1
|
Azar A, Bhutta MF, Del-Pozo J, Milne E, Cheeseman M. Trans-cortical vessels in the mouse temporal bulla bone are a means to recruit myeloid cells in chronic otitis media and limit peripheral leukogram changes. Front Genet 2022; 13:985214. [PMID: 36246635 PMCID: PMC9555619 DOI: 10.3389/fgene.2022.985214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic otitis media, inflammation of the middle ear, is a sequel to acute otitis media in ∼8% of children. Chronic otitis media with effusion is the most common cause of childhood deafness and is characterised by effusion of white blood cells into the auditory bulla cavity. Skull flat bones have trans-cortical vessels which are responsible for the majority of blood flow in and out of the bone. In experimental models of stroke and aseptic meningitis there is preferential recruitment of myeloid cells (neutrophils and monocytes) from the marrow in skull flat bones. We report trans-cortical vessels in the mouse temporal bone connect to the bulla mucosal vasculature and potentially represent a means to recruit myeloid cells directly into the inflamed bulla. The mutant mouse strains Junbo (MecomJbo/+) and Jeff (Fbxo11Jf/+) develop chronic otitis spontaneously; MecomJbo/+ mice have highly cellular neutrophil (90%) rich bulla exudates whereas Fbxo11Jf/+ mice have low cellularity serous effusions (5% neutrophils) indicating differing demand for neutrophil recruitment. However we found peripheral leukograms of MecomJbo/+ and Fbxo11Jf/+ mice are similar to their respective wild-type littermate controls with healthy bullae and infer preferential mobilization of myeloid cells from temporal bulla bone marrow may mitigate the need for a systemic inflammatory reaction. The cytokines, chemokines and haematopoietic factors found in the inflamed bulla represent candidate signalling molecules for myeloid cell mobilization from temporal bone marrow. The density of white blood cells in the bulla cavity is positively correlated with extent of mucosal thickening in MecomJbo/+, Fbxo11Jf/+, and EdaTa mice and is accompanied by changes in epithelial populations and bone remodelling. In MecomJbo/+ mice there was a positive correlation between bulla cavity WBC numbers and total bacterial load. The degree of inflammation varies between contralateral bullae and between mutant mice of different ages suggesting inflammation may wax and wane and may be re-initiated by a new wave of bacterial infection. Clearance of white blood cells and inflammatory stimuli from the bulla cavity is impaired and this may create a pro-inflammatory feedback loop which further exacerbates otitis media and delays its resolution.
Collapse
Affiliation(s)
- Ali Azar
- Developmental Biology Division, Roslin Institute and The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Mahmood F. Bhutta
- Brighton and Sussex Medical School, Brighton, United Kingdom
- Department of ENT, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Jorge Del-Pozo
- Veterinary Pathology, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Elspeth Milne
- Veterinary Pathology, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Michael Cheeseman
- Developmental Biology Division, Roslin Institute and The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- Division of Pathology, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- Centre for Comparative Pathology, Division of Pathology, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- *Correspondence: Michael Cheeseman,
| |
Collapse
|
2
|
Javadinia SA, Nazeminezhad N, Ghahramani-Asl R, Soroosh D, Fazilat-Panah D, PeyroShabany B, Saberhosseini SN, Mehrabian A, Taghizadeh-Hesary F, Nematshahi M, Dhawan G, Welsh JS, Calabrese EJ, Kapoor R. Low-dose radiation therapy for osteoarthritis and enthesopathies: a review of current data. Int J Radiat Biol 2021; 97:1352-1367. [PMID: 34259615 DOI: 10.1080/09553002.2021.1956000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Osteoarthritis (OA), the most common degenerative joint disease, is associated with severe functional limitation and impairment of quality of life. Numerous reports have documented the clinical efficacy of low-dose radiotherapy (LD-RT) in the management of various inflammatory disorders, including OA. In this paper, we assessed the clinical literature involving the use of LD-RT in the treatment of OA, its dose-response features, possible underlying mechanistic features, and optimal therapeutic dose range. METHODS We carried out a systematic review based on the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statements and evaluated articles meeting the inclusion criteria for this review. RESULTS A total of 361 articles were identified from databases, such as Scopus, PubMed, Embase, and Science Direct out of which 224 articles were duplicates and were discarded. Of the remaining 137 articles, 74 articles were un-related, 27 articles were review articles, eight were conference abstracts, three were letters, two were editorials, two were notes, and one was a book chapter. Finally, 20 articles met all the inclusion criteria and were included in this systematic review. DISCUSSION Several single-arm retrospective/prospective studies showed advantages for LD-RT in the management of OA in terms of pain relief, improvement of mobility and function, and showed minimal side effects. Mechanistic considerations involve positive subcellular effects mediated by the activation of a nuclear factor erythroid 2-related transcription factor (Nrf2) mediated antioxidant response. Further research on both the short- and long-term effects of LD-RT on OA and other inflammatory disorders is recommended.
Collapse
Affiliation(s)
- Seyed Alireza Javadinia
- Clinical Research Development Unit, Hospital Research Development Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Ruhollah Ghahramani-Asl
- Clinical Research Development Unit, Hospital Research Development Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Davood Soroosh
- Clinical Research Development Unit, Hospital Research Development Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Babak PeyroShabany
- Department of Internal Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Arezoo Mehrabian
- Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Nematshahi
- Department of Anesthesiology and Critical Care, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Gaurav Dhawan
- Sri Guru Ram Das University of Health Sciences, Amritsar, India
| | - James S Welsh
- Edward Hines Jr. VA Hospital, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA
| | - Edward J Calabrese
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Rachna Kapoor
- Saint Francis Hospital and Medical Center, Hartford, CT, USA
| |
Collapse
|
3
|
Oakley PA, Betz JW, Harrison DE, Siskin LA, Hirsh DW. Radiophobia Overreaction: College of Chiropractors of British Columbia Revoke Full X-Ray Rights Based on Flawed Study and Radiation Fear-Mongering. Dose Response 2021; 19:15593258211033142. [PMID: 34421439 PMCID: PMC8375354 DOI: 10.1177/15593258211033142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 01/11/2023] Open
Abstract
Fears over radiation have created irrational pressures to dissuade radiography use within chiropractic. Recently, the regulatory body for chiropractors practicing in British Columbia, Canada, the College of Chiropractors of British Columbia (CCBC), contracted Pierre Côté to review the clinical use of X-rays within the chiropractic profession. A "rapid review" was performed and published quickly and included only 9 papers, the most recent dating from 2005; they concluded, "Given the inherent risks of radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine." The CCBC then launched an immediate review of the use of X-rays by chiropractors in their jurisdiction. Member and public opinion were gathered but not presented to their members. On February 4, 2021, the College announced amendments to their Professional Conduct Handbook that revoked X-ray rights for routine/repeat assessment and management of patients with spine disorders. Here, we highlight current and historical evidence that substantiates that X-rays are not a public health threat. We also point out critical and insurmountable flaws in the single paper used to support irrational and unscientific policy that discriminates against chiropractors who practice certain forms of evidence-based X-ray-guided methods.
Collapse
Affiliation(s)
| | | | | | | | | | - International Chiropractors Association Rapid Response Research Review Subcommittee
- Private Practice, Newmarket, ON, Canada
- Private Practice, Boise, ID, USA
- CBP NonProfit, Inc, Eagle, ID, USA
- Private Practice, Green Brook, NJ, USA
- Private Practice, Laurel, MD, USA
| |
Collapse
|
4
|
Gheorghe DC, Niculescu AG, Bîrcă AC, Grumezescu AM. Nanoparticles for the Treatment of Inner Ear Infections. NANOMATERIALS (BASEL, SWITZERLAND) 2021; 11:1311. [PMID: 34067544 PMCID: PMC8156593 DOI: 10.3390/nano11051311] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022]
Abstract
The inner ear is sensitive to various infections of viral, bacterial, or fungal origin, which, if left untreated, may lead to hearing loss or progress through the temporal bone and cause intracranial infectious complications. Due to its isolated location, the inner ear is difficult to treat, imposing an acute need for improving current therapeutic approaches. A solution for enhancing antimicrobial treatment performance is the use of nanoparticles. Different inorganic, lipidic, and polymeric-based such particles have been designed, tested, and proven successful in the controlled delivery of medication, improving drug internalization by the targeted cells while reducing the systemic side effects. This paper makes a general presentation of common inner ear infections and therapeutics administration routes, further focusing on newly developed nanoparticle-mediated treatments.
Collapse
Affiliation(s)
- Dan Cristian Gheorghe
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- “M.S. Curie” Clinical Emergency Hospital for Children, 050474 Bucharest, Romania
| | - Adelina-Gabriela Niculescu
- Faculty of Engineering in Foreign Languages, University Politehnica of Bucharest, 060042 Bucharest, Romania;
| | - Alexandra Cătălina Bîrcă
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania;
| | - Alexandru Mihai Grumezescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania;
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
| |
Collapse
|
5
|
Oakley PA, Harrison DE. Radiophobic Fear-Mongering, Misappropriation of Medical References and Dismissing Relevant Data Forms the False Stance for Advocating Against the Use of Routine and Repeat Radiography in Chiropractic and Manual Therapy. Dose Response 2021; 19:1559325820984626. [PMID: 33628151 PMCID: PMC7883173 DOI: 10.1177/1559325820984626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/14/2022] Open
Abstract
There is a faction within the chiropractic profession passionately advocating against the routine use of X-rays in the diagnosis, treatment and management of patients with spinal disorders (aka subluxation). These activists reiterate common false statements such as "there is no evidence" for biomechanical spine assessment by X-ray, "there are no guidelines" supporting routine imaging, and also promulgate the reiterating narrative that "X-rays are dangerous." These arguments come in the form of recycled allopathic "red flag only" medical guidelines for spine care, opinion pieces and consensus statements. Herein, we review these common arguments and present compelling data refuting such claims. It quickly becomes evident that these statements are false. They are based on cherry-picked medical references and, most importantly, expansive evidence against this narrative continues to be ignored. Factually, there is considerable evidential support for routine use of radiological imaging in chiropractic and manual therapies for 3 main purposes: 1. To assess spinopelvic biomechanical parameters; 2. To screen for relative and absolute contraindications; 3. To reassess a patient's progress from some forms of spine altering treatments. Finally, and most importantly, we summarize why the long-held notion of carcinogenicity from X-rays is not a valid argument.
Collapse
|
6
|
Ghahramani-Asl R, Porouhan P, Mehrpouyan M, Welsh JS, Calabrese EJ, Kapoor R, Dhawan G, Javadinia SA. Feasibility of Treatment Planning System in Localizing the COVID-19 Pneumonia Lesions and Evaluation of Volume Indices of Lung Involvement. Dose Response 2020; 18:1559325820962600. [PMID: 33088245 PMCID: PMC7545774 DOI: 10.1177/1559325820962600] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 12/20/2022] Open
Abstract
Background and purpose To assess the feasibility of a treatment planning system in localizing, contouring, and targeting lung lesions along with an evaluation of volume indices of lung involvement in patients with COVID-19 pneumonia. Methods We evaluated 10 patients with PCR-confirmed COVID-19 pneumonia. The CT images were imported into the ISOgray® treatment planning system to anatomically define and contour the volumes of the pulmonary lesions, the lungs, and other nearby organs. Results The ratio of lung lesion volume to lung volume in this study was 0.11 ± 0.13 (11.13%). The highest mean biosynthesis ratio of lung lesions was 0.36. The ratio of lesion volume in the left lung of patients with the highest volume of involvement, was 0.44, and the ratio of lesion volume in the right lung of these patients was 0.27 (approximately 1.5 times more in the left lung than the right lung). On average, CTDIvol and DLP for all patients studied in our study were 11.22 ± 2.47 mGy and 354.20 ± 65.11 mGy.cm. Conclusion We reported the feasibility of using a treatment planning system in localizing COVID-19 pulmonary lesions and its validity in the volumetric assessment of infected lung regions.
Collapse
Affiliation(s)
- Ruhollah Ghahramani-Asl
- Department of Medical Physics and Radiation Sciences, Faculty of Paramedicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.,Clinical Research Development Unit, Hospital Research Development Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Pejman Porouhan
- Department of Radiation Oncology, Vasei Educational Hospital, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mohammad Mehrpouyan
- Department of Medical Physics and Radiation Sciences, Faculty of Paramedicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - James S Welsh
- Loyola University Chicago, Edward Hines Jr., VA Hospital, Stritch School of Medicine, Department of Radiation Oncology, Maywood, IL, USA
| | - Edward J Calabrese
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Rachna Kapoor
- Saint Francis Hospital and Medical Center, Hartford, CT, USA
| | | | - Seyed Alireza Javadinia
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| |
Collapse
|
7
|
Oakley PA, Navid Ehsani N, Harrison DE. 5 Reasons Why Scoliosis X-Rays Are Not Harmful. Dose Response 2020; 18:1559325820957797. [PMID: 32963506 PMCID: PMC7488912 DOI: 10.1177/1559325820957797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
Radiographic imaging for scoliosis screening, diagnosis, treatment, and management is the gold standard assessment tool. Scoliosis patients receive many repeat radiographs, typically 10-25 and as many as 40-50, equating to a maximum 50 mGy of cumulative exposure. It is argued this amount of radiation exposure is not carcinogenic to scoliosis patients for 5 main reasons: 1. Estimated theoretical cumulative effective doses remain below the carcinogenic dose threshold; 2. Scoliosis patient x-rays are delivered in serial exposures and therefore, mitigate any potential cumulative effect; 3. Linear no-threshold cancer risk estimates from scoliosis patient cohorts are flawed due to faulty science; 4. Standardized incidence/mortality ratios demonstrating increased cancers from aged scoliosis cohorts are confounded by the effects of the disease entity itself making it impossible to claim cause and effect resulting from low-dose radiation exposures from spinal imaging; 5. Children are not more susceptible to radiation damage than adults. Radiophobia concerns from patients, parents, and doctors over repeat imaging for scoliosis treatment and management is not justified; it adds unnecessary anxiety to the patient (and their parents) and interferes with optimal medical management. X-rays taken in the evidence-based management of scoliosis should be taken without hesitation or concern about negligible radiation exposures.
Collapse
|
8
|
van Dijk B, Lemans JVC, Hoogendoorn RM, Dadachova E, de Klerk JMH, Vogely HC, Weinans H, Lam MGEH, van der Wal BCH. Treating infections with ionizing radiation: a historical perspective and emerging techniques. Antimicrob Resist Infect Control 2020; 9:121. [PMID: 32736656 PMCID: PMC7393726 DOI: 10.1186/s13756-020-00775-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/09/2020] [Indexed: 01/09/2023] Open
Abstract
Background Widespread use and misuse of antibiotics have led to a dramatic increase in the emergence of antibiotic resistant bacteria, while the discovery and development of new antibiotics is declining. This has made certain implant-associated infections such as periprosthetic joint infections, where a biofilm is formed, very difficult to treat. Alternative treatment modalities are needed to treat these types of infections in the future. One candidate that has been used extensively in the past, is the use of ionizing radiation. This review aims to provide a historical overview and future perspective of radiation therapy in infectious diseases with a focus on orthopedic infections. Methods A systematic search strategy was designed to select studies that used radiation as treatment for bacterial or fungal infections. A total of 216 potentially relevant full-text publications were independently reviewed, of which 182 focused on external radiation and 34 on internal radiation. Due to the large number of studies, several topics were chosen. The main advantages, disadvantages, limitations, and implications of radiation treatment for infections were discussed. Results In the pre-antibiotic era, high mortality rates were seen in different infections such as pneumonia, gas gangrene and otitis media. In some cases, external radiation therapy decreased the mortality significantly but long-term follow-up of the patients was often not performed so long term radiation effects, as well as potential increased risk of malignancies could not be investigated. Internal radiation using alpha and beta emitting radionuclides show great promise in treating fungal and bacterial infections when combined with selective targeting through antibodies, thus minimizing possible collateral damage to healthy tissue. Conclusion The novel prospects of radiation treatment strategies against planktonic and biofilm-related microbial infections seem feasible and are worth investigating further. However, potential risks involving radiation treatment must be considered in each individual patient.
Collapse
Affiliation(s)
- B van Dijk
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - J V C Lemans
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R M Hoogendoorn
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Dadachova
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - J M H de Klerk
- Department of Nuclear Medicine, Meander Medical Center Amersfoort, Amersfoort, The Netherlands
| | - H C Vogely
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Weinans
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Biomechanical engineering, TU Delft, Delft, The Netherlands
| | - M G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B C H van der Wal
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
9
|
Oakley PA, Harrison DE. X-Ray Hesitancy: Patients' Radiophobic Concerns Over Medical X-rays. Dose Response 2020; 18:1559325820959542. [PMID: 32994755 PMCID: PMC7503016 DOI: 10.1177/1559325820959542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/20/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022] Open
Abstract
All too often the family physician, orthopedic surgeon, dentist or chiropractor is met with radiophobic concerns about X-ray imaging in the clinical setting. These concerns, however, are unwarranted fears based on common but ill-informed and perpetuated ideology versus current understanding of the effects of low-dose radiation exposures. Themes of X-ray hesitancy come in 3 forms: 1. All radiation exposures are harmful (i.e. carcinogenic); 2. Radiation exposures are cumulative; 3. Children are more susceptible to radiation. Herein we address these concerns and find that low-dose radiation activates the body's adaptive responses and leads to reduced cancers. Low-dose radiation is not cumulative as long as enough time (e.g. 24 hrs) passes prior to a repeated exposure, and any damage is repaired, removed, or eliminated. Children have more active immune systems; the literature shows children are no more affected than adults by radiation exposures. Medical X-rays present a small, insignificant addition to background radiation exposure that is not likely to cause harm. Doctors and patients alike should be better informed of the lack of risks from diagnostic radiation and the decision to image should rely on the best evidence, unique needs of the patient, and the expertise of the physician-not radiophobia.
Collapse
|
10
|
Hanekamp YN, Giordano J, Hanekamp JC, Khan MK, Limper M, Venema CS, Vergunst SD, Verhoeff JJC, Calabrese EJ. Immunomodulation Through Low-Dose Radiation for Severe COVID-19: Lessons From the Past and New Developments. Dose Response 2020; 18:1559325820956800. [PMID: 33013251 PMCID: PMC7513398 DOI: 10.1177/1559325820956800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Low-dose radiation therapy (LD-RT) has historically been a successful treatment for pneumonia and is clinically established as an immunomodulating therapy for inflammatory diseases. The ongoing COVID-19 pandemic has elicited renewed scientific interest in LD-RT and multiple small clinical trials have recently corroborated the historical LD-RT findings and demonstrated preliminary efficacy and immunomodulation for the treatment of severe COVID-19 pneumonia. The present review explicates archival medical research data of LD-RT and attempts to translate this into modernized evidence, relevant for the COVID-19 crisis. Additionally, we explore the putative mechanisms of LD-RT immunomodulation, revealing specific downregulation of proinflammatory cytokines that are integral to the development of the COVID-19 cytokine storm induced hyperinflammatory state. Radiation exposure in LD-RT is minimal compared to radiotherapy dosing standards in oncology care and direct toxicity and long-term risk for secondary disease are expected to be low. The recent clinical trials investigating LD-RT for COVID-19 confirm initial treatment safety. Based on our findings we conclude that LD-RT could be an important treatment option for COVID-19 patients that are likely to progress to severity. We advocate the further use of LD-RT in carefully monitored experimental environments to validate its effectiveness, risks and mechanisms of LD-RT.
Collapse
Affiliation(s)
- Yannic N. Hanekamp
- University Medical Centre Groningen, University of Groningen, the
Netherlands
| | - James Giordano
- Departments of Neurology and Biochemistry, and Pellegrino Center for
Clinical Bioethics, Georgetown University Medical Center, Washington, DC, USA
| | - Jaap C. Hanekamp
- University College Roosevelt, Middelburg, the Netherlands
- Department of Environmental Health Sciences, University of
Massachusetts, Amherst, MA, USA
| | - Mohammad K. Khan
- Department of Radiation Oncology, Winship Cancer Institute, Emory
University School of Medicine, Atlanta, GA, USA
| | - Maarten Limper
- Department of Rheumatology and Clinical Immunology, University
Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Samuel D. Vergunst
- University Medical Centre Groningen, University of Groningen, the
Netherlands
| | - Joost J. C. Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht,
Utrecht University, Utrecht, the Netherlands
| | - Edward J. Calabrese
- Department of Environmental Health Sciences, University of
Massachusetts, Amherst, MA, USA
| |
Collapse
|
11
|
Dhawan G, Kapoor R, Dhawan R, Singh R, Monga B, Giordano J, Calabrese EJ. Low dose radiation therapy as a potential life saving treatment for COVID-19-induced acute respiratory distress syndrome (ARDS). Radiother Oncol 2020; 147:212-216. [PMID: 32437820 PMCID: PMC7206445 DOI: 10.1016/j.radonc.2020.05.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 01/22/2023]
Abstract
The new coronavirus COVID-19 disease caused by SARS-CoV-2 was declared a global public health emergency by WHO on Jan 30, 2020. Despite massive efforts from various governmental, health and medical organizations, the disease continues to spread globally with increasing fatality rates. Several experimental drugs have been approved by FDA with unknown efficacy and potential adverse effects. The exponentially spreading pandemic of COVID-19 deserves prime public health attention to evaluate yet unexplored arenas of management. We opine that one of these treatment options is low dose radiation therapy for severe and most critical cases. There is evidence in literature that low dose radiation induces an anti-inflammatory phenotype that can potentially afford therapeutic benefit against COVID-19-related complications that are associated with significant morbidity and mortality. Herein, we review the effects and putative mechanisms of low dose radiation that may be viable, useful and of value in counter-acting the acute inflammatory state induced by critical stage COVID-19.
Collapse
Affiliation(s)
- Gaurav Dhawan
- Human Research Protection Office, University of Massachusetts, Amherst, United States.
| | - Rachna Kapoor
- Saint Francis Hospital and Medical Center, Hartford, United States
| | - Rajiv Dhawan
- Radiotherapy Department, Government Medical College, Amritsar, India
| | - Ravinder Singh
- MedSurg Urgent Care, Gilbertsville, Pennsylvania, United States
| | - Bharat Monga
- Division of Hospital Medicine, Mount Sinai Morningside Hospital, New York, United States
| | - James Giordano
- Department of Neurology and Biochemistry and Chief, Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC, United States; Program in Biosecurity, Technology, and Ethics, US Naval War College, Newport, United States
| | - Edward J Calabrese
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, United States
| |
Collapse
|
12
|
Lara PC, Nguyen NP, Macias-Verde D, Burgos-Burgos J, Arenas M, Zamagni A, Vinh-Hung V, Baumert BG, Motta M, Myint AS, Bonet M, Popescu T, Vuong T, Appalanaido GK, Trigo L, Karlsson U, Thariat J. Whole-lung Low Dose Irradiation for SARS-Cov2 Induced Pneumonia in the Geriatric Population: An Old Effective Treatment for a New Disease? Recommendation of the International Geriatric Radiotherapy Group. Aging Dis 2020; 11:489-493. [PMID: 32489696 PMCID: PMC7220282 DOI: 10.14336/ad.2020.0506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/06/2020] [Indexed: 01/08/2023] Open
Abstract
A cytokine storm induced by SARS-Cov2 may produce pneumonitis which may be fatal for older patients with underlying lung disease. Hyper-elevation of Interleukin1 (IL-1), Tumor necrosis factor-1alfa (TNF-1 alfa), and Interleukin 6 (IL-6) produced by inflammatory macrophage M1 may damage the lung alveoli leading to severe pneumonitis, decreased oxygenation, and potential death despite artificial ventilation. Older patients may not be suitable candidates for pharmaceutical intervention targeting IL-1/6 blockade or artificial ventilation. Low dose total lung (LDTL) irradiation at a single dose of 50 cGy may stop this cytokine cascade, thus preventing, and/or reversing normal organs damage. This therapy has been proven in the past to be effective against pneumonitis of diverse etiology and could be used to prevent death of older infected patients. Thus, LDRT radiotherapy may be a cost-effective treatment for this frail patient population whom radiation -induced malignancy is not a concern because of their advanced age. This hypothesis should be tested in future prospective trials.
Collapse
Affiliation(s)
- Pedro C Lara
- Department of Radiation Oncology, Hospital Universitario San Roque, Fernando Pessoa Canarias Las Palmas University, Las Palmas, Spain.
| | - Nam P Nguyen
- Department of Radiation Oncology, Howard University, Washington D.C., USA.
| | - David Macias-Verde
- Department of Radiation Oncology, Hospital Universitario San Roque, Fernando Pessoa Canarias Las Palmas University, Las Palmas, Spain.
| | - Javier Burgos-Burgos
- Department of Radiation Oncology, Hospital Universitario San Roque, Fernando Pessoa Canarias Las Palmas University, Las Palmas, Spain.
| | - Meritxell Arenas
- Department of Radiation Oncology, Sant Joan de Reus University, University Rovira I Virgili, Tarragona, Spain.
| | - Alice Zamagni
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, University Hospital of Martinique, Martinique, France.
| | - Brigitta G Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubuenden, Chur, Switzerland.
| | - Micaela Motta
- Department of Radiation Oncology, ASST Papa Giovanni XXIII, Bergamo, Italy.
| | - Arthur Sun Myint
- Department of Radiation Oncology, Clatterbridge Cancer Center, Liverpool, United Kingdom.
| | - Marta Bonet
- Department of Radiation Oncology, Arnau de Vilanova University Hospital, Lleida, Spain.
| | - Tiberiu Popescu
- Department of Radiation Oncology, Prof. Dr. Ion Chricuta Oncology Institute, Cluj-Napoca, Romania.
| | - Te Vuong
- Department Of Radiation Oncology, McGill University, Montreal, Canada.
| | | | - Lurdes Trigo
- Department of Radiation Oncology, Instituto Portuges de Oncologia Porto Francisco Gentil E.P.E, Porto, Portugal.
| | - Ulf Karlsson
- Department of Radiation Oncology, International Geriatric Group, Washington D.C., USA.
| | - Juliette Thariat
- Department of Radiation Oncology, Baclesse Cancer Center, Caen, France.
| |
Collapse
|
13
|
Oakley PA, Harrison DE. Are Restrictive Medical Radiation Imaging Campaigns Misguided? It Seems So: A Case Example of the American Chiropractic Association's Adoption of "Choosing Wisely". Dose Response 2020; 18:1559325820919321. [PMID: 32425722 PMCID: PMC7218311 DOI: 10.1177/1559325820919321] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 12/18/2022] Open
Abstract
Since the 1980s, increased utilization of medical radiology, primarily computed tomography, has doubled medically sourced radiation exposures. Ensuing fear-mongering media headlines of iatrogenic cancers from these essential medical diagnostic tools has led the public and medical professionals alike to display escalating radiophobia. Problematically, several campaigns including Image Gently, Image Wisely, and facets of Choosing Wisely propagate fears of all medical radiation, which is necessary for the delivery of effective and efficient health care. Since there are no sound data supporting the alleged risks from low-dose radiation and since there is abundant evidence of health benefits from low-doses, these imaging campaigns seem misguided. Further, thresholds for cancer are 100 to 1000-fold greater than X-rays, which are within the realm of natural background radiation where no harm has ever been validated. Here, we focus on radiographic imaging for use in spinal rehabilitation by manual therapists, chiropractors, and physiotherapists as spinal X-rays represent the lowest levels of radiation imaging and are critical in the diagnosis and management of spine-related disorders. Using a case example of a chiropractic association adopting "Choosing Wisely," we argue that these campaigns only fuel the pervasive radiophobia and continue to constrain medical professionals, attempting to deliver quality care to patients.
Collapse
|
14
|
Oakley PA, Harrison DE. Death of the ALARA Radiation Protection Principle as Used in the Medical Sector. Dose Response 2020; 18:1559325820921641. [PMID: 32425724 PMCID: PMC7218317 DOI: 10.1177/1559325820921641] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/17/2022] Open
Abstract
ALARA is the acronym for "As Low As Reasonably Achievable." It is a radiation protection concept borne from the linear no-threshold (LNT) hypothesis. There are no valid data today supporting the use of LNT in the low-dose range, so dose as a surrogate for risk in radiological imaging is not appropriate, and therefore, the use of the ALARA concept is obsolete. Continued use of an outdated and erroneous principle unnecessarily constrains medical professionals attempting to deliver high-quality care to patients by leading to a reluctance by doctors to order images, a resistance from patients/parents to receive images, subquality images, repeated imaging, increased radiation exposures, the stifling of low-dose radiation research and treatment, and the propagation of radiophobia and continued endorsement of ALARA by regulatory bodies. All these factors result from the fear of radiogenic cancer, many years in the future, that will not occur. It has been established that the dose threshold for leukemia is higher than previously thought. A low-dose radiation exposure from medical imaging will likely upregulate the body's adaptive protection systems leading to the prevention of future cancers. The ALARA principle, as used as a radiation protection principle throughout medicine, is scientifically defunct and should be abandoned.
Collapse
|
15
|
Cuttler JM. Application of Low Doses of Ionizing Radiation in Medical Therapies. Dose Response 2020; 18:1559325819895739. [PMID: 31933547 PMCID: PMC6945458 DOI: 10.1177/1559325819895739] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 01/08/2023] Open
Abstract
The discovery of X-rays and radioactivity in 1895/1896 triggered a flood of studies and applications of radiation in medicine that continues to this day. They started with imaging fractures/organs and progressed to treating diseases by exposing areas to radiation from external and internal sources. By definition, low-dose treatments stimulate damage control (or adaptive protection) systems that remedy diseases. Publications are identified on low-dose ionizing radiation (LDIR) therapies for different cancers, infections, inflammations, and autoimmune and neurodegenerative diseases. The high rate of endogenous DNA damage, due to leakage of oxygen from aerobic metabolism, and the damage control systems that deal with this are discussed. Their stimulation and inhibition by radiation are described. The radium dial painter studies revealed the radium ingestion threshold for malignancy and the dose threshold for bone sarcoma. The radiation scare that misled the medical profession and the public is a barrier to LDIR therapies. Many studies on nasal radium irradiation demonstrated that children are not unduly radiation sensitive. Omissions in the medical textbooks misinform physicians about the effects of LDIR therapy, which blocks clinical trials to determine optimal doses, efficacy, and thresholds for onset of harm. Information from many recent case reports on LDIR therapies, including successes with radon therapy, is provided.
Collapse
|
16
|
Oakley PA, Ehsani NN, Harrison DE. Repeat Radiography in Monitoring Structural Changes in the Treatment of Spinal Disorders in Chiropractic and Manual Medicine Practice: Evidence and Safety. Dose Response 2019; 17:1559325819891043. [PMID: 31839759 PMCID: PMC6900628 DOI: 10.1177/1559325819891043] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 12/18/2022] Open
Abstract
There is substantial evidence for normal relationships between spine and postural parameters, as measured from radiographs of standing patients. Sagittal balance, cervical lordosis, thoracic kyphosis, lumbar lordosis, pelvic tilt, and the more complex understanding of the interrelations between these essential components of normal stance have evolved to where there are known, established thresholds for normalcy. These spinal parameters are reliably measured from X-ray images and serve as goals of care in the treatment of spine and postural disorders. Initial and follow-up spinal imaging by X-ray is thus crucial for the practice of contemporary and evidence-based structural rehabilitation. Recent studies have demonstrated that improvement in the spine and posture by nonsurgical methods offers superior long-term patient outcomes versus conventional methods that only temporarily treat pain/dysfunction. Low-dose radiation from repeated X-ray imaging in treating subluxated patients is substantially below the known threshold for harm and is within background radiation exposures. Since alternative imaging methods are not clinically practical at this time, plain radiography remains the standard for spinal imaging. It is safe when used in a repeated fashion for quantifying pre-post spine and postural subluxation and deformity patterns in the practice of structural correction methods by chiropractic and other manual medicine practices.
Collapse
|
17
|
Dhawan G, Kapoor R, Dhamija A, Singh R, Monga B, Calabrese EJ. Necrotizing Fasciitis: Low-Dose Radiotherapy as a Potential Adjunct Treatment. Dose Response 2019; 17:1559325819871757. [PMID: 31496924 PMCID: PMC6716184 DOI: 10.1177/1559325819871757] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 12/27/2022] Open
Abstract
Necrotizing fasciitis (NF) is a rapidly spreading bacterial infection causing extensive tissue necrosis and destruction. Despite appropriate therapy, the disease results in significant morbidity/mortality and substantial treatment costs. Several studies published in the early 1900s demonstrated the effective use of low-dose X-ray radiotherapy (RT) for the treatment of many diverse inflammatory conditions and diseases (eg, gas gangrene, sinus infections, arthritis, tendonitis, and serious inflammatory lung conditions). The mechanism by which therapeutic RT doses produce positive patient outcomes is related at least in part to its capacity to induce tissue-based anti-inflammatory responses. This action is due to the polarization of macrophages to an anti-inflammatory or M2 phenotype via optimized low-dose RT. Low-dose RT has the potential to significantly reduce debilitating surgeries and aggressive treatments required for NF, providing a 3-prong benefit in terms of patient mortality, length of hospitalization stays, and cost of health care (both short term and long term). Low cost and easy availability of low-dose RT makes it a potentially useful option for patients of every age-group. In addition, low-dose RT may be a particularly useful option in countries treating many patients who are unable to afford surgeries, antibiotics, and hyperbaric oxygen.
Collapse
Affiliation(s)
- Gaurav Dhawan
- Human Research Protection Office, University of Massachusetts, Amherst, MA, USA
| | - Rachna Kapoor
- Saint Francis Hospital and Medical Center, Hartford, CT, USA
| | | | | | - Bharat Monga
- Division of Hospital Medicine, Mount Sinai St Luke's Hospital, New York, NY, USA
| | - Edward J Calabrese
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| |
Collapse
|
18
|
Calabrese EJ, Dhawan G, Kapoor R, Kozumbo WJ. Radiotherapy treatment of human inflammatory diseases and conditions: Optimal dose. Hum Exp Toxicol 2019; 38:888-898. [DOI: 10.1177/0960327119846925] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
During the early part of the past century, hundreds of clinical studies involving more than 37,000 patients were conducted that showed radiotherapy (RT) to be a successful and safe alternative to drug therapy for the treatment of many diverse inflammatory conditions and diseases (e.g. tendonitis, bursitis, arthritis, and serious inflammatory lung conditions). Data from these studies were collected and analyzed with the intent of estimating an optimal dosing range for RT that would induce an efficacious treatment response. RT was reported to be frequently effective after only a single treatment, with a rapid (within 24 h) and often long-lasting (from months to years) relief from symptoms. Over a two-decade span from the 1920s to the 1940s, the therapeutic responses to a single RT treatment consistently improved as the dosing for multiple ailments decreased over time to between 30 roentgen (r) and 100 r. These findings are significant and in agreement with a number of contemporary reports from Germany where RT has been commonly and successfully employed in treating ailments with an inflammatory origin. A proposed mechanism by which RT mitigates inflammation and facilitates healing is via the polarization of macrophages to an anti-inflammatory or M2 phenotype.
Collapse
Affiliation(s)
- EJ Calabrese
- Department of Environmental Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - G Dhawan
- Mass Venture Center, Research Compliance, University of Massachusetts, Hadley, MA, USA
| | - R Kapoor
- Saint Francis Hospital and Medical Center, Hartford, CT, USA
| | | |
Collapse
|
19
|
Calabrese EJ, Giordano JJ, Kozumbo WJ, Leak RK, Bhatia TN. Hormesis mediates dose-sensitive shifts in macrophage activation patterns. Pharmacol Res 2018; 137:236-249. [DOI: 10.1016/j.phrs.2018.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023]
|
20
|
Abstract
X-ray therapy was used to treat pertussis/whooping cough during a 13-year period from 1923 to 1936 in North America and Europe. Twenty studies from clinicians in the United States reported that approximately 1500 cases of pertussis were treated by X-ray therapy usually with less than 0.5 erythema dose. Young children (<3 years) comprised about 70% to 80% of the cases, with the age of cases ranging from as young as 1 month to 50 years. In general, symptoms of severe coughing, vomiting episodes, and spasms were significantly relieved in about 85% of cases following up to 3 treatments, while about 15% of the cases showed nearly full relief after only 1 treatment. The X-ray therapy was also associated with a marked reduction in mortality of young (<3 years) children by over 90%. Despite such reported clinical success from a wide range of experienced researchers, the use of X-rays for the treatment of pertussis in young children was controversial, principally due to concerns of exposure to the thymus and thyroid even with the availability of lead shielding. By the mid-1930s, the treatment of pertussis cases via vaccine therapy came to dominate the therapeutic arena, and the brief era of a radiotherapy option for the treatment of pertussis ended.
Collapse
Affiliation(s)
- Edward J Calabrese
- Environmental Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Gaurav Dhawan
- Research Compliance, University of Massachusetts, Mass Venture Center, Hadley, MA, USA
| | | |
Collapse
|
21
|
Socol Y, Welsh JS. Changing Attitude Toward Radiation Carcinogenesis and Prospects for Novel Low-Dose Radiation Treatments. Technol Cancer Res Treat 2015; 15:732-736. [PMID: 26391015 DOI: 10.1177/1533034615605639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 06/30/2015] [Accepted: 08/11/2015] [Indexed: 11/15/2022] Open
Abstract
All procedures involving ionizing radiation, whether diagnostic or therapeutic, are subject to strict regulation, and public concerns have been raised about even the low levels of radiation exposures involved in diagnostic imaging. During the last 2 decades, there are signs of more balanced attitude to ionizing radiation hazards, as opposed to the historical "radiophobia." The linear no-threshold hypothesis, based on the assumption that every radiation dose increment constitutes increased cancer risk for humans, is increasingly debated. In particular, the recent memorandum of the International Commission on Radiological Protection admits that the linear no-threshold hypothesis predictions at low doses (that International Commission on Radiological Protection itself has used and continues to use) are "speculative, unproven, undetectable, and 'phantom'." Moreover, numerous experimental, ecological, and epidemiological studies suggest that low doses of ionizing radiation may actually be beneficial to human health. Although these advances in scientific understanding have not yet yielded significant changes in radiation regulation and policy, we are hopeful such changes may happen in the relatively near future. This article reviews the present status of the low-dose radiation hazard debate and outlines potential opportunities in the field of low-dose radiation therapy.
Collapse
Affiliation(s)
| | - James S Welsh
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| |
Collapse
|
22
|
Calabrese EJ, Dhawan G, Kapoor R. The Use of X Rays in the Treatment of Bronchial Asthma: A Historical Assessment. Radiat Res 2015. [PMID: 26207685 DOI: 10.1667/rr14080.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This article provides a historical assessment of the role of X-ray therapy in the treatment of bronchial asthma. This analysis revealed that X-ray therapy in the treatment of bronchial asthma spanned the first six decades of the 20th century, and involved nearly 6,000 patients in published clinical case studies. Patients selected typically had at least moderate to severe asthma and were refractory to other commonly employed treatments. The results of more than 60 studies indicated that about 70% of patients had rapid and marked reductions in clinical symptoms with about half of these patients showing complete symptom relief. The duration of the beneficial responses was variable but was approximately 1-6 months for about 50% of the benefited patients, and between 1 to 4 years for the upper 25% of benefited patients. The use of X rays to treat such patients fell into disfavor during the 1950s due to mounting concerns over possible enhanced risks of cancer that coincided with the discoveries and use of antihistamine medications, antibiotics and the methyl xanthine bronchodilators aminophylline and theophylline.
Collapse
Affiliation(s)
| | | | - Rachna Kapoor
- b Public Health, University of Massachusetts, Amherst, Massachusetts, 01003
| |
Collapse
|
23
|
Yao JJ, Zhou GQ, Yu XL, Tang LL, Chen L, Mao YP, Lin L, Zhang LL, Shao JY, Guo Y, Ma J, Sun Y. Incidence of and Risk Factors for Mastoiditis after Intensity Modulated Radiotherapy in Nasopharyngeal Carcinoma. PLoS One 2015; 10:e0131284. [PMID: 26114761 PMCID: PMC4483256 DOI: 10.1371/journal.pone.0131284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 06/01/2015] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To report the incidence of and risk factors for mastoiditis after intensity-modulated radiotherapy (IMRT) in nasopharyngeal carcinoma (NPC). PATIENTS AND METHODS Retrospective analysis of pretreatment and follow-up magnetic resonance imaging (MRI) data for 451 patients with NPC treated with IMRT at a single institution. The diagnosis of mastoiditis was based on MRI; otomastoid opacification was rated as Grade 0 (none), 1 (mild), 2 (moderate) or 3 (severe) by radiologists blinded to clinical outcome. This study mainly focused on severe mastoiditis; patients were divided into three groups: the G0M (Grade 0 mastoiditis before treatment) group, G1-2M (Grade 1 to 2 mastoiditis before treatment) group and G3M (Grade 3 mastoiditis before treatment) group. The software SAS9.3 program was used to analyze the data. RESULTS For the entire cohort, the incidence of Grade 3 mastoiditis was 20% before treatment and 31%, 19% and 17% at 3, 12 and 24 months after radiotherapy, respectively. In the G0M group, the incidence of severe mastoiditis was 0% before treatment and 23%, 15% and 13% at 3, 12 and 24 months after radiotherapy, respectively. Multivariate analysis revealed T category (OR=0.68, 95% CI = 0.469 to 0.984), time (OR=0.668, 95% CI = 0.59 to 0.757) and chemotherapy (OR=0.598, 95% CI = 0.343 to 0.934) were independent factors associated with severe mastoiditis in the G0M group after treatment. CONCLUSIONS Mastoiditis, as diagnosed by MRI, occurs as a progressive process that regresses and resolves over time in patients with NPC treated using IMRT.
Collapse
Affiliation(s)
- Ji-Jin Yao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, People’s Republic of China
| | - Guan-Qun Zhou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, People’s Republic of China
| | - Xiao-Li Yu
- Department of Radiation Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Ling-Long Tang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, People’s Republic of China
| | - Lei Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, People’s Republic of China
| | - Yan-Ping Mao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, People’s Republic of China
| | - Li Lin
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, People’s Republic of China
| | - Lu-Lu Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, People’s Republic of China
| | - Jian-Yong Shao
- Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, People’s Republic of China
| | - Ying Guo
- Department of Medical Statistics and Epidemiology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, People’s Republic of China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong Province, People’s Republic of China
| |
Collapse
|
24
|
Radiation-hormesis phenotypes, the related mechanisms and implications for disease prevention and therapy. J Cell Commun Signal 2014; 8:341-52. [PMID: 25324149 DOI: 10.1007/s12079-014-0250-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 10/08/2014] [Indexed: 01/20/2023] Open
Abstract
Humans are continuously exposed to ionizing radiation throughout life from natural sources that include cosmic, solar, and terrestrial. Much harsher natural radiation and chemical environments existed during our planet's early years. Mammals survived the harsher environments via evolutionarily-conserved gifts ̶ a continuously evolving system of stress-induced natural protective measures (i.e., activated natural protection [ANP]). The current protective system is differentially activated by stochastic (i.e., variable) low-radiation-dose thresholds and when optimally activated in mammals includes antioxidants, DNA damage repair, p53-related apoptosis of severely-damaged cells, reactive-oxygen-species (ROS)/reactive-nitrogen-species (RNS)- and cytokine-regulated auxiliary apoptosis that selectively removes aberrant cells (e.g., precancerous cells), suppression of disease promoting inflammation, and immunity against cancer cells. The intercellular-signaling-based protective system is regulated at least in part via epigenetic reprogramming of adaptive-response genes. When the system is optimally activated, it protects against cancer and some other diseases, thereby leading to hormetic phenotypes (e.g., reduced disease incidence to below the baseline level; reduced pain from inflammation-related problems). Here, some expressed radiation hormesis phenotypes and related mechanisms are discussed along with their implications for disease prevention and therapy.
Collapse
|
25
|
Use of X-rays to treat shoulder tendonitis/bursitis: a historical assessment. Arch Toxicol 2014; 88:1503-17. [DOI: 10.1007/s00204-014-1295-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
|
26
|
Calabrese EJ. Low doses of radiation can enhance insect lifespans. Biogerontology 2013; 14:365-81. [PMID: 23793937 DOI: 10.1007/s10522-013-9436-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 05/30/2013] [Indexed: 01/14/2023]
Abstract
This paper assesses the capacity of ionizing radiation to extend the lifespans of experimental insect models based on the peer-reviewed literature. Ionizing radiation biphasically affects the lifespans of adult males and females for a broad range of insect models with high doses reducing lifespan whereas lower doses can enhance lifespan, typically in the 20-60 % range. The average adult insect lifespan can be increased when ionizing radiation exposure is administered during early developmental stages or during the adult stage. The effective dose inducing the average adult insect lifespan enhancement may vary considerably depending upon which life stage is exposed. Recent findings have identified specific genes affecting anti-oxidant defenses, DNA repair, apoptosis and heat shock proteins as well as several cell signaling pathways that mediate the longevity enhancing hormetic response.
Collapse
Affiliation(s)
- Edward J Calabrese
- Department of Public Health, Division of Environmental Health Sciences, University of Massachusetts, Amherst, 01003, USA.
| |
Collapse
|
27
|
Abstract
Approximately 160,000 people evacuated the area around the Fukushima Dai-ichi NPP shortly after it was damage by the earthquake and tsunami. The evacuation order applied to 70,000 of them, while the other 90,000 left voluntarily and returned soon afterward. After more than two years, most of the 70,000 are still not allowed to return to their homes. The 1100 disaster-related deaths caused by the evacuation order show that this pre-cautionary action, taken to minimize cancer risks, was not "conservative." In this paper, recent studies are reviewed on the consequences of the radioactive releases and on the benefits of many medical treatments with low doses of radiation that were carried out until the 1950s, before the radiation scare was created. Recent research has shed light on the high rate of spontaneous double-strand breaks in DNA and the adaptive protections in cells, tissues and humans that are up-regulated by low radiation. These defences prevent, repair, remove and replace damage, from all causes including external agents. Cancer mortality is reduced. The ICRP's concept of radiation risk is wrong. It should revert to its 1934 concept, which was a tolerance dose of 0.2 roentgen (r) per day based on more than 35 years of medical experience.
Collapse
|
28
|
Abstract
The aim of this paper is to assess the historical role of radiotherapy in the treatment of sinus infections. This assessment involved a literature-based review of how radiotherapy was used to treat sinus infections in the first half of the 20(th) century. Low doses of x-rays were used with considerable success to treat nearly 3,000 patients of sinus infection in a span of 12 years with these cases being reported in leading medical journals as case studies. The mechanism of x-ray induced reduction of inflammation and increased tissue repair is uncertain but appears to be related to the development of a multifactorial and integrative anti-inflammatory phenotype.
Collapse
Affiliation(s)
- Edward J Calabrese
- Department of Public Health, Environmental Health Sciences, University of Massachusetts, Amherst, MA
| | | |
Collapse
|