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"David, Rowan"
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Incidence of genitourinary complications following radiation therapy for localised prostate cancer
PurposeStudies of genitourinary toxicity following radiotherapy for prostate cancer are mainly from high volume single institutions and the incidence and burden of treatment remain uncertain. Hence we determine the cumulative incidence of treatment-related genitourinary toxicity in patients with localised prostate cancer treated with primary external beam radiotherapy (EBRT) at a state population level.MethodsWe analysed data from a prospective population-based cohort, including hospital admission and cancer registry data, for men with localised prostate cancer who underwent primary EBRT without nodal irradiation between 1998 and 2019 in South Australia. The 10-year cumulative incidence of genitourinary toxicity requiring hospitalisation or procedures was determined. Clinical predictors of toxicity and the volume of admissions, non-operative, minor operative and major operative procedures were determined.ResultsAll the included patients (n = 3350) had EBRT, with a median (IQR) of 74 Gy (70–78) in 37 fractions (35–39). The 10-year cumulative incidence of was 28.4% (95% CI 26.3–30.6) with a total of 2545 hospital admissions, including 1040 (41%) emergency and 1893 (74%) readmissions. The 10-year cumulative incidence of patients in this cohort requiring a urological operative procedure was 18% (95% CI 16.1–19.9), with a total of 106 (4.2%) non-operative, 1044 (41%) minor operative and 57 (2.2%) major operative urological procedures.ConclusionsGenitourinary toxicity after radiotherapy for prostate cancer is common. Although there continue to be advancements in radiotherapy techniques, patients and physicians should be aware of the risk of late toxicity when considering EBRT.
Journal Article
A sensitive method to determine 210Po and 210Pb in environmental samples by alpha spectrometry using CuS micro-precipitation
A new sensitive method to determine polonium-210 (
210
Po) and lead-210 (
210
Pb) in a diversity of environmental samples was developed. For fresh and marine waters, Po was pre-concentrated using a titanium (III) hydroxide (Ti(OH)
3
) co-precipitation. Solid environmental samples were digested with nitric acid (HNO
3
) and hydrogen peroxide (H
2
O
2
). The alpha thin layer source was prepared using CuS micro-precipitation and
210
Po was measured by alpha spectrometry. Lead-210 was left to decay for up to a year and indirectly measured via its progeny,
210
Po. The chemical recoveries for
210
Po and
210
Pb were high, 90% and 97%, respectively, for a large variety of samples and a very low minimum detectable activity (MDA) was obtained. The method was validated using standardized solutions and certified reference materials.
Journal Article
This idea is brilliant : lost, overlooked, and underappreciated scientific concepts everyone should know
Presents essays responding to a question about what scientific term or concept ought to be more widely known, written by such authors as Jared Diamond, Richard Thaler, Richard Dawkins, Lisa Randall, Steven Pinker, and Carlo Roveri.
BOOK
Vulnerability of Canadian aquatic ecosystems to nuclear accidents
Several cesium and strontium bioaccumulation models are used widely in national and international guidance for ecological and human health risk assessments for radiocesium (¹³⁴Cs and ¹³⁷Cs) and radiostrontium (⁹⁰Sr), but have not been used to make predictions of radiological risk from nuclear accidents under variable environmental conditions on broad geographical scales. In this paper, we first present models for predicting the bioaccumulation of cesium and strontium by aquatic biota based on ambient concentrations of dissolved potassium and calcium, respectively, and then test these models using independent data from aquatic ecosystems at Canadian nuclear sites. Secondly, models yielding the best predictions across a wide range of input parameters were selected to estimate bioaccumulation factors (BAFs) for cesium and strontium in aquatic ecosystems across Canada, using trophic level of organisms and dissolved potassium for cesium and calcium concentrations for strontium as predictor variables, and presented as contour maps of radiological risk. The models show that risk from bioaccumulation of cesium and strontium can vary by several orders of magnitude depending on site-specific environmental conditions and trophic ecology. Overall, our results suggest that single-parameter approaches taken by regulatory standards may either over- or under-predict radiological risk at many locations, and are thus not readily suitable to inform siting decisions for new nuclear developments.
Journal Article
Risk of secondary malignancy following radiation therapy for prostate cancer
We investigated whether prostate cancer patients treated with external beam radiation therapy (EBRT) have a higher cumulative incidence of secondary cancer compared with patients treated with radical prostatectomy (RP). We used state-wide linked data from South Australia to follow men with prostate cancer diagnosed from 2002 to 2019. The cumulative incidence of overall and site-specific secondary cancers between 5 and 15 years after treatment was estimated. Fine-Gray competing risk analyses were performed with additional sensitivity analyses to test different scenarios. A total of 7625 patients were included (54% underwent RP and 46% EBRT). Characteristics of the two groups differed significantly, with the EBRT group being older (71 vs. 64 years), having higher comorbidity burden and being more likely to die during follow-up than the RP group. Fifteen-year cumulative incidence for all secondary cancers was 27.4% and 22.3% in EBRT and RP groups, respectively. In the adjusted models, patients in the EBRT group had a significantly higher risk of genitourinary (adjusted subhazard ratio (aSHR), 2.29; 95%CI 1.16–4.51) and lung (aSHR, 1.93; 95%CI 1.05–3.56) cancers compared with patients in the RP group. However, there was no statistically significant difference between the two groups for risk of any secondary cancer, gastro-intestinal, skin or haematologic cancers. No statistically significant differences in overall risk of secondary cancer were observed in any of the sensitivity analyses and patterns for risk at specific cancer sites were relatively consistent across different age restriction and latency/time-lag scenarios. In conclusion, the increased risk of genitourinary and lung cancers among men undergoing EBRT may relate partly to treatment effects and partly to unmeasured residual confounding.
Journal Article
N-P Fertilization Stimulates Anaerobic Selenium Reduction in an End-Pit Lake
Selenium (Se), an essential micro nutrient, is toxic to aquatic life at slightly higher water concentrations. Watersheds receiving leachate from selenium rich sources require large-scale, long-term treatment to mitigate Se toxicity. We applied the principles of anaerobic bacterial bioreactors, previously successful in small scale Se mitigation, to a whole end-pit lake ecosystem. Fertilization of the lake with N and P increased primary production, creating a meromictic, anoxic layer, and enhanced the habitat for locally present, anaerobic, Se and sulfur reducing bacteria. Within two years, Se concentrations were reduced ten-fold, reaching water-quality guideline values. The successful experiment demonstrated a novel treatment of large volumes of Se-contaminated water, and introduced an inexpensive method to mitigate a persistent aquatic pollutant of global concern.
Journal Article
Penile gangrene due to calciphylaxis: a multidisciplinary approach to a complex clinical challenge
Penile calciphylaxis is a rare but clinically challenging condition to manage. While multiple treatment options have been proposed, the underlying evidence is anecdotal, and the overall prognosis remains extremely poor. We describe the case of a patient who underwent urgent debridement of a suspected gangrenous penile tip, who was intraoperatively found to have penile calciphylaxis. The necrosis progressed and the patient had a glans amputation. A non-healing wound developed, requiring reconstruction with two skin grafts using foreskin by the plastic and reconstructive surgical unit. The patient was commenced on sodium thiosulfate and his wound had completely healed 2 months following his last operation. We review the literature to determine the biochemical features, management options and outcomes in patients with penile calciphylaxis.
Journal Article
Gall bladder torsion: a disease of the elderly
We describe the case of a gall bladder torsion in an elderly female patient, which was discovered during laparoscopic exploration for presumed acute cholecystitis. The rising incidence of this relatively uncommon process can be attributed to increasing life expectancy. Gall bladder torsion typically manifests in septuagenarians and octogenarians of the female gender, as seen in the presented case. It is thought that local mesenteric redundancy predisposes to the development of mechanical organoaxial torsion along the gall bladder’s longitudinal axis involving the cystic duct and artery. Clinicians must have a high index of suspicion for gall bladder torsion, as a mimicker of acute cholecystitis, in the described patient demographic. Preoperative diagnosis is challenging with the vast majority of reported cases being diagnosed intraoperatively, and only five cases preoperatively. Prompt surgical intervention results in an overall mortality rate of approximately 5%, while a delay in diagnosis can lead to catastrophic patient outcomes.
Journal Article