Reduced healthcare access contributes to delay of care in endometrial cancer.

OBJECTIVE: We aimed to characterize delays to care in patients with endometrioid endometrial cancer and the role healthcare access plays in these delays. METHODS: A chart review was performed of patients with endometrioid endometrial cancer who presented with postmenopausal bleeding at a diverse, urban medical center between 2006 and 2018. The time from symptom onset to treatment was abstracted from the medical record. This interval was subdivided to assess for delay to presentation, delay to diagnosis, and delay to treatment. RESULTS: We identified 484 patients who met the inclusion criteria. The median time from symptom onset to treatment was 4 months with an interquartile range of 2 to 8 months. Most patients had stage I disease at diagnosis (88.6%). There was no significant difference in race/ethnicity or disease stage at time of diagnosis between different groups. Patients who had not seen a primary care physician or general obstetrician-gynecologist in the year before symptom onset were more likely to have significantly delayed care (27.7% vs 14.3%, p = 0.02) and extrauterine disease (20.2% vs 4.9%, p < 0.01) compared to those with established care. Black and Hispanic patients were more likely to experience significant delays from initial biopsy to diagnosis. CONCLUSIONS: Delays exist in the evaluation of endometrial cancer. This delay is most pronounced in patients without an established outpatient primary care provider or obstetrician-gynecologist.

Neonatal isolation stress alters bidirectional long-term synaptic plasticity in amygdalo-hippocampal synapses in freely behaving adult rats.

The basolateral amygdala (BLA) is known to be involved in emotional and stress responses, while the dentate gyrus (DG), a subfield of the hippocampus, is implicated in learning and memory. Together, the BLA-DG neuronal pathway is thought to link memory with emotional and physiological stress responses. To assess whether neonatal isolation, a known early life stressor, has enduring effects on bidirectional neuroplasticity in adulthood, changes in long-term potentiation (LTP) and long-term depression (LTD) of BLA-DG synapses were recorded in neonatally isolated and non-handled freely behaving adult male rats. Rats isolated (ISO) from their mother and each other for 1 h daily from postnatal days 2-9 were allowed to mature to adulthood at which time they were chronically implanted with stimulating electrodes in the BLA and recording electrodes in the DG via stereotaxic surgery. A second group of rats which received no isolation treatment and which were not handled (NH) during the neonatal period underwent the same surgical procedures and served as the control group. Following a 1-week postsurgical recovery period, either LTP (100-pulse, 5-Hz theta-burst stimulation [TBS]) or LTD (900-pulse, 1-Hz low-frequency stimulation [LFS]) was induced in the DG of both groups. ISO rats showed significantly enhanced levels of both LTP and LTD compared to NH counterparts. These results indicate that neonatal isolation stress alters bidirectional neural plasticity in BLA-DG synapses, which may help to clarify the development of neural mechanisms linking emotional and stress responses in the amygdala with memory consolidation and information processing in the hippocampus.