Assessment and management of radiation-induced trismus in patients with nasopharyngeal carcinoma: a best practice implementation project.

INTRODUCTION AND AIMS: Intensity-modulated radiotherapy (IMRT) is the most commonly used radiotherapy technology in oncology, which enables precise conformation of the radiation dose to the target volume and reduces the risk of radiation damage to the adjacent normal structures. Nevertheless, it is still inevitable for IMRT of head and neck cancer to cause radiation-related toxic and side effects, such as dry mouth, mucositis, oral dysarthria, taste disorder, osteonecrosis, and trismus. Trismus is one of the most common late side effects caused by radiotherapy of nasopharyngeal carcinoma (NPC), which seriously affects the quality of life for patients with NPC. However, the current clinical assessment and management of trismus after radiotherapy for NPC are still imperfect. This best practice implementation project aimed to implement an evidence-based practice in assessing and managing trismus for NPC patients who underwent radiotherapy, thereby improving the compliance of clinical practice with the best evidence and the quality of life of patients with NPC. METHODS: This evidence-based audit and feedback project was implemented using a three-phase approach at a third-class hospital in China, following JBI's Practical Application of Clinical Evidence System (PACES) and GRiP evidence application. The first phase included a baseline audit with six evidence-based audit criteria derived from the best available evidence. The second phase included analyzing the results of the baseline audit, identifying barriers to compliance with best practice principles, and developing and implementing strategies to address the barriers identified in the baseline audit. The third phase involved a follow-up audit to assess the results of the interventions implemented to improve practice. RESULTS: After evidence application, the compliance rate for audit criterion 1 increased from 0% at baseline audit to 70% at follow-up audit. The compliance rate for audit criterion 2 increased from 0% to 100%. The compliance rate for audit criterion 3 increased from 22 to 62%. The compliance rate for audit criterion 4 increased from 88 to 100%. The compliance rate for audit criterion 5 was 100% at baseline audit and follow-up audit. The compliance rate for audit criterion 6 increased from 0 to 55%. CONCLUSION: Implementation of the best evidence for the assessment and management of trismus of patients with NPC after radiotherapy is conducive to improving the compliance of clinical practice with the best evidence, standardizing clinical nursing practice, improving the quality of clinical nursing, and better preventing severe trismus in patients with NPC after radiotherapy.

A7RC peptide modified paclitaxel liposomes dually target breast cancer.

A7R peptide (ATWLPPR), a ligand of the NRP-1 receptor, regulates the intracellular signal transduction related to tumor vascularization and tumor growth. Here, we designed A7R-cysteine peptide (A7RC) surface modified paclitaxel liposomes (A7RC-LIPs) to achieve targeting delivery and inhibition of tumor growth and angiogenesis simultaneously. The cytotoxicity, inhibiting angiogenesis, and internalization of various liposomes by cells were assessed in vitro to confirm the influence of the peptide modification. The accumulations of A7RC-LIPs in various xenografts in mice were tracked to further identify the function of the peptide on the liposomes' surface. The results confirmed that A7RC peptides could enhance the uptake of vesicles by MDA-MB-231 cells, leading to stronger cytotoxicity in vitro and higher accumulation of vesicles in MDA-MB-231 xenografts in vivo. In addition, A7RC peptides enhanced the inhibitory effects of LIPs on the HUVEC tubular formation on Matrigel. The A7RC-LIPs may be promising drug carriers for anticancer therapy.