Advanced endometrial cancer-The next generation of treatment: A society of gynecologic oncology journal club clinical commentary.

In February of 2024, the Society of Gynecologic Oncology (SGO) hosted a journal club focused on new treatment options for the management of advanced and metastatic endometrial cancer. This clinical commentary is intended to provide a summary report of that presentation. The session described the importance of molecular characterization shown in the work of The Cancer Genome Atlas (TCGA). The updated 2023 FIGO staging of endometrial cancer was reviewed. The panel then described the role of upfront immunotherapy for the treatment of advanced or recurrent endometrial cancer as demonstrated in four recent trials (RUBY, NRG-GY018, AtTEnd, and DUO-E studies). The DUO-E study uniquely examined the combination immunotherapy with a PARP inhibitor. The trials had unique differences in inclusion criteria, primary outcomes, and length of maintenance therapy, but all boasted similarly promising results particularly in mismatch repair deficient (dMMR) endometrial cancer. This era of rapid innovation in advanced and recurrent endometrial cancer will hopefully enhance individualized treatment approaches and improved outcomes for patients with endometrial cancer.

A rare case of follicular dendritic sarcoma of the vagina.

Follicular dendritic sarcoma of the vagina is an exceptionally rare malignancy. Here, we present a reproductive-aged female with no pertinent past medical history who initially presented with a protruding vaginal mass. Pathology from initial excision was consistent with follicular dendritic sarcoma of the vagina. This was ultimately treated with wide radical resection of the mass leading to iatrogenic vaginal stenosis.

Quantifying Patient-Physician Communication and Perceptions of Risk During Admissions for Possible Acute Coronary Syndromes.

STUDY OBJECTIVE: Disposition decision for patients with possible acute coronary syndrome in the emergency department (ED) is driven primarily by perception of short-term risks. We sought to evaluate communication between patient and physician about these risks by ascertaining the content of discussions surrounding disposition decision. METHODS: We conducted matched-pair surveys of patients admitted for possible acute coronary syndrome and their physicians in 2 academic, inner-city EDs. After disposition conversation, trained research assistants administered surveys querying perceived and communicated risk estimates and purpose of admission. Primary exclusion criteria were ECG or troponin value diagnostic of acute coronary syndrome. The primary outcome measure was agreement in assessment of the risk of myocardial infarction, defined as the proportion of patient-physician pairs whose risk estimates were within 10% of each other. RESULTS: A total of 425 patient-physician survey pairs were collected. Fifty-three percent of patients were men. Patients reported discussing the likelihood of their symptoms' being due to myocardial infarction in 65% of cases, whereas physicians reported this in 46%. After their discussion, physicians' (n=415) median estimate of short-term risk was 5% (95% confidence interval [CI] 3% to 7%), whereas patients' (n=401) was 8% (95% CI 5% to 11%). Most patients (63%; 95% CI 57% to 67%) reported that this estimate remained the same or increased after their conversation. Risk agreement within 10% occurred in 36% of cases (n=404; 95% CI 32% to 41%). Patients' median estimates of the mortality of myocardial infarction at home versus in the hospital were 80% (n=398; 95% CI 76% to 84%) and 10% (n=390; 95% CI 7% to 13%), respectively, whereas physician estimates were 15% (n=403; 95% CI 12% to 18%) and 10% (n=398; 95% CI 7% to 13%). CONCLUSION: Our survey demonstrates poor communication, with overestimation of both the risks of myocardial infarction and potential benefit of hospital admission. These findings suggest that communication surrounding disposition decisions in chest pain patients may at times be ineffective or misleading.

Women's strategies for handling household detergents.

Performing household-cleaning chores involves the use of chemical detergents; these are commonly believed to provide cleaner and safer households. Occupational health studies have associated health risks with detergents, including respiratory and skin problems. Women are the major users of household detergents, as they are in general the primary homemakers. Detergent-handling strategies including storage, use, and precautionary measures affect women's exposure to chemical detergents and thus affect their health. Studies investigating the behavioral component of chemical exposure to detergents at the domestic level are scarce. In this study of detergent-handling strategies, women's potential exposure was investigated by an ergonomics methodology combining in-depth interviews and observations. The participants were 28 women who were responsible for cleaning chores in their households. The women lived in Nabaa, a low socioeconomic, religiously and ethnically diverse neighborhood on the outskirts of Beirut, Lebanon. Information on how women in Nabaa used and perceived household detergent, added to the understanding of their potential chemical exposure. All the study subjects washed dishes, cleaned bathrooms, and swept floors on at least a daily basis. We found that more than half of the participants stored different incompatible detergents in close proximity to each other. Many of the women stated that they over-consumed detergents. A large proportion mixed different detergents together but most of them opened the windows while cleaning for ventilation. The majority did not wear gloves and did not follow label directions. The participants were consistently exposed to chemical detergents and minimal precautionary measures were taken. Cleanliness and hygiene had a strong cultural value and were of utmost importance to women who prioritized them over excessive exposure to chemicals. The use of an ergonomics methodology provided access to important information concerning how women make choices that affect their environmental exposure.