Reactivity boundaries to separate the fate of a chemical reaction associated with an index-two saddle

Reactivity boundaries that divide the destination and the origin of trajectories are of crucial importance to reveal the mechanism of reactions. We investigate whether such reactivity boundaries can be extracted for higher index saddles in terms of a nonlinear canonical transformation successful for index-one saddles by using a model system with an index-two saddle. It is found that the true reactivity boundaries do not coincide with those extracted by the transformation taking into account a nonlinearity in the region of the saddle even for small perturbations, and the discrepancy is more pronounced for the less repulsive direction of the index-two saddle system. The present result indicates an importance of the global properties of the phase space to identify the reactivity boundaries, relevant to the question of what reactant and product are in phase space, for saddles with index more than one.

Contrast inversion of the h-BN nanomesh investigated by nc-AFM and Kelvin probe force microscopy

Single sheets of hexagonal boron nitride (h-BN) on transition metals provide a model system for layered insulating materials as well as a functional substrate for molecules and metal clusters. The progress in the understanding of h-BN layers on transition metals was mainly driven by scanning tunnelling microscopy (STM) and photoelectron spectroscopy (PES) measurements within the last decade, while direct measurements of mechanical and electrical properties are still rare. Our investigations of the two-dimensional (2D) h-BN nanomesh on a Rh(111) substrate by high-resolution noncontact atomic force microscopy (nc-AFM) reveal a complex surface structure including a frequently observed contrast inversion. Detailed 2D force spectroscopy measurements are revealing towards a mechanical elastic deformation of the h-BN monolayer caused by the tip-sample interaction. Furthermore, Kelvin probe force microscopy (KPFM) and spectroscopy measurements show local work function variations of the nanomesh, proving the results obtained by PES but additionally providing detailed local information.

High-resolution imaging of C60 molecules using tuning-fork-based non-contact atomic force microscopy

Recent advances in non-contact atomic force microscopy (nc-AFM) have led to the possibility of achieving unprecedented resolution within molecular structures, accomplished by probing short-range repulsive interaction forces. Here we investigate C(60) molecules adsorbed on KBr(111) and Cu(111) by tuning-fork-based nc-AFM. First, measurements of C(60) deposited on KBr(001) were conducted in cryogenic conditions revealing highly resolved nc-AFM images of the self-assembly. Using constant-frequency shift mode as well as three-dimensional spectroscopic measurements, we observe that the relatively weak molecule-substrate interaction generally leads to the disruption of molecular assembled structures when the tip is probing the short-range force regime. This particular issue hindered us in resolving the chemical structure of this molecule on the KBr surface. To obtain a better anchoring of C(60) molecules, nc-AFM measurements were performed on Cu(111). Sub-molecular resolutions within the molecules was achieved which allowed a direct and unambiguous visualization of their orientations on the supporting substrate. Furthermore, three-dimensional spectroscopic measurements of simultaneous force and current have been performed above the single molecules giving information of the C(60) molecular orientation as well as its local conductivity. We further discuss the different imaging modes in nc-AFM such as constant-frequency shift nc-AFM, constant-height nc-AFM and constant-current nc-AFM as well as three-dimensional spectroscopic measurement (3D-DFS) employed to achieve such resolution at the sub-molecular scale.

Three-dimensional dynamic force spectroscopy measurements on KBr(001): atomic deformations at small tip-sample separations

Three-dimensional dynamic force spectroscopy measurements were carried out above KBr(001) at low temperature in order to investigate the distance dependence of the tip-sample interactions. In particular, the recorded 3D frequency shift data as well as the extracted interaction force and potential energy fields were analysed with respect to influences of tip and/or sample deformations. We found that a postprocessing correction of the observed deformations significantly modifies the magnitude of the extracted interaction forces and also the image contrast.

Robust existence of a reaction boundary to separate the fate of a chemical reaction

Nonlinear dynamics around a rank-one saddle is investigated in a high energy regime above the reaction threshold. The transition state (TS) is considered as a surface of a "point of no return" through which all reactive trajectories pass only once in the process of climbing over the saddle before being captured in the product state. A no-return TS ceases to exist above a certain high energy regime. However, even at high energies where the no-return TS can no longer exist, it is shown that "an impenetrable barrier" in the phase space robustly persists, which acts as a boundary between reactive and nonreactive trajectories. This implies that we can yet predict the fate of reactions even when the no-return TS may not exist. As an example, we show the analysis of dynamical systems theory for a hydrogen atom in crossed electric and magnetic fields.

Determination of effective tip geometries in Kelvin probe force microscopy on thin insulating films on metals

In scanning probe techniques, accurate height measurements on heterogeneous surfaces are a major requirement. Different electrostatic potentials of various materials have a significant influence on the measured force/current and therefore a direct influence on the tip-sample distance. Kelvin probe force microscopy (KPFM) is based on a dynamic compensation of the electrostatic force while performing non-contact atomic force microscopy measurements. Thus, the influence of the electrostatic potentials can be minimized and accurate height measurements become possible. Here, the study of ultra-thin alkali halide films on Cu(111) investigated by KPFM is presented. This work is focused on the interface between areas of bare Cu(111) and the first layers of salt. The compensation of the electrostatic potential allow us to determine layer heights with high accuracy. The second objective was to elaborate on the characterization of tip geometries across suitable nanostructures. Simulations of measured images are performed with different input parameters, which gives a direct estimation of the effective tip radius and geometry used for the measurements.

Long-term safety and efficacy of tocilizumab, an anti-IL-6 receptor monoclonal antibody, in monotherapy, in patients with rheumatoid arthritis (the STREAM study): evidence of safety and efficacy in a 5-year extension study

OBJECTIVES

To evaluate the safety and efficacy of 5-year, long-term tocilizumab monotherapy for patients with rheumatoid arthritis.

METHODS

In an open-label, long-term extension trial following an initial 3-month randomised phase II trial, 143 of the 163 patients who participated in the initial blinded study received tocilizumab monotherapy (8 mg/kg) every 4 weeks. Concomitant therapy with non-steroidal anti-inflammatory drugs and/or oral prednisolone (10 mg daily maximum) was permitted. All patients were evaluated with American College of Rheumatology (ACR) improvement criteria, disease activity score (DAS) in 28 joints, and the European League Against Rheumatism response, as well as for safety issues.

RESULTS

143 patients were enrolled in the open-label, long-term extension trial and 94 (66%) patients had completed 5 years as of March 2007. 32 patients (22%) withdrew from the study due to adverse events and one patient (0.7%) due to unsatisfactory response. 14 patients withdrew because of the patient's request or other reasons. The serious adverse event rate was 27.5 events per 100 patient-years, with 5.7 serious infections per 100 patient-years, based on a total tocilizumab exposure of 612 patient-years. Of the 88 patients receiving corticosteroids at baseline, 78 (88.6%) were able to decrease their corticosteroid dose and 28 (31.8%) discontinued corticosteroids. At 5 years, 79/94 (84.0%), 65/94 (69.1%) and 41/94 (43.6%) of the patients achieved ACR20, ACR50, and ACR70 improvement criteria, respectively. Remission defined as DAS28 less than 2.6 was achieved in 52/94 (55.3%) of the patients.

CONCLUSION

In this 5-year extension study, tocilizumab demonstrated sustained long-term efficacy and a generally good safety profile.

Effect of nuclear motion on molecular high-order harmonics and on generation of attosecond pulses in intense laser pulses

We calculate harmonic spectra and shapes of attosecond-pulse trains using numerical solutions of Non-Born-Oppenheimer time-dependent Shrödinger equation for 1D H2 molecules in an intense laser pulse. A very strong signature of nuclear motion is seen in the time profiles of high-order harmonics. In general the nuclear motion shortens the part of the attosecond-pulse train originating from the first electron contribution, but it may enhance the second electron contribution for longer pulses. The shape of time profiles of harmonics can thus be used for monitoring the nuclear motion.

Administration of Optimum Sustained-Insulin Release PLGA Microcapsules to Spontaneous Diabetes-Prone BB/WorTky Rats

To show the possibility of sustained-release insulin formulation composed of PLGA, the optimum one was administered to BioBreeding rat, a model of spontaneous type I diabetes mellitus (IDDM). Every 2 weeks subcutaneous administration made their blood glucose level depend on the insulin release and food intake. However, all of them kept alive with little change or rather a little gain in body weight. Furthermore, some of pregnant rats with intermittent treatment bore fetuses, although additional insulin therapy seemed necessary. Therefore, the formulation could become a new tool as a provider of basal insulin for IDDM patients.

Porphyromonas gingivalis gingipains cause G(1) arrest in osteoblastic/stromal cells

INTRODUCTION

The program for mammalian cell growth and division consists of four successive phases; G(1), S, G(2), and M. Porphyromonas gingivalis may manipulate the host cell cycle to benefit bacterial virulence expression, which likely causes the cell and tissue tropism observed in chronic periodontal infections. We examined P. gingivalis for its effects on cell-cycle modulation in mouse ST2 osteoblastic/stromal cells.

METHODS

Synchronized ST2 cells were infected with P. gingivalis ATCC33277 (wild-type, WT), gingipain-mutants [KDP136 (DeltargpADeltargpBDeltakgp), KDP129 (DeltargpADeltargpB), and KDP133 (Deltakgp)], and a fimbria-deficient mutant (KDP150) for 24 h, then the cell cycle was evaluated using flow cytometry. Cell-cycle-related molecule expression was examined with a microarray, as well as with quantitative real-time polymerase chain reaction and Western blotting assays.

RESULTS

Both the WT and KDP150 strains significantly inhibited cellular proliferation and arrested the cell cycle in the G(0)/G(1) phase, while the expression levels of the cell-cycle regulatory molecules cyclin D and cyclin E were also decreased. In contrast, KDP136 did not show any effects. G(1) arrest was also clearly induced by KDP129 and KDP133, with KDP129 being more effective.

CONCLUSION

The present findings suggest that P. gingivalis gingipains reduce cyclin expression and cause early G(1) arrest, leading to the inhibition of cellular proliferation.

Heterogenic virulence and related factors among clinical isolates of Porphyromonas gingivalis with type II fimbriae

BACKGROUND/AIMS

Porphyromonas gingivalis is a periodontal pathogen whose fimbriae are classified into six genotypes (types I-V and Ib) based on the diversity of the fimA genes encoding the fimbrial subunits. Accumulated evidence suggests that P. gingivalis strains with type II fimbriae are more virulent as compared to those with other types. However, it is unknown if strong virulence is uniformly conserved among clones with type II fimbriae. In the present study, we compared infectious inflammatory changes in clinical isolates of P. gingivalis with type II fimbriae using a mouse abscess model to examine their pathogenic heterogeneity and heterogeneity-related factors.

METHODS

Suspensions of nine different clinical isolates with type II fimbriae were subcutaneously injected into female BALB/c mice and inflammatory parameters, such as serum sialic acid concentration, were compared.

RESULTS

Many of the type II fimbrial isolates caused severe inflammation in the mice, though some were less causative, as was the control strain ATCC 33277 (type I fimbria strain). These results showed that pathogenic heterogeneity exists among P. gingivalis clones with type II fimbriae. Further, the heterogeneity-related factors of P. gingivalis strains were analyzed and the pathogenic potentials showed positive relationships to gingipain activities and invasive efficiency but not to hydrophobicity or autoaggregation. In addition, invasive efficiency was related to the activities of gingipains that were extracellularly secreted.

CONCLUSION

These results suggest that pathogenic heterogeneity has relationships with the invasive and proteolytic activities of P. gingivalis clones with type II fimbriae.

Transition state theory for laser-driven reactions

Recent developments in transition state theory brought about by dynamical systems theory are extended to time-dependent systems such as laser-driven reactions. Using time-dependent normal form theory, the authors construct a reaction coordinate with regular dynamics inside the transition region. The conservation of the associated action enables one to extract time-dependent invariant manifolds that act as separatrices between reactive and nonreactive trajectories and thus make it possible to predict the ultimate fate of a trajectory. They illustrate the power of our approach on a driven Henon-Heiles system, which serves as a simple example of a reactive system with several open channels. The present generalization of transition state theory to driven systems will allow one to study processes such as the control of chemical reactions through laser pulses.

Quasiclassical trajectory study of O(1D) + N2O --> NO + NO: classification of reaction paths and vibrational distribution

Quasiclassical trajectory calculations for the planar reaction of O(1D) + N2O --> NO + NO are performed on a newly constructed ab initio potential energy surface. In spite of the reduced dimension approximation, the agreement between the computational and experimental results is largely satisfactory, especially on the similar amount of excitation of the two kinds of NO products found by Akagi et al. [J. Chem. Phys. 111, 115 (1999)]. Analyzing the initial condition dependence of the trajectories, we find that the trajectories of this reaction can be classified into four reaction paths, which correspond to respective areas in the space of initial condition. In one of the four paths, a long-lived stable complex is formed in the course of reaction, whereas the other three paths have direct mechanism. Contradictory to conventional understanding of the chemical reaction dynamics, the direct paths show more efficient energy exchange between the NO stretching modes than that with a long-lived intermediate. This indicates that the vibrational mode coupling along the short-lived paths is considerably stronger than expected.

Vanishing N = 20 shell gap: study of excited states in (27,28)Ne

This Letter reports on the (1)H((28)Ne, (28)Ne) and (1)H((28)Ne, (27)Ne) reactions studied at intermediate energy using a liquid hydrogen target. From the cross section populating the first 2(+) excited state of (28)Ne, and using the previously determined BE(2) value, the neutron quadrupole transition matrix element has been calculated to be M(n)=13.8 +/- 3.7 fm(2). In the neutron knockout reaction, two low-lying excited states were populated in (27)Ne. Only one of them can be interpreted by the sd shell model while the additional state may intrude from the fp shell. These experimental observations are consistent with the presence of fp shell configurations at low excitation energy in (27,28)Ne nuclei caused by a vanishing N=20 shell gap at Z=10.

Effect of phenytoin on collagen accumulation by human gingival fibroblasts exposed to TNF-alphain vitro

OBJECTIVE

Tumor necrosis factor (TNF)-alpha is associated with chronic gingival inflammation and reported to induce gingival overgrowth (GO), while phenytoin (PHT) is also known to be a causative agent of GO. We examined the synergistic effect of PHT and TNF-alpha on collagen metabolism in human gingival fibroblasts (HGFs).

MATERIALS AND METHODS

HGFs were cultured with TNF-alpha and PHT. Quantitative real-time RT-PCR was employed to determine the mRNA levels for collagen, matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs) and integrin subunits. Cellular collagen endocytosis was determined using a flow-cytometry.

RESULTS

The proliferation of HGFs was not affected by TNF-alpha or PHT individually, whereas both synergistically increased collagen accumulation in HGFs. Further, collagen mRNA expression was not increased by TNF-alpha or PHT, although together they markedly prevented cellular collagen endocytosis, associated with the suppression of alpha2beta1-integrin mRNA expression. The mRNA expression of MMP-1 and-2 was suppressed by PHT, while TIMP-1 mRNA expression was enhanced by both TNF-alpha and PHT.

CONCLUSION

Our results suggest that TNF-alpha and PHT together cause impaired collagen metabolism by suppression of enzymatic degradation with MMPs/TIMP-1 and integrin-mediated endocytosis. These synergistic effects may also be involved in TNF-alpha- and PHT-induced collagen accumulation, leading to GO.

Outbreak of Nocardia farcinica infection with the same pattern in randomly amplified polymorphic DNA analysis

We experienced three cases of nocardiosis by Nocardia farcinica in the same ward within a six-month period. The result of gene analysis by randomly amplified polymorphic DNA gave the same pattern. Thus, these three cases were considered to be caused by the same strain of N. farcinica, implying the presence of nosocomial infection.

Establishment of a mass-production system for NADP using bacterial inorganic polyphosphate/ATP-NAD kinase

The inorganic polyphosphate/ATP-dependent NAD kinase (Ppnk) of Mycobacterium tuberculosis was applied to the mass-production of NADP from NAD and inorganic polyphosphate (metaphosphate). When Ppnk purified from recombinant Escherichia coli cells overexpressing the M. tuberculosis Ppnk was used, 30 mM (27 g/l) NADP was produced from 50 mM NAD and 100 mg/ml metaphosphate at 37 degrees C and pH 7.0. The recombinant E. coli cells were immobilized in polyacrylamide gel, and treated with acetone to render the cells permeable to substrates and products. When acetone-treated immobilized cells were used, 16 mM (14 g/l) NADP was produced from 50 mM NAD and 100 mg/ml metaphosphate at 37 degrees C and pH 7.0. The isolation of NADP formed in the reaction mixture was easy because of the absence of by-products (ATP degradation compounds), and this NADP production system using purified Ppnk or immobilized recombinant E. coli cells expressing Ppnk is thought to be feasible in the production of NADP on an industrial scale.

Safety of tacrolimus, an immunosuppressive agent, in the treatment of rheumatoid arthritis in elderly patients

OBJECTIVE

To prospectively evaluate the safety of tacrolimus in active rheumatoid arthritis (RA) in elderly patients with insufficient response to disease-modifying antirheumatic drugs (DMARDs).

METHODS

Fifty-seven patients aged > or =65 yr with RA for > or =6 months were enrolled in an open-label, non-controlled study. All DMARDs were discontinued and tacrolimus was administered orally once daily after the evening meal for 28 weeks. Tacrolimus, initiated at 1.5 mg/day, was increased to 3 mg/day after 6 weeks if no abnormal changes developed. Existing NSAID and oral corticosteroid (< or =7.5 mg/day prednisolone equivalent) therapy could be continued during the study. Safety was evaluated as clinical symptoms, abnormal changes in laboratory values and the development of infection. Treatment response was determined using the American College of Rheumatology (ACR) criteria for improvement. Whole blood concentrations of tacrolimus 12 h after administration were measured by high-performance liquid chromatography and tandem mass spectrometry.

RESULTS

Clinical adverse events developed in 25 patients (46.3%). Abnormal changes in laboratory values occurred in 25 patients (46.3%). Ten patients (18.5%) developed infection. An ACR20 response was achieved by 50.0% of efficacy-evaluable patients and ACR20 success rates (the proportion of patients achieving ACR20 response and completing the study) was 46.3%. The ACR50 response rate was 18.5% of evaluable patients. Mean blood concentration of tacrolimus was 3.3 and 5.3 ng/ml in patients receiving 1.5 and 3.0 mg daily, respectively. No relationship between its concentration and adverse reactions was observed.

CONCLUSION

In elderly patients with insufficient response to DMARD therapy, tacrolimus at 1.5-3.0 mg/day is safe and well-tolerated and provides clinical benefit.

Comparative studies on susceptibilities of two different Japanese isolates of Oncomelania nosophora to three strains of Schistosoma japonicum originating from Japan, China, and the Philippines

Oncomelania nosophora (Gastropoda: Pomatiopsidae) is the intermediate host of Schistosoma japonicum in Japan. Although most of the snails were eliminated during the 20th century, they are still found in two areas in Japan. One area is in the Kofu Basin, including Nirasaki City, in Yamanashi Prefecture. The other is the Obitsu River Basin in Kisarazu City, Chiba Prefecture. Snails collected in Nirasaki and Kisarazu were exposed to 3 geographical strains of S. japonicum originating from Japan, China, and the Philippines. Both isolates of O. nosophora showed high susceptibility to the Japanese strain of S. japonicum (74.0% - 82.2%, for the Nirasaki isolate and 58.0% - 56.0% for the Kisarazu isolate) and low susceptibility to the Chinese strain (0.0% - 1.3% and 1.4% - 7.9% respectively). In contrast, the susceptibility of the snails to the Philippine strain was significantly different (P < 0.01) between the isolates (3.3% - 6.6% for the Nirasaki isolate and 31.9% - 75.9% for the Kisarazu isolate). To examine the differences in infectivity in detail, we conducted histological observations of snails exposed to the Philippine strain at 3 h, 1, 3, and 15 days after miracidial exposure. We found differences in the development of the parasite between the isolates of snails from early after exposure.

Femoral reconstruction by single, folded or double free vascularised fibular grafts

We reviewed 17 patients for a mean of 25 months period after free vascularised fibular transfer to reconstruct massive bone defect or recalcitrant nonunion of the femur. There were 11 cases of posttraumatic nonunion and six patients had a large bony defect following resection of bone tumour. Ten patients underwent double or folded and seven patients underwent single vascularised fibula graft transfer. Mean bony defect of the femur was 6.5 cm and mean length of grafted fibula was 15 cm. Revision surgery due to postoperative vascular complications was required in five cases. Twenty-three out of 24 (96%) vascularised fibulas were transferred successfully. The resultant outcome was successful in 15 out of 16 (94%) patients with confirmed bone union. Stress fracture occurred in three inlay fibula grafts. Hypertrophic change of the fibula graft was significantly noted in inlay grafts as compared to onlay grafts. All patients could walk without brace at a mean of 11 months postoperatively. Donor-site morbidity was minimum. Vascularised fibula grafting is a reliable and safe reconstructive procedure for massive femur defects. Folded or double fibula grafts cannot prevent stress fractures and the key point is to rigidly stabilise the femur in an anatomically aligned position.

A single treatment with microcapsules containing a CXCR4 antagonist suppresses pulmonary metastasis of murine melanoma

Biodegradable poly D,L-lactic acid (PLA, molecular weight: ca. 5000) microcapsules containing a CXCR4 antagonist (4F-benzoyl-TE14011) were prepared (4F-benzoyl-TE14011-PLA), and their anti-metastatic activity was evaluated in mice. A single subcutaneous administration of 4F-benzoyl-TE14011-PLA significantly reduced the number of colonies formed by pulmonary metastasis of B16-BL6 melanoma cells expressing CXCR4. The same dose of 4F-benzoyl-TE14011 in a single or a series of treatments affected little. The substance 4F-benzoyl-TE14011 dose-dependently suppressed B16-BL6 cell growth. In the cells cultured with SDF-1, a more potent suppression was observed. 4F-Benzoyl-TE14011 was rapidly released from 4F-benzoyl-TE14011-PLA for an initial period, both in vitro and in vivo. A steady release was thereafter observed. Therefore, this drug release profile might contribute to prevention of melanoma metastasis at the steps involving the migration and cell growth. These results also show that a sustained drug release formulation could be a useful drug delivery system for CXCR4 antagonists.

Exit interaction effect on nascent product state distribution of O(1D)+N2O-->NO+NO

We have determined the rotational state distributions of NO(v'=0,1,2) products produced from the reaction O(1D)+N2O. This is the first full characterization of the product rotational distribution of this reaction. The main part of each rotational distribution (up to j' approximately 80) has rotational temperature approximately 20,000 K and all these distributions are quite near to those predicted by the phase space theory (PST). This observation and previously reported vibrational distribution indicate that the most part of the energy partitioning of the reaction products is at least apparently statistical although the intermediate of this reaction is not so stable as to ensure the long lifetime. On the other hand, the distributions in the high rotational levels (j'=80-100) are found to decrease more sharply as j' increases than the PST predictions. The origin of the observed decrease of the distribution is discussed with quasiclassical trajectory (QCT) calculations on a five-dimensional ab initio potential energy surface (PES). The observed near-statistical distribution and the sharp decrease in the high-j' levels are well reproduced by a "half-collision" QCT calculation, where statistical distribution at the reaction intermediate is assumed. This agreement shows the rotation-translation interaction in the exit region has an effect of yielding small high-j' populations. However, a little bias of the calculated distribution toward lower rotational excitation than the observed one indicates that the combination of the statistical intermediate and the exit interaction on the current PES does not completely describe the real system. It is suggested that the reaction intermediate is generated with the distribution which is close to statistical but a little biased toward yielding high-j' products, and that the interaction in the exit region of the PES results in the sharp decrease in the high-j' levels.

Phase I trial of concurrent chemoradiotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN)

The aim of this study was to evaluate the efficacy and toxicity of a concurrent chemoradiotherapy using docetaxel, cisplatin and 5-fluorouracil (5-FU) (TPF) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). In total, 19 patients with previously untreated stage III–IV SCCHN were entered onto this trial. Patients received two cycles of chemotherapy. Cycles were repeated every 4 weeks. The starting doses (dose level 1) were docetaxel 60 mg m⁻², cisplatin 70 mg m⁻², and 5-day continuous infusion of 5-FU 600 mg m⁻² day⁻¹. Radiation was targeted to begin on the first day of chemotherapy, day 1. The total radiation dose to the primary tumour site and neck lymph nodes was between 63.0 and 74.0 Gy. At least three patients were examined at each dose level before advancing to the next level. The maximum-tolerated dose (MTD) of this regimen was docetaxel 60 mg m⁻², cisplatin 60 mg m⁻² and 5-FU 600 mg m⁻² day⁻¹. The main toxicities were mucositis (grade 3 and 4, 79%), leukocytopenia (grade 3 and 4, 53%), neutropenia (grade 3 and 4, 42%), anaemia (grade 3, 16%), liver dysfunction (grade 3, 11%) and renal dysfunction (grade 2, 11%). The overall response rate was 100%, including 84% complete responses (CRs). This concurrent chemoradiotherapy with TPF was safe and well tolerated. The high CR rate justifies further evaluation of this chemoradiotherapy modality in advanced SCCHN patients.