A predictive score for the result of carbapenem-resistant Enterobacterales and vancomycin-resistant enterococci screening.

BACKGROUND: The duration of extensively drug-resistant bacteria (XDR) carriage depends on several factors for which the information can be difficult to recover. AIM: To determine whether past screening and clinical results of patients can predict the results of subsequent screening. METHODS: In total, 256 patients were retrospectively included from 10 healthcare centres in France from January 2014 to January 2022. We created a predictive clearance score, ranging from -5 to +7, that included the number of XDR species and the type of resistance detected in the sample, as well as the time from the last positive sample, the number of previous consecutive negative samples, and obtaining at least one negative PCR result in the collection. This score could be used for the upcoming rectal screening of a patient carrying an XDR as soon as the last screening sample was negative. FINDINGS: The negative predictive value was >99% for score ≤0. The median time to achieve XDR clearance was significantly shorter for a score of 0 (443 days (259-705)) than that based on previously published criteria. CONCLUSION: This predictive score shows high performance for the assessment of XDR clearance. Relative to previous guidelines, it could help to lift specific infection prevention and control measures earlier. Nevertheless, the decision should be made according to other factors, such as antimicrobial use and adherence to hand hygiene.

Immunology of Aging: the Birth of Inflammaging.

The inflammaging concept was introduced in 2000 by Prof. Franceschi. This was an evolutionary or rather a revolutionary conceptualization of the immune changes in response to a lifelong stress. This conceptualization permitted to consider the lifelong proinflammatory process as an adaptation which could eventually lead to either beneficial or detrimental consequences. This dichotomy is influenced by both the genetics and the environment. Depending on which way prevails in an individual, the outcome may be healthy longevity or pathological aging burdened with aging-related diseases. The concept of inflammaging has also revealed the complex, systemic nature of aging. Thus, this conceptualization opens the way to consider age-related processes in their complexity, meaning that not only the process but also all counter-processes should be considered. It has also opened the way to add new concepts to the original one, leading to better understanding of the nature of inflammaging and of aging itself. Finally, it showed the way towards potential multimodal interventions involving a holistic approach to optimize the aging process towards a healthy longevity.

Novel approach to analysis of the immune system using an ungated model of immune surface marker abundance to predict health outcomes.

Traditionally, the immune system is understood to be divided into discrete cell types that are identified via surface markers. While some cell type distinctions are no doubt discrete, others may in fact vary on a continum, and even within discrete types, differences in surface marker abundance could have functional implications. Here we propose a new way of looking at immune data, which is by looking directly at the values of the surface markers without dividing the cells into different subtypes. To assess the merit of this approach, we compared it with manual gating using cytometry data from the Singapore Longitudinal Aging Study (SLAS) database. We used two different neural networks (one for each method) to predict the presence of several health conditions. We found that the model built using raw surface marker abundance outperformed the manual gating one and we were able to identify some markers that contributed more to the predictions. This study is intended as a brief proof-of-concept and was not designed to predict health outcomes in an applied setting; nonetheless, it demonstrates that alternative methods to understand the structure of immune variation hold substantial progress.

Mechanical behavior and corrosion resistance of sol-gel derived 45S5 bioactive glass coating on Ti6Al4V synthesized by electrophoretic deposition.

The purpose of this work is the synthesis and the characterization of sol-gel derived 45S5 bioactive glass coatings deposited onto Ti6Al4V alloy substrates. This coating aims the improvement of the biocompatibility of metallic implants for use in dentistry and orthopedy. The 45S5 bioactive glass powder was synthetized by the sol-gel process and the coatings were produced by the electrophoretic deposition technique (EPD). A grinding protocol was developed to reduce the particle size distribution of the sol-gel powder in order to obtain a stable suspension needed for the electrophoretic deposition. The particle size distribution of the sol-gel powder was determined using Dynamic Light Scattering (DLS). Different characterization techniques including X-ray diffraction (XRD), Scanning electron microscopy (SEM) associated to X-ray microanalysis (EDXS), were used to investigate the microstructure and the morphology of the coatings before and after an optimized thermal treatment. Homogeneous 45S5 bioactive glass coatings were obtained with no observable defects. However these coatings are functional if they present good mechanical properties. Thus, a mechanical study using nano-indentation and micro-scratch testing was carried out. The obtained results showed that well adherent and cohesive coatings were obtained. The Young's modulus and the hardness are improved with the thermal treatment. Indeed, they increased from 11 ± 0.54 GPa and 100 ± 4.34 MPa respectively to 28 ± 1.34 GPa and 300 ± 14.21 MPa. The corrosion resistance of the coatings was also studied. The electrochemical were carried using a Potentiostat-Galvanostat PGZ301 in 3.5% NaCl solution at 37 °C. It was observed that the 45S5 sol-gel derived bioactive glass coatings allowed the enhancement of corrosion resistance of the implant.

Adipokines and the risk of active TB: a nested case-control study.

BACKGROUND: Adipokines are emerging mediators of immune response, and may affect susceptibility to active TB.OBJECTIVE: To examine the associations between adipokines and the risk of active TB.METHODS: In a case-control study nested within a prospective cohort of middle-aged and older adults in Singapore, 280 incident active TB cases who donated blood for research before diagnosis were matched with 280 controls. Serum levels of adiponectin, resistin, leptin and ghrelin were measured. Multivariable logistic regression models were used to compute the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between adipokines and the risk of active TB.RESULTS: Higher levels of leptin and resistin were associated with reduced risk of TB in a dose-dependent manner. Compared to those in the lowest quartile of leptin levels, those in the highest quartile had an OR of 0.46 (95%CI 0.26-0.82; P for trend = 0.009). Similarly, compared to those in the lowest quartile of resistin levels, those in the highest quartile had an OR of 0.46 (95%CI 0.24-0.90; P for trend = 0.03). Adiponectin and ghrelin levels were not associated with TB risk.CONCLUSION: Increased serum levels of leptin and resistin may be associated with reduced susceptibility to active TB infection.

Immunosenescence is both functional/adaptive and dysfunctional/maladaptive.

Alterations in the immune system with aging are considered to underlie many age-related diseases. However, many elderly individuals remain healthy until even a very advanced age. There is also an increase in numbers of centenarians and their apparent fitness. We should therefore change our unilaterally detrimental consideration of age-related immune changes. Recent data taking into consideration the immunobiography concept may allow for meaningful distinctions among various aging trajectories. This implies that the aging immune system has a homeodynamic characteristic balanced between adaptive and maladaptive aspects. The survival and health of an individual depends from the equilibrium of this balance. In this article, we highlight which parts of the aging of the immune system may be considered adaptive in contrast to those that may be maladaptive.

Granzyme B PET Imaging of Immune Checkpoint Inhibitor Combinations in Colon Cancer Phenotypes.

PURPOSE: Immune checkpoint inhibitor (ICI) monotherapy and combination regimens are being actively pursued as strategies to improve durable response rates in cancer patients. However, the biology surrounding combination therapies is not well understood and may increase the likelihood of immune-mediated adverse events. Accurate stratification of ICI response by non-invasive PET imaging may help ensure safe therapy management across a wide number of cancer phenotypes. PROCEDURES: We have assessed the ability of a fluorine-labelled peptide, [18F]AlF-mNOTA-GZP, targeting granzyme B, to stratify ICI response in two syngeneic models of colon cancer, CT26 and MC38. In vivo tumour uptake of [18F]AlF-mNOTA-GZP following ICI monotherapy, or in combination with PD-1 was characterised and correlated with changes in tumour-associated immune cell populations. RESULTS: [18F]AlF-mNOTA-GZP showed good predictive ability and correlated well with changes in tumour-associated T cells, especially CD8+ T cells; however, overall uptake and response to monotherapy or combination therapies was very different in the CT26 and MC38 tumours, likely due to the immunostimulatory environment imbued by the MSI-high phenotype in MC38 tumours. CONCLUSIONS: [18F]AlF-mNOTA-GZP uptake correlates well with changes in CD8+ T cell populations and is able to stratify tumour response to a range of ICIs administered as monotherapies or in combination. However, tracer uptake can be significantly affected by preexisting phenotypic abnormalities potentially confusing data interpretation.

Impact of ultra-low dose CT acquisition on semi-automated RECIST tool in the evaluation of malignant focal liver lesions.

PURPOSE: To compare the evaluation of malignant focal liver lesions (FLLs) using a semi-automated RECIST tool with a standard and an ultra-low dose (ULD) computed tomography (CT) protocol. MATERIALS AND METHODS: Thirty-four patients with malignant FLLs underwent two abdominal-pelvic CT examinations one using a standard protocol and one using an ULD protocol. There were 23 men and 11 women with a mean age 64.3±14.4 (SD) years (range: 22-91 years). Dosimetric indicators were recorded, and effective dose was calculated for both examinations. Mean malignant FLL attenuation, image noise and contrast-to-noise-ratio (CNR) were compared. The largest malignant FLL per patient was evaluated using the semi-automated RECIST tool to determine longest axis length, longest orthogonal axis length, volume and World Health Organisation area. RESULTS: Dosimetric values were significantly reduced by -56% with ULD compared to standard protocol. No differences in mean malignant FLL attenuation values were found between the two protocols. Image noise was significantly increased for all locations (P<0.05) with ULD compared to standard protocol, and CNR was significantly reduced (P<0.05). On the 34 malignant FLLs analyzed, six semi-automated shapes non-concordant with radiologist's visual impression were highlighted with the software, including one FLL (1/34; 3%) with standard CT acquisition only, three FLLs (3/34; 9%) with ULD CT acquisition only and two FLLs (2/34; 6%) with both CT acquisitions. After manual editing, the concordance of the values of the studied criteria between both acquisitions was good and no significant difference was reported. CONCLUSION: Semi-automated RECIST tool demonstrates good performances using ULD CT protocol. It could be used in routine clinical practice with a ULD protocol for follow-up studies in patients with known malignant FLL.

Optimization of radiation dose for CT detection of lytic and sclerotic bone lesions: a phantom study.

OBJECTIVES: To determine the best compromise between low radiation dose and suitable image quality for the detection of lytic and sclerotic bone lesions of the lumbar spine and pelvis. METHODS: A phantom was scanned using the routine protocol (STD, 13 mGy) and six decreasing dose levels. Raw data were reconstructed using level 3 of iterative reconstruction (IR3) with 1-mm slice thickness for the STD protocol and highest IR levels with 3-mm slice thickness for the others. CTDIvol was used for radiation dose assessment. Quantitative criteria (noise power spectrum [NPS], task-based transfer function [TTF], and the detectability index [d']), as well as qualitative analysis, were used to compare protocols. NPS and TTF were computed using specific software (imQuest). d' was computed for two imaging tasks: lytic and sclerotic bone lesions. A subjective analysis was performed to validate the image quality obtained on the anthropomorphic phantom with the different dose values. RESULTS: Similar d' values were found for CTDIvol from 3 to 4 mGy with IR4 and from 1 to 2 mGy for IR5 compared with d' values using the STD protocol. Image quality was validated subjectively for IR4 but rejected for IR5 (image smoothing). Finally, for the same d', the dose was reduced by 74% compared with the STD protocol, with the CTDIvol being 3.4 mGy for the lumbar spine and for the pelvis. CONCLUSION: A dose level as low as 3.4 mGy, in association with high levels of IR, provides suitable image quality for the detection of lytic and sclerotic bone lesions of the lumbar spine and pelvis. KEY POINTS: • A CTDI volof 3.4 mGy, in association with high iterative reconstruction level, provides suitable image quality for the detection of lytic and sclerotic bone lesions, both at objective and subjective analysis. • Compared with the standard protocol, radiation dose can be reduced up to 74% for the lumbar spine and pelvis. • A task-based image quality assessment using  the detectability index represents an objective method for the assessment of image quality and bridges the gap between complex physical metrics and subjective image analysis.

CT iterative reconstruction algorithms: a task-based image quality assessment.

PURPOSE: To assess the dose performance in terms of image quality of filtered back projection (FBP) and two generations of iterative reconstruction (IR) algorithms developed by the most common CT vendors. MATERIALS AND METHODS: We used four CT systems equipped with a hybrid/statistical IR (H/SIR) and a full/partial/advanced model-based IR (MBIR) algorithms. Acquisitions were performed on an ACR phantom at five dose levels. Raw data were reconstructed using a standard soft tissue kernel for FBP and one iterative level of the two IR algorithm generations. The noise power spectrum (NPS) and the task-based transfer function (TTF) were computed. A detectability index (d') was computed to model the detection task of a large mass in the liver (large feature; 120 HU and 25-mm diameter) and a small calcification (small feature; 500 HU and 1.5-mm diameter). RESULTS: With H/SIR, the highest values of d' for both features were found for Siemens, then for Canon and the lowest values for Philips and GE. For the large feature, potential dose reductions with MBIR compared with H/SIR were - 35% for GE, - 62% for Philips, and - 13% for Siemens; for the small feature, corresponding reductions were - 45%, - 78%, and - 14%, respectively. With the Canon system, a potential dose reduction of - 32% was observed only for the small feature with MBIR compared with the H/SIR algorithm. For the large feature, the dose increased by 100%. CONCLUSION: This multivendor comparison of several versions of IR algorithms allowed to compare the different evolution within each vendor. The use of d' is highly adapted and robust for an optimization process. KEY POINTS: • The performance of four CT systems was evaluated by using imQuest software to assess noise characteristic, spatial resolution, and lesion detection. • Two task functions were defined to model the detection task of a large mass in the liver and a small calcification. • The advantage of task-based image quality assessment for radiologists is that it does not include only complicated metrics, but also clinically meaningful image quality.

PICC management led by technicians: Establishment of a cooperation program with radiologists and evaluation of complications.

PURPOSE: The purpose of this study was to evaluate a cooperation program in order to compare incidence of complications after peripherally inserted central catheter (PICC) placement between radiologists and technicians. MATERIALS AND METHODS: PICC placement technique was standardized with ultrasound-guided puncture and fluoroscopic guidance. Numbers of PICC delegated to technicians, and PICC placement difficulties, were prospectively recorded for the whole study population whereas complications such as PICC infection, deep venous thrombosis and catheter occlusion were prospectively recorded until PICC removal for a subgroup of patients included during one month. RESULTS: A total of 722 patients had PICC placement. There were 382 men and 340 women with a mean age of 66.8±15.8 (SD) years (range: 18-94years); of these, 442/722 patients (61.22%) were included in the cooperation program with 433/722 patients (59.97%) who effectively had PICC placement by technicians and 289/722 (40.03%) by radiologists. Technicians needed radiologists' help for 23/442 patients (5.20%) including 6 failed PICC placement subsequently performed by radiologists. Twenty complications (20/77; 26%) were recorded in the subgroup of 77 patients studied for complications. No differences in complications rate were found between the 33 patients who underwent PICC placement by radiologists (6/33; 18%) and the 44 patients who underwent PICC placement by technicians (14/44; 32%) (P=0.296). Complications included 8 PICC-related infections (8/77; 10.4%), 3 deep venous thromboses (3/77; 3.9%) and 9 catheter occlusions (9/77; 11.7%). CONCLUSION: PICC placement led by technicians is feasible and safe without statistical difference in terms of complications compared to PICC placement made by radiologists.

Asymptomatic carriage of extensively drug-resistant bacteria (eXDR), a simple way to assess spontaneous clearance.

The duration of eXDR carriage depends on several factors that might be difficult to recover. We aim to assess the duration of eXDR carriage by using a simple to recover parameter: the number of consecutive negative screening. 131 eXDR carriers (51 VRE and 80 CPE) were included. The number of consecutive negative screenings was strongly associated with eXDR clearance. All patients displaying at least three negative screenings over a seven-month period were never screened positive thereafter. Taking into account the number of negative screenings as a part of a case-by-case risk assessment would be helpful for the decision to maintain or lift eXDR-focused precautions.

Noise assessment across two generations of iterative reconstruction algorithms of three manufacturers using bone reconstruction kernel.

PURPOSE: To compare the noise-magnitude and noise-texture obtained using strong kernel across two generations of iterative reconstruction (IR) algorithms proposed by three manufacturers. MATERIALS AND METHODS: Five computed tomography (CT) systems equipped with two generations of IR algorithm (hybrid/statistical IR [H/SIR] or full/partial model-based IR [MBIR]) were compared. Acquisitions on Catphan 600 phantom were performed at 120kV and three dose levels (CTDIvol: 3, 7 and 12mGy). Raw data were reconstructed using standard "bone" kernel for filtered back projection and one iterative level of two generations of IR algorithms. Contrast-to-noise ratio (CNR) was computed using three regions of interest placed semi-automatically: two placed in the low-density polyethylene and Teflon inserts and another placed on the solid water. Noise power spectrum (NPS) was computed to assess the NPS-peak and noise-texture. RESULTS: CNR was significantly greater in MBIR compared to H/SIR algorithms for all CT systems (P<0.01). CNR were improved on average from H/SIR to MBIR of 36±14% [SD] (range: 24-57%) for GE-Healthcare, 109±19 [SD] % (range: 89-139%) for Philips Healthcare and 42±5 [SD] % (range: 36-47%) for Siemens Healthineers. The mean NPS peak decreased from H/SIR to MBIR by -41±6 [SD] % (range: -47--35%) for GE Healthcare, -79±3 [SD] % (range: -82--76%) for Philips Healthcare and -52±2 [SD] % (range: -54--51%) for Siemens Healthineers systems. NPS spatial frequencies were greater with MBIR than with H/SIR for Philips Healthcare (20 ± 2 [SD] %; range: 19-22%) and for Siemens Healthineers (9±5 [SD] %; range: 4-14%) but lower for GE Healthcare (-17±3 [SD] %; range: -14--20%). CONCLUSION: Using bone kernel with recent MBIR algorithms reduces the noise-magnitude for all CT systems assessed. Noise texture shifted towards high frequency for Siemens Healthineers and Philips Healthcare but the opposite for GE Healthcare.

Comparison of noise-magnitude and noise-texture across two generations of iterative reconstruction algorithms from three manufacturers.

PURPOSE: To compare the noise-magnitude and noise-texture across two generations of iterative reconstruction (IR) algorithms proposed by three manufacturers according to the dose level. MATERIALS AND METHODS: Five computed tomography (CT) systems equipped with two generations of IR algorithms (hybrid/statistical IR [H/SIR] or full/partial model-based IR [MBIR]) were compared. Acquisitions on Catphan 600 phantom were performed at 120kV and three dose levels (3-, 7- and 12-mGy). Raw data were reconstructed using standard "soft tissue" kernel for filtered back projection and one iterative level of two generations of IR algorithms. Contrast to-noise-ratio (CNR) was computed using three regions of interest: two of them placed in the low-density polyethylene (LDPE) and Teflon® inserts and another placed on the solid water. Noise power spectrum (NPS) was computed to assess the noise-magnitude (NPS peak) and noise-texture (NPS spatial frequency). RESULTS: CNR increased significantly in MBIR compared to H/SIR algorithms for General-Electric (GE) Healthcare (45%±12 [SD]) and Philips Healthcare systems (62%±11 [SD]) (P<0.001). Regarding Siemens Healthineers systems, CNR of MBIR was significantly lower than that of H/SIR (mean difference: -4%±5 [SD]) (P<0.001) for Teflon® insert but not for LDPE insert (mean difference: -4%±7 [SD]) (P=N.S.). NPS peaks were lower with MBIR than with H/SIR for GE Healthcare (-42%±8 [SD]) and Philips Healthcare (-75%±4 [SD]) systems, whereas it was greater with MBIR than with H/SIR for Siemens Healthineers (13%±11 [SD]) systems. NPS spatial frequencies were higher with MBIR than with H/SIR for Siemens (14%±10 [SD]) but lower for others (-17%±5 [SD] for GE Healthineers and -55%±3 [SD] for Philips Healthcare systems). CONCLUSION: This study demonstrates that recent MBIR algorithms, by comparison with the preceding generation, differ according to the main manufacturers with respect to noise-magnitude and noise-texture.

Comparison of bone lesion distribution between prostate cancer and multiple myeloma with whole-body MRI.

PURPOSE: To assess the distribution of bone lesions in patients with prostate cancer (PCa) and those with multiple myeloma (MM) using whole-body magnetic resonance imaging (MRI); and to assess the added value of four anatomical regions located outside the thoraco-lumbo-pelvic area to detect the presence of bone lesions in a patient-based perspective. MATERIALS AND METHODS: Fifty patients (50 men; mean age, 67±10 [SD] years; range, 59-87 years) with PCa and forty-seven patients (27 women, 20 men; mean age, 62.5±9 [SD] years; range, 47-90 years) with MM were included. Three radiologists assessed bone involvement in seven anatomical areas reading all MRI sequences. RESULTS: In patients with PCa, there was a cranio-caudal increasing prevalence of metastases (22% [11/50] in the humeri and cervical spine to 60% [30/50] in the pelvis). When the thoraco-lumbo-pelvic region was not involved, the prevalence of involvement of the cervical spine, proximal humeri, ribs, or proximal femurs was 0% in patients with PCa and≥4% (except for the cervical spine, 0%) in those with MM. CONCLUSION: In patients with PCa, there is a cranio-caudal positive increment in the prevalences of metastases and covering the thoraco-lumbo-pelvic area is sufficient to determine the metastatic status of a patient with PCa. In patients with MM, there is added value of screening all regions, except the cervical spine, to detect additional lesions.

Influence of iterative reconstruction and dose levels on metallic artifact reduction: A phantom study within four CT systems.

PURPOSE: To compare metallic artifact reduction (MAR) algorithms proposed by four vendors according to the delivered dose and iterative level using a phantom study. METHODS: Four CT systems (Revolution GSI®, Ingenuity Elite®, Somatom Edge®, and Aquilion Prime®) equipped with MAR algorithms (Smart MAR®, O-MAR®, iMAR®, and SEMAR®) were compared. Acquisitions were performed with CIRS model 062M Phantom containing a titanium rod core insert using 120kV and two dose levels (3 and 7mGy). Images were reconstructed with and without MAR algorithms using standard "soft tissue" kernel for filtered back projection (FBP) and intermediary iterative level. Artifact propagation was assessed by counting the number of pixels containing a HU outside a defined threshold interval (>100HU and<-80 HU). Artifact correction was evaluated by computing the differences between images with and without MAR. RESULTS: Accuracy of NCT values increased significantly using MAR algorithms, IR, and high dose levels (P<0.001). Image noise reduced -31±15 (SD) % (range: -50%;-14%) with Smart-MAR®, -28±3 (SD) % (range -31%; -25%) with O-MAR®, -32±7 (SD) % (range: -40%; -24%) with iMARCN®, -52±8 (SD) % (range: -60%; -42%) with iMARTH® and -29±6 (SD) % (range: -37%; -23%) with SEMAR®. The number of pixels outside the threshold interval was also reduced using MAR algorithms. Each MAR algorithm corrected in distinct patterns, with satisfactory artifact correction for all MAR algorithms. CONCLUSION: This study demonstrates that artifact correction using MAR algorithms differs according to the main manufacturers, although corrections are satisfactory for all systems. Corrections also improved by using IR and increasing the dose level.

Impact of rapid diagnostic tests on the management of patients presenting with Enterobacteriaceae bacteremia.

OBJECTIVE: Pathogens are usually identified from blood cultures using a two-step procedure: Gram staining on the day of bacterial growth (D0), followed by identification and susceptibility testing the following day (D1). We aimed to evaluate the use of rapid tests performed on D0 in patients presenting with Enterobacteriaceae bacteremia. PATIENTS AND METHODS: Patients with≥1 positive monomicrobial blood culture with Gram staining suggestive of an Enterobacteriaceae were prospectively included. Two successive strategies were evaluated: i) conventional strategy (CS), ii) combination of a rapid identification test and third-generation cephalosporin susceptibility testing (rapid strategy, e.g. RS). RESULTS: Eighty-three patients were included (CS=42; RS=41). Compared with CS, the median delay of identification was significantly shorter with RS (22 hours [20-27] vs. 47 hours [42-53]; P<0.001). Patients in the RS group more frequently received an effective (82.9% vs. 73.8%, P=0.43) and appropriate (70.7% vs. 54.7%, P=0.17) antibiotic therapy on D1. Moreover, all five RS patients infected with a non-susceptible strain received an effective therapy on D1 versus only three of eight CS patients. CONCLUSIONS: Use of rapid testing was associated with a reduced time to result availability. This strategy should be useful to initiate an early effective and appropriate therapy and to improve the care of patients.

Patient dose reference levels in surgery: a multicenter study.

OBJECTIVE: To assess diagnostic reference levels (DRLs) in surgery for the most frequent procedures as required by the European Directive 2013/59/Euratom. METHODS: A survey was conducted in six centers. Eight orthopedic, urology and gastrointestinal surgical procedures were analyzed. Kerma area product (KAP) and fluoroscopy time (FT) were recorded for 50 patients (except for elbow: 30 patients) per procedure and per center from September 2016 to September 2017. DRLs were calculated as the 3rd quartiles of the distributions. For shoulder surgery, DRLs were defined according to the complexity of the procedure. For hand/wrist and foot/ankle surgery, DRLs were defined according to the technology (conventional C-arm vs. mini-C-arm). RESULTS: Results of 1870 procedures were retrieved. DRLs were calculated for the two dosimetric indicators and the eight procedures. DRLs were 2130 mGy.cm2 and 1.4 min for proximal femoral intramedullary nail, 1185 mGy.cm2 and 0.9 min for laparoscopic cholecystectomy and 2195 mGy.cm2 and 1.0 min for double-J (pigtail) ureteral catheter insertion. For shoulder surgery, KAP and FT were significantly higher (p < 0.05) for intramedullary procedures compared to extramedullary procedures. For hand/wrist and foot/ankle surgery, the KAPs were significantly higher (p < 0.05) with conventional C-arm compared to mini-C-arm, but FTs were not significantly different (p: not significant). CONCLUSION: This study reports DRLs in surgery based on a multicentric survey. KEY POINTS: • Delivered dose in surgery depends on procedure, practice and patient. • Diagnostic reference levels (DRLs) are proposed for eight surgical procedures. • DRLs are useful to benchmark practices and optimize protocols.

Effect of direct fed microbial in layer diets, on egg laying performance and health response of indigenous Ghanaian guinea fowls (Numida meleagris).

The aim of the present experiment was to examine the effect of direct fed microbial (DFM) on egg laying performance and health response of indigenous Ghanaian guinea fowls (Numida meleagris). A total of 216, 9-wk-old guinea keets (already sexed) were randomly assigned to 4 DFM administering treatments. These included control, daily, 3 consecutive days per week, and 7 d repeated every other week at 1.5 mL/L through water for 30 wk. Feed intake, body weight gain, feed conversion ratio, egg weight, yolk weight, egg albumen weight, shell weight, shell thickness, mortality, hematological and serum biochemical parameters were recorded. Birds on daily DFM treatment consumed the least feed (P = 0.007) with an increased weight gain (P = 0.009). Hen-day egg production, eggshell thickness and eggshell weight, albumen weight, albumen height, yolk weight, and yolk height were not different between treatments (P > 0.05). Egg weight was higher in daily supplementation of DFM in water than other treatments (P < 0.0001). Serum albumin was higher (P = 0.024) in daily DFM treatment, whereas serum low-density lipoprotein (LDL) cholesterol concentration was reduced (P = 0.017). The results showed that supplementing DFM daily at 1.5 mL/L of water resulted in increased total proteins and albumin as well as reduced LDL cholesterol. It could be concluded that these health indices increased the quality of guinea fowls eggs and may have improved the hatchability of eggs in the 1.5 mL/L DFM supplementation and there the supplementing DFM daily at 1.5 mL/L is recommended in Guinea fowls to increase hatchling numbers.

Correction to: Patient dose reference levels in surgery: a multicenter study.

The original version of this article, published on 01 August 2018, unfortunately contained two mistakes.