Evaluation of learning curves for contact laser vaporization of the prostate using the 980 nm diode laser for benign prostatic hyperplasia.

OBJECTIVES: We investigated the background of patients who underwent contact laser vaporization of the prostate (CVP) surgery and the learning curve of the operators. METHODS: A total of 207 patients who underwent CVP surgery for benign prostatic hyperplasia between August 2018 and March 2023 were included in this study. Patient background, perioperative results, pre- and postoperative urinary flow tests, and complications were collected retrospectively. RESULTS: We enrolled 12 doctors who were divided into expert (five doctors) and novice (seven doctors) groups based on the number of TURP experiences before CVP. The median patient age was 73 years (51-92 years) and prostate volume was 56 cc (15-190 cc) with no difference between the expert and novice groups. Complications included urinary retention (eight cases), hematuria (four), urinary tract infection (four), intraoperative perforation (two), and postoperative stricture (one). Both cases of intraoperative perforation occurred in the novice group. The expert group had a significantly shorter operative time (38 vs. 66 min) and a higher operative efficacy of prostate volume divided by operative time (1.43 vs. 0.88 cc/min). Postoperatively, IPSS, quality of life scores, and postvoid residual urine volume decreased, and maximal flow rate increased; however, there was no significant difference between the groups. The expert group showed stable operative time and operative efficacy after about five to eight cases, while the novice group showed stable after about 15 cases. CONCLUSIONS: Our findings suggest that CVP was safely performed at our hospital, and operators with limited experience in TURP can achieve stable perioperative results.

Prevalence and predisposing factors of neuropathic pain in patients with rotator cuff tears.

BACKGROUND: The management of pain in patients with rotator cuff tears can be challenging. Neuropathic pain is reportedly associated with pain occurrence in musculoskeletal diseases. However, to date, few studies have reported on the prevalence of neuropathic pain in patients with rotator cuff tears or identified the factors associated with neuropathic pain in a multicenter study. METHODS: A total of 391 patients (205 males and 186 females; median age, 67.7 years; range, 27-92 years) with rotator cuff tears were included in this study. The prevalence of neuropathic pain in rotator cuff tears was investigated using the Japanese version of the painDETECT questionnaire for all patients. In addition, factors significantly associated with the occurrence of neuropathic pain were examined using multivariate logistic regression analysis. RESULTS: Twenty-eight patients (7.2%) were classified into the neuropathic pain group (score ≥19), 97 (24.8%) into the uncertainty regarding neuropathy group (score 13-18), and 266 (68.0%) into the nociceptive pain group (score ≤12). According to the multivariate logistic regression analysis, the independent predictors of neuropathic pain were the VAS score (most severe pain during the past 4 weeks; odds ratio, 1.55; 95% confidence interval [CI], 1.23-2.09) and UCLA shoulder score (odds ratio, 0.81; 95% CI, 0.65-0.97). CONCLUSIONS: Based on the study findings, the prevalence of neuropathic pain in patients with rotator cuff tear was 7.2%. It is important to investigate the presence or absence of neuropathic pain when treating patients with painful rotator cuff tears, because neuropathy associated with rotator cuff tears may adversely affect patient outcomes.

Photodissociative Modules that Control Dual-Emission Properties in Donor-π-Acceptor Organoborane Fluorophores.

Donor-π-acceptor fluorophores that consist of an electron-donating amino group and an electron-accepting triarylborane moiety generally exhibit substantial solvatochromism in their fluorescence while retaining high fluorescence quantum yields even in polar media. Herein, we report a new family of this compound class, which bears ortho-P(=X)R2 -substituted phenyl groups (X=O or S) as a photodissociative module. The P=X moiety that intramolecularly coordinates to the boron atom undergoes dissociation in the excited state, giving rise to dual emission from the corresponding tetra- and tricoordinate boron species. The susceptibility of the systems to photodissociation depends on the coordination ability of the P=O and P=S moieties, whereby the latter facilitates dissociation. The intensity ratios of the dual emission bands are sensitive to environmental parameters, including temperature, solution polarity, and the viscosity of the medium. Moreover, precise tuning of the P(=X)R2 group and the electron-donating amino moiety led to single-molecule white emission in solution.

Prognostic Impact of Peak Aortic Jet Velocity on Patients With Acute Myocardial Infarction.

BACKGROUND: Aortic valve stenosis (AS) leads to increased cardiovascular mortality and morbidity, and recent studies reported that even mild-to-moderate AS was associated with poor prognosis in the general population. This study investigated the prognostic impact of mild or moderate AS, defined as 2.0 m/s ≤ peak aortic jet velocity (Vmax) ≤3.9 m/s using echocardiography in acute myocardial infarction (AMI) patients.Methods and Results: This study enrolled 3,049 AMI patients using data from the Mie ACS registry. Patients were divided into 2 groups according to Vmax: Group 1: Vmax <2.0 m/s and/or visually intact aortic valve in which all 3 leaflets are fully and evenly open; Group 2: 2.0 m/s ≤ Vmax ≤ 3.9 m/s. There were 2,976 patients in Group 1and 73 patients in Group 2. The Group 2 patients were older, had a higher percentage of males and had lower body mass index and Killip ≥2 than the Group 1 patients. Angiographic data, door-to-balloon time, and mechanical support were not different between the 2 groups. The Group 2 patients demonstrated a significantly higher all-cause mortality rate (P<0.01) and composite of cardiovascular death and heart failure hospitalization (P<0.01), and Kaplan-Meier analysis showed the same tendency in propensity score-matched patients. CONCLUSIONS: The present study revealed that mild or moderate AS based on Vmax is associated with poor prognosis following AMI.

Oxy-Borylenes as Photoreductants: Synthesis and Application in Dehalogenation and Detosylation Reactions.

While the range of accessible borylenes has significantly broadened over the last decade, applications remain limited. Herein, we present tricoordinate oxy-borylenes as potent photoreductants that can be readily activated by visible light. Facile oxidation of CAAC stabilized oxy-borylenes (CAAC)(IPr2 Me2 )BOR (R=TMS, CH2 CH2 C6 H5 , CH2 CH2 (4-F)C6 H4 ) to their corresponding radical cations is achieved with mildly oxidizing ferrocenium ion. Cyclovoltammetric studies reveal ground-state redox potentials of up to -1.90 V vs. Fc+/0 for such oxy-borylenes placing them among the strongest organic super electron donors. Their ability as photoreductants is further supported by theoretical studies and showcased by the application as stoichiometric reagents for the photochemical hydrodehalogenation of aryl chlorides, aryl bromides and unactivated alkyl bromides as well as the detosylation of anilines.

Physics of phonon-polaritons in amorphous materials.

The nature of bosonic excitations in disordered materials has remained elusive due to the difficulties in defining key concepts such as quasi-particles in the presence of disorder. We report on an experimental observation of phonon-polaritons in glasses, including a prominent boson peak (BP), i.e., excess of THz modes over the Debye law. A theoretical framework based on the concept of diffusons is developed to describe the broadening linewidth of the polariton due to disorder-induced scattering. It is shown here for the first time that the BP frequency and the Ioffe-Regel (IR) crossover frequency of the polariton collapse onto the same power-law decay with the diffusivity of the bosonic excitation. This analysis dismisses the hypothesis of the BP being caused by a relic of the van Hove singularity. The presented framework establishes a new methodology to analyze bosonic excitations in amorphous media, well beyond the traditional case of acoustic phonons, and establishes the IR crossover as the fundamental physical mechanism behind the BP.

Stump classification was correlated with retear in the suture-bridge and double-row repair techniques for arthroscopic rotator cuff repair.

PURPOSE: The Stump classification is significantly correlated with a retear after arthroscopic rotator cuff repair. However, no study has evaluated whether or not the stump classification is correlated with retear in the suture-bridge or double-row repair techniques. The aim of this study was to evaluate the relationship between a retear and the stump classification in the suture-bridge and double-row repair techniques. METHODS: Among 389 patients who underwent arthroscopic repairs of full-thickness rotator cuff tears using suture-bridge or double-row repair techniques, 326 patients (median age 67.0 years; range 25-85) were included. There were 51 small, 172 medium, 83 large, and 20 massive tears. Two hundred forty patients were treated with the suture-bridge technique, and 86 patients were treated with the double-row technique. The following variables were analyzed: age, sex, the Cofield classification, anteroposterior and mediolateral tear size on preoperative MRI, global fatty degeneration index, and the stump classification. Cuff integrity was evaluated on magnetic resonance imaging at 6 months after surgery. The patients were divided into the intact and retear groups and the relationship between the variables and retear was evaluated by multivariate logistic regression analysis. RESULTS: The overall retear rate was 10.1%. In the multivariate logistic regression analysis, the independent predictors of a retear were the stump classification type 3 (Odds ratio: 4.71, p = 0.0246), global fatty degeneration index (Odds ratio: 3.87, p = 0.0030), and anteroposterior tear size (Odds ratio: 1.07, p = 0.0077) in the suture bridge technique. In the double-row technique, the independent predictors of retear were stump classification type 3 (Odds ratio: 7.82, p = 0.0348), and age (Odds ratio: 1.22, p = 0.0163). CONCLUSION: The stump classification was significantly correlated with retear in the suture-bridge and double-row repair technique. Stump classification type 3 was indicated to be an important risk factor for predicting retear. LEVEL OF EVIDENCE: III.

Microsurgical confirmation of parenchymal contamination of hair in a pediatric patient with a penetrating head injury.

Penetrating head injuries are rare, but can cause severe morbidity in children. In particular, penetrating head trauma with a wooden foreign body is considered to be likely to cause central nervous system infections because of its porosity and softness. However, actually confirming minute contaminations, such as skin debris or hair, in the brain parenchyma is rare. We report the case of a 2-year-old boy who presented with a penetrating head injury by a chopstick. During surgical removal of the chopstick, intraparenchymal hair contamination was confirmed under a surgical microscope. The postoperative course of the patient was uneventful. After 13 months of follow-up without any infectious events, the patient remains well and asymptomatic. The findings in the present case demonstrate that in the case of a penetrating head trauma with a wooden foreign body, surgical removal and active debridement should be the treatment of first choice.

Meniscal ramp lesions should be considered in anterior cruciate ligament-injured knees, especially with larger instability or longer delay before surgery.

PURPOSE: To determine the incidence of meniscal ramp lesions in an anterior cruciate ligament (ACL) injured knees and to clarify whether ramp lesions are related to chronic ACL deficiency and increased knee instability. METHODS: Consecutive ACL injured patients were evaluated arthroscopically for a ramp lesion via a trans-notch view and evidence of menisco-capsular injury was recorded. Other concomitant injuries to the knee were also noted. Incidence of meniscal ramp lesions, delay before surgery, and anterior-posterior stability was analyzed. All patients underwent bilateral KT-2000 evaluation. RESULTS: One hundred and three consecutive ACL injured patients with a mean age of 24 years were included in this study. In total, a ramp lesion was found in 10 knees (9.7%) via a trans-notch view. None of these lesions could be identified by the standard view from the anterolateral portal. Other medial meniscal lesions were found in 26 knees (25.2%) by standard arthroscopic viewing. The ramp lesion group had significantly longer delay before surgery with a median of 191 days (p < 0.01) as well as a larger side-to-side difference of KT-2000 measurement (7.3 ± 1.8 mm; p < 0.01), compared with the intact medial meniscus group (53 days and 5.5 ± 1.5 mm, respectively). CONCLUSION: Ramp lesions that were identified using a trans-notch view were not visualized with standard arthroscopic views. Increased anterior tibial translation and longer delay before surgery were seen in knees with ramp lesions. Careful inspection of the posteromedial menisco-capsular region is required as hidden menisco-capsular lesions may occur which may result in residual knee instability. LEVEL OF EVIDENCE: Level II.

Mechanical Thrombectomy for Acute Ischemic Stroke Patients Aged 80 Years or Older.

BACKGROUND: There are limited data about the prognostic factors predicting outcomes after mechanical thrombectomy with stent retrievers for the elderly. Here, we evaluated outcomes in elderly patients in a real-world setting. METHODS: Between April 2015 and January 2017, 80 patients with anterior intracranial acute large vessel occlusion, who had lived independently before ictus, were treated with mechanical thrombectomy using a stent retriever at our institute. We compared outcomes between patients ≥80 years old (n = 36) and those <80 years old (n = 44), and assessed prognostic factors for favorable outcomes (modified Rankin Scale score 0-2) at 90 days in all patients. RESULTS: There was no significant difference in baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early Computed Tomography Score between the 2 groups. Successful revascularization (modified Thrombolysis in Cerebral Infarction [mTICI] scores 2b/3) (83% versus 93%, P = .286), complete recanalization (mTICI 3) (47% versus 50%, P = .826), and favorable outcomes (42% versus 57%, P = .261) were achieved more often in those <80 years old, but differences did not reach statistical significance. Multivariate regression analysis showed that baseline National Institutes of Health Stroke Scale (P = .013) and mTICI scores of 3 (P = .006) were significant predictive factors, but being ≥80 years old and baseline Alberta Stroke Program Early Computed Tomography Score were not. In those ≥80 years old, mTICI score of 3 was an influential factor for favorable outcome (P = .017). CONCLUSIONS: Being aged 80 years or older was not a significant predictor for outcomes after mechanical thrombectomy, whereas complete recanalization was an influential predictor of outcome in the elderly.

Radiographic occult cerebellar germinoma presenting with progressive ataxia and cranial nerve palsy.

BACKGROUND: Although the usefulness of susceptibility-weighted imaging (SWI) for detecting basal ganglia germinoma has been reported, the technique is not widely used. We recently encountered an unusual case of primary cerebellar germinoma, presenting with progressive ataxia and cranial nerve palsy, characterized by gradually enlarging low-intensity lesions visible with both T2*-weighted imaging (T2*WI), which were the key to the diagnosis. CASE PRESENTATION: A 30-year-old man was referred to our hospital because of slowly progressive dizziness and mild ataxia. Magnetic resonance imaging (MRI) revealed a small, low-intensity spot in the left cerebellar peduncle on the T2*WI and SWI without enhancement. Cerebral angiography revealed no vascular abnormality. The serum α-fetoprotein value was normal. A steroid-pulse was administered as a therapeutic and diagnostic trial, but the symptoms improved little. The patient was discharged from the hospital but soon developed brainstem dysfunction, characterized by dyspnea or hiccups, and he was readmitted. T2*WI imaging revealed expanded and extended spotty lesions in the cerebellum and brainstem, which had not enhanced with contrast agent previously. Targeted stereotactic biopsy of the newly enhanced cerebellar lesion was performed; histopathological examination of the tissue revealed pure germinoma. Serum and cerebral spinal fluid values of beta-human chorionic gonadotropin were not significantly elevated. Chemotherapy with carboplatin and etoposide was initiated. The enhanced lesion disappeared promptly, but the patient continued to require assisted automatic ventilation because of paralysis of respiratory muscles. CONCLUSIONS: We conclude that enlarging low-intensity lesions on T2*WI and SWI may be a reliable clue to the diagnosis of germinomas, irrespective of their location, even without enhancement. Biopsy of the tumor at an early stage is the only way to make the diagnosis conclusively and enable prompt start of treatment.

An electrically driven, ultrahigh-speed, on-chip light emitter based on carbon nanotubes.

The integration of high-speed light emitters on silicon chips is an important issue that must be resolved in order to realize on-chip or interchip optical interconnects. Here, we demonstrate the first electrically driven ultrafast carbon nanotube (CNT) light emitter based on blackbody radiation with a response speed (1-10 Gbps) that is more than 10(6) times higher than that of conventional incandescent emitters and is either higher than or comparable to that of light-emitting diodes or laser diodes. This high-speed response is explained by the extremely fast temperature response of the CNT film, which is dominated by the small heat capacity of the CNT film and its high heat dissipation to the substrate. Moreover, we experimentally demonstrate 140 ps width pulsed light generation and real-time optical communication. This CNT-based emitter with the advantages of ultrafast response speeds, a small footprint, and integration on silicon can enable novel architectures for optical interconnects, photonic, and optoelectronic integrated circuits.

Direct carotid-cavernous fistula presenting with intracranial hemorrhage without ocular symptoms.

Herein, we report a unique case of nontraumatic direct carotid-cavernous fistula presenting with intracerebral hemorrhage without any ocular symptoms. A 90-year-old woman was found unconscious and vomiting due to a subcortical hemorrhage in the temporal lobe. Magnetic resonance angiography revealed a direct carotid-cavernous fistula of Barrow type A. Extensive cortical venous reflux from the superficial middle cerebral vein was observed and identified as a probable contributor to the cerebral hemorrhage. We performed successful embolization using combined transarterial and transvenous approaches. We first occluded the dangerous venous drainage via the transvenous approach, followed by selective occlusion of the direct carotid-cavernous fistula via the transarterial approach. This strategy provided that the dangerous venous drainage was completely occluded first in case complete obliteration could not be achieved with the transarterial approach.

Next-Generation Exoscopic Surgery Featuring a Head-Mounted 3-Dimensional Display for Carotid Endarterectomy: 2-Dimensional Operative Video.

Recent advancements in medical equipment have led to the use of exoscopes in neurosurgery, thereby replacing conventional operating microscopes.1,2 These devices enable surgeons to work comfortably, even in situations requiring a tilted visual axis, and their effectiveness in carotid endarterectomy (CEA) for carotid artery stenosis has been reported.3,4 However, the placement of 3-dimensional (3D) monitoring devices is challenging.3,4 To address this issue, we present a case in which CEA was performed using ORBEYE with a 3D head-mounted display. This device allows continuous 3D observation of the surgical field on the preocular screen. Case: A 79-year-old man who had undergone chemoradiotherapy for left maxillary cancer 5 years earlier was referred to our department to undergo treatment for left internal carotid artery stenosis. Computed tomography angiography revealed severe left internal carotid artery stenosis with hypoechoic vulnerable plaques on carotid ultrasound. Carotid artery stenting was considered to be a better option than CEA. However, CEA yields better outcomes, especially in patients with vulnerable soft plaques.5 Left CEA was performed using ORBEYE with a 3D head-mounted display (HOGY Medical Co., Ltd.). The procedure was successfully performed under the observation of the head-mounted display, from skin incision to closure. Postoperatively, the patient had no neurological deficits but experienced transient hoarseness. Using an exoscope under the guidance of a head-mounted display represents a next-generation surgical technique that overcomes the limitations of traditional exoscopic surgery. The patient consented to the procedure, and the participants and any identifiable individuals consented to publication of his/her image. Our institutional review board approved this publication (#B230184).

A vertebrobasilar junction aneurysm successfully treated with a combination of surgical clipping and flow diverter placement based on the results of computational fluid dynamics analysis: illustrative case.

BACKGROUND: The treatment of vertebrobasilar junction (VBJ) aneurysms is challenging. Although flow diverters (FDs) are a possible treatment option, geometrical conditions hinder intervention. VBJ aneurysms possess dual inflow vessels from the bilateral vertebral arteries (VAs), one of which is ideally occluded prior to FD treatment. However, it remains unclear which VA should be occluded. OBSERVATIONS: A 75-year-old male with a growing VBJ complex aneurysm exhibiting invagination toward the brainstem and causing perifocal edema required intervention. Preoperative computational fluid dynamics (CFD) analysis demonstrated that left VA occlusion would result in more stagnant flow and less impingement of flow than right VA occlusion. According to the simulated strategy, surgical clipping of the left VA just proximal to the aneurysm was performed, followed by FD placement from the basilar artery trunk to the right VA. The patient demonstrated tolerance of the VA occlusion, and follow-up computed tomography angiography at 18 months after FD treatment confirmed the disappearance of the aneurysm. LESSONS: Preoperative flow dynamics simulations using CFD analysis can reveal an optimal treatment strategy involving a hybrid surgery that combines FD placement and direct surgical occlusion for a VBJ complex aneurysm.

Indium-based ultraviolet-transparent electroconductive oxyfluoride InOF: ambient-pressure synthesis and unique electronic properties in comparison with In2O3.

A method for the synthesis of single-phase powdered InOF under ambient pressure has been developed. The method involves pyrolysis of a hydrate of InF3 in an O2 atmosphere of controlled humidity. Various intermediate phases were formed during the pyrolysis, and their structures and interconversions were analyzed. Combined results of optical absorption measurements and density functional calculations indicate that InOF is a direct band gap material with a band gap energy of ∼3.7 eV. Unlike In2O3, the electrical conductivity of polycrystalline InOF pellets can be controlled over ∼8 orders of magnitude from ∼10(-8) S cm(-1) to ∼2 S cm(-1) by thermal annealing, and the sample with the highest conductivity was a nearly degenerate n-type semiconductor with a relatively small carrier concentration of ∼10(18) cm(-3). The work function of InOF measured by ultraviolet photoelectron spectroscopy is ∼3.5 eV and is smaller by ∼1.5 eV than that of In2O3. This difference comes from a decrease in the electron affinity.

Introducing next-generation transcranial surgery with the head-mounted 3D View Vision display in extracorporeal microsurgery: illustrative cases.

BACKGROUND: Exoscopy in neurosurgery offers various advantages, including increased freedom of the viewing axis while the surgeon maintains a comfortable upright position. However, the optimal monitor positioning to avoid interference with surgical manipulation remains unresolved. Herein, the authors describe two cases in which a three-dimensional head-mounted display (3D-HMD) was introduced into a transcranial neurosurgical procedure using an exoscope. OBSERVATIONS: Case 1 was a 50-year-old man who presented with recurrent epistaxis and was diagnosed with an olfactory neuroblastoma that extended from the nasal cavity to the anterior cranial base and infiltrated the right anterior cranial fossa. Case 2 was a 65-year-old man who presented with epistaxis and was diagnosed with a left-sided olfactory neuroblastoma. In both cases, en bloc tumor resection was successfully performed via a simultaneous exoscopic transcranial approach using a 3D-HMD and an endoscopic endonasal approach, eliminating the need to watch a large monitor beside the patient. LESSONS: This is the first report of using a 3D-HMD in transcranial surgery. The 3D-HMD effectively addressed issues with the field of vision and concentration while preserving the effectiveness of traditional microscopic and exoscopic procedures when observed on a 3D monitor. Combining the 3D-HMD with an exoscope holds the potential to become a next-generation surgical approach.

SMARCB1/INI1-deficient intrathoracic neoplasm with rhabdoid/plasmacytoid cytomorphology in a patient with plasma cell myeloma: A case report.

SMARCB1 (INI1) is one of the switch/sucrose nonfermentable (SWI/SNF) complexes whose loss is associated with several tumors. SMARCB1 (INI1)-deficient intrathoracic neoplasms are extremely rare and known to be highly malignant and lethal. This report presents the case of a patient diagnosed with SMARCB1 (INI1)-deficient intrathoracic neoplasm during chemotherapy for plasma cell myeloma. A 77-year-old male patient complained of cough, bloody sputum, and fever with an enlarged right lung mass and pleural effusion. His cytological examination revealed undifferentiated epithelioid and rhabdoid/plasmacytoid cells with bi- or multinucleation, vacuolization, mitosis, and pleomorphism. However, it was difficult to distinguish the relapse of plasma cell myeloma as atypical plasmacytoid cells were detected. Immunohistochemically, the neoplastic cells showed a loss of SMARCB1 (INI1) expression in the cell block of pleural fluid and in the right lung of the autopsy specimen. Further, the patient was diagnosed with SMARCB1 (INI1)-deficient intrathoracic neoplasm of the right lung based on histological and autopsy findings. To the best of our knowledge, this is the first report of cytomorphology in a SMARCB1 (INI1)-deficient intrathoracic neoplasm.

Endovascular Treatment of Tandem Atherosclerotic Cervical Internal Carotid Artery Occlusion in the Setting of Acute Ischemic Stroke.

BACKGROUND: Among tandem occlusions, atherosclerotic cervical internal carotid artery occlusion (ACICAO) can be technically challenging and associated with its unique complications. We evaluated our experience with endovascular treatment (EVT) of ACICAO in the setting of acute ischemic stroke. METHODS: In total, 154 consecutive patients who underwent EVT for acute anterior circulation stroke at our institute were retrospectively reviewed. Patients with tandem ACICAO were analyzed in this study. Procedures, recanalization rates, complications, and prognoses were evaluated. RESULTS: Ten patients (6%) of all 154 patients had ACICAO. In nine (90%) of the 10 patients, cervical lesions were successfully crossed and intervened upon. Four patients underwent stenting and five underwent angioplasty alone, followed by intracranial procedure. Eight patients (80%) achieved successful recanalization following mechanical thrombectomy for intracranial occlusion. However, one patient had massive subarachnoid hemorrhage during the procedure and another patient developed massive intracranial hemorrhage after EVT, both after stenting. Four of the five patients who initially underwent angioplasty alone subsequently underwent staged endarterectomy or stenting for residual stenosis on or after the next day. The single patient in whom the cervical lesion could not be crossed and another with reocclusion after EVT underwent a rescue bypass procedure due to persistent ischemic symptoms. After 90 days, four patients (40%) were functionally independent (modified Rankin scale score 0-2). CONCLUSIONS: Our experience suggests that EVT for ACICAO is technically feasible; however, it involves the potential risk of several significant complications. To avoid serious hemorrhagic complications, cervical lesions may be better treated with angioplasty alone first.

Recent advances of pyrethroids for household use.

Development of pyrethroids for household use and recent advances in the syntheses of (1R)-trans-chrysanthemic acid, the acid moiety of most of the household pyrethroids, are reviewed. As another important acid moiety, we discovered norchrysanthemic acid to have a significant vapor action at room temperature when esterified with fluorobenzyl alcohols. In particular, 2,3,5,6-tetrafluoro-4-methoxymethylbenzyl (1R)-trans-norchrysanthemate (metofluthrin) exhibits the highest potency in mosquito coil formulations as well as the vapor action at room temperature against various mosquitoes. Structure-activity relationships of norchrysanthemic acid esters and synthetic studies of norchrysanthemic acid are discussed.