Management of inguinal lymph nodes in locally advanced, surgically unresectable, squamous cell carcinoma of the vulva.

OBJECTIVE: To assess clinical outcomes of inguinal lymph node surgical resection compared to primary groin radiotherapy for locally advanced, surgically unresectable vulvar cancer. METHODS: All patients treated with radiation for vulvar cancer were identified between Jan 1, 2000 - Dec 31, 2020 at 2 academic centres. Inclusion criteria were those treated with curative intent primary radiotherapy +/- chemotherapy, tumors >4 cm, and surgically unresectable squamous cell vulvar carcinoma. Groin recurrence-free survival (RFS) was compared for groin surgery and primary groin radiotherapy using the Kaplan Meier method and log rank test. Groin failures are described by treatment modality, radiation dose and lymph node size. RESULTS: Of 476 patients treated with radiation for vulvar cancer, 112 patients (23.5%) met inclusion and exclusion criteria. The median (95% CI) follow up was 1.9 (1.4-2.5) years. Complete clinical response was significantly higher (80.0%) in patients with surgical groin resection compared to patients treated with primary groin radiotherapy (58.2%) (p = 0.04). On multivariable analysis, after adjusting for clinical and/or radiologically abnormal lymph nodes (p = 0.67), surgical groin resection was significantly associated with lower groin recurrence (HR 0.2 (95%CI 0.05-0.92), p = 0.04). The 3-year groin recurrence-free survival (RFS) was significantly higher at 94.4% (87.1-100) in patients with surgical groin resection compared to 79.2% (69.1-90.9) in patients treated with primary radiation (p = 0.02). CONCLUSIONS: In locally advanced squamous cell vulvar cancer, surgical groin management improves groin RFS compared to radiotherapy alone.

Neutrophil motion in numbers: How to analyse complex migration patterns.

In vivo imaging has revolutionised the study of leukocyte trafficking and revealed many insights on the dynamic behaviour of immune cells in their native environment. Neutrophil migration represents a prominent example whereby live imaging led to discovery of unanticipated cell migration patterns. These cells are the first to enter inflammatory sites and their recruitment had once been thought to be driven primarily by extrinsic signals and resolved by apoptosis in these lesions. However, in vivo imaging in zebrafish and mice indicated that neutrophils are also able to self-organise their migration to a large extent, through collective generation of gradients, in a process referred to as 'swarming', and that they can leave sites of inflammation, in a process referred to as 'reverse migration'. An important step in understanding these newly defined behaviours is the ability to detect and quantify them through statistical analysis. Here we provide a summary of considerations and recommendations for quantitative analysis of neutrophil swarming and reverse migration, with the purpose of introducing relevant analysis tools to new researchers in the field and establishing common frameworks and standards.

Intense/obsessional interests in children with gender dysphoria: a cross-validation study using the Teacher's Report Form.

OBJECTIVE: This study assessed whether children clinically referred for gender dysphoria (GD) show symptoms that overlap with Autism Spectrum Disorder (ASD). Circumscribed preoccupations/intense interests and repetitive behaviors were considered as overlapping symptoms expressed in both GD and ASD. METHODS: To assess these constructs, we examined Items 9 and 66 on the Teacher's Report Form (TRF), which measure obsessions and compulsions, respectively. RESULTS: For Item 9, gender-referred children (n = 386) were significantly elevated compared to the referred (n = 965) and non-referred children (n = 965) from the TRF standardization sample. For Item 66, gender-referred children were elevated in comparison to the non-referred children, but not the referred children. CONCLUSIONS: These findings provided cross-validation of a previous study in which the same patterns were found using the Child Behavior Checklist (Vanderlaan et al. in J Sex Res 52:213-19, 2015). We discuss possible developmental pathways between GD and ASD, including a consideration of the principle of equifinality.