Background A subset of HPV-associated oropharyngeal squamous cell carcinoma (HPV-OSCC) patients experience poor clinical outcomes. We explored prognostic risk factors on overall survival (OS) and recurrence free survival (RFS). Methods Patients with incident HPV-OSCC treated at the Johns Hopkins Hospital between 1997– 2008 with available tissue for HPV testing and demographic and clinicopathologic information (N=176) were included. Tissue was tested for HPV by in situ hybridization (ISH) and/or p16 immunohistochemistry (IHC). Demographic and clinicopathologic information was extracted from medical records. Results 90% (157/176) of the OSCC cases were HPV-associated. In the HPV-OSCC patients, we observed a 3- and 5-year OS rate of 93% (95% CI: 88%–98%) and 89% (95% CI: 81%–97%), respectively. Lower survival was observed with older patient age (HR 2.33 per 10-year increase, CI: 1.05–5.16, p=0.038), advanced clinical T-stage (HR 5.78, 95% CI: 1.60–20.8, p=0.007), and current tobacco use (HR 4.38, 95% CI: 1.07–18.0, p=0.04). Disease recurrence was associated with advanced clinical T stage (HR 8.32, 95% CI: 3.06–23, p<0.0001), current/former alcohol use (HR 13, 95% CI: 1.33–120, p=0.03), and unmarried status (HR 3.28, 95% CI: 1.20–9.00, p=0.02).. Patients who remained recurrence-free for 5 years had an 8.6% chance of recurrence by 10 years (one-sided 95% CI upper bound is 19%, p=0.088). Conclusions Prognostic risk factors are identified for HPV-OSCC patients. Observed recurrence rates between 5 and 10 years following definitive therapy needs to be validated in additional studies to determine whether extended cancer surveillance is warranted in this cancer population.

Background: Cigarette smoking has been proposed as a risk factor for amyotrophic lateral sclerosis (ALS), but epidemiological studies supporting this hypothesis have been small and mostly retrospective.Objective: To prospectively examine the relation between smoking and ALS in 5 well-established large cohorts.Design: Five prospective cohorts with study-specific follow-up ranging from 7 to 28 years.

We aimed to assess prevalence, birth outcome, associated anomalies and prenatal diagnosis of congenital clubfoot in Europe using data from the EUROCAT network, and to validate the recording of congenital clubfoot as a major congenital anomaly by EUROCAT registries. Cases of congenital clubfoot were included from 18 EUROCAT registries covering more than 4.8 million births in 1995-2011. Cases without chromosomal anomalies born during 2005-2009, were randomly selected for validation using a questionnaire on diagnostic details and treatment. There was 5,458 congenital clubfoot cases of which 5,056 (93%) were liveborn infants. Total prevalence of congenital clubfoot was 1.13 per 1,000 births (95% CI 1.10-1.16). Prevalence of congenital clubfoot without chromosomal anomaly was 1.08 per 1,000 births (95% CI 1.05-1.11) and prevalence of isolated congenital clubfoot was 0.92 per 1,000 births (95% CI 0.90-0.95), both with decreasing trends over time and large variations in prevalence by registry. The majority of cases were isolated congenital clubfoot (82%) and 11% had associated major congenital anomalies. Prenatal detection rate of isolated congenital clubfoot was 22% and increased over

The data that support the findings of this study are available from the corresponding author upon reasonable request.

BackgroundIt has been found that significantly different clinical outcomes occur in trauma patients with different mechanisms of injury. Ground level falls (GLF) are usually considered “minor trauma” with less injury occurred in general. However, it is not uncommon that geriatric trauma patients sustain cervical spine (C-spine) fractures with other associated injuries due to GLF or less. The aim of this study is to determine the injury patterns and the roles of clinical risk factors in these geriatric trauma patients.MethodsData were reviewed from the institutional trauma registry of our local level 1 trauma center. All patients had sustained C-spine fracture(s). Basic clinical characteristics, the distribution of C-spine fracture(s), and mechanism of injury in geriatric patients (65 years or older) were compared with those less than 65 years old. Furthermore, different clinical variables including age, gender, Glasgow coma scale (GCS), blood alcohol level, and co-existing injuries were analyzed by multivariate logistic regression in geriatric trauma patients due to GLF and internally validated by random bootstrapping technique.ResultsFrom 2006 - 2010, a total of 12,805 trauma patients were included in trauma registry, of which 726 (5.67%) had sustained C-spine fracture(s). Among all C-spine fracture patients, 19.15% (139/726) were geriatric patients. Of these geriatric patients 27.34% (38/139) and 53.96% (75/139) had C1 and C2 fractures compared with 13.63% (80/587) and 21.98% (129/587) in young trauma patients (P < 0.001). Of geriatric trauma patients 13.67% (19/139) and 18.71% (26/139) had C6 and C7 fractures compared with 32.03% (188/587) and 41.40% (243/587) in younger ones separately (P < 0.001). Furthermore, 53.96% (75/139) geriatric patients had sustained C-spine fractures due to GLF with more upper C-spine fractures (C1 and C2). Only 3.2% of those had positive blood alcohol levels compared with 52.9% of younger patients (P < 0.001). In addition, 6.34% of geriatric patients due to GLF had intracranial pathology (ICP) which was one of the most common co-injuries with C-spine fractures. Logistic regression analysis showed the adjusted odds ratios of 1.17 (age) and 91.57 (male) in geriatric GLF patients to predict this co-injury pattern of C-spine fracture and ICP.ConclusionGeriatric patients tend to sustain more upper C-spine fractures than non-geriatric patients regardless of the mechanisms. GLF or less not only can cause isolated C-spines fracture(s) but also lead to other significant injuries with ICP as the most common one in geriatric patients. Advanced age and male are two risk factors that can predict this co-injury pattern. In addition, it seems that alcohol plays no role in the cause of GLF in geriatric trauma patients.