Disease Characteristics, Treatment and Survival for Oropharyngeal Squamous Cell Carcinoma of Elderly

PURPOSE/OBJECTIVE(S)

Incidence of oropharyngeal cancers (OP) has been increasing over the past few decades, mainly driven by human papilloma virus (HPV) associated cancers in younger men. However, a large number of OP patients in recent years are ≥65 years of age. We wanted to determine if there is a difference in outcomes in elderly patients with OP as compared to younger patients.

MATERIALS/METHODS

We queried our institutional prospectively maintained head and neck cancer database for patients with non-metastatic OP treated between 1/2009-6/2020. We excluded patients who did not receive any definitive treatment. We analyzed clinicopathological and treatment characteristics for elderly (age at diagnosis ≥65 years) compared to young (<65 years) across HPV subtypes. We also studied survival endpoints among age groups using Kaplan-Meier curves and log-rank test. Independent predictors were estimated using multivariate (MVA) Cox regression models for each HPV subtype.

RESULTS

We identified 340 patients who met our inclusion criteria: elderly 123 (36%) and young 213 (64%). The proportion of elderly HPV+ve patients showed an increasing trend over the years studied. Median age was 70 years (range 65-91) in elderly and 56 years (38-64) in young (p<0.001); and HPV+ve/-ve were 73.2/26.8% vs 74.6/25.3% for both age groups respectively (p = 0.86). Elderly patients had higher Charlson Comorbidity Index (CCI) and included more divorcees (p<0.05). There were more elderly current/former smokers (97% vs 82%; p = 0.007) within HPV-ve cases. Definitive radiotherapy (RT) +/- systemic therapy (CRT) was utilized in 73.2% (n = 249), while the remainder had surgery +/- adjuvant RT/CRT. There was no difference with age for OP subsite, 8th edition AJCC stage and treatment received except for more use of cetuximab (22.5% vs 10.2%; p<0.001) and weekly cisplatin (32.4% vs 25.8%; p<0.001) among elderly patients. After a median follow up of 5.24 years (IQR: 3.53), 3-year overall (OS) (HPV+ve: 85 vs 81%; HPV-ve: 39 vs 52%), locoregional free (LRFS) (HPV+ve: 86 vs 90%; HPV-ve: 67 vs 69%) and distant metastasis free (DMFS) survival (HPV+ve: 91 vs 90%; HPV-ve: 79 vs 81%) were all non-significant for elderly vs young respectively. On MVA, CCI and AJCC stage for HPV+ve; and smoking, T-stage and lymphovascular space invasion for HPV- were associated with OS. For HPV+ve, AJCC stage, adjuvant vs definitive RT and treatment in later years were predictive of better LRFS, whereas smoking index and extracapsular space invasion were deterministic for DMFS. Interestingly, outcomes among those who received cetuximab was similar to those who received concurrent cisplatin for all endpoints.

CONCLUSION

We did not note any significant difference in outcomes among elderly patients treated for OP when compared to the younger patients when multi-disciplinary head and neck cancer care is provided. This was noted even though a significantly larger proportion of elderly patients received cetuximab concurrent with RT as opposed to standard of care cisplatin.

From coral reefs to Joshua trees: What ecological interactions teach us about the adaptive capacity of biodiversity in the Anthropocene

The pervasive loss of biodiversity in the Anthropocene necessitates rapid assessments of ecosystems to understand how they will respond to anthropogenic environmental change. Many studies have sought to describe the adaptive capacity (AC) of individual species, a measure that encompasses a species’ ability to respond and adapt to change. Only those adaptive mechanisms that can be used over the next few decades (e.g. via novel interactions, behavioural changes, hybridization, migration, etc.) are relevant to the timescale set by the rapid changes of the Anthropocene. The impacts of species loss cascade through ecosystems, yet few studies integrate the capacity of ecological networks to adapt to change with the ACs of its species. Here, we discuss three ecosystems and how their ecological networks impact the AC of species and vice versa. A more holistic perspective that considers the AC of species with respect to their ecological interactions and functions will provide more predictive power and a deeper understanding of what factors are most important to a species’ survival. We contend that the AC of a species, combined with its role in ecosystem function and stability, must guide decisions in assigning ‘risk’ and triaging biodiversity loss in the Anthropocene.

This article is part of the theme issue ‘Ecological complexity and the biosphere: the next 30 years’.

A Stable Genetic Transformation System and Implications of the Type IV Restriction System in the Nitrogen-Fixing Plant Endosymbiont Frankia alni ACN14a

Genus Frankia is comprised primarily of nitrogen-fixing actinobacteria that form root nodule symbioses with a group of hosts known as the actinorhizal plants. These plants are evolutionarily closely related to the legumes that are nodulated by the rhizobia. Both host groups utilize homologs of nodulation genes for root-nodule symbiosis, derived from common plant ancestors. The corresponding endosymbionts, Frankia and the rhizobia, however, are distantly related groups of bacteria, leading to questions about their symbiotic mechanisms and evolutionary history. To date, a stable system of electrotransformation has been lacking in Frankia despite numerous attempts by research groups worldwide. We have identified type IV methyl-directed restriction systems, highly-expressed in a range of actinobacteria, as a likely barrier to Frankia transformation. Here we report the successful electrotransformation of the model strain F. alni ACN14a with an unmethylated, broad host-range replicating plasmid, expressing chloramphenicol-resistance for selection and GFP as a marker of gene expression. This system circumvented the type IV restriction barrier and allowed the stable maintenance of the plasmid. During nitrogen limitation, Frankia differentiates into two cell types: the vegetative hyphae and nitrogen-fixing vesicles. When the expression of egfp under the control of the nif gene cluster promoter was localized using fluorescence imaging, the expression of nitrogen fixation in nitrogen-limited culture was localized in Frankia vesicles but not in hyphae. The ability to separate gene expression patterns between Frankia hyphae and vesicles will enable deeper comparisons of molecular signaling and metabolic exchange between Frankia-actinorhizal and rhizobia-legume symbioses to be made, and may broaden potential applications in agriculture. Further downstream applications are possible, including gene knock-outs and complementation, to open up a range of experiments in Frankia and its symbioses. Additionally, in the transcriptome of F. alni ACN14a, type IV restriction enzymes were highly expressed in nitrogen-replete culture but their expression strongly decreased during symbiosis. The down-regulation of type IV restriction enzymes in symbiosis suggests that horizontal gene transfer may occur more frequently inside the nodule, with possible new implications for the evolution of Frankia.

Science potential from a Europa lander

The prospect of a future soft landing on the surface of Europa is enticing, as it would create science opportunities that could not be achieved through flyby or orbital remote sensing, with direct relevance to Europa's potential habitability. Here, we summarize the science of a Europa lander concept, as developed by our NASA-commissioned Science Definition Team. The science concept concentrates on observations that can best be achieved by in situ examination of Europa from its surface. We discuss the suggested science objectives and investigations for a Europa lander mission, along with a model planning payload of instruments that could address these objectives. The highest priority is active sampling of Europa's non-ice material from at least two different depths (0.5-2 cm and 5-10 cm) to understand its detailed composition and chemistry and the specific nature of salts, any organic materials, and other contaminants. A secondary focus is geophysical prospecting of Europa, through seismology and magnetometry, to probe the satellite's ice shell and ocean. Finally, the surface geology can be characterized in situ at a human scale. A Europa lander could take advantage of the complex radiation environment of the satellite, landing where modeling suggests that radiation is about an order of magnitude less intense than in other regions. However, to choose a landing site that is safe and would yield the maximum science return, thorough reconnaissance of Europa would be required prior to selecting a scientifically optimized landing site.

The astrobiology primer: an outline of general knowledge--version 1, 2006

The Astrobiology Primer has been created as a reference tool for those who are interested in the interdisciplinary field of astrobiology. The field incorporates many diverse research endeavors, but it is our hope that this slim volume will present the reader with all he or she needs to know to become involved and to understand, at least at a fundamental level, the state of the art. Each section includes a brief overview of a topic and a short list of readable and important literature for those interested in deeper knowledge. Because of the great diversity of material, each section was written by a different author with a different expertise. Contributors, authors, and editors are listed at the beginning, along with a list of those chapters and sections for which they were responsible. We are deeply indebted to the NASA Astrobiology Institute (NAI), in particular to Estelle Dodson, David Morrison, Ed Goolish, Krisstina Wilmoth, and Rose Grymes for their continued enthusiasm and support. The Primer came about in large part because of NAI support for graduate student research, collaboration, and inclusion as well as direct funding. We have entitled the Primer version 1 in hope that it will be only the first in a series, whose future volumes will be produced every 3-5 years. This way we can insure that the Primer keeps up with the current state of research. We hope that it will be a great resource for anyone trying to stay abreast of an ever-changing field.

Using e-mail to facilitate nursing scholarship

A central tenet of university education is the development of scholarly abilities. The traditional hallmarks of scholarship, such as critical thinking, reflection, creativity, critical analysis, and openness to new thinking, need to be fostered in the face of increasing technological change. Contemporary e-mail applications provide a sophisticated environment in which many of the fundamental skills of scholarship can be nurtured. This article describes an interdisciplinary curricular project in which e-mail was employed as a vehicle to support the development of students' understanding of scholarship within a cohort of first-year undergraduate nursing students. The project involved the establishment of "Virtual Colleague" activity, which used e-mail to conduct scholarly activities, including critical analysis of electronic journals and web sites and peer review. The theoretical underpinning of the project and an evaluation of the project are presented. Future use of such technologies in the promotion of scholarship among nurses is discussed.

Smoking behavior, knowledge, and beliefs among Korean Americans

PURPOSE

The purpose of the study was to examine smoking behavior, knowledge, and beliefs among Korean Americans.

DESCRIPTION OF STUDY

One hundred four Korean American men and 159 women, 40 to 69 years old, living in Chicago, Illinois, served as study respondents. The National Health Interview Survey (NHIS) Cancer Control Supplement Questionnaire was used to collect data. The NHIS was translated into Korean with minor modifications to develop a culturally appropriate instrument.

RESULTS

This study suggests that smoking is almost exclusively a male behavior (38.5%) and that Korean American men smoke mostly cigarettes. Almost 90% of women have never smoked, whereas 23% of men reported never smoking. Respondents with a non-Christian background or no religious affiliation were 16.5 times more likely to be current smokers. Respondents who had lived in the United States less than 10 years were 12.5 times more likely to be current smokers. More than 90% of men, regardless of smoking status, were able to identify an association between smoking and major chronic diseases.

CLINICAL IMPLICATIONS

The prevalence of smoking among these Korean American men places them at considerable risk for smoking-related disease. Healthcare providers must be better informed about smoking behavior in this group, and specific attention to recently migrated men and those reporting religions other than Christianity is recommended. Health-protecting strategies for women and children who fall victim to secondhand smoke, or who may be targeted by tobacco advertising, are also an important step in disease prevention for this population.

Psychiatric disorders and survival after lung transplantation

The 30 patients who underwent lung transplantation between 1990 and 1996 were included in this study, and data were analyzed to find predictors of 1-year survival posttransplantation. All patients were followed throughout the posttransplantation period. Fifteen patients had a pretransplantation diagnosis of an anxiety and/or depressive disorders. Of the 30 patients transplanted, 19 survived 12 months or more, and 11 died less than 12 months posttransplantation. The > 12-month survival group had a mean age of 45.2 years at transplantation, compared with a mean age of 43.0 years in the < 12-month group (NS). The mean Psychosocial Assessment of Candidates for Transplant score and premorbid history of smoking did not differ between the groups. The > 12-month survival group had more psychiatric illness pretransplantation than the < 12-month survival group (56% vs. 27%, P < 0.05). The recipients with a psychiatric history (N = 15) were more likely to survive 1 year posttransplantation than the recipients without a psychiatric history (80% vs. 47%, P < 0.05) and were not significantly different from the recipients without a psychiatric history in terms of episodes of rejection, bronchiolitis obliterans, or noncompliance with treatment. Depression and anxiety are treatable disorders that occur frequently in patients with end-stage lung disease, and a premorbid history of either did not predict a worse outcome posttransplantation in this study of lung transplantation recipients.

Transthoracic defibrillation: effect of sternotomy on chest impedance

The purpose of this study was to determine the effect of sternotomy on transthoracic impedance, a major determinant of current flow and defibrillation success. Transthoracic impedance was determined by using a validated test-pulse technique that does not require actual shocks. Seventeen patients undergoing median sternotomy were studied prospectively. Transthoracic impedance was determined before operation, 3 to 5 days after operation and (in eight patients) greater than or equal to 1 month after operation. When measured using paddle electrodes placed in the standard apex-right parasternal defibrillating position, transthoracic impedance declined after sternotomy in all patients, from 77 +/- 18 to 59 +/- 17 omega (p less than 0.01); smaller declines were demonstrated by using other electrode positions. Transthoracic impedance remained below the preoperative level in the eight patients who underwent a second set of measurements at least 1 month after operation. Six normal subjects not undergoing sternotomy underwent serial transthoracic impedance measurements at least 5 days apart; mean transthoracic impedance did not change. It is concluded that transthoracic impedance declines after sternotomy. At any operator-selected energy level a higher current flow will result after sternotomy; this may facilitate postoperative defibrillation.

The relationship of brain-tissue loss volume and lesion location to cognitive deficit

We examined the relationship of preinjury intelligence, a lesion-severity variable (brain-tissue loss volume), and lesion location to the persistence of cognitive deficits in Vietnam veterans with penetrating brain wounds. Using stepwise multiple linear regression procedures, we found that preinjury intelligence predicted a significant amount of the variance on postinjury cognitive testing, being a better predictor for tests requiring a number of complementary cognitive processes (e.g., intelligence tests) than for tests measuring a specific cognitive process (e.g., face recognition). Brain-tissue volume loss was found to play a larger role when a global cognitive measure was used, but a smaller role when a specific cognitive process was measured. Finally, lesion location was shown to be a significant predictor of performance only for specific cognitive processes. Nevertheless, preinjury intelligence/education appears to play an even larger role in postinjury performance than either brain-tissue loss volume or a particular structural loss.