Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4) were female. Most patients (n = 3685 84.7%) were from low-and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 62.8%), followed by strabismus (n = 429 10.2%) and proptosis (n = 309 7.4%). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 95% CI, 12.94-24.80, and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 95% CI, 4.30-7.68). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs. © 2020 American Medical Association. All rights reserved

EDTA assisted phytorremediation of a Pb contamined soil: metal leaching and uptake by jack beans Lixiviação e absorção de Pb pelo feijão-de-porco assistido pela aplicação de EDTA no solo

Lead (Pb) is one of the main soil contaminants. It is also of difficult phytoremediation due to its low solubility and high retention on soil particles. EDTA application to soil is a strategy to increase heavy metal phytoextraction, but such chelants usually cause phytotoxicity and metal leaching side effects. Therefore, these research work objectives were to evaluate the effects of single (0.5 g kg-1) and split (0.25 + 0.25 g kg-1) EDTA application on Pb uptake by jack beans (Canavalia ensiformis L.) as well as on Pb vertical movement in a Pb contaminated soil material. Two sets of experiments were carried out under greenhouse conditions: in the first one, plants were grown in 3L-pots filled with a Pb-contaminated soil to evaluate Pb uptake by plants; for the second experiment, PVC-columns (42 cm height) were used to evaluate soil Pb leaching: the upper half-column (20 cm) was filled up with Pb-contaminated soil (1800 mg kg-1) whereas the lower half-column (20 cm) was filled with clean soil. Ten 60 mm-rainfalls with a duration of five hours were simulated by dropping distilled water on the top of columns, and leachates were collected for chemical analysis. Plants did not show any visual Pb toxicity symptoms or reduction in dry matter yield. Nevertheless, Pb uptake by jack beans regarded as total plant Pb accumulation was higher in EDTA-treated plants. Vertical Pb movement was observed mostly for the single EDTA application. EDTA addition to the soil favor Pb-phytoextraction by jack beans and the split EDTA application decrease the metal leaching, indicating less risk of environmental contamination.<br>O chumbo (Pb) é um dos principais contaminantes de solo. Os processos de remediação são dificultados devido à alta retenção do elemento às partículas do solo. A utilização do EDTA para aumentar a fitoextração dos metais do solo tem apresentado bons resultados. Contudo, os quelantes podem causar efeitos indesejáveis como a fitotoxidez e a lixiviação do metal. Nesse sentido, avaliou-se o efeito da aplicação única (0,5 g kg-1) e parcelada de EDTA (0,25 + 0,25 g kg-1) na absorção de Pb pelas plantas de feijão-de-porco (Canavalia ensiformis L.) e na movimentação vertical de Pb em solo contaminado, sob condições de casa de vegetação. Em um experimento, as plantas foram crescidas em vasos contendo 3 L de solo contaminado por Pb. No outro, utilizaram-se colunas de PVC com 42 cm de altura, preenchendo-se os primeiros 20 cm com solo contaminado com 1800 mg kg-1de Pb, seguido de outros 20 cm, com amostra de solo não contaminado. Nesse experimento, foram feitas dez lixiviações com água em volume equivalente a uma chuva de 60 mm cada. As plantas não apresentaram sintomas visuais de toxicidade de Pb, nem diferença na produção de massa seca do feijão em função dos tratamentos aplicados. No entanto, a absorção de Pb foi superior para as plantas que receberam EDTA. Houve movimentação vertical de Pb no solo, principalmente devido à aplicação única de EDTA. A adição de EDTA ao solo auxilia a fitoextração de Pb por plantas de feijão-de-porco e que o parcelamento do EDTA diminui a lixiviação do metal, mostrando se menos agressivo ao ambiente