Uranium and other natural radionuclides in drinking water and risk of leukemia: a case-cohort study in Finland

Objective: We assessed the effect of natural uranium and other radionuclides in drinking water on risk of leukemia. Methods: The subjects (n = 144,627) in the base cohort had lived outside the municipal tapwater system during 1967–1980. A subcohort was formed as a stratified random sample of the base cohort and subjects using drinking water from drilled wells prior to 1981 were identified. A case–cohort design was used comparing exposure among cases with leukemia (n = 35) with a stratified random sample (n = 274) from the subcohort. Activity concentrations of uranium, radium-226, and radon in the drinking water were analyzed using radiochemical and alpha-spectrometric methods. Results: The median activity concentration of uranium in well water was 0.08 Bq/L for the leukemia cases and 0.06 Bq/L for the reference group, radon concentrations 80 and 130 Bq/L, respectively, and radium-226 concentrations 0.01 Bq/L for both groups. The hazard ratio of leukemia for uranium was 0.91 (95% confidence interval 0.73–1.13) per Bq/L, for radon 0.79 per Bq/L (95% CI 0.27–2.29), and for radium-226 0.80 (95% CI 0.46–1.39) per Bq/L. Conclusions: Our results do not indicate an increased risk of leukemia from ingestion of natural uranium or other radionuclides through drinking water at these exposure levels.     

Biological effects of alpha particle radiation exposure on human monocytic cells

Radon ((222)Rn) gas produces decay progeny that emits high energy alpha (α)-particles. Epidemiological studies have shown that exposure to (222)Rn is linked with elevated risk of developing lung cancer, however clear mechanisms leading to such effects have not been delineated. Cytokines play a critical role in inflammation and their dysregulated production often contributes to disease pathogenesis. In this study, Bio-plex multiplex technology was employed to investigate modulations of 27 pro-inflammatory cytokines following exposure of human monocytic cells to 1.5 Gy of α-particle radiation. Concurrently, DNA damage was assessed by examining the formation of phosphorylated H2A histone family X (γ-H2AX) sites. Of the 27 cytokines assessed, 4 cytokines were shown to be statistically downregulated by ～2 fold relative to the untreated controls and included the interleukin (IL) family of proteins (IL-2, IL-15 and IL-17) and macrophage inflammatory protein 1 beta (MIP-1b). Interferon-inducible protein-12 (IP-12), vascular endothelial growth factor and regulated on activation normal T cell expressed and secreted (RANTES) were shown to be high expressors and upregulated. Cells irradiated with α-particles ranging from 0.27 to 2.14 Gy showed statistically significant, dose-dependant increases in γ-H2AX formation. These data suggest that α-particle radiation causes dysregulation in the production of a number of pro-inflammatory cytokines and results in significant DNA damage.     

作用于骨基质的放射性药物在治疗骨转移前列腺癌中的潜在协同作用

遗传学异质性和抗化疗干细胞是制定新的晚期前列腺癌治疗方案过程中面临的两大最严峻的问题．尽管很早以前就有了治疗局限性前列腺癌的方案,但目前,我们对转移性前列腺癌仍束手无策．尽管借助于一些新通过的治疗方案,其治疗结果可能有很大的改善,但很明显还需要制定新的联合疗法．本文主要讨论作用于骨基质的放射性药物与其它骨转移前列腺癌治疗方案的潜在协同作用。放射疗法已被证明与细胞毒性化疗方案有协同作用,最近也有数据显示放射疗法与基于免疫的疗法之间可能有协同作用。将来,可能必须执行联合疗法以盟著提高抗去势型转移型前列腺痛患者的存活率。我们假设作用于骨基质的放射性药物将在这一过程中起重要作用。     

Radiation Exposure to Personnel in Departments of Gynaecologic Oncology in Sweden

Radium-226 and cesium-137 are used at six departments of gynaecologic oncology in Sweden. A survey of radiation exposure (dose equivalents) to the personnel is reported. The measurements were performed with TL dosemeters. From dose distribution measurements, the dose equivalents in different parts of the body, related to different working procedures, were determined. Effective dose equivalents and collective dose equivalents were also estimated. The estimated collective dose equivalent for this category of personnel in Sweden was 1.3 manSv. The effective dose equivalent was less than the dose equivalent measured with dosemeters worn on the chest, and was less than half the annual limit set by ICRP.     

Real-world Outcomes and Factors Predicting Survival and Completion of Radium 223 in Metastatic Castrate-resistant Prostate Cancer

Aims

To analyse outcomes in metastatic castrate-resistant prostate cancer (mCRPC) patients treated with radium 223 (Ra-223) across the Yorkshire and Humber Cancer Network.

Optimising Radium 223 Therapy for Metastatic Castration-Resistant Prostate Cancer –5-year Real-World Outcome: Focusing on Treatment Sequence and Quality of Life

AimsReal-world evidence of radium 223 (Ra-223) for the treatment of men with metastatic castration-resistant prostate cancer is emerging. In this prospective single-centre service evaluation, we report for the first time in the UK, real-world quality of life (QoL) and survival outcomes, including the sequencing impact, in 228 treated patients. We aim to share our 5-year experience on how to optimise Ra-223 treatment.Materials and methodsPatients who received Ra-223 therapy between 2014 and 2018 at the Northern Centre for Cancer Care, Newcastle upon Tyne, UK were included in this evaluation. Demographics, clinical characteristics, blood parameters, treatment sequencing and QoL data using abbreviated Functional Assessment of Cancer Therapy-Prostate questionnaires were prospectively collected and analysed.ResultsIn total, 228 patients were included; median age 72 years (51–87). The medium overall survival was 11.1 months. Overall survival in post-chemotherapy and chemotherapy-naïve patients was 8.1 and 12.3 months, respectively (P = 0.02, hazard ratio 1.52, 95% confidence interval 1.06–2.17); in pre-enzalutamide and post-enzalutamide patients was 11.3 and 10.4 months, respectively (P = 0.65, hazard ratio 0.92, 95% confidence interval 0.63–1.33); in pre-abiraterone and prednisolone and post-abiraterone and prednisolone patients was 11.8 and 10.5 months, respectively (P = 0.08, hazard ratio 0.74, 95% confidence interval 0.51–1.06); in this latter group, the fracture rate was 24% (15/63). QoL post Ra-223 (n = 101 evaluated) showed that pain scores improved in 54%, there was no change in 17% and pain scores worsened in 30% of treated patients. Overall QoL scores showed a similar trend. QoL was not significantly associated with overall survival.ConclusionsRa-223 palliates pain and improves disease-related QoL in most patients in the real-world setting. Our survival outcome is comparable with other real-world studies. Chemotherapy-naïve patients seemed to have better survival than those who received prior chemotherapy. No significant survival differences were observed between pre- and post-abiraterone and prednisolone or enzalutamide patients. The fracture rate in the post-abiraterone and prednisolone group seemed to be high. Bone health evaluation and protection should be incorporated as standard of care.     

Optimizing skeletal‐related events prevention in patients with advanced prostate cancer

In patients with metastatic castration‐resistant prostate cancer (mCRPC), bone is a dominant site of metastasis. Bone metastases often lead to skeletal‐related events (SREs), which include pain, spinal cord compression and fractures. The treatment of bone metastases in men with mCRPC aims to improve SRE‐free survival, quality of life and clinical outcomes. Effective treatment options include antiresorptive bone‐targeted agents such as zoledronic acid and denosumab, and radium‐223, a bone‐targeting radiopharmaceutical. Although overseas and local guidelines have widely recommended using either zoledronic acid or denosumab for the prevention of SREs in men with mCRPC and associated bone metastases, current evidence suggests that denosumab is superior to zoledronic acid in terms of longer SRE‐free time and fewer total SREs observed in patients.     

Submarine groundwater discharge as a major source of nutrients to the Mediterranean Sea

The Mediterranean Sea (MS) is a semienclosed basin that is considered one of the most oligotrophic seas in the world. In such an environment, inputs of allochthonous nutrients and micronutrients play an important role in sustaining primary productivity. Atmospheric deposition and riverine runoff have been traditionally considered the main external sources of nutrients to the MS, whereas the role of submarine groundwater discharge (SGD) has been largely ignored. However, given the large Mediterranean shore length relative to its surface area, SGD may be a major conveyor of dissolved compounds to the MS. Here, we used a ²²⁸Ra mass balance to demonstrate that the total SGD contributes up to (0.3–4.8)⋅10¹² m³⋅y⁻¹ to the MS, which appears to be equal or larger by a factor of 16 to the riverine discharge. SGD is also a major source of dissolved inorganic nutrients to the MS, with median annual fluxes of 190⋅10⁹, 0.7⋅10⁹, and 110⋅10⁹ mol for nitrogen, phosphorous, and silica, respectively, which are comparable to riverine and atmospheric inputs. This corroborates the profound implications that SGD may have for the biogeochemical cycles of the MS. Inputs of other dissolved compounds (e.g., iron, carbon) via SGD could also be significant and should be investigated.The Mediterranean Sea (MS) is one of the most oligotrophic seas in the world (1), resulting from an antiestuarine circulation by which Mediterranean intermediate waters export nutrients to the Atlantic Ocean. In such an oligotrophic system, external inputs of nutrients play a significant role in sustaining marine productivity (2–6). Among these inputs, atmospheric deposition and riverine runoff have been traditionally considered the major sources of nutrients to the MS (5, 7, 8). Even though submarine groundwater discharge (SGD) has been recognized as an important source of dissolved compounds (e.g., nutrients, metals, carbon) to the ocean (9–11), its role as a conveyor of dissolved chemicals to the MS has been largely overlooked.SGD into the coastal ocean is composed of fresh meteoric groundwater, which may enter the ocean directly, and former seawater recirculating through permeable sediments (12, 13). Both types of SGD are important in oceanic chemical budgets, as SGD may become enriched in various solutes (i.e., nutrients, metals, carbon) during its pathway through the coastal aquifer (14). Previous studies have estimated the fresh groundwater discharge to the MS, using hydrologic approaches (15, 16), but none of them has evaluated the total SGD flow and the associated total contribution of dissolved compounds to the MS. Because recirculated SGD usually dominates the water flow (12), its quantification is key to fully understanding the role of SGD in the biogeochemical cycles of nutrients and other chemical species in the MS.Radium isotopes have been widely used as tracers of SGD, mainly because they are highly enriched in SGD relative to seawater and because they behave conservatively once released into the sea (17). The approach we followed to estimate the magnitude of SGD into the entire MS is based on a mass balance of ²²⁸Ra (18). Assuming steady state, ²²⁸Ra outputs must be equal to its inputs, most of which originate from continental margins. By evaluating all of the sink and source terms, the ²²⁸Ra supplied by SGD can be determined as the difference between its inputs and outputs, and this flux can be converted to an SGD flow by characterizing the ²²⁸Ra concentration in the SGD fluids. We used ²²⁸Ra over other Ra isotopes (i.e., ²²³Ra, ²²⁴Ra, and ²²⁶Ra) because its half-life (T_1/2= 5.75 y) is considerably lower than the residence time of the MS waters [∼100 y (19)]; hence, its radioactive decay is the primary sink of ²²⁸Ra in the MS and allows us to accurately constrain the ²²⁸Ra removal terms (18).     

Prelude to specialization: US cancer nursing, 1920-50

This study used historical research methodology to assess the work of US nurses caring for patients with cancer from 1920 to 1950. Primary sources, obtained from several US archives, included nursing procedure books, student nurses' lecture notes, hospital and nursing annual reports, and meeting minutes. Secondary sources included journal articles and textbooks. The aim was to document the clinical work of nurses caring for patients with cancer and assess this work for evidence of emerging specialization in cancer nursing. Following a review of cancer in the 1920s, nursing education specific to cancer, nursing care related to specific cancer therapies, and the practice of concealing a diagnosis of cancer, were examined. Nurses were consistently educated in cancer nursing, but their cancer education became more focused over the decades. Nurses were closely involved with cancer patients as they monitored their patients' radium or assisted patients following radical surgery. The issue of concealing the diagnosis of cancer was problematic to some nurses. This paper reveals the nature of nurses' hospital work with cancer patients and demonstrates a core body of cancer nursing knowledge. The emergence of cancer nursing as a specialty is presented.     

建筑材料放射性限制量研究

1982～1984年间我们进行了建筑材料天然放射性水平的全国性调查,在29省市自治区(除台湾省外)的主要建材厂收集了常用建材和工业废渣建材样品。本文报道了照射量率、比括度和²²²Rn释出率的调查结果。常用建材的比活度序为:粘土砖>混凝土和砂石>石灰和普通水泥。发现石煤渣砖、磷石膏和赤泥具有最高比活度,故这些材料在建筑工业中使用必须严格控制。结果还表明:我国常用建材的代表性比活度²²²Ra为5Bq/kg,²³²Th为50Bq/kg和⁴⁰K为500Bq/kg。据调查结果和参考国外标准,我们建议:(1)A_R²/370+A_Th/260+A_K/4660≤1;(2)A_R²/200≤l作为建造住房和公共建筑物用材的放射性限制式。