Survival disparities in vulvar cancer patients in Commission on Cancer®-accredited facilities.

OBJECTIVES: To investigate survival disparities and prognostic factors in vulvar cancer by age at diagnosis. METHODS: Women who underwent surgery and were diagnosed with stage I-IV vulvar cancer from 2004 to 2014 in the National Cancer Database were eligible. Proportions were compared using Chi-Square test. Survival was evaluated using Cox analysis. RESULTS: There were 18,207 eligible women. Median age at diagnosis was 64 years, and 31% diagnosed ≥75 years old were categorized as elderly. Most vulvar cancers were diagnosed at stage I and with squamous histology. Diagnosis with higher stage or non-squamous histology was more common in elderly vs. non-elderly patients (P < 0.001). Survival was 3.5 times worse in the elderly than the non-elderly (P < 0.0001). Risk of death for each 5-year increment in age increased by 22% for non-elderly and 43% for elderly patients (P < 0.0001). The prognostic value of comorbidity score, stage, regional node assessment and histology was smaller in elderly vs. non-elderly women (each P < 0.05). Adjuvant chemoradiotherapy (CTRT) use in the elderly vs. non-elderly was rare for stage I-II disease (3% vs. 2%) and more common for stage III-IV disease (6% vs. 43%), respectively (P < 0.0001). The survival disadvantage for elderly patients persisted following no adjuvant therapy, radiotherapy or chemotherapy alone, or CTRT (P < 0.0001). In stage III-IV disease, survival was superior following CTRT vs. radiotherapy when diagnosed <75 years (HR = 0.80, 95% CI = 0.69-0.93) but not in the elderly (HR = 0.99, P > 0.05). CONCLUSIONS: Age-associated risk of death increased at different rates in vulvar cancer and was larger in elderly vs. non-elderly patients. The impact of other prognostic factors was smaller in elderly vs. non-elderly women. The survival benefit of CTRT over radiotherapy in stage III-IV did not extend to the elderly.

Structural and Optical Properties of Sb-Substituted BiSI Grown from Sulfur/Iodine Flux.

Bismuth and antimony were reacted in sulfur/iodine flux mixtures at various temperatures and iodine concentrations to explore the effects of these variables on the synthesis and properties of Bi1-xSbxSI products. The products grow as crystals; microprobe elemental analysis and UV/vis/NIR spectroscopy of the Bi1-xSbxSI solid solutions indicate that substitution is homogeneous within individual crystals but varies up to 15% between crystals within each synthesis batch. Raman spectra show a two-mode behavior upon substitution, indicating covalent bonding within the structure, and TEM/SEM data confirm no presence of nanoclustering or segregation within the crystals.

Addressing immunizations in nursing education: Immunization resources for undergraduate nursing.

Nursing faculty are challenged to integrate immunization content in prelicensure nursing curricula. Historically, most immunization content has been delivered in pediatrics courses, with less emphasis on other populations across the lifespan. Skills related to vaccine administration may be prioritized over the most current immunization science, such as pathophysiology, immunology, and epidemiology. As the most trusted profession rated by the public (Saad, 2020), nurses are ideally suited to address vaccine hesitancy and promote vaccination in the communities they serve. Nurses apply active listening, problem solving, and communication skills with patients and their families, contributing to a person's confidence in their decision to be vaccinated. The Centers for Disease Control and Prevention and the Association for Prevention Teaching and Research collaborated to develop a framework for immunization content and teaching resources, Immunization Resources for Undergraduate Nursing (IRUN), for faculty to use in designing the nursing curricula. Content includes a curriculum framework, curriculum mapping tool, multiple teaching resources, and a dedicated website (IRUNursing.org). The framework provides guidance for faculty on integrating immunization content into a curriculum. Teaching resources include case studies, simulation scenarios, and PowerPoint slide decks. Although primarily focused on prelicensure nursing education, resources are also relevant to advanced professional nursing education.

Recurrent Occipital Seizures with Transient MRI Changes.

Peri-ictal magnetic resonance imaging (MRI) findings following seizure activity are a recognized phenomenon that is not well understood (Cole, 2004). Transient changes are not usually expected to be present in postictal MRI studies because of their rarity. Here, we present a unique case of peri-ictal MRI findings located in the occipital lobe, present in a 34-year-old female with recurrent occipital seizures occurring twice in four years. MRI changes completely resolved after both episodes with no residual focal damage. The peri-ictal occipital changes on MRI in this patient are unique because they have been captured on more than one occasion. Peri-ictal MRI findings are a known phenomenon with unknown pathophysiology, although attempts have been made to understand these findings. Though the MRI findings and presentation appear to be stroke-like or PRES-like, seizures should be kept in the differential for better treatment outcomes.

Acquisition of Relative Interstrand Crosslinker Resistance and PARP Inhibitor Sensitivity in Fanconi Anemia Head and Neck Cancers.

PURPOSE: Fanconi anemia is an inherited disorder associated with a constitutional defect in the Fanconi anemia DNA repair machinery that is essential for resolution of DNA interstrand crosslinks. Individuals with Fanconi anemia are predisposed to formation of head and neck squamous cell carcinomas (HNSCC) at a young age. Prognosis is poor, partly due to patient intolerance of chemotherapy and radiation requiring dose reduction, which may lead to early recurrence of disease. EXPERIMENTAL DESIGN: Using HNSCC cell lines derived from the tumors of patients with Fanconi anemia, and murine HNSCC cell lines derived from the tumors of wild-type and Fancc(-/-) mice, we sought to define Fanconi anemia-dependent chemosensitivity and DNA repair characteristics. We utilized DNA repair reporter assays to explore the preference of Fanconi anemia HNSCC cells for non-homologous end joining (NHEJ). RESULTS: Surprisingly, interstrand crosslinker (ICL) sensitivity was not necessarily Fanconi anemia-dependent in human or murine cell systems. Our results suggest that the increased Ku-dependent NHEJ that is expected in Fanconi anemia cells did not mediate relative ICL resistance. ICL exposure resulted in increased DNA damage sensing and repair by PARP in Fanconi anemia-deficient cells. Moreover, human and murine Fanconi anemia HNSCC cells were sensitive to PARP inhibition, and sensitivity of human cells was attenuated by Fanconi anemia gene complementation. CONCLUSIONS: The observed reliance upon PARP-mediated mechanisms reveals a means by which Fanconi anemia HNSCCs can acquire relative resistance to the ICL-based chemotherapy that is a foundation of HNSCC treatment, as well as a potential target for overcoming chemoresistance in the chemosensitive individual.

Beliefs about diabetes and medication adherence among Lumbee Indians living in rural southeastern North Carolina.

This study assessed personal beliefs about the causes and meaning of having diabetes among the members of the Lumbee Indian tribe living in rural southeastern North Carolina. The sample included 20 males (50%) and 20 females (50%); the mean duration of having diabetes was 9.82 years. The average body mass index (BMI) for females was 34.76 (range, 24.21-55.44), whereas the average BMI for males was 35.10 (range, 22.71-59.71). Ninety percent reported a family history of diabetes. The majority of participants held beliefs that diabetes was a serious and chronic condition and that the disease was amenable to personal control. Participants perceived that diabetic medications were an essential and effective part of their treatment regimen, and they reported greater comfort in adhering to prescribed medication regimens than making long-term lifestyle changes. This study highlights the high prevalence of diabetes among Lumbee Indians and also the need for future studies in this area.