Cytogenetic AbnormalityIRADIENTNCT04363190
Genomic Instability in Vascular Surgeons
An observational study of Cytogenetic Abnormality and Radiation Exposure, run by Hospital Clínico Universitario de Valladolid at 1 site in Spain.
Trial summary
The past two decades have witnessed the development and growth of the endovascular techniques, however, this new technology is not exempt from risks, since its use requires an ionizing radiation exposure to both patients and surgeons. Read more about this study
- Who is it for?
- Any age
- Conditions the study is for
- Cytogenetic Abnormality, Radiation Exposure
- What is being tested?
- Cytogenetic analysis
- How many people
- 28 participants
- Where
- 1 siteSpain
- Study dates
- 9 Nov 2018to 5 Nov 2019
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- Child, Adult, Older adult
Study population: The peripheral blood samples of the case group were collected from vascular surgeons during the VI International Symposium of Endovascular Surgery. The blood samples were followed by a demographic and endovascular practice questionnaire. On the other hand, the samples for the control group were collected from healthy patients undergoing saphenectomy and/or phlebectomy in our department at Hospital Clínico Universitario de Valladolid.
Who may be able to join
- Cases
- Vascular surgeons regularly involved in endovascular procedures.
- Over 10 years of endovascular experience.
- Accept to participate in the present study.
- Controls:
- Healthy patients undergoing saphenectomy and/or phlebectomy.
- Accept to participate in the present study.
Who cannot join
- Cases:
- Less than 10-year endovascular experience.
- Previous medical history of cancer.
- Have been treated with radiotherapy.
- Have been exposed to ionizing radiation outside the endovascular field.
- Not accept to participate in the present study.
Show all 11Show fewer
- Controls:
- Previous medical history of cancer.
- Have been treated with radiotherapy.
- Have been exposed to ionizing radiation.
- Not accept to participate in the present study.
Trial locations and contacts
1 site in 1 country.
Spain1 site
Hospital Clínico Universtario de Valladolid
Valladolid, Castille and León, 47003
About this study
Official title: Genomic Instability Associated With Chronic Long Term Exposure to Ionizing Radiation in Vascular Surgeons
The past two decades have witnessed the development and growth of the endovascular techniques, however, this new technology is not exempt from risks, since its use requires an ionizing radiation exposure to both patients and surgeons. In this context, the long-term repercussion of this type of chronic exposure to low dose ionizing radiation of the vascular surgeons is still unknown. Although conventional dosimetry is used to monitoring the occupational radiation exposure, it doesn't take into consideration a number of individual variables such as: age, sex, exposure to other carcinogen substances or previous medical history; that may affect the radio-sensibility of each individual. Some studies suggest the use of routine cytogenetic analysis to complement the conventional dosimetry, yet the real genomic effects of chronic low dose ionizing radiation exposure is still unclear and an ideal biodosimetry marker hasn't been described. In this setting, the main objective of the present study was to determine the genomic instability associated to the chronic low dose exposure to ionizing radiation of vascular surgeons versus healthy control patients with no history of radiation exposure.
The secondary endpoints were to determine the impact of demographic and clinical practice activities associated to genomic instability among both groups of patients.
National, observational and transversal case control study of genomic instability among vascular surgeons chronically exposed to low dose ionizing radiation compared to healthy control patients with no previous history of radiation exposure. The peripheral blood samples of the case group were collected from vascular surgeons during the VI International Symposium of Endovascular Surgery. The blood samples were followed by a demographic and endovascular practice questionnaire. On the other hand, the samples for the control group were collected from healthy patients undergoing saphenectomy and/or phlebectomy in our department at Hospital Clínico Universitario de Valladolid. All blood samples were send to the Cancer Investigation Center at Salamanca University where three types of genomic analysis were performed: (1) fluorescence in situ hybridization (FISH) study in interphase for the chromosomes 3, 7 and 17 and locus 9p21; (2) metaphase study with G banding technique; and (3) sister chromatid exchange (SCE) metaphase study.
- Conditions
- Cytogenetic Abnormality, Radiation Exposure
- Being tested
- Cytogenetic analysis
- Keywords
- Vascular surgery, Endovascular surgery
- Medical subject headings
- Chromosome Aberrations
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Cytogenetic analysisDiagnostic test
- FISH study using the UroVysion kit in interphase peripheral lymphocytes, that allows the study of numerical aberrations for chromosomes 3, 7 and 17 and locus 9p21.
- G banding study to analyse the whole karyotype study regarding both numerical and structural aberrations during metaphase.
- Sister chromatid exchanges (SCE) analysis with bromodeoxyuridine (BrdU) staining for the whole karyotype during metaphase: analizing the proportion of SCE per metaphase (NSM).
| Study group | Role | What they receive |
|---|---|---|
| Cases | Not described Receives: Diagnostic Test: Cytogenetic analysis | |
| Controls | Not described Receives: Diagnostic Test: Cytogenetic analysis |
What is being measured
The primary outcome is the main question the study is designed to answer.
The differences between cases and controls regarding chromosomal numerical aberrations during interphase using FISH technique
The differences between cases and controls regarding chromosomal numerical aberrations during interphase of chromosomes 3, 7, 17 and locus 9p21.
The differences between cases and controls regarding chromosomal numerical aberrations during interphase using FISH technique with the UroVysion kit for chromosomes 3, 7, 17 and locus 9p21.
Measured: 2 years
The differences between cases and controls after G banding technique
The differences between cases and controls regarding chromosomal numerical and structural aberrations during metaphase.
Measured: 2 years
The differences between cases and controls regarding the presence of SCE during metaphase.
The differences between cases and controls regarding the presence of SCE during metaphase.
Measured: 2 years
Secondary outcomes (2)
Demographic variables, in terms of age and sex, regarding the presence of chromosomal aberrations and SCE.
Demographic variables, in terms of age and sex, regarding the presence of chromosomal aberrations and SCE.
Measured: 2 years
The impact of the anatomical region treated as well as the performance of complex aortic endovascular procedures amongst the group of vascular surgeons included in the present study regarding the presence of chromosomal aberrations and SCE.
The impact of the anatomical region treated as well as the performance of complex aortic endovascular procedures amongst the group of vascular surgeons included in the present study regarding the presence of chromosomal aberrations and SCE.
Measured: 2 years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted27 Apr 2020
- Study start9 Nov 2018
- Primary completion20 Apr 2019
- Study completion5 Nov 2019
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (23)Papers the sponsor has linked to this study.
- Other trials for Cytogenetic AbnormalityStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Case-control
- Time perspective
- Cross-sectional
- Enrolment
- 28 participants (actual)
Sponsor and investigators
- Lead sponsor
- Hospital Clínico Universitario de Valladolid
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Enrique M. San Norberto, Hospital Clínico Universitario de Valladolid
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04363190
- Sponsor's protocol ID
- PI-18-967
- Acronym
- IRADIENT
- Status last verified
- Apr 2020
- First submitted
- 23 Apr 2020
- Last updated
- 27 Apr 2020
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Mu H, Sun J, Li L, Yin J, Hu N, Zhao W, Ding D, Yi L. Ionizing radiation exposure: hazards, prevention, and biomarker screening. Environ Sci Pollut Res Int. 2018 Jun;25(16):15294-15306. doi: 10.1007/s11356-018-2097-9. Epub 2018 Apr 29.
PubMed 29705904Jaco JW, Miller DL. Measuring and monitoring radiation dose during fluoroscopically guided procedures. Tech Vasc Interv Radiol. 2010 Sep;13(3):188-93. doi: 10.1053/j.tvir.2010.03.009.
PubMed 20723835Balter S, Hopewell JW, Miller DL, Wagner LK, Zelefsky MJ. Fluoroscopically guided interventional procedures: a review of radiation effects on patients' skin and hair. Radiology. 2010 Feb;254(2):326-41. doi: 10.1148/radiol.2542082312.
PubMed 20093507Hertault A, Maurel B, Midulla M, Bordier C, Desponds L, Saeed Kilani M, Sobocinski J, Haulon S. Editor's Choice - Minimizing Radiation Exposure During Endovascular Procedures: Basic Knowledge, Literature Review, and Reporting Standards. Eur J Vasc Endovasc Surg. 2015 Jul;50(1):21-36. doi: 10.1016/j.ejvs.2015.01.014. Epub 2015 Mar 25.
PubMed 25818982Stecker MS, Balter S, Towbin RB, Miller DL, Vano E, Bartal G, Angle JF, Chao CP, Cohen AM, Dixon RG, Gross K, Hartnell GG, Schueler B, Statler JD, de Baere T, Cardella JF; SIR Safety and Health Committee; CIRSE Standards of Practice Committee. Guidelines for patient radiation dose management. J Vasc Interv Radiol. 2009 Jul;20(7 Suppl):S263-73. doi: 10.1016/j.jvir.2009.04.037. No abstract available.
PubMed 19560006Wdowiak A, Skrzypek M, Stec M, Panasiuk L. Effect of ionizing radiation on the male reproductive system. Ann Agric Environ Med. 2019 Jun 17;26(2):210-216. doi: 10.26444/aaem/106085. Epub 2019 May 6.
PubMed 31232047Sunada S, Haskins JS, Kato TA. Sister Chromatid Exchange as a Genotoxic Stress Marker. Methods Mol Biol. 2019;1984:61-68. doi: 10.1007/978-1-4939-9432-8_7.
PubMed 31267420Wilson DM 3rd, Thompson LH. Molecular mechanisms of sister-chromatid exchange. Mutat Res. 2007 Mar 1;616(1-2):11-23. doi: 10.1016/j.mrfmmm.2006.11.017. Epub 2006 Dec 6.
PubMed 17157333Miller DL, Vano E, Bartal G, Balter S, Dixon R, Padovani R, Schueler B, Cardella JF, de Baere T; Cardiovscular and Interventional Radiology Society of Europe; Society of Interventional Radiology. Occupational radiation protection in interventional radiology: a joint guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology. Cardiovasc Intervent Radiol. 2010 Apr;33(2):230-9. doi: 10.1007/s00270-009-9756-7. Epub 2009 Dec 18. No abstract available.
PubMed 20020300The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007;37(2-4):1-332. doi: 10.1016/j.icrp.2007.10.003.
PubMed 18082557Boc V, Boc A, Zdesar U, Blinc A. Patients' radiation doses during percutaneous endovascular procedures in arteries of the lower limbs. Vasa. 2019 Mar;48(2):167-174. doi: 10.1024/0301-1526/a000744. Epub 2018 Oct 16.
PubMed 30322344Dendy PP. Radiation risks in interventional radiology. Br J Radiol. 2008 Jan;81(961):1-7. doi: 10.1259/bjr/15413265. Epub 2007 Nov 26.
PubMed 18039723Sailer AM, Schurink GW, Bol ME, de Haan MW, van Zwam WH, Wildberger JE, Jeukens CR. Occupational Radiation Exposure During Endovascular Aortic Repair. Cardiovasc Intervent Radiol. 2015 Aug;38(4):827-32. doi: 10.1007/s00270-014-1025-8. Epub 2014 Dec 5.
PubMed 25476871Patel AP, Gallacher D, Dourado R, Lyons O, Smith A, Zayed H, Waltham M, Sabharwal T, Bell R, Carrell T, Taylor P, Modarai B. Occupational radiation exposure during endovascular aortic procedures. Eur J Vasc Endovasc Surg. 2013 Oct;46(4):424-30. doi: 10.1016/j.ejvs.2013.05.023. Epub 2013 Jul 19.
PubMed 23871303Kostova-Lefterova DD, Nikolov NN, Stanev SS, Stoyanova BB. Patient doses in endovascular and hybrid revascularization of the lower extremities. Br J Radiol. 2018 Nov;91(1091):20180176. doi: 10.1259/bjr.20180176. Epub 2018 Aug 13.
PubMed 30028182
Study at a glance
From the registry record, last updated by the sponsor on 27 Apr 2020. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Genomic Instability Associated With Chronic Long Term Exposure to Ionizing Radiation in Vascular Surgeons
- ClinicalTrials.gov ID
- NCT04363190
- Acronym / sponsor ID
- IRADIENT / PI-18-967
- Conditions
- Cytogenetic Abnormality, Radiation Exposure
- Keywords
- Vascular surgery, Endovascular surgery
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 28 participants (actual)
- Lead sponsor
- Hospital Clínico Universitario de ValladolidUniversity, hospital or other
- Study start
- 9 Nov 2018 (actual)
- Primary completion
- 20 Apr 2019 (actual)
- Study completion
- 5 Nov 2019 (actual)
- First posted
- 27 Apr 2020 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The past two decades have witnessed the development and growth of the endovascular techniques, however, this new technology is not exempt from risks, since its use requires an ionizing radiation exposure to both patients and surgeons. In this context, the long-term repercussion of this type of chronic exposure to low dose ionizing radiation of the vascular surgeons is still unknown. Although conventional dosimetry is used to monitoring the occupational radiation exposure, it doesn't take into consideration a number of individual variables such as: age, sex, exposure to other carcinogen substances or previous medical history; that may affect the radio-sensibility of each individual. Some studies suggest the use of routine cytogenetic analysis to complement the conventional dosimetry, yet the real genomic effects of chronic low dose ionizing radiation exposure is still unclear and an ideal biodosimetry marker hasn't been described. In this setting, the main objective of the present study was to determine the genomic instability associated to the chronic low dose exposure to ionizing radiation of vascular surgeons versus healthy control patients with no history of radiation exposure.
The secondary endpoints were to determine the impact of demographic and clinical practice activities associated to genomic instability among both groups of patients.
National, observational and transversal case control study of genomic instability among vascular surgeons chronically exposed to low dose ionizing radiation compared to healthy control patients with no previous history of radiation exposure. The peripheral blood samples of the case group were collected from vascular surgeons during the VI International Symposium of Endovascular Surgery. The blood samples were followed by a demographic and endovascular practice questionnaire. On the other hand, the samples for the control group were collected from healthy patients undergoing saphenectomy and/or phlebectomy in our department at Hospital Clínico Universitario de Valladolid. All blood samples were send to the Cancer Investigation Center at Salamanca University where three types of genomic analysis were performed: (1) fluorescence in situ hybridization (FISH) study in interphase for the chromosomes 3, 7 and 17 and locus 9p21; (2) metaphase study with G banding technique; and (3) sister chromatid exchange (SCE) metaphase study.
Study design
- Observational model
- Case-control
- Time perspective
- Cross-sectional
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Cases | – | Diagnostic Test: Cytogenetic analysis |
| Controls | – | Diagnostic Test: Cytogenetic analysis |
Who may qualify
- Sex
- All
- Age groups
- Child, Adult, Older adult
- Study population
- The peripheral blood samples of the case group were collected from vascular surgeons during the VI International Symposium of Endovascular Surgery. The blood samples were followed by a demographic and endovascular practice questionnaire. On the other hand, the samples for the control group were collected from healthy patients undergoing saphenectomy and/or phlebectomy in our department at Hospital Clínico Universitario de Valladolid.
Key inclusion criteria (7 listed)
- Cases
- Vascular surgeons regularly involved in endovascular procedures.
- Over 10 years of endovascular experience.
- Accept to participate in the present study.
- Healthy patients undergoing saphenectomy and/or phlebectomy.
Key exclusion criteria (11 listed)
- Less than 10-year endovascular experience.
- Previous medical history of cancer.
- Have been treated with radiotherapy.
- Have been exposed to ionizing radiation outside the endovascular field.
- Not accept to participate in the present study.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Cytogenetic analysis1. FISH study using the UroVysion kit in interphase peripheral lymphocytes, that allows the study of numerical aberrations for chromosomes 3, 7 and 17 and locus 9p21. 2. G banding study to analyse the whole karyotype study regarding both numerical and structural aberrations during metaphase. 3. Sister chromatid exchanges (SCE) analysis with bromodeoxyuridine (BrdU) staining for the whole karyotype during metaphase: analizing the proportion of SCE per metaphase (NSM). | Diagnostic test | Cases, Controls |
Primary outcome
The differences between cases and controls regarding chromosomal numerical aberrations during interphase using FISH technique
Time frame: 2 years
The differences between cases and controls regarding chromosomal numerical aberrations during interphase of chromosomes 3, 7, 17 and locus 9p21. The differences between cases and controls regarding chromosomal numerical aberrations during interphase using FISH technique with the UroVysion kit for chromosomes 3, 7, 17 and locus 9p21.
The differences between cases and controls after G banding technique
Time frame: 2 years
The differences between cases and controls regarding chromosomal numerical and structural aberrations during metaphase.
The differences between cases and controls regarding the presence of SCE during metaphase.
Time frame: 2 years
The differences between cases and controls regarding the presence of SCE during metaphase.
2 secondary outcomes
Demographic variables, in terms of age and sex, regarding the presence of chromosomal aberrations and SCE.
Time frame: 2 years
The impact of the anatomical region treated as well as the performance of complex aortic endovascular procedures amongst the group of vascular surgeons included in the present study regarding the presence of chromosomal aberrations and SCE.
Time frame: 2 years
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 27 Apr 2020.
- Results publication: PubMed 29705904Mu H, Sun J, Li L, Yin J, Hu N, Zhao W, Ding D, Yi L. Ionizing radiation exposure: hazards, prevention, and biomarker screening. Environ Sci Pollut Res Int. 2018 Jun;25(16):15294-15306. doi: 10.1007/s11356-018-2097-9. Epub 2018 Apr 29.
- Results publication: PubMed 20723835Jaco JW, Miller DL. Measuring and monitoring radiation dose during fluoroscopically guided procedures. Tech Vasc Interv Radiol. 2010 Sep;13(3):188-93. doi: 10.1053/j.tvir.2010.03.009.
- Results publication: PubMed 20093507Balter S, Hopewell JW, Miller DL, Wagner LK, Zelefsky MJ. Fluoroscopically guided interventional procedures: a review of radiation effects on patients' skin and hair. Radiology. 2010 Feb;254(2):326-41. doi: 10.1148/radiol.2542082312.
- Results publication: PubMed 25818982Hertault A, Maurel B, Midulla M, Bordier C, Desponds L, Saeed Kilani M, Sobocinski J, Haulon S. Editor's Choice - Minimizing Radiation Exposure During Endovascular Procedures: Basic Knowledge, Literature Review, and Reporting Standards. Eur J Vasc Endovasc Surg. 2015 Jul;50(1):21-36. doi: 10.1016/j.ejvs.2015.01.014. Epub 2015 Mar 25.
- Results publication: PubMed 19560006Stecker MS, Balter S, Towbin RB, Miller DL, Vano E, Bartal G, Angle JF, Chao CP, Cohen AM, Dixon RG, Gross K, Hartnell GG, Schueler B, Statler JD, de Baere T, Cardella JF; SIR Safety and Health Committee; CIRSE Standards of Practice Committee. Guidelines for patient radiation dose management. J Vasc Interv Radiol. 2009 Jul;20(7 Suppl):S263-73. doi: 10.1016/j.jvir.2009.04.037. No abstract available.
- Results publication: PubMed 31232047Wdowiak A, Skrzypek M, Stec M, Panasiuk L. Effect of ionizing radiation on the male reproductive system. Ann Agric Environ Med. 2019 Jun 17;26(2):210-216. doi: 10.26444/aaem/106085. Epub 2019 May 6.
- Results publication: PubMed 31267420Sunada S, Haskins JS, Kato TA. Sister Chromatid Exchange as a Genotoxic Stress Marker. Methods Mol Biol. 2019;1984:61-68. doi: 10.1007/978-1-4939-9432-8_7.
- Results publication: PubMed 17157333Wilson DM 3rd, Thompson LH. Molecular mechanisms of sister-chromatid exchange. Mutat Res. 2007 Mar 1;616(1-2):11-23. doi: 10.1016/j.mrfmmm.2006.11.017. Epub 2006 Dec 6.
- Results publication: PubMed 20020300Miller DL, Vano E, Bartal G, Balter S, Dixon R, Padovani R, Schueler B, Cardella JF, de Baere T; Cardiovscular and Interventional Radiology Society of Europe; Society of Interventional Radiology. Occupational radiation protection in interventional radiology: a joint guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology. Cardiovasc Intervent Radiol. 2010 Apr;33(2):230-9. doi: 10.1007/s00270-009-9756-7. Epub 2009 Dec 18. No abstract available.
- Results publication: PubMed 18082557The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007;37(2-4):1-332. doi: 10.1016/j.icrp.2007.10.003.
- Results publication: PubMed 30322344Boc V, Boc A, Zdesar U, Blinc A. Patients' radiation doses during percutaneous endovascular procedures in arteries of the lower limbs. Vasa. 2019 Mar;48(2):167-174. doi: 10.1024/0301-1526/a000744. Epub 2018 Oct 16.
- Results publication: PubMed 18039723Dendy PP. Radiation risks in interventional radiology. Br J Radiol. 2008 Jan;81(961):1-7. doi: 10.1259/bjr/15413265. Epub 2007 Nov 26.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Cytogenetic Abnormality and Radiation Exposure, run by Hospital Clínico Universitario de Valladolid at 1 site in Spain.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 7 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 27 Apr 2020. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The differences between cases and controls regarding chromosomal numerical aberrations during interphase using FISH technique (time frame: 2 years). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04363190, which also lists 23 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Apr 2020.