Radiochemotherapy-induced oral mucositis(OM)is a common oral complication in patients with tumors following head and neck radiotherapy or chemotherapy.Erosion and ulcers are the main features of OM that seriously affe...Radiochemotherapy-induced oral mucositis(OM)is a common oral complication in patients with tumors following head and neck radiotherapy or chemotherapy.Erosion and ulcers are the main features of OM that seriously affect the quality of life of patients and even the progress of tumor treatment.To date,differences in clinical prevention and treatment plans for OM have been noted among doctors of various specialties,which has increased the uncertainty of treatment effects.On the basis of current research evidence,this expert consensus outlines risk factors,clinical manifestations,clinical grading,ancillary examinations,diagnostic basis,prevention and treatment strategies and efficacy indicators for OM.In addition to strategies such as basic oral care,antiinflammatory and analgesic agents,anti-infective agents,pro-healing agents,and photobiotherapy recommended in previous guidelines,we also emphasize the role of traditional Chinese medicine in OM prevention and treatment.This expert consensus aims to provide references and guidance for dental physicians and oncologists in formulating strategies for OM prevention,diagnosis,and treatment,standardizing clinical practice,reducing OM occurrence,promoting healing,and improving the quality of life of patients.展开更多
Background: Chemotherapy induced mucositis is one of the deterring factors influencing adherence to cancer treatment. Sodium bicarbonate mouth wash was recently shown to increase patients’ compliance. However, the co...Background: Chemotherapy induced mucositis is one of the deterring factors influencing adherence to cancer treatment. Sodium bicarbonate mouth wash was recently shown to increase patients’ compliance. However, the cost implication of this strategy was never explored. Aim: This study is designed to explore the compounding of sodium bicarbonate 2% mouth wash from sodium bicarbonate powder USP and commercially procured intravenous solution, and to determine the estimated cost implication for patients using this strategy. Materials and Methods: Sodium bicarbonate 2% were compounded using commercially procured sterile intravenous 8.4% solution and powder USP, diluted and dissolved in sterile water for irrigation respectively. The estimated cost savings between the 2 methods were compared to each other as well as to savings from when used in preventing or in adjuvant therapy for chemotherapy induced mucositis. Ethical approval not required by UVA Institutional Review Board. Study conducted according to the International Standards of Good Practice. Result: We came up with a new recipe, sodium bicarbonate 2% mouth wash using commercially procured sterile liquid formulation. Due to shortage, we compounded with sodium bicarbonate powder USP. Using USP 795 regulation, we assigned 14 days beyond use date with refrigeration to these formulations. These formulations resulted in estimated cost savings of $3597.52 and $3686.56 respectively if patients were to be treated for chemotherapy induced mucositis for 21 days. When compared to commercially procured sterile liquid formulation, the use of powder USP, will lead to additional estimated 60 to 66.67% savings for patients. Conclusion: By using sodium bicarbonate powder or solution to compound a 2% mouth wash, we came up with a cheap product that could be used by patients in the moment in the hospital. We were also able to suggest ways that an estimated cost savings for patients undergoing cancer treatment that use this product can be computed.展开更多
Chemotherapy-induced intestinal mucositis(IM)is a prevalent complication affecting up to 80%of cancer patients undergoing treatment.Current therapies focus on symptomatic relief rather than addressing the underlying m...Chemotherapy-induced intestinal mucositis(IM)is a prevalent complication affecting up to 80%of cancer patients undergoing treatment.Current therapies focus on symptomatic relief rather than addressing the underlying mechanism.Recent advances in integrative medicine highlight the potential of traditional Chinese medicine formulations as alternatives or adjuncts to existing therapies.In this context,this editorial discusses the recent results of a study published by Qiu et al,which investigates the multifaceted potential of modified Pulsatilla decoction(PD),a formulation of PD with licorice(Glycyrrhiza uralensis)and Ejiao(Colla corii asini),on 5-fluorouracil-induced IM in mice to alleviate clinical symptoms including diarrhea,weight loss,and intestinal damage.A series of histological,biochemical,bioinformatic,and microbiological assays evaluated body weight,diarrhea scores,inflammatory cytokine profiles,oxidative stress modulation,and microbiota composition.The findings indicated a reduction in diarrhea and oxidative stress,as well as an improvement in body weight and intestinal histopathology.Furthermore,the modified PD suppressed the TLR4/MyD88/nuclear factor kappa-B inflammatory pathway and down-regulated key proinflammatory cytokines.Moreover,the study underscores the role of gut microbiota in IM pathogenesis.Modified PD treatment reshaped microbial diversity by promoting beneficial genera such as Bacteroides acidifaciens while suppressing pathogenic species like Salmonella.These findings suggest that the therapeutic effects of the modified PD extend beyond inflammation modulation to encompass microbiome reprogramming and mucosal barrier repair.Although the study provides significant insights,several limitations still prevail.The broader implications of modified PD in gastrointestinal disorders and integrative oncology need further exploration.展开更多
BACKGROUND Modified Pulsatilla decoction(PD),a PD with licorice and ejiao,is a classic Traditional Chinese Medicine formula with significant efficacy in treating intestinal mucositis(IM)induced by tumor therapy.Howeve...BACKGROUND Modified Pulsatilla decoction(PD),a PD with licorice and ejiao,is a classic Traditional Chinese Medicine formula with significant efficacy in treating intestinal mucositis(IM)induced by tumor therapy.However,its specific molecular and biological mechanisms remain unclear.AIM To investigate the therapeutic effect and mechanism of modified PD in IM.METHODS This study used an IM mouse model established using 5-fluorouracil injections to investigate the effects of the modified PD(3,6,and 12 g/kg)in IM.The primary chemical components of the modified PD were identified using liquid chromatography-mass spectrometry.Body weight loss,diarrhea scores,intestinal length,histopathological scores,and inflammatory cytokine levels were measured to evaluate the effects of the modified PD in IM.Effects on the TLR4/MyD88/NF-κB pathway were evaluated using western blot analysis.The intestinal microbiota was characterized using Illumina NovaSeq sequencing.RESULTS The results showed that modified PD significantly improved weight loss and diarrhea and shortened the intestines in IM mice.Mechanistically,modified PD suppressed the TLR4/MyD88/NF-κB pathway and downregulated the expression of reactive oxygen species,lipopolysaccharides,and pro-inflammatory cytokines(IL-1β,TNF-α,IFN-γ,IL-6,IL-8,and IL-17),while increasing the expression of the anti-inflammatory cytokine IL-10.Furthermore,modified PD protected the intestinal mucosal barrier by increasing the expression of tight junction proteins(occludin-1,claudin-1,and ZO-1)and mucin-2.Finally,16S rDNA sequencing revealed that modified PD improved intestinal dysbiosis.CONCLUSION Our research offers new insights into the potential mechanism of modified PD in alleviating IM and provides experimental evidence supporting its pharmaceutical application in clinical IM treatment.展开更多
AIM To investigate the effects of orally gavaged aqueous rhubarb extract(RE) on 5-fluorouracil(5-FU)-induced intestinal mucositis in rats. METHODS Female Dark Agouti rats(n = 8/group) were gavaged daily(1 mL) with wat...AIM To investigate the effects of orally gavaged aqueous rhubarb extract(RE) on 5-fluorouracil(5-FU)-induced intestinal mucositis in rats. METHODS Female Dark Agouti rats(n = 8/group) were gavaged daily(1 mL) with water, high-dose RE(HDR; 200 mg/kg) or low-dose RE(LDR; 20mg/kg) for eight days. Intestinal mucositis was induced(day 5) with 5-FU(150 mg/kg) via intraperitoneal injection. Intestinal tissue samples were collected for myeloperoxidase(MPO) activity and histological examination. Xenopus oocytes expressing aquaporin 4 water channels were prepared to examine the effect of aqueous RE on cell volume, indicating a potential mechanism responsible for modulating net fluid absorption and secretion in the gastrointestinal tract. Statistical significance was assumed at P < 0.05 by one-way ANOVA. RESULTS B o d y w e i g h t w a s s i g n i f i c a n t l y r e d u c e d i n r a t s administered 5-FU compared to healthy controls(P < 0.01). Rats administered 5-FU significantly increased intestinal MPO levels(≥ 307%; P < 0.001), compared to healthy controls. However, LDR attenuated this effect in 5-FU treated rats, significantly decreasing ileal MPO activity(by 45%; P < 0.05), as compared to 5-FU controls. 5-FU significantly reduced intestinal mucosal thickness(by ≥ 29% P < 0.001) as compared to healthy controls. LDR significantly increased ileal mucosal thickness in 5-FU treated rats(19%; P < 0.05) relative to 5-FU controls. In xenopus oocytes expressing AQP4 water channels, RE selectively blocked water influx into the cell, induced by a decrease in external osmotic pressure. As water efflux was unaltered by the presence of extracellular RE, the directional flow of water across the epithelial barrier, in the presence of extracellular RE, indicated that RE may alleviate water loss across the epithelial barrier and promote intestinal health in chemotherapy-induced intestinal mucositis.CONCLUSION In summary, low dose RE improves selected parameters of mucosal integrity and reduces ileal inflammation, manifesting from 5-FU-induced intestinal mucositis.展开更多
Objective:The present study investigated how mild moxibustion treatment affects the intestinal Microbiome and expression of NLRP3-related immune factors in a rat model of intestinal mucositis(IM)induced with 5-fluorou...Objective:The present study investigated how mild moxibustion treatment affects the intestinal Microbiome and expression of NLRP3-related immune factors in a rat model of intestinal mucositis(IM)induced with 5-fluorouracil(5-Fu).Methods:Forty male Sprague-Dawley rats were randomly divided into control,chemotherapy,moxibustion and probiotics groups.The IM rat model was established by intraperitoneal injection of 5-Fu.Mild moxibustion treatment and intragastric probiotic administration were provided once daily for 15 days.Tissue morphology,serum levels of inflammatory factors and the expression levels of tight junction proteins,caspase-1,gasdermin D and NLRP3 were evaluated in colon tissue,through hematoxylin and eosin staining,electron microscopy,enzyme-linked immunosorbent assay,Western blotting,quantitative realtime reverse transcription polymerase chain reaction and immunofluorescence.Gut microbiome profiling was conducted through 16 S rRNA amplicon sequencing.Results:Moxibustion and probiotic treatments significantly increased the expression levels of tight junction proteins,reduced cell apoptosis and the expression levels of caspase-1,gasdermin D and NLRP3;they also decreased the serum levels of tumor necrosis factor-α,interleukin(IL)-6,IL-1βand IL-18,while increasing serum levels of IL-10.Moxibustion and probiotic treatments also corrected the reduction inα-diversity andβ-diversity in IM rats,greatly increased the proportion of the dominant bacterial genus Lactobacillus and reduced the abundance of the genera Roseburia and Escherichia in chemotherapytreated rats to levels observed in healthy animals.We also found that these dominant genera were firmly correlated with the regulation of pyroptosis-associated proteins and inflammatory factors.Finally,moxibustion and probiotic treatments elicited similar effects in regulating intestinal host-microbial homeostasis and the expression of NLRP3 inflammasome-related factors.Conclusion:Moxibustion exerts its therapeutic effect on IM by ameliorating mucosal damage and reducing inflammation.Moreover,moxibustion modulates the gut microbiota,likely via decreasing the expression levels of the NLRP3 inflammasome.展开更多
The aim of this study was to evaluate the efficacy of palifermin, an N-terminal truncated version of endogenous keratinocyte growth factor, in the control of oral mucositis during antiblastic therapy. Twenty patients ...The aim of this study was to evaluate the efficacy of palifermin, an N-terminal truncated version of endogenous keratinocyte growth factor, in the control of oral mucositis during antiblastic therapy. Twenty patients undergoing allogeneic stem-cell transplantation for acute lymphoblastic leukaemia were treated with palifermin, and compared to a control group with the same number of subjects and similar inclusion criteria. Statistical analysis were performed to compare the outcomes in the treatment vs. control groups. In the treatment group, we found a statistically significant reduction in the duration of parenteral nutrition （P=0.002）, duration of mucositis （P= 0.003） and the average grade of mucositis （P= 0.03）. The statistical analysis showed that the drug was able to decrease the severity of mucositis. These data, although preliminary, suggest that palifermin could be a valid therapeutic adjuvant to improve the quality of life of patients suffering： from leukaemia.展开更多
Oral mucositis(OM) caused by cancer therapy is the most common adverse reaction in the radiotherapy of head and neck tumors. In severe cases, it can lead to the interruption of treatment, which affects the control of ...Oral mucositis(OM) caused by cancer therapy is the most common adverse reaction in the radiotherapy of head and neck tumors. In severe cases, it can lead to the interruption of treatment, which affects the control of the disease and the quality of life.Shuanghua Baihe Tablet(SBT) is a traditional Chinese medicine(TCM) formula, which is administerd to treat OM in China. It has been clinically effective for more than 30 years, but the underlying mechanism is not completely understood. With the development of multiple omics, it is possible to explore the mechanism of Chinese herbal compound prescriptions. Based on transcriptomics and metabolomics, we explored the underlying mechanism of SBT in the treatment of OM. An OM model of rats was established by 5-FU induction, and SBT was orally administered at dosages of 0.75 and 3 g·kg;·d;. In order to search for SBT targets and related metabolites, the dysregulated genes and metabolites were detected by transcriptomics and metabolomics. Immune related indicators such as interleukin-17(IL-17) and tumor necrosis factor-α(TNF-α) were detected by ELISA. Treg cell disorders was analyzed by flow cytometry. Our results showed that SBT significantly alleviated the symptoms of OM rats and the inflammatory infiltration of ulcer tissues.After SBT administration, inflammatory related metabolic pathways including linoleic acid metabolism, valine, leucine and isoleucine biosynthesis were significantly altered. Furthermore, the production of proinflammatory factors like IL-17 and TNF-α, were also dramatically reduced after SBT administration. Besides, the infiltration degree of Treg cells in the spleen of OM modeling rats was significantly improved by SBT administration, thus maintaining the immune balance of the body. The current study demonstrates that SBT regulates inoleic acid metabolism, glycerophospholipid metabolism and amino acid metabolism, and inhibits IL-17/TNF signal transduction to restore Treg and Th17 cell homeostasis in OM rats, thereby alleviating chemotherapy-induced OM.展开更多
Background: Oral mucositis(OM) is one of the most common complications of mucotoxic cancer therapy.Mucositis induces clinically significant pain, increases the risk of infections and affects the patients’ quality of ...Background: Oral mucositis(OM) is one of the most common complications of mucotoxic cancer therapy.Mucositis induces clinically significant pain, increases the risk of infections and affects the patients’ quality of life.Objective: This study investigated the effects of an herbal preparation from Plantago ovata hydrocolloid in the prevention and treatment of OM, in breast cancer patients undergoing chemotherapy with a regimen including adriamycin.Design, setting, participants, and interventions: This research was a double-blind, randomized, controlled crossover trial. The herbal compound consisted of a mixture of 500 mg of P. ovate husk in 30 m L water plus three drops of vinegar per dose, which was used as a mouthwash. Phytochemical and physicochemical tests of the compound were also performed. Twenty-eight patients who developed mucositis during the chemotherapy screening cycle were randomized to the herbal compound(n = 14) and placebo(n = 14) groups. They received herbal compound or placebo three times per day during their next chemotherapy cycle(cycle 1 of treatment). Patients were crossed over during cycle 2 of treatment and received the alternative therapy. An oral care protocol was prescribed to all patients in cycles 1 and 2 of the treatment.Main outcome measures: The patients were visited at baseline, the end of the first and second weeks of the screening cycle, and the end of the first and second weeks of each of two treatment cycles. The degree of mucositis was used as the main treatment outcome. Other indexes, such as the severity of pain, xerostomia grade and the quality of life were also measured.Results: Compared with the placebo, the herbal compound significantly reduced the degree of mucositis,the severity of pain and the xerostomia grade;it also improved the patients’ quality of life(P < 0.05).Comparison between the screening cycle and placebo treatment group showed that the oral care protocol had a significant effect in the reduction of OM(P < 0.05).Conclusion: The oral care protocol and the herbal compound based on P. ovata are effective ways for preventing and treating OM in patients undergoing mucotoxic cancer therapy.Trial registration: Iranian registry of clinical trials IRCT20180923041093 N1.展开更多
BACKGROUND Pembrolizumab is an anti-programmed death receptor 1(PD-1)that was shown to have a tolerable safety profile with 17%of grade 3-4 drug-related adverse events,notable response rate of 16%with median duration ...BACKGROUND Pembrolizumab is an anti-programmed death receptor 1(PD-1)that was shown to have a tolerable safety profile with 17%of grade 3-4 drug-related adverse events,notable response rate of 16%with median duration of response of 8 mo,and median overall survival of 8 mo.Severe mucositis is a very rare complication with only two cases of grade 4 mucositis reported,and both cases had good response to intravenous methylprednisolone and subsequent oral prednisone tapering.We report the first case of pembrolizumab-induced severe mucositis that was refractory to steroid treatment.CASE SUMMARY An 80-year-old woman with a past medical history of recurrent right cheek nodular melanoma status post resection and new right lung metastatic melanoma on immunotherapy presented with dysphagia and odynophagia for 2 mo.She initially received 2 doses of ipilimumab 1 year ago with good outcome,but treatment was discontinued after developing severe diarrhea and rash.Pembrolizumab was then initiated 4 mo after disease progression.Significant improvement was noted after 3 doses.However,after 6 cycles of pembrolizumab,patient developed odynophagia and malnutrition.Improvement of symptoms was noted after discontinuation of pembrolizumab and initiation of steroids.3 mo later,patient developed pharyngeal swelling with hoarseness and new oxygen requirement due to impending airway obstruction while being on prednisone tapering regimen,finally ended up with intubation and tracheostomy.Histologic analysis of left laryngeal and epiglottis tissue showed granulation tissue with acute on chronic inflammation,negative for malignancy and infection.Patient achieved marked improvement after 2 doses of infliximab of 5 mg/kg every 2 wk while continuing on prednisone tapering course.CONCLUSION We report the first case of pembrolizumab-induced grade 4 mucositis that had limited recovery with prolonged steroid course but had rapid response with addition of infliximab.The patient had recurrent mucositis symptoms whenever steroids was tapered but achieved complete response after receiving two doses of infliximab while continuing to be on tapering steroids.The success of infliximab in this patient with pembrolizumab-induced severe mucositis presents a potentially safe approach to reduce prolonged steroid course and accelerate recovery in managing this rare complication.展开更多
[Objectives] The aim was to observe the clinical effect of Yangyin Jiedu Decoction for acute oral mucositis caused by radiotherapy for nasopharyngeal carcinoma( NPC). [Methods]Total 64 patients with non-keratinizing s...[Objectives] The aim was to observe the clinical effect of Yangyin Jiedu Decoction for acute oral mucositis caused by radiotherapy for nasopharyngeal carcinoma( NPC). [Methods]Total 64 patients with non-keratinizing squamous cell carcinoma of nasopharynx were divided evenly and randomly into two groups,treatment group and control group. In the treatment group,the patients began to take Yangyin Jiedu Decoction one week before radiotherapy; while in the control group,the patients were treated with mixed solution of dexamethasone,lidocaine,recombinant human granulocyte colony stimulating factor and vitamin B12. From the beginning to the end of radiotherapy,the curative effect in the two groups was observed and compared. In addition,the levels of serum CRP,TGF-β1 and IL-6 were measured to detect the inflammatory response. [Results] The incidence of acute oral mucositis in the treatment group was significantly lower than that in the control group( P <0. 05). The effective rate was 96. 88% in the treatment group and 67. 74% in the control group. The levels of serum CRP,TGF-β1 and IL-6 in the treatment group were also lower than those in the control group. [Conclusions]Yangyin Jiedu Decoction has a good effect on prevention and treatment of acute radioactive oral mucositis and it is worthy of clinical application.展开更多
AIM:To study usefulness of high-potency sucralfate(HPS)in a patient with chemoradiation mucositis and discuss its mechanism of action.METHODS:HPS,a non-covalently cross-link of sucralfate,cations and bidentate anionic...AIM:To study usefulness of high-potency sucralfate(HPS)in a patient with chemoradiation mucositis and discuss its mechanism of action.METHODS:HPS,a non-covalently cross-link of sucralfate,cations and bidentate anionic chelators,has a maintains a surface concentration of sucralfate 3 h following administration that is 7-23 fold that possible with standard-potency sucralfate.The accelerated mucosal healing and pain alleviation of HPS in patients with erosive esophageal reflux,prompted its use in this patient with chemoradiation mucositis of the oropharynx and alimentary tract.A literature-based review of the immuno-modulatory effects of sucralfate is discussed.RESULTS:Within 48 h of intervention:(1)there was complete disappearance of oral mucositis lesions;tenderness with(2)patient-reported disappearance of pain,nausea and diarrhea;patient required(3)no opiate analgesia and(4)no tube-feeding supplements to regular diet.Dysgeusia and xerostomia persisted.A modified Naranjo Questionnaire score of 10 supported the likelihood that HPS intervention caused the observed clinical effects.No adverse reactions noted.CONCLUSION:In this patient HPS was useful to treat chemo-radiation mucositis of the oropharynx and alimentary tract.HPS may directly or indirectly facilitate an immunomodulatory mechanism involving accelerated growth factor activation,which may be a new target for therapeutic intervention in such patients.展开更多
Oral mucositis is a common morbidity induced by radiation therapy and chemo-radiotherapy for head and neck malignancies. This often results in treatment delays, premature treatment cessation and increased cost. New tr...Oral mucositis is a common morbidity induced by radiation therapy and chemo-radiotherapy for head and neck malignancies. This often results in treatment delays, premature treatment cessation and increased cost. New treatments of oral mucositis are emerging but effective remedies remain limited. Between February 2007 and May 2008, 21 patients with head and neck malignancies were treated with a supersaturated calcium phosphate oral rinse (Caphosol) that was performed for 4-10 times daily, each consisting of two one-minute rinses. There were 21 matched patients who received supportive care without the oral rinse. All patients in the two groups were treated with intensity modulated radiation therapy (IMRT) for average prescription doses of 66 Gy in 33 fractions. The effects of this rinse vs. supportive care on mucositis, PEG tube requirements, hospitalization, xerostomia, analgesic requirements and weight was respectively evaluated. We have observed statistically significant decreases in the incidence of radiation induced oral mucositis (p=0.0002) with WHO grade 3 (38% vs. 52%) and 4 mucositis (0% vs. 19%), need for PEG tube placement (33% vs. 57%) and hospitalization (0% vs 19%). There was also a favorable impact on the incidence of grade 3 (29% vs. 43%) xerostomia in the treated patients but it was statistically insignificant (p=0.58). Incremental costs related to treatment of oral mucositis were reduced considerably. Our data suggest that use of a supersaturated calcium phosphate oral rinse is an effective treatment for mucositis in patients undergoing IMRT. It may also be helpful in the reduction of hospitalization and PEG tube requirements.展开更多
Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyng...Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyngeal mucositis is currently unknown.This study investigated the incidence of malnutrition and radiation pharyngeal mucositis in patients with HNC during radiotherapy and analyzed the impact of the nutritional status on radiation pharyngeal mucositis.Methods Consecutive patients with HNC receiving radiotherapy were recruited for this longitudinal observational study.Data were collected at baseline(T_(1)),midtreatment(T_(2)),and at the end of treatment(T3).The Common Terminology Criteria for Adverse Events version 4.0 and the Global Leadership Initiative on Malnutrition criteria were used to assess pharyngeal mucositis and the nutritional status,respectively.Results There were 348 HNC patients who completed all assessments.The pharyngeal mucositis of patients with HNC was aggravated during radiotherapy(χ^(2)=553.521,P<0.001).At T3,56.0%of patients had moderate or severe pharyngeal mucositis.The proportion of patients with malnutrition increased significantly during treatment(21.3%at T_(1)vs 46.8%at T_(2)vs 76.1%at T3,χ^(2)=209.768,P<0.001).Both a multivariable analysis of generalized estimating equations and a logistic regression analysis showed that pharyngeal mucositis was associated with malnutrition.Conclusions Malnutrition was common in patients with HNC during radiotherapy,and it was closely related to pharyngeal mucositis.Joint interventions targeting nutrition and symptom management should be considered for patients with HNC.展开更多
Mucositis is a known complication following use of chemotherapy,but fatal mucositis is unusual and management of such cases may be challenging.Pathologically there is denudation of mucosa of gastrointestinal tract. Se...Mucositis is a known complication following use of chemotherapy,but fatal mucositis is unusual and management of such cases may be challenging.Pathologically there is denudation of mucosa of gastrointestinal tract. Severe cases can develop ileus and even perforation of bowel wall.We report here a case of multiple myeloma who developed World Health Organization grade 4 gut mucositis following the use of high dose melphalan with the expulsion of"intestine-like"material.展开更多
BACKGROUND Severe oral mucositis associated with cancer therapy is a frequent complication that may affect a patient's systemic condition,resulting in interruption and/or prolongation of cancer therapy.Dentoxol...BACKGROUND Severe oral mucositis associated with cancer therapy is a frequent complication that may affect a patient's systemic condition,resulting in interruption and/or prolongation of cancer therapy.Dentoxol®is a medical solution in the form of a mouthwash that has been shown to result in statistically significant improvement in the prevention of severe oral mucositis.However,knowing the measures of the clinical significance of this therapy is important for accurate decision-making.To describe the clinical impact of Dentoxol®use in severe oral mucositis.METHODS Clinical significance was measured using the results obtained in a randomized controlled clinical trial previously conducted by the same group of researchers.The measures of clinical significance evaluated were the absolute risk or incidence,relative risk,absolute risk reduction,relative risk reduction,number needed to treat,and odds ratio.RESULTS The data obtained show that the impact of Dentoxol®on reducing the severity of oral mucositis has important clinical relevance.CONCLUSION The results of this study justify the incorporation of Dentoxol®mouth rinse into clinical protocols as a complement to cancer therapy to prevent and/or treat oral mucositis secondary to radiotherapy.展开更多
Background: Green tea has been used as a daily beverage for several years. Anti-inflammatory effect of tea has also been depicted in different papers. Therefore we had set forward this study to examine the potential a...Background: Green tea has been used as a daily beverage for several years. Anti-inflammatory effect of tea has also been depicted in different papers. Therefore we had set forward this study to examine the potential anti- inflammatory activity of green tea in small intestine mucositis experimental models. Aims: Evaluation of anti- inflammatory effects of green tea on mice. Materials and Methods: Green tea decoction (20%) was prepared by soaking 20 g of green tea in 100 ml boiled water separately, soaked for 2 minutes and thereafter filtered. In- flammatory activity was induced using methotrexate (2.75 g/kg/24 h sc), and a protecting effect of mucositis con- dition was investigated by vitamin E and Camellia sinensis decoction. Study Design: An experimental study was approved by an Animal Ethical Commitee. Results: Green tea decoction (20%) has shown significant anti-in- flammatory effects (65% and 70%) on methotrexate-induced acute mucositis model. In villous atrophy Green tea decoction (10% and 20%) has shown no protecting action at different intestinal segments. But at intestinal crypt hyperplasia, green tea decoction has shown 65.74%, as compared to mucositis group. An increase of apoptotic bodies were acchieved at MTX group, CS reduced this occurrence. Conclusion: Taken together, our data indi- cate that green tea (20%) has a potential anti-inflammatory compared vitamin E antioxidant action and cor- roborates with the current trend of tea being promoted as “health drink”. However more pharmacological and biochemical assays is necessary to elucidate mechanisms.展开更多
AIM To determine if almond extracts reduce the severity of chemotherapy-induced mucositis as determined through biochemical,histological and behavioural markers.METHODS Intestinal mucositis is a debilitating condition...AIM To determine if almond extracts reduce the severity of chemotherapy-induced mucositis as determined through biochemical,histological and behavioural markers.METHODS Intestinal mucositis is a debilitating condition characterized by inflammation and ulceration of the gastrointestinal mucosa experienced by cancer patients undergoing chemotherapy.Certain bioactive plant products have shown promise in accelerating mucosal repair and alleviating clinical symptoms.This study evaluated almond extracts for their potential to reduce the severity of chemotherapy-induced mucositis in Dark Agouti rats.Female Dark Agouti rats were gavaged(days 3-11) with either PBS,almond hull or almond blanched water extract at two doses,and were injected intraperitoneally with 5-fluorouracil(5-FU-150 mg/kg) or saline on day 9 to induce mucositis.Burrowing behavior,histological parameters and myeloperoxidase activity were assessed.RESULTS Bodyweight was significantly reduced in rats that received 5-FU compared to saline-treated controls(P < 0.05).Rats administered 5-FU significantly increased jejunal and ileal MPO levels(1048%; P < 0.001 and 409%; P < 0.001),compared to healthy controls.Almond hull extract caused a pro-inflammatory response in rats with mucositis as evidenced by increased myeloperoxidase activity in the jejunum when compared to 5-FU alone(rise 50%,1088 ± 96 U/g vs 723 ± 135 U/g,P = 0.02).Other extractrelated effects on inflammatory activity were minimal.5-FU significantly increased histological severity score compared to healthy controls confirming the presence of mucositis(median of 9.75 vs 0; P < 0.001).The extracts had no ameliorating effect on histological severity score in the jejunum or ileum.Burrowing behavior was significantly reduced in all chemotherapy-treated groups(P = 0.001).The extracts failed to normalize burrowing activity to baseline levels.CONCLUSION Almond extracts at these dosages offer little beneficial effect on mucositis severity.Burrowing provides a novel measure of affective state in studies of chemotherapyinduced mucositis.展开更多
The mechanism of radiotherapy or chemotherapy-induced oral mucositis is not yet clear.And model establishment is needed in further study.In order to summarize the methods of model establishment and make a comparison,l...The mechanism of radiotherapy or chemotherapy-induced oral mucositis is not yet clear.And model establishment is needed in further study.In order to summarize the methods of model establishment and make a comparison,literature databases including Web of Science、Pubmed and CNKI were searched for related researches from January 2015 to January 2021.Hamsters,mice,rats,guinea pigs and miniature pigs were chosen to be modeling animals and modeling methods could be classified into:chemotherapy,chemotherapy combined with superficial mucosal irritation,radiotherapy,radiotherapy combined with superficial mucosal irritation and chemoradiotherapy.Advantages and disadvantages had been analyzed in this study to provide reference for following studies.展开更多
Oral mucositis is a common adverse reaction of radiotherapy and chemotherapy in cancer patients,which reduces the quality of life of patients and affects the progress of cancer treatment.Most of the patients with mali...Oral mucositis is a common adverse reaction of radiotherapy and chemotherapy in cancer patients,which reduces the quality of life of patients and affects the progress of cancer treatment.Most of the patients with malignant tumor belong to the syndrome of deficiency in root case and excess in manifestation.When undergoing radiotherapy or chemotherapy,the patients’ministerial fire becomes hyperactive,which may cause oral mucositis.With the method of“conducting fire back to its origin”,ministerial fire can be led to vital gate,as well as recovering its physiological functions.In the treatment of oral mucositis,instead of attacking ministerial fire with too much heat-clearing herbs,we should,under the guidance of the theory of“conducting fire back to its origin”,differentiate the syndrome,and then we can use the methods of treatment of clearing and lowering heart fire,warmly invigorating spleen and stomach,nourishing liver and kidney,or warmly invigorating vital gate,to conduct ministerial fire back to vital gate.This article aims to provide theoretical reference for Traditional Chinese Medicine treatment of radiotherapy or chemotherapy induced oral mucositis.展开更多
基金supported by the National Natural Science Foundation of China(U23A20445)the Science and Technology Program of Guangzhou(202206080009)。
文摘Radiochemotherapy-induced oral mucositis(OM)is a common oral complication in patients with tumors following head and neck radiotherapy or chemotherapy.Erosion and ulcers are the main features of OM that seriously affect the quality of life of patients and even the progress of tumor treatment.To date,differences in clinical prevention and treatment plans for OM have been noted among doctors of various specialties,which has increased the uncertainty of treatment effects.On the basis of current research evidence,this expert consensus outlines risk factors,clinical manifestations,clinical grading,ancillary examinations,diagnostic basis,prevention and treatment strategies and efficacy indicators for OM.In addition to strategies such as basic oral care,antiinflammatory and analgesic agents,anti-infective agents,pro-healing agents,and photobiotherapy recommended in previous guidelines,we also emphasize the role of traditional Chinese medicine in OM prevention and treatment.This expert consensus aims to provide references and guidance for dental physicians and oncologists in formulating strategies for OM prevention,diagnosis,and treatment,standardizing clinical practice,reducing OM occurrence,promoting healing,and improving the quality of life of patients.
文摘Background: Chemotherapy induced mucositis is one of the deterring factors influencing adherence to cancer treatment. Sodium bicarbonate mouth wash was recently shown to increase patients’ compliance. However, the cost implication of this strategy was never explored. Aim: This study is designed to explore the compounding of sodium bicarbonate 2% mouth wash from sodium bicarbonate powder USP and commercially procured intravenous solution, and to determine the estimated cost implication for patients using this strategy. Materials and Methods: Sodium bicarbonate 2% were compounded using commercially procured sterile intravenous 8.4% solution and powder USP, diluted and dissolved in sterile water for irrigation respectively. The estimated cost savings between the 2 methods were compared to each other as well as to savings from when used in preventing or in adjuvant therapy for chemotherapy induced mucositis. Ethical approval not required by UVA Institutional Review Board. Study conducted according to the International Standards of Good Practice. Result: We came up with a new recipe, sodium bicarbonate 2% mouth wash using commercially procured sterile liquid formulation. Due to shortage, we compounded with sodium bicarbonate powder USP. Using USP 795 regulation, we assigned 14 days beyond use date with refrigeration to these formulations. These formulations resulted in estimated cost savings of $3597.52 and $3686.56 respectively if patients were to be treated for chemotherapy induced mucositis for 21 days. When compared to commercially procured sterile liquid formulation, the use of powder USP, will lead to additional estimated 60 to 66.67% savings for patients. Conclusion: By using sodium bicarbonate powder or solution to compound a 2% mouth wash, we came up with a cheap product that could be used by patients in the moment in the hospital. We were also able to suggest ways that an estimated cost savings for patients undergoing cancer treatment that use this product can be computed.
文摘Chemotherapy-induced intestinal mucositis(IM)is a prevalent complication affecting up to 80%of cancer patients undergoing treatment.Current therapies focus on symptomatic relief rather than addressing the underlying mechanism.Recent advances in integrative medicine highlight the potential of traditional Chinese medicine formulations as alternatives or adjuncts to existing therapies.In this context,this editorial discusses the recent results of a study published by Qiu et al,which investigates the multifaceted potential of modified Pulsatilla decoction(PD),a formulation of PD with licorice(Glycyrrhiza uralensis)and Ejiao(Colla corii asini),on 5-fluorouracil-induced IM in mice to alleviate clinical symptoms including diarrhea,weight loss,and intestinal damage.A series of histological,biochemical,bioinformatic,and microbiological assays evaluated body weight,diarrhea scores,inflammatory cytokine profiles,oxidative stress modulation,and microbiota composition.The findings indicated a reduction in diarrhea and oxidative stress,as well as an improvement in body weight and intestinal histopathology.Furthermore,the modified PD suppressed the TLR4/MyD88/nuclear factor kappa-B inflammatory pathway and down-regulated key proinflammatory cytokines.Moreover,the study underscores the role of gut microbiota in IM pathogenesis.Modified PD treatment reshaped microbial diversity by promoting beneficial genera such as Bacteroides acidifaciens while suppressing pathogenic species like Salmonella.These findings suggest that the therapeutic effects of the modified PD extend beyond inflammation modulation to encompass microbiome reprogramming and mucosal barrier repair.Although the study provides significant insights,several limitations still prevail.The broader implications of modified PD in gastrointestinal disorders and integrative oncology need further exploration.
基金Supported by Basic and Applied Basic Research Foundation of Guangdong Province,No.2021B1515140043,No.2022A1515140124 and No.2023A1515140115.
文摘BACKGROUND Modified Pulsatilla decoction(PD),a PD with licorice and ejiao,is a classic Traditional Chinese Medicine formula with significant efficacy in treating intestinal mucositis(IM)induced by tumor therapy.However,its specific molecular and biological mechanisms remain unclear.AIM To investigate the therapeutic effect and mechanism of modified PD in IM.METHODS This study used an IM mouse model established using 5-fluorouracil injections to investigate the effects of the modified PD(3,6,and 12 g/kg)in IM.The primary chemical components of the modified PD were identified using liquid chromatography-mass spectrometry.Body weight loss,diarrhea scores,intestinal length,histopathological scores,and inflammatory cytokine levels were measured to evaluate the effects of the modified PD in IM.Effects on the TLR4/MyD88/NF-κB pathway were evaluated using western blot analysis.The intestinal microbiota was characterized using Illumina NovaSeq sequencing.RESULTS The results showed that modified PD significantly improved weight loss and diarrhea and shortened the intestines in IM mice.Mechanistically,modified PD suppressed the TLR4/MyD88/NF-κB pathway and downregulated the expression of reactive oxygen species,lipopolysaccharides,and pro-inflammatory cytokines(IL-1β,TNF-α,IFN-γ,IL-6,IL-8,and IL-17),while increasing the expression of the anti-inflammatory cytokine IL-10.Furthermore,modified PD protected the intestinal mucosal barrier by increasing the expression of tight junction proteins(occludin-1,claudin-1,and ZO-1)and mucin-2.Finally,16S rDNA sequencing revealed that modified PD improved intestinal dysbiosis.CONCLUSION Our research offers new insights into the potential mechanism of modified PD in alleviating IM and provides experimental evidence supporting its pharmaceutical application in clinical IM treatment.
文摘AIM To investigate the effects of orally gavaged aqueous rhubarb extract(RE) on 5-fluorouracil(5-FU)-induced intestinal mucositis in rats. METHODS Female Dark Agouti rats(n = 8/group) were gavaged daily(1 mL) with water, high-dose RE(HDR; 200 mg/kg) or low-dose RE(LDR; 20mg/kg) for eight days. Intestinal mucositis was induced(day 5) with 5-FU(150 mg/kg) via intraperitoneal injection. Intestinal tissue samples were collected for myeloperoxidase(MPO) activity and histological examination. Xenopus oocytes expressing aquaporin 4 water channels were prepared to examine the effect of aqueous RE on cell volume, indicating a potential mechanism responsible for modulating net fluid absorption and secretion in the gastrointestinal tract. Statistical significance was assumed at P < 0.05 by one-way ANOVA. RESULTS B o d y w e i g h t w a s s i g n i f i c a n t l y r e d u c e d i n r a t s administered 5-FU compared to healthy controls(P < 0.01). Rats administered 5-FU significantly increased intestinal MPO levels(≥ 307%; P < 0.001), compared to healthy controls. However, LDR attenuated this effect in 5-FU treated rats, significantly decreasing ileal MPO activity(by 45%; P < 0.05), as compared to 5-FU controls. 5-FU significantly reduced intestinal mucosal thickness(by ≥ 29% P < 0.001) as compared to healthy controls. LDR significantly increased ileal mucosal thickness in 5-FU treated rats(19%; P < 0.05) relative to 5-FU controls. In xenopus oocytes expressing AQP4 water channels, RE selectively blocked water influx into the cell, induced by a decrease in external osmotic pressure. As water efflux was unaltered by the presence of extracellular RE, the directional flow of water across the epithelial barrier, in the presence of extracellular RE, indicated that RE may alleviate water loss across the epithelial barrier and promote intestinal health in chemotherapy-induced intestinal mucositis.CONCLUSION In summary, low dose RE improves selected parameters of mucosal integrity and reduces ileal inflammation, manifesting from 5-FU-induced intestinal mucositis.
基金supported by the National Natural Science Foundation of China(No.82030118,82074232,81830120,81774095and 8170388)the Project of Shanghai Science and Technology Committee(No.19401972200)Shanghai Training Project for Leading Talents of Traditional Chinese Medicine(No.ZY[2018-2020]-RCPY-1024)。
文摘Objective:The present study investigated how mild moxibustion treatment affects the intestinal Microbiome and expression of NLRP3-related immune factors in a rat model of intestinal mucositis(IM)induced with 5-fluorouracil(5-Fu).Methods:Forty male Sprague-Dawley rats were randomly divided into control,chemotherapy,moxibustion and probiotics groups.The IM rat model was established by intraperitoneal injection of 5-Fu.Mild moxibustion treatment and intragastric probiotic administration were provided once daily for 15 days.Tissue morphology,serum levels of inflammatory factors and the expression levels of tight junction proteins,caspase-1,gasdermin D and NLRP3 were evaluated in colon tissue,through hematoxylin and eosin staining,electron microscopy,enzyme-linked immunosorbent assay,Western blotting,quantitative realtime reverse transcription polymerase chain reaction and immunofluorescence.Gut microbiome profiling was conducted through 16 S rRNA amplicon sequencing.Results:Moxibustion and probiotic treatments significantly increased the expression levels of tight junction proteins,reduced cell apoptosis and the expression levels of caspase-1,gasdermin D and NLRP3;they also decreased the serum levels of tumor necrosis factor-α,interleukin(IL)-6,IL-1βand IL-18,while increasing serum levels of IL-10.Moxibustion and probiotic treatments also corrected the reduction inα-diversity andβ-diversity in IM rats,greatly increased the proportion of the dominant bacterial genus Lactobacillus and reduced the abundance of the genera Roseburia and Escherichia in chemotherapytreated rats to levels observed in healthy animals.We also found that these dominant genera were firmly correlated with the regulation of pyroptosis-associated proteins and inflammatory factors.Finally,moxibustion and probiotic treatments elicited similar effects in regulating intestinal host-microbial homeostasis and the expression of NLRP3 inflammasome-related factors.Conclusion:Moxibustion exerts its therapeutic effect on IM by ameliorating mucosal damage and reducing inflammation.Moreover,moxibustion modulates the gut microbiota,likely via decreasing the expression levels of the NLRP3 inflammasome.
文摘The aim of this study was to evaluate the efficacy of palifermin, an N-terminal truncated version of endogenous keratinocyte growth factor, in the control of oral mucositis during antiblastic therapy. Twenty patients undergoing allogeneic stem-cell transplantation for acute lymphoblastic leukaemia were treated with palifermin, and compared to a control group with the same number of subjects and similar inclusion criteria. Statistical analysis were performed to compare the outcomes in the treatment vs. control groups. In the treatment group, we found a statistically significant reduction in the duration of parenteral nutrition （P=0.002）, duration of mucositis （P= 0.003） and the average grade of mucositis （P= 0.03）. The statistical analysis showed that the drug was able to decrease the severity of mucositis. These data, although preliminary, suggest that palifermin could be a valid therapeutic adjuvant to improve the quality of life of patients suffering： from leukaemia.
基金supported by the Clinical Research Special Fund of Wu Jieping Medical Foundation(No.320.6750.2020-04-9)the National Key Research and Development Program of China(No.2017YFC0909900)+2 种基金the National Natural Science Foundation of China(No.82002433)the Science and Technology Project of Henan Provincial Department of Education(Nos.18A320044 and 21A320036)Henan Province Medical Science and Technology Research Project Joint Construction Project(Nos.LHGJ20190003 and LHGJ20190055)。
文摘Oral mucositis(OM) caused by cancer therapy is the most common adverse reaction in the radiotherapy of head and neck tumors. In severe cases, it can lead to the interruption of treatment, which affects the control of the disease and the quality of life.Shuanghua Baihe Tablet(SBT) is a traditional Chinese medicine(TCM) formula, which is administerd to treat OM in China. It has been clinically effective for more than 30 years, but the underlying mechanism is not completely understood. With the development of multiple omics, it is possible to explore the mechanism of Chinese herbal compound prescriptions. Based on transcriptomics and metabolomics, we explored the underlying mechanism of SBT in the treatment of OM. An OM model of rats was established by 5-FU induction, and SBT was orally administered at dosages of 0.75 and 3 g·kg;·d;. In order to search for SBT targets and related metabolites, the dysregulated genes and metabolites were detected by transcriptomics and metabolomics. Immune related indicators such as interleukin-17(IL-17) and tumor necrosis factor-α(TNF-α) were detected by ELISA. Treg cell disorders was analyzed by flow cytometry. Our results showed that SBT significantly alleviated the symptoms of OM rats and the inflammatory infiltration of ulcer tissues.After SBT administration, inflammatory related metabolic pathways including linoleic acid metabolism, valine, leucine and isoleucine biosynthesis were significantly altered. Furthermore, the production of proinflammatory factors like IL-17 and TNF-α, were also dramatically reduced after SBT administration. Besides, the infiltration degree of Treg cells in the spleen of OM modeling rats was significantly improved by SBT administration, thus maintaining the immune balance of the body. The current study demonstrates that SBT regulates inoleic acid metabolism, glycerophospholipid metabolism and amino acid metabolism, and inhibits IL-17/TNF signal transduction to restore Treg and Th17 cell homeostasis in OM rats, thereby alleviating chemotherapy-induced OM.
基金a part of a Ph.D.thesis(NO.97000143),conducted by Fatemeh Sadat Hasheminasabsupported by Kerman University of Medical Sciences,Kerman,Iran.
文摘Background: Oral mucositis(OM) is one of the most common complications of mucotoxic cancer therapy.Mucositis induces clinically significant pain, increases the risk of infections and affects the patients’ quality of life.Objective: This study investigated the effects of an herbal preparation from Plantago ovata hydrocolloid in the prevention and treatment of OM, in breast cancer patients undergoing chemotherapy with a regimen including adriamycin.Design, setting, participants, and interventions: This research was a double-blind, randomized, controlled crossover trial. The herbal compound consisted of a mixture of 500 mg of P. ovate husk in 30 m L water plus three drops of vinegar per dose, which was used as a mouthwash. Phytochemical and physicochemical tests of the compound were also performed. Twenty-eight patients who developed mucositis during the chemotherapy screening cycle were randomized to the herbal compound(n = 14) and placebo(n = 14) groups. They received herbal compound or placebo three times per day during their next chemotherapy cycle(cycle 1 of treatment). Patients were crossed over during cycle 2 of treatment and received the alternative therapy. An oral care protocol was prescribed to all patients in cycles 1 and 2 of the treatment.Main outcome measures: The patients were visited at baseline, the end of the first and second weeks of the screening cycle, and the end of the first and second weeks of each of two treatment cycles. The degree of mucositis was used as the main treatment outcome. Other indexes, such as the severity of pain, xerostomia grade and the quality of life were also measured.Results: Compared with the placebo, the herbal compound significantly reduced the degree of mucositis,the severity of pain and the xerostomia grade;it also improved the patients’ quality of life(P < 0.05).Comparison between the screening cycle and placebo treatment group showed that the oral care protocol had a significant effect in the reduction of OM(P < 0.05).Conclusion: The oral care protocol and the herbal compound based on P. ovata are effective ways for preventing and treating OM in patients undergoing mucotoxic cancer therapy.Trial registration: Iranian registry of clinical trials IRCT20180923041093 N1.
文摘BACKGROUND Pembrolizumab is an anti-programmed death receptor 1(PD-1)that was shown to have a tolerable safety profile with 17%of grade 3-4 drug-related adverse events,notable response rate of 16%with median duration of response of 8 mo,and median overall survival of 8 mo.Severe mucositis is a very rare complication with only two cases of grade 4 mucositis reported,and both cases had good response to intravenous methylprednisolone and subsequent oral prednisone tapering.We report the first case of pembrolizumab-induced severe mucositis that was refractory to steroid treatment.CASE SUMMARY An 80-year-old woman with a past medical history of recurrent right cheek nodular melanoma status post resection and new right lung metastatic melanoma on immunotherapy presented with dysphagia and odynophagia for 2 mo.She initially received 2 doses of ipilimumab 1 year ago with good outcome,but treatment was discontinued after developing severe diarrhea and rash.Pembrolizumab was then initiated 4 mo after disease progression.Significant improvement was noted after 3 doses.However,after 6 cycles of pembrolizumab,patient developed odynophagia and malnutrition.Improvement of symptoms was noted after discontinuation of pembrolizumab and initiation of steroids.3 mo later,patient developed pharyngeal swelling with hoarseness and new oxygen requirement due to impending airway obstruction while being on prednisone tapering regimen,finally ended up with intubation and tracheostomy.Histologic analysis of left laryngeal and epiglottis tissue showed granulation tissue with acute on chronic inflammation,negative for malignancy and infection.Patient achieved marked improvement after 2 doses of infliximab of 5 mg/kg every 2 wk while continuing on prednisone tapering course.CONCLUSION We report the first case of pembrolizumab-induced grade 4 mucositis that had limited recovery with prolonged steroid course but had rapid response with addition of infliximab.The patient had recurrent mucositis symptoms whenever steroids was tapered but achieved complete response after receiving two doses of infliximab while continuing to be on tapering steroids.The success of infliximab in this patient with pembrolizumab-induced severe mucositis presents a potentially safe approach to reduce prolonged steroid course and accelerate recovery in managing this rare complication.
基金Supported by National Natural Science Foundation of China(81301971)
文摘[Objectives] The aim was to observe the clinical effect of Yangyin Jiedu Decoction for acute oral mucositis caused by radiotherapy for nasopharyngeal carcinoma( NPC). [Methods]Total 64 patients with non-keratinizing squamous cell carcinoma of nasopharynx were divided evenly and randomly into two groups,treatment group and control group. In the treatment group,the patients began to take Yangyin Jiedu Decoction one week before radiotherapy; while in the control group,the patients were treated with mixed solution of dexamethasone,lidocaine,recombinant human granulocyte colony stimulating factor and vitamin B12. From the beginning to the end of radiotherapy,the curative effect in the two groups was observed and compared. In addition,the levels of serum CRP,TGF-β1 and IL-6 were measured to detect the inflammatory response. [Results] The incidence of acute oral mucositis in the treatment group was significantly lower than that in the control group( P <0. 05). The effective rate was 96. 88% in the treatment group and 67. 74% in the control group. The levels of serum CRP,TGF-β1 and IL-6 in the treatment group were also lower than those in the control group. [Conclusions]Yangyin Jiedu Decoction has a good effect on prevention and treatment of acute radioactive oral mucositis and it is worthy of clinical application.
基金Supported by Translation Medicine Research Compassionate Use Program of MMI,No.2006-001Data collection was funded as part of Mueller Medical International LLC research on polyanionic saccharides as in-vivo surface active immuno-modulating agents for epithelial mediated processes at its Center for Translational Medicine Research in Foster Rhode Island
文摘AIM:To study usefulness of high-potency sucralfate(HPS)in a patient with chemoradiation mucositis and discuss its mechanism of action.METHODS:HPS,a non-covalently cross-link of sucralfate,cations and bidentate anionic chelators,has a maintains a surface concentration of sucralfate 3 h following administration that is 7-23 fold that possible with standard-potency sucralfate.The accelerated mucosal healing and pain alleviation of HPS in patients with erosive esophageal reflux,prompted its use in this patient with chemoradiation mucositis of the oropharynx and alimentary tract.A literature-based review of the immuno-modulatory effects of sucralfate is discussed.RESULTS:Within 48 h of intervention:(1)there was complete disappearance of oral mucositis lesions;tenderness with(2)patient-reported disappearance of pain,nausea and diarrhea;patient required(3)no opiate analgesia and(4)no tube-feeding supplements to regular diet.Dysgeusia and xerostomia persisted.A modified Naranjo Questionnaire score of 10 supported the likelihood that HPS intervention caused the observed clinical effects.No adverse reactions noted.CONCLUSION:In this patient HPS was useful to treat chemo-radiation mucositis of the oropharynx and alimentary tract.HPS may directly or indirectly facilitate an immunomodulatory mechanism involving accelerated growth factor activation,which may be a new target for therapeutic intervention in such patients.
文摘Oral mucositis is a common morbidity induced by radiation therapy and chemo-radiotherapy for head and neck malignancies. This often results in treatment delays, premature treatment cessation and increased cost. New treatments of oral mucositis are emerging but effective remedies remain limited. Between February 2007 and May 2008, 21 patients with head and neck malignancies were treated with a supersaturated calcium phosphate oral rinse (Caphosol) that was performed for 4-10 times daily, each consisting of two one-minute rinses. There were 21 matched patients who received supportive care without the oral rinse. All patients in the two groups were treated with intensity modulated radiation therapy (IMRT) for average prescription doses of 66 Gy in 33 fractions. The effects of this rinse vs. supportive care on mucositis, PEG tube requirements, hospitalization, xerostomia, analgesic requirements and weight was respectively evaluated. We have observed statistically significant decreases in the incidence of radiation induced oral mucositis (p=0.0002) with WHO grade 3 (38% vs. 52%) and 4 mucositis (0% vs. 19%), need for PEG tube placement (33% vs. 57%) and hospitalization (0% vs 19%). There was also a favorable impact on the incidence of grade 3 (29% vs. 43%) xerostomia in the treated patients but it was statistically insignificant (p=0.58). Incremental costs related to treatment of oral mucositis were reduced considerably. Our data suggest that use of a supersaturated calcium phosphate oral rinse is an effective treatment for mucositis in patients undergoing IMRT. It may also be helpful in the reduction of hospitalization and PEG tube requirements.
基金This research was supported by the National Key Research and Development Project of China(No.2017YFC1309204)the Medical Nutrition Clinical Research Project of China International Medical Foundation(No.Z-2017-24-2110).
文摘Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyngeal mucositis is currently unknown.This study investigated the incidence of malnutrition and radiation pharyngeal mucositis in patients with HNC during radiotherapy and analyzed the impact of the nutritional status on radiation pharyngeal mucositis.Methods Consecutive patients with HNC receiving radiotherapy were recruited for this longitudinal observational study.Data were collected at baseline(T_(1)),midtreatment(T_(2)),and at the end of treatment(T3).The Common Terminology Criteria for Adverse Events version 4.0 and the Global Leadership Initiative on Malnutrition criteria were used to assess pharyngeal mucositis and the nutritional status,respectively.Results There were 348 HNC patients who completed all assessments.The pharyngeal mucositis of patients with HNC was aggravated during radiotherapy(χ^(2)=553.521,P<0.001).At T3,56.0%of patients had moderate or severe pharyngeal mucositis.The proportion of patients with malnutrition increased significantly during treatment(21.3%at T_(1)vs 46.8%at T_(2)vs 76.1%at T3,χ^(2)=209.768,P<0.001).Both a multivariable analysis of generalized estimating equations and a logistic regression analysis showed that pharyngeal mucositis was associated with malnutrition.Conclusions Malnutrition was common in patients with HNC during radiotherapy,and it was closely related to pharyngeal mucositis.Joint interventions targeting nutrition and symptom management should be considered for patients with HNC.
文摘Mucositis is a known complication following use of chemotherapy,but fatal mucositis is unusual and management of such cases may be challenging.Pathologically there is denudation of mucosa of gastrointestinal tract. Severe cases can develop ileus and even perforation of bowel wall.We report here a case of multiple myeloma who developed World Health Organization grade 4 gut mucositis following the use of high dose melphalan with the expulsion of"intestine-like"material.
文摘BACKGROUND Severe oral mucositis associated with cancer therapy is a frequent complication that may affect a patient's systemic condition,resulting in interruption and/or prolongation of cancer therapy.Dentoxol®is a medical solution in the form of a mouthwash that has been shown to result in statistically significant improvement in the prevention of severe oral mucositis.However,knowing the measures of the clinical significance of this therapy is important for accurate decision-making.To describe the clinical impact of Dentoxol®use in severe oral mucositis.METHODS Clinical significance was measured using the results obtained in a randomized controlled clinical trial previously conducted by the same group of researchers.The measures of clinical significance evaluated were the absolute risk or incidence,relative risk,absolute risk reduction,relative risk reduction,number needed to treat,and odds ratio.RESULTS The data obtained show that the impact of Dentoxol®on reducing the severity of oral mucositis has important clinical relevance.CONCLUSION The results of this study justify the incorporation of Dentoxol®mouth rinse into clinical protocols as a complement to cancer therapy to prevent and/or treat oral mucositis secondary to radiotherapy.
文摘Background: Green tea has been used as a daily beverage for several years. Anti-inflammatory effect of tea has also been depicted in different papers. Therefore we had set forward this study to examine the potential anti- inflammatory activity of green tea in small intestine mucositis experimental models. Aims: Evaluation of anti- inflammatory effects of green tea on mice. Materials and Methods: Green tea decoction (20%) was prepared by soaking 20 g of green tea in 100 ml boiled water separately, soaked for 2 minutes and thereafter filtered. In- flammatory activity was induced using methotrexate (2.75 g/kg/24 h sc), and a protecting effect of mucositis con- dition was investigated by vitamin E and Camellia sinensis decoction. Study Design: An experimental study was approved by an Animal Ethical Commitee. Results: Green tea decoction (20%) has shown significant anti-in- flammatory effects (65% and 70%) on methotrexate-induced acute mucositis model. In villous atrophy Green tea decoction (10% and 20%) has shown no protecting action at different intestinal segments. But at intestinal crypt hyperplasia, green tea decoction has shown 65.74%, as compared to mucositis group. An increase of apoptotic bodies were acchieved at MTX group, CS reduced this occurrence. Conclusion: Taken together, our data indi- cate that green tea (20%) has a potential anti-inflammatory compared vitamin E antioxidant action and cor- roborates with the current trend of tea being promoted as “health drink”. However more pharmacological and biochemical assays is necessary to elucidate mechanisms.
文摘AIM To determine if almond extracts reduce the severity of chemotherapy-induced mucositis as determined through biochemical,histological and behavioural markers.METHODS Intestinal mucositis is a debilitating condition characterized by inflammation and ulceration of the gastrointestinal mucosa experienced by cancer patients undergoing chemotherapy.Certain bioactive plant products have shown promise in accelerating mucosal repair and alleviating clinical symptoms.This study evaluated almond extracts for their potential to reduce the severity of chemotherapy-induced mucositis in Dark Agouti rats.Female Dark Agouti rats were gavaged(days 3-11) with either PBS,almond hull or almond blanched water extract at two doses,and were injected intraperitoneally with 5-fluorouracil(5-FU-150 mg/kg) or saline on day 9 to induce mucositis.Burrowing behavior,histological parameters and myeloperoxidase activity were assessed.RESULTS Bodyweight was significantly reduced in rats that received 5-FU compared to saline-treated controls(P < 0.05).Rats administered 5-FU significantly increased jejunal and ileal MPO levels(1048%; P < 0.001 and 409%; P < 0.001),compared to healthy controls.Almond hull extract caused a pro-inflammatory response in rats with mucositis as evidenced by increased myeloperoxidase activity in the jejunum when compared to 5-FU alone(rise 50%,1088 ± 96 U/g vs 723 ± 135 U/g,P = 0.02).Other extractrelated effects on inflammatory activity were minimal.5-FU significantly increased histological severity score compared to healthy controls confirming the presence of mucositis(median of 9.75 vs 0; P < 0.001).The extracts had no ameliorating effect on histological severity score in the jejunum or ileum.Burrowing behavior was significantly reduced in all chemotherapy-treated groups(P = 0.001).The extracts failed to normalize burrowing activity to baseline levels.CONCLUSION Almond extracts at these dosages offer little beneficial effect on mucositis severity.Burrowing provides a novel measure of affective state in studies of chemotherapyinduced mucositis.
基金National Natural Science Foundation of China(No.81973693)。
文摘The mechanism of radiotherapy or chemotherapy-induced oral mucositis is not yet clear.And model establishment is needed in further study.In order to summarize the methods of model establishment and make a comparison,literature databases including Web of Science、Pubmed and CNKI were searched for related researches from January 2015 to January 2021.Hamsters,mice,rats,guinea pigs and miniature pigs were chosen to be modeling animals and modeling methods could be classified into:chemotherapy,chemotherapy combined with superficial mucosal irritation,radiotherapy,radiotherapy combined with superficial mucosal irritation and chemoradiotherapy.Advantages and disadvantages had been analyzed in this study to provide reference for following studies.
基金General project of national science foundation of China(No.81973693)。
文摘Oral mucositis is a common adverse reaction of radiotherapy and chemotherapy in cancer patients,which reduces the quality of life of patients and affects the progress of cancer treatment.Most of the patients with malignant tumor belong to the syndrome of deficiency in root case and excess in manifestation.When undergoing radiotherapy or chemotherapy,the patients’ministerial fire becomes hyperactive,which may cause oral mucositis.With the method of“conducting fire back to its origin”,ministerial fire can be led to vital gate,as well as recovering its physiological functions.In the treatment of oral mucositis,instead of attacking ministerial fire with too much heat-clearing herbs,we should,under the guidance of the theory of“conducting fire back to its origin”,differentiate the syndrome,and then we can use the methods of treatment of clearing and lowering heart fire,warmly invigorating spleen and stomach,nourishing liver and kidney,or warmly invigorating vital gate,to conduct ministerial fire back to vital gate.This article aims to provide theoretical reference for Traditional Chinese Medicine treatment of radiotherapy or chemotherapy induced oral mucositis.
