Surgical Outcomes of Full-Endoscopic Lumbar Discectomy in the Early Adoption Phase.

Background We adopted full-endoscopic lumbar discectomy (FELD) in 2019 with the assistance of the Japanese Society for Minimally Invasive and Endoscopic Techniques of Spinal Neurosurgery (JASMETS). This study analyzed short-term outcomes in our initial FELD cases and compared them with microdiscectomy cases performed during the same period. Methods FELD was performed in 21 patients over a period of 2 years and 6 months (15 men and 6 women; mean age, 57.0±17.0 years). The transforaminal approach was performed in 8 patients, the posterolateral approach in 3, and the interlaminar approach in 10. During the same period, microdiscectomy was performed in 30 patients. Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores, operation time, blood loss volume, complications, and incidence of lumbar disc herniation recurrence were compared between the groups. Results Preoperative VAS and JOA scores did not significantly differ between the FELD and microdiscectomy groups. JOA and VAS scores significantly improved in both groups after surgery. Operation time and incidence of recurrence rate did not differ. Conclusion Spine surgeons who adopt FELD can achieve good surgical outcomes similar to those of microdiscectomy, even in the early period. Participation in JASMETS seminars and training and proctoring by a certified endoscopic spine surgeon were instrumental in our experience.

[Attainment of the Lessinvasive Neurospinal Surgery: Full Endoscopic Spinal Surgery].

Full endoscopic spinal surgery(FESS)is the the least invasive surgery among the current spinal surgeries. FESS approach can be used to perform discectomy, decompression for stenosis, posterolateral fusion, etc. with little destruction of the spinal structure and posterior supporting elements, under local or general anesthesia. A major difference from conventional spinal surgeries is "underwater surgery," in which surgery is performed under continuous saline irrigation. In addition, for neurosurgeons, there is a steep learning curve to becoming proficient in using a small diameter endoscope for full-endoscopic surgery as well as performing treatment with the surgical field completely. We would like to explain the indication and surgical procedure of the transforaminal approach, then introduce decompression by FESS at the cervical spine level as well as full endoscopic lateral lumbar interbody fusion(ELIF).

Micro-anatomical structures of the lumbar intervertebral foramen for full-endoscopic spine surgery: review of the literatures.

Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive spinal surgical technique. PELD can be performed via 2 routes, transforaminal (TF) or interlaminar. The TF approach is a well-established modality in the treatment of patients with herniated lumbar discs. This technique makes the most of the space within the intervertebral foramen where, as Kambin claimed, the safe approach to the lesion is possible. Knowledge of the lumbar artery with its branches and various ligaments of anatomies of the intervertebral foramen are needed to perform successful surgeries and to reduce complications.

[Establishment of Endoscopic Spinal Neurosurgery and its Current Status].

Percutaneous endoscopic lumbar discectomy(PELD)has been used as a standard surgical technique for lumbar disc herniation at the Southern TOHOKU Healthcare Group since its introduction in 2009. We present our clinical experiences with PELD for 6 years and discuss the decision-making process for its surgical indication with a review of the pertinent literature. PELD can be performed under both local anesthesia and general anesthesia, and requires only a stab wound for surgery and 3 days of hospitalization. Our surgical results showed generally satisfactory outcomes; however, a salvage surgery was required for 10 of the 96 patients(10.4%)because of early recurrence, insufficient removal of the transligamentous disc fragment, and coexistent canal stenosis. Surgery was discontinued because of unbearable intraoperative pain in one patient each undergoing transforaminal approach and extraforaminal approach under local anesthesia. Although our experience is limited, PELD is considered a promising minimally invasive surgery for lumbar disc herniation. It is generally indicated for patients who are young, sports oriented, or extremely busy. Recurrent disc herniation after microdiscectomy, high risk for general anesthesia, and emergency are considered ideal indications for this technique. Since PELD is a newer technique with a high learning curve, further study, continuous training, and education are required before its widespread implementation. Careful selection of patients is crucial to achieve satisfactory surgical results.

A case of dural arteriovenous fistula draining to the diploic vein presenting with intracerebral hemorrhage.

The authors report an unusual case of a dural arteriovenous fistula (dAVF) draining only to the diploic vein and causing intracerebral hemorrhage. A 62-year-old woman presented with disturbance of consciousness and left hemiparesis. Brain CT scanning on admission showed a right frontal subcortical hemorrhage. Digital subtraction angiography revealed an arteriovenous shunt located in the region around the pterion, which connected the frontal branch of the right middle meningeal artery with the anterior temporal diploic vein and drained into cortical veins in a retrograde manner through the falcine vein. The dAVF was successfully obliterated by percutaneous transarterial embolization with N-butyl-2-cyanoacrylate. The mechanism of retrograde cortical venous reflux causing intracerebral hemorrhage is discussed.

Accuracy evaluation of a Compton X-ray spectrometer with bremsstrahlung X-rays generated by a 6 MeV electron bunch.

A Compton-scattering-based X-ray spectrometer is developed to obtain the energy distribution of fast electrons produced by intense laser and matter interactions. Bremsstrahlung X-rays generated by fast electrons in a material are used to measure fast electrons' energy distribution in matter. In the Compton X-ray spectrometer, X-rays are converted into recoil electrons by Compton scattering in a converter made from fused silica glass, and a magnet-based electron energy analyzer is used to measure the energy distribution of the electrons that recoil in the direction of the incident X-rays. The spectrum of the incident X-rays is reconstructed from the energy distribution of the recoil electrons. The accuracy of this spectrometer is evaluated using a quasi-monoenergetic 6 MeV electron bunch that emanates from a linear accelerator. An electron bunch is injected into a 1.5 mm thick tungsten plate to produce bremsstrahlung X-rays. The spectrum of these bremsstrahlung X-rays is obtained in the range from 1 to 9 MeV. The energy of the electrons in the bunch is estimated using a Monte Carlo simulation of particle-matter interactions. The result shows that the spectrometer's energy accuracy is ±0.5 MeV for 6.0 MeV electrons.

First demonstration of laser engagement of 1-Hz-injected flying pellets and neutron generation.

Pellet injection and repetitive laser illumination are key technologies for realizing inertial fusion energy. Numerous studies have been conducted on target suppliers, injectors, and tracking systems for flying pellet engagement. Here we for the first time demonstrate the pellet injection, counter laser beams' engagement and neutron generation. Deuterated polystyrene (CD) bead pellets, after free-falling for a distance of 18 cm at 1 Hz, are successfully engaged by two counter laser beams from a diode-pumped, ultra-intense laser HAMA. The laser energy, pulse duration, wavelength, and the intensity are 0.63 J per beam, 104 fs, and 811 nm, 4.7 × 10(18) W/cm(2), respectively. The irradiated pellets produce D(d,n)(3)He-reacted neutrons with a maximum yield of 9.5 × 10(4)/4π sr/shot. Moreover, the laser is found out to bore a straight channel with 10 µm-diameter through the 1-mm-diameter beads. The results indicate potentially useful technologies and findings for the next step in realizing inertial fusion energy.

[Outcomes of endoscopic sinus surgery in chronic sinusitis cases complicated/ not complicated by bronchial asthma and eosinophilic infiltration of the sinus mucosa].

BACKGROUND: Intractable sinusitis is, in most cases, complicated by bronchial asthma and severe eosinophilic infiltration of the sinus mucosa. Our aim here was to study the postoperative outcomes of chronic sinusitis complicated/not complicated by bronchial asthma and of cases with eosinophilic sinusitis/non-eosinophilic sinusitis. METHODS: We conducted a prospective analysis of the outcome of 180 patients with or without bronchial asthma and eosinophilic infiltration who underwent endoscopic sinus surgery (ESS) for chronic sinusitis. The patients were divided into four groups by the presence/absence of asthma and presence/absence of eosinophilic infiltration of the sinus mucosa. One surgeon performed the ESS, and all the groups received the same postoperative treatment. RESULTS: The outcomes of ESS were significantly worse in the cases complicated by eosinophilic sinusitis and asthma, especially in relation to the incidence of smell disturbances and the endonasal findings. Patients suffering from chronic sinusitis without asthma showed good improvement following ESS. There was no significant differences in the outcome after ESS between cases of eosinophilic sinusitis and those with non-eosinophilic sinusitis among the patients without asthma. CONCLUSIONS: We contend that eosinophilic sinusitis without asthma may not represent intractable sinusitis. We wish to emphasize that complication by

Hydrogen production by fermentation using acetic acid and lactic acid.

Microbial hydrogen production from sho-chu post-distillation slurry solution (slurry solution) containing large amounts of organic acids was investigated. The highest hydrogen producer, Clostridium diolis JPCC H-3, was isolated from natural environment and produced hydrogen at 6.03+/-0.15 ml from 5 ml slurry solution in 30 h. Interestingly, the concentration of acetic acid and lactic acid in the slurry solution decreased during hydrogen production. The substrates for hydrogen production by C. diolis JPCC H-3, in particular organic acids, were investigated in an artificial medium. No hydrogen was produced from acetic acid, propionic acid, succinic acid, or citric acid on their own. Hydrogen and butyric acid were produced from a mixture of acetic acid and lactic acid, showing that C. diolis. JPCC H-3 could produce hydrogen from acetic acid and lactic acid. Furthermore, calculation of the Gibbs free energy strongly suggests that this reaction would proceed. In this paper, we describe for the first time microbial hydrogen production from acetic acid and lactic acid by fermentation.