Robotic sentinel lymph node dissection experiences in endometrial cancer at our tertiary cancer treatment institution.

OBJECTIVE: In endometrial cancer surgery, sentinel lymph node dissection is used instead of staging surgery, particularly in advanced disease that is limited to the uterus. The aim of this study is to evaluate our practice of robotic sentinel lymph node dissection, which is applied to endometrial cancer patients in our tertiary cancer treatment center, according to the current literature, and to share our own data. METHODS: Included in our analysis are patients who underwent robotic sentinel lymph node dissection for endometrial cancer utilizing indocyanine green in our center between January 2018 and January 2024. RESULTS: In all, of the 93 endometrial carcinoma patients who underwent sentinel lymph node biopsy, 63 were classified as low-risk, while 30 were high-risk according to the European Society of Gynaecological Oncology and National Comprehensive Cancer Network guidelines. We found sentinel lymph nodes in both low-risk and high-risk patients, with an overall sensitivity of 96.32% (95% confidence interval [CI], 85.12-99.71), specificity of 100% (95%CI, 92.20-99.8), negative predictive value of 96.72% (95%CI, 87.03-99.89), and negative likelihood ratio of 0.06 (95%CI, 0.01-0.36). CONCLUSION: After evaluating our data retrospectively, we determined that we were compatible with the current literature.

vNOTES scarless and painless endometrial cancer staging surgery.

AIMS: Sentinel lymph node dissection is performed in endometrial cancer surgery instead of staging surgery, particularly when the disease is advanced and confined to the uterus. The aim of this study is to share our sentinel lymph node detection rates via the vaginal natural orifice transluminal endoscopic surgery method with the literature and to demonstrate a safer and more comfortable surgical treatment process. METHODS: The analysis includes the patients who underwent surgery sentinel lymph node dissection for endometrial cancer utilizing indociyanin green in our center between January 2022 and June 2024. RESULTS: In all, of 24 endometrial cancer patients underwent surgery sentinel lymph node dissection, nonendometrioid (serous) pathology was observed in only 1 (4%) patient, our other patients (96%) had endometrioid adenocarcinoma pathology. The rates of our sentinel lymph node dissection bilateral and symmetric are 96% (23/24), 94% (22/24), and 79% (19/24), respectively. We would like to emphasize that we successfully used vaginal natural orifice transluminal endoscopic surgery approach on four of our patients who were unsuitable for laparoscopic and robotic surgery due to pain scores of 2 at the 12th hour after surgery and low lung capacity. CONCLUSIONS: Vaginal natural orifice transluminal endoscopic surgery and sentinel lymph node dissection will be considered as surgical options in other gynecological cancers due to the comfort it brings to the patient in endometrial cancer.

Effect of adenomyosis on prognosis of patients with endometrial cancer.

OBJECTIVE: Our goal was to contrast the prognoses of patients with endometrial cancer who had adenomyosis against those that did not. METHODS: All patients who had received surgical staging for hysterectomy-based endometrial cancer had their medical data retrospectively examined. The analysis covered 397 patients, who were split into two groups depending on the presence of adenomyosis. Comparisons were made between patients covering type of surgery, histopathology, endometrial cancer stage, lymphovascular space invasion, presence of biochemical or histochemical markers, adjuvant therapy, presence of adenomyosis in the myometrial wall, and outcomes in terms of overall survival and disease-free survival. RESULTS: There is no statistically significant difference in the 5-year disease-free survival or overall survival rates between endometrial cancer patients with and without adenomyosis. This is based on comparisons of tumor stage, tumor diameter, histological type and grade of tumor, myometrial invasion, lymphovascular space invasion, and biochemical markers that affect the course of the disease. The median follow-up times were 61 months for the adenomyosis-positive group and 56 months for the group without adenomyosis. CONCLUSION: Coexisting adenomyosis in endometrial cancer has no bearing on survival rates and is not a prognostic factor.

Greenhouse gas emissions, economic globalization, and health expenditures nexus: does population aging matter in emerging market economies?

Papers on population aging and the effects of environmental quality on health expenditure have critical policy consequences. However, findings in the relevant literature are mixed, and papers generally focus on developed countries. To provide new information to the literature, this paper examines the impact of globalization, economic growth, greenhouse gas emissions, and population aging on health expenditures in emerging market economies with annual data for the period 2000 to 2018. The paper follows a second-generation advanced panel data method that considers cross-sectional dependency. The estimation results reveal that population aging, economic growth, and greenhouse gas emissions have an increasing effect on health expenditures, while globalization has a decreasing effect. Furthermore, one-way causality running from population aging to health expenditures is confirmed, while a feedback causality relationship is observed between health expenditures and other indicators (globalization, economic growth, and greenhouse gas emissions). After all, the outputs of this paper can provide critical policy implications about the relationships between aging, globalization, air quality, and health expenditures in developing countries.

Zebrafish prdm12b acts independently of nkx6.1 repression to promote eng1b expression in the neural tube p1 domain.

BACKGROUND: Functioning of the adult nervous system depends on the establishment of neural circuits during embryogenesis. In vertebrates, neurons that make up motor circuits form in distinct domains along the dorsoventral axis of the neural tube. Each domain is characterized by a unique combination of transcription factors (TFs) that promote a specific fate, while repressing fates of adjacent domains. The prdm12 TF is required for the expression of eng1b and the generation of V1 interneurons in the p1 domain, but the details of its function remain unclear. METHODS: We used CRISPR/Cas9 to generate the first germline mutants for prdm12 and employed this resource, together with classical luciferase reporter assays and co-immunoprecipitation experiments, to study prdm12b function in zebrafish. We also generated germline mutants for bhlhe22 and nkx6.1 to examine how these TFs act with prdm12b to control p1 formation. RESULTS: We find that prdm12b mutants lack eng1b expression in the p1 domain and also possess an abnormal touch-evoked escape response. Using luciferase reporter assays, we demonstrate that Prdm12b acts as a transcriptional repressor. We also show that the Bhlhe22 TF binds via the Prdm12b zinc finger domain to form a complex. However, bhlhe22 mutants display normal eng1b expression in the p1 domain. While prdm12 has been proposed to promote p1 fates by repressing expression of the nkx6.1 TF, we do not observe an expansion of the nkx6.1 domain upon loss of prdm12b function, nor is eng1b expression restored upon simultaneous loss of prdm12b and nkx6.1. CONCLUSIONS: We conclude that prdm12b germline mutations produce a phenotype that is indistinguishable from that of morpholino-mediated loss of prdm12 function. In terms of prdm12b function, our results indicate that Prdm12b acts as transcriptional repressor and interacts with both EHMT2/G9a and Bhlhe22. However, bhlhe22 function is not required for eng1b expression in vivo, perhaps indicating that other bhlh genes can compensate during embryogenesis. Lastly, we do not find evidence for nkx6.1 and prdm12b acting as a repressive pair in formation of the p1 domain - suggesting that prdm12b is not solely required to repress non-p1 fates, but is specifically needed to promote p1 fates.

TALE factors use two distinct functional modes to control an essential zebrafish gene expression program.

TALE factors are broadly expressed embryonically and known to function in complexes with transcription factors (TFs) like Hox proteins at gastrula/segmentation stages, but it is unclear if such generally expressed factors act by the same mechanism throughout embryogenesis. We identify a TALE-dependent gene regulatory network (GRN) required for anterior development and detect TALE occupancy associated with this GRN throughout embryogenesis. At blastula stages, we uncover a novel functional mode for TALE factors, where they occupy genomic DECA motifs with nearby NF-Y sites. We demonstrate that TALE and NF-Y form complexes and regulate chromatin state at genes of this GRN. At segmentation stages, GRN-associated TALE occupancy expands to include HEXA motifs near PBX:HOX sites. Hence, TALE factors control a key GRN, but utilize distinct DNA motifs and protein partners at different stages - a strategy that may also explain their oncogenic potential and may be employed by other broadly expressed TFs.

Ciliary signaling cascades in photoreceptors.

For being a polarized neuron and having a sensory cilium, photoreceptors attract remarkable attention. This is due their highly polarized structure and active visual signal transduction cascades and for the enrichment of complex networks of proteins in the cilium. Structural and functional maintenance of the photoreceptor sensory cilium, also called outer segment, ensures that light signal is received and relayed appropriately to the brain. Any perturbations in the protein content of the outer segment result in photoreceptor dysfunction, degeneration and eventually, blindness. This review focuses on the importance of photoreceptor sensory cilium to carry out signal transduction cascade for vision.