Background Glutamine is the primary fuel for the gastrointestinal epithelium and maintains the mucosal structure. Oncologists frequently encounter oral mucositis, which can cause unplanned breaks in radiotherapy (RT). Objectives The aim of this study was to explore the association between oral glutamine and acute toxicities in patients with head and neck cancer undergoing RT. Methods This was a parallel, double-blind, randomized, placebo-controlled Phase III trial conducted in a university hospital. A central randomization center used computer-generated tables to allocate interventions to 71 patients with stages I–IV head and neck cancers. The patients, care providers, and investigators were blinded to the group assignment. Eligible patients received either oral glutamine (5 g glutamine and 10 g maltodextrin) or placebo (15 g maltodextrin) 3 times daily from 7 d before RT to 14 d after RT. The primary and secondary endpoints were radiation-induced oral mucositis and neck dermatitis, respectively. These were documented in agreement with the National Cancer Institute Common Terminology Criteria for Adverse Events version 3. Results The study included 64 patients (placebo n = 33; glutamine n = 31) who completed RT for the completers’ analysis. Based on multivariate analysis, glutamine had no significant effect on the severity of oral mucositis (OR: 0.3; 95% CI: 0.05, 1.67; P = 0.169). Only the change in body mass index (BMI) was significant in both multivariate completers (OR: 0.41; 95% CI: 0.20, 0.84; P = 0.015) and per-protocol analysis (OR: 0.40; 95% CI: 0.20, 0.83; P = 0.014). No difference was found in the incidence and severity of neck dermatitis between the two arms. Conclusions The decrease in BMI was strongly related to the severity of oral mucositis in the head and neck cancer patients under RT, but not to the use of glutamine. This trial was registered at clinicaltrials.gov as NCT03015077.

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The concept of corrective emotional experience, originally formulated by psychoanalysts Alexander and French (1946), has been redefined by contemporary researchers to be theoretically nonspecific, that is, as "coming to understand or experience an event or relationship in a different or unexpected way" (Castonguay & Hill, 2011). Using postsession questionnaires, videotapes, and posttermination interviews, we explored whether (and how) a corrective experience occurred in a successful case of short-term dynamic psychotherapy (STDP; Davanloo, 1980). A 35-year-old woman suffering severe panic attacks was seen for 31 sessions by an experienced STDP therapist. The questionnaires and interviews focused on (a) perceived intrapsychic and interpersonal changes, and (b) how these changes came about. At termination, the client reported complete symptom relief, greater self-acceptance, improved relationships, and more emotional flexibility. Her corrective experience was evident in the qualitative themes, which showed that she came to understand and affectively experience her relationships with both parents differently. Moreover, the themes reflected both STDP-specific (e.g., confrontation of defenses) and nonspecific (e.g., rapport, acceptance) mechanisms of change. Conversation analysis (Sacks, 1995) of what the client described as "the 'gentle shove' of questions that make me see what I have been trying to ignore since childhood" showed, on a microlinguistic level, how she overcame resistance to strong emotional experience and expression.