Combined Epstein-Barr Virus and Human Papillomavirus Infection in Nasopharyngeal Carcinoma

Epstein-Barr virus (EBV) has been shown to be a likely etiologic agent in nasopharyngeal carcinogenesis. Human papillomaviruses (HPVs) have previously been identified in numerous upper aerodigestive tract carcinomas. This pilot study was undertaken to investigate the prevalence of combined EBV and HPV infection in 17 patients with nasopharyngeal carcinoma (NPCA) using polymerase chain reaction (PCR). The primary goal was to determine if the presence of HPV could be correlated with molecular, histologic, or clinical parameters. There were seven patients with undifferentiated NPCA (World Health Organization [WHO] type III) and 10 patients with squamous cell carcinoma (WHO type I). All 17 patients had stage IV disease at presentation. EBV was identified in 15 patients (88.2%), and HPV subtypes were identified in samples from nine patients (52.9%). All HPV-positive cases were also EBV positive. Western blot analysis of six samples showed a high level of expression of c-myc and cdc2 kinase and a low level of p53 protein in NPCAs that contained both HPV and EBV (n = 3). Increased expression of c-myc and cdc2 kinase was seen in the cases that contained EBV only, but to a lesser extent (n = 2). These findings indicate an effect of the virus on cellular proliferation and differentiation. Similarly, an elevated level of Rb protein was found only in the HPV-containing NPCAs. Moderate differentiation (keratinization) occurred in four of eight HPV-negative and none of the nine HPV-positive NPCAs. (All HPV-positive cases were poorly differentiated or undifferentiated.) This difference is statistically significant for this sample size (P < 0.03). There was a trend for the group that was HPV positive to have WHO III histology and for the HPV-negative group to have WHO I. The presence of HPV could not be correlated with any clinical parameters in this small group of patients with advanced disease; however, these data suggest that coexistence of EBV and HPV infection may be a factor in the pathogenesis of NPCA and may have an effect on regulation of cellular proliferation and differentiation.     

Aberrant localization of synchronous hemodynamic activity in auditory cortex reliably characterizes schizophrenia.

BACKGROUND: Among the most prominent features of schizophrenic brains are abnormalities in auditory cortex structure and function, particularly in the superior temporal gyrus (STG). In this study, we attempted to examine auditory cortex function using an intrinsic, task-uncorrelated measure. METHODS: Using functional magnetic resonance imaging data, we calculated synchronous hemodynamic independent maps (SHIMs) of auditory cortex in patients with schizophrenia and matched healthy control subjects while they performed an auditory oddball task. RESULTS: Patient SHIMs revealed greater synchrony in ventral and medial STG regions (including auditory association Brodmann area [BA] 42); control SHIMs had greater synchrony in dorsal and lateral STG regions (which did not include BA 42). A within-participant subtractive comparison of these two sets of regions differentiated schizophrenic from healthy control subjects with 97% accuracy initially (further validated by a retest of the healthy control subjects) and performed with 94% accuracy in a confirmatory study of new subjects scanned at a different site. CONCLUSIONS: These results shed new light on STG functional differences in schizophrenia, suggest that aberrant patterns of coherence in temporal lobe cortical regions are a cardinal abnormality in schizophrenia, and have the potential to provide a powerful, quantitative clinical tool for the assessment of schizophrenia.     

Age-related changes in orofacial force generation in women.

OBJECTIVES: This study was designed to assess the effect of age on orofacial force generation. STUDY DESIGN: Forty women participated in a cross-sectional design, with 10 in each age group from 20 to 39, 40 to 59, 60 to 79, and 80 to 100 years of age. METHODS: Measures of force generation were obtained for the upper lip, lower lip, tongue, and jaw. RESULTS: There were no statistical differences among age groups, probably because of large individual variability within groups. Trends indicated a decline, particularly after age 80 years. CONCLUSION: Although trends in the data suggest some decline in the function of orofacial structures with age, it is unlikely that these changes would noticeably affect functional communication.     

Surgical options for Ebstein’s anomaly for optimal functional outcome

Background Ebstein’s anomaly of the tricuspid valve is a complex malformation. Historically, because valve replacement yielded poor results, surgical treatment has focused on valvuloplasties with or without associated procedures. An individualised combination of surgical procedures was practised over three years and forms the subject of this presentation. Method Between November 1995 and September 1999, 7 patients with Ebstein’s anomaly underwent surgical repair (age 3.5 to 40 years). Cyanosis with severe tricuspid regurgitation was present in all. Surgical repair, individualised according to the morphology of the tricuspid valve and right ventricle to provide maximum possible symptom free survival, included, (1) Tricuspid valve: Replacement (n=1); Repair (Carpentier type n=1, Unicuspid repair n=5), (2) Atrial septal defect: left open (n=1), closed partially (n=1), closed compeletely (n=5), and (3) Bidirectional Cavopulmonary Shunt (BCPS)-4 Results There was no hospital death. Intraoperative transoesophageal echocardiography showed only mild tricuspid regurgitation in all, following repair. There were no late deaths at a mean follow up of 29 months. All but one patient were in functional Class 1 New York Heart Association(NYHA). Complications included a thrombus in the right ventricular cavity six months postoperatively in one patient. Conclusion Individualisation of surgical management in Ebstein’s anomaly provides optimal results.     

Peer review and risk management.

As physicians and other health-care providers are experiencing an increased number of lawsuits, external pressures also are being exerted by various third-party payers and peer review organizations. An overview of some of the problems that may arise and methods for responding is presented. Knowledge of the processes involved by peer groups will help in risk management concerns as well. A new approach to quality assurance by the federal government is also described, the Health Care Quality Improvement Initiative.