Summary Despite numerous anecdotal reports of small clusters of cases of childhood leukaemia, formal statistical analyses have yielded equivocal results (Linet, 1985). Incidence data from the UK national children's tumour registry (CCRG) for 1968-1983 have recently become available for small area analyses by location at diagnosis (OPCS, 1991). Extensive analyses using a variety of methodologies have shown consistent, though weak, evidence of the occurrence of both spatial clustering and space-time interactions. Results from one of these analyses (Alexander, 1991) are now extended to test specific prior hypotheses generated by an independent case-control study (Alexander et. al., 1992). These suggested that transmission of a specific, though unknown, agent (Z) plays some role in the development of childhood acute lymphoblastic leukaemia (ALL) with the times when children are susceptible to infection differing by age-of-onset and hence subtype of ALL. For cases with older onset (aged 5 years and over) it was suggested that persistent infection may have been established in utero or early infancy and, now, formal testing of appropriate space-time interactions provide indirect confirmation of this (P=0.0002). More recent exposure to Z may contribute to ALL in the childhood peak years (Alexander et. al., 1992)

BackgroundThere is little reported on the efficacy and safety of direct oral anticoagulants (DOAC) in morbid obesity after venous thromboembolism (VTE).MethodsThis was an observational study of patients after intermediate- or high- risk pulmonary embolus (PE) who followed up in the University of Rochester Pulmonary Hypertension Clinic 2–4 months after the initial event with echocardiogram and V/Q imaging regardless of symptoms. Rates of recurrent VTE, thrombus resolution, and development of chronic thromboembolic pulmonary hypertension (CTEPH) in patients with morbid obesity treated with a DOAC compared to vitamin K antagonists and non-morbidly obese patient after PE. Using the electronic medical record, recurrent events were assessed out to 12 months.Results107 patients (32, BMI>40; 39, BMI 30–39.9; and 36, BMI<30) followed up after treatment for PE. A DOAC was used in 70 patients (19, BMI>40; 27, BMI 30–39.9; and 24, BMI<30). There were no recurrent events within the first 12 months of initial diagnosis based on symptoms and imaging in any patient. There was no difference in rate of residual unmatched perfusion defect with DOAC or conventional anticoagulation, 49% versus 49%. This finding remained in the subset of morbidly obese patients at 47% versus 50%. For the overall cohort, there was no difference in the rate of CTEPH development based on anticoagulation with DOAC having a rate of 5% (versus 8% with warfarin). There were no major bleeding complications with DOAC.ConclusionDOAC therapy appears to be effective and safe in morbid obesity even after intermediate- or high- risk PE. ​

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Unexplained clusters of childhood leukaemia have generated concern that they may be causally related to environmental exposure to ionising radiation. The workshop provides in-depth examination of the aetiology of childhood leukaemia, patterns of clustering exhibited by cases and the influence of exposure to ionising radiation. Special attention has been focussed on the EUROCLUS study of clustering of childhood leukaemia and monitoring of populations exposed to contamination following the Chernobyl accident. There is insufficient evidence to conclude that environmental ionising radiation exposure is a causative agent for small clusters such as that reported in the vicinity of the Krü mmel nuclear facility