Effects Of Low-dose Exposure Research Articles

Radiation dosage is related to changes in lymphocyte count, interleukin-6, and c-reactive protein levels during C-arm use in closed femoral nailing surgery

Introduction: Although the C-arm allows real-time image capture and intensification to allow accurate placement of implants and fixation devices with minimal incisions, these advantages have the disadvantage of the amount of radiation exposure to operating room personnel, especially surgical operators. The exposure mainly was low dose (<1 Sv). However, the effects of low-dose exposure may be accurate and should be considered seriously. Methods: This research was an observational prospective cohort study. A total of 30 residents who met the inclusion criteria had blood samples taken before and after femoral nailing surgery. Then, the blood sample underwent a complete blood count, IL-6, and CRP levels examination. During surgery, C-arm radiation will be measured using a personal dosimeter. The statistical tests used were descriptive statistics, proportion comparison analysis with the dependent t-test, and simple linear regression tests. Results: Univariate analysis using paired t-test proved changes in lymphocyte count, IL-6, and CRP levels of orthopedic residents before and after femoral nailing surgery with c-arm guiding with a statistically significant difference, based on p-values respectively: p=0.001; p=0.001; p=0.002. Simple linear regression test proved that radiation dosage of c-arm during operation is associated with a change in lymphocyte count, IL-6 and CRP levels before and after femoral nailing surgery with R squared values respectively: 0.474 (p=0.001), 0.694 (p=0.001) and 0.701 (p=0.001). Conclusion: Radiation dosage of c-arm during femoral nailing surgery is related to changes in lymphocyte count, interleukin-6, and c-reactive protein levels among orthopedics and traumatology residents.

Deeper insights into the effects of low dietary levels of polychlorinated biphenyls on pig metabolism using gas chromatography-high resolution mass spectrometry metabolomics

Polychlorinated biphenyls (PCBs) are a class of contaminants of great concern, linked to the development of many chronic diseases. Adverse effects of PCBs have been documented in humans after accidental and massive exposure. However, little is known about the effect of chronic exposure to low-dose PCB mixtures, and studies regarding scattered lifetime exposures to non-dioxin-like (NDL)-PCBs are especially missing. In this work, serum samples from pigs chronically exposed through their diet during 22 days to Aroclor 1260 (i.e. a commercially available mixture of NDL-PCBs) underwent a metabolomics analysis using gas chromatography-high resolution mass spectrometry (GC-HRMS), with the objective to investigate the effect of exposure to low doses of NDL-PCBs (few ng/kg body weight (b.w.) per day). The study showed that the serum profiles of 84 metabolites are significantly altered by the administration of Aroclor 1260, of which 40 could be identified at level 1. The aggregate interpretation of the results of this study, together with the outcome of a previous one involving LC-HRMS profiling, provided a substantial and concise overview of the effect of low dose exposure to NDL-PCBs, reflecting the hepatotoxic and neurotoxic effects already reported in literature at higher and longer exposures. These results are intended to contribute to the debate on the current toxicological reference values for these substances.

Removal of pesticides from fresh-cut Chinese cabbage (Brassica rapa var. chinensis L.) by sequential multi-frequency ultrasound cleaning treatments

Pesticides may remain on the surface of fresh produce due to inappropriate and inadequate cleaning. In view of the public health significance of pesticide residues in fresh produce and the long-term effects of low dose exposure of these pesticides, decontamination procedures are needed for ready-to-eat foods, especially vegetables. Ultrasound cleaning is considered to be an effective environmentally-friendly decontamination process which is unique in its ability to remove pesticides compared to other conventional methods. The reduction of dimethoate and diazinon residues from fresh Chinese cabbage by sequential multi-frequency ultrasound cleaning treatments was investigated in this study to ascertain the levels of reduction after cleaning. The ultrasonic treatment has higher efficiency on the removal of these organophosphorus pesticides compared to ordinary water cleaning. The removal rates of ultrasonic cleaning treatments for dimethoate and diazinon residues were in the range of 20.10–72.42% and 29.60–77.37% compared to the ordinary water cleaning with 13.24–19.89% and 17.32–24.16% respectively. In addition, quality parameters for the leaves treated were also assessed. The physical impairment and vitamin C loss increased with the increase in ultrasonic frequency combination and cleaning time. Application of triple frequency ultrasound and extended washing time resulted in high dimethoate (>70%) and diazinon reduction (>75%) alongside slight perceptible darkening in colour of the leaves. The use of multi-frequency ultrasound in sequential mode is an effective technique for the removal of pesticide residues from leafy vegetables. However, ultrasonic operating conditions should be considered to maintain product quality.

Developmental exposure to thyroid disruptors: misprogramming of the brain's stem cells in later life?

Developmental exposure to thyroid disruptors: misprogramming of the brain's stem cells in later life?

Impact of medical imaging on the epigenome – low-dose exposure in the course of computed tomography does not induce detectable changes of DNA-methylation profiles in peripheral blood cells

Background Computed tomography (CT) is a main contributor to artificial low-dose exposure. Understanding the biological effects induced by CT exposure and their dependency on the characteristics of photon spectra is essential for knowledge-driven risk assessment. In a previous gene expression study, we have identified upregulation of AEN, BAX, DDB2, EDA2R and FDXR after ex vivo exposure with single-energy CT and dual-energy CT (DECT). In this study, we focused on CT-induced changes of DNA methylation. This epigenetic modification of DNA is a central regulator of gene expression and instrumental in preserving genome integrity. Previous studies reported focal hypermethylation and global hypomethylation after exposure with doses above 100 mSv, however, the effect of low dose exposure on DNA methylation is hardly explored. Materials and methods DNA was isolated from peripheral blood of three healthy individuals 6 h after ex vivo exposition to single-energy (80 kV and 150 kV) and DECT (80 kV/Sn150 kV) with a calculated effective dose of 7.0 ± 0.08 mSv. The experimental setting was identical to the one used in our previous gene expression study enabling a direct comparison of gene expression results with changes of DNA methylation identified in this study. DNA methylation was analyzed by high-throughput sequencing of bisulfite-treated DNA targeted methylation sequencing. Results Unsupervised hierarchical clustering based on DNA methylation profiles of all samples created three distinct clusters. Formation of these three clusters was solely determined by the origin of samples, indicating the absence of prominent irradiation-associated changes of DNA methylation. In line with this observation, inter-individual comparison of non-irradiated samples revealed 1163, 1224 and 4550 significant differentially methylated regions (DMRs), respectively, whereas the pairwise comparison of irradiated and non-irradiated samples failed to identify irradiation-induced DMRs in any of the three probands. This even applied to the genomic regions harboring AEN, BAX, DDB2, EDA2R and FDXR, the five genes known to be upregulated by CT exposure. Conclusions CT exposure with various photon spectra did not result in detectable changes of DNA methylation. However, minor effects in a subpopulation of irradiated cells cannot be ruled out. Thus, future studies with extended observation intervals are needed to investigate DNA methylation changes that are induced by indirect effects at later points of time or become detectable by clonal expansion of affected cells. Moreover, our data suggest that DNA methylation analysis is less sensitive in detecting immediate effects of low-dose irradiation when compared to gene expression analysis.

Oral deoxynivalenol toxicity in Harlan Sprague Dawley (Hsd:Sprague Dawley® SD®) rat dams and their offspring

There is widespread human exposure to deoxynivalenol (DON), a fungal mycotoxin found globally in many grain-based foods and animal feed. Acute exposures to high levels of DON are associated with gastrointestinal effects and emesis in humans and some animals, but the effects of low-dose exposures throughout the lifetime, a more likely exposure scenario in humans, are understudied. Therefore, this study was designed to identify doses of DON that could be used to evaluate long-term toxicity following perinatal exposure. Time-mated Harlan Sprague Dawley (Hsd:Sprague Dawley® SD®) rats were administered 0, 0.03, 0.1, 0.3, 1, or 3 mg/kg/day of DON once daily via gavage starting on gestational day 6 through postnatal day (PND) 27. F1 animals were administered the same dose as their respective dams via gavage starting on PND 12 until PND 27. Animals were euthanized on PND 28. DON had no effect on maternal body weight or feed consumption at any dose. Findings were limited to the 3 mg/kg/day group: F0 females had smaller live litter sizes than controls and F1 pups had lower body weight (4–13%) compared to controls. By PND 28, F1 body weight, after adjustments for litter effects, was 10–13% lower than controls. Blood samples obtained on PND 28 showed no increases in frequencies of micronucleated immature erythrocytes in either F0 or F1 animals. In summary, doses of DON up to 3 mg/kg/day did not affect maternal survival or body weight. Doses of 3 mg/kg/day resulted in slight toxicity manifested as decreased body weight in the offspring. The no-observed effect level was 1 mg/kg/day.

Toxicity, gut microbiota and metabolome effects after copper exposure during early life in SD rats

Copper, an essential microelement, can still be harmful to health and has a significant impact on the gut microbiota, which is closely related to health when copper is ingested excessively. However, the effects of low dose exposure to copper early in life on health and the gut microbiota are not well understood. Here, the effects of early-life exposure of copper on the toxicity, gut microbiota and the metabolome were investigated in Sprague-Dawley (SD) rats. The results showed that 0.20 and 1.00 mg/kg BW copper early-life exposure in SD rats significantly increased ALT, AST, and ALP levels in the blood and caused liver damage. Copper exposure had a dose-dependent effect on the alpha and beta diversity and reduced the abundance of probiotics, the ratio of Firmicutes to Bacteroidetes (F/B), and changed the abundance of fat metabolism and intestinal inflammation-related bacteria. The results of the fecal metabolome also demonstrated the effects of early-life copper exposure on liver damage and intestinal inflammation-related metabolic pathways. Together, our findings demonstrated that copper exposure during early life induced liver damage and gut microbiota dysbiosis and affected the relevant metabolic pathways.

THE ABILITY OF CYTOGENETIC ANALYSIS TO ESTIMATE RADIATION DOSES RETROSPECTIVELY IN CHERNOBYL ACCIDENT RECOVERY WORKER

Relevance. There is a need to evaluate doses retrospectively in Chernobyl nuclear power plant accident recovery workers without established external doses.Intention: To assess the ability of cytogenetic analysis to estimate external radiation doses retrospectively in Chernobyl nuclear power plant accident recovery workers exposed to low-dose radiation in the remote period.Methodology. Cytogenetic biological indication and biological dosimetry were performed in Chernobyl nuclear power plant accident recovery workers 27–30 years after their participation in recovery works. Stable and unstable chromosome aberrations were assessed in peripheral blood lymphocytes.Results and Discussion. The analysis of unstable chromosome aberrations showed that 45.1 % of Chernobyl nuclear power plant accident recovery workers had radiation markers more frequently than in the comparison group. Biological doses were retrospectively evaluated in 18 % of Chernobyl nuclear power plant accident recovery workers and ranged within 14–48 cGy. Specific anamnestic factors should be assessed while evaluating doses retrospectively.Conclusion. Analysis of stable chromosome aberrations allows retrospective dosimetry after low-dose exp sure if external dose is unavailable. Based on this, adverse health effects of low-dose exposure can be assessed and reimbursed in Chernobyl nuclear power plant accident recovery workers.

Toxicity assessment due to prenatal and lactational exposure to lead, cadmium and mercury mixtures

The heavy metals lead (Pb), cadmium (Cd) and mercury (Hg) are common environmental pollutants that can be detected simultaneously in blood, serum, and urine samples from the general human population. However, there is limited information regarding toxicity of low-level exposure to Pb, Cd, and Hg mixtures. Our previous research showed the interaction of these three elements at low concentrations in vitro. In this study, we further evaluate early effects of low dose exposure to Pb, Cd, and Hg mixtures on the brain, heart, liver, kidney, and testicle in rats. Pregnant rats were exposed to various concentrations of heavy metal mixtures (MM) in drinking water, during gestation and lactation, and the impacts on offspring were measured at postnatal day 23. Our results showed that the concentrations of Pb, Cd, and Hg in the blood of rat pups were similar to those in the blood of the general human population. Additionally, the MM concentrations in their blood and brain significantly increased in a dose-dependent manner. MM exposure caused histopathological changes in the brain, liver, kidney and testicle. Statistically significant increases in liver CYP450 and PON1, kidney KIM1, and decrease in testicle SDH were observed. In the brain, significant increases were detected in oxidative stress, intracellular free calcium, and cell apoptosis. Further neurobehavioral testing revealed that MM exposure caused dose-dependent impairments in learning and memory as well as sensory perception. MM exposure also disrupted synapse remodeling, which may be associated with pathways involved in dendritic spine growth, maintenance, and elimination. These results suggested that exposure to Pb, Cd, and Hg mixtures, at human environmental exposure related levels, caused damage to multiple organs as well as impairments in neurobehavioral functions of rats. Our findings emphasize the need to control and regulate potential sources of heavy metal contamination.

Low concentrations of perfluorooctane sulfonate repress osteogenic and enhance adipogenic differentiation of human mesenchymal stem cells

Humans are exposed to perfluorooctane sulfonate (PFOS) from sources of both continuing discharges and environmental legacies, and the health effects of low dose exposure remain unknown. We assessed the effects of PFOS at 0.2–200 nmol/L on osteogenic and adipogenic differentiation of human bone marrow-derived mesenchymal stem cells (hBMSCs). PFOS affected hBMSCs differentiation in a nonmonotonic dose-response relationship, where the effects peaked at 100 nmol/L. PFOS repressed calcium deposition on day 14 of osteogenic differentiation. The molecular osteogenic biomarkers, osteopontin, osteonectin and osteocalcin, and the transcription factor β-catenin, were also decreased on differentiation day 7. In hBMSCs co-treated by PFOS and WNT signaling agonist, LiCl, the osteogenic marker levels were higher than those treated by PFOS alone. Moreover, the osteogenic effect of PFOS was repressed by DKK1, the WNT signaling antagonist. PFOS additionally supported the receptor activator of nuclear factor κB ligand/osteoprotegerin ratio. In contrast, PFOS enhanced adipogenesis in regard to lipid droplet formation and marker gene expression of PPARγ, CCAAT/enhancer-binding protein-α (C/EBPα), lipoprotein lipase and leptin. Microarray analysis identified 597 differentially expressed genes at p < .05 and log2 (fold change) > 0.3. These results demonstrated that PFOS repressed osteogenesis and enhanced adipogenesis, which could well explain the homeostatic imbalance seen in human bone associated with exposure to PFOS.

The Case for BPA as an Obesogen: Contributors to the Controversy.

Since the inception of the term endocrine disruptor, the idea that the environment is an important determinant of phenotype has motivated researchers to explore the effect of low dose exposure to BPA during organogenesis. The syndrome observed was complex, affecting various endpoints such as reproduction and reproductive tissues, behavior, mammary gland development and carcinogenesis, glucose homeostasis, and obesity. This constellation of impacted endpoints suggests the possibility of complex interactions among the multiple effects of early BPA exposure. One key finding of our rodent studies was alterations of energy and amino-acid metabolism that were detected soon after birth and continued to be present at all time points examined through 6 months of age. The classical manifestations of obesity and associated elements of metabolic disease took a longer time to become apparent. Here we examine the validity of the often-mentioned lack of reproducibility of obesogenic effects of BPA, starting from the known environmental causes of variation, which are diverse and range from the theoretical like the individuation process and the non-monotonicity of the dose-response curve, to the very pragmatic like housing, feed, and time and route of exposure. We then explore environmental conditions that may hinder reproducibility and discuss the effect of confounding factors such as BPA-induced hyperactivity. In spite of all the potential sources of variation, we find that some obesogenic or metabolic effects of BPA are reproducibly observed when study conditions are analogous. We recommend that study authors describe details of their study conditions including the environment, husbandry, and feed. Finally, we show that when experimental conditions are strictly maintained, reproducibility, and stability of the obese phenotype is consistently observed.

Проблема оценки последствий воздействия низкой дозы облучения

Проблема оценки последствий воздействия низкой дозы облучения

SR-TXRF analysis of trace elements in whole blood and heart of rats: effects of irradiation with low and high doses

In the last decades, studies showed that the exposure to low doses of ionizing radiation of the body could sense and activate the cell signaling pathways needed to respond to any induced cellular damage. This procedure reduces cell killing compared with a single dose of high radiation dose. Damage to the vasculature can affect the function of most body organs by restricting blood flow and oxygen to tissues; however, the heart and brain are of main concern. The precise relationship between long-term health effects and low-dose exposures remain poorly understood. Biological markers are powerful tools that can be used to determine dose- response relationships and to estimate risk, especially when dealing with, the effects of low dose exposures in humans. These markers should be specific, sensitive, as well as easy and fast to quantify. Various types of biologic specimens are potential candidates for identifying biomarkers but blood has the advantage of being minimally invasive to obtain. In this study, we propose to apply total reflection X-ray fluorescence to quantify possible chemical elemental concentration (sulfer, iron, zinc, potassium and calcium) changes in blood and heart tissues of Wistar rats after total body irradiation with low (0.1 Gy) and high (2.5 Gy) doses. The fluorescence measurements were carried out at the X-ray Fluorescence beamline in the Brazilian Synchrotron Light Laboratory. The results showed that the irradiated animals with low doses have significant alterations in blood and cardiac tissue when compared with animals that received high doses of radiation. Taken together the analysis of all the elements, we can observe that the radiation induced oxidative stress may be the leading cause for alteration of the elemental level in the studied samples.

Adverse effects of low dose exposures to cadmium below renal damage level should be emphasized for human health effect studies

Currently, the pollution of heavy metal, including lead, cadmium (Cd) and mercury, was one of the major environmental problems in China. Cd could cause adverse effects on kidney, bone, lung and reproductive system. Most of the past researches focused on renal damage effect, and some evidences suggestedadverse effects on bone, tumor, cardiovascular diseases, diabetes and mineral elements, etc, which was occurred at low dose exposures to Cd below renal damage level. An important content of human health effect Studies on exposures to Cd is to follow up the development and consequences of adverse effects after long-term exposure to environmental Cd and then reduction or cessation of its exposure among this population. In this paper, the progress and development trend of long-term environmental exposure to Cd and its health damage effect were reviewed.

Early-Life Organophosphate Insecticide Exposure And Visual Acuity In Infants

Introduction: Organophosphate insecticides (OPs) are neurotoxic at high doses, however effects of low dose exposure are not well understood. Laboratory studies have shown that OPs at low doses may inhibit neuronal myelination, a process critical to visual pathway development early in life. Grating visual acuity (VA) rapidly improves in infancy, reflecting visual pathway myelination. VA might thus be sensitive to OP exposure. The aim here was to investigate the effect of prenatal OP exposure on infant VA. Methods: 24 OPs and 6 OP metabolites were measured using GC-tandem MS in umbilical cord blood plasma from infants in Fuyang County, China. VA was measured using Teller Acuity Cards at 6 wk (N=300), 9 mo (N=291), and 18 mo (N=288). Composite variables were created for total OP detects and total OP metabolite detects. Individual OPs and metabolites were analyzed as dichotomous (non-detect [ND]/detect), 3-level ordinal (ND/medium/high), or continuous, depending on detection rates. Multivariate linear regression was used to evaluate relationships between OP variables and VA. Results: 16 OPs and 6 metabolites were detected in at least one sample. Analyses of composite and dichotomous OP variables did not yield significant associations with VA. Chlorpyrifos, methamidophos, and trichlorfon were detected in 40, 66, and 56% of samples, respectively, and analyses as 3-level ordinal variables revealed suggestive, but not statistically significant, inverse associations between chlorpyrifos and trichlorfon and VA at 9 and 18 mo. Naled was detected in 94% of samples and continuous analyses found inverse associations with VA at 6 wk (β=-0.01; 95%CI:-0.02--0.001; p=0.03). Conclusions: VA in infancy may be adversely affected by certain OPs, though our results are largely inconclusive. Visual system development in infancy is critical to later learning processes and altered timing of visual pathway maturation may potentially contribute to poorer developmental outcomes later on.

The effects of pH on the migration of melamine from children’s bowls

Contamination of pet foods and infant formula with high levels of melamine has resulted in a number of cases of illness and deaths among pets and children; however, the long-term effects of low dose exposures is poorly understood. Exposure to melamine from the consumption of foods using melamine-based tableware has been identified as a potential source of concern due to the role that melamine may play in human kidney disease, especially among children. In this study, the migration of melamine into solutions of varying pH was characterized in order to better understand the migration risk associated with foods of different chemical characteristics. Two brands of bowls marketed toward children’s use were tested in pH 3.0, 5.0, 7.0, 9.0, and 11.0 solutions at 95 °C over a series of ten 30 min exposures runs. Melamine migration was significantly greater in the pH 3.0 solution than others and migration was significantly different between the two brands. Migration dropped substantially after the initial run and reached consistent values by the fifth run. Despite the potential for long term melamine exposure to contribute to human disease, melamine based products are widely available. Exposures to foods cooked in bowls of this type would be less than Tolerable Daily Intake (TDI) levels; however, gaps in the understanding of chronic exposure to melamine may warrant caution among consumers, especially parents of young children. Currently, labeling requirements are inadequate to inform consumers of the potential for exposure to melamine.

Studies of Health Effects from Nuclear Testing near the Semipalatinsk Nuclear Test Site, Kazakhstan.

The nuclear bomb testing conducted at the Semipalatinsk nuclear test site in Kazakhstan is of great importance for today’s radiation protection research, particularly in the area of low dose exposures. This type of radiation is of particular interest due to the lack of research in this field and how it impacts population health. In order to understand the possible health effects of nuclear bomb testing, it is important to determine what studies have been conducted on the effects of low dose exposure and dosimetry, and evaluate new epidemiologic data and biological material collected from populations living in proximity to the test site. With time, new epidemiological data has been made available, and it is possible that these data may be linked to biological samples. Next to linking existing and newly available data to examine health effects, the existing dosimetry system needs to be expanded and further developed to include residential areas, which have not yet been taken into account. The aim of this paper is to provide an overview of previous studies evaluating the health effects of nuclear testing, including some information on dosimetry efforts, and pointing out directions for future epidemiologic studies.

On the estimation of radiation-induced cancer risks from very low doses of radiation and how to communicate these risks.

The article is intended to give a short overview of epidemiological data on cancer risks associated with very low absorbed doses of ionising radiation. The linear no-threshold (LNT) approach to estimate cancer risks involves the use of epidemiological data at higher doses (>100 mSv), but is supported by data from lower exposure of more sensitive population groups like fetuses and children and the presence of rare types of cancer. The International Commission on Radiological Protection (ICRP) concludes that the LNT model, combined with a dose and dose-rate effectiveness (reduction) factor (DDREF) of 2 for extrapolation from high doses, should be used. The numerical value of the DDREF is challenged by the findings from some recent epidemiological studies demonstrating risks per unit dose compatible with the risks observed in the higher dose studies. In general there is very limited knowledge about the cancer risk after low absorbed doses (10-100 mSv), as most of epidemiological studies have limitations in detecting small excess risks arising from low doses of radiation against fluctuations in the influence of background risk factors. Even if there may be significant deviations from linearity in the relevant dose range 0-100 mSv, one does not know the magnitude or even the direction of any such deviations. The risks could be lower than those predicted by a linear extrapolation, but they could also be higher. Until more results concerning the effects of low-dose exposure are available, a reasonable radiation protection approach is to consider the risk proportional to the dose.

0194 Circulatory system disease mortality among French uranium miners

ObjectivesThere is currently no consensus for an association between risk of Circulatory System Diseases (CSD) and low exposure to ionising radiation. The aim is to study the relationship between CSD...

Deoxyribonucleic acid damage-associated biomarkers of ionising radiation: current status and future relevance for radiology and radiotherapy

Diagnostic and therapeutic radiation technology has developed dramatically in recent years, and its use has increased significantly, bringing clinical benefit. The use of diagnostic radiology has become widespread in modern society, particularly in paediatrics where the clinical benefit needs to be balanced with the risk of leukaemia and brain cancer increasing after exposure to low doses of radiation. With improving long-term survival rates of radiotherapy patients and the ever-increasing use of diagnostic and interventional radiology procedures, concern has risen over the long-term risks and side effects from such treatments. Biomarker development in radiology and radiotherapy has progressed significantly in recent years to investigate the effects of such use and optimise treatment. Recent biomarker development has focused on improving the limitations of established techniques by the use of automation, increasing sensitivity and developing novel biomarkers capable of quicker results. The effect of low-dose exposure (0-100 mGy) used in radiology, which is increasingly linked to cancer incidences, is being investigated, as some recent research challenges the linear-no-threshold model. Radiotherapy biomarkers are focused on identifying radiosensitive patients, determining the treatment-associated risk and allowing for a tailored and more successful treatment of cancer patients. For biomarkers in any of these areas to be successfully developed, stringent criteria must be applied in techniques and analysis of data to reduce variation among reports and allow data sets to be accurately compared. Newly developed biomarkers can then be used in combination with the established techniques to better understand and quantify the individual biological response to exposures associated with radiology tests and to personalise treatment plans for patients.