Publications by authors named "Maureen Sullivan"

62 Publications

The role of the parent-child relationship in fostering resilience in American Indian/Alaskan Native children.

J Community Psychol 2021 Mar 1;49(2):419-431. Epub 2020 Nov 1.

Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA.

Resilience is a key characteristic to study in families, particularly those who have experienced significant systemic risk factors. While much resilience research focuses on ethnic and cultural minorities, little research focuses specifically on American Indian/Alaskan Native (AI/AN) families. The parent-child relationship has been demonstrated to be a key characteristic in families, and this relationship may also serve as a protective factor for AI/AN families. Positive parent-child relationships are consistently linked to positive child outcomes, and parental psychological symptoms are linked with child psychological symptoms in non-Native families. These associations warrant further examination among AI/AN families. We hypothesized that the parent-child relationship would moderate the link between parent distress (i.e., depressive and anxious symptoms) and child internalizing problems in a sample of 57 AI/AN parents of children 3-5 years of age. As expected, the parent-child relationship moderated the associations between parent anxiety symptoms and child internalizing symptoms, and between parent depressive symptoms and child internalizing symptoms. Furthermore, the strength of the parent-child relationship buffered the effects of parent distress on child internalizing symptoms. Results highlight the potentially protective role of strong parent-child relationships in AI/AN families.
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http://dx.doi.org/10.1002/jcop.22468DOI Listing
March 2021

Serial Testing for SARS-CoV-2 and Virus Whole Genome Sequencing Inform Infection Risk at Two Skilled Nursing Facilities with COVID-19 Outbreaks - Minnesota, April-June 2020.

MMWR Morb Mortal Wkly Rep 2020 Sep 18;69(37):1288-1295. Epub 2020 Sep 18.

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), can spread rapidly in high-risk congregate settings such as skilled nursing facilities (SNFs) (1). In Minnesota, SNF-associated cases accounted for 3,950 (8%) of 48,711 COVID-19 cases reported through July 21, 2020; 35% of SNF-associated cases involved health care personnel (HCP*), including six deaths. Facility-wide, serial testing in SNFs has been used to identify residents with asymptomatic and presymptomatic SARS-CoV-2 infection to inform mitigation efforts, including cohorting of residents with positive test results and exclusion of infected HCP from the workplace (2,3). During April-June 2020, the Minnesota Department of Health (MDH), with CDC assistance, conducted weekly serial testing at two SNFs experiencing COVID-19 outbreaks. Among 259 tested residents, and 341 tested HCP, 64% and 33%, respectively, had positive reverse transcription-polymerase chain reaction (RT-PCR) SARS-CoV-2 test results. Continued SARS-CoV-2 transmission was potentially facilitated by lapses in infection prevention and control (IPC) practices, up to 12-day delays in receiving HCP test results (53%) at one facility, and incomplete HCP participation (71%). Genetic sequencing demonstrated that SARS-CoV-2 viral genomes from HCP and resident specimens were clustered by facility, suggesting facility-based transmission. Residents and HCP working in SNFs are at risk for infection with SARS-CoV-2. As part of comprehensive COVID-19 preparation and response, including early identification of cases, SNFs should conduct serial testing of residents and HCP, maximize HCP testing participation, ensure availability of personal protective equipment (PPE), and enhance IPC practices (4-5).
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http://dx.doi.org/10.15585/mmwr.mm6937a3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498172PMC
September 2020

Fabrication of a Toe Prosthesis with Paintable and Interchangeable Nail: A Clinical Report.

J Prosthodont 2020 Jun 19;29(5):453-455. Epub 2020 May 19.

Department of Dentistry/Oral Oncology and Maxillofacial Prosthetics at Erie County Medical Center, Buffalo, NY.

This report describes the treatment of a 44-year-old woman with history of left great toe amputation due to surgical complications from metatarsophalangeal joint fusion procedure. The fabrication of a prosthetic great toe with interchangeable nail that is paintable is described in detail. This prosthetic demonstrates that the clinical and laboratory techniques used in fabrication of traditional maxillofacial prosthetics can be adapted for the fabrication of somatic prosthetics to enhance quality of life.
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http://dx.doi.org/10.1111/jopr.13184DOI Listing
June 2020

Correlation Between Etest and Reference Broth Microdilution for Antimicrobial Susceptibility Testing of .

Microb Drug Resist 2020 Apr 9;26(4):311-318. Epub 2019 Oct 9.

Divisions of Healthcare Quality Promotion and Centers for Disease Control and Prevention, Atlanta, Georgia.

A three-center study was performed to see if Etest gradient diffusion minimum inhibitory concentration (MIC) methodology correlated with reference broth microdilution (BMD) for antimicrobial susceptibility testing of against six antimicrobial agents known to be usually effective against . This study was performed to assist in the decision-making process for possible deployment of the Etest method for antimicrobial susceptibility testing of into several regional public health laboratories in the United States. Three laboratories each tested a challenge set of 30 genotypically diverse isolates collected from 15 different countries. MICs were performed by both Etest gradient diffusion and reference BMD for amoxicillin/clavulanate, ceftazidime, doxycycline, imipenem, tetracycline, and trimethoprim/sulfamethoxazole. Etest results for amoxicillin/clavulanate, ceftazidime, doxycycline, and imipenem correlated well with reference BMD by both category interpretation (≥97%) and essential agreement of MIC (≥93%). Tetracycline and trimethoprim/sulfamethoxazole Etests yielded poor correlation with BMD by category interpretation (80%) and essential agreement (70%), respectively. In conclusion, Etest gradient diffusion represents a valid option for antimicrobial susceptibility testing of against amoxicillin/clavulanate, ceftazidime, doxycycline, and imipenem. Tetracycline and trimethoprim/sulfamethoxazole Etest results showed some concerning lack of correlation with the corresponding reference BMD results.
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http://dx.doi.org/10.1089/mdr.2019.0260DOI Listing
April 2020

Prevalence of in Ticks, Minnesota, 2017.

Vector Borne Zoonotic Dis 2019 08 12;19(8):596-603. Epub 2019 Feb 12.

1Foodborne, Waterborne, Vectorborne, and Zoonotic Diseases Section, Minnesota Department of Health, St. Paul, Minnesota.

The prevalence of in Minnesota ticks is unknown. Ticks collected at seven sites were tested to determine the infection prevalence of in in Minnesota. Ticks were collected from two properties at an epizootic site and at five long-term tick research sites. Ticks were pooled by species, sex, date, and site with a maximum of 10 ticks per pool. Ticks were bisected and homogenized; DNA from supernatant was extracted and tested by real-time PCR (RT-PCR). Twice, additional ticks were collected for bacterial culture and isolation of . Proportion of positive pools and minimum infection rate (MIR) were calculated. A total of 3527 ticks were tested for including 1601 male and 1926 female . Across all sites, 128 (34%) of 378 pools were RT-PCR positive for . Of 128 positive pools, from 96 (75%) was identified as type A; from 32 pools was unable to be subtyped. The overall MIR was 3.6%. The MIR was significantly lower at the epizootic site compared with Morrison County 1 (3.9% vs. 7.2%;  = 0.02) but did not differ between the epizootic site and Pine County 1 (3.9% vs. 2.1%;  = 0.49). Within the epizootic site, the MIR was significantly higher at Washington County 2 compared with the adjacent property (5.7% vs. 2.3%;  < 0.001). was cultured from 6 (15%) of 40 pools. was found in ticks at a majority of sites tested. The MIR of in ticks in Minnesota varied geographically. Our findings support the hypothesis that plays an important role in the natural history of tularemia in Minnesota. Further ecologic studies are needed to fully understand the importance of tick species in the maintenance and transmission of in Minnesota.
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http://dx.doi.org/10.1089/vbz.2018.2388DOI Listing
August 2019

Public Health and Law Enforcement Joint Investigation of Unknown Suspicious Substances and Potential Threat Evaluations, Minnesota, 2007-2016.

Health Secur 2017 Nov/Dec;15(6):642-649

From the Field is a semi-regular column that explores what it means to be a local health professional on the front lines of an emergency. Typically, National Association of County and City Health Officials (NACCHO) members share their stories of preparing for and responding to disasters, epidemics, and other major health issues. This month's column features a submission from a state health department that describes their experience in investigating white powder incidents. Through exploring the analysis of the challenges faced and the solutions developed, readers can learn how these public health champions keep their communities safe even in extreme situations. Readers may submit topics of interest to the column's editor, Meghan McGinty, PhD, MPH, MBA, at mmcginty@naccho.org.
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http://dx.doi.org/10.1089/hs.2017.0029DOI Listing
July 2018

Safety and Accuracy of Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry for Identification of Highly Pathogenic Organisms.

J Clin Microbiol 2017 12 11;55(12):3513-3529. Epub 2017 Oct 11.

Texas Department of State Health Services Laboratory, Austin, Texas, USA.

Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) sample preparation methods, including the direct, on-plate formic acid, and ethanol/formic acid tube extraction methods, were evaluated for their ability to render highly pathogenic organisms nonviable and safe for handling in a biosafety level 2 laboratory. Of these, the tube extraction procedure was the most successful, with none of the tested strains surviving this sample preparation method. Tube extracts from several agents of bioterrorism and their near neighbors were analyzed in an eight-laboratory study to examine the utility of the Bruker Biotyper and Vitek MS MALDI-TOF MS systems and their diagnostic (IVD), research-use-only, and Security-Relevant databases, as applicable, to accurately identify these agents. Forty-six distinct strains of , , , , , , , , , and were extracted and distributed to participating laboratories for analysis. A total of 35 near-neighbor isolates were also analyzed.
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http://dx.doi.org/10.1128/JCM.01023-17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5703816PMC
December 2017

Tularemia in Minnesota: an emerging and underappreciated infection.

Minn Med 2017 May;100(3):40-43

Tularemia is a rare but often serious infectious disease caused by Francisella tularensis, a bacterium with an extremely low infectious dose and the ability to cause illness through several routes including arthropod bites, contact with infected animals and exposure to contaminated water, food or soil. Tularemia is found throughout the northern hemisphere, and cases have occurred in all U.S. states except Hawaii. Thirteen cases have been reported to the Minnesota Department of Health since 1994, including 3 in 2016. This article presents the 2016 cases as well as data on all the reported cases. Clinicians should consider tularemia in patients with a compatible clinical illness and exposure history, particularly those who present with acute fever and regional lymphadenopathy. Treatment should be initiated early in highly suspect cases, without waiting for laboratory results.
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May 2017

Notes from the Field: Francisella tularensis Type B Infection from a Fish Hook Injury - Minnesota, 2016.

MMWR Morb Mortal Wkly Rep 2017 Feb 24;66(7):194. Epub 2017 Feb 24.

On June 27, 2016, the Minnesota Department of Health (MDH) Public Health Laboratory (PHL) was notified of a suspected Francisella tularensis isolate cultured at a hospital laboratory. The isolate was confirmed as F. tularensis type B at MDH PHL by reverse transcription-polymerase chain reaction, culture, and direct fluorescent antibody testing. Francisella tularensis subspecies tularensis (type A) and holarctica (type B) bacteria are the causative agents of tularemia.
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http://dx.doi.org/10.15585/mmwr.mm6607a3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657846PMC
February 2017

Comprehensive Psychometric Analysis of the Eyberg Child Behavior Inventory in Children with Autism Spectrum Disorder.

J Autism Dev Disord 2017 May;47(5):1354-1368

Department of Communication Sciences and Disorders, Oklahoma State University, 026B Murray Hall, Stillwater, OK, 74078, USA.

Many assessment measures have only been validated for one specific diagnostic population, which is costly and reduces the clinical utility of assessments. The Eyberg Child Behavior Inventory (ECBI) is one popular measure designed to assess disruptive behavior problems in youth. The ECBI has sound psychometric properties in typically developing youth, but the factor structure has never been examined in children with autism spectrum disorder (ASD). Therefore, the current study conducted a comprehensive psychometric analysis of the ECBI in children with ASD. Retrospective data from a nationally representative sample was collected from 335 children with ASD ages 2-12 years old. A four factor solution was identified for this sample. Implications of these findings and directions for future research are discussed.
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http://dx.doi.org/10.1007/s10803-017-3048-xDOI Listing
May 2017

Incorporating a Drug Information Consult into a Pharmacy Practice Course to Build Literature Search and Evaluation Skills Through a 3-Stage Model.

J Pharm Pract 2017 Jun 19;30(3):306-312. Epub 2016 May 19.

3 Department of Social, Behavioral & Administrative Pharmacy, Touro College of Pharmacy, New York, NY, USA.

Objective: Pharmacy students need to be equipped with skills to research and evaluate literature to effectively apply evidence-based medicine (EBM) in practice. To prepare them, a 3-stage approach to writing a drug information consult (3sDIC) was incorporated into a pharmacy course. The primary objective was to assess students' abilities to retrieve and analyze literature pursuant to a drug information consult. Secondary objectives were to examine feasibility of faculty participation and continuation of the assignment.

Design: Ninety students were given a clinical scenario about a patient. The assignment consisted of 3 stages incorporating use of the Population, Intervention, Comparison intervention, Outcome (PICO) method and modified systematic approach (MSA) for stage 1, evaluation of primary literature to write a draft for stage 2, and stage 3, the final consult. All 3 stages were reviewed and graded by faculty.

Assessment: All students completed the 3sDIC, with no grade failures. The rubric employed by faculty was effective, providing students the opportunity to improve the consult. The 3sDIC was found to be feasible with adequate faculty support.

Conclusion: The 3sDIC, although not a substitute for a complete drug information course, demonstrated a streamlined approach for Pharmacy year 2 (P2) students to acquire and develop drug information skills.
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http://dx.doi.org/10.1177/0897190016637793DOI Listing
June 2017

Progression of gingival squamous cell carcinoma from early to late stage after invasive dental procedure.

Gen Dent 2016 Mar-Apr;64(2):38-43

Early presentation of gingival squamous cell carcinoma (GSCC) is at times misdiagnosed as a benign inflammatory or reactive oral condition. Some misdiagnosed patients undergo unnecessary, invasive dental procedures, resulting in delayed cancer diagnosis and an increased risk of accelerated disease progression due to disruption of the periosteum and cortical bone. The records of 58 patients with biopsy-proven GSCC were retrospectively reviewed. The sample included 32 patients who underwent an invasive dental procedure (IDP) prior to cancer diagnosis and 26 patients who did not undergo an IDP (non-case group). Patients from both groups initially presented with similar symptoms. The median duration of symptoms at initial clinical presentation was 6 months for the IDP group and 2 months for the non-case group. In IDP patients, symptoms worsened after the IDP was rendered, with 37.5% presenting with a severe-grade symptom. In both groups, the majority of lesions were found on the posterior mandible and had a histologic grading of moderately differentiated GSCC. The odds of the IDP group having late-stage disease were 2.94 times greater than the odds for the control group. Stage T3/T4 malignancy was diagnosed in 77.4% of the IDP patients versus 53.8% of non-case patients. Disease-specific mortality was comparable; however, surgical treatment was significantly more extensive in the IDP group than in the non-case group. The disruption of alveolar periosteum in undiagnosed oral cancer patients results in significant delay in diagnosis, necessitating more complicated treatment regimens because of local tumor progression.
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March 2017

Bringing Light to Dental Trauma and Oral Cavity Cancer.

JAMA Otolaryngol Head Neck Surg 2015 Nov;141(11):1029

Department of Head and Neck Surgery/Plastic and Reconstructive Surgery, The Center for Oncology Care at Erie County Medical Center, Buffalo, New York.

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http://dx.doi.org/10.1001/jamaoto.2015.2407DOI Listing
November 2015

Investigation of inhalation anthrax case, United States.

Emerg Infect Dis 2014 Feb;20(2):280-3

Inhalation anthrax occurred in a man who vacationed in 4 US states where anthrax is enzootic. Despite an extensive multi-agency investigation, the specific source was not detected, and no additional related human or animal cases were found. Although rare, inhalation anthrax can occur naturally in the United States.
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http://dx.doi.org/10.3201/eid2002.130021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901464PMC
February 2014

Photodynamic therapy with 3-(1'-hexyloxyethyl) pyropheophorbide a for cancer of the oral cavity.

Clin Cancer Res 2013 Dec 2;19(23):6605-13. Epub 2013 Oct 2.

Authors' Affiliations: Photodynamic Therapy Center at the Department of Cell Stress Biology, Departments of Head and Neck Surgery, Molecular and Cellular Biology, Biostatistics and Bioinformatics, Dentistry, and Pathology, Roswell Park Cancer Institute (RPCI), Buffalo, New York.

Purpose: The primary objective was to evaluate safety of 3-(1'-hexyloxyethyl)pyropheophorbide-a (HPPH) photodynamic therapy (HPPH-PDT) for dysplasia and early squamous cell carcinoma of the head and neck (HNSCC). Secondary objectives were the assessment of treatment response and reporters for an effective PDT reaction.

Experimental Design: Patients with histologically proven oral dysplasia, carcinoma in situ, or early-stage HNSCC were enrolled in two sequentially conducted dose escalation studies with an expanded cohort at the highest dose level. These studies used an HPPH dose of 4 mg/m(2) and light doses from 50 to 140 J/cm(2). Pathologic tumor responses were assessed at 3 months. Clinical follow up range was 5 to 40 months. PDT induced cross-linking of STAT3 were assessed as potential indicators of PDT effective reaction.

Results: Forty patients received HPPH-PDT. Common adverse events were pain and treatment site edema. Biopsy proven complete response rates were 46% for dysplasia and carcinoma in situ and 82% for squamous cell carcinomas (SCC) lesions at 140 J/cm(2). The responses in the carcinoma in situ/dysplasia cohort are not durable. The PDT-induced STAT3 cross-links is significantly higher (P = 0.0033) in SCC than in carcinoma in situ/dysplasia for all light doses.

Conclusion: HPPH-PDT is safe for the treatment of carcinoma in situ/dysplasia and early-stage cancer of the oral cavity. Early-stage oral HNSCC seems to respond better to HPPH-PDT in comparison with premalignant lesions. The degree of STAT3 cross-linking is a significant reporter to evaluate HPPH-PDT-mediated photoreaction.
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http://dx.doi.org/10.1158/1078-0432.CCR-13-1735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3911775PMC
December 2013

Human papillomavirus and tobacco use in tongue base cancers.

Ear Nose Throat J 2013 Aug;92(8):372-80

Department of Head and Neck Surgery, Roswell Park Cancer Institute, Buffalo, N.Y., USA.

Human papillomavirus 16 (HPV-16) infection and tobacco use are associated with human oropharyngeal cancers. We conducted a study of the role of HPV and tobacco use in base of the tongue (BOT) cancers. DNA from 34 such cancers was subjected to HPV-16 and HPV-18-specific polymerase chain reaction analysis. Demographic and clinicopathologic data were obtained from each patient's medical record. HPV-16 was detected in 68% of tumors. Tobacco use was the only factor found to be significantly associated with HPV status. Tumors from 100% of patients who had never used tobacco tested positive for HPV, compared with only 56% of those who had ever used tobacco (Fisher exact test, p = 0.024). All tumors were associated with either tobacco use or HPV infection. These findings are consistent with the hypothesis that either tobacco use or HPV infection is necessary to the etiology of BOT tumors, and they suggest that tongue base carcinoma may be prevented by combining HPV vaccination with tobacco avoidance.
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http://dx.doi.org/10.1177/014556131309200812DOI Listing
August 2013

Osteonecrosis of the jaw - prevention and treatment strategies for oral health professionals.

Oral Oncol 2013 Sep 23;49(9):878-886. Epub 2013 Jul 23.

Department of Dentistry & Maxillofacial Prosthetics, Roswell Park Cancer Institute, Buffalo, NY, USA. Electronic address:

Patients diagnosed with multiple myeloma and metastatic breast, prostate and renal cancers have a better opportunity for longer survival due to a myriad of chemotherapies regimens that attempt to manage disease progression while decreasing treatment-related side effects. Osteonecrosis of the jaws (ONJ) is a known side effect of bisphosphonates and other anti-neoplastic drugs. This complication can lead to oncologic treatment interruptions as well as diminished quality of life. Most recommendations for treatment of ONJ are based on position papers and case reports, while evidence-based treatment paradigms are lacking. With cancer survivorship on the rise, long-term chemotherapeutic side effects are becoming more prevalent and attention to untoward oral complications cannot be understated. In this review, the accepted recommendations for dental clearance prior to head and neck chemo-radiation therapy are put forth as a means of possibly preventing and treating drug induced ONJ.
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http://dx.doi.org/10.1016/j.oraloncology.2013.06.008DOI Listing
September 2013

Adjuvant intraoperative photodynamic therapy in head and neck cancer.

JAMA Otolaryngol Head Neck Surg 2013 Jul;139(7):706-11

Department of Head and Neck Surgery, Roswell Park Cancer Institute, Buffalo, New York, USA.

Importance: There is an immediate need to develop local intraoperative adjuvant treatment strategies to improve outcomes in patients with cancer who undergo head and neck surgery.

Objectives: To determine the safety of photodynamic therapy with 2-(1-hexyloxyethyl)-2-devinyl pyropheophorbide-a (HPPH) in combination with surgery in patients with head and neck squamous cell carcinoma.

Design, Setting, And Participants: Nonrandomized, single-arm, single-site, phase 1 study at a comprehensive cancer center among 16 adult patients (median age, 65 years) with biopsy-proved primary or recurrent resectable head and neck squamous cell carcinoma.

Interventions: Intravenous injection of HPPH (4.0 mg/m2), followed by activation with 665-nm laser light in the surgical bed immediately after tumor resection.

Main Outcomes And Measures: Adverse events and highest laser light dose.

Results: Fifteen patients received the full course of treatment, and 1 patient received HPPH without intraoperative laser light because of an unrelated myocardial infarction. Disease sites included larynx (7 patients), oral cavity (6 patients), skin (1 patient), ear canal (1 patient), and oropharynx (1 patient, who received HPPH only). The most frequent adverse events related to photodynamic therapy were mild to moderate edema (9 patients) and pain (3 patients). One patient developed a grade 3 fistula after salvage laryngectomy, and another patient developed a grade 3 wound infection and mandibular fracture. Phototoxicity reactions included 1 moderate photophobia and 2 mild to moderate skin burns (2 due to operating room spotlights and 1 due to the pulse oximeter). The highest laser light dose was 75 J/cm2.

Conclusions And Relevance: The adjuvant use of HPPH-photodynamic therapy and surgery for head and neck squamous cell carcinoma seems safe and deserves further study.

Trial Registration: clinicaltrials.gov Identifier: NCT00470496.
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http://dx.doi.org/10.1001/jamaoto.2013.3387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4302749PMC
July 2013

Sentinel node biopsy in lieu of neck dissection for staging oral cancer.

JAMA Otolaryngol Head Neck Surg 2013 Aug;139(8):779-82

Roswell Park Cancer Institute, Elm and Carlton St, Buffalo, NY 14263, USA.

Importance: Neck dissection is the standard staging procedure to ascertain the pathologic status of cervical lymph nodes in patients with oral cavity squamous cell carcinoma (OSCC), but it results in multiple morbidities.

Objective: To examine outcomes of patients with OSCC who underwent sentinel node biopsy (SNB) as the sole neck staging procedure.

Design: Retrospective review of patients who underwent SNB during the period 2005 through 2011.

Setting: National Cancer Institute–designated comprehensive cancer center.

Participants: Thirty-eight patients with clinically T1 or T2N0 OSCC.

Interventions: Preoperative lymphoscintigraphy with intraoperative gamma probe localization was used. Sentinel lymph nodes were serially sectioned, formalin fixed, and examined at 3 levels. All patients with positive SNB results underwent neck dissection, and the patients with negative SNB results were observed clinically.

Main Outcomes And Measures: Sensitivity and predictive value of SNB, recurrence rates, and disease-specific survival rates.

Results: There were 18 T1 and 20 T2 tumors. Five patients had positive SNB results, of whom 3 had additional positive nodes on subsequent neck dissection. Two of 33 patients with negative SNB results developed a regional recurrence. The sensitivity and negative predictive value for staging the neck with SNB alone were 71% (5 of 7) and 94% (31 of 33), respectively. Mean follow-up was 31 months. The mean disease-free survival duration for patients with positive and negative SNB results was 30 and 65 months, respectively (P = .08). The disease-specific survival rate for patients with positive and negative SNB results was 80% and 91%, respectively. There was no significant difference in disease-specific survival between patients with true-negative and false-negative SNB results (34 vs 44 months; P = .38).

Conclusions And Relevance: The majority of patients with positive results on SNB had additional positive nodes on neck dissection. A low rate of isolated neck recurrence was found in patients with negative results on SNB. Individuals with negative results on SNB exhibited better overall and disease-specific survival than those with positive results.
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http://dx.doi.org/10.1001/jamaoto.2013.3863DOI Listing
August 2013

Pretreatment weight status and weight loss among head and neck cancer patients receiving definitive concurrent chemoradiation therapy: implications for nutrition integrated treatment pathways.

Support Care Cancer 2013 Oct 7;21(10):2825-33. Epub 2013 Jun 7.

Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA,

Purpose: The purpose was to examine the effect of pretreatment weight status on loco-regional progression for patients with squamous cell carcinoma of the head and neck (SCCHN) after receiving definitive concurrent chemoradiation therapy (CCRT).

Methods: In an expanded cohort of 140 patients, we retrospectively reviewed weight status and loco-regional progression of SCCHN patients treated with CCRT between 2004 and 2010.

Results: Pretreatment ideal body weight percentage (IBW%) was statistically significantly different for patients with disease progression than for those without progression (p = 0.02) but was not an independent predictor of progression. Median pretreatment IBW% was 118 (72-193) for the progression-free group and was 101.5 (73-163) for the group with progression. Both groups suffered clinically severe weight loss of approximately 9 % from baseline to end treatment.

Conclusions: Pretreatment weight status, a very crude indicator of nutrition status, may have prognostic value in patients with SCCHN undergoing definitive CCRT. Inadequate nutritional status in these patients has been associated with poor clinical outcomes and decreased quality of life. Based on this report and others, the best next steps include routine validated malnutrition screening and the testing of evidence-based nutrition care protocols with the goals of minimizing weight loss and improvement of quality of life.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5048914PMC
http://dx.doi.org/10.1007/s00520-013-1861-0DOI Listing
October 2013

Survival rates and prognostic factors for infiltrating salivary duct carcinoma: Analysis of 228 cases from the Surveillance, Epidemiology, and End Results database.

Head Neck 2014 May 7;36(5):694-701. Epub 2013 Oct 7.

Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York; Department of Dentistry and Maxillofacial Prosthetics, Roswell Park Cancer Institute, Buffalo, New York.

Background: The survival rates and prognostic factors for salivary duct carcinoma (SDC) are not clear.

Methods: Survival estimates and prognostic factors were evaluated for 228 patients with SDC identified from the Surveillance, Epidemiology, and End Results (SEER) database.

Results: Median overall survival (OS) duration for patients with SDC was 79 months and 5-year disease-specific survival (DSS) rate was 64%. Among patients with SDC with lymph node involvement, larger primary tumor size (>3 cm) was associated with twice the risk of death (p < .03). Factors predictive of improved DSS were age (p = .01), tumor size (p = .006), tumor grade (p = .02), and lymph node involvement (p < .001). Adjuvant radiotherapy did not improve survival when compared to surgery alone for early-stage (I-II) disease (p = .28).

Conclusion: Younger patients with SDC (<50 years) showed a better prognosis. Primary tumor size and lymph node involvement were independent and additive risk factors for poor prognosis. The role of adjuvant radiotherapy in the treatment of SDC needs to be explored further.
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http://dx.doi.org/10.1002/hed.23350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4524549PMC
May 2014

Persistent complete response after single-agent sunitinib treatment in a case of TFE translocation positive relapsed metastatic pediatric renal cell carcinoma.

J Pediatr Hematol Oncol 2013 Jan;35(1):e1-3

Department of Oncology, Great Ormond Street Hospital, UCL Institute of Child Health, London, UK.

Forty percent of renal cell carcinomas (RCCs) in childhood are characterized by translocation involving transcription factor E3 (TFE3) family members. Here, we describe a case of TFE3-positive RCC in which metastatic relapse to the mediastinal lymph nodes and pulmonary nodules was treated with single-agent sunitinib, a multitargeted tyrosine inhibitor. Complete radiologic remission was achieved after only 3 courses of treatment, and surgical exploration of metastases failed to identify any residual viable disease. The published experience of sunitinib in TFE-RCC is limited, and prospective evaluation of its activity in a larger number of patients is warranted.
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http://dx.doi.org/10.1097/MPH.0b013e318266bf34DOI Listing
January 2013

Enterococcus faecalis enhances cell proliferation through hydrogen peroxide-mediated epidermal growth factor receptor activation.

Infect Immun 2012 Oct 30;80(10):3545-58. Epub 2012 Jul 30.

Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.

Enterococcus faecalis is a member of the intestinal and oral microbiota that may affect the etiology of colorectal and oral cancers. The mechanisms by which E. faecalis may contribute to the initiation and progression of these cancers remain uncertain. Epidermal growth factor receptor (EGFR) signaling is postulated to play a crucial role in oral carcinogenesis. A link between E. faecalis and EGFR signaling in oral cancer has not been elucidated. The present study aimed to evaluate the association between E. faecalis and oral cancer and to determine the underlying mechanisms that link E. faecalis to EGFR signaling. We report the high frequency of E. faecalis infection in oral tumors and the clinical association with EGFR activation. Using human oral cancer cells, we support the clinical findings and demonstrate that E. faecalis can induce EGFR activation and cell proliferation. E. faecalis activates EGFR through production of H(2)O(2), a signaling molecule that activates several signaling pathways. Inhibitors of H(2)O(2) (catalase) and EGFR (gefitinib) significantly blocked E. faecalis-induced EGFR activation and cell proliferation. Therefore, E. faecalis infection of oral tumor tissues suggests a possible association between E. faecalis infection and oral carcinogenesis. Interaction of E. faecalis with host cells and production of H(2)O(2) increase EGFR activation, thereby contributing to cell proliferation.
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http://dx.doi.org/10.1128/IAI.00479-12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3457582PMC
October 2012

Quantification of the effect of treatment duration on local-regional failure after definitive concurrent chemotherapy and intensity-modulated radiation therapy for squamous cell carcinoma of the head and neck.

Head Neck 2013 May 22;35(5):684-8. Epub 2012 May 22.

Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.

Background: The purpose of this study was to quantify the effect of treatment duration on locoregional progression after definitive concurrent chemoradiation (CCRT) for squamous cell carcinoma of the head and neck (SCCHN).

Methods: We conducted a retrospective chart review of patients treated between 2004 and 2010. After a prior analysis, measures were taken to limit therapy beyond 7 weeks. Comparison of outcomes were made between cohorts 1 (2004-2007, n = 78) and 2 (2007-2010, n = 62).

Results: Median therapy duration was statistically significantly different between cohorts as follows: 51 days, cohort 1 and 46 days, cohort 2 (p < .01). Locoregional progression in cohorts 1 and 2 was 19% and 5% (p = .01), respectively. On multivariate analysis, patients with prolonged treatment (≥57 days) had an 8-fold increase in risk of locoregional progression compared to patients who completed on time (p < .01).

Conclusion: Treatment duration was a significant predictor of locoregional progression in patients with SCCHN who received definitive CCRT.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061340PMC
http://dx.doi.org/10.1002/hed.23024DOI Listing
May 2013

Pharmacy student absenteeism and academic performance.

Am J Pharm Educ 2012 Feb;76(1)

Touro College of Pharmacy, 2090 Adam Clayton Powell Jr. Blvd, New York, NY 10027, USA.

Objectives: To assess the association of pharmacy students' personal characteristics with absenteeism and academic performance.

Methods: A survey instrument was distributed to first- (P1) and second-year (P2) pharmacy students to gather characteristics including employment status, travel time to school, and primary source of educational funding. In addition, absences from specific courses and reasons for not attending classes were assessed. Participants were divided into "high" and "low" performers based on grade point average.

Results: One hundred sixty survey instruments were completed and 135 (84.3%) were included in the study analysis. Low performers were significantly more likely than high performers to have missed more than 8 hours in therapeutics courses. Low performers were significantly more likely than high performers to miss class when the class was held before or after an examination and low performers were significantly more likely to believe that participating in class did not benefit them.

Conclusions: There was a negative association between the number of hours students' missed and their performance in specific courses. These findings provide further insight into the reasons for students' absenteeism in a college or school of pharmacy setting.
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http://dx.doi.org/10.5688/ajpe7618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298406PMC
February 2012

Pretreatment nutritional status and locoregional failure of patients with head and neck cancer undergoing definitive concurrent chemoradiation therapy.

Head Neck 2011 Nov 15;33(11):1561-8. Epub 2010 Dec 15.

Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York, USA.

Background: This study was carried out to determine if markers of nutritional status predict for locoregional failure following intensity-modulated radiation therapy (IMRT) with concurrent chemoradiotherapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN).

Methods: We performed a retrospective chart review of 78 patients with SCCHN who received definitive CCRT. We compared patient factors, tumor characteristics, and nutritional status indicators between patients with and without locoregional failure.

Results: Fifteen of 78 patients (19%) experienced locoregional failure. Median follow-up for live patients was 38 months. On univariate analysis, pretreatment percentage of ideal body weight (%IBW) (p < .01), pretreatment hemoglobin (p = .04), and treatment duration (p < .01) were significant predictors of failure. On multivariate analysis, pretreatment %IBW (p = .04) and treatment time (p < .01) remained statistically significant.

Conclusions: Although treatment time is an accepted risk factor for failure, differences in outcome for patients with head and neck cancer undergoing definitive CCRT based on pretreatment %IBW should be examined further.
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http://dx.doi.org/10.1002/hed.21640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403643PMC
November 2011

Previous head and neck cancers portend poor prognoses in lung cancer patients.

Ann Thorac Surg 2011 Sep;92(3):1056-60; discussion 1060-1

Department of Dentistry and Maxillofacial Prosthetics, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.

Background: Although a common clinical pairing, the epidemiology and prognosis of lung cancer (LC) after head and neck cancer (HNC) is not well described.

Methods: Data from the database of the Surveillance, Epidemiology and End Results (SEER) Program were used to study the epidemiology and survival of patients with LC after HNC. These data were compared with those from our institutional cancer registry.

Results: Of all patients with a history of HNC in the SEER database, 8,225 (5%) patients went on to develop LC. This was more than three times the incidence of second primary lung cancers (1.5%). Subsequent LCs in patients with a history of HNC were more common among those with hypopharyngeal and laryngeal cancer and those with localized HNC. Patients with HNC followed by LC had poorer overall survival than did the overall population of patients with LCs in the SEER database. Overall survival after the onset of LC was dismal (median survival, 8 months). Survival was not affected by histologic concordance between HNC and LC. An analysis of 72 patients with LC after HNC reported in our institutional tumor registry over the past 37 years yielded similar results.

Conclusions: Of patients who survive LC or HNC, the latter are much more likely to develop a new pulmonary malignancy. Lung cancers that develop after HNC have a poor prognosis. This phenomenon is not explained by misclassified metastases, because histologically discordant cases behave just as poorly. Enhanced surveillance and chemoprevention strategies are needed to detect and prevent subsequent primary LC in survivors of HNC.
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http://dx.doi.org/10.1016/j.athoracsur.2011.03.146DOI Listing
September 2011

Human papillomavirus types 16 and 18 in epithelial dysplasia of oral cavity and oropharynx: a meta-analysis, 1985-2010.

Oral Oncol 2011 Nov 3;47(11):1048-54. Epub 2011 Aug 3.

Department of Dentistry and MFP, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.

Human papillomavirus (HPV) types 16 and 18 are causally related to a sub-set of oral cavity and oropharyngeal squamous cell cancers. However, a clear estimate of the prevalence of HPV-16/18 in oral cavity and oropharyngeal dysplasia (OOPD) is not available. This literature review and meta-analysis was conducted to provide a prevalence estimate for HPV-16/18 in OOPD. Twenty-two studies that reported prevalence of HPV-16 and/or 18 in 458 OOPD lesions were analyzed. Meta-analysis was used to evaluate the prevalence of HPV-16/18 and logistic regression was used for stratified analysis by age, gender, and histological grade. The overall prevalence of HPV-16/18 in OOPD lesions was 24.5% [95% confidence interval (CI), 16.4-36.7%)]. The individual prevalence for HPV-16 alone was 24.4%. The prevalence of HPV-16/18 in oral cavity lesions alone was 25.3% (95% CI, 14.2-45.2%). The odds of detection of HPV-16/18 in dysplastic lesions in males were twice that of females [odds ratio (OR), 2.44]. HPV-16/18 were 3 times more common in dysplastic lesions (OR, 3.29; 95% CI, 1.95-5.53%) and invasive cancers (OR, 3.43; 95% CI, 2.07-5.69%), when compared to normal biopsies. There was no significant difference in HPV-16/18 rates between dysplastic lesions and cancers or between mild, moderate or severe dysplastic lesions. This meta-analysis provides a quantification of the prevalence of HPV types 16/18 in OOPD lesions. These results also support the assumption that HPV-16/18 infection occurs during the early phase of the oral cavity and oropharyngeal carcinogenesis.
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http://dx.doi.org/10.1016/j.oraloncology.2011.07.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3640331PMC
November 2011

Osteonecrosis of the jaw: dental outcomes in metastatic breast cancer patients treated with bisphosphonates with/without bevacizumab.

Clin Breast Cancer 2011 Aug 5;11(4):252-7. Epub 2011 May 5.

Department of Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.

The etiology, optimal management, and outcome of osteonecrosis of the jaw (ONJ) are not well understood. Because healing after mucosal trauma requires revascularization, theoretically, the combination of bevacizumab (bev) and a bisphosphonate (BP) could affect the time to development of ONJ and/or the response to dental therapy. We reviewed all cases of ONJ in metastatic breast cancer patients treated at our institution with bev+BPs and BPs alone between October 2002 and April 2010. We identified 27 ONJ patients with a median age of 57 years (range, 40 to 68 years). Seven patients received bev+BPs; 20 patients received BPs alone. Patients received intravenous zolendronate (95%), pamidronate (20%), or both (15%). Patients were treated with antibiotics (93%), alveoplasty/debridement (67%), and chlorhexidine scrub (81%). There was no difference in dental treatment between the groups or by the year of diagnosis (before 2007 versus 2007-2010). Complete resolution (CR) was achieved in 24% of all patients; 33% treated with bev+BPs, and 21% treated with BPs alone. Rates of CR improved from 15% to 33% after 2007. The median time to response was 5.6 months (range, 1.3 to 67.5 months). The addition of bev to BPs did not appear to alter the time to development of ONJ (32.6 months versus 34.6 months, respectively). The number of BP treatments administered before the diagnosis of ONJ between bev+BPs and BPs (32 doses versus 36.5 doses) was similar. However, our sample size was too small to characterize the difference statistically. Because dental management of ONJ has not changed over time at our institute, early recognition and screening may account for the improvement in dental outcomes.
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http://dx.doi.org/10.1016/j.clbc.2011.02.001DOI Listing
August 2011