Human Papillomavirus (HPV)-Associated Cancers Among Hispanic Males in the United States: Late-Stage Diagnosis by Country of Origin.

INTRODUCTION: The epidemiology of human papillomavirus (HPV)-associated cancers has changed since the development of the multivalent vaccine. This is evidenced by the decline in incidence of cervical cancers in the post-vaccine era. By contrast, studies have reported the rise in incidence of these cancers in males. Though little is known regarding HPV-associated cancers in males, Hispanic males have been largely excluded from research on these cancers. OBJECTIVE: The purpose of this study was to examine the differences in late-stage diagnosis of HPV-associated cancers (oropharyngeal, anorectal, or penile) among subgroups of Hispanic males in the U.S. METHODS: We performed a population-based retrospective cohort study using the 2005-2016 North American Association of Central Cancer Registries Cancer in North America Deluxe data file (n = 9242). Multivariable logistic regression modeling was used in studying late-stage diagnosis. RESULTS: There were no differences in late-stage diagnosis of oropharyngeal cancer between Hispanic subgroups. Higher odds of late-stage penile cancers were observed among Mexican and Puerto Rican males relative to European Spanish males. Lower odds of late-stage anorectal cancers were observed among Central or South American and Puerto Rican males. Having Medicaid or no insurance were associated with late-stage diagnosis for all cancers. CONCLUSION: Certain subgroups of Hispanic males have higher odds of late-stage HPV-associated cancer diagnosis based on country of origin and insurance status. These findings call for improved efforts to increase HPV vaccination, particularly among these subgroups of Hispanic males. Efforts to improve health care access and early detection from health care providers are also needed.

Acute respiratory distress syndrome and COVID-19 in a child with systemic lupus erythematosus.

We report a case of COVID-19 in a pediatric patient with systemic lupus erythematosus (SLE), who presented with respiratory distress marked by increased work of breathing and low oxygen saturation. Lab tests confirmed COVID-19, and showed lymphocytopenia and elevated markers of inflammation and coagulopathy. Chest X-ray showed bilateral mid-lung opacities, and the patient required intubation early in his disease course. Imaging and clinical findings were consistent with acute respiratory distress syndrome (ARDS) with inflammation. The patient was treated with different combinations of antivirals (hydroxychloroquine and remdesivir), cytokine inhibitors (anakinra and tocilizumab), glucocorticoids (hydrocortisone and methylprednisolone), and an anticoagulant (enoxaparin). Inflammatory markers decreased before clinical improvement in lung aeration. This case highlights the potential for pediatric patients with SLE to present with COVID-19 similar to the clinical presentation described in adults.

Trabecular Bone Structure in the Distal Femur of Humans, Apes, and Baboons.

Trabecular bone structure has been used to investigate the relationship between skeletal form and locomotor behavior on the premise that trabecular bone remodels in response to loading during an animal's lifetime. The aim of this study is to characterize human distal femoral trabecular bone structure in comparison to three non-human primate taxa and relate the patterns of trabecular structural variation in the distal femur to knee posture during habitual locomotor behavior. A whole-epiphysis approach was applied using microCT scans of the distal femora of extant Homo sapiens, Pan troglodytes, Pongo pygmaeus, and Papio spp. (N = 48). Bone volume fraction (BV/TV) was quantified in the epiphysis and analyzed with both whole-condyle and a novel sector analysis. The results indicate high trabecular bone structural variation within and between species. The sector analysis reveals the most distinctive patterns in the stereotypically loaded human knee, with a pattern of high BV/TV distally. In general, Pan, Pongo, and Papio show evidence of flexed knee postures, typical of their locomotor behaviors, with regions of high BV/TV posteriorly within the condyles. The pairwise comparisons confirm the unique pattern in Homo and reveal a shared high BV/TV region in the patellar groove of both Homo and Papio. The distinct pattern found in Homo relative to the other primate taxa suggests a plastic response to unique loading patterns during bipedal locomotion. Results may facilitate resolving the antiquity of habitual bipedality in the hominin fossil record. This analysis also presents new approaches for statistical analysis of whole-epiphysis trabecular bone structure. Anat Rec, 2018. © 2018 American Association for Anatomy.

Asymmetry in the Cortical and Trabecular Bone of the Human Humerus During Development.

Many studies have noted that the bones of the human upper limb display bilateral asymmetry, commonly linking this asymmetry in external and internal morphology to handedness and lateralization. Few studies, however, have attempted to track asymmetry throughout ontogeny. This study assesses the ontogenetic development of cortical and trabecular bone asymmetry in the humerus. We predict that directional asymmetry in structural properties will emerge in concert with hand preference and increased activity levels during the juvenile period. Paired humeri from 57 individuals from the Norris Farms #36 archaeological skeletal collection ranging in age from neonate to adult were used in the current study. Cortical bone cross-sectional properties and three-dimensional trabecular bone structure were quantified from microcomputed tomography data. The results indicate significant absolute asymmetry in all measured cortical and trabecular bone variables across all ages. Trabecular bone displays significantly higher absolute asymmetry than cortical bone. Contrary to expectations, however, this study found very little evidence for significant directional asymmetry in humeral length and cortical or trabecular bone variables, except in adults. The presence of significant absolute asymmetry in all age groups, and the lack of significant directional asymmetry in almost all variables at all ages, suggests that structural differences due to higher levels of habitual loading in the dominant arm are overlain on a template of potentially significant existing asymmetry. Anat Rec, 301:1012-1025, 2018. © 2017 Wiley Periodicals, Inc.

Evolution of the hominin knee and ankle.

The dispersal of the genus Homo out of Africa approximately 1.8 million years ago (Ma) has been understood within the context of changes in diet, behavior, and bipedal locomotor efficiency. While various morphological characteristics of the knee and ankle joints are considered part of a suite of traits indicative of, and functionally related to, habitual bipedal walking, the timing and phylogenetic details of these morphological changes remain unclear. To evaluate the timing of knee and ankle joint evolution, we apply geometric morphometric methods to three-dimensional digital models of the proximal and distal tibiae of fossil hominins, Holocene Homo sapiens, and extant great apes. Two sets of landmarks and curve semilandmarks were defined on each specimen. Because some fossils were incomplete, digital reconstructions were carried out independently to estimate missing landmarks and semilandmarks. Group shape variation was evaluated through shape-and form-space principal component analysis and fossil specimens were projected to assess variation in the morphological space computed from the extant comparative sample. We show that a derived proximal tibia (knee) similar to that seen in living H. sapiens evolved with early Homo at ∼2 Ma. In contrast, derived characteristics in the distal tibia appear later, probably with the arrival of Homo erectus. These results suggest a dissociation of the morphologies of the proximal and distal tibia, perhaps indicative of divergent functional demands and, consequently, selective pressures at these joints. It appears that longer distance dispersals that delivered the Dmanisi hominins to Georgia by 1.8 Ma and H. erectus to east-southeast Asia by 1.6 Ma were facilitated by the evolution of a morphologically derived knee complex comparable to that of recent humans and an ankle that was morphologically primitive. This research sets the foundation for additional paleontological, developmental, and functional research to better understand the mechanisms underlying the evolution of bipedalism.

An ontogenetic framework linking locomotion and trabecular bone architecture with applications for reconstructing hominin life history.

The ontogeny of bipedal walking is considered uniquely challenging, due in part to the balance requirements of single limb support. Thus, locomotor development in humans and our bipedal ancestors may track developmental milestones including the maturation of the neuromuscular control system. Here, we examined the ontogeny of locomotor mechanics in children aged 1-8, and bone growth and development in an age-matched skeletal sample to identify bony markers of locomotor development. We show that step-to-step variation in mediolateral tibia angle relative to the vertical decreases with age, an indication that older children increase stability. Analyses of trabecular bone architecture in the distal tibia of an age-matched skeletal sample (the Norris Farms #36 archaeological skeletal collection) show a bony signal of this shift in locomotor stability. Using a grid of eleven cubic volumes of interest (VOI) in the distal metaphysis of each tibia, we show that the degree of anisotropy (DA) of trabecular struts changes with age. Intra-individual variation in DA across these VOIs is generally high at young ages, likely reflecting variation in loading due to kinematic instability. With increasing age, mean DA converges on higher values and becomes less variable across the distal tibia. We believe the ontogeny of distal tibia trabecular architecture reflects the development of locomotor stability in bipeds. We suggest this novel bony marker of development may be used to assess the relationship between locomotor development and other life history milestones in fossil hominins.