Detection of Pancreatic Cancer by Urine Volatile Organic Compound Analysis.

BACKGROUND/AIM: Most pancreatic cancer patients are diagnosed at an advanced stage, since the diagnosis is demanding. Field asymmetric waveform ion mobility spectrometry (FAIMS) is a sensitive technique used for the detection of volatile organic compounds (VOC). We evaluated the ability of FAIMS to discriminate between pancreatic cancer and healthy controls from a urine sample. PATIENTS AND METHODS: For a proof-of-concept study in three Finnish hospitals, 68 patients with pancreatic cancer, 36 with acute pancreatitis, 18 with chronic pancreatitis, 8 with pancreatic pre-malign lesions and 52 healthy controls were prospectively recruited. Urine samples were collected at the time of diagnosis and stored at -70°C. The samples were subsequently measured with FAIMS. The data were processed with linear discriminant analysis and cross-validated with leave-one-out cross-validation. RESULTS: FAIMS distinguished pancreatic cancer from controls with a sensitivity of 79% and specificity of 79%. CONCLUSION: As a non-invasive and rapid urine test, FAIMS can discriminate patients with pancreatic cancer from healthy controls.

Ovarian tumours of different histologic type and clinical stage induce similar changes in lipid metabolism.

BACKGROUND: Previous results obtained from serum samples of late-stage, high-grade serous ovarian carcinoma patients showed large alterations in lipid metabolism. To validate and extend the results, we studied lipidomic changes in early-stage ovarian tumours. In addition to serous ovarian cancer, we investigated whether these changes occur in mucinous and endometrioid histological subtypes as well. METHODS: Altogether, 354 serum or plasma samples were collected from three centres, one from Germany and two from Finland. We performed lipidomic analysis of samples from patients with malignant (N = 138) or borderline (N = 25) ovarian tumours, and 191 controls with benign pathology. These results were compared to previously published data. RESULTS: We found 39 lipids that showed consistent alteration both in early- and late-stage ovarian cancer patients as well as in pre- and postmenopausal women. Most of these changes were already significant at an early stage and progressed with increasing stage. Furthermore, 23 lipids showed similar alterations in all investigated histological subtypes. CONCLUSIONS: Changes in lipid metabolism due to ovarian cancer occur in early-stage disease but intensify with increasing stage. These changes occur also in other histological subtypes besides high-grade serous carcinoma. Understanding lipid metabolism in ovarian cancer may lead to new therapeutic and diagnostic alternatives.

FAIMS analysis of urine gaseous headspace is capable of differentiating ovarian cancer.

AIM: We hypothesized that field asymmetric waveform ion mobility spectrometry (FAIMS) as a novel artificial olfactory technology could differentiate urine of women with malignant ovarian tumors from controls and women with benign tumors, based on previous findings on the ability of canine olfactory system to "smell" cancer. PATIENTS AND METHODS: Preoperative urine samples from 51 women with ovarian tumors, both benign and malignant, and from 18 women with genital prolapse, as controls, were collected. The samples were analyzed by FAIMS device. Data analysis was processed by quadratic data analysis (QDA) and linear discriminant analysis (LDA), and cross-validated using 10-fold cross-validation. RESULTS: Thirty-three women had malignant ovarian tumors, of which 18 were high-grade cancers. FAIMS distinguished controls from malignancies with the accuracy of 81.3% (sensitivity 91.2% and specificity 63.1%), and benign tumors from malignancies with the accuracy of 77.3% (sensitivity 91.5% and specificity 51.4%). Moreover, low grade tumors were also separated from high grade cancers and benign ovarian tumors with accuracies of 88.7% (sensitivity 87.8% and specificity 89.6%) and 83.9% (sensitivity 73.1% and specificity 92.9%), respectively. CONCLUSIONS: This proof of concept-study indicates that the FAIMS from urine has potential to discriminate malignant ovarian tumors from no tumor-bearing controls and benign tumors.

Urinary Polyamines as Biomarkers for Ovarian Cancer.

OBJECTIVES: Elevated concentrations of polyamines have been found in urine of patients with malignant tumors, including ovarian cancer. Previous research has suffered from poorly standardized detection methods. Our liquid chromatography-tandem mass spectrometry (LC-MS/MS) method is capable of simultaneous standardized analysis of most known polyamines. Liquid chromatography-tandem mass spectrometry has not previously been used in the differential diagnostics of ovarian tumors in postmenopausal women. MATERIALS AND METHODS: In this prospective study, postmenopausal women (n = 71) presenting with an adnexal mass and, as controls, women with genital prolapse or urinary incontinence scheduled for surgery (n = 22) were recruited in the study. For analysis of the polyamines, a morning urine sample was obtained before surgery. Preoperative serum CA125 concentrations were determined in the study group. RESULTS: Twenty-three women with benign and 37 with malignant ovarian tumors were eligible. Of all analyzed polyamines, only urinary N,N-diacetylspermine showed statistically significant differences between all groups except controls versus benign tumors. N,N-diacetylspermine was elevated in malignant versus benign tumors (P < 0.001), in high-grade versus low malignant potential tumors (P < 0.001), in stage III to IV versus stage I to II cancers (P < 0.001), and even in early-stage cancer (stage I-II) versus benign tumors (P = 0.017). N,N-diacetylspermine had better sensitivity (86.5%) but lower specificity (65.2%) for distinguishing benign and malignant ovarian tumors than CA125 with a cut-off value of 35 kU/L (sensitivity, 75.7%; specificity, 69.6%). CONCLUSIONS: Urinary N,N-diacetylspermine seems to be able to distinguish benign and malignant ovarian tumors as well as early and advanced stage, and low malignant potential and high-grade ovarian cancers from each other, respectively.

Vulvodynia-Younger Age and Combined Therapies Associate With Significant Reduction in Self-Reported Pain.

OBJECTIVES: Eight percent of women have vulvodynia (VD), a chronic pain disorder with unknown etiology. The aim of our study was to assess the efficacy of given VD treatments measured by numerical rating scale (NRS) for pain and patients' quality of life. MATERIALS AND METHODS: Study material consisted of a retrospective VD patient cohort (N = 70). Data were collected by postal questionnaires and review of the medical records. RESULTS: We report here a statistically significant reduction in NRS only with combination of therapies (median NRS before treatments 8 vs median NRS 4 after treatments, p < .001) but not with any individual therapy alone, i.e., physiotherapy, topical medications, oral pharmaceutical therapy, sexual counseling by a trained nurse, sacral neuromodulation, and laser treatment or surgery. Older age (>30) and frequent (≥6) outpatient clinic visits associated with a significantly minor reduction in NRS (p = .03 and p = .04, respectively). CONCLUSIONS: The results of this retrospective study suggest that an effective, multimodality-based treatment is most beneficial for VD patients and VD at older age may represent a subtype more resistant to therapy.

Reliability of preoperative evaluation of postmenopausal ovarian tumors.

BACKGROUND: Preoperative evaluation of ovarian tumors is challenging. This study was undertaken to evaluate the performance of conventional two-dimensional (2D) ultrasound and CA125 in predicting malignant or benign nature of pelvic masses, and to investigate if three-dimensional power Doppler (3DPD) ultrasound provides any added value. Ninety-six postmenopausal and four perimenopausal women with supposed ovarian tumors were examined by standardized 2D and 3DPD ultrasounds preoperatively. The tumors were evaluated using the risk of malignancy index (RMI), International Ovarian Tumors Analysis (IOTA) group simple rules, expert opinion, IOTA logistic regression model 2 (LR2) and 3D vascular indices, and were postoperatively compared to histopathological results. RESULTS: Ninety-eight tumors turned out to be ovarian in origin. Of these, 66 were benign and 32 malignant. RMI (cut-off value 200), simple rules, expert opinion and LR2 (cut-off value 25) were used to predict malignant nature of the tumors and had sensitivities of 71.9, 90.6, 87.5 and 90.6%, and specificities of 80.3, 84.6, 92.4 and 77.3%, respectively. When the 3D vascularization flow index (VFI) was added to RMI and LR2, the accuracy of the test improved from 77.6 to 81.4% and from 81.6 to 86.5%, respectively, at the expense of sensitivity, while VFI gave no added benefit for simple rules and expert opinion. Agreement between two examiners using expert opinion was good (Cohen's kappa = 0.89). CONCLUSIONS: The subjective opinion of an expert seems to be the most reliable method in assessing ovarian tumors, and the 3DPD indices seem to provide no significant added value.

Ozone effects on Sphagnum mosses, carbon dioxide exchange and methane emission in boreal peatland microcosms.

Microcosms of a boreal peatland originating from an oligotrophic fen in Eastern Finland were fumigated under four ozone concentrations (0, 50, 100 and 150 ppb O3) in laboratory growth chambers during two separate experiments (autumn and summer) for 4 and 6 weeks, respectively. Ozone effects on Sphagnum mosses and the fluxes of carbon dioxide and methane were evaluated. In both experiments, the three Sphagnum species studied showed only a few significant responses to ozone. In the autumn experiment, membrane permeability of S. angustifolium, measured as conductivity and magnesium leakage, was significantly higher under ozone fumigation (P = 0.005 and < 0.001, respectively), and there was a distinct dose-dependence. S. magellanicum showed no clear responses, either for membrane leakage or pigment content. There were no substantial ozone responses in the gross photosynthesis or net CO2 exchange during the 6-week-long summer experiment, but dark ecosystem respiration was transiently increased by ozone concentration of 100 ppb after 14 days of exposure (P < 0.05). Fumigation with 100 ppb of ozone, however, more than doubled (P < 0.05) methane emission from the peatland monoliths. Our results suggest that increasing tropospheric ozone concentration may cause substantial changes in the carbon gas cycling of boreal peatlands, even though these changes are not closely associated with the changes in Sphagnum vegetation.

Responses of two Sphagnum moss species and Eriophorum vaginatum to enhanced UV-B in a summer of low UV intensity.

• The flux of ultraviolet (UV)-B radiation to the Earth's surface is increasing, particularly in high latitudes. We studied the sensitivity of some dominant plant species of boreal and subarctic peatlands to this increase. • Intact peat monoliths with the mosses Sphagnum balticum and Sphagnum papillosum, and cotton grass (Eriophorum vaginatum) were exposed to ambient solar UV-B or ambient solar UV-B supplemented by 30% in a field experiment in central Finland. • Although the UV-B dose was low during the growing season, owing to frequent cloudiness, both Sphagnum species showed significantly higher membrane permeability under enhanced UV-B. In S. balticum, UV-B tended to decrease the capitulum dry mass and induced a 30-40% increase in the concentration of chlorophyll and carotenoid pigments. Enhanced UV-B had no effects on leaf morphology, chlorophyll fluorescence or stomatal functioning in E. vaginatum. • The various UV-B responses in the Sphagnum species under investigation indicate that they may be sensitive even to small increases in solar UV-B radiation. By contrast, E. vaginatum appeared to tolerate the UV-B fluxes of the experiment.