Улучшенные модели оценки радиационного риска для отдельных когорт пациентов в Швеции

In radiological diagnostics and therapy, it is important that practitioners, referrers, (i.e. radiologists, radiation oncologists and others in health-care) are aware of how much radiation a patient may receive from the various procedures used and associated health risk. The profession has a duty to inform patients or their representatives of the advantages and disadvantages of specific investigations or treatment plans. The need to estimate and communicate risks in connection with medical use of ionizing radiation is highlighted e.g. in the Russian Federation State Law No 3, §17.2,1996 and in the EU directive (2013/59/EURATOM 2014). The most commonly used way to express harm in relation to low doses of ionizing radiation is use of the quantity effective dose (E). Effective dose, a radiation protection quantity, however is not intended to provide risk estimates for medical exposures. Its purpose is to optimize conditions for radiation workers (18-65 years) or the general public; all groups with age distributions that differ from patients. In this paper the lifetime attributable risk was used to estimate the excess risk of receiving and dying of radiogenic cancer. The lifetime attributable risk estimations are generated from three different variables, gender, attained age and age at exposure giving the possibility to create age and gender specific cancer risk estimations. Initially, the US Environmental Protection Agency lifetime attributable risk coefficients which are intended to predict the cancer risk from ionizing radiation to a normal US population were applied. In this work, the lifetime attributable risk predictions were modified to the normal Swedish population and to cohorts of Swedish patients undergoing radiological and nuclear medicine examinations or treatments with survival times that differfrom the normal population. For Swedish males, all organs were given the same absorbed dose, exposed at 20, 40 and 70 years, the lifetime attributable risk coefficients (Gy-1) were 0.11, 0.068, and 0.038, respectively, which is lower than the corresponding figures for US males, 0.13, 0.077, and 0.040. For Swedish females, all organs were given the same absorbed dose, exposed at 40 years of age with a diagnosis of breast, colon or liver cancer, the lifetime attributable risk coefficients are 0.064, 0.034, and 0.0038, respectively, which is much lower than if a 40 years female without known cancer is exposed, 0.073.В лучевой диагностике и терапии крайне важно, чтобы медицинский персонал (врачи-рентгенологи, лечащие врачи, радиационные онкологи и пр.) имели представление о том, какую дозу облучения получил пациент от различных рентгенорадиологических исследований и с каким риском для здоровья эта доза связана. Медицинский персонал несет ответственность за информирование пациентов и их законных представителей о достоинствах и недостатках выбранных исследований или планов лечения. Так, например, необходимость оценки и коммуникации рисков в контексте использования ионизирующего излучения в медицине особо отмечена в Федеральном законе ФЗ-3 «О радиационной безопасности населения» в Россйской Федерации и в директиве Евросоюза 2013/59/EURATOM 2014. Наиболее распространенным способом выражения вреда от низких доз ионизирующего излучения является использование эффективной дозы, которая, хотя и является основной величиной в радиационной защите, не предназначена для оценки рисков от медицинского облучения. Ее задачей является обеспечение оптимизации радиационной защиты персонала (людей в возрасте 18—65лет) и населения — групп с возрастным распределением, резко отличающимся от возрастных распределений пациентов. В данном исследовании величина пожизненного атрибутивного риска была использована для оценки избыточного риска получить и умереть от радиогенного рака различной нозологии. Оценки значений пожизненного атрибутивного риска основывались на трех переменных: пол, возраст дожития и возраст при облучении, что позволило определить риски развития радиогенного рака с учетом пола и возраста пациентов. Изначально были использованы коэффициенты пожизненного атрибутивного риска, разработанные Агентством по защите окружающей среды США, которые позволяют оценить избыточные радиогенные раки для нормальной популяции США. В данной работе значения коэффициентов пожизненного атрибутивного риска были изменены с учетом специфики здорового шведского населения, а также когорт шведских пациентов, проходящих различные рентгенорадиологические исследования и курсы лучевой терапии, время дожития которых существенно отличалось от такового для обычного населения. Для шведских мужчин, при условии, что все органы организма получили одну и ту же поглощенную дозу и облучение произошло в возрасте 20, 40 и 70 лет, соответствующие коэффициенты пожизненного атрибутивного риска (Гр-1) составили 0,11, 0,068, и 0,038 соответственно, что ниже по сравнению с аналогичными данными для американских мужчин — 0,13, 0,077, и 0,040 соответственно. Для шведских женщин, при условии, что все органы организма получили одну поглощенную дозу и облучение произошло в возрасте 40 лет с диагнозом рака груди, прямой кишки или печени, коэффициенты пожизненного атрибутивного риска (Гр-1) составили 0,064, 0,034, и 0,0038 соответственно, что существенно ниже значения 0,073 в случае облучения 40-летних женщин, у которых диагноз рака установлен не был

Helping and Cooperation in Children with Autism

Helping and cooperation are central to human social life. Here, we report two studies investigating these social behaviors in children with autism and children with developmental delay. In the first study, both groups of children helped the experimenter attain her goals. In the second study, both groups of children cooperated with an adult, but fewer children with autism performed the tasks successfully. When the adult stopped interacting at a certain moment, children with autism produced fewer attempts to re-engage her, possibly indicating that they had not formed a shared goal/shared intentions with her. These results are discussed in terms of the prerequisite cognitive and motivational skills and propensities underlying social behavior

Moonlighting Newborn Screening Markers: The Incidental Discovery of a Second-Tier Test for Pompe Disease

Purpose: To describe a novel biochemical marker in dried blood spots suitable to improve the specificity of newborn screening for Pompe disease. Methods: The new marker is a ratio calculated between the creatine/creatinine (Cre/Crn) ratio as the numerator and the activity of acid α-glucosidase (GAA) as the denominator. Using Collaborative Laboratory Integrated Reports (CLIR), the new marker was incorporated in a dual scatter plot that can achieve almost complete segregation between Pompe disease and false-positive cases. Results: The (Cre/Crn)/GAA ratio was measured in residual dried blood spots of five Pompe cases and was found to be elevated (range 4.41–13.26; 99%ile of neonatal controls: 1.10). Verification was by analysis of 39 blinded specimens that included 10 controls, 24 samples with a definitive classification (16 Pompe, 8 false positives), and 5 with genotypes of uncertain significance. The CLIR tool showed 100% concordance of classification for the 24 known cases. Of the remaining five cases, three p.V222M homozygotes, a benign variant, were classified by CLIR as false positives; two with genotypes of unknown significance, one likely informative, were categorized as Pompe disease. Conclusion: The CLIR tool inclusive of the new ratio could have prevented at least 12 of 13 (92%) false-positive outcomes

Measuring Reciprocity in High Functioning Children and Adolescents with Autism Spectrum Disorders

Few instruments have been developed that measure impairments in reciprocity, a defining feature of autism. We introduce a new test assessing the quality of reciprocal behaviour: the interactive drawing test (IDT). Children and adolescents (n = 49) with and without high functioning autism spectrum disorders (HFASD) were invited to collaborate with an experimenter in making a joint drawing. Within both groups the performance on collaborative reciprocity improved with age. However, compared to the control group, HFASD participants showed less collaborative and more basic reciprocal behaviour and preferred to draw their own objects. They were less tolerant of the experimenter’s input as well. Performance on the IDT was independent of estimated verbal IQ. Reciprocal behaviour in self-initiated objects corresponded with more parental reported autistic traits, while reciprocal behaviour in other-initiated objects corresponded with less autistic traits. The findings of this study suggest that IDT is a promising instrument to assess reciprocity

Children Base Their Investment on Calculated Pay-Off

To investigate the rise of economic abilities during development we studied children aged between 3 and 10 in an exchange situation requiring them to calculate their investment based on different offers. One experimenter gave back a reward twice the amount given by the children, and a second always gave back the same quantity regardless of the amount received. To maximize pay-offs children had to invest a maximal amount with the first, and a minimal amount with the second. About one third of the 5-year-olds and most 7- and 10-year-olds were able to adjust their investment according to the partner, while all 3-year-olds failed. Such performances should be related to the rise of cognitive and social skills after 4 years

Scopolamine Administration Modulates Muscarinic, Nicotinic and NMDA Receptor Systems

Studies on the effect of scopolamine on memory are abundant but so far only regulation of the muscarinic receptor (M1) has been reported. We hypothesized that levels of other cholinergic brain receptors as the nicotinic receptors and the N-methyl-D-aspartate (NMDA) receptor, known to be involved in memory formation, would be modified by scopolamine administration