Advancements in Understanding the Hide-and-Seek Strategy of Hibernating Breast Cancer Cells and Their Implications in Oncology from a Broader Perspective: A Comprehensive Overview.

Despite recent advancements in technology, breast cancer still poses a significant threat, often resulting in fatal consequences. While early detection and treatments have shown some promise, many breast cancer patients continue to struggle with the persistent fear of the disease returning. This fear is valid, as breast cancer cells can lay dormant for years before remerging, evading traditional treatments like a game of hide and seek. The biology of these dormant breast cancer cells presents a crucial yet poorly understood challenge in clinical settings. In this review, we aim to explore the mysterious world of dormant breast cancer cells and their significant impact on patient outcomes and prognosis. We shed light on the elusive role of the G9a enzyme and many other epigenetic factors in breast cancer recurrence, highlighting its potential as a target for eliminating dormant cancer cells and preventing disease relapse. Through this comprehensive review, we not only emphasise the urgency of unravelling the dynamics of dormant breast cancer cells to improve patient outcomes and advance personalised oncology but also provide a guide for fellow researchers. By clearly outlining the clinical and research gaps surrounding dormant breast cancer cells from a molecular perspective, we aim to inspire further exploration of this critical area, ultimately leading to improved patient care and treatment strategies.

Sweet vernal grasses (Anthoxanthum) colonized African mountains along two fronts in the Late Pliocene, followed by secondary contact, polyploidization and local extinction in the Pleistocene.

High tropical mountains harbour remarkable and fragmented biodiversity thought to a large degree to have been shaped by multiple dispersals of cold-adapted lineages from remote areas. Few dated phylogenetic/phylogeographic analyses are however available. Here, we address the hypotheses that the sub-Saharan African sweet vernal grasses have a dual colonization history and that lineages of independent origins have established secondary contact. We carried out rangewide sampling across the eastern African high mountains, inferred dated phylogenies from nuclear ribosomal and plastid DNA using Bayesian methods, and performed flow cytometry and AFLP (amplified fragment length polymorphism) analyses. We inferred a single Late Pliocene western Eurasian origin of the eastern African taxa, whose high-ploid populations in one mountain group formed a distinct phylogeographic group and carried plastids that diverged from those of the currently allopatric southern African lineage in the Mid- to Late Pleistocene. We show that Anthoxanthum has an intriguing history in sub-Saharan Africa, including Late Pliocene colonization from southeast and north, followed by secondary contact, hybridization, allopolyploidization and local extinction during one of the last glacial cycles. Our results add to a growing body of evidence showing that isolated tropical high mountain habitats have a dynamic recent history involving niche conservatism and recruitment from remote sources, repeated dispersals, diversification, hybridization and local extinction.

Colonization and diversification in the African 'sky islands': insights from fossil-calibrated molecular dating of Lychnis (Caryophyllaceae).

The flora on the isolated high African mountains or 'sky islands' is remarkable for its peculiar adaptations, local endemism and striking biogeographical connections to remote parts of the world. Ages of the plant lineages and the timing of their radiations have frequently been debated but remain contentious as there are few estimates based on explicit models and fossil-calibrated molecular clocks. We used the plastid region maturaseK (matK) and a Caryophylloflora paleogenica fossil to infer the age of the genus Lychnis, and constructed a data set of three plastid (matK; a ribosomal protein S16 (rps16); and an intergenic spacer (psbE-petL)) and two nuclear (internal transcribed spacer (ITS) and a region spanning exon 18-24 in the second largest subunit of RNA polymerase II (RPB2)) loci for joint estimation of the species tree and divergence time of the African representatives. The time of divergence of the African high-altitude Lychnis was placed in the late Miocene to early Pliocene. A single speciation event was inferred in the early Pliocene; subsequent speciation took place sporadically from the late Pliocene to the middle Pleistocene. We provide further support for a Eurasian origin of the African 'sky islands' floral elements, which seem to have been recruited via dispersals at different times: some old, as in Lychnis, and others very recent. We show that dispersal and diversification within Africa play an important role in shaping these isolated plant communities.

Assessment of occupational radiation exposure during a specific endoscopic retrograde cholangiopancreatography procedure.

AIM: The aim of this study was to evaluate the occupational radiation exposure of staff during endoscopic retrograde cholangiopancreatography (ERCP), with a focus on individuals closest to the radiation source, and to identify potential increases in exposure to hands and eye lenses. Patient radiation exposure during ERCP was also assessed. MATERIALS AND METHODS: Staff organ doses were monitored using a Philips Allura Xper FD 20 fluoroscopy system, during 24 ERCP procedures for a period of 7 months. Staff doses were measured using thermoluminescence dosemeters and electronic personal dosemeters, and patient effective doses were simulated and calculated. RESULTS: Physicians' annual organ doses ranged from 0.2 to 1.6 mSv for shoulders, 0.1 to 0.4 mSv for eye lenses, and 0.3 to 1.6 mSv for fingers. The annual organ dose of the nursing staff ranged from 0.08 to 2.4 mSv for shoulders, 0.02 to 2.3 mSv for eye lenses, and 1.2 to 5.3 mSv for fingers. The effective dose to patients ranged from 0.009 to 0.46 mSv. CONCLUSION: Staff doses were within safe limits, but patient doses were high, emphasizing the need for improved radiation protection.

Exploring Myocardial Infarction Knowledge, Attitudes, and Practice Among Mogadishu's Somali Residents.

Introduction: Myocardial infarction and cardiovascular disease are significant global health issues, particularly in Somalia. The Somali population faces challenges due to armed conflict, limited education, and underdeveloped healthcare infrastructure. Cardiovascular risk factors like diabetes, hypertension, and obesity are prevalent, and Somali people face increased susceptibility. Methods: This study examined Somalia residents' perceptions, attitudes, and behaviors towards myocardial infarction using a cross-sectional paper-based questionnaire. The sample consisted of 313 urban residents in Mogadishu, aged 20 and above. The questionnaire was written in Somali and was designed for the demographic. Knowledge, attitude, and practice scores were categorized into two groups, with associations between knowledge, attitude, and practice with sociodemographic and health characteristics assessed using Logistic Regression. Results: This study analyzed data from A random sample of participants who arrived at the hospital for various reasons regarding their perceptions, attitudes, and responses towards myocardial infarction. The mean age was 42 ±19 years, with 54% being male and 46% female. Hypertension was the most common comorbidity, followed by dyslipidemia and diabetes. Over half of the respondents had no formal education, and only 3.8% had a smoking history. About 5.7% had a previous history of myocardial infarction. The mean knowledge score was 11.07 ± 0.697, with 53.35% of respondents not knowing enough about myocardial infarction. The majority of the patients showed a favorable attitude, but only a slight majority could recognize symptoms of myocardial infarction. The majority of the patients had inadequate practice and behavior, with 53.6% not practicing regularly or engaging in sports. Conclusion: The research highlights gaps in Mogadishu's Somali community's knowledge and practices regarding myocardial infarction. It emphasizes the need for health education, primary care, and community involvement to improve cardiovascular health awareness and reduce MI incidence.

Implementation of the WHO surgical safety checklist in resource-limited Somalia: a new standard in surgical safety.

BACKGROUND: Surgical safety remains a critical global health concern, with complications from surgical procedures resulting in significant morbidity and mortality, particularly in low- and middle-income countries. The World Health Organization (WHO) Surgical Safety Checklist (SSC) has been shown to reduce surgical complications and mortality rates. However, its implementation and impact in resource-limited settings like Somalia remain understudied. This study aimed to evaluate the implementation of the WHO SSC in selected hospitals in Mogadishu, Somalia, and assess its impact on surgical safety practices. METHODS: A pre- and post-intervention study was conducted in 15 randomly selected hospitals in Mogadishu, Somalia. The intervention involved a comprehensive training program on the WHO SSC for surgical teams. Data on hospital characteristics, surgical details, and adherence to the SSC were collected over two periods: pre-intervention (April 12th to May 4th, 2024) and post-intervention (May 12th to June 3rd, 2024). The primary outcome was the adherence to the SSC, categorized as good (> 60%) or poor (≤ 60%). Descriptive statistics, McNemar's test, and binary logistic regression were used for data analysis. RESULTS: Adherence to the WHO SSC significantly improved post-intervention, with 98.8% of surgical cases demonstrating good adherence compared to 37% pre-intervention (p < 0.001). The mean adherence score increased from 51.6% (SD = 29.6) to 94.1% (SD = 8.2). Significant improvements were observed for most individual checklist items, including patient identity confirmation, surgical site marking, anesthesia machine checks, and pulse oximeter use (p < 0.001). Team dynamics and communication also improved significantly post-intervention. Hospital type, size, years of service, funding source, surgical department, surgery type, urgency, and staff numbers were associated with checklist adherence pre-intervention. CONCLUSION: The implementation of a comprehensive training intervention significantly improved adherence to the WHO Surgical Safety Checklist in resource-limited hospitals in Mogadishu, Somalia. The findings highlight the feasibility and effectiveness of the SSC in enhancing surgical safety practices, team communication, and patient outcomes in challenging healthcare environments. Tailored implementation strategies, ongoing training, and cultural adaptation are crucial for the successful adoption of the SSC in resource-constrained settings.

Parachute tricuspid valve unique case and the first case in Somalia.

Atrioventricular valve parachute deformity is rare and is generally seen in the mitral position, called the parachute mitral valve. It is rare to see it in the tricuspid valve and up to now, there have been approximately 14 cases of parachute abnormalities in tricuspid valves in a literature review. We present here a 21-year-old male who presented to the emergency department with progressive shortness of breath over several months. Despite the absence of chest pain, palpitations, or weight changes, examination revealed a soft, holosystolic murmur at the left lower sternal border. Further investigation through electrocardiogram and echocardiogram identified a rare structural abnormality known as parachute tricuspid valve, resulting in significant tricuspid regurgitation with mild right chamber enlargement. The patient was recommended to go abroad for further management since a cardiothoracic surgeon is not available in our country.

A Rare Case of Apixaban-Induced Subdural Hematoma in Elderly Heart Failure Patient.

New oral anticoagulants (NOACs) have become more popular in the last few decades. Although apixaban has been proven to be safer than warfarin and causes less hemorrhage in comparison to other NOACs, it still poses a risk of spontaneous bleeding. We present here an 81-year-old male known case of heart failure with reduced ejection fraction (HFrEF) associated with an apical thrombus of 0.93×1.29 cm who presents with cognitive decline, slurred speech, and right side weakness following apixaban use for his apical thrombus. On further evaluation of non-contrast brain computerized tomography (CT), there was a large extra-axial subacute subdural hematoma with thick septations in the left parietal region, measuring 2.6 cm in thickness, causing an a mass effect, and an a midline shift of 1 mm. Following neurosurgery, cardiology, and anesthesiology discussions, the surgery was deferred due to his age and coexisting conditions with regular follow-ups. The patient has now gained full consciousness and is currently undergoing physiotherapy. This case highlights an elderly patient with apixaban-induced subdural hemorrhage, which is a rare entity in the medical literature. Although apixaban is safer than other NOACs, it may cause subdural hemorrhage.

Simultaneous acute cardio-cerebral infarction associated with isolated left ventricle non-compaction cardiomyopathy.

Introduction and importance: The co-occurrence of acute ischemic stroke and acute myocardial ischemia; cardio-cerebral infarction (CCI) has been linked to increased morbidity and mortality. The incidence of these conditions to occur simultaneously has been reported to be less than 1% according to the published data. Left Ventricular Non-Compaction (LVNC), on the other hand, is characterized by large left ventricular (LV) trabeculae, a thin compacted layer, and deep intertrabecular recesses. In the inter-trabecular recesses, where blood flow is slow, cardiac mural thrombi may form, which can lead to systemic embolization. Case presentation: In this report, we describe a 51-year-old male patient with a history of hypertension and diabetes who developed a non-ST segment elevated myocardial infraction and an acute ischemic stroke that were thought to be related to left ventricular hypertrabeculation. Clinical discussion: Although it is rare, the simultaneous occurrence of myocardial infarction and an acute ischemic stroke can be fatal. There are numerous potential mechanisms for CCI, including cardiac thrombi-embolism, hypoperfusion during AMI. Both conditions have a narrow therapeutic window and management is very crucial. Conclusion: To the best of the author's knowledge, this is the first reported case of cardiocerebral infraction (CCI) in the setting of non-compaction left ventricle. Early and precise diagnosis is critical to the successful management of these conditions.

Retrospective Analysis of Left Ventricular Thrombus Among Heart Failure Patients with Reduced Ejection Fraction at a Single Tertiary Care Hospital in Somalia.

Introduction: Left ventricular thrombus (LVT) is a common complication in patients with systolic heart failure and can cause thromboembolic consequences including stroke. In order to determine the characteristics of LV thrombus among heart failure patients with reduced ejection fraction (HFrEF), the present study was undertaken. Methods and Materials: This was retrospective cross-sectional study conducted from referral tertiary hospital in a year period. A total of 810 transthoracic echocardiograms were carried out in our center from January 2021 to December 2021. Forty participants had met the inclusion criteria of the study. Results: About 75% of the population was male and the mean age at diagnosis was 51 years (SD: 15). Ischemic cardiomyopathy and dilated cardiomyopathy (DCMP) found to be the most underlying cause of LVT represented (57.5% and 42.5% respectively). Hypertension, hypothyroidism, and atrial fibrillation were found to be the commonest associated risk factors of LVT, 45%, 12.5%, and 30% respectively. Simpson's Biplane's approach yielded a mean LVEF of 25.25 ± 6.97. 60% of the patients had a LVEF of ≤25%. The mean LV end-diastolic and end-systolic diameters were 59.2 ± 9.4 mm and 51 ± 8.3mm respectively. Warfarin was administered to 19 (47.5), Rivaroxaban to 8 (20), and Dabigatran to 10 (25). The most prevalent anticoagulant among the individuals in our study was warfarin. A stroke complication was found in 8 patients (20%), two of them were hemorrhagic stroke and they were on dabigatran. A Peripheral Arterial Disease (PAD) affected 6 of the patients (15%). One of those with PAD had also ischemic stroke. Conclusion: This study determines that Ischemic and Dilated cardiomyopathy were the most common cause of left ventricular thrombosis among HFrEF patients in Somalia.

Exceptional Clinical Response to Surgery in Somalian Child Affected by Hyper Secretive Adrenal Cortical Carcinoma.

Adrenocortical cancers in childhood are very rare tumors. They are categorized as functional (hormone-secreting) or silent and as either benign or malignant. They have a bimodal distribution. Although in most adults they are non-functional, in the pediatric age group they may present as hormonal active or as an active tumor presenting with either virilizing forms or Cushing's syndrome or both sometimes. In children, due to the rapid development of symptoms, they come to attention early. However, if not diagnosed and treated early, they can develop into serious medical conditions. We present here a 6-year-old girl complaining of voice changes (deepening), extremely overweight, excessive hair growth over her body, and clitoromegaly for one year. Abdominal ultrasound and computed tomography revealed a well-defined adrenal mass with a slightly heterogeneous appearance and heterogeneous-contrast enhancement containing some necrotic areas. The patient was discharged one week after unilateral right adrenalectomy in good condition, and oral medications were given along with high-dose corticosteroid medications, which were reduced gradually. All the symptoms disappeared 6 months after the operation.

Correction: Abdi et al. Visual Evaluation of Image Quality of a Low Dose 2D/3D Slot Scanner Imaging System Compared to Two Conventional Digital Radiography X-ray Imaging Systems. Diagnostics 2021, 11, 1932.

In the original publication [...].

Primary perimenarcheal ovarian leiomyosarcoma: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Leiomyosarcomas of the ovary are extremely rare neoplasia usually occurring in perimenopausal patients. CASE PRESENTATION: A 16-year-old female patient, with no particular pathological history, who presented with chronic pelvic pain. On imaging; presence of a suprauterine solid cystic formation of 12 cm long axis. Tumor markers were normal. On exploration, solid cystic formation of 15 cm long axis. A total hysterectomy with bilateral salpingo-oophorectomy associated with bilateral pelvic and para-aortic lymphadenectomy and a total omentectomy were performed. Anatomical pathology; an ovarian leiomyosarcoma. CLINICAL DISCUSSION: Leiomyosarcomas of the ovary are extremely rare, representing less than 1% of all ovarian malignancies. They probably derive from the smooth muscle component. No definitive diagnostic criteria for ovarian leiomyosarcomas have been adopted to date, however the histological criteria adopted are those for uterine leiomyosarcomas. The differential diagnosis of these tumors includes fibrosarcomas, rhabdomyosarcomas, thecomas and extradigestive stromal tumors. The prognosis of ovarian leiomyosarcomas is generally poor. Complete surgical resection remains for all authors the cornerstone of treatment. The benefit of adjuvant therapies, namely chemotherapy or radiotherapy, remains to be proven. CONCLUSION: Leiomyosarcoma of the ovary, although exceptional, should always be included among the diagnostic possibilities when an ovarian cyst of organic appearance is discovered in a perimenarcheal patient.

Quantitative Image Quality Metrics of the Low-Dose 2D/3D Slot Scanner Compared to Two Conventional Digital Radiography X-ray Imaging Systems.

The aim of this study was to determine the quantitative image quality metrics of the low-dose 2D/3D EOS slot scanner X-ray imaging system (LDSS) compared with conventional digital radiography (DR) X-ray imaging systems. The effective detective quantum efficiency (eDQE) and effective noise quantum equivalent (eNEQ) were measured using chest and knee protocols. METHODS: A Nationwide Evaluation of X-ray Trends (NEXT) of a chest adult phantom and a PolyMethylmethacrylate (PMMA) phantom were used for the chest and knee protocols, respectively. Quantitative image quality metrics, including effective normalised noise power spectrum (eNNPS), effective modulation transfer function (eMTF), eDQE and eNEQ of the LDSS and DR imaging systems were assessed and compared. RESULTS: In the chest acquisition, the LDSS imaging system achieved significantly higher eNEQ and eDQE than the DR imaging systems at lower and higher spatial frequencies (0.001 ≤ p ≤ 0.044). For the knee acquisition, the LDSS imaging system also achieved significantly higher eNEQ and eDQE than the DR imaging systems at lower and higher spatial frequencies (0.001 ≤ p ≤ 0.002). However, there was no significant difference in eNEQ and eDQE between DR systems 1 and 2 at lower and higher spatial frequencies (0.10 < p < 1.00) for either chest or knee protocols. CONCLUSION: The LDSS imaging system performed well compared to the DR systems. Thus, we have demonstrated that the LDSS imaging system has the potential to be used for clinical diagnostic purposes.

Visual Evaluation of Image Quality of a Low Dose 2D/3D Slot Scanner Imaging System Compared to Two Conventional Digital Radiography X-ray Imaging Systems.

The purpose of this study was to assess the image quality of the low dose 2D/3D slot scanner (LDSS) imaging system compared to conventional digital radiography (DR) imaging systems. Visual image quality was assessed using the visual grading analysis (VGA) method. This method is a subjective approach that uses a human observer to evaluate and optimise radiographic images for different imaging technologies. METHODS AND MATERIALS: ten posterior-anterior (PA) and ten lateral (LAT) images of a chest anthropomorphic phantoms and a knee phantom were acquired by an LDSS imaging system and two conventional DR imaging systems. The images were shown in random order to three (chest) radiologists and three experienced (knee) radiographers, who scored the images against a number of criteria. Inter- and intraobserver agreement was assessed using Fleiss' kappa and weighted kappa. RESULTS: the statistical comparison of the agreement between the observers showed good interobserver agreement, with Fleiss' kappa coefficients of 0.27-0.63 and 0.23-0.45 for the chest and knee protocols, respectively. Comparison of intraobserver agreement also showed good agreement with weighted kappa coefficients of 0.27-0.63 and 0.23-0.45 for the chest and knee protocols, respectively. The LDSS imaging system achieved significantly higher VGA image quality compared to the DR imaging systems in the AP and LAT chest protocols (p < 0.001). However, the LDSS imaging system achieved lower image quality than one DR system (p ≤ 0.016) and equivalent image quality to the other DR systems (p ≤ 0.27) in the knee protocol. The LDSS imaging system achieved effective dose savings of 33-52% for the chest protocol and 30-35% for the knee protocol compared with DR systems. CONCLUSIONS: this work has shown that the LDSS imaging system has the potential to acquire chest and knee images at diagnostic quality and at a lower effective dose than DR systems.

Food Hygiene Practices and Associated Factors Among Food Handlers Working in Food Establishments in the Bole Sub City, Addis Ababa, Ethiopia.

BACKGROUND: Consumers' health would be at risk unless food preparation and handling hygiene is ensured by food establishments. Literature indicates that poor food handling and sanitation practices are more common among food handlers in developing countries resulting in food-borne illness. Hence, food handlers can play a significant role in ensuring food hygiene. To this end, the paper aims to assess the level of food hygiene practices and its associated factors of food handlers working in food establishments in Bole sub-city, Addis Ababa, Ethiopia. METHODS: Through across-sectional study design, a total of 394 food handlers selected randomly from food establishments have participated in the study. The data were collected between July and December 2017, through interview and observation. Percentage, cross tabulations, and logistic regressions were used to analyze the data. RESULTS: The findings show that among 394 study subjects only 27.4% (i.e., 108 food handlers), were found to have good food hygiene practices. In other words, majority of food handlers observed were poor in maintaining food hygiene. Food hygiene practices were highly influenced by level score of favorable attitude (AOR = 3.9, 95% CI = 1.93, 7.87), extensive knowledge towards food hygiene (AOR= 3.33, 95% CI= 1.93, 5.76) and availability of water storage equipment at food establishments (AOR= 2.67, 95% CI= 1.38, 5.15). CONCLUSION: Food handlers had poor food hygiene practices in the study area. Shortages of a continuous water supply at food establishments, poor knowledge, and unfavorable attitude of food handlers towards food hygiene practice were all contributing factors associated with poor food hygiene practice. However, these can be improved through health education programs and environmental health services, such as periodic inspections, effective enforcement of food safety regulations, and enhancing the capacity of food hygiene regulators.

Prevalence of refractive error and visual impairment among school-age children of Hargesia, Somaliland, Somalia.

BACKGROUND: Childhood visual impairment is a global public health problem, especially in low and middle-income countries. Its most common causes are avoidable by early diagnosis and treatment. AIMS: To assess prevalence of refractive error and visual impairment among school-aged children in Hargeisa, Somaliland, Somalia. METHODS: This was a cross-sectional study of 1204 students (aged 6-15 years) in 8 randomly selected primary schools in Hargeisa from November 2017 to January 2018. We used the modified Refractive Error Study in Children to determine prevalence of refractive error and visual impairment, including the following investigations: distance visual acuity, assessed by Snellen Tumbling E-chart; refraction, assessed by retinoscope binocular vision assessment; and examination of anterior and posterior segments. RESULTS: Prevalence of uncorrected, presenting and best-corrected visual impairment of 6/12 or worse was 13.6%, 7.6% and 0.75%, respectively. Only 16 of 91 (17.6%) children were using spectacles and the rest were unaware of the problem. Refractive error was the cause of visual impairment in 76.8% of participants, amblyopia in 22.0%, trachoma in 2.4%, and corneal opacity and cataract in 0.6%. Anterior segment abnormalities were found in 8.3%, mainly vernal keratoconjunctivitis, while posterior abnormalities were observed in 0.7%. Prevalence of myopia was 9.1%, hypermetropia 2.7% and astigmatism 3.9%. Prevalence of visual impairment because of Refractive Error was associated with increasing age, but there was no significant association with school grade or sex. CONCLUSION: Prevalence of visual impairment among school-aged children in Hargeisa was high, and the leading cause was uncorrected Refractive Error. There are barriers to care and it is critical that they are overcome.

Afro-alpine flagships revisited: Parallel adaptation, intermountain admixture and shallow genetic structuring in the giant senecios (Dendrosenecio).

Distantly related lineages of the enigmatic giant rosette plants of tropical alpine environments provide classical examples of convergent adaptation. For the giant senecios (Dendrosenecio), the endemic landmarks of the East African sky islands, it has also been suggested that parallel adaptation has been important for within-lineage differentiation. To test this hypothesis and to address potential gene flow and hybridization among the isolated sky islands, we organized field expeditions to all major mountains. We sampled all currently accepted species and all but one subspecies and genotyped 460 plants representing 109 populations. We tested whether genetic structuring corresponds to geography, as predicted by a parallel adaptation hypothesis, or to altitudinal belt and habitat rather than mountains, as predicted by a hypothesis of a single origin of adaptations. Bayesian and Neighbor-Net analyses showed that the main genetic structure is shallow and largely corresponds to geography, supporting a hypothesis of recent, rapid radiation via parallel altitude/habitat adaptation on different mountains. We also found evidence for intermountain admixture, suggesting several long-distance dispersals by wind across vast areas of unsuitable habitat. The combination of parallel adaptation, secondary contact, and hybridization may explain the complex patterns of morphological variation and the contradicting taxonomic treatments of these rare enigmatic giants, supporting the use of wide taxonomic concepts. Notably, the within-population genetic diversity was very low and calls for increased conservation efforts.

COMPARISON OF RADIATION EXPOSURE TO THE PATIENT AND CONTRAST DETAIL RESOLUTIONS ACROSS LOW DOSE 2D/3D SLOT SCANNER AND TWO CONVENTIONAL DIGITAL RADIOGRAPHY X-RAY IMAGING SYSTEMS.

PURPOSE: To assess and compare the radiation dose and image quality of the low dose 2D/3D EOS slot scanner (LDSS) to conventional digital radiography (DR) X-ray imaging systems for chest and knee examination protocols. METHODS AND MATERIALS: The effective doses (ED) to the patient in the chest and knee clinical examination protocols for LDSS and DR X-ray imaging systems were determined using the dose area product and PCXMC Monte Carlo simulation software. The CDRAD phantom was imaged with 19 cm, and 13 cm thick Polymethyl Methacrylate (PMMA) blocks to simulate the chest and knees respectively of a patient of average adult size. The contrast detail resolution was calculated using image analysis software. RESULTS: The EDs for the LDSS default setting were up to 69% and 51% lower than for the DR systems for the chest (speed 4) and knee (speed 6) protocols, respectively, while for the increased dose level setting then the EDs were up to 42% and 35% lower than for the DR systems for the chest (speed 6) and knee (speed 8) protocols respectively. At the default setting, the contrast detail was lowest for the default setting of the 2D/3D low dose slot scanner (LDSS) for both chest and knee examinations, but at the highest dose levels then the threshold were equal or higher than the contrast resolution of DR imaging systems. CONCLUSION: The LDSS has the potential to be used for clinical diagnosis of chest and knee examinations using the higher dose level. For speed 6 in chest protocol and speed 8 in knee protocol, the measured contrast detail resolution was comparable with the DR systems but at a lower effective dose.