Pathway Analysis using Gene-expression Profiles of HPV-positive and HPV-negative Oropharyngeal Cancer Patients in a Hispanic Population: Methodological Procedures.

OBJECTIVE: The incidence of oral cavity and pharyngeal cancer in Puerto Rican men is higher than it is in the men of any other ethnic/racial group in the United States of America (US). The information regarding the effect of the human papilloma virus (HPV) in the gene-expression profile among patients with this cancer is limited in Hispanic community. We aim to describe the methodology for future studies to identify the molecular networks for determining overrepresented signaling and metabolic canonical pathways, based on the differential gene-expression profiles of HPV+ and HPV- samples from patients with oropharyngeal squamous cell carcinoma in Puerto Rico. METHODS: We analyzed the RNA expression of 5 tissue samples from subjects diagnosed with oropharyngeal squamous cell carcinoma, 2 HPV+ and 3 HPV-, using Affymetrix GeneChips. The relative difference between the average gene expressions of the HPV+ and HPV- samples was assessed, based on the fold change (log2-scale). RESULTS: Our analysis revealed 10 up regulated molecules (Mup1, LRP1, P14KA, ALYREF, and BHMT) and 5 down regulated ones (PSME4, KEAP1, ELK3, FAM186B, and PRELID1), at a cutoff of 1.5-fold change. Ingenuity Pathway Analysis showed the following biological functions to be affected in the HPV+ samples: cancer, hematological disease, and RNA post-transcriptional modification. QRT-PCR analysis confirmed only the differential regulation of ALYREF, KEAP1, and FAM186B genes. CONCLUSION: The relevant methodological procedures described are sufficient to detect the most significant biological functions and pathways according to the HPV status in patients with oropharyngeal cancer in Puerto Rico.

Smoking tobacco use among operating room personnel.

OBJECTIVE: To evaluate the prevalence of smoking operating room personnel and compare this with that of the general public. Given the first hand exposure of these individuals to patients with smoking related illnesses, we believe they should have a decreased tendency to smoke. METHODS: A survey instrument was given to operating room personnel in order to learn the prevalence of smoking and other tobacco use related data. Prevalence for the general population and other healthcare related populations was investigated using various search engines and compared with our results. RESULTS: A total of 113 individuals completed the survey, 6% were found to be current smokers and 15% were found to be past smokers. Data from the Center for Disease Control shows that the prevalence of cigarette smoking among United States adults is 19%, which is significantly higher than what we found in our population (<0.01). In Puerto Rico, the prevalence of smoking is 11%, which is also higher than our study population (p=0.05). Among current smokers, 86% have tried to quit at least once (p=0.02), and all claimed to have knowledge of the possible complications associated with smoking. CONCLUSIONS: Smoking tobacco remains the number one cause of preventable death in the United States despite many efforts to educate the general public on the dangers associated with its use. a more visual or hand's on encounter with the effects of smoking may help decrease tobacco burden in the general population.

Laryngeal cleft type IV: One pathology, two different presentations.

Laryngotracheoesophageal cleft is a rare congenital malformation where a communication exists between the aero-digestive tracts that is associated with high morbidity and mortality. In this case series, we describe our experience with two neonates evaluated in our institution with two diverse initial presentations and symptomatology of type IV laryngotracheoesophageal clefts. One patient presented with acute distress and respiratory failure due to bowel contents obstructing the trachea and the other presented with mild subcostal retractions and inspiratory stridor without overt respiratory failure. Most importantly, not every patient with type IV laryngotracheoesophageal clefts will present with fulminant respiratory difficulty. This prompted a literature review.