Merkel Cell Virus (MCV) is a newly discovered polyomavirus, recently found in a rare skin cancer, Merkel cell carcinoma (MCC). However, MCV has also been detected in some normal tissue samples. We tested and compared the relative quantity of the MCV in a set of diverse human tissue samples with the MCC samples. The levels of MCV in MCCs were over 60 times higher than the highest values in all other tissues. Low quantities of MCV were detected in diverse tissue samples independently of malignant or benign histologic status. Higher levels of the virus were found in the upper aerodigestive tract, digestive system, and saliva compared to the lung and genitourinary system samples. These results confirm that MCV is widespread in the human body and suggest a possible fecal-oral transmission route similar to the Hepatitis A virus. Despite widespread presence of the virus, it appears that only neuroendocrine skin cells are susceptible to transformation by MCV.Merkel cell carcinomas (MCC) are rare neuroendocrine skin tumors that develop from neuroendocrine cells responsible for the sense of touch and pressure. The incidence of MCC has tripled over the past 20 years to about 1,500 cases a year. Increased ascertainment has at least in part contributed to this rise in incidence. People at risk include those with fair skin, excessive sunlight exposure, and a history of numerous nonmelanoma skin cancers. Additionally, patients under immunosuppression including solid organ transplant recipients, and patients with altered lymphocytic function such as patients with AIDS, lymphoma, and leukemia appear to be predisposed to MCC.

Nasopharyngeal carcinoma (NPC) is a rare malignancy with unique genetic, viral and environmental characteristic that distinguishes it from other head and neck carcinomas. The clinical management of NPC remains challenging largely due to the lack of early detection strategies for this tumor. In our study, we have sought to identify novel genes involved in the pathogenesis of NPC that might provide insight into this tumor's biology and could potentially be used as biomarkers. To identify these genes, we studied the epigenetics of NPC by characterizing a panel of methylation markers. Eighteen genes were evaluated by quantitative methylation-specific polymerase chain reaction (PCR) in cell lines as well as in tissue samples including 50 NPC tumors and 28 benign nasopharyngeal biopsies. Significance was evaluated using Fisher's exact test and quantitative values were optimized using cut off values derived from receiver-operator characteristic curves. The methylation status of AIM1, APC, CALCA, deleted in colorectal carcinomas (DCC), DLEC, deleted in liver cancer 1 (DLC1), estrogen receptor alpha (ESR), FHIT, KIF1A and PGP9.5 was significantly associated with NPC compared to controls. The sensitivity of the individual genes ranged from 26 to 66% and the specificity was above 92% for all genes except FHIT. The combination of PGP9.5, KIF1A and DLEC had a sensitivity of 84% and a specificity of 92%. Ectopic expression of DCC and DLC1 lead to decrease in colony formation and invasion properties. Our results indicate that methylation of novel biomarkers in NPC could be used to enhance early detection approaches. Additionally, our functional studies reveal previously unknown tumor suppressor roles in NPC.Nasopharyngeal carcinoma (NPC) is a relatively rare head and neck malignancy in the United States. The global age adjusted incidence is one per 100,000 per year representing 0.7% of all cancers.1 In contrast, certain southern regions of China have an incidence as high as 50 cases per 100,000 per year.2 In fact in Hong Kong, NPC is the leading cancer in men age 20-44 years representing 25% of all cancers.3 NPC is particularly interesting because of its unique genetic, viral and environmental factors. Epstein-Barr virus (EBV) is a critical factor for malignant transformation in NPC. 4 However, only a small fraction of widespread EBV-infected patients will develop a NPC and not all NPC are EBV positive.5 EBV is present in more than 95% of the endemic Type I non-keratinizing lesions, while 30-50% of the Type II keratinizing lesions in the non endemic regions are EBV negative.6 Aside from EBV, environmental exposure to food preservatives in food, salted fish and occupational exposures have been related to increased NPC incidence. 3The initial presentation of NPC varies widely but rarely is the disease localized to the nasopharynx. Commonly, patients present with advanced disease that has metastasized to the

Some improvements in pharmacologic management of pain in NHs have been realized. Yet, presence of pain without scheduled analgesics prescribed was still common. Evidence-based procedures to assure adherence to clinical practice guidelines for pain management in this setting are warranted.

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Use of an analgesic with improved gastrointestinal tolerability may potentially reduce use of NVC medications and hospital resources.