Κυριακή, 21 Αυγούστου 2016

Sequencing: A sparkling standard

Nature Reviews Genetics. doi:10.1038/nrg.2016.113

Author: Darren J. Burgess

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Three-dimensional analysis of jaw kinematic alterations in patients with chronic TMD – disc displacement with reduction


The study investigated whether chronic TMD patients with disc displacement with reduction (DDR), performing non-assisted maximum jaw movements, presented any changes in their mandibular kinematics with respect to an age-matched control group. Moreover, it was examined whether jaw kinematics and a valid clinic measure of oro-facial functional status have significant associations. Maximum mouth opening, mandible protrusion and bilateral laterotrusions were performed by 20 patients (18 women, 2 men; age, 18–34 years) and 20 healthy controls (17 women, 3 men; age, 20–31 years). The three-dimensional coordinates of their mandibular interincisor and condylar reference points were recorded by means of an optoelectronic motion analyser and were used to quantitatively assess their range of motion, velocity, symmetry and synchrony. Three functional indices (opening–closing, mandibular rototranslation, laterotrusion – right and left – and protrusion) were devised to summarise subject's overall performance, and their correlation with the outcome of a clinical protocol, the oro-facial myofunctional evaluation with scores (OMES), was investigated. TMD patients were able to reach maximum excursions of jaw movements comparable to healthy subjects' performances. However, their opening and closing mandibular movements were characterised by remarkable asynchrony of condylar translation. They had also reduced jaw closing velocity and asymmetric laterotrusions. The functional indices proved to well summarise the global condition of jaw kinematics, highlighting the presence of alterations in TMD-DDR patients, and were linearly correlated with the oro-facial functional status. The jaw kinematic alterations seem to reflect both oro-facial motor behaviour adaptation and a DDR-related articular impairment.

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Longitudinal association of dentition status with dietary intake in Japanese adults aged 75 to 80 years


Limited information is available on the temporal association between dentition status and dietary intake. The aim of this 5-year prospective cohort study was to investigate whether impaired dentition was associated with subsequent decline in dietary intake in older Japanese adults. Two hundred and eighty-six community-dwelling Japanese individuals, all aged 75 years at baseline, were included in the study. Functional tooth units (FTUs), defined as a pair of opposing natural or prosthetic teeth excluding third molars (range: 0–14), were counted on the basis of baseline dental examinations. Individuals with ≤5 FTUs were defined as having impaired dentition. Dietary intake was assessed at baseline and 5 years later, using a validated dietary questionnaire. Robust regression analyses were used to evaluate the differences in change in dietary intake between participants with and without impaired functional dentition, after adjustment for potential confounders. Sixty-one study participants (21·3 %) were defined as having impaired dentition. Overall, mean values for all estimated dietary variables (energy, nutrients and food groups) declined over time. Notably, individuals with impaired dentition demonstrated a significantly (P < 0·05) greater degree of decline in the intake of multiple nutrients (protein, sodium, potassium, calcium, vitamin A, vitamin E and dietary fibre) and food groups (vegetable and meat) than those without impaired dentition, after adjusting for potential confounders. The results of this study describe the temporal association of impaired dentition with the decline in selected nutrient and food group intake among older Japanese adults.

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Why not stop looking at bruxism as a black/white condition? Aetiology could be unrelated to clinical consequences

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Pa. photographers offer free family photos for first responders

By Amy Marchiano
The Republican & Herald

SCHUYLKILL HAVEN, Pa. — Wanting to recognize first responders for their contribution to the community, photographers invited them and their families to a free photo shoot.

Ashley Farr, Jen Shaeffer and Melanie Runkle, all of Schuylkill Haven, snapped photos during the Free Photos for First Responders event at Bubeck Park on Friday. Families were invited to take five to six photos during the event.

"They don't even think twice (about responding to 911 calls). I just want them to know that they are respected and appreciated," Farr said.

Farr said she wanted to host the event after she was moved by reading a post online about a wife of a police officer who took a photo of her husband and their children everyday before he went to work.

"They will never know when they will have their last photo," Farr said.

The photos were available for firefighters, police, EMS or correction officers. Farr said the goal was to take photos of 25 families.By 5:30 p.m., at least 10 families attended the event.

A local company donated free 8-by-10 photos for families. Amanda Morris of Triple A Cakes donated and distributed cupcakes.

A corporal from the state police at Schuylkill Haven and his family were the first to get their pictures taken.

Also attending the event were Connie Showalter, 48, of Spring Township, Berks County, and her husband, Sgt. Sean Showalter, 48, of the Northern Berks Regional Police Department, Reading. With them were their children, Ryan, 19, and Kiera, 16. Connie appreciates the chance to get photos of her family.

"When he walks out the door, there is no guarantee he is coming home," she said, which changes your whole perspective on life.

Showalter, who was dressed in his police uniform, said he has been with the police department for 14 years. He appreciated the generosity of the community. He doesn't get a lot of thanks for the job he does but doesn't expect a lot either.

He wants people to know that "we are not bad people. We are just trying to keep order. Without the police it would be chaotic," he said.

Chris Dampman, 32, assistant chief of the Port Clinton Fire Department, was there with his daughter, Serenade Dampman, 8, of Shartlesville, Berks County. Serenade wore his helmet while he wore his turnout gear.

Dampman said he has been with the fire department for 10 years, two as assistant chief, two as captain and six years as a firefighter.

"It's rewarding to help the public out," he said, adding the fire department is always in need of volunteers.

He appreciates that others are giving their time to capture memories for people they might not even know.

Schuylkill EMS paramedic Edward Lizewski, 23, of Pine Grove, and his wife, Brittney, 23, and their children, Landen, 1, Sophia, 3, and Alexandrea, 7, sat on a bench for one of their photos.

"Make sure you smile," Brittney said to her daughters.

Lizewski said he loves what he does, although the hours can be long and that he worked a 12-hour-shift Thursday.

"I love being able to go out and help people and make a difference if they are sick or injured," he said.

Brittney said events like Friday shows the community cares and supports the first responders.

Farr said the photos will be available possibly within a week and that she would like to have another event in the spring at Bubeck Park for those who could not attend Friday.

Copyright 2016 the Republican & Herald

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Can neurologic examination predict pathophysiology of ulnar neuropathy at the elbow?


Publication date: October 2016
Source:Clinical Neurophysiology, Volume 127, Issue 10
Author(s): Gregor Omejec, Tomaž Žgur, Simon Podnar
ObjectiveTo explore the utility of neurologic examination to predict the pathophysiology of ulnar nerve lesions in patients with ulnar neuropathies at the elbow (UNE).MethodsWe prospectively recruited consecutive patients with suspected UNE. Four blinded investigators took a history and performed neurologic, electrodiagnostic (EDx) and ultrasonographic (US) examinations. In patients with axonal UNE, conduction block and conduction slowing, the pathophysiologies of UNE and neurologic examination findings were compared.ResultsWe found significant differences in muscle bulk and strength of the ulnar hand muscles between 96 arms with axonal UNE, 34 with conduction block, and 45 with isolated conduction slowing. Severe muscle atrophy and weakness (0–3/5 on MRC) predicted axonal UNE, and moderate weakness (−4/5 on MRC) with normal muscle bulk predicted UNE with conduction block. Using more restrictive criteria for axonal and conduction block UNE, muscle strength of 4–5/5 on MRC was predictive of isolated conduction slowing.ConclusionAlthough we found significant differences in patterns of muscle bulk and strength between groups of UNE patients with different UNE pathophysiologies, in the majority of arms, neurologic examination could not reliably predict UNE pathophysiology.SignificanceResults confirm that nerve conduction studies are essential for determination of the pathophysiology of ulnar neuropathy at the elbow.

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Exploring 222Rn as a tool for tracing groundwater inflows from eskers and moraines into slope peatlands of the Amos region of Quebec, Canada


Publication date: November 2016
Source:Journal of Environmental Radioactivity, Volume 164
Author(s): Laureline Berthot, Daniele L. Pinti, Marie Larocque, Sylvain Gagné, Miryane Ferlatte, Vincent Cloutier
Peatlands can play an important role in the hydrological dynamics of a watershed. However, interactions between groundwater and peat water remain poorly understood. Here, we present results of an exploratory study destined to test radon (222Rn) as a potential tracer of groundwater inflows from fluvioglacial landform aquifers to slope peatlands in the Amos region of Quebec, Canada. 222Rn occurs in groundwater but is expected to be absent from peat water because of its rapid degassing to the atmosphere. Any 222Rn activity detected in peat water should therefore derive from groundwater inflow. 222Rn activity was measured in groundwater from municipal, domestic wells and newly drilled and instrumented piezometers from the Saint-Mathieu-Berry and Barraute eskers (n = 9), from the Harricana Moraine (n = 4), and from the fractured bedrock (n = 3). Forty measurements of 222Rn activity were made from piezometers installed in five slope peatlands, along six transects oriented perpendicular to the fluvioglacial deposits. The relationship between 222Rn and total dissolved solids (TDS) measured in water from the mineral deposits underlying the peat layer suggests that 222Rn is introduced by lateral inflow from eskers and moraine together with salinity. This input is then diluted by peat water, depleted in both TDS and 222Rn. The fact that a relationship between TDS and 222Rn is visible calls for a continuous inflow of groundwater from lateral eskers/moraines, being 222Rn rapidly removed from the system by radioactive decay. Although more research is required to improve the sampling and tracing techniques, this work shows the potential of 222Rn tracer to identify groundwater inflow areas from granular aquifers found in eskers and moraines to slope peatlands.

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Exposure to tritiated water at an elevated temperature: Genotoxic and transcriptomic effects in marine mussels (M. galloprovincialis)


Publication date: November 2016
Source:Journal of Environmental Radioactivity, Volume 164
Author(s): Lorna J. Dallas, Tim P. Bean, Andrew Turner, Brett P. Lyons, Awadhesh N. Jha
Temperature is an abiotic factor of particular concern for assessing the potential impacts of radionuclides on marine species. This is particularly true for tritium, which is discharged as tritiated water (HTO) in the process of cooling nuclear institutions. Additionally, with sea surface temperatures forecast to rise 0.5–3.5 °C in the next 30–100 years, determining the interaction of elevated temperature with radiological exposure has never been more relevant. We assessed the tissue-specific accumulation, transcriptional expression of key genes, and genotoxicity of tritiated water to marine mussels at either 15 or 25 °C, over a 7 day time course with sampling after 1 h, 12 h, 3 d and 7d. The activity concentration used (15 MBq L−1) resulted in tritium accumulation that varied with both time and temperature, but consistently produced dose rates (calculated using the ERICA tool) of <20 Gy h−1, i.e. considerably below the recommended guidelines of the IAEA and EURATOM. Despite this, there was significant induction of DNA strand breaks (as measured by the comet assay), which also showed a temperature-dependent time shift. At 15 °C, DNA damage was only significantly elevated after 7 d, in contrast to 25 °C where a similar response was observed after only 3 d. The transcription profiles of two isoforms of hsp70, hsp90, mt20, p53 and rad51 indicated potential mechanisms behind this temperature-induced acceleration of genotoxicity, which may be the result of compromised defence. Specifically, genes involved in protein folding, DNA double strand break repair and cell cycle checkpoint control were upregulated after 3 d HTO exposure at 15 °C, but significantly downregulated when the same exposure occurred at 25 °C. This study is the first to investigate temperature effects on radiation-induced genotoxicity in an ecologically relevant marine invertebrate, Mytilus galloprovincialis. From an ecological perspective, our study suggests that mussels (or similar marine species) exposed to increased temperature and HTO may have a compromised ability to defend against genotoxic stress.

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Effects of the nuclear disaster on marine products in Fukushima: An update after five years

Publication date: November 2016
Source:Journal of Environmental Radioactivity, Volume 164
Author(s): Toshihiro Wada, Tsuneo Fujita, Yoshiharu Nemoto, Shinya Shimamura, Takuji Mizuno, Tadahiro Sohtome, Kyoichi Kamiyama, Kaoru Narita, Masato Watanabe, Nobuyuki Hatta, Yasuo Ogata, Takami Morita, Satoshi Igarashi
Original data (134Cs and 137Cs, and sampling location) of marine products in Fukushima Prefecture monitored during 2011–2015 (n = 32,492) were analyzed to present an updated detailed description of radiocesium contamination after the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident and to examine taxon/habitat-specific decreasing trends in different areas. Furthermore, marine species data presented by the Tokyo Electric Power Company (TEPCO) during 2012–2015 (n = 5458) were analyzed to evaluate the decreasing trends of 137Cs inside and outside (within a 20 km radius) of the FDNPP port. Monitoring results by Fukushima Prefecture show that percentages of samples higher than the Japanese regulatory limit of 100 Bq kg−1-wet (>RL%) were higher, whereas those below the detection limit (<DL%) (mean 8.3 and 7.4 Bq kg−1-wet for 134Cs and 137Cs, respectively) were lower in demersal fishes than in pelagic fish or other taxa. However, >RL% and <DL% of demersal fish respectively decreased dramatically and increased gradually to 0.06% and 86.3% in 2015, although slightly elevated radiocesium concentrations were still observed in shallow areas south of the FDNPP. The drastic decrease in radioactivity was supported by the spatiotemporal distribution of radiocesium concentrations in demersal fish, in which higher concentrations that were frequently observed in 2011 and 2012 were rarely detected in 2015, even within the 20 km radius area (maximum 220 Bq kg−1-wet in Japanese rockfish Sebastes cheni). Statistical analyses of TEPCO data revealed that 137Cs concentrations both inside and outside of the FDNPP port decreased exponentially with time: The respective geometric mean days of ecological half-lives were 218 d and 386 d. These results show clearly that the contamination level of marine products in Fukushima Prefecture, even within the 20 km radius area, has decreased drastically during the five years after the FDNPP accident, although 137Cs concentrations higher than 10 kBq kg−1-wet were still detected in some specimens of sedentary rockfishes (S. cheni, Sebastes oblongus, and Sebastes pachycephalus) in the FDNPP port. Fishing operations started on a trial basis in June 2012 have gradually expanded the target areas and species. Careful monitoring should be continued to accelerate the restoration of coastal fisheries in Fukushima Prefecture.

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Novel method of measurement of radon exhalation from building materials

Publication date: November 2016
Source:Journal of Environmental Radioactivity, Volume 164
Author(s): A. Awhida, P. Ujić, I. Vukanac, M. Đurašević, A. Kandić, I. Čeliković, B. Lončar, P. Kolarž
In the era of the energy saving policy (i.e. more air tight doors and windows), the radon exhaled from building materials tends to increase its concentration in indoor air, which increases the importance of the measurement of radon exhalation from building materials. This manuscript presents a novel method of the radon exhalation measurement using only a HPGe detector or any other gamma spectrometer. Comparing it with the already used methods of radon exhalation measurements, this method provides the measurement of the emanation coefficient, the radon diffusion length and the radon exhalation rate, all within the same measurement, which additionally defines material's radon protective properties. Furthermore it does not necessitate additional equipment for radon or radon exhalation measurement, which simplifies measurement technique, and thus potentially facilitates introduction of legal obligation for radon exhalation determination in building materials.

Graphical abstract


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Current status of post-operative antibiotic prophylaxis in surgical wards

Source: National Journal of Physiology, Pharmacy and Pharmacology
Tejas Khakhkhar, Rima Shah, K. G. Hemavathi.
Background: Appropriate antibiotic prophylaxis can reduce the risk of post-operative wound infections, but misuse and overuse of antibiotics increase cost and emergence of resistant bacteria. Despite the existence of general recommendations for antibiotic prophylaxis, many deviations from these recommendations are still reported notably for antibiotic choice and duration of prophylactic administration. Objective: This study was conducted to evaluate the pattern of post-operative prophylactic antibiotics in surgical wards at Dhiraj Hospital, a tertiary care teaching hospital attached with SBKS Medical Institute and Research Center, Piparia, Vadodara, Gujarat, India. Materials and Methods: In this prospective observational study, a total of 200 patients from various surgical wards were included. Pretested pro forma which included information on choice of antimicrobial agents as well as their route, number and total duration of prophylaxis were completed. Furthermore, appropriateness of antibiotic prophylaxis was assessed as per standard guidelines. Results: All the patients received post-operative antibiotic doses. The majority of patients (98, 49%) were prescribed three antibiotics. Most of the post-operative use of antibiotics was not as per standard guidelines in terms of choice of antibiotics and total duration of treatment. The patients received post-operative antibiotics for a mean duration of 9.84 days during their hospital stay. Conclusion: In spite of existence of the written guidelines for antimicrobial surgical prophylaxis, there are significant deviations from the recommendations in current clinical practice. To promote the rational use of antibiotics in surgical prophylaxis, implementation of and adherence to evidence-based guidelines and recommendations for antimicrobial surgical prophylaxis is strictly required.

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Perception of family medicine residents towards use of portfolio in their assessment in joint program of family medicine, Jeddah, Saudi Arabia, 2015

Source: International Journal of Medical Science and Public Health
Ahmad A Algarni, Sulaiman Anagreyyah, Mubarak Al-Mansour, Salwa Alaidarous.
Background: Recently, medical education all over the world transfer from the measure of ability of student to recall information towards evaluation of student performing under simulation or real life. One of the new methods of assessment is portfolio. Objective: To assess the perception of family medicine residents and trainees in joint program of family medicine in Jeddah toward use of portfolio in their assessment as well as to identify the barriers to use portfolio as a tool of assessment. Materials and Methods: A quantitative cross sectional survey was done including all residents and trainees enrolled in training from level 1 to level 4 in joint program of family medicine in Jeddah for the academic year 20152016. Total number of residents is 110 (males and females). Data were collected by a self-administered valid and reliable questionnaire. It is composed of two parts; first part includes inquiry about demographic data of the residents and second part consist of 23 items inquires about information regarding perception of residents towards use of portfolio. Result: The study included 120 physicians. Majority of them (95%) aged between 25 and 34 years. Females represent 60% of them. Nearly half of the family medicine residents (46.7%) reported attending any course regarding portfolio. The highest agreed upon statement regarding use of portfolio was that writing the portfolio is a stressful process (weighted mean 4.22±1.10) whereas the lowest agreed upon statements were the portfolio should be part of every medical program (weighted mean 1.96±1.00), and enjoying writing the portfolio (weighted mean 1.92±0.93). The overall portfolio score ranged between 0 and 44 with a mean of 14.08 and standard deviation of 10.26. The only significantly associated factor with perception score was level of training as family medicine residents and trainees of the first training level had perception toward use of portfolio score significantly higher than those of higher levels of training, p

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Promoting Authentic Learning for Our Students

Probably more than any other profession, nursing has recognized that "learning by doing" is one of the most effective ways to learn. Historically, educating nurses was accomplished through highly structured apprenticeship models at training schools. Fortunately, we have moved away from that model, and nursing education is now appropriately situated in colleges and graduate schools. Yet we have not lost sight of the value of learning by doing, and largely thanks to the Internet, we now have at our disposal a variety of communication, visualization, and simulation technologies that provide students with authentic learning experiences that promote creativity, experimentation, and real-world problem solving.

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Table of Contents

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You Hold the Key to Improving the Well-Being of Children

The challenges of providing comprehensive, family-centered care to all children in a rapidly changing health care delivery system continue to grow. The scope of practice of pediatric advanced practice nurses and the diversity of settings in which our practitioners are employed continue to evolve to meet the ever-changing health care needs of children and families (American Nurses Association, National Association of Pediatric Nurse Practitioners, & Society of Pediatric Nurses, 2015). In my opinion, our expert pediatric knowledge coupled with the application of both the art and science of nursing make us uniquely qualified to lead in devising solutions for these challenges.

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Open Mouth, Open Mind: Expanding the Role of Primary Care Nurse Practitioners

Oral health is essential to overall health at any age, although in children it is particularly important because poor oral health can have a deleterious effect on deciduous and permanent dentition. For decades, oral health providers have urged primary care providers to incorporate oral health assessment, risk factor identification, parent education, and preventive therapy into routine well-child visits. Despite recommendations from various professional associations and governmental organizations, the incidence of dental disease in young children remains relatively unchanged.

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Editorial Board

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Open Mouth, Open Mind: Expanding the Role of Primary Care Nurse Practitioners

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NAPNAP Position Statement on Child Maltreatment

A goal of the National Association of Pediatric Nurse Practitioners (NAPNAP) is to enhance the quality of health care for infants, children, and adolescents. To achieve this purpose, NAPNAP promotes the provision of a safe, caring, and healthy environment that contributes to optimal growth and development of children from infancy to adulthood.

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Information for Readers

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Maternal Nutrition During Pregnancy: Intake of Nutrients Important for Bone Health


Objectives Maternal nutrition during pregnancy plays an important role in predisposing offspring to the development of chronic disease in adulthood, including osteoporosis. Our aim was to investigate maternal dietary intakes during pregnancy, with a focus on nutrients important for skeletal development in the offspring. Methods In this case–control study, cases were pregnant women recruited for the Vitamin D in Pregnancy Study (n = 350, age 20–40 years) and controls were non-pregnant peers participating in the Geelong Osteoporosis Study (n = 305, age 20–40 years). Dietary intakes of nutrients were quantified using a validated food frequency questionnaire. Results Compared to controls, cases consumed more energy [median (interquartile range): 7831 (6506–9461) vs. 7136 (6112–8785) kJ/day]; median intakes for cases were greater for carbohydrates [206.2 (172.5–249.9) vs. 188.2 (147.7–217.5) g/day], fat [77.9 (60.3–96.6) vs. 72.1 (53.3–87.4) g/day], potassium [2860 (2363–3442) vs. 2606 (2166–3442) mg/day] and calcium [1022 (819–1264) vs. 918 (782–1264) mg/day] (all p ≤ 0.05). However, pregnant women were not consuming greater amounts of those nutrients which had an increased demand (protein, magnesium, phosphorus and zinc). Similarly, this translated to the likelihood of achieving national recommendations for corresponding nutrients. Conclusions for Practice Compared to their non-pregnant peers, pregnant women were more likely to meet dietary recommendations for calcium and potassium; however, this was not the pattern observed for protein, magnesium and zinc. Future public health messages should perhaps focus on increasing awareness of the importance of all these nutrients during pregnancy.

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Cataractogenesis following high-LET radiation exposure

Publication date: Available online 20 August 2016
Source:Mutation Research/Reviews in Mutation Research
Author(s): Nobuyuki Hamada, Tatsuhiko Sato
Biological effectiveness of ionizing radiation differs with its linear energy transfer (LET) such that high-LET radiation is more effective for various biological endpoints than low-LET radiation. Human exposure to high-LET radiation occurs in cancer patients, nuclear workers, aviators, astronauts and other space travellers. From the radiation protection viewpoint, the ocular lens is among the most radiosensitive tissues in the body, and cataract (a clouding of the normally transparent lens) is classified as tissue reactions (formerly called nonstochastic or deterministic effects) with a threshold below which no effect would occur. To prevent radiation cataracts, the International Commission on Radiological Protection (ICRP) has recommended an equivalent dose limit for the lens according to the threshold for vision-impairing cataracts. ICRP recommended the threshold of >8Gy in 1984 and an occupational dose limit of 150 mSv/year in 1980. These remained unchanged until 2011, when ICRP recommended lowering the threshold to 0.5Gy and the dose limit to 20 mSv/year (averaged over 5 years with no single year exceeding 50 mSv). Although such reduction of the threshold was based on findings from low-LET radiation, the dose limit was recommended in Sv. Historically, the lens is the exceptional tissue for which ICRP had assigned a special factor in addition to a general radiation weighting factor, predicated on a belief that the lens is more vulnerable to high-LET radiation than other tissues. Considering such radiosensitive nature of the lens, a deeper understanding of a cataractogenic potential of high-LET radiation is indispensable. This review is thus designed to provide an update on the current knowledge as to high-LET radiation cataractogenesis. To this end, changes in ICRP recommendations on lenticular radiation protection, epidemiological and biological findings on high-LET cataractogenesis are reviewed, and future research needs are then discussed.

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Burst firing of single neurons in the human medial temporal lobe changes before epileptic seizures

Epilepsy is not a disease in and of itself, but a chronic condition of the brain characterized by paroxysmal and recurrent epileptic events that occur as a result of chronic structural and/or functional changes. A number of studies have investigated seizure initiation at a neuronal population level using EEG or local field potential (LFP) recordings both in humans and animal models of epilepsy (Szabo et al. 2015). However, it is not possible to extrapolate meaningfully from this population level to the behavior of its cellular elements, even though they underlie this activity.

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Optimal cervical screw insertion angle determined by means of CT scans pre- and postoperatively

Cervical pedicle screw (CPS) insertion is technically demanding and carries a risk of serious neurovascular complications when screws perforate. To avoid such serious risks, we currently perform CPS insertion using a computed tomography (CT)-guided navigation system. However, there remains a low probability of screw perforation during CPS insertion that is affected by factors such as CPS insertion angle and anatomical pedicle transverse angle (PTA).

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The efficacy of interlaminar epidural steroid administration in multilevel intervertebral disc disease with chronic low back pain; a randomized, blinded, prospective study

Epidural steroid injection is commonly used in patients with chronic low back pain. Applying a mixture of alocal anesthetic (LA) and steroid using the interlaminar (IL), transforaminal (TF), and caudal techniques is a preferred approach.

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