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Assessing Cancer Health Disparities Within Racial/Ethnic Groups in Tarrant, Dallas, and Bexar County
No full textBackground: Cancer health disparities refers to significant differences in cancer incidence, prevalence, death, survivorship, and burden that exist among different population groups in the United States. Those who have limited or lack access to effective health care are often impacted more severely by cancer compared to the general population. Social and economic factors such as insurance status, income level, neighborhood poverty, and education level also play a large influence in cancer disparities observed among groups. Strong public health policies can serve an important role in reducing cancer health disparities by tackling prevention and early detection, especially within vulnerable populations. Health disparities are particularly pronounced in racial/ethnic groups such as African Americans and Latinos, and even persist when comparing groups of similar socioeconomic status. The findings of this research project will provide valuable information regarding the urgent need to address cancer disparities within Texas counties, especially Tarrant County, Dallas County, and Bexar County. Purpose: Highlight disparities in the frequency and rate of cervical, breast, prostate, lung, and colorectal cancer among racial/ethnic groups within Tarrant, Dallas, and Bexar county to increase awareness for policy making. Methods: County-level cancer data was pulled from the Surveillance, Epidemiology, and End Results (SEER) cancer registry. The statistics in this registry were categorized by the patient's racial group. Focusing only on statistically significant changes, we ranked all counties by their average annual percent change (APC) from 2000-2020 trend for frequency and age-adjusted rate per 100,000 population for cervical, breast, prostate, colorectal, and lung cancer. Results: In Tarrant County, the annual percent change of cancer frequency between 2000-2020 were as follows: 2.5% increase for cervix, 2.7% increase for breast, 0.9% increase for prostate, 1.3% increase for colorectal, and 0.6% increase for lung cancer. Also in Tarrant County, the annual percent change of cancer rates from 2000-2020 were as follows: 0.2% increase for cervix, 0.2% increase for breast, -3.1% decrease for prostate, -2.2% decrease for colorectal, and -2.8% decrease for lung cancer. Tarrant county was also ranked 1st in Texas and 5th in the nation for cervical cancer in Non-hispanic black. Dallas county was ranked 7th in Texas and 15th in the nation for cervical cancer in Hispanics. Conclusion: This data brings awareness to certain groups within Tarrant County, Dallas County, and Bexar county that are more likely to be diagnosed with cancer mainly because of their ethnicity. These findings bring up crucial discussions about the underlying factors contributing to the increase in cancer risk among specific ethnic populations, whether it is a genetic association or a socioeconomic association. For example, despite initiatives taken to tackle this disparity, the data shows that Hispanic women are still highly at risk for developing cervical cancer across all three counties. Policymakers and advocates can use this data to identify which type of cancers and ethnic groups require focused intervention and attention in the community
Os Intermetatarseum: An important consideration in chronic foot pain
No full textBackground: The os intermetatarseum is the rarest accessory bone of the foot. It was first described by Gruber in 1856 but well documented cases have been infrequently reported throughout literature. This accessory bone is located on the dorsal aspect of the foot in between the base of the first and second metatarsals. It varies in shape and size and usually presents bilaterally. Chronic dorsal mid foot pain following impingement of the deep peroneal nerve by the os intermetatarseum is common in symptomatic patients and an important consideration in this case. Case Presentation: A 70 year old Caucasian female with a past medical history of depression, thyroid disease, and neuropathy presents with chronic left foot pain rated 10/10, starting 4 years ago. She describes it as a burning and aching pain that comes and goes. The pain, described as burning and aching, occurs on the left anterior ankle, lateral ankle, and forefoot, aggravated by walking, prolonged standing, and toe extension. Alleviated by leg elevation, rest, and sitting. She has been seen by 2 podiatrists and was given a steroid injection by both. The first injection did not help and the 2nd injection lasted for one year. Physical examination revealed pain upon palpation of the peroneal tendon as it courses posterior to the lateral malleolus and at the tip of the fibula. Both peroneus longus and brevis were intact with manual testing. No pain upon palpation of the 1st metatarsal joint, but pain upon palpation of the left 3rd and 4th metatarsal shaft. The dorsalis pedis pulse was 2/4 bilaterally and the posterior tibial pulse was 2/4 bilaterally. Neurological assessment of positive sensation and light touch were intact bilaterally. There were no significant dermatologic lesions present. Bilateral foot assessment showed adequate skin tone, texture, and turgor with a normal temperature gradient. After the initial visit, the patient was instructed to modify her activity and shoe wear to incorporate more fitted supportive tennis-type shoe. On the one-week follow-up visit to discuss MRI findings, the patient reported her pain level decreased to a 4/10. MRI reveals a marked longitudinal arch, moderate hallux valgus, longitudinal split tear of peroneus brevis retromalleolar to inframalleolar distribution, and short segmental split tear of peroneus longus proximal to cuboid tunnel. There was no convincing evidence of an occult fracture or stress injury. A small intermetatarseum was noted between the bases of the first and second metatarsals dorsally that likely articulates with the 1st metatarsal base. Due to the presence of segmental tears involving the peroneus brevis and longus, the podiatrist catered his treatment plan to address tenosynovitis. After discussing the diagnosis and potential treatment plans the patient opted to undergo surgery. Conclusion: Refractory foot pain aggravated by physical activity and symptoms of deep peroneal nerve compression should prompt consideration of a painful os intermetatarseum. Initially, conservative measures like NSAIDs, shoe adjustments, and rest should be employed to address this potential diagnosis, reserving surgical interventions as a final option
Cannabis Use and Oral Health Behaviors: A Nationally Representative Study of U.S. Adults aged 30-59.
No full textPurpose: Given that individuals who use cannabis may exhibit distinct oral health behaviors, including irregular dental visits, reduced adherence to oral hygiene practices such as flossing, and potentially increased tobacco and alcohol use, this research seeks to compare these behaviors with those of non-users. By highlighting these differences and understanding their impact on oral health, the study aims to inform targeted public health interventions, guide healthcare providers in offering tailored advice, and contribute to the development of policies that address the unique oral health challenges faced by cannabis users. This study aimed to explore the association between cannabis use and oral health behaviors among U.S. adults aged 30-59.
Methods: We analyzed secondary data using the 2011-2018 National Health and Nutrition Examination Survey (n = 9345). Self-reported cannabis use was categorized as never (reference), experimental (used at least once in their lifetime), or regular (monthly use for more than one year). Outcomes included dental visit reasons (Routine Checkup (ref), Issues & Treatment, Other reasons), flossing frequency (=<3 vs. > 3 times a week), and oral cancer examination in the past year (Yes vs No). Associations between cannabis use and dental health outcomes were examined via multinomial logistic regression for dental visit reasons and binary logistic regression for flossing frequency and oral cancer exam participation. Models were adjusted for age, sex, race, education, income, marital status, diabetes, smoking, and alcohol use.
Results: Analysis revealed that individuals who used cannabis experimentally had elevated odds of receiving an oral cancer examination compared to never users (aOR=1.5, 95% CI: 1.1-1.9). Among individuals who used cannabis regularly, there was an observed increase in the odds of flossing more than three times a week (aOR=1.1, 95% CI: 0.9-1.3), although this association was not statistically significant. Furthermore, individuals who used cannabis regularly were more likely to report dental visits for issues and treatment rather than routine check-ups when compared to never users (aOR=1.3, 95% CI: 1.0-1.7)
Conclusion: Study findings suggest that cannabis use is associated with certain oral health behaviors. This research highlights the need for targeted investigations to inform public health strategies for improving oral health outcomes among people who use cannabis. Furthermore, these insights underscore the importance of integrating oral health education and preventive measures into cannabis use counseling to improve oral health outcomes and promote overall well-being among cannabis users
Derivation of Indices of Cognitive Change Among Hispanic Adults and Elders
No full textIMPORTANCE: Determining the influence of race and ethnicity on change in cognitive test performance has significant implications for clinical practice and research in populations at risk for Alzheimer disease. OBJECTIVE: To evaluate the significance of race and ethnicity in predicting longitudinal cognitive test performance and to develop models to support evidence-based practice. DESIGN, SETTING, AND PARTICIPANTS: This prognostic study included baseline and 24-month follow-up data that were obtained from the Health and Aging Brain Study-Health Disparities (HABS-HD) study, an ongoing longitudinal observational study of aging and dementia in a multiracial, multiethnic cohort. Participants included community-dwelling adults and elders living in the Dallas and Fort Worth metropolitan area who were Hispanic and non-Hispanic adults older than the age of 50 years and were cognitively unimpaired. EXPOSURE: The primary exposure of interest was time, measured in months. MAIN OUTCOMES AND MEASURES: Demographic variables included age, sex, education, and race and ethnicity. Cognitive domains included attention and working memory, processing speed, language, memory, and executive functioning. Linear regression models predicted follow-up performance from baseline performance and demographic variables for 13 commonly used neuropsychological tests. Follow-up testing was the primary outcome for all domains. Raw scores from 13 standardized tests were used for analyses. RESULTS: This study included 799 adults who were cognitively unimpaired (352 Hispanic individuals [44.1%]; 447 non-Hispanic individuals [55.9%]; 524 female [65.6%]; mean [SD] age, 65.4 [8.1] years). In the regression models, all 13 follow-up scores were significantly predicted from their respective baseline scores and demographic variables. Baseline performance and education were the most consistent predictors of follow-up scores, contributing to all 13 models. Age was significantly associated with follow-up in 11 models, and sex was significant in 5 models. Race and ethnicity contributed to 10 of 13 models, with Hispanic participants predicted to have poorer follow-up scores than their non-Hispanic White counterparts on each test. CONCLUSIONS AND RELEVANCE: In this longitudinal study of cognitive change in Hispanic and non-Hispanic older adults who were cognitively unimpaired, standardized regression-based models were influenced by multiple demographic variables, including race and ethnicity. These findings highlight the importance of including race and ethnicity in such cognitive change models. This ability to accurately predict cognitive change is expected to become increasingly important as clinical practice and clinical trials need to become more diverse and culturally appropriate in this burgeoning global medical and societal crisis.Research reported on this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Nos. R01AG054073, R01AG058533, P41EB015922, and U19AG078109. Dr Miller was supported by grant P20 AG068053 from the Nevada Exploratory Alzheimer's Disease Research Center, grant P20 GM109025 from the National Institute of General Medical Sciences, and Keep Memory Alive
A Missed Case of Synovial Osteochondromatosis
No full textBackground: Synovial osteochondromatosis is a benign, uncommon, and interesting disorder that presents challenges in diagnosis and treatment. It is a complication of the synovial membrane of joints, tendon sheath, and bursae that can cause dysfunction most commonly in the knee, hip, or shoulder that has the potential of transforming into chondrosarcoma. While the exact etiology of a primary synovial osteochondromatosis is still in question, hypotheses point toward the metaplasia of the synovial membrane and the detachment of cartilaginous fragments as potential causation. The cause of secondary synovial osteochondromatosis is associated with an underlying joint pathology or condition that triggers development such as osteoarthritis, rheumatoid arthritis, or traumatic joint injuries Patients with this condition usually present with a history of pain in the joint affected, swelling, crepitus, and limited range of motion (ROM).The pain is usually aching in nature and is exacerbated by weight-bearing activities such as prolonged periods of walking or standing.
Case Information:
A 62-year-old female with a past medical history of hypertension and hypothyroidism presented to the clinic with a chief complaint of bilateral knee pain and effusions, which was diagnosed as osteoarthritis based on clinical exam and past X-rays. The patient had been experiencing moderate relief from bilateral steroid injections that were administered approximately every four to six months. As for diagnostic imaging, she had two MRI scans of her left knee; the first in 2020 and the second in 2023.
The differential diagnosis formulated in the clinic after the MRI scan (Fi [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10705034/figure/FIG1/]was pigmented villonodular synovitis (PVNS), rheumatoid arthritis (RA), or synovial chondromatosis.
Conclusions:
Although synovial osteochondromatosis is generally a benign condition, transformation to chondrosarcoma is still a possibility. Imaging may assist in identifying the loose bodies floating in the joint space, but this becomes much more difficult if the loose bodies are radiotransparent (chondromatosis). Calcified nodules (osteochondromatosis) are relatively less difficult to view on X-ray. T2 weighted MRI imaging can help identify synovial hyperplasia which can help clue clinicians in with other physical exam findings. Although an arthroscopy with histopathology is the gold-standard diagnostic modality, it is important to keep in mind that one or even two different types of imaging modalities may not be sufficient for synovial osteochondromatosis to make the differential. As seen in our case, it took three years after the pain from the onset of chondromatosis for suspicion to arise on MRI. Sometimes patients may not be so fortunate by the time it is noticed and, although uncommon, the formation of chondrosarcoma may already be in progress. If left untreated, patients can also develop severe osteoarthritis. Clinicians must not hesitate to diversify the imaging modalities in which they order, as a diagnosis may become more apparent in one versus the other. Another lesson to take from our case is to stay vigilant in regard to who can present with synovial osteochondromatosis. Although our patient did fit the expected location of the disease (larger joint, the knee in this case), she did not fit the expected gender or age group in which these processes arise
Assessing Quality of Life and Adverse Events in Prostate Cancer Patients: A Retrospective Study
Get PDFThis retrospective study evaluates the impact of both standard and neurovascular-sparing stereotactic ablative radiotherapy (SAbR) on quality of life and toxicity in patients with localized prostate cancer. Utilizing de-identified records from a Phase 2 randomized trial at UTSW's Department of Radiation Oncology, the analysis focuses on genitourinary (GU) and gastrointestinal (GI) toxicities, prostate-specific antigen (PSA) levels, and quality of life over six months. A total of 45 patients were assessed at baseline, three months, and six months after treatment, with quality of life measured via the Expanded Prostate Cancer Index Composite (EPIC) questionnaire. The statistical analysis showed no significance differences in PSA reduction or overall toxicity rates between the two treatment groups. The neurovascular-sparing approach showed statistical significance in urinary bother scores, indicating better urinary function. These results suggest that neurovascular-sparing stereotactic ablative radiotherapy (SAbR) may enhance urinary outcomes without increasing risks, highlighting the importance of considering patient quality of life in addition to treatment efficacy. Further, longitudinal studies are needed to validate these advantages and inform clinical decision-making
Installation of an Indole on the BRCA1 Disordered Domain Using Triazine Chemistry
Get PDFThe functionalization of protein sidechains with highly water-soluble chlorotriazines (or derivatives thereof) using nucleophilic aromatic substitution reactions has been commonly employed to install various functional groups, including poly(ethylene glycol) tags or fluorogenic labels. Here, a poorly soluble dichlorotriazine with an appended indole is shown to react with a construct containing the disordered domain of BRCA1. Subsequently, this construct can undergo proteolytic cleavage to remove the SUMO-tag: the N-terminal poly(His) tag is still effective for purification. Steady-state fluorescence, circular dichroism spectroscopy, and isothermal titration calorimetry with the binding partner of BRCA1, PALB2, are used to characterize the indole-labeled BRCA1. Neither the reaction conditions nor the indole-tag appreciably alter the structure of the BRCA1. Mass spectrometry confirms that the target is modified once, although the location of modification cannot be determined by tandem mass spectrometry with collision-induced dissociation due to disadvantageous fragmentation patterns.This research was funded by the National Institutes of Health (R15GM 135900 to E.E.S./ M.D.S.) and the Robert A. Welch Foundation (P-0008 to E.E.S., BK-0031 to L.P.)
Masticatory muscle morphology in early postnatal mice with osteogenesis imperfecta
No full textPurpose: Osteogenesis imperfecta (OI) is a connective tissue disorder resulting from mutations in COL1A1 or COL1A2, responsible for encoding type I collagen alpha chains. While OI is primarily distinguished by manifestations of bone fragility, including recurrent fractures and bone deformities, muscle abnormalities have also been documented in those affected by OI. While prior research has shown postcranial muscle weakness in mouse models of OI, it remains unclear whether this also applies to feeding musculature and if these differences are present at birth or develop postnatally. This study investigates the development of the masticatory muscles during the early postnatal period in a mouse model. Our hypothesis posits that mice affected by OI will exhibit decreased muscle mass, and therefore potentially weaker muscles, in comparison to unaffected mice.
Methods: Cranial tissues from OIM mice (B6C3Fe a/a-Col1a2oim/J) and unaffected wild type (WT) littermates were collected at day of birth (P0) and postnatal day 14 (P14). Tissues were fixed and stained with 1.25% buffered Lugol’s solution, then micro-CT scanned with a reconstruction of 0.02 mm3 voxels. 3D Slicer software was used to isolate and measure the volumes of the superficial masseter, deep masseter, and temporalis muscles. Muscle volumes were compared between genotypes using a Mann-Whitney U test.
Results: At birth, no significant differences were observed in body mass or muscle volumes between OIM and WT mice. A trend was observed for OIM mice to have lower superficial masseter volumes compared to WT mice at P0, but this difference was not significant. At P14, OIM mice have significantly lower body weights (p=0.002). Data collection is ongoing for volumetric muscle data from the P14 stage. After birth, body masses diverge rapidly between OIM and WT mice. These growth curves suggest poor feeding performance during the suckling stage in OIM mice. Although masticatory muscle volumes (similar to body mass) start out similar between genotypes at birth, a trend for decreased superficial masseter volume in OIM mice suggests feeding musculature will also lag behind unaffected mice during early postnatal growth.
Conclusion: The production of strain above an osteogenic threshold by feeding musculature is critical to typical craniofacial growth during early life. Weaker masticatory muscles may produce lower (yet still osteogenic) levels of strain, contributing to the midfacial hypoplasia seen in OIM mice. A better understanding of muscle development during this critical growth period will provide insight on feeding disorders seen in OI, and the development of the craniofacial phenotype in pediatric patients with OI.UNTHSC Department of Physiology & Anatomy Seed Grant, UNTHSC Small Animal Imaging Facility Pilot Gran
The SAVVY Study: SGS/AAGL Survey of Barriers for Vaginal Access Surgery
No full textPurpose: The aim was to study vaginal hysterectomy practices, factors enabling or hindering its performance, and factors affecting its teaching. Vaginal hysterectomies for benign conditions are linked to fewer intra-operative injuries, fewer long-term complications, and lower costs compared to other methods. Nonetheless, the number of vaginal hysterectomies and training opportunities has decreased over the past decade. This study was established to develop strategies to improve training and utilization of vaginal hysterectomies.
Methods: We conducted a mixed-method study involving qualitative and quantitative approaches. Members of American Association of Gynecologic Laparoscopists and Society of Gynecologic Surgeons participated in a survey exploring their views on hysterectomy practice patterns and factors affecting vaginal hysterectomy and its teaching. Responses were used to develop a qualitative interview guide for further exploration. Surgeons who completed the survey were invited to participate in interviews until thematic saturation was achieved. All interviews were recorded, de-identified, and transcribed. Two independent researchers coded the transcript line by line. Grounded Theory was utilized to develop new codes and data analysis was completed utilizing STATA and NIVO.
Results: 505 gynecologic surgeons who practice across the world participated in the survey. The mean age was 50.8 +/- 12.7 years. 34.5% of participants performed 1-10 vaginal hysterectomies per year and 23% of participants performed over 30 hysterectomies. Most surgeons agreed that vaginal hysterectomies are important to women’s health (82.8%), that all gynecologic surgeons should be able to perform vaginal hysterectomies (66.3%), and disagreed that other modalities get better outcomes (67.5%). Common barriers to performing vaginal hysterectomy included preference for other surgical routes, previous training experience, low surgical volume, and lack of assistance in the operating room. Surgeons reported that pathology impacted their ability in performing vaginal hysterectomy more than the requirement for morcellation, ability to obtain or control hemostasis, and ability to perform anterior and/or posterior repair. Higher surgical volumes were the only intervention rated by most as enabling the performance of vaginal hysterectomy. Surgeons suggested that creating institutions that specialize in vaginal hysterectomy and funneling patients to surgeons with specialized training would increase volume. In terms of medical education, surgeons thought that residents should be required to achieve competency for vaginal hysterectomies prior to graduation (71.7%) and disagreed that we should eliminate residency graduation requirements for vaginal hysterectomy numbers (56%); however, recent data shows that laparoscopy is comparable in safety to vaginal hysterectomies. Since there is a decreasing trend in vaginal hysterectomy numbers, many surgeons believe that it is best to focus on laparoscopy so that residents can graduate competent in at least one form of minimally invasive hysterectomy.
Conclusions: The study reveals that many surgeons choose to perform laparoscopy despite believing that vaginal hysterectomy is the best surgical option. Some surgeons believed that concentrating efforts on laparoscopic hysterectomy was in the best interest for the specialty. The study gathered preliminary data on facilitators and inhibitors to perform and teach vaginal hysterectomy. Future research needs to focus on the design and implementation of programs that can address barriers and enhance facilitators of vaginal hysterectomies.Dr. Halder is supported by a research career development award (K12HD052023: Building Interdisciplinary Research Careers in Women’s Health Program-BIRCWH; Berenson, PI) from the Office of the Director (OD), National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health