Omadacycline therapy for Mycobacterium abscessus species infections.

BACKGROUND: Antimicrobial resistance and therapy-related adverse effects make Mycobacterium abscessus treatment challenging. Omadacycline is a novel, bioavailable aminomethylcycline with favourable in vitro activity against M. abscessus. AIMS: To describe a case report and review the published literature describing outcomes for M. abscessus infections treated with omadacycline. METHODS: Systematic literature review. RESULTS: We identified three articles that, in addition to our case report, describe 18 patients. Pulmonary infections were most frequent. Minimum inhibitory concentrations were reported for two isolates (0.25 and 0.5 mg/L). Despite half the patients starting omadacycline because of failure of prior therapy, 15 (83%) had a favourable outcome, defined as 'cure', 'improvement' or 'clinical success' as determined by the primary study authors. One patient (6%) discontinued omadacycline because of gastrointestinal intolerance. CONCLUSIONS: Although the limited observational data and in vitro susceptibility results are encouraging, randomised control trials are required to determine the role of omadacycline as part of combination therapy for this most difficult-to-treat pathogen.

The impact of induction and/or concurrent chemoradiotherapy on acute and late patient-reported symptoms in oropharyngeal cancer: Application of a mixed-model analysis of a prospective observational cohort registry.

BACKGROUND: The goal of this study was to comprehensively investigate the association of chemotherapy with trajectories of acute symptom development and late symptom recovery in patients with oropharyngeal cancer (OPC) by comparing symptom burden between induction chemotherapy followed by concurrent chemoradiotherapy (ICRT), concurrent chemo-radiotherapy (CRT), or radiotherapy (RT) alone. METHODS: Among a registry of 717 patients with OPC, the 28-item patient-reported MD Anderson Symptom Inventory-Head and Neck Module (MDASI-HN) symptoms were collected prospectively at baseline, weekly during RT, and 1.5, 3 to 6, 12, and 18 to 24 months after RT. The effect of the treatment regimen (ICRT, CRT, and RT alone) was examined with mixed-model analyses for the acute and late period. In the CRT cohort, the chemotherapy agent relationship with symptoms was investigated. RESULTS: Chemoradiation (ICRT/CRT) compared with RT alone resulted in significantly higher acute symptom scores in the majority of MDASI-HN symptoms (ie, 21 out of 28). No late symptom differences between treatment with or without chemotherapy were observed that were not attributable to ICRT. Nausea was lower for CRT with carboplatin than for CRT with cisplatin; cetuximab was associated with particularly higher scores for acute and late skin, mucositis, and 6 other symptoms. The addition of ICRT compared with CRT or RT alone was associated with a significant increase in numbness and shortness of breath. CONCLUSION: The addition of chemotherapy to definitive RT for OPC patients was associated with significantly worse acute symptom outcomes compared with RT alone, which seems to attenuate in the late posttreatment period. Moreover, induction chemotherapy was specifically associated with worse numbness and shortness of breath during and after treatment. LAY SUMMARY: Chemotherapy is frequently used in addition to radiotherapy cancer treatment, yet the (added) effect on treatment-induced over time is not comprehensively investigated This study shows that chemotherapy adds to the symptom severity reported by patients, especially during treatment.

Bioaccumulation, tissue and cell distribution, biomarkers and toxicopathic effects of CdS quantum dots in mussels, Mytilus galloprovincialis.

The bioaccumulation, cell, tissue distribution, and biological effects of 5 nm glutathione-capped CdS quantum dots (CdS QDs) in mussels was compared to bulk and aqueous Cd forms through a two-tier experimental approach. In the 1st tier, mussels were exposed for 3 d to 0.05, 0.5 and 5 mg Cd/l (QDs, bulk, aqueous), bioaccumulation, distribution and lysosomal responses were investigated. In the 2nd tier, mussels were exposed for 21 d to the same forms at the lowest effective concentration selected after Tier 1 (0.05 mg Cd/l), biomarkers and toxicopathic effects were investigated. Accumulation was comparable in QDs and aqueous Cd exposed mussels after 3 d. After 21 d, QDs exposed mussels accumulated less than mussels exposed to aqueous Cd and localised in the endo-lysosomal system and released to the alveoli lumen (21 d) after exposure to QDs and aqueous Cd. Intracellular levels of Cd increased on exposure to QDs and aqueous Cd, and to a lesser extent to bulk, and accompanied by the up-regulation of metallothionein 10 (1 d) and 20 (1, 21 d). Lysosomal membrane destabilisation depended on Cd2+ released by all forms but was marked after exposure to aqueous Cd (1 d). Toxicopathic effects (vacuolisation, loss of digestive cells and haemocytic infiltration) were evident after exposure to QDs (1 d) and aqueous Cd (21 d). Toxicity most likely depended on the ionic load resulting from Cd2+ release from the different forms of Cd; yet nanoparticle-specific effects of QDs cannot be disregarded.