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Although colloidal lead halide perovskite quantum dots (PQDs) exhibit desirable emitter characteristics with high quantum yields and narrow bandwidths, instability has limited their applications in devices. In this paper, we describe spray-synthesized CsPbI3 PQD quantum emitters displaying strong photon antibunching and high brightness at room temperature and stable performance under continuous excitation with a high-intensity laser for more than 24 h. Our PQDs provided high single-photon emission rates, exceeding 9 × 106 count/s, after excluding multiexciton emissions and strong photon antibunching, as confirmed by low values of the second-order correlation function g(2)(0) (reaching 0.021 and 0.061 for the best and average PQD performance, respectively). With such high brightness and stability, we applied our PQDs as quantum random number generators, which demonstrably passed all of the National Institute of Standards and Technology's randomness tests. Intriguingly, all of the PQDs exhibited self-healing behavior and restored their PL intensities to greater than half of their initial values after excitation at extremely high intensity. Half of the PQDs even recovered almost all of their initial PL intensity. The robust properties of these spray-synthesized PQDs resulted from high crystallinity and good ligand encapsulation. Our results suggest that spray-synthesized PQDs have great potential for use in future quantum technologies (e.g., quantum communication, quantum cryptography, and quantum computing).

Patients with severe coronavirus disease 2019 (COVID‐19) can develop a systemic inflammatory response that can lead to lung injury and multisystem organ dysfunction. The current treatment guideline recommends the use of corticosteroids in patients who require supplemental oxygen or are mechanically ventilated. This study reports a patient with severe COVID‐19 pneumonia. Initially, the patient was treated with dexamethasone for 10 days and remdesivir for 5 days. There was clinical improvement following the treatments. However, on day 15, the patient experienced rebound pneumonia and clinical deterioration. His clinical condition improved until dexamethasone was re‐administered. This case demonstrates the rebound phenomenon after the steroid was discontinued. The duration and timing of steroids are crucial to reduce the risk of prolonged systemic inflammation and rebound pneumonia., We report a patient with coronavirus disease 2019 (COVID‐19) who was recovering following steroid treatment but experienced rebound pneumonia after the steroid was discontinued. The duration and timing of steroids are crucial to reduce the risk of prolonged systemic inflammation and rebound pneumonia.

Spinal epidural abscess is a rare disease that is less likely to occur in the cervical region. When it occurs here, cervical spondylodiscitis can develop. Surgical treatment is recommended because of possible life-threatening septic and neurological complications. We present a case of an 81-year-old man who suffered from right side paralysis and was subsequently diagnosed with a C4 to C7 epidural abscess. We utilized full endoscopic surgery for patient management. The traditional surgical methods for treating cervical epidural abscesses may cause spinal instability. There has only been one previous case report on the endoscopic-assisted method. Minimal invasive surgery by a full endoscopic method can be done with a small incision and is associated with minimal blood loss and muscle damage. This is the first report on cervical epidural abscess drainage utilization a full endoscopic method. We recommend this alternative minimally invasive method to manage cervical epidural abscess.

Background There are currently no high-quality studies on the optimal therapeutic approach for juxtafacet cyst, as treatment guidelines have not been developed. Herein, a novel technique in which we used an endoscopic transfacet approach to treat a patient with symptomatic lumbar synovial cyst is presented. Case Description An 87-year-old man presented with severe dull pain in the right anterior thigh. Lumbar magnetic resonance imaging revealed disc extrusion over the central canal zone at the L2–L3 and L4–L5 levels and an ovoid lesion with a hyperintense center plus a hypointense rim on the T2-weighted image. The lesion was located over the medial side of the right juxtafacet region at the L2–L3 level, causing thecal sac compression. After the operation, the visual analog pain scale improved with a value of 0–1/10, and straight leg raise test was negative. Microscopically, cystic fibrous tissue with focal myxoid degeneration, fibrin exudate, and scant synovial-like lining was observed. These findings were consistent with clinical synovial cyst. Three months later, lumbar magnetic resonance imaging was performed, and no evidence of cyst was disclosed. Lumbar computed tomography revealed the upper part of left L2–L3 facet joint was removed. The patient did not report any radicular pain during the 6-month follow-up period. Conclusions Percutaneous endoscopic lumbar surgery could be a new option for the management of lumbar synovial cysts, especially when general anesthesia is not appropriate for the patient.

Background Endoscopic surgery has been successfully applied in treatment of degenerative spinal disease, but few studies have assessed its use in treating sacral metastasis. We report a successful full endoscopic interlaminar approach for sacral nerve root decompression of a sacral metastatic tumor. Case Description An 80-year-old man with a history of hepatocellular carcinoma presented with buttock pain with radiation to the right lower leg for 1 week. There was also decreased muscle power of the right lower extremity. Lumbosacral magnetic resonance imaging revealed metastasis of the sacral spine and right iliac bone with S1 exiting nerve root compression. S1 nerve root decompression via a full endoscopic interlaminar approach under local anesthesia was performed. Under fluorescence guidance, a working sleeve with a beveled opening was placed in the interlaminar space of L5-S1. We entered the sacral canal and identified the S1 exiting nerve root. A laminotomy was performed from the internal edge of the right sacral laminae toward the lateral recess. During decompression of the nerve root, buttock and leg pain improved gradually. There was almost complete resolution of leg pain after surgery, and the patient recovered the ability to walk. Visual analog scale score for pain decreased from 8 to 2 after 3 months of follow-up. Conclusions For patients with sacral metastasis without spinal instability or difficulty lying in prone position under local anesthesia, the full endoscopic interlaminar approach for nerve root decompression of sacral metastasis may be a suitable method.

Spinal tuberculosis (STB) is a common manifestation of extrapulmonary tuberculosis (TB). STB accounts for around 2% of all cases of TB and around 15% of extrapulmonary TB cases. The World Health Organization has proposed a global strategy and targets for TB prevention, care, and control after 2015. Under this strategy, patients will receive standard care according to the recommendations and guidelines after confirmation of STB diagnosis. However, current recommendations and guidelines focus on disease and medication therapy management, and recommendations for early detection or decision-making algorithms regarding STB are lacking. In this review, we identified five key components for early diagnosis: (1) risk factors for STB; (2) common symptoms/signs of STB; (3) significant neuroradiological findings of STB; (4) significant laboratory findings of STB, including positive interferon-γ release assays and nonpyogenic evidence in initial laboratory data; and (5) significant clinical findings of STB. Individualized consideration for each patient with STB is essential, and we hope that the algorithm established in this review will provide a valuable tool for physicians who encounter cases of STB.

A 3 MHz-to-1.8 GHz, 94 $\mu\hbox {W}$ -to-9.5 mW, all-digital delay-locked loop (ADDLL) using 65-nm CMOS technology is presented. In this paper, a cyclic half-delay-line architecture that uses the same type of delay lines for cyclic delay determination and coarse locking is proposed and used to achieve the design goals of small footprint and fast locking for a large operating frequency range. In addition, a new delay structure is developed for the cyclic delay units and coarse delay line. In addition to clock gating, which is used to reduce power consumption in the lock-in state regardless of the clock frequency, the automatic bypassing of the cyclic operation is developed and used to reduce power consumption during high-frequency operation. Through the use of proposed techniques, the active area is reduced to only 0.0153 mm $^{2}$ , and the operating frequency range is from 3 MHz to 1.8 GHz. The measurement results show that the proposed ADDLL achieves a peak-to-peak jitter of 3 ps with 9.5 mW power consumption when operated at 1.8 GHz.

SummaryHypophysitis is a rare inflammatory disorder that can mimic a pituitary tumor clinically or radiologically. Furthermore, immunoglobulin G4 (IgG4)-related systemic disease is only a just recently characterized disorder. It can manifest as a systemic disease involving multiple organs, including the pancreas, salivary glands, lungs, liver, bile duct, gallbladder, kidneys, and retroperitoneum. It is characterized by a high serum level of IgG4 clinically and dense lymphoplasmacytic infiltration with sclerosis and phlebitis histologically. Herein, we report the case of a man 66 years of age who presented with nausea, vomiting, and poor appetite with a body weight loss of 4 kg. Image study revealed a pituitary infundibulum mass, right-posterior mediastinal and paraspinal masses, as well as infiltrating masses in bilateral kidneys. Therefore, he received a thoracoscopic biopsy for the right-posterior mediastinal and paraspinal masses and a pathologic examination reported an IgG4-related inflammatory pseudotumor. Then, transsphenoidal removal of the infundibulum mass was performed. Histologically, the infundibulum mass represented a IgG4-related hypophysitis manifested as an infiltration of plasma cells, lymphocytes, histiocytes, and some eosinophils with a fair number of IgG4-immunoreactive plasma cells. After the operation was complete, the patient took 5 mg of prednisolone every 2 days for 3 months. A follow-up computed tomography scan revealed improvement of the infiltrating masses in the bilateral kidneys.

Supplemental Digital Content is available in the text, Postcraniotomy meningitis (PCM) is a major challenge in neurosurgery, and changing patterns of infectious agents in PCM have been noted. The limited epidemiological data and urgent clinical needs motivated this research. We conducted this study to determine a risk assessment for PCM and the current pattern of infectious agents. We performed a retrospective case-control study of significant cases of postcraniotomy meningitis in the Changhua Christian Hospital System between January 1, 2008, and December 31, 2012. Postcraniotomy meningitis was diagnosed in 22 out of 4392 surgical patients; this data was reviewed for risk assessment. This study assessed the risk factors for postcraniotomy meningitis and found that it was more frequently seen in patients who were elderly (OR = 1.57, 95% CI = 1.32–2.98, P = 0.013), underwent emergency procedures (OR = 4.82, 95% CI = 1.50–14.53, P = 0.008), had leak of cerebrospinal fluid (OR = 4.62, 95% CI = 2.03–10.50, P = 0.012), had external ventricular drainage (OR = 4.68, 95% CI = 2.46–8.87, P = 0.006), were admitted to the intensive care unit (OR = 2.41, 95% CI = 1.53–8.08, P = 0.012), had used drain placement >72 hours (OR = 2.66, 95% CI = 1.04–4.29, P = 0.007), had surgery >4.5 hours (OR = 2.38, 95% CI = 1.39–4.05, P = 0.005), had repeat operations (OR = 2.74, 95% CI = 1.31–5.73, P = 0.018), endured trauma (OR = 5.97, 95% CI = 1.57–17.61, P = 0.007), or had 30-days mortality (OR = 5.07, 95% CI = 2.20–11.48, P = 0.001). The predominant pathogens isolated from cerebrospinal fluid were Staphylococcus aureus in 8 patients (36.7%) and Acinetobacter baumannii in 7 patients (31.8%). In our study, the mortality rate was 5.1% among all postcraniotomy patients. Accurate risk assessment, early diagnosis, and choice of appropriate antibiotics in accordance with epidemiologic information are the cornerstones of reducing mortality and morbidity in PCM. The changing pattern of infectious agents in PCM over time suggests the necessity of further studies to provide the most up-to-date insight to physicians.

Background The incidence of spinal epidural hematoma (SEH) is estimated to be 1 per 1,000,000 patients per year; SEH can be classified as idiopathic, spontaneous, and secondary. The cause of spontaneous SEH is uncertain but it may be associated with minor trauma. SEH can compress surrounding structures, shown by clinical symptoms and signs that affect the spinal cord or nerve roots. Surgical treatment may be considered if medical treatment fails. Case Description A 26-year-old man presented with lower back pain and significant radicular symptoms on the left side for a week. He denied previous lumbar trauma or the use of anticoagulation drugs. We used the full-endoscopic transforaminal approach (extraforaminal technique) to remove the SEH under local anesthesia. The patient was discharged home 2 days after surgery and the radicular pain disappeared completely. Three months later, follow-up magnetic resonance imaging showed that the dark-brown lesion had been totally removed. Conclusions Spontaneous SEHs are uncommon. Although lumbar laminectomy is the mainstream treatment in those with neurologic deficits caused by epidural hematomas, the percutaneous full-endoscopic transforaminal approach may be an option for certain SEHs.

In practice, a system or equipment has a finite useful life. When an aged system is replaced by a new system, the new system seldom has exactly the same characteristics, functions, investment cost, maintenance expenses, etc., as those of the aged system. However, the literature has shown that most researchers are devoted to studying maintenance problems in an infinite time span, which assumes that the replaced system in each replacement cycle (or period) has the same conditions and costs. Apparently, the assumption might not be practical, since the useful operating life of most systems is finite in the real world. Therefore, the purpose of this research is to develop an optimal preventive maintenance (PM) policy having failure rate reduction within a finite time span under a warranty consideration by minimizing the expected total maintenance cost. The PM cost is assumed to be a linear function of each PM effect. Two cases are studied and compared; one is with no warranty provided and the other is with a g...

It has been shown that the incorporation of the Total Productive Maintenance (TPM) into the manufacturing machine is a success in that: the decrease of the machine failure rate and the improvement of the machine reliability. The major subject of the TPM system is focused on the Daily Maintenance Service (DMS) of the manufacturing machine such as cleaning and inspection performed by in-line operators. The DMS is classified as a preventive maintenance policy and has significant contribution in practical applications. However, little research has been devoted to modeling the Daily Maintenance Service. This research assumes that the machine failure rate will be improved if the DMS is performed for a long period of time. If DMS is performed, the machine will at least be restored to “as bad as old” state but can not reach the “as good as new” state. Thus, the DMS is categorized as an imperfect maintenance according to its characteristics. The emphasis of this research is to model the DMS for high preci...

It is challenging to design a closed-loop all-digital delay-locked loop (ADDLL) that also has a small area, low power, and fast locking for a wide frequency range operation. In this work a cyclic half-delay-line architecture with the same type of delay lines for cyclic delay deduction and coarse locking is proposed to achieve the design goals of small area and fast locking for a wide frequency range operation. In addition to clock gating, which is used to reduce power consumption in the lock-in state regardless of the clock frequency, automatic bypassing of the cyclic operation is developed to reduce power consumption for high-frequency operations. Based on these proposed techniques, a 3 MHz-to-1.8 GHz 94 μW-to-9.5 mW 0.0153-mm2 closed-loop ADDLL is realized in 65-nm CMOS.

Background Closure of the dura defect may be easy to perform in open lumbar surgery but could be difficult in minimally invasive transforaminal lumbar interbody fusions (MIS-TLIF) since MIS-TLIF was done through a small tube, which limited the use of standard dural repair instruments. We used nonpenetrating titanium clips that were originally designed for the vascular anastomoses to repair the dura defect, which is never described in the literature. Methods We presented a case of spinal stenosis with incidental durotomy while performing MIS-TLIF. We closed the dura laceration with three medium-sized nonpenetrating titanium clips (AnastoClip Vessel Closure System, LeMaitre Vascular, Inc., Burlington, MA). Results Nonpenetrating titanium clips have the benefits of being technically easy to use, reduced durotomy repair time, decreased bed rest due to related medical complications, superior postoperation with immediate hydrostatic strength, and better reapproximation if it fails to clip successfully. As for the postoperation follow up, clips are tiny and reveal no obvious artifact, especially in cases where the pedicle screws are already causing much artifact. Conclusion Primary dural closure during MIS-TLIF with clips is an effective way in cases that involve limited tubular space.

Preventive maintenance (PM) can slow the deterioration process of a repairable system and restore the system to a younger state. The proposed PM model of this paper focuses on the restoration effect of degradation rate reduction which can only relieve stress temporarily and slow the rate of system degradation while the hazard rate is still monotonically increased. This PM model considers a deteriorating but repairable system (or equipment) with a finite life time period. This PM model is modified based on an original degradation-rate-reduction PM model over a finite time span of which the searching range for the optimal solution of the time interval between each PM is limited. It is demonstrated that the proposed degradation-rate-reduction PM model over a finite time period can have a better optimal solution than the original PM model. The algorithm of finding the optimal solution for the modified PM model is developed. Examples are provided and are compared with the corresponding original PM model.

Historically deep brain stimulation (DBS) for Parkinson's disease (PD) has been performed by frame-based stereotaxy. However, recently the option of frameless stereotaxy has become available. This avoids the potential discomfort the patient may experience because of the frame fixed to the head. This study compared clinical outcomes of DBS performed using frame-based and frameless procedures for PD patients. Twelve patients underwent DBS operations; from these patients, six underwent frame-based and six underwent frameless DBS operations, and assessed 6 months later. Operation time, subthalamic electrode contact length, microelectrode recording (MER) tracts, and unified PD rating scale scores were evaluated and the scores were compared. This small study found no differences between frameless or frame based DBS, and concludes that framless system maybe an acceptable alternative.

A Parkinson's disease patient with deep brain stimulation (DBS) implantation experienced an acute subdural haematoma (SDH) after a fall. The DBS electrodes and brain parenchyma were shifted. Fortunately, the patient recovered after craniectomy and removal of SDH, and the DBS was re-activated with the same parameters. Patients with DBS implants who suffer a traumatic brain injury do not necessarily incur permanent implant failure; there is every chance that the DBS may continue to work as reported here.

This paper proposes a new solution to improve the coding efficiency of depth map in 2D plus depth map of 3D video coding. The proposed algorithm is achieved to reduce coding time on using H.264 encoding for both color image and depth map and to enhance the encoding quality for 2D MV sharing to depth encoding. The method uses 3D perceptual attention regions to determine re-motion estimation MBs in depth map. Moreover, to reduce the coding time for the remotion estimation, the proposed algorithm achives a fast mode decision MBs by motion activity to select coding mode. Experimental results show that the entire encoding time is reduced by about 41.09% compared with the exhaustive full mode decision approach, and the SSIM is increased by about 0.0764 and the PSNR is increased by about 6.7685dB compared with the MV sharing approach.

This paper describes the design of a multi-GHz ADDLL. HDSC-based coarse-fine architecture is adopted to achieve low power and to avoid harmonic locking at large operating frequency ranges. A new resettable coarse delay line and an asynchronous binary-search design are proposed to achieve fast coarse locking and fine locking, respectively. A novel maintenance operation is also proposed to allow phase adjustments to be performed during each cycle to effectively suppress the jitter. The measurement results show that the designed 1.0-V, 55-nm ADDLL has a peak-to-peak jitter of 3 ps and a locking time of 8 cycles when operated at 2.5 GHz with a power dissipation of only 1.96 mW.

Wireless sensor network is used for several applications starting from surveillance to health monitoring. Nodes are usually deployed randomly and densely over the monitored region and are supposed to monitor it time to time. The nodes in wireless sensor networks are battery powered and therefore, it is crucial to manage the power consumption of the nodes efficiently. Though most of the existing power-saving protocols minimize the power consumption by periodic sleep and wake up schedules, they fail to adjust a sensor node's sleep duration based on its traffic load. In this paper an adaptive traffic load based node scheduling protocol is proposed to decide the active and sleep schedules of the nodes. The whole network is divided into finite number of virtual zones and a routing path algorithm is designed based on residual energy of the next hop nodes. Simulation results of our protocol shows that the control packet overhead and energy consumption are reduced considerably as compared to similar quorum-based medium access control protocols.

This paper presents an all digital delay-locked loop (ADDLL) that uses asynchronous-deskewing technology and achieves low power/voltage, small jitter, fast locking, and high process, voltage, and temperature (PVT)-variation tolerance. The measurement results show that the maximum frequency is 100 MHz at 0.35 V with 19μW power dissipation, 62 ps peak-to-peak jitter, and 3 locking cycles. When operated at 0.5 V, the measured maximal operating clock frequency is 450 MHz with 12 ps peak-to-peak jitter, 6 locking cycles, and 119μW power dissipation. The ADDLL is fabricated with 55nm CMOS technology, and the active area is only 0.019 mm2.

Common cause failures usually occurred in redundant systems in which the units or components are either identical or sharing the same power supply. Earlier research aim to improve reliability, availability and maintenance (RAM) of safety-related equipments by establishing optimal testing schedules for those systems. However, frequency maintenance tasks may not only induce unexpected failure due to inappropriate maintenance, but also increase the maintenance cost. Cost-effective preventive maintenance model for the equipments were provided to maintenance equipment availability with minimal cost. In this study, the impacts of common cause failures (CCF) on the testing schedule and average maintenance cost are provided.

This work proposes an ADDLL/VDD-biasing co-design methodology for variation-tolerant designs. A modified ADDLL behaves as a variability sensor in the beginning of operation, and the sensing result is used by a VDD-biasing circuit to adjust the VDD of a loaded design for performance calibration. During normal operation, the ADDLL is reused as a de-skewing element for the calibrated design. With this methodology, not only the performance of the loaded design but also that of the ADDLL can be effectively adjusted toward their design specifications even under serious process variations.

The open-loop de-skewing circuits are traditionally used for fast clock synchronization, but they are unable to deal with the problems induced by run-time variations. This paper presents the design of a skew compensation circuit that can achieve fast lock-in and also perform maintenance operation after lock-in. This circuit is designed on top of the open-loop half-delay-line skew compensation circuit (HDSC) to get a lock-in time of two cycles, and extra circuits are added for monitoring the influence of runtime temperature and supply-voltage variations and maintaining the de-skewing effect.

This paper presents the design of a 55nm 1.0V 1GHz open-loop de-skewing circuit for clock synchronization in a SoC. All-digital architecture and circuit design techniques are adopted and developed to achieve small jitter, low power, super fast locking, and input duty-cycle independence. Even running at 1 GHz, the proposed circuit wakes up from sleep with only one-cycle locking time. Measurement results show a peak-to-peak jitter of 4 ps and a static phase error of 5.46 ps at 1 GHz. To the best of our knowledge, this is the first GHz open-loop de-skewing circuit achieving sub-|TW/MHz active power. By power gating, 84% of leakage power is saved in the sleep mode.

A system normally has a finite useful life. The new system in each replacement cycle seldom has exactly the same characteristics and properties. However, maintenance problems are usually defined over the infinite time span where the system is assumed to have the same conditions and costs in each replacement cycle. This assumption might not be practical. Therefore, the purpose of this research is to develop the optimal preventive maintenance (PM) policies with degradation rate reduction over a finite time span under a warranty consideration by minimizing the expected total maintenance cost. Two cases are studied and compared, one is no warranty provided and the other is with a given warranty period. For the second case, two policies, performing and not performing PM within the warranty period, are examined. In this paper, the algorithm for searching the optimal solution is presented. Examples are given and the sensitivity analysis is also provided.

For the maintenance and replacement of system subject to stochastic deterioration, flexibility is an important consideration factor. Different possible maintenance policies are discussed in this paper where the failure distribution modeled by the Weibull distribution. The total discounted cost concept is very important in decision making for the complex system such as expensive capital equipment with operating life cycle lasting for years. A modified maintenance model is proposed with incorporating the costs of operating cost, the maintenance cost of minimal repairs, failure replacements and preventive replacements. We investigate the maintenance policies by modeling the deteriorating process of a system as a Markov decision process. Under the discounted cost criterion, the optimal parameters for the control limit policy are obtained. The sensitivity analysis of these control limits is performed for the flexibility of decision making. The optimal equations of the Markov decision process are solved by using the backward recursive scheme over a set of finite planning horizons to approximate the optimal policies for the infinite planning horizons.

Preventive maintenance (PM) can slow the deterioration process of a repairable system and restore the system to a younger age or state. Many researchers focus on studying PM models for the cases of age or failure rate reduction and developing optimal PM policies. However, the PM actions, such as cleaning, adjustment, alignment, and lubrication work, may not always reduce system's age or failure rate. Instead, it may only reduce the degradation rate of the system to a certain level. Furthermore, most of the existing optimal PM policies result in very low reliability at the time of preventive replacement (PR). In practice, however, high reliability is usually required for a system to avoid failures being occurred. This paper is to develop an optimal periodic PM policy over an infinite time span by minimizing the expected cost rate with the consideration of reliability limit (Rmin,) for Weibull-failure-time systems with degradation rate reduction after each PM. The proposed optimal periodic PM policy consists of two PM models. One model has fully periodic PM time-interval for every preventive replacement cycle; the other model has partially periodic PM time-interval where the time interval between the final PM and the PR is not a constant. For specified reliability limit, the proper model is chosen by using the algorithm provided in this paper. Examples are demonstrated and the sensitivity analysis is also presented for the proposed PM models.

The conventional SAR controller for DLL applications is shown in this paper to have the problem of dead lock. With this problem, the DLLs adopting the SAR controller are useless because they will go unlocked forever in face of supply voltage and temperature variations. An improved SAR controller is proposed to overcome this problem and then to rescue the DLLs.

Some systems work for a job with random working and processing times, and are checked at periodic and random times. When a failure occurs, we execute the backup operation to the latest checking time. First, the expected costs with periodic and random backups are formulated, and comparisons between periodic and random policies are made. Next, we focus on the backup policies when the system is checked at the Nth interval of working times, two total expected costs are obtained and optimal numbers N* which minimize them are derived analytically. Finally, one modified backup model in which failures are detected only at checking times is proposed and two expected costs are obtained.

Spontaneous spinal epidural hematoma (SSEH) is a neurosurgical emergency that requires prompt diagnosis and treatment. We report a 24-year-old woman who presented with acute onset of paralysis in both lower limbs and sensory disturbance below the fourth-thoracic dermatome. Spinal magnetic resonance image (MRI) revealed an intraspinal, extradural mass is extending from the fifth to the seventh thoracic vertebrae with compression of the spinal cord. Laminectomy of the T5 to T7 vertebrae was performed 12 h after onset. During the procedure, an epidural hematoma with hypervascularization and an abnormal vascular network were observed grossly on the dorsal dural surface. Postoperative angiography and MRI revealed complete resolution of the hematoma and no evidence of residual vascular lesion in the intra- or extra-dural region. At 6-month follow-up, the patient had regained full muscle power and sensation in the lower limbs. There was no evidence of urinary or stool incontinence. The patient had a history of remaining seated for prolonged periods of time, which may have elevated the spinal venous return pressure, resulting in spontaneous hemorrhage due to rupture of the spinal epidural arteriovenous fistula. This case report shows that patients with SSEH can have excellent neurologic outcomes if the condition is treated early with decompressive laminectomy.

Background: Osteoporosis is predominantly a condition of the elderly. In this study, we evaluated the effects of teriparatide on lung function and pain relief in elderly women with multiple osteoporotic vertebral compression fractures. Methods: A total of 37 patients who received teriparatide treatment during the period January 2010 to December 2011 were enrolled. Dual-energy X-ray absorptiometry scans were used to measure bone mineral density (BMD) and lung function was measured using a MasterScreen Body Jaeger spirometer. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) values were recorded. The Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) for pain were used to evaluate physical health and pain intensity, respectively, at baseline and after 6 months of teriparatide treatment. Results: Mean BMD at the lumbar spine increased from 0.716 g/cm2 at baseline to 0.829 g/cm2 after 6 months of treatment. In addition, both mean FVC and FEV1 values after 6 months of treatment were significantly higher than baseline values (99.01% and 100.06% vs. 87.62% and 90.62%, respectively). Teriparatide treatment also resulted in a significant reduction in self-reported pain intensity and a significant improvement in physical health as measured by VAS and ODI scores, respectively. Conclusions: In addition to increasing BMD, teriparatide treatment improves the lung function and results in diminished pain intensity in women with multiple osteoporotic vertebral compression fractures.

Background: High-grade primary glioma have poor prognosis and predictive biomarkers is very important. Midkine (MDK), a heparin-binding growth factor, is important in regulating carcinogenesis, cell proliferation, mitogenesis, and angiogenesis. This study aimed to identify over-expression of MDK in gliomas and correlate this with clinical outcomes. The authors put forward their hypothesis correlating proliferation and poor survival with over-expression of this novel protein. Methods: Two datasets from Gene Expression Omnibus (GEO) included human data of 100 and 180 patients, respectively. The MDK expression, World Health Organization (WHO) pathological grade, sex, age, and survival time were identified for statistical analysis. Results: A search of the GEO profile revealed that MDK expression level was statistically greater in the WHO grade IV compared with grade II (P = 0.002), in grades III and IV compared with nontumor control (P = 0.044 and P < 0.001, respectively) after adjustments using the Bonferroni method. By the Kaplan-Meier survival curve, the high MDK expression group had poorer survival outcome (2.38-fold hazard, 95% confidence interval: 1.22-4.63) than the low MDK expression group after adjustments for WHO grade and age. Conclusions: Taken together, there is a positive correlation between MDK expression and WHO grading of human gliomas. Moreover, MDK over-expression is significant correlated to poor survival outcome in high-grade, suggesting that MDK may be an important therapeutic target.

Background: Spinal manipulation is widely used for low back pain treatments. Complications associated with spinal manipulation are seen. Lumbar epidural hematoma (EDH) is one of the complications reported in the literature. If lumbar chronic EDH symptoms are present, which are similar to those of a herniated nucleus pulposus, surgery may be considered if medical treatment fails. Percutaneous endoscopic discectomy utilizing an interlaminar approach can be successfully applied to those with herniated nucleus pulposus. We use the same technique to remove the lumbar chronic EDH, which is the first documented report in the related literature. Methods: We present a case with chronic lumbar EDH associated with spinal manipulation. Neurologic deficits were noted on physical examination. We arranged for a full-endoscopic interlaminar approach to remove the hematoma for the patient with the rigid endoscopy (Vertebris system; Richard Wolf, Knittlingen, Germany). Results: After surgery, the patient's radiculopathy immediately began to disappear. Magnetic resonance imaging (MRI) follow-up 10 days after the surgery revealed no residual hematoma. No complications were noted during the outpatient department follow up. Conclusions: Lumbar EDH is a possible complication of spinal manipulation. Patient experiencing rapidly progressive neurologic deficit require early surgical evacuation, while conservative treatment may only be applied to those with mild symptoms. A percutaneous full-endoscopic interlaminar approach may be a viable alternative for the treatment of those with chronic EDH with progressive neurologic deficits.

This paper presents an all-digital delay locked loop (ADDLL) that uses asynchronous-deskewing technology and achieves low power/voltage, small jitter, fast locking, and high process, voltage, and temperature (PVT)-variation tolerance. The measurement results show that the maximum frequency is 100 MHz at 0.35 V with 19 μW power dissipation, 62 ps peak-to-peak jitter, and 3 locking cycles. When operated at 0.5 V, the measured maximal operating clock frequency is 450 MHz with 12 ps peak-to-peak jitter, 6 locking cycles and 119 μW power dissipation. The ADDLL is fabricated with 55 nm CMOS technology, and the active area is only 0.019 mm2.