orabase and Breast-Neoplasms

Full healing was achieved within eight weeks in a malignant fungating wound using the principles of the TIME paradigm. This concept appears to provide a structured and systematic approach for managing such non-healing wounds.

Topics: Adult; Bandages, Hydrocolloid; Breast Neoplasms; Carboxymethylcellulose Sodium; Clinical Protocols; Drug Combinations; Exudates and Transudates; Female; Gelatin; Humans; Humidity; Infection Control; Inflammation; Metronidazole; Nursing Assessment; Odorants; Palliative Care; Patient Selection; Pectins; Polyenes; Referral and Consultation; Skin Care; Skin Neoplasms; Wound Healing; Wound Infection

Restricted shoulder mobility is a major upper extremity dysfunction associated with lower quality of life and disability after breast cancer surgery. We hypothesized that a poloxamer and sodium alginate mixture (Guardix-SG®) applied after axillary lymph node dissection (ALND) would significantly improve shoulder range of motion (ROM) in patients with breast cancer.. We conducted a double-blind, randomized, prospective study to evaluate the clinical efficacy and safety of Guardix-SG® for the prevention of upper extremity dysfunction after ALND. The primary outcome measure was shoulder ROM at baseline (T0) and 3 (T1), 6 (T2), and 12 months (T3) after surgery. Secondary outcome measures were the Disabilities of the Arm, Shoulder, and Hand score(DASH), pain associated with movement, which was assessed using a numeric rating scale, and lymphedema assessed using body composition analyzer.. A total of 83 women with breast cancer were randomly assigned to either the Guardix-SG® group or the control group. In the Guardix-SG® group (n = 37), Guardix-SG® was applied to the axillary region after ALND. In the control group (n = 46), ALND was performed without using Guardix-SG®. Comparing ROM for shoulder flexion before surgery (178.2°) and 12 months after surgery (172.3°), that was restored 12 months after surgery in the Guardix-SG® group, and there was no statistically significant difference between that at before surgery and 12 months after surgery (p = 0.182). No adverse effect was observed in either group.. The results of this study have shown that Guardix-SG® help improve shoulder ROM without causing adverse effects in patients who underwent breast cancer surgery. However, there was no statistically significant difference from the control group. A further large-scale study is needed to obtain a more conclusive conclusion.. CRISKCT0003386; https://cris.nih.go.kr (20181207).

Topics: Axilla; Breast Neoplasms; Carboxymethylcellulose Sodium; Case-Control Studies; Double-Blind Method; Drug Combinations; Female; Follow-Up Studies; Humans; Hyaluronic Acid; Lymph Node Excision; Lymphatic Metastasis; Mastectomy; Middle Aged; Pilot Projects; Poloxamer; Prognosis; Prospective Studies; Range of Motion, Articular; Shoulder; Surface-Active Agents

The incidence of surgical site infections (SSIs) after breast cancer surgery is relatively high; ranging from 3 to 19%. The role of wound dressings in the prevention of SSI after breast cancer surgery is unclear. This study compares a silver carboxymethylcellulose dressing (AQUACEL Ag Surgical (Aquacel) with standard wound dressing in SSI rate after breast cancer surgery.. A single-centre randomized controlled trial among women ≥18 years, diagnosed with breast cancer, undergoing breast conserving or ablative surgery, was conducted in a combined in and outpatient setting. The intervention was the use of Aquacel, compared with standard gauze dressing. Primary outcome measure was SSI following CDC criteria.. A total of 230 patients were analysed: 106 in the Aquacel group and 124 controls. Seven patients (6.6%) developed SSI in the Aquacel group and 16 patients (12.9%) in the control group (RR 0.51 [95% Confidence Interval (CI): 0.22-1.20]; p = 0.112; adjusted OR 0.49 [0.19-1.25] p = 0.135)). Unplanned exploratory subgroup analysis of breast conserving surgery patients showed that SSI rate was 1/56 (1.8%) in the Aquacel group vs. 7/65 (10.8%) in controls; adjusted OR 0.15 [0.02-1.31] p = 0.087. The Aquacel group showed better patient satisfaction (median 8 vs. 7 on a Numerical Rating Scale, p = 0.006), fewer dressing changes within 48 hours(adjusted OR 0.12 [0.05-0.27] p<0.001), fewer re-operations (0% vs. 3.2%, p = 0.062), and lower mean wound-related treatment costs, both in a high (€265.42 (SD = 908) vs. €470.65 (SD = 1223) [p<0.001]) and low (€59.12 (SD = 129) vs. €67.55 (SD = 172) [p<0.001]) attributable costs of SSI model.. In this randomized controlled trial in women undergoing surgery for breast cancer, the use of AQUACEL Ag Surgical wound dressing did not significantly reduce the occurrence of SSIs compared to standard gauze dressing. The use of Aquacel resulted in significantly improved patient satisfaction, reduced dressing changes and reduced wound-related costs.. www.trialregister.nl: NTR5840.

Topics: Bandages; Breast Neoplasms; Carboxymethylcellulose Sodium; Female; Humans; Mastectomy; Middle Aged; Surgical Wound Infection

Restricted shoulder mobility is a major upper limb dysfunction related to lower quality of life and disability after breast cancer surgery. We hypothesized that sodium hyaluronate-carboxymethyl cellulose (HA-CMC) applied to the surface of the pectoralis major muscle after mastectomy would significantly reduce pain and improve range of motion (ROM) of the shoulder in breast cancer patients. We conducted a double-blind, randomized controlled study to evaluate the clinical efficacy and safety of HA-CMC in the prevention of upper limb dysfunction after total mastectomy (TM). A total of 99 women with breast cancer were randomly assigned to one of two groups. In the HA-CMC group (n = 50), a mixed HA-CMC was applied to the surface of the pectoralis major and serratus anterior muscle after TM. In the control group (n = 49), TM was performed without the use of HA-CMC. The primary outcomes were ROM of the shoulder and motion-related pain assessed using a numeric rating scale measured before surgery (T0) and 3 (T1) and 6 months (T2) after surgery. Secondary outcomes included disabilities of the arm, shoulder, and hand (DASH) and the pectoralis minor length test. Compared with the control group, the HA-CMC group showed greater reductions in postoperative restriction of total shoulder ROM (sum of flexion and horizontal abduction) at 3 months (10.20°, P = 0.004). Mean pain levels related to flexion and horizontal abduction were significantly lower in the HA-CMC group (-1.32 and -0.93, respectively, P < 0.05). The DASH score was lower (-4.94; P = 0.057) in the HA-CMC group at T2. No adverse effect was observed in either group. These results provide evidence that HA-CMC may provide pain relief and improve ROM of the shoulder without causing adverse effects. The effect on pectoralis tightness should be investigated in further studies.

Topics: Adult; Aged; Breast Neoplasms; Carboxymethylcellulose Sodium; Double-Blind Method; Exercise Therapy; Female; Humans; Hyaluronic Acid; Mastectomy; Middle Aged; Range of Motion, Articular; Treatment Outcome; Upper Extremity

The current treatment protocols for breast cancer have shifted from single agent therapies to combinatorial approaches that offer synergistic efficacies and reduced side effects. Self-assembled nanogels comprising natural polysaccharides and functional proteins provide an intelligent platform for the targeted co-delivery of therapeutic molecules. Herein, we report the fabrication of self-assembled nanogels utilizing hydrophilic biocompatible proteins, lactoferrin (Lf), and polysaccharide carboxy methyl cellulose (CMC), for the combined delivery of the antimetabolite pemetrexed (PMT) and the herbal polyphenol honokiol (HK). PMT was conjugated to LF via an amide bond. The conjugate was then electrostatically assembled into CMC under optimized conditions to form nanogels (Lf-CMC NGs). An inclusion complex of HK with hydroxypropyl-β-cyclodextrin was then encapsulated in the prepared Lf-CMC NGs with an entrapment efficiency of 66.67%. The dual drug-loaded cross-linked Lf-CMC NGs exhibited a particle size of 193.4 nm and zeta potential of - 34.5 mV and showed a sustained release profile for both drugs. PMT/HK-loaded Lf-CMC NGs were successfully taken up by MDA-MB-231 breast cancer cells and demonstrated superior in vitro cytotoxicity, as elucidated by a low combination index value (CI=0.17) and a higher dose reduction index (DRI) compared to those of the free drugs. An in vivo antitumor study using an Ehrlich ascites tumor (EAT) mouse model revealed the robust efficacy of PMT/HK-loaded Lf-CMC NGs in inhibiting tumor growth, which was ascribed to the reduced expression level of VEGF-1, elevated protein expression level of caspase-3, and suppressed Ki-67 protein level in the tumor tissue (P ˂0.05). In conclusion, our green fabricated self-assembled dual-loaded nanogels offer a promising biocompatible strategy for targeted combinatorial breast cancer therapy.

Topics: Animals; Breast Neoplasms; Carboxymethylcellulose Sodium; Drug Carriers; Green Chemistry Technology; Lactoferrin; Mice; Nanogels; Particle Size; Pemetrexed; Phytotherapy

In this work, magnetic molybdenum disulfide (mMoS2) was synthesized firstly. Then, layer-by-layer (LbL) self-assembly technology was used for the preparation of chitosan/carboxymethylcellulose functionalized mMoS2 nanocomposites. The nanocomposites with the diameter of 0.4 μm did not easily agglomerate in biological suspensions, thus had good dispersion and stability. Simultaneously, mMoS2-CS/CMC strongly inhibited the adsorption of non-specific proteins to mMoS2. In a drug loading experiment, in which doxorubicin hydrochloride (DOX) was used as a model drug, it was found that the drug loading capacity of mMoS2-CS/CMC was high and the drug loading rate could reach 86%. When the drug was released, mMoS2-CS/CMC-DOX showed an obvious pH-dependent release behavior. In cellular studies, the nanocomposites were easily taken up by tumor cells, and mainly located in the cytoplasm. The pure carrier materials had good biocompatibility with no obvious cytotoxicity, but they could cause dose-dependent cytotoxicity after DOX loading. Moreover, mMoS2-CS/CMC had an excellent photothermal effect, and an in vivo study showed that after it was injected into mice, more nanocomposites concentrated in the tumor site than mMoS2, indicating the tumor targeting properties. Therefore, the modification of mMoS2 with chitosan and sodium carboxymethylcellulose will promote the development of tumor therapy.

Topics: Adsorption; Animals; Antibiotics, Antineoplastic; Breast Neoplasms; Carboxymethylcellulose Sodium; Cell Survival; Chitosan; Disulfides; Doxorubicin; Drug Screening Assays, Antitumor; Female; Humans; Magnetic Phenomena; Magnetic Resonance Imaging; Mammary Neoplasms, Experimental; Mice; Mice, Inbred BALB C; Molybdenum; Nanocomposites; Particle Size; Phototherapy; Surface Properties; Tumor Cells, Cultured

Biocompatible drug delivery vehicles with sustained drug release property are valuable in cancer therapy and can reduce some of the side effects. Hence, to achieve the biocompatible system with sustained drug release behavior a new drug carrier was fabricated via in situ synthesis of MIL-53 (MIL = Materials of Institute Lavoisier) within the carboxymethylcellulose/graphene quantum dots matrix (CMC/GQDs) as a biological macromolecule based platform (MIL-53@CMC/GQDs). Fourier transform infrared (FT-IR), and X-ray diffraction (XRD) analysis revealed successful synthesis of MIL-53@CMC/GQDs. The mean pore diameter of MIL-53@CMC/GQDs obtained 18.66 nm. Scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) exhibited that MIL-53 is well distributed in hydrogel matrix. Doxorubicin (DOX) was loaded about 55.80% and 88.90% into the MIL-53 and MIL-53@CMC/GQDs, respectively. Drug release studies showed the pH-dependent DOX release behavior for DOX@MIL-53@CMC/GQDs. The cytotoxic assay approved the biocompatibility of MIL-53@CMC/GQDs against the human breast cancer cell line (MDA-MB 231). The fragmentation of nuclei and condensation of chromatin after treatment with DOX@MIL-53@CMC/GQDs displayed its capability in cancer treatment. Moreover, an arrest in sub-G1 of cell cycle after treatment with MIL-53@CMC/GQDs showed cell's apoptosis. The results conveyed a new concept that the MIL-53@CMC/GQDs could be proposed as a potential carrier for the delivery.

Topics: Antineoplastic Agents; Apoptosis; Breast Neoplasms; Carboxymethylcellulose Sodium; Cell Line, Tumor; Delayed-Action Preparations; Doxorubicin; Drug Carriers; Drug Delivery Systems; Drug Liberation; Female; Graphite; Humans; Hydrogels; Metal-Organic Frameworks; Nanocomposites; Quantum Dots; Spectroscopy, Fourier Transform Infrared

Polymer conjugation is an attractive approach for delivering insoluble and highly toxic drugs to tumors. However, most reports in the literature only disclose the optimal composition without emphasizing rational design or composition optimization to achieve maximized biological effects. In this study, we aimed to demonstrate that composition of a polymer conjugate would determine its physiochemical characteristics, tumor penetration, and, ultimately, the in vivo efficacy. We also aimed to examine whether the tumor spheroid model could generate comparable results with the in vivo tumor model in terms of tumor penetration and efficacy of the various polymer conjugates. We have designed a polymer conjugate delivery system for a chemotherapeutic drug podophyllotoxin (PPT) by covalently conjugating PPT and polyethylene glycol (PEG) with acetylated carboxymethyl cellulose to yield conjugates containing various amounts of PPT and PEG. Depending on the composition, these conjugates self-assembled into nanoparticles (NPs) with different physicochemical properties. Conjugates with an increased PPT content formed particles with an increased diameter. In the present study, we selected three conjugates representing compositions containing high, medium, and low drug content, and compared their particle formation, drug release kinetics, their ability to penetrate tumor spheroid and in vivo s.c. tumor, and finally their antitumor efficacy in spheroid culture and an in vivo s.c. tumor model. We found that the low drug content conjugate formed smaller NPs (20 nm) compared to the high drug content conjugates (30-120 nm), and displayed faster drug release kinetics (5%/day vs 1-3%/day), improved tumor penetration, and enhanced antitumor efficacy in both the spheroid model and s.c. tumor model. In particular, the low drug content conjugate preferentially accumulated in the hypovascular region within the tumor, inducing complete regression of s.c. tumors and the metastasis to the lungs. Our data indicate composition optimization is needed to select the optimal conjugate, and tumor spheroid culture is a robust screening tool to help select the optimal formulation.

Topics: Animals; Antineoplastic Agents; Breast Neoplasms; Carboxymethylcellulose Sodium; Cell Proliferation; Drug Carriers; Female; Humans; Mice; Mice, Inbred BALB C; Mice, Nude; Nanoparticles; Podophyllotoxin; Polymers; Spheroids, Cellular; Tumor Cells, Cultured; Xenograft Model Antitumor Assays

Breast cancer remains a leading cause of cancer death worldwide. There is evidence that immunotherapy may play a role in the eradication of residual disease. Peptide vaccines for immunotherapy are capable of durable immune memory, but vaccines alone have shown sparse clinical activity against breast cancer to date. Toll-like receptor (TLR) agonists and helper peptides are excellent adjuvants for vaccine immunotherapy and they are examined in this human clinical trial.. A vaccine consisting of 9 MHC class I-restricted breast cancer-associated peptides (from MAGE-A1, -A3, and -A10, CEA, NY-ESO-1, and HER2 proteins) was combined with a TLR3 agonist, poly-ICLC, along with a helper peptide derived from tetanus toxoid. The vaccine was administered on days 1, 8, 15, 36, 57, 78. CD8. Twelve patients with breast cancer were treated: five had estrogen receptor positive disease and five were HER2 amplified. There were no dose-limiting toxicities. Toxicities were limited to Grade 1 and Grade 2 and included mild injection site reactions and flu-like symptoms, which occurred in most patients. The most common toxicities were injection site reaction/induration and fatigue, which were experienced by 100% and 92% of participants, respectively. In the stimulated ELIspot assays, peptide-specific CD8. Peptide vaccine administered in the adjuvant breast cancer setting was safe and feasible. The TLR3 adjuvant, poly-ICLC, plus helper peptide mixture provided modest immune stimulation. Further optimization is required for this multi-peptide vaccine/adjuvant combination.. ClinicalTrials.gov (posted 2/15/2012): NCT01532960. Registered 2/8/2012. https://clinicaltrials.gov/show/NCT01532960.

Topics: Adjuvants, Immunologic; Adult; Breast Neoplasms; Cancer Vaccines; Carboxymethylcellulose Sodium; Female; Humans; Immunotherapy; Interferon Inducers; Middle Aged; Pilot Projects; Poly I-C; Polylysine

Taxanes are a class of anticancer agents with a broad spectrum and have been widely used to treat a variety of cancer. However, its long-term use has been hampered by accumulating toxicity and development of drug resistance. The most extensively reported mechanism of resistance is the overexpression of P-glycoprotein (Pgp). We have developed a PEGylated carboxymethylcellulose conjugate of docetaxel (Cellax), which condenses into ∼120 nm nanoparticles. Here we demonstrated that Cellax therapy did not upregulate Pgp expression in MDA-MB-231 and EMT-6 breast tumor cells, whereas a significant increase in Pgp expression was measured with native docetaxel (DTX) treatment. Treatment with DTX led to 4-7-fold higher Pgp mRNA expression and 2-fold higher Pgp protein expression compared with Cellax treatment in the in vitro and in vivo system, respectively. Cellax also exhibited significantly increased efficacy compared with that of DTX in a taxane-resistant breast tumor model. Against the highly Pgp expressing EMT6/AR1 cells, Cellax exhibited a 6.5 times lower IC50 compared with that of native DTX, and in the in vivo model, Cellax exhibited 90% tumor growth inhibition, while native DTX had no significant antitumor activity.

Topics: Animals; Antineoplastic Agents; ATP Binding Cassette Transporter, Subfamily B, Member 1; Breast Neoplasms; Carboxymethylcellulose Sodium; Cell Line, Tumor; Docetaxel; Drug Delivery Systems; Drug Resistance, Multiple; Drug Resistance, Neoplasm; Female; Humans; Inhibitory Concentration 50; Mammary Neoplasms, Experimental; Mice; Mice, Inbred BALB C; Mice, Inbred NOD; Mice, SCID; Nanoparticles; Phenotype; Polymers; RNA, Messenger; Taxoids

Topics: Adult; Aged; Breast Neoplasms; Carboxymethylcellulose Sodium; Drug Evaluation; Female; Humans; Interferon Inducers; Methylcellulose; Middle Aged; Neoplasm Metastasis; Poly I-C; Polylysine