Radiation exposure doses to the surgical team during hip surgery is significantly higher during lateral imaging than posteroanterior imaging: a cadaveric simulation study.

BACKGROUND: Fluoroscopy is indispensable when determining appropriate and effective interventions in orthopedic surgery. On the other hand, there is growing concern about the health hazards of occupational radiation exposure. The aim of this cadaveric simulation study was to measure radiation exposure doses to the surgical team during hip surgery. METHODS: We reproduced the intraoperative setting of hip surgery using 7 fresh frozen cadavers (5 male, 2 female) to simulate patients and mannequins to simulate the surgeon, scrub nurse, and anesthesiologist. Six real-time dosimeters were mounted at sites corresponding to the optic lens, thyroid gland, chest, gonads, foot, and hand on each mannequin. The radiation exposure dose to each team member was measured during posteroanterior and lateral fluoroscopic imaging. RESULTS: Radiation exposure doses to the surgeon were significantly higher during 3 min of lateral imaging than during 3 min of posteroanterior imaging at the optic lens (8.1 times higher), thyroid gland (10.3 times), chest (10.8 times), and hand (19.8 times) (p = 0.018, p = 0.018, p = 0.018, and p = 0.018, respectively). During lateral imaging, the radiation doses to the nurse were 0.16, 0.12, 0.09, 0.72, and 0.38 times those to the surgeon at the optic lens, thyroid, chest, gonads, and foot, respectively. The radiation dose to the anesthesiologist was zero at all anatomic sites during posteroanterior imaging and very small during lateral imaging. CONCLUSIONS: Radiation exposure dose was significantly higher during lateral imaging up to 19.8 times comparing to the posteroanterior imaging. It is effective to reduce the lateral imaging time for reducing the intraoperative radiation exposure. In addition, appropriate distance from fluoroscopy resulted in very low exposure for nurses and anesthesiologists. Surgeon should pay attention that surgical staff do not get closer than necessary to the irradiation field.

A Cadaveric Simulation Study of Radiation Exposure to the Surgical Team during Fluoroscopic Spinal Surgery: How Much Are We Exposed?

Introduction: The harmful effects of long-term low-dose radiation have been well known. There are few comprehensive reports evaluating concrete real exposure doses for each part of a surgeon, assistant surgeon, scrub nurse, and anesthesiologist associated with fluoroscopic spinal procedures. This research aimed to quantify the radiation exposure dose to surgical team members during C-arm fluoroscopy-guided spinal surgery. Methods: Seven fresh cadavers were irradiated for 1 and 3 min with C-arm fluoroscopy. The position of the X-ray source was under the table, over the table, and laterally. The radiation exposure doses were measured at the optic lens, thyroid gland, and hand in mannequins used to simulate surgical team members. Results: A significant difference was observed in the radiation exposure dose according to the position of the X-ray source and the irradiated body area. The risk of scatter radiation exposure was the biggest for the lateral position (nearly 30-fold that for the position under the table). All radiation exposure doses were positively correlated with irradiation time. Conclusions: The occupational radiation exposure dose to surgical team members during C-arm fluoroscopy-guided lumbar spinal procedures varies according to the X-ray source position. Our findings would help surgical team members to know the risk of radiation exposure during various fluoroscopic procedures. Surgeons in particular need to reduce their radiation exposure by using appropriate shielding and technique.

Republication of "Gelatinous Transformation of Bone Marrow in the Calcaneus, Diagnosed by Open Bone Biopsy in a Patient With Anorexia Nervosa: A Case Report".

Gelatinous transformation of bone marrow (GTBM) is a complication of various diseases, one of which is anorexia nervosa (AN). We describe a rare case of a 20-year-old man who presented to our clinic with a 3-month history of heel pain without trauma. At presentation, he was noted to have a low body mass index (BMI) of 16.2 kg/m2 and pancytopenia. On magnetic resonance imaging, the left calcaneus showed low intensity on T1-weighted and high intensity on T2-weighted images. Open biopsy was done because we suspected that the lesion was either a lymphoproliferative tumor or a trabecular-type bone metastatic tumor. However, tissue histology of bone samples showed atrophy of fat cells with deposition of gelatinous material and a decreased hematopoietic cell population. Therefore, we made a diagnosis of GTBM, most likely caused by AN. We started treatment with nutritional support, and 6 months later, the hematological parameters returned to normal and BMI improved to 19.4 kg/m2. He was able to return to work and had no left heel pain. This case indicates that foot and ankle surgeons need to be aware of this rare pathology, although it might be difficult to diagnose without biopsy. To our knowledge, very few descriptions of GTBM in the calcaneus have been reported to date.

Controlled release of molasses melanoidin-like product from hybrid organic-inorganic silica xerogels and its application to the phytoextraction of lead through the Indian mustard.

In this study, we investigate the release of melanoidin-like product (MLP) from hybrid silica xerogels to control the quantity of MLP in the medium for lead phytoextraction. In the preparation of the hybrid organic-inorganic xerogels with MLP, tetraethoxysilane (TEOS), methyltriethoxysilane (MTES), propyltriethoxysilane (PTES), and 3-aminopropyltriethoxysilane (APTES) were used as precursors. The experimental results suggest that the release of MLP can be easily controlled by partially substituting TEOS with the organosilanes. The addition of the organosilanes lowered the release rate of MLP in the following order of xerogels: TEOS, MTES/TEOS, PTES/TEOS, and APTES/TEOS. Furthermore, a novel phytoextraction of lead through the Indian mustard was conducted using the MLP-doped TEOS xerogel. Results show that the addition of TEOS xerogel did not have any influence on the growth of the mustard, whereas the lead uptake significantly increased in a nutrition medium with 1-mM Pb(NO3)2. In conclusion, the beneficial effect of the MLP-doped TEOS xerogel on lead phytoextraction was confirmed.

Full-endoscopic Spine Surgery for Discogenic Low Back Pain with High-intensity Zones and Modic Type 1 Change in a Professional Baseball Player.

Non-specific low back pain in athletes can be caused by discogenic back pain, Modic type 1 change, and facet joint arthritis. In this report, we describe a full-endoscopic surgical strategy that we have used to treat a patient with both discogenic pain and Modic type 1 change. The patient was a 32-year-old professional baseball player who played an infield position and had a 2-year history of low back pain. Three years earlier, he had undergone micro-endoscopic discectomy for left herniated nucleus pulposus at L5/S1. His leg symptoms resolved postoperatively, and he returned to playing baseball the following season. However, his low back pain gradually increased. Two years after the initial surgery, he was experiencing low back pain in daily life and found it very difficult to play baseball. Short T1 inversion recovery (STIR) magnetic resonance imaging (MRI) revealed Modic type 1 change and high-signal intensity zones in degenerated discs at L4/5 and L5/S1. Injection of xylocaine 1% reduced the pain temporarily, confirming that the pain generator was at L4/5 and L5/S1. The pathological diagnosis was discogenic pain with Modic type 1 change. We performed full-endoscopic disc cleaning (FEDC) surgery for the Modic type 1 change and thermal annuloplasty (TA) for the discogenic pain at these levels. The patient's low back pain decreased steadily thereafter. Six months after surgery, he returned to baseball, playing for a full season without pain. We have successfully treated a professional baseball player with discogenic pain and Modic type 1 change by full-endoscopic surgery.

Successful full-endoscopic decompression surgery under local anesthesia for L5 radiculopathy caused by L5-Sforaminal stenosis and L4-5 lateral recess stenosis†: A case report.

In this report, we presented a 65 year-old male case having right leg pain due to L5 radiculopathy. Based on the radiological examination including CT, MRI and radiculography, double crash impingement of L5 nerve root due to L4-5 lateral recess and L5-S foraminal stenosis was diagnosed. Because of the strong pain, he could not work anymore. His job was a general manager of big hospital, he needed to return to job as soon as possible. We decided to conduct the full-endoscopic decompression surgery of ventral facetectomy (FEVF) for L4-5 lateral recess stenosis and foraminoplasty (FELF) for L5-S foraminal stenosis. The technique can be done under the local anesthesia with only 8 mm skin incision; thus, it must be the least invasive spine surgery. Soon after the surgery, he could return to the original job as a general manager. In conclusion, the full-endoscopic decompression surgery for the spinal canal stenosis such as FELF and FEVF would be minimally invasive procedure and it enable patients the quick return to the original activity. J. Med. Invest. 67 : 192-196, February, 2020.

A Superhydrophilic Aluminum Surface with Fast Water Evaporation Based on Anodic Alumina Bundle Structures via Anodizing in Pyrophosphoric Acid.

A superhydrophilic aluminum surface with fast water evaporation based on nanostructured aluminum oxide was fabricated via anodizing in pyrophosphoric acid. Anodizing aluminum in pyrophosphoric acid caused the successive formation of a barrier oxide film, a porous oxide film, pyramidal bundle structures with alumina nanofibers, and completely bent nanofibers. During the water contact angle measurements at 1 s after the water droplet was placed on the anodized surface, the contact angle rapidly decreased to less than 10°, and superhydrophilic behavior with the lowest contact angle measuring 2.0° was exhibited on the surface covered with the pyramidal bundle structures. As the measurement time of the contact angle decreased to 200-33 ms after the water placement, although the contact angle slightly increased in the initial stage due to the formation of porous alumina, at 33 ms after the water placement, the contact angle was 9.8°, indicating that superhydrophilicity with fast water evaporation was successfully obtained on the surface covered with the pyramidal bundle structures. We found that the shape of the pyramidal bundle structures was maintained in water without separation by in situ high-speed atomic force microscopy measurements.

Spontaneous colloidal metal network formation driven by molten salt electrolysis.

The molten salt-based direct reduction process for reactive solid metal outperforms traditional pyrometallurgical methods in energy efficiency. However, the simplity and rapidity of this process require a deeper understanding of the interfacial morphology in the vicinity of liquid metal deposited at the cathode. For the first time, here we report the time change of electrode surface on the sub-millisecond/micrometre scale in molten LiCl-CaCl2 at 823 K. When the potential was applied, liquid Li-Ca alloy droplets grew on the electrode, and the black colloidal metal moved on the electrode surface to form a network structure. The unit cell size of the network and the number density of droplets were found to depend on the applied potential. These results will provide important information about the microscale mixing action near the electrode, and accelerate the development of metallothermic reduction of oxides.

Column and film lifetimes in bubble-induced two-liquid flow.

We investigated the transient behavior of immiscible two-liquid interfaces initiated by a single rising gas bubble and characterized by liquid "column" and "film" morphologies. To analyze the effect of the buoyancy force, viscosity, and interfacial tension on these morphologies, the single-solution density was controlled continuously by association with the rising velocity of the bubble. It was observed that the extension of the liquid column further into the upper liquid phase owing to the wake flow under the bubble is driven by the buoyancy force, with the velocity decreasing gradually with the distance between the bubble and the liquid-liquid interface. Based on this mechanism, we determined that a strong dimensionless correlation exists between the lifetime of the column and the physical properties of the two liquid phases. On the other hand, gravitational drainage does not affect the film lifetime. However, marginal pinching is dominant, probably owing to the existence of a surface tension gradient between the film and the meniscus.

Advancing and receding contact angle investigations for highly sticky and slippery aluminum surfaces fabricated from nanostructured anodic oxide.

The fabrication of sticky and slippery superhydrophobic aluminum was achieved by anodizing in pyrophosphoric acid and modification with self-assembled monolayers (SAMs). In addition, the corresponding sliding behaviors of a water droplet were investigated by contact angle measurements and direct observations. For the formation of anodic alumina nanofibers, 4N aluminum plates were anodized in a concentrated pyrophosphoric acid solution at 25-75 V. The morphology of the anodic oxide successively changed to barrier oxide, porous oxide, nanofibers, bundle structures with many nanofibers, and then weak nanofibers during anodizing. The anodized specimens were immersed in a fluorinated phosphonic acid/ethanol solution to form SAMs on the surface of the anodic oxide. The contact angle hysteresis drastically changed with anodizing time: it increased with the formation of porous oxide, decreased for the nanofibers and bundle structures, and then increased once again for the weak nanofibers. Correspondingly, the adhesion interaction between the water droplet and the aluminum surface also drastically changed to show sticky, slippery, and sticky behaviors with anodizing time. More sticky and slippery aluminum surfaces can be obtained by anodizing at higher voltages. The slippery behavior was further improved through two distinct anodizing processes with the formation of ordered alumina nanofibers. A superhydrophobic aluminum surface with coexisting sticky and slippery properties was fabricated by the selective anodizing method.

Ultra-high density single nanometer-scale anodic alumina nanofibers fabricated by pyrophosphoric acid anodizing.

Anodic oxide fabricated by anodizing has been widely used for nanostructural engineering, but the nanomorphology is limited to only two oxides: anodic barrier and porous oxides. Therefore, the discovery of an additional anodic oxide with a unique nanofeature would expand the applicability of anodizing. Here we demonstrate the fabrication of a third-generation anodic oxide, specifically, anodic alumina nanofibers, by anodizing in a new electrolyte, pyrophosphoric acid. Ultra-high density single nanometer-scale anodic alumina nanofibers (10(10) nanofibers/cm(2)) consisting of an amorphous, pure aluminum oxide were successfully fabricated via pyrophosphoric acid anodizing. The nanomorphologies of the anodic nanofibers can be controlled by the electrochemical conditions. Anodic tungsten oxide nanofibers can also be fabricated by pyrophosphoric acid anodizing. The aluminum surface covered by the anodic alumina nanofibers exhibited ultra-fast superhydrophilic behavior, with a contact angle of less than 1°, within 1 second. Such ultra-narrow nanofibers can be used for various nanoapplications including catalysts, wettability control, and electronic devices.