 83.4%, 78.7%, and 19.8%, respectively. And five-year OS rates in the low-, intermediate-, and high-risk groups were 89.3%, 81.1%, and 14.4%, respectively. On multivariate analysis performed with patient- and tumor-related factors, we identified AMLPS, age, and pathologic tumor-node-metastasis stage as the most valuable prognostic factors impacting DFS and OS. CONCLUSION: AMLPS identified patients with a poor DFS and OS, and it was independent of age, pathologic stage, and various inflammatory markers.

Changes in bone density after cancer treatment in patients with cervical and endometrial cancer.

OBJECTIVE: This study aimed to evaluate the impact of cancer treatment on bone mineral density (BMD) in the lumbar spine (LS) and femur in the postmenopausal women with cervical or endometrial cancer without bone metastasis compared to normal control postmenopausal women. METHODS: We retrospectively evaluated the BMD data in the LS, femur neck (FN) and trochanter (FT) by dual-energy X-ray absorptiometry and laboratory data of bone turnover markers at baseline and after one year in 130 patients with cervical cancer, 68 patients with endometrial cancer, and 225 healthy controls. RESULTS: There were no significant differences in the T-scores of basal BMD in LS and femur between patients with endometrial cancer and controls, and only T-score of basal BMD at the fourth lumbar vertebra (L4) was significantly lower in patients with cervical cancer compared to controls. One year later, T-scores of BMD at all LS sites and FN in patients with cervical cancer and T-scores of BMD at L3, L4, FN, and FT in those with endometrial cancer after cancer treatment were significantly lower compared to controls. Lower proportions of normal BMD at all skeletal sites except L2 in patients with endometrial cancer and those at L1, L4, and FN in patients with cervical cancer were observed compared to controls after cancer treatment. CONCLUSIONS: Our results suggest that cancer treatment increase bone loss in postmenopausal women with cervical and endometrial cancer.

Prediction of preterm delivery using levels of vascular endothelial growth factor and leptin in amniotic fluid from the second trimester.

PURPOSE: Impaired angiogenesis of the developing placenta in the early pregnancy is one etiology of preterm delivery. Vascular endothelial growth factor (VEGF) is a key regulator of normal angiogenesis. Leptin stimulates other angiogenic factors, including VEGF. In this study, we aimed to investigate whether levels of VEGF and leptin in amniotic fluid during the second trimester could serve as markers for preterm delivery. METHODS: This study was conducted on second trimester amniotic fluid samples obtained from women undergoing genetic amniocentesis at 16-20 weeks of gestation. VEGF and leptin levels were measured by enzyme-linked immunosorbent assay in every case of delivery at <37 weeks' gestation (n = 36) and in 36 matched controls who delivered at ≥ 37 weeks' gestation. RESULTS: Amniotic fluid VEGF levels in the preterm group (32.24 ± 4.87 pg/ml) were significantly higher than those in the control group (23.49 ± 2.09 pg/ml) (p < 0.05). Leptin levels in the amniotic fluid were higher in the preterm group (6.64 ± 0.68 ng/ml) compared to the control group (5.35 ± 0.59 ng/ml), but this difference was not significant. Amniotic fluid VEGF and leptin levels were highest in women with placenta previa and were lowest in women with intrauterine growth retardation and pregnancy-induced hypertension. CONCLUSIONS: These results show that amniotic fluid VEGF levels in the second trimester are more predictive of preterm delivery than leptin levels. This study also demonstrates that VEGF levels vary depending on the cause of preterm delivery.

Detection of endometrial and subendometrial vasculature on the day of embryo transfer and prediction of pregnancy during fresh in vitro fertilization cycles.

OBJECTIVES: Successful implantation depends on interaction between a blastocyst and a receptive endometrium. Endometrial vasculature is important in the early endometrial response to blastocyst implantation, and vascular changes can affect uterine receptivity. This study aims to investigate whether vascular parameters measured using three-dimensional power Doppler ultrasound (3D PD-US) could predict pregnancy following fresh in vitro fertilization and embryo transfer (IVF-ET) using a gonadotropin releasing hormone (GnRH) agonist long protocol. MATERIALS AND METHODS: This prospective observational study enrolled 236 nulliparous women who underwent a first IVF-ET using a GnRH long protocol with stimulation by recombinant FSH (rFSH) from May 2009 to April 2012. After excluding two cases of tubal pregnancy, 234 women were in either a pregnant group (n = 113) or a nonpregnant group (n = 121). Color Doppler ultrasound and 3D PD-US examinations were performed on the day of embryo transfer. Main outcomes were pulsatility index (PI), resistance index (RI), systolic/diastolic ratio (S/D) of the uterine artery, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) of the endometrium and subendometrial region. Measurements were analyzed relative to IVF-ET outcome (pregnant vs. nonpregnant). RESULTS: No significant differences were observed in patient age, infertility duration, body mass index (BMI), basal FSH levels, number of retrieved oocytes or good quality embryos, or endometrial thickness or volume between the two groups. The pregnant group had higher endometrial VI, FI, and VFI scores than the nonpregnant group (p = 0.001, p = 0.000, p = 0.021, respectively). By contrast, neither subendometrial region VI, FI, and VFI scores (p = 0.770, p = 0.252, p = 0.451), nor uterine artery PI, RI, or S/D scores (p = 0.256, p = 0.527, p = 0.365) differed between groups. Cut-off values of endometrial VI, FI, and VFI scores were 0.95, 12.94, and 0.15 for pregnancy achievement. CONCLUSION: Three dimensional PD-US was a useful and effective method for assessing endometrial blood flow in IVF cycles. Good endometrial blood flow on the day of embryo transfer might be associated with high pregnancy success with a GnRH long protocol, because this is indicative of endometrial receptivity in fresh IVF cycles.