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The effects of maternal vitamin E supplementation on the antioxidant status of chicks were investigated. Female breeder chicks were fed corn-soybean growing diets without supplemental vitamin E for a 17-wk developmental period. After 17 wk, the birds were randomly assigned to 5 treatments and fed corn-soybean diets supplemented with 0, 40, 80, 120, and 160 mg/kg vitamin E (all-rac-alpha-tocopherol acetate), respectively. Blood samples were collected and pullets were artificially inseminated at 35 wk of age. Eggs laid beginning on d 2 after insemination were placed in an incubator. At the time of hatching, 12 chicks from each treatment were randomly sampled and killed. Livers and brains of chicks were collected for the subsequent evaluation of antioxidant status. Plasma vitamin E concentrations increased linearly (P < 0.001; r = 0.997) with the increase in supplemental vitamin E, but those in egg yolk reached a plateau at 120 mg/kg supplemental vitamin E. The malondialdehyde (MDA) concentration, an indicator of lipid peroxidation, of chick brain decreased linearly (P < 0.01; r = -0.909) with the increase in supplemental vitamin E. Pullets given 160 mg/kg supplemental vitamin E had lower plasma MDA concentrations than those given 0 mg/kg (P < 0.05). Similar results were found for the reactive oxygen species levels, an indicator of oxidative stress, of chick brain and liver. For antioxidant enzymes, chicks of pullets given 120 mg/kg supplemental vitamin E had higher (P < 0.05) activities of liver catalase than those given 0-80 mg/kg. Chicks of pullets given 160 mg/kg supplemental vitamin E had higher (P < 0.05) activities of brain superoxide dismutase than those given 0-40 mg/kg. These results indicated that maternal supplementation with high levels of vitamin E (120-160 mg/kg) enhances antioxidant capability and depresses oxidative stress in chicks.

OBJECTIVE To estimate the risk of and risk factors for progression among human immunodeficiency virus (HIV)-seropositive women with abnormal cervical cytology but negative colposcopy. METHODS In a prospective cohort study, 391 HIV-seropositive and 103 seronegative women with cervical cytology read as atypical squamous cells (ASC) or low-grade squamous intraepithelial lesion (LSIL) but negative colposcopy were followed up for a mean of 4.0 years with cytology at 6-month intervals. Colposcopy was prescribed for any epithelial abnormality. RESULTS Progression to CIN2, CIN3, high-grade SIL/severe dysplasia, or cancer occurred in 47 (12%) HIV-seropositive women and 4 (4%) HIV-seronegative women (P = .02). Progression to CIN1 was seen in an additional 12 HIV-seropositive women and 1 seronegative woman. In multivariate analysis, high-risk but not low-risk HPV detection (hazard ratio [HR] 2.46-95% confidence interval [CI] 1.18-5.12, P = .02 for high risk, HR 1.41, 95% CI 0.62-3.21, P = .42 for low risk), satisfactory colposcopy (HR 2.01, 95% CI 1.11-3.65, P = .02), and non-Hispanic African-American ethnicity (HR 5.08, 95% CI 1.72-14.98, P = .003) were the only factors associated with progression, while HIV serostatus was marginally significant (HR 2.53, 95% CI 0.85-7.50, P = .09). CONCLUSION Human immunodeficiency virus-seropositive women with negative colposcopy after borderline cytology face a higher risk of progression than seronegative women, but the absolute risk is low and becomes nonsignificant after controlling for HPV risk type, ethnicity, and colposcopic findings. Observation is appropriate. LEVEL OF EVIDENCE II-2.

Background. There are a few cases of "small cell neuroendocrine carcinoma" of the Bartholin's gland as well as Merkel cell carcinoma of the vulva reported in the gynecologic oncology literature, most with aggressive clinical behavior. Merkel cells were originally described in the epidermis with neuroendocrine properties. Merkel cell carcinoma is different from the neuroendocrine small cell (oat cell) tumor arising in the lung and other internal organs based on morphology and immunohistochemistry. Case. A 49-year-old female was diagnosed with a FIGO stage I Merkel cell carcinoma of the Bartholin's gland. The tumor originated from the duct and stained with endocrine markers and cytokeratin 7 and 20. She was treated with radical wide local excision and bilateral inguinal lymph node dissection followed by radiation therapy to the pelvis, perineum, vulva, and inguinal regions. Two years after the diagnosis, she is alive with no evidence of recurrent disease. Conclusion. This is a case of Merkel cell carcinoma of the Bartholin's gland discovered in the early stage with a survival of 2 years following diagnosis and treatment with no evidence of disease recurrence.

The Estimated Average Requirement (EAR) and Recommended Dietary Allowance (RDA) of vitamin B-6 for children were recently estimated by extrapolating from adult values because of limited available information. To determine vitamin B-6 requirements and provide recommendations for intakes, vitamin B-6 intake, nutritional status and anthropometry of 168 healthy children (79 boys and 89 girls) were studied in Tainan, Taiwan. Direct and indirect vitamin B-6 status indicators were measured in plasma, erythrocytes and urine. Anthropometric data of children in this study were similar to those of the first Nutrition and Health Survey in Taiwan (NAHSIT) conducted in 1993-1996. The plasma pyridoxal phosphate (PLP) concentration of each child was >/=30 nmol/L, indicating an adequate vitamin B-6 status. Daily dietary vitamin B-6 intakes of boys and girls were 0.80 +/- 0.16 and 0.74 +/- 0.16 mg/d, respectively. Daily dietary vitamin B-6 intakes of children who had adequate urinary 4-pyridoxic acid (4-PA) (>3.0 micro mol/L), erythrocyte alanine aminotransferase activity coefficient (EALT-AC) (

Purpose This prospective, randomized phase III intergroup trial of the Gynecologic Oncology Group and National Cancer Institute of Canada Clinical Trials Group was designed to test the effectiveness and safety of adding the hypoxic cell sensitizer tirapazamine (TPZ) to standard cisplatin (CIS) chemoradiotherapy in locally advanced cervix cancer. Patients and Methods Patients with locally advanced cervix cancer were randomly assigned to CIS chemoradiotherapy versus CIS/TPZ chemoradiotherapy. Primary end point was progression-free survival (PFS). Secondary end points included overall survival (OS) and tolerability. Results PFS was evaluable in 387 of 402 patients randomly assigned over 36 months, with enrollment ending in September 2009. Because of the lack of TPZ supply, the study did not reach its original target accrual goal. At median follow-up of 28.3 months, PFS and OS were similar in both arms. Three-year PFS for the TPZ/CIS/RT and CIS/RT arms were 63.0% and 64.4%, respectively (log-rank P = .7869). Three-year OS for the TPZ/CIS/RT and CIS/RT arms were 70.5% and 70.6%, respectively (log-rank P = .8333). A scheduled interim safety analysis led to a reduction in the starting dose for the TPZ/CIS arm, with resulting tolerance in both treatment arms. Conclusion TPZ/CIS chemoradiotherapy was not superior to CIS chemoradiotherapy in either PFS or OS, although definitive commentary was limited by an inadequate number of events (progression or death). TPZ/CIS chemoradiotherapy was tolerable at a modified starting dose.

OBJECTIVE: To examine the association between cone biopsy and pathologic findings at radical hysterectomy in stage I cervical carcinoma. METHODS: Fifty-four patients diagnosed by cone biopsy with stage I cervical carcinoma and treated with radical hysterectomy comprised the study group. The association between the depth of invasion on conization, lymph-vascular invasion, positive cone margins, positive endocervical curettage (ECC), and the depth of residual invasion in the radical hysterectomy specimen was examined using Pearson r and point biserial correlation. Independent predictors of the depth of residual invasion were determined by multiple regression. RESULTS: The depth of residual invasion correlated significantly with the depth of invasion (r = .374) and presence of lymph-vascular invasion (rpb= .372) in the conization specimen, post-cone ECC status (rpb = .669), and age at diagnosis (r = .347). The same factors were jointly assessed using multiple regression (R2 = .636, P CONCLUSION: Depth of invasion, presence of lymph-vascular invasion, and age at diagnosis were independent predictors of the depth of residual invasion in the subsequent hysterectomy specimen. These factors should be considered in treatment planning. Patients with a combination of these factors may have increased risk for deep residual invasion, positive hysterectomy margins, and adjuvant radiation.

ObjectiveThis study aimed to externally validate a nomogram for predicting overall survival of women with uterine cancer in an African American population.MethodsAfter the institutional review board approval, data from the uterine cancer database from 2 major teaching hospitals in Brooklyn, NY, were analyzed. The predicted survival for each patient was calculated with the use of the nonogram; the data were clustered in deciles and compared with the observed survival data.ResultsHigh incidence of aggressive histologic types (22% carcinosarcoma, 16% serous/clear cell), poorly differentiated (53% grade 3), and advanced stage (38% stage III or IV) tumors was found in our study population. The median follow-up for survivors was 52 months (range, 1–274 months). The observed and predicted 3-year overall survival probabilities were significantly different (62.5% vs 72.6%, P < 0.001). Similarly, the observed 5-year overall survival probability was significantly lower than the predicted by the nomogram (55.5% vs 63.4%, P < 0.001). The discrepancy between predicted and observed survival was more pronounced in the midrisk groups.ConclusionsThe nomogram is not an adequate tool to predict survival in the African American population with cancer of the uterine corpus. Race seems to be a significant, independent factor that affects survival and should be included in predictive models.

Background. Pelvic actinomycosis is a chronic suppurative inflammatory disease caused by the anaerobic Gram-positive bacilli Actinomyces israelii. The propensity of this disease to simulate gynecological malignancies has been described previously. The great majority of these patients were diagnosed with actinomycotic diseases during or after exploratory laparotomy, but rarely preoperatively. We reviewed the literature pertaining the management of pelvic actinomycosis. Case. A nulliparous woman with a long history of intrauterine contraceptive device (IUD) and recent Papanicolaou smear findings consistent with the presence of actinomyces presented with chronic vague lower abdominal pain, weight loss, poor appetite, and recent increase in abdominal girth associated with a large immobile pelvic mass. Transcutaneous computed tomography guided core needle biopsy established the diagnosis of pelvic actinomycosis obviating immediate surgical intervention. Intravenous and subsequent long-term oral penicillin therapy was constituted and resulted in a significant decrease in the size of the pelvic mass. Conclusion. In patients presenting with pelvic masses and a history of IUD placement, actinomycotic infection should be considered and diagnosis attempted by imaging guided needle biopsy. Furthermore, this case suggested that correct nonsurgical diagnosis of pelvic actinomycosis followed by prolonged antibiotic therapy might eliminate the need for extensive extirpative surgery and assist in maintaining future fertility.

Background. Squamous cell carcinoma arising from malignant degeneration of a mature cystic teratoma is rare with a reported incidence of approximately 1–3%. The most common presenting symptoms are lower abdominal pain and increasing abdominal girth of several months' duration. Approximately 50% of the patients present with FIGO stage I while 35–38% present with stage III diseases. Case. The case described herein represents an unusual presentation and initial diagnostic dilemma of locally aggressive squamous cell carcinoma arising in an ovarian dermoid cyst, with invasion into the distal rectum and anal canal causing rectal bleeding similar to the presentation of anal squamous cell carcinoma. Despite aggressive surgical management with posterior exenteration and optimal tumor debulking followed by 5040-cGy pelvic radiation utilizing 25-MV photons, the patient developed pelvic recurrence at the vaginal cuff 6 weeks after completion of her adjuvant radiotherapy. She subsequently failed cis -platinum single-agent chemotherapy and died 9 months after her initial surgery and diagnosis. Conclusion. Squamous cell carcinoma in the anal canal, diagnosed by colonoscopy or proctoscopy, could be an unusual presentation of that arising from malignant degeneration of an ovarian dermoid cyst. This tumor may behave in a locally aggressive manner and be resistant to pelvic radiation or single-agent chemotherapy of cis -platinum. The current experience of adjuvant treatment after comprehensive staging and cytoreductive surgery reported in the world literature is limited, and the optimal management of the malignancy remains unclear.

Objective. The aim of this study was to determine the incidence and severity of dysplasia associated with a cytologic diagnosis of atypical cells of undetermined significance (ASCUS) in women infected with the human immunodeficiency virus (HIV). Methods. A cross-sectional analysis of cervical cytology, colposcopic impression, and cervical biopsy results was performed on 261 HIV-positive women diagnosed with ASCUS. The prevalence and grade of histologically documented cervical intraepithelial neoplasia (CIN) was determined. Patients with CD4 counts above and below 200 cells/mm 3 were compared using χ 2 analysis to determine any effect of worsening immunosuppression on the rates of associated dysplasia. Results. Seven hundred sixty-one Pap smears were performed during the study period. Two hundred nine (27%) were diagnosed as ASCUS. All patients (pts) received colposcopic evaluation. The incidence of human papilloma virus (HPV) effect, low-grade CIN (I), and high-grade CIN (II, III, and carcinoma in situ ) documented by cervical biopsy, cervical conization or endocervical curettings was 40, 17, and 15%, respectively. No cases of invasive cancer were found. These results are similar to those of previous cytohistologic studies of ASCUS in HIV-untested populations. There was no significant difference in frequency or severity of CIN in pts with severe immunosuppression ( P = 0.4). Conclusion. A cytologic diagnosis of ASCUS in HIV-positive women identifies a group at significant risk for histologic abnormalities. The majority of pts will be diagnosed with HPV or low-grade CIN. HIV infection and severe immunosuppression do not appear to increase the frequency or severity of CIN associated with ASCUS. Given the 32% risk of associated CIN, all HIV-positive women with ASCUS cytology should undergo colposcopic evaluation.

OBJECTIVE Malignant neoplasms of the vagina are rare gynecologic tumors. Primary vaginal sarcomas are even more unusual lesions, representing fewer than 2% of malignant vaginal lesions. CASE We present a case of a primary vaginal spindle cell sarcoma, treated with neoadjuvant radiation followed by total pelvic exenteration. The patient remains without evidence of disease 2 years after surgery. CONCLUSIONS The mainstay of treatment of vaginal sarcomas is surgical. Neoadjuvant radiation treatment may decrease surgical morbidity and lead to long-term cure.

Recent studies have suggested that the fetal dysmorphogenesis in diabetic pregnancies is associated with an increase in embryonic oxygen-free radicals. This excess of oxygen-free radicals may result from either overproduction or decreased clearance by the enzymatic scavenging mechanism. However, there are no in vivo data on the activity of embryonic oxygen-free radical scavenging enzymes. The purpose of the current study is to investigate whether this increase in embryonic oxygen-free radicals is the result of a change in the activity of the fetal oxygen-free radical scavenging/antioxidant enzymes during pregnancy complicated by maternal diabetes in an in vivo rat model. Thirty-six Sprague-Dawley rats were randomly assigned to one of two study groups: nondiabetic control and an untreated diabetic group. On day 12, fetuses were examined for crown-rump lengths, somite numbers, and external anomalies. The activity of fetal oxygen-free radical scavenging enzymes, including superoxide dismutase (SOD), glutathione peroxidase (GPX), and catalase (CAT), were determined. The untreated diabetic group of rats had a significantly higher mean blood glucose level than that of the nondiabetic controls and also a significantly lower weight gain, higher resorption rate, smaller embryonic size with lower total protein content, and a approximately 6-fold increase in the rate of fetal neural tube defects compared to the nondiabetic controls. Superoxide dismutase activity was significantly reduced in the embryos with neural tube defects regardless of maternal diabetic status (2.25 +/- 0.83 vs. 1.17 +/- 0.04 u/mg protein; P < 0.05). Glutathione peroxidase and catalase activity were significantly reduced in malformed versus normal-formed embryos of nondiabetic mothers (GPX-2.68 +/- 1.15 vs. 4.46 +/- 1.12 mu/mg protein, CAT -1.67 +/- 0.53 vs 2.49 +/- 0.61 u/mg protein respectively; P < 0.01). However, overall catalase activity was increased in embryos of diabetic mothers as compared to controls. Two-way analysis of variance identified fetal malformations as the variance associated with reduced fetal SOD activity, whereas maternal diabetes was associated with the increase in fetal catalase activity. Neither neural tube defect nor maternal diabetes was found to be the variable affecting fetal GPX activity, Fetal oxygen-free radical scavenging enzymes respond differently to the adverse environment created by maternal diabetes during pregnancy. Defects in embryonic SOD and catalase activity, regardless of maternal diabetic status, may reduce the ability of the fetus to clear free oxygen radicals, thereby exposing it to an increased oxidative load that may cause fetal dysmorphogenesis. The diabetic state of the mothers did not decrease embryonic activity of any of the scavenging enzymes. Therefore, although excess oxidative load, as observed in diabetes, may cause tissue injury and embryopathy, the mechanism does not appear to be a diabetes-induced reduction in the action of the scavenging enzymes.

Objective The purpose of this study is to summarize the data on the incidence, clinical behavior and overall survival of patients with glassy cell cervical carcinoma (GCCC). Methods Twenty-four case series and fifteen case reports identified by searching PubMed database qualified for inclusion in this study. The published cases were combined with data from a retrospective chart review of patients with GCCC in two major teaching hospitals in Brooklyn, NY. Results A total of 292 cases were collected through our literature and chart review. Median age at diagnosis was 45 years old (range 12-87 years of age). GCCC incidence ranges from 0.2 to 9.3% of all cervical cancers and 2 to 30.2% of cervical adenocarcinomas. The stage distribution is similar to squamous cell carcinoma with 79% of the patients being diagnosed with Stage I or II disease. Most common sites of recurrence for Stage I patients are the vagina and pelvis. In Stage II patients locoregional and distant metastases are equally common. Recurrence rate was higher among patients treated only with surgery (32.7%), as compared to patients treated with surgery followed by radiation (11%) or patients treated with radiation only (10%). Median overall survival (OS) was 25 months (95% CI 8.4-41.6). Overall 5-year survival for all stages is lower when compared to all cervical cancers (54.8% vs 75%). There was no interaction between race and OS (p=0.66). Conclusion GCCC is a rare histologic type of cervical cancer that presents at a younger age, is associated with high risk for distant failure and carries worse prognosis as compared to the squamous cell type. Radiation therapy is associated with decreased risk of recurrence.

Starbucks is a world well-known coffee shop company. Starbucks originated from the United States where people used to drink low quality and poor taste coffee. To teach the customers how to taste the best coffee and to provide people with a very relaxing and comfortable environment where people can enjoy their coffee as comfortable at their homes as possible, Starbucks developed some strategies which have been attributed to its success in its coffee chain store business. In this context vision and mission statements have emerged as strategic tools that it had separated into six categories that are: company focus, core values, concern for people, human resource, customer focus, and quality. The value congruence between what an organization such as Starbucks stands for and of its members can transform the jobs into a mission with a higher order meaning. Mission statements are no longer used as decorative devices rather the espoused values are enacted by managers in their behavior and policies.

Endometriosis occurring in a cesarean section abdominal wall scar is reported at a rate of 0.03-0.45%. Malignant transformation of this type of endometriosis is exceptionally rare.A 51-year-old, G3P2012, Black woman presented with a lump in her cesarean section abdominal wall scar that was increasing in size. Biopsy of the mass revealed metastatic adenocarcinoma with poorly differentiated, nonmucinous ovarian primary. She received 3 cycles of neoadjuvant chemotherapy and underwent an interval debulking with the final pathology showing malignant transformation of endometriosis within her abdominal wall scar. She then completed radiotherapy to the area and is disease-free 6 months later.Our combination of neoadjuvant chemotherapy and excision of the mass with negative margins followed by adjuvant radiotherapy is a feasible treatment option.

This paper derives and implements a new technique called horizontal and vertical Enhance Gabor discriminant analysis (HVGD) for image representation and recognition. In this approach, we firstly use Gabor wavelets to extract local features at different frequencies and orientations from facial images. The horizontal and vertical principal component analysis (HVPCA) is then applied directly on the Gabor transformed matrices to reduce sensitivity to imprecise eye detection and face cropping. To improve upon the traditional discriminant analysis methods for face verification, the enhanced Fisher linear discriminant model (EFM) method is finally applied to further remove redundant information and form a discriminant representation more suitable for face recognition. The results show that the HVGD method performs better than the PCA, the FLD, and the EFM. The top recognition accuracy of our proposed method can reach 97.7% on the Yale database.

Vertebrates need to maintain extracellular chloride (Cl−) concentrations to ensure the normal operation of physiological processes; the transition from aquatic to terrestrial environments necessitated the development of sophisticated mechanisms to ensure Cl−homeostasis in the face of fluctuating Cl−levels. Zebrafish calcitonin gene-related peptide (CGRP), unlike its splice variant calcitonin, does not respond to environmental Ca2+levels. This study aimed to test the hypothesis that CGRP is involved in the control of body fluid Cl−homeostasis. Acclimation to high-Cl−artificial water stimulated the mRNA expression ofcgrpand the receptor (crlr1) when compared with low-Cl−. CGRP knockdown induced upregulation of the Na+-Cl−co-transporter (ncc2b), while overexpression of CGRP resulted in the downregulation ofncc2bmRNA synthesis and a simultaneous decrease in Cl−uptake in embryos. Consistent with these findings, knockdown of eithercgrporcrlr1was found to increase the density of NCC2b-expressing cells in embryos. This is the first demonstration that CGRP acts as a hypochloremic hormone through suppressing NCC2b expression and the differentiation of NCC-expressing ionocytes. Elucidation of this novel function of CGRP in fish body fluid Cl−homeostasis promises to enhance our understanding of the related physiology in vertebrates.

To determine whether hydronephrosis is an independent prognostic indicator of survival among patients with advanced cervical carcinoma. Moreover, we wanted to demonstrate the relationship between unilateral and bilateral hydronephrosis and overall survival.Retrospective analysis of 197 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIB cervical carcinoma or higher treated between 1990 and 2007 was conducted. Inclusion criteria were clinical staging according to FIGO criteria, standardized radiation treatment and cisplatin-based chemosensitization regimens. Associations between hydronephrosis and covariates-age, race, histopathologic diagnosis, pelvic sidewall involvement, stage, nodal involvement, and Gynecologic Oncology Group/Eastern Cooperative Oncology Group performance status (PS)-were determined. Statistical analysis including Kaplan-Meier, log-rank test, proportional hazards regression, Fisher exact test, and Mann-Whitney test were used where appropriate, with P0.05 considered significant.Of 143 included patients, 73 patients had no hydronephrosis (HN), 39 patients had unilateral HN, and 31 patients had bilateral HN. Twenty-nine patients (40%) with no HN died compared to 24 patients (61.5%) with unilateral HN and 21 patients (67.7%) with bilateral HN. Median time to death was significantly shorter for patients with unilateral HN (27 months; 95% confidence interval [CI], 10-48) and bilateral HN (12 months; 95% CI, 6-23) versus patients without HN (68 months; 95% CI, 39-∞; P0.001). Unadjusted hazard ratio (HR) for HN (both unilateral and bilateral) was 2.4 (95% CI, 1.5-3.8); P0.001. Of potential covariates evaluated, PS and sidewall involvement were significantly associated with HN (P = 0.021 and P = 0.014, respectively). Proportional hazards regression revealed that controlling for use of radiation, chemotherapy, and for PS, HN was still significantly associated with poor prognosis (HR unilateral HN = 2.0, 95% CI, 1.2-3.5; HR bilateral HN = 3.2, 95% CI, 1.7-6.0); P ≤ 0.001.Hydronephrosis is an independent poor prognostic indicator of survival in patients with advanced cervical cancer. Bilateral hydronephrosis compared to unilateral involvement confers a worse overall prognosis. Additional studies are needed to determine if FIGO staging should be amended.

Objectives The purpose of this study is to detect differences in overall survival between the 1988 FIGO staging and current staging of uterine carcinosarcomas to determine if revised 2009 staging accurately predicts actual patient survival. Methods From 1988 until 2010, patients with uterine carcinosarcoma were retrospectively identified from tumor registry records. Patients were grouped in both broad stages (1–4) and all FIGO substages in order to detect differences. Time-dependant receiver operating characteristic curves (ROC) were generated to predict death before the end of the second year post-diagnosis for both the new and revised system. Kaplan Meier estimated median survival time was utilized to compare actual patient survival. Results Of 112 patients with carcinosarcoma, 37 patients (33%) had FIGO Stage I disease, 15 patients (13.4%) had Stage II disease, 36 patients (32%) were diagnosed as Stage III, and 24 patients (21.4%) had Stage IV disease. 106 of 112 (94.6%) patients underwent lymphadenectomy (pelvic +/− para-aortic). Four patients (3.6%) were downstaged when utilizing broad staging criteria: 2 patients were downstaged from Stage II to I, and 2 patients were downstaged from Stage III to Stage I and II respectively. When looking at substage, the area under the ROC was 0.67 for the former staging system, and 0.65 for the revised staging. Kaplan–Meier estimated median survival time post-diagnosis was 610days (95% CI [478,930]). Conclusion Based upon our reclassification of 112 patients with uterine carcinosarcoma, the revised FIGO staging system does not predict survival more accurately than former staging. Carcinosarcoma has an overall poor prognosis and better indicators of survival are needed.

Similar to mammalian proximal tubular cells, H+-ATPase rich (HR) cells in zebrafish skin and gills are also responsible for Na+uptake and acid secretion functions. However, the basolateral transport pathways in HR cells are still unclear. In the present study, we tested the hypothesis if there are specific slc4 members involved in basolateral ion transport pathways in HR cells. Fourteen isoforms were identified in the zebrafish(z) slc4 family, and the full-length cDNAs of two novel isoforms, z slc4a1b (anion exchanger, zAE1b) and z slc4a4b (Na+/HCO3−cotransporter, zNBCe1b), were sequenced. mRNA signals of z slc4a1b and z slc4a4b were mainly detected in certain groups of ionocytes in zebrafish skin/gills. Further double immunocytochemistry or in situ hybridization demonstrated that zAE1b, but not zNBCe1b, was localized to basolateral membranes of HR cells. Acclimation to low-Na+or acidic environments stimulated the mRNA expression of z slc4a1b in zebrafish gills, and loss-of-function of zslc4a1b with specific morpholinos caused significant decreases in both the whole body Na+content and the skin H+activity in the morphants. On the basis of these results, it was concluded that zAE1b, but not zNBCe1b, is involved in the basolateral transport pathways in Na+uptake/acid secretion mechanisms in zebrafish HR cells.

Objectives. To evaluate the activity and toxicity of fulvestrant in advanced, recurrent, or persistent endometrial carcinoma. Methods. Eligible patients with advanced, recurrent or persistent endometrial carcinoma not amenable to curative therapy were treated with fulvestrant at a dose of 250mg by IM injection every 4weeks for at least 8weeks. Therapy was continued until evidence of progressive disease, or adverse effects prohibited further therapy. Response was assessed in patients with at least one target lesion as defined by Response Evaluation Criteria in Solid Tumors (RECIST) v1.0. Immunohistochemical analysis of tumor tissue (histology or cytology) for estrogen and progesterone receptors was required from the metastatic or recurrent site. Results. Sixty-seven patients were enrolled in this study. Upon review, 14 patients were excluded. In the 22 estrogen receptor (ER) negative patients, no patients demonstrated either a complete or partial response, and 4 (18%) demonstrated stable disease (as best response). In the 31 ER positive patients, 1 (3%), 4 (13%) and 9 (29%) patients demonstrated a complete, partial response, and stable disease (as best response), respectively. The median progression free survival and overall survival in the ER negative patients were 2 and 3months and in the ER positive patients 10 and 26months. Treatment was well tolerated, and no patient discontinued therapy due to toxicity. Conclusions. Fulvestrant has minimal activity in advanced, recurrent, or persistent endometrial carcinoma.

Background. The association of human immunodeficiency virus (HIV) infection with rapid progression of cervical and anal squamous cell carcinoma has been clearly established by several studies. Human papilloma virus (HPV) infection of the anogenital tract is believed to be the causative agent of cervical, anal, vaginal, and vulvar squamous cell carcinoma. While a myriad of reports exist in the literature pertaining to the rapid progression of cervical and anal carcinoma in HIV-infected patients, no association of HIV infection and vaginal carcinoma has been reported. We present an unusual case of a young woman infected with HIV who was diagnosed with advanced vaginal carcinoma and succumbed to her disease shortly thereafter despite aggressive treatment. Case. A 40-year-old woman with a 2-year history of HIV infection presented with Stage IVA squamous cell carcinoma of the vagina and a large vesicovaginal fistula from the tumor eroding through the posterior bladder wall. Computed tomography (CT) of the abdomen and pelvis revealed a large tumor replacing the vagina with mild hydronephrosis and diffuse pelvic and inguinal lymphadenopathy. She underwent urinary diversion with a transverse colon conduit followed by pelvic radiation with weekly cisplatin chemosensitization. A repeat CT scan of the abdomen and pelvis upon completion of her treatment revealed progression of disease with multiple liver metastases and gastrohepatic ligament adenopathy. She subsequently died of advanced metastatic vaginal carcinoma 2 months after completion of treatment. Conclusion. Due to the rarity of primary vaginal carcinoma, the clinical behavior of this neoplasm in the HIV-infected patient is poorly understood. Our case indicates that, although vaginal carcinoma is a disease of the elderly, young women infected with HIV and HPV are predisposed not only to develop cervical or anal carcinoma but also may be at increased risk for vaginal carcinoma with more aggressive and less responsive disease. Furthermore, although vaginal carcinoma is usually a slow-growing neoplasm, this case illustrates the aggressive behavior of such a tumor when associated with HIV infection.

In this paper, two-dimensional locality preserving projections (2DLPP) was proposed to extract Gabor features for face recognition. 2DPCA is first utilized for dimensionality reduction of Gabor feature space, which is implemented directly from 2D image matrices. The objective of 2DLPP is to preserve the local structure of the image space by detecting the intrinsic manifold structure. In our method, an original image is convolved with Gabor filters corresponding to various orientations and scales to give its Gabor representation. 2DPCA is implemented in the row direction prior to 2DLPP in the column direction. Experiments are conducted on the ORL face database, which shows higher recognition performance of the proposed methods. The top recognition rate can reach 95.5%.

Bilateral uterine artery embolization has become an accepted therapeutic modality in the management of patients with symptomatic uterine leiomyomata. Complications of bilateral uterine artery embolization, including rare cases of malignancies, have been reported following this procedure.We present a 46-year-old woman, gravida 3, para 1, who was treated with bilateral uterine artery embolization for symptomatic uterine leiomyomata following pelvic sonography and magnetic resonance imaging, which depicted bilateral normal adnexa. Nine months after the procedure she was diagnosed with stage III ovarian carcinoma.Patients undergoing bilateral uterine artery embolization should be informed of the possibility of preexisting or potential subsequent development of ovarian carcinoma, reflecting the lack of an effective screening method for this disease.

I-kappa-B kinase e (IKBKE; IKKepsilon) has been recently identified as a breast cancer oncogene, and its alteration appears to be an early event in breast cancer development. In this study, we demonstrated that IKKepsilon is frequently overexpressed and activated in human ovarian cancer cell lines and primary tumors. Of 96 ovarian cancer specimens examined, 63 exhibited elevated levels of IKKepsilon. Furthermore, alterations of IKKepsilon were associated with late-stage and high-grade tumors, suggesting a role of IKKepsilon in ovarian tumor progression rather than in tumor initiation. Overall survival in patients with elevated levels of IKKepsilon was significantly lower than patients whose tumors expressed normal levels of IKKepsilon. Moreover, both early and late-stage tumors that overexpressed IKKepsilon conferred a poor prognosis, as compared with those that did not possess elevated IKKepsilon levels. Notably, overexpression of IKKepsilon rendered cells resistant to cisplatin, whereas knockdown of IKKepsilon overcame cisplatin resistance in both A2780CP and C13 cells, which express high levels of endogenous IKKepsilon. Therefore, these data demonstrate for the first time that deregulation of IKKepsilon is a highly recurrent event in human ovarian cancer and could play a pivotal role in tumor progression and cisplatin resistance. IKKepsilon could also serve as a prognostic marker and potential therapeutic target for this malignancy.

Background: Dehydroepiandrosterone sulfate (DHEAS) is metabolized to active androgens and estrogens, which may have a role in the development of endometrial cancer. Methods: We studied DHEAS conversion to dehydroepiandrosterone (DHEA) in normal and neoplastic endometrium utilizing gas chromatography-mass spectral (GC-MS) analysis. Endometrial homogenate was incubated with known amounts of DHEAS for 4 h at 37°C. Methanol extract was separated from debris by centrifugation, concentrated to 200 μl and 1 μl injected into the GC-MS instrument, equipped with a CP-Sil 8 column. DHEAS and DHEA areas were calculated by autoquantization and DHEA/DHEAS ratio was used for comparing sulfatase activity among normal endometrium (n = 6), Stage I endometrioid carcinoma (EC) (n = 15), Stage I mixed mesodermal Müllerian tumor (MMMT) (n = 6) and Stage I uterine papillary serous carcinoma (UPSC) (n = 7). Results: DHEA/DHEAS ratios in normal endometrium, EC, MMMT and UPSC were 1.45 ± 1.10, 5.63 ± 3.27, 2.88 ± 0.99, and 3.04 ± 1.76, respectively. Sulfatase activity was significantly higher in EC when compared with normal endometrium (p < 0.001), MMMT (p < 0.05), and UPSC (p < 0.05). The enzyme activity did not differ significantly between low-grade and high-grade EC tumors (5.8 ± 2.77 and 5.49 ± 3.84, respectively, p > 0.05). Conclusion: Stage I EC have higher sulfatase activity than normal endometrium, and Stage I MMMT and UPSC tumors.

Leiomyomas represent the most common uterine neoplasms, noted clinically in 20% to 30% of all women older than 30 years, and are found in 75% of hysterectomy specimens. 1 Although rare, the most common mesenchymal neoplasm of the vagina is the leiomyoma. 2 The mean patient age at detection of a vaginal leiomyoma, is approximately 40 years, with a reported range between 19 and 72 years. 2 Vaginal leiomyomas vary from 0.5 to 15 cm in diameter, averaging approximately 3 cm in size, and may occur anywhere within the vagina, usually in a submucosal location. Although these rare lesions are often asymptomatic, larger tumors may be associated with pain, dystocia, dyspareunia, or obstructive urinary symptoms. We report the sonographic and magnetic resonance imaging (MRI) findings of a patient with an isolated vaginal wall leiomyoma.

Purpose After initial surgery, there has been no established consensus regarding adjunctive therapy for patients with uterine carcinosarcoma (CS). This study was designed to compare patient outcome following treatment with adjuvant whole abdominal irradiation (WAI) versus (vs.) chemotherapy for patients with this rare group of female pelvic malignancies. Patients and methods Eligible, consenting women with stage I–IV uterine CS, no more than 1 cm postsurgical residuum and/or no extra-abdominal spread had their treatments randomly assigned as either WAI or three cycles of cisplatin (C), ifosfamide (I), and mesna (M). Results 232 patients were enrolled, of whom 206 (WAI=105; CIM=101) were deemed eligible. Patient demographics and characteristics were similar between arms. FIGO stage (both arms) was: I=64 (31%); II=26 (13%); III=92 (45%); IV=24 (12%). The estimated crude probability of recurring within 5 years was 58% (WAI) and 52% (CIM). Adjusting for stage and age, the recurrence rate was 21% lower for CIM patients than for WAI patients (relative hazard [RH]=0.789, 95% confidence interval [CI]: (0.530–1.176), p =0.245, 2-tail test). The estimated death rate was 29% lower among the CIM group (RH=0.712, 95% CI: 0.484–1.048, p =0.085, two-tail test). Conclusion We did not find a statistically significant advantage in recurrence rate or survival for adjuvant CIM over WAI in patients with uterine CS. However, the observed differences favor the use of combination chemotherapy in future trials.

The vitamin B6 status of high school students and its relationship with dietary intake were investigated in this cross-sectional study by face-to-face interview. A total of 157 healthy students aged 16–18 years (eighty-three boys and seventy-four girls) were randomly recruited from two out of nineteen senior high schools in Tainan, Taiwan. Vitamin B6 intakes were calculated from three 24-h dietary records. Direct and indirect vitamin B6 status indicators were measured in plasma, erythrocytes and urine. The anthropometric data, being similar to those of the first Nutrition and Health Survey in Taiwan (1993–1996), showed the normal growth and development of these students. All students except one girl (28·7 nmol/l) had plasma pyridoxal-5′-phosphate (PLP) levels >35 nmol/l, indicating an adequate vitamin B6 status. The mean dietary vitamin B6 intakes of boys and girls were 1·04 (sd 0·29) and 0·96 (sd 0·27) mg/d, respectively. Vitamin B6 status indicators, including plasma PLP, erythrocyte alanine aminotransferase activity coefficient (EALT-AC), aspartate aminotransferase activity coefficient (EAST-AC) and urinary 4-pyridoxic acid (4-PA), were correlated with vitamin B6 intake. Students with adequate values of plasma PLP (>35 nmol/l), EALT-AC ( 3·0 μmol/d) had median intakes of 1·08 and 1·01 mg/d, respectively, for boys and girls. This study suggests that vitamin B6 requirements for boys and girls aged 16–18 years were approximately 1·1 and 1·0 mg/d, respectively.

Objective : To evaluate whether body mass index (BMI) is an independent risk factor for survival in patients with endometrial adenocarcinoma. Methods : Women treated for endometrial cancer at the State University of New York (SUNY), Downstate and Kings County Hospital between January 1982 and September 2003 were eligible. Patients were divided into groups based upon their histology at the time of diagnosis. The first included patients with low-grade endometrioid adenocarcinoma (FIGO grades 1 and 2); the second included grade 3 endometrioid adenocarcinoma; and the third contained papillary serous and clear cell carcinomas. Data regarding BMI, patient age, race, grade, and stage of disease and overall survival, were assessed by survival analysis, with P < 0.05 considered significant throughout. Results : The analysis included 442 patients. Mean BMI was 32.6 ± 8.2. There were 312 patients (70%) treated for low-grade endometrial adenocarcinoma; 64 patients (14%) for grade 3 endometrioid adenocarcinoma; and 71 patients (16%) for papillary serous and clear cell adenocarcinoma. Increased BMI was associated with improved overall survival (P = 0.003). BMI was also correlated to tumor grade, stage at diagnosis, age, and race. Tumor grade, stage, age, and race were correlated to survival. Statistical analyses revealed the majority of the association between BMI and survival can be attributed to the association between BMI and these other risk factors for survival in endometrial cancer. Conclusions : Increased BMI is associated with survival advantage among patients with endometrial cancer. Because of the relationship between obesity and other confounding variables obesity alone is not an independent predictor of survival.

CAH and EIN who underwent any type of hysterectomy. Of these patients, 2315 had concurrent bilateral or unilateral oophorectomy (83.2%). Occult ovarian cancer was found in 27 of these cases, representing an overall risk of 1.2%. Stratified by age, 15 of 1838 women b65 years of age and 12 of 477 who were ≥65 years old had ovarian cancer on final pathology, representing an 0.8% and 2.5% risk of ovarian cancer in these age groups, respectively. We determined the relative risk of occult ovarian malignancy at the time of surgical management of CAH to be 3.1 at age ≥65 vs. age b65 years (relative risk 3.08, 95% CI 1.5–6.5, Fisher's exact test P b 0.006). Conclusions: Conventional management of CAH/EIN in women who have completed childbearing does not differ from that of endometrial cancer, including total abdominal hysterectomy/bilateral salpingooophorectomy. This practice is compelled by the theoretical risk of continued hormonal stimulation of residual endometrial disease, the risk of a synchronous ovarian malignancy, and the risk of metastasis to the ovary. Studies endorsing the safety of hormone replacement therapy in endometrial cancer patients argue against the detrimental effect of estrogen in endometrial cancer patients and, therefore, in CAH/ EIN as well. Our study demonstrates a low incidence of ovarian malignancy in women with CAH/EIN, especially in women b65 years of age, providing compelling evidence to support ovarian preservation. As data increase regarding the health benefits of ovarian preservation in postmenopausal women, a paradigm shift in the surgical management of CAH in these same women should follow.

Objective To identify parameters associated with the presence or development of invasive cervical cancer among patients who underwent cold knife conization (CKC) following loop electrocautery excision procedure (LEEP) revealing positive endocervical curettings for stage 3 cervical intraepithelial neoplasia (CIN III). Study Design Patients who underwent CKC following LEEP with endocervical curettings indicating CIN III were observed retrospectively. Results Of 146 patients identified, 133 (91.1%) had residual CIN on their cone biopsy; 23 (15.8%) had invasive cervical carcinoma. Patients with residual CIN III, ectocervical and endocervical margins with CIN, and positive endocervical curettings on cone biopsy were more likely to harbor or develop invasive cervical carcinoma. Conclusion Patients with CIN III on endocervical curettage at the time of LEEP procedure are at high risk for harboring residual cervical dysplasia or micros-invasive carcinoma, or developing carcinoma in the future. Residual CIN III, ectocervical or endocervical margins positive for CIN, and/or positive endocervical curettings on CKC subsequent to LEEP with positive endocervical curettings for CIN III all indicate a higher likelihood of harboring or developing cervical carcinoma.

Metastases to the uterus are rare and account for less than 10% of all metastases to the female genital tract from extragenital cancers. 1 The endometrium is even less frequently affected by metastases. 1 The most common type of breast cancer that metastasizes to the uterus is infiltrating lobular carcinoma. 1 Other histologic types of breast carcinoma that may metastasize to the endometrium include infiltrating ductal carcinoma and signet ring breast carcinoma. 1-5 We report an unusual case in which a postmenopausal patient with infiltrating mammary ductal carcinoma receiving tamoxifen presented because of recent mild uterine bleeding. Transvaginal sonography depicted a symmetrically thickened endometrium and a small hydrometra. Tissue obtained at curettage confirmed metastatic carcinoma consistent with mammary ductal carcinoma.

Emphysematous vaginitis is a rare, self-limited entity (∼200 reported cases) characterized by multiple, discrete, gas-filled cystic cavities in the vaginal mucosa or ectocerdx. 1-3 Most patients have vaginal discharge, although some have reported being aware of popping sounds associated with rupture of the cysts, which may occur spontaneously or during intercourse. 1,2 Evidence suggests that emphysematous vaginitis is an unusual manifestation or a common infection in an immunocompromised or pregnant host. 1,4-7 Although both Gardnerella vaginalis and Trichomonas have been implicated, no single organism has been identified as the causative agent. 1,7 We present transvaginal sonographic findings associated with biopsy-proven emphysematous vaginitis in a patient at 32 weeks' gestation.

In the ovary cortisol-cortisone inter-conversion is catalyzed by the enzyme 11beta-hydroxysteroid dehydrogenase (11beta-HSD). Its role in carcinomas of human ovary is unknown. The majority of ovarian cancers are derived from ovarian surface epithelium and the inflammation caused by successive ovulation seems to a play a role in the development of cancer. Cortisol is known to act as anti-inflammatory agent and its metabolism by type 1 and type 11beta-HSD may control the inflammatory action by cortisol in ovary. We undertook this study to investigate type 2 11beta-HSD activity which functions exclusively oxidative direction, in normal ovarian tissue compared to ovarian epithelial cancer. Ovarian tissue was obtained from patients undergoing hysterectomy for both benign and malignant disease. Tissue was placed immediately on dry ice and subsequently transferred to a freezer where they were maintained at -70 degrees C. NAD dependent 11beta-HSD activity was then determined in this tissue. T-test was performed to determine statistical significance. Mean type 2 enzyme activity was 0.87 +/- 1.65 pmol/min g tissue in normal ovarian tissue versus a mean enzyme activity of 2.96 +/- 1.37 pmol/mim g tissue in from cancer specimens. This difference was statistically significant with a p-value of 0.03. Type 2 1beta-HSD activity in ovarian cancer specimens was significantly higher than enzyme activity measured in normal post-menopausal ovarian tissue. Decreased cortisol levels due type 2 1beta-HSD activity may play a role neoplastic transformation as well as tumor proliferation in ovarian cancer by eliminating anti-inflammatory action of cortisol.

This article reports a novel approach to deconstructing cellulose into 5-hydroxymethylfurfural (HMF) with a high yield (46.1%) by integrating a sequential enzyme cascade technique in an aqueous system with solid acid catalysis in an organic-solvent system. We executed the rational design and synthesis of mesoporous silica nanoparticles (MSNs) with various pore sizes and surface functionalities, which proved to be useful for the immobilization of various enzymes (i.e., cellulase and isomerase) and nanoparticles (i.e., magnetic Fe3 O4 ) and for functionalization of various acid groups (i.e., H2 PO3 , COOH, and SO3 H). We separately applied the synthesized biocatalysts (i.e., cellulase-Fe3 O4 @MSN and isomerase-Fe3 O4 @MSN) and chemical catalysts (i.e., HSO3 -MSN) in a sequential cellulose-to-glucose, glucose-to-fructose, and fructose-to-HMF conversion, respectively, across both aqueous- and organic-solvent systems after the optimization of reaction conditions (e.g., reaction temperature, water ratio, catalyst amount). The integrated enzymatic and chemocatalytic concept in this study could be an effective and economically friendly process for various catalytic applications.