Oral Cavity Cancers: Ethnic Differences in Radiotherapy Outcomes in a Majority South Asian Leicester Community

AIMS

Squamous cell carcinoma oral cavity cancers (SCCOCCs) have a higher reported incidence in South Asian countries. We sought to compare presenting stage and outcome by ethnicity in patients with SCCOCC treated with radical radiotherapy in a single centre in the UK.

MATERIALS AND METHODS

All patients with SCCOCC treated with radical radiotherapy at an oncology department in Leicester (UK) between 2011 and 2017 were identified. Baseline demographic, clinical data and 2-year treatment outcomes were reported.

RESULTS

Of the 109 patients included, 40 were South Asian and 59 were non-South Asian. South Asians had significantly poorer 2-year disease-free survival compared with non-South Asians (54.6% versus 73%, P = 0.01).

CONCLUSION

Our analysis suggests that South Asians with SCCOCC have poorer outcomes despite a younger age and similar disease characteristics. Environmental, social factors and differing biology of disease may be responsible and further research is required to inform targeted interventions.

A digital health intervention to support patients with chronic pain during prescription opioid tapering: a pilot randomised controlled trial

Introduction

Recent changes in opioid prescribing guidelines have led to an increasing number of patients with chronic pain being recommended to taper. However, opioid tapering can be challenging, and many patients require support.

Objectives

We evaluated the feasibility, acceptability, and potential efficacy of a codesigned digital health intervention to support patients with chronic pain during voluntary prescription opioid tapering.

Methods

In a pilot randomised controlled trial, participants received a psychoeducational video and 28 days of text messages (2 SMS/day) in addition to their usual care (intervention) or usual care alone (control). The feasibility, acceptability, and potential efficacy of the intervention were evaluated. The primary outcome was opioid tapering self-efficacy. Secondary outcomes were pain intensity and interference, anxiety and depression symptom severity, pain catastrophising, and pain self-efficacy.

Results

Of 28 randomised participants, 26 completed the study (13 per group). Text message delivery was high (99.2%), but fidelity of video delivery was low (57.1%). Most participants rated the messages as useful, supportive, encouraging, and engaging; 78.5% would recommend the intervention to others; and 64.2% desired a longer intervention period. Tapering self-efficacy (Cohen d = 0.74) and pain self-efficacy (d = 0.41) were higher, and pain intensity (d = 0.65) and affective interference (d = 0.45) were lower in the intervention group at week 4.

Conclusion

First evidence supports the feasibility, acceptability, and potentially efficacy of a psychoeducational video and SMS text messaging intervention to support patients with chronic pain during voluntary prescription opioid tapering. Definitive trials with longer intervention duration are warranted.

A digital health intervention to support patients with chronic pain during prescription opioid tapering: a pilot randomised controlled trial

Introduction

Recent changes in opioid prescribing guidelines have led to an increasing number of patients with chronic pain being recommended to taper. However, opioid tapering can be challenging, and many patients require support.

Objectives

We evaluated the feasibility, acceptability, and potential efficacy of a co-designed psycho-educational video and SMS text messaging intervention to support patients with chronic pain during prescription opioid tapering.

Methods

A pilot randomised controlled trial was conducted. In addition to their usual care, participants in the intervention group received a psycho-educational video and 28 days of text messages (two SMS/day). The control group received usual care. The feasibility, acceptability, and potential efficacy of the intervention were evaluated. The primary outcome was opioid tapering self-efficacy. Secondary outcomes were pain intensity and interference, anxiety and depression symptom severity, pain catastrophising, and pain self-efficacy.

Results

Of 28 randomised participants, 26 completed the study (13 in each group). Text message delivery was 99.2% successful. Most participants rated the messages as useful, supportive, encouraging, and engaging, 78.5% would recommend the intervention to others, and 64% desired a longer intervention period. Tapering self-efficacy (Cohen's d = 0.74) and pain self-efficacy (d = 0.41) were higher and pain intensity (d = 0.65) and affective interference (d = 0.45) lower in the intervention group at week 4.

Conclusions

It is feasible, acceptable, and potentially efficacious to support patients with chronic pain during prescription opioid tapering with a psycho-educational video and SMS text messaging intervention. A definitive trial has been initiated to test a 12-week intervention.

Evaluating acceptability and feasibility of a mobile health intervention to improve self-efficacy in prescription opioid tapering in patients with chronic pain: protocol for a pilot randomised, single-blind, controlled trial

INTRODUCTION

Opioid medications are no longer recommended as long-term therapy for chronic non-cancer pain, and many patients are advised to reduce or discontinue opioid medications. Many patients report difficulties in tapering opioid medications, necessitating supporting interventions. This protocol describes a pilot randomised controlled trial (RCT) to investigate the acceptability, feasibility and potential efficacy of a mobile health intervention to improve the opioid tapering self-efficacy of patients with chronic non-cancer pain.

METHODS AND ANALYSIS

The trial will be a single-blind (clinician, data collector and statistician-blinded) pilot RCT with two parallel arms. Forty adult patients with chronic non-cancer pain who are voluntarily reducing their prescribed opioid medications under medical guidance will be recruited from two tertiary pain clinics (Start date 25 August 2021). Participants will be randomly assigned to an intervention or control group. Both groups will receive usual care, including multidisciplinary pain management. In addition to usual care, the intervention group will receive a short informational and testimonial video about opioid tapering and will receive two specifically text messages per day for 28 days. The intervention is codesigned with patients and clinicians to provide evidence-based informational, motivational and emotional support to patients with chronic pain to taper opioid medications. Feasibility of the intervention and a future definitive RCT will be evaluated by measuring patient acceptability, delivery of the intervention, rates and reasons of exclusions and drop-outs, completion rates and missing data in the study questionnaires, and obtaining estimates for sample size determination. Potential efficacy will be evaluated by comparing changes in opioid tapering self-efficacy between the two groups.

ETHICS AND DISSEMINATION

The study protocol was reviewed and approved by the Northern Sydney Local Health District (Australia). Study results will be published in peer-reviewed journals and presented at scientific and professional meetings.

TRIAL REGISTRATION NUMBER

ACTRN12621000795897.

Energy-Optimal Siting of Decentralized Water Recycling Systems

Decentralized water recycling systems (DWRS) have emerged as a viable option for incrementally augmenting water supply in water-stressed regions, but DWRS are generally more energy-intensive than traditional centralized water treatment systems. When DWRS are deployed incrementally in small batches, the marginal energy intensity (MEI) of water supply quantifies the location-specific energy footprint of centralized water supply and serves as a robust metric measuring the energy implications of replacing centralized supply with DWRS supply. This research develops and applies a MEI-based decision framework that identifies the energy-optimal siting of DWRS to minimize the overall system operational energy consumption given a target fraction of water demand to be met by newly deployed DWRS. In a small benchmark water supply system where the energy intensity of the intended DWRS is 5.3% higher than the current system average energy intensity of centralized supply, we demonstrate that the optimal siting of DWRS to offset 10% of the system-wide water demand reduces the overall system energy consumption by 0.77%. In contrast, the naive and worst-case siting of the same DWRS increases the energy consumption of the overall system by 0.65 and 2.0%, respectively. The proposed MEI-based decision framework is particularly valuable for application in large multi-source systems, where an optimization-based approach is computationally intractable. This study highlights the importance of accounting for both distribution and treatment energy intensity when evaluating new water sources and demonstrates the viability of DWRS as an energy-efficient tool for augmenting water supply.

Superselective Removal of Lead from Water by Two-Dimensional MoS2 Nanosheets and Layer-Stacked Membranes

Point-of-use (POU) devices with satisfactory lead (Pb²⁺) removal performance are urgently needed in response to recent outbreaks of lead contamination in drinking water. This study experimentally demonstrated the excellent lead removal capability of two-dimensional (2D) MoS₂ nanosheets in aqueous form and as part of a layer-stacked membrane. Among all materials ever reported in the literature, MoS₂ nanosheets exhibit the highest adsorption capacity (740 mg/g), and the strongest selectivity/affinity toward Pb²⁺ with a distribution coefficient K_d that is orders of magnitude higher than that of other lead adsorption materials (5.2 × 10⁷ mL/g). Density functional theory (DFT) simulation was performed to complement experimental measurements and to help understand the adsorption mechanisms. The results confirmed that the cation selectivity of MoS₂ follows the order Pb²⁺ > Cu²⁺ ≫ Cd²⁺ > Zn²⁺, Ni²⁺ > Mg²⁺, K⁺, Ca²⁺. The membrane formed with layer-stacked MoS₂ nanosheets exhibited a high water flux (145 L/m²/h/bar), while effectively decreasing Pb²⁺ concentration in drinking water from a few mg/L to less than 10 μg/L. The removal capacity of the MoS₂ membrane is a few orders of magnitude higher than that of other literature-reported membrane filters. Therefore, the layer-stacked MoS₂ membrane has great potential for POU removal of lead from drinking water.

Removal and Recovery of Heavy Metal Ions by Two-dimensional MoS2 Nanosheets: Performance and Mechanisms

We investigated the removal of heavy metals from water by two-dimensional MoS₂ nanosheets suspended in aqueous solution, and restacked as thin film membranes, respectively. From these studies we elucidated a new heavy metal ion removal mechanism that involves a reduction-oxidation (redox) reaction between heavy metal ions and MoS₂ nanosheets. Ag⁺ was used as a model species and MoS₂ nanosheets were prepared via chemical exfoliation of bulk powder. We found that the Ag⁺ removal capacity of suspended MoS₂ nanosheets was as high as ∼4000 mg/g and adsorption accounted for less than 20% of removal, suggesting the reduction of Ag⁺ to metallic silver as a dominant removal mechanism. Furthermore, we demonstrated that MoS₂ membranes were able to retain a similar high removal capacity, and attribute this capability to the formation of a conductive, permeable multilayer MoS₂ structure, which enables a corrosion-type reaction involving electron transfer from a MoS₂ site inside the membrane (anode) to another site on membrane surface (cathode) where heavy metal ions are reduced to metallic particles. The membrane surface remains active to efficiently recover metallic particles, because the primary oxidation products are soluble, nontoxic molybdate and sulfur species, which do not form an insulating oxide layer to passivate the membrane surface. Therefore, MoS₂ membranes can be used effectively to remove and recover precious heavy metals from wastewater.

An evaluation of a common elements treatment approach for youth in Somali refugee camps

BACKGROUND

This paper reports on: (1) an evaluation of a common elements treatment approach (CETA) developed for comorbid presentations of depression, anxiety, traumatic stress, and/or externalizing symptoms among children in three Somali refugee camps on the Ethiopian/Somali border, and (2) an evaluation of implementation factors from the perspective of staff, lay providers, and families who engaged in the intervention.

METHODS

This project was conducted in three refugee camps and utilized locally validated mental health instruments for internalizing, externalizing, and posttraumatic stress (PTS) symptoms. Participants were recruited from either a validity study or from referrals from social workers within International Rescue Committee Programs. Lay providers delivered CETA to youth (CETA-Youth) and families, and symptoms were re-assessed post-treatment. Providers and families responded to a semi-structured interview to assess implementation factors.

RESULTS

Children who participated in the CETA-Youth open trial reported significant decreases in symptoms of internalizing (d  =  1.37), externalizing (d  =  0.85), and posttraumatic stress (d  =  1.71), and improvements in well-being (d  =  0.75). Caregivers also reported significant decreases in child symptoms. Qualitative results were positive toward the acceptability and appropriateness of treatment, and its feasibility.

CONCLUSIONS

This project is the first to examine a common elements approach (CETA: defined as flexible delivery of elements, order, and dosing) with children and caregivers in a low-resource setting with delivery by lay providers. CETA-Youth may offer an effective treatment that is easier to implement and scale-up versus multiple focal interventions. A fullscale randomized clinical trial is warranted.

Laparoscopic radical nephrectomy with inferior vena cava thrombectomy: highlight of key surgical steps

Objective:

Vascular involvement in the form of renal vein (RV) or inferior vena cava (IVC) thrombus can be seen in 4-10% of patients presented with RCC. In patients without presence of metastasis, surgical treatment in the form of radical nephrectomy remains the treatment of choice with 5-year survival rates of 45-70%. Open surgery is still the first treatment option of choice at the moment for RCC patients with IVC thrombus.

Materials and Methods:

In our study, we are reporting a case of patient with RCC and level I IVC thrombus treated with laparoscopy. Our patient is a 72 years old man with underlying co-morbidity of hypertension and chronic kidney disease (CKD) presented with right-sided RCC. The CT scan done showed a large right renal upper pole tumor measuring 8.4x5.2cm with level I IVC thrombus (Figure-1). There were no regional lymphadenopathy and the staging scans were negative.

Results:

The operative time was 124 minutes and blood loss was minimal. The patient was progressed to diet on POD 1 with bowel movement on POD 2. There was no significant change in the pre and post-operative glomerular filtration rate (GFR). The surgical drain was removed on POD2. The patient was discharged well on POD 5. There were no perioperative complications. The pathology was pT3bN0M0 Fuhrman grade II clear cell RCC.

Conclusions:

As a conclusion, laparoscopic radical nephrectomy and IVC thrombectomy is a complex and technically demanding surgery. With advancement of surgical skills as well as technology, more cases of minimally invasive laparoscopic radical nephrectomy and IVC thrombectomy can performed to improve the perioperative outcomes of carefully selected patients in a high volume center.

[Treatment of invasive bladder cancer: robot-assisted radical cystectomy and intracorporeal urinary diversion]

PURPOSE

Robot-assisted radical cystectomy (RARC) and intracorporeal urinary diversion are only performed in a few centers of excellence worldwide. Functional and oncologic outcomes are comparable. We report on our experience with RARC and intracorporeal diversion.

PATIENTS AND METHODS

We retrospectively identified 86 RARCs in 72 men and 14 women (mean age 69.7 years). All patients underwent robot-assisted radical cystectomy and pelvic lymphadenectomy followed by intracorporeal urinary diversion using ileal conduit or neobladder. Of the 86 patients, 24 patients (28%) underwent intracorporeal ileal conduit and 62 patients (72%) underwent intracorporeal neobladder formation. A Studer pouch was created in all who underwent intracorporeal neobladder diversion. Cancer specific survival (CSS) and overall survival (OS) are reported.

RESULTS

The mean operative time was 418.9 min (range 205-690 min) and blood loss was 380 ml (range 100-1000 ml). The mean hospital stay was 17.5 days (range 5-62 days). All the surgeries were completed with no open conversions. Minor complications (grade I and II) were reported in 23 patients, while major complications (grade III and above) were reported in 21 patients. The mean nodal yield was 20.3 (range 0-46). Positive margins were found in in 8%. The average follow-up was 31.5 months (range 3-52 months). Continence could be achieved in 88% of patients who received an intracorporeal neobladder. The cancer-specific survival (CSS) and overall survival (OS) were 80% and 70%, respectively.

CONCLUSION

RARC with intracorporeal diversion seems to be safe and reproducible in tertiary centers with robotic expertise. Operative times are acceptable and complications as well as functional and oncologic outcomes are comparable. Further standardization of RARC with intracorporeal diversion may lead to a wider adoption of the approach.

Cost analysis of a community pharmacy 'minor ailment scheme' across three primary care trusts in the North East of England

BACKGROUND

A large proportion of primary care medical consultations relate to minor ailments, placing a substantial burden on the UK National Health Service (NHS). In response, minor ailment schemes (MAS) have been introduced in several community pharmacies.

METHODS

Patients using MAS across three neighbouring primary care trusts were asked what action they would have taken if the MAS had not been in place. The net cost impact of the MAS was calculated using standard health-care reference costs. The observation period was one calendar month with annualized cost data.

RESULTS

During the observation period 396 patients used the MAS of whom 230 (58.1%) stated they would have made an appointment with their general practitioner (GP) if the MAS was not in place. A further 155 (39.1%) would have bought a medicine from the pharmacy. Other responses included attending the accident and emergency department at hospital (n= 2), consulting a health visitor (n= 1), or doing nothing (n= 8). The MAS is estimated to reduce local health-care costs by £6739 per month.

CONCLUSIONS

MAS release NHS resources (especially in relation to GP consultations) by preventing (or minimizing) patient use of alternative and more costly branches of the NHS.

Browsing affects intra-ring carbon allocation in species with contrasting wood anatomy

Current knowledge on tree carbon (C) allocation to wood is particularly scarce in plants subjected to disturbance factors, such as browsing, which affects forest regeneration worldwide and has an impact on the C balance of trees. Furthermore, quantifying the degree to which tree rings are formed from freshly assimilated vs. stored carbohydrates is highly relevant for our understanding of tree C allocation. We used (13)C labelling to quantify seasonal allocation of stored C to wood formation in two species with contrasting wood anatomy: Betula pubescens Ehrh. (diffuse-porous) and Quercus petraea [Matt.] Liebl. (ring-porous). Clipping treatments (66% shoot removal, and unclipped) were applied to analyse the effect of browsing on C allocation into tree rings, plus the effects on tree growth, architecture, ring width and non-structural carbohydrates (NSCs). The relative contribution of stored C to wood formation was greater in the ring-porous (55-70%) than in the diffuse-porous species (35-60%), although each species followed different seasonal trends. Clipping did not cause a significant depletion of C stores in either species. Nonetheless, a significant increase in the proportion of stored C allocated to earlywood growth was observed in clipped birches, and this could be explained through changes in tree architecture after clipping. The size of C pools across tree species seems to be important in determining the variability of seasonal C allocation patterns to wood and their sensibility to disturbances such as browsing. Our results indicate that the observed changes in C allocation to earlywood in birch were not related to variations in the amount or concentration of NSC stores, but to changes in the seasonal availability of recently assimilated C caused by modifications in tree architecture after browsing.

Control of gene expression by CpG island methylation in normal cells

The role of DNA methylation in the control of mammalian gene expression has been the subject of intensive research in recent years, partly due to the critical role of CpG island methylation in the inactivation of tumour suppressor genes during the development of cancer. However, this research has also helped elucidate the role that DNA methylation plays in normal cells. At present, it is also clear that DNA methylation forms an important part of the normal cell-regulatory processes that govern gene transcription. Methylation, targeted at CpG islands, is an important part of the mechanisms that govern X-chromosome inactivation; it is also essential for the maintenance of imprinted genes and, at least in some cases, is critical in determining the cell-type-specific expression patterns of genes. Study of these examples will be important in identifying the mechanisms that control targeting of DNA methylation and how these processes are disrupted during disease pathogenesis.

A role for mismatch repair in control of DNA ploidy following DNA damage

Many reports have shown a link between mismatch repair (MMR) deficiency and loss of normal cell cycle control, particularly loss of G2 arrest. However almost all of these studies utilized transformed cell lines, and thus the involvement of other genes in this phenotype cannot be excluded. We have examined the effects of cisplatin treatment on primary embryo fibroblasts (MEFs) derived from mice in which the MMR gene Msh2 had been inactivated (Msh2(-/-)). This analysis determined that both primary Msh2(-/-) and wild type (WT) fibroblasts exhibited an essentially identical G2 arrest following cisplatin treatment. Similarly, we observed a cisplatin-induced G2 arrest in immortalized MMR deficient (Mlh1(-/-) and Pms2(-/-)) and WT MEFs. p53 deficient primary MEFs (p53(-/-)) exhibited both a clear G2 arrest and an increase in cells with a DNA content of 8N in response to cisplatin. When the Msh2 and p53 defects were combined (p53(-/-)/Msh2(-/-)) the G2 arrest was essentially identical to the p53(-/-) fibroblasts. However, the p53(-/-)/Msh2(-/-) fibroblasts demonstrated a further increase in cells with an 8N DNA content, above that seen in the p53(-/-) fibroblasts. These results suggest that loss of MMR on its own is not enough to overcome G2 arrest following exposure to cisplatin but does play a role in preventing polyploidization, or aberrant DNA reduplication, in the absence of functional p53.

Effect of nitrogen supply and defoliation on loss of organic compounds from roots of Festuca rubra

The aim of this study was to determine the effects of N-supply and defoliation on rhizodeposition from Festuca rubra, in the context of whole-plant C- partitioning and root morphology. Plants were grown for 36 d in axenic sand microcosms continuously percolated with nutrient solutions of either high or low N concentration (2 mM or 0.01 mM NH(4)NO(3), respectively). The effects of partial defoliation at weekly intervals were determined at high and low N. At low N, dry matter accumulation in roots and shoots was reduced significantly (P<0.001), with proportionately increased partitioning to roots, in comparison with the high N treatment. Root morphology was also affected by N-treatment; at low N, lower biomass production was offset by increased specific root length (P<0.001), reducing the magnitude of the significant (P=0.002) increase in total root length at high N. Cumulative release of organic C from roots of F: rubra over the experimental period was not altered significantly by N-treatment. However, as a proportion of net C-assimilation, rhizodeposition was significantly (P<0.001) greater at low N than at high N. Defoliation transiently (3-5 d) increased the release of soluble organic compounds from roots at each N-supply rate, and increased significantly (P<0.001) cumulative rhizodeposition over the experimental period. These effects of N-supply and defoliation on rhizodeposition are of importance in understanding interactions between plant and microbial productivity in grazed grasslands, and in interpretation of concurrent effects on microbially driven nutrient cycling processes in these systems.

Rivastigmine: a review

The acetylcholinesterase inhibitors are the first useful and useable drugs for palliative treatment of dementia of the Alzheimer type. This article reviews the second-generation carbamate cholinesterase inhibitor, rivastigmine (EXELON, Novartis, Basel) whose distinctive pharmacology is not only of immediate clinical relevance but also the key to some tantalizing therapeutic possibilities.

Cortical cell fluxes and transport to the stele in excised root segments of Allium cepa L. : IV. Calcium as affected by its external concentration

From compartmental analysis of radioisotope elutin measurements, fluxes of Ca(2+) were estimated for cortical cells in root segments of onion, Allium cepa L., relative to complete nutrient solutions containing a range of calcium concentrations ([Ca0]) from 2 μeq l(-1) to 20 meq l(-1), increasing in 10-fold steps for Ca(2+). Except for the calcium counter-ion (usually NO 3 (-) , sometimes Cl(-) at the highest [Ca0]), the composition of the nutrient solution was other-wise the same at all calcium concentrations. Compartmental analysis indicated that the cytoplasm had a high content of exchangeable Ca(2+) but, in the light of evidence from animal studies, ionic activity of calcium in the cytoplasm was assumed to be no greater than 0.002 μeq ml(-1). With the Ussing-Teorell flux equation as the criterion, it was concluded that at all values of [Ca0] tested, Ca(2+) entered the cytoplasm passively and was actively pumped back into the external solution. Entry of calcium to the vacuole from the cytoplasm was active in all cases. The conclusions regarding the character of ion transport across the plasmalemma were the same as when the whole calcium content of the cytoplasm was taken to contribute to the ionic activity. However, the electrochemical activity gradient was very much steeper than formerly estimated. Calcium was transported to the stele in proportion to the calcium content of the cytoplasm and moved in the xylem almost exclusively in the basipetal direction.

Cortical cell fluxes and transport to the stele in excised root segments of Allium cepa L. : III. Magnesium

From compartmental analysis of radioisotope elution measurements, concentrations and fluxes of Mg(2+) were estimated for cortical cells in root segments of onion, Allium cepa L., relative to a complete nutrient solution containing 0.25 mM Mg(2+). Five compartments for Mg(2+) in the cortex were found and, in order of increasing rates of exchange, identified with the vacuoles and the cytoplasm of the cortical parenchyma, the Donnan free space, the water free space, and the superficial film of solution on the segments. With the Ussing-Teorell flux ratio equation as the criterion, it was concluded that Mg(2+) entered the cytoplasm passively and was actively pumped back across the plasmalemma. Mg(2+) concentration in the vacuole could be estimated only as lying between wide limits (1.3 to 14.3 μeq ml(-1)), but whatever the concentration within this range, it was concluded that Mg(2+) was passively distributed across the tonoplast. Net flux was zero and the vacuolar concentration commensurate with this was found to be 6.6 μeq ml(-1). The transported fraction of total efflux, appearing at the segment cut ends, was estimated separately. Magnesium was found to be transported almost exclusively in the basipetal direction.