Gastric cancer detection rates using GI endoscopy with serologic risk stratification: a randomized controlled trial.

BACKGROUND AND AIMS: Efforts have been made to develop an endoscopic screening system incorporating serologic gastric cancer (GC) risk stratification (ABC classification) alongside annual population-based GC screening using barium. We conducted a randomized controlled trial (RCT) to compare GC detection rates between the Ba-Endo group, which underwent annual barium tests for primary screening followed by detailed endoscopic examinations, and the ABC-Endo group, where endoscopy intervals were determined based on individual gastric cancer risk in the ABC classification. METHODS: In total, 1206 individuals from Yurihonjo and Nikaho City, Akita Prefecture, were randomized through the minimization method using sex and age as allocation factors. The intervention study was conducted for both groups over 5 years. The Ba-Endo group received annual barium tests, and the ABC-Endo group underwent EGD at different intervals: group A, EGD only at entry; group B, EGD once every 3 years; group C, EGD once every 2 years; and group D, EGD every year. RESULTS: There were 24 detected GC lesions, with a GC detection rate of 1.9%. GC detection rates in the Ba-Endo and ABC-Endo groups were 2.0% and 1.8%, respectively, with no significant differences between groups (P = 1.0). However, the rate of GC cured by endoscopic resection alone was 41.6% in the Ba-Endo group and was significantly higher at 90.9% in the ABC-Endo group (P = .02). CONCLUSIONS: There were no differences between the Ba-Endo and ABC-Endo groups in GC detection rates. However, the rate of detected GCs that could be cured by endoscopic resection alone was significantly higher in the ABC-Endo group. (Clinical trial registration number: UMIN000005962.).

Analyzing the performance of synthesized nano-catalysts for transesterification of waste cooking oil as environment friendly drilling fluid.

Ester-based drilling fluids (EBDF) are preferred over oil-based drilling fluids (OBDF) and water-based drilling fluids (WBDF) because of their great biodegradability, low toxicity, and improved performance. In this work, waste cooking oil methyl ester (WCOME) was used to prepare an environmentally friendly EBDF. Through a transesterification process utilizing a modified calcium oxide based heterogenous catalyst, the waste cooking oil is transformed into waste cooking oil methyl ester. Response surface approach was used to strengthen the transesterification. The optimize conditions for CaO/Al2O3 resulted in the highest yield of 96.56% at a molar ratio of 11.9:1, 3.19 wt % of CaO/Al2O3, 53.79 °C, and 76.86 min. In contrast, CaO/TiO2 yielded 98.15% at a molar ratio of 11.99:1, with a CaO/TiO2 of 2.53 wt % at 59.79 in 68.14 min. Additionally, two separate densities of 9 ppg and 12 ppg EBDF are formulated with two distinct oil-to-water ratios (70:30 and 80:20) using synthesized WCOME. To assess the effectiveness of formulated EBDF thorough rheological investigation is conducted at 150°. Additionally, the filtration loss at HPHT conditions, emulsion stability, and Barite sag analysis of the drilling fluid are all analyzed at before ageing and after dynamic ageing. With better rheological features, less fluid loss, good emulsion stability, and minimal barite sagging, the designed EBDF performs efficiently. The drilling fluid met the API requirement and demonstrated stability even after ageing at 250 °F for 72 h, suggesting that it may be used for extended periods of time in drilling.

Improved radiologic diagnosis of delayed gastric conduit emptying (DGCE) after esophagectomy using a functional upper gastrointestinal contrast study.

BACKGROUND: With increasing incidence of esophageal cancer, a growing number of patients are at risk of developing delayed gastric conduit emptying (DGCE) in the early postoperative phase after esophagectomy. This condition is of great postoperative concern due to its association with adverse outcomes. PURPOSE: To give a narrative review of the literature concerning radiological diagnosis of DGCE after esophagectomy and a proposal for an improved, functional protocol with objective measurements. MATERIAL AND METHODS: The protocol was designed at Virginia Mason Medical Center in Seattle and is based on the Timed Barium Esophagogram (TBE) concept, which has been adapted to assess the passage of contrast from the gastric conduit into the duodenum. RESULTS: The literature review showed a general lack of standardization and scientific evidence behind the use of radiology to assess DGCE. We found that our proposed standardized upper gastrointestinal (UGI) contrast study considers both the time aspect in DGCE and provides morphologic information of the gastric conduit. This radiological protocol was tested on 112 patients in a trial performed at two high-volume centers for esophageal surgery and included an UGI contrast study 2-3 days postoperatively. The study demonstrated that this UGI contrast study can be included in the standardized clinical pathway after esophagectomy. CONCLUSION: This new, proposed UGI contrast study has the potential to diagnose early postoperative DGCE in a standardized manner and to improve overall patient outcomes after esophagectomy.

Is the collateral circulation pattern in the hard palate affected by cleft deformity?

OBJECTIVES: To evaluate the influence of collateral vascularization on surgical cleft palate closure and deformities. MATERIALS AND METHODS: Corrosion casting was performed using red-colored acrylic resin in twelve fresh adult cadavers with a normal hard palate. Additionally, white-colored barium sulfate was injected into a fetus with a unilateral complete cleft palate, and layer-by-layer tissue dissection was performed. Both substances were injected into the external carotid arteries. Corrosion casting involved dissolving the soft and hard tissues of the orofacial area utilizing an enzymatic solution. RESULTS: In normal palates, bilateral intraosseous infraorbital arteries formed a network in the premaxilla with the intraosseous nasopalatine- and greater palatine arteries (GPAs). The perforating GPAs anastomosed with the sphenopalatine artery sub-branches. Bilateral extraosseous GPA anastomoses penetrated the median palatine suture. Complex vascularization in the retrotuberal area was detected. In the cleft zone, anastomoses were omitted, whereas in the non-cleft zone, enlarged GPAs were distributed along the cleft edges and followed the anatomical course anteriorly to initiate the network with facial artery sub-branches. CONCLUSIONS: The anatomical subunits of the palate exhibited distinct anastomosis patterns. Despite omitted anastomoses with collateral circulation in the cleft zone, arteries maintained their anatomical pattern as seen in the normal specimen in the non-cleft zone. CLINICAL RELEVANCE: Based on the findings in normal- and cleft palates, surgeons may expect developed anastomosis patterns in the non-cleft zone. Due to the lack of microcirculation in the cleft zone, the existent anastomoses should be maintained as much as possible by the surgical technique. This applies anteriorly in the incisive canal territory, alveolar ridges, and posteriorly in the retrotuberal area.

[ADVANCES ON ESOPHAGEAL MEASUREMENTS: HIGH RESOLUTION MANOMETRY, TIMED BARIUM SWALLOW, ENDOFLIP AND PH MONITORING].

INTRODUCTION: Upper gastrointestinal (UGI) symptoms are very common in the general adult population. Dysphagia, heartburn, regurgitation and non-cardiac chest pain are the most common signs. The clinical approach in managing these symptoms starts with upper GI endoscopy in order to exclude inflammatory, neoplastic and fibrotic disorders that involve the esophagus. Upper GI endoscopy is mandatory especially when alarm signs exist. In patients with no structural abnormalities, physiological testing might aid to better understand the origin of the symptoms and to improve management.

Controls on Barite (BaSO4) Precipitation in Unconventional Reservoirs.

Barite (BaSO4) precipitation is one of the most ubiquitous examples of secondary sulfate mineral scaling in shale oil and gas reservoirs. Often, a suite of chemical additives is used during fracturing operations to inhibit the accumulation of mineral scales, though their efficacy is widely varied and poorly understood. This study combines experimental data and multi-component numerical reactive transport modeling to offer a more comprehensive understanding of the geochemical behavior of barite accumulation in shale matrices under conditions typical of fracturing operations. A variety of additives and conditions are individually tested in batch reactor experiments to identify the factors controlling barite precipitation. Our experimental results demonstrate a pH dependence in the rate of barite precipitation, which we use to develop a predictive model including a pH-dependent term that satisfactorily reproduces our observations. This model is then extended to consider the behavior of three major shale samples of highly variable mineralogy (Eagle Ford, Marcellus, and Barnett). This data-validated model offers a reliable tool to predict and ultimately mitigate against secondary mineral accumulation in unconventional shale reservoirs.

Improvement of the Stability of IO3--, SeO32--, and SeO42--Coprecipitated Barite after Treatment with Phosphate.

Coprecipitation of radionuclides with barite has been studied to remove radionuclides from radioactive liquid waste because of its excellent removal efficiency; however, little information exists concerning the stability of the ions coprecipitated with barite. This study systematically investigated the stability of iodate, selenite, and selenate coprecipitated with barite via leaching tests. These oxyanions were gradually leached from the oxyanion-bearing barite into ultrapure water over time. Leaching of the oxyanions significantly increased in leaching solutions containing NaCl (pH 5.3), NaNO3 (pH 5.9), and Na2SO4 (pH 5.7). Conversely, leaching of the oxyanions was suppressed in KH2PO4 solution (pH 8.5), indicating that phosphate stabilized the oxyanion-bearing barite. The effect of phosphate treatment on oxyanion-bearing barite was further investigated. The results showed that the barite surface was modified with phosphate, and a thin surface layer of a barium phosphate-like structure was formed. The amount of oxyanions leached from the phosphate-treated samples into leaching solutions containing NaCl or NaNO3 was much lower than the amounts leached from the untreated barite samples into ultrapure water. The barite coprecipitation combined with subsequent phosphate treatment may be a promising method to efficiently remove iodate, selenite, and selenate from wastewater and stabilize them as barite coprecipitates.

Double-contrast barium enema is no longer justified as a backup examination for colonoscopy in the population screening program: Population study in an organized fecal immunochemical test-based screening program.

BACKGROUND AND AIM: Currently, some countries still acknowledge double-contrast barium enema (DCBE) as a backup confirmatory examination when colonoscopy is not feasible or incomplete in colorectal cancer (CRC) screening programs. This study aims to compare the performance of colonoscopy and DCBE in terms of the risk of incident CRC after negative results in the fecal immunochemical test (FIT)-based Taiwan Colorectal Cancer Screening Program. METHODS: Subjects who had positive FITs and received confirmatory exams, either colonoscopy or DCBE, without the findings of neoplastic lesions from 2004 to 2013 in the screening program comprised the study cohort. Both the colonoscopy and DCBE subcohorts were followed until the end of 2018 and linked to the Taiwan Cancer Registry to identify incident CRC cases. Multivariate analysis was conducted to compare the risk of incident CRC in both subcohorts after controlling for potential confounders. RESULTS: A total of 102 761 colonoscopies and 5885 DCBEs were performed after positive FITs without neoplastic findings during the study period. By the end of 2018, 2113 CRCs (2.7 per 1000 person-years) and 368 CRCs (7.6 per 1000 person-years) occurred in the colonoscopy and DCBE subcohorts, respectively. After adjusting for major confounders, DCBE had a significantly higher risk of incident CRC than colonoscopy, with an adjusted HR of 2.81 (95% CI = 2.51-3.14). CONCLUSIONS: In the FIT screening program, using DCBE as a backup examination was associated with a nearly threefold risk of incident CRC compared with colonoscopy, demonstrating that it is no longer justified as a backup examination for incomplete colonoscopy.

Quantifying the subjective: length-to-height ratio characterizes achalasia esophageal tortuosity.

BACKGROUND: Esophageal morphology in achalasia is thought to affect outcomes, with "end-stage" sigmoidal morphology faring poorly; however, evaluation of morphology's role in outcomes has been limited by lack of objective characterization. Hence, the goals of this study were twofold: characterize the variability of timed barium esophagram (TBE) interpretation and evaluate an objective classification of TBE tortuosity: length-to-height ratio (LHR). We hypothesized that the esophagus must elongate to become sigmoidal such that sigmoidal morphology would demonstrate a larger LHR. METHODS: Ninety pre-operative TBEs were selected from an institutional database. Esophageal morphology was categorized as straight, intermediate, or sigmoidal. Esophageal length was measured by a mid-lumen line from the aortic knob to the esophagogastric junction on TBE; height was measured vertically from the aortic knob to the level of the esophagogastric junction. The length divided by the height generated the LHR. Descriptive statistics and frequency of expert agreement were calculated. Median LHR was compared between consensus morphologies. A receiver operating characteristic (ROC) determined the optimal LHR for sigmoidal vs non-sigmoidal characterization. RESULTS: From a total of 90 pre-operative TBEs, expert consensus morphology was reached in 56 (62.2%) cases. Pairs of experts agreed on morphology in 62-74% of TBEs, with all three experts agreeing on 46.7-48.9% of cases. Median LHR between expert consensus morphologies was 1.03, 1.09, and 1.24 for straight, intermediate, and sigmoidal morphologies, respectively (p < 0.001). ROC demonstrated that an LHR cutoff of 1.13 was 100% sensitive and 95% specific (AUC 0.99) for ruling out sigmoidal morphology. CONCLUSION: These findings confirm our anecdotal experience that subjective morphology interpretation is variable, even between experts at a high-volume center. LHR provides an objective method for classification, allowing us to overcome the limitations of inter-observer variability, thus paving the way for future study of the role of morphology in achalasia outcomes.

Determination of carbonate content in barite ore by headspace gas chromatography.

This paper reports a method for determining the carbonate content in barite ore using headspace gas chromatography. Based on the acidification reaction, the carbonate in the barite ore was converted to CO2 in a closed headspace vial. When the carbonate content was significant, the pressure caused changes in the CO2 and O2 signals and affected the measurement accuracy. It was found that carbonate content is proportional to the intensity ratio of the CO2 to O2 signals. Thus, the carbonate content in barite ore can be measured indirectly using a theoretical model. The results showed that the carbonate in 3 g of barite ore sample with a particle size of 74 µm could react completely with a hydrochloric acid solution (2 mol/L) at 65°C for 5 min. The method described herein had good precision (relative standard deviation < 4.14%) and accuracy (relative differences < 6.12%). Further, the limit of quantification was 0.07 mol/L. Owing to its simplicity and speed, this method can be used for the batch determination of carbonate content in barite ore.

Stakeholder Perspectives on Radiation Use and Interdisciplinary Collaboration in Adult Modified Barium Swallow Studies.

The Modified Barium Swallow Study (MBSS) is a videofluoroscopic examination of the anatomy and physiology involved in swallowing. Like other fluoroscopic examinations, the MBSS uses ionizing radiation with related radiation risks. Thus, the procedures and protocols related to MBSSs must balance the benefit of the diagnostic information gained with the risk of radiation exposure. This requires complex decision-making for any given clinician but becomes complicated due to the interprofessional nature of conducting MBSSs, namely the direct involvement of both the speech-language pathologist and radiologist with indirect involvement of the medical physicist and the referring physician. This editorial provides the perspectives of the various stakeholder groups related to radiation use in adult MBSSs, identifies barriers to conducting MBSSs in an evidence-based manner, and suggests areas for improvement.

Review on treatment and utilization of barium slag in China.

Barium slag (BS) is generated as a by-product waste during the production of barium salts from barite. A large amount of BS is discharged annually threating the ecological environment and restricting the development of the barium salts industry. In China, BS is classified as hazardous waste due to its corrosivity, and more importantly because of its extraction toxicity of barium. Soluble barium is toxic and can result in barium poisoning for environment and human beings. The current review presents a detailed summary on general characteristics, discharge and disposal status, harmless treatment pathways and comprehensive utilization of BS in China. BaO, SiO2, CaO, and SO3 occur as main chemical compositions in BS, especially BaO accounting approximately for 35-40%. The mineral compositions include unreacted barite, quartz, clay minerals, newly-formed phases from the side reactions such as BaCO3, BaSiO3 and BaSO3, and residual carbon. A special attention is given to the assessment of the harmless treatment methods for BS from hazardous waste to general waste, which will decrease its management costs. Precipitation and solidification of soluble barium is the common pathway for harmless treatment of BS, and the using of other industrial waste can realize cost-saving. Methods for comprehensive utilization of BS include recovery of barium and carbon, application in building materials, and using as adsorbents for wastewater treatment. In particular, we analyzed and discussed the advantages and disadvantages of these existing process routes, intending to promote potentials for comprehensive utilization of BS in the future.

Opacifiers on color stability of maxillofacial silicone under aging and Indian weathering conditions: An in vitro study.

STATEMENT OF PROBLEM: Resistance to long-term color change is a desirable property for facial prosthetic elastomers. Evidence for the color stability of maxillofacial silicones under aging and hot and humid Indian weathering conditions is lacking. PURPOSE: The purpose of this in vitro study was to evaluate the effect of adding opacifiers on the color stability of maxillofacial silicone under human aging and Indian weather conditions. MATERIAL AND METHODS: A total of 93 specimen disks were obtained from the A-2186, platinum-based, room-temperature vulcanized, maxillofacial silicone elastomer by using a Ø30×6-mm stainless-steel die. The specimens were divided into 3 main groups (n=30), C (control), T (titanium dioxide), and B (barium sulfate), and 1 additional specimen (n=1) from each group was stored in a closed box and further subgrouped as outdoor weathering (COut, TOut, BOut), acidic perspiration (CAcid, TAcid, BAcid), sebum (CSebum, TSebum, BSebum) (n=10), and visual comparison (CVis, TVis, BVis) (n=1). Baseline L∗, a∗, b∗ values were recorded by using a spectrophotometer and visual perception. The specimens were subjected to human and extraoral aging conditions, and the values were recorded again after 6 months. Data were analyzed statistically by using analysis of variance (ANOVA) and post hoc analysis with the Tukey post hoc test. RESULTS: In group C, the mean color change for COut was 3.69 ±0.49; CAcid, 3.58 ±0.68; and CSebum, 7.53 ±0.22 (P<.001). In group T, the mean color change for TOut was 2.60 ±0.24; TAcid, 2.35 ±0.13; and TSebum, 4.91 ±0.44 (P<.001). In group B, BOut was 1.59 ±0.28, BAcid was 1.46 ±0.28, and BSebum was 4.03 ±0.71 (P<.001). The specimens containing barium sulfate showed the maximum color stability. The least color stability was observed in all specimens exposed to sebum solution and was significantly different (P<.001) from the outdoor weather and acidic perspiration specimens. Visually perceivable color changes were observed in specimens exposed to the sebum solution. CONCLUSIONS: The addition of titanium dioxide and barium sulfate as opacifiers resulted in clinically acceptable color change when exposed to outdoor weathering and acidic perspiration but not in sebum solution.

Manipulation of Morphology, Particle Size of Barium Sulfate and the Interacting Mechanism of Methyl Glycine Diacetic Acid.

In this paper, methyl glycine diacetic acid (MGDA) was found to have great influence on the morphology and particle size of barium sulfate. The effects of additive, concentration, value of pH and reaction temperature on the morphology and particle size of barium sulfate were studied in detail. The results show that the concentration of reactant and temperature have little effect on the particle size of barium sulfate. However, the pH conditions of the solution and the dosage of MGDA can apparently affect the particle size distribution of barium sulfate. The particle size of barium sulfate particles increases and the morphology changes from polyhedral to rice-shaped with the decreasing of the dosage of MGDA. In solution with higher pH, smaller and rice-shaped barium sulfate was obtained. To investigate the interacting mechanism of MGDA, the binding energy between MGDA and barium sulfate surface was calculated. It was found that the larger absolute value of the binding energy would result in stronger growth inhibition on the crystal face. Finally, the experimental data and theoretical calculations were combined to elucidate the interacting mechanism of the additive on the morphology and particle size of barium sulfate.

Intestinal obstruction due to bariolith impaction.

"Bariolith" is defined as the concretion of barium sulfate in the intestine after performing a radiological study with said contrast. Complications derived from the use of barium are exceptional, but appendicitis, intussusception, volvulus, ulceration, ischemia and perforation have been described. We present the case of a 62 years old woman, who underwent a EGD exploration on the 15th of January 2021 as a part of her study for suspected GERD.

BARIUM SULFATE GELATIN AS A NOVEL APPROACH TO FACILITATE GASTROINTESTINAL TRACT POSITIVE CONTRAST STUDIES IN A CAPTIVE HARBOR SEAL (PHOCA VITULINA) AND CALIFORNIA SEA LIONS (ZALOPHUS CALIFORNIANUS) WITHOUT RESTRAINT.

Gastrointestinal tract contrast medium studies are a valuable diagnostic modality to evaluate gastrointestinal anatomy, motility, and pathology. Four positive contrast medium studies were performed twice on a harbor seal (Phoca vitulina) and once each on two California sea lions (Zalophus californianus) to evaluate for gastrointestinal abnormalities by using barium-impregnated gelatin. Because marine mammals in human care routinely receive plain gelatin as a component of their diet and as secondary reinforcement, feeding a barium gelatin mitigates the need for tube feeding or restraint. Operant conditioning was used to position the pinnipeds for voluntary radiographs. The barium gelatin permitted adequate evaluation of gastric emptying and intestinal transit times and good evaluation of the structure of the intestinal tract. Full evaluation of gastric anatomy was limited due to the gelatin blocks not conforming to the stomach in their solid form and the barium quickly exiting the stomach as barium gelatin blocks disintegrated and because orthogonal views could not always be acquired. Even with these limitations, barium gelatin resulted in diagnostically valuable contrast imaging in a stress-free patient setting with reduced risk of aspiration and eliminated the effects that anesthesia can have on gastric motility as well as other anesthesia-associated risks.

Selenite and Selenate Sequestration during Coprecipitation with Barite: Insights from Mineralization Processes of Adsorption, Nucleation, and Growth.

Coprecipitation of selenium oxyanions with barite is a facile way to sequester Se in the environments. However, the chemical composition of Se-barite coprecipitates usually deviates from that predicted from thermodynamic calculations. This discrepancy was resolved by considering variations in nucleation and growth rates controlled by ion-mineral interactions, solubility, and interfacial energy. For homogeneous precipitation, ∼10% of sulfate, higher than thermodynamic predictions (<0.3%), was substituted by Se(IV) or Se(VI) oxyanion, which was attributed to adsorption-induced entrapment during crystal growth. For heterogeneous precipitation, thiol- and carboxylic-based organic films, utilized as model interfaces to mimic the natural organic-abundant environments, further enhanced the sequestration of Se(VI) oxyanions (up to 41-92%) with barite. Such enhancement was kinetically driven by increased nucleation rates of selenate-rich barite having a lower interfacial energy than pure barite. In contrast, only small amounts of Se(IV) oxyanions (∼1%) were detected in heterogeneous coprecipitates mainly due to a lower saturation index of BaSeO3 and deprotonation degree of Se(IV) oxyanion at pH 5.6. These roles of nanoscale mineralization mechanisms observed during composition selection of Se-barite could mark important steps toward the remediation of contaminants through coprecipitation.

Synergistic Enhancement of Lead and Selenate Uptake at the Barite (001)-Water Interface.

The interactions of heavy metals with minerals influence the mobility and bioavailability of toxic elements in natural aqueous environments. The sorption of heavy metals on covalently bonded minerals is generally well described by surface complexation models (SCMs). However, understanding sorption on sparingly soluble minerals is challenging because of the dynamically evolving chemistry of sorbent surfaces. The interpretation can be even more complicated when multiple metal ions compete for sorption. In the present study, we observed synergistically enhanced uptake of lead and selenate on the barite (001) surface through two sorption mechanisms: lattice incorporation that dominates at lower coverages and two-dimensional monolayer growth that dominates at higher coverages. We also observed a systematic increase in the sorption affinity with increasing co-sorbed ion coverages, different from the assumption of invariant binding constants for individual adsorption processes in classical SCMs. Computational simulations showed thermodynamically favorable co-incorporation of lead and selenate by simultaneously substituting for barium and sulfate in neighboring sites, resulting in the formation of molecular clusters that locally match the net dimension of the substrate lattice. These results emphasize the importance of ion-ion interactions at mineral-water interfaces that control the fate and transport of contaminants in the environment.

No inflammatory effects after acute inhalation of barium sulfate particles in human volunteers.

BACKGROUND: Most threshold limit values are based on animal experiments. Often, the question remains whether these data reflect the situation in humans. As part of a series of investigations in our exposure lab, this study investigates whether the results on the inflammatory effects of particles that have been demonstrated in animal models can be confirmed in acute inhalation studies in humans. Such studies have not been conducted so far for barium sulfate particles (BaSO4), a substance with very low solubility and without known substance-specific toxicity. Previous inhalation studies with zinc oxide (ZnO), which has a substance-specific toxicity, have shown local and systemic inflammatory respones. The design of these human ZnO inhalation studies was adopted for BaSO4 to compare the effects of particles with known inflammatory activity and supposedly inert particles. For further comparison, in vitro investigations on inflammatory processes were carried out. METHODS: Sixteen healthy volunteers were exposed to filtered air and BaSO4 particles (4.0 mg/m3) for two hours including one hour of ergometric cycling at moderate workload. Effect parameters were clinical signs, body temperature, and inflammatory markers in blood and induced sputum. In addition, particle-induced in vitro-chemotaxis of BaSO4 was investigated with regard to mode of action and differences between in vivo and in vitro effects. RESULTS: No local or systemic clinical signs were observed after acute BaSO4 inhalation and, in contrast to our previous human exposure studies with ZnO, no elevated values of biomarkers of inflammation were measured after the challenge. The in vitro chemotaxis induced by BaSO4 particles was minimal and 15-fold lower compared to ZnO. CONCLUSION: The results of this study indicate that BaSO4 as a representative of granular biopersistent particles without specific toxicity does not induce inflammatory effects in humans after acute inhalation. Moreover, the in vitro data fit in with these in vivo results. Despite the careful and complex investigations, limitations must be admitted because the number of local effect parameters were limited and chronic toxicity could not be studied.

Radiation Effective Doses to Adults Undergoing Modified Barium Swallow Studies.

Modified Barium Swallow Studies (MBSSs) are important tests to aid the diagnosis of swallowing impairment and guide treatment planning. Since MBSSs use ionizing radiation, it is important to understand the radiation exposure associated with the exam. This study reports the average radiation dose in routine clinical MBSSs, to aid the evidence-based decision-making of clinical providers and patients. We examined the MBSSs of 200 consecutive adult patients undergoing clinically indicated exams and used kilovoltage (kV) and Kerma Area Product to calculate the effective dose. While 100% of patients underwent the exam in the lateral projection, 72% were imaged in the upper posterior-anterior (PA) projection and approximately 25% were imaged in the middle and lower PA projection. Average kVs were 63 kV, 77 kV, 78.3 kV, and 94.3 kV, for the lateral, upper, middle, and lower PA projections, respectively. The average effective dose per exam was 0.32 ± 0.23 mSv. These results categorize a typical adult MBSS as a low dose examination. This value serves as a general estimate for adults undergoing MBSSs and can be used to compare other sources of radiation (environmental and medical) to help clinicians and patients assess the risks of conducting an MBSS. The distinction of MBSS as a low dose exam will assuage most clinician's fears, allowing them to utilize this tool to gather clinically significant information about swallow function. However, as an X-ray exam that uses ionizing radiation, the principles of ALARA and radiation safety must still be applied.