Characterization of Objective Skin Color Changes during and after Breast and Chest Wall Radiotherapy and Correlation with Radiation-Induced Skin Toxicity in Breast Cancer Patients, Including Patients with Skin of Color

PURPOSE/OBJECTIVE(S)

Radiation dermatitis (RD) is common among women undergoing breast and chest wall radiotherapy (RT); however, existing scales to assess the severity of RD are subjective and do not account for variability in skin of color (SOC). For instance, the Common Terminology Criteria for Adverse Events (CTCAE) criteria do not include hyperpigmentation in the grading scale. There is data indicating worse RD in African American and Hispanic patients; however, the rate and severity in SOC remains unknown given the lack of data using objective measures of RD. Spectrophotometry is one method to quantify the appearance of color by measuring spectral characteristics without the bias associated with subjective clinical scoring. We present a phase I prospective non-therapeutic clinical trial to objectively define SOC at baseline and evaluate spectrophotometric skin changes during and after breast or chest wall RT in parallel with physician-graded RD using CTCAE criteria. We hypothesize that there will be greater discrepancy between physician graded RD and objective measures of RD in patients with SOC in whom hyperpigmentation will be undercaptured by physician-grading. This is the first study intending to correlate SOC with objective changes after RT as a reliable indicator of RD. We offer a novel system for evaluating RD that is applicable to SOC.

MATERIALS/METHODS

A total of 60 patients with localized breast cancer (stage 0-III) undergoing conventional whole breast or chest wall RT (50Gy/ 25 fx), hypofractionated whole breast RT (40.5Gy/15 fx) or ultrahypofractionated partial breast RT (6Gy x5), with or without regional nodal RT were enrolled. 3 skin color readouts using the Commission International de l'Eclairage 3D color system (l*, a*, b*) were measured within the radiation field using a spectrophotometer at baseline, once weekly during RT, 10 days post RT, 4 weeks and 12 months post RT. The spectrophotometer is a non-invasive, hand-held device that is used in the clinic room with no additional equipment or setup requirements. Data is automatically exported to a spreadsheet organized by timepoint and patient. The l* axis is a gray scale (0 = black, 100 = white) correlating with skin pigmentation and the a* axis describes red and green values correlating with erythema. The primary objective is to evaluate the changes from baseline in skin color readouts in the quadrant of tumor location during and after RT based on fractionation. The secondary objective is to evaluate changes within and across groups defined by baseline skin color. Exploratory objectives include evaluating the association of baseline color readouts and changes after RT with acute and late grade > 2 clinician-rated skin and subcutaneous tissue effects according to the CTCAE, v5.0, physician graded cosmesis and clinical interventions to treat RD, such as use of topical steroids and oral analgesics. As of January 2023, we have enrolled 100% of the planned patients.

RESULTS

To be determined.

CONCLUSION

To be determined. Clinical Study Identifier: S22-00192.

Endocranial volumes and human evolution

Enlarging brains have been held up as the classic (if not the only) example of a consistent long-term trend in human evolution.  And hominin endocranial volumes certainly expanded four-fold over the subfamily's seven-million-year history, while on a very coarse scale later hominids showed a strong tendency to have larger brains than earlier ones.  However, closer scrutiny of this apparent trend reveals that it was extremely episodic and irregular, a fact that argues against the notion that it was driven by social interactions internal to the hominin clade.  In addition, an overall tendency to brain volume increase was expressed independently and concurrently within at least three separate lineages of the genus Homo - suggesting that, whatever the exact influences were that promoted this global trend, they need to be sought among stimuli that acted comprehensively over the entire vast range of periods, geographies and environments that members of our subfamily occupied.  Significantly, though, the dramatic recent shrinkage of the brain within the species Homo sapiens implies that the emergence of modern human cognition (via the adoption of the symbolic information processing mode, likely driven by the spontaneous invention of language in an exaptively enabled brain) was not the culmination of the overall hominin trend towards brain enlargement, but rather a departure from it.

Evolutionary theory, systematics, and the study of human origins

Paleoanthropology's relationship with evolutionary theory has not been entirely happy. The anatomists who dominated paleoanthropology for its first century had little interest in biological diversity and its causes, or in hominins' place in that diversity, or in the rules and principles of zoological nomenclature - which they basically ignored entirely. When, as the twentieth century passed its midpoint, Ernst Mayr introduced theory to paleoanthropology in the form of the gradualist Modern Evolutionary Synthesis (in its most hardened form), he shocked students of human evolution not only into a strictly linear evolutionary mindset, but into a taxonomic minimalism that would for years obscure the signal of phylogenetic diversity and vigorous evolutionary experimentation among hominins that was starting to emerge from a rapidly enlarging hominin fossil record. Subsequently, the notion of episodic as opposed to gradualist evolution re-established phylogenies as typically branching, and species as bounded entities with births, histories, and deaths; but the implications of this revised perspective were widely neglected by paleoanthropologists, who continued to reflexively cram diverse new morphologies into existing taxonomic pigeonholes. For Pleistocene hominins, the effective systematic algorithm became, "if it isn't Australopithecus, it must be Homo" (or vice versa), thereby turning both taxa into wastebaskets. The recent development of the "Extended Evolutionary Synthesis" has only exacerbated the resulting caricature of phylogenetic structure within Homininae, by offering developmental/phenotypic plasticity as an excuse for associating wildly differing morphologies within the same taxon. Homo erectus has been a favorite victim of this foible. Biological species are indeed morphologically variable. But they are only variable within limits; and until we stop brushing diverse morphologies under the rug of developmental plasticity, paleoanthropology will remain at a major impasse.

What kind of hominin first left Africa?

Recent discoveries of stone tools from Jordan (2.5 Ma) and China (2.1 Ma) document hominin presence in Asia at the beginning of the Pleistocene, well before the conventional Dmanisi datum at 1.8 Ma. Although no fossil hominins documenting this earliest Out of Africa phase have been found, on chronological grounds a pre-Homo erectus hominin must be considered the most likely maker of those artifacts. If so, this sheds new light on at least two disputed subjects in paleoanthropology, namely the remarkable variation among the five Dmanisi skulls, and the ancestry of Homo floresiensis.

How assumptions shape the paleosciences

Science is a very special form of storytelling, one in which the stories told have to be testable against empirical observation. But the world is a complicated place; and, to provide a coherent account of it, scientists often find themselves obliged to join up their observable dots using untestable or as-yet-untested lines. This is a necessary part of constructing many valuable and predictive scientific scenarios; and it is perfectly good procedure as long as the assumptions involved are fully compatible with what is known and testable. But it also means that, in formulating their ideas about how the world works (or worked), scientists must remain keenly aware not only of what is and is not assumption in those complex ideas, but of how untested elements may color their beliefs. The contributions to this volume cover many interesting examples of how assumptions have affected ideas in diverse areas of the paleosciences, both practical and theoretical, and they serve together as a salutary reminder that vigilance and a willingness to rethink are always in order.

The Minimalist Program and the Origin of Language: A View From Paleoanthropology

In arguing that articulate language is underpinned by an algorithmically simple neural operation, the Minimalist Program (MP) retrodicts that language emerged in a short-term event. Because spoken language leaves no physical traces, its ancient use must be inferred from archeological proxies. These strongly suggest that modern symbolic human behavior patterns – and, by extension, cognition – emerged both abruptly and late in time (subsequent to the appearance of Homo sapiens as an anatomical entity some 200 thousand years kyr ago). Because the evidence is compelling that language is an integral component of modern symbolic thought, the archeological evidence clearly supports the basic tenet of the MP. But the associated proposition, that language was externalized in an independent event that followed its initial appearance as a conduit to internal thought, is much more debatable.

What lies beneath Brian Switek Riverhead Books, 2019. 288 pp

An idiosyncratic biography of bone probes the secrets and sensitive spots of the human skeletal system

The story of life: critical insights from evolutionary biology

The notion that humans, in all their complexity, are merely an evolutionary accident, an insignificant speck in a boundless cosmos, is deeply unsatisfying for most nonscientists and fails to resonate with their life experience. What, then, can evolutionary biology ultimately tell us about the meaning of our lives? In conversation with Steve Paulson, executive producer and host of To the Best of Our Knowledge, paleoanthropologists Melanie Lee Chang and Ian Tattersall, and paleontologist Simon Conway Morris share their insights on these competing concepts and explain how meaning and purpose can be gleaned from the remarkable story of life itself.

Species, genera, and phylogenetic structure in the human fossil record: a modest proposal

Because of the greater morphological distances among them, genera should be more robustly recognizable in the fossil record than species are. But there are clearly upper as well as lower bounds to their species inclusivity. Currently, the vast majority of fossils composing the large and rapidly expanding paleoanthropological record are crammed into one of two genera (Australopithecus vs Homo), expanding the latter, especially, far beyond any reasonable morphological or phylogenetic limits. This excessive inclusivity obscures both diversity and the complexities of phylogenetic structure within the hominid family.

The material record and the antiquity of language

One view of language origins sees it as ancient and selection-driven; the other as recent and emergent. Such disagreement occurs because language is ephemeral, detectable only by indirect proxies. Because internalized language and symbolic thought are tightly linked, the best archaeological proxies for language are symbolic objects. Nothing indicates convincingly that any hominid behaved symbolically prior to Homo sapiens, which originated 200kyr ago but started behaving symbolically only 100kyr later. Most probably the necessary neural underpinnings arose exaptively in the extensive developmental reorganization that gave rise to anatomically distinctive Homo sapiens, and were recruited subsequently via a necessarily behavioral stimulus. This was most plausibly the spontaneous invention of externalized language, in an isolate of Homo sapiens in Africa, that initiated a feedback process between externalized structured language and internalized language/organized thought. These subsequently spread in tandem throughout a species already biologically predisposed for them. Despite its qualitatively remarkable result, this exaptive process would have been perfectly routine and unremarkable in terms of evolutionary mechanism.

A tentative framework for the acquisition of language and modern human cognition

Modern human beings process information symbolically, rearranging mental symbols to envision multiple potential realities. They also express the ideas they form using structured articulate language. No other living creature does either of these things. Yet it is evident that we are descended from a non-symbolic and non-linguistic ancestor. How did this astonishing transformation occur? Scrutiny of the fossil and archaeological records reveals that the transition to symbolic reasoning happened very late in hominid history - indeed, within the tenure of anatomically recognizable Homo sapiens. It was evidently not simply a passive result of the increase in brain size that typified multiple lineages of the genus Homo over the Pleistocene. Instead, a brain exaptively capable of complex symbolic manipulation and language acquisition was acquired in the major developmental reorganization that gave rise to the anatomically distinctive species Homo sapiens. The new capacity it conferred was later recruited through the action of a cultural stimulus, most plausibly the spontaneous invention of language.

Fixed Drug Eruption due to Achiote Dye

Fixed drug eruption (FDE) is a localized type IV sensitivity reaction to a systemically introduced allergen. It usually occurs as a result of new medication, making identification and avoidance of the trigger medication straightforward; however, in a rare subset of cases no pharmacological source is identified. In such cases, the causative agent is often a food or food additive. In this report we describe a case of a FDE in a 12-year-old girl recently immigrated to the United States from Ecuador who had no medication exposure over the course of her illness. Through an exhaustive patient history and literature review, we were able to hypothesize that her presentation was caused by a dietary change of the natural achiote dye used in the preparation of yellow rice to a locally available commercial dye mix containing tartrazine, or Yellow 5, which has previously been implicated in both systemic hypersensitivity reactions and specifically in FDE. This report adds to the small body of available literature on non-pharmacological fixed hypersensitivity eruptions and illustrates an effective approach to the management of such a presentation when history is not immediately revealing.

Language: UG or not to be, that is the question

Language is not the same as speech or communication; rather, it is a computational cognitive system. It has appeared very recently, consistent with a minimalist view of language's hierarchical syntactic structure.

How could language have evolved?

The evolution of the faculty of language largely remains an enigma. In this essay, we ask why. Language's evolutionary analysis is complicated because it has no equivalent in any nonhuman species. There is also no consensus regarding the essential nature of the language "phenotype." According to the "Strong Minimalist Thesis," the key distinguishing feature of language (and what evolutionary theory must explain) is hierarchical syntactic structure. The faculty of language is likely to have emerged quite recently in evolutionary terms, some 70,000-100,000 years ago, and does not seem to have undergone modification since then, though individual languages do of course change over time, operating within this basic framework. The recent emergence of language and its stability are both consistent with the Strong Minimalist Thesis, which has at its core a single repeatable operation that takes exactly two syntactic elements a and b and assembles them to form the set {a, b}.

Comment on "A complete skull from Dmanisi, Georgia, and the evolutionary biology of early Homo"

Lordkipanidze et al. (Research Article, 18 October 2013, p. 326) conclude, from gross morphological comparisons and geometric-morphometric analysis of general shape, that the five hominid crania from Dmanisi in Georgia represent a single regional variant of Homo erectus. However, dental, mandibular, and cranial morphologies all suggest taxic diversity and, in particular, validate the previously named H. georgicus.

The mystery of language evolution

Understanding the evolution of language requires evidence regarding origins and processes that led to change. In the last 40 years, there has been an explosion of research on this problem as well as a sense that considerable progress has been made. We argue instead that the richness of ideas is accompanied by a poverty of evidence, with essentially no explanation of how and why our linguistic computations and representations evolved. We show that, to date, (1) studies of nonhuman animals provide virtually no relevant parallels to human linguistic communication, and none to the underlying biological capacity; (2) the fossil and archaeological evidence does not inform our understanding of the computations and representations of our earliest ancestors, leaving details of origins and selective pressure unresolved; (3) our understanding of the genetics of language is so impoverished that there is little hope of connecting genes to linguistic processes any time soon; (4) all modeling attempts have made unfounded assumptions, and have provided no empirical tests, thus leaving any insights into language's origins unverifiable. Based on the current state of evidence, we submit that the most fundamental questions about the origins and evolution of our linguistic capacity remain as mysterious as ever, with considerable uncertainty about the discovery of either relevant or conclusive evidence that can adjudicate among the many open hypotheses. We conclude by presenting some suggestions about possible paths forward.

Paleoanthropology and evolutionary theory

Paleoanthropologists of the first half of the twentieth century were little concerned either with evolutionary theory or with the technicalities and broader implications of zoological nomenclature. In consequence, the paleoanthropological literature of the period consisted largely of a series of descriptions accompanied by authoritative pronouncements, together with a huge excess of hominid genera and species. Given the intellectual flimsiness of the resulting paleoanthropological framework, it is hardly surprising that in 1950 the ornithologist Ernst Mayr met little resistance when he urged the new postwar generation of paleoanthropologists to accept not only the elegant reductionism of the Evolutionary Synthesis but a vast oversimplification of hominid phylogenetic history and nomenclature. Indeed, the impact of Mayr's onslaught was so great that even when developments in evolutionary biology during the last quarter of the century brought other paleontologists to the realization that much more has been involved in evolutionary histories than the simple action of natural selection within gradually transforming lineages, paleoanthropologists proved highly reluctant to follow. Even today, paleoanthropologists are struggling to reconcile an intuitive realization that the burgeoning hominid fossil record harbors a substantial diversity of species (bringing hominid evolutionary patterns into line with that of other successful mammalian families), with the desire to cram a huge variety of morphologies into an unrealistically minimalist systematic framework. As long as this theoretical ambivalence persists, our perception of events in hominid phylogeny will continue to be distorted.

Human evolution and cognition

Human beings are distinguished from all other organisms by their symbolic way of processing information about the world. This unique cognitive style is qualitatively different from all the earlier hominid cognitive styles, and is not simply an improved version of them. The hominid fossil and archaeological records show clearly that biological and technological innovations have typically been highly sporadic, and totally out of phase, since the invention of stone tools some 2.5 million years ago. They also confirm that this pattern applied in the arrival of modern cognition: the anatomically recognizable species Homo sapiens was well established long before any population of it began to show indications of behaving symbolically. This places the origin of symbolic thought in the realms of exaptation, whereby new structures come into existence before being recruited to new uses, and of emergence, whereby entire new levels of complexity are achieved through new combinations of attributes unremarkable in themselves. Both these phenomena involve entirely routine evolutionary processes; special as we human beings may consider ourselves, there was nothing special about the way we came into existence. Modern human cognition is a very recent acquisition; and its emergence ushered in an entirely new pattern of technological (and other behavioral) innovation, in which constant change results from the ceaseless exploration of the potential inherent in our new capacity.

Architecture of the nasal complex in neanderthals: comparison with other hominids and phylogenetic significance

Although paranasal sinus configuration has occasionally been the focus in analyses of the phylogenetic relationships of various primates, other elements of the region of the nasal fossa--in particular, the turbinals--have received far less attention. A preliminary study of Neanderthal cranial morphology revealed the presence of an apparently unique configuration of the lateral wall of the nasal cavity: namely, in the region in which in Homo sapiens the anterior extremity of the maxilloturbinal (also referred to as the inferior nasal concha) articulates with the internal surface of the maxilla along a relatively anteroposteriorly long and essentially horizontally oriented conchal crest, there exists a vertically oriented thickening that protrudes medially into the nasal cavity (Schwartz and Tattersall, Proc Natl Acad Sci USA 1996; 93:10852-10854). Subsequent citations of this report either claimed that this "medial projection" in Neanderthals is merely an enlarged maxilloturbinal or mistakenly identified as this structure the base of a maxilloturbinal that had fused to the lateral wall of the nasal cavity and subsequently broken off. In light of the potential significance that any novel configuration of the nasal complex architecture may have for elucidating hominid evolution, we present here a comparative overview of this region in fossil and extant large-bodied hominoids, and demonstrate that Neanderthals do indeed possess a configuration that is unique among hominids.