Study protocol of the TEC-ORL clinical trial: a randomized comparative phase II trial investigating the analgesic activity of capsaicin vs Laroxyl in head and neck Cancer survivors presenting with neuropathic pain sequelae

BACKGROUND

Neuropathic pain is common in cancer survivorship and is one of the most distressing symptoms for patients previously treated for head and neck cancer. Persistent neuropathic pain, when it is ongoing and uncontrolled, has a detrimental effect and erodes patients' quality of life. Patients treated for head and neck cancer are chronic opioid users to manage their post-treatment pain, which may entail an increased risk of addiction and overdose. We propose to evaluate the analgesic activity of high-concentration capsaicin patches for the treatment of head and neck cancer survivors presenting with neuropathic pain sequelae.

METHODS

TEC-ORL is a parallel, multicenter randomized comparative phase II study evaluating whether Capsaïcin patches (Qutenza®) reduce neuropathic pain when compared to Amitriptyline (Laroxyl®) in head and neck cancer survivors presenting with neuropathic pain sequelae. The primary efficacy outcome is the rate of patients with a pain reduction of at least two points at 9 months compared to baseline. Assuming that 5% of patients become lost to follow-up, 130 patients will need to be randomized to detect a 25% improvement (i.e., standard: 25%, experimental: 50%) using a one-sided chi-square test with an alpha of 0.05%. According to the recommendations for comparative phase II trials, the target differences and type I error rates are relaxed. Randomized patients will either be treated with a capsaicin 8% (Qutenza®) patch applied at three time intervals in the experimental arm or with Amitriptyline (Laroxyl®) (oral solution 40 mg/ml) taken for 9 months at the recommended daily dose of 25 mg to 75 mg in the control arm.

DISCUSSION

TEC-ORL is a randomized comparative phase II trial designed to comprehensively evaluate the analgesic activity of capsaicin compared to Laroxyl in Head and Neck Cancer survivors presenting with neuropathic pain sequelae.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04704453 Date of registration: 2021/01/13.

High-Energy Electron and Proton Irradiation of Cu(In,Ga)Se2 Heterojunction Solar Cells

We investigate radiation-induced defects in high-efficiency Cu(In,Ga)Se2/CdS/ZnO heterojunction solar cells after 1-MeV electron and 4-MeV proton irradiation. We use electron and proton fluences of more than 1018 cm−2 and up to 1014 cm−2, respectively. The irradiation experiments performed at three independent electron irradiation facilities consistently prove the superior radiation resistance of these Cu(In,Ga)Se2 devices compared to other types of solar cells. The reduction of the solar cell efficiency in all experiments is predominantly caused by a loss ΔVOC of the open circuit voltage VOC. An analytical model describes ΔVOC in terms of radiation-induced defects enhancing recombination in the Cu(In,Ga)Se2 absorber material. From our model we extract the defect introduction rates for recombination centers in Cu(In,Ga)Se2 for the respective particles and energies. Isochronal annealing steps fully recover VOC of the irradiated Cu(In,Ga)Se2 solar cells. Exposure to temperatures of approx. 400 K are sufficient to restore the initial VOC within less than 5 %, even after excessive irradiation. The annealing process displays an activation energy of EA = 1.1 eV. Admittance spectroscopy directly reveals the generation and the annealing of radiation-induced defects.

Platelet concentrates transfusion in cardiac surgery and platelet function assessment by multiple electrode aggregometry

BACKGROUND

Platelet dysfunction contributes to the pathophysiology of bleeding complications during and after cardiac surgery. In most surgical institutions, no peri-operative point-of-care monitoring of platelet function is used. We evaluated the usefulness of the Multiplate platelet function analyser based on impedance aggregometry for identifying groups of patients at a high risk of transfusion of platelet concentrates (PC).

METHODS

Platelet function parameters were determined in 60 patients before and after routine cardiac surgery. Impedance aggregometry measurements were performed on Multiplate using ADP (ADPtest), collagen (COLtest) and thrombin receptor activating peptide (TRAPtest) as platelet activators. The correlations between the aggregometry results and the transfusion of PC were calculated. The results of the aggregation tests were also divided into tertiles and the differences in PC transfusion between the low and the high tertile were assessed.

RESULTS

Low aggregometry delimited groups of patients with significantly higher PC transfusion. In the receiver operating characteristic curve, low pre-operative aggregation in the ADPtest identified patients with high total transfusion of PC (area under the curve 0.74, P=0.001), while the ADPtest performed at the end of the operation identified patients with high PC transfusion on the intensive care unit (ICU) (area under the curve 0.76, P=0.002).

CONCLUSIONS

Near-patient platelet aggregation may allow the identification of patients with enhanced risk of PC transfusion, both pre-operatively and upon arrival on the ICU.