Recurrence Risk Stratification for Women with FIGO Stage I Uterine Endometrioid Carcinoma Who Underwent Surgical Lymph Node Evaluation

Purpose/Objective(s): To estimate the recurrence risk based on the number of prognostic factors in women with FIGO stage I uterine endometrioid carcinoma (EC) in a large cohort of patients who underwent surgical staging including surgical lymph node evaluation (SLNE) and were managed with no adjuvant therapy. Materials/Methods: We queried our in-house prospectively maintained uterine cancer database for patients with FIGO stage I EC underwent surgical staging including SLNE between 1/1990-12/2020. Patients with synchronous ovarian and breast cancer diagnosis were excluded as well as those who received adjuvant therapy of any form. Patient\u27s demographics and pathologic variables were analyzed. We used multivariate analysis (MVA) with Stepwise Model Selection to determine risk factors for 5-year recurrence-free survival (RFS). Study population was then stratified based on the number of risk factors identified (0, 1 or 2). The resultant groups were compared for RFS, disease-specific survival (DSS) and overall survival (OS) using log-rank test and Kaplan-Meier curves. Additionally, independent predictors of DSS and overall OS were estimated. Results: 706 patients were identified who met our inclusion criteria with a median age of 60 years (range, 30-93) and a median follow-up of 120 months. All patients had at least pelvic SLNE with a median number of examined lymph node (LN) of 8 (range, 1-66): 66 patients (11%) had a sentinel LN sampling and 43% had paraaortic SLNE. 639 patients (91%) were stage IA and lymphovascular space invasion (LVSI) was detected in 6% (n=41). Recurrence was diagnosed in 44 patients (6%). Independent predictors of 5-year RFS include age ≥ 60 years (p=0.038), grade 2 vs. 1 (p=0.003), and grade 3 vs 1 (p\u3c0.001). 5-year RFS for group-0 (age \u3c 60 years and grade 1) was 98% vs. 92% for group-1 (either: age ≥ 60 years or grade 2/3) vs 84% for group-2 (both: age ≥ 60 years and grade 2/3), respectively (p\u3c0.001). 5- year DSS for the three groups was (100% vs 98% vs 95%, p=0.012) and 5-year OS was (98% vs 90% vs 81%, p\u3c0.001), respectively. On MVA, stage IB vs IA was deterministic for DSS (p=0.02); whereas age ≥ 60 years (p\u3c0.001) and grade 3 vs grade 1 (p=0.004) were predictors for worse OS. Conclusion: In patients with stage I endometrioid carcinoma who had surgical staging including SLNE and no adjuvant therapy, only age ≥ 60 years and high tumor grade were independent predictors of cancer recurrence and hence can be used to quantify individualized recurrence risk. Surprisingly, LVSI was not an independent prognostic factor in this study cohort with SLNE

Survival Outcomes and Patterns of Recurrence After Adjuvant Vaginal Cuff Brachytherapy and Chemotherapy in Early-Stage Uterine Serous Carcinoma

Background: Uterine serous carcinoma (USC) is a relatively rare histology that portends a poor prognosis. The optimal adjuvant therapy for early-stage USC remains controversial; however, adjuvant vaginal cuff brachytherapy (VB) and chemotherapy is a commonly utilized strategy. Objectives: We sought to characterize predictors of survival endpoints and determine recurrence patterns in women with early-stage USC who received adjuvant VB and chemotherapy. Methods: We queried our prospectively maintained database for patients with 2009 FIGO stages I-II USC who underwent adequate surgical staging at our institution and received adjuvant chemotherapy with carboplatin and paclitaxel along with VB. We excluded women with synchronous malignancies. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were assessed by Kaplan-Meier and log-rank tests. Univariate (UVA) and multivariate analyses (MVA) were performed to identify statistically significant predictors of survival endpoints. Variables with P\u3c0.1 on UVA were included in a MVA and any variable with P\u3c0.05 was considered statistically significant. Results: We identified 77 women who met our inclusion criteria who underwent surgical staging between 1991 and 2018. The median follow-up time was 36 months (range 6-125). The median age was 66 years. Of the cohort, 70% were FIGO stage IA, 17% were stage IB, and 13% were stage II. The median number of dissected lymph nodes (LN) was 22. There were 10 women (13%) diagnosed with a recurrence with a median time to recurrence of 12.0 months. The main site of initial recurrence was distant in seven patients (70%) with the remaining recurrences being pelvic/para-aortic. The 5-year RFS for patients who experienced a distant recurrence was 87% (95% Confidence Interval [CI] 0.75-0.94). For the entire cohort, 5-year OS, DSS, and RFS were 83% (95% CI 0.68-0.91), 92% (95% CI 0.78-0.97), and 83% (95% CI 0.71-0.91), respectively. The sole predictor of 5-year OS on UVA was receipt of omentectomy (P=0.09). The predictors of 5-year DSS on UVA were presence of positive peritoneal cytology (P=0.03), number of LN examined (Hazard Ratio [HR] 1.10, 95% CI 1.00-1.21, P=0.05), and number of para-aortic LN examined (HR 1.16 [95% CI 1.01-1.32], P=0.03). The sole independent predictor of DSS was the presence of positive peritoneal cytology (HR 0.03 [95% CI 0.00-0.72], P=0.03). Predictors of five-year RFS on UVA were robotic vs open surgery technique (P=0.06), presence of positive peritoneal cytology (P=0.01), percent myometrial invasion (HR 5.59 [95% CI 0.84-37.46], P=0.08), and presence of lymphovascular space invasion (LVSI) (P=0.05). Conclusions: Five-year survival outcomes were promising in this cohort of women with early-stage USC treated with adjuvant chemotherapy and VB; however, this study shows that the predominant pattern of relapse in this population is distant, suggesting the need to optimize systemic therapy. Possible predictors of worse outcomes include positive peritoneal cytology, deep myometrial invasion, and presence of LVSI. Multi-institutional pooled analyses are warranted to confirm our study results

Attitudes to lesbian, gay, bisexual and transgender parents seeking health care for their children in two early parenting services in Australia

Aim: to examine the attitudes to and knowledge and beliefs about homosexuality, of nurses and allied professionals in two early parenting services in Australia. Background: Early parenting services employ nurses and allied professionals. Access and inclusion policies are important in community health and early childhood service settings. However, little is known about the perceptions of professionals who work within early parenting services in relation to lesbian, gay, bisexual and transgender families. Design: This is the final in a series of studies and was undertaken in two early parenting services in two states in Australia using a cross-sectional design with quantitative and qualitative approaches. Methods: Validated questionnaires were completed by 51 nurses and allied professionals and tested with Chi-squared test of independence (or Fisher’s exact test), Mann–Whitney U-test, Kruskal–Wallis one-way analysis of variance, or Spearman’s rank correlation. Thematic analysis examined qualitative data collected in a box for free comments. Results: Of the constructs measured by the questionnaires, no significant relationships were found in knowledge, attitude and gay affirmative practice scores by sociodemographic variables or professional group. However, attitude to lesbians and to gay men scores were significantly negatively affected by conservative political affiliation (p=0.038), held religious beliefs (p=0.011), and frequency of praying (p=0.018). Six overall themes were found: respect, parenting role, implications for the child, management, disclosure, resources and training. Conclusions: The study provided an in-depth analysis of the attitudes, knowledge and beliefs of professionals in two early parenting services, showing that work is needed to promote acceptance of diversity and the inclusion of LGBT families in planning, developing, evaluating and accessing early parenting services. Relevance to clinical practice: Access and inclusion plans for lesbian, gay, bisexual and transgender families are crucial in early parenting services in Australia and should be included in professional development programs

ADHD-like behavior and entrepreneurial intentions

Little is known about the relation between entrepreneurship and the extent of psychiatric symptoms. Validated psychiatric symptom scores are seldom used for non-clinical reasons. One prevalent symptom that deserves our interest is Attention Deficit and Hyperactivity Disorder (ADHD). ADHD is a developmental disorder characterized by inattentiveness and hyperactivity that has been linked to occupational choice and performance. Building on the person–environment fit literature, we hypothesize that individuals who exhibit behavior associated with ADHD are more likely to have entrepreneurial intentions. Using a sample of 10,104 students enrolled in higher education, we can confirm our prediction that students with a higher level of ADHD-like behavior are more likely to have entrepreneurial intentions. Additionally, we show that risk taking propensity is a mediator that partly explains this positive effect. Our study points to the importance of behavioral tendencies associated with developmental disorders, when making entrepreneurship decisions. Our study contributes to the literature on the determinants of entrepreneurship, which so far has largely neglected the effects of psychiatric symptoms on entrepreneurship

Molar substitution and C2/C6 ratio of hydroxyethyl starch: influence on blood coagulation

Background. Development of hydroxyethyl starches (HES) with a low impact on blood coagulation but a long intravascular persistence is of clinical interest. A previous in vitro study showed that low substituted high molecular weight HES does not compromise blood coagulation more than medium molecular weight HES. In the present study we assessed the individual effects on blood coagulation of molar substitution and C2/C6 ratio of a high molecular weight HES. Methods. Blood was obtained from 30 healthy patients undergoing elective surgery and mixed with six high molecular weight (700 kDa) HES solutions differing in their molar substitution (0.42 and 0.51) and C2/C6 ratio (2.7, 7 and 14) to achieve 20, 40 and 60% dilution. Blood coagulation was assessed by Thrombelastograph® analysis (TEG) and plasma coagulation tests.Data were compared using a three-way analysis of variance model with repeated measures on the three factors. Results. Higher molar substitution compromised blood coagulation most (for all TEG parameters, P0.50). The higher molar substitution was associated with a lesser increase in PT (P=0.007) and a greater decrease in factor VIII (P=0.010). PTT, functional and antigenic von Willebrand factors were not significantly influenced by molar substitution (P for all >0.20). No significant differences between solutions with the same molar substitution but different C2/C6 ratios were found in plasma coagulation parameters (P for all >0.05). Conclusions. TEG analysis indicates that high molecular HES with a molar substitution of 0.42 and a C2/C6 ratio of 2.7 has the lowest effect on in vitro human blood coagulatio

Flow cytometric maturity score as a novel prognostic parameter in patients with acute myeloid leukemia

The European LeukemiaNet (ELN) classification is widely accepted for risk stratification of patients with acute myeloid leukemia (AML). In order to establish immunophenotypic features that predict prognosis, the expression of single AML blast cell antigens has been evaluated with partly conflicting results; however, the influence of immunophenotypic blast maturity is largely unknown. In our study, 300 AML patients diagnosed at our institution between January 2003 and April 2012 were analyzed. A flow cytometric maturity score was developed in order to distinguish "mature" AML (AML-ma) from "immature" AML (AML-im) by quantitative expression levels of early progenitor cell antigens (CD34, CD117, and TdT). AML-ma showed significantly longer relapse-free survival (RFS) and overall survival (OS) than AML-im (p < 0.001). Interestingly, statistically significant differences in RFS and OS were maintained within the "intermediate-risk" group according to ELN (RFS, 7.0 years (AML-ma) vs. 3.3 years (AML-im); p = 0.002; OS, 5.1 years (AML-ma) vs. 3.0 years (AML-im); p = 0.022). Our novel flow cytometric score easily determines AML blast maturity and can predict clinical outcome. It remains to be clarified whether these results simply reflect an accumulation of favorable molecular phenotypes in the AML-ma subgroup or whether they rely on biological differences such as a higher proportion of leukemia stem cells and/or a higher degree of genetic instability within the AML-im subgroup

ADHD-like behavior and entrepreneurial intentions

Little is known about the relation between validated psychiatric symptoms scores and the entrepreneurial decision. Building on the Person-Environment (P-E) fit literature and using data of over 10,000 students, we test whether individuals with higher levels of attention deficit and hyperactivity (ADHD) have higher entrepreneurial career intentions compared to others. We find that students reporting higher levels of ADHD-like behavior (assessed with a symptom score on an ADHD screening scale) are more likely than their peers to display entrepreneurial intentions and become student entrepreneurs. This can be partly explained by their high need for independence and their risk tolerance

Absence of spin dependence in the final state interaction of the d(pol) p --> 3He eta reaction

The deuteron tensor analysing power t_{20} of the d(pol) p --> 3He eta reaction has been measured at the COSY-ANKE facility in small steps in excess energy Q up to Q = 11 MeV. Despite the square of the production amplitude varying by over a factor of five through this range, t_{20} shows little or no energy dependence. This is evidence that the final state interaction causing the energy variation is not influenced by the spin configuration in the entrance channel. The weak angular dependence observed for t_{20} provides useful insight into the amplitude structure near threshold.Comment: 5 pages, 4 figure

Catalysis by hen egg-white lysozyme proceeds via a covalent intermediate

Hen egg-white lysozyme (HEWL) was the first enzyme to have its three-dimensional structure determined by X-ray diffraction techniques(1). A catalytic mechanism, featuring a long-lived oxo-carbenium-ion intermediate, was proposed on the basis of model-building studies(2). The `Phillips' mechanism is widely held as the paradigm for the catalytic mechanism of beta -glycosidases that cleave glycosidic linkages with net retention of configuration of the anomeric centre. Studies with other retaining beta -glycosidases, however, provide strong evidence pointing to a common mechanism for these enzymes that involves a covalent glycosyl-enzyme intermediate, as previously postulated(3). Here we show, in three different cases using electrospray ionization mass spectrometry, a catalytically competent covalent glycosyl-enzyme intermediate during the catalytic cycle of HEWL. We also show the three-dimensional structure of this intermediate as determined by Xray diffraction. We formulate a general catalytic mechanism for all retaining beta -glycosidases that includes substrate distortion, formation of a covalent intermediate, and the electrophilic migration of C1 along the reaction coordinate

The Cutaneous Microbiome and Wounds: New Molecular Targets to Promote Wound Healing

The ecological community of microorganisms in/on humans, termed the microbiome, is vital for sustaining homeostasis. While culture-independent techniques have revealed the role of the gut microbiome in human health and disease, the role of the cutaneous microbiome in wound healing is less defined. Skin commensals are essential in the maintenance of the epithelial barrier function, regulation of the host immune system, and protection from invading pathogenic microorganisms. In this review, we summarize the literature derived from pre-clinical and clinical studies on how changes in the microbiome of various acute and chronic skin wounds impact wound healing tissue regeneration. Furthermore, we review the mechanistic insights garnered from model wound healing systems. Finally, in the face of growing concern about antibiotic-resistance, we will discuss alternative strategies for the treatment of infected wounds to improve wound healing and outcomes. Taken together, it has become apparent that commensals, symbionts, and pathogens on human skin have an intimate role in the inflammatory response that highlights several potential strategies to treat infected, non-healing wounds. Despite these promising results, there are some contradictory and controversial findings from existing studies and more research is needed to define the role of the human skin microbiome in acute and chronic wound healing