Obesity is the strongest risk factor for endometrial cancer (EC). To inform targeted screening and prevention strategies, we assessed the impact of obesity and subsequent bariatric surgery‐induced weight loss on endometrial morphology and molecular pathways implicated in endometrial carcinogenesis. Blood and endometrial tissue were obtained from women with class III–IV obesity (body mass index ≥40 and ≥50 kg/m
2
, respectively) immediately prior to gastric bypass or sleeve gastrectomy, and at two and 12 months’ follow up. The endometrium underwent pathological examination and immunohistochemistry was used to quantify proliferation (Ki‐67), oncogenic signaling (PTEN, pAKT, pERK) and hormone receptor (ER, PR) expression status. Circulating biomarkers of insulin resistance, reproductive function and inflammation were also measured at each time point. Seventy‐two women underwent bariatric surgery. At 12 months, the mean change in total and excess body weight was −32.7 and −62.8%, respectively. Baseline endometrial biopsies revealed neoplastic change in 10 women (14%): four had EC, six had atypical hyperplasia (AH). After bariatric surgery, most cases of AH resolved (5/6) without intervention (3/6) or with intrauterine progestin (2/6). Biomarkers of endometrial proliferation (Ki‐67), oncogenic signaling (pAKT) and hormone receptor status (ER, PR) were significantly reduced, with restoration of glandular PTEN expression, at 2 and 12 months. There were reductions in circulating biomarkers of insulin resistance (HbA1c, HOMA‐IR) and inflammation (hsCRP, IL‐6), and increases in reproductive biomarkers (LH, FSH, SHBG). We found an unexpectedly high prevalence of occult neoplastic changes in the endometrium of women undergoing bariatric surgery. Their spontaneous reversal and accompanying down‐regulation of PI3K‐AKT–mTOR signaling with weight loss may have implications for screening, prevention and treatment of this disease.
The Lewis acids β-aluminium() fluoride and γ-alumina, fluorinated at room temperature with sulfur tetrafluoride, both interact with hydrogen fluoride and chloride, as demonstrated by radiotracer measurements using [ 18 F] and [ 36 Cl]. The different behaviour of HCl towards the two surfaces is rationalised by considering plausible surface sites and, in the case of β-AlF 3 , the role of residual water. Both materials promote dehydrochlorination of tert-butyl chloride. β-Aluminium() fluoride also has some catalytic activity in Friedel-Crafts alkylation whereas oligomerisation of Bu t Cl dominates on fluorinated γ-alumina. The different behaviour appears to be due to the presence of both Lewis and Brønsted surface acidity on γ-alumina that has been fluorinated under static conditions. A description for this surface is proposed.
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