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Background: Diagnostic reference levels are radiation dose levels in medical radiodiagnostic practices for typical examinations for groups of standard-sized individuals for broadly defined types of equipment. This study aimed to contribute to national diagnostic reference levels for common hand and wrist procedures using mini C-arm fluoroscopy. Small joint and digital fracture procedure diagnostic reference levels have not been reported in significant numbers previously with procedure-level stratification. Methods: Data were collected from fluoroscopy logbooks and were cross-referenced against the audit log kept on fluoroscopy machines. A total of 603 procedures were included. Results: The median radiation dose for wrist fracture open fixation was 2.73 cGycm2, Kirschner wiring (K-wiring) procedures was 2.36 cGycm2, small joint arthrodesis was 1.20 cGycm2, small joint injections was 0.58 cGycm2, and phalangeal fracture fixation was 1.05 cGycm2. Conclusions: Wrist fracture fixation used higher radiation doses than phalangeal fracture fixation, arthrodeses, and injections. Injections used significantly less radiation than the other procedures. There are significant differences in total radiation doses when comparing these procedures in hand and wrist surgery. National and international recommendations are that institutional audit data should be collected regularly and should be stratified by procedure type. This study helps to define standards for this activity by adding to the data available for wrist fracture diagnostic reference levels and defining standards for digital and injection procedures. [ABSTRACT FROM AUTHOR]

The article examines the pro-life petitions that advocates brought before the Court from Justice Kavanaugh's confirmation until the Court granted certiorari in U.S. Supreme Court case June Medical Services v. Russo on abortion. It mentions about opinions in June Medical of the five conservative justices. It also mentions that the best way to fight for life is to directly attack Roe v. Wade and Planned Parenthood v. Casey because the justices are open to such a challenge.

The article critically analyzes the decision of the U.S. Supreme Court case of Pliva, Inc. v. Mensing in which the state failed to warn the claims against generic drug manufacturers. It depicts Justice Thomas remark in context to the above case in which he informed that majority's hands were tied by the supremacy of federal law. It analyzes the role of the U.S. Food and Drug Administration (FDA) in drug approval and drug label changes which plays a vital role in interpreting the above case.

Objectives To examine the extent of brain abnormality in patients with coeliac disease referred for neurological opinion and evaluate MR imaging sequences as biomarkers for neurological dysfunction, given the lack of readily available serological markers of neurological disease in this cohort Methods Retrospective examination of a consecutive cohort of patients (n=33, mean age=44±13 years (range 19±64)) with biopsy proven coeliac disease referred for neurological opinion. Patients were divided into subgroups based on their primary neurological complaint (balance disturbance, headache and sensory loss). 3T MR was used to evaluate differences in brain grey matter density, cerebellar volume, cerebellar neurochemistry and white matter abnormalities (WMAs) between subjects and controls. Results Cerebellar volume was significantly less in the patient group than in controls (6.960.7% vs 7.460.9% of total intracranial volume, p<0.05). Significantly less grey matter density was found in multiple brain regions, both above and below the tentorium cerebelli, than in controls (p<0.05). 12 (36%) patients demonstrated WMAs unexpected for the patient's age, with the highest incidence occurring in the headache subgroup. This subgroup averaged almost twice the number of WMAs per MR imaging than the subgroup with balance disturbance and six times more than the subgroup with sensory loss. Conclusion Patients with established coeliac disease referred for neurological opinion show significant brain abnormality on MR imaging. MR imaging may provide valuable biomarkers of disease in this patient cohort. [ABSTRACT FROM AUTHOR]