Reference Level Research Articles

Paleo-ecological quality status induced by natural and anthropogenic impacts in the last 2000 years: a multidisciplinary approach in the outer region of Sepetiba Bay (SE Brazil)

Abstract Purpose Some marine organisms can be used as Biological Quality Elements to estimate the degree of environmental impact and to monitor the health of benthic habitats. Organisms with mineralized protections, such as benthic foraminifera, can provide helpful information on the evolution of the coastal system over a long period and determine the Paleo-Ecological Quality Status (Paleo-EcoQS). This work aims at reconstructing the Paleo-EcoQS in the heavily anthropized Sepetiba Bay (SB; Rio de Janeiro State, SE Brazil). Materials and methods This work is based on a multiproxy approach, including textural, geochemical, and foraminiferal data along the core SP11 retrieved near the Pico da Marambaia (a mountain on the tip of the Marambaia Barrier Island). Geochemical analyses encompassing total organic carbon (TOC), total sulfur (S), total nitrogen (N), calcium carbonate (CaCO3), stable isotopes in organic matter (OMδ13C, and OMδ15N) and elemental concentrations as well as 201Pb, 137Cs, and radiocarbon dating were performed to characterize the Paleo-EcoQS in the bay. Results The values of the Paleo-EcoQS.st (standardized Paleo-EcoQS) index in core SP11 indicate that the paleoenvironmental quality varied from moderate to good between ≈50 AD and ≈1500 AD and from good to high between the ~ 1920s and ~ 1990s. Since the 1990s, the Paleo-EcoQS.st has deteriorated considerably, probably due to the deposition of contaminated dredging material in nearby areas. Ballast water discharge may have introduced alien species, such as Ammonia buzasi, into the SB. Conclusions The results obtained in core SP11, compared to those of another core (i.e., SP8) from a nearby area, suggest that the reference level of maximum environmental quality is not always reached in a period before industrialization in coastal ecosystems with significant interaction with the ocean; natural factors, related, for example, to sedimentary dynamic processes or geomorphological changes, can lead to unexpected results.

Clinical diagnostic reference levels and image quality metrics for CT in oncology patients

Background: In CT, the volumetric CT dose index (CTDIvol), dose-length product (DLP) and patient’s size-specific dose estimates (SSDE) are used as diagnostic reference level (DRL) metrics.Objectives: To develop clinical local DRL values for CT chest-abdomen-pelvis (CAP) examinations using the CTDIvol, DLP and SSDE, and to determine the image quality achieved.Method: In total, 201 cancer patients were included in the study. The scanning parameters, dose metrics from the CT unit and participants’ body mass index (BMI) were documented. The local CT DRL values for CAP examinations were defined as the median and 75th percentiles of the dose distribution.Results: The local DRL values given in terms of median CTDIvol ranged between 8.4 mGy and 12.7 mGy for the different types of cancers. The median DLPs ranged from 848 to 1173.4 mGy.cm for the various cancers. Generally, the radiation dose was directly proportional to the BMI and number of scan phases. Significant differences were observed between the DRLs for the various size-related parameters, number of scan phases and BMI classifications. The image quality was clinically satisfactory.Conclusion: No baseline data for clinical DRL values were available for this medical oncology department. The achieved DRLs were similar to published size-specific DRLs. The image quality was maintained during CT imaging. Dose optimisation and image quality assessment should be implemented to ensure optimal scanning parameters for different cancers in CT CAP examinations.Contribution: The first size-specific local DRL values for CT CAP investigations carried out on oncology patients in South Africa have been established.

Assessment of Mortality Attributable to Air Pollution in the Urban Area of Pisa (Central Italy) Characterized by Multi-Source Exposures

Air pollution is one of the main risk factors for human health. The aim of this study was to provide an Integrated Environmental and Health Impact Assessment (IEHIA) tool to estimate the impacts on both environment and human health in Pisa municipality (central Italy). For each pollutant considered (PM2.5, PM10, and NO2), both Population-Weighted Exposure (PWE) and Attributable Deaths (ADs) were calculated considering the difference between the PWE and the latest air quality guidelines suggested by the World Health Organization. The PWEs were 16.1 µg/m3, 24.9 µg/m3, and 25.9 µg/m3 for PM2.5, PM10, and NO2, respectively. The ADs from natural causes due to exposure to PM2.5, PM10, and NO2 were 63, 29, and 51, respectively. The AD distribution was mainly concentrated in urban areas for particulate matter and in urban and suburban areas for NO2. The results highlighted significantly higher levels of air pollution than the reference levels, with a percentage of ADs from natural causes of approximately 6% of the total mortality in Pisa. IEHIA offers support for environmental and health policies and territorial planning. The authors recommend the adoption of prevention measures aimed at mitigating air pollution in critical areas, with a consequent reduction in avoidable mortality.

The change of paradigm: high HDL-c levels could not mean a long lifespan

Abstract Background It is known that a low HDL-c level is associated with a high risk of overall mortality. Consequently, it was presumed that achieving higher levels of high-density lipoprotein cholesterol (HDL-c) would reduce the risk or even extend the lifespan. However, clinical trials with medical intervention failed to find clinical benefits. Aim We aimed to investigate the association between (HDL-c) levels and overall mortality using a prospective cohort from Portugal. Methods A prospective sub-study (2001-2022) was performed in a cohort of 1718 participants without coronary artery disease (CAD) of the control arm of the ongoing GENEMACOR study. The participants <65 years were followed during a mean follow-up of 7.0±5.7 years. All demographic, biochemical, and clinical data were collected. Participants were stratified into six levels of HDL-c. Kaplan-Meier estimated differences in the survival probability of each HDL-c level. Cox proportional analysis models (unadjusted and adjusted) were used to assess the association between HDL-c levels and overall mortality. Results The HDL-c levels with the lowest overall mortality rate were 60 to 70 mg/dl, set as the reference level. Total HDL-c strata were associated with overall mortality with a U-shaped relationship: in the control group, the first level (<40 mg/dl) was independently associated with increased risk of overall mortality (HR of 3.533; 95% CI: 1.738-7.178; p<0.0001). This risk drops and falls to the reference level (the lower risk) and rises again to an HR of 3.875 (95% CI: 1.472-10.201; p=0.006) in the very high HDL-c levels (≥80 mg/dl). Conclusions Our results, based on a large Portuguese cohort, suggest that very high HDL-c levels in the normal population may not represent a good prognosis, especially in women. Future research may confirm these findings and investigate the underlying mechanisms.

Radiation exposure of patients undergoing multiple-slice CT scans in Romania

Abstract Ionizing radiation is largely used in medicine due to its role in the diagnosis and treatment of patients. In the past 50 years computed tomography (CT) has become indispensable for medical practice because it offers sub-millimeter cross-sectional imaging of any region of the body. New CT scanners use thinner slices, providing more accurate results, but also an increased radiation exposure with possible long-term harmful effects for the patients. The parameter used as an indicator of radiation dose in CT is the dose-length product (DLP). The study included 4507 patients who were CT scanned using a 16, 32, 64 or 128-slice CT machine. DLP was measured for head, sinuses, thorax, abdomen, pelvis, abdomen+pelvis, and trunk scans - regions for which the health authorities have established national diagnostic reference levels (DRL - the expected radiation dose received by a patient in CT). One-way ANOVA was used to analyse data considering the use of contrast agents, the gender, age, and weight of patients. Average DLP values were higher (up to 80%) than national DRL for all regions in 64 and 128-slice scans. The highest DLP values were registered in contrast CT for all scanners (p < 0.01); the maximum average (a threefold increase compared to DRL) was measured in the 32-slice sinuses contrast CT. Average DLP correlated with patients’ gender and weight (p < 0.01), but the influence was lower compared to the use of contrast agents. In conclusion, CT scans acquired using thinner slices lead to more accurate results and high-quality images, but the study suggests an increased radiation exposure. CT has an uncontestable contribution to a precise and rapid diagnosis, but more attention must be given to the stochastic effects risks associated with the radiation dose received during a CT scan. Are all scans necessary? Do all patients really need to receive high doses? The role of the practitioner is decisive, and the justifiable process is “a must” in all radiodiagnosis practices. Key messages • CT doses must be kept “as low as reasonably achievable” while maintaining diagnostic image quality. • Justification, dose limitation, and optimisation are fundamental principles of radioprotection.

Status of Horizontal Violence, Level of Psychological Empowerment, and Their Correlation Among Obstetric Nurses: A Cross-Sectional Survey.

China's maternity policy has led to an increase in work pressure, which has prompted horizontal violence among obstetric nurses. To understand this phenomenon better, we attempted to identify the factors that influence horizontal violence as well as the level of psychological empowerment among obstetric nurses. This cross-sectional survey was conducted among 522 obstetric nurses from December 2022 to February 2023. The findings revealed that 40.42% (211) of the obstetric nurses had experienced horizontal violence in the past 3 months. The overall level of psychological empowerment of obstetric nurses was relatively low. Regression analysis indicated that being a formal worker, being from the area where one serves, the meaning attributed to work, and perceptions of autonomy, self-efficacy, and work impact acted as protective factors against the risk of horizontal violence among obstetric nurses. When compared with the 20-29-year-old age group, those in the 30-39-year-old age group showed a lower risk of experiencing horizontal violence (odds ratio [OR] = 0.369, p < 0.01). Compared with nurses who had worked in obstetrics for < 3 years, those who had worked for 3-5, 6-10, 11-20, and > 20 years showed lower risks of experiencing horizontal violence than the reference level (OR = 0.234, p < 0.05; OR = 0.182, p < 0.05; OR = 0.105, p < 0.05; and OR = 0.056, p < 0.05, respectively). The incidence of horizontal violence among obstetric nurses is high, and the overall level of psychological empowerment is low. Nursing managers can alleviate the occurrence of horizontal violence by augmenting the psychological empowerment level of obstetric nurses.

Establishing Local Diagnostic Reference Levels for Head Computed Tomography Examinations

Background/Objectives: Head Computed Tomography (CT) is an essential diagnostic tool for identifying brain pathologies and visualizing blood vessels. However, CT exposes patients to ionizing radiation, making it necessary to establish local diagnostic reference levels (DRLs) to ensure patient safety. This study aimed to establish DRLs for head CT scans and assess the influence of patient characteristics on radiation dose. Methods: A retrospective analysis was conducted on 2043 non-contrast and 488 contrast-enhanced head CT scans performed between 1 July 2023 and 31 March 2024 using a SIEMENS SOMATOM Definition Edge machine. Computed Tomography Dose Index (CTDIvol) and Dose-Length Product (DLP) values were analyzed, with DRLs set at the 75th percentile. The influence of gender, height, and weight on radiation dose was also evaluated. Results: The DRL for both non-contrast and contrast-enhanced scans was 58.18 mGy for CTDIvol and 1018.11 mGy·cm for DLP per acquisition. Total DLP was 2046.09 mGy·cm for contrast-enhanced and 1027.99 mGy·cm for non-contrast scans. No significant correlation was found between patient characteristics and radiation dose, allowing for a uniform DRL to be established. Conclusions: Uniform DRLs were successfully established for head CT scans, ensuring safe radiation doses for both non-contrast and contrast-enhanced studies. The lack of correlation between patient-specific factors and dose supports the use of standardized DRLs, contributing to optimized radiation safety in head CT diagnostics.

Graded association of muscle strength with all-cause and cause-specific mortality in older adults with diabetes: Prospective cohort study across 28 countries.

The worldwide prevalence of diabetes is increasing, particularly among older adults. Understanding the association between muscle strength and mortality in this population is crucial for developing targeted exercise recommendations. To assess the prospective association of muscle strength with mortality in older adults with diabetes. From the Survey of Health, Ageing and Retirement in Europe (SHARE) study, spanning 28 countries, we included 16 149 diabetic adults aged 50 years and older (mean age 68.2 [standard deviation, SD, 9.2] years). Participants fulfilled two criteria: (1) diabetes diagnosis (ever) and (2) current use of diabetes medication. Muscle strength was assessed using handgrip dynamometry (unit: kg). Using time-varying Cox regression with restricted cubic splines, we determined the prospective association of muscle strength with all-cause and cause-specific mortality, controlling for various confounders. Over a mean follow-up of 5.9 years (SD 3.8), 2754 participants died (17%). Using the median level of muscle strength as reference (30 kg), lower and higher levels were associated in a curvilinear fashion with higher and lower all-cause mortality risk, respectively. The 10th percentile of muscle strength (17 kg) showed a hazard ratio (HR) of 1.65 (95% confidence interval (CI) 1.53-1.79). The 90th percentile (47 kg) of muscle strength showed a HR of 0.55 (95% CI 0.49-0.63). A somewhat similar pattern, with varying strength of associations, was seen for mortality due to cardiovascular disease (CVD), respiratory disease, severe infectious disease, digestive system disease and cancer. Muscle strength is gradually and inversely associated with all-cause and cause-specific mortality risk in older adults with diabetes. As muscle strength is highly adaptable to resistance training at all ages, the present findings highlight the importance of improving muscle strength in older adults with diabetes.

Risk Stratification for Chronic Kidney Disease After Liver Transplant for Metabolic Dysfunction-associated Steatohepatitis (MASH) Cirrhosis: Results From the NailMASH Consortium.

Chronic kidney disease (CKD) is a well-recognized complication in patients undergoing liver transplantation (LT), particularly those with metabolic dysfunction-associated steatohepatitis (MASH), a leading cause of cirrhosis in the modern era. This study sought to refine risk stratification for CKD events post-LT in cirrhosis patients with MASH by leveraging baseline renal function at transplant. A total of 717 MASH cirrhosis patients who had LT (1997-2017) at 7 US centers (NailMASH Consortium) were analyzed. Patients were categorized by estimated glomerular filtration rate (eGFR) at transplant: low (LGFR, eGFR ≤30 mL/min/1.73 m²), medium (MGFR, eGFR >30-≤60 mL/min/1.73 m²), and high (HGFR, eGFR >60 mL/min/1.73 m²). Time-related eGFR intercepts, slopes, and assessments of advanced-stage CKD (aCKD) events, defined as 2 eGFR levels <30 mL/min/1.73 m² separated by ≥90 d, were examined. Post-LT, LGFR group showed increased eGFR, whereas the HGFR group experienced a decline. The 3-mo mark was identified as a "reset point," signifying a new reference level, beyond which a different rate of decline was observed. After 3 mo, mean eGFRs of the LGFR group approached MGFRs, whereas the mean eGFR of the HGFR group continued to decrease but remained higher than other groups during a 60-mo follow-up. LGFR patients had significantly higher aCKD probability than MGFR and HGFR groups. Subanalysis at 3 mo post-LT revealed more aCKD events in the LGFR group compared with MGFR and HGFR groups (P < 0.0001). The study underscores renal impact of LT in MASH cirrhosis, indicating unique eGFR trajectories post-LT tied to baseline eGFR, with a reset point at 3 mo. Monitoring post-LT renal function, especially in those at aCKD risk, is crucial. Renal-sparing immunosuppression may help, regardless of baseline eGFR. Further studies are needed for interventions addressing renal dysfunction of patients with MASH post-LT.

Association of Muscle Strength With All-Cause Mortality in the Oldest Old: Prospective Cohort Study From 28 Countries.

Ageing is associated with a gradual loss of muscle strength, which in the end may have consequences for survival. Whether muscle strength and mortality risk associate in a gradual or threshold-specific manner remains unclear. This study investigates the prospective association of muscle strength with all-cause mortality in the oldest old. We included 1890 adults aged ≥ 90 years (61.6% women, mean age 91.0 ± 1.5 years) from 27 European countries and Israel participating in the Survey of Health, Ageing and Retirement in Europe (SHARE) study. Muscle strength was assessed using handgrip dynamometry (unit: kilogram). Using time-varying Cox regression with restricted cubic splines, we determined the prospective association of muscle strength with mortality, controlling for age, sex, smoking, BMI, marital status, education, geographical region and self-perceived health. Over a mean follow-up of 4.2 ± 2.4 years, more than half of the participants died (n = 971, 51.4%). The mean handgrip strength was 20.4 ± 8.0 kg for all participants, with men (26.7 ± 7.5 kg) showing significantly higher strength than women (16.4 ± 5.4 kg) (p < 0.001). Using the median level of muscle strength as reference (18 kg), lower and higher levels were associated in a gradual and curvilinear fashion with higher and lower mortality risk, respectively. The 10th percentile of muscle strength (10 kg) showed a hazard ratio (HR) of 1.27 (95% CI 1.13-1.43, p < 0.001). The 90th percentile (31 kg) showed an HR of 0.69 (95% CI 0.58-0.82, p < 0.001). Stratified for sex, the median levels of muscle strength were 26 kg for men and 16 kg for women. The 10th percentile of muscle strength showed HRs of 1.33 (95% CI 1.10-1.61, p < 0.001) at 15 kg for men and 1.19 (95% CI 1.05-1.35, p < 0.01) at 10 kg for women. The 90th percentile of muscle strength showed HRs of 0.75 (95% CI 0.59-0.95, p < 0.01) at 35 kg for men and 0.75 (95% CI 0.62-0.90, p < 0.001) at 23 kg for women. Sensitivity analyses, which excluded individuals who died within the first 2 years of follow-up, confirmed the main findings. Rather than a specific threshold, muscle strength is gradually and inversely associated with mortality risk in the oldest old. As muscle strength at all ages is highly adaptive to resistance training, these findings highlight the importance of improving muscle strength in both men and women among the oldest old.

ОЦІНКА ПОТОЧНОГО СТАНУ РАДІАЦІЙНОГО ЗАБРУДНЕННЯ ТЕРИТОРІЇ МАЙДАНЧИКУ УРАНОВОЇ СПАДЩИНИ КОЛИШНЬОГО ВО «ПХЗ»

The article summarizes the results of long-term radioecological monitoring of the environment radioactive state within the former 'Prydniprovsk chemical plant' and adjacent territories at the preparatory stage life cycle of uranium legacy site. Data analysis have been determined the background activity levels of natural radionuclides (in particular 238U, 226Ra, 230Th, 210Pb, 210Po) in soils, underground and surface waters, air (fall density and volume activity), exhalation of 222Rn from the soil surface and its volume activity. The results of the determined dynamics and trends in the formation of pollution of environmental elements, which form the main factors of exposure of workers and the population, are presented. Areas with elevated dose rate (≥0.5 μSv·h-1) occupy more than 30% of the entire legacy site territory. In the soil activity may be 10 to 1000 times higher than background (30-50 Bq·kg-1) and can exceed 1000 times the exemption level. In aerosols 238U and 226Ra activitis exceeding the background (0.1 µBq·m-2·s-1, 11.5 µBq·m3) by 100-200 times only during periods of earthworks, under normal conditions they are up to 1.5-2.0 times. The monthly average activity 222Rn in the air of open space are 4-5 times higher of the background (median 200±68 Bq∙m-3), in some areas they can exceed by up to 50 times. In the buildings premises on the site 222Rn can exceed the reference level (250 Bq∙m-3) by 1-5 times, and in individual basements by up to 100 times. The data analysis proves that main ways of exposure of workers are external gamma radiation, the inhalation exposure routes from aerosol pollution and the spread of OA 222Rn in the air can be significant only for workers work at the legacy site and do not pose a threat to the city's population. Radiation assessment contamination of underground and surface water showed in present conditions aquatic pathways cannot form any significant contributions to the radiation exposure dose of the public. The obtained results and data analysis of monitoring observations were used to substantiate the measures of the remediation strategy legacy site.

IPEM topical report: the first UK survey of cone beam CT dose indices in radiotherapy verification imaging for adult patients.

Cone beam CT is integral to most modern radiotherapy treatments. The application of daily and repeat CBCT imaging can lead to high imaging doses over a large volume of tissue that extends beyond the treatment site. Hence, it is important to ensure exposures are optimised to keep doses as low as reasonably achievable, whilst ensuring images are suitable for the clinical task. &#xD;This IPEM topical report presents the results of the first UK survey of dose indices in radiotherapy CBCT. Dose measurements, as defined by the Cone Beam Dose Index (CBDIw), were collected along with protocol information for seven treatment sites. Where a range of optimised protocols were available in a centre, a sample of patient data demonstrating the variation in protocol use were requested. Protocol CBDIw values were determined from the average dosimetry data for each type of linear accelerator, and median CBDIw and scan length were calculated for each treatment site at each centre. Median CBDIw values were compared and summary statistics derived that enable the setting of national dose reference levels (DRLs). &#xD;A total of 63 UK radiotherapy centres contributed data. The proposed CBDIw DRLs are; prostate 20.6 mGy, gynaecological 20.8 mGy, breast 5.0 mGy, 3D-lung 6.0 mGy, 4D-lung 11.8 mGy, brain 3.5 mGy and head/neck 4.2 mGy. However, large differences between models of imaging system were noted. Where centres had pro-active optimisation strategies in place, such as sized based protocols with selection criteria, dose reductions on the 'average' patient were possible compared with vendor defaults. Optimisation of scan length was noted in some clinical sites, with Elekta users tending to fit different collimators for prostate imaging (relatively short) compared with gynaecological treatments (longest). This contrasts with most Varian users who apply the default scan length in most cases.

Age and size dependent diagnostic reference levels and achievable doses for 48 types of CT examinations: a multicenter cross-sectional study of one million CT examinations in China

Age and size dependent diagnostic reference levels and achievable doses for 48 types of CT examinations: a multicenter cross-sectional study of one million CT examinations in China

National diagnostic reference levels (DRLs) for general and interventional radiography, mammography, and CT scan based on the latest surveys in Iran

National diagnostic reference levels (DRLs) for general and interventional radiography, mammography, and CT scan based on the latest surveys in Iran

Protein supplementation preserves muscle mass in persons against sleeve gastrectomy.

Sleeve gastrectomy surgery can lead to deficiencies in both macro and micronutrients, with protein being particularly crucial due to its role in muscle mass, physiological, and metabolic functions. Inadequate protein intake due to physiological, psychological, or financial reasons may prevent achieving the recommended intake levels. The significance of this issue is often underappreciated. This study evaluates the impact of protein supplementation on muscle mass in individuals undergoing sleeve gastrectomy and emphasizes the need for more comprehensive dietary training by expert dietitians. Data were collected from 60 participants (15 male, 45 female, aged 20-54) who visited the surgery clinic. Participants were divided into two groups: those receiving the recommended protein supplement (15 g/day) with post-bariatric surgery diet training (BSD + PS), and those receiving only the post-bariatric surgery diet (BSD). A pre-surgery questionnaire gathered health and general information. Daily energy and nutrient intakes were recorded using 24-h food consumption logs on the day before surgery and at 7 days, 1 month, and 3 months postoperatively. Anthropometric measurements, including muscle and fat mass, and International Physical Activity Questionnaire (IPAQ) data were also collected. The characteristics of participants in both groups were similar, although there were more females in the BSD + PS group (86.7%) compared to the BSD group (63.3%). Despite an increase in energy and nutrient intake over time, levels remained below the recommended amounts in both groups. A significant difference was found in protein supplement consumption between the groups (p = 0.000). Repeated measures showed significant differences in body muscle mass percentage over time (F = 202.784; p = 0.000). In individuals who underwent sleeve gastrectomy surgery, deficiencies in macro and micronutrient intake were observed below reference levels. For this reason, the first approach in the treatment of obesity should always be medical nutrition therapy accompanied by a dietician. When designing post-bariatric surgery nutrition programs, it should be taken into consideration that nutrition protocols and trainings should be followed more closely and given in more detail under the supervision of a specialist before supplements are considered.

Local potential energy density – A DFT analysis and the local binding energy in complexes with multiple interactions

A recently developed method, so-called local potential energy density, LPED, provides the binding energy density of intra/intermolecular interactions. The LPED cannot directly give the binding energy of intra/intermolecular interactions. However, it can indirectly give the binding energy through the linear equation between LPED and supramolecular binding energy, SME. In addition, the LPED can be used to obtain the SME of local or individual interactions indirectly for the case of complexes with multiple interactions, which cannot be obtained for any other method to our knowledge. The calculation of the LPED was evaluated with three different levels of theory using density functional methods. The linearity of LPED and SME between the reference level of theory (ωB97X-D/aug-cc-pVTZ) and the other levels of theory are similar among the studied levels of theory. In addition, LPED was used indirectly to obtain the local binding energy of intermolecular interactions of complexes with multiple interactions, such as the EDTA-Ca+2 and the fosfomycin-Ca+2.

Assessment of local diagnostic reference levels (LDRLS) for full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) mammography in Tamil Nadu, India.

The purpose of this study was to assess local diagnostic reference levels (LDRLs) for full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) mammography in India. Data from 1500 women were collected from five different mammography facilities in major cities in Tamil Nadu, India. The mean of mean glandular dose were used to arrive at an LDRL. The noted mean compressed breast thickness was 55.26±3.4. The recorded mean MGDs for the five centres were 3.1±0.1 and 3.8±0.2mGy for FFDM and DBT, respectively. The 75th percentile value for all five centers is 3.3 and 4.0mGy for FFDM and DBT, respectively. The LDRLs found in the current study were also compared with those from earlier studies conducted in other nations, such as the United Kingdom, Malaysia, Morocco, and Ghana. The present study is the first of its kind to determine the LDRL for the FFDM and DBT scanners operating in the Tamil Nadu region, India, and is proposed as a starting point that will allow professionals to evaluate and optimize their practice. Furthermore, similar studies in other regions of India are necessary in order to establish National DRLs.

High-density lipoprotein functionality in cholesterol efflux in early childhood is related to the content ratio of triglyceride to cholesterol

Cholesterol efflux capacity (CEC), commonly measured as a useful risk marker of atherosclerotic cardiovascular disease, depends on high-density lipoprotein (HDL) functionality and its concentration. We defined the relative HDL functionality in cholesterol efflux, not influenced by HDL concentration, as the ratio of measured CEC to standardized CEC (stCEC) based on HDL-cholesterol (HDL-C) of each individual using the curve regression equation obtained from the correlation. HDL-C, CEC, and CEC/stCEC levels in the < 28-day-old participants (neonates) were significantly low compared to those of the ≥ 28-day-old participants, indicating that the low CEC levels in the neonates depend on not only lower HDL-C but also lower HDL functionality. The low level of CEC/stCEC was remarkable in neonates born at < 34 weeks of gestation and did not improved to the reference level (1.000) until the infantile period. The relatively low or high CEC/stCEC ratios in neonates and infants were associated with lower or higher HDL-TG and HDL-TG/HDL-C ratio, respectively. However, no apparent effect of HDL-TG and HDL-TG/HDL-C ratio on CEC/stCEC was observed in the ≥ 1-year-old participants, indicating that HDL functionality in cholesterol efflux could be associated with the various HDL particles with various lipid compositions, but not just with HDL-TG and HDL-TG/HDL-C ratio.

Diagnostic reference levels for the city of Moscow during X-ray examinations

Diagnostic reference levels are one of the effective tools for optimizing patient radiation doses in diagnostic radiology. The staff of domestic radiology departments does not have an understanding of the development process and use of diagnostic reference levels during X-ray examinations, although this tool is a generally accepted in practice abroad. The article shows the experience of forming regional diagnostic reference levels based on measurements provided by the accredited testing laboratory of the Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department. The diagnostic reference levels for radiography in Moscow were developed for eight of the most common types of examinations based on the operation of 216 digital X-ray machines. The resulting levels, expressed in the dose-area product (cGy-cm2) and effective dose (mSv), were compared with the local diagnostic reference levels for the Ryazan region, Russia, and national diagnostic reference levels for other countries. The analysis showed continuity in the values. Some types of studies have been optimized. The developed diagnostic reference levels are the quality performance indicators foe diagnostic radiology departments and will be used to optimize a patient radiation dose during diagnostic studies in Moscow.

Establishment of typical values in cerebral thrombectomy according to the stroke anatomical region and procedure clinical outcome.

The aim of the study is to establish local diagnostic reference levels (DRLs) in cerebral thrombectomy, according to the anatomical region of ischemic stroke. This is a retrospective study from a single center involving 255 examinations. The proposed median values (P50) for thrombectomy are: 123Gy.cm2 for air kerma-area product (PKA) and 915mGy for air kerma (Ka,r). For middle cerebral artery (MCA) thrombectomies, the proposed DRLs are 118Gy.cm2 for PKA and 112Gy.cm2 for internal carotid artery (ICA). The Ka,r values for MCA and ICA are 849 and 775mGy, respectively. It was observed that 94.9% of patients presented grade 0 on the initial modified treatment in cerebral infarction (mTICI) scale, and after thrombectomy, 63.1% of patients reached a final mTICI grade of 3. Stents were implanted in 37 patients (14.5% of cases). It was concluded that 16.1% of patients exceeded one trigger value of the Safety in Radiological Procedures' recommended parameters. Establishing DRLs is an important tool for optimizing practices and is considered a standard for quality control.