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- Lubin, Jay H., et al.
(author)
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Thyroid Cancer Following Childhood Low-Dose Radiation Exposure : A Pooled Analysis of Nine Cohorts
- 2017
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In: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 102:7, s. 2575-2583
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Journal article (peer-reviewed)abstract
- Context: The increased use of diagnostic and therapeutic procedures that involve radiation raises concerns about radiation effects, particularly in children and the radiosensitive thyroid gland.Objectives: Evaluation of relative risk (RR) trends for thyroid radiation doses <0.2 gray (Gy); evidence of a threshold dose; and possible modifiers of the dose-response, e.g., sex, age at exposure, time since exposure.Design and Setting: Pooled data from nine cohort studies of childhood external radiation exposure and thyroid cancer with individualized dose estimates, ≥1000 irradiated subjects or ≥10 thyroid cancer cases, with data limited to individuals receiving doses <0.2 Gy.Participants: Cohorts included the following: childhood cancer survivors (n = 2); children treated for benign diseases (n = 6); and children who survived the atomic bombings in Japan (n = 1). There were 252 cases and 2,588,559 person-years in irradiated individuals and 142 cases and 1,865,957 person-years in nonirradiated individuals.Intervention: There were no interventions.Main Outcome Measure: Incident thyroid cancers.Results: For both <0.2 and <0.1 Gy, RRs increased with thyroid dose (P < 0.01), without significant departure from linearity (P = 0.77 and P = 0.66, respectively). Estimates of threshold dose ranged from 0.0 to 0.03 Gy, with an upper 95% confidence bound of 0.04 Gy. The increasing dose–response trend persisted >45 years after exposure, was greater at younger age at exposure and younger attained age, and was similar by sex and number of treatments.Conclusions: Our analyses reaffirmed linearity of the dose response as the most plausible relationship for “as low as reasonably achievable” assessments for pediatric low-dose radiation-associated thyroid cancer risk.
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- Lundell, C., et al.
(author)
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Effects of confined geometry on phase-separated dextran/gelatine mixtures exposed to shear
- 2005
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In: Journal of Colloid and Interface Science. - : Elsevier BV. - 0021-9797 .- 1095-7103. ; 288:1, s. 222-229
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Journal article (peer-reviewed)abstract
- The effect of shear on aqueous phase-separated dextran/fish gelatine mixtures with a total concentration of 5 and 10% was studied in a confined geometry. It was measured as a function of composition, strain rate and gap size. This was done by using both small-angle light scattering and a shear cell combined with a confocal laser scanning microscope. At a total polymer concentration of 5%, small-angle light scattering results showed that up to 100 s-1 the deformation of the domains increases with the strain rate. At strain rates less than 100 s-1, the response of the system to strain is dominated by strain rate-dependent deformation. At a higher strain rate there might be balance between break-up and re-coalescence. At a total concentration of 10%, small effects of the gap size were found. In confined geometry, the coalescence rate was faster than expected from viscous hydrodynamic growth. The microscope images showed that the gelatine-enriched phase forms a wetting layer on the surface of the glass wall. The degree of wetting appears to increase with increasing the strain rate up to 60 s -1 and decreases again at higher strain rates. © 2005 Elsevier Inc. All rights reserved.
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- Pauwels, A, et al.
(author)
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How to select patients for antireflux surgery? The ICARUS guidelines (international consensus regarding preoperative examinations and clinical characteristics assessment to select adult patients for antireflux surgery)
- 2019
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In: Gut. - : BMJ. - 1468-3288 .- 0017-5749. ; 68:11, s. 1928-1941
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Journal article (peer-reviewed)abstract
- Antireflux surgery can be proposed in patients with GORD, especially when proton pump inhibitor (PPI) use leads to incomplete symptom improvement. However, to date, international consensus guidelines on the clinical criteria and additional technical examinations used in patient selection for antireflux surgery are lacking. We aimed at generating key recommendations in the selection of patients for antireflux surgery.DesignWe included 35 international experts (gastroenterologists, surgeons and physiologists) in a Delphi process and developed 37 statements that were revised by the Consensus Group, to start the Delphi process. Three voting rounds followed where each statement was presented with the evidence summary. The panel indicated the degree of agreement for the statement. When 80% of the Consensus Group agreed (A+/A) with a statement, this was defined as consensus. All votes were mutually anonymous.ResultsPatients with heartburn with a satisfactory response to PPIs, patients with a hiatal hernia (HH), patients with oesophagitis Los Angeles (LA) grade B or higher and patients with Barrett’s oesophagus are good candidates for antireflux surgery. An endoscopy prior to antireflux surgery is mandatory and a barium swallow should be performed in patients with suspicion of a HH or short oesophagus. Oesophageal manometry is mandatory to rule out major motility disorders. Finally, oesophageal pH (±impedance) monitoring of PPI is mandatory to select patients for antireflux surgery, if endoscopy is negative for unequivocal reflux oesophagitis.ConclusionWith the ICARUS guidelines, we generated key recommendations for selection of patients for antireflux surgery.
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