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Long-day photoperiod is known to positively affect milk production in confinement dairy systems, and it has been hypothesized that pineal melatonin (MT) secretion plays a substantial role in this process. Specialized mammalian photoreceptors that regulate MT secretion are optimally stimulated by short wavelength blue light. We investigated the blue light intensity administered to one eye required to suppress MT secretion in nonlactating dairy cows, and subsequently examined effects on milk production in grazing dairy cows. Following a 14-d light-dark 8:16 h environmental conditioning period, 5 nonlactating Holstein-Friesian cows were exposed to treatments of <1, 70, 125, 175, and 225 lx for 8 additional hours using a 5 × 5 Latin square design. Light was administered via headpieces fitted with light-emitting diodes emitting blue light (465 nm) to the right eye. All cows were then exposed to a light-dark 16:8 h cycle for one night via the indoor lighting system (>200 lx white light). Plasma samples collected at regular intervals were assayed for MT. A dose-dependent effect of light treatment on mean circulating MT concentrations (and 95% CI) was observed [9.4 (7.2, 12.3), 5.0 (3.8, 6.6), 4.4 (3.3, 5.7), 3.3 (2.5, 4.3) and 1.7 (1.3, 2.3) pg/mL for treatments of 0, 70, 125, 175, and 225 lx, respectively. Only the 225 lx treatment acutely suppressed plasma melatonin concentration to levels similar to the light-dark 16:8 h treatment [1.9 (1.4, 2.5) pg/mL]. Forty spring-calving cows were blocked on parity, calving date and Economic Breeding Index for milk production and assigned to the control treatment or blue light to a single eye (LT) treatment from calving through 32 wk of lactation. The cows assigned to LT treatment were fitted with headpieces providing 225 lx of blue light to the right eye from 1700 until 0000 h. Mean milk production (and 95% CI) during 32 wk of lactation was not affected by treatment [20.3 (19.3, 21.3) vs. 20.9 (19.8, 22.0) kg/d, control and LT, respectively]. Within multiparous cows, a treatment by week interaction was detected, whereby LT treatment increased milk production during the first 12 wk of lactation [25.8 (24.3, 27.3) vs. 28.0 (26.5, 29.5) kg/d; +8.5%], but had no effect thereafter. Treatment did not affect plasma insulin-like growth factor 1. We identified the blue light intensity to one eye required to acutely suppress MT concentrations. Transient favorable effects on milk production were observed in multiparous cows. It remains unclear how single-eye blue light treatment affects galactopoiesis in grazing dairy cows, and further research is needed to explore whether this modality of light delivery represents a useful means to aid productivity in pasture-based dairy systems. [ABSTRACT FROM AUTHOR]

Biological rhythms evolved to provide temporal coordination across all tissues and organs and allow synchronization of physiology with predictable environmental cycles. Most important of these are circadian and circannual rhythms, primarily regulated via photoperiod signals from the retina. Understanding the nature of physiological rhythms in horses is crucially important for equine management. Predominantly, they have been removed from exposure to their natural environmental stimuli; the seasonally changing photoperiod, continuous foraging and feeding activity, social herd interactions, and the continuous low-intensity exercise of a grassland dweller. These have been replaced in many cases with confined indoor housing, regimental feeding and exercise times, social isolation, and exposure to lighting that is often erratic and does not come close to mimicking the spectral composition of sunlight. Man has further altered seasonal timing cues through the use of artificial lighting programs that impact reproductive behavior, breeding efficiency, and the development of youngstock. Understanding how these new environmental cues (some stronger and some weaker) impact the internal physiology of the horse in the context of the natural endogenous rhythms that evolved over millennia is key to helping to improve equine health, welfare, and performance, now and into the future. This review provides an overview of the field, highlights the recent discoveries related to biological timing in horses, and discusses the implications that these findings may have for the production and management of the elite equine athlete. • Horses exhibit circadian and circannual rhythms in physiology and behavior • Exercise is a potent entrainment factor for circadian rhythms in equine muscle • Circannual rhythms influence ovarian activity, gestation length, and foal birth weight • Short-wavelength blue light effectively regulates equine biological rhythms • Future research should evaluate stable lighting that supports biological rhythms [ABSTRACT FROM AUTHOR]

The objectives of this report were 1) to examine the quality of life (QOL) of patients with a newly diagnosed oral cavity or oropharyngeal (OCOP) cancer; and 2) to examine factors contributing to QOL before cancer treatment. The sample included 115 participants with a new diagnosis of OCOP cancer. Participants completed the demographic form, oral cancer disease and treatment form, Hospital Anxiety and Depression Scale (HADS), Brief Health Literacy Screen (BHLS), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Pearson correlations and linear regressions were used for data analysis. Participants had a median global health related QOL score of 66.7 (interquartile range, IQR = 50.0, 83.4) with median scores for the subdomains being generally high (all >80 of possible 100). Anxiety and depression were significantly inversely correlated with all areas of EORTC QOL (r = - 0.48 to −0.78, all p <.001). Multivariable associations were strongest with the physical functioning domain (R = 0.56, p <.001), with younger age, higher income, Stage I/II cancer (compared to Stage III/IV) significant contributors to the multiple correlation (beta > ± 0.20, p <.05). Health care providers should be attentive to OCOP cancer patients with older age, lower household income, advanced cancer stage, and presence of anxious and/or depressive symptoms for indicators of poor QOL. initiating supportive interventions before cancer treatment among OCOP cancer patients with poor QOL. • Individuals with a new diagnosis of oral cavity and oropharyngeal cancer may have poor quality of life before treatment. • Persons most at risk for having poor quality of life included those with older age, advanced cancer stage, and lower income. • Clinicians should provide supportive interventions before cancer treatment for individuals with poor quality of life. [ABSTRACT FROM AUTHOR]

A light program transmitted via blue LED light directed at one eye from individual light masks (Equilume, Kildare, Ireland) to pregnant mares from the middle of December onwards advanced the onset of foaling with birth of mature and healthy foals, but they were slightly smaller than foals from untreated control pregnancies (Lutzer et al., Domestic Anim Endocrinol 2022;78:106675). Differences, however, equilibrated within the first year of life. In this study we followed the hypothesis that light treatment of pregnant mares is without detrimental effects on body size and gonadal development of offspring after puberty. A total of 47 warmblood horses born and raised on the same stud farm to blue LED light-treated (17 males and 9 females) or control mares (14 males and 9 females) were included. At 24 months of age, their body weight, height at withers and cannon bone circumference was determined. In males, the external genitalia were examined, testis size was measured by transcutaneous ultrasound. The total testicular volume (TTV) was calculated. In females, a transrectal ultrasound examination of the genital tract was performed, the presence of corpora lutea was detected via plasma progesterone concentration and the antral follicle count (AFC) was assessed. Statistical comparisons weremade by analysis of variance (general linear model) with group (blue light vs. control) and sex (male vs. female) as between subject factors (IBM SPSS 27). Results are given as mean ± SEM. There were no group or sex differences with regard to bodyweight or height at the withers. The cannon bone circumference was larger in male vs. female horses (p<0.001) but not affected by blue light treatment during pregnancy. Testes were classified as normal in size and location (Love et al., J Reprod Fertil Suppl 1991;44:99-105) in 13 of 17 blue light and 11 of 14 control colts (n.s., chi2 analysis). The TTV was 232±14cm3 in the blue light and 218±11cm3 in the control group (n.s.). Abnormal testicular development was diagnosed in 7 males with unequal testicular size in 3 blue light and 2 control animals, both testes too small (1 blue light) or unilaterally cryptorchid (1 control). In females, no abnormalities were present. A corpus luteum (progesterone >1ng/ml) was present in 8 / 9 females from the blue light and 5 / 8 from the control group. The AFC was 20.6±2.5 in blue light and 22.1±3.7 in control females (n.s.). Results demonstrate that blue LED light treatment of pregnant mares has no detrimental effects on body and genital tract development of their offspring at two years of age. [ABSTRACT FROM AUTHOR]

Purpose Family caregivers provide vital support for patients with head and neck cancer (HNC), yet few studies have focused on HNC caregiving. Our objective was to develop and conduct initial validation of the HNC Caregiving Task Inventory, an instrument to characterize caregiving task burden in the HNC population. Methods This 5-phase instrument development project involved the conceptualization of caregiving task burden (Phase 1), initial instrument development (Phase 2), assessment of content validity through expert panel review (Phase 3), assessment of face validity through family caregiver review (Phase 4), and preliminary validation in a sample of 106 family caregivers (Phase 5). Results We identified 11 domains of the HNC caregiving role and caregiving tasks for each domain. In Phase 3, the experts deemed all tasks relevant to HNC family caregiving. No tasks were eliminated and 19 were added. In Phase 4, family caregiver feedback indicated that the tasks were comprehensive and relevant. Wording and formatting changes were made and one task was added. In Phase 5, we evaluated discrimination of responses to derive a final version comprised of 58 tasks in 11 domains. Kuder-Richardson values for domains with ≥3 items ranged from 0.65 to 0.94. Associations were generally high with the Caregiving Burden Scale, moderate with the Caregiver Reaction Assessment and Profile of Mood States-Short Form, and low or non-existent with the Preparedness Scale. Conclusion Convergent and divergent validity were supported. The HNC Caregiving Task Inventory can be used to evaluate caregiving task burden across the treatment trajectory and identify targets for intervention. [ABSTRACT FROM AUTHOR]

Purpose Measurement of head and neck external lymphedema and fibrosis (LEF) is challenging. To address this gap, we developed the Head and Neck External Lymphedema and Fibrosis (HN-LEF) Assessment Criteria. This article aimed to report preliminary data on reliability and validity of the HN-LEF Assessment Criteria. Methods Sixty head and neck cancer (HNC) patients who were ≥3-month post cancer therapy were recruited. Study measures included 1) demographic/medical data; 2) LEF physical examination completed independently by two staff members for interrater reliability (intrarater reliability completed by one of them); and 3) grayscale ultrasound examination of the head and neck skin. Reliability estimates used percent agreement and Kappa statistic. Validity was assessed via Spearman correlations of physical examination findings with ultrasound measurements. Results Fifty-one out of 60 HNC patients completed both physical examination and ultrasound assessments. Interrater reliability : 91.0% agreement (Kappa = 0.81, p < 0.001) on the presence of types of LEF; 84.9% agreement regarding the grade of LEF (Kappa = 0.70, p < 0.001) across all anatomic sites. Intrarater reliability: 96.1% agreement for type of LEF; and 91.4% agreement for grade across all sites. Ultrasound examination demonstrates characteristics and patterns for different types of LEF (particularly in the cheek, submental, and neck regions). Conclusions The study provided initial reliability and validity data for a clinician-reported tool evaluating external LEF in the HNC population. These preliminary findings demonstrate that the tool had good reliability. Associations with the ultrasound examination results demonstrate that the tool validly captures soft tissue changes at select sites. Further validation of the tool is warranted. [ABSTRACT FROM AUTHOR]

Objectives To determine rates and factors associated with referral to the California Children's Services high-risk infant follow-up (HRIF) program among very low birth weight (BW) infants in the California Perinatal Quality of Care Collaborative. Study design Using multivariable logistic regression, we examined independent associations of demographic and clinical variables, neonatal intensive care unit (NICU) volume and level, and California region with HRIF referral. Results In 2010-2011, 8071 very low BW infants were discharged home; 6424 (80%) were referred to HRIF. Higher odds for HRIF referral were associated with lower BW (OR 1.9, 95% CI 1.5-2.4; ↜ 750 g vs 1251-1499 g), higher NICU volume (OR 1.6, 1.2-2.1; highest vs lowest quartile), and California Children's Services Regional level (OR 3.1, 2.3-4.3, vs intermediate); and lower odds with small for gestational age (OR 0.79, 0.68-0.92), and maternal race African American (OR 0.58, 0.47-0.71) and Hispanic (OR 0.65, 0.55-0.76) vs white. There was wide variability in referral among regions (8%-98%) and NICUs (<5%-100%), which remained after risk adjustment. Conclusions There are considerable disparities in HRIF referral, some of which may indicate regional and individual NICU resource challenges and barriers. Understanding demographic and clinical factors associated with failure to refer present opportunities for targeted quality improvement initiatives. [ABSTRACT FROM AUTHOR]

Purpose To develop assessment criteria for evaluating and documenting status of external lymphedema and fibrosis in patients with head and neck cancer (HNC). Methods This was a two-phase instrument development study. In Phase I, initial assessment criteria for head and neck external lymphedema and fibrosis were generated based on a conceptual framework developed to describe the continuum of lymphedema – fibrosis in HNC patients. The initial Head and Neck External Lymphedema and Fibrosis (HN-ELAF) Assessment Criteria with three components were revised based on expert feedback. In Phase II, a pilot study was conducted to evaluate the revised assessment criteria through direct physical examination of 30 HNC patients with facial swelling and/or scar-like tissue >3 months post-treatment. The following statistical methods were used to evaluate interrater reliability in Phase II: simple percent agreement, the Kappa statistic, and the concordance correlation coefficient. Then, a post-test revision was made to further modify the tool based on the results of the pilot test. Results In Phase I, the initial HN-ELAF was revised including deleting Grade 0 (subclinical disease) and two components (i.e., symptoms and functional impairments). The revised HN-ELAF Assessment Criteria demonstrated good content/face validity. In Phase II, the assessment criteria had an acceptable interrater reliability, e.g., 83% exact agreement on grading lymphedema and fibrosis severity; and kappa = 0.75 ( p < .001). The assessment criteria were further modified including three dimensions: type, severity, and anatomical sites of lymphedema and fibrosis. Conclusions Validation of the modified HN-ELAF Assessment Criteria in larger sample sizes is ongoing. [ABSTRACT FROM AUTHOR]

• Height of neonates born to blue LED light-treated mares were lower than in controls. • Height differences decreased over time and were no longer evident at 10 months of age. • The guard hair was shorter in foals born to treated mares compared to controls at birth. • Differences in guard hair length did not persist beyond the age of 2 months. • Blue LED light treatment of pregnant mares is not detrimental to foal development. In horses, blue LED light directed at one eye of pregnant mares shortens gestation length and results in the birth of foals with lower wither heights, similar weight and reduced hair length compared to controls. In this study, we have therefore analysed postnatal development of foals born to either blue LED light-treated (n = 20) or control mares (n = 20). Size, weight and hair coat changes were determined for 1 year and heart rate, heart rate variability (HRV) and selected haematology parameters for 1 month. Haematocrit decreased (P <.001) and leukocyte and lymphocyte counts increased (P <.001) but none of the parameters differed between groups. Heart rate (P <.001) and HRV (P <.01) increased until day 6 but did not differ between groups, indicating that foals born to blue LED light-treated mares were mature and healthy. The guard hair was shorter in foals born to treated mares compared to control foals at birth (P <.001) but no differences in hair coat length were observed beyond the age of 2 months. At birth and 6 days thereafter, wither height (P <.01) and elbow to carpus distance (P <.05) of control foals were increased relative to foals born to blue LED light-treated mares. Height differences decreased over time and and for elbow-to-carpus distance there was a time x group interaction (P <.005) In conclusion, blue LED light treatment of pregnant mares is without detrimental effects on postnatal foal growth and development. [ABSTRACT FROM AUTHOR]

Summary: Objectives: Patients with head and neck cancer have a high potential for body image disturbance due to highly visible disfigurement resulting from both the primary cancer and its treatment. The purpose of this review is to examine the conceptual framework for understanding body image in patients treated for head and neck cancer, present the current state of the science, discuss measurement issues, and identify areas for future investigation. A novel hypothetical model based on ongoing work is proposed, and it asserts that head and neck cancer therapy results in two main tumor/treatment related physical effects: (1) disfigurement and (2) dysfunction. In this model, personal, social and environmental factors moderate the effect of dysfunction and disfigurement on body image. Results: A search of the empirical literature revealed a paucity of data on body image in head and neck cancers including a lack of longitudinal data as well as a lack of data on the relationship between body image disturbance and other psychosocial variables such as depression, anxiety, and social isolation over the course of treatment and throughout recovery. Additionally, the need for measurement tools specifically developed for the assessment of body image in head and neck cancer patients was identified. Conclusion: Prospective longitudinal studies that define the trajectory of body image issues and the mediating and moderating factors associated with body image will allow researchers to design targeted interventions to limit body image disturbance and thereby improve quality of life in patients with head and neck cancer. [Copyright &y& Elsevier]

Highlights: [•] We describe immunosuppression in renal transplantation from a mechanistic standpoint. [•] We examine in detail drugs clinically used for maintenance immunosuppression in the United States. [•] From recent trials, steroid-minimization and calcineurin-minimization strategies are effective with reduction in characteristic side effects. [•] Established adverse events remain a challenge and continued surveillance is needed for emerging adverse effects. [ABSTRACT FROM AUTHOR]

The circadian system provides animals with a means to adapt their internal physiology to the constantly changing environmental stimuli that exist on a rotating planet. Light information is translated into molecular timing mechanisms within pacemaker cells of the mammalian hypothalamic suprachiasmatic nucleus (SCN) via transcriptional-translational feedback loops. Humoral and neural outputs from this 'master' clock result in circadian rhythms of physiology and behaviour. The larger circadian system involves SCN synchronisation of cellular clocks throughout the organism such that individual organs can adapt their specific function to the time of day. In the short history of this scientific field, the vast majority of mammalian chronobiological research has been conducted using small laboratory animals. This review examines what these studies have revealed, discusses how recent chronobiological findings in the horse compare to what is known and highlights how the principles of circadian biology are applicable to equine husbandry and veterinary care. [ABSTRACT FROM AUTHOR]

Abstract: The objective of this study was to estimate health care-resource utilization in head and neck cancer (HNC) patients. This was a prospective, longitudinal, multicenter, noninterventional study of mucositis in patients receiving radiation with or without chemotherapy for HNC. Mouth and throat soreness and functional impairment were measured using the Oral Mucositis Weekly Questionnaire-HNC. Resource utilization data were obtained from patient interviews and recorded from the patient''s medical chart. Seventy-five patients were enrolled from six centers. Fifty (67%) patients received concurrent chemoradiation therapy; 34 (45%) received intensity-modulated radiation therapy. Over the course of treatment, 57 (76%) patients reported severe mouth and throat soreness. Pain and functional impairment because of mouth and throat soreness increased during the course of therapy despite the use of opioid analgesics in 64 (85%) of the patients. Complications of radiation therapy resulted in increased patient visits to physicians, nurses, and nutritionists. Thirty-eight (51%) patients had a feeding tube placed. Twenty-eight patients (37%) were hospitalized, five of whom were hospitalized twice; of the 33 admissions, 10 (30%) were designated as secondary to mucositis by their treating physician. Mean length of hospitalization was 4.9 days (range: 1–16). This study demonstrates that mucositis-related pain and functional impairment is associated with increased use of costly health resources. Effective treatments to reduce the pain and functional impairment of oral mucositis are needed in this patient population. [Copyright &y& Elsevier]

Abstract: The treatment paradigm for locally advanced head and neck cancers has evolved over the past two decades as the role of chemotherapy has been substantiated by clinical trials. Presently, concurrent chemoradiation is considered a standard treatment option for patients with resectable head and neck tumors desiring an organ preservation approach, as well as for patients with locally advanced nasopharyngeal cancers and patients in the postoperative setting who are at high risk for recurrence. The addition of a taxane to induction chemotherapy appears to improve efficacy over cisplatin and 5-FU. Targeted biologic therapies such as the monoclonal antibody Cetuximab has demonstrated efficacy with radiation that appear comparable to chemoradiation combinations and has a favorable toxicity profile. This review will discuss key clinical trials supporting the current standard of care. Emerging new technologies such as intensity modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT) will also be reviewed. Functional assessments and quality of life issues will be addressed. [Copyright &y& Elsevier]

Dysphagia is commonly seen in patients undergoing radiation-based therapy for locally advanced squamous carcinoma of the head and neck. Within 4 to 5 weeks of starting therapy, patients develop mucositis, radiation dermatitis, and edema of the soft tissues. Resulting pain, copious mucous production, xerostomia, and tissue swelling contribute to acute dysphagia. As the acute effects resolve, late effects including fibrosis, lymphedema, and damage to neural structures become manifest. Both acute and late effects result in adverse sequelae including aspiration, feeding tube dependence, and nutritional deficiencies. Early referral for evaluation by speech-language pathologists is critical to (1) ensure adequate assessment of swallow function, (2) determine whether further testing is needed to diagnose or treat the swallowing disorder, (3) generate a treatment plan that includes patient education and swallow therapy, (4) work with dieticians to ensure adequate and safe nutrition, and (5) identify patients with clinically significant aspiration. [Copyright &y& Elsevier]

Diabetic kidney disease (DKD) occurs in 20% to 40% of patients with diabetes mellitus and is the leading cause of chronic kidney disease and end-stage renal disease in the United States. Despite the American Diabetes Association and the National Kidney Foundation advocating annual screening of diabetic patients, DKD remains underdiagnosed in the diabetic population. Early recognition of diabetic nephropathy by health care professionals is vital for proper management. The presence of microalbuminuria is particularly important as even low levels of dipstick-negative albuminuria indicate early disease long before a diminished glomerular filtration rate and are associated with an elevated cardiovascular disease risk. Like all forms of chronic kidney disease, DKD causes a progressive decline in renal function that, despite current treatment strategies, is largely irreversible. Many patients with DKD might be expected to develop end-stage renal disease, but many more patients will likely die of a cardiovascular event before renal replacement therapy is needed. Therefore, a renewed focus on cardiovascular risk factor reduction and a timely nephrology consultation with an emphasis on patient education is essential to proper DKD management. [ABSTRACT FROM AUTHOR]

Summary: Chronic kidney and end-stage renal disease are important complications of HIV disease and treatment. African Americans with HIV infection are at significantly increased risk for development of chronic kidney disease and for progression to end-stage renal disease. Survival of HIV-positive patients on dialysis has improved dramatically since the introduction of combination antiretroviral therapy, with hemodialysis and peritoneal dialysis appearing to offer similar survival. Renal transplant has been shown to be successful in HIV-positive patients and emerging data suggest a survival benefit over remaining on dialysis, despite data indicating an increased incidence of acute rejection. Immunosuppression dosing is complicated by interactions with antiretroviral therapy, and drug levels must be followed closely. Experience to date suggests that HIV-positive transplant recipients are best cared for in academic institutions with multi-disciplinary teams devoted to their care. [ABSTRACT FROM AUTHOR]

Abstract: There has been an abundance of publications describing genetic variability in molecules affecting innate and adaptive immunity, pharmacogenetics, and other nonimmunological factors like the renin-angiotensin aldosterone system, coagulation, and fibrosis markers. Studies indicated some associations between polymorphisms in these candidate genes with outcomes in organ transplantation and underlined a potential role of genetic variability in transplantation. To be clinically applicable, large prospective studies must be performed to better define the potential benefits of genotyping on these genetic markers and clinical outcomes. The purposes of this review are to summarize recent data describing associations of polymorphisms in both immunological and nonimmunological molecules with transplant outcomes, with a particular emphasis on renal transplantation, and discuss limitations and clinical implications. [Copyright &y& Elsevier]

Abstract: Quality of life (QOL) has become an increasingly important outcome measure for patient''s undergoing treatment for a wide array of illnesses. QOL is a global construct that reflects a patient''s general sense of well being. It is by definition multi-dimensional and reflective of the patient''s point of view. Health related issues are among the many factors that may influence QOL. Since head and neck cancer (HNC) affects structures that are critical for normal functions such as speech and swallowing, and treatment may lead to deformities that adversely impact psychosocial functioning, there is particular interest in assessing QOL in this cohort of patients. In order to interpret the HN QOL literature, it is important to have an understanding of the significance and limitations of QOL assessments in the head and neck patient population as well as an appreciation for the currently available measurement tools. Unfortunately, the HNC QOL literature has many limitations including: small sample size, lack of prospective data and poor study design. None-the-less, important insights can be obtained by review of the current literature. First, it is important that QOL studies be reported in such a way as to provide clinically meaningful data to clinicians. Linking measurements with clinical benchmarks is one way to accomplish this goal. In addition, both general and HNC specific measures are needed in order to provide a comprehensive assessment of global health and tumor specific issues. In general, QOL declines immediately after therapy and returns toward baseline by 1 year. Several factors have been identified that may predict for worse QOL outcomes including: the presence of a feeding tube, co-morbid disease, tracheotomy, site and stage. Data correlating QOL with functional outcome and symptom burden fails to demonstrate a consistent relationship. This may be attributed to methodological issues in study design or the patient''s ability to adapt to functional and symptom control problems. Whether routine use of QOL measures in the clinical setting is beneficial to patients has yet to be determined. Further studies are warranted as currently available instruments may not be valid for repeated clinical use. [Copyright &y& Elsevier]

Purpose: To determine efficacy and toxicities of postoperative concurrent chemoradiation using docetaxel in high-risk head and neck cancer. Methods and Materials: High-risk patients were enrolled 2–8 weeks after surgery. Treatment included 60 Gy for 6 weeks with weekly docetaxel 25 mg/m2 and erythropoietin alpha 40,000 U for hemoglobin ≤12 g/dL. Primary endpoints included locoregional control (LC), disease-free survival (DFS), and patterns of failure (POF). Secondary endpoints were toxicity and quality of life. Results: Eighteen patients were enrolled (14 male, 4 female), aged 24–70 years (median, 55 years). Primary site included oropharynx = 7, oral cavity = 8, hypopharynx = 1, and larynx = 2. Pathologic American Joint Committee on Cancer Stage was III = 3 patients, IV = 15 patients. High-risk eligibility included ≥2 positive lymph nodes = 13, extracapsular extension = 10, positive margins = 8 (11 patients with two or more risk factors). Docetaxel was reduced to 20 mg/m2/week after 5 patients had prolonged Grade 3 or higher mucositis. Overall, number of doses delivered was 2 of 6 = 1, 3 of 6 = 2, 4 of 6 = 2, 5 of 6 = 4, 6 of 6 = 9 patients. With median follow-up of 30 months (range, 5–66), 10 (56%) patients are alive and have no evidence of disease (NED); POF: three local recurrences (two with distant) and 1 distant only. One-year survival was 76%, median PFS and DFS had not been reached. Three-year LC was 82%. No Grade 3 or higher late toxicities were observed, although a few cases of prolonged mucositis and taste loss (>3 months) were seen, particularly at 25 mg/m2/week. Conclusion: Postoperative radiation therapy with weekly docetaxel 20 or 25 mg/m2/week for high-risk postoperative head and neck cancer caused intolerable mucosal toxicity, prompting early study termination. Further studies should consider 15 mg/m2. Actuarial 3-year LC is 82%, similar to cisplatin-based chemoradiation regimens. Distant metastasis remains an important issue requiring additional systemic interventions. [Copyright &y& Elsevier]

Background: While many studies have investigated cognitive impairments in patients after coronary artery bypass graft surgery, very few have closely evaluated presurgical cognitive functioning of bypass candidates. Methods: A battery of neuropsychologic tests was administered to a consecutive series of patients listed for bypass surgery (n = 109). Cognitive function of bypass candidates was compared with that of a healthy control group (n = 25) and published test norms. Results: Cognitive test scores in candidates for bypass were significantly lower than those of the control group on tests of attention, information processing speed, and verbal memory. Additionally, bypass candidates’ cognitive test scores were significantly reduced compared with expected values derived from validated test norms, on all but one cognitive test. Conclusions: Cognitive performances of candidates for bypass were significantly lower than those of a healthy control group and published cognitive test norms. [Copyright &y& Elsevier]

Background: Cognitive difficulties have been reported after coronary artery bypass graft surgery using cardiopulmonary bypass. However, the cognitive benefit of off-pump surgery remains unclear. Methods: Consecutively listed candidates for elective bypass were randomly assigned to either off-pump or on-pump techniques (n = 107). A battery of 11 standardized neuropsychological tests was administered before surgery, and again at 2 and 6 months after surgery. The two groups were compared using a range of statistical procedures, including growth modeling. Results: There were no significant differences in cognitive test scores between the off-pump and on-pump groups using t tests at any of the time points. There were no differences between off-pump and on-pump groups in the incidence of cognitive deficits at 2 months or 6 months, with the exception that fewer off-pump patients showed impairment on one test of verbal fluency at 6 months. When the pattern of cognitive change over time between the two groups was compared using sophisticated modeling techniques, the two groups were again comparable, except for results on the test of verbal fluency, in which the off-pump group showed more rapid postsurgical cognitive gains than the on-pump group. Conclusions: The off-pump group appears to be generally comparable to the on-pump group in terms of short-term and long-term postsurgical neurocognitive outcomes. [Copyright &y& Elsevier]

Head and neck cancer (HNC) and its treatment are associated with significant symptom burden and functional impairment. HNC patients must engage in intensive and complex self-management protocols to minimize acute and late treatment effects. Self-management among HNC patients is understudied due to the limited availability of disease-specific self-management measures. This article describes the initial psychometric testing of the HNC Patient Self-Management Inventory (HNC-PSMI), an instrument that characterizes self-management tasks in the HNC population. A cross-sectional survey design was used. One hundred HNC patients completed the HNC-PSMI, the Vanderbilt Head and Neck Cancer Symptom Survey plus General Symptom Survey, and the Profile of Mood States-Short Form. To evaluate the psychometric properties of the HNC-PSMI, the relevance of items, internal consistency of domain item responses, and the direction and strength of associations between domain scores and other measures were examined. There was variability both in the number of self-management tasks performed overall and in each domain as well as in the reported difficulty completing those tasks. Kuder-Richardson values for domains with > 3 items ranged from 0.61 to 0.86. Hypothesized associations were supported. Overall, the psychometric properties for the HNC-PSMI were acceptable. The HNC-PSMI can be used to advance an understanding of self-management requirements and challenges in HNC patients. • Head and neck cancer patients must complete intensive self-management protocols to prevent and manage treatment toxicities. • Self-management in head and neck cancer patients is understudied. • We conducted preliminary psychometric testing of the Head and Neck Cancer Patient Self-Management Inventory (HNC-PSMI). • Reliability and validity of the HNC-PSMI were supported. • The HNC-PSMI can be used to develop a better understanding of self-management in head and neck cancer patients. [ABSTRACT FROM AUTHOR]

The study aimed to describe the prevalence, severity, and trajectory of internal lymphedema, external lymphedema, and fibrosis in patients with oral cavity or oropharyngeal (OCOP) cancer. One hundred twenty patients with newly diagnosed OCOP cancer were enrolled in a prospective longitudinal study. Recruitment was conducted at a comprehensive medical center. Participants were assessed pretreatment; at end of treatment; and at 3, 6, 9, and 12 months post–cancer treatment. Validated clinician-reported measures and computed tomography were used to assess the study outcomes. Seventy-six patients who completed the 9- or 12-month assessments were included in this report. Examination of the external lymphedema and fibrosis trajectories revealed that the total severity score peaked between the end of treatment and 3 months posttreatment and then decreased gradually over time but did not return to baseline by 12 months posttreatment (P <.001). The longitudinal patterns of severity scores for patients treated with surgery only or with multimodality therapy were similar. Examination of the internal swelling trajectories revealed that all patients experienced a significant increase in sites with swelling immediately posttreatment. For patients treated with surgery only, swelling was minimal and returned to baseline by 9 to 12 months posttreatment. Patients receiving multimodal treatment experienced a gradual decrease in number of sites with swelling during the 12-month posttreatment period that remained significantly above baseline (P <.05). Computed tomography revealed different patterns of changes in prevertebral soft tissue and epiglottic thickness in the surgery-only and multimodality treatment groups during the 12-month posttreatment period. There were minimal changes in thickness in both regions in the surgery-only group. Patients with multimodal treatment had significant increases in thickness in both regions 3 months posttreatment that remained thicker at 12 months than at baseline (P <.001). Lymphedema and fibrosis are the common complications of OCOP cancer therapy. Routine assessment, monitoring, and timely treatment of lymphedema and fibrosis are critical. [ABSTRACT FROM AUTHOR]

Purpose Studies of familial coping with a child's chronic condition have highlighted psychological distress; family functioning; and quality of life; as issues that demand coping strategies. There are conflicting findings on impact and coping and a paucity of information about the specific coping challenges for parents of a child with heart disease, with few qualitative studies in this area. The purpose of the study was to explore the way parents coped with their child's heart condition as it impacted on different domains of family functioning. Design and Method In this qualitative study, interviews were held with 17 parents attending a pediatric hospital-based family support program in 2015. Fifteen of the 17 children's conditions were classified as “major”. Domains covered in the interviews included: coping challenges posed at different stages of the illness trajectory, parenting, condition management, transitions, psychological impact, social support and coping strategies. Interview transcripts were coded thematically. Results Multiple points of stress and challenges to coping were identified: coping with the diagnosis, including consideration of termination; dealing with the challenges facing their child; coping with parenting including co-parenting issues; the role of social support in coping; and identification of adaptive and maladaptive coping behaviours. Conclusion A large range of positive coping strategies were identified, as was the need for coping-focused psychological support throughout the parents' and children's journey. Practice implications. The strategies identified have formed the basis of a manualised intervention for these parents. [ABSTRACT FROM AUTHOR]

The authors reviews the results of various studies on circadian rhythm including those of Oishi et al. in 1998, O'Neill and Reddy in 2011 and Murphy et al. in 2011. She underscores the importance of the experiments of Doctor Keitaro Ohmori and colleagues of the Tokyo University of Agriculture and technology which found that the Per1 gene rhythmically oscillates in canine blood cells. The author stresses the importance of such studies in the care and administration of drugs for domestic species.