Editorial: The society for environmental geochemistry and health (SEGH): 50 years and beyond.

When the SEGH international board released a short editorial paper back in 2019, we described an aim to increase the membership offering, whilst improving the diversity of input regionally, by scientific discipline and to ensure greater and more regular contact across the regions from 2020 onwards. Wider aspirations described in 2019 (Watts et al. 2019) are discussed within this short communication at the end of 2021 to evaluate progress made. In particular, how the SEGH community adapted to the unprecedented circumstances that have challenged each and every one of us throughout the COVID-19 pandemic since early 2020 and are likely to influence our activities for the foreseeable future.

Continuous Hyperfractionated Accelerated Radiotherapy (CHART) for Non-small Cell Lung Cancer (NSCLC): 7 Years' Experience From Nine UK Centres.

AIM: Continuous hyperfractionated accelerated radiotherapy (CHART) remains an option to treat non-small cell lung cancer (NSCLC; NICE, 2011). We have previously published treatment outcomes from 1998-2003 across five UK centres. Here we update the UK CHART experience, reporting outcomes and toxicities for patients treated between 2003 and 2009. MATERIALS AND METHODS: UK CHART centres were invited to participate in a retrospective data analysis of NSCLC patients treated with CHART from 2003 to 2009. Nine (of 14) centres were able to submit their data into a standard database. The Kaplan-Meier method estimated survival and the Log-rank test analysed the significance. RESULTS: In total, 849 patients had CHART treatment, with a median age of 71 years (range 31-91), 534 (63%) were men, 55% had undergone positron emission tomography-computed tomography (PET-CT) and 26% had prior chemotherapy; 839 (99%) patients received all the prescribed treatment. The median overall survival was 22 months with 2 and 3 year survival of 47% and 32%, respectively. Statistically significant differences in survival were noted for stage IA versus IB (33.2 months versus 25 months; P = 0.032) and IIIA versus IIIB (20 months versus 16 months; P = 0.018). Response at 3 months and outcomes were significantly linked; complete response showing survival of 34 months against 19 months, 15 months and 8 months for partial response, stable and progressive disease, respectively (P < 0.001). Age, gender, performance status, prior chemotherapy and PET-CT did not affect the survival outcomes. Treatment was well tolerated with <5% reporting ≥grade 3 toxicity. CONCLUSION: In routine practice, CHART results for NSCLC remain encouraging and we have been able to show an improvement in survival compared with the original trial cohort. We have confirmed that CHART remains deliverable with low toxicity rates and we are taking a dose-escalated CHART regimen forward in a randomised phase II study of sequential chemoradiotherapy against other accelerated dose-escalated schedules.

Afatinib use in non-small cell lung cancer previously sensitive to epidermal growth factor receptor inhibitors: the United Kingdom Named Patient Programme.

INTRODUCTION: Afatinib prolongs progression-free survival (PFS) in patients with non-small cell lung cancer (NSCLC) who were previously sensitive to erlotinib or gefitinib. This study investigated experience of afatinib under a Named Patient Use (NPU) programme. PATIENTS AND METHODS: Retrospective data for 63 patients were collected, including demographics, dose, toxicity and clinical efficacy. RESULTS: Response rate and median PFS were 14.3% and 2.6months, respectively. Diarrhoea and rash were the most common toxicities; 46% of patients required a dose reduction and 41% had a dose delay. CONCLUSIONS: Efficacy and safety in the NPU programme are consistent with the LUX-Lung 1 trial.

Arsenic speciation in polychaetes (Annelida) and sediments from the intertidal mudflat of Sundarban mangrove wetland, India.

This paper documents the concentration of total arsenic and individual arsenic species in four soft-bottom benthic polychaetes (Perenereis cultifera, Ganganereis sootai, Lumbrinereis notocirrata and Dendronereis arborifera) along with host sediments from Sundarban mangrove wetland, India. An additional six sites were considered exclusively for surface sediments for this purpose. Polychaetes were collected along with the host sediments and measured for their total arsenic content using inductively coupled plasma mass spectrometry. Arsenic concentrations in polychaete body tissues varied greatly, suggesting species-specific characteristics and inherent peculiarities in arsenic metabolism. Arsenic was generally present in polychaetes as arsenate (As(V) ranges from 0.16 to 0.50 mg kg(-1)) or arsenite (As(III) ranges from 0.10 to 0.41 mg kg(-1)) (30-53 % as inorganic As) and dimethylarsinic acid (DMA(V) <1-25 %). Arsenobetaine (AB < 16 %), and PO(4)-arsenoriboside (8-48 %) were also detected as minor constituents, whilst monomethylarsonic acid (MA(V)) was not detected in any of the polychaetes. The highest total As (14.7 mg kg(-1) dry wt) was observed in the polychaete D. arborifera collected from the vicinity of a sewage outfall in which the majority of As was present as an uncharacterised compound (10.3 mg kg(-1) dry wt) eluted prior to AB. Host sediments ranged from 2.5 to 10.4 mg kg(-1) of total As. This work supports the importance of speciation analysis of As, because of the ubiquitous occurrence of this metalloid in the environment, and its variable toxicity depending on chemical form. It is also the first work to report the composition of As species in polychaetes from the Indian Sundarban wetlands.

Clinical application of image-guided radiotherapy in bladder and prostate cancer.

Advances in radiotherapy planning reduced the volumes of irradiated normal tissue and allowed safe dose escalation in prostate cancer. Image-guided radiotherapy solutions to prostate and bladder cancer offer further improvements. The initial process is understanding the causes and extent of internal organ motion, followed by development of equipment and protocols to minimise geographical miss. Further refinements may allow margin reduction and further dose escalation. This paper reviews these issues for bladder and prostate cancer.

Endovascular management of thoraco-abdominal aneurysms.

The recent advances in stent technology have provided a choice of techniques in the treatment of thoracoabdominal aortic aneurysms. These techniques should reduce the physiological insult associated with aneurysm repair. Because numbers are small and these techniques are still being perfected, there is as yet limited evidence for a significantly improved survival or reduced paraplegia rates. This evidence is particularly limited as early reported series were based upon patients deemed unfit for open repair. The choice of technique is influenced by a number of factors including aneurysm anatomy and physiological reserve of the patient. It must be remembered that a large proportion of these patients are elderly with significant co-morbidities. Thoracoabdominal aneurysms often affect an extensive section of the aorta and this region provides a major proportion of spinal perfusion. Treatment of these patients--by any modality--will always carry significant risks and this explains the persistently high morbidity and mortality figures. Case selection and balancing the risks of treatment with those of the disease itself will remain crucial in providing best management to our patients. With future device improvements a greater proportion of patients may be suitable for endovascular aneurysm repair. The single biggest advance needed to facilitate this is the development of a system allowing 'off the shelf' stenting of urgent cases, but in-situ fenestration will be required to facilitate this and such a technique remains experimental at present.

Cellular engineering of conduits for coronary and lower limb bypass surgery: role of cell attachment peptides and pre-conditioning in optimising smooth muscle cells (SMC) adherence to compliant poly(carbonate-urea)urethane (MyoLink) scaffolds.

OBJECTIVE: We are developing a hybrid arterial bypass graft of compliant poly(carbonate-urea)urethane (MyoLink), endothelial and smooth muscle cells (SMCs). To enhance adhesion of SMCs we assessed various attachment factors and the effect of pre-conditioning on cell retention. METHODS: MyoLink segments were coated with either RGD, superfibronectin, fibronectin, fibronectin-like engineered polymer protein (FEPP), FEPP plus or type 1 collagen overnight. (111)Indium-radiolabelled SMCs were placed onto MyoLink segments for 48 h before being aspirated, then lavaged off. All grafts, aspirates and lavages were counted in a gamma counter. SMC viability on the MyoLink segments was also assessed for viability using the Alamar blue redox assay. Separately, MyoLink grafts lined with radiolabelled SMCs were divided into a pre-conditioned group, exposed to subarterial pulsatile flow whilst another group were held in static culture. After 1-week, grafts were exposed to arterial pulsatile flow whilst radioactivity was assessed using a gamma camera. RESULTS: Only FEPP plus significantly enhanced SMC attachment: mean of 32+/-6% cell attachment compared to 21+/-5% for uncoated control. Cell viability was enhanced by all attachment factors except fibronectin. Pre-conditioning was shown to significantly enhance the retention of SMCs onto the MyoLink once exposed to pulsatile arterial flow: the final attachment was 57+/-7% for the static and 76+/-7% for the pre-conditioned group. CONCLUSIONS: FEPP plus enhances SMC attachment to MyoLink. We believe this is because of its repeating sequences of RGD and its positive charge. Pre-conditioning enhances the retention of SMCs to MyoLink once exposed to pulsatile arterial flow.

Efficient syntheses of thiochromans via cationic cycloadditions.

alpha-(Benzotriazolyl)methyl thioethers 1a-e reacted with styrenes under Lewis acid catalysis to give novel polysubstituted thiochromans (3,4-dihydro-2H-1-benzothiopyrans) 3-14 and 16-20 in generally high yields. Most thiochromans were isolated as one diastereomer following recrystallization. The configuration and conformation of the products are predicted on the basis of their NMR data. A stepwise reaction, proceeding via a [4(+) + 2] cationic polar cycloaddition mechanism, is proposed.

Segmental bony reconstruction of the thumb by composite groin flap: a case report.

The use of a pedicled, osteocutaneous groin flap to reconstruct a composite, interpositional loss of tissue in the thumb is reported. The bone is transferred as a living segment, not a dying graft, and hence affords the rapidity and strength of primary bony union.

Epitheloid sarcoma: a case report.

Epitheloid sarcoma of the pulp of the thumb followed repeated penetrating injuries to the digit. It was treated aggressively and successfully to date, nearly 5 years later. In some respects this case report parallels those animal experiments in which foreign body tumorigenesis has been demonstrated, and one might entertain a correlation.