Caucasian Females Research Articles

Young-onset colorectal cancer: hospitalization trends and gender disparities in the United States 2010-2014.

Study national hospitalization trends for colorectal cancer in patients younger than 50years of age. Patients under age 50years hospitalized for colorectal cancer were studied using the national inpatient sample databases (2010-2014), using validated ICD-CM-9 codes and hospitalizations represented per 100,000 total inpatient population. Colorectal cancer hospitalizations demonstrated a significant uptrend in the 41-50years age group, with Caucasians and females most affected, stratifying for age and excluding those with a family history of colorectal cancer (p trend < 0.001). Younger colorectal cancer patients aged 41-50years (especially younger Caucasian females) are burdened with increasing hospitalization rates.

&lt;p&gt;Salzmann nodular degeneration: prevalence, impact, and management strategies&lt;/p&gt;

PurposeThis review will summarize the clinical and histological presentation of Salzmann nodular degeneration (SND), its prevalence and risk factors, potential underlying mechanisms, diagnostic tools, management options, and impact on cataract surgery and co-morbid ocular surface diseases.MethodPubMed review of 44 articles published between 1976 and 2018.ResultsSND is a corneal disease characterized by whitish gray or bluish nodules on the peripheral or central cornea. The clinical presentation of SND is variable and the nodules can be asymptomatic or cause foreign body sensation and/or blurred vision. Histologically, SND appears as subepithelial nodules with thin overlying epithelium, disrupted or absent Bowman’s layer, and activated fibroblasts within the nodule. SND pathogenesis is not fully understood but is thought to involve poor epithelial protection and disruption of the epithelial–stromal interface, allowing for penetration of epithelially derived growth factors into the stroma and subsequent activation of stromal fibroblasts, eventually leading to sub-epithelial deposition of disorganized extracellular membrane components. SND most commonly occurs in Caucasian females in a bimodal distribution, occurring in the fifth or eighth and ninth decades of life. Risk factors for SND include ocular surface diseases and surgery. Surgical intervention is recommended in individuals with symptomatic nodules – primarily superficial keratectomy performed with or without intraoperative mitomycin C, photokeratectomy, and/or amniotic membrane transplantation. These procedures have been successful in removing the lesion and reducing corneal irregularity, but have variable recurrence rates (0–31%).ConclusionThe pathogenesis of SND is complex and multifactorial. Advances in diagnostic and treatment modalities have allowed for earlier and more accurate diagnosis and effective treatment of SND.

TIMP2 Polymorphisms Association With Curve Initiation and Progression of Thoracic Idiopathic Scoliosis in the Caucasian Females.

Idiopathic scoliosis (IS) etiology remains unclear, but strong genetic background is suggested. Previously reported TIMP2 study indicates an association of genic rs8179090 with IS progression in a Han Chinese population. However, there has been a lack of investigation into intragenic TIMP2 polymorphisms in IS patients. We recruited 100 Caucasian females with IS and 100 controls. Patients were subdivided accordingly to: progression rate, curve severity, joint mobility, and curve pattern. Allele-specific-polymerase chain reaction based on fluorescence resonance energy transfer was applied to evaluate nine TIMP2 polymorphisms. Distribution of genotype and allele frequency in only one polymorphism (rs11658743) differed in case-control study. Four of the polymorphisms (rs2277700, rs11077401, rs2376999, and rs4789934) showed non-equal distributions either in genotype or/and allele distributions in the patients of different progression rates. The rs11077401 was related to curve severity patients distinction and the rs8179090 distinguished patients with different joint mobility level. Two polymorphisms either differed statistically in case of curve patterns subgrouping (rs8068674 and rs8179090) or showed a slight tendency toward significance in the recessive model of allele distributions (rs9916809 and rs8179090). The remaining two polymorphisms (rs2377005, rs11658743) showed no association with either clinical or radiographic IS characteristics. The influence of the G allele of the rs8179090 on the clinical course of IS has not yet been confirmed. We identified four TIMP2 polymorphisms (rs11077401, rs2376999, rs2277700, and rs4789934) that were associated with a higher risk of the progressive IS form. Further genetic association studies based on suggested clinical criteria would be necessary to validate TIMP2 polymorphisms associated with the curve progression. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2217-2225, 2019.

Use of formulations for sensitive skin improves the visible signs of aging, including wrinkle size and elasticity.

Background: Sensitive skin affects an increasingly large proportion of the population and is less tolerant to frequent and prolonged use of cosmetics. This study investigates the antiaging effects of a skin care system developed for use on sensitive skin.Methods: A total of 30 healthy Caucasian females, aged 32–72, were enrolled in this double-blind randomized placebo-controlled split-face study. A routine consisting of twice daily topical applications of the test cleanser and test moisturizer or placebo or positive control products was followed for 28 days, with parameters measured at baseline and at 7-day intervals. Objective skin assessments for hydration, transepidermal water loss (TEWL), skin surface topography, elasticity and safety assessment were conducted.Results: Wrinkle surface, length and depth significantly improved by 34.8±4.7% (P<0.001), 19.0±3.2% (P<0.05) and 24.3±3.5% (P<0.05), respectively, after 28 days of skin care treatment with the test cleanser and test moisturizer. R2 (gross elasticity), R5 (net elasticity) and R7 (biological elasticity) significantly increased by 32.8±6.5% (P<0.001), 47.3±8.6% (P<0.001) and 50.6±5.1% (P<0.001), respectively, while R6 (viscoelastic portion) significantly decreased by 33.4±4.6% (P<0.001) after 28 days. Skin hydration was also found to increase significantly after 28 days by 42.2±8.5% (P<0.01), but there was no change in TEWL. No adverse events were reported.Conclusions: A novel skin care routine developed for use on sensitive skin significantly improves the signs of aging including hydration, wrinkle size and elasticity without significant adverse effects.

Cannabis Use and Markers of Systemic Inflammation: The Coronary Artery Risk Development in Young Adults Study

BackgroundIt is unclear whether cannabis use in humans plays a role in the regulation of inflammatory responses. This study aimed to examine cannabis-attributable immunomodulation as manifested in levels of fibrinogen, C-reactive protein (CRP), and interleukin-6 (IL-6). MethodsThe Coronary Artery Risk Development in Young Adults (CARDIA) study is a cohort of 5115 African-American and Caucasian males and females enrolled in 1985-1986, and followed up for over 25 years, with repeated measures of cannabis use. Fibrinogen levels were measured at year 5, year 7, and year 20, CRP levels were measured at year 7, year 15, year 20, and year 25, and IL-6 levels were measured at year 20. We estimated the association of cannabis use and each biomarker using generalized estimating equations adjusting for demographic factors, tobacco cigarette smoking, alcohol drinking, and body mass index. ResultsCompared with never use (reference), recent cannabis use was not associated with any of the biomarkers studied here after adjusting for potential confounding variables. Former cannabis use was inversely associated with fibrinogen levels (β = −5.4; 95% confidence interval [CI], −9.9, −0.9), whereas the associations were weaker for serum CRP (β = −0.02; 95% CI, −0.10, 0.06) and IL-6 (β = −0.06; 95% CI, −0.13, 0.02). ConclusionsA modest inverse association between former cannabis use and fibrinogen was observed. Additional studies are needed to investigate the immunomodulatory effects of cannabis while considering different cannabis preparation and mode of use.

Nation-wide trends in mortality of patients with ocular and orbit melanoma: 2000 to 2014.

e21061 Background: Ocular and orbit melanoma is a rare subtype of melanoma for which outcomes have not been adequately reported. In this study we he have analyzed the incidence-based mortality trends of ocular and orbit melanoma over a 15 year period. Most ocular melanomas originate from the uvea and to a lesser extent from the conjunctiva. Primary orbital melanoma is exceedingly rare. The incidence of ocular melanoma has been stable for the past few decades but incidence-based mortality has not been studied over the past 15 years. Methods: The Surveillance, Epidemiology, and End Results (SEER) Database was utilized to query the incidence-based mortality for all patients diagnosed with ocular and orbit melanoma for the years 2000 to 2014. The results were grouped by gender and race (Caucasian/White, African American/Black, American Indian/Alaskan native and Asian/Pacific Islander). Paired T-test was used to determine statistically significance difference between various subgroups (p &lt; 0.05). Results: Incidence-based mortality has been the highest in Caucasian/White patients from 2000 to 2014 followed by African American/Black and Asian/Pacific Islander patients. American Indian/Alaskan native patients appear to have the least mortality. There was a statistically significant difference (p &lt; 0.05) in mortality between Caucasian/White patients from 2000 to 2014 followed by African American/Black and Asian/Pacific Islander patients. The sample size for African American/Black and American Indian/Alaskan native patients was too low for discerning a meaningful trend in mortality. Overall it appears that Caucasian males and females have a far higher and worsening incidence-based mortality compared to other races. Conclusions: Ocular melanoma and orbit melanoma are rare entities which are predominantly seen in Caucasian/White patients. This study shows that the incidence-based-mortality has been worsening for these patients in the past two decades. These entities have poor prognosis and have not been studied extensively in immunotherapy trials. This study highlights the need for new clinical trials to help improve the mortality rates.

KRAS mutation and microsatellite instability in colorectal cancer: Screening pattern and mutational landscape across the US.

e15138 Background: To assess screening patterns for KRAS mutation and microsatellite instability (MSI), associated mutational prevalence in colorectal cancer (CRC), and whether mutational screening affects survival. Methods: Patients with adenocarcinoma of the colon, sigmoid, and rectum were included from the 2010-2015 National Cancer Database. Socioeconomic, geographic and cancer factors were correlated with screening patterns. Propensity score matching was used to account for confounding. Overall survival was assessed in the matched cohort via Cox proportional hazards models. Results: 371,669 patients were included, of which 113,197 (30.4%) were screened: n=63,967 for MSI, n=33,319 for KRAS, and n=15,911 for MSI + KRAS. Younger patients with private insurance, high income locally advanced and metastatic sigmoid CRC treated at academic centers in Middle Atlantic and New England states were more likely to be screened. MSI was more prevalent among older female Caucasians from East South Central and Middle Atlantic States. KRAS mutation showed no significant discrepancies according to patient age or US geography, but was more prevalent among female African Americans. KRAS mutation was associated with locally advanced and metastatic CRC. MSI was more common in localized, non-metastatic CRC. Distinct mutational patterns were evident among primary CRC sites, with highest mutation rates in cecum/appendix and ascending colon (table). In the propensity score matched cohort with balanced distribution of confounders (n=157,678), mutational screening was not associated with overall survival (HR=1.012, 95% CI: 0.99-1.03, p=0.15). MSI versus MSS did not significantly influence patients´ overall survival (matched cohort n=26,014, HR=1.00, 95% CI: 0.96-1.05, p=0.88). Kras mutation versus wildtype showed decreased overall survival after accounting for confounders (matched cohort n=28,084, HR=1.11, 95% CI: 1.07-1.15, p&lt;0.001). Conclusions: Testing for MSI and Kras mutation in CRC shows distinct patterns across the US, but does not influence outcomes. Decreased overall survival is observed in those patients with Kras mutation versus wildtype. [Table: see text]

Assessment of interprofessional collaboration before and after a simulated disaster drill experience

IntroductionWith increasing acuity, patient care requires a collaborative approach by a team of providers. Recent literature indicates healthcare professionals lack the ability to work in collaboration with other healthcare professionals resulting from communication and collaborative practice gaps. Background/LiteratureDisasters require a rich collaboration of teams in order to be effective. As a result, interprofessional collaboration is a foundational underpinning of disaster preparedness. The overall purpose of this study was to assess perceptions of interprofessional collaboration before and after participating in an interprofessional simulated disaster drill as part of a Community Health Nursing course. MethodsThis pre-test, post-test descriptive research design assessed communication, collaboration, roles/responsibilities, patient focus, team functioning and conflict management of nursing students who participated in a simulated disaster drill. Data/ResultsParticipants were nursing majors and primarily Caucasian females (n = 50, 89% and n = 56, 97% respectively), representative of the school of nursing population at the University. Wilcoxon Signed-Ranks test indicated that scores for the total ICAR post-test were significantly lower than the Total ICAR pre-test (Z = −2.006, p = .045, r = −0.19). While each of the individual sections of the ICAR had a lower mean score on the ICAR post-test as compared to the pre-test, collaborative patient/client-family centered approach was statistically significant (p = 0,0.002). DiscussionFollowing the simulated disaster drill experience, nursing students identified gaps in communication, collaboration, roles and responsibilities, collaborative patient/client-family centered approach, team functioning, conflict management/resolution. ConclusionsThe study assessed the perceptions of interprofessional collaboration among undergraduate nursing students before and after a simulated disaster drill. The assessment identified the need to integrate interprofessional competencies in disaster preparedness education.

Long Noncoding RNA Analyses for Osteoporosis Risk in Caucasian Women.

Osteoporosis is a prevalent bone metabolic disease characterized by bone fragility. As a key pathophysiological mechanism, the disease is caused by excessive bone resorption (by osteoclasts) over bone formation (by osteoblasts). Peripheral blood monocytes (PBMs) is a major systemic cell model for bone metabolism by serving as progenitors of osteoclasts and producing cytokines important for osteoclastogenesis. Protein-coding genes for osteoporosis have been widely studied by mRNA analyses of PBMs in high versus low hip bone mineral density (BMD) subjects. However, long noncoding RNAs (lncRNAs), which account for a large proportion of human transcriptome, have seldom been studied. In this study, microarray analyses of monocytes were performed using Affymetrix exon 1.0 ST arrays in 73 Caucasian females (age: 47-56). LncRNA profile was generated by re-annotating exon array for lncRNAs detection, which yielded 12,007 lncRNAs mapped to the human genome. 575 lncRNAs were differentially expressed between the two groups. In the high BMD subjects, 309 lncRNAs were upregulated and 266 lncRNAs were downregulated (nominally significant, raw p-value < 0.05). To investigate the relationship between mRNAs and lncRNAs, we used two approaches to predict the target genes of lncRNAs and found that 26 candidate lncRNAs might regulate mRNA expression. The majority of these lncRNAs were further validated to be potentially correlated with BMD by GWAS analysis. Overall, our findings for the first time reported the lncRNAs profiles for osteoporosis and suggested the potential regulatory mechanism of lncRNAs on protein-coding genes in bone metabolism.

Smile dimensions in adult African American and Caucasian females and males.

To test smile dimension variations in adult African American and Caucasian females and males. The University of Alabama at Birmingham School of Dentistry and Hospital. Three hundred and ninety-four participants were recruited; African American females and males distributed over five age groups: 20-30, 30-40, 40-50, 50-60 and older than 60. Three-dimensional surface imaging was used to acquire two images of each participant, one at rest and one upon smile. Landmarks were plotted on the lips and linear distances measured to assess the length of the upper and lower lips, mouth width at rest and upon smile, gingival and dental display upon smile. Linear dimensions are larger in males than in females, and in African Americans than in Caucasians, except for the length of the upper lip that does not differ between male African American and Caucasian males, in any given age group. Gingival display and dental display decrease with age in all groups. Norms should reflect race, age and sex in order to optimize treatment goals.

Race/Ethnicity and Sex and Opioid Administration in the Emergency Room.

Although racial/ethnic and sex disparities have been examined in health care generally and pain management more specifically, the combined influence of these sociodemographic factors together has not been well documented. The aim of this study was to examine the association between administration of opioid analgesics in the emergency department (ED) and interaction of race/ethnicity and sex. We conducted a retrospective cohort study using 2010-2014 Center for Disease Control-National Hospital Ambulatory Medical Care Survey data for patients 12-55 years of age presenting to EDs with a primary diagnosis of appendicitis or gallbladder disease as defined by International Classification of Diseases, Ninth Revision codes. The primary outcome was the receipt of opioid analgesic medications. Secondary outcomes included: receipt of nonopioids, receipt of antiemetic medications, wait time to see a provider, and length of visit in the ED. The association between sex and analgesic receipt within Caucasian non-Hispanic and non-Caucasian groups was evaluated adjusting for pain score on presentation, patient age, emergent status, number of comorbidities, time of visit (month, day of the week, standard versus nonstandard working hours, year), and US region. After exclusions, a weighted sample of 553 ED visits was identified, representing 2,622,926 unique visits. The sample population was comprised of 1,858,035 (70.8%) females and 1,535,794 (58.6%) Caucasian non-Hispanics. No interaction was found in adjusted sampling-weighted model between sex and race/ethnicity on the odds of receiving opioids (P = .74). There was no difference in opioid administration to males as compared to females (odds ratio [OR] = 0.96, 95% CI, 0.87-1.06; P = .42) or to non-Caucasians as compared to Caucasians (OR = 0.99, 95% CI, 0.89-1.10; P = .84). In adjusted weighted models, non-Caucasian males, 123,121/239,457 (51.4%) did not differ from Caucasian non-Hispanic males, 317,427/525,434 (60.4%), on odds of receiving opioids, aOR = 0.88, 95% CI, 0.39-1.99; P = .75. Non-Caucasian females, 547,709/847,675 (64.6%) also did not differ from Caucasian females, 621,638/1,010,360 (61.5%), on odds of receiving opioids, aOR = 1.01, 95% CI, 0.53-1.90; P = .98. Across both sexes, non-Caucasians did not differ from Caucasians on receipt of nonopioid analgesics or antiemetics. Neither wait time to see a provider nor the length of the hospital visit was significantly different between sexes or race/ethnicities. Based on National Hospital Ambulatory Medical Care Survey data from 2010 to 2014, there is no statistically significant interaction between race/ethnicity and sex for administration of opioid analgesia to people presenting to the ED with appendicitis or gallbladder disease. These results suggest that the joint effect of patient race/ethnicity and sex may not manifest in disparities in opioid management.

Dynamics of hyaluronic acid fillers formulated to maintain natural facial expression.

BackgroundSubjects seeking facial rejuvenation want the results to appear natural. Currently, however, there is no consensus definition of, or assessment scale for, “naturalness.”AimsThis open‐label pilot study explored evaluation techniques and criteria to assess naturalness of facial movement and expression following optimal bilateral correction of moderate‐to‐severe nasolabial folds and marionette lines with soft‐tissue hyaluronic acid fillers formulated with XpresHAn Technology™.MethodsPrimary efficacy was investigator assessed naturalness of dynamic expressions using baseline and Day 42 posttreatment 2D video. Other evaluations included investigator assessed naturalness using static images, wrinkle severity, investigator and subject Global Aesthetic Improvement Scale assessments, and subject satisfaction.ResultsThirty Caucasian females (41‐65 years) received either Restylane ® Refyne, Restylane ® Defyne or both. Naturalness of dynamic expressions was at least maintained in all subjects. Naturalness of static expressions was not negatively affected in most subjects (96.7%). For dynamic expressions, 83.3% of subjects showed enhanced attractiveness, younger appearance and maintained naturalness.ConclusionsOverall, nasolabial folds and marionette lines improved significantly based on severity and Global Aesthetic Improvement Scale scores, with high subject satisfaction and favorable safety profile. Based on subject satisfaction and investigator assessments, using highly flexible hyaluronic acid dermal fillers did not compromise naturalness of lower facial expressions while achieving the desired improvements in attractiveness and youthfulness. The preliminary results obtained in this pilot study suggest that dynamic and static assessments of facial animation may aid the evaluation of natural outcomes in facial rejuvenation procedures.

Real-time predictors and consequences of binge eating among adults with type 1 diabetes

BackgroundObjective binge eating (OBE) is common among individuals with type 1 diabetes (T1D) and may have negative consequences for glycemic control. Recent studies have suggested that diabetes distress (i.e., emotional distress specific to diabetes and living with the burden of management) is a distinct emotional experience among individuals with diabetes. Preliminary studies have found diabetes distress is associated with eating disorder symptoms and poor glycemic control. The aim of the current study was to examine real-time emotional precursors and consequences of OBE in adults with T1D (i.e., general negative affect, specific emotional states and diabetes distress) using ecological momentary assessment methods. We also explore the impact of OBE on 2-h postprandial glycemic control relative to non-OBE eating episodes.MethodsAdults with T1D (N = 83) completed 3-days of ecological momentary assessment assessing mood and eating behavior using a telephone-based survey system. Participants were prompted to rate momentary affect, including level diabetes distress, at random intervals and reported on eating episodes. Participants also wore continuous glucose monitors allowing for ongoing assessment of glycemic control. Multi-level modeling was used to examine between- and within-person effects of momentary increases in emotions prior to eating on the likelihood of OBE and the impact of OBE on postprandial blood glucose. Generalized linear mixed models examined whether change in post-meal affect differed between OBE and non-OBE episodes.ResultsParticipants were predominately middle-aged (Mean = 42; SD = 12.43) Caucasian (87%) females (88%) reporting clinically significant eating disorder symptoms (76%). Nearly half of the sample (43%) reported OBE during the 3-day study period. The between-person effect for negative affect was significant (OR = 1.93, p < .05), indicating a 93% increased risk of OBE among individuals with higher negative affect compared to individuals with average negative affect. Between-person effects were also significant for guilt, frustration and diabetes distress (OR = 1.48–1.77, ps < .05). Analyses indicated that mean change in post-meal negative affect was significantly greater for OBE relative to non-OBE episodes (B = 0.44, p < .001). Blood glucose at 120 min postprandial was also higher for OBE than for non-OBE episodes (p = .03).ConclusionsFindings indicate that individuals who tend to experience negative affect and diabetes distress before eating are at increased risk of OBE at the upcoming meal. Results also suggest that engaging in binge eating may result in greater subsequent negative affect, including diabetes distress, and lead to elevated postprandial blood glucose levels. These findings add to a growing literature suggesting diabetes distress is related to eating disordered behaviors among individuals with T1D.

Abstract P1-14-02: A phase 2 study of low dose metronomic eribulin in metastatic breast cancer

Abstract Background: Eribulin mesylate is a non-taxane microtubule dynamics inhibitor approved by FDA in treatment of metastatic breast cancer (MBC) based on improvements in overall survival in the pivotal EMBRACE trial. Eribulin is approved at 1.4mg/m2 administered D1,8 of q21d cycle. However, this dose and schedule may have significant myelosuppression and peripheral neuropathy requiring dose reductions and treatment delays for some patients. We hypothesized that a low dose metronomic schedule will allow responding patients to remain on treatment, resulting in longer TTP (time to progression) and decreased incidence of toxicities and treatment-related discontinuations. Methods: A multi-site prospective open-label phase II trial of metronomic dosing of eribulin in patients with MBC has completed accrual of 60 patients, outcomes will be updated at presentation. Patients whose disease had progressed following 1-6 prior regimens with prior exposure to a taxane, ECOG performance status of 0 – 2, measurable disease per RECIST 1.1, with normal marrow and organ function were eligible. Eribulin was administered at 0.9mg/m2 weekly for 3 out of 4 weeks. For patients with HER2 positive disease, concurrent trastuzumab administration was allowed. Concurrent denosumab or bisphosphonates were allowed for patients with bone disease. Results: 60 patients were enrolled, average age 58 (range 34-83). Majority were postmenopausal Caucasian females, but the study included African American, Hispanic, native American, male patients. The majority of tumors were ER+, infiltrating ductal, but the study included 13 HER2+, and 12 TN tumors, with 5 ILC, and 5 mixed ILC/IDC. Nearly half of the enrolled patients had clinical benefit from the regimen, remaining on therapy for 6 months or longer, with stable disease or response; 50% had progression PD at 3 months 32% had stable disease and 18% had a partial or complete response (1, long term). Overall Survival, OS, for the entire group of heavily pre-treated patients was 1.2 years, with TN and HER2 positive patients faring better than ER+ in this small study. One HER2+ patient remains in long-term remission, off chemotherapy. The regimen was extremely well tolerated. The majority of the patients experienced grade 0 or 1 toxicity for alopecia (48/60) and peripheral neuropathy (7 with grade 2 neuropathy, 5 pre-existing, 2 with grade 3 neuropathy). There were few dose reductions (n=15), thrombocytopenia (11 grade 1 only), or use of G-CSF (14). Conclusions: Metronomic weekly low dose eribulin appears to be an active and tolerable regimen with less myelosuppression, alopecia and peripheral neuropathy than is seen with approved dose, allowing longer duration of use and disease control, with similar outcomes compared to the standard dose regimen. Outcomes will be updated at presentation. Citation Format: Chalasani P, Liu AJ, Khanjian JA, Peha M, Buening BJ, Gadi VK, Specht JM, Salazar L, Linden HM. A phase 2 study of low dose metronomic eribulin in metastatic breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-14-02.

Obesity is associated with altered gene expression in human tastebuds.

The role of taste perception in the development and persistence of obesity is currently unclear due to conflicting results from psychophysical and other studies. No study to date has assessed whether there is an underlying fundamental difference in the physiology of taste tissue between lean and obese individuals. We analysed the transcriptomic profile (RNA-seq) of human fungiform taste papillae biopsied from lean (n = 23) and obese (n = 13) Caucasian females (age range 18-55) to identify differences in gene expression. Obesity status was the major contributor to variance in global gene expression between individuals. A total of 62 genes had significantly different gene expression levels between lean and obese (P < 0.0002), with the specific taste associated genes phospholipase C beta 2 (PLCβ2) and sonic hedge-hog (SHH) having significantly reduced expression in obese group. Genes associated with inflammation and immune response were the top enriched biological pathways differing between the lean and the obese groups. Analysis of a broader gene set having a twofold change in expression (2619 genes) identified three enriched theme groups (sensory perception, cell and synaptic signalling, and immune response). Further, analysis of taste associated genes identified a consistent reduction in the expression of taste-related genes (in particular reduced type II taste cell genes) in the obese compared to the lean group. The findings show obesity is associated with altered gene expression in tastebuds. Furthermore, the results suggest the tastebud microenvironment is distinctly different between lean and obese persons and, that changes in sensory gene expression contribute to this altered microenvironment. This research provides new evidence of a link between obesity and altered taste and in the future may help design strategies to combat obesity.

A morphometric study of age- and sex-dependent changes in eyebrow height and shape✰

Rejuvenation procedures of the periorbital region and the forehead, with the eyebrow as a key structure, are often performed in plastic surgery. There is no common consent on the changes of aging in this region and the consecutive treatment options. This study was designed to support the body of literature with a broader data basis about the natural changes of eyebrow position and its shape. The brow shape, the lid axis, and the distance between both medial canthi (DMC) were analyzed retrospectively on randomly selected standardized photographs of healthy Caucasian females and males. Six defined heights of the upper brow border, including the position and height of the highest brow point (HBP) and the angle of the upper brow line, were measured. A total of 244 Caucasian females and males in two groups (<34 years and >55 years) were analyzed. The data showed a difference between brow shapes of young females and males, especially relating to the HBP, which is located medially in young females. The brow shape of females assimilates toward a male shape with aging. The eyebrow moves upward, the DMC widens, and the lid axis drops laterally in both sexes with aging. Our data suggest that rejuvenation procedures should focus on not only lifting the brow but also reshaping and stabilizing the brow, especially the HBP, which plays an important role in defining the upper brow line. Our findings can explain why lifting the brow can create not only an undesired surprise but also an older look.

Circulating 25-hydroxycholecalciferol in Relationship to Central Dual-Energy X-Ray Absorptiometry Assesses. A clinical study

The aim of the research was to realize a clinical study on menopausal patients, focused on 25-hydroxyvitamin D (25OHD) assays versus Dual-Energy X-Ray Absorptiometry (DXA) categories. This transversal, observational, real-life study was effectuated on Caucasian Romanian females. A total of 60 subjects were grouped according to lumbar T-score: normal T-score (N=28), osteopenia (N=22), and osteoporosis (N=10). The lowest average value of 25OHD is found in patients with osteoporosis, which is statistically significant lower than in patients with osteopenia. The average values of PTH were within normal levels for each group. 25OHD did not correlate with PTH or lumbar BMD. Overall the mean values of 25OHD are in deficient ranges regardless osteoporosis, osteopenia or normal DXA.

Adherence to Guideline Recommendations in Patients with Thyroid Nodules

Thyroid nodules are common and fine-needle aspiration (FNA) biopsy is the standard of care for work-up to exclude thyroid cancer. In this study, we examined the discrepancy between daily practice and recommended diagnostic approach for management of thyroid nodules, based on history taking, laboratory, and imaging studies. This was a retrospective chart review of 199 patients who had ultrasound-guided fine needle aspiration (UGFNA) performed at a Midwest academic medical center from January 2010 to December 2011. The quality measures were selected based on recommended clinical practice guidelines, including family history, history of neck radiation, neck symptoms, TSH test, and thyroid ultrasound. The majority of patients were Caucasian females. Family history of thyroid cancer and childhood neck radiation exposure were documented in 79 subjects (40%) and 76 subjects (38%), respectively. Neck symptoms were documented in most subjects, including dysphonia (56.8%), dysphagia (69.9%), and dyspnea (41.2%). Most subjects had a TSH measured and an ultrasound performed prior to biopsy (75% and 86%, respectively). It appears there is a gap between current patient care and clinical practice guidelines for management of thyroid nodules. Clinical history and ultrasound features for risk stratification of UGFNA were lacking, which could reflect physicians' unfamiliarity with the guidelines. As thyroid nodules are common, enhancing knowledge of the current guidelines could improve appropriate work-up. Further studies are needed to identify factors associated with the poor compliance with clinical guidelines in management of thyroid nodules.

Demographic, Clinical, and Radiologic Characteristics of a Cohort of Patients with Takayasu Arteritis

Takayasu arteritis is a rare large-vessel vasculitis that predominantly affects females of Asian descent. This retrospective analysis was performed to increase understanding of the epidemiology of the disease in the United States. We performed a retrospective cohort study in 2 tertiary centers. Patients were selected according to the American College of Rheumatology classification criteria for Takayasu arteritis. Data collected included demographic characteristics and details of physical examinations, treatments, and surgical interventions. Data were managed with REDCap (Research Electronic Data Capture) tools. The study included 57 patients. The female:male ratio was 4.2:1, the median age at diagnosis was 29 years, 61.4% of the patients were Caucasians, and 86% of the patients had stenosis on imaging. Hata V was the most common angiographic classification (37.5% of patients). Vascular interventions were required in 43.9% of patients. The most frequent complications were hypertension (56.1%), renal artery stenosis (28.1%), and aortic insufficiency (19.3%). Takayasu arteritis continues to be a rare large-vessel vasculitis. In the United States, it tends to affect predominantly Caucasian females, with cervicobrachial involvement. This cohort reflects the morbidity, multiple interventions, and complications experienced by patients with Takayasu arteritis.

Hidradenoma papilliferum of the vulva with extensive squamous metaplasia mimicking malignancy: Rare entity with diagnostic challenge

Hidradenoma papilliferum (HP) is an uncommon benign cutaneous adnexal neoplasm of the anogenital region commonly seen in middle-aged, Caucasian females. Anastomosing and branching tubules, lined by columnar cells, and a basal layer of myoepithelial cells are the characteristic histopathological features. We report a case of HP in a 60-year-old female presented with a vulvar lesion. The case was evaluated for malignancy, with the initial histopathology showing extensive squamous metaplasia but ultimately found to have HP.