Disparities in Fertility-Sparing Treatment and Use of assisted Reproductive Technology after a Diagnosis of Cervical, Ovarian, or Endometrial Cancer

OBJECTIVE: to assess the presence of sociodemographic and clinical disparities in fertility-sparing treatment and assisted reproductive technology (ART) use among patients with a history of cervical, endometrial, or ovarian cancer. METHODS: We conducted a population-based cohort study of patients aged 18-45 years who were diagnosed with cervical cancer (stage IA, IB), endometrial cancer (grade 1, stage IA, IB), or ovarian cancer (stage IA, IC) between January 1, 2000, and December 31, 2015, using linked data from the CCR (California Cancer Registry), the California Office of Statewide Health Planning and Development, and the Society for Assisted Reproductive Technology. The primary outcome was receipt of fertility-sparing treatment , defined as surgical or medical treatment to preserve the uterus and at least one ovary. The secondary outcome was fertility preservation , defined as ART use after cancer diagnosis. Multivariable logistic regression analysis was used to estimate odds ratios and 95% CIs for the association between fertility-sparing treatment and exposures of interest: age at diagnosis, race and ethnicity, health insurance, socioeconomic status, rurality, and parity. RESULTS: We identified 7,736 patients who were diagnosed with cervical, endometrial, or ovarian cancer with eligible histology. There were 850 (18.8%) fertility-sparing procedures among 4,521 cases of cervical cancer, 108 (7.2%) among 1,504 cases of endometrial cancer, and 741 (43.3%) among 1,711 cases of ovarian cancer. Analyses demonstrated nonuniform patterns of sociodemographic disparities by cancer type for fertility-sparing treatment, and ART. Fertility-sparing treatment was more likely among young patients, overall, and of those in racial and ethnic minority groups among survivors of cervical and ovarian cancer. Use of ART was low (n=52) and was associated with a non-Hispanic White race and ethnicity designation, being of younger age (18-35 years), and having private insurance. CONCLUSION: This study demonstrates that clinical and sociodemographic disparities exist in the receipt of fertility-sparing treatment and ART use among patients with a history of cervical, endometrial, or ovarian cancer

Introduction: Pedagogy, Education and Innovation in Virtual Worlds

IntroductionPedagogy, Education and Innovation in Virtual WorldsGuest Editors:Leslie Jarmon, University of Texas at Austin;Kenneth Y. T. Lim, Nanyang Technological University, Singapore;B. Stephen Carpenter, II, Texas A&M University

Spirituality and Cardiovascular Health in the HANDLS Study: Evidence for Within-Race Differences

Objective: This cross-sectional study explored the associations between spiritual transcendence (ST)—prayer/meditation fulfillment, connectedness, and universality— and the American Heart Association’s Life’s Simple 7 (LS7), and if variations across and within racial and socioeconomic groups emerged. Methods: Data were taken from the Healthy Aging in Neighborhoods of Diversity across the Life Span study and included 1110 midlife and older African American and white adults [mean (SD) age=56.13 (8.91) y; 65.0% above poverty; 78.1% ≥high school education]. ST was self-reported. LS7 comprised physical activity, smoking, diet, body mass index, cholesterol, glucose, and blood pressure. Higher LS7 reflects better cardiovascular health (CVH). Multiple linear regression estimated associations between ST and LS7. A 3-way interaction term (ST, race, and either education or poverty status) was included in models adjusted for sex and age. Results: A 3-way interaction was observed for ST, race, and poverty status (b=1.29, SE=0.35, p<.001). Simple slopes showed a positive association for white adults living above poverty only (b=0.54, SE=0.15, p<.001). Exploratory analyses found a nonlinear 3-way interactive effect including ST, race, and age (ie, U-shaped; b=0.04, SE=0.02, p=.048). Both lesser and greater ST were associated with higher LS7 for older African American adults exclusively (b=0.03, SE=0.01, p=.024). Conclusions: Although spirituality was associated with overall CVH, it was not beneficial for everyone equally. If tailored appropriately, the integration of spirituality into care practices may promote better CVH.The study was supported by the following funding sources: the National Institute on Aging Intramural Research Program (Baltimore, MD, US) ZIAG000513 (Evans) and the University of Maryland Claude D. Pepper Older Americans Independence Center (Baltimore, MD, US) P30 AG028747 (subcontract to Waldstein).https://journals.lww.com/bsam/abstract/9900/spirituality_and_cardiovascular_health_in_the.4.asp

Development of a CRISPRi Human Retinal Pigmented Epithelium Model for Functional Study of Age-Related Macular Degeneration Genes

Age-related macular degeneration (AMD) is a blinding disease characterised by dysfunction of the retinal pigmented epithelium (RPE) which culminates in disruption or loss of the neurosensory retina. Genome-wide association studies have identified &gt;60 genetic risk factors for AMD; however, the expression profile and functional role of many of these genes remain elusive in human RPE. To facilitate functional studies of AMD-associated genes, we developed a human RPE model with integrated CRISPR interference (CRISPRi) for gene repression by generating a stable ARPE19 cell line expressing dCas9-KRAB. We performed transcriptomic analysis of the human retina to prioritise AMD-associated genes and selected TMEM97 as a candidate gene for knockdown study. Using specific sgRNAs, we showed that knockdown of TMEM97 in ARPE19 reduced reactive oxygen species (ROS) levels and exerted a protective effect against oxidative stress-induced cell death. This work provides the first functional study of TMEM97 in RPE and supports a potential role of TMEM97 in AMD pathobiology. Our study highlights the potential for using CRISPRi to study AMD genetics, and the CRISPRi RPE platform generated here provided a useful in vitro tool for functional studies of AMD-associated genes.</jats:p