Navigated African American breast cancer patients as incidental change agents in their family/friend networks.

BACKGROUND: Patient navigation is an increasingly widespread intervention to address the persistent, severe, and disproportionate breast cancer (BC) burden that African Americans (AA) face. Navigation may have more widespread effects than previously estimated due to patient-driven diffusion of BC information. METHODS: This pilot study examined the network effects of a randomized controlled trial via recruitment of navigated and non-navigated AA BC patients as well as their network members. We estimated study arm differences in patient BC promotion (i.e., number of individuals to whom BC patients promote BC screening) and network BC screening (i.e., % BC screening among network members). RESULTS: Among our sample of 100 AA BC patients, navigated patients promoted BC screening to more individuals than non-navigated patients. BC patients were more likely to promote BC screening to children and individuals with whom they communicated more frequently. Some models further suggested more network BC screening among "navigated" network members relative to "non-navigated" network members. CONCLUSIONS: Navigated AA patients promoted BC screening more widely throughout their networks than non-navigated AA BC patients. There were also suggestive findings regarding increased BC screening among their network members. Our pilot study highlights the potential for social network analysis to improve the precision of intervention effect estimates and to inform future innovations (e.g., integrating navigation and network-based interventions) with multilevel effects on cancer health disparities.

Understanding the relationship between positive and negative social support and the quality of life among African American breast cancer survivors.

PURPOSE: Social support improves several quality of life (QOL) domains among African American breast cancer survivors. How different dimensions of social support are associated with QOL among African American breast cancer survivors may however differ from other populations. This study explores this hypothesis by examining associations of positive social support (supportive interactions that promote affection) and negative social support (non-supportive interactions wherein the provider of support may not have the best intended actions) with QOL among Chicago-based African American breast cancer survivors. METHODS: Study participants were eligible if they (1) were identified as being an African American female, (2) were at least 18 years of age or older, and (3) were diagnosed with breast cancer during or after navigation was implemented at the study hospital. Participants completed validated questionnaires via telephone or in-person interviews. RESULTS: Among our sample of 100 participants, positive support was associated with greater mental well-being in non-imputed (Std ß=1.60, CI: 0.51, 2.69, p= 0.004) and imputed models (Std ß= 1.67, CI: 0.68, 2.73, p=0.001). There was also a weaker inverse association with negative support and mental well-being when using non-imputed data (Std ß=-0.82, CI:-1.65, 0.02, p= 0.05). CONCLUSIONS: Our findings suggest that positive support, in particular, is highly influential for improving mental well-being among African American breast cancer survivors. Simultaneously, negative support appears to be an independent, albeit weaker, determinant of mental well-being.

Oral examination findings, taste and smell testing during and following head and neck cancer therapy.

PURPOSE: Diet and nutrition are critical in health and disease and are highly impacted by the presence and treatment for head and neck cancer (HNC). The purpose of this paper is to present oral examination findings and taste and smell test results in patients during and following HNC. METHODS: Patients with HNC were evaluated during and following radiation therapy with/without chemotherapy. Oral examination findings including mucositis, saliva, oral hygiene (plaque levels, gingivitis), and taste and smell testing was completed on all subjects. NCI Common Terminology Criteria for Adverse Events (CTCAE) 4.0, and the Scale of Subjective Total Taste Acuity (STTA) were used to provide patient report of symptoms. RESULTS: Mucositis and pain affected oral diet during therapy and improved in follow-up. Weight loss of 5% during and 12% following treatment was identified. Tobacco use was associated with increased severity of mucositis and increased weight loss. The subjects maintained excellent oral hygiene as reflected in plaque levels and gingivitis. Spicy/pungent perception was the most strongly disliked of testing stimuli. Umami and fat taste perception were reported of highest intensity during HNC treatment and rated as moderate in intensity after treatment. These results suggest improvement in these taste functions over time following treatment. Salt taste was of high intensity and associated with strong dislike in follow-up. CONCLUSIONS: In HNC patients, oral status and taste change occurs throughout the cancer trajectory and represent potential concerns in cancer survivorship. Taste change (as evaluated by taste testing) occurred in all HNC patients, whereas olfactory changes occurred in 30% of cases. Management of oral changes and symptoms should be considered in all HNC patients in addition to dietary and nutritional guidance in patient care to promote oral intake. Continuing study of taste changes may further define this problem and support dietary and nutritional guidance and product development.

Leveraging system sciences methods in clinical trial evaluation: An example concerning African American women diagnosed with breast cancer via the Patient Navigation in Medically Underserved Areas study.

BACKGROUND: Systems science methodologies offer a promising assessment approach for clinical trials by: 1) providing an in-silico laboratory to conduct investigations where purely empirical research may be infeasible or unethical; and, 2) offering a more precise measurement of intervention benefits across individual, network, and population levels. We propose to assess the potential of systems sciences methodologies by quantifying the spillover effects of randomized controlled trial via empirical social network analysis and agent-based models (ABM). DESIGN/METHODS: We will evaluate the effects of the Patient Navigation in Medically Underserved Areas (PNMUA) study on adult African American participants diagnosed with breast cancer and their networks through social network analysis and agent-based modeling. First, we will survey 100 original trial participants (50 navigated, 50 non-navigated) and 150 of members of their social networks (75 from navigated, 75 non-navigated) to assess if navigation results in: 1) greater dissemination of breast health information and breast healthcare utilization throughout the trial participants' networks; and, 2) lower incremental costs, when incorporating navigation effects on trial participants and network members. Second, we will compare cost-effectiveness models, using a provider perspective, incorporating effects on trial participants versus trial participants and network members. Third, we will develop an ABM platform, parameterized using published data sources and PNMUA data, to examine if navigation increases the proportion of early stage breast cancer diagnoses. DISCUSSION: Our study results will provide promising venues for leveraging systems science methodologies in clinical trial evaluation.

Efficacy of a glycopolymer-based oral rinse upon pain associated with ulcerative and erosive lesions of the oral mucosa: A within-subject pilot study.

OBJECTIVES: The purpose of this pilot study was to assess the magnitude of effect for a new topical rinse that may impact oral soreness and function in ulcerative oral mucosal lesions. STUDY DESIGN: Twenty-five consecutive patients with ulcerative/erosion lesion and moderate pain visual analogue pain score (≥4) rated their mouth and throat soreness and oral symptoms at baseline and at 24, 48, and 72 hours after open-label use of a chitosan-based, nonanesthetic oral rinse (Synvaza) at least twice a day. No changes in prior therapy, including analgesics, were allowed during the trial. RESULTS: All measures of oral soreness decreased in severity from baseline to 72 hours, and overall oral soreness decreased by 28% (P < .01). Oral soreness associated with talking decreased by 67% (P < .01), drinking by 62% (P < .01), swallowing by 56% (P = .04), sleeping by 51% (P = .02) and eating by 50% (P < .01). The product was rated favorably for texture, flavor, soothing relief, mouth feel, and burning/stinging with use. CONCLUSIONS: Oral rinsing with the study product reduced mucosal pain without anesthetic effect and improved oral function.

Patterns of oral and dental care education and utilization in head and neck cancer patients.

PURPOSE: The purpose of this study was to examine patterns of oral health care among patients undergoing oral cancer therapy in order to better understand how oral care is being utilized, what types of providers are being utilized at various stages of cancer therapy, and assessing patients' satisfaction with the care they received at these stages. METHODS: An online survey was conducted via the Oral Cancer Foundation's support group message board. Participants were asked about their oral care immediately prior to cancer therapy, during cancer therapy, and post cancer therapy. The participants were also given the opportunity to provide open response feedback on their oral care which was analyzed qualitatively. RESULTS: Seventy-four participants completed the survey. Participants reported being informed that they needed to receive an oral evaluation 72.6 and 53.6% of the time in the pre- and post-treatment stages, respectively. Compliance with this recommendation was 71.2% pre cancer therapy but dropped precipitously to 49.2% post cancer therapy. Pre- and post-therapy oral care was provided most commonly by the patient's usual dentist 41.1 and 55.9%, respectively, with medical providers predominating the treatment phase, 77.7%. Patients reported dissatisfaction rates of 29.0, 20.6, and 21.0% sequentially. CONCLUSIONS: There is a general lack of consistency with how, when, and from whom oral cancer patients receive their oral health education. It is likely that this contributes to insufficient education resulting in high levels of patient dissatisfaction with their oral care.

Comparison of nonoperative and surgical management of renal trauma: Can we predict when nonoperative management fails?

BACKGROUND: Limited data exist on risk factors for the failure of nonoperative management of renal trauma. Our study objective was to determine the incidence, salvage procedure, and risk factors for failure of nonoperative management of renal trauma. METHODS: The National Trauma Data Bank research data sets for admission years 2010-2014 were queried for renal injury by Abbreviated Injury Score code. Patients were stratified by interventional therapy (renal procedure code <24 hours from admission) and nonoperative management (no surgical renal procedure <24 hours). Abbreviated Injury Score was converted to American Association for the Surgery of Trauma renal injury grade. Demographics, patient and injury characteristics were compared between groups using stratified analysis. Multivariable logistic regression models were used to determine variables that were associated with failure of nonoperative management. RESULTS: A review of 3,977,634 cases revealed 19,572 renal injuries that met study criteria. A total of 16.6% were managed with interventional therapy, and 83.4% were managed nonoperatively, of which 2.7% failed nonoperative management. Risk-adjusted multivariate regression indicated that penetrating injury (stab: odds ratio [OR], 1.61; 95% confidence interval [CI], 1.02-2.53 [p = 0.040]; and gunshot wound: OR, 1.40; 95% CI, 1.04-1.90 [p = 0.029]), highest abdominal injury grade for nonrenal organs (OR, 2.06; 95% CI, 1.65-2.57), and highest renal injury grade (OR, 1.85; 95% CI, 1.54-2.21) were associated with failure of nonoperative management (all p < 0.001). Increasing injury grades were associated with increasing risk of failing nonoperative management (Grade III: OR, 1.94; 95% CI, 1.35-2.90; Grade IV: OR, 9.79; 95% CI, 7.04-13.63; and Grade V: OR, 9.45; 95% CI, 6.02-14.86 [all p < 0.001]). CONCLUSIONS: Nonoperative management in the first 24 hours after fails in up to 2.7%. Renal injury grade, nonrenal abdominal injuries, and penetrating injuries predict for nonoperative management failure. Highest-grade renal injuries are at increased risk of failure. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III; therapeutic study, level IV.

Management of dry mouth: assessment of oral symptoms after use of a polysaccharide-based oral rinse.

OBJECTIVE: Salivary dysfunction is associated with a range of oral/dental issues, and management of oral symptoms may improve oral function and overall quality of life. The purpose of this pilot study was to evaluate oral symptoms and function in a xerostomic population after use of a proprietary topical for dry mouth, Moisyn (Synedgen Inc., Claremont, CA), which is a polysaccharide-based product. STUDY DESIGN: A pre- and post-test survey was completed by 57 patients with xerostomia. Patients rated their common oral symptoms, based on the Vanderbilt Head and Neck Symptom Survey, before and after 1-week use of Moisyn rinse and spray. Saliva production under resting and chewing stimulation was also assessed. RESULTS: Most patients reported relief from dry mouth symptoms and thick saliva (81.7% and 76.0%, respectively) for more than 30 minutes after product use. Statistically significant reductions were found in 15 of 33 oral symptoms. Symptom improvement ranged from 10.7% to 28.4% for thick saliva, 8.4% to 30.6% for pain, 5.5% to 30.4% for dry mouth, and 12% to 21.3% for taste/diet change. Whole unstimulated/resting saliva improved by 100%, and whole stimulated saliva improved by 23.8%. CONCLUSIONS: These findings suggest that the product has utility in symptom control in patients with xerostomia and may lead to an increase in saliva production.

What do I do? Developing a taxonomy of chaplaincy activities and interventions for spiritual care in intensive care unit palliative care.

BACKGROUND: Chaplains are increasingly seen as key members of interdisciplinary palliative care teams, yet the specific interventions and hoped for outcomes of their work are poorly understood. This project served to develop a standard terminology inventory for the chaplaincy field, to be called the chaplaincy taxonomy. METHODS: The research team used a mixed methods approach to generate, evaluate and validate items for the taxonomy. We conducted a literature review, retrospective chart review, focus groups, self-observation, experience sampling, concept mapping, and reliability testing. Chaplaincy activities focused primarily on palliative care in an intensive care unit setting in order to capture a broad cross section of chaplaincy activities. RESULTS: Literature and chart review resulted in 438 taxonomy items for testing. Chaplain focus groups generated an additional 100 items and removed 421 items as duplications. Self-Observation, Experience Sampling and Concept Mapping provided validity that the taxonomy items were actual activities that chaplains perform in their spiritual care. Inter-rater reliability for chaplains to identify taxonomy items from vignettes was 0.903. CONCLUSIONS: The 100 item chaplaincy taxonomy provides a strong foundation for a normative inventory of chaplaincy activities and outcomes. A deliberative process is proposed to further expand and refine the taxonomy to create a standard terminological inventory for the field of chaplaincy. A standard terminology could improve the ways inter-disciplinary palliative care teams communicate about chaplaincy activities and outcomes.

Lenalidomide monotherapy in chemotherapy-naive, castration-resistant prostate cancer patients: final results of a phase II study.

BACKGROUND: We investigated the activity of lenalidomide, which has antiangiogenic, antineoplastic, and immunomodulatory properties, in chemotherapy-naive, castration-resistant prostate cancer (CRPC) patients. PATIENTS: Patients received 25 mg/d lenalidomide for 21 days in 28-day cycles, until disease progression or unacceptable toxicity developed. Endpoints included overall response rate and clinical benefit (overall response + stable disease), toxicity, time to radiographic progression, and time to prostate-specific antigen (PSA) progression, overall survival, and quality of life. RESULTS: Thirty-two patients were enrolled in the study; of these, 77% (n = 25) had Gleason scores ≥ 7. The median age was 74 years (58-89 y), the median PSA level was 66 ng/mL (2-919 ng/mL), and 5 of 32 patients (17%) had liver or lung involvement. The median number of lenalidomide cycles was 3 (1-16 cycles). Stable disease was seen in 20 patients, for a clinical benefit rate of 63%. The median time to radiographic progression was 4 months (2-16 mo); the median overall survival was 20 months. Of 27 PSA-evaluable patients, 13 (48%) had a decline in PSA level; 3 (11%) had > 50% PSA decrease; the median time to PSA progression was 3 months (2-9 mo). Grade 3/4 hematologic toxicities were the most common adverse events without adverse impact on quality of life. Serious adverse events occurred in 14 patients (44%), including 1 patient (3%) with a rash definitely related to lenalidomide. CONCLUSION: Lenalidomide monotherapy demonstrates modest activity in chemotherapy-naive CRPC.

A systematic review of comparative schedule-related toxicities with maintenance rituximab in follicular and mantle cell lymphomas.

Abstract We conducted a systematic review of grade 3/4 adverse events (AEs) reported in prospective trials enrolling patients with follicular lymphoma (FL) and mantle cell lymphoma (MCL) receiving maintenance rituximab (MR). Random-effects models were used to calculate summary estimates and 95% confidence intervals for the proportion of AEs occurring during MR. Differences by induction program, histology, setting and MR schedule were examined by stratified analyses and univariate random-effects meta-regression. Eleven trials met the search criteria, with nine sufficiently reporting AEs during the MR phase. Of 1009 patients receiving MR, the proportion experiencing cumulative grade 3/4 toxicity was 24% (95% confidence interval [CI]: 14-36%). Patients receiving MR every 6 months as four weekly infusions for 2 years had significantly less toxicity compared with those receiving MR every 2 months (10% vs. 28%; p = 0.035). Patients treated with rituximab alone during induction had fewer toxicities compared to those treated with rituximab plus chemotherapy induction (12% vs. 35%; p = 0.031). Myelosuppression and infections were the most common toxicities. Our literature analysis suggests that MR given every 6 months and rituximab alone as induction may be associated with fewer grade 3/4 AEs for patients with FL and MCL; however, assessing the true independent impact of induction regimens and schedule on toxicity will require prospective trials.

Survival after resection of cutaneous adnexal carcinomas with eccrine differentiation: risk factors and trends in outcomes.

BACKGROUND: Current staging systems do not specifically address cutaneous adnexal carcinomas with eccrine differentiation. Due to their rarity, prognosis and management strategies are not well established. A population-based study was performed to determine prognostic factors and survival. METHODS: Patients diagnosed with cutaneous adnexal carcinomas with eccrine differentiation were identified using the surveillance, epidemiology, and end results population-based cancer registry. Associations between risk factors, treatment modalities, and survival were calculated using logistical regression, Kaplan-Meier estimates and log-rank analysis. RESULTS: The incidence of distinct eccrine subtypes was determined within 1,045 patients with cutaneous adnexal tumors containing eccrine differentiation. All-cause 5-year survival (OS) was 82%, while age-adjusted survival was 94%. Patients with microcystic adnexal carcinoma had improved OS (90%) compared to patients with hidradenocarcinoma (74%), spiradenocarcinoma (77%), porocarcinoma (79%), and eccrine adenocarcinoma (81%). The majority of patients were treated with surgical excision and a small subset with surgery plus radiation, with similar OS. Patients with well-to-moderately differentiated tumors demonstrated improved OS compared to those with poorly differentiated/anaplastic disease. CONCLUSIONS: Histological subtype and grade were associated with survival, and should be specified in biopsies and excised specimens. Surgical excision is appropriate, and the addition of adjuvant radiation may not be associated with survival. These results highlight survival data and high-risk prognostic factors that warrant prospective validation, and may augment current staging systems.

Can we predict which residents are going to pass/fail the oral boards?

OBJECTIVE: Previously, we identified a positive correlation between administration of regularly structured mock oral examinations and successful first time pass rates on the American Board of Surgery Certifying Examination (ABSCE)/oral boards. In this study, we investigated factors associated with test results to determine whether residents at risk of not passing the ABSCE can be identified a priori. DESIGN: All general surgery chief residents who graduated from a large academic/community program between 2001 and 2010 were identified. Residents who did not pass the ABSCE on the first attempt were compared to a control group of chief residents who passed the examination on the first attempt. Evaluation metrics included "knowledge," "professional communication," and "spoken English" scores. Differences between groups were determined using one-way ANOVA and χ(2) calculations. RESULTS: Over the decade, 13 residents made more than 1 attempt to pass the ABSCE. The element of the "knowledge" score associated with ABSCE first-attempt pass rates included United States medical licensing examination (USMLE) Step 2 scores (p = 0.02), and not ABSITE, American Board of Surgery Qualifying examination (ABSQE)/written examination or USMLE Step 1 scores. "Professional communication" scores associated with first-attempt pass rates included in-house mock oral examination scores (p = 0.01) and Citywide mock oral examination scores (p = 0.02). ABSCE pass rates did not differ in native vs. non-native English speakers or graduation from a United States vs. International medical school. CONCLUSIONS: Compared with a control group of residents from the same program, residents who passed the ABSCE examination on the first attempt were more likely to have higher USMLE Step 2 and professional communication scores. USMLE Step 1 scores and English as a native language were not associated with certifying examination pass rates. These criteria may offer guidance for residents preparing to take the ABSCE and may aid in the selection of residents for residency programs. Larger studies to validate these findings and to investigate the role of improving communication skills and conducting interventions between the 1st and 2nd attempt are warranted.

Coblation tonsillectomy in children: incidence of bleeding.

OBJECTIVES/HYPOTHESIS: To evaluate the intraoperative and postoperative bleeding rate utilizing the Coblation device for total tonsillectomy in children. STUDY DESIGN: Prospectively designed clinical study. METHODS: Institutional review board approval was obtained to study patients undergoing Coblation tonsillectomy. Records of all children 1 to 18 years of age undergoing tonsillectomy or adenotonsillectomy from April 2003 to April 2010 were reviewed. All children underwent total tonsillectomy utilizing the Coblation device, and the intraoperative and postoperative bleeding complications were analyzed. The data were also analyzed to determine whether surgeon experience with the technique influenced the bleeding rate. RESULTS: A total of 1,918 patients were evaluated. Intraoperative blood loss was <5 mL in >90% of the patients, with no patients experiencing >20 mL of blood loss. The postoperative bleeding rate was consistent with the literature (n = 87, 4.5%). Of the patients with bleeding following surgery, five (5.7%) experienced primary bleeding and 82 (94.3%) secondary bleeding. Postoperative bleeding that ceased spontaneously and did not require intervention was present in 56 (2.9%). The number of patients who actually required intervention to control postoperative bleeding was 31 (1.6%). The majority of bleeding occurred by postoperative day 7. There was no statistically significant difference in bleeding rates by age, and there was no evidence found to support a surgeon learning curve for performing Coblation tonsillectomy. CONCLUSIONS: This study provides further support that Coblation total tonsillectomy in children is a reliable and safe procedure with a relatively low incidence of intraoperative and postoperative bleeding.

Laryngeal mask airway versus endotracheal tube in pediatric adenotonsillectomy.

OBJECTIVES/HYPOTHESIS: Evaluation of safety and postoperative outcomes of the laryngeal mask airway (LMA) during pediatric tonsil surgery compared to use of the endotracheal tube (ETT). STUDY DESIGN: Randomized controlled trial. METHODS: A population-based sample of 117 patients ages 2 to 18 years requiring adenotonsillectomy, adenoidectomy, or tonsillectomy was studied. Evaluation forms covering 36 safety, surgery duration, and patient comfort variables were given to the surgeon, anesthesiologist, and phase I and phase II recovery nurses to collect data on the intra- and postoperative course. A phone survey was conducted 24 hours after surgery. RESULTS: At the α level following Bonferroni correction, LMA showed less coughing or gagging during the anesthesia phase for all surgeries combined (48% for ETT vs. 20% for LMA; χ(2) = 10.153, P = .002), and for ETT nontonsillectomy vs. LMA nontonsillectomy (48% for ETT vs. 3% for LMA; χ(2) = 15.196, P = .000), spontaneous ventilation was used more often in the LMA group when comparing all surgeries (χ(2) = 19.493, P = .000), and when comparing ETT tonsillectomy and LMA tonsillectomy (χ(2) = 11.131, P = .000). CONCLUSIONS: Use of the LMA during pediatric tonsil surgery does not appear to have any major disadvantages compared to use of the ETT. In fact, analysis of safety, comfort, complications, and postoperative problems suggests that LMA may be superior for some outcome variables such as coughing and gagging. Use of spontaneous ventilation is more common among LMA patients, although the significance of this finding is uncertain.

The down regulation of neutrophil oxidative metabolism by S100A8 and S100A9: implication of the protease-activated receptor-2.

S100A8 and S100A9 regulate polymorphonuclear neutrophils (PMNs) recruitment and represent 40% of PMN cytosolic protein weight. We have shown that S100A8/S100A9 inhibit PMN oxidative metabolism. The present study was designed to elucidate the mechanisms of this anti-oxidative effect. We hypothesized that the protease activated receptor-2 (PAR-2) played a role in the down-regulation of PMN oxidative metabolism by S100A8/S100A9. Freshly isolated PMNs were tested for their ability to oxidize dichlorofluorescin-diacetate. Functional inhibition of PAR-2 with ENMD-1068, the pepducin P2pal-21 or an antibody directed at PAR-2 cleavage/activation site, resulted in a significant inhibition of S100A8 and S100A9 anti-oxidative effect. Conversely, the controlled activation of PAR-2 potentiated S100 anti-oxidative effect. Taken together, the data indicate that the anti-oxidative effect of S100A8/A9 is initiated by PAR-2 activation. S100A8/S100A9 may therefore dampen inflammation without interfering with its initial strength. This finding opens translational possibilities to limit deleterious PMN activation with a dual PAR-2/S100 strategy.

Bortezomib (Velcade), rituximab, cyclophosphamide, and dexamethasone combination regimen is active as front-line therapy of low-grade non-Hodgkin lymphoma.

OBJECTIVE: To evaluate the efficacy and toxicity of the combination of VRCD (velcade/rituximab/cyclophosphamide/dexamethasone) in chemotherapy-naïve low-grade non-Hodgkin lymphoma or patients with transplantation-ineligible mantle cells. METHODS: The patients were treated with velcade, at 1.6 mg/m(2), on days 1, 8, 15, and 22 on every 35-day cycle. Rituximab was given at 375 mg/m(2) on the same days as velcade during cycle 1 and then only on day 1 in subsequent cycles. Dexamethasone was given orally at 40 mg on days 1, 2, 8, 9, 15, 16, 22, and 23. Cyclophosphamide was administered orally at 400 mg/m(2) on days 1-4. The patients had to meet criteria to initiate therapy and had to demonstrate adequate performance status and organ function. RESULTS: Twelve patients were enrolled, after which the study was closed due to a lack of funding. The median age was 68 years (37-83 years), with 83% having stage III/IV disease. Five patients had marginal zone, 4 had follicular, 2 had small lymphocytic, and 1 had mantle cell histologies. The overall response rate was 90% (complete response, 54%). At a median follow-up of 22 months, 9 (75%) patients remain alive, and the median time to progression has not been reached. A third of the patients required dose reductions after a median of 6.5 cycles. No grade 3 or 4 peripheral neuropathy was witnessed. CONCLUSIONS: Although the number of studied patients is small, VRCD appears safe and active as front-line therapy for low-grade non-Hodgkin lymphoma. Further studies are justified.

The prevalence of persistent pain after nonsurgical root canal treatment.

OBJECTIVE: To investigate the prevalence of persistent pain of neuropathic origin after nonsurgical root canal treatment and to determine its characteristics, location, and severity utilizing a self-reported validated postal survey. METHOD AND MATERIALS: A modified version of the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) survey was mailed to 2,338 adult subjects who received a single-tooth nonsurgical root canal treatment at the University of Illinois at Chicago College of Dentistry Postgraduate Endodontics Clinic over a 4-year period. Two-hundred and fifty (10.7%) completed surveys were returned. Descriptive analysis, Pearson correlation to determine correlations between the S-LANSS scores and variables of interest, and t tests for group comparisons of the S-LANSS score were performed. Statistical significance was determined at P<.05. RESULTS: The prevalence of persistent pain of neuropathic origin among respondents after receiving single-tooth nonsurgical root canal treatment was 7% with the average pain reported as 7.2 on a visual analogue scale (where 0 is no pain and 10 is pain as severe as it could be). Neuropathic pain was more common in middle-aged (mean 50.6 years of age) individuals with no sex predilection and occurred more frequently in the mandibular arch without any differences attributable to the number of canals treated. Also, the majority of subjects most frequently endorsed their pain experiences as abnormal sensitivity to touch and pain when the area is pressed or rubbed. CONCLUSION: Dental providers need to recognize and understand the differences between nociceptive and neuropathic pain. Understanding these concepts will assist in preventing inappropriate, irreversible, and unnecessary interventions.

Effect of human immunodeficiency virus infection on S100A8/A9 inhibition of peripheral neutrophils oxidative metabolism.

Neutrophils are endowed with a highly active oxidative metabolism that is crucial for their antimicrobial functions but can produce oxidative conditions disruptive to the host. Opportunistic infections associated with HIV disease and ex vivo studies of neutrophils from HIV patients suggest that neutrophil dysfunctions significantly contribute to HIV disease. The calcium-binding proteins S100A8 and S100A9 are abundant cytosolic constituents of human neutrophils. Our previous work has shown that S100A8 and S100A9 inhibit neutrophil oxidative metabolism. In this study, we tested the hypothesis that neutrophils from HIV infected subjects respond differently to S100A8 and S100A9 when compared to neutrophils isolated from control HIV naive subjects. Neutrophils, freshly isolated from whole blood, were tested in a 96-well plate assay for their ability to oxidize the DCFH-DA probe. The neutrophils from HIV+ and HIV- subjects were stimulated with LPS and inhibited with recombinant S100A8 and S100A9. Our data indicate that when compared to neutrophils isolated from HIV- subjects, neutrophils from HIV+ subjects display an exaggerated response to LPS and a diminished response to S100A8 and S100A9 inhibition. Our data support our hypothesis and signify that, in HIV disease, dysregulated neutrophil responses to endotoxins stimulation and S100A8/A9 inhibition may contribute to a higher risk for oxidative stress associated ailments. The mechanism for the observed differences in neutrophil response and their biological significance in the course of HIV disease should be addressed in further studies.