Ovarian Cancer in the Older Manitoban Population-Treatment Tolerance and Cancer-Related Outcomes: A Manitoba Ovarian Cancer Outcomes (MOCO) Group Study.

BACKGROUND: In Canada, individuals with gynecologic reproductive organs (ovaries, fallopian tubes, uterus) over the age of 70 comprise a large proportion of epithelial ovarian cancer patients. These patients often have co-morbidities, polypharmacy, or decreased functional status that may impact treatment initiation and tolerance. Despite this, there is limited evidence to guide treatment for older patients diagnosed with ovarian epithelial carcinoma. METHODS: This is a retrospective study with data from Manitoba, Canada. The data were obtained from the Manitoba Ovarian Cancer Database, the Manitoba Cancer Registry, and electronic health records. All individuals with epithelial ovarian, fallopian tube, or peritoneal cancer diagnosed between 2009 and 2018 were identified. Patients aged > 70 at the time of diagnosis were included in the study cohort. RESULTS: Four hundred and forty individuals were included. The majority had advanced stage disease (56%). Moreover, 59% of patients received no chemotherapy. Of the patients who received chemotherapy, 20% received <2 cycles and 21% required a dose reduction due to toxicity. Univariable and multivariable analysis identified advanced stage (p < 0.001), treatment modality (p < 0.001), and advanced age at diagnosis (p < 0.001) with poorer overall survival. CONCLUSIONS: Our study demonstrated a high rate of chemotherapy dose reduction and discontinuation in the elderly epithelial ovarian cancer population. Further research is needed to identify risk factors for treatment discontinuation and intolerance in this population.

Effects of available cover and feeding schedule on the behavior and growth of the juvenile African clawed frog (Xenopus laevis).

Though the African clawed frog (Xenopus laevis) is the most commonly used amphibian in biological research, there are no standard protocols for the husbandry of this species. With the goal of developing optimal conditions for raising these frogs, the authors assessed the effects of available cover and feeding schedule on post-metamorphic growth and behavior of juvenile X. laevis. Frogs, which were housed four per tank, had access to varying numbers of shelters (zero, two or four) and were fed either daily or episodically (three times per week) over a period of 6 months. Though X. laevis growth was not influenced by the availability of cover, frogs that were fed daily grew larger than frogs that were fed episodically. Additionally, frogs that were fed daily and had no access to cover were most likely to exhibit foraging behavior when disturbed. These results suggest that feeding frogs daily will promote growth and fecundity. Furthermore, although labs often provide frogs with hiding places, such cover does not enhance X. laevis growth.

A passion for castration: characterizing men who are fascinated with castration, but have not been castrated.

INTRODUCTION: A number of men have extreme castration ideations. Many only fantasize about castration; others actualize their fantasies. AIMS: We wish to identify factors that distinguish those who merely fantasize about being castrated from those who are at the greatest risk of genital mutilation. METHODS: Seven hundred thirty-one individuals, who were not castrated, responded to a survey posted on http://www.eunuch.org. We compared the responses of these "wannabes" to those of 92 men who were voluntarily castrated and responded to a companion survey. Main Outcome Measures. Respondents answered the questionnaire items relating to demographics, origin of interest in castration, and ambition toward eunuchdom. RESULTS: Two categories of wannabes emerged. A large proportion ( approximately 40%) of wannabes' interest in castration was singularly of a fetishistic nature, and these men appeared to be at a relatively low risk of irreversible genital mutilation. Approximately 20% of the men, however, appeared to be at great risk of genital mutilation. They showed a greater desire to reduce libido, change their genital appearance, transition out of male, and prevent sexually offensive behavior. Nineteen percent of all wannabes have attempted self-castration, yet only 10% have sought medical assistance. CONCLUSIONS: We identify several motivating factors for extreme castration ideations and provide a classification for reasons why some males desire orchiectomies. Castration ideations fall under several categories of the Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. (DSM-IV), most notably a Gender Identity Disorder other than male-to-female (MtF) transsexual (i.e., male-to-eunuch) and a Body Identity Integrity Disorder. Physicians need to be aware of males who have strong desires for emasculation without a traditional MtF transsexual identity.

Eunuchs in contemporary society: characterizing men who are voluntarily castrated (part I).

INTRODUCTION: Some males desire to be emasculated for no medical reason. These individuals are often secretive about their desires and little is known about their background and motivation. AIMS: We sought to characterize these modern eunuchs and to identify risk factors for genital self-mutilation or self-administered chemical castration. METHODS: We posted a questionnaire on the Eunuch Archive ( http://www.eunuch.org) that was responded to by 135 voluntarily castrated males. Questionnaire data were supplemented by accompanying narrative responses and several personal interviews. MAIN OUTCOME MEASURES: Participants answered questionnaire items pertaining to their knowledge about androgen deprivation, the nature of their castration, and the length of time between initial presentation of castration paraphilia and castration. These questionnaire data allowed us to compare and contrast voluntary chemical and physical eunuchs. RESULTS: The physical castrations were largely premeditated, with an average of 18 years from the time that an individual developed interest in being a eunuch to the time of their actual castration. We identified four factors that may promote castration ideations: (i) abuse sustained during childhood, including parental threats of castration; (ii) homosexuality; (iii) exposure to animal castration during youth; and (iv) religious condemnation of sexuality. Chemical eunuchs were more likely to have sought castration for libido control or to advance transition from male to female (P < 0.05). Physical eunuchs had a nonsignificant tendency to have masochistic paraphilia involving genital mutilation in advance of their castration (P < 0.1). Both Body Integrity Identity Disorder and Gender Identity Disorders occur among those who self-identify as eunuch. CONCLUSIONS: We present evidence that the majority of self-identified voluntary eunuchs are not male-to-female transsexuals. Whereas the majority identify as male, many view themselves as in an alternate nonmale, nonfemale, gender space. We therefore suggest that male-to-eunuch is a valid transgender identity.

Eunuchs in contemporary society: expectations, consequences, and adjustments to castration (part II).

INTRODUCTION: There are men in the Western world who are voluntarily castrated and are not male-to-female transsexuals. AIMS: We surveyed members of this group to understand their responses to androgen deprivation (AD) and how their experiences matched their expectations of AD. METHODS: We posted a questionnaire on the Eunuch Archive (http://www.eunuch.org) that received responses from 92 voluntarily orchiectomized males who identified as eunuchs. Data from this questionnaire were supplemented with interviews with 19 of the eunuchs. MAIN OUTCOME MEASURES: Participants completed questionnaire items regarding: (i) the side effects they expected and experienced; (ii) their current physical and psychological condition; (iii) their level of regret; (iv) what they appreciated most about their castrated status; and (v) who performed their orchiectomies. RESULTS: The most appreciated aspect of castration was the sense of control over sexual urges and appetite (52%). The major side effects experienced were loss of libido (66%), hot flashes (63%), and genital shrinkage (55%). The population had high self-rated sociability, and mental and physical health. Although there was an insignificant reduction in depression after castration, the overall level of self-reported obsessive-compulsive disorders decreased significantly (P < 0.01). Twenty-two percent of the population reported a change in sexual orientation. Many respondents (60%) took supplemental hormone treatments to counteract the side effects of AD. The use of both supplemental testosterone and high-dose estrogen correlated with a significant increase in self-reported sexual desire and activity above the agonadal level (P < 0.001). The majority of the castrations (53%) were not performed by medical professionals. CONCLUSION: The medical community needs to be aware of men at risk of unsafe castrations in order to provide them with more information on the side effects of AD and access to safe orchiectomies.