There is a heightened use of prefrontal/executive control resources in older adults and post-stroke adults during walking. The level of prefrontal resource utilization, particularly during complex walking tasks like obstacle crossing, may approach the ceiling of available resources for people who have walking deficits. Prior cognitive research has revealed that prefrontal over-activation combined with limited prefrontal resources can lead to poor cognitive performance. The present study suggests a similar situation influences walking performance. Future research should further investigate the extent to which prefrontal over-activation during walking is linked to adverse mobility outcomes.

ObjectivesHealth disparities and inequalities in access to care among different socioeconomic, ethnic, and racial groups have been well documented in the U.S. healthcare system. In this review, we aimed to provide an overview of barriers to care contributing to health disparities in gynecological oncology management and to describe site-specific disparities in gynecologic care for endometrial, ovarian, and cervical cancer.MethodsWe performed a literature review of peer-reviewed academic and governmental publications focusing on disparities in gynecological care in the United States by searching PubMed and Google Scholar electronic databases.ResultsThere are multiple important underlying issues that may contribute to the disparities in gynecological oncology management in the United States, namely geographic access and hospital-based discrepancies, research-based discrepancies, influence of socioeconomic and health insurance status, and finally the influence of race and biological factors. Despite the reduction in overall cancer-related deaths since the 1990s, the 5-year survival for Black women is significantly lower than for White women for each gynecologic cancer type and each stage of diagnosis. For ovarian and endometrial cancer, black patients are less likely to receive treatment consistent with evidence-based guidelines and have worse survival outcomes even after accounting for stage and comorbidities. For cervical and endometrial cancer, the mortality rate for black women remains twice that of White women.ConclusionHealth care disparities in the incidence and outcome of gynecologic cancers are complex and involve biologic factors as well as racial, socioeconomic, and geographic barriers that influence treatment and survival. These barriers must be addressed to provide optimal care to women in the U.S. with gynecologic cancer.

The results suggest that punch biopsy provides an accurate histopathological diagnosis prior to commencing definitive surgical management and may be a useful tool in the management of periocular basal cell carcinomas.

Background : Functional near-infrared spectroscopy (fNIRS) is a valuable neuroimaging approach for studying cortical contributions to walking function. Recruitment of prefrontal cortex during walking has been a particular area of focus in the literature. The present study investigated whether task-related change in prefrontal recruitment measured by fNIRS is affected by individual differences in people post-stroke. The primary hypotheses were that poor mobility function would contribute to prefrontal over-recruitment during typical walking, and that poor cognitive function would contribute to a ceiling in prefrontal recruitment during dual-task walking (i.e., walking with a cognitive task). Methods : Thirty-three adults with chronic post-stroke hemiparesis performed three tasks: typical walking at preferred speed ( Walk ), serial-7 subtraction ( Serial7 ), and walking combined with serial-7 subtraction ( Dual-Task ). Prefrontal recruitment was measured with fNIRS and quantified as the change in oxygenated hemoglobin concentration (ΔO 2 Hb) between resting and active periods for each task. Spatiotemporal gait parameters were measured on an electronic walkway. Stepwise regression was used to assess how prefrontal recruitment was affected by individual differences including age, sex, stroke region, injured hemisphere, stroke chronicity, 10-meter walking speed, balance confidence measured by Activities-specific Balance Confidence (ABC) Scale, sensorimotor impairment measured by Fugl-Meyer Assessment, and cognitive function measured by Mini-Mental State Examination (MMSE). Results : For Walk , poor balance confidence (ABC Scale score) significantly predicted greater prefrontal recruitment (ΔO 2 Hb; R 2 = 0.25, p = 0.003). For Dual-Task , poor cognitive function (MMSE score) significantly predicted lower prefrontal recruitment (ΔO 2 Hb; R 2 = 0.25, p = 0.002). Conclusions : Poor mobility function predicted higher prefrontal recruitment during typical walking, consistent with compensatory over-recruitment. Poor cognitive function predicted lower prefrontal recruitment during dual-task walking, consistent with a recruitment ceiling effect. These findings indicate that interpretation of prefrontal recruitment should carefully consider the characteristics of the person and demands of the task.

Objective To examine the cost of care during the first year after a diagnosis of ovarian cancer, estimate the sources of cost, and explore the out-of-pocket costs. Methods We performed a retrospective, cohort study of women with ovarian cancer diagnosed from 2009–2012 who underwent both surgery using the Truven Health MarketScan database. This database is comprised of patients covered by commercial insurance sponsored by over 100 employers in the United States. Medical expenditures, including physician reimbursement, for a 12-month period beginning on the date of surgery were estimated. All payments were examined, including out-of-pocket costs for patients. Payments were divided into expenditures for inpatient care, outpatient care (including chemotherapy), and outpatient drug costs. The 12-month treatment period was divided into 3 phases: surgery-30 days (operative period), 1–6 months (adjuvant therapy), and 6–12 months after surgery. The primary outcome was the overall cost of care within the first year of diagnosis of ovarian cancer, while secondary outcomes included assessment of factors associated with cost. Results A total of 26,548 women with ovarian cancer who underwent surgery were identified. After exclusion of patients with incomplete insurance enrollment/coverage, those who did not undergo chemotherapy, and those with capitated plans, our cohort consisted of 5,031 women. The median total medical expenditures per patient during the first year after the index procedure was $93,632 (interquartile range [IQR] $62,319–140,140). Inpatient services accounted for $30,708 (IQR, $20,102–51,107; 37.8%) in expenditures, outpatient services $52,700 (IQR, $31,210–83,206; 58.3%) and outpatient drug costs $1,814 (IQR, $603–4,402; 3.8%). The median out-of-pocket expense was $2988 (IQR, $1649–5088). This included $1509 (IQR, $705–2878) for outpatient services, $589 (IQR, $3–1715) for inpatient services, and $351 (IQR, $149–656) for outpatient drug costs. Conclusion The average cost of care for women with ovarian cancer in the first year after surgery is approximately $100,000. Patients bear approximately 3% of these costs in the form of out-of-pocket expenses.

Background Solitomab is a novel bispecific single-chain antibody which targets EpCAM on tumor cells and also contains a CD3 binding region. We evaluated in vitro activity of solitomab against primary chemo-resistant epithelial ovarian carcinoma cell lines as well as malignant cells in ascites. Methods EpCAM expression was evaluated by flow cytometry in 5 primary ovarian cancer cell lines and 42 fresh ovarian tumor cell cultures from ascites of patients with mainly advanced or recurrent chemo-resistant disease. The potential activity of solitomab against EpCAM + tumor cells was evaluated by flow-cytometry, proliferation and 4-hr chromium-release cell-mediated cytotoxicity assays. Results Expression of EpCAM was detected by flow cytometry in approximately 80% of fresh ovarian tumors and primary ovarian tumor cell lines tested. EpCAM + chemo-resistant cell lines were found resistant to NK or T-cell-mediated killing after exposure to peripheral blood lymphocytes (PBL) in 4-hour chromium-release assays (mean killing ± SEM, 3.6 ± 0.7% after incubation of EpCAM + cell lines with control BiTE). In contrast, after incubation with solitomab, EpCAM + chemo-resistant cells became highly sensitive to T cell cytotoxicity (mean killing ± SEM of 28.2 ± 2.05%; P < 0.0001) by PBL. Ex vivo incubation of autologous tumor associated lymphocytes (TAL) with EpCAM expressing malignant cells in ascites with solitomab, resulted in a significant increase in T-cell activation markers, and a reduction in number of viable ovarian tumor cells in ascites (P < 0.001). Conclusions Solitomab may represent a novel, potentially effective agent for treatment of chemo-resistant ovarian cancer overexpressing EpCAM.

Although there was a transient decrease in the use of extended cytoreductive procedures from 2010 to 2011 after the publication of randomized neoadjuvant trial data, use of these procedures again rose in 2012 and 2013.

Background Walking adaptability tasks are challenging for people with motor impairments. The construct of perceived challenge is typically measured by self-report assessments, which are susceptible to subjective measurement error. The development of an objective physiologically-based measure of challenge may help to improve the ability to assess this important aspect of mobility function. The objective of this study to investigate the use of sympathetic nervous system (SNS) activity measured by skin conductance to gauge the physiological stress response to challenging walking adaptability tasks in people post-stroke. Methods Thirty adults with chronic post-stroke hemiparesis performed a battery of seventeen walking adaptability tasks. SNS activity was measured by skin conductance from the palmar surface of each hand. The primary outcome variable was the percent change in skin conductance level (ΔSCL) between the baseline resting and walking phases of each task. Task difficulty was measured by performance speed and by physical therapist grading of performance. Walking function and balance confidence were measured by preferred walking speed and the Activities Specific Balance Confidence Scale, respectively. Results There was a statistically significant negative association between ΔSCL and task performance speed and between ΔSCL and clinical score, indicating that tasks with greater SNS activity had slower performance speed and poorer clinical scores. ΔSCL was significantly greater for low functioning participants versus high functioning participants, particularly during the most challenging walking adaptability tasks. Conclusion This study supports the use of SNS activity measured by skin conductance as a valuable approach for objectively quantifying the perceived challenge of walking adaptability tasks in people post-stroke.