Angiogenesis, Metabolism, Endothelial and Platelet Markers in Diabetes and Cardiovascular Disease

Introduction: Diabetes is a leading risk factor for cardiovascular disease (CVD), the pathophysiology of both being linked to metabolic, endothelial, renal, angiogenic and platelet abnormalities. We hypothesised that abnormalities in these systems are more adverse in those whose CVD is compounded by diabetes, compared to those with diabetes or CVD alone.

Materials and methods: Serum or plasma from 66 patients with diabetes alone, 76 with CVD alone, and 70 with both diabetes and CVD i.e. diabetic cardiovascular disease, was probed for markers of angiogenesis [angiopoietin 1 and 2, vascular endothelial growth factor (VEGF) and endoglin], metabolic [soluble receptor for advanced glycation products (sRAGE), leptin, lipocalin-2, interleukin-8, and cystatin-C], the endothelium (von Willebrand factor, endothelial microparticles and soluble E selectin)], and the platelet (platelet microparticles and soluble P selectin) by ELISA, Luminex or flow cytometry.

Results: VEGF (p = 0.04), von Willebrand factor (p = 0.001) and endothelial microparticles (p = 0.042) were all higher in diabetic cardiovascular disease than in diabetes alone and cardiovascular disease alone. Soluble E selectin was higher in diabetic cardiovascular disease than in diabetes alone (p = 0.045), whilst cystatin-C (p = 0.004) and soluble P selectin (p < 0.001) were higher in diabetes and diabetic cardiovascular disease than in cardiovascular disease alone. There were no differences in angiopoietin 1 or 2, endoglin, sRAGE, leptin, lipocalin-2, or interleukin-8.

Conclusion: Angiopoietin 1 or 2, endoglin, sRAGE, leptin, lipocalin-2, interleukin-8, and cystatin-c cannot differentiate diabetes from cardiovascular disease, or both conditions combined. Our data point to a more adverse endothelial (von Willebrand factor, endothelial microparticles), and angiogenic profile (VEGF) in those with diabetic cardiovascular disease, supporting the view that this group should be targeted more aggressively.

Landscape distribution and abundance of animal-associated adult filth flies on commercial swine facilities in North Carolina, US

Filth flies associated with animal production transmit pathogens to humans and animals, propagate antimicrobial resistance in microbial communities and provoke nuisance litigation. Although dispersal of flies from facilities is often responsible for these negative effects, filth fly research on swine facilities has been limited to within the barns. Filth fly adaptations in space and time, as well as influences of abiotic and biotic factors impact distribution and abundance of animal-associated filth flies on swine production facilities. In this study, fly surveillance was conducted around four swine facilities in Bladen County, North Carolina, U.S.A. from January 2019 to October 2019. Traps were replaced weekly and animal-associated filth flies were identified. Flies were grouped for comparison based on biology and differences in pest management strategies. There were distinct differences in abundance and spatial distribution of different filth fly groups on the swine facilities, which are likely linked to environmental factors like spatial relation to crop production and species phenology. The impact of the observed temporal and spatial distribution and abundance is discussed in the context of filth fly management.

Consequences for Norway from a hypothetical accident at the Sellafield reprocessing plant: Atmospheric transport of radionuclides

The potential consequences for Norway should a nuclear accident at the Sellafield nuclear site occur, have been of concern for Norwegian authorities for several decades. Meteorological data from a 33-year period and the dispersion model 'SNAP' were used to evaluate meteorological conditions for which atmospheric transport of radionuclides from Sellafield to Norway would lead to the most severe impacts. The worst-case meteorological scenario for Norway, was found on 25^th June 1989 for a low elevation (0-800 m) release and on 29^th June 2001 for a higher elevation (800-1600 m) release. In both cases the western part of Norway was most affected. In general, the probability for depositions (>10 Bq/m² of ¹³⁷Cs) increased about 40% during the autumn and winter compared to the spring and summer months. An influence of climate change on the depositions was analysed, but not verified. Results from a number of simulations were also compared to identify how factors such as radioactive particle characteristics and initial release conditions could affect the predicted radionuclide deposition. The impact on predicted total depositions as well as hot-spot depositions by varying particle density and size as well as release elevation in worst-case scenario simulations amounted to about 40%-50%.

Management of bone metastasis and cancer treatment-induced bone loss during the COVID-19 pandemic: An international perspective and recommendations

Optimum management of patients with cancer during the COVID-19 pandemic has proved extremely challenging. Patients, clinicians and hospital authorities have had to balance the risks to patients of attending hospital, many of whom are especially vulnerable, with the risks of delaying or modifying cancer treatment. Those whose care has been significantly impacted include patients suffering from the effects of cancer on bone, where delivering the usual standard of care for bone support has often not been possible and clinicians have been forced to seek alternative options for adequate management. At a virtual meeting of the Cancer and Bone Society in July 2020, an expert group shared experiences and solutions to this challenge, following which a questionnaire was sent internationally to the symposium's participants, to explore the issues faced and solutions offered. 70 respondents, from 9 countries (majority USA, 39%, followed by UK, 19%) included 50 clinicians, spread across a diverse range of specialties (but with a high proportion, 64%, of medical oncologists) and 20 who classified themselves as non-clinical (solely lab-based). Spread of clinician specialty across tumour types was breast (65%), prostate (27%), followed by renal, myeloma and melanoma. Analysis showed that management of metastatic bone disease in all solid tumour types and myeloma, adjuvant bisphosphonate breast cancer therapy and cancer treatment induced bone loss, was substantially impacted. Respondents reported delays to routine CT scans (58%), standard bone scans (48%) and MRI scans (46%), though emergency scans were less affected. Delays in palliative radiotherapy for bone pain were reported by 31% of respondents with treatments often involving only a single dose without fractionation. Delays to, or cancellation of, prophylactic surgery for bone pain were reported by 35% of respondents. Access to treatments with intravenous bisphosphonates and subcutaneous denosumab was a major problem, mitigated by provision of drug administration at home or in a local clinic, reduced frequency of administration or switching to oral bisphosphonates taken at home. The questionnaire also revealed damaging delays or complete stopping of both clinical and laboratory research. In addition to an analysis of the questionnaire, this paper presents a rationale and recommendations for adaptation of the normal guidelines for protection of bone health during the pandemic.

"The use of bisphosphonates to treat skeletal complications in solid tumours"

The skeleton is the most common site of secondary disease in breast cancer and prostate cancer, with up to 80% of patients with advanced disease developing bone metastases (BM). The proportion is also substantial in advanced lung cancer (20%-40%). Because of the high prevalence of cancers of the breast, prostate and lung, these cancers account for more than 80% of cases of metastatic bone disease occurring in solid tumours. Metastatic bone disease is associated with greatly increased bone resorption by osteoclasts, leading to moderate to severe pain and other skeletal complications, with major impact on quality of life (QoL). Skeletal Related Events (SREs) have been defined as: pathological long bone or vertebral fractures; spinal cord compression; need for radiation for pain relief or to prevent fracture/spinal cord compression, need for surgery to bone and hypercalcaemia. More recently, Symptomatic Skeletal Events (SSEs) have been defined to monitor QoL. Although there are currently no curative treatments for metastatic bone disease, patients with breast or prostate cancer and BM are now surviving for several years and sometimes longer, and prevention of SREs is the key aim to optimization of QoL. Since their discovery 50 years ago and their introduction more than 30 years ago into the field of metastatic bone disease, a range of oral and intravenous bisphosphonate drugs have made a major contribution to prevention of SREs. Large trials have clearly demonstrated the clinical value of different bisphosphonate-based drugs (including the oral drugs ibandronate and clodronate and intravenous agents such as zoledronate and pamidronate), in treatment of hypercalcaemia of malignancy and the reduction of SREs and SSEs in a range of cancers. Despite the success of denosumab in reducing osteolysis, bisphosphonates also remain mainstay drugs for treatment of metastatic bone disease. Recognizing the 50th Anniversary of the discovery of bisphosphonates, this review focuses on their continuing value in BM treatment and their future potential, for example in providing a bone-targeting vehicle for cytotoxic drugs.

Resistant Starch Production and Glucose Release from Pre-Prepared Chilled Food: The SPUD Project

With an increasing prevalence of diabetes worldwide, effective dietary strategies for blood glucose control are crucial. As carbohydrates make up approximately 50% of the diet, it is neither practical nor advisable to avoid them altogether. Most of the carbohydrate in the diet is derived from starch, found in potatoes, pasta, rice and bread. These foods are often processed in some way before consumption, yet little is known about the effects processing, such as chilling and reheating, has on the glycaemic response, particularly when the food is consumed in the context of a mixed meal. This article introduces the SPUD project, a BBSRC DRINC‐funded initiative. Taking the potato as the model carbohydrate, this project will investigate, via in vitro and in vivo studies, the effects of domestic food processing techniques on the glycaemic response. A final study, utilising intrinsically labelled potato and a dual stable isotope methodology, will model glucose flux data to determine the underlying mechanisms of action.

Using a chain of models to predict health and environmental impacts in Norway from a hypothetical nuclear accident at the Sellafield site

When a nuclear accident occurs, decision makers in the affected country/countries would need to act promptly to protect people, the environment and societal interests from harmful impacts of radioactive fallout. The decisions are usually based on a combination of model prognoses, measurements, and expert judgements within in an emergency decision support system (DSS). Large scale nuclear accidents would need predictive models for the atmospheric, terrestrial, freshwater, and marine ecosystems, for the connections between these in terms of radionuclide fluxes, and for the various exposure pathways to both humans and biota. Our study showed that eight different models and DSS modules could be linked to assess the total human and environmental consequences in Norway from a hypothetical nuclear accident, here chosen to be the Sellafield nuclear reprocessing plant. Activity concentrations and dose rates from ¹³⁷Cs for both humans and the environment via various exposure routes were successfully modelled. The study showed that a release of 1% of the total inventory of ¹³⁷Cs in the Highly Active Liquor Tanks at Sellafield Ltd is predicted to severely impact humans and the environment in Norway if strong winds are blowing towards the country at the time of an accidental atmospheric release. Furthermore, since the models did not have built-in uncertainty ranges when this Sellafield study was performed, investigations were conducted to identify the key factors contributing to uncertainty in various models and prioritise the ones to focus on in future research.

Exploring taxonomic and phylogenetic relationships to predict radiocaesium transfer to marine biota

One potentially useful approach to fill data gaps for concentration ratios, CRs, is based upon the hypothesis that an underlying taxonomic and/or phylogenetic relationship exists for radionuclide transfer. The objective of this study was to explore whether these relationships could be used to explain variation in the transfer of radiocaesium to a wide range of marine organisms. CR data for ¹³⁷Cs were classified in relation to taxonomic family, order, class and phylum. A Residual Maximum Likelihood (REML) mixed-model regression modelling approach was adopted. The existence of any patterns were then explored using phylogenetic trees constructed with mitochondrial COI gene sequences from various biota groups and mapping the REML residual means onto these trees. A comparison of the predictions made using REML with blind datasets allowed the efficacy of the procedure to be tested. The only significant correlation between predicted and measured activity concentrations was revealed at the taxonomic level of order when comparing REML analysis output with data from the Barents Sea Region. For this single case a correlation 0.80 (Spearman rank) was derived which was significant at the 0.01 level (1-tailed test) although this was not the case once a (Bonferroni) correction was applied. The application of the REML approach to marine datasets has met with limited success, and the phylogenetic trees illustrate complications of using predictions based on values from different levels of taxonomic organization, where predicted values for the order level can mask the values at lower taxonomic levels. Any influence of taxonomy and phylogeny on transfer is not immediately conspicuous and categorizing marine organisms in this way is limited in providing a potentially robust prognostic extrapolation tool. Other factors may plausibly affect transfer to a much greater degree in marine systems, such as quite diverse life histories and different diets, which may confound any phylogenetic pattern.

Benefits and risks of adjuvant treatment with zoledronic acid in stage II/III breast cancer. 10 years follow-up of the AZURE randomized clinical trial (BIG 01/04)

Adjuvant bisphosphonates improve disease outcomes in postmenopausal early breast cancer (EBC) but the long-term effects are poorly described. The AZURE trial (ISRCTN79831382) was designed to determine whether adjuvant zoledronic acid (ZOL) improves disease outcomes in EBC. Previous analyses showed no effect on overall outcomes but identified benefits in postmenopausal women. Here we present the long-term risks and benefits of adjuvant ZOL with 10-years follow-up.

Patients and methods

3360 patients with stage II/III breast cancer were included in an academic, international, phase III, randomized, open label trial. Patients were followed up on a regular schedule until 10 years. Patients were randomized on a 1:1 basis to standard adjuvant systemic therapy +/− intravenous ZOL 4 mg every 3–4 weeks x6, and then at reduced frequency to complete 5 years treatment. The primary outcome was disease free survival (DFS). Secondary outcomes included invasive DFS (IDFS), overall survival (OS), sites of recurrence, skeletal morbidity and treatment outcomes according to primary tumor amplification of the transcription factor, MAF. Pre-planned subgroup analyses focused on interactions between menopausal status and treatment effects.

Results

With a median follow up of 117 months [IQR 70.4–120.4), DFS and IDFS were similar in both arms (HR_DFS= 0.94, 95%CI = 0.84–1.06, p = 0.340; HR_IDFS= 0.91, 95%CI = 0.82–1.02, p = 0.116). However, outcomes remain improved with ZOL in postmenopausal women (HR_DFS= 0.82, 95%CI = 0.67–1.00; HR_IDFS= 0.78, 95%CI = 0.64–0.94). In the 79% of tested women with a MAF FISH negative tumor, ZOL improved IDFS (HR_IDFS= 0.75, 95%CI = 0.58–0.97) and OS HR_OS= 0.69, 95%CI = 0.50–0.94), irrespective of menopause. ZOL did not improve disease outcomes in MAF FISH + tumors. Bone metastases as a first DFS recurrence (B_DFS) were reduced with ZOL (HR_B-DFS= 0.76, 95%CI = 0.63–0.92, p = 0.005). ZOL reduced skeletal morbidity with fewer fractures and skeletal events after disease recurrence. 30 cases of osteonecrosis of the jaw in the ZOL arm (1.8%) have occurred.

Conclusions

Disease benefits with adjuvant ZOL in postmenopausal early breast cancer persist at 10 years of follow-up. The biomarker MAF identified a patient subgroup that derived benefit from ZOL irrespective of menopausal status.

Induction of Human Factor VIII Inhibitors in Rats by Immunization with Human Recombinant Factor VIII: a Small Animal Model for Humans with High Responder Inhibitor Phenotype

Hemophilia A is a clotting disorder that is due to reduced or absent coagulation factor VIII (FVIII) activity. In approximately 25% of people with severe hemophilia A, standard treatment with intravenous plasma-derived or recombinant FVIII (rFVIII) induces anti-FVIII antibodies that inhibit FVIII activity (inhibitors). We describe the development of a rat model to study the formation of inhibitors. Immunization of rats with human rFVIII in adjuvant induced an anti-human rFVIII antibody response characteristic of an anti-FVIII inhibitor response in hemophilia A patients. The rats exhibited a rapid, polyclonal secondary antibody response to human rFVIII. These antibodies were reactive against epitopes located in the heavy and light chains. All the rFVIII-immunized rats developed antibodies against the FVIII C2 domain, a region of major reactivity in hemophilia A patients with inhibitors. Furthermore, competition ELISAs demonstrated that rat and human anti-FVIII antibodies recognized identical or overlapping epitopes of the FVIII molecule. The rat anti-FVIII antibodies also functioned as human FVIII inhibitors with titers ranging from 120 to 2048 Bethesda Units (B.U.). We propose that this rat model may be useful to investigate immune responses to FVIII and may lead to better therapies for FVIII inhibitors.

Investigation of the vertical distribution and speciation of 137Cs in soil profiles at burnt and unburnt forest sites in the Belarusian Exclusion Zone

The effects of fire events on contaminant radionuclides within soils of the Belarusian Exclusion Zone were investigated. A number of cores were taken from locations known to have been subject to fire events in the past as well as a series of cores from nearby unburnt locations. Both burnt and unburnt cores were analyzed for contaminant radionuclides as well as a range of relevant soil parameters. The distribution of ¹³⁷Cs between various fractions (reversibly bound, irreversibly bound and insoluble) was analyzed. Results indicate no evidence of enhancement or enrichment of radionuclides within the soil column although this does not negate the possibility that such effects were evident at some point in the past, the fire events at two of the sites having occurred almost ten years earlier. Evidence was present of a persistent effect on how ¹³⁷Cs was distributed between different fractions of the soil, primarily in relation to the proportions associated with oxides of Fe and Mn and organic matter. The results of the study appear to indicate that the long-term effects of a forest fire on contaminant ¹³⁷Cs within the soil column are expressed through changes in the physico-chemical forms of the nuclide to a larger extent than simple redistribution of the contaminant within the soil column.

On the divergences in assessment of environmental impacts from ionising radiation following the Fukushima accident

The accident at the Fukushima-Daiichi Nuclear Power Station on March 11, 2011, led to significant contamination of the surrounding terrestrial and marine environments. Whilst impacts on human health remain the primary concern in the aftermath of such an accident, recent years have seen a significant body of work conducted on the assessment of the accident's impacts on both the terrestrial and marine environment. Such assessments have been undertaken at various levels of biological organisation, for different species, using different methodologies and coming, in many cases, to divergent conclusions as to the effects of the accident on the environment. This article provides an overview of the work conducted in relation to the environmental impacts of the Fukushima accident, critically comparing and contrasting methodologies and results with a view towards finding reasons for discrepancies, should they indeed exist. Based on the outcomes of studies conducted to date, it would appear that in order to avoid the fractured and disparate conclusions drawn in the aftermath of previous accidents, radioactive contaminants and their effects can no longer simply be viewed in isolation with respect to the ecosystems these effects may impact. A combination of laboratory based and field studies with a focus on ecosystem functioning and effects could offer the best opportunities for coherence in the interpretation of the results of studies into the environmental impacts of ionising radiation.

Modelling dispersal of radioactive contaminants in Arctic waters as a result of potential recovery operations on the dumped submarine K-27

Of the wide variety of dumped objects containing radioactive materials in the Arctic seas, the submarine K-27 constitutes a major risk due to the large amount of highly enriched uranium onboard and its location in shallow waters. As the matter of potential operations involving raising of the submarine have entered the public arena, a priori assessment of the contamination in the Arctic marine environment that could result after a possible accident during such operations is a matter of some interest. The dispersion of contaminants within the Arctic has been assessed using a large scale hydrodynamic model for a series of plausible accident scenarios and locations under different oceanographic regimes. Results indicate that, depending primarily on the nature of a release (i.e. instantaneous or continuous), large areas of the Arctic marine environment will exhibit contamination to varying degrees.

Impacts on the terrestrial environment in case of a hypothetical accident involving the recovery of the dumped Russian submarine K-27

Objects containing radioactivity have been routinely dumped in Arctic waters near NW Russia up until the 1990s. One of the most radioactive objects in this region, the nuclear submarine K-27, was dumped in Stepogovo Fjord and contained spent nuclear fuel (SNF). Although the two K-27 submarine reactors were mothballed before dumping, concerns about the potential long term risks of contamination remain and plans to retrieve and decommission K-27 exist. In this article, human dose and environmental impact aseessments are presented for two possible future scenarios involving: (1) an ingress of water into a reactor in situ leading to a spontaneous chain reaction (SCR) and (2) an on-board fire when SNF is being removed at the mainland decommissiong site at Gremhika Bay on the Kola Peninsula. Assessments have been completed using conservative assumptions, focusing on possible effects to Norwegian territory. Atmospheric transport and deposition of radioactivity was modelled near field and regionally, using appropriate models, whilst human doses and environmental exposures were modelled using a standard IAEA approach and the ERICA tool, respectively. Results indicate that large areas of Norwegian territory could be affected by fallout from the Gremhika scenario, especially in the north, though at levels two orders of magnitude lower than those observed after the Chernobyl accident. Potential doses, primarily due to ground shine, to a critical group of personnel on-site at Stepogovo resulting from a SCR could require preventative measures based on ICRP recommendations (20-100 mSv). Doses to non-human biota in Norway for the Gremhika scenario would be negligible, typical of background dose rates for terrestrial organisms.

Temporal genetic stability of Stegomyia aegypti (= Aedes aegypti) populations

The mosquito Stegomyia aegypti (= Aedes aegypti) (Diptera: Culicidae) is the primary vector of viruses that cause yellow fever, dengue and Chikungunya fever. In the absence of effective vaccines, the reduction of these diseases relies on vector control strategies. The success of these strategies is tightly linked to the population dynamics of target populations. In the present study, 14 collections from St. aegypti populations separated by periods of 1-13 years were analysed to determine their temporal genetic stability. Although temporal structure is discernible in most populations, the degree of temporal differentiation is dependent on the population and does not obscure the geographic structure of the various populations. The results suggest that performing detailed studies in the years prior to and after population reduction- or modification-based control interventions at each target field site may be useful in assessing the probability of success.

A new version of the ERICA tool to facilitate impact assessments of radioactivity on wild plants and animals

A new version of the ERICA Tool (version 1.2) was released in November 2014; this constitutes the first major update of the Tool since release in 2007. The key features of the update are presented in this article. Of particular note are new transfer databases extracted from an international compilation of concentration ratios (CRwo-media) and the modification of 'extrapolation' approaches used to select transfer data in cases where information is not available. Bayesian updating approaches have been used in some cases to draw on relevant information that would otherwise have been excluded in the process of deriving CRwo-media statistics. All of these efforts have in turn led to the requirement to update Environmental Media Concentration Limits (EMCLs) used in Tier 1 assessments. Some of the significant changes with regard to EMCLs are highlighted.

Synthesis, analysis and biological evaluation of novel indolquinonecryptolepine analogues as potential anti-tumour agents

A small library of cryptolepine analogues were synthesised incorporating halogens and/or nitrogen containing side chains to optimise their interaction with the sugar–phosphate backbone of DNA to give improved binding, interfering with topoisomerase II hence enhancing cytotoxicity.

Clinical and radiographic assessment of the efficacy of calcium silicate indirect pulp capping: a randomized controlled clinical trial

The aims of this study were to assess the effectiveness of calcium silicate cement (Biodentine) versus glass ionomer cement (GIC; control group) as indirect pulp capping materials in patients with reversible pulpitis and to compare the effectiveness of cone beam computed tomography (CBCT) versus periapical (PA) radiographs in detecting PA changes at baseline (T0) and at 12 mo (T12) postoperatively. Seventy-two restorations (36 Biodentine, 36 Fuji IX) were placed randomly in 53 patients. CBCT/PA radiographs were taken at T0 and T12. Two calibrated examiners assessed the presence/absence and increase/decrease in the size of existing PA radiolucencies under standardized conditions. The Kappa coefficient evaluated statistically the effectiveness of CBCT versus PA radiographs in detecting PA changes. Chi-square/Mann-Whitney tests were used to evaluate the association between PA changes in CBCT with various clinical measures. Significance was predetermined at α = 0.05. Clinical success rates for Biodentine and Fuji IX GIC were 83.3%. CBCT was significantly more effective in detecting PA radiolucencies compared with radiographs (P = 0.0069). Of the teeth, 65.4% and 90.4% were deemed healthy using CBCT and PA radiographs, respectively, at T12. Healing/healed rates were 17.3%/0%, while new/progressed radiolucency were 30.8%/9.6% with CBCT/PA radiographs, respectively. Seventy-one percent of healed lesions had received Biodentine; 88% of new/progressed lesions received Fuji IX GIC. Teeth presenting with an initial CBCT PA lesion had a failure rate of 63%, whereas teeth with no initial lesion had a failure rate of 16%. Although no statistically significant difference was detected in the clinical efficacy of Biodentine/Fuji IX when used as indirect pulp capping materials in patients with reversible pulpitis, CBCT showed a significant difference in that most healed CBCT lesions had received Biodentine while most that did not heal received Fuji IX. Longer-term follow-up is needed to establish their effect on the healing dynamics of PA tissues (ClinicalTrials.gov NCT02201641).

Abstract P2-11-07: Proteins predictive of bone metastasis development in breast cancer patients

Background

Bone is the commonest site of metastasis in breast cancer and bone metastasis is associated with skeletal complications and reduced quality of life. Adjuvant use of zoledronic acid (ZA) has been explored to prevent or reduce development of bone metastases. In the large international AZURE trial (N = 3360), early stage (II/III) breast cancer patients were randomised to standard therapy (control arm) or to standard therapy + ZA. There is an unmet need for biomarkers to identify early stage patients at high risk of developing bone metastasis so that therapy can be appropriately targeted. We report a study using proteomics and primary tumour tissue microarrays (TMAs) from patients in the AZURE trial to address this need.

Methods

Bone- and lung-homed variants of the MDA-MB-231 cell line were compared to the parental (non-bone homing) cell type using proteomics (difference gel electrophoresis and mass spectrometry) to identify differentially regulated proteins for clinical validation using TMAs from the AZURE trial. Following characterisation on breast cancer TMAs of different grade, protein expression of candidate biomarkers on AZURE TMAs was assessed semi-quantitatively (low, medium, or high) based on immunohistochemical staining intensity. Statistical analysis investigated associations between protein expression, clinical variables (e.g. ER/PR/HER2 status) and time to local and distant recurrence events (updated to 59 months follow-up).

Results

Over 140 proteins were differentially expressed and two were chosen for validation based on fold change, biological relevance and antibody availability: Macrophage-capping protein (CAPG) and PDZ domain-containing protein GIPC1. Cox proportional hazards regression analysis of 378 AZURE breast tumour samples showed that patients who did not receive ZA were 4.5-fold more likely to develop bone-only metastasis (p = 0.006) if both proteins were highly expressed in the primary tumour (adjusted for systemic therapy plan, ER status, lymph node involvement, Table 1). This effect was not seen in patients who received ZA. Kaplan-Meier analysis indicated that the effect was not linked to menopausal status.

Discussion

We have identified two proteins expressed in primary breast tumours of patients which are significantly associated with subsequent development of bone-only metastases and appear to predict for benefit from ZA. Biologically, the two proteins are reported to be involved in cellular structures and signalling, and are implicated in cancers, but their association with breast cancer bone metastasis appears to be novel. Ongoing analysis will extend validation in a further AZURE TMA sample set. These proteins have potential as biomarkers to predict development of bone metastasis.

Table 1: Cox proportional hazards regressions for breast cancer patients with high expression of CAPG and GIPC1 protein in primary tumour cells ArmN (events)HR95% CIp OV691.4520.673-3.1330.342Any distant recurrenceC341.2110.542-2.7040.641 ZA351.2400.468-3.2870.665 OV313.0361.150-8.0170.025Skeletal and other distant metastasesC172.9721.119-7.8890.029 ZA140.9780.214-4.4700.977 OV214.4461.547-12.7800.006Skeletal metastases onlyC144.4491.545-12.8080.006 ZA71.0560.122-9.1540.961Arm: OV, Overall, n = 378; C, Control, n = 191; ZA, n = 187

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-11-07.

Application of the Bayesian approach for derivation of PDFs for concentration ratio values

Concentration ratios (CRs) are used to derive activity concentrations in wild plants and animals. Usually, compilations of CR values encompass a wide range of element-organism combinations, extracted from different studies with statistical information reported at varying degrees of detail. To produce a more robust estimation of distribution parameters, data from different studies are normally pooled using classical statistical methods. However, there is inherent subjectivity involved in pooling CR data in the sense that there is a tacit assumption that the CRs under any arbitrarily defined biota category belong to the same population. Here, Bayesian inference has been introduced as an alternative way of making estimates of distribution parameters of CRs. This approach, in contrast to classical methods, is more flexible and also allows us to define the various assumptions required, when combining data, in a more explicit manner. Taking selected data from the recently compiled wildlife transfer database (http://www.wildlifetransferdatabase.org/) as a working example, attempts are made to refine the pooling approaches previously used and to consider situations when empirical data are limited.

Approaches to providing missing transfer parameter values in the ERICA Tool--how well do they work?

A required parameter for the ERICA Tool is the concentration ratio (CR), which is used to describe the transfer from environmental media to a range of organisms. For the original parameterisation of the ERICA Tool, 60% of these values were derived using a variety of extrapolation approaches, including the application of allometric models, the use of values for a similar organism or element with similar biogeochemical behaviour and the use of values from a different ecosystem. Although similar approaches are applied in other assessment systems, there has been little attempt to see how well these approaches perform. In this paper, CR values in the ERICA Tool derived using extrapolation approaches are compared to more recently available empirical data from the IAEA wildlife transfer database. The primary purpose of the default CR database in the ERICA Tool, and other models, is to enable the user to conduct conservative screening assessments. Conservatism was therefore introduced to the analyses by selecting the 95th percentile CR values for subsequent calculations. The extrapolation methodologies are not guaranteed to provide conservative estimates of empirical 95th percentile CRs. For the terrestrial ecosystem, the extrapolation methods provide underpredictions of empirical 95th percentiles as often as they produce overpredictions. In a few cases the underestimation of CR values, when considering all ecosystems, is substantial - by orders of magnitude - which is clearly unacceptable for a screening assessment. Thus, although extrapolation approaches will remain an essential component of screening assessments in the future, because data gaps will always be present, diligence is important in their application. Finally, by synthesizing the results from the current analyses and through other considerations, some recommendations are provided with regards to modifying the original guidance on use of extrapolation approaches in the ERICA Tool.

An international database of radionuclide concentration ratios for wildlife: development and uses

A key element of most systems for assessing the impact of radionuclides on the environment is a means to estimate the transfer of radionuclides to organisms. To facilitate this, an international wildlife transfer database has been developed to provide an online, searchable compilation of transfer parameters in the form of equilibrium-based whole-organism to media concentration ratios. This paper describes the derivation of the wildlife transfer database, the key data sources it contains and highlights the applications for the data.

TRS Cs CRwo-water values for the marine environment: analysis, applications and comparisons

A new TRS document on Transfer of radionuclides to Wildlife has compiled equilibrium CR(wo-media) values for a variety of radionuclides and ecosystems. Assessment tools such as the ERICA Tool use equilibrium whole organism concentration ratios (CR(wo-media)) to predict radionuclide activity concentrations in wildlife from those in media (e.g. water). The aim of this paper is to compare and contrast model predictions of doses from (137)Cs to marine organisms using three different approaches: (i) the ERICA Tool utilising the new TRS values to estimate internal and external doses to reference organisms for the Black sea and the Aegean Sea and for the sea close to the Fukushima Dai-ichi plant. (ii) a hydrodynamic site specific model for seawater for parts of the Aegean Sea, Greece which estimates radionuclide concentrations using site specific data and (iii) a biokinetic model for fish applied to the Fukushima releases to the Pacific. The advantages and limitations of these approaches are discussed with respect to determining doses to pelagic fish. The applicability of the three approaches will vary with the objective of an assessment. The site specific model can predict variation in (137)Cs with depth and uses site specific CR values. The application of the biokinetic model to predicted (137)Cs activity concentrations in seawater and fish due to near coastal inputs from Fukushima Dai-ichi showed that the maximum internal dose-rates in fish attributable to (137)Cs would be substantially lower than those determined using equilibrium assumptions in ERICA but the accumulative doses over 100 days were similar.

Polymorphic microsatellite markers for the tsetse fly Glossina fuscipes fuscipes (Diptera: Glossinidae), a vector of human African trypanosomiasis

Our understanding of Glossina fuscipes fuscipes, a major vector of sleeping sickness, has been severely constrained by a lack of genetic markers for mapping and population genetic studies. Here we present 10 newly developed microsatellite loci for this tsetse species. Heterozygosity levels in Moyo, an Ugandan population, averaged 0.57, with only two loci showing very low heterozygosity. Five loci carried more than six alleles. Together with five recently published microsatellite loci, this brings the number of available microsatellite loci for this species to 15. Their availability will greatly facilitate future studies on the genetics of this important human disease vector.

The IAEA handbook on radionuclide transfer to wildlife

An IAEA handbook presenting transfer parameter values for wildlife has recently been produced. Concentration ratios (CRwo-media) between the whole organism (fresh weight) and either soil (dry weight) or water were collated for a range of wildlife groups (classified taxonomically and by feeding strategy) in terrestrial, freshwater, marine and brackish generic ecosystems. The data have been compiled in an on line database, which will continue to be updated in the future providing the basis for subsequent revision of the Wildlife TRS values. An overview of the compilation and analysis, and discussion of the extent and limitations of the data is presented. Example comparisons of the CRwo-media values are given for polonium across all wildlife groups and ecosystems and for molluscs for all radionuclides. The CRwo-media values have also been compared with those currently used in the ERICA Tool which represented the most complete published database for wildlife transfer values prior to this work. The use of CRwo-media values is a pragmatic approach to predicting radionuclide activity concentrations in wildlife and is similar to that used for screening assessments for the human food chain. The CRwo-media values are most suitable for a screening application where there are several conservative assumptions built into the models which will, to varying extents, compensate for the variable data quality and quantity, and associated uncertainty.

Assessing doses to terrestrial wildlife at a radioactive waste disposal site: inter-comparison of modelling approaches

Radiological doses to terrestrial wildlife were examined in this model inter-comparison study that emphasised factors causing variability in dose estimation. The study participants used varying modelling approaches and information sources to estimate dose rates and tissue concentrations for a range of biota types exposed to soil contamination at a shallow radionuclide waste burial site in Australia. Results indicated that the dominant factor causing variation in dose rate estimates (up to three orders of magnitude on mean total dose rates) was the soil-to-organism transfer of radionuclides that included variation in transfer parameter values as well as transfer calculation methods. Additional variation was associated with other modelling factors including: how participants conceptualised and modelled the exposure configurations (two orders of magnitude); which progeny to include with the parent radionuclide (typically less than one order of magnitude); and dose calculation parameters, including radiation weighting factors and dose conversion coefficients (typically less than one order of magnitude). Probabilistic approaches to model parameterisation were used to encompass and describe variable model parameters and outcomes. The study confirms the need for continued evaluation of the underlying mechanisms governing soil-to-organism transfer of radionuclides to improve estimation of dose rates to terrestrial wildlife. The exposure pathways and configurations available in most current codes are limited when considering instances where organisms access subsurface contamination through rooting, burrowing, or using different localised waste areas as part of their habitual routines.

Incidence, risk factors, and outcomes of osteonecrosis of the jaw: integrated analysis from three blinded active-controlled phase III trials in cancer patients with bone metastases

BACKGROUND

Osteonecrosis of the jaw (ONJ) has been reported in patients receiving bisphosphonates for metastatic bone disease. ONJ incidence, risk factors, and outcomes were evaluated in a combined analysis of three phase III trials in patients with metastatic bone disease receiving antiresorptive therapies.

PATIENTS AND METHODS

Patients with bone metastases secondary to solid tumors or myeloma were randomly assigned to receive either s.c. denosumab (120 mg) or i.v. zoledronic acid (4 mg) every 4 weeks. On-study oral examinations were conducted by investigators at baseline and every 6 months. Oral adverse events were adjudicated by an independent blinded committee of dental experts.

RESULTS

Of 5723 patients enrolled, 89 (1.6%) patients were determined to have ONJ: 37 (1.3%) received zoledronic acid and 52 (1.8%) received denosumab (P = 0.13). Tooth extraction was reported for 61.8% of patients with ONJ. ONJ treatment was conservative in >95% of patients. As of October 2010, ONJ resolved in 36.0% of patients (29.7% for zoledronic acid and 40.4% for denosumab).

CONCLUSIONS

In this combined analysis of three prospective trials, ONJ was infrequent, management was mostly conservative, and healing occurred in over one-third of the patients. Educating physicians about oral health before and during bone-targeted therapy may help reduce ONJ incidence and improve outcomes.

Validation of quantitative ELISAS for measuring anti-Yersinia pestis F1 and V antibody concentrations in nonhuman primate sera

This study systematically validated two quantitative enzyme-linked immunosorbent assays (ELISAs) for determining Yersinia pestis anti-F1 or anti-V IgG concentration in cynomolgus macaque sera. The results demonstrated that these ELISAs are reliable, reproducible, and suitable for their intended use to measure both anti-F1 and anti-V IgG in monkey sera following vaccination with a heterologous recombinant fusion F1-V protein (rF1-V). Statistical analysis demonstrated assay precision, accuracy, specificity, linearity/dilutional linearity, and robustness for both assays. The quantitative ranges of standard curves were defined as 40-700 ng/mLfor both anti-F1 and anti-V IgG. Either serological assay could be used to determine potency of F1/V antigen-based vaccines in surrogate clinical studies or to define correlates of protective immunity against plague under the Food and Drug Administration's (FDA) two-animal rule.

Levels and transfer of 210Po and 210Pb in Nordic terrestrial ecosystems

Recent developments regarding environmental impact assessment methodologies for radioactivity have precipitated the need for information on levels of naturally occurring radionuclides within and transfer to wild flora and fauna. The objectives of this study were therefore to determine activity concentrations of the main dose forming radionuclides (210)Po and (210)Pb in biota from terrestrial ecosystems thus providing insight into the behaviour of these radioisotopes. Samples of soil, plants and animals were collected at Dovrefjell, Central Norway and Olkiluoto, Finland. Soil profiles from Dovrefjell exhibited an approximately exponential fall in (210)Pb activity concentrations from elevated levels in humus/surface soils to "supported" levels at depth. Activity concentrations of (210)Po in fauna (invertebrates, mammals, birds) ranged between 2 and 123 Bq kg(-1)d.w. and in plants and lichens between 20 and 138 Bq kg(-1)d.w. The results showed that soil humus is an important reservoir for (210)Po and (210)Pb and that fauna in close contact with this media may also exhibit elevated levels of (210)Po. Concentration ratios appear to have limited applicability with regards to prediction of activity concentrations of (210)Po in invertebrates and vertebrates. Biokinetic models may provide a tool to explore in a more mechanistic way the behaviour of (210)Po in this system.

Method for Analysis, and Distribution Profile, of Covalently-linked Ferritin-daunorubicin Conjugate in the Blood of Trypanosome-infected Mice

Daunorubicin is a highly potent trypanocide in-vitro but is inactive in-vivo. When daunorubicin is conjugated to bovine serum albumin or horse spleen ferritin using Schiffs base linkages, the complex is trypanocidal in-vitro and in-vivo. We have developed novel analytical methods, using HPLC with fluorimetric detection, for the quantitation of daunorubicin and doxorubicin in biological samples, either as unconjugated drug, or when covalently linked to macromolecules or particles. Ferritin-daunorubicin conjugate (25 mg kg−1) was administered intraperitoneally to mice infected with monomorphic Trypanosoma brucei rhodesiense; peak plasma levels occurred after 1·5 h, and were 5 times higher than those resulting from administration of an equivalent amount of unconjugated daunorubicin. Plasma levels then declined rapidly (t½ for 1–6 h period was 0·58 and 0·86 h respectively for conjugated and unconjugated daunorubicin). However, higher plasma levels were seen 24 h after treatment, suggesting the distribution profile of daunorubicin when conjugated to ferritin is multiphasic with resultant high levels of daunorubicin obtained for a prolonged time period.

Aspirin and alterations in DNA repair proteins in the SW480 colorectal cancer cell line

Regular aspirin intake is associated with a reduction in the incidence of colorectal cancer. Aspirin has been shown to be cytotoxic to colorectal cancer cells in vitro. The molecular basis for this cytotoxicity is controversial, with a number of competing hypotheses in circulation. One suggestion is that the protective effect is related to the induction of expression of the DNA mismatch repair (MMR) proteins hMLH1, hMSH2, hMSH6 and hPMS2 in DNA MMR proficient cells. We report that treatment of the DNA MMR competent/p53 mutant colorectal cancer cell line SW480 with 1 mM aspirin for 48 h caused changes in mRNA expression of several key genes involved in DNA damage signalling pathways, including a significant down-regulation in transcription of the genes ATR, BRCA1 and MAPK12. Increases in the transcription of XRCC3 and GADD45alpha genes are also reported. Regulation of these genes could potentially have profound effects on colorectal cancer cells and may play a role in the observed chemo-protective effect of aspirin in vivo. Although a correlation was not seen between transcript and protein levels of ATR, BRCA1 and GADD45alpha, an increase in XRCC3 encoded protein expression upon aspirin treatment in SW480 cells was observed by immunoblotting, immunofluorescence and immunohistochemical analysis. This is the first report of XRCC3 gene transcription and encoded protein expression being susceptible to exposure to the non-steroidal anti-inflammatory drug, aspirin. Furthermore, this study indicates that alterations in gene transcription seen in microarray studies must be verified at the protein level.

A randomized phase III trial of denosumab versus zoledronic acid in patients with bone metastases from castration-resistant prostate cancer

LBA4507

Background: Bone metastases from hormone-refractory (castration-resistant) prostate cancer (CRPC) are associated with RANKL-mediated osteoclast activation resulting in bone destruction and skeletal-related events (SRE). Denosumab is a fully human monoclonal antibody against RANKL. This phase III, randomized, double-blind, active-controlled trial compared the efficacy and safety of denosumab vs. zoledronic acid (ZA) in patients with metastatic CRPC.

Methods: Patients (n = 1,901) with CRPC and at least 1 bone metastasis, but no prior IV bisphosphonate use, received either SC denosumab 120 mg and IV placebo (n = 950), or SC placebo and IV ZA 4 mg (n = 951) adjusted for creatinine clearance every 4 weeks. All patients were instructed to take supplemental calcium and vitamin D. The primary endpoint was time to first on-study SRE, defined as pathologic fracture, radiation or surgery to bone, or spinal cord compression.

Results: Denosumab significantly delayed the time to first on-study SRE compared with ZA, (HR 0.82 ; 95% CI: 0.71, 0.95 ; p = 0.008.) The median time to first on-study SRE was 20.7 mo denosumab vs. 17.1 mo ZA, a difference of 3.6 months. Denosumab also significantly delayed the time to first and subsequent on-study SRE (multiple event analysis) (HR 0.82 ; 95% CI: 0.71, 0.94 ; p = 0.004). Greater suppression of the bone turnover markers uNTx and BSAP occurred in denosumab patients compared with ZA (p < 0.0001 for both). Overall, adverse event (AE) rates (97% each) and serious AEs (63% denosumab, 60% ZA) were similar, irrespective of potential relationship to study drugs. AEs of hypocalcemia were reported in 13% and 6% of denosumab and ZA patients. Osteonecrosis of the jaw occurred in 22 (2.3%) denosumab compared with 12 (1.3%) ZA patients (p = 0.09). Overall survival (HR 1.03 ; 95% CI: 0.91, 1.17 ; p = 0.65) and time to cancer progression (HR 1.06; 95% CI: 0.95, 1.18; p = 0.30) were similar between treatment arms.

Conclusions: Denosumab demonstrated superiority over ZA in delaying or preventing SREs in patients with bone metastases from CRPC. Adverse events were consistent in both treatment groups with those previously reported in advanced cancer populations.

[Table: see text]

Background dose-rates to reference animals and plants arising from exposure to naturally occurring radionuclides in aquatic environments

In order to put dose-rates derived in environmental impact assessments into context, the International Commission on Radiological Protection (ICRP) has recommended the structuring of effects data according to background exposure levels. The ICRP has also recommended a suite of reference animals and plants (RAPs), including seven aquatic organisms, for use within their developing framework. In light of these propositions, the objective of this work was to collate information on activity concentrations of naturally occurring primordial radionuclides for marine and freshwater ecosystems and apply appropriate dosimetry models to derive absorbed dose-rates. Although coverage of activity concentration data is comprehensive for sediment and water, few, or in some cases no, data were found for some RAPs, e.g. for frogs (Ranidae) and freshwater grasses (Poaceae) for most radionuclides. The activity concentrations for individual radionuclides in both organisms and their habitat often exhibit standard deviations that are substantially greater than arithmetic mean values, reflecting large variability in activity concentrations. To take account of variability a probabilistic approach was adopted. The dominating radionuclides contributing to exposure in the RAPs are (40)K, (210)Po and (226)Ra. The mean unweighted and weighted dose-rates for aquatic RAPs are in the ranges 0.07-0.39 microGy h(-1) and 0.37-1.9 microGy h(-1) respectively.

An international model validation exercise on radionuclide transfer and doses to freshwater biota

Under the International Atomic Energy Agency (IAEA)'s EMRAS (Environmental Modelling for Radiation Safety) programme, activity concentrations of (60)Co, (90)Sr, (137)Cs and (3)H in Perch Lake at Atomic Energy of Canada Limited's Chalk River Laboratories site were predicted, in freshwater primary producers, invertebrates, fishes, herpetofauna and mammals using eleven modelling approaches. Comparison of predicted radionuclide concentrations in the different species types with measured values highlighted a number of areas where additional work and understanding is required to improve the predictions of radionuclide transfer. For some species, the differences could be explained by ecological factors such as trophic level or the influence of stable analogues. Model predictions were relatively poor for mammalian species and herpetofauna compared with measured values, partly due to a lack of relevant data. In addition, concentration ratios are sometimes under-predicted when derived from experiments performed under controlled laboratory conditions representative of conditions in other water bodies.

Assessment of risk to wildlife from ionising radiation: can initial screening tiers be used with a high level of confidence?

A number of models are being used to assess the potential environmental impact of releases of radioactivity. These often use a tiered assessment structure whose first tier is designed to be highly conservative and simple to use. An aim of using this initial tier is to identify sites of negligible concern and to remove them from further consideration with a high degree of confidence. In this paper we compare the screening assessment outputs of three freely available models. The outputs of these models varied considerably in terms of estimated risk quotient (RQ) and the radionuclide-organism combinations identified as being the most limiting. A number of factors are identified as contributing to this variability: values of transfer parameters (concentration ratios and K(d)) used; organisms considered; different input options and how these are utilised in the assessment; assumptions as regards secular equilibrium; geometries and exposure scenarios. This large variation in RQ values between models means that the level of confidence required by users is not achieved. We recommend that the factors contributing to the variation in screening assessments be subjected to further investigation so that they can be more fully understood and assessors (and those reviewing assessment outputs) can better justify and evaluate the results obtained.

Protection of the environment from ionising radiation in a regulatory context--an overview of the PROTECT coordinated action project

The outcome of the PROTECT project (Protection of the Environment from Ionising Radiation in a Regulatory Context) is summarised, focusing on the protection goal and derivation of dose rates which may detrimentally affect wildlife populations. To carry out an impact assessment for radioactive substances, the estimated dose rates produced by assessment tools need to be compared with some form of criteria to judge the level of risk. To do this, appropriate protection goals need to be defined and associated predefined dose rate values, or benchmarks, derived and agreed upon. Previous approaches used to estimate dose rates at which there may be observable changes in populations or individuals are described and discussed, as are more recent derivations of screening benchmarks for use in regulatory frameworks. We have adopted guidance and procedures used for assessment and regulation of other chemical stressors to derive benchmarks. On the basis of consultation with many relevant experts, PROTECT has derived a benchmark screening dose rate, using data on largely reproductive effects to derive species sensitivity distributions, of 10 microGy h(-1) which can be used to identify situations which are below regulatory concern with a high degree of confidence.

Predicting the radiation exposure of terrestrial wildlife in the Chernobyl exclusion zone: an international comparison of approaches

There is now general acknowledgement that there is a requirement to demonstrate that species other than humans are protected from anthropogenic releases of radioactivity. A number of approaches have been developed for estimating the exposure of wildlife and some of these are being used to conduct regulatory assessments. There is a requirement to compare the outputs of such approaches against available data sets to ensure that they are robust and fit for purpose. In this paper we describe the application of seven approaches for predicting the whole-body ((90)Sr, (137)Cs, (241)Am and Pu isotope) activity concentrations and absorbed dose rates for a range of terrestrial species within the Chernobyl exclusion zone. Predictions are compared against available measurement data, including estimates of external dose rate recorded by thermoluminescent dosimeters attached to rodent species. Potential reasons for differences between predictions between the various approaches and the available data are explored.

Considerations for the integration of human and wildlife radiological assessments

A number of tools and approaches have been developed recently to allow assessments of the environmental impact of radiation on wildlife to be undertaken. The International Commission on Radiological Protection (ICRP) has stated an intention to provide a more inclusive protection framework for humans and the environment. Using scenarios, which are loosely based on real or predicted discharge data, we investigate how radiological assessments of humans and wildlife can be integrated with special consideration given to the recent outputs of the ICRP. We highlight how assumptions about the location of the exposed population of humans and wildlife, and the selection of appropriate benchmarks for determining potential risks can influence the outcome of the assessments. A number of issues associated with the transfer component and numeric benchmarks were identified, which need to be addressed in order to fully integrate the assessment approaches. A particular issue was the lack of comparable benchmark values for humans and wildlife. In part this may be addressed via the ICRP's recommended derived consideration reference levels for their 12 Reference Animals and Plants.

Vertical distribution of anthropogenic radionuclides in cores from contaminated floodplains of the Yenisey River

The Mining and Chemical Industrial Combine, Zheleznogorsk (MCIC, previously known as Krasnoyarsk-26) on the River Yenisey has contaminated the surrounding environment with anthropogenic radionuclides as a result of discharges of radioactive wastes. The purpose of this study was to investigate the vertical distribution of anthropogenic contamination ((137)Cs and plutonium) within floodplain areas at different distances from the discharge point. Sites were chosen that display different characteristics with respect to periodic inundation with river water. Cs-137 activity concentrations were in the range 23-3770 Bq/kg (dry weight, d.w.); Pu-239,240 activity concentrations were in the range <0.01-14.2 Bq/kg (d.w.). Numerous sample cores exhibited sub-surface maxima which may be related to the historical discharges from the MCIC. Possible evidence indicating the deposition of earlier discharges at MCIC in deeper core layers was observed in the (238)Pu:(239,240)Pu activity ratio data: a Pu signal discernible from global fallout could be observed in numerous samples. Cs-137 and Pu-239,240 activity concentrations were correlated with the silt fraction (% by mass <63 microm) though no significant correlation was observed between (grain-size) normalised (137)Cs activity concentrations and distance downstream from the MCIC.

Estimation of ionizing radiation impact on natural Vicia cracca populations inhabiting areas contaminated with uranium mill tailings and radium production wastes

Industrial areas in proximity to the Vodny settlement in the Komi Republic, Russia, have been contaminated by uranium mill tailings and radium production wastes. These areas, exhibiting high activity concentrations of naturally occurring radionuclides in soils, constitute a field laboratory where the effects of combined chronic exposures to alpha-, beta- and gamma-emitting radionuclides on natural plant populations can be studied. The aim of the present work was to determine dose-effect relationships and the range of doses that cause biological effects in natural Vicia cracca L. populations inhabiting the study area. The studied plant species is native to the area and is found ubiquitously. Soil and vegetation samples were taken at a reference location and six contaminated sites characterized by distinct floodplain depositional units with different enhanced levels of naturally occurring radionuclides. A large fraction of the dose at the study sites (including the reference location) was attributable to internal irradiation and (226)Ra was found to be an important contributor to this component of dose. The relationship between the frequency of chromosome aberrations in seedlings' root tip cells and the absorbed dose was found to be quadratic. An exponential model provided the best result in describing the empirical dependence between the absorbed dose and both the germination capacity of seeds and the survival rate of sprouts of V. cracca. For V. cracca plants inhabiting areas contaminated with uranium mill tailings and radium production wastes, a weighted absorbed dose of 0.2 Gy (weighting factor for alpha particles=5) during the vegetation period could be considered to be a level below which no increase in genetic variability and decrease in reproductive capacity might be observed above background.

Cone beam computed sialography of sialoliths

Cone beam CT is an emerging imaging modality used in maxillofacial imaging. This paper describes the use of cone beam sialography in two patients with salivary gland obstruction. In both cases, the obstruction was identified. The dose is comparable with conventional fluoroscopic techniques and has the advantage that the data may be viewed in a series of fine slices and in three dimensions, which may help in diagnosis and further management of the patient.

Correlation of N-telopeptide of type I collagen (NTX) with survival and fractures in patients (pts) with bone metastases from renal cell carcinoma (RCC)

e16016

Background: The osteolysis marker NTX has shown prognostic significance in pts with bone metastases from a broad range of solid tumors, but its potential in pts with RCC has not been investigated. Methods: This was an exploratory correlative analysis of NTX levels and outcomes in the RCC subset of pts treated with zoledronic acid (ZOL) in a 21-month phase III trial (Rosen et al. J Clin Oncol. 2002). In North American pts in this study, urinary NTX was measured approximately every 3 mo and was expressed per mmol creatinine (CR). Endpoints included overall survival (OS), disease progression in bone, and pathologic fractures. Relative risks and 95% confidence intervals for pts with elevated NTX (NTX ≥ 64 nmol/mmol CR) versus normal NTX (< 64 nmol/mmol CR) were calculated by Cox regression for baseline and most recent (≤ 6 mo prior) NTX assessments. Results: Among 55 ZOL-treated RCC pts, 29 had baseline NTX data (median = 60 nmol/mmol CR). Whereas baseline NTX levels showed trends for outcomes, recent NTX levels profoundly correlated with outcomes ( Table ). An elevated recent NTX measurement correlated with a > 13-fold increased risk of death and a > 11-fold increased risk of progression in bone. Correlations were also significant for first and all on-study fractures. Conclusions: In pts with RCC receiving ZOL, serial NTX assessments may provide important prognostic insight. Although based on a small sample size, correlations between recent NTX levels and outcomes in RCC pts are more profound than those previously reported in pts with other solid tumors (Brown et al. J Natl Cancer Inst. 2005). Elevated NTX could alert physicians to the need to more closely monitor bone lesions and intervene to prevent fractures in RCC pts. This may be especially important in the context of new systemic therapies that are improving the outlook in the advanced RCC setting. [Table: see text]

[Table: see text]

Retrospective study of the effectiveness of high-resolution ultrasound compared with sialography in the diagnosis of Sjogren's syndrome

OBJECTIVE

This report aimed to evaluate the effectiveness of high-resolution ultrasound compared with conventional sialography in the diagnosis of Sjögren's syndrome (SS) and to establish whether less invasive ultrasound could replace sialography as a diagnostic investigation.

METHOD

Clinical records and examination results of 105 consecutive subjects investigated contemporaneously by ultrasound and sialography of the parotid glands for SS were reviewed retrospectively. Results were compared against the final diagnosis established on the basis of revised international classification criteria for SS. 45 subjects were excluded from the study due to incomplete records. Of 60 remaining subjects under investigation for SS, 45 were confirmed (36 primary SS, 9 secondary SS), the remaining 15 subjects being proven not to have the condition.

RESULTS

Ultrasound showed a decreased and heterogeneous honeycomb pattern of parotid gland reflectivity in patients with SS, while sialography demonstrated a punctate pattern of sialectasis. Sensitivity, specificity and accuracy for ultrasound were 84.44%, 73% and 81.6%, respectively, and for conventional sialography were 77.77%, 86.66% and 80%, respectively. The diagnostic difference between the two investigations approached significance (P = 0.074). By combining both imaging modalities, sensitivity increased to 91% with 60% specificity and 83.3% accuracy. There was no significant difference between investigations when diagnosing primary vs secondary SS.

CONCLUSION

High-resolution ultrasound is a useful, non-invasive and more sensitive alternative to sialography as a diagnostic test in patients with suspected SS. Accuracy may be increased by supplementing ultrasound with sialography.