Fracture risk prediction using FRAX in patients following hematopoietic stem cell transplantation.

We aimed to study the utility of the FRAX tool in predicting fractures in patient's receiving a hematopoietic stem cell transplantation (HSCT). Our results indicate that the FRAX tool has modest fracture predictive ability in patients greater than 50 years of age at the time of HSCT. PURPOSE: Identifying patients at high risk of osteoporotic fractures following HSCT is challenging. We aimed to evaluate the utility of the FRAX tool at the time of HSCT in predicting fractures following transplant. METHODS: We conducted a retrospective chart review of adults (> 18 years) who underwent HSCT at MD Anderson Cancer Center from January 1, 2001, to December 31, 2010, and were followed until December 31, 2013, to identify osteoporotic fractures. Multivariate Cox regression models were built using FRAX score thresholds of low risk < 10%, medium risk 10 to 20%, and high risk > 20% probability of osteoporotic fracture. RESULTS: We identified 5170 patients who had undergone HSCT, 10% of whom developed an osteoporotic fracture during a median follow-up of 3.2 years. In patients > 65 years of age, those with medium risk (hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.27-4.47) and high risk (HR 3.41, 95% CI 1.73-6.75) had a greater probability of developing an osteoporotic fracture compared to those at low risk. Similar trends were seen in patients 50 to 65 years of age. CONCLUSIONS: In patients greater than 50 years, the FRAX tool has modest predictive ability and could be used to aid in preventive treatment decision-making at the time of transplant.

Cancer-Related Fatigue in Cancer Survivorship.

Cancer-related fatigue (CRF) significantly interferes with usual functioning because of the distressing sense of physical, emotional, and cognitive exhaustion. Assessment of CRF is important and should be performed during the initial cancer diagnosis, throughout cancer treatment, and after treatment using a fatigue scoring scale (mild-severe). The general approach to CRF management applies to cancer survivors at all fatigue levels and includes education, counseling, and other strategies. Nonpharmacologic interventions include psychosocial interventions, exercise, yoga, physically based therapy, dietary management, and sleep therapy. Pharmacologic interventions include psychostimulants. Antidepressants may also benefit when CRF is accompanied by depression.

Zinc chloride mediated degradation of cellulose at 200 degrees C and identification of the products.

The effect of ZnCl(2) on the degradation of cellulose was studied to develop conditions to produce useful feedstock chemicals directly from cellulosic biomass. Cellulose containing 0.5 mol of ZnCl(2)/mol of glucose unit of cellulose was found to degrade at 200 degrees C when heated for more than 60 s in air. The major non-gaseous products of the degradation were identified as furfural, 5-hydroxymethylfurfural and levulinic acid. The maximum yields for furfural and 5-hydroxymethylfurfural are 8% and 9%, respectively, based on glucose unit of cellulose. These yields are reached after 150 s of heating at 200 degrees C. A cellulose sample containing 0.5 mol of ZnCl(2)/mol of glucose unit of cellulose and 5.6 equivalents of water when heated for 150 s at 200 degrees C produced levulinic acid as the only product in 6% yield. The ZnCl(2) mediated controlled degradation of cellulose at 200 degrees C is shown to produce useful feedstock chemicals in low yield.

Mechanism of the dehydration of D-fructose to 5-hydroxymethylfurfural in dimethyl sulfoxide at 150 degrees C: an NMR study.

The anomeric composition of d-fructose in dimethyl sulfoxide changes when the solution is heated from room temperature to 150 degrees C, with a small increase in the alpha-furanose form at the expense of the beta-pyranose tautomer. Additionally, a small amount of alpha-pyranose form was also observed at 150 degrees C. A mechanism is proposed for the dehydration of D-fructose to 5-hydroxymethylfurfural in DMSO at 150 degrees C, where the solvent acts as the catalyst. A key intermediate in the reaction was identified as (4R,5R)-4-hydroxy-5-hydroxymethyl-4,5-dihydrofuran-2-carbaldehyde by using (1)H and (13)C NMR spectra of the sample during the reaction.