Aim: Radiation-induced mucositis is an early effect of head and neck radiotherapy. Mucositis can cause ulcers, and patients may experience pain and dysphasia which need treatment. The aim of this study is to evaluate the effect of pure natural honey on radiation induced mucositis. Methods and Materials:In this randomized single blind (examiner blind) clinical trial 40 patients with head and neck cancer requiring radiation to the oropharyngeal mucosa were randomly assigned to two groups. Twenty patients assigned to the study group received honey, while both the study and control groups received standard head and neck radiation therapy based on a standard protocol. In the study group patients were instructed to take 20 ml of honey 15 minutes before radiation therapy, then again at intervals of 15 minutes and six hours after radiation. In the control group patients were instructed to rinse with 20 ml of saline before and after radiation. Patients were evaluated weekly for progression of mucositis using the Oral Mucositis Assessing Scale (OMAS). Data were analyzed using the independent t-test, Mann-Whitney, and Friedman tests.Results: A significant reduction in mucositis among honey-received patients compared with controls (p=0.000) occurred. Conclusion:Within the limits of this study the results showed the application of natural honey is effective in managing radiation induced mucositis. Abstract © Seer PublishingClinical Significance: Natural honey is a product with rich nutritional qualities that could be a pleasant, simple, and economic modality for the management of radiation mucositis.

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This study was designed to determine the effect of Calendula officinalis flowers extract mouthwash as oral gel on radiation-induced oropharyngeal mucositis (OM) in patients with head-and-neck cancer. Forty patients with neck and head cancers under radiotherapy or concurrent chemoradiotherapy protocols were randomly assigned to receive either 2% calendula extract mouthwash or placebo (20 patients in each group). Patients were treated with telecobalt radiotherapy at conventional fractionation (200 cGy/fraction, five fractions weekly, 30–35 fractions within 4–7 weeks). The oropharyngeal mucositis was evaluated by two clinical investigators (a radiation oncologist and a dentist), using the oral mucositis assessment scale (OMAS). Trying to find out the possible mechanism of action of the treatment, total antioxidant, polyphenol and flavonoid contents, and quercetin concentration of the mouth wash were measured. Calendula mouthwash significantly decreased the intensity of OM compared to placebo at week 2 (score: 5.5 vs. 6.8, p = 0.019), week 3 (score: 8.25 vs. 10.95, p < 0.0001) and week 6 (score: 11.4 vs. 13.35, p = 0.031). Total antioxidant, polyphenol and flavonoid contents and quercetin concentration of the 2% extract were 2353.4 ± 56.5 μM, 313.40 ± 6.52 mg/g, 76.66 ± 23.24 mg/g, and 19.41 ± 4.34 mg/l, respectively. Calendula extract gel could be effective on decreasing the intensity of radiotherapy- induced OM during the treatment and antioxidant capacity may be partly responsible for the effect.

AimsAcute myeloblastic leukemia (AML) is the most common type of acute leukemia in adults. Despite numerous treatment strategies including chemotherapy and radiotherapy, a large number of patients do not respond to treatment and experience relapse. The main problem of these patients is the development of resistance to anti-cancer drugs. Therefore, any endeavor to reduce drug resistance in these patients is of high priority. In general, several mechanisms such as changes in drug metabolic pathways, drug inactivation, drug target alterations and reduced drug accumulation in the cells contribute to drug resistance of cancer cells. In this context, evidence suggests that exosomes could reduce drug resistance by removing drugs from their parent cells. In the present study, we aimed to investigate the effects of exosome release inhibition on the resistance of U937 cells to PEGylated liposomal doxorubicin (PLD).Main MethodsIn order to find a suitable ABCG2 (ATP-binding cassette sub-family G member 2) transporter substrate, virtual screening was performed among a list of drugs used in leukemia and PLD was selected. U937 cells were treated with PLD with/without co-treatment with the exosome release inhibitor, GW4869. Released exosomes within different study groups were isolated and characterized to determine the differences between groups. Doxorubicin presence in the isolated exosomes was also measured by high performance liquid chromatography (HPLC) to confirm drug export through the exosomes. Finally, the effect of exosome inhibition on the cytotoxicity of PLD on U937 cells was determined using different cytotoxicity assays including the standard lactate dehydrogenase (LDH) release assay and the flow cytometric analysis of apoptotic and non-apoptotic cell death.Key FindingsGW4869 treatment caused a significant decrease in the exosome release of U937 cells compared to the untreated cells, as evidenced by the reduction of the protein content of the isolated exosomes (P&lt;0.05). Co-treatment with GW4869 significantly increased cytotoxic cell death in the groups treated with 0.5 and 1 µM PLD, compared to the same groups without GW4869 co-treatment (P&lt;0.05). Interestingly, co-treatment with GW4896 and 0.5 µM PLD was enough to induce the same cytotoxic effect as that of the sole 1 µM PLD group.SignificanceOur findings showed that U937 cells increase their resistance against the cytotoxic effects of PLD through the exosome-mediated expelling of the drug. Inhibition of exosome release could prevent PLD efflux and consequently increase the vulnerability of the U937 cells to the cytotoxic effects of PLD. Our results along with prior studies indicate that the integration of exosome release inhibitors into the common PLD-containing chemotherapy regimens could significantly lower the required concentrations of the drug and consequently reduce its associated side effects. Further studies are warranted to identify clinically safe inhibitors and investigate their clinical efficacy.

Background. The treatment of candidiasis infections is an important problem in the health care system. This study aimed to investigate the in vitro effect of lavender essential oil and clotrimazole on isolated C. albicans from vaginal candidiasis. Materials and Methods. In this clinical trial, C. albicans isolated from the vaginal discharge samples was obtained. Results. The pairwise comparison showed that lavender and clotrimazole had a significant difference; this difference in the lavender group was lower than clotrimazole. But, after 48 hours, there was no difference seen between groups. There was a significant difference between clotrimazole and DMSO groups. Comparing the changes between groups based on the same dilution, at 24 h and 48 h in clotrimazole group, showed a significant difference two times in the fungal cell count that its average during 48 h was less than 24 h. A significant difference was observed between the two periods in lavender group, only at the dilutions of 1/20 and 1/80. The average fungal cell count after 48 h was also lower in lavender group. Conclusions. Given that the lavender has antifungal activity, this can be used as an antifungal agent. However, more clinical studies are necessary to validate its use in candida infection.

BackgroundRecurrent aphthous stomatitis (RAS) is one of the most common painful oral lesions of which there is no certain treatment.ObjectiveThe aim of this study was to determine the effect of Chitosan mouthwash 0.5% on RAS.MethodsThis randomized double-blind crossover clinical trial was conducted at a dental school in Babol, Iran, from 2015 to 2016. Twenty patients with a history of minor aphthous stomatitis were entered into this study. All patients were initially monitored in the first episode without treatment, and then were randomly treated in three other episodes with Chitosan, Triamcinolone or Biogel mouthwashes. The ulcer size and pain intensity by using visual analogous score (VAS) were recorded in each episode. Data were analyzed by ANOVA and Tukey test. We used SPSS version 20 to analyze data.ResultsThe mean ulcer size on the fifth day (p=0.026, p=0.042, respectively) and VAS on the third and fifth days (p=0.011, p=0.013, respectively) were significantly less in Triamcinolone and Chitosan groups than Biogel and the no treatment episode. There were no significant differences between Chitosan and Triamcinolone groups in the average ulcer size and pain intensity in all the examination days.ConclusionsChitosan mouthwash is effective on pain relief and reducing ulcer size of minor aphthous stomatitis and this effect is almost the same as Triamcinolone mouthwash.Clinical trial registrationThe study was registered and approved by Iranian Registry of Clinical Trials (http://www.irct.ir) with IRCT ID: IRCT2015030718753N2.FundingThe study was funded by Deputy of Research and Technology of Babol University of Medical Sciences (ref. no.: 9133625).

Background and Objective. 5-Fluorouracil is one of the most common chemotherapeutic agents used in the treatment of solid tumors. 5-Fluorouracil-associated cardiotoxicity is the second cause of cardiotoxicity induced by chemotherapeutic drugs after anthracyclines. Colchicine is a strong anti-inflammatory drug used to prevent and treat acute gout and treat familial Mediterranean fever. And also, its protective effects on cardiovascular disease have been reported in various studies. The current study is aimed at appraising the effect of colchicine on 5-fluorouracil-induced cardiotoxicity in rats. Methods. Twenty male Wistar rats were divided into four groups as follows: control, 5-fluorouracil, colchicine (5 mg/kg), and 5-fluorouracil+5 mg/kg colchicine. Cardiotoxicity was induced with an intraperitoneal injection of a single dose of 5-fluorouracil (100 mg/kg). The control group received normal saline, and the treatment groups received colchicine with an intraperitoneal injection for 14 days. Findings. 5-Fluorouracil resulted in significant cardiotoxicity represented by an increase in cardiac enzymes, malondialdehyde levels, cyclooxygenase-2 and tumor necrosis factor-alpha expression, cardiac enzymes, and histopathological degenerations. 5-Fluorouracil treatment also decreased body weight, total antioxidant capacity and catalase values, blood cells, and hemoglobin levels. In addition, 5-fluorouracil disrupted electrocardiographic parameters, including increased elevation in the ST segment and increased QRS duration. Treatment with colchicine reduced oxidative stress, cardiac enzymes, histopathological degenerations, and cyclooxygenase-2 expression in cardiac tissue, improved electrocardiographic disorders, and enhanced the number of blood cells and total antioxidant capacity levels. Moreover, body weight loss was hampered after treatment with colchicine. Our results demonstrated that treatment with colchicine significantly improved cardiotoxicity induced by 5-fluorouracil in rats.

Objective and background: One of the most significant side effects of radiotherapy for head and neck cancers is xerostomia as a result of salivary gland damage. Considering pharmacological effects of propolis, we evaluated its protective effect on salivary glands subjected to radiotherapy of head and neck cancer patients. Materials and methods:Twenty-one male albino rats (8-11 W, 190 ± 5 gm) were divided into three groups of seven animals. Scintigraphy was performed in all the groups. Then groups 1 (S) and 2 (SR) received normal saline injections and group 3 (PR) received propolis injection over 3 days. After that groups 2 and 3 were exposed to gamma radiation and all the rats underwent scintigraphic assessment on third day and 70th day after irradiation. The lips and tongues of rats in groups 2 and 3 were examined for mucositis daily in first 10 days. At the end, the parotid glands of all rats were examined histologically.Results: Scintigraphy results of third and 70th day after irradiation showed statistically significant differences between PR and SR as well as SR and S. However, there was no significant difference between the PR and S groups. Histopathologic assessment demonstrated significant difference between SR, PR and S. Original research Conclusion:These results suggest that propolis has protective effects on salivary gland function in animal models whilst it did not prevent radiation-induced histologic changes in tissues. Further investigations are needed to elucidate mechanisms of propolis actions.Clinical significance: Regarding to the results of this study, propolis may be useful in reduction xerostomia due to radiation to salivary glands and may be helpful for head and neck cancer patients.