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        Fertility-sparing treatment in early endometrial cancer: current state and future strategies

        ( Andreas Obermair ),( Franzcog ),( Eva Baxter ),( Donal J. Brennan ),( Jessica N. Mcalpine ),( Jennifer J. Mueller ),( Frédéric Amant ),( Mignon D. J. M. Van Gent ),( Robert L. Coleman ),( Shannon N. 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.4

        Endometrial cancer (EC) is the fifth most common cancer in women worldwide. Global estimates show rising incidence rates in both developed and developing countries. Most women are diagnosed postmenopausal, but 14-25% of patients are premenopausal and 5% are under 40 years of age. Established risk factors include age and hyperestrogenic status associated with nulliparity, obesity, and metabolic syndrome. Standard treatment for EC, which involves total hysterectomy and bilateral salpingo-oophorectomy, has excellent survival outcomes, particularly for low-grade endometrioid tumors. However, it leads to permanent loss of fertility among women who wish to preserve their reproductive potential. With current trends of reproductive-age women delaying childbearing, rising EC incidence rates, and a growing epidemic of obesity, particularly in developed countries, research on conservative non-surgical treatment approaches remains a top priority. Fertility-sparing treatment predominantly involves the use of oral progestins and levonorgestrel-releasing intrauterine devices, which have been shown to be feasible and safe in women with early stage EC and minimal or no myometrial invasion. However, data on the efficacy and safety of conservative management strategies are primarily based on retrospective studies. Randomized clinical trials in younger women and high-risk obese patients are currently underway. Here, we have presented a comprehensive review of the current literature on conservative, fertility-sparing approaches, defining the optimal candidates and evaluating tumor characteristics, reproductive and oncologic outcomes, and ongoing clinical trials. We have also summarized current guidelines and recommendations based on the published literature.

      • <i>ZC4H2</i> , an XLID gene, is required for the generation of a specific subset of CNS interneurons

        May, Melanie,Hwang, Kyu-Seok,Miles, Judith,Williams, Charlie,Niranjan, Tejasvi,Kahler, Stephen G.,Chiurazzi, Pietro,Steindl, Katharina,Van Der Spek, Peter J.,Swagemakers, Sigrid,Mueller, Jennifer,Stef Oxford University Press 2015 Human Molecular Genetics Vol.24 No.17

        <P>Miles–Carpenter syndrome (MCS) was described in 1991 as an XLID syndrome with fingertip arches and contractures and mapped to proximal Xq. Patients had microcephaly, short stature, mild spasticity, thoracic scoliosis, hyperextendable MCP joints, rocker-bottom feet, hyperextended elbows and knees. A mutation, p.L66H, in <I>ZC4H2</I>, was identified in a XLID re-sequencing project. Additional screening of linked families and next generation sequencing of XLID families identified three <I>ZC4H2</I> mutations: p.R18K, p.R213W and p.V75in15aa. The families shared some relevant clinical features. <I>In silico</I> modeling of the mutant proteins indicated all alterations would destabilize the protein. Knockout mutations in <I>zc4h2</I> were created in zebrafish and homozygous mutant larvae exhibited abnormal swimming, increased twitching, defective eye movement and pectoral fin contractures. Because several of the behavioral defects were consistent with hyperactivity, we examined the underlying neuronal defects and found that sensory neurons and motoneurons appeared normal. However, we observed a striking reduction in GABAergic interneurons. Analysis of cell-type-specific markers showed a specific loss of V2 interneurons in the brain and spinal cord, likely arising from mis-specification of neural progenitors. Injected human wt <I>ZC4H2</I> rescued the mutant phenotype. Mutant zebrafish injected with human p.L66H or p.R213W mRNA failed to be rescued, while the p.R18K mRNA was able to rescue the interneuron defect. Our findings clearly support <I>ZC4H2</I> as a novel XLID gene with a required function in interneuron development. Loss of function of <I>ZC4H2</I> thus likely results in altered connectivity of many brain and spinal circuits.</P>

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