Biological dosimetry after radiosynoviorthesis with rhenium-186 sulphide and erbium-169 citrate

Zur Abschätzung der radiobiologischen Sicherheit des Verfahrens wird in dieser Arbeit die Radiosynoviorthese (RSO) mit Re-186 und Er-169 hinsichtlich biologischer Strahleneffekte untersucht. Bei 23 Patienten wurde eine RSO mit Rhenium-186-Sulfid- (10 Patienten) oder Erbium-169-Zitratkolloid (13 Patienten) durchgeführt. Das behandelte Gelenk wurde anschließend ruhig gestellt. Bei allen Patienten erfolgte vor und 17–19 Tage (Re-186) bzw. 45–50 Tage (Er-169) nach der RSO eine venöse Blutentnahme. Zur Analyse der Strahlenexposition wurde die Häufigkeit von dizentrischen Chromosomen in Lymphozyten der ersten Zellteilung in vitro bestimmt. Pro Patient wurden mindestens 1000 Zellen vor und nach der RSO untersucht, was nach längerer Einwirkung niederenergetischer Strahlung ausreichend ist, um im bestrahlten Kollektiv die im Rahmen der RSO erwarteten Strahlendosen nachzuweisen. Ergänzend wurde bei den mit Re-186 behandelten Patienten der Aktivitätsabtransport aus dem Gelenk mittels Ganzkörperszintigraphie bestimmt. In der Untersuchung von insgesamt 47017 Zellen fanden sich vor RSO mit Re-186 bzw. Er-169 40 bzw. 88, danach 59 bzw. 105 dizentrische Chromosomen in Lymphozyten des peripheren Blutes. Eine signifikante Zunahme der dizentrischen Chromosomen nach der RSO zeigte sich nicht. Der Aktivitätsabtransport nach RSO mit Re-186 lag durchschnittlich unter 5 % (unter 3 MBq) und ist damit als gering einzustufen. Die Ergebnisse der Untersuchung von Chromosomenaberrationen und des Aktivitätsabtransports nach Radiosynoviorthese mit Rhenium-186 und Erbium-169 sprechen für eine geringe Strahlenexposition der Patienten und damit für die Sicherheit des Verfahrens.The aim of the present studies was to investigate the biological radiation effect of radiosynoviorthesis (RSO) with Re-186 and Er-169 in order to evaluate the safety of this procedure. RSO with rhenium-186 sulfide colloid (10 patients) or erbium-169 citrate colloid (13 patients) was carried out in a total of 23 patients. Afterwards, the treated joint was immobilised for three days using splints. From all patients, blood was drawn immediately before and 17 to 19 days (Re-186) or 45 to 50 days (Er-169) after RSO. To evaluate the radiation dose, the yield of dicentric chromosomes in lymphocytes was determined exclusively in metaphases of the first cell cycle in vitro. At least 1000 cells per patient have been analysed before and after RSO which is sufficient to find potential radiation effects after long-term exposure to low energy radiation such as to expect after RSO. In addition, for Re-186 the activity leakage from the treated joint was measured by whole-body scintigraphy. In a total of 47017 cells analysed from 46 blood samples, 40 and 88 before and 59 and 105 dicentrics after RSO with Re-186 and Er-169 were found. This showed no statistically significant increase in the number of dicentric chromosomes. The measured average activity leakage of less than 5 % (less than 3 MBq) was considered to be low. The results of chromosome analysis and activity measurement after RSO prove that this procedure is associated with a low effective dose in treated patients and thus can be considered a safe treatment

Die Grünberger Bäckerzunft vom 16./19. Jahrhundert

Vitamin D deficiency affects 1 billion people globally. It has an important role in bone homeostasis, brain development and modulation of the immune system and yet the impact of antenatal vitamin D deficiency on infant outcomes is poorly understood. We assessed the association of 25- hydroxyvitamin D levels (25-OHD) in late pregnancy and early infant growth and developmental outcomes in rural Vietnam.A prospective cohort study of 960 women who had previously participated in a double-blind cluster randomized controlled trial of antenatal micronutrient supplementation in rural Vietnam was undertaken. Maternal 25-OHD concentration was measured at 32 weeks gestation, and infants were followed until 6 months of age. Main outcome measures were cognitive, motor, socio-emotional and language scores using the Bayley Scales of Infant Development, 3rd edition, and infant length-for-age z scores at 6 months of age.60% (582/960) of women had 25-OHD levels <75 nmol/L at 32 weeks gestation. Infants born to women with 25-OHD deficiency (<37.5 nmol/L) had reduced developmental language scores compared to those born to women who were vitamin D replete (≥75 nmol/L) (Mean Difference (MD) -3.48, 95% Confidence Interval (CI) -5.67 to -1.28). For every 25 nmol increase in 25-OHD concentration in late pregnancy, infant length-for-age z scores at 6 months of age decreased by 0.08 (95% CI -0.15 to -0.02).Low maternal 25- hydroxyvitamin D levels during late pregnancy are of concern in rural Vietnam, and are associated with reduced language developmental outcomes at 6 months of age. Our findings strengthen the evidence for giving vitamin D supplementation during pregnancy

Developmental composite scores at 6 months of age associated with maternal serum 25-OHD concentration (nmol/L) at 32 weeks gestation.

1<p>Values are estimated mean difference for each outcome associated with a 25 nmol/l increase in vitamin.</p><p>D concentration (95% confidence interval).</p>2<p>Unadjusted model.</p>3<p>Model adjusted for micronutrient intervention, maternal education, and clustering.</p>4<p>Model adjusted for maternal age, education, month of sampling of maternal vitamin D, micronutrient.</p><p>intervention, maternal body mass index, gravidity, post-partum depression and clustering at commune level.</p><p>SD = standard deviation, CI = Confidence Interval.</p

Infant anthropometric outcomes at 6 months of age associated with maternal serum 25-OHD concentration (nmol/L) at 32 weeks gestation.

1<p>Values are estimated mean difference for each outcome associated with a 25 nmol/L increase in vitamin D.</p><p>concentration (95% confidence interval).</p>2<p>Values are relative changes in the odds for each outcome associated with a 25 nmol/L increase in vitamin D concentration (95% confidence interval).</p>3<p>Unadjusted model.</p>4<p>Model adjusted for maternal age, education, month of sampling of maternal vitamin D, micronutrient intervention, maternal body mass index, gravidity, and clustering.</p

Flow diagram.

<p>Flow diagram.</p

Birth outcomes associated with maternal serum 25-OHD concentration (nmol/L) at 32 weeks gestation (unadjusted and adjusted models).

1<p>Values are estimated mean difference for each outcome associated with a 25 nmol/L increase in vitamin D concentration (95% confidence interval).</p>2<p>Values are relative changes in the odds for each outcome associated with a 25 nmol/L increase in vitamin D concentration (95% confidence interval).</p>3<p>Unadjusted model.</p>4<p>Model adjusted for micronutrient intervention, maternal body mass index, gravidity, and clustering at commune level.</p>5<p>Model adjusted for maternal age, education, month of sampling of maternal vitamin D, micronutrient intervention, maternal body mass index, gravidity, and clustering at commune level.</p><p>SD = standard deviation; CI = Confidence Interval.</p

Maternal 25(OH)-Vitamin D concentration (nmol/L) at 32 weeks gestation.

<p>Maternal 25(OH)-Vitamin D concentration (nmol/L) at 32 weeks gestation.</p

Distribution of baseline maternal sociodemographic, anthropometric characteristics, and maternal serum 25-OHD concentration (nmol/L) at 32 weeks gestation.

<p>IFA = Iron folic acid, MMN = Multiple micronutrients, SD = Standard Deviation.</p

Developmental composite scores in infants at 6 months of age according to maternal serum 25-OHD concentration levels at 32 weeks gestation.

1<p>Values are estimated mean difference (95% confidence interval).</p>2<p>Unadjusted model.</p>3<p>Model adjusted for maternal age, education, month of sampling of maternal vitamin D, micronutrient intervention, maternal body mass index, gravidity, maternal depression and clustering.</p