Obesity and glomerular filtration rate.

Obesity has received considerable attention in general medicine and nephrology over the last few years. This condition increases the risk of metabolic syndrome, diabetes mellitus, hypertension, and dyslipidemia, which are the main risk factors for developing chronic kidney disease (CKD). Kidney damage caused by obesity can be explained by many mechanisms, such as sympathetic nervous and renin-angiotensin-aldosterone systems activation, mechanical stress, hormonal unbalance, as well as inflammatory cytokines production. Even though creatinine-based glomerular filtration rate (GFR) equations in obese individuals have been validated (Salazar-Corcoran and CKD-MCQ), changes in body weight after bariatric surgery (BS) leads to changes in creatininemia, affecting its reliability. Thus, an average between creatine and cystatin-based GFR equations would be more appropriate in this setting. Bariatric surgery can reverse diabetes mellitus and improve hypertension, which are the main causes of CKD. Conclusion: GFR can be affected by obesity and BS, and its value should be cautiously evaluated in this setting.

Conservative treatment of cervical cancer: A single center experience over a two-decade period.

Objective: To report the surgical, oncological, and obstetrical outcomes of the different surgical techniques used for the fertility-sparing treatment of patients with early-stage cervical cancer. Methods: We retrospectively analyzed all fertility-sparing procedures performed between 2004 and 2020. The study included patients desiring to preserve fertility who had squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma histology, all grades, and FIGO 2009 stage IA2-IB1 tumors. Results: 48 patients met the inclusion criteria. Eight patients (16.7%) had stage IA2, and 40 (83.3%) had stage IB1 tumors. Conization with pelvic lymph node assessment was performed in 5 (10.4%) patients, an open radical trachelectomy in 21 (43.8%), and a laparoscopic radical trachelectomy in 22 (45.8%). No major intraoperative complications were registered. Two patients required surgery due to an early postoperative complication. Late postoperative complications were seen in 15 patients (31.2%), with cervical stenosis being the most frequent (60%). The rate of DFS at 2 and 5 years was 89% (95% CI, 76-95%), and the 5- year OS was 96% (95% CI, 83-98%). Univariate analysis demonstrated a relationship between tumor size and recurrence, but not for other prognostic tumor factors or surgical approach. One patient (4.8%) developed recurrent disease in the open radical trachelectomy group, and five (22.7%) in the laparoscopic radical trachelectomy group. The pregnancy rate was 41.4%, and the live birth rate 88.2%. Conclusion: Fertility-sparing treatment for patients with early-stage cervical cancer is ever-evolving. This study adds information to the literature about the outcomes of these quite uncommon procedures, and allows a critical analysis of many of the topics which are under discussion.

Ghost-arc geochemical anomaly at a spreading ridge caused by supersized flat subduction.

The Southern Atlantic-Southwest Indian ridges (SASWIR) host mid-ocean ridge basalts with a residual subduction-related geochemical fingerprint (i.e., a ghost-arc signature) of unclear origin. Here, we show through an analysis of plate kinematic reconstructions and seismic tomography models that the SASWIR subduction-modified mantle source formed in the Jurassic close to the Georgia Islands slab (GI) and remained near-stationary in the mantle reference frame. In this analysis, the GI lies far inboard the Jurassic Patagonian-Antarctic Peninsula active margin. This was formerly attributed to a large-scale flat subduction event in the Late Triassic-Early Jurassic. We propose that during this flat slab stage, the subduction-modified mantle areas beneath the Mesozoic active margin and surrounding sutures zones may have been bulldozed inland by >2280 km. After the demise of the flat slab, this mantle anomaly remained near-stationary and was sampled by the Karoo mantle plume 183 Million years (Myr) ago and again since 55 Myr ago by the SASWIR. We refer to this process as asthenospheric anomaly telescoping. This study provides a hitherto unrecognized geodynamic effect of flat subduction, the viability of which we support through numerical modeling.

Catastrophic slab loss in southwestern Pangea preserved in the mantle and igneous record.

The Choiyoi Magmatic Province represents a major episode of silicic magmatism in southwestern Pangea in the mid-Permian-Triassic, the origin of which remains intensely debated. Here, we integrate plate-kinematic reconstructions and the lower mantle slab record beneath southwestern Pangea that provide clues on late Paleozoic-Mesozoic subducting slab configurations. Also, we compile geochronological information and analyze geochemical data using tectono-magmatic discrimination diagrams. We demonstrate that this magmatic event resulted from a large-scale slab loss. This is supported by a paleogeographic coincidence between a reconstructed 2,800-3,000-km-wide slab gap and the Choiyoi Magmatic Province and geochemical data indicating a slab break-off fingerprint in the latter. The slab break-off event is compatible with Permian paleogeographic modifications in southwestern Pangea. These findings render the Choiyoi Magmatic Province the oldest example of a geophysically constrained slab loss event and open new avenues to assess the geodynamic setting of silicic large igneous provinces back to the late Paleozoic.

Transvesical laparoscopy for bladder leiomyoma excision: a novel surgical technique.

INTRODUCTION AND HYPOTHESIS: Leiomyomas of the urinary bladder are rare tumors. Submucosal leiomyomas, when small and easily accessible, can be treated with transurethral resection, while unfavorably positioned or larger leiomyomas may be treated through an abdominal approach. In these cases, a laparoscopic approach for intravesical surgery is an alternative that may be considered. We aim to demonstrate a novel transvesical laparoscopic approach to bladder leiomyoma excision with a video. METHODS: A 45-year-old woman with urinary symptoms and a 40-mm submucosal bladder leiomyoma located at the interureteric ridge was referred to our hospital (tertiary referral hospital). Due to the location and size of the leiomyoma, and to increase the probability of complete resection, a transvesical laparoscopic approach was decided. A step-by-step video is presented to describe the surgical technique. RESULTS: There were no intra- or postoperative complications. The patient was discharged 48 h after the surgery. At 60 months' follow-up, the patient remains asymptomatic. CONCLUSIONS: Transvesical laparoscopy may be considered for excision of bladder leiomyomas. This approach is feasible for trained surgeons as it requires a small working space.

From Work Well-Being to Burnout: A Hypothetical Phase Model.

Upon exposure to chronic stressors, how do individuals move from being in a healthy state to a burnout? Strikingly in literature, this has prevailed a categorical view rather than a dimensional one, thus the underlying process that explains the transition from one state to another remains unclear. The aims of the present study are (a) to examine intermediate states between work engagement and burnout using cluster analysis and (b) to examine cortisol differences across these states. Two-hundred and eighty-one Argentine workers completed self-report measures of work engagement and burnout. Salivary cortisol was measured at three time-points: immediately after awakening and 30 and 40min thereafter. Results showed four different states based on the scores in cynicism, exhaustion, vigor, and dedication: engaged, strained, cynical, and burned-out. Cortisol levels were found to be moderate in the engaged state, increased in the strained and cynical states, and decreased in the burned-out state. The increase/decrease in cortisol across the four stages reconciles apparent contradictory findings regarding hypercortisolism and hypocortisolism, and suggests that they may represent different phases in the transition from engagement to burnout. A phase model from engagement to burnout is proposed and future research aimed at evaluating this model is suggested.

Surface and mantle records reveal an ancient slab tear beneath Gondwana.

Vertical slab-tearing has been widely reported in modern convergent settings profoundly influencing subduction and mantle dynamics. However, evaluating a similar impact in ancient convergent settings, where oceanic plates have been subducted and the geological record is limited, remains challenging. In this study, we correlate the lower mantle structure, which retained the past subduction configuration, with the upper-plate geological record to show a deep slab rupture interpreted as a large-scale tearing event in the early Mesozoic beneath southwestern Gondwana. For this purpose, we integrated geochronological and geological datasets with P-wave global seismic tomography and plate-kinematic reconstructions. The development of a Late Triassic-Early Jurassic slab-tearing episode supports (i) a slab gap at lower mantle depths, (ii) a contrasting spatiotemporal magmatic evolution, (iii) a lull in arc activity, and (iv) intraplate extension and magmatism in the Neuquén and Colorado basins. This finding not only has implications for identifying past examples of a fundamental process that shapes subduction zones, but also illustrates an additional mechanism to trigger slab-tearing in which plate rupture is caused by opposite rotation of slab segments.

Light pollution: the possible consequences of excessive illumination on retina.

Light is the visible part of the electromagnetic radiation within a range of 380-780 nm; (400-700 on primates retina). In vertebrates, the retina is adapted to capturing light photons and transmitting this information to other structures in the central nervous system. In mammals, light acts directly on the retina to fulfill two important roles: (1) the visual function through rod and cone photoreceptor cells and (2) non-image forming tasks, such as the synchronization of circadian rhythms to a 24 h solar cycle, pineal melatonin suppression and pupil light reflexes. However, the excess of illumination may cause retinal degeneration or accelerate genetic retinal diseases. In the last century human society has increased its exposure to artificial illumination, producing changes in the Light/Dark cycle, as well as in light wavelengths and intensities. Although, the consequences of unnatural illumination or light pollution have been underestimated by modern society in its way of life, light pollution may have a strong impact on people's health. The effects of artificial light sources could have direct consequences on retinal health. Constant exposure to different wavelengths and intensities of light promoted by light pollution may produce retinal degeneration as a consequence of photoreceptor or retinal pigment epithelium cells death. In this review we summarize the different mechanisms of retinal damage related to the light exposure, which generates light pollution.

Emission of CO2 and N2O from soil cultivated with common bean (Phaseolus vulgaris L.) fertilized with different N sources.

Addition of different forms of nitrogen fertilizer to cultivated soil is known to affect carbon dioxide (CO(2)) and nitrous oxide (N(2)O) emissions. In this study, the effect of urea, wastewater sludge and vermicompost on emissions of CO(2) and N(2)O in soil cultivated with bean was investigated. Beans were cultivated in the greenhouse in three consecutive experiments, fertilized with or without wastewater sludge at two application rates (33 and 55 Mg fresh wastewater sludge ha(-1), i.e. 48 and 80 kg N ha(-1) considering a N mineralization rate of 40%), vermicompost derived from the wastewater sludge (212 Mg ha(-1), i.e. 80 kg N ha(-1)) or urea (170 kg ha(-1), i.e. 80 kg N ha(-1)), while pH, electrolytic conductivity (EC), inorganic nitrogen and CO(2) and N(2)O emissions were monitored. Vermicompost added to soil increased EC at onset of the experiment, but thereafter values were similar to the other treatments. Most of the NO(3)(-) was taken up by the plants, although some was leached from the upper to the lower soil layer. CO(2) emission was 375 C kg ha(-1) y(-1) in the unamended soil, 340 kg C ha(-1) y(-1) in the urea-amended soil and 839 kg ha(-1) y(-1) in the vermicompost-amended soil. N(2)O emission was 2.92 kg N ha(-1) y(-1) in soil amended with 55 Mg wastewater sludge ha(-1), but only 0.03 kg N ha(-1) y(-1) in the unamended soil. The emission of CO(2) was affected by the phenological stage of the plant while organic fertilizer increased the CO(2) and N(2)O emission, and the yield per plant. Environmental and economic implications must to be considered to decide how many, how often and what kind of organic fertilizer could be used to increase yields, while limiting soil deterioration and greenhouse gas emissions.

Flocculant in wastewater affects dynamics of inorganic N and accelerates removal of phenanthrene and anthracene in soil.

Recycling of municipal wastewater requires treatment with flocculants, such as polyacrylamide. It is unknown how polyacrylamide in sludge affects removal of polycyclic aromatic hydrocarbons (PAH) from soil. An alkaline-saline soil and an agricultural soil were contaminated with phenanthrene and anthracene. Sludge with or without polyacrylamide was added while emission of CO(2) and concentrations of NH(4)(+), NO(3)(-), NO(2)(-), phenanthrene and anthracene were monitored in an aerobic incubation experiment. Polyacrylamide in the sludge had no effect on the production of CO(2), but it reduced the concentration of NH(4)(+), increased the concentration of NO(3)(-) in the Acolman soil and NO(2)(-) in the Texcoco soil, and increased N mineralization compared to the soil amended with sludge without polyacrylamide. After 112d, polyacrylamide accelerated the removal of anthracene from both soils and that of phenanthrene in the Acolman soil. It was found that polyacrylamide accelerated removal of phenanthrene and anthracene from soil.

Impact of moisture dynamic and sun light on anthracene removal from soil.

In a previous study, remediation of anthracene from soil was faster in the top 0-2 cm layer than in the lower soil layers. It was not clear whether this faster decrease was due to biotic or abiotic processes. Anthracene-contaminated soil columns were covered with black or transparent perforated polyethylene so that aeration occurred but that fluctuations in water content were minimal and light could reach (LIGHT treatment) or not reach the soil surface (DARK treatment), or left uncovered so that soil water content fluctuate and light reached the soil surface (OPEN treatment). The amount of anthracene, microbial biomass C, and microbial activity as reflected by the amount of CO(2) produced within 3 days were determined in the 0-2 cm, 2-8 cm, and 8-15 cm layer after 0, 3, 7, 14, and 28 days. In the 0-2 cm layer of the OPEN treatment, 17% anthracene remained, 48% in the LIGHT treatment and 61% in the DARK treatment after 28 days. In the 2-8 cm and 8-15 cm layer, treatment had no significant effect on the dissipation of anthracene from soil after 14 and 28 days. It was found that light and fluctuations in water content stimulated the removal of anthracene from the top 0-2 cm soil layer, but not from the lower soil layers. It can be speculated that covering contaminated soil or piling it up will inhibit the dissipation of the contaminant.

Remediation of PAHs in a saline-alkaline soil amended with wastewater sludge and the effect on dynamics of C and N.

Contamination of soil with hydrocarbons occurs frequently and organic material, such as sludge, is often applied to accelerate their dissipation. Little is known, however, how sludge characteristics affect removal of polycyclic aromatic hydrocarbons (PAHs) from alkaline-saline soil. Soil of the former lake Texcoco with pH 9 and electrolytic conductivity 7 dS m(-1) was contaminated with phenanthrene and anthracene and amended with sludge, sterilized sludge, sludge adjusted to maintain pH in contaminated soil or glucose plus an inorganic N and P source while emission of CO2 and concentrations of NH4+, NO3-, NO2-, extractable P, phenanthrene and anthracene were monitored in an aerobic incubation experiment of 112 days. An agricultural soil from Acolman treated in the same way served as control. Contaminating the Texcoco soil increased emission of CO2 significantly, but not in the Acolman soil. After 112 days, the largest concentration of anthracene and phenanthrene was found in the Acolman soil added with glucose and the lowest in the sludge-amended soil. The largest concentration of anthracene in the Texcoco soil was found in soil added with sterile sludge and the lowest in the sludge-amended soil. The largest concentration of phenanthrene in the Texcoco soil was found in the glucose-amended soil and the lowest in the sludge-amended soil. It was found that addition of sludge removed more phenanthrene, but not anthracene from soil compared to the unamended contaminated soil, glucose inhibited dissipation of PAHs while microorganisms in the sludge contributed to their removal, and adjustment of soil pH had no effect. Organic material can be used to accelerate removal of hydrocarbons from soil, but the effect is controlled by soil type, contaminant and organic material characteristics.

Comparison of virulence of different Sporothrix schenckii clinical isolates using experimental murine model.

The virulence of two strains of Sporothrix schenckii isolated from patients with lymphocutaneous or disseminated sporotrichosis were examined in BALB/c mice (Group 1 and 2, respectively). The mice were inoculated subcutaneously into the left hind footpad with 4 x 10(6) S. schenckii yeast cells in order to evaluate (i) the development of cutaneous lesions, (ii) signs of inactivity, (iii) weight loss, (iv) survival rates, (v) number of viable yeast cells in the lungs and spleen, (vi) splenic index, (vii) extent of organ lesions, and (viii) immunological responses. Comparison of the two groups showed more severe disease in Group 2 mice that developed significant weight and hair loss associated with inactivity and left hind footpad lesions that extended close to the testicular area. The histopathology and large number of viable microorganisms isolated from the spleen confirmed the higher invasive ability of this strain. Moreover, a decrease of an in vitro specific lymphoproliferative response and IFN-gamma production were observed over time in Group 2 mice. As a result, at the end of the experiment, the S. schenckii-antigen (Ss-Ag) response was considered negative with a stimulation index (SI) = 2. In contrast, Group 1 mice presented a positive response to Ss-Ag (SI = 14.1). These results confirm the existence of different virulence profiles in S. schenckii strains. In addition, the use of subcutaneous inoculation as a suitable route for verification of the pathogenicity of this fungus in the murine model was confirmed.

Detection of beta-catenin mutations in paraffin-embedded sporadic desmoid-type fibromatosis by mutation-specific restriction enzyme digestion (MSRED): an ancillary diagnostic tool.

Desmoid-type fibromatosis is a locally aggressive deep soft tissue tumor. Some cases are associated with adenosis polyposis coli germline mutations whereas others harbor somatic beta-catenin point mutations mainly in exon 3, codons 41 and 45. These mutations result in stabilization of beta-catenin, and activation of the Wnt signaling pathway. The aim of this study was to determine the specificity and sensitivity of these 3 most common beta-catenin mutations in the diagnosis of desmoid-type fibromatosis using paraffin-embedded material. The results were compared with nuclear expression of beta-catenin. Mutation-specific restriction enzyme digestion methodology was employed to detect the 3 mutations. One hundred and thirty-three cases were analyzed, including 76 desmoid-type, and 18 superficial fibromatosis, in addition to a further 39 fibromatosis mimics. A restriction site was present for analysis of the codon 41 mutation. Mismatch primers were designed for the codon 45 mutations. Mutations were detected in 66 cases (87%) of 76 desmoid-type fibromatosis (71 extra-abdominal). Of these, 34 (45%) were in codon 45 (TCT>TTT), 27 (35%) in codon 41 (ACC>GCC), and 5 (7%) in codon 45 (TCT>CCT). No mutations were detected in the other lesions studied. All desmoid-type fibromatosis cases and 72% of the mimics tested showed nuclear positivity for beta-catenin indicating immunohistochemistry is a sensitive but not a specific test for desmoid-type fibromatosis. In contrast, to date, beta-catenin mutations have not been detected in any lesions which mimic desmoid-type fibromatosis. Mutation-specific restriction enzyme digestion, a simple and efficient means of detecting the common beta-catenin mutations in desmoid-type fibromatosis, complements light microscopy in reaching a diagnosis.

Synthesis of retinal ganglion cell phospholipids is under control of an endogenous circadian clock: daily variations in phospholipid-synthesizing enzyme activities.

Retinal ganglion cells (RGCs) are major components of the vertebrate circadian system. They send information to the brain, synchronizing the entire organism to the light-dark cycles. We recently reported that chicken RGCs display daily variations in the biosynthesis of glycerophospholipids in constant darkness (DD). It was unclear whether this rhythmicity was driven by this population itself or by other retinal cells. Here we show that RGCs present circadian oscillations in the labeling of [32P]phospholipids both in vivo in constant light (LL) and in cultures of immunopurified embryonic cells. In vivo, there was greater [32P]orthophosphate incorporation into total phospholipids during the subjective day. Phosphatidylinositol (PI) was the most 32P-labeled lipid at all times examined, displaying maximal levels during the subjective day and dusk. In addition, a significant daily variation was found in the activity of distinct enzymes of the pathway of phospholipid biosynthesis and degradation, such as lysophospholipid acyltransferases (AT II), phosphatidate phosphohydrolase (PAP), and diacylglycerol lipase (DGL) in cell preparations obtained in DD, exhibiting differential but coordinated temporal profiles. Furthermore, cultures of immunopurified RGCs synchronized by medium exchange displayed a circadian fluctuation in the phospholipid labeling. The results demonstrate that chicken RGCs contain circadian oscillators capable of generating metabolic oscillations in the biosynthesis of phospholipids autonomously.

c-Fos associates with the endoplasmic reticulum and activates phospholipid metabolism.

c-Fos, a transcription factor that constitutes DNA-binding AP-1 complexes, regulates gene expression that promotes long-lasting cellular changes. We show that, in addition to its transcription factor activity, c-Fos regulates the metabolism of phospholipids cytoplasmically by an AP-1-independent activity. Two waves of c-Fos expression that promote subsequent waves of stimulation of 32P-orthophosphate incorporation into phospholipids are evidenced in quiescent cultured fibroblasts induced to re-enter the cell cycle. The first wave of c-Fos expression peaks at 7.5 min and returns to control levels by 15 min. The second wave starts by 30 min and remains elevated at 120 min. In the first wave, the lipids that incorporate 32P are predominantly second-messenger polyphosphoinositides (PIP, PIP2, PIP3); whereas in the second wave, membrane-biogenesis-related lipids (PI, PE, PA), become radioactive. Both waves of phospholipid activation depend on c-Fos expression. It is interesting that a peptide that blocks AP-1 nuclear import does not affect phospholipid activation. Immunocytochemical examination showed c-Fos immunoreactivity associated to the endoplasmic reticulum. We conclude that c-Fos, rapidly induced upon cell stimulation, associates to the endoplasmic reticulum where it first regulates the synthesis/ replenishment of phospholipids required for signal transduction pathways and subsequently regulates enzymes involved in the genesis of new membrane necessary for cell growth.

Circadian regulation of phospholipid metabolism in retinal photoreceptors and ganglion cells.

The neural retina is a key component of the vertebrate circadian system that is responsible for synchronizing the central circadian pacemaker to external light-dark (LD) cycles. The retina is itself rhythmic, showing circadian cycles in melatonin levels and gene expression. We assessed the in vivo incorporation of 32P-phosphate and 3H-glycerol into phospholipids of photoreceptor cells (PRCs) and retina ganglion cells (GCs) from chicks in constant illumination conditions (dark: DD or light: LL) over a 24-h period. Our findings showed that in DD there was a daily oscillation in 32P-labeling of total phospholipids synthesized in GCs and axonally transported to the brain. This metabolic fluctuation peaked during the subjective night (zeitgeber time [ZT] 20), persisted for several hours well into the subjective day and declined at subjective dusk (ZT 10-12). PRCs also exhibited an in vivo rhythm of 32P-phospholipid synthesis in DD. This rhythm peaked around ZT 22, continued a few hours into the day and declined by the end of subjective dusk. The major individual species labeled 1 h after 32P administration was phosphatidylinositol (PI) in both PRCs and GCs. Rhythmic phospholipid biosynthesis was also observed in DD after 3H-glycerol administration, with levels in GCs elevated from midday to early night. PRCs exhibited a similar rhythmic profile with the lowest levels of labeling during midnight. Phosphatidylcholine (PC) accounted for the individual species with the highest ratio of 3H-glycerol incorporation in both cell populations at all phases examined. By contrast, in LL the rhythm of 3H-glycerol labeling of phospholipids damped out in both cell layers. Our findings support the idea that, in constant darkness, the metabolism of retinal phospholipids, including their de novo biosynthesis, is regulated by an endogenous circadian clock.

Immediate early gene expression within the visual system: light and circadian regulation in the retina and the suprachiasmatic nucleus.

Immediate early genes are a family of genes that share the characteristic of having their expression rapidly and transiently induced upon stimulation of neuronal and non-neuronal cells. In this review, first a short description of the IEGs is given, then it is discussed the stimulus-induced and circadian-induced variations in the expression of IEGs in the visual system, mainly in the retina and the suprachiasmatic nucleus. The possible physiological consequences of these variations in IEG expression are also considered. Finally, we refer to two aspects of our recent studies and those of other laboratories involving light-driven IEG expression. The first is the finding that in the chick retina, the expression of c-fos is differentially modulated in the different cell types and that c-fos regulates the synthesis of the quantitatively most important lipids of all cells, the phospholipids, by a non-genomic mechanism. The second is the occurrence of differential waves of IEG expression in the mammalian suprachiasmatic nucleus regarding light induction or spontaneous oscillations.

Asian-american variants of human papillomavirus type 16 have extensive mutations in the E2 gene and are highly amplified in cervical carcinomas.

Human-papillomavirus (HPV)-E2 protein is involved in gene-expression regulation and replication of HPV genome. Disruption of the E2 gene during viral integration has been proposed as a mechanism of tumoral progression, since the expression of E6/E7 viral oncogenes is allowed. However, retention of E1/E2 genes and high viral amplification are frequently found in HPV16-positive carcinomas of some populations. In this study, we investigated whether retention of E1/E2 and viral amplification are associated with particular HPV16 E2 variants in cervical carcinomas. HPV16 detection, E1/E2 integrity and viral amplification were explored by Southern blot in 123 cervical carcinomas. HPV16 variants were identified by Southern blot and by sequencing E6, L1/MY and E2 regions. Of 46 HPV16-positive tumors, 34 were positive for E1/E2 and 14 of them showed a variant restriction pattern by mutations in E2. All 14 were Asian-American (AA) variants and, of 11 sub-classified, 6 were AA-a and 5 AA-c. Two E1/E2-negative tumors also contained the AA-c variant, while the remaining HPV16-positive tumors contained only European variants. The E2 gene of AA variants showed 24 mutations, 19 identical in both sub-classes. The 24 mutations were distributed throughout the entire gene and 19 result in 18 amino-acid changes. The AA variants were associated with E1/E2-positive carcinomas with more than 50 viral copies/cell (p = 0.035). The association of Asian-American E2 variants with retention of E1/E2 suggests that E2 variation may be an alternative mechanism de-regulating the expression of viral oncogenes.