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BackgroundSentinel lymph node (SLN) biopsy is increasingly used in endometrial cancer staging; however, success of the technique is variable, and the learning curve needs to be better understood. Success is defined as identification of a SLN specimen containing nodal tissue in bilateral hemi-pelvises.ObjectiveTo assess the learning curve of surgeons at an academic institution in performing successful SLN mapping and biopsy during robotic staging for endometrial cancer.MethodsAfter institutional review board approval, patients who underwent staging with robotic SLN mapping using indocyanine green at a single academic program between July 2012 and December 2017 were identified. Demographic, pathologic, and surgical data were retrospectively collected from the medical records. Descriptive and comparative statistics were performed. Surgeon rates of successful bilateral SLN mapping and removal of lymphoid-containing SLN specimens were compared. A logistic model was used to analyze the probability of successful SLN mapping and removal of lymph node-containing tissue with increasing number of procedures performed.ResultsThree hundred and seventeen patients met the eligibility criteria. Most had early-stage, low-grade endometrial cancer. A total of 194 (61%) patients had successful bilateral mapping. Among seven surgeons, a plateau in rates of successful bilateral mapping was achieved after 40 cases. No linear correlation was seen between the number of surgeries performed and the rate of removal of lymph node-containing tissue among surgeons. Each additional 10 procedures performed was associated with a 5% and an 11% increase in the odds of successful SLN mapping and removal of lymph node-containing tissue, respectively.DiscussionThe successful removal of lymph node-containing specimens appears to be a surgeon-specific phenomenon. The plateau of the learning curve for successful bilateral mapping seems to be reached at around 40 cases. These first 40 cases offer a time for auditing of individual rates of SLN mapping and removal to identify surgeons who may benefit from procedure-specific remediation.

A diagnosis of myelodysplastic syndrome (MDS) is typically unexpected and can be difficult for patients to grasp. Not only is MDS a complicated disease to understand, which can contribute to stress and anxiety, but it also has an uncertain prognosis, which can be emotionally paralyzing. Not surprisingly, emotional distress and the symptom burden of MDS, including extreme fatigue due to cytopenias, negatively impact a patient's quality of life (QOL). Studies have shown that patient-centered care-including greater physician understanding of the disease burden their patients experience, discussing and establishing agreed-on treatment goals, and including patients in the decision-making process about their care-may help improve patient QOL. To better understand patient and caregiver experiences with MDS and how the disease impacts QOL, a small survey was conducted of patients with MDS or leukemia and their caregivers on an online health network. Among the 30 respondents who completed the survey, four had MDS and one was a caregiver for a patient with MDS. Here we focus on the five MDS respondents and contextualize the findings with personal experiences from a patient and physician perspective. The patient perspective was provided by John Soper, PhD, DABCC, who was diagnosed with MDS in 2019. Dr Soper is a retired board-certified clinical chemist and a member of the MDS Foundation. The physician perspective was provided by Dr Ruben Mesa, Executive Director of the Mays Cancer Center at UT Health San Antonio MD Anderson. The survey responses and the accompanying patient and physician perspectives highlight the importance of open communication between patients and their healthcare provider to better serve those with MDS and improve their QOL.

Circulating tumor cells consist of phenotypically distinct subpopulations that originate from the tumor microenvironment. We report a circulating tumor cell dual selection assay that uses discrete microfluidics to select circulating tumor cell subpopulations from a single blood sample; circulating tumor cells expressing the established marker epithelial cell adhesion molecule and a new marker, fibroblast activation protein alpha, were evaluated. Both circulating tumor cell subpopulations were detected in metastatic ovarian, colorectal, prostate, breast, and pancreatic cancer patients and 90% of the isolated circulating tumor cells did not co-express both antigens. Clinical sensitivities of 100% showed substantial improvement compared to epithelial cell adhesion molecule selection alone. Owing to high purity (>80%) of the selected circulating tumor cells, molecular analysis of both circulating tumor cell subpopulations was carried out in bulk, including next generation sequencing, mutation analysis, and gene expression. Results suggested fibroblast activation protein alpha and epithelial cell adhesion molecule circulating tumor cells are distinct subpopulations and the use of these in concert can provide information needed to navigate through cancer disease management challenges. Diagnostics: Dual selection improves circulating tumor cell assay Using two selection markers, instead of one, can improve the sensitivity of a blood test for circulating tumor cells (CTCs). Steven A. Soper from the University of Kansas in Lawrence, USA, and colleagues analyzed blood samples from patients with cancers of the pancreas, colon, breast, ovaries and prostate, as well blood from healthy donors and those with benign disease. They ran each patient’s blood through two microfluidic devices, one chip targeting the established marker epithelial cell adhesion molecule (EpCAM) and another targeting a new marker, fibroblast activation protein alpha (FAPα). Doing so detected CTCs in nearly all the cancer patients—a substantial improvement over testing for EpCAM CTCs alone. Molecular and genetic analyses of the CTCs showed that those expressing EpCAM and FAPα are distinct subpopulations, and testing for both could prove valuable for clinical management.

ObjectiveOpen radical hysterectomy followed by adjuvant radiation for cervical cancer has been associated with significant rates of morbidity. Radical hysterectomy is now often performed robotically. We sought to examine if the robotic platform decreased the morbidity associated with radical hysterectomy followed by adjuvant radiation.Materials/MethodsA retrospective cohort of patients with cervical cancer undergoing radical hysterectomy from 1995 to 2013 was evaluated. Complications were assessed using electronic record review and graded. χ2 tests and Student t tests were used for analysis.ResultsOverall, 243 patients underwent radical hysterectomy for cervical cancer. Surgical approach was 43% open and 57% robotic. Eighty-three patients (34.2%) required adjuvant radiation. Overall, radical hysterectomy plus adjuvant radiation was associated with increased risk of complication (29%) compared to radical hysterectomy alone (7%) (P < 0.001). Complications included lymphedema (n = 18), bowel-associated complications (n = 10), and urinary complications (n = 7). There was no difference in time to initiation of radiation between open and robotic surgery (43 vs 47 days; P = 0.33). There was no difference in grade 2/3 complications in patients receiving adjuvant radiation between open and robotic surgery (27.5% vs 27.9%; P = 0.97). Patients undergoing open surgery followed by radiation experienced a trend toward increased adhesion-related complications, such as bowel obstruction and ureteral stricture (10% vs 2.3%; P = 0.19); whereas patients undergoing robotic surgery followed by radiation experienced a trend toward increased lymphedema (19% vs 8%; P = 0.20).ConclusionsWe found no difference in long-term complications between patients who underwent robotic surgery compared to open radical hysterectomy with adjuvant radiation. There may be fewer adhesion-related complications with robotic surgery. However, as many radiation-related complications occur at later time points, continued follow-up to evaluate for potential differences between the 2 groups is necessary.

Cold temperatures during early reproductive development may result in reduced pod and seed formation in soybean [Glycine max (L.) Merr.]. The objectives of this work were to quantify cold tolerance of six potential parents, to screen breeding populations for cold tolerance, to search for associations between molecular markers and cold tolerance phenotypes, and to evaluate field performance of breeding lines. Six cultivars were evaluated for pod and seed set after exposure to 0 to 6 wk cold periods (15/5°C day/night), which began at flowering in growth cabinets. Evaluation at 6 vs. 2 wk following the end of a 3 or 6 wk cold period best discriminated between cold tolerant (CT) and cold sensitive (CS) cultivars. Two recombinant inbred line populations were cold stressed in growth cabinets with divergent selection performed over the F5 through F7 generations to select CT and CS lines. Bulked segregant analysis identified six chromosomal regions, four of which are related by homology, as potentially impacting the trait. Over 8 yr in the field at Ottawa, Canada, CT lines yielded 379 kg ha−1 more but matured 5.5 d later than CS lines without visual symptoms of cold damage. Following selection for early maturity, random lines from an additional four populations developed from a selected CT and CS line each crossed to another CT and CS parent were field tested in three environments. Cold tolerant × CT lines yielded about 8% more than CS × CS lines, again without visual cold damage symptoms.

This concise and practical guide enables the gynecologist to differentiate between benign and malignant gynecologic conditions to determine the best management options for the patient. Over the past three decades, as the specialty of obstetrics and gynecology has matured into a broad and diverse group of skills and disciplines, it has become apparent that there are diagnoses and conditions in gynecologic oncology where the obstetrician-gynecologist has a level of uncertainty, or lack of confidence in his ability or knowledge base to adequately manage the patient and therefore refers the patient to a gynecologic oncologist. This text portrays the advances in the field and reviews the current management of a number of gynaecologic conditions to give the reader the confidence needed to deal with these issues. The distinguides Editors have crafted the book to include: Case vignettes to provide clinical context Pathology notes to aid diagnostic outcomes Management guidance for obgyn practitioners to enable the best outcome for their patients Each topic is introduced with a concise overview followed by case-based scenarios which discuss the specific management of common problems. Providing the general gynecologist with the current clinical information necessary to manage conditions and identify the situations where consultation or referral to a gynecologic oncologist would be in the patient's best interest. 

The density and utility of the molecular genetic linkage map of cultivated sunflower (Helianthus annuus L.) has been greatly increased by the development and mapping of several hundred simple sequence repeat (SSR) markers. Of 1089 public SSR markers described thus far, 408 have been mapped in a recombinant inbred line (RIL) mapping population (RHA280 × RHA801). The goal of the present research was to increase the density of the sunflower map by constructing a new RIL map (PHA × PHB) based on SSRs, adding loci for newly developed SSR markers to the RHA280 × RHA801 RIL map, and integrating the restriction fragment length polymorphism (RFLP) and SSR maps of sunflower. The latter was accomplished by adding 120 SSR marker loci to a backbone of 80 RFLP marker loci on the HA370 × HA372 F2 map. The map spanned 1275.4 centimorgans (cM) and had a mean density of 6.3 cM per locus. The PHA × PHB SSR map was constructed from 264 SSR marker loci, spanned 1199.4 cM, and had a mean density of 4.5 cM per locus. The RHA280 × RHA801 map was constructed by adding 118 new SSR and insertion–deletion (INDEL) marker loci to 459 previously mapped SSR marker loci. The 577‐locus map spanned 1423.0 cM and had a mean density of 2.5 cM per locus. The three maps were constructed from 1044 DNA marker loci (701 unique SSR and 89 unique RFLP or INDEL marker loci) and supply a dense genome‐wide framework of sequence‐based DNA markers for molecular breeding and genomics research in sunflower.

A method was developed for simultaneously analyzing cocaine (COC), benzoylecgonine (BZE), norbenzoylecgonine (BNE), norcocaine (NCOC), ecgonine (ECG), ecgonine methyl ester (EME), m-hydroxybenzoylecgonine (HBZE), anhydroecgonine methyl ester (AEME), cocaethylene (CE), norcocaethylene (NCE), and ecgonine ethyl ester (EEE) in blood, urine, and muscle. Available deuterated analogs of these analytes were used as internal standards. Proteins from blood and muscle homogenate were precipitated with cold acetonitrile. After the removal of acetonitrile by evaporation, the supernatants and urine were subjected to solid-phase extraction. The eluted analytes were converted to their hydrochloride salts and derivatized with pentafluoropropionic anhydride and 2,2,3,3,3-pentafluoro-1-propanol. The derivatized products were analyzed by a gas chromatograph (GC)/mass spectrometer by selected ion monitoring. The limit of detection (LOD) for COC, BZE, NCOC, EME, CE, NCE, and EEE was 2 ng/ml, while the LODs for BNE, ECG, HBZE, and AEME were 25, 640, 50, and 13 ng/ml, respectively. This method was successfully applied in analyzing 13 case samples from aviation accident pilot fatalities and motor vehicle operators. AEME concentrations found in the 13 samples were consistent with those produced solely by the GC inlet pyrolysis of COC controls in blood. Anhydroecgonine cannot be used as a marker for the abuse of COC by smoking because it is also pyrolytically produced from COC metabolites on the GC inlet. The developed method can be effectively adopted for analyzing COC and related compounds in urine, blood, and muscle by a single extraction with increased sensitivity through formation of hydrochloride salts and using a one-step derivatization.

Recently, reniform nematode (Rotylenchulus reniformis Linford and Oliveira) has been recognized to be a major problem on soybean [Glycine max (L.) Merr.] in the southern USA. Planting reniform nematode–resistant soybean cultivars is the most cost effective control method. With restriction fragment length polymorphism (RFLP) markers, Pioneer Hi‐Bred International, Inc. had previously identified quantitative trait loci (QTL) on linkage group B1 (LG‐B1) and another on LG‐L associated with reniform nematode resistance in a cross between ‘BSR101’ and PI 437654. In this study, we refined the QTL locations and identified additional QTL conditioning resistance to reniform nematode in a population of 228 recombinant inbred lines (RILs) from a cross of BSR101 × PI 437654. A QTL (R2 = 21%) conditioning reniform reproductive index (RI) was found on LG‐L and was flanked by Sat_184 and Satt513. Two other QTL were identified, one on LG‐B1 (R2 = 16%) and the other on LG‐G (R2 = 8%). These two QTL acted in an epistatic manner with lines homozygous for PI 437654 alleles at both QTL providing the lowest reniform RI. The 31 RILs from BSR101 × PI 437654 that were homozygous for the PI 437654 alleles at Satt513, Satt359, and Sat_168 averaged 1077 reniform eggs and juveniles (RI = 0.63), while the 33 RILs homozygous for the BSR101 alleles averaged 10606 (RI = 6.24). By screening the RILs population of ‘Prichard’ × ‘Anand’ we confirmed that the QTL on LG‐G and‐B1 conditioned reniform RI.

The purpose of this study was to evaluate the toxicity profile of weekly low-dose paclitaxel and carboplatin in patients with gynecologic malignancies. Patients had measurable disease defined by clinical examination or radiographic studies. Each cycle of treatment consisted of carboplatin at an AUC of 2 and paclitaxel at 80 mg/m2 on days 1, 8, and 15 of a 28-day cycle. Twenty-eight patients with advanced or recurrent cervical and endometrial cancers were included in this study. The overall response rate (ORR) was 39% (2 CR, 9 PR). Among the 15 cervical cancers the ORR was 20%, while the 13 endometrial cancers had a 62% ORR. Median time to progression and overall survival was 3.4 and 7.6 months for those with cervical cancer and 5.5 and 15.4 months for those with endometrial cancer. Grade 3 or 4 hematologic toxicity was uncommon (7% grade 3 anemia, 21% grade 3 or 4 neutropenia, 7% grade 3 or 4 thrombocytopenia). A regimen of weekly low-dose paclitaxel and carboplatin has an acceptable toxicity profile that is easily managed by dose adjustment and the use of erythropoietic therapy. This regimen appears to have activity in advanced or recurrent endometrial cancer which warrants further evaluation.