Mesenchymal gene expression subtyping analysis for early-stage human papillomavirus-negative head and neck squamous cell carcinoma reveals prognostic and predictive applications

Patients with oral cavity squamous cell carcinoma (OCSCC) are predominantly human papillomavirus (HPV)(-), and treatment typically involves surgical resection ± neck dissection, followed by radiation ± chemotherapy. We previously described four mRNA expression patterns (classical, atypical, basal, and mesenchymal), each with unique genomic features and prognosis. Here, we examine the clinical utility of gene expression subtyping in head and neck squamous cell carcinoma (HNSCC) and introduce potentially predictive applications in HPV(-) OCSCC. A retrospective genomic database analysis was performed including 562 HNSCC patients from MD Anderson (MDA-GSE41116) and The Cancer Genome Atlas (TCGA). Samples were assigned molecular subtypes (classical, atypical, basal, and mesenchymal) using an 88-gene classifier. HPV status was determined by gene expression. The clinical endpoint was overall survival censured at 36 months. The Kaplan-Meier plots and log-rank tests were used to investigate associations between clinical variables and survival. Of the 418 TCGA training patients who met analysis criteria, nearly 20% presented as stage I/II. Among node(-) OCSCC patients, the mesenchymal subtype is associated with worse survival (hazard ratio (HR) = 2.4, p = 0.021), offering a potentially actionable biomarker in otherwise early-stage, low-risk disease. This was confirmed in the MDA validation cohort. Node(-) non-mesenchymal OCSCC patients had far better survival compared to node(-) mesenchymal, and all node(+) patients had similarly poor survival. These findings suggest that the mesenchymal subtype is associated with poor survival in surgically resected, early-stage, node(-) OCSCC otherwise expected to have favorable outcomes. These findings highlight the potential value of gene expression subtyping as a pathology adjunct for prognostication and treatment decision-making in OCSCC patients

Profile of the Older Population Living in Miami-Dade County, Florida

Abstract Florida has the greatest proportion (19%) of older population (65 years or older) in the United States. The age distribution of its residents, in conjunction with a major shift in the leading cause of death within all age groups from acute illnesses to chronic disease, creates unprecedented health care challenges for the state. The objective of this study is to profile the older population living in Miami-Dade County (MDC) using 3 population-based, household-based surveys conducted over the past 5 years. This study examined cross-sectional data (demographics, health outcomes, risk factors, health assess, and utilization) collected from probability-sampled, household-based surveys conducted in 3 areas of MDC: north Miami-Dade, Little Haiti, and South Miami. The questionnaire was administered face-to-face by trained interviewers in English, Spanish, French, or Creole. Analyses were restricted to households containing at least 1 member aged 65 years or older (n?=?935). One consenting adult answered the questionnaire on behalf of household members. The mean age of the respondent (60% females) was 60 years. Overall, respondents were predominantly African-Americans, Hispanics, and blacks of Haitian origin. One-third of all households fell below the US poverty thresholds. One-quarter of all households had at least 1 member who was uninsured within the year before the survey. Twenty percent of households had at least 1 member with an acute myocardial infarction or stroke during the year before the survey. Bone density tests and blood stool tests were strikingly underutilized. The health outcomes most prevalent within household members were cardiovascular diseases followed by cancer, anxiety/depression, obesity, asthma, and bone fractures. Twenty percent of households reported having at least 1 current smoker. Overall, emergency rooms were the most commonly used places of care after doctor\u27s offices. Findings of 3 household-based surveys show a predominantly elderly, female, uninsured, and poor minority populations living in MDC, FL. The reported use of preventive services was constrained, and emergency room use was often reported as a main resource for health care. Cardiovascular disease, cancer, bone fractures, and related risk factors were the most prevalent health outcomes

Association between gender and receipt of magnetic resonance imaging (MRI) in stroke patients from Puerto Rico

Introduction: Stroke is the fifth principal cause of death in the United States and Puerto Rico and a prime cause of adult disability. Women tend to have worse outcomes post-stroke. Initial diagnoses and management of stroke include the use of computed tomography (CT) and magnetic resonance image (MRI) scans. MRI scans are more sensitive and more specific than CT scans. Still, CT scans are used more commonly. Whether differences in the choice of imaging techniques exists for gender and whether that can be a potential reason for gender differences in post-stroke outcomes it is yet unknown. The study is directed to evaluate the association between gender and receipt of a MRI in stroke patients in the Puerto Rico population. Methods: We did a secondary analysis of data collected from patients who suffered from a stroke and who participated in the Puerto Rican Cardiovascular Surveillance System (PRCSS) in 2007, 2009 and 2011. The main independent variable was gender (male and female). The dependent variable will be receipt of a MRI (alone or in combination with any other imaging modality as recorded in the medical charts). Multivariate logistic regression was used to assess for the independent associations. P-value < 0.05 for a two tailed test was considered to be statistically significant. SPSS software was used for analysis. Results: A total of 1,950 patients suffered from an ischemic stroke and participated at the PRCSS. We excluded 595 patients due to BMI ≥35 (n=135) or no recorded BMI (n=460). MRI was used for 50% of participants. Women were 85% less likely to receive a MRI compared to men in both the unadjusted (OR-0.85, 95% CI=0.11-0.20, p-value <0.001) and after adjusting for BMI, age, marital status, hypertension, and transient ischemic attacks (TIA) (OR=0.15; 95%CI: 0.11-0.20). No other variables assessed had significant independent association with the receipt of a MRI. Conclusions: We found evidence of gender disparities in the receipt of MRI during hospitalization for stroke in patients in the Puerto Rico. Women were less likely to receive MRI compared to men. Further research on potential reasons for such dispairites, increasing awareness, and testing intervention as to decrease these potential disparities are needed

Diabetes and atypical presentations of patients hospitalized for an acute myocardial infarction in Puerto Rico

Introduction: Diabetes mellitus is one of the fastest growing health issues concerning the world today with an estimated 382 million individuals affected as of 2013 and a projected increase in number to 592 million by 2035. Diabetes mellitus is a condition affecting 12-15% of the population or around 400,000 people in Puerto Rico. The most common presenting complaint of diabetics who are hospitalized for an acute myocardial infarction (AMI) is chest pain. However, the pervasiveness of atypical symptoms in diabetic patients is yet unclear. The aim of this study is to determine if there is an association between diabetes and the presentation of atypical symptoms in the emergency room in those suffering from an AMI in Puerto Rico. Methods: We conducted a secondary data analysis of data from participants from the 2007, 2009 and 2011 Puerto Rico Cardiovascular Disease Surveillance system (PRCDS), an observational, non-concurrent, cross-sectional study. The main independent variable was presence of diabetes mellitus (Type I and Type II). The outcome was the presence of atypical symptoms at the time of presentation, defined as the absence of chest pain on admission. The prevalence of atypical symptoms in diabetic patients and non-diabetic patients was compared. Binary logistic regression was used to test for independent association. Statistical significance was considered for p-values ≤0.05 for a two-tailed test. Analysis was conducted using SPSS software. Results: We found no association between atypical presentation of an AMI and diabetes, before or after adjustment for age, gender, congestive heart failure, stroke history and BMI. (unadjusted OR= 1.0, 95%CI=0.7-1.4 and adjusted OR=1.0, 95% CI=0.6-1.5). Other independent associations identified were that patients older than 75 were 3.5 times more likely to present atypically than people younger than 55 (OR= 3.5, 95% CI=1.6-7.6), and those with CHF and stroke were more likely to present with atypical symptoms (OR=3.2, 95% CI=1.7-6.1 and OR=4.2 95% CI=2.1-8.4, respectively). Lastly, overweight patients were 3.3 times more likely to present atypically than healthy weight patients (OR=2.0, 95% CI=0.6-7.0). Conclusion: We found no evidence of an association between diabetes and the presentation of atypical symptoms in patients hospitalized for AMI in Puerto Rico

VULNERABILIDAD PARA LA EXPLOTACIÓN SEXUAL EN ADOLESCENTES DE EXTREMA POBREZA DE PUNCHANA, LORETO, 2011

La presente investigación, tiene como objetivo identificar el nivel de vulnerabilidad para la explotación sexual en adolescentes de la Institución Educativa Santa María del Amazonas – Distrito de Punchana 2011. Este estudio tiene un diseño transversal y la metodología aplicada fue la observación directa, mediante la aplicación de encuestas validadas. De los 94 adolescentes encuestados, se determinó que, un total de 6.4% de adolescentes presentan vulnerabilidad alta, 45.7% vulnerabilidad media y 47.9% vulnerabilidad baja. Por otro lado, en cuanto al nivel de vulnerabilidad según edad, se detectó que esta fluctúa entre las edades de 15 a 16 años; en lo que se refiere a sexo, el nivel de vulnerabilidad fue alto tanto en hombres y mujeres (50%)

In-hospital mortality of non-st segment elevation myocardial infarction in a Puerto Rican population

Introduction: Currently, there is limited published information on in-hospital mortality regarding ST segment elevation and non-ST segment elevation myocardial infarction. This information is even scarcer on the Hispanic population. We aim to study if there is a difference on in-hospital mortality between ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) in a mostly Hispanic population. Methods: A secondary data analysis of a non-concurrent prospective study was performed using the Puerto Rican Heart Attack study database. Dependent variable was in-hospital mortality and independent variable was type of myocardial infarction (STEMI or NSTEMI). We conducted, sequentially, a descriptive, bivariate and multivariate analysis. The chi-squared test was used to compare categorical variables and t-test for continuous variables. Finally, a logistic regression model was used to perform the multivariate analysis. Results: From the 838 Puerto Rican patients hospitalized with ST classification, 310 (37%) were diagnosed with STEMI. Patients with STEMI were younger (65 years vs 68 years; p=0.008), more likely to receive invasive treatment (47.9% vs 27.5%, p<0.001), and less likely to have a history of hypertension (72.5% vs 79.0%, p=0.033) compared to NSTEMI patients. For every 1- year increase in age, there is a 4% increase in in-hospital mortality. Patients with hyperlipidemia were approximately two times more likely to die in the hospital compared to patients without hyperlipidemia. In the unadjusted analysis, there was no significant association between STEMI and NSTEMI patients and in-hospital mortality. After adjusting for confounders, patients with STEMI had twice the risk of dying than those with NSTEMI. Conclusions: Findings from this study suggest that Puerto Ricans with STEMI have double the risk of in-hospital mortality than NSTEMI patients. Our findings were similar to those reported in the literature. A timely recognition of at-risk patients, especially among STEMI patients, may help reduce short-term morality among patients hospitalized with acute myocardial infarction in Puerto Rico

Influence of sociocultural factors in Eating Disorders

Carta al [email protected] al edito

Phenotypic and molecular characterization of plants regenerated from non-cryopreserved and cryopreserved wild Solanum lycopersicum Mill. seeds

BACKGROUND: Before cryopreservation is routinely used, its effect on the trueness-to-type of the regenerated plant material needs to be evaluated. OBJECTIVE: In this work, we studied the effect of seed cryopreservation on the phenotypic and molecular characteristics of wild Solanum lycopersicum Mill. plants. METHODS: Thirty-five morphological traits of plants regenerated from cryopreserved seeds were compared to those measured on plants regenerated from non-cryopreserved seeds. RESULT: No statistically significant differences were observed between cryopreserved and non-cryopreserved samples, either in the first or in the second generation post-liquid nitrogen exposure. However, at the molecular level, the genetic analyses performed on the second generation plants germinated from control and cryopreserved seeds using 14 nuclear Simple Sequences Repeats (SSR) markers uncovered some changes in microsatellite length between control and cryopreserved samples. These results confirm at the botanical phenotype level the effectiveness of seed cryostorage for conservation and regeneration of true-to-type S. lycopersicum plants. CONCLUSION: Further experiments are required to clarify potential phenotypic effects of the changes observed in the DNA