Interventions for preventing oral mucositis for patients with cancer receiving treatment

Background: Treatment of cancer with chemotherapy is becoming increasingly more effective but is associated with short and long-term side effects. Oral side effects remain a major source of illness despite the use of a variety of agents to prevent them. Objectives: To evaluate the effectiveness of oral (and topical) prophylactic agents for oral mucositis and oral candidiasis in patients with cancer (excluding head and neck cancer), compared with placebo or no treatment. Search Strategy: Computerised MEDLINE, EMBASE, CINAHL, CANCERLIT, the Cochrane Controlled Trials Register and the Cochrane Oral Health Group Specialist Register search up to July 1999. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted to identify trials and obtain additional information. Selection Criteria: Studies were selected if they met the following criteria: design - random or quasi-random allocation of participants; participants - anyone with cancer receiving chemotherapy (excluding head and neck cancer); interventions - prophylactic agents prescribed to reduce oral conditions arising from cancer or its treatment; outcomes - mucositis and oral candidiasis. Data Collection and Analysis: Information regarding methods, participants, interventions and outcome measures and results were independently extracted, in duplicate, by two reviewers (JC &amp; HW). Specialist advice was sought to categorise interventions. Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out using the Jadad criteria (Jadad 1998). The Cochrane Oral Health Group statistical guidelines were followed and relative risk values calculated using random effects models where significant heterogeneity was detected (P &lt; 0.1). Main Results: Thirty-eight reports of trials were initially included. Two were duplicate reports and nine were excluded as there was no useable information. Of the 27 useable studies 14 had data for mucositis comprising 945 randomised patients and 15 included data for oral candidiasis with 1164 randomised patients. Of the eight prophylactic agents used for mucositis only one, ice chips, was effective (Relative risk 0.57, 95% CI 0.43 to 0.77, chi-square for heterogeneity = 0.26 (df = 1), p = 0.61). The NNT to prevent one extra case of mucositis over the baseline incidence using ice chips was 4 (95%CI: 3 to 7). The NNT for when the baseline incidence of mucositis in the population ranges from 50% to 80% are 5 to 4 respectively. There is evidence that antifungal agents which are partially or fully absorbed from the gastrointestinal tract prevent oral candidiasis and that the partially absorbed agents may be more effective than the fully absorbed agents. The RR for partially absorbed agents was 0.13 (95% CI 0.06 to 0.27, chi-square for heterogeneity = 5.3 (df = 3), P = 0. 15). The NNT to prevent one extra case of oral candidiasis over the baseline incidence using partially absorbed drugs was 3 (95% CI: 3 to 5). The NNT for when the baseline incidence of oral candidiasis in the population ranges from 30% to 70% are 4 to 2 respectively. The general reporting of RCT's was poor however the median Jadad score was acceptable and improved further when the authors provided additional information. The sensitivity analysis confirmed the findings for oral candidiasis. Reviewer's Conclusions: There is some evidence that ice chips prevent mucositis. None of the other prophylactic agents included in this review prevented mucositis. There is evidence that prophylactic use of antifungal agents which are absorbed or partially absorbed from the gastrointestinal tract reduce the clinical signs of oral candidiasis, and the partially absorbed drugs may be more effective. Future trials in this area should address the link between oral and general health including outcomes relevant to the patient. Collaboration between medical and dental teams is indicated.</p

The Oslo Health Study: A Dietary Index Estimating Frequent Intake of Soft Drinks and Rare Intake of Fruit and Vegetables Is Negatively Associated with Bone Mineral Density

Background. Since nutritional factors may affect bone mineral density (BMD), we have investigated whether BMD is associated with an index estimating the intake of soft drinks, fruits, and vegetables. Methods. BMD was measured in distal forearm in a subsample of the population-based Oslo Health Study. 2126 subjects had both valid BMD measurements and answered all the questions required for calculating a Dietary Index = the sum of intake estimates of colas and non-cola beverages divided by the sum of intake estimates of fruits and vegetables. We did linear regression analyses to study whether the Dietary Index and the single food items included in the index were associated with BMD. Results. There was a consistent negative association between the Dietary Index and forearm BMD. Among the single index components, colas and non-cola soft drinks were negatively associated with BMD. The negative association between the Dietary Index and BMD prevailed after adjusting for gender, age, and body mass index, length of education, smoking, alcohol intake, and physical activity. Conclusion. An index reflecting frequent intake of soft drinks and rare intake of fruit and vegetables was inversely related to distal forearm bone mineral density

Pakistanis living in Oslo have lower serum 1,25-dihydroxyvitamin D levels but higher serum ionized calcium levels compared with ethnic Norwegians. The Oslo Health Study

Background Persons of Pakistani origin living in Oslo have a much higher prevalence of vitamin D deficiency and secondary hyperparathyroidism but similar bone mineral density compared with ethnic Norwegians. Our objective was to investigate whether Pakistani immigrants living in Oslo have an altered vitamin D metabolism by means of compensatory higher serum levels of 1,25-dihydroxyvitamin D (s-1,25(OH)2D) compared with ethnic Norwegians; and whether serum levels of ionized calcium (s-Ca2+) differ between Pakistanis and Norwegians. Methods In a cross-sectional, population-based study venous serum samples were drawn from 94 Pakistani men and 67 Pakistani women aged 30–60 years, and 290 Norwegian men and 270 Norwegian women aged 45–60 years; in total 721 subjects. Results Pakistanis had lower s-1,25(OH)2D compared with Norwegians (p < 0.001). Age- and gender adjusted mean (95% CI) levels were 93 (86, 99) pmol/l in Pakistanis and 123 (120, 126) pmol/l in Norwegians, p < 0.001. The difference persisted after controlling for body mass index. There was a positive relation between serum 25-hydroxyvitamin D (s-25(OH)D) and s-1,25(OH)2D in both groups. S-Ca2+ was higher in Pakistanis; age-adjusted mean (95% CI) levels were 1.28 (1.27, 1.28) mmol/l in Pakistanis and 1.26 (1.26, 1.26) mmol/l in Norwegians, p < 0.001. In both groups, s-Ca2+ was inversely correlated to serum intact parathyroid hormone levels (s-iPTH). For any s-iPTH, s-Ca2+ was higher in Pakistanis, also when controlling for age. Conclusion Community-dwelling Pakistanis in Oslo with low vitamin D status and secondary hyperparathyroidism have lower s-1,25(OH)2D compared with ethnic Norwegians. However, the Pakistanis have higher s-Ca2+. The cause of the higher s-Ca2+ in Pakistanis in spite of their higher iPTH remains unclear

Combination of ensiling and fungal delignification as effective wheat straw pretreatment

BACKGROUND: Utilization of lignocellulosic feedstocks for bioenergy production in developing countries demands competitive but low-tech conversion routes. White-rot fungi (WRF) inoculation and ensiling are two methods previously investigated for low-tech pretreatment of biomasses such as wheat straw (WS). This study was undertaken to assess whether a combination of forced ensiling with Lactobacillus buchneri and WRF treatment using a low cellulase fungus, Ceriporiopsissubvermispora, could produce a relevant pretreatment effect on WS for bioethanol and biogas production. RESULTS: A combination of the ensiling and WRF treatment induced efficient pretreatment of WS by reducing lignin content and increasing enzymatic sugar release, thereby enabling an ethanol yield of 66 % of the theoretical max on the WS glucan, i.e. a yield comparable to yields obtained with high-tech, large-scale pretreatment methods. The pretreatment effect was reached with only a minor total solids loss of 5 % by weight mainly caused by the fungal metabolism. The combination of the biopretreatments did not improve the methane potential of the WS, but improved the initial biogas production rate significantly. CONCLUSION: The combination of the L. buchneri ensiling and C. subvermispora WRF treatment provided a significant improvement in the pretreatment effect on WS. This combined biopretreatment produced particularly promising results for ethanol production. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13068-016-0437-x) contains supplementary material, which is available to authorized users

National monitoring of iodine, sodium, and vitamin D status in toddlers and women of childbearing age - results and lessons learned from a pilot study in Norway

BACKGROUND Norway is lacking a population-based national monitoring program for iodine, sodium, and vitamin D status. OBJECTIVE The aim of this study was to pilot-test a study design for collecting biological samples from a country-representative sample of 2-year-old children and their mothers and to report results for iodine, salt, and vitamin D at baseline, before initiation of salt iodization in Norway. DESIGN In a cross-sectional study, we recruited 2-year-old children and their mothers during the routine 2-year check-up through 38 randomly selected health clinics in 2021. Spot urine samples were analyzed for iodine, creatinine, and sodium, and dried blood spots from the mothers were analyzed for thyroglobulin (Tg) and 25-hydroxyvitamin D (25(OH)D). RESULTS We aimed at including 400 mother-child pairs but recruited only 55 pairs. Major challenges were closed health clinics due to the COVID-19 pandemic, lack of motivation of the health personnel to prioritize recruiting, missing information about non-participation, and high workload for participants. The median urinary iodine concentration (UIC) was 123 (95% CI: 76, 228) µg/L in the toddlers and 83 (95% CI: 72, 99) µg/L in the mothers. The median urinary sodium concentration (UNaC) was 62 (95% CI: 37, 91) mmol/L in the toddlers and 93 (95% CI: 77, 107) mmol/L in the mothers. Of the mothers, 18% had levels of 25(OH)D <50 nmol/L (suboptimal status). DISCUSSION AND CONCLUSION Lessons learned from the pilot study will be used to design a national monitoring program for toddlers and women of childbearing age in Norway. The results indicate that 2-year-old children and women of childbearing age in Norway may have inadequate iodine intakes at the group level, while for vitamin D, most of the mothers had adequate status

The association between alcohol consumption and risk of hip fracture differs by age and gender in Cohort of Norway: a NOREPOS study

Under embargo until: 13.07.2019Summary: The association between alcohol consumption and hip fracture differed by gender: Men aged 30–59 years drinking frequently or 14+ gl/week had higher risk than moderate drinkers. No significant association was seen in older men. Women not drinking alcohol had higher risk than those drinking moderately both regarding frequency and amount. Introduction: We aimed to examine alcohol consumption and risk of hip fracture according to age and gender in the population-based Cohort of Norway (1994–2003). Methods: Socio-demographics, lifestyle, and health were self-reported and weight and height were measured in 70,568 men and 71,357 women ≥ 30 years. Information on subsequent hip fractures was retrieved from hospitals’ electronic patient registries during 1994–2013. Frequency of alcohol consumption was categorized: never/seldom, moderate (≤ 2–3 times/week), or frequent (≥ 4 times/week), and amount as number of glasses per week: 0, 1–6, 7–13, 14–27, and 28+. Type of alcohol (wine vs. beer/hard liquor) was also examined. Cox’s proportional hazards regression was used to estimate hazard ratios (HRs) stratified on gender and baseline age < 60 and ≥ 60 years. Results: During median 15-year follow-up, 1558 men and 2511 women suffered a hip fracture. Using moderate drinkers as reference, men < 60 years drinking frequently had multivariable adjusted HR = 1.73 (CI 1.02–2.96) for hip fracture and more than 2.5 times higher risk if they consumed 14+ glasses compared to 1–6 glasses per week. In other groups of age and gender, no statistically significant increased risk was found in those consuming the highest levels of alcohol. Compared to women with moderate or frequent alcohol use, never/seldom-drinking women had the highest fracture risk. In women, use of wine was associated with lower fracture risk than other types of alcohol. Conclusions: Risk of hip fracture was highest in men < 60 years with the highest frequency and amount of alcohol consumption and in non-drinking women.acceptedVersio

Grip strength in men and women aged 50–79 years is associated with non-vertebral osteoporotic fracture during 15 years follow-up: The Tromsø Study 1994–1995

Under embargo until: 2020-10-25Summary In 50–79-year-olds who participated in the Tromsø Study (1994–1995), the risk of non-vertebral osteoporotic fractures during 15 years follow-up increased by 22% in men and 9% in women per 1 SD lower grip strength. The strongest association was observed in men aged 50–64 years. Introduction We aimed to explore whether low grip strength was associated with increased risk of non-vertebral osteoporotic fracture in the population-based Tromsø Study 1994–1995. Methods Grip strength (bar) was measured by a Martin Vigorimeter and fractures were retrieved from the X-ray archives at the University Hospital of North Norway between 1994 and 2010. At baseline, weight and height were measured, whereas information on the other covariates were obtained through self-reported questionnaires. Cox regression was used to estimate the hazard ratio (HR) of fracture in age- and gender-specific quintiles of grip-strength, and per 1 SD lower grip strength. Similar analyses were done solely for hip fractures. Adjustments were made for age, height, body mass index (BMI), marital status, education, smoking, physical activity, use of alcohol, self-perceived health, and self-reported diseases. Results In 2891 men and 4002 women aged 50–79 years, 1099 non-vertebral osteoporotic fractures—including 393 hip fractures—were sustained during the median 15 years follow-up. Risk of non-vertebral osteoporotic fracture increased with declining grip strength: hazard ratios per SD decline was 1.22 (95% CI 1.05–1.43) in men and 1.09 (95% CI 1.01–1.18) in women. HR for fracture in lower vs. upper quintile was 1.58 (95% CI 1.02–2.45) in men and 1.28 (95% CI 1.03–1.59) in women. The association was most pronounced in men aged 50–64 years with HR = 3.39 (95% CI 1.76–6.53) in the lower compared to the upper quintile. Conclusions The risk of non-vertebral osteoporotic fracture increased with declining grip-strength in both genders, particularly in men aged 50–64 years.acceptedVersio

Hepatitis C viral evolution in genotype 1 treatment-naïve and treatment-experienced patients receiving telaprevir-based therapy in clinical trials

Background: In patients with genotype 1 chronic hepatitis C infection, telaprevir (TVR) in combination with peginterferon and ribavirin (PR) significantly increased sustained virologic response (SVR) rates compared with PR alone. However, genotypic changes could be observed in TVR-treated patients who did not achieve an SVR. Methods: Population sequence analysis of the NS3•4A region was performed in patients who did not achieve SVR with TVR-based treatment. Results: Resistant variants were observed after treatment with a telaprevir-based regimen in 12% of treatment-naïve patients (ADVANCE; T12PR arm), 6% of prior relapsers, 24% of prior partial responders, and 51% of prior null responder patients (REALIZE, T12PR48 arms). NS3 protease variants V36M, R155K, and V36M+R155K emerged frequently in patients with genotype 1a and V36A, T54A, and A156S/T in patients with genotype 1b. Lower-level resistance to telaprevir was conferred by V36A/M, T54A/S, R155K/T, and A156S variants; and higher-level resistance to telaprevir was conferred by A156T and V36M+R155K variants. Virologic failure during telaprevir treatment was more common in patients with genotype 1a and in prior PR nonresponder patients and was associated with higher-level telaprevir-resistant variants. Relapse was usually associated with wild-type or lower-level resistant variants. After treatment, viral populations were wild-type with a median time of 10 months for genotype 1a and 3 weeks for genotype 1b patients. Conclusions: A consistent, subtype-dependent resistance profile was observed in patients who did not achieve an SVR with telaprevir-based treatment. The primary role of TVR is to inhibit wild-type virus and variants with lower-levels of resistance to telaprevir. The complementary role of PR is to clear any remaining telaprevir-resistant variants, especially higher-level telaprevir-resistant variants. Resistant variants are detectable in most patients who fail to achieve SVR, but their levels decline over time after treatment

Creating Calibration Curves to Determine Shock Pressure in Clinopyroxene

Impact cratering is an important geological process that occurs on every rocky body in the solar system. It alters the texture and mineralogy of rocks via shock metamorphism. The peak shock pressures experienced by a rock are traditionally evaluated using qualitative optical methods however, quantitative methods do exist. One such method was developed by Uchizono et al., who used X-ray Diffraction (XRD) to measure lattice strain () in several artificially shocked olivine grains using XRD peak broadening as a function of tan , where is the diffraction angle. They plotted the values against the known peak shock pressures experienced by the olivine grains. Using this calibration curve, the precise shock pressure experienced by a grain of olivine can be determined using its measured value. Another method was developed by McCausland et al. and Izawa et al., who used in situ XRD to measure strain-related mosaicity (SRM) of olivine in several ordinary chondrites and enstatite in enstatite chondrites, respectively. They plotted these results against the shock stage estimates for these meteorites. Using these plots, meteorites can be assigned to shock stage bins by measuring the SRM of olivine and/or enstatite. Both methods are useful for evaluating shock metamorphism, however, they have limitations. Uchizono et al.s calibration curve has been successfully applied to martian meteorites, however it can only be applied to olivine-bearing rocks. McCausland et al.s and Izawa et al.s SRM method is uncalibrated and is limited to binning meteorites by shock stage. This work aims to expand on both methods by creating calibration curves for clinopyroxene (CPX): one for , similar to Uchizono et al.s calibration curve for olivine, and one for SRM. This will extend the application of shock calibration methods to a greater variety of rock types. Preliminary results are presented herein

Validation of the cardiovascular risk model NORRISK 2 in South Asians and people with diabetes

To evaluate the predictive ability of the previously published NORRISK 2 cardiovascular risk model in Norwegian-born and immigrants born in South Asia living in Norway, and to add information about diabetes and ethnicity in an updated model for South Asians and diabetics (NORRISK 2-SADia). Design. We included participants (30–74 years) born in Norway (n = 13,885) or South Asia (n = 1942) from health surveys conducted in Oslo 2000–2003. Cardiovascular disease (CVD) risk factor information including self-reported diabetes was linked with information on subsequent acute myocardial infarction (AMI) and acute cerebral stroke in hospital and mortality registry data throughout 2014 from the nationwide CVDNOR project. We developed an updated model using Cox regression with diabetes and South Asian ethnicity as additional predictors. We assessed model performance by Harrell’s C and calibration plots. Results. The NORRISK 2 model underestimated the risk in South Asians in all quintiles of predicted risk. The mean predicted 13-year risk by the NORRISK 2 model was 3.9% (95% CI 3.7–4.2) versus observed 7.3% (95% CI 5.9–9.1) in South Asian men and 1.1% (95% CI 1.0–1.2) versus 2.7% (95% CI 1.7–4.2) observed risk in South Asian women. The mean predictions from the NORRISK 2-SADia model were 7.2% (95% CI 6.7–7.6) in South Asian men and 2.7% (95% CI 2.4–3.0) in South Asian women. Conclusions. The NORRISK 2-SADia model improved predictions of CVD substantially in South Asians, whose risks were underestimated by the NORRISK 2 model. The NORRISK 2-SADia model may facilitate more intense preventive measures in this high-risk population.publishedVersio