Nicolas F Schlecht

Albert Einstein College of Medicine, New York, New York, United States

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Publications (69)256.52 Total impact

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    ABSTRACT: We evaluated the risk factors associated with oral human papillomavirus (HPV) infection and oral lesions in 161 HIV-positive and 128 HIV-negative patients presenting for oral examination at two urban health-care centers. Patients were interviewed on risk factors and provided oral-rinse samples for HPV-DNA typing by PCR. Statistical associations were assessed by logistic regression. Oral HPV was prevalent in 32% and 16% of HIV-positive and negative patients, including high-risk type 16 (8% and 2%, respectively, p=0.049) and uncommon types 32/42 (6% and 5%, p=0.715). Among HIV-negative patients, significant risk factors for oral HPV included multiple sexual partners (≥21 vs. ≤5; odds ratio [OR]=9.1, 95% confidence interval [CI]:1.7-49.3), heavy tobacco smoking (>20 pack-years vs. none; OR=9.2, 95%CI:1.4-59.4), and marijuana use (OR=4.0, 95%CI:1.3-12.4). Among HIV-positive patients, lower CD4 count only was associated with oral HPV detection (≤200 vs. ≥500 T-cells/mm(3); OR=4.5, 95%CI:1.3-15.5). Detection of high-risk HPV was also associated with concurrent detection of potentially cancerous oral lesions in HIV-negative patients but not among HIV-positive patients. The observed risk factor associations with oral HPV in HIV-negative patients are consistent with sexual transmission and local immunity, whereas in HIV-positive patients, oral HPV detection is strongly associated with low CD4 count. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail:
    The Journal of Infectious Diseases 02/2015; DOI:10.1093/infdis/jiv080 · 5.78 Impact Factor
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    ABSTRACT: Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is recognized as a distinct disease entity associated with improved survival. DNA hypermethylation profiles differ significantly by HPV status suggesting that a specific subset of methylated CpG loci could give mechanistic insight into HPV-driven OPSCC. We analyzed genome-wide DNA methylation of primary tumor samples and adjacent normal mucosa from 46 OPSCC patients undergoing treatment at Montefiore Medical Center, Bronx, NY using the Illumina HumanMethylation27 beadchip. For each matched tissue set, we measured differentially methylated CpG loci using a change in methylation level (M value). From these analyses, we identified a 22 CpG loci panel for HPV+ OPSCC that included four CDKN2A loci downstream of the p16(INK4A) and p14(ARF) transcription start sites. This panel was significantly associated with overall HPV detection (P < 0.05; ROC area under the curve = 0.96, 95% CI: 0.91–1.0) similar to the subset of four CDKN2A-specific CpG loci (0.90, 95% CI: 0.82–0.99) with equivalence to the full 22 CpG panel. DNA hypermethylation correlated with a significant increase in alternative open reading frame (ARF) expression in HPV+ OPSCC primary tumors, but not to the other transcript variant encoded by the CDKN2A locus. Overall, this study provides evidence of epigenetic changes to the downstream region of the CDKN2A locus in HPV+ oropharyngeal cancer that are associated with changes in expression of the coded protein products.
    Cancer Medicine 12/2014; DOI:10.1002/cam4.374
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    ABSTRACT: While its prognostic significance remains unclear, p16INK4a protein expression is increasingly being used as a surrogate marker for oncogenic human papillomavirus (HPV) infection in head and neck squamous cell carcinomas (HNSCC). To evaluate the prognostic utility of p16 expression in HNSCC, we prospectively collected 163 primary tumor specimens from histologically confirmed HNSCC patients who were followed for up to 9.4 years. Formalin fixed tumor specimens were tested for p16 protein expression by immunohistochemistry. HPV type-16 DNA and RNA was detected by MY09/11-PCR and E6/E7 RT-PCR on matched frozen tissue, respectively. P16 protein expression was detected more often in oropharyngeal tumors (53%) as compared with laryngeal (24%), hypopharyngeal (8%), or oral cavity tumors (4%; P<0.0001). With respect to prognosis, p16-positive oropharyngeal tumors exhibited significantly better overall survival than p16-negative tumors (log-rank test p=0.04), whereas no survival benefit was observed for non-oropharyngeal tumors. However, when both p16 and HPV DNA test results were considered, concordantly positive non-oropharyngeal tumors had significantly better disease-specific survival than concordantly negative non-oropharyngeal tumors after controlling for sex, nodal stage, tumor size, tumor subsite, primary tumor site number, smoking, and drinking (adjusted hazard ratio [HR]=0.04, 0.01–0.54). Compared with concordantly negative non-oropharyngeal HNSCC, p16(+)/HPV16(-) non-oropharyngeal HNSCC (n=13, 7%) demonstrated no significant improvement in disease-specific survival when HPV16 was detected by RNA (adjusted HR=0.83, 0.22–3.17). Our findings show that p16 immunohistochemistry alone has potential as a prognostic test for oropharyngeal cancer survival, but combined p16/HPV testing is necessary to identify HPV-associated non-oropharyngeal HNSCC with better prognosis. © 2014 Wiley Periodicals, Inc.
    International Journal of Cancer 11/2014; 135(10). DOI:10.1002/ijc.28876 · 6.20 Impact Factor
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    ABSTRACT: Context .- Global proteomic analysis of oral cavity squamous cell carcinoma was performed to identify changes that reflect patient outcomes. Objectives .- To identify differentially expressed proteins associated with patient outcomes and to explore the use of imaging mass spectrometry as a clinical tool to identify clinically relevant proteins. Design .- Two-dimensional separation of digested peptides generated from 43 specimens with high-resolution mass spectrometry identified proteins associated with disease-specific death, distant metastasis, and loco-regional recurrence. RNA expressions had been correlated to protein levels to test transcriptional regulation of clinically relevant proteins. Imaging mass spectrometry explored an alternative platform for assessing clinically relevant proteins that would complement surgical pathologic diagnosis. Results .- Seventy-two peptide features were found to be associated with 3 patient outcomes: disease-specific death (9), distant metastasis (16), and loco-regional recurrence (39); 8 of them were associated with multiple outcomes. Functional ontology revealed major changes in cell adhesion and calcium binding. Thirteen RNAs showed strong correlation with their encoded proteins, implying transcriptional control. Reduction of DSP, PKP1, and TRIM29 was associated with significantly shorter time to onset of distant metastasis. Reduction of PKP1 and TRIM29 correlated with poorer disease-specific survival. Additionally, S100A8 and S100A9 reductions were verified for their association with poor prognosis using imaging mass spectrometry, a platform more adaptable for use with surgical pathology. Conclusions .- Using global proteomic analysis, we have identified proteins associated with clinical outcomes. The list of clinically relevant proteins observed will provide a means to develop clinical assays for prognosis and optimizing treatment selection.
    Archives of pathology & laboratory medicine 10/2014; DOI:10.5858/arpa.2014-0131-OA · 2.88 Impact Factor
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    ABSTRACT: Objective: To validate an algorithm for oral health status and compare to overall health. Decayed-Missing-Filled-Teeth (DMFT) scores, oral hygiene and medical co-morbidities provide measures to assess caries risk. Hypotheses: 1. DMFT score should be lower with children and higher with decreased health status. Method: Cohort 1: Children age 1 through 12 years of age; Cohort 2: people with multiple chronic illnesses and living with Human Immunodeficiency Virus (HIV)/Autoimmune deficiency syndrome (AIDS) and other medical comorbidities; Cohort 3: People requiring complex prosthodontic rehabilitation. DMFT scores were measured. The number of medical co-morbidities was measured using the Charlson Comorbidity Index (CCI) and an electronic health record data mining program, Clinical Looking Glass®. Result: The DMFT scores were compared between the three cohorts, with a mean value of 0.695833±0.32 standard deviations (SD). Mean [A] = 0.023±0.018 SD, and 0.012±0.015 SD. DMFT scores varied considerably with age mean T ratio = 0.73±0.96 SD with a median of 0.5 and range of 0.14-7.0. Age and number of comorbidities was positively associated with DMFT although this was not significant (p=0.094). Whereas DMFT score increased with age (p=0.571) and decreased with comorbidities (p=0.772), the small sample size (N=55) and variability in measurements precluded associations from being significant. CCI scores ranged to include 58 co-morbidities in Cohort 2. Conclusion: Further study with increased sample size is required to demonstrate associations and identify predisposition to caries for targeting interventions. Diet, personal oral hygiene, microbiome, fluoride supplementations and/or access to dental care are overwhelming and confounding factors that need to be considered.
    IADR General Session and Exhibition 2014; 06/2014
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    ABSTRACT: Background. Sexually transmitted infections (STIs) are common among adolescents, and multiple STIs over one's lifetime can increase health risks. Few studies have assessed lifetime STI prevalence. This study evaluates minority, underserved adolescents' self-reported lifetime STI history and objective STI rates. Methods. Lifetime STI rates of female patients at an urban adolescent health center were obtained from self-administered questionnaires. Additionally, STI test results were retrieved from electronic medical records. Results. Patients reported a high lifetime prevalence of STIs. By comparing self-report and objective data, underreporting was identified for chlamydia, gonorrhea, and herpes. Conclusions. STI rates in at-risk adolescent females are higher than in the general population and remain elevated over time. Lifetime STI reports could expand our understanding of sexual health and should be further studied. Underreporting, which may increase health risks and hinder health care delivery, requires further investigation. Improvements in STI screening and prevention targeting at-risk populations are warranted.
    Clinical Pediatrics 05/2014; 53(9). DOI:10.1177/0009922814533816 · 1.26 Impact Factor
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    ABSTRACT: Dental services are increasingly recognized as complimentary to medical care and acknowledged as part of the Chronic Care Model (CCM). The Patient Assessment of Chronic Illness Care (PACIC), a validated, primary care assessment instrument is used to measure patient centered outcomes in medical settings. These outcomes include satisfaction with care and whether it aligns with the CCM. We report on the use of the PACIC instrument for assessing dental patient centered outcomes. Objectives: 1) Provide a baseline evaluation of whether patients receive patient-centered, proactive, planned care that includes collaborative goal setting; problem-solving and follow-up support in the dental setting; 2) Assess the validity of using the PACIC survey in dental settings by comparing baseline dental outcomes to baseline medical outcomes, and 3) Use PACIC data to improve dental patient satisfaction with care and outcomes. Methods: During a 3-month period (2012), 563 adults reporting one or more chronic illnesses were randomly selected from approximately 14,500 unique dental patients who received dental care at an urban, inner city academic health center. These adults completed the 20-item PACIC survey, which measures patient activation (items 1-3), delivery system design/decision support (items 4-6), goal setting (items 7-11), problem solving/contextual counseling (items 12-15), and follow-up/coordination of care (items 16-20). PACIC rating consists of a 5-point Likert scale and an overall summary score. Results: We compared the overall summary PACIC scores from the dental patients to those reported in the medical literature. In our survey, baseline mean dental PACIC values ranged from 2.79–3.12 (Standard Deviation (SD) = 0.14) compared to baseline medical range 3.25–3.46 (SD =1.21). Conclusion: The PACIC appears to be a practical, reliable instrument for assessing dental patient satisfaction with care and outcomes. PACIC may be a valuable tool for bringing CCM concepts into the dental setting.
    AADR Annual Meeting & Exhibition 2014; 03/2014
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    ABSTRACT: Clinical research with adolescents can be challenging due to issues of informed consent, parental involvement, institutional review board requirements, and adolescent psychosocial development. These requirements present a dilemma, particularly in the area of sexual health research, as adolescents are disproportionately affected by sexually transmitted infections such as human papillomavirus (HPV). To successfully conduct adolescent research in the clinical setting, one requires an awareness of state statutes regarding adolescent confidentiality and consent for medical care, and a close partnership with the IRB. In 2007, the Mount Sinai Adolescent Health Center in collaboration with the Albert Einstein College of Medicine developed a longitudinal research study to examine the natural history of oral, cervical, and anal HPV in an adolescent female population engaged in high-risk sexual behaviors. We use this research project as a case study to explore the ethical, methodological, and clinical issues related to conducting adolescent health research. Several strategies were identified to promote adolescent study participation, including: (1) building a research team that is motivated to work with adolescents; (2) combining research and patient care visits to avoid duplication of services; and (3) establishing a personalized communication network with participants. Using these methods, adolescent sexual health research can successfully be integrated into the clinical setting. While retaining a prospective cohort of adolescents has its challenges, a persistent and multi-disciplinary approach can help improve recruitment, sustain participation, and acquire critical data that will lead to improved healthcare knowledge applicable to understudied populations of adolescents.
    Journal of pediatric and adolescent gynecology 12/2013; DOI:10.1016/j.jpag.2013.08.004 · 0.90 Impact Factor
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    ABSTRACT: Objectives: To develop an algorithm to identify individuals that need targeted fluoride (F) supplementation. Decayed-Missing-Filled-Teeth (DMFT) scores, enamel thickness and fluoride (F) content of teeth, oral hygiene and medical co-morbidities may provide measures to assess caries susceptibility. Hypotheses: 1. DMFT score should be lower with thicker enamel. Rationale: Demineralization requires longer time for caries progression. 2. DMFT score should be lower with higher F content in enamel or dentin. Rationale: F decreases enamel/dentin (E/D) solubility in an acidic cariogenic environment. Methods: Cohort 1: Enamel thickness measurements: Digital radiographs were measured from enamel surface to the DEJ at the Mesial (M) height of contour and calibrated against a standard 5mm ball. F content was determined in powdered enamel and dentin using F-ion selective electrode. DMFT scores were measured. Cohort 2: The number of medical co-morbidities was measured using the Charlson Comorbidity Index (CCI) and an electronic health record data mining program. Results: The enamel thickness ranged from 1.2 to 2.65 mm, with a mean value of 1.63±0.32 standard deviations (SD). Mean [F] = 0.023±0.018 SD for enamel, and 0.012±0.015 SD for dentin. DMFT scores varied considerably with mean T ratio = 0.73±0.96 SD with a median of 0.5 and range of 0.14-7.0. Enamel thickness was positively associated with DMFT although this was not significant (p=0.094). Whereas DMFT score increased with F content in enamel (p=0.571) and decreased with F content in dentin (p=0.772), the small sample size (N=55) and variability in measurements precluded associations from being significant. CCI scores ranged to include 58 co-morbidities in Cohort 2. Conclusion: Further study with increased sample size is required to demonstrate associations and identify predisposition to caries for targeting interventions. Diet, personal oral hygiene, microbiome, fluoride supplementations and/or access to dental care are overwhelming and confounding factors that need to be considered.
    6th AADR Fall Focused Symposium: Personalized Oral Health Care: Concept Design to Clinical Practice 2013; 10/2013
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    ABSTRACT: Recent evidence suggests that human papillomavirus (HPV)-positive head and neck squamous cell carcinoma (HNSCC) patients have better survival than HPV-negative patients. However, it is unclear if similar patterns for survival exist across different tumor sites, and whether HPV-associated prognosis is modified by type of treatment. We prospectively tested 222 histologically confirmed HNSCC primary tumors for HPV DNA by PCR and HPV E6/E7 RNA by RT-PCR prior to treatment at a large urban health center. Cox proportional hazard ratio models were constructed to assess HPV-associated differences in overall and disease-specific survival adjusting for clinical and demographic covariates. HPV detection varied significantly by primary HNSCC tumor site, from 35 % for oropharynx, to 25 % for hypopharynx, 5 % for larynx, and 3 % for oral cavity (p < 0.0001), with HPV16 accounting for the majority (95 %) of HPV-positive tumors. The hazard-risk of overall and disease-specific death comparing HPV16-positive versus negative oropharyngeal HNSCC was reduced by 74 and 89 %, respectively (p values < 0.05), and was independent of other prognostic indicators; no statistically significant changes in outcomes were observed for non-oropharyngeal HNSCC sites. Prediction of overall survival was better with combined DNA and RNA HPV16 positive PCR detection. There was no difference in HPV16-associated survival whether patients received either surgery or (chemo)radiotherapy as their initial treatment modality. Improved HPV-associated HNSCC survival is limited to patients with oropharyngeal primaries. No selective treatment advantage is observed for HPV-positive tumors, although clinical trials are needed to evaluate which treatment modalities provide the most benefit for HPV-positive HNSCC.
    Head and Neck Pathology 09/2013; DOI:10.1007/s12105-013-0486-4
  • Cancer Research 08/2013; 73(8 Supplement):4939-4939. DOI:10.1158/1538-7445.AM2013-4939 · 9.28 Impact Factor
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    ABSTRACT: We have utilized a genome-wide approach to identify novel differentially methylated CpG dinucleotides that are seen in different anatomic sites of head and neck squamous cell carcinoma (HNSCC), as well as those that might be related to HPV status in the oropharynx. We performed genome-wide DNA methylation profiling of primary tumor samples and corresponding adjacent mucosa from 118 HNSCC patients undergoing treatment at Montefiore Medical Center, Bronx, NY using the Illumina HumanMethylation27 beadchip. For each matched tissue set, we measured differentially methylated CpG loci using a change in methylation level (M-value). When datasets were individually analyzed by anatomic site of the primary tumor, we identified 293 differentially methylated CpG loci in oral cavity SCC, 219 differentially methylated CpG loci in laryngeal SCC, and 460 differentially methylated in oropharyngeal SCC. A subset of these differentially methylated CpG loci was common across all anatomic sites of HNSCC. Stratification by HPV status revealed a significantly higher number of differentially methylated CpG loci in HPV-positive patients. Novel epigenetic biomarkers derived from clinical HNSCC specimens can be used molecular classifiers of this disease, revealing many new avenues of investigation for this disease.
    Clinical Cancer Research 07/2013; 19(19). DOI:10.1158/1078-0432.CCR-12-3280 · 8.19 Impact Factor
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    ABSTRACT: To demonstrate the importance of comorbid conditions in head and neck squamous cell carcinoma (HNSCC), we assessed the association between comorbidity and survival in an inner-city population of HNSCC patients. Comorbid status at diagnosis was derived using medical records and the Adult Comorbidity Evaluation-27 (ACE-27) index on 288 patients with histologically confirmed HNSCC from Montefiore Medical Center in the Bronx (NY) between 2002 and 2011. The association between comorbidity, tumor human papillomavirus (HPV) status and overall and disease specific survival was assessed by Kaplan-Meier analysis and multivariable Cox regression adjusting for clinico-pathologic factors. The study population consisted of primary oropharyngeal (36%), laryngeal (33%) and oral cavity cancer patients (31%). Overall, 19% had no comorbidity, 43% mild comorbidity, 29% moderate comorbidity, and 9% severe comorbidity. The most common comorbid conditions were hypertension, diabetes mellitus, respiratory disease, other malignancies, and illicit drug use. Survival analyses revealed that increased comorbidity at diagnosis was significantly related to poorer overall survival (p=0.016), but not to cancer survival (p=0.369) or recurrence (p=0.652). Oropharyngeal cancer patients with HPV DNA positive tumors and lower levels of comorbidity had significantly better overall survival compared to patients with HPV negative tumors (hazard ratio=0.2, 95%CI: 0.04-0.8), however there was no significant difference in overall (or disease specific) survival by HPV status among patients with higher levels of comorbidity at diagnosis (hazard ratio=0.7, 95%CI: 0.2-2.8). In an inner-city predominantly minority population, comorbidity at HNSCC diagnosis is relatively common and associated with poor overall survival, but not cancer survival or recurrence. Interestingly, the relationship between HPV and improved survival appears to be specific to patients with low comorbidity at diagnosis.
    Oral Oncology 07/2013; DOI:10.1016/j.oraloncology.2013.07.001 · 3.03 Impact Factor
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    ABSTRACT: Viral load measurements may predict whether human papillomavirus (HPV) type16 infections may become persistent and eventually lead to cervical lesions. Today, multiple PCR methods exist to estimate viral load. We tested three protocols to investigate viral load as a predictor of HPV clearance. We measured viral load in 418 HPV16-positive cervical smears from 224 women participating in the Ludwig-McGill cohort study by low-stringency PCR (LS-PCR) using consensus L1 primers targeting over 40 known HPV types, and quantitative real-time PCR (qRTPCR) targeting the HPV16-E6 and L1 genes. HPV16 clearance was determined by MY09/11 and PGMY PCR testing on repeated smears collected over five years. Correlation between viral load measurements by qRTPCR (E6 vs. L1) was excellent (r=0.88), but decreased for L1 qRTPCR versus LS-PCR (r=0.61). Viral load by LS-PCR was higher for HPV16 and related types independently of other concurrent HPV infections. Median duration of infection was longer for smears with high copy number by all three PCR protocols (log rank p<0.05). Viral load is inversely related to HPV16 clearance independently of concurrent HPV infections and PCR protocol.
    Journal of General Virology 05/2013; DOI:10.1099/vir.0.051722-0 · 3.53 Impact Factor
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    ABSTRACT: Discovery of folic acid grain fortification in reducing birth defects is an important public health achievement. Hypothesis: Nutritional deficiencies related to one carbon metabolism contribute to birth defects. Objective: (i) determine trends among birth defects, (ii) search for common risk factors related to occurrence of orofacial clefts, conal, truncal or midline birth defects. Method: We looked at the population of live births and stillbirths at Montefiore Medical Center (MMC), using electronic health information tools: Clinical Looking Glass®, patented data mining software; and direct query of Electronic Medical Record (EMR) data. Result: There were 78, 334 cases of live births and stillbirths in the time period between 1997 to 2012. We recorded 85 cases of neural tube defects using International Classification of Disease-9 (ICD-9) codes for anencephalus (740.0, 740.1, and 740.2), spina bifida (741.0 and 741.9) and encephalocele (742.0). We recorded 120 cases of cleft lip and palate (749.0, 749.1, and 749.2) that occurred since 1997. We identified an extremely large number of cases of patent ductus arteriosus(PDA) (ICD-9 code 747.0): 1163 within 78,334 births which gave an incidence of 14.8 per 1000 births (1.48%). PDA is nearly 100 times larger than the national average. The estimated incidence of PDA in US children born at term is between 0.02% and 0.006% of live births. We determined that it may not be possible to identify nutritional deficiencies or folate use from data mining or chart review alone. Nutritional status was not conclusively identified using slow fetal growth, malnutrition (ICD-9 764.0): none; or short gestation/low birth weight (ICD-9 765.0): none. Conclusion: Improved understanding of causation: nutritional deficiencies, extrinsic perturbations (toxins), epigenomics, and the potential for synergistic genetic affect on birth outcomes may allow for prevention. Future studies should focus on common factors that may contribute to birth defect formation and prevention.
    IADR/AADR/CADR General Session and Exhibition 2013; 03/2013
  • Journal of Adolescent Health 02/2013; 52(2):S6-S7. DOI:10.1016/j.jadohealth.2012.10.020 · 2.75 Impact Factor
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    ABSTRACT: OBJECTIVE: To evaluate reproducibility of oral rinse self-collection for human papillomavirus (HPV) detection and investigate associations between oral HPV, oral lesions, immune and sociodemographic factors, we performed a cross-sectional study of older adults with human immunodeficiency virus (HIV) infection. STUDY DESIGN: We collected oral rinse samples from 52 subjects at 2 different times of day, followed by an oral examination and interview. We identified HPV with the use of polymerase chain reaction platforms optimized for detection of mucosal and cutaneous types. RESULTS: Eighty-seven percent of individuals had oral HPV, of which 23% had oncogenic alpha, 40% had nononcogenic alpha, and 46% had beta or gamma HPV. Paired oral specimens were concordant in all parameters tested. Significant associations observed for oral HPV with increased HIV viral load, hepatitis C seropositivity, history of sexually transmitted diseases, and lifetime number of sexual partners. CONCLUSIONS: Oral cavity may be a reservoir of subclinical HPV in older adults who have HIV infection. Understanding natural history, transmission, and potential implications of oral HPV warrants further investigations.
    01/2013; DOI:10.1016/j.oooo.2012.11.004
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    ABSTRACT: The Risk Model is a validated outcome predictor for patients with head and neck squamous cell carcinoma (Brandwein-Gensler et al. in Am J Surg Pathol 20:167-178, 2005; Am J Surg Pathol 34:676-688, 2010). This model may potentially shift treatment paradigms for patients with low-stage cancers, as current protocols dictate that they might receive only primary surgery. Here we test the hypothesis that the Risk Model has added prognostic value for low-stage oral cavity squamous cell carcinoma (OCSCC) patients. 299 patients with Stage I/II OCSCC were characterized according to the Risk Model (Brandwein-Gensler et al. in Am J Surg Pathol 20:167-178, 2005; Am J Surg Pathol 34:676-688, 2010). Cumulative incidence and competing risk analysis were performed for locoregional recurrence (LRR) and disease-specific survival (DSS). Receiver operating characteristic analyses were performed for worst pattern of invasion (WPOI) and the risk categories. 292 patients were analyzed; 30 T1N0 patients (17 %) and 26 T2N0 patients (23 %) developed LRR. Disease-specific mortality occurred in 9 T1N0 patients (6 %) and 9 T2N0 patients (10 %). On multivariable analysis, the Risk Model was significantly predictive of LRR (p = 0.0012, HR 2.41, 95 % CI 1.42, 4.11) and DSS (p = 0.0005, HR 9.16, 95 % CI 2.65, 31.66) adjusted for potential confounders. WPOI alone was also significantly predictive for LRR adjusted for potential confounders with a cut-point of either WPOI-4 (p = 0.0029, HR 3.63, 95 % CI 1.56, 8.47) or WPOI-5 (p = 0.0008, HR 2.55, 95 % CI 1.48, 4.41) and for DSS (cut point WPOI-5, p = 0.0001, HR 6.34, 95 % CI 2.50, 16.09). Given a WPOI-5, the probability of developing locoregional recurrence is 42 %. Given a high-risk classification for a combination of features other than WPOI-5, the probability of developing locoregional recurrence is 32 %. The Risk Model is the first validated model that is significantly predictive for the important niche group of low-stage OCSCC patients.
    Head and Neck Pathology 12/2012; DOI:10.1007/s12105-012-0412-1
  • Journal of Urban Health 08/2012; DOI:10.1007/s11524-012-9756-9 · 1.89 Impact Factor

Publication Stats

2k Citations
256.52 Total Impact Points


  • 2005–2015
    • Albert Einstein College of Medicine
      • • Department of Epidemiology & Population Health
      • • Department of Pathology
      • • Oncology
      New York, New York, United States
  • 1998–2013
    • McGill University
      • Department of Oncology
      Montréal, Quebec, Canada
  • 2012
    • Albert Einstein Medical Center
      Philadelphia, Pennsylvania, United States
    • Montefiore Medical Center
      • Albert Einstein College of Medicine
      New York City, New York, United States
  • 2002
    • Government of Nunavut
      Iqaluit, Nunavut, Canada