A longitudinal evaluation of oral mucositis in patients receiving radiation therapy (IMRT) with/without chemotherapy (CTX)

e20572

Background: Oral mucositis is a major side effect of RT ± CTX to the head and neck. A variety of instruments and techniques have been used to quantify oral cavity changes during treatment. Few studies have reported on the evaluation of oral mucositis using both subjective and objective methods. A secondary aim in our study testing an innovative mouthwash is to increase our understanding of using subjective and objective methods for measuring oral mucositis, functional status, and weight changes over time. Methods: Patients reported functional status, pain and investigators measured oral mucositis and weight at four times (beginning of RT [T1], onset of mucositis [T2], end of RT [T3], and healing of mucositis [T4]) over a 10 - 15 week period, using the Karnofsky Performance Status [KPS]) and the Oral Mucositis Assessment Scale (OMAS). The OMAS measures researcher-evaluated ulceration/pseudomembrane formation and erythema in specific sites in the mouth, and self-report by patients, rating severity of mouth pain, ability to swallow and chew. Results: Of 51 head and neck cancer patients enrolled, 3 never developed mucositis. Mean days to onset of mucositis was 15.58 (SD 6.85), and mean days to healing of mucositis was 77.86 (SD 40.1). Mucositis pain scores (possible range 0–45) were moderate at T2 (x=6.25, SD 3.5) and T3 (x=12, SD 5.0). Subjective pain, chewing, and swallowing scores were positively correlated with each other (r= .31 - .73, p<.05) and objective oral mucositis scores were positively correlated with each other (r= .49 - .77, p<.01), however, no significant correlations were obtained between the subjective and objective scores. In both the RT-only group as well as the RT+CTX group, weight significantly decreased from T1 to T4, and KPS significantly decreased from T1 to T3. RT+CTX patients showed lower KPS and greater weight loss from T1 to T4 (X=10lbs) compared to the RT-only group (X=3 lbs), but neither was significantly different. Conclusions: During RT+CTX, patients need more supportive care to maintain functional status and avoid weight loss. Lack of correlations between the subjective and objective scores is interesting in that they are measuring something quite different, which may provide some insight into underlying mechanisms.

No significant financial relationships to disclose.

Formulation and process parameters affecting protein encapsulation into PLGA microspheres during ethyl acetate-based microencapsulation process

The objective of this study was to investigate formulation and process parameters affecting protein encapsulation into PLGA microspheres during an ethyl acetate-based double emulsion microencapsulation process. Lysozyme was used as a model protein throughout this study. An aqueous lysozyme solution was emulsified in ethyl acetate containing 0.6 approximately 1.2 g PLGA75 : 25. The primary emulsion was then transferred quickly to an aqueous phase to make a water-in-oil-in-water emulsion. Ethyl acetate quenching was performed on the double emulsion stirred for 5, 15, 30 or 45 min. The resultant microspheres were further hardened, collected and dried overnight under vacuum. The bicinchoninic acid assay was carried out to determine the quantity of lysozyme present in the aqueous continuous phase and inside the microspheres. While the primary emulsion was stirred without quenching, lysozyme in the inner water phase continued diffusing across the ethyl acetate phase into the aqueous continuous phase. Emulsion droplets were also broken into smaller ones with ongoing stirring; this event also contributed to lysozyme leaking out of the inner water phase. The amount of lysozyme leaching to the aqueous continuous phase ranged from 4.79 +/- 2.1 to 51.9 +/- 5.3% under the experimental condition. Ethyl acetate quenching stopped the primary emulsion droplets from being fragmented into smaller ones and caused PLA75 : 25 precipitation to form microspheres. As a result, the rate of ethyl acetate removal influenced lysozyme encapsulation efficiency, as well as microsphere size. Depending on the timing of ethyl acetate quenching, lysozyme encapsulation efficiencies were found to be 9.89 +/- 4.53 approximately 75.82 +/- 6.55%. Optimization of the onset of ethyl acetate quenching and formulations could permit attainment of a desirable protein encapsulation efficiency.

Measurement of OH radical CT for inactivating Cryptosporidium parvum using photo/ferrioxalate and photo/TiO2 systems

AIM

This study investigates the inactivation of Cryptosporidium parvum using the OH radical and reports the OH radical CT (OH radical concentration x contact time) values for C. parvum inactivation.

METHODS AND RESULTS

Although a wealth of information has demonstrated the efficacy of the microbial inactivation activity of the OH radical, no studies have performed a quantitative estimation of the OH radical for C. parvum inactivation. The CT value of the OH radical required for 2 log C. parvum inactivation was measured with two OH radical-generating systems, photo/ferrioxalate and photo/TiO2. The OH radical was approx. 10(4)-10(7)-fold more effective for microbial inactivation than other popular chemical disinfectants such as ozone, chlorine dioxide and free chlorine.

CONCLUSIONS

The OH radical appears to be suitable for microbial inactivation with a calculated CT value required for 2 log C. parvum inactivation of 9.3 x 10(-5) mg min l(-1).

SIGNIFICANCE AND IMPACT OF THE STUDY

This study is the first report of an investigation on the role of the OH radical in the photo/ferrioxalate and photo/TiO2 systems and on the OH radical CT required for C. parvum inactivation.

Highly birefringent terahertz polarization maintaining plastic photonic crystal fibers

Guided-wave propagation of sub-ps terahertz (THz) pulses in a highly birefringent plastic photonic crystal fiber was studied by using a THz time domain spectroscopy technique. The plastic photonic crystal fiber was fabricated by using high density polyethylene tubes and solid filaments. The fabricated THz plastic photonic crystal fibers exhibit an extremely large birefringence of ~ 2.1 x 10(-2), which is almost one order of magnitude larger than that of previously reported photonic crystal fibers.

In dementia with Lewy bodies, Braak stage determines phenotype, not Lewy body distribution

We used an autopsy series to determine whether the newest dementia with Lewy bodies (DLB) consensus pathologic classification correlates with premortem diagnosis of DLB. Neocortical sections from a total of 95 cases with Lewy bodies were stained with alpha-synuclein antibodies. We assigned cases according to the DLB consensus' categories and found a significant association with the premortem clinical diagnosis of DLB. Clinical diagnosis of DLB, however, depended on the presence of low Alzheimer disease pathology (by Braak staging) rather than on Lewy body distribution.

Content-Adaptive Finite Element Mesh Generation of 3-D Complex MR Volumes for Bioelectromagnetic Problems

In studying bioelectromagnetic problems, finite element method offers several advantages over other conventional methods such as boundary element method. It allows truly volumetric analysis and incorporation of material properties such as anisotropy. Mesh generation is the first requirement in the finite element analysis and there are many different approaches in mesh generation. However conventional approaches offered by commercial packages and various algorithms do not generate content-adaptive meshes, resulting in numerous elements in the smaller volume regions, thereby increasing computational load and demand. In this work, we present an improved content-adaptive mesh generation scheme that is efficient and fast along with options to change the contents of meshes. For demonstration, mesh models of the head from a volume MRI are presented in 2-D and 3-D.

Quantitative evaluation and application of Cryptosporidium parvum inactivation with ozone treatment

Despite a wealth of studies concerning the factors affecting the inactivation of Cryptosporidium parvum on ozone disinfection, practical approaches for predicting the inactivation level on ozone treatment system and determining the required ozone dose or contact time to achieve the required inactivation level remain unclear. When modified version of the "Delayed Chick-Watson model" was applied, the results show that Cryptosporidium parvum inactivation was well fitted with one unique line as "CTlag" and "inactivation slope" for several water parameters and water types. Thus, this study suggests quantitative methodology for predicting the Cryptosporidium parvum inactivation level with observation for the contact time of ozone and Cryptosporidium parvum and ozone residual.

Prognostic significance of CD44s expression in bile duct carcinomas

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Background: CD44 is a surface glycoprotein and has a key role for surface hyaluronan receptor, which is associated with adhesion and metastasis in many solid tumors. There are CD44 standard isoform (CD44s) and ten variant isoforms (CD44v1–10). CD44s and CD44 variant 6 (CD44v6) were evaluated to clarify the applicable prognostic factor in patients with bile duct carcinomas. Methods: A retrospective study was performed in bile duct carcinomas. Immunohistochemical stain was done with primary antibodies for CD44 (Novocastra, Newcastle upon Tyne, UK) and CD44v6 (Novocastra) using automated machine (Vision Biosystems, Mount Waverley, VIC, Australia) and bond polymer detection system with counterstain (Vision Biosystems) in paraffin embedded tissues. The extent of staining categorized as 0% (none), <10% (weak), 10%-50% (moderate), and >50% (strong). Clinical characteristics including age, sex, stage, grade and overall survival were reviewed. Results: Ninety six patients (M:F=35:61) were evaluated and the median age of these patients was 64 years old (37∼86). The rate of overexpression (>10%) of CD44s was 50% and the rate of CD44v6 expression was 16.9%. With median 34.2 months of follow up, the overall survival of total 96 patients was 12.2 months. The Cox proportional hazards test identified CD44s overexpression. (HR:2.379, 95% CI:1.195–4.736, p=0.014) and the stage as prognostic factors. But the expression of CD44v6 (weak vs. moderate to strong, HR:3.983, 95%CI:0.295–1.588, p=0.377) showed no prognostic significance on overall survival. Conclusion: CD44s overexpression can be a poor prognostic marker in bile duct carcinomas. And there is a potential to apply postoperative investigational or aggressive therapy in this poor prognostic group.

No significant financial relationships to disclose.

Two missense mutations of EGR2 R359W and GJB1 V136A in a Charcot-Marie-Tooth disease family

During mutational analysis of Charcot-Marie-Tooth (CMT) causative genes, we identified a CMT family with two missense mutations in different genes. A R359W mutation in EGR2 was shared by the affected daughter (proband) and her father. In addition, she had a V136A mutation in GJB1, which was determined to be a de novo mutation. The daughter with two different gene mutations showed more severe clinical, electrophysiological and histopathological phenotypes than her father who had only the EGR2 mutation. We suggest that these phenotypic differences between the proband and her father may have been caused by an altered effect of the genetic modifier in EGR2, or by the additive effect of the EGR2 and GJB1 mutations.

Amide I Vibrational Dynamics ofN-Methylacetamide in Polar Solvents: The Role of Electrostatic Interactions

The vibrational frequency of the amide I transition of peptides is known to be sensitive to the strength of its hydrogen bonding interactions. In an effort to account for interactions with hydrogen bonding solvents in terms of electrostatics, we study the vibrational dynamics of the amide I coordinate of N-methylacetamide in prototypical polar solvents: D2O, CDCl3, and DMSO-d6. These three solvents have varying hydrogen bonding strengths, and provide three distinct solvent environments for the amide group. The frequency-frequency correlation function, the orientational correlation function, and the vibrational relaxation rate of the amide I vibration in each solvent are retrieved by using three-pulse vibrational photon echoes, two-dimensional infrared spectroscopy, and pump-probe spectroscopy. Direct comparisons are made to molecular dynamics simulations. We find good quantitative agreement between the experimentally retrieved and simulated correlation functions over all time scales when the solute-solvent interactions are determined from the electrostatic potential between the solvent and the atomic sites of the amide group.