Double-blind randomized phase III study comparing a mixture of natural agents versus placebo in the prevention of acute mucositis during chemoradiotherapy for head and neck cancer

Abstract

Background

There is no widely accepted intervention in the prevention of acute mucositis during chemoradiotherapy for head and neck carcinoma. In the present double-blind study, we tested 4 natural agents, propolis, aloe vera, calendula, and chamomile versus placebo.

Methods

Patients undergoing concomitant chemo-intensity-modulated radiotherapy (IMRT) were given natural agent or matched placebo; grade 3 mucositis on physical examination according to Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 was the primary endpoint. Various covariates were tested at logistic regression, including the individual amount of mucosa receiving at least 9.5 Gy per week (V9.5w).

Results

One hundred seven patients were randomized from January 2011 to July 2014, and 104 were assessable (51%-49% were assigned to the placebo group and 53%-51% were assigned to the natural agent). Overall, 61 patients developed peak grade 3 mucositis with no difference between arms (P = .65). Conversely, V9.5w (P = .007) and primary site (P = .037) were independent predictors.

Conclusion

The selected natural agents do not prevent mucositis, whereas the role of V9.5w is confirmed.

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p16 protein expression and correlation with clinical and pathological features in osteosarcoma of the jaws: Experience of 37 cases

Abstract

Background

In literature, no markers have been reported as predictive and prognostic factors in osteosarcoma of the jaw.

Methods

A retrospective analysis of p16 expression was performed in 37 patients with high-grade osteosarcoma of the jaw to investigate its potential prognostic and predictive value.

Results

p16 positivity was found in 56.7% of cases. The absence of p16 expression was associated with an adverse disease-free survival (P = .003). At the multivariate Cox regression, positive margins were the only independent factor. In the subgroup of 17 patients who underwent neoadjuvant chemotherapy, a significant association was noted between p16 expression and pathological response to chemotherapy (P = .015) and the negativity of p16 increased the risk of negative outcome (P = .01).

Conclusion

Our data indicate that the wide surgical margin is the most important prognostic factor. The expression of p16 confers greater sensitivity to chemotherapy and its loss of expression is associated with a worse prognosis.

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Impact of positive margins on outcomes of oropharyngeal squamous cell carcinoma according to p16 status

Abstract

Background

Currently, positive surgical margins in head and neck cancer are considered to be an indicator for postoperative chemoradiotherapy (CRT) over radiotherapy (RT) alone. However, there are less data regarding the impact of margin status on human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (SCC).

Methods

We performed a retrospective review of 55 patients with oropharyngeal SCC undergoing primary surgical treatment. The impact of margin status on disease-specific survival (DSS) was studied according to p16 status.

Results

Twenty-one patients had positive margins. Adjuvant treatment in these cases was CRT (n = 6), RT alone (n = 14), and none (n = 1). Among p16-negative patients, positive margins and dysplasia at margins predicted significantly worse DSS. Among patients with p16-positive disease, margin status had no impact on DSS.

Conclusion

Patients with p16-positive oropharyngeal SCC and positive margins after excision maintain a low risk of recurrence despite most receiving RT alone as adjuvant treatment. These findings raise questions regarding the additional benefit of postoperative CRT in this group.

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Evaluation of ultrasound reporting for thyroid cancer diagnosis and surveillance

Abstract

Background

Despite the importance of ultrasound imaging in thyroid disease care, ultrasound reports vary greatly in the features described. It is essential that ultrasound reports contain and present all components necessary for a clinical decision in a reader-friendly format.

Methods

One hundred ninety thyroid and neck ultrasound reports were scored using the universal ultrasound report template developed by Su et al, along with the American Thyroid Association (ATA) and the American Association of Clinical Endocrinologists/Associazione Medici Endocrinologi/European Thyroid Association (AACE/AME/ETA) guidelines. All ultrasounds were performed on patients seen between August and November 2015 by a single surgeon (M.L.U), and originated from a variety of physicians and institutions.

Results

An average of 30.9% of Su et al's criteria was satisfactorily included in the reports. Similar results were reached when the ATA and the AACE/AME/ETA guidelines were applied as scoring templates.

Conclusion

Our results reveal the wide variation in ultrasound reporting. The standardization of ultrasound reporting would help to improve physicians' ability to properly diagnose and manage patients with thyroid disease. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Comparison of the immunogenicity of BM32, a recombinant hypoallergenic B cell epitope-based grass pollen allergy vaccine with allergen extract-based vaccines

Publication date: Available online 31 May 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Milena Weber, Katarzyna Niespodziana, Birgit Linhart, Angela Neubauer, Hans Huber, Rainer Henning, Rudolf Valenta, Margarete Focke-Tejkl




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Emphysematous gastritis with hepatic portal venous gas: a shift towards conservative management

Description

A female aged 94 years with a history of diabetes presented with acute onset abdominal pain, haematemesis and altered mental status. She denied alcoholism, corrosive ingestion, pancreatitis or abdominal trauma. She appeared toxic and was hypotensive. Her hemogram showed leucocytosis at 14.8 x 10^9/L. CT scan of the abdomen showed air scattered within the liver, portal vein and gastric wall (figures 1 and 2). Also, dense calcifications of the aorta and abdominal arteries were noted (figure 3). Due to the high risk of surgery, she was managed conservatively with proton pump inhibitors, broad-spectrum antibiotics, nasogastric decompression and intravenous hydration, with progressive improvement noted.

Figure 1

Axial CT scan of the abdomen and pelvis without contrast showing air within the portal vein (white arrows) and in the stomach wall (black arrow).

Figure 2

Coronal CT scan...

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The effect of subinhibitory concentrations of gentian violet on the germ tube formation by Candida albicans and its adherence to oral epithelial cells

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): T. Mafojane, S.L. Shangase, M. Patel
ObjectiveThis study investigated the effect of subinhibitory concentrations of gentian violet on the germ tube formation by Candida albicans and its adherence ability to oral epithelial cells.MethodsThirty strains of C. albicans isolated from denture wearers, normal healthy individuals and HIV positive patients were used in the study. The antifungal property (Minimum Fungicidal Concentration) of gentian violet was determined at various time intervals using a microdilution technique. The effect of subinhibitory concentrations of gentian violet on the adherence ability (0.000244%) and on germ tube formation ((0.000244%, 0.000122%, 0.000061% and 0.000031%) was determined. In both experiments, water was used as a control. The test results were compared using the Kruskal-Wallis test.ResultsAt 60min a high concentration (0.0078%) of gentian violet was required to completely kill C. albicans. Subinhibitory concentrations of gentian violet significantly reduced the adherence ability of C. albicans by 57% (p<0.01) and equally inhibited germ tube formation (p<0.01) compared with the controls. The inhibition was concentration dependent, with up to 98% reduction at a concentration of 0.000244%. Germ tube reduction was significantly higher in the isolates from the HIV positive patients than in the isolates from denture wearers.ConclusionAt high concentrations, gentian violet killed C. albicans, whereas at subinhibitory concentrations it reduced its virulence by preventing the adherence ability and germ tube formation. This suggests that the beneficial effects of gentian violet would last beyond the fungicidal concentrations in the treatment of candidiasis.

Graphical abstract

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