A Phase 1 study Combining Pexidartinib, Radiation Therapy, and Androgen Deprivation Therapy in Men With Intermediate- and High-Risk Prostate Cancer.

PURPOSE: This study aimed to evaluate a combination of radiation therapy (RT), androgen deprivation therapy (ADT), and pexidartinib (colony-stimulating factor 1 receptor [CSF1R]) inhibitor in men with intermediate- and high-risk prostate cancer. CSF1R signaling promotes tumor infiltration and survival of tumor-associated macrophages, which in turn promote progression and resistance. Counteracting protumorigenic actions of tumor-associated macrophages via CSF1R inhibition may enhance therapeutic efficacy of RT and ADT for prostate cancer. METHODS AND MATERIALS: In this phase 1 study, the treatment regimen consisted of pexidartinib (800 mg, administered as a split-dose twice daily) and ADT (both for a total of 6 months), and RT that was initiated at the start of month 3. RT volumes included the prostate and proximal seminal vesicles. The delivered dose was 7920 cGy (180 cGy per fraction) using intensity modulated RT with daily image guidance for prostate localization. The primary objective was to identify the maximum tolerated dose based on dose-limiting toxicities. RESULTS: All 4 enrolled patients who were eligible to receive RT had T1 stage prostate cancer, 2 were intermediate risk, and 2 were high risk. The median age was 62.5 years, and the prostate-specific antigen levels were in the range 6.4 to 10.7 ng/mL. The patients' individual Gleason scores were 3 + 3, 4 + 3, 4 + 4, and 4 + 5. All 4 patients reported ≥1 adverse events before RT. Grade 1 hypopigmentation was observed in 1 patient, and grade 3 pulmonary embolus in another. One patient experienced fatigue and joint pain, and another elevated amylase and pruritus (all grade 3 toxicities). Five of the 6 adverse events noted in 3 patients were all grade 3 toxicities attributable to pexidartinib, qualifying as dose-limiting toxicities and ultimately resulting in the study closure. CONCLUSIONS: The combination was not well tolerated and does not warrant further investigation in men with intermediate- and high-risk prostate cancer.

Management of severe neuropathic cancer pain: an illustrative case and review.

Neuropathic cancer pain is common, very disabling and difficult to treat. It can be related to tumor invasion of neural structures and neuronal damage by surgery, chemotherapy and radiation therapy. Adjuvant analgesics are often used with opioids to control neuropathic pain in cancer patients. Methadone, a synthetic opioid with multiple mechanisms of action, is gaining increasing importance as an effective agent in the treatment of cancer related neuropathic pain. This case illustrates the challenges of managing severe pain in a patient with head and neck cancer while undergoing anti-tumor treatment. A review of the adjuvant analgesics and opioids, particularly methadone, in the management of neuropathic pain is also included.

A review of the literature: the economic impact of preventive dental hygiene services.

The contributions of dental hygiene as a discipline of prevention, the inception of systemic fluoride in community water systems, the continual research conducted by the National Institute of Dental and Craniofacial Research (NIDCR), and the success of dental sealants have all contributed to the decrease in incidences of dental diseases. The prevalence of employer-based dental insurance must also be recognized as contributing to a substantial paradigm shift on the utilization of oral health preventive services. This review of the economic impact of oral health preventive services on the consumer and the private dental practice suggests that these services have had a significant impact. Dentistry's challenge remains to extend these considerable gains in oral health status to the 150 million U.S. citizens who do not have access to oral health care services identified in the 2000 Oral Health in America: A Report of the Surgeon General. Utilizing preventive, therapeutic, and educational aspects of dental hygiene services, reaching communities without fluoridation of the public water supply, and incorporating mass pediatric dental sealant programs analogous to immunization programs would improve the oral health status of underserved populations.

Cultural adaptability of dental hygiene students in the United States: a pilot study.

PURPOSE: Dental hygiene students should prepare to competently provide services to culturally diverse patients; therefore, this study was conducted as a baseline to determine the cross-cultural adaptability of dental hygiene students. METHODS: The sample consisted of 188 dental hygiene students attending four culturally diverse dental hygiene programs (N = 108) and four non-culturally diverse dental hygiene programs (N = 80). The culturally diverse programs randomly selected were located in the southwest, southeast and mid-Atlantic regions of the U.S., and the non-diverse programs were located in the northwest, northcentral, central, and southern regions of the U.S. Any dental hygiene program with students representing four of the five ethnic categories (Caucasian, African American, Hispanic/Latino, American Indian/Alaska Native, and Asian/Pacific Islander) with a culturally diverse student enrollment of 40% or greater, was considered a culturally diverse program; any dental hygiene program enrolling students from only one ethnic category was considered a non-culturally diverse program. Participating students completed the Cross-Cultural Adaptability Inventory (CCAI), a 50 item instrument that measures and individual's cultural adaptability and its four research dimensions; emotional resilience, flexibility/openness, perpetual acuity, and personal autonomy. The instrument does not target one particular cultural, rather it is culture general, meaning the inventory is proficient in assessing all cultures. RESULTS: The unpaired t-test revealed a statistically significant difference, at the 0.05 level, in the overall, emotional resilience, flexibility/openness, and perceptual acuity between the two dental hygiene groups. Data analyses revealed the overall score of the dental hygiene students was lower than the CCAI norm group, which consisted of individuals with cross-cultural experience. The culturally diverse group scored higher than the non-diverse group in emotional resilience but scored lower than the non-diverse group in flexibility/openness and perpetual acuity. There was no statistically significant difference between the culturally diverse and non-culturally diverse groups in the dimension of personal autonomy. CONCLUSION: Results of the study led to the conclusion that dental hygiene students attending culturally diverse and non-culturally diverse programs possess some qualities such as personal autonomy and self-identity needed for cultural adaptability. The overall CCAI scores were lower than the CCAI norm group suggesting students need cross-cultural education and training. For this reason, it is important that dental hygiene curricula incorporate cross-cultural educational strategies and peer and patient cross-cultural encounters to enable students to develop competency in providing cross-cultural health care.

Prioritization of the National Dental Hygiene Research Agenda.

The profession of dental hygiene has made considerable progress over the past 30 years toward developing a unique body of knowledge for guiding education, practice, and research. The 1993-1994 American Dental Hygienists' Association Council on Research published the first national dental hygiene research agenda in 1994. The 1994 research agenda focused dental hygienists' research efforts; however, publication of two national reports--the Surgeon General's Report on Oral Health, and Healthy People 2010--have made it necessary to revisit the research agenda. After considering input from participants in the Fourth National Dental Hygiene Research Conference and evaluating the Surgeon General's Report, the 2000-2001 Council on Research has established recommendations for the prioritization of the 1993-1994 research agenda. This report outlines for readers the rationale for the proposed recommendations.