BMC Research Notes

Perceived knowledge and intention to prepare advance directives: a cross-sectional study of Thai gynecologic cancer patients and families

To examine perceived and objective knowledge of advance directives (AD), attitudes toward end-of-life care, and factors associated with intention to prepare AD among Thai gynecologic cancer patients and their family members attending a tertiary hospital in Bangkok.​ RESULTS DESCRIPTION: A cross-sectional survey was conducted with 101 patients and 105 accompanying family members recruited between August 2017 and January 2018. Over 60% of both groups had never heard of AD and mean objective knowledge scores were low (3.4/8 for patients and 3.7/8 for family members), with common misconceptions including equating AD with euthanasia. Most participants preferred a natural death without life-prolonging measures. Yet only 6% of patients and 1% of family members had completed an AD, while 22% and 27%, respectively, reported an intention to prepare one. Multiple regression showed that perceived knowledge was the only significant predictor of intention to prepare an AD for both patients (B = 0.339, p < 0.001) and family members (B = 0.246, p < 0.001), suggesting that interventions that enhance perceived understanding may strengthen engagement in advance care planning.

Potential clinical application of anti-Müllerian hormone testing in radioiodine treatment of thyroid carcinoma

AbstractDifferentiated thyroid cancer is the most common endocrinological malignancy. Radioiodine treatment has a clear benefit in locally aggressive and metastatic cancers. There are discussions about long-term and acute adverse events.Anti-Müllerian hormone is regarded as the best endocrine marker for evaluating the physiological loss of oocytes in healthy women with regard to age. The impact of radioiodine treatment on anti-Müllerian hormone levels has been more significantly reported in patients over 35 years of age. About reproductive dysfunction, calculations of individual absorbed doses of radioiodine in ovaries after thyroid cancer therapy have not been performed yet. The aim of our ongoing prospective study is to determine serum anti-Müllerian hormone to estimate ovarian reserve for premenopausal women treated with radioiodine and to compare anti-Müllerian hormone levels before and after radioiodine treatment. Predicting radioiodine side effects by evaluating a simple serum biomarker may help to select an appropriate treatment strategy for young women planning pregnancy, specifically in the assessment of ovarian reserve and premature ovarian failure with early onset of menopause.

Genetic analysis of uterine lavage fluids to identify women at high risk of endometrial cancer

Abstract Objectives Endometrial cancer (EC) is the most common malignancy of the female genital tract in developed countries, yet preventive screening remains unavailable, and diagnostic approaches are largely limited to symptomatic women. Despite advancements in precision oncology, the biology of precancerous lesions is less understood compared to advanced disease. To address this gap, we conducted a prospective case-control study analysing uterine lavage fluid from women undergoing diagnostic evaluation. The study included 257 participants: 80 diagnosed with endometrial intraepithelial neoplasia (EIN), 89 with early-stage EC, and 88 healthy controls. Using targeted next-generation sequencing, we examined genetic alterations in 22 selected genes associated with EC development. Results Our findings did not confirm a direct association between specific genetic mutations in uterine lavage fluid and the presence of EIN or early-stage EC (p = 0.501). Mutations were detected in both cases and controls, with a higher overall mutation burden observed in controls, suggesting potential background genomic alterations unrelated to EC development. In conclusion, while molecular profiling of uterine lavage fluid remains a promising concept for non-invasive diagnosis, our results highlight significant challenges in specificity. Further studies with larger cohorts and additional biomarkers are necessary to clarify its diagnostic relevance and clinical applicability.

Proteomics of Ishikawa endometrial cancer cells: impact of liposomal backbone

The Ishikawa cell line is the most widely used model system for investigating implantation and endometrial cancer. Understanding the biology of this cell line is essential for developing effective interventional strategies. To gain a deeper understanding of its cellular protein profile, we extracted cellular proteins from Ishikawa cells and analyzed the peptides using mass spectrometry. Our goal was to create a proteomic resource specifically tailored for Ishikawa cells. This data set is of particular significance in the realm of targeted drug delivery. Liposomes are synthetic spherical vesicles composed of hydrophobic bilayer phospholipids and have received immense recognition as highly effective carriers for the delivery of pharmaceutical drugs and essential nutrients to the endometrium. Phosphatidylcholine and phosphatidylethanolamine are often combined to create functional liposomal systems. To discern any potential interfering effects originating from the liposome backbone, our investigation involved direct effects of phospholipid liposomes on endometrial epithelial cells. The data set includes peptide spectra derived from the intracellular proteomes of Ishikawa endometrial cancer cell isolates and their phospholipid-treated counterparts. Representing a proteome-wide profile, this dataset aims to contribute to a broader understanding of the physiology of endometrial epithelial cells. Proteomic analysis identified key proteins involved in the intricate regulation of cellular metabolism, cell cycle progression, and signaling. Between-group analysis revealed no differentially expressed proteins after adjusting for multiple testing using the applied thresholds (p-value  1). Data are available via ProteomeXchange with identifier PXD050871.

Dataset of obesity in relation to female-specific cancers in middle eastern countries, 1990 to 2016

Understanding the relationship between obesity and female-specific cancers (FSCs) is crucial for public health planning and policy development. The current data paper presented a dataset that includes obesity prevalence and incidence rates of breast, ovarian, cervical, and uterine cancers among women in Middle Eastern countries. This dataset could be used for time-trend analysis and different forecasting models. Moreover, exploring the relationship between obesity and FSCs is important to develop preventive healthcare services, especially among developing countries. The dataset comprises official statistics obtained from reputable sources including the world bank and global burden of disease (GBD) database. The data include a total of 405 observations across 15 middle-eastern countries, from 1990 to 2016. Key variables are obesity prevalence and incidence rate of four major cancers in women including breast cancer, ovarian cancer, cervical cancer, and uterine cancer. This panel data is mainly prepared to investigate the temporal relationship between obesity prevalence and FSC incidence rates, and also performing Counterfactual analysis. Moreover, this data could be utilized for advanced machine learning techniques to estimate future shifts in trend and patterns over time.

Upregulation of PCAT1, PCAT2, and PCAT3 LncRNAs in cervical cancer patients and their diagnostic value

Cervical cancer is one of the most common cancers among women. Despite advances in vaccination and screening, barriers to early detection and effective treatment remain. lncRNAs play an important role in cancer progression and therapeutic responses. New lncRNAs such as PCAT1, PCAT2, and PCAT3 have shown oncogenic activities in multiple cancers, but their role in cervical cancer is not understood. This study investigated the expression patterns of PCAT1, PCAT2, and PCAT3 in cervical cancer to evaluate their use as diagnostic markers and therapeutic targets. The expression level of PCAT1, PCAT2, and PCAT3 was significantly (P value < 0.05) higher in tumor tissues.ROC analysis showed a moderate diagnostic biomarker value for PCAT1 (AUC 0.79, sensitivity 79%, specificity 69%). Spearman's analysis showed a positive correlation between PCAT1-PCAT2 and PCAT1-PCAT3. PCAT1, PCAT2, and PCAT3 lncRNAs significantly increase in cervical cancerous tissues and may play a role as novel oncogenes. Their use as clinical diagnostic markers requires further studies.

Analysis of miR-497/195 cluster identifies new therapeutic targets in cervical cancer

Abstract Objective miR-497/195, located at 17p13.1, is a highly conserved miRNA cluster whose abnormal expression is a key regulator of carcinogenesis. We performed a comprehensive analysis of the miR-497/195 cluster to determine its prognostic utility and role in cervical cancer (CC) using publicly available datasets. Results In silico analysis and validation revealed that this cluster is downregulated in CC. A total of 60 target genes of miR-497/195 cluster were identified as differentially expressed between normal and CC samples. ShinyGO, STRING, CytoHubba, Timer 2.0, HPA, and HCMBD were used for functional enrichment, PPIN network construction, hub gene identification, immune infiltration correlation, histopathological expression, and determination of the metastatic potential of miR-497/195 cluster and their target genes. PPIN analysis identified CCNE1, CCNE2, ANLN, RACGAP1, KIF23, CHEK1, CDC25A, E2F7, CDK1, and CEP55 as the top 10 hub genes (HGs). Furthermore, the upregulation of RECK, ATD5, and BCL2, downregulation of OSBPL3, RCAN3, and HIST1H3H effected overall survival of CC patients. We identified 6 targets (TFAP2A, CLSPN, RASEF, HIST1H3H, AKT3, and ITPR1) of miR-497/195 cluster to influence metastasis. In addition, 8 druggable genes and 38 potential drugs were also identified. Our study identified miR-497/195 cluster target genes and pathways that could be used for prognostic and therapeutic applications in CC.

Geographic variation in urinary tract and genital cancers in Iran: a hypothesis involving exposure to solar radiation

Abstract Objective Sunlight and vitamin D intake are considered as essential elements for human health. Insufficient intake of this vitamin is one of the causes of various cancers and some other diseases. The aim of this study was to investigate the relation between bladder, prostate, cervical and ovarian cancers with solar ultraviolet exposure in Iran. In this ecological study, data from 30 provinces were studied and analyzed by correlation and linear regression tests in SPSS software version 22. Physical activity, gender, human development index, lung cancer and altitude were adjusted at population level. Results The incidence of bladder cancer in both sexes was inversely related to ultraviolet radiation, but it was significant only in men. Unlike bladder cancer, the incidence of cervical cancer showed a positive relation with ultraviolet radiation. No relation was found between the incidence of prostate and ovarian cancers with ultraviolet radiation. Among the adjusting variables, the incidence of lung cancer (surrogate for smoking) in women had the highest coefficient in the linear regression model.

Quantification of circulating microRNAs by droplet digital PCR for cancer detection

Abstract Objective Circulating cell-free microRNAs (miRNAs) which consist of short-sequence RNAs are released from cells into the blood stream and has emerged as new biomarkers in the clinical cancer diagnosis and treatment. For instance, ovarian cancer comprises one of the three major malignant tumor types in the female reproductive system. The mortality rate of this cancer is the highest among all gynecological tumors, with ovarian cancer metastasis constituting an important cause of death. Therefore, development of a diagnostic tool that enables the ovarian cancer diagnosis in earlier stages is urgent. Results We have described an efficient protocol for an accurate absolute quantification of circulating miRNAs in healthy and ovarian cancer serum samples. Our data showed that ddPCR methodology can accurately measure circulating miRNAs levels and that can be a useful tool in biomarkers discovery for ovarian cancer detection.

Molecular comparison of pure ovarian fibroma with serous benign ovarian tumours

Abstract Objective Ovarian fibromas and adenofibromas are rare ovarian tumours. They are benign tumours composed of spindle-like stromal cells (pure fibroma) or a mixture of fibroblast and epithelial components (adenofibroma). We have previously shown that 40% of benign serous ovarian tumours are likely primary fibromas due to the neoplastic alterations being restricted to the stromal compartment of these tumours. We further explore this finding by comparing benign serous tumours to pure fibromas. Results Performing copy number aberration (CNA) analysis on the stromal component of 45 benign serous tumours and 8 pure fibromas, we have again shown that trisomy of chromosome 12 is the most common aberration in ovarian fibromas. CNAs were more frequent in the pure fibromas than the benign serous tumours (88% vs 33%), however pure fibromas more frequently harboured more than one CNA event compared with benign serous tumours. As these extra CNA events observed in the pure fibromas were unique to this subset our data indicates a unique tumour evolution. Gene expression analysis on the two cohorts was unable to show gene expression changes that differed based on tumour subtype. Exome analysis did not reveal any recurrently mutated genes.

Expression of the miR-200 family in tumor tissue, plasma and urine of epithelial ovarian cancer patients in comparison to benign counterparts

Abstract Objective Plasma, but also urine sample could represent a simple liquid biopsy for ovarian cancer biomarker detection. The miRNA-200 family has been shown to be dysregulated in ovarian cancer. The aim of this study was to isolate three members of miR-200 family from tumor tissue, plasma and urine of high-grade serous ovarian cancer patients in comparison with samples from patients with benign ovarian tumors. This is a methodological pilot study of a prospective ovarian cancer patient cohort investigating the potential of liquid biopsies and the role of miRNAs in ovarian cancer treatment. Results MiR-200a, miR-200b and miR-200c were isolated from samples of nine ovarian cancer patients and seven patients with benign ovarian tumor. The most significant finding is that all three miRNAs were detectable in all sample types. Tumor tissue and plasma, but not urine analysis was able to discriminate malignant and benign samples. A correlation between the miRNA-200 expression in urine and plasma was observed in malignant samples only. Plasma and urine with respect to miRNA detection show potential according to this study, but larger studies are needed to clarify the usefulness of these liquid biopsies in ovarian cancer. Trial registration: ClinicalTrials.gov NCT02758652, May 2, 2016.

Analysis of the first inpatient expenditure for cervical cancer patients before and during the COVID-19 pandemic in a provincial maternal and children care hospital in China

COVID-19 has led to economic difficulties for many cancer patients. This study aimed to identify the trend and the major cost items of inpatient expenditure for the admittance to hospital for cervical cancer patients in Hunan Province Maternal and Children Care Hospital from 2017 to 2021. This study assessed the composition of inpatient expenditure using the gray correlation method and the variation in the hospitalization expense structure using the degree of structural variation. A total of 909 patients were identified. The median age of the patients was 49±10.25 years. Insurance payments for cancer patients accounted for 33.51% before the COVID-19 pandemic (2017-2019) but increased to 80.29% during the pandemic (2020-2021). Diagnosis costs accounted for the largest proportion of medical expenditure every year and showed an increasing trend during the study period. Although the consumables cost accounted for the lowest proportion of total costs each year, they showed a fluctuating growth trend with an average annual growth rate of 23.54%, which was the only fluctuation cost of the six constituents. Drug cost had the only positive value for the structural variation of total medical expenditure over the five years. The proportion of hospitalization expenses paid by insurance after COVID-19 is higher than that paid before COVID-19. Attention should be paid to the rising costs of drugs after the COVID-19 pandemic and reasonable control should be maintained for the diagnosis costs to reduce the total expenditure on cervical cancer patients after COVID-19.

Specific transcriptional signature dataset of extracellular signal-regulated kinase 5 in leiomyosarcoma derived cell lines

Soft-tissue sarcomas, particularly leiomyosarcomas, are aggressive tumors characterized by limited therapeutic options due to an insufficient understanding of their molecular drivers. To identify novel therapeutic targets, we investigated the role of Extracellular signal-regulated kinase-5 (ERK5), a critical signaling protein in soft-tissue sarcoma biology. The primary objective was to define the transcriptomic profile specifically associated with ERK5, enhancing the understanding of molecular mechanisms underlying leiomyosarcoma. Two uterine leiomyosarcoma cell lines, SK-UT-1 and AA, underwent ERK5 genetic knockdown via lentiviral transduction with shRNA followed by puromycin selection. Knockdown efficiency was confirmed through RT-qPCR and Western blotting. RNA sequencing was performed using the DNBSEQ platform. Raw reads underwent quality filtering and were aligned to the human genome (GRCh38.p13) with Bowtie2. Gene expression was quantified by RSEM, and differential expression analysis was conducted with DESeq2 (|log2FC|≥ 1, q-value ≤ 0.05). As a result, we identified 1218 and 227 differentially expressed genes for AA and SK-UT-1 respectively, and 81 in common for both cell lines. The raw and RNAseq data and sequences are available at the NCBI GEO repository under GSE297879. Sequence comparison could reveal new therapeutic targets based on the ERK5 signalling pathway, which is critical in experimental models of soft-tissue sarcoma.

Epstein-Barr virus nuclear antigen 1 (EBNA1) increases the expression levels of MDM2 and MDM4 genes in HeLa cells: a review on MDM2 and MDM4 roles in cancer

Epstein-Barr virus nuclear antigen 1 (EBNA1) is a key viral protein expressed in all latency phases and EBV-associated tumors. It can modulate the expression of various host and viral genes. This study aimed to investigate the impact of EBNA1 on the expression levels of two cellular genes involved in p53 pathway regulation-MDM2 and MDM4-in HeLa cells. This investigation was conducted as part of our broader research on EBV-related oncogenic mechanisms. HeLa cells were transfected with either an EBNA1-expressing plasmid or a control plasmid. Gene expression levels of MDM2 and MDM4 were analyzed using real-time PCR. The results demonstrated a statistically significant increase in MDM4 expression in EBNA1-transfected cells compared to controls (p = 0.028). Although MDM2 expression was also elevated, the difference was not statistically significant (p = 0.11). These findings suggest that EBNA1 may play a role in cervical cancer development by upregulating genes that inhibit p53 tumor suppressor activity.

The participation in cervical cancer screening is not altered by the Hawthorne effect among patients of doctors participating in the randomized clinical trial PaCUDAHL

The PaCUDAHL randomized clinical trial evaluated an HPV self-sampling device provided by the family doctor to female patients not participating in the usual opportunistic cervical screening program from 2016 to 2019. Reliable data on the Hawthorne (observer) effect (HE) in clinical trials were lacking. This nested study aimed to verify whether there was a significant difference between participating and non-participating general practitioners (GPs) in the trial, and to measure whether there was an HE in the female patients of participating GPs. We carried out an analytical retrospective cohort study involving 332 GPs and their 70,983 female patients, aged 25-65, registered with the Health Insurance Fund of Flanders, using claims database for the three-year periods 2012-2015 and 2016-2019. Statistical analyses were performed using a linear generalized hierarchical mixed model with geographic level as a random effect. The patients of the 24 participating GPs did not have a cervical cancer screening rate different from that of the non-participating GPs, either before recruitment (p = 0.24) or during the PaCUDAHL trial period (p = 0.15). There were significant increases in cervical cancer screening rates over four years regardless of the group considered (p < 0.0001). In conclusion there was no observer effect but a significant cohort effect.

Results comparison of cervical cancer early detection using cerviray ® with VIA test

Abstract Objectives This study investigates the performance of artificial intelligence (AI) technology, namely Cerviray AI®, compared with Cerviray® expert, aiming to compare its sensitivity, specificity, positive predictive value (PPV), and area under the receiver operating characteristic curve (AUC ROC). The Visual Inspection with Acetic Acid (VIA) test is used as the gold standard. Results The study involved 44 patients from various health centers in West Java Province. Performance of Cerviray AI®, or Cerviray® expert, and lastly VIA tests were compared in their ability to detect pre-cancerous cervical lesions in high-risk women of childbearing age. The current study indicated that Cerviray AI® had a sensitivity of 42.9%, specificity of 100%, PPV of 100%, and ROC AUC values of 71.4%. In comparison, the evaluation of the Cerviray® expert demonstrated a sensitivity of 71.4%, specificity of 97.3%, PPV of 83.3%, and ROC AUC values of 84.4%. In conclusion, the evaluation of Cerviray® expert outperformed Cerviray AI® in ROC AUC values. Trial registration Clinical Trials.gov Identifier NCT06518070 Retrospectively registered.

Genotype-specific prevalence of human papillomavirus infection in asymptomatic Peruvian women: a community-based study

Abstract Objective To determine the general and genotype-specific prevalence of HPV and to identify potential risk factors for the infection in a population-based screening of Peruvian women. Results A total of 524 samples were analyzed by PCR and a total of 100 HPV positive samples were found, of which 89 were high-risk, 19 were probably oncogenic, 9 were low-risk and 27 other HPV types. The 26–35 and 36–45 age groups showed the highest proportion of HPV positive samples with a total of 37% (37/100) and 30% (30/100), respectively. Moreover, high-risk HPV was found in 33.7% of both groups and probably oncogenic HPV in 52.6% and 31.6%, respectively. High-risk HPV were the most frequent types identified in the population studied, being HPV-52, HPV-31 and HPV-16 the most commonly detected with 17.6%, 15.7% y 12.9%, respectively. Demographic characteristics and habits were assessed in the studied population. A total of 62% high-risk HPV were detected in married/cohabiting women. Women with two children showed the highest proportion (33.8%) of high-risk HPV, followed by women with only one child (26.9%). Those women without history of abortion had a higher frequency of high-risk HPV (71.9%), followed by those with one abortion (25.8%).

Dataset for vaginal human papillomavirus infection among adolescent and early adult girls in Jos, Nigeria

Abstract Objectives To assess risk factors for HPV infection, determine knowledge about HPV vaccines, assess willingness to receive the HPV vaccine among adolescent and early adult girls in Nigeria, we administered a structured questionnaire. We also collected samples to determine the prevalence and patterns of HPV infections. Data description The dataset contains the responses of 205 participants from 10 randomly selected public and private secondary schools in Jos, Nigeria. The data includes information on risk factors for HPV infections such as sexual behaviours, knowledge about HPV vaccine and willingness to receive the vaccine. This is valuable information that can be compared to data from studies in other environments or to determine changes in the pattern of risk factors and HPV prevalence in this population over time.

Analysis of inflammation parameter value lymphocyte monocyte ratio (LMR), platelet lymphocyte ratio (PLR), and systemic inflammation response index (SIRI) to differentiate malignant and benign ovarian tumors

Ovarian cancer is the leading cause of death from gynecological cancers. In the early stages, it is generally asymptomatic, leading to delays in the early diagnosis of ovarian cancer. Inflammation, which is the body's response to tissue damage, plays a crucial role in the pathogenesis of cancer. Inflammatory responses result in cellular changes, damaged tissue repair, and affected area proliferation. This research aims to determine the differences in LMR (Lymphocyte-to-Monocyte Ratio), PLR (Platelet-to-Lymphocyte Ratio), and SIRI (Systemic Immune-Inflammation Index), which were the parameters of inflammation between ovarian malignant tumors and benign ovarian tumors. This retrospective cohort study analyzed medical records of 327 patients treated at Dr. Hasan Sadikin General Hospital, Bandung, between 2020 and 2022, including 166 cases of malignant ovarian tumors and 161 benign ovarian tumors. Inflammatory markers were calculated from routine blood counts. The mean LMR was significantly lower in the malignant group than the benign group (3.32 vs. 3.83, P = 0.004). Conversely, PLR and SIRI values were significantly higher in malignant tumors (PLR: 355 vs. 213, P = 0.001; SIRI: 3.50 vs. 2.97, P = 0.042). These findings suggest that LMR, PLR, and SIRI may serve as supportive inflammatory biomarkers in distinguishing malignant from benign ovarian tumors.

The role of CA-125, GLS and FASN in predicting cytoreduction for epithelial ovarian cancers

Abstract Objective Cytoreduction has an important role in improving the survival rate of epithelial ovarian cancer (EOC) patients. This study aimed to assess the ability of preoperative serum CA125, FASN and GLS as predictors of cytoreductive surgery for epithelial ovarian cancer (EOC). Results The average values of serum CA-125, FASN, and GLS in the suboptimal cytoreduction group were higher than those in optimal cytoreduction group. The cut off point (COP) was 248.55 (p = 0.0001) with 73.2% sensitivity and 73.6% specificity for CA-125, 0.445 (p = 0.017) with 62.5% sensitivity and 60.4% specificity for FASN, and 22.895 (p = 0.0001) with 73.2% sensitivity and 75.5% specificity for GLS. The COP of CA-125 and GLS combined was 29.16 (p = 0.0001) with sensitivity 82.1% and specificity 73.6%, while the COP of CA-125, GLS, and FASN combined was 0.83 (p = 0.0001) with 87.5% sensitivity and 73.6% specificity.

MDC1 depletion promotes cisplatin induced cell death in cervical cancer cells

Abstract Objective Cisplatin, the most common chemotherapeutic drug for the treatment of advanced stage cervical cancers has limitations in terms of drugs resistance observed in patients partly due to functional DNA damage repair (DDR) processes in the cell. Mediator of DNA damage checkpoint 1 (MDC1) is an important protein in the Ataxia telangiectasia mutated (ATM) mediated double stranded DNA break (DSB) repair pathway. In this regard, we investigated the effect of MDC1 change in expression on the cisplatin sensitivity in cervical cancer cells. Results Through modulation of MDC1 expression in the cervical cancer cell lines; Hela, SiHa and Caski, we found that all the three cell lines silenced for MDC1 exhibited higher sensitivity to cisplatin treatment with inefficiency in accumulation of p γH2AX, Ser 139 foci and increased accumulation of pChk2 Thr 68 at the damaged chromatin followed by enhanced apoptosis. Further, we observed the increased p53 Ser 15 phosphorylation in the MDC1 depleted cells. Our studies suggest that MDC1 expression could be a key determinant in cervical cancer prognosis and its depletion in combination with cisplatin has the potential to be explored for the sensitisation of chemo-resistant cervical cancer cells.

Bixin and fucoxanthin sensitize human lung cancer and cervical cancer cell to cisplatin in vitro

Abstract Objective Cisplatin is a conventional anticancer drug that generates reactive oxygen species and causes apoptosis. However, many cancer cells develop alterations in the ATP binding cassette transporter responsible for the uptake and efflux process, which leads to resistance. Many natural products have shown potential to compete with ATP binding cassette transporter and may sensitize resistant cells to cisplatin. Studies have shown pro-oxidant effect of carotenoids that promote apoptosis of cancer cells. Bixin and fucoxanthin are well-known carotenoids with known antioxidant properties, however their bioactivity in lung cancer cells, clinically known to develop resistance due to ATP binding cassette transporter, has been minimally studied. This study is the first to investigate the potential of bixin and fucoxanthin to sensitize human lung cancer cell line, A549 and cervical cancer cell line, HeLa, to cisplatin. Drug combination method developed by Chou and Talalay theorem was employed. Result Employing the best combination ratio, this study shows selective sensitization of cancer cells to cisplatin after bixin and fucoxanthin treatment. Further study on the mechanism of action in specific types of cancer cells is warranted. It may improve cisplatin sensitivity in tumors and rational use of cancer drugs. Graphical Abstract

Variations in cervico-vaginal microbiota among HPV-positive and HPV-negative asymptomatic women in Peru

Abstract Objective To characterize the cervicovaginal microbiota of HPV-positive and HPV-negative asymptomatic Peruvian women, by identifying the presence of 13 representative bacteria genus. Results A total of 100 HPV-positive and 100 HPV-negative women were matched by age for comparison of microbiota. The following bacteria were more frequently identified in HPV-positive patients compared to HPV-negative: Eubacterium (68 vs 32%), Actinobacteria (46 vs 33%), Fusobacterium (11 vs 6%) and Bacteroides (20 vs 13%). A comparison between high-risk and low-risk genotypes was performed and differences were found in the detection of Actinobacteria (50 vs 33.33%), Bifidobacterium (50 vs 20.83%) and Enterococcus (50 vs 29.17%).

Cervical pre-cancerous lesion detection: development of smartphone-based VIA application using artificial intelligence

Abstract Objective Visual inspection of cervix after acetic acid application (VIA) has been considered an alternative to Pap smear in resource-limited settings, like Indonesia. However, VIA results mainly depend on examiner’s experience and with the lack of comprehensive training of healthcare workers, VIA accuracy keeps declining. We aimed to develop an artificial intelligence (AI)-based Android application that can automatically determine VIA results in real time and may be further developed as a health care support system in cervical cancer screening. Result A total of 199 women who underwent VIA test was studied. Images of cervix before and after VIA test were taken with smartphone, then evaluated and labelled by experienced oncologist as VIA positive or negative. Our AI model training pipeline consists of 3 steps: image pre-processing, feature extraction, and classifier development. Out of the 199 data, 134 were used as train-validation data and the remaining 65 data were used as test data. The trained AI model generated a sensitivity of 80%, specificity of 96.4%, accuracy of 93.8%, precision of 80%, and ROC/AUC of 0.85 (95% CI 0.66–1.0). The developed AI-based Android application may potentially aid cervical cancer screening, especially in low resource settings.