42 research outputs found

    Characterization of Oral Cavity and Oropharyngeal Cancer in the Texas Rio Grande Valley

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    Cancers of the oral cavity (OC) and oropharynx (OP) account for 3% of cancers diagnosed in the United States each year. A primary cause of death among the Hispanic population in the United States is cancer, accounting for 20% of annual mortality. The Rio Grande Valley (RGV) is a medically-underserved area of South Texas with a large Hispanic population facing health disparities. In this study, we examine the incidence and mortality of OC and OP cancer in the RGV. CDC population-level incidence and mortality rate per 100,000 of OC/OP cancer among patients in the RGV counties of Hidalgo and Cameron County between 2014-2018 compared to Texas and national incidence data was used. Starr and Willacy County data was omitted due to case rates below the reporting threshold. Age-adjusted incidence and 95% confidence interval of OC/OP cancer in the RGV from 2014-2018 is 7.3 [6.6, 8.0], as compared to 11.2 [11.0, 11.3] in Texas, and 11.9 [11.8, 12.0] in the United States. Rates of OC/OP cancer among RGV Hispanics was 6.7 [6.0, 7.5] as compared to 6.8 [6.5, 7.1] in Texas and 6.9 [6.8, 7.0] nationally. Mortality rate in these cancers in the RGV is 1.8 [1.5, 2.2] compared to 2.5 [2.4, 2.5] in Texas. OC/OP cancer rates are prevalent in the Rio Grande Valley but there may be an under-reporting of data. Of note, cancer cases could not be separated by subsite (OC vs. OP) due to the method of reporting to the database. The rising rates nationally may pose a larger problem to the RGV due to cancer health disparities and inequities

    Characterization of Oral Cavity and Oropharyngeal Cancer in the Texas Rio Grande Valley

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    Background: Cancers of the oral cavity (OC) and oropharynx (OP) account for 3% of cancers diagnosed in the United States each year. A primary cause of death among the Hispanic population in the United States is cancer, accounting for 20% of annual mortality. The Rio Grande Valley (RGV) is a medically-underserved area of South Texas with a large Hispanic population facing health disparities. In this study, we examine the incidence and mortality of OC and OP cancer in the RGV. Methods: CDC population-level incidence and mortality rate per 100,000 of OC/OP cancer among patients in the RGV counties of Hidalgo and Cameron County between 2014-2018 compared to Texas and national incidence data was used. Results: Age-adjusted incidence and 95% confidence interval of OC/OP cancer in the RGV from 2014-2018 is 7.3 [6.6, 8.0], as compared to 11.2 [11.0, 11.3] in Texas, and 11.9 [11.8, 12.0] in the United States. Rates of OC/OP cancer among RGV Hispanics was 6.7 [6.0, 7.5] as compared to 6.8 [6.5, 7.1] in Texas and 6.9 [6.8, 7.0] nationally. Mortality rate in these cancers in the RGV is 1.8 [1.5, 2.2] compared to 2.5 [2.4, 2.5] in Texas. Conclusion: OC/OP cancer rates are prevalent in the Rio Grande Valley but there may be an under-reporting of data. Of note, cancer cases could not be separated by subsite (OC vs. OP) due to the method of reporting to the database. The rising rates nationally may pose a larger problem to the RGV due to cancer health disparities and inequities

    Acute Aseptic Meningoencephalitis due to COVID-19 in an Otherwise Healthy Patient: A Case Report

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    Several studies have shown the extrapulmonary manifestations of COVID-19 disease caused by the SARS-CoV2 virus. Although extrapulmonary manifestation to the heart, kidney, blood, and skin are common, neurological and cerebrovascular manifestations are rare with most of these cases being described in patients who also have the pulmonary manifestation of the disease. Here we present the case of an 18 year-old male with no prior history of respiratory symptoms who presented to the emergency department with altered mental status. Neurology was consulted and the patient was started empirical on ceftriaxone, vancomycin, dexamethasone, and acyclovir for meningoencephalitis. Urine drug screen, head CT, and brain MRI were negative. EEG revealed mild generalized slowing without epileptiform abnormalities. CSF analysis revealed RBC 2,230 (spun: clear, colorless), WBC 84 (segs 2%, lymphocytes 96%, monocytes 2%), protein 112 mg/dL, glucose 69 mmol/L, and gram stain with no polyps or organisms seen. CSF meningoencephalitis PCR panel for 14 common pathogens was negative. Due to recent contact with co-workers who tested positive, nasopharyngeal SARS-CoV2 PCR was ordered and it returned positive. This patient was diagnosed with acute aseptic meningoencephalitis due to COVID-19 and the vancomycin, ceftriaxone and acyclovir were discontinued. Patient’s encephalopathy improved and he was discharged home on oral steroids

    Policy Feedback and the Politics of the Affordable Care Act

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    There is a large body of literature devoted to how “policies create politics” and how feedback effects from existing policy legacies shape potential reforms in a particular area. Although much of this literature focuses on self‐reinforcing feedback effects that increase support for existing policies over time, Kent Weaver and his colleagues have recently drawn our attention to self‐undermining effects that can gradually weaken support for such policies. The following contribution explores both self‐reinforcing and self‐undermining policy feedback in relationship to the Affordable Care Act, the most important health‐care reform enacted in the United States since the mid‐1960s. More specifically, the paper draws on the concept of policy feedback to reflect on the political fate of the ACA since its adoption in 2010. We argue that, due in part to its sheer complexity and fragmentation, the ACA generates both self‐reinforcing and self‐undermining feedback effects that, depending of the aspect of the legislation at hand, can either facilitate or impede conservative retrenchment and restructuring. Simultaneously, through a discussion of partisan effects that shape Republican behavior in Congress, we acknowledge the limits of policy feedback in the explanation of policy stability and change

    The genetic architecture of the human cerebral cortex

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    The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

    Conversion Discriminative Analysis on Mild Cognitive Impairment Using Multiple Cortical Features from MR Images

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    Neuroimaging measurements derived from magnetic resonance imaging provide important information required for detecting changes related to the progression of mild cognitive impairment (MCI). Cortical features and changes play a crucial role in revealing unique anatomical patterns of brain regions, and further differentiate MCI patients from normal states. Four cortical features, namely, gray matter volume, cortical thickness, surface area, and mean curvature, were explored for discriminative analysis among three groups including the stable MCI (sMCI), the converted MCI (cMCI), and the normal control (NC) groups. In this study, 158 subjects (72 NC, 46 sMCI, and 40 cMCI) were selected from the Alzheimer's Disease Neuroimaging Initiative. A sparse-constrained regression model based on the l2-1-norm was introduced to reduce the feature dimensionality and retrieve essential features for the discrimination of the three groups by using a support vector machine (SVM). An optimized strategy of feature addition based on the weight of each feature was adopted for the SVM classifier in order to achieve the best classification performance. The baseline cortical features combined with the longitudinal measurements for 2 years of follow-up data yielded prominent classification results. In particular, the cortical thickness produced a classification with 98.84% accuracy, 97.5% sensitivity, and 100% specificity for the sMCI–cMCI comparison; 92.37% accuracy, 84.78% sensitivity, and 97.22% specificity for the cMCI–NC comparison; and 93.75% accuracy, 92.5% sensitivity, and 94.44% specificity for the sMCI–NC comparison. The best performances obtained by the SVM classifier using the essential features were 5–40% more than those using all of the retained features. The feasibility of the cortical features for the recognition of anatomical patterns was certified; thus, the proposed method has the potential to improve the clinical diagnosis of sub-types of MCI and predict the risk of its conversion to Alzheimer's disease

    Quantitative 18F-AV1451 Brain Tau PET Imaging in Cognitively Normal Older Adults, Mild Cognitive Impairment, and Alzheimer's Disease Patients

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    Recent developments of tau Positron Emission Tomography (PET) allows assessment of regional neurofibrillary tangles (NFTs) deposition in human brain. Among the tau PET molecular probes, 18F-AV1451 is characterized by high selectivity for pathologic tau aggregates over amyloid plaques, limited non-specific binding in white and gray matter, and confined off-target binding. The objectives of the study are (1) to quantitatively characterize regional brain tau deposition measured by 18F-AV1451 PET in cognitively normal older adults (CN), mild cognitive impairment (MCI), and AD participants; (2) to evaluate the correlations between cerebrospinal fluid (CSF) biomarkers or Mini-Mental State Examination (MMSE) and 18F-AV1451 PET standardized uptake value ratio (SUVR); and (3) to evaluate the partial volume effects on 18F-AV1451 brain uptake.Methods: The study included total 115 participants (CN = 49, MCI = 58, and AD = 8) from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Preprocessed 18F-AV1451 PET images, structural MRIs, and demographic and clinical assessments were downloaded from the ADNI database. A reblurred Van Cittertiteration method was used for voxelwise partial volume correction (PVC) on PET images. Structural MRIs were used for PET spatial normalization and region of interest (ROI) definition in standard space. The parametric images of 18F-AV1451 SUVR relative to cerebellum were calculated. The ROI SUVR measurements from PVC and non-PVC SUVR images were compared. The correlation between ROI 18F-AV1451 SUVR and the measurements of MMSE, CSF total tau (t-tau), and phosphorylated tau (p-tau) were also assessed.Results:18F-AV1451 prominently specific binding was found in the amygdala, entorhinal cortex, parahippocampus, fusiform, posterior cingulate, temporal, parietal, and frontal brain regions. Most regional SUVRs showed significantly higher uptake of 18F-AV1451 in AD than MCI and CN participants. SUVRs of small regions like amygdala, entorhinal cortex and parahippocampus were statistically improved by PVC in all groups (p < 0.01). Although there was an increasing tendency of 18F-AV-1451 SUVRs in MCI group compared with CN group, no significant difference of 18F-AV1451 deposition was found between CN and MCI brains with or without PVC (p > 0.05). Declined MMSE score was observed with increasing 18F-AV1451 binding in amygdala, entorhinal cortex, parahippocampus, and fusiform. CSF p-tau was positively correlated with 18F-AV1451 deposition. PVC improved the results of 18F-AV-1451 tau deposition and correlation studies in small brain regions.Conclusion: The typical deposition of 18F-AV1451 tau PET imaging in AD brain was found in amygdala, entorhinal cortex, fusiform and parahippocampus, and these regions were strongly associated with cognitive impairment and CSF biomarkers. Although more deposition was observed in MCI group, the 18F-AV-1451 PET imaging could not differentiate the MCI patients from CN population. More tau deposition related to decreased MMSE score and increased level of CSF p-tau, especially in ROIs of amygdala, entorhinal cortex and parahippocampus. PVC did improve the results of tau deposition and correlation studies in small brain regions and suggest to be routinely used in 18F-AV1451 tau PET quantification
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