Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols

Purpose: There is a large body of evidence supporting the efficacy of low-level laser therapy (LLLT), more recently termed photobiomodulation (PBM) for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved and dosimetric parameters may lead to the management of a broader range of complications associated with HNC treatment. This could enhance patient adherence to cancer therapy, and improve quality of life and treatment outcomes. The mechanisms of action, dosimetric, and safety considerations for PBM have been reviewed in part 1. Part 2 discusses the head and neck treatment side effects for which PBM may prove to be effective. In addition, PBM parameters for each of these complications are suggested and future research directions are discussed. Methods: Narrative review and presentation of PBM parameters are based on current evidence and expert opinion. Results: PBM may have potential applications in the management of a broad range of side effects of (chemo)radiation therapy (CRT) in patients being treated for HNC. For OM management, optimal PBM parameters identified were as follows: wavelength, typically between 633 and 685 nm or 780–830 nm; energy density, laser or light-emitting diode (LED) output between 10 and 150 mW; dose, 2–3 J (J/cm2), and no more than 6 J/cm2 on the tissue surface treated; treatment schedule, two to three times a week up to daily; emission type, pulsed (<100 Hz); and route of delivery, intraorally and/or transcutaneously. To facilitate further studies, we propose potentially effective PBM parameters for prophylactic and therapeutic use in supportive care for dermatitis, dysphagia, dry mouth, dysgeusia, trismus, necrosis, lymphedema, and voice/speech alterations. Conclusion: PBM may have a role in supportive care for a broad range of complications associated with the treatment of HNC with CRT. The suggested PBM irradiation and dosimetric parameters, which are potentially effective for these complications, are intended to provide guidance for well-designed future studies. It is imperative that such studies include elucidating the effects of PBM on oncology treatment outcomes.National Institutes of Health (U.S.) (NIH grant R01AI050875

Low level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 1: mechanisms of action, dosimetric, and safety considerations

Purpose: There is a large body of evidence supporting the efficacy of low level laser therapy (LLLT), more recently termed photobiomodulation (PBM), for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved, may expand the applications for PBM in the management of other complications associated with HNC treatment. This article (part 1) describes PBM mechanisms of action, dosimetry, and safety aspects and, in doing so, provides a basis for a companion paper (part 2) which describes the potential breadth of potential applications of PBM in the management of side-effects of (chemo)radiation therapy in patients being treated for HNC and proposes PBM parameters. Methods: This study is a narrative non-systematic review. Results: We review PBM mechanisms of action and dosimetric considerations. Virtually, all conditions modulated by PBM (e.g., ulceration, inflammation, lymphedema, pain, fibrosis, neurological and muscular injury) are thought to be involved in the pathogenesis of (chemo)radiation therapy-induced complications in patients treated for HNC. The impact of PBM on tumor behavior and tumor response to treatment has been insufficiently studied. In vitro studies assessing the effect of PBM on tumor cells report conflicting results, perhaps attributable to inconsistencies of PBM power and dose. Nonetheless, the biological bases for the broad clinical activities ascribed to PBM have also been noted to be similar to those activities and pathways associated with negative tumor behaviors and impeded response to treatment. While there are no anecdotal descriptions of poor tumor outcomes in patients treated with PBM, confirming its neutrality with respect to cancer responsiveness is a critical priority. Conclusion: Based on its therapeutic effects, PBM may have utility in a broad range of oral, oropharyngeal, facial, and neck complications of HNC treatment. Although evidence suggests that PBM using LLLT is safe in HNC patients, more research is imperative and vigilance remains warranted to detect any potential adverse effects of PBM on cancer treatment outcomes and survival.National Institutes of Health (U.S.) (grant R01AI050875

Simultaneous observations of NLCs and MSEs at midlatitudes: implications for formation and advection of ice particles

We combined ground-based lidar observations of noctilucent clouds (NLCs) with collocated, simultaneous radar observations of mesospheric summer echoes (MSEs) in order to compare ice cloud altitudes at a midlatitude site (Kühlungsborn, Germany, 54°&thinsp;N, 12°&thinsp;E). Lidar observations are limited to larger particles ( &gt; 10&thinsp;nm), while radars are also sensitive to small particles ( &lt; 10&thinsp;nm), but require sufficient ionization and turbulence at the ice cloud altitudes. The combined lidar and radar data set thus includes some information on the size distribution within the cloud and through this on the history of the cloud. The soundings for this study are carried out by the IAP Rayleigh–Mie–Raman (RMR) lidar and the OSWIN VHF radar. On average, there is no difference between the lower edges (zlowNLC and zlowMSE). The mean difference of the upper edges zupNLC and zupMSE is  ∼ 500&thinsp;m, which is much less than expected from observations at higher latitudes. In contrast to high latitudes, the MSEs above our location typically do not reach much higher than the NLCs. In addition to earlier studies from our site, this gives additional evidence for the supposition that clouds containing large enough particles to be observed by lidar are not formed locally but are advected from higher latitudes. During the advection process, the smaller particles in the upper part of the cloud either grow and sediment, or they sublimate. Both processes result in a thinning of the layer. High-altitude MSEs, usually indicating nucleation of ice particles, are rarely observed in conjunction with lidar observations of NLCs at Kühlungsborn.</p

Oral microbial changes, oral mucositis and febrile neutropenia during myelosuppressive chemotherapy in patients diagnosed with a solid tumor or lymphoma

ObjectivesTo evaluate the possible changes of the oral microbiome during myelosuppressive chemotherapy (CT) and to investigate the potential relationship between the oral microbiome, the presence of oral mucositis (OM) and febrile neutropenia (FN).MethodsA prospective, longitudinal, observational study was conducted in patients receiving myelosuppressive CT for a solid tumor or lymphoma. Oral rinsing samples were retrieved before, during and after the start of CT, but also when OM or FN was present. The samples were analyzed using 16S rRNA gene amplicon sequencing and statistical analysis was performed using alpha (Shannon) and beta (PERMANOVA) diversity analyses. Furthermore, differential abundances were analyzed using ALDEx2v1.32.0. Differences between groups were calculated using the Mann Whitney U-test, Kruskal-Wallis test and Wilcoxon Signed Rank using R.ResultsForty-six patients, with a mean follow up of 114 days, were included for analysis and a total of 138 oral rinsing samples were available in the CLR-transformed data for PERMANOVA and 137 samples—for alpha diversity calculation. Significant changes in alpha diversity were seen when OM or FN was present. Moreover, significant changes were seen in beta diversity during the course of the CT treatment and when OM was present. Genera showing substantial changes in relative abundance were Streptococcus during the course of CT treatment and Prevotella, Fusobacterium, Selenomonas, Actinomyces and Leptotrichia when OM was present.ConclusionChanges in the oral microbiome were observed during the CT-regimen and when OM was present. Furthermore, changes of the oral microbiota during FN episodes were observed; however, larger studies should be performed to substantiate our results

The Golden Rule and Sustainable Development

Treat others as you want to be treated is one of the most familiar formulations of the Golden Rule. In this article, seven different expressions are described that can all be seen as varieties of the same rule. The Golden Rule can be a very useful instrument for Applied Ethics in both theoretical and practical moral thinking. However, none of these variations gives a definite moral advice. The reason is that the Golden Rule does not contain any reference to value standards. It rather serves as a rule of reversibility and consistency that tells us that we should act upon others as we would like to be treated by them, i.e. the Golden Rule asks for a harmony between our moral ac-tions and our desires. This Principle of Reciprocity may lead to a number of misconceptions, but several exam-ples serve to gain a morally acceptable understanding of this universal moral code.Traktuj innych tak, jak sam chciałbyś być traktowany to jedno z najbardziej znanych sformułowań Złotej Reguły. W niniejszym artykule opisujemy siedem zachowań, które można postrzegać jako odmiany tej właśnie zasady. Złota Reguła może być bardzo użytecznym instrumentem dla etyki stosowanej zarówno podczas teoretycznych jak i praktycznych rozważań moralnych. Jednak żadna z tych odmian nie daje pełnej moralnej wykładni. Dzieje się tak, ponieważ Złota Reguła nie zawiera w sobie żadnych odniesień do standardów wartości. Jest to raczej zasada odwracalności i zgodności, która mówi nam, że powinniśmy zachowywać się w stosunku do innych tak samo, jak chcemy być przez nich traktowani. Przykładowo Złota Reguła mówi o harmonii pomiędzy działaniami moralnymi a pragnieniami. Ta zasada wzajemności może prowadzić do wielu nieporozumień. Za sprawą kilku podanych tu przykładów chcemy osiągnąć moralnie akceptowalne zrozumienie tego uniwersalnego kodeksu moralnego

Learning from Mistakes: Creating a New Spirit for a Democratic School System in South Africa.

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