Impact on Health-Related Quality of Life of Induction Chemotherapy Compared With Concurrent Cisplatin and Radiation Therapy in Patients With Head and Neck Cancer

AimsOrgan preservation, an important goal in the treatment of head and neck squamous cell carcinoma (HNSCC), may include induction chemotherapy and cisplatin with radiation therapy (CRT). To our knowledge, no reports have directly compared the impact of induction chemotherapy with that of CRT on health-related quality of life (HRQOL).Materials and methodsIn a phase II trial, we assessed the HRQOL of patients treated with induction chemotherapy followed by CRT. Eligible patients had stage III–IV HNSCC. HRQOL questionnaires were administered at baseline, the end of induction (EOI), the end of CRT (EOCRT) and after CRT. Functional Assessment of Cancer Therapy (FACT version 4) assessed HRQOL. We carried out a comparison of changes in HRQOL from baseline to EOI and from EOI to EOCRT. This trial is registered with ClinicalTrials.gov (NCT01566435).ResultsThirty patients were enrolled in the study. Most HRQOL questionnaires were completed (88%). The mean total FACT scores did not differ from baseline to EOI (general: 83.8 versus 79.1, P = 0.08; head and neck: 109.7 versus 105.8, P = 0.33; Total Outcome Index: 69.7 versus 62.3, P = 0.03; respectively, using P ≤ 0.01 to adjust for multiple simultaneous tests of differences). However, total FACT scores significantly worsened from EOI to EOCRT (79.1 versus 62.3, P = 0.01; 105.8 versus 74.2, P < 0.01; 62.3 versus 34.2, P = 0.01; respectively). Within domains, the head and neck cancer subscale score did not differ from baseline to EOI (median 28.5 versus 27.0, P = 0.69), but significantly worsened from EOI to EOCRT (27.0 versus 9.5, P < 0.01). Swallowing, oral pain and voice quality improved from baseline to EOI, but worsened from EOI to EOCRT. Physical and functional scores worsened from baseline to EOI and from EOI to EOCRT. The emotional well-being score improved from baseline to EOI but worsened from EOI to EOCRT.ConclusionsOverall, HRQOL did not significantly change from baseline to EOI but dramatically worsened from EOI to EOCRT.     

Abrasion and stain removal by different manual toothbrushes and brush actions: studies in vitro

BACKGROUND AND AIMS: A limited amount of data using flat trim multitufted toothbrushes shows that abrasion of substrate surfaces by a standard toothpaste varies dependent on filament stiffness and configuration; soft brushes producing the most abrasion. The aims of these studies in vitro were to assess toothpaste abrasion of acrylic and stain removal by 5 proprietary medium toothbrushes with different head filament arrangements, and a prototype brush with rectangular filaments. The prototype brush had a medium texture in the long axis and soft texture at right angles to the long axis. MATERIAL AND METHOD: Optically clear acrylic was used as the substrate for abrasion by a standard toothpaste. Loss of substrate was determined by profilometry after 5000, 10000, 15000 and 20000 linear or rotary brushing actions. Stain removal was determined spectrophotometrically from optically clear acrylic specimens stained by chlorhexidine tea soaking sequences. Stained specimens were brushed with water using linear or rotary actions and measurements taken every 10 s to 60 s. RESULTS: Abrasion was progressive with increasing strokes and the pattern for each brush and brush action was to a first approximation linear. Overall, abrasion was significantly greater with linear compared to rotary action. Also overall brushes differed in the abrasion produced with both actions and particularly at greater exposure times. Within brush differences for the two motions were all significant by 20000 strokes except for the prototype brush. Stain removal was progressive over time with each brush but the pattern was non-linear. For the proprietary brushes the rotary motion removed less stain. For the prototype brush more stain was removed with the rotary action. Overall brushes differed significantly in stain removal within each motion and for each motion most differences between the proprietary and prototype brushes reached significance. CONCLUSIONS: The differences between brushes for both abrasion and stain removal must in large part relate to the filament contact area with the substrate surface. Whilst the model may not be predictive of clinical differences, it could find use to establish minimum criteria for toothbrush action.     

Care of the critically ill patient in a military unique environment: a program of research

The goal of the Air Force Nursing Research Program at WHMC is to conduct research on topics unique to Air Force and military nursing. The nine stressors of flight and the military environment of care have been used as a conceptual model to guide the development of research studies. The studies conducted to date describe how the environment affects practice and when the environment directly affects the patient. The studies conducted are examples of the numerous military nursing research projects supported by funding from the TSNRP. The research funded by TSNRP contributes to the body of nursing knowledge by supporting scientific research, particularly knowledge that is unique to the military. As our nation faces the threat of chemical and biologic attacks, terrorism, and increased deployment of soldiers to battlefields in remote locations throughout the world, it is more important than ever that we ensure the advancement of military nursing research. Supporting research that advances healthcare in peace and in war is critical to the care of our military members and their families. This will require that research funds continue to be available to support military nursing research, that a strong infrastructure to provide resources in support of nursing research programs continues to exist, and that the military nursing corps continues to attract, train, and retain PhD prepared nurse researchers. Given the results of the research completed to date, the following evidence-based practice can be applied to the care of the patient described at the beginning of this article: The nurse positions the patient in the center of the cargo compartment, away from the bulkhead, toward the front of the aircraft, the warmest location during flight. While enroute, the patient will need to be positioned on an aerovac mattress, repositioned frequently, and have his/her heels elevated at all times. Additional padding may be needed for areas adjacent to the litter cross members to reduce pressure on the skin in areas prone to pressure ulcer formation. Should the patient need endotracheal suctioning, the nurse knows that hyperoxygenation-hyperinflation is effective in preventing suctioning-induced hypoxemia. In addition, the suction pressure will need to be increased to account for the effects of altitude without exceeding the pressure limits on the transport ventilator and causing catastrophic ventilator failure. Because there is not enough room on the litter for the chest tube drainage tubing to lay straight, it will be coiled and should dependent loops develop, they should be drained every 15 minutes. This is Air Force nursing research in practice.     

DNA Methylation Variants at HIF3A Locus,B-Vitamin Intake,and Long-term Weight Change: Gene-Diet Interactions in Two U.S. Cohorts

The first epigenome-wide association study of BMI identified DNA methylation at an HIF3A locus associated with BMI. We tested the hypothesis that DNA methylation variants are associated with BMI according to intake of B vitamins. In two large cohorts, we found significant interactions between the DNA methylation–associated HIF3A single nucleotide polymorphism (SNP) rs3826795 and intake of B vitamins on 10-year changes in BMI. The association between rs3826795 and BMI changes consistently increased across the tertiles of total vitamin B₂ and B₁₂ intake (all P for interaction <0.01). The differences in the BMI changes per increment of minor allele were −0.10 (SE 0.06), −0.01 (SE 0.06), and 0.12 (SE 0.07) within subgroups defined by increasing tertiles of total vitamin B₂ intake and −0.10 (SE 0.06), −0.01 (SE 0.06), and 0.10 (SE 0.07) within subgroups defined by increasing tertiles of total vitamin B₁₂ intake. In two independent cohorts, a DNA methylation variant in HIF3A was associated with BMI changes through interactions with total or supplemental vitamin B₂, vitamin B₁₂, and folate. These findings suggest a potential causal relation between DNA methylation and adiposity.     

Sialyltransferase specificity in selectin ligand formation

Selectin ligands are glycan structures that participate in leukocyte trafficking and inflammation. At least 6 ST3Gal sialyltransferases (I-VI) have been identified that may contribute to selectin ligand formation. However, it is not known which of these sialyltransferases are involved in vivo and whether they may differentially regulate selectin function. We have produced and characterized mice genetically deficient in ST3Gal-I, ST3Gal-II, ST3Gal-III, and ST3Gal-IV. Unlike mice bearing severe defects in selectin ligand formation, there was no finding of leukocytosis with these single ST3Gal deficiencies. Among neutrophils, only ST3Gal-IV was found to play a role in the synthesis of selectin ligands. In vitro rolling of marrow-derived neutrophils on E- or P-selectins presented by Chinese hamster ovary cells was reduced in the absence of ST3Gal-IV. However, in a tumor necrosis factor alpha (TNF-alpha)-induced inflammation model in vivo, no defect among P-selectin ligands was observed. Nevertheless, the number of leukocytes rolling on postcapillary venules in an E-selectin-dependent manner was decreased while E-selectin-dependent rolling velocity was increased. We propose that multiple ST3Gal sialyltransferases contribute to selectin ligand formation, as none of these ST3Gal deficiencies recapitulated the degree of E- and P-selectin ligand deficit observed on neuraminidase treatment of intact neutrophils. Our findings indicate a high degree of functional specificity among sialyltransferases and a substantial role for ST3Gal-IV in selectin ligand formation.     

Design,Synthesis, and Evaluation of Tetrasubstituted Pyridines as Potent 5-HT2C Receptor Agonists

相似文献