Dose assessment to workers in a dicalcium phosphate production plant

The production of dicalcium phosphate (DCP) uses phosphate rock (PR) as a raw material. Sedimentary phosphate rocks are enriched with relevant concentrations of natural radionuclides from the ²³⁸U decay chain (around 10³ Bq·kg^-1), leading to the need of controlling potential exposures to radiation of workers and members of the public in accordance with IAEA safety standards. Indeed, phosphate industries are classified as Naturally Occurring Radioactive Material (NORM) industries. Thus, the aim of this work is to assess the radiological risk of the workers in a DCP production plant located in the Iberian Peninsula (South-West Europe), which digests PR with hydrochloric acid. In the present study ²³⁸U, ²³⁰Th, ²²²Rn, ²¹⁰Pb and ²¹⁰Po concentrations in aerosols (indoor and outdoor areas) are reported. Aerosols showed concentrations between 0.42-92 mBq·m^-3 for ²³⁸U, 0.24-33 mBq·m^-3 for ²³⁰Th, 0.67-147 mBq·m^-3 for ²¹⁰Pb and 0.09-34 mBq·m^-3 for ²¹⁰Po. Long-term exposure (four months) of passive ²²²Rn detectors provided concentrations that ranged from detection limit (< DL) to 121 Bq·m^-3 in outdoor areas and from < DL to 211 Bq·m^-3 in indoor areas, similar to concentrations obtained from short-term measurements with active detectors from < DL to 117 Bq·m^-3 in outdoor areas and from < DL to 318 Bq·m^-3 in indoor places. ²²⁶Ra accumulation in ebonite and pipe scales were the most important contributions to the ambient dose equivalent H*(10), resulting in 0.07 (background)-27 μSv·h^-1 with a median value of 1.1 μSv·h^-1. Average ²²²Rn air concentrations were lower than the 300 Bq·m^-3 limit and therefore, according to European Directive 2013/59/EURATOM, ²²²Rn concentration is excluded from the worker operational annual effective dose. Thus, considering the inhalation of aerosols and the external dose sources, the total effective dose determined for plant operators was 0.37 mSv·y^-1.

Abacavir/lamivudine + unboosted atazanavir in routine clinical practice: Twelve years experience

OBJECTIVE

To describe the experience using the combination abacavir, lamivudine plus non-boosted atazanavir (ABC/3TC+ATV) in a group of pretreated patients.

PATIENTS AND METHODS

We performed a retrospective observational study to describe baseline characteristics and the evolution of patients who had received or were treating with ABC/3TC+ATV, from November 2004 and June 15th 2015, in the clinical setting.

RESULTS

Overall, 236 patients were included in the study. Median age (IQR) was 45 (42-50) years and 69% were male. The main reasons for using this combination were previous toxicity in 130 patients (56%), simplification in 60 (20%) and virologic failure in 29 (14%). Previous treatment was based in boosted protease inhibitor in 115 patients (48.7%), 3 analogs in 56 (28%) and non-analogous based in 19 (8.1%). Median treatment length was 2.2 years (IQR0.8-5.3). A total of 66 (28%) patients continue receiving ABC/3TC+ATV (median time 5.7, IQR2.2-8.3), treatment was changed in 170 patients (72%) (median time 1.6 years, IQR0.7-3.6), and 22 (9.3%) patients were lost. Virological failure was assessed in 30 patients.

CONCLUSION

In selected patients, ABC/3TC+ATV is a durable and attractive therapeutic alternative.

Excessive collagen turnover products are released during colorectal cancer progression and elevated in serum from metastatic colorectal cancer patients

During cancer progression, the homeostasis of the extracellular matrix becomes imbalanced with an excessive collagen remodeling by matrix metalloproteinases. As a consequence, small protein fragments of degraded collagens are released into the circulation. We have investigated the potential of protein fragments of collagen type I, III and IV as novel biomarkers for colorectal cancer. Specific fragments of degraded type I, III and IV collagen (C1M, C3M, C4M) and type III collagen formation (Pro-C3) were assessed in serum from colorectal cancer patients, subjects with adenomas and matched healthy controls using well-characterized and validated ELISAs. Serum levels of the biomarkers were significantly elevated in colorectal cancer patients compared to subjects with adenomas (C1M, Pro-C3, C3M) and controls (C1M, Pro-C3). When patients were stratified according to their tumour stage, all four biomarkers were able to differentiate stage IV metastatic patients from all other stages. Combination of all markers with age and gender in a logistic regression model discriminated between metastatic and non-metastatic patients with an AUROC of 0.80. The data suggest that the levels of these collagen remodeling biomarkers may be a measure of tumour activity and invasiveness and may provide new clinical tools for monitoring of patients with advanced stage colorectal cancer.

Adverse reactions and tolerability of high-dose sublingual allergen immunotherapy

BACKGROUND

Sublingual allergen immunotherapy is an effective treatment against allergic respiratory disease. Many studies have shown the safety of this type of therapy, although the factors that might affect the tolerability of high-dose sublingual immunotherapy have not been well established. The aim of this study was to determine the factors that affect the tolerability of sublingual allergen immunotherapy.

PATIENTS AND METHODS

A total of 183 subjects aged ≥5 years, diagnosed with allergic rhinitis with/without mild to moderate asthma due to sensitization to grass, olive pollen, or mites, were included in this open, retrospective, multicentric, noninterventional study. Sublingual immunotherapy was administered for at least 3 months.

RESULTS

The most frequent adverse reaction was oral pruritus (13.7% of the patients). Most of the reactions were local (84.7%) and immediate (93.5%) and occurred during the initiation phase (60.6%). All reactions were mild to moderate in severity. No serious adverse reactions were registered. When comparing factors with potential influence on the occurrence of adverse reactions, the results between the groups of subjects with and without adverse reactions showed no statistically significant differences in sex (P=0.6417), age (P=0.1801), years since the disease was first diagnosed (P=0.3800), treatment composition (P=0.6946), polysensitization (P=0.1730), or clinical diagnosis (P=0.3354). However, it was found that treatment duration had a statistically significant influence (3 months, >3 months: P=0.0442) and the presence of asthma was close to statistical significance (P=0.0847).

CONCLUSION

In our study, treatment duration is significantly associated with the occurrence of adverse reactions after the administration of high doses of sublingual allergen immunotherapy.

Randomized dose–response study of subcutaneous immunotherapy with a Dermatophagoides pteronyssinus extract in patients with respiratory allergy

Aim: To evaluate the efficacy of Dermatophagoides pteronyssinus (DPT) subcutaneous immunotherapy in allergic rhinoconjunctivitis patients. Patients & methods: This 17-week double-blind study randomized 136 patients (95 evaluable) to five dose groups of DPT depot extract (0.0625–0.75 skin prick test [SPT] units) or placebo, administered in a six updosing schedule. Results: A dose–response was observed for clinical efficacy (allergen concentration needed to induce a positive nasal provocation test response from baseline to final visit) and safety (adverse reactions). Local and systemic reactions occurred with 14.8 and 6.4% of administered doses, respectively; a single anaphylactic reaction occurred in each of Groups 3, 4 and 5 (0.3% of doses). Conclusion: The risk–benefit profile appeared most favorable with a DPT dose of 0.125 SPT units.

Short Communication: p21/CDKN1A Expression Shows Broad Interindividual Diversity in a Subset of HIV-1 Elite Controllers

The p21/CDKN1A protein has been described in vitro as well as in a small subset of patients as a restriction factor for HIV infection. We evaluated p21/CDKN1A mRNA expression on CD4(+) T cells from HIV-infected individuals with two outcomes (18 elite controllers and 28 viremic progressors). Our results show broad interindividual variation in this factor, which is unrelated to the patient's phenotype. Considering the gene's genetic surroundings in chromosome 6, such as HLA genotype and single nucleotide polymorphisms (SNPs), there was a positive association with carrying HLA-B2705 alleles and the rs733590 SNP. Thus, this natural variation of p21/CDKN1A alone does not appear to be a prognostic indicator of effective viral control in vivo and other factors must be considered.

Soil radon dynamics in the Amer fault zone: An example of very high seasonal variations

Soil radon levels of the Amer fault zone have been measured for a 4 year-period with the aim of checking seasonal fluctuations obtained in previous studies and to understand radon origin and dynamics. In this manuscript additional results are presented: updated continuous and integrated soil radon measurements, radionuclide content of soil materials and a detailed analysis of an urban profile by means of the electrical resistivity imaging technique and punctual soil radon, thoron and CO2 measurements. Integrated and continuous measurements present a wide range of values, [0.2-151.6] kBq m(-3) for radon, [4.5-39.6] kBq m(-3) for thoron and [4.0-71.2] g m(-2) day(-1) for CO2. The highest soil radon levels in the vicinity of the Amer fault (>40 kBq m(-3)) are found close to the fractured areas and present very important fluctuations repeated every year, with values in summer much higher than in winter, confirming previous studies. The highest radon values, up to 150 kBq m(-3), do not have a local origin because the mean value of radium concentration in this soil (19 ± 5 Bq kg(-1)) could not explain these values. Then soil radon migration through the fractures, influenced by atmospheric parameters, is assumed to account for such a high seasonal fluctuation. As main conclusion, in fractured areas, seasonal variations of soil radon concentration can be very important even in places where average soil radon concentration and radium content are not especially high. In these cases the migration capability of the soil is given not by intrinsic permeability but by the fracture structure. Potential risk estimation based on soil radon concentration and intrinsic permeability must be complemented with geological information in fractured systems.

Use of text-message reminders to improve participation in a population-based breast cancer screening program

To analyze the effect of a cell text message reminder service on participation in a mammogram screening program in Catalonia, Spain. A quasi-experimental design was used with women aged 50 to 69 years who had been scheduled mammogram appointments in June or July 2011. Women were personally invited by letter to attend to the breast cancer screening program (n = 12,786). Prior to the invitation, 3,719 (29.1 %) of them had provided their cell telephone number to the National Health Service. These women received a text message reminder 3 days before their scheduled appointment. Logistic regression models were used to analyze whether the text message reminder was associated with participation in screening. Cost-effectiveness of adding a text message reminder to the invitation letter was also analyzed. The overall rate of participation in breast cancer screening was 68.4 %. The participation rate was significantly higher in the text messaging group, with an age-adjusted OR of 1.56 (95 %CI: 1.43-1.70). A detailed analysis showed that the increase in participation related to the text message reminder was higher among women without previous screening who lived in areas where access to postal mail was limited (OR=2.85; 95 %CI: 2.31-3.53) compared to those who lived in areas of easier postal mail access (OR=1.66; 95 %CI: 1.36-2.02). The invitation letter+text message reminder was a cost-effective strategy. Text message reminders are an efficient cost-effective approach to improve participation in difficult-to-reach populations, such as rural areas and newly developed suburbs.