Medicine and Health Sciences Commons^™

Headquarters Report: Membership Outlook Hazy But Optimistic, Karen Burgess Cae

The Journal of the Michigan Dental Association

This MDA Executive Director Report discusses the annual membership snapshot of the ADA, MDA, and component dental societies, specifically focusing on Michigan's experience in 2022. The analysis reveals a decline in active membership and a decrease in market share. A 57% national percentage of active dentists in membership is alarming, as further erosion may impact advocacy efforts and organized dentistry’s ability to voice dentistry’s needs. The article explores the reasons behind this decline, including demographic trends and the changing landscape of dental practice. It emphasizes the importance of adapting to the evolving needs of younger dentists and non-owner practitioners while …

Staff Matters: When Should We Use A Performance Improvement Plan?, Jodi Schafer Sphr, Shrm-Scp

The Journal of the Michigan Dental Association

This article explores using Performance Improvement Plans (PIPs) to address employee issues. It defines what a PIP is and outlines its primary purpose: employee development and performance improvement. The article provides guidance on when to use a PIP, emphasizing its appropriateness for performance-related deficiencies that coaching hasn't resolved. It also highlights situations where a PIP may not be suitable, such as policy violations or severe misconduct. The key is to choose the right communication tool based on the specific circumstances and the potential for employee improvement.

Improving Access For Children And Adults With Disabilities Through Enhanced Commercial Benefits, Holli Seabury Edd, Jeff Johnston Dds, Ms

The Journal of the Michigan Dental Association

This article explores the critical issue of accessibility to oral healthcare for people with disabilities in the United States. Delta Dental of Michigan, Ohio, and Indiana has taken a step by providing enhanced commercial benefits to children and adults with disabilities. The article delves into the challenges faced by this vulnerable population, including cost barriers and transition issues, and discusses how expanded benefits and coding, along with special dental care provisions, aim to improve access. It emphasizes the importance of proper benefits verification and presents a case study illustrating the utilization of these benefits. The article highlights the need for …

Comparing Experiences Of Women Who Were Direct Breastfeeding And Women Who Used Expressed Breast Milk To Feed Their Infants, Lisa A. Anders, Karen Robinson, Jennifer M. Ohlendorf, Lisa Hanson

College of Nursing Faculty Research and Publications

Purpose:

To provide understanding about feeding experiences of women who provide breast milk through direct breastfeeding and exclusive expression and to compare these experiences.

Study Design and Methods:

A qualitative study was conducted to gather experiences from the perspectives of women who had given birth to a healthy, term infant within the past 12 months and exclusively fed breast milk for at least 2 weeks. The sample was recruited from motherhood and breastfeeding support groups on Facebook. Groups had state- or national-based memberships. Interviews were examined for themes that were compared between feeding groups using thematic analysis.

Results:

Fifteen new …

Multicultural Counselor Supervision And Perceived Differences On Client Outcome, Andrew Perez, Saara Grizzell, Jerome Fischer, Jennifer Jazinski

School of Rehabilitation Services & Counseling Faculty Publications

The purpose of this study was to examine the differences between counselor supervisors’ and supervisees’ perceptions of the impact of multicultural supervision on client outcome. Counselor supervisors and supervisees may have differences in how much they believe multicultural factors affect client outcome and this study aimed to determine what differences exist. There were 61 participants in the study consisting of faculty, counselor supervisors, counselors, and graduate students in counseling-related fields. The current study found that multicultural supervision/competence alone predicted supervisor perceptions of client outcome. The findings suggest that training in supervision and multicultural supervision is vital to the professional development …

Psychoanalytic Insights For Rehabilitation Professionals: Three Major Psychoanalytic Perspectives., Kenneth R. Thomas, David M. Rosenthal, Zhou Kaiqi, Jeong Han Kim

School of Rehabilitation Services & Counseling Faculty Publications

This manuscript presents data on how counselors can use theoretical concepts derived from three major schools of psychoanalysis to understand and treat clients with a disability. We survey historical data on the three schools of psychoanalysis (classical, ego psychology, and self-psychology), as well as detailed information on the founders and major contributors to these various schools of psychoanalysis. The data are presented not only to inform counselors about the three approaches to psychoanalysis, but also to help practitioners facilitate their clients' emotional health. In other words, the manuscript serves both an educational and clinical objective.

Anaphylaxis, Children's Mercy Kansas City

Clinical Pathways (Formally Known As Clinical Practice Guidelines)

No abstract provided.

Practice Management: Cpa Vs. Dental Cpa: What’S The Difference?, John Looby Cpa

The Journal of the Michigan Dental Association

This article underscores the advantages of working with a specialized dental Certified Public Accountant (CPA) over generalist CPAs or accountants for dental practitioners. A dental CPA offers deeper insights into practice management, tax planning, and financial strategies tailored to the dental industry. Dental CPAs provide valuable guidance on production, insurance, and cost management, helping dentists make informed decisions. They also prove invaluable during critical times, such as during the COVID-19 pandemic, and offer expertise in tax, retirement, and practice transition planning, ensuring optimal financial outcomes for dentists.

Timolol As A Migraine Acute Attack Therapy: Randomized, Otcs Control Study, Shimaa Elgamal, Hossam Egila, Ibrahim Kabbash, Hussien El-Ansarey, Mohamed Elshafie, Osama Elshafei

Mansoura Medical Journal

Background: Migraine is manifested by recurrent headache attacks, with variable characteristics and associated symptoms. Oral beta blockers are widely used to prevent and reduce the frequency these attacks. However, the use of topical beta blockers for acute treatment is still controversial. Aims: In this randomized double – armed study, we aim to compare the efficacy of Timolol 0.5% eyedrops compared to other over-the-counter (OTC) medications used for acute treatment of migraine. Methods: Fifty-seven patients were randomly allocated to group A (treatment group: Timolol 0.5% eyedrops), and group B (control group: OTC drugs including Non-steroidal anti-inflammatory drugs (NSAIDs), caffeine, aspirin, and …

Assessment Of Serum Levels Of Cxcl10 In Patients With Non-Segmental Vitiligo, Sara Khashaba, Mohammed Hussein Elmogy, Hanan Fathy Mohamed, Mohammad El-Nablaway, Ahmed Fawzi Ismael

Mansoura Medical Journal

Background: Vitiligo is the most common depigmenting skin disorder. Destruction of melanocytes result in depigmented skin lesions. Pathogenesis is not fully understood and mostly is multifactorial. However, the autoimmune theory is the most widely accepted one. The interaction between genetic, environmental, biochemical and immunologic factors contribute to the disease. Cytokines have an important role in development of the disease and its progression. Aim of the work: The aim of the present study is to measure the blood levels of C-X-C motif chemokine ligand 10 (CXCL10) in vitiligo and to correlate it with disease activity and severity. Methods: This is a …

The Pandemic Anxiety Inventory: A Validation Study, Irvin Sam Schonfeld, Tasmyn Prytherch, Mark Cropley, Renzo Bianchi

Publications and Research

The Pandemic Anxiety Inventory (PAI) assesses anxiety symptoms individuals attribute to the presence of a pandemic. We conducted this study of 379 British adults during the COVID-19 pandemic and found that the PAI exhibited excellent reliability and solid criterion validity. Pandemic anxiety was associated with reduced social support, anticipated life changes, financial strain, job loss, economic insecurity, and the hospitalization or death of a close friend or relative. Using correlational and bifactor analyses, we found that the PAI demonstrated solid convergent and discriminant validity. The findings suggest that the PAI can be used in research and clinical practice.

Logic Model And Data System Recommendations, Kristen Lacijan, Claire Devine, Natalie Royal Kenton, Maggie Weller

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No abstract provided.

Pattern And Trends Of Helicobacter Pylori Genotypes In Gastric Cancer: A Kenyan 8-Year Study, Priscilla Njenga, Allan Njau, Zahir Moloo, Gunturu Revathi, Evariste Tshibangu, Yoshio Yamaoka

Pathology, East Africa

Background: Notable geographic and temporal variations in the prevalence and genotypes of Helicobacter pylori, in relation to gastric pathologies, have been observed; however, their significance and trends in African populations is scarcely described. The aim of this study, was to investigate the association of H. pylori and its respective CagA and vacuolating cytotoxin A (VacA) genotypes with gastric adenocarcinoma, and to describe the trends of H. pylori genotypes over an 8-year period (2012–2019).

Materials and methods: A total of 286 samples of gastric cancer cases and benign controls (one-to-one matching), from three main cities in Kenya, between …

Actin Cytoskeleton Vulnerability To Disulfide Stress Mediates Disulfidptosi, Xiaoguang Liu, Litong Nie, Yilei Zhang, Yuelong Yan, Chao Wang, Medina Colic, Kellen Olszewski, Amber Horbath, Xiong Chen, Guang Lei, Chao Mao, Shiqi Wu, Li Zhuang, Masha V Poyurovsky, M James You, Traver Hart, Daniel D Billadeau, Junjie Chen, Boyi Gan

Faculty, Staff and Student Publications

SLC7A11-mediated cystine uptake suppresses ferroptosis yet promotes cell death under glucose starvation; the nature of the latter cell death remains unknown. Here, we show that aberrant accumulation of intracellular disulfides in SLC7A11high cells under glucose starvation induces a previously uncharacterized form of cell death distinct from apoptosis or ferroptosis. We term this cell death disulfidptosis. Chemical proteomics and cell biological analyses showed that glucose starvation in SLC7A11high cells induces aberrant disulfide bonds in actin cytoskeleton proteins and F-actin collapse in a SLC7A11-dependent manner. CRISPR screens and functional studies revealed that inactivation of the WAVE regulatory complex (WRC, which promotes actin …

Highly Synchronized Cortical Circuit Dynamics Mediate Spontaneous Pain In Mice, Weihua Ding, Lukas Fischer, Qian Chen, Ziyi Li, Liuyue Yang, Zerong You, Kun Hu, Xinbo Wu, Xue Zhou, Wei Chao, Peter Hu, Tewodros Mulugeta Dagnew, Daniel M Dubreuil, Shiyu Wang, Suyun Xia, Caroline Bao, Shengmei Zhu, Lucy Chen, Changning Wang, Brian Wainger, Peng Jin, Jianren Mao, Guoping Feng, Mark T Harnett, Shiqian Shen

Faculty, Staff and Student Publications

Cortical neural dynamics mediate information processing for the cerebral cortex, which is implicated in fundamental biological processes such as vision and olfaction, in addition to neurological and psychiatric diseases. Spontaneous pain is a key feature of human neuropathic pain. Whether spontaneous pain pushes the cortical network into an aberrant state and, if so, whether it can be brought back to a "normal" operating range to ameliorate pain are unknown. Using a clinically relevant mouse model of neuropathic pain with spontaneous pain-like behavior, we report that orofacial spontaneous pain activated a specific area within the primary somatosensory cortex (S1), displaying synchronized …

Integrative Bioinformatic Analysis Of P53 And Pathway Alterations In Two Different Lung Cancer Subtypes, Yun Zhang, Abie Williams-Villalobo, Jyotsna D Godavarthi, Faith Shakoor, Shunbin Xiong, Bin Liu

Faculty, Staff and Student Publications

Whether p53, either wild type (WT) or mutant, plays cell-specific or uniform role remains controversial. Using The Cancer Genome Atlas, we examined p53 in the lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC), two lung cancers with different cellular origins and frequent p53 mutation (52% and 83%, respectively). Mutant p53 more strongly correlates with different genomic alteration and protein expression profiles in LUAD than in LUSC. p53 mutation in LUAD and LUSC is associated with multiple exacerbated clinical outcomes. Although the presence of p53 mutation does not change the survival of LUAD patients, LUSC patients containing p53 mutation exhibit …

Common Kinase Mutations Do Not Impact Optimal Molecular Responses In Core Binding Factor Acute Myeloid Leukemia Treated With Fludarabine, Cytarabine, And G-Csf Based Regimens, Jayastu Senapati, Tareq Abuasab, Fadi G Haddad, Farhad Ravandi, Tapan Kadia, Courtney Dinardo, Naval Daver, Naveen Pemmaraju, Yesid Alvarado, Mark A Brandt, Hagop Kantarjian, Gautam Borthakur

Faculty, Staff and Student Publications

No abstract provided.

Understanding Itch In Cutaneous T-Cell Lymphoma: Exploring The Impact Of Comorbidities, Treatment Regimens, And Racial Differences On Quality Of Life, Tejas P Joshi, Madeleine Duvic

Faculty, Staff and Student Publications

No abstract provided.

Human Papillomavirus Status And Prognosis Of Oropharyngeal High-Grade Neuroendocrine Carcinoma, Luana G De Sousa, Felippe Lazar Neto, Eduardo A Dal Lago, Andrew Sikora, Ehab Hanna, Amy Moreno, Jack Phan, Bonnie S Glisson, Diana Bell, Renata Ferrarotto

Faculty, Staff and Student Publications

Background: The prognostic impact of human papillomavirus (HPV) infection or smoking on oropharyngeal high-grade neuroendocrine carcinoma (HG-NEC) is not established.

Methods: Retrospective study with patients with oropharyngeal HG-NEC seen at MD Anderson Cancer Center from 1997 to 2020, and previously reported patients with oropharyngeal HG-NEC and known p16 and HPV status from the literature review. Survival was estimated with the Kaplan-Meier method, and survival differences assessed with the log-rank test and Cox proportional hazards models.

Results: Thirty patients were included; most had a heavy (≥10 pack-years) smoking history (52%), locoregional disease (stage III-IVB; 77%), and p16-positive tumor (92%). HPV was …

Treatment Of Cancer-Related-Fatigue In Acute Hematological Malignancies: Results Of A Feasibility Study Of Using Cognitive Behavioral Therapy, Sriram Yennurajalingam, Marina Konopleva, Cindy L Carmack, Courtney D Dinardo, Melissa Gaffney, Hayley Kristen Michener, Zhanni Lu, Penny Stanton, Jing Ning, Wei Qiao, Eduardo Bruera

Faculty, Staff and Student Publications

Background: Despite cancer related fatigue (CRF) being the most common, and debilitating symptom in patients with recently diagnosed acute hematological malignancies (HM), there are limited effective treatments for CRF in HM. The aim of this study was to determine the feasibility of cognitive behavioral therapy (CBT) for CRF in HM.

Methods: In this preliminary longitudinal prospective study, HM patients diagnosed a median of one month previously with moderate to severe fatigue were enrolled. Patients received CBT in seven weekly sessions for eight weeks. Change in Functional Assessment of Cancer Illness Therapy (FACIT) - Fatigue (primary), FACT-G, Pittsburg Sleep Quality Index …

Trpv4 Functional Status In Cystic Cells Regulates Cystogenesis In Autosomal Recessive Polycystic Kidney Disease During Variations In Dietary Potassium, Kyrylo Pyrshev, Anna Stavniichuk, Viktor N Tomilin, Naghmeh Hassanzadeh Khayyat, Guohui Ren, Mariya Kordysh, Oleg Zaika, Mykola Mamenko, Oleh Pochynyuk

Faculty, Staff and Student Publications

Mechanosensitive TRPV4 channel plays a dominant role in maintaining [Ca2+] i homeostasis and flow‐sensitive [Ca2+] i signaling in the renal tubule. Polycystic kidney disease (PKD) manifests as progressive cyst growth due to cAMP‐dependent fluid secretion along with deficient mechanosensitivity and impaired TRPV4 activity. Here, we tested how regulation of renal TRPV4 function by dietary K+ intake modulates the rate of cystogenesis and mechanosensitive [Ca2+] i signaling in cystic cells of PCK453 rats, a homologous model of human autosomal recessive PKD (ARPKD). One month treatment with both high KCl (5% K+) and KB/C (5% K+ with bicarbonate/citrate) diets significantly increased TRPV4 …

Clinical Characteristics And Cause Of Death Among Hospitalized Decedents With Cancer And Covid-19, Dereddi Raja Reddy, John A Cuenca, Joshua Botdorf, Mayoora Muthu, Ankit Hanmandlu, Robert Wegner, John Crommett, Cristina Gutierrez, Nisha Rathi, Bilja Sajith, Mark Knafl, Hussein A Abbas, Scott E Woodman, Joseph L Nates

Faculty, Staff and Student Publications

There is scant information on the clinical progression, end-of-life decisions, and cause of death of patients with cancer diagnosed with COVID-19. Therefore, we conducted a case series of patients admitted to a comprehensive cancer center who did not survive their hospitalization. To determine the cause of death, 3 board-certified intensivists reviewed the electronic medical records. Concordance regarding cause of death was calculated. Discrepancies were resolved through a joint case-by-case review and discussion among the 3 reviewers. During the study period, 551 patients with cancer and COVID-19 were admitted to a dedicated specialty unit; among them, 61 (11.6%) were nonsurvivors. Among …

Joint 2022 European Society Of Thoracic Surgeons And The American Association For Thoracic Surgery Guidelines For The Prevention Of Cancer-Associated Venous Thromboembolism In Thoracic Surgery, Yaron Shargall, Wojtek Wiercioch, Alessandro Brunelli, Sudish Murthy, Wayne Hofstetter, Jules Lin, Hui Li, Lori-Ann Linkins, Marc Crowther, Roger Davis, Gaetano Rocco, Gian Paolo Morgano, Finn Schünemann, Giovanna Muti-Schünemann, James Douketis, Holger J Schünemann, Virginia R Litle

Faculty, Staff and Student Publications

Background: Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a potentially fatal but preventable postoperative complication. Thoracic oncology patients undergoing surgical resection, often after multimodality induction therapy, represent among the highest risk groups for postoperative VTE. Currently there are no VTE prophylaxis guidelines specific to these thoracic surgery patients. Evidenced-based recommendations will help clinicians manage and mitigate risk of VTE in the postoperative period and inform best practice.

Objective: These joint evidence-based guidelines from The American Association for Thoracic Surgery and the European Society of Thoracic Surgeons aim to inform clinicians and patients in decisions about …

Global Epidemiology And Clinical Outcomes Of Carbapenem-Resistant Pseudomonas Aeruginosa And Associated Carbapenemases (Pop): A Prospective Cohort Study, Jinnethe Reyes, Lauren Komarow, Liang Chen, Lizhao Ge, Blake M Hanson, Eric Cober, Erica Herc, Thamer Alenazi, Keith S Kaye, Julia Garcia-Diaz, Lanjuan Li, Souha S Kanj, Zhengyin Liu, Jose M Oñate, Robert A Salata, Kalisvar Marimuthu, Hainv Gao, Zhiyong Zong, Sandra L Valderrama-Beltrán, Yunsong Yu, Paul Tambyah, Gregory Weston, Soraya Salcedo, Lillian M Abbo, Qing Xie, Karen Ordoñez, Minggui Wang, Martin E Stryjewski, Jose M Munita, David L Paterson, Scott Evans, Carol Hill, Keri Baum, Robert A Bonomo, Barry N Kreiswirth, Maria Virginia Villegas, Robin Patel, Cesar A Arias, Henry F Chambers, Vance G Fowler, Yohei Doi, David Van Duin, Michael J Satlin

Faculty, Staff and Student Publications

BACKGROUND: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a global threat, but the distribution and clinical significance of carbapenemases are unclear. The aim of this study was to define characteristics and outcomes of CRPA infections and the global frequency and clinical impact of carbapenemases harboured by CRPA.

METHODS: We conducted an observational, prospective cohort study of CRPA isolated from bloodstream, respiratory, urine, or wound cultures of patients at 44 hospitals (10 countries) between Dec 1, 2018, and Nov 30, 2019. Clinical data were abstracted from health records and CRPA isolates were whole-genome sequenced. The primary outcome was 30-day mortality from the day …

Immunocompromised Host Pneumonia: Definitions And Diagnostic Criteria: An Official American Thoracic Society Workshop Report, Guang-Shing Cheng, Kristina Crothers, Stefano Aliberti, Anne Bergeron, Michael Boeckh, Jason W Chien, Catia Cilloniz, Keira Cohen, Nathan Dean, Charles S Dela Cruz, Robert P Dickson, Alexander L Greninger, Chadi A Hage, Tobias M Hohl, Steven M Holland, Barbara E Jones, Joseph Keane, Mark Metersky, Rachel Miller, Anne Puel, Julio Ramirez, Marcos I Restrepo, Ajay Sheshadri, Bashar Staitieh, Jeffrey Tarrand, Kevin L Winthrop, Richard G Wunderink, Scott E Evans

Faculty, Staff and Student Publications

Pneumonia imposes a significant clinical burden on people with immunocompromising conditions. Millions of individuals live with compromised immunity because of cytotoxic cancer treatments, biological therapies, organ transplants, inherited and acquired immunodeficiencies, and other immune disorders. Despite broad awareness among clinicians that these patients are at increased risk for developing infectious pneumonia, immunocompromised people are often excluded from pneumonia clinical guidelines and treatment trials. The absence of a widely accepted definition for immunocompromised host pneumonia is a significant knowledge gap that hampers consistent clinical care and research for infectious pneumonia in these vulnerable populations. To address this gap, the American Thoracic …

Real-Time Prediction Of Organ Failures In Patients With Acute Pancreatitis Using Longitudinal Irregular Data, Jiawei Luo, Lan Lan, Shixin Huang, Xiaoxi Zeng, Qu Xiang, Mengjiao Li, Shu Yang, Weiling Zhao, Xiaobo Zhou

Faculty, Staff and Student Publications

It is extremely important to identify patients with acute pancreatitis who are at high risk for developing persistent organ failures early in the course of the disease. Due to the irregularity of longitudinal data and the poor interpretability of complex models, many models used to identify acute pancreatitis patients with a high risk of organ failure tended to rely on simple statistical models and limited their application to the early stages of patient admission. With the success of recurrent neural networks in modeling longitudinal medical data and the development of interpretable algorithms, these problems can be well addressed. In this …

Leukemic Phase Follicular Lymphoma In A Young Adult, Daniel Rivera, Wei Wang, Zubaidah Al-Jumaili, Zhihong Hu

Faculty, Staff and Student Publications

Background: Leukemic presentation of follicular lymphoma (FL) is uncommon, with most cases reported in older adults.

Design: This report describes an unusual case of a young adult diagnosed with leukemic phase of FL. We reviewed the existing literature on this rare presentation of the disease and its potential impact on patient outcomes.

Results: Leukemic phase of FL in young adults can be mistaken for other high-grade hematologic malignancies. Morphology assessment and ancillary testing, such as flow cytometry and FISH analysis, can assist in achieving an accurate diagnosis of the leukemic phase of FL. Notably, our young patient responded well to …

Unique Pathologic Features And Gene Expression Signatures Distinguish Blastoid High-Grade B-Cell Lymphoma From B-Acute Lymphoblastic Leukemia/Lymphoma, Lianqun Qiu, Jie Xu, Pei Lin, Evan N Cohen, Guilin Tang, Sa A Wang, Mahsa Khanlari, Wei Wang, Joseph D Khoury, Sergej Konoplev, C Cameron Yin, Jeffrey L Jorgensen, Francisco Vega, L Jeffrey Medeiros, Shaoying Li

Faculty, Staff and Student Publications

No abstract provided.

A Phase I, Open-Label, Dose Confirmation, Escalation, And Expansion Trial Of Bi 1810631 As Monotherapy In Patients With Advanced Or Metastatic Solid Tumors With Her2 Aberrations, John Heymach, Frans Opdam, Minal Barve, Neil Gibson, Behbood Sadrolhefazi, Josep Serra, Noboru Yamamoto

Faculty, Staff and Student Publications

Background: BI 1810631 is a human HER2-selective tyrosine kinase inhibitor that covalently binds to both wild-type and mutated HER2 receptors, including exon 20 insertion mutations, whilst sparing EGFR signaling. This phase Ia/Ib, open-label, non-randomized study will determine the safety, maximum tolerated dose (MTD), pharmacokinetics (PK), pharmacodynamics, and preliminary efficacy of BI 1810631 in patients with HER2 aberration-positive solid tumors (NCT04886804).

Patients and methods: In phase Ia, patients with histologically/cytologically confirmed HER2 aberration-positive advanced/metastatic solid tumors will receive BI 1810631 orally twice daily (BID) or once daily (QD) at escalating doses. Starting dose level is 15 mg BID; QD …

What Are Risk Factors For And Outcomes Of Late Amputation After Treatment For Lower Extremity Sarcoma: A Childhood Cancer Survivor Study Report, Erik J Geiger, Wei Liu, Deo Kumar Srivastava, Nicholas M Bernthal, Brent R Weil, Yutaka Yasui, Kirsten K Ness, Kevin R Krull, Robert E Goldsby, Kevin C Oeffinger, Leslie L Robison, Bryan V Dieffenbach, Christopher B Weldon, Mark C Gebhardt, Rebecca Howell, Andrew J Murphy, Wendy M Leisenring, Gregory T Armstrong, Eric J Chow, Rosanna L Wustrack

Faculty, Staff and Student Publications

Background: Although pediatric lower extremity sarcoma once was routinely treated with amputation, multiagent chemotherapy as well as the evolution of tumor resection and reconstruction techniques have enabled the wide adoption of limb salvage surgery (LSS). Even though infection and tumor recurrence are established risk factors for early amputation (< 5 years) after LSS, the frequency of and factors associated with late amputation (≥ 5 years from diagnosis) in children with sarcomas are not known. Additionally, the resulting psychosocial and physical outcomes of these patients compared with those treated with primary amputation or LSS that was not complicated by subsequent amputation are not well studied. Studying these outcomes is critical to enhancing the quality of life of patients with sarcomas.

Questions/purposes: (1) How have treatments changed over time in patients with lower extremity sarcoma who are included in the Childhood Cancer Survivor Study (CCSS), and did primary treatment with amputation or LSS affect overall survival at 25 years among patients who had survived at least 5 years from diagnosis? (2) What …