Reducing Salivary Toxicity with Adaptive Radiotherapy (ReSTART): A Randomized Controlled Trial Comparing Conventional IMRT to Adaptive IMRT in Head and Neck Squamous Cell Carcinomas

BACKGROUND

The utility of Adaptive Radiotherapy (ART) in Head and Neck Squamous Cell Carcinoma (HNSCC) remains to be ascertained. While multiple retrospective and single-arm prospective studies have demonstrated its efficacy in decreasing parotid doses and reducing xerostomia, adequate randomized evidence is lacking.

METHODS AND ANALYSIS

ReSTART (Reducing Salivary Toxicity with Adaptive Radiotherapy) is an ongoing phase III randomized trial of patients with previously untreated, locally advanced HNSCC of the oropharynx, larynx, and hypopharynx. Patients are randomized in a 1:1 ratio to the standard Intensity Modulated Radiotherapy (IMRT) arm {Planning Target Volume (PTV) margin 5 mm} vs. Adaptive Radiotherapy arm (standard IMRT with a PTV margin 3 mm, two planned adaptive planning at 10th and 20th fractions). The stratification factors include the primary site and nodal stage. The RT dose prescribed is 66Gy in 30 fractions for high-risk PTV and 54Gy in 30 fractions for low-risk PTV over six weeks, along with concurrent chemotherapy. The primary endpoint is to compare salivary toxicity between arms using salivary scintigraphy 12 months' post-radiation. To detect a 25% improvement in the primary endpoint at 12 months in the ART arm with a two-sided 5% alpha value and a power of 80% (and 10% attrition ratio), a sample size of 130 patients is required (65 patients in each arm). The secondary endpoints include acute and late toxicities, locoregional control, disease-free survival, overall survival, quality of life, and xerostomia scores between the two arms.

DISCUSSION

The ReSTART trial aims to answer an important question in Radiation Therapy for HNSCC, particularly in a resource-limited setting. The uniqueness of this trial, compared to other ongoing randomized trials, includes the PTV margins and the xerostomia assessment by scintigraphy at 12 months as the primary endpoint.

Holistic strategies to mitigate the economic, societal, and health burden of the Coronavirus disease-2019 pandemic

Pandemics are not the unique features of modern civilization; epidemics/pandemics can be traced back to ancient civilization. History is replete with such pandemics. Coronavirus first originated in Hubei province, China, in November 2019 and then manifested in Wuhan but within a very short span of time it has spread like wildfire all over the world and its impact has been multifaceted. It is indeed an indication of the fact that we live in a truly globalized world. Due to the outbreak of Coronavirus disease-2019 (COVID-19), people lost their lives but due to the consequent lockdown, people lost their livelihood, and the economy is shattered. Global GDP and trade experienced a huge contraction during the period of pandemic and the improvements to date are not worth mentioning. Actually, pandemic acts like a serial killer and its aftermath is devastating on human lives and the global economy.

Limits on the Existence of sub-MeV Sterile Neutrinos from the Decay of ^{7}Be in Superconducting Quantum Sensors

Sterile neutrinos are natural extensions to the standard model of particle physics and provide a possible portal to the dark sector. We report a new search for the existence of sub-MeV sterile neutrinos using the decay-momentum reconstruction technique in the decay of ^{7}Be. The experiment measures the total energy of the ^{7}Li daughter atom from the electron capture decay of ^{7}Be implanted into sensitive superconducting tunnel junction (STJ) quantum sensors. This first experiment presents data from a single STJ operated at a low count rate for a net total of 28 days, and provides exclusion limits on sterile neutrinos in the mass range from 100 to 850 keV that improve upon previous work by up to an order of magnitude.

Folic acid and vitamin B12 ameliorate nicotine-induced testicular toxicity in rats

Introduction and Aim: Cigarette smoking, one of the fundamental roots of preventable morbidity, has a myriad of notorious effects. Nicotine is the most bountiful and symbolic constituent of cigarette smoke. The liaison between smoking and infertility has been investigated for decades; but it’s still dubious whether the noxious effects of cigarette smoking on testis and sperm characteristics are by virtue of nicotine. Therefore, the current study interrogated the ameliorative effects of folic acid and vitamin B12 on nicotine induced catastrophe in testicular tissue and sperm characters in male albino rats. Materials and Methods: Rats were treated with nicotine (3 mg/kg body weight/day, intraperitoneal) with or without folic acid (36µg/kg body weight/day, orally) and vitamin B12 (0.63µg/kg body weight/ day, orally) for 21 days. Sperm qualities were analyzed for motility and morphology. Various oxidative and anti- oxidative stress parameters, pro inflammatory cytokines levels, hormonal assays were performed. Results: Findings marked that nicotine caused degenerative changes in the testicular tissue. Supplementation with folic acid and vitamin B12 reversed these results along with suppressing the nicotine induced changes in TNF- ?, IL-6, and markers of oxidative stress. Moreover, folic acid and vitamin B12 in combination also significantly blunted the altered activities of testicular key androgenic enzymes, plasma levels of testosterone, LH, and FSH following nicotine exposure. Conclusion: In closure, testimonies manifested that folic acid and vitamin B12 may act as plausible strategy against oxidative stress, which is a pivotal step in nicotine-induced reproductive toxicity, and bettering functional status of testicular tissue by scavenging free radicals and hindering the generation of pro- inflammatory cytokines.  

Association between duration of coal dust exposure and respiratory impairment in coal miners of West Bengal, India

Purpose. The prevalence and severity of respiratory disorders are very high among coal miners as continuous exposure of workers in such an environment leads to accumulation of dust in the lungs. This study was designed to assess the prevalence of lung function impairment and to determine whether there is any correlation between dust exposure duration and lung function indices. Materials. Two hundred and thirty underground coal dust-exposed workers and 130 age-matched non-exposed workers were recruited from an underground mine in West Bengal, India. A spirometry test was performed for lung function and also basic information on personnel's dust exposure, smoking and respiratory morbidity was collected. Student's t test, Pearson's correlation coefficient (r), uncorrected Pearson's χ² test and Fischer's exact test were performed for statistical analysis. Results. Lung function indices were significantly (p < 0.050) impaired between the exposed (43.91%) and non-exposed (23.85%) groups. In addition, highly significant decrements in the pulmonary volumes of exposed subjects were also noted. Furthermore, a high negative correlation was observed between spirometric results and exposure time in the exposed group compared with the non-exposed group. Conclusion. This study suggested a positive relationship between exposure time and lung function deterioration.

Combined effect of coal dust exposure and smoking on the prevalence of respiratory impairment among coal miners of West Bengal, India

Accelerating prevalence of coal workers pneumoconiosis is considered as a serious occupational health problem. This cross-sectional study was designed to determine the prevalence of lung function impairment of underground coal miners in West Bengal, India. A total of 230 underground coal dust-exposed subjects and 130 nonexposed subjects were examined for lung function test and also information on sociodemographic characteristics, addiction, respiratory morbidity, personnel protective equipment and dust exposure were collected. Lung function impairment was significantly higher in exposed group than nonexposed group and personnel dust exposure level were exceeded above the NIOSH recommended level. In addition, respiratory ailments were found to be higher in exposed group than the nonexposed group. So, this study has established the need for an advanced understanding of the quantifiable and measurable remedies for protection of lung disorder of coal mine workers.

Histone/protein deacetylase inhibitor therapy for enhancement of Foxp3+ T-regulatory cell function posttransplantation

T-regulatory (Treg) cells are like other cells present throughout the body in being subject to biochemical modifications in response to extracellular signals. An important component of these responses involves changes in posttranslational modifications (PTMs) of histones and many nonhistone proteins, including phosphorylation/dephosphorylation, ubiquitination/deubiquitination, and acetylation/deacetylation. Foxp3, the key transcription factor of Tregs, is constantly being rapidly turned over, and a number of these PTMs determine its level of expression and activity. Of interest in the transplant setting, modulation of the acetylation or deacetylation of key lysine residues in Foxp3 can promote the stability and function, leading to increased Treg production and increased Treg suppressive activity. This mini-review focuses on recent data concerning the roles that histone/protein deacetylases (HDACs) play in control of Treg function, and how small molecule HDAC inhibitors can be used to promote Treg-dependent allograft survival in experimental models. These data are discussed in the light of increasing interest in the identification and clinical evaluation of isoform-selective HDAC inhibitors, and their potential application as tools to modulate Foxp3+ Treg cell numbers and function in transplant recipients.

Extraction of effective solid-liquid interfacial free energies for full 3D solid crystallites from equilibrium MD simulations

Molecular dynamics simulations of an embedded atom copper system in the isobaric-isenthalpic ensemble are used to study the effective solid-liquid interfacial free energy of quasi-spherical solid crystals within a liquid. This is within the larger context of molecular dynamics simulations of this system undergoing solidification, where single individually prepared crystallites of different sizes grow until they reach a thermodynamically stable final state. The resulting equilibrium shapes possess the full structural details expected for solids with weakly anisotropic surface free energies (in these cases, ∼5% radial flattening and rounded [111] octahedral faces). The simplifying assumption of sphericity and perfect isotropy leads to an effective interfacial free energy as appearing in the Gibbs-Thomson equation, which we determine to be ∼177 erg/cm², roughly independent of crystal size for radii in the 50-250 Å range. This quantity may be used in atomistically informed models of solidification kinetics for this system.

Correction: Functionalised type-I collagen as a hydrogel building block for bio-orthogonal tissue engineering applications

Correction for 'Functionalised type-I collagen as a hydrogel building block for bio-orthogonal tissue engineering applications' by R. Ravichandran et al., J. Mater. Chem. B, 2016, 4, 318-326.

CO2 hydrogenation to higher hydrocarbons on K/Fe–Al–O spinel catalysts promoted with Si, Ti, Zr, Hf, Mn and Ce

Si and Zr species grafted on Fe–Al–O catalysts act as an inhibitor and promoter, respectively, in CO₂ hydrogenation.

A feasibility study of educational tools for osteomalacia

Many people in the UK, particularly people of South Asian origin, are advised to supplement their vitamin D intake, yet most do not. This suggests an unmet educational need. The osteomalacia mind map was developed to meet this need. The mind map contains culturally sensitive images, translated into Urdu and made interactive on a DVD. This study explores the feasibility of a randomised controlled study to measure the effect of education on improving vitamin D knowledge and adherence. This was a pilot and feasibility study. Cluster randomisation was used to avoid inter person contamination. Two South Asian women's groups were recruited to receive information about osteomalacia either by interactive DVD or an Arthritis Research UK leaflet. Knowledge and compliance were tested before and after the educational interventions via a knowledge questionnaire and the measurement of vitamin D and parathormone levels. The groups were found to be mismatched for knowledge, educational attainment and language at baseline. There were also organisational difficulties and possible confounding due to different tutors and translators. The DVD group had high knowledge at baseline which did not improve. The leaflet group had low knowledge at baseline that did improve. The DVD group had lower parathormone which did not change. The leaflet group had an increase in vitamin D but parathormone remained high. Performing a randomised study with this population utilising an educational intervention was difficult to execute. If cluster randomisation is used, extreme care must be taken to match the groups at baseline.

Functionalised type-I collagen as a hydrogel building block for bio-orthogonal tissue engineering applications

Modulating the hydrogel properties from injectable to implantable scaffolds using the bio-orthogonal thiol-Michael addition click reaction.

A Study of the Workload of Underground Trammers in the Ranigang Coal Field Area of West Bengal, India

Thirty healthy trammers were examined in underground haulage mines during their normal activity. Physiological strain in terms of heart rate (HR) varied between 101.6 and 104.7 beats/min with mean net cardiac cost of 33.06 and 34.06 beats/min for younger and older groups respectively. The average relative cardiac cost was lower for younger subjects than for older ones. Oxygen consumption (VO2) was measured with an Oxylog-II machine (UK); subsequently values were estimated. Maximum aerobic capacity was estimated with an indirect method following a standard step test protocol. The responses revealed that the average VO2 during the activity was 0.75 and 0.8 L/min, which corresponded to energy expenditure (EE) of 3.8 and 3.97 Kcal/min for younger and older subjects respectively. The workload in terms of HR and EE was moderate, whereas the aerobic strain experienced by aged workers was above the acceptable level.

Cardiac strain of confectionery worker in relation to heat exposure during regular work shift

Context:

In India, a wide variety of occupations are performed in adverse indoor working environment. Work physiological studies in these jobs are scanty as compared to investigations done on more arduous outdoor occupations.

Aims and Objectives:

Physiological strain of workers engaged in sweet making activities was assessed in terms of cardiac strain indices in relation to heat stress.

Setting and Design:

33 full-time workers from eastern India were compared for cardiac strain profile obtained during summer and winter during their regular work shift. A comparison was also done in between younger (n=12) and older (n=16) subjects.

Materials and Methods:

Working heart rate (WHR) was recorded continuously during work. The pulse deceleration index (PDI) was obtained from recovery heart rate (RHR). Net cardiac cost (NCC) and relative cardiac cost (RCC) were the main indices used to evaluate physical strain. Thermal stress assessed from wet bulb globe temperature (WBGT).

Statistical Analysis:

Students’ t-test and Wilcoxon signed rank paired tests were used for comparing physiological responses. Values were considered significant when P < 0.05.

Results:

Work load was significantly higher in summer for all workers. RCC of younger workers in winter and summer ranged between 18% and 26%. This was significantly lower as compared to the RCC of older workers which was 27% in winter and 30% in summer. The physiological workload appeared to be moderate in nature. The WBGT index was above the recommended range in summer for both the groups. Older workers showed a no recovery pattern in terms of recovery pulse that indicated toward a cumulative stress which may be attributed to a combined effect of heat and work in summer and extra amount of work performed in winter season.

Conclusion:

The physical workload is aggravated with various ergonomic stressors present in the work place. An ergonomic intervention has been indicated as further scope of this study.

Assessment of cardiac strain in small - scale aluminium casting works

Background: The occupational health status scenario in unorganised sector is not impressive. There is a lack of awareness on occupational health and safety issues and manual labour is still obligatory. Ergonomic and work physiological studies conducted among different unorganised sector occupations are scanty. Aims and Objective: The present study intended a physiological evaluation of workload in small scale aluminium casting works. In accordance, cardiac strain of the workers is assessed in actual work situation. Methods: Seventeen regular male workers (mean age 32.6 ± 10.9; range 22 – 55) years, were examined for the magnitude of physiological strain. Different tasks performed were identified including work and rest hours. Working heart rate, net cardiac cost, relative cardiac cost and recovery heart rates were determined. Tasks performed were analysed in terms of heaviness, recommended strain level and thermal stress of the workplace. Results: Work study revealed the predominant static nature of the tasks performed. Overall strain of the job appeared to be moderate in nature with mean working heart rate of 99 ± 5.2 beats/min. Recovery patterns were inadequate for majority of the workers. Thermal stress prevailing was more than the recommended level. Conclusion: The subjects were exposed to cumulative circulatory stress which might have deleterious long term effect particularly on older workers. Interventions are required to ameliorate ergonomic stressors, which indicate further scope of study.DOI: http://dx.doi.org/10.3126/ijosh.v2i2.6565 International Journal of Occupational Safety and Health, Vol 2. No 2 (2012) 8-13 

A systematic MEDLINE analysis of therapeutic approaches in ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disorder involving the sacroiliac joints (SIJs), spine and less frequently the peripheral joints. Traditionally, it is well recognised that AS is a challenging disease to manage due to the lack of effective therapeutic options. Current evidence would suggest this has changed and there are now a number of therapies available that provide persistent control of inflammatory symptoms with improvement in daily function. NSAIDs remain the first step in patient treatment. Sulphasalazine may be effective in peripheral arthritis and there are emerging data to support its use in early inflammatory back pain. Studies have shown that pamidronate and steroid injection into SIJ have a symptom-modifying effect in AS. Current data suggest that anti-TNF treatment promises early benefit which is likely to continue in the longer term. Treatment with biologics should be considered sooner rather than later in the management of AS.

TEL-AML1 preleukemic activity requires the DNA binding domain of AML1 and the dimerization and corepressor binding domains of TEL

The t(12;21)(p13;q22) translocation generates the TEL-AML1 (TEL, translocation-Ets-leukemia; AML1, acute myeloid leukemia-1) (ETV6-RUNX1) fusion product and is the most common chromosomal abnormality in pediatric leukemia. Our previous studies using a murine fetal liver transplantation model demonstrated that TEL-AML1 promotes the self-renewal of B-cell precursors in vitro and enhances the expansion of hematopoietic stem cells (HSCs) in vivo. This is consistent with the hypothesis that TEL-AML1 induces expansion of a preleukemic clone. Several studies have described domains within TEL-AML1 involved in the transcriptional regulation of specific target genes. However, it is unclear which of these domains is important for the activity of TEL-AML1 in preleukemic hematopoiesis. In order to examine this, we have generated a panel of deletion mutants and expressed them in HSCs. These experiments demonstrate that TEL-AML1 requires multiple domains from both TEL and AML1 to alter hematopoiesis. Furthermore, mutation of a single amino-acid residue within the runt homology domain of AML1, required for DNA binding, was sufficient to abrogate TEL-AML1 activity. These data suggest that TEL-AML1 acts as an aberrant transcription factor to perturb multiple pathways during hematopoiesis.

A comparative study of physiological strain of underground coal miners in India

Ninety-eight healthy underground coal miners aged between 23-58 years were studied during their activity period. Physiological strain of different category of miners in terms of heart rate was monitored continuously with heart rate monitor that revealed the tasks as heavy to very heavy for them. Oxygen consumption was measured directly by using oxylog-2 machine that corresponded to metabolic costs for different activities ranging from 4.96 kcal/min to 5.47 kcal/min. The mean relative aerobic strain varied from 47.4%-56.8%--depicting acceptable level of physical strain was well encroached by the miners who irrespective of ages and categories showed poor recovery responses. This entails that miners are exerting themselves beyond their capacities where inevitably older workforce face the maximum burden.

Cardiovascular load assessment of coal mine shovelers in west Bengal, India: a comparison between middle age groups

Cardiovascular load of underground shovelers was assessed in terms of heart rate changes at work in haulage coalmines. Twenty underground shovelers of two different age groups (those of age 31-39 and those of age 40-49) served as subjects. Working heart rate was significantly higher (p < 0.01) in the older group (138.2 beats/min) than in the younger group (130.4 beats/min). Though the net cardiac cost did not differ significantly between the groups (64.8 beats/min and 69.4 beats/min in younger and older groups, respectively), difference in the relative cardiac cost (54.17% and 64.86% in younger and older groups, respectively) proved to be highly significant (p < 0.001). The heart rate up to the third minute of recovery showed significant differences between the groups (p < 0.01). While analysis of physiological responses indicated that the task was very strenuous irrespective of age, cardiac strain was found to be more excessive in the older subjects if continued. The arduous nature of the working environment in the coalfaces was also reported.

Tuning the size and optical properties in molecular nano/microcrystals: manifestation of hierarchical interactions

Intermolecular interactions, such as hydrogen bonding, dipolar and van der Waals, occurring in molecular crystals cover a range of magnitudes. As the crystal evolves from a relatively softer state in the nanoscopic size regime to a harder one in the microcrystalline and bulk solid state, the impact of the hierarchy of intermolecular interactions can be expected to emerge in a progressive fashion. The strongest interactions alone would be manifested at small sizes; as the crystal grows, the effect of the weaker ones will be added on, with the bulk crystals exhibiting the cumulative impact of the different interactions. We demonstrate this phenomenon through investigations of the solution, colloid, and solid state of a novel zwitterionic molecule based on the diaminodicyanoquinodimethane framework. A reprecipitation-digestion protocol is developed for the fabrication of nano/microcrystals of varying sizes. Microscopic and spectroscopic characterizations reveal tuning of the size and optical properties of this material. The optical absorption of the colloidal particles evolves with size towards that of the bulk solid, the emission showing a steady enhancement of intensity. Crystallographic investigations coupled with semiempirical computations provide a viable model to describe the range of observations in terms of the gradual accumulation of hierarchical intermolecular interactions.

Wheelchair charity: a useless benevolence in community-based rehabilitation

PURPOSE

Hand rim-propelled manual wheelchairs (WC) are conventionally distributed to persons with dysfunctioning lower limbs for independent ambulation in community-based rehabilitation. The purpose of the present study was to survey the fate of the donated WCs and the difficulties encountered by the users by identifying the cause of rejection, and to evaluate the performance by assessing physiological strain on the recipients during their routine ambulation using cardiorespiratory parameters.

METHODS

Personal interview was arranged for the recipients and they were to answer regarding the fate of the donated WC and the cause of rejection for the recipients who rejected their WC. A simple field test was also administered to the users to evaluate the ambulatory performance using the WC. The energetics of WC propulsion at freely chosen speed was studied.

RESULTS

Of the WC, 10.49% were for attendant-dependent ambulation, 57.4% were not used, 14.19% were sold and 7.4% were in regular use and 10.5% in occasional use. Most of the recipients rejected their WC due to pain, fatigue and discomfort and lack of habitat adaptability. The cardiorespiratory response was higher in occasional users than regular users. Locomotive tasks using WC are highly energy demanding and contribute to physiological strain.

CONCLUSIONS

Hand rim-propelled manual WC are unsuitable for outdoor ambulation due to low speed and high physiological demand; they are also of little use indoors as they are difficult to maneuver under the environmental conditions and architectural restraints. So, they should not be recommended without proper assessment of the user's activity level and requirements.

Effect of chronic use of different propulsion systems in wheelchair design on the aerobic capacity of Indian users

BACKGROUND & OBJECTIVE

The use of wheelchairs (WC) of ergonomically different propulsion mechanisms may influence the cardiorespiratory capacity of the WC user. The purpose of the present investigation was to observe the impact of chronic use of four ergonomically different propulsion systems and age of the WC users on their aerobic capacity.

METHODS

The male subjects (n=77), exclusively using hand rim (n=20), arm crank using both arms (n=22), arm crank using one arm (n=17), and arm lever using one arm (n=18) propelled WCs and 20 able-bodied (AB) subjects as the control group participated They performed maximal exercise test in continuous, step-wise incremental workload at a crank rate of 50 rpm on an arm-crank ergometer. The VO(2) and heart rate obtained during 2.45 to 3 min of each test exercise, and VO(2max) and HR(max) were derived respectively. Two-way ANOVA and multiple comparison tests were performed to compare the groups with respect to VO(2max) and HR(max). Age was used as a classificatory variable.

RESULTS

The maximal physiological response of the AB subjects was superior to the WC users but the WC user groups did not show any significant differences amongst them. The aerobic capacity decreased with advancement of age and for WC users this is more pronounced. Equations for age predicted VO(2max) and HR(max) were also derived.

INTERPRETATION & CONCLUSION

As the WC users used the four distinct propulsion systems, it was anticipated that it would induce variation in the physiological variables of the users. But the results of the study revealed that there was no significant difference. Suggesting that the WC users might have developed certain self-regulatory mechanisms in order to overcome the variation induced by the different propulsion systems.

Arm-crank propelled three-wheeled chair: physiological evaluation of the propulsion using one arm and both arm patterns

Disabled people in India frequently use the arm-crank propelled three-wheeled chair (ACWC) for outdoor transportation. Two models of these chairs are commercially available: one is powered by cranking using one arm (ACWC-1) and the other uses both arms (ACWC-2). The purpose of the study was to compare the efficiency of the two types of propulsion with respect to the standard physiological responses and, consequent upon the findings, to recommend the use of a suitable one. The energetics of locomotion of the users at their freely chosen speed (FCS) were measured and compared with changes in the physiological parameters in the within-subject groups. The study was conducted in outdoor settings to simulate the actual locomotive conditions encountered by the users in their practical life. 14 males, who had been regular and proficient users of both propulsion systems for more than last six years and who had a history of paraplegia (below the 10th thoracic vertebra, n=11) and poliomyelitis (n=3) participated in the study. The subjects were required to propel the test chair (a combination of both the propulsion systems built in a single model) on an oval track of 358 m circumference at their FCS for 5 min; ambulatory data were collected during last 3 min of exercise and averaged. The FCS (m/min), heart rates (bpm) and oxygen uptake (l/min) were measured. Physiological cost index (b/m) oxygen consumption (ml/kg/min), oxygen cost (ml/kg/m) and net locomotor energy cost (kcal/kg/km) of the two sets of observations were derived and compared using a t-test for the paired observations. The FCS was significantly higher and the physiological parameters were lower with the ACWC-2 than with ACWC-1, except for heart rate and oxygen consumption, where the difference was not significant . It is concluded that two-arm use is more efficient and less physically demanding than one-arm use in the arm-crank propulsion system and that the former is more suitable for efficient ambulation.