Impact of lymphadenectomy and lymphoedema on health-related quality of life 1 year after surgery for endometrial cancer. A prospective longitudinal multicentre study

OBJECTIVE

To assess the impact of lymphadenectomy and lymphoedema of the lower limbs (LLL) on health-related quality of life (HRQoL) 1 year after surgery for endometrial cancer (EC).

DESIGN

Prospective longitudinal cohort multicentre study.

SETTING

Departments of obstetrics and gynaecology at four university hospitals, six central hospitals and four county hospitals in Sweden.

POPULATION

Two-hundred-and-thirty-five women with early stage EC were included; 116 with high-risk EC underwent surgery including lymphadenectomy (+LA), and 119 with low-risk EC had surgery without lymphadenectomy (-LA).

METHODS

The generic SF-36 and EQ-5D-3L and the lymphoedema-specific LYMQOL questionnaire were used to assess HRQoL. LLL was assessed by systematic circumferential measurements of the legs enabling volume estimation, clinical evaluation and patient-reported perception of leg swelling. All assessments were carried out on four occasions; preoperatively, and 4-6 weeks, 6 months and 1 year postoperatively.

MAIN OUTCOME MEASURE

HRQoL scores.

RESULTS

No significant differences were seen in HRQoL between the +LA and -LA groups 1 year postoperatively. Irrespective of method of determining LLL, women with LLL were significantly more affected in the LYMQOL domains Function, Appearance/body image and Physical symptoms, but not in the domain Emotion/mood, than women without LLL. No such differences were seen in the generic HRQoL or in the LYMQOL global score between the groups with and without LLL.

CONCLUSIONS

Lymphadenectomy did not seem to affect generic HRQoL adversely. Irrespective of the method of measuring, LLL affected the lymphoedema-specific HRQoL negatively, mainly in physical domains, but had no impact on the generic HRQoL.

TWEETABLE ABSTRACT

Lymphoedema has impact on lymphoedema-specific, but not on generic, HRQoL, 1 year after surgery for EC.

Disentangling functional trait variation and covariation in epiphytic lichens along a continent-wide latitudinal gradient

Characterizing functional trait variation and covariation, and its drivers, is critical to understand the response of species to changing environmental conditions. Evolutionary and environmental factors determine how traits vary among and within species at multiple scales. However, disentangling their relative contribution is challenging and a comprehensive trait-environment framework addressing such questions is missing in lichens. We investigated the variation in nine traits related to photosynthetic performance, water use and nutrient acquisition applying phylogenetic comparative analyses in lichen epiphytic communities on beech across Europe. These poikilohydric organisms offer a valuable model owing to their inherent limitations to buffer contrasting environmental conditions. Photobiont type and growth form captured differences in certain physiological traits whose variation was largely determined by evolutionary processes (i.e. phylogenetic history), although the intraspecific component was non-negligible. Seasonal temperature fluctuations also had an impact on trait variation, while nitrogen content depended on photobiont type rather than nitrogen deposition. The inconsistency of trait covariation among and within species prevented establishing major resource use strategies in lichens. However, we did identify a general pattern related to the water-use strategy. Thus, to robustly unveil lichen responses under different climatic scenarios, it is necessary to incorporate both among and within-species trait variation and covariation.

Towards an integrated phylogenetic classification of the Tremellomycetes

Families and genera assigned to Tremellomycetes have been mainly circumscribed by morphology and for the yeasts also by biochemical and physiological characteristics. This phenotype-based classification is largely in conflict with molecular phylogenetic analyses. Here a phylogenetic classification framework for the Tremellomycetes is proposed based on the results of phylogenetic analyses from a seven-genes dataset covering the majority of tremellomycetous yeasts and closely related filamentous taxa. Circumscriptions of the taxonomic units at the order, family and genus levels recognised were quantitatively assessed using the phylogenetic rank boundary optimisation (PRBO) and modified general mixed Yule coalescent (GMYC) tests. In addition, a comprehensive phylogenetic analysis on an expanded LSU rRNA (D1/D2 domains) gene sequence dataset covering as many as available teleomorphic and filamentous taxa within Tremellomycetes was performed to investigate the relationships between yeasts and filamentous taxa and to examine the stability of undersampled clades. Based on the results inferred from molecular data and morphological and physiochemical features, we propose an updated classification for the Tremellomycetes. We accept five orders, 17 families and 54 genera, including seven new families and 18 new genera. In addition, seven families and 17 genera are emended and one new species name and 185 new combinations are proposed. We propose to use the term pro tempore or pro tem. in abbreviation to indicate the species names that are temporarily maintained.

Roselliniella revealed as an overlooked genus of Hypocreales, with the description of a second species on parmelioid lichens

Based on newly obtained 28S rDNA sequences from Roselliniella atlantica and R. euparmeliicola sp. nov., the genus Roselliniella has to be placed in Hypocreales and not in Sordariales; however, the family placement could not be resolved from the sequences obtained. The mature ascospores are single-celled and brown, but young ascospores are hyaline and sometimes have a median septum. The new species occurs on a Parmelia s.str. species in China, and differs in 24 nucleotide substitution positions in the nu-LSU rDNA region and ascospore size from R. atlantica. In this case, small variations in ascospore sizes and shape prove to be phylogenetically and taxonomically informative. The two species occur in the same clade with 95 % jack-knife support. Roselliniella atlantica occurs on Xanthoparmelia and Melanohalea species in Europe, whereas R. euparmeliicola was found on the species of Parmelia s.str. DNA was successfully recovered from a dried specimen of R. atlantica collected in 1992. Two unidentified fungi were also recovered from the Chinese specimen, and these belong to Sordariomycetidae and Dothideomycetes; whether these two are additional fungi living endolichenically in the lichen host, saprobes, or contaminants could not be ascertained.

Effect of high-fat diet on glucose homeostasis and gene expression in glucokinase knockout mice

AIM

We have generated a heterozygous glucokinase knockout mouse (gk(del/wt)), upon which we investigated the effect of high-fat diet (HFD) with respect to metabolic control and both hepatic and beta-cell gene expression. We also investigated the in vitro efficacy of a glucokinase activator (GKA) on glucose-stimulated insulin secretion (GSIS) in gk(del/wt)mouse islets.

METHODS

Male gk(del/wt)and gk(wt/wt)mice were grouped (n = 8-10) at 10 weeks of age and fed HFD or chow diet (CD) for 10 weeks. Multiple parameters including blood glucose, plasma insulin and glucose tolerance were assessed. Further animal groups were used for in vitro GSIS and islet and liver gene expression analysis.

RESULTS AND CONCLUSIONS

gk(del/wt)mice showed early-onset persistent hyperglycaemia, raised glycated haemoglobin levels, impaired GSIS and glucose tolerance but no change in plasma cholesterol, non-esterified fatty acids or triglyceride levels. After HFD feeding, insulin levels of gk(del/wt)mice were less than half that of gk(wt/wt)mice, although they were equivalent to gk(wt/wt)mice on CD. While gk(wt/wt)mice maintained moderate hyperglycaemia, gk(del/wt)mice became overtly diabetic, with worsened glucose tolerance. A GKA (GKA50) increased GSIS, at 10 mM glucose, in gk(del/wt)mice to an extent at least as great as that seen in gk(wt/wt)mice on both CD and HFD. gk(del/wt)mice showed only a small number of changes in gene expression compared with gk(wt/wt)mice. We propose the high fat-fed gk(del/wt)mouse as a model of type 2 diabetes and report retained efficacy of a GKA on in vitro GSIS.

An exceptional group-I intron-like insertion in the SSU rDNA of lichen mycobionts

An exceptional group-I intron-like insertion at position 940 of the nuclear small subunit rDNA is found in lichen mycobionts of the families Parmeliaceae and Lecanoraceae. This shared insertion site is exceptional as it follows a G. Although several features of the self-splicing Tetrahymena intron are missing, the conserved structure of the presumed core region indicates that the new intron-like insertion, which is missing in mature transcripts, is not part of a silenced ribosomal repeat. It is unlikely that the new insertion is horizontally transferred from the adjacent position 943. A phylogenetic analysis indicates congruence with lichen phylogeny and suggests that the insertion has been vertically inherited.

New Dibenzofurans and Depsides From the Lichen Bunodophoron patagonicum

The lichen Bunodophoron patagonicum has been shown to contain five new dibenzo -furans: ascomatic acid (3,7-dimethoxy-1,9-dimethyldibenzofuran-2-carboxylic acid) (2) and the corresponding methyl ester (3); 7-O-methylnorascomatic acid (3-hydroxy-7-methoxy-1,9-dimethyldibenzofuran-2-carboxylic acid) (4) and the corresponding methyl ester (5); and norascomatic acid (3,7-dihydroxy-1,9-dimethyldibenzofuran-2-carboxylic acid) (6). The lichen also contains two new depsides : patagonic acid [2-hydroxy-4-(2′-hydroxy-4′-methoxy-6′-methyl-benzoyloxy)-6-(2′-oxononyl)benzoic acid] (10) and isopatagonic acid [2-hydroxy-4-(2′-hydroxy-4′-methoxy-6′-(2′-oxononyl) benzoyloxy )-6-methylbenzoic acid] (11). The structure of all new natural products was confirmed by total synthesis.