Improving Radiation Awareness and Feeling of Personal Security of Non-Radiological Medical Staff by Implementing a Traffic Light System in Computed Tomography.

PURPOSE: Non-radiological medical professionals often need to remain in the scanning room during computed tomography (CT) examinations to supervise patients in critical condition. Independent of protective devices, their position significantly influences the radiation dose they receive. The purpose of this study was to assess if a traffic light system indicating areas of different radiation exposure improves non-radiological medical staff's radiation awareness and feeling of personal security. MATERIAL AND METHODS: Phantom measurements were performed to define areas of different dose rates and colored stickers were applied on the floor according to a traffic light system: green = lowest, orange = intermediate, and red = highest possible radiation exposure. Non-radiological medical professionals with different years of working experience evaluated the system using a structured questionnaire. Kruskal-Wallis and Spearman's correlation test were applied for statistical analysis. RESULTS: Fifty-six subjects (30 physicians, 26 nursing staff) took part in this prospective study. Overall rating of the system was very good, and almost all professionals tried to stand in the green stickers during the scan. The system significantly increased radiation awareness and feeling of personal protection particularly in staff with ≤ 5 years of working experience (p < 0.05). The majority of non-radiological medical professionals stated that staying in the green stickers and patient care would be compatible. Knowledge of radiation protection was poor in all groups, especially among entry-level employees (p < 0.05). CONCLUSION: A traffic light system in the CT scanning room indicating areas with lowest, intermediate, and highest possible radiation exposure is much appreciated. It increases radiation awareness, improves the sense of personal radiation protection, and may support endeavors to lower occupational radiation exposure, although the best radiation protection always is to re-main outside the CT room during the scan. KEY POINTS: • A traffic light system indicating areas with different radiation exposure within the computed tomography scanner room is much appreciated by non-radiological medical staff. • The traffic light system increases non-radiological medical staff's radiation awareness and feeling of personal protection. • Knowledge on radiation protection was poor in non-radiological medical staff, especially in those with few working experience.

Routine approach to qualitatively screening 300 pesticides and quantification of those frequently detected in fruit and vegetables using liquid chromatography tandem mass spectrometry (LC-MS/MS).

This paper describes an efficient and effective analytical scheme to first screen for 300 pesticides in fruit and vegetables samples using liquid chromatography tandem mass spectrometry (LC-MS/MS) with a commercially enhanced product ion method. Then presumed positive extracts are analysed using a quantitative and confirmatory LC-MS/MS method optimized for 55 pesticides. A quick, easy, cheap, effective, rugged, and safe (QuEChERS) method with acetate buffering (AOAC Official Method 2007.01) was used for sample preparation, which has been previously shown to yield high-quality results for hundreds of pesticide residues in foods. The advantages and disadvantages of both the qualitative screening and quantitative/confirmatory methods and their combination are critically discussed. No false-negatives for the 55 pesticides occurred above 10 ng g(-1) for extracts analysed by both LC-MS/MS methods, and the no false-positives were encountered from the screening analysis (after analyst review) because all presumptive identifications were confirmed in the second analysis. The monitoring scheme was applied during a one-year period on 200 fruit and vegetable samples from Hungarian markets. No pesticide residues were found in half the samples, and twelve violations of European maximum residue limits were detected.

Validation and uncertainty study of a comprehensive list of 160 pesticide residues in multi-class vegetables by liquid chromatography-tandem mass spectrometry.

A rapid and sensitive liquid chromatography-tandem mass spectrometry method, in electrospray ionization positive mode, has been developed for the determination of 160 selected multi-class pesticides over a 33-min run time. Extracts were obtained using the acetonitrile-based QuEChERS (quick, easy, cheap, effective, rugged and safe) sample preparation technique. The validation study was carried out on tomato, pear and orange matrices following DG SANCO/2007/3131 of the European Quality Control Guidelines. These matrices represent high water, high sugar and high acidic content commodities, respectively. Matrix influence on recoveries and its effects on ionization were evaluated for the three matrices. Ten out of the 160 pesticides showed very low intensity, linearity and/or sensitivity problems. Linearity was studied in the 5-500 microg kg(-1) concentration range. Soft (<20%), medium (20-50%), and strong (>50%) matrix effects were obtained for 69%, 20%, and 11% of the studied compounds, respectively. Recoveries were investigated at the 10 and 100 microg kg(-1) levels, and depending on the commodity, 97%, 98% and 97% of the compounds in tomato, pear and orange, respectively, were in the 70-120% range. More than 90% of the investigated compounds had less or equal to a 5 microg kg(-1) limit of detection in the studied matrices. The relative standard deviations obtained exceeded 20% in only very few cases. The overall standard deviation obtained in the survey study (0.1551) was used for the method's uncertainty estimation. The expanded uncertainty resulted as being 0.3002 (coverage factor K=2, confidence level 95%). The method was applied on 59 real samples from 14 different kinds of fruits and vegetables. Thirty-three compounds were detected in 50 positive samples.

Total selenium and selenomethionine in pharmaceutical yeast tablets: assessment of the state of the art of measurement capabilities through international intercomparison CCQM-P86.

Results of an international intercomparison study (CCQM-P86) to assess the analytical capabilities of national metrology institutes (NMIs) and selected expert laboratories worldwide to accurately quantitate the mass fraction of selenomethionine (SeMet) and total Se in pharmaceutical tablets of selenised-yeast supplements (produced by Pharma Nord, Denmark) are presented. The study, jointly coordinated by LGC Ltd., UK, and the Institute for National Measurement Standards, National Research Council of Canada (NRCC), was conducted under the auspices of the Comité Consultatif pour la Quantité de Matière (CCQM) Inorganic Analysis Working Group and involved 15 laboratories (from 12 countries), of which ten were NMIs. Apart from a protocol for determination of moisture content and the provision of the certified reference material (CRM) SELM-1 to be used as the quality control sample, no sample preparation/extraction method was prescribed. A variety of approaches was thus used, including single-step and multiple-step enzymatic hydrolysis, enzymatic probe sonication and hydrolysis with methanesulfonic acid for SeMet, as well as microwave-assisted acid digestion and enzymatic probe sonication for total Se. For total Se, detection techniques included inductively coupled plasma (ICP) mass spectrometry (MS) with external calibration, standard additions or isotope dilution MS (IDMS), inductively coupled plasma optical emission spectrometry , flame atomic absorption spectrometry and instrumental neutron activation analysis. For determination of SeMet in the tablets, five NMIs and three academic/institute laboratories (of a total of five) relied upon measurements using IDMS. For species-specific IDMS measurements, an isotopically enriched standard of SeMet (76Se-enriched SeMet) was made available. A novel aspect of this study relies on the approach used to distinguish any errors which arise during analysis of a SeMet calibration solution from those which occur during analysis of the matrix. To help those participants undertaking SeMet analysis to do this, a blind sample in the form of a standard solution of natural abundance SeMet in 0.1 M HCl (with an expected value of 956 mg kg(-1) SeMet) was provided. Both high-performance liquid chromatography (HPLC)-ICP-MS or gas chromatography (GC)-ICP-MS and GC-MS techniques were used for quantitation of SeMet. Several advances in analytical methods for determination of SeMet were identified, including the combined use of double IDMS with HPLC-ICP-MS following extraction with methanesulfonic acid and simplified two-step enzymatic hydrolysis with protease/lipase/driselase followed by HPLC-ICP-IDMS, both using a species-specific IDMS approach. Overall, satisfactory agreement amongst participants was achieved; results averaged 337.6 mg kg(-1) (n = 13, with a standard deviation of 9.7 mg kg(-1)) and 561.5 mg kg(-1) (n = 11, with a standard deviation of 44.3 mg kg(-1)) with median values of 337.6 and 575.0 mg kg(-1) for total Se and SeMet, respectively. Recovery of SeMet from SELM-1 averaged 95.0% (n = 9). The ability of NMIs and expert laboratories worldwide to deliver accurate results for total Se and SeMet in such materials (selensied-yeast tablets containing approximately 300 mg kg(-1) Se) with 10% expanded uncertainty was demonstrated. The problems addressed in achieving accurate quantitation of SeMet in this product are representative of those encountered with a wide range of organometallic species in a number of common matrices.

Interspecific distribution and co-associations of chemical elements in the liver tissue of marine mammals from the Polish Economical Exclusive Zone, Baltic Sea.

Concentrations of Al, B, Ba, Cd, Co, Cr, Cu, Fe, Ga, Hg, Li, Mn, Mo, Ni, Pb, Se, Si, Sr, Tl, V, Zn, Ca, K, Mg, Na and P in the livers of marine mammals obtained from by-catches or stranded on beaches on the Polish Baltic coast were determined by ICP-MS or ICP-AES and CV AAS. Interspecific diversity with respect to the contents of these elements was found in cetaceans and pinnipeds. The diverse Cd contents in the livers of these mammals can be attributed to the variable concentrations of this element in their food. Mercury was correlated with age and can reach high concentration associated with higher level of Se in older specimens. No significant relationships were found between concentration of the chemical elements studied and nutritional status/condition of the Baltic harbour porpoises as well as between their concentration in specimens from the Gulf of Gdansk and open Baltic. It seems that the nutritional and health status of the specimens studied is generally enough good since the specimens studied were not stranded on beach because of starvation but almost incidentally caught in salmon gill nets. Strong correlations were found between the macroelements analysed, i.e. for the Ba-Ca-Sr, Ca-K, Ca-Mg, Mg-P, Zn-Mg and Zn-P assemblies. Significantly higher content of Al was found in males of harbour porpoises.

Multiple sclerosis gender issues: clinical practices of women neurologists.

Substantially more women than men develop multiple sclerosis (MS), but information about the effects of MS and gender-specific issues such as pregnancy, breastfeeding, menstruation and hormone use is lacking. A survey study of neurologists' practice patterns was undertaken to elicit information about gender-specific topics and the use of disease-modifying MS therapies (DMT) including the interferons and glatiramer acetate (GA). A total of 147 surveys were returned. Half of respondents require patients to discontinue DMT during pregnancy, while 35% encourage discontinuation. Among those who allow patients to continue therapy, half consider GA to be safer during pregnancy than the interferons. Nearly 86% of respondents do not use DMT in patients who are breastfeeding. Among the 11% who actually prescribe during breastfeeding, most recommend GA. Neurologists generally leave the decision to breastfeed up to patients, and most refer patients to obstetrician/gynaecologists for counselling about contraception or hormone replacement therapy. The survey results described here provide insight into how neurologists manage reproductive health issues among women with MS.

Distribution and biotransformation of arsenic species in chicken cardiac and muscle tissues.

This study evaluated the bioaccumulation and biotransformation of arsenic species in chicken heart and meat tissues. The experimental study was carried out using two sets of samples. In the first one, 10-d-old chickens were exposed to sodium arsenate, using spiked drinking water. These chickens grew normally and were killed after 50 d of arsenic exposure. The second set were edible chickens used as blanks for a parallel study. The total arsenic and arsenic species content in the exposed samples were at least twice those in the normal edible chicken. It has been demonstrated that sodium arsenate is biotransformed to arsenite and an unknown species and its distribution varies among the different cardiac and meat tissues. One important aspect is the capability of the auricle to preconcentrate the most toxic species, arsenite, in the exposed chicken. A nonidentified arsenic species from the edible chicken was detected. Arsenobetaine was also detected in several tissues. This article shows that chicken can be used as a representative animal when considering inorganic arsenic exposure in humans.

Evaluation of performance of time-saving extraction devices in the BCR three-step sequential extraction procedure.

Two alternative extraction methods--a routine ultrasonic bath and a microwave oven--were developed and optimized for their eventual exploitation in the three-stage sequential extraction procedure proposed by the European Standards, Measurements and Testing (S, M & T) Programme, formerly Bureau Communitaire de Reference (BCR), for the operationally defined speciation of Cd, Cr, Cu, Ni and Zn. The conventional BCR three-stage sequential extraction procedure was modified at each stage, applying ultrasonic or microwave devices in order to shorten the required 16 h of shaking in all three steps. The experimental tests and the optimization of the operating parameters were carried out on a highly homogenized estuarine sediment reference material (RM S7) prepared by the Joint Research Centre (JRC) of ISPRA. Extractable metal contents were measured by inductively coupled plasma-mass spectrometry (ICP-MS) and the results obtained in each fraction by all three methods were statistically compared for all the studied elements. The conventional and newly developed alternative extraction methods were finally compared by the analysis of BCR 601, which is certified for the three-step BCR sequential extraction procedure. According to the statistical evaluation of the results, the proposed accelerated sequential extraction methods are valid alternatives to conventional shaking, with much shorter extraction times.

Improving selenium extraction by sequential enzymatic processes for Se-speciation of selenium-enriched Agaricus bisporus.

Sample preparation methods based on the use of proteolytic and cell wall digesting enzymes for the speciation analysis of selenized mushroom were investigated. The sample (Agaricus bisporus; 160 microg total Se per g sample) was grown on compost supplemented with selenized yeast. Experiments were carried out to elucidate the possible role of the cell wall digesting enzymes--Lysing enzyme and Driselase--in the improvement of extraction efficiency with and without inhibiting proteolysis during cell wall digestion. A 3-step procedure applying Lysing enzyme and pronase gave the highest extraction efficiency (89%); however, the best species recovery was achieved by a one-step proteolytic procedure. All the procedures of selenium speciation were controlled by independent ICP-AES analysis measuring the total amount of selenium.

Speciation of inorganic selenium and selenoamino acids by an HPLC-UV-HG-AFS system.

For the on-line speciation of selenocystine (SeCys), selenomethionine (SeMet), selenoethionine (SeEt), selenite (Se(IV)) and selenate (Se(VI)), a high-performance liquid chromatography-UV irradiation-hydride generation-atomic fluorescence spectro- metric method is described. Separation was carried out on a conventional reversed-phase C18 column modified with didodecyl- dimethylammonium bromide with gradient elution applying two concentrations of ammonium acetate as the mobile phase. UV irradiation and hydride generation parameters were optimized. The obtained detection limits for SeCys, SeMet, SeEt, Se(IV) and Se(VI) were 0.31, 0.43, 0.7, 0.44 and 0.32 ng ml(-1), respectively, using a 100-microl loop. The method was tested with spiked mineral water and two volunteers' urine samples.

Comparison of sample preparation methods based on proteolytic enzymatic processes for Se-speciation of edible mushroom (Agaricus bisporus) samples.

A sequential sample preparation process was developed for the speciation analysis for Se-enriched edible mushroom, Agaricus bisporus containing 110.2 mug of total Se/g sample. Five different sample extraction methods were compared and the most efficient method (a three-step process involving the use of water extraction and two proteolytic enzymes - pepsin and trypsin) proved to be the most suitable for extracting selenium, with an extraction efficiency of 75%. As the analogues of these enzymes play an important role in human digestion the bioavailability of the selenium present in the sample was estimated. Selenocystine (SeCys(2)) and Se(IV) were detected in considerable amounts (27.7 mug Se/g sample and 46.4 mug Se/g sample, respectively). For the quality control of peak identification a spiking procedure was developed, using a low selenium mushroom containing 4.3 mug of total Se/g sample. During the analysis with HPLC-HHPN (Hydraulic High Pressure Nebuliser)-AFS complicated background effects and matrix problems were observed: stable and reproducible signals generated by the low selenium mushroom and the compounds used in sample preparation were detected. The three-step sample preparation method connected with the HPLC-HHPN-AFS system proved to be applicable for the speciation analysis of the Se-enriched Agaricus bisporus.

Power-assisted lipoplasty.

Efforts to improve lipoplasty results through the application of focused energy continue to arouse interest. The author's initial experience with power-assisted lipoplasty indicates that this technique is safe, fast, and capable of producing results equal or superior to those achieved through use of traditional lipoplasty.

Autologous cultured fibroblasts as cellular therapy in plastic surgery.

Autologous cultured fibroblasts serve as injectable protein repair systems for correction of acne scars, rhytids, and other facial scars. The system uses the patient's own cultured fibroblasts to correct contour deformities over time.

Autologous cultured fibroblasts: a protein repair system.

Cultured autologous fibroblasts create a living injectable system that has been utilized effectively to treat rhytids, depressed scars, subcutaneous atrophy, acne irregularities, and laser wounds. Autologous cultured fibroblasts (Isolagen) as a protein repair system is produced from a 3-mm cutaneous punch biopsy. Skin biopsies are initiated in an in vitro tissue culture system. The cells are expanded to produce large quantities of fibroblasts and extracellular matrix totaling 1.0 to 1.5 ml. This cellular system is injected into the patient after 8 weeks of cellular expansion. Each area of treatment is injected once every 2 weeks for three injections. A total of 1,450 patients in the United States and Europe have been treated at designated centers. A total of 4,800 injections were given. At the University of Medicine and Dentistry of New Jersey and Hackensack University Medical Center, 94 patients were treated from 1995 through 1999. Long-term follow-up ranged from 36 to 48 months. A subjective patient satisfaction survey showed 92% of the patients were satisfied with the grade of correction. A long-term follow-up survey revealed continuing improvement beyond the initial correction in 70% of patients. Results from other designated centers correlated with the authors' findings. Cultured autologous fibroblasts (Isolagen) appears to be a living, cellular, dynamic filler system capable of immediate correction and continued repair of dermal and superficial subcutaneous deficiencies.

[Postoperative insufficiency of duodenal stump sutures caused by Ascaris lumbricoides]. / Ascaris lumbricoides okozta duodenumcsonk insufficientia.

A 43 years old female patient suffered ventricular resection (Billroth II) because of tumor. On the 11. postoperative day an Ascaris lumbricoides (with the length of 20 cm) was creeping out of the site of the draining tube onto the abdominal wall. Enteral parasites are very rare and strange reasons for postoperative duodenal suture insufficience but our case may deserve some attention considering the well known spreading of Ascaris infections.

Wetting solutions in ultrasound-assisted lipoplasty.

Wetting solutions play a crucial role in traditional lipoplasty by reducing blood loss in the aspirate and diminishing postoperative ecchymosis and edema. From the inception of ultrasound-assisted lipoplasty a "wet environment" has been considered essential for efficient fat emulsification and for control of thermal side effects. This article reviews the historical role of wetting solutions in lipoplasty and examines the risks of their use in an overzealous manner. The authors provide safety guidelines for maximizing the benefits of wetting solutions in traditional and ultrasound-assisted lipoplasty while minimizing their side effects and complications.

Simultaneous determination of dimethylarsinic acid and monomethylarsonic acid after derivatization with thioglycol methylate by gas chromatography/mass spectrometry.

A gas chromatography/mass spectrometry (GC/MS) method has been developed to determine two methylated arsenic species in human urine samples. The yield of derivatization for dimethylarsinic acid (DMA) and monomethylarsonic acid (MMA) using thioglycol methylate (TGM) was measured. The detection limit for the derivatized DMA and MMA using the GC/MS method are 0.95 and 0.8 ng cm-3, respectively. This simple and rapid method has good precision and accuracy. Fragmentation routes of derivatized MMA and DMA are suggested on accurate mass measurements.

Autologous fibroblasts for treatment of facial rhytids and dermal depressions. A pilot study.

OBJECTIVE: To assess effectiveness of intradermal injections of autologous fibroblasts for the treatment of facial rhytids and dermal depressions. DESIGN: Six-month prospective pilot study. Photographs and silicone molds were taken of a prominent rhytid or dermal depression from each patient prior to treatment and at 6 months after treatment. SETTING: Specialty clinic in academic medical center. PATIENTS: Ten adults (age range, 24-69 years) who each exhibited a prominent rhytid or depressed facial scar. INTERVENTION: A 3-mm postauricular skin biopsy specimen from each participant was sent to Isolagen Technologies, Inc, laboratories, where a fibroblast cell line was developed. Three injection sessions were performed at 2-week intervals; target areas were the study site as well as behind the ear. MAIN OUTCOME MEASURES: Subjective improvement scores were obtained by each patient and 2 clinicians at every follow-up visit. Skin surface topographical features were evaluated with optical profilometry by comparing silicone molds before and after injection. Histological analysis was performed on a biopsy specimen of the postauricular injection site. RESULTS: Nine of 10 patients noted a 60% to 100% improvement with the treatment; clinicians made similar observations. Size reduction of 10% up to 85% of the study site was demonstrated by optical profilometry for every patient. Microscopically, there was evidence of increased thickness and density of dermal-layer collagen. CONCLUSIONS: Intradermal injection of autologous fibroblasts may be an effective treatment option for facial rhytids and depressed scars.