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- Beral, V, et al.
(författare)
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Alcohol, tobacco and breast cancer - collaborative reanalysis of individual data from 53 epidemiological studies, including 58515 women with breast cancer and 95067 women without the disease
- 2002
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Ingår i: British Journal of Cancer. - : Springer Science and Business Media LLC. - 1532-1827 .- 0007-0920. ; 87, s. 1234-45
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Tidskriftsartikel (refereegranskat)abstract
- Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58515 women with invasive breast cancer and 95067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19 - 1.45, P < 0.00001) for an intake of 35 - 44 g per day alcohol, and 1.46 (1.33 - 1.61, P < 0.00001) for greater than or equal to 45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1 % per 10 g per day, P < 0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers= 1.03, 95% CI 0.98 - 1.07, and for current smokers=0.99, 0.92 - 1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver. (C) 2002 Cancer Research UK.
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- Corino, Valentina D.A., et al.
(författare)
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Non-invasive evaluation of the effect of metoprolol on the atrioventricular node during permanent atrial fibrillation
- 2014. - January
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Ingår i: Computing in Cardiology 2014. - : Oxford University Press (OUP). - 2325-8861. - 9781479943463 - 9781479943470 ; 41, s. 889-892
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Konferensbidrag (refereegranskat)abstract
- The aim of this study was to evaluate changes in AV nodal properties during administration of metoprolol, using a novel ECG-based method for parameter estimation. The AV nodal parameters account for the probability of an impulse not passing through the fast pathway, the absolute refractory periods of the slow and fast pathways (aRPs and aRPf), representing the functional refractory period, and related prolongation in the respective refractory periods. Twenty patients (age 71±8 years, 14 men) with permanent AF from the RATe control in Atrial Fibrillation (RATAF) database were included in this study. Recordings during baseline and metoprolol administration were analyzed. Furthermore, simulated RR series were generated mimicking metoprolol administration. During metoprolol administration, aRP was significantly prolonged in both pathways (aRPs: 342±39 vs. 408±81 ms, p<0.001; aRPf: 432±74 vs. 527±83 ms, p<0.001). Similar results were found for the simulated RR series: both aRPs and aRPf were significantly prolonged with metoprolol. The AV nodal parameters reflect expected changes after metoprolol administration, i.e., a prolongation in functional refractory period. The simulations suggest that aRP may serve as an estimate of the functional refractory period.
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| 7. |
- Corino, Valentina D. A., et al.
(författare)
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Rate-Control Drugs Affect Variability and Irregularity Measures of RR Intervals in Patients with Permanent Atrial Fibrillation
- 2015
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Ingår i: Journal of Cardiovascular Electrophysiology. - : Wiley. - 1540-8167 .- 1045-3873. ; 26:2, s. 137-141
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Tidskriftsartikel (refereegranskat)abstract
- Heart Rate Variability and Irregularity During AF IntroductionIrregularity measures have been suggested as risk indicators in patients with atrial fibrillation (AF); however, it is not known to what extent they are affected by commonly used rate-control drugs. We aimed at evaluating the effect of metoprolol, carvedilol, diltiazem, and verapamil on the variability and irregularity of the ventricular response in patients with permanent AF. Methods and ResultsSixty patients with permanent AF were part of an investigator-blind cross-over study, comparing 4 rate-control drugs (diltiazem, verapamil, metoprolol, and carvedilol). We analyzed five 20-minute segments per patient: baseline and the 4 drug regimens. On every segment, heart rate (HR) variability and irregularity of RR series were computed. The variability was assessed as standard deviation, pNN20, pNN50, pNN80, and rMSSD. The irregularity was assessed by regularity index, approximate (ApEn), and sample entropy. A significantly lower HR was obtained with all drugs, the HR was lowest using the calcium channel blockers. All drugs increased the variability of ventricular response in respect to baseline (as an example, rMSSD: baseline 171 47 milliseconds, carvedilol 229 +/- 58 milliseconds; P < 0.05 vs. baseline, metoprolol 226 +/- 66 milliseconds; P < 0.05 vs. baseline, verapamil 228 +/- 84; P < 0.05 vs. baseline, diltiazem 256 +/- 87 milliseconds; P < 0.05 vs. baseline and all other drugs). Only -blockers significantly increased the irregularity of the RR series (as an example, ApEn: baseline 1.86 +/- 0.13, carvedilol 1.92 +/- 0.09; P < 0.05 vs. baseline, metoprolol 1.93 +/- 0.08; P < 0.05 vs. baseline, verapamil 1.86 +/- 0.22 ns, diltiazem 1.88 +/- 0.16 ns). ConclusionModification of AV node conduction by rate-control drugs increase RR variability, while only -blockers affect irregularity.
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- Enger, Shirin A., et al.
(författare)
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Gadolinium-153 as a brachytherapy isotope
- 2013
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Ingår i: Physics in Medicine and Biology. - : IOP Publishing. - 0031-9155 .- 1361-6560. ; 58:4, s. 957-964
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this work was to present the fundamental dosimetric characteristics of a hypothetical Gd-153 brachytherapy source using the AAPM TG-43U1 dose-calculation formalism. Gadolinium-153 is an intermediate-energy isotope that emits 40-100 keV photons with a half-life of 242 days. The rationale for considering Gd-153 as a brachytherapy source is for its potential of patient specific shielding and to enable reduced personnel shielding requirements relative to Ir-192, and as an isotope for interstitial rotating shield brachytherapy (I-RSBT). A hypothetical Gd-153 brachytherapy source with an active core of 0.84 mm diameter, 10 mm length and specific activity of 5.55 TBq of Gd-153 per gram of Gd was simulated with Geant4. The encapsulation material was stainless steel with a thickness of 0.08 mm. The radial dose function, anisotropy function and photon spectrum in water were calculated for the Gd-153 source. The simulated Gd-153 source had an activity of 242 GBq and a dose rate in water 1 cm off axis of 13.12 Gy h(-1), indicating that it would be suitable as a low-dose-rate or pulsed-dose-rate brachytherapy source. The beta particles emitted have low enough energies to be absorbed in the source encapsulation. Gadolinium-153 has an increasing radial dose function due to multiple scatter of low-energy photons. Scattered photon dose takes over with distance from the source and contributes to the majority of the absorbed dose. The anisotropy function of the Gd-153 source decreases at low polar angles, as a result of the long active core. The source is less anisotropic at polar angles away from the longitudinal axes. The anisotropy function increases with increasing distance. The Gd-153 source considered would be suitable as an intermediate-energy low-dose-rate or pulsed-dose-rate brachytherapy source. The source could provide a means for I-RSBT delivery and enable brachytherapy treatments with patient specific shielding and reduced personnel shielding requirements relative to Ir-192.
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- Quast, Ulrich, et al.
(författare)
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A brachytherapy photon radiation quality index Q(BT) for probe-type dosimetry
- 2016
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Ingår i: Physica medica (Testo stampato). - : ELSEVIER SCI LTD. - 1120-1797 .- 1724-191X. ; 32:6, s. 741-748
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: In photon brachytherapy (BT), experimental dosimetry is needed to verify treatment plans if planning algorithms neglect varying attenuation, absorption or scattering conditions. The detectors response is energy dependent, including the detector material to water dose ratio and the intrinsic mechanisms. The local mean photon energy E(r) must be known or another equivalent energy quality parameter used. We propose the brachytherapy photon radiation quality index Q(BT) ((E) over bar), to characterize the photon radiation quality in view of measurements of distributions of the absorbed dose to water, D-w, around BT sources. Materials and methods: While the external photon beam radiotherapy (EBRT) radiation quality index Q(EBRT) ((E) over bar) = TPR1020((E) over bar) is not applicable to BT, the authors have applied a novel energy dependent parameter, called brachytherapy photon radiation quality index, defined as Q(BT) ((E) over bar) = D-prim(r = 2 cm; theta(0) = 90 degrees)/D-prim(r(0) = 1 cm; theta(0) = 90 degrees), utilizing precise primary absorbed dose data, D-prim, from source reference databases, without additional MC-calculations. Results and discussion: For BT photon sources used clinically, Q(BT) ((E) over bar) enables to determine the effective mean linear attenuation coefficient (mu) over bar (E) and thus the effective energy of the primary photons E-prim(eff)(r(0), theta(0)) at the TG-43 reference position P-ref (r(0) = 1 cm; theta(0) = 90 degrees) being close to the mean total photon energy (E) over bar (tot)(r(0), theta(0)). If one has calibrated detectors, published (E) over bar (tot)(r) and the BT radiation quality correction factor k(Q, Q0)(BT) ((E) over bar, r, theta) for different BT radiation qualities Q and Q(0), the detectors response can be determined and D-w(r, theta) measured in the vicinity of BT photon sources. Conclusions: This novel brachytherapy photon radiation quality index Q(BT) characterizes sufficiently accurate and precise the primary photon` s penetration probability and scattering potential. (C) 2016 Published by Elsevier Ltd on behalf of Associazione Italiana di Fisica Medica.
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