Conceptual study on extraction of formic acid from the electrolyte after electroreduction of CO2: Desalination and dehydration using a high-silica chabazite zeolite membrane.

Here, we propose a two-step pervaporation system with a high-silica CHA (chabazite) membrane, which has sufficient resistance to water and acid, to demonstrate the extraction and condensation of the formic acid formed by electroreduction of CO2. The kinetic diameters of water and formic acid are similar and smaller than the pore size of CHA, while the hydrated electrolyte ions (e.g., K+ and Cl-) are larger than the pore size of CHA. Consequently, the electrolyte ions are separated from the mixture of water and formic acid in the first desalination process, and then water molecules are easily removed from the mixture in the second dehydration process. From 300 ml of an approximately 3 wt% formic acid aqueous solution containing 0.5 M KCl, 10 ml of 18.2 wt% formic acid was obtained.

Necessity of infraorbital wall reconstruction in patients with residual periosteum after total maxillectomy.

BACKGROUND: To date, there have been no reports regarding the necessity or methods of reconstruction for cases where the orbital periosteum remains even though the orbital floor bone has been resected in primary reconstruction after total maxillectomy. This study investigated the reconstruction methods for infraorbital wall reconstruction in patients with residual orbital periosteum. METHODS: This was a retrospective cohort study at a single center from June 2010 to June 2019. The following two main cohorts were evaluated: non-reconstruction and reconstruction groups (reconstructed with fascia or costal cartilage) according to whether the orbital floor was reconstructed after total maxillectomy with residual orbital periosteum. The main outcomes were the deviation of the globe evaluated using computed tomography images and subjective signs of diplopia obtained from medical records. RESULTS: Enophthalmos occurred in all five cases in the non-reconstruction group, and diplopia appeared in four cases. In five out of six cases in the reconstruction group, deviation of the globe was not observed. Exophthalmos occurred in one case reconstructed with costal cartilage. Diplopia was not observed in the reconstruction group. In the statistical assessment, a significant difference was observed in the globe deviation between the two groups (P = 0.004). CONCLUSIONS: In cases where the orbital periosteum remains, it is necessary to actively reconstruct the infraorbital wall. Moreover, we believe that the reconstruction with fascia is convenient and useful because it is less invasive, the surgical procedure is simple, and the fascia can be collected from the same surgical field when the flap is elevated. LEVEL OF EVIDENCE: 4 (retrospective cohort study).

Adrenal Insufficiency Following Prolonged Administration of Ultra-High Topical Steroid: A Case of Refractory Dermatitis.

Replacement of a usual medication with a remarkably effective medication might result in a dramatic improvement for a specific disease. However, an abrupt change in medication might bring about other challenges. Herein, we report the case of an 84-year-old man who developed severe hyponatremia after the abrupt discontinuation of prolonged ultra-high topical steroid use. At the time of visiting the emergency department, he had been treating chronic eczema with the medication dupilumab for three months. We initially considered this newly started medication as the cause of the problem. However, dupilumab has not been reported to be connected to any electrolyte or endocrine disorder (e.g., syndrome of inappropriate anti-diuretic hormone secretion), and severe hyponatremia did not improve by the administration of high volume of NaCl. Thus, we reconsidered alternative causes for this hyponatremia and checked the patient's history of medication. He had been prescribed clobetasol propionate 0.05% by the dermatologist until one month before arriving at the emergency department. In addition, he had completely stopped using topical steroids for the last two weeks because his dermal condition had substantially improved. His cortisol level was low, substantiating a diagnosis of adrenal insufficiency. Hydrocortisone administration improved both hyponatremia and his symptoms. Therefore, when a patient with newly administered medication presents with new symptoms, we recommend that differential diagnosis include a medical review of the patient's last three months of medication and the conditions of use including how the topical agents were used.

Rehabilitation effects in idiopathic normal pressure hydrocephalus: a randomized controlled trial.

BACKGROUND: Gait-balance disturbances are core symptoms of idiopathic normal pressure hydrocephalus (iNPH). However, the rehabilitation effects of cerebrospinal fluid (CSF) shunting along with other treatment or no further treatment (natural course [NC]) for iNPH are unknown. OBJECTIVES: This study evaluated whether dynamic equilibrium gait training (DEGT) can improve gait-balance functions after CSF shunting of patients with iNPH compared to standard exercise (SE) and NC. Furthermore, it investigated the incidence of falls. METHODS: A total of 70 patients with iNPH who underwent CSF shunting were randomly assigned to 6 weeks of DEGT (n = 23), 6 weeks of SE (n = 23), or NC (n = 24). Evaluation was performed at baseline (preoperatively) and at 1 week, 7 weeks (postintervention), and 6 months postoperatively (follow-up). Outcomes were measured using the functional gait assessment (FGA), 10-m walk test, timed up-and-go test, life-space assessment (LSA), and fall incidence. RESULTS: A total of 65 participants completed the study. During the intention-to-treat analysis, the DEGT group demonstrated significant recovery of gait-balance functions according to only the FGA at postintervention and follow-up compared to the SE and NC groups; however, recovery of the SE group did not differ from that of the NC group. The DEGT group had a significantly lower fall incidence than the other groups at follow-up. Significantly better LSA results were observed for all groups at follow-up compared to baseline; however, no difference in LSA results were observed between groups. CONCLUSIONS: DEGT in addtion to CSF shunting can facilitate the recovery of gait-balance function and reduce the fall incidence of iNPH patients.

Facile Surface Modification of MgMn2O4 Positive-Electrode Material for Improving Cycle Performance of Magnesium Rechargeable Batteries.

MgMn2O4 with a tetragonal spinel structure shows promise as a positive-electrode material in magnesium rechargeable batteries (MRBs), which have drawn considerable attention as post lithium-ion batteries. However, the material currently suffers from poor cycle performance. In this study, we attempt to improve the cycle performance of MgMn2O4 via the Zr modification of its particle surface. X-ray photoelectron spectroscopy and energy-dispersive X-ray spectroscopy demonstrate that the surface modification is successfully performed by immersing MgMn2O4 powder into a Zr-containing aqueous solution, followed by heat treatment. However, Zr segregation is observed at high Zr concentration. Furthermore, structural analyses using synchrotron X-rays indicate that the Zr modification has an influence on the bulk structure of the MgMn2O4 powder. The positive-electrode properties of the powders are investigated using discharge/charge cycle tests, which show that Zr modification can drastically improve the cycle performance and coulombic efficiency. These improvements are supposed to be due to suppression of an unexpected reaction by the Zr-surface modification and lower structural distortion after the modification. These findings clearly demonstrate the significant potential of surface modification as a method for obtaining high-performance MRBs.

Positive-electrode properties and crystal structures of Mg-rich transition metal oxides for magnesium rechargeable batteries.

In this work, we focus on Mg-Fe-O and Mg-Ni-O with Mg-rich compositions as positive-electrode materials for magnesium rechargeable batteries, and prepare them by a thermal decomposition of precipitates obtained by a solution method. It is indicated from X-ray diffraction patterns that the Mg-Fe-O and Mg-Ni-O samples have the spinel and rocksalt structures, respectively. X-ray absorption near edge structures indicate that Fe and Ni are trivalent and divalent, respectively, in the Mg-rich oxides. From charge/discharge cycle test, it is demonstrated that the Mg-Fe-O shows higher discharge capacity than the other and then has good cycle performance while keeping a discharge capacity over 100 mA h g-1. To gain deeper understanding on a relationship between the electrode properties and the crystal structure of the Mg-Fe-O, the crystal structure is investigated by a Rietveld refinement using a synchrotron X-ray diffraction profile and an analysis on total correlation functions. It is indicated from these studies that a vacant octahedral site in the spinel structure is partially occupied by the excess Mg in the synthesized sample. This structural feature might result in a stable charge/discharge cycle performance of the Mg-rich Mg-Fe-O.

Use of a Fascial Reverse Dorso-Ulnar Metacarpal Bone Flap for Non-union of the Distal Phalanx of the Thumb: A Case Report.

Reports describing the treatment of non-union of the distal phalanx of the thumb are limited. We present the case of a 45-year-old man who developed a symptomatic non-union after an open fracture of the distal phalanx of the thumb. He was treated with a reverse dorso-ulnar vascularised fascial metacarpal bone flap. Bone union was achieved 3 months post surgery, and he was well at 7 months post surgery. The reverse dorso-ulnar fascial metacarpal bone flap is an alternative to consider in patients with non-union of the distal phalanx of the thumb. Level of Evidence: Level V (Therapeutic).

Dynamic gait stability in patients with idiopathic normal pressure hydrocephalus with high and low fall-risk.

BACKGROUND: This study aimed to investigate whether dynamic gait stability differs between idiopathic normal-pressure hydrocephalus with high- and low-fall-risk. METHODS: Participants comprised 40 idiopathic normal-pressure hydrocephalus patients and 23 healthy-controls. Idiopathic normal-pressure hydrocephalus patients were divided into those with high-fall-risk (n = 20) and low-fall-risk (n = 20) groups using the cut-off score of ≤14/30 for fall-risk on the Functional Gait Assessment. Dynamic stability during gait was assessed by three-dimensional motion analysis. Dynamic stability was defined as the ability to maintain an extrapolated center of mass within the base of support at heel contact, with the distance between the two defined as the margin of stability. Conscious motor control was assessed by the Movement-Specific Reinvestment Scale. FINDINGS: Anteroposterior and mediolateral margin of stabilities were significantly larger in both idiopathic normal-pressure hydrocephalus groups than in healthy-controls. The mediolateral margin of stability was significantly higher in the high-fall-risk group than in the low-fall-risk group; whereas, the anteroposterior margin of stability did not differ between idiopathic normal-pressure hydrocephalus groups. The Movement-Specific Reinvestment Scale was significantly higher in the high-fall-risk group than in the low-fall-risk group. INTERPRETATION: Idiopathic normal-pressure hydrocephalus patients with have high forward and lateral dynamic stability during gait regardless of their fall-risk. In particular, idiopathic normal-pressure hydrocephalus patients with high-fall-risk may consciously maintain lateral dynamic stability to a greater extent than those with low-fall-risk. These findings highlight a conscious motor control component in the pathological gait of idiopathic normal-pressure hydrocephalus, and provide clues for rehabilitation and fall prevention strategies in idiopathic normal-pressure hydrocephalus patients.

Interactions between pH, reactive species, and cells in plasma-activated water can remove algae.

Lightning strikes cause nitrogen to dissolve in water and form reactive nitrogen and oxygen species, which form natural fertilizers that can be absorbed through plant roots. Such processes during rainstorm events can be simulated by applying plasma to a solution. Plasma-activated water (PAW) has great potential as a source of various dissolved reactive chemical species. Different mixtures of species are produced using different solution compositions. Here, basil seeds were grown in PAW to prevent blooms of Chlorella vulgaris and ion chromatography and UV-vis spectroscopy were used to quantify reactive ions. NO2 -, NO3 -, and H2O2 were found to be key to the antialgal effect. Secondary reactive ions such as peroxynitrite (ONOO-, ONOOH) were also involved. The antialgal effect was strongly related to the pH around the algal cells. Acidification was predominantly caused by the generation of NO2 - and H2O2. After two weeks monitoring basil growth, the antifungal properties were preserved, few reactive oxygen species formed in the plasma zone, and only reactive nitrogen species were transformed into reactive peroxynitrite ions. The pH around the cells was determined using an iridium oxide microelectrode. The PAW antialgal mechanism depended on acidic conditions (pH 2.2, at which peroxynitrite can be generated) under which ONOOH penetrated the algal cell membranes, destroying the cells and preventing growth. This practical and sustainable PAW process allows a surprising amount of fertilizer to be generated with an antialgal effect that could be used in various eco-friendly agricultural processes under ambient conditions.

Dynamic stability during gait in idiopathic normal pressure hydrocephalus and Parkinson's disease.

OBJECTIVES: To clarify a characteristic of dynamic stability during gait in idiopathic normal pressure hydrocephalus (iNPH) and Parkinson's disease (PD), and to explore the association between dynamic stability and disease severity in each disease. MATERIALS AND METHODS: The 5-m gait of 36 iNPH (precerebrospinal fluid drainage), 20 PD (medicated state), and 25 healthy controls (HC) were evaluated using three-dimensional motion analysis. Ambulatory dynamic stability was defined as the ability to maintain the extrapolated center of mass within the base of support at heel contact, with the distance between the two referred to as the margin of stability (MOS). RESULTS: Anteroposterior direction (AP) MOS was significantly larger in the iNPH and PD groups than in the HC group; no significant difference was found between the iNPH and PD groups. Mediolateral direction (ML) MOS was significantly larger in the iNPH and PD groups than in the HC group and significantly larger in the iNPH group than in the PD group. In the iNPH group, the disease severity was positively correlated with only ML MOS. In the PD group, the disease severity was positively correlated with the AP MOS and ML MOS. CONCLUSIONS: Dynamic stability in iNPH increases in AP and ML, and it may be associated with not only iNPH-associated gait disturbance but also with a voluntarily cautious gait strategy. Dynamic stability in PD only increased in AP, and this may be associated with PD symptoms. These findings will help physicians understand the difference in pathological gait including dynamic stability between patients with iNPH and PD.

Complete decomposition of sulfamethoxazole during an advanced oxidation process in a simple water treatment system.

A simple water treatment system consisting of a deep UV light (λ = 222 nm) source, a mesoporous TiO2/boron-doped diamond (BDD) photocatalyst, and a BDD electrode was prepared and used to decompose sulfamethoxazole (SMX) in an advanced oxidation process. The mesoporous TiO2/BDD photocatalyst used with the electrochemical treatment promoted SMX decomposition, but the mesoporous TiO2/BDD photocatalyst alone had a similar ability to decompose SMX as photolysis. Fragments produced through photocatalytic treatment were decomposed during the electrochemical treatment and fragments produced during the electrochemical treatment were decomposed during the photocatalytic treatment, so performing the electrochemical and photocatalytic treatments together effectively decomposed SMX and decrease the total organic carbon concentration to a trace.

Deep Learning-Based Functional Independence Measure Score Prediction After Stroke in Kaifukuki (Convalescent) Rehabilitation Ward Annexed to Acute Care Hospital.

Introduction Prediction models of functional independent measure (FIM) score after kaifukuki (convalescent) rehabilitation ward (KRW) are needed to decide the treatment strategies and save medical resources. Statistical models were reported, but their accuracies were not satisfactory. We made such prediction models using the deep learning (DL) framework, Prediction One (Sony Network Communications Inc., Tokyo, Japan). Methods Of the 559 consecutive stroke patients, 122 patients were transferred to our KRW. We divided our 122 patients' data randomly into halves of training and validation datasets. Prediction One made three prediction models from the training dataset using (1) variables at the acute care ward admission, (2) those at the KRW admission, and (3) those combined (1) and (2). The models' determination coefficients (R2), correlation coefficients (rs), and residuals were calculated using the validation dataset. Results Of the 122 patients, the median age was 71, length of stay (LOS) in acute care ward 23 (17-30) days, LOS in KRW 53 days, total FIM scores at the admission of KRW 85, those at discharge 108. The mean FIM gain and FIM efficiency were 19 and 0.417. All patients were discharged home. Model (1), (2), and (3)'s R2 were 0.794, 0.970, and 0.972. Their mean residuals between the predicted and actual total FIM scores were -1.56±24.6, -4.49±17.1, and -2.69±15.7. Conclusion Our FIM gain and efficiency were better than national averages of FIM gain 17.1 and FIM efficiency 0.187. We made DL-based total FIM score prediction models, and their accuracies were superior to those of previous statistically calculated ones. The DL-based FIM score prediction models would save medical costs and perform efficient stroke and rehabilitation medicine.

Chronic subdural hematoma in patients over 65 years old: Results of using a postoperative cognitive evaluation to determine whether to permit return to driving.

BACKGROUND: Chronic subdural hematoma (CSDH) is usually associated with good recovery with burr hole irrigation and postoperative drainage under local anesthesia. In Japan, traffic accidents by the elderly drivers over 65 years old are severely increasing, and there is no consensus on whether or not to return to driving after CSDH treatment. We perform a postoperative cognitive assessment. We retrospectively investigated the return-to-driving rate and associated factors. METHODS: Of the 45 patients over 65 y.o. and who had usually driven, 30 patients wished to drive again. We performed tests composed of Mini-Mental State Examination (MMSE), line cancellation and line bisection task, Kohs block design test, trail making test (TMT)-A and B, Kana-hiroi test, Rey-Osterrieth complex figure test, and behavioral assessment of the dysexecutive syndrome, in order. When all tests' scores were better than the cutoff values, we let patients drive again. When some of the scores were worse than the cutoff values, we reevaluated the patients at the outpatient every month. If the patients' scores could not improve at the outpatient, we recommended them to stop driving. RESULTS: Nineteen of 30 patients could return to driving. Worse MMSE, Kohs block design test, TMT-A, TMT-B scores, higher age, dementia, or consciousness disturbance as chief complaints were associated with driving disability. CONCLUSION: CSDH is known as treatable dementia. However, we should perform an objective cognitive assessment before discharge because only 63% of the patients over 65 y.o. who wished to drive could return to driving.

A case with bilateral thalamic infarction manifesting mutism - Cerebral blood flow and neural fibers evaluation.

BACKGROUND: Acute bilateral thalamic infarction is rare, and occlusion of the artery of percheron (AOP) may be one of its reasons. AOP occlusion results in an acute disturbance of consciousness, but mutism due to AOP occlusion is rare. We described a mutism patient with bilateral thalamic infarction presumably due to AOP occlusion. We also performed cerebral blood flow (CBF) evaluation by N-isopropyl-p-[123I]-iodoamphetamine single-photon emission computed tomography (123I-IMP-SPECT) as well as neural fiber evaluation by diffusion tensor tractography, discussing the mechanism of mutism. CASE DESCRIPTION: A 92-year-old woman presented a gradual deterioration of consciousness. Diffusion-weighted images revealed high-intensity areas at the bilateral thalami, and we diagnosed AOP occlusion. We administered a recombinant tissue plasminogen activator. On day 14, her Glasgow Coma Scale score was 11 (E4V1M6), and she did not present any apparent paresis. She was mute but cognitively alert, although she could communicate by nodding or facial expression. 123I-IMP-SPECT showed CBF increase in the bilateral cerebellum and CBF decrease in the infarcted bilateral thalami and frontal lobes. Diffusion tensor tractography revealed the bilateral dentatothalamo-cortical tracts (DTCs). However, the tracts terminated at the parieto-occipital cortex, but not at the frontal cortex. She still had mutism on day 30. CONCLUSION: We reported the bilateral thalamic infarction patient presumably due to AOP occlusion, who presented mutism. The discontinuity of the bilateral DTCs resulted in her mutism, and our results supported the hypothesis that the cerebellum plays a significant role in uttering, associated with the bilateral DTCs.

Perceived and actual changes in gait balance after CSF shunting in idiopathic normal pressure hydrocephalus.

OBJECTIVES: We evaluated the perceived and actual changes in gait and balance function immediately after cerebrospinal fluid (CSF) shunting in patients with idiopathic normal pressure hydrocephalus (iNPH), including those with mild cases. MATERIALS AND METHODS: Ninety-nine iNPH patients were assessed using the timed Up and Go (TUG) and Functional Gait Assessment (FGA) before and 1-week after CSF shunting and their perceived changes were assessed on a Global Rate of Change (GRC) scale. Minimal clinically important differences (MCIDs) were calculated using a receiver operating characteristic (ROC) curve method using GRC scores. RESULTS: In all patients (n = 99), the TUG value postoperatively was significantly faster than the preoperative value (difference; 3.1 ± 4.6 s, p < 0.001), and the postoperative FGA score was significantly better than the preoperative score (difference; 3.8 ± 3.3 points, p < 0.001). In the TUG <15 s group (n = 51), the postoperative FGA score was significantly improved (difference; 3.3 ± 2.9 points, p < 0.001), whereas the TUG value was only slightly improved (difference; 0.6 ± 1.6 s, p = 0.008). The ROC curve MCIDs of GRC ≥2 points, which is the recommended level of improvement, were 1.7 s (16.5%) for the TUG and 4 points (20.0%) for the FGA in all patients (n = 99) and the TUG <15 s group (n = 51). CONCLUSIONS: FGA can be used to confirm treatment effects, including perceived and actual changes after CSF shunting, in patients with mild iNPH. Our results can help clinicians to determine the clinical significance of improvements in gait and balance function immediately after CSF shunting in individual patients with iNPH.

Prediction Model of Deep Learning for Ambulance Transports in Kesennuma City by Meteorological Data.

PURPOSE: With the aging population in Japan, the prediction of ambulance transports is needed to save the limited medical resources. Some meteorological factors were risks of ambulance transports, but it is difficult to predict in a classically statistical way because Japan has 4 seasons. We tried to make prediction models for ambulance transports using the deep learning (DL) framework, Prediction One (Sony Network Communications Inc., Tokyo, Japan), with the meteorological and calendarial variables. MATERIALS AND METHODS: We retrospectively investigated the daily ambulance transports and meteorological data between 2017 and 2019. First, to confirm their association, we performed classically statistical analysis. Second, to test the DL framework's utility for ambulance transports prediction, we made 3 prediction models for daily ambulance transports (total daily ambulance transports more than 5 or not, cardiopulmonary arrest (CPA), and trauma) using meteorological and calendarial factors and evaluated their accuracies by internal cross-validation. RESULTS: During the 1095 days of 3 years, the total ambulance transports were 5948, including 240 CPAs and 337 traumas. Cardiogenic CPA accounted for 72.3%, according to the Utstein classification. The relation between ambulance transports and meteorological parameters by polynomial curves were statistically obtained, but their r2s were small. On the other hand, all DL-based prediction models obtained satisfactory accuracies in the internal cross-validation. The areas under the curves obtained from each model were all over 0.947. CONCLUSION: We could statistically make polynomial curves between the meteorological variables and the number of ambulance transport. We also preliminarily made DL-based prediction models. The DL-based prediction for daily ambulance transports would be used in the future, leading to solving the lack of medical resources in Japan.

Musician developed right putaminal hemorrhage but conserved absolute pitch ability -Case report.

Absolute pitch (AP) is known as the ability to recognize and label the pitch chroma of a given tone without external reference. The neural mechanism and its asymmetry of AP musicians remain unclear. We herein report a 41-year-old AP musician who developed a right putaminal hemorrhage. On a postoperative day 5, a fluid-attenuated inversion recovery image revealed the rest of the hematoma and edematous lesion at the right white matter between the Heschl's gyrus and other cortices. Diffusion tensor tractography with the region of interest at the Heschl's gyrus was performed. In the left hemisphere, the anterior part of the arcuate fiber and middle longitudinal fasciculus were observed. However, these connections were absent in the right hemisphere, but her AP ability was maintained. Our case suggested that the fibers from the right Heschl's gyrus to the right frontal lobe via the right ventral stream is not associated with AP.

Preliminary development of a prediction model for daily stroke occurrences based on meteorological and calendar information using deep learning framework (Prediction One; Sony Network Communications Inc., Japan).

BACKGROUND: Chronologically meteorological and calendar factors were risks of stroke occurrence. However, the prediction of stroke occurrences is difficult depending on only meteorological and calendar factors. We tried to make prediction models for stroke occurrences using deep learning (DL) software, Prediction One (Sony Network Communications Inc., Tokyo, Japan), with those variables. METHODS: We retrospectively investigated the daily stroke occurrences between 2017 and 2019. We used Prediction One software to make the prediction models for daily stroke occurrences (present or absent) using 221 chronologically meteorological and calendar factors. We made a prediction models from the 3-year dataset and evaluated their accuracies using the internal cross-validation. Areas under the curves (AUCs) of receiver operating characteristic curves were used as accuracies. RESULTS: The 371 cerebral infarction (CI), 184 intracerebral hemorrhage (ICH), and 53 subarachnoid hemorrhage patients were included in the study. The AUCs of the several DL-based prediction models for all stroke occurrences were 0.532-0.757. Those for CI were 0.600-0.782. Those for ICH were 0.714-0.988. CONCLUSION: Our preliminary results suggested a probability of the DL-based prediction models for stroke occurrence only by meteorological and calendar factors. In the future, by synchronizing a variety of medical information among the electronic medical records and personal smartphones as well as integrating the physical activities or meteorological conditions in real time, the prediction of stroke occurrence could be performed with high accuracy, to save medical resources, to have patients care for themselves, and to perform efficient medicine.

Where to make burr hole for endoscopic hematoma removal against intracerebral hemorrhage at the basal ganglia to increase the hematoma removal rate - Comparison between trans-forehead and along-the-long-axis approaches.

BACKGROUND: Endoscopic hematoma removal is performed to treat intracerebral hemorrhage (ICH) at the basal ganglia. In our hospital, young neurosurgical trainees perform it for the only 1st to the 3rd time. We perform a "trans-forehead approach" and hypothesized that our technique would contribute to higher hematoma removal rate and easiness despite their inexperience. We compared our dataset with an open dataset with along-the-long-axis approaches using pre- and intraoperative neuronavigation by well-trained neurosurgeons and tested the utility of our trans-forehead approach. METHODS: We retrospectively investigated our 17 consecutive patients with hypertensive ICH who underwent endoscopic hematoma removal using the trans-forehead approach. We obtained the open dataset and compared our data with the 12 patients from the open dataset using the inverse probability weighting method. Operative time, hematoma removal rate, postoperative hematoma volume, Glasgow Coma Scale (GCS) on day 7, and modified Rankin Scale (mRS) at 6 months were assessed as outcomes. RESULTS: The median age was 68 (interquartile range; 58-78) years. Median postoperative hematoma volume, removal rate, operative time, GCS on day 7, and mRS at 6 months were 9 (2-24) mL, 90 (79-98)%, 53 (41-80) min, 13 (12-13), and 4 (2-5), respectively. The weighted generalized estimating equations revealed that operative time was shorter in the along-the-long-axis group, but other items were not significantly different between the two approaches. CONCLUSION: The hematoma removal rate of endoscopic hematoma removal with the trans-forehead approach by young trainees was not different from that of the along-the-long-axis approach by well-trained neurosurgeons using neuronavigation.

Unilateral posterior reversible encephalopathy syndrome characterized with a long and gradually exacerbating course over 3 years and that presented propofol infusion syndrome - A case report.

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is characterized by acute neurological symptoms and vasogenic edema, and most patients wholly recover. We report a unilateral PRES patient characterized by a gradual onset followed by propofol infusion syndrome (PRIS) due to general anesthesia therapy. CASE DESCRIPTION: A 32-year-old woman had ovarian dysfunction treated by Kaufmann's treatment for 17 years. Three years ago, she developed seizures, and photophobia and myoclonus sometimes occurred. This time, she had strong photophobia and nausea for 3 months and then developed tonic-clonic seizures for 3 min. Her blood pressure and laboratory test on admission were all within normal limits. She presented no neurological deficits at admission, but the T2-weighted image (T2WI) showed a high-intensity area (HIA), and arterial spin labeling (ASL) image described cerebral blood flow (CBF) increase in the left parieto-occipital region. We diagnosed PRES and started anticonvulsants, antihypertensive, and steroid pulse therapy. However, her aphasia and neuroimaging findings worsened, so we started general anesthesia treatment with propofol on day 29. On day 32, she suddenly developed multiple organ dysfunctions due to PRIS. After intensive care with other sedatives over 2 months, the systemic status and neurological symptoms gradually improved almost as before the onset. On day 90, HIA in the T2WI in the lesion became small, and CBF was severely downregulated in the ASL image. CONCLUSION: Unilateral PRES's pathophysiology and the association with the female hormone remain unknown. Some patients undergo gradual onset and long-term courses, and we should care for PRIS during PRES treatment.