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The outbreak of coronavirus disease 2019 (COVID-19) markedly affected the way healthcare professionals approach patients with cancer worldwide, not only in terms of therapeutic decision-making but also in terms of supportive care. With the rapid appearance of signs and symptoms and the need of close re-assessment, standard management of oral mucositis has been challenged by physical distancing and limited resources due to the global crisis. Building on the clinical experience developed during the acute phase by members of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO), the implications of COVID-19 on the prevention, assessment, and treatment of mucositis are critically reported. Inspired by the restructuring of supportive care measures in response to the pandemic, suggestions for new models of approaching acute side effects are also discussed.

The analysis of micro-inclusions in fibrous diamonds from the Diavik mine, Canada revealed the presence of high density fluids (HDFs) that span a continuous compositional range between carbonatitic and saline end-members. The carbonatitic end-member is rich in Na, Ca, Mg, Fe, Ba and carbonate; the saline one is rich in K, Cl and water. In molar proportions, the composition of the saline end-member is: K 38 Na 7.7 Ca 1.8 Mg 1.6 Fe 1.5 Ba 1.9 SiO 3.1 Cl 46 (CO 3 ) 5.5 (H 2 O) 56 and that of the carbonatitic end member is: K 15 Na 21 Ca 6.7 Mg 8.1 Fe 6.2 Ba 5.7 Si 4.8 Ti 1.4 Al 1.9 O 17 Cl 29 (CO 3 ) 29 (H 2 O) 29 . The micro-inclusions in one diamond span a narrow range between a silicic end-member (rich in Si, K and water) and a carbonatitic one (rich in Mg, Ca, Fe and carbonate). Its average composition is: K 26 Na 5.5 Ca 13.8 Mg 8.3 Fe 9.6 Ba 0.9 P 2.5 Si 25 Ti 1.6 Al 3.8 Cl 2.5 O 81 (CO 3 ) 29 (H 2 O) 78 . Thus, the Diavik diamonds span most of the known compositional range for fluids trapped in diamonds. Based on these data and previous analyses of fluids trapped in diamonds, we discuss possible models for the evolution of diamond-forming fluids. The most plausible model is where carbonatitic-HDFs are parental to all the other compositions. They evolve by fractionation of divalentions- and alkali-carbonates and by immiscible separation into saline- and silicic-HDFs. Each phase continues to evolve separately, crystallizing carbonates, diamond, and accessory silicates, phosphates, halides and more of the immiscible phase. Other processes, like the mixing of evolved fluids with fresh parental carbonatitic fluids, or metasomatic interactions with the wallrock also play a role in the evolution of the HDFs. We also propose that the parental carbonatitic-HDF evolves through fractional crystallization of an alkali-rich, low degree melt that is similar to the high pressure parental melts of kimberlites or lamproites.

Microinclusions analyzed in a coated diamond from the Diavik mine in Canada comprise peridotitic minerals and fluids. The fluids span a wide compositional range between a carbonatitic melt and brine. The diamond is concentrically zoned. The brine microinclusions reside in an inner growth zone and their endmember composition is K19Na25Ca5Mg8Fe3Ba2Si4Cl32 (mol%). The carbonatitic melt is found in an outer layer and its endmember composition is K11Na21Ca11Mg26Fe7Ba2Si10Al3P2Cl5. The transition in inclusion chemistry is accompanied by a change in the carbon isotopic composition of the diamond from −8.5‰ in the inner zone to −12.1‰ in the outer zone. We suggest that this transition reflects mixing between already evolved brine and a freshly introduced carbonatitic melt of different isotopic composition. The compositional range found in diamond ON-DVK-294 is the widest ever recorded in a single diamond. It closes the gap between brine found in cloudy octahedral diamonds from South Africa and carbonatitic melt analyzed in cubic diamonds from Zaire and Botswana. Thus, all microinclusions analyzed to date fall along two arrays connecting the carbonatitic melt composition to either a hydrous-silicic endmember or to a brine endmember. This connection suggests that many diamonds are formed from fluids derived form a mantle source not significantly influenced by local heterogeneities.

Silicates, carbonates and brine were detected in microinclusions in cloudy diamonds from Koffiefontein. The silicates belong to either the eclogitic or the peridotitic paragenesis. They are similar in composition to the larger mineral inclusions found in other Koffiefontein diamonds and record similar pressures and temperatures of formation (1000–1200°C, 4–6 GPa). The clouds also carry additional mineral phases that were not detected before in Koffiefontein: phlogopite, high-Si mica, an Al-Mg-rich phase and carbonates. In many cases silicate minerals coexist together with brine in individual microinclusions. Brines associated with either eclogitic or peridotitic minerals have similar composition and both are rich in water, Cl, K and carbonates (Izraeli et al., 2001). The above findings, together with the high proportion of cloudy diamonds in Koffiefontein, suggest that brine penetration into neighboring peridotitic and eclogitic rocks was pervasive. The high carbon content of the brine (as dissolved carbonates) initiated diamond growth in both rock types, most, on preexisting diamonds that now form inclusion-free cores. The low aggregation state of nitrogen in the cloudy diamonds, relative to other diamonds from Koffiefontein indicates either a somewhat lower temperature of storage in the mantle (which may be the reason for the presence of brine rather than melt) or a young event of cloudy diamond formation.

Objective To evaluate the efficacy and safety of an intraoral electrostimulation device, consisting of stimulating electrodes, an electronic circuit, and a power source, in treating xerostomia. The device delivers electrostimulation through the oral mucosa to the lingual nerve in order to enhance the salivary reflex. Methods The device was tested on a sample of patients with xerostomia due to Sjogren's syndrome and other sicca conditions in a 2-stage prospective, randomized, multicenter trial. Stage I was a double-blind, crossover stage designed to compare the effects of the electrically active device with the sham device, each used for 1 month, and stage II was a 3-month open-label stage designed to assess the long-term effects of the active device. Improvement in xerostomia severity from baseline was the primary outcome measure. Results A total of 114 patients were randomized. In stage I, the active device performed better than the sham device for patient-reported xerostomia severity (P < 0.002), xerostomia frequency (P < 0.05), quality of life impairment (P < 0.01), and swallowing difficulty (P < 0.02). At the end of stage II, statistically significant improvements were verified for patient-reported xerostomia severity (P < 0.0001), xerostomia frequency (P < 0.0001), oral discomfort (P < 0.001), speech difficulty (P < 0.02), sleeping difficulty (P < 0.001), and resting salivary flow rate (P < 0.01). Conclusion Our findings indicate that daily use of the device alleviated oral dryness, discomfort, and some complications of xerostomia, such as speech and sleeping difficulties, and increased salivary output. The results show a cumulative positive effect of the device over the period of the study, from baseline to the end of the trial.

Micro-inclusions in cloudy diamonds from Koffiefontein consist of three main types: silicates, carbonates and brine inclusions. The silicates belong to either the eclogitic or the peridotitic paragenesis and both are associated with carbonates and brine. The brine composition is roughly (K,Na)8(Ca,Fe,Mg)4SiO(CO3)4Cl10(H2O)28–44. Average mass proportions are about 30–42% water, 19–22% chlorine, 14–17% sodium and potassium, 22–25% Fe–Ca–Mg–carbonates, and 3–4% silica. The brine composition is distinct from that of fluids trapped in fibrous diamonds mainly by its high chlorine and low silica content. The close association of carbon-bearing brine, silicate minerals and diamonds suggests that such brines are important for diamond growth in both eclogitic and peridotitic environments. The similarity of brine composition in both environments may indicate that diamonds of both suites grew in a single event.

Item does not contain fulltext PURPOSE: Despite advances in personalizing the efficacy of cancer therapy, our ability to identify patients at risk of severe treatment side effects and provide individualized supportive care is limited. This is particularly the case for mucositis (oral and gastrointestinal), with no comprehensive risk evaluation strategies to identify high-risk patients. We, the Multinational Association for Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO) Mucositis Study Group, therefore aimed to systematically review current evidence on that factors that influence mucositis risk to provide a foundation upon which future risk prediction studies can be based. METHODS: We identified 11,018 papers from PubMed and Web of Science, with 197 records extracted for full review and 113 meeting final eligibility criteria. Data were then synthesized into tables to highlight the level of evidence for each risk predictor. RESULTS: The strongest level of evidence supported dosimetric parameters as key predictors of mucositis risk. Genetic variants in drug-metabolizing pathways, immune signaling, and cell injury/repair mechanisms were also identified to impact mucositis risk. Factors relating to the individual were variably linked to mucositis outcomes, although female sex and smoking status showed some association with mucositis risk. CONCLUSION: Mucositis risk reflects the complex interplay between the host, tumor microenvironment, and treatment specifications, yet the large majority of studies rely on hypothesis-driven, single-candidate approaches. For significant advances in the provision of personalized supportive care, coordinated research efforts with robust multiplexed approaches are strongly advised.