Effect of saline irrigation temperature difference on postoperative acute pain and hypothermia during biportal endoscopic spine surgery.

BACKGROUND: Recently, enhanced recovery after surgery (ERAS) protocols have attracted attention; they emphasize on avoiding intraoperative hypothermia while performing lumbar fusion surgery. However, none of the studies have reported the protocol for determining the temperature of saline irrigation during biportal endoscopic spine surgery (BESS) procedure. This study evaluated the effectiveness of warm saline irrigation during BESS in acute postoperative pain and inflammatory reactions. MATERIALS AND METHODS: Fifty-five patients who underwent BESS procedure were retrospectively analyzed for the incidence of perioperative hypothermia (< 36oC), postoperative inflammatory factors (white blood cells (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6), serum amyloid A (SAA)), and clinical outcomes (back visual analog scale (VAS) score, postoperative shivering). The patients were divided into the warm and cold saline irrigation groups. RESULTS: Hemoglobin, WBC, ESR, creatine kinase, and creatine kinase-muscle brain levels did not significantly differ between the warm and cold saline groups. The mean CRP, IL-6, and SAA levels were significantly higher in the cold saline group than in the warm saline group (p = 0.0058, 0.0028, and 0.0246, respectively); back VAS scores were also higher with a statistically significant difference until two days postoperatively (p < 0.001). During the entire procedure, the body temperature was significantly lower in the cold saline irrigation group, but the hypothermia incidence rate significantly differed 30 min after the operation was started. CONCLUSIONS: Using warm saline irrigation during BESS is beneficial for early recovery after surgery, as it is associated with reduced postoperative pain and complication rates.

Efficacy of Staged Surgery in the Treatment of Open Tibial Fractures with Severe Soft Tissue Injury and Bone Defect.

PURPOSE: We aimed to report the clinical and radiological outcomes of staged surgery using the acute induced membrane technique with an antibiotic-impregnated cement spacer (ACS) and soft-tissue reconstructive surgery and to identify factors affecting clinical outcomes. MATERIALS AND METHODS: Thirty-two patients with severe open tibia fractures were treated via staged surgery from January 2014 to December 2019 and followed up for ≥1 year. In the first surgery, an ACS was inserted into the bone defect site along with debridement and irrigation and was temporarily fixed in place with an external fixator. The internal fixator was placed, and flap surgery and cement spacer changes were performed during the next surgery. In the third surgery, an autogenous bone graft was performed. Radiologic and functional results were investigated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria, and factors affecting the ASAMI score were analyzed. RESULTS: The average bone defect width was 43.9 mm, and the size of soft-tissue defect was 79.3 cm² . Bone union was achieved in all cases except one and required 9.4 months on average. Complications occurred in 10 cases (31.2%). Good or better clinical effects, in terms of ASAMI radiologic and functional scores, were observed in 29 and 24 cases, respectively. Complications and additional surgery were common factors affecting the two scores. CONCLUSION: Staged surgery using the acute induced membrane technique and soft-tissue reconstructive surgery is an efficacious treatment for open tibial fractures with bone defects.

A humeral hemiarthroplasty with biologic resurfacing of the glenoid using an allo-Achilles tendon: two case reports.

A hemiarthroplasty with biologic resurfacing of the glenoid is one procedure that can be performed in young patients where total shoulder arthroplasty may be difficult. The authors introduced two cases in which this procedure was performed. This approach is one treatment option for young glenoid humeral arthritis patients that addresses some of the shortcomings of an isolated hemiarthroplasty.

A Multi-Core Controller for an Embedded AI System Supporting Parallel Recognition.

Recent advances in artificial intelligence (AI) technology encourage the adoption of AI systems for various applications. In most deployments, AI-based computing systems adopt the architecture in which the central server processes most of the data. This characteristic makes the system use a high amount of network bandwidth and can cause security issues. In order to overcome these issues, a new AI model called federated learning was presented. Federated learning adopts an architecture in which the clients take care of data training and transmit only the trained result to the central server. As the data training from the client abstracts and reduces the original data, the system operates with reduced network resources and reinforced data security. A system with federated learning supports a variety of client systems. To build an AI system with resource-limited client systems, composing the client system with multiple embedded AI processors is valid. For realizing the system with this architecture, introducing a controller to arbitrate and utilize the AI processors becomes a stringent requirement. In this paper, we propose an embedded AI system for federated learning that can be composed flexibly with the AI core depending on the application. In order to realize the proposed system, we designed a controller for multiple AI cores and implemented it on a field-programmable gate array (FPGA). The operation of the designed controller was verified through image and speech applications, and the performance was verified through a simulator.

An FPGA-Based ECU for Remote Reconfiguration in Automotive Systems.

Growing interest in intelligent vehicles is leading automotive systems to include numerous electronic control units (ECUs) inside. As a result, efficient implementation and management of automotive systems is gaining importance. Flexible updating and reconfiguration of ECUs is one appropriate strategy for these goals. Software updates to the ECUs are expected to improve performance and bug handling, but there are limitations due to the fixed hardware circuit. By applying hardware-reconfigurable ECUs to the automotive system, patches that are not able to be handled with only software updates are enabled. In this paper, a remotely hardware-reconfigurable ECU for automotive systems is proposed. The proposed ECU is implemented with a field programmable gate array (FPGA) and microcontroller unit (MCU) to support in-system reconfiguration (ISR). The communication interface between the FPGA and MCU employs Zipwire communication for high speed and resilient communication. For the Zipwire communication, a Zipwire controller is designed and implemented in the FPGA. The proposed hardware-reconfigurable ECU was successfully implemented, and feasibility was demonstrated.

Lossless Decompression Accelerator for Embedded Processor with GUI.

The development of the mobile industry brings about the demand for high-performance embedded systems in order to meet the requirement of user-centered application. Because of the limitation of memory resource, employing compressed data is efficient for an embedded system. However, the workload for data decompression causes an extreme bottleneck to the embedded processor. One of the ways to alleviate the bottleneck is to integrate a hardware accelerator along with the processor, constructing a system-on-chip (SoC) for the embedded system. In this paper, we propose a lossless decompression accelerator for an embedded processor, which supports LZ77 decompression and static Huffman decoding for an inflate algorithm. The accelerator is implemented on a field programmable gate array (FPGA) to verify the functional suitability and fabricated in a Samsung 65 nm complementary metal oxide semiconductor (CMOS) process. The performance of the accelerator is evaluated by the Canterbury corpus benchmark and achieved throughput up to 20.7 MB/s at 50 MHz system clock frequency.

Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis.

There is a debate regarding the distal fusion level for degenerative lumbar scoliosis. Whether a healthy L5-S1 motion segment should be included or not in the fusion remains controversial. The purpose of this study was to determine the optimal indication for the fusion to the sacrum, and to compare the results of distal fusion to L5 versus the sacrum in the long instrumented fusion for degenerative lumbar scoliosis. A total of 45 patients who had undergone long instrumentation and fusion for degenerative lumbar scoliosis were evaluated with a minimum 2 year follow-up. Twenty-four patients (mean age 63.6) underwent fusion to L5 and 21 patients (mean age 65.6) underwent fusion to the sacrum. Supplemental interbody fusion was performed in 12 patients in the L5 group and eleven patients in the sacrum group. The number of levels fused was 6.08 segments (range 4-8) in the L5 group and 6.09 (range 4-9) in the sacrum group. Intraoperative blood loss (2,754 ml versus 2,938 ml) and operative time (220 min versus 229 min) were similar in both groups. The Cobb angle changed from 24.7 degrees before surgery to 6.8 degrees after surgery in the L5 group, and from 22.8 degrees to 7.7 degrees in the sacrum group without statistical difference. Correction of lumbar lordosis was statistically better in the sacrum group (P = 0.03). Less correction of lumbar lordosis in the L5 group seemed to be associated with subsequent advanced L5-S1 disc degeneration. The change of coronal and sagittal imbalance was not different in both groups. Subsequent advanced L5-S1 disc degeneration occurred in 58% of the patients in the L5 group. Symptomatic adjacent segment disease at L5-S1 developed in five patients. Interestingly, the development of adjacent segment disease was not related to the preoperative grade of disc degeneration, which proved minimal degeneration in the five patients. In the L5 group, there were nine patients of complications at L5-S1 segment, including adjacent segment disease at L5-S1 and loosening of L5 screws. Seven of the nine patients showed preoperative sagittal imbalance and/or lumbar hypolordosis, which might be risk factors of complications at L5-S1. For the patients with sagittal imbalance and lumbar hypolordosis, L5-S1 should be included in the fusion even if L5-S1 disc was minimal degeneration.

Biological properties of 2'-[18F]fluoroflumazenil for central benzodiazepine receptor imaging.

A novel positron emitting agent, 2'-[18F]fluoroflumazenil (fluoroethyl 8-fluoro-5-methyl-6-oxo-5,6-dihydro-4H-benzo-[f]imidazo[1,5-a][1,4]diazepine-3-carboxylate, FFMZ), has been reported for benzodiazepine imaging. In the present study, biological properties of [18F]FFMZ were investigated. Stability tests of [18F]FFMZ in human and rat sera were performed. Biodistribution was investigated in mice and phosphorimages of brains were obtained from rats. A receptor binding assay was performed using rat brain (mixture of cortex and cerebellum) homogenate. A static positron emission tomography (PET) image was obtained from a normal human volunteer. Although [18F]FFMZ was stable in human serum, it was rapidly hydrolyzed in rat serum. The hydrolysis was 39%, 63% and 92% at 10, 30 and 60 min, respectively. According to the biodistribution study in mice, somewhat even distribution (between 2 approximately 3% ID/g) was observed in most organs. Intestinal uptake increased up to 6% ID/g at 1 h due to biliary excretion. Bone uptake slowly increased from 1.5% to 3.5% ID/g at 1 h. High uptakes in the cortex, thalamus and cerebellum, which could be completely blocked by coinjection of cold FMZ, were observed by phosphorimaging study using rats. Determination of Kd value and Bmax using rat brain tissue was performed by Scatchard plotting and found 1.45+/-0.26 nM and 1.08+/-0.03 pmol/mg protein, respectively. The PET image of the normal human volunteer showed high uptake in the following decreasing order: frontal cortex, temporal cortex, occipital cortex, cerebellum, parietal cortex and thalamus. In conclusion, the new FMZ derivative, [18F]FFMZ appears to be a promising PET agent for central benzodiazepine receptor imaging with a convenient labeling procedure and a specific binding property.

Novel one-pot one-step synthesis of 2'-[(18)F]fluoroflumazenil (FFMZ) for benzodiazepine receptor imaging.

We describe the synthesis of 2'-[(18)F]fluoroflumazenil (FFMZ), which differs from the typically used [(18)F]fluoroethylflumazenil (FEFMZ) for benzodiazepine receptor imaging. For one-pot one-step labeling, the precursors, 2'-tosyloxyflumazenil (TFMZ) and 2'-mesyloxyflumazenil (MFMZ), were synthesized in three steps. The precursors were successfully labeled with no-carrier-added (18)F-fluoride which was activated by repeated azeotropic distillation with Kryptofix 2.2.2./potassium carbonate in MeCN. An automated system for labeling and purification of [(18)F]FFMZ was developed. Labeling efficiency and radiochemical purity of [(18)F]FFMZ after synthesis by the automated system were 68% and 98%, respectively. Specific binding of [(18)F]FFMZ to central benzodiazepine receptor of rats was demonstrated by phosphoimaging.