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BACKGROUND Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of severe spinal cord compression and degenerative cervical myelopathy. Because OPLL is rarely accompanied by prominent syringomyelia, when both are observed, other causes of syringomyelia should be considered. Simultaneous presentation of OPLL and hemangioblastoma of the cervical spine is a rare encounter and has never been reported in the English-language literature. OBSERVATIONS The authors present a case of a 64-year-old man with muscle weakness of the right upper limb and worsening dysesthesia of the right thumb and index finger. Noncontrast magnetic resonance imaging (MRI) of the cervical spine from another institution revealed OPLL from the C2 to C6 levels with severe spinal cord compression and prominent syringomyelia. Repeated MRI with contrast showed an intramedullary tumor, about 11 mm in diameter, at the right posterior aspect of the C4 level. The authors performed laminectomies from C1 to C6 with posterolateral fusion and removed the C4 tumor. Pathohistological examination of the tumor demonstrated hemangioblastoma. LESSONS Careful evaluation of the preoperative imaging study is extremely important in surgical decision making. Although rare, concomitant cervical hemangioblastoma should be listed in the differential diagnosis when OPLL is accompanied with prominent syringomyelia.

BACKGROUND Flow diverter stenting is an effective treatment for large proximal internal carotid artery (ICA) aneurysms. Cranial neuropathy caused by the mass effect of the aneurysm usually subsides over time. However, a new onset of compressive optic neuropathy after successful flow diverter stenting of a large proximal ICA aneurysm is seldom reported. OBSERVATIONS A 57-year-old woman had a right supraclinoid ICA aneurysm (approximately 17 mm) on magnetic resonance angiography (MRA) in a health checkup. She received intervention with the Pipeline embolization device. Six months later, she started to experience progressive hemianopia in the left half of the visual field. Nine months after stenting, MRA showed that the aneurysm was growing and causing mass effect, but digital subtraction angiography confirmed that the aneurysm was completely excluded from the circulation. She received a craniotomy for microsurgical decompression of the optic nerve and coagulation shrinkage of the aneurysm. Clipping and thrombectomy were not attempted. Her visual fields recovered gradually. Follow-up MRA showed that the aneurysm also diminished in size. LESSONS Whether the coagulation technique of the flow-diverter-occluded aneurysm alone is enough to cause satisfactory shrinkage and interaction between the flow diverter and the aneurysmal vasa vasorum/neointima formation should be further examined.

Metastasis to the skull often occurs in patients with lung, breast, and prostate cancer. However, solitary skull metastasis mimicking a meningioma with dural tail sign from hepatocellular carcinoma (HCC) is exceedingly rare. We report a 49-year-old male who is a hepatitis B virus carrier presenting with an enlarging subcutaneous mass at the right occipital region for more than 5 months. The brain CT and MRI showed a huge extra-axial mass at the right temporo-parieto-occipital region with dural tail sign and bony destruction. The pre-operative diagnosis was an atypical meningioma. We performed a craniectomy along with tumor removal, and the pathological report was metastatic HCC. The patient had titanium mesh cranioplasty two weeks later. Subsequent treatments (sorafenib plus focal radiation) were arranged. The post-operative brain MRI at 3 months follow-up showed no recurrence. Further aggressive treatment for his HCC was arranged. In the English literature (PubMed search), 19 cases of skull metastasis from HCC as the initial presentation were reported in the recent decade. Among them, only seven cases had dural involvement. Whether these patients received aggressive or palliative treatments following the diagnosis of metastatic HCC depended on the disease stage and severity of the underlying liver disease. Solitary skull metastasis of HCC mimicking a meningioma is very rare but should be considered as a differential diagnosis in patients with chronic hepatitis B presenting with scalp lesion. Treatment should be individualized to alleviate symptoms, improve quality of life, and increase survival.

Surgical treatments for skull base meningiomas are challenging. We found that most of these lesions (75%), despite locating at the anterior, middle or posterior fossa, could be dealt with a combo skill—the pretemporal trans-cavernous trans-Meckel’s trans-tentorial trans-petrosal approach (PCMTP), which adopted the same curvilinear skin incision as for the classic pterional approach. Our aim of this study is to validate the application of this technique in treating skull base meningiomas. Patients underwent surgical intervention at our institute during 2010–2018 were retrospectively reviewed. We statistically analyzed the clinical, radiological, and pathological outcomes. In total, 109 patients operated with at least part of the PCMTP combo technique were included. The median follow-up time was 26.6 months. Tumor locations were categorized into: Zone I—sphenoid ridge, olfactory groove, and juxtasellar meningiomas which could be dealt with pterional approach. Zone II—clinoidal and cavernous sinus meningiomas which could be dealt with pretemporal trans-cavernous approach. Zone III—Meckel’s and Incisura meningiomas which could be dealt with trans-Meckel’s trans tentorial approach. Zone IV—petroclival menigiomas which could be dealt with trans-petrosal approach. When an extensive tumor occupied the anterior, middle, and posterior fossa, the whole combination of the PCMTP technique was applied. The mortality rate is 3.7% (4 patients). Three patients (2.8%) suffered from postoperative deterioration and required occasional assistance. The location of tumor was associated with different Simpson grade removal (p = 0.0015) and resection rate (p

Background Selective amygdalohippocampectomy (SAH) is designed to treat patients with mesial temporal lobe epilepsy (MTLE). Objective To determine the volume and impact of temporal lobe infarction after retractorless transsylvian SAH (en bloc resection of the hippocampus) that have not been reported. Methods A retrospective analysis of patients treated with retractorless transsylvian SAH. Infarctions were detected by magnetic resonance imaging (MRI) within the first week after the operation. Neuropsychological testing was performed preoperatively and 6 mo later. Seizure outcome was evaluated 2 yr after epilepsy surgery. Results Between 2010 and 2014, a total of 30 patients were included in this study. Analysis of postoperative MRI showed the following: (1) mean removal volume of the hippocampus-parahippocampus was 5.72 cm3, and (2) mean volumes of temporal and insular infarctions were 1.71 and 0.25 cm3, respectively. Twenty-five patients (83.3%) were free of disabling seizures (Engel class I) at 2 yr of outcome. Neuropsychological testing revealed improvement in Perceptual Organization Index (P = .036) and verbal paired associates II (P = .014) after the operation. Neither infarction volume nor removal volume was related to epilepsy outcome in linear regression model. Conclusion Transsylvian SAH has comparable seizure outcomes but bears inherent risks of vasospasm/vascular injury. Immediate postoperative small infarction volume around resection cavity or along surgical corridor was noticed after retractorless transsylvian SAH, which did not cause neuropsychological deteriorations, in contrast to previous study with the use of self-sustaining rigid retraction system. Further study should be performed to compare procedure-related infarctions and their impacts on neuropsychological outcomes in different selective approaches.

Background Esophageal injury is a severe surgical complication of a transsternal approach to high thoracic vertebral metastasis, which can result in mediastinitis and life-threatening consequences. A covered stent can be placed in the esophagus to prevent mediastinal leakage. However, tracheomalacia is a rare complication following esophageal stenting. Case Description A 56-year-old man had a pathologic fracture of the T3 vertebral body with spinal cord compression, myelopathy, and neurogenic bladder. An esophageal injury was noticed during the transsternal approach. Immediate suture repair, drainage tube placement, and subsequent esophageal stenting were carried out. One month after discharge, the endoscopic examination revealed nonhealing of the esophagus, and a new covered stent was replaced. Episodes of severe stridor and dyspnea led to the patient being sent to the emergency department. Computed tomography scan of the chest revealed a focal collapse of the trachea at the thoracic inlet, and tracheomalacia was suspected. The covered stent was removed, despite nonhealing of the esophagus. His stridor, dyspnea, and constant coughing subsided afterwards. The endoscopic examination at 3 months after stent removal showed complete healing of the esophagus. Conclusions Esophageal stenting can be used to prevent mediastinal leakage due to esophageal injury in the transsternal approach for high thoracic vertebral metastasis, but the stent might be a cause of tracheomalacia. Stent removal should be considered if upper airway obstruction occurs. Awareness of the radial force of the stent, esophageal composition (e.g., status post suture repair), and esophageal diameter must be considered for optimal stent tolerance to avoid complications.

This research aims to identify the role of natural wetlands in arsenic (As) removal. Phu Lek wetland in Loei Province, Thailand, was selected as the study area. Monthly samples of water (144), plant (360), and sediment (144) were collected from the wetland for 24 months. As concentration in the surface water at the wetland inlet was 0.85±0.26 mg L-1, and 0.02±0.01 mg L-1 at the wetland outlet. It was observed that the As level in water decreased significantly along its flow path, with an As removal efficiency of 98 %. As concentration in the sediment was 89.53-356.22 mg kg-1 at the inlet of wetland, but decreased gradually downstream of the water flow. Three dominant emergent plant species were observed in this wetland. As accumulation (0.02-2.37 mg kg-1) was noted in all the parts of the three plant species. As content was the highest in the rootlet (0.00-1.27 mg kg-1) compared to that in foliage (0.00-0.84 mg kg-1), leaf stalk (0.00-1.86 mg kg-1), and rhizome (0.00-2.64 mg kg-1). The level of As in the different vegetation species was in the order Diplazium esculentum > Colocasia esculenta > Lasia spinose. Further, As entrapment in the different plant plants followed the order rootlet > rhizome > foliage > leaf stalk. All the three plant species showed high bioconcentrationfactors, with values of 0.03-1.28, 0.02-0.93, 0.00-0.84, and 0.00-0.38at the rootlet, rhizome, foliage, and leaf stalk, respectively, but had low translocation factors (foliage/rootlet: 0.02-0.90 and leaf stalk/rootlet: 0.00-0.44). In summary, As present in the surface water could be effectively removed by the wetland system.

Background A subgroup of patients with acute minor stroke (AMS) or transient ischemic attack (TIA) become disabled due to disease progression (DP) or recurrent stroke within 3 months. The aim of this article is to identify the risk factors for DP in AMS/TIA patients. In the literature, no studies focused on computed tomography perfusion (CTP) in AMS/TIA patients at the acute stage. Methods This retrospective study included patients with AMS or TIA (onset of symptoms ≤4.5 hours, baseline National Institutes of Health Stroke Scale [NIHSS] score of 0-4). DP was defined as a deterioration of NIHSS score of ≥2 points during hospitalization or modified Ranking Scale ≥2 at 3-month follow-up. Clinical data and imaging results were retrieved and measured for statistical analysis. Results From 2011 to 2017, total 135 patients were eligible for further analysis: 28 patients (20.7%, DP group) and 107 patients (79.3%, non-DP group). The DP group had significantly higher larger penumbra volumes (p = 0.028). In univariate model of the logistic regression, patients with the following risk factors tended to have unfavorable outcome: female gender, higher HbA1c, chronic kidney disease stage ≥3b, intracranial atherosclerosis, and penumbra volume were associated unfavorable outcome, but larger deadcore volume was not. In further multivariate analysis, only penumbra volume >5 cm (p = 0.049, odds ratio [OR] = 3.21, 95% CI: 1.00-10.27) had the statistical significance. The cut-point value of the penumbra volume for unfavorable outcome in AMS/TIA patients was 4.73 cm. Conclusion One fifth of the AMS/TIA patients had unfavorable outcome at 90 days. In CTP performed within 4.5 hours after the onset of AMS/TIA, the penumbra volume (>5 cm) was a significant risk factor for DP, and the cut-point value was 4.73 cm. Further studies could be designed to involve this subgroup of patients for more aggressive treatment.

This work demonstrates the utilization of phosphotungstic acid (PTA) as a novel acidic catalyst for carbohydrate reactions, such as per-O-acetylation, regioselective O-4,6 benzylidene acetal formation, regioselective O-4 ring-opening, and glycosylation. These reactions are basic and salient during the synthesis of carbohydrate-based bioactive oligomers. Phosphotungstic acid's high acidity and eco-friendly character make it a tempting alternative to corrosive homogeneous acids. The various homogenous acid catalysts were replaced by the phosphotungstic acid solely for different carbohydrate reactions. It can be widely used as a catalyst for organic reactions as it is thermally stable and easy to handle. In our work, the reactions are operated smoothly under ambient conditions; the temperature varies from 0 °C to room temperature. Good to excellent yields were obtained in all four kinds of reactions.

Cerebral venous sinus thrombosis (CVST) is a rare cause of cerebral infarction. Once patients survive the acute phase, long-term prognosis is generally satisfactory. CVST patients who harbored risk factors known for poor prognosis (e.g., deterioration of consciousness/neurological functions and seizures) were oftentimes unresponsive to systemic heparin treatment. The advantage of combined endovascular mechanical thrombectomy (EMT) and on-site chemical thrombolysis (OCT) plus systemic heparin for CVST over the heparin treatment alone has not been proved. A retrospective study was conducted to analyze consecutive patients with CVST from 2005 to 2015. Patients having clinical improvement or stable disease after heparin treatment were in I/S group; patients having continuous deterioration of consciousness/neurological functions and refractory seizures (despite the use of multiple anti-epileptic drugs) after heparin treatment were in D group. EMT and OCT were indicated for patients in D group. Imaging studies and medical records were reviewed for statistical analysis. Safety issues included new-onset/progression of symptomatic intracerebral hemorrhages (ICH) or procedure-related complications. Total thirty patients were included (I/S group = 16; D group = 14). In D group, the mean time frame from the start of heparin treatment to the endovascular treatment was 3.2 days. Compared with I/S group, all patients in D group had complete stenosis of the sinuses, with higher initial mRS, lower initial GCS, and more seizures (p = 0.006, 0.007, and 0.031, respectively), but no significant differences in the mRS at discharge (p = 0.504). Shorter length of thrombosis and lower initial mRS were associated with better outcomes (p = 0.009 and 0.003, respectively). Thrombosis involving the superior sagittal sinus (SSS) was associated with bad outcomes (p = 0.026). There were two patients (6.7%) with worsening symptomatic ICH, one in each group, managed surgically. The overall mortality of the study was 6.7% (2/30). Combined EMT and OCT after heparin treatment for severe CVST were reasonably safe, which might be considered as a salvage treatment in severe CVST patients who are unresponsive to heparin with heavy clot burden involving SSS in the acute phase. However, further studies are needed to confirm its efficacy and validity.

Endovascular embolization is the treatment of choice for carotid-cavernous fistulas (CCFs), but failure to catheterize the cavernous sinus may occur as a result of vessel tortuosity, hypoplasia, or stenosis. In addition to conventional transvenous or transarterial routes, alternative approaches should be considered. The authors present a case in which a straightforward route to the CCF was accessed via transsphenoidal puncture of the cavernous sinus in a neurosurgical hybrid operating suite.This 82-year-old man presented with severe chemosis and proptosis of the right eye. Digital subtraction angiography revealed a Type B CCF with a feeding artery arising from the meningohypophyseal trunk of the right cavernous segment of the internal carotid artery. The CCF drained through a thrombosed right superior ophthalmic vein that ended deep in the orbit; there were no patent sinuses or venous plexuses connecting to the CCF. An endoscope-assisted transsphenoidal puncture created direct access to the nidus for embolization. Embolic agents were deployed through the puncture needle to achieve complete obliteration. Endoscope-assisted transsphenoidal puncture of the cavernous sinus is a feasible alternative to treat difficult-to-access CCFs in a neurosurgical hybrid operating suite.

Arsenic (As) removal by nano bimetallic Cu-Fe synthesized by in-situ (Cu-Fe)IS and impregnation (Cu-Fe)IM techniques was studied. Synthesized Cu-Fe by both techniques provided smaller particles than NZVI particles. (Cu-Fe)IM showed higher efficiency in As removal, compared to (Cu-Fe)IS and pristine NZVI. Batch experiments were performed by varying percent Cu loading (0–30% by wt). As(III) was removed completely by 10 wt % Cu loading on NZVI under an IM technique. It also provided double removal rate compared to pristine NZVI. X-ray absorption near edge structure analysis supported that a mixed phases of Cu2O and CuO in (Cu-Fe)IM enhanced As removal toward co-precipitating with iron species about 20% for both As(III) and As(V) removal. © 2017 American Institute of Chemical Engineers Environ Prog, 2017

Resource recovery in wastewater treatment is the major challenge for achieving sustainable development. Further than only treatment, the recovery and reuse of nitrogen (N) and phosphorus (P) as a slow release fertilizer from actual swine wastewater (SW) was performed in this study. The development of a novel technique of converting soft sludge into hard particles using homogeneous granulation process in a fluidized bed reactor helps address the recovery. Under conditions of pH 8.5 ± 0.2, an Mg:P ratio of 1.2, total suspended solids (TSS)

OBJECTIVE The treatment of paraclinoid aneurysms remains challenging. It is important to determine the exact location of the paraclinoid aneurysm when considering treatment options. The authors herein evaluated the effectiveness of using the optic strut (OS) and tuberculum sellae (TS) as radiographic landmarks for distinguishing between intradural and extradural paraclinoid aneurysms on source images from CT angiography (CTA). METHODS Between January 2010 and September 2013, a total of 49 surgical patients with the preoperative diagnoses of paraclinoid aneurysm and 1 symptomatic cavernous-clinoid aneurysm were retrospectively identified. With the source images from CTA, the OS and the TS were used as landmarks to predict the location of the paraclinoid aneurysm and its relation to the distal dural ring (DDR). The operative findings were examined to confirm the definitive location of the paraclinoid aneurysm. Statistical analysis was performed to determine the diagnostic effectiveness of the landmarks. RESULTS Nineteen patients without preoperative CTA were excluded. The remaining 30 patients comprised the current study. The intraoperative findings confirmed 12 intradural, 12 transitional, and 6 extradural paraclinoid aneurysms, the diagnoses of which were significantly related to the type of aneurysm (p < 0.05) but not factors like sex, age, laterality of aneurysm, or relation of the aneurysm to the ophthalmic artery on digital subtraction angiography. To measure agreement with the correct diagnosis, the OS as a reference point was far superior to the TS (Cohen's kappa coefficients 0.462 and 0.138 for the OS and the TS, respectively). For paraclinoid aneurysms of the medial or posterior type, using the base of the OS as a reference point tended to overestimate intradural paraclinoid aneurysms. The receiver operating characteristic curve indicated that if the aneurysmal neck traverses the axial plane 2 mm above the base of the OS, the aneurysm is most likely to grow across the DDR and present as a transitional aneurysm (sensitivity 0.806; specificity 0.792). CONCLUSIONS High-resolution thin-cut CTA is a fast and crucial tool for diagnosing paraclinoid aneurysms. The OS serves as an effective landmark in CTA source images for distinguishing between intradural and extradural paraclinoid aneurysms. The DDR is supposed to be located 2 mm above the base of the OS in axial planes.

The role of plant Colocasia esculenta L. schott (C. esculenta) in arsenic removal was investigated in a pilot-scale constructed wetland (PCW), which was filled with laterite soil (19.90–28.25% iron by weight). This PCW consists of 2 sets of flow systems in parallel, with C. esculenta planted at a density of 20 plants/m2 in one system and the other without any plants. The synthetic water containing arsenic concentration of 0.50 mg/l, with its pH controlled at 7.0 and influent flow at 1.5 m3/day. With C. esculenta, the arsenic in water decreased from 0.485 mg/l to 0.054 mg/l (89% removal), whereas, without C. esculenta, the arsenic decreased from 0.485 mg/l to 0.233 mg/l (52% removal). As for the fate of the influent arsenic, the C. esculenta was responsible for 65% of arsenic accumulation. Note that the arsenic was found mostly within the root zone depth (20–40 cm). It appears that such a high capacity of arsenic removal was enhanced both by the plants through rhizostabilization and by the iron-adsorbed process within the laterite soil bed. In addition, the arsenic removal was observed to increase along with the time from 30 to 90 days, and it reached to a maximum removal around 90 days, and then decreased after 122 days. Thus, the arsenic removal efficiency including mechanisms founded can then be applied in designing of constructed wetland for arsenic treatment from gold mine drainage with similar site/soil characteristic.

Most of nutrients in municipal wastewater originate from human urine. In this study, a novel fluidized-bed homogeneous crystallization process was developed for the simultaneous recovery of phosphorus (P) and potassium (K) from synthetic human urine. The operational variables including pH, Mg:K ratios and up-flow velocity were tested in the laboratory. The total removal of P and K (TR%) reached 98.4% and 70.5%, respectively, and the crystallization ratios (CR%) were 86.5% and 62.3%, respectively, at conditions of pH 10 ± 0.2, molar ratio Mg:K = 1.25, initial concentrations 850 mg P/L and 1830 mg K/L. The SEM and XRD analyses showed that the fluidized bed homogeneous crystallization (FBHC) product was pure magnesium potassium phosphate (K-struvite) (average size = 0.85 mm; purity = 95 ± 3%). The modelling of minimum fluidization velocity (MFV) resulted in values of up-flow 1.5–2.0 times the MFV for the effective fluidization. The profit of the recovery of P and K from human urine via FBHC process could be $0.26/m3-urine.

The role of plant Colocasia esculenta L. schott (C. esculenta) in arsenic removal was investigated in a pilot-scale constructed wetland (PCW), which was filled with laterite soil (19.90–28.25% iron by weight). This PCW consists of 2 sets of flow systems in parallel, with C. esculenta planted at a density of 20 plants/m2 in one system and the other without any plants. The synthetic water containing arsenic concentration of 0.50 mg/l, with its pH controlled at 7.0 and influent flow at 1.5 m3/day. With C. esculenta, the arsenic in water decreased from 0.485 mg/l to 0.054 mg/l (89% removal), whereas, without C. esculenta, the arsenic decreased from 0.485 mg/l to 0.233 mg/l (52% removal). As for the fate of the influent arsenic, the C. esculenta was responsible for 65% of arsenic accumulation. Note that the arsenic was found mostly within the root zone depth (20–40 cm). It appears that such a high capacity of arsenic removal was enhanced both by the plants through rhizostabilization and by the iron-adsorbed process within the laterite soil bed. In addition, the arsenic removal was observed to increase along with the time from 30 to 90 days, and it reached to a maximum removal around 90 days, and then decreased after 122 days. Thus, the arsenic removal efficiency including mechanisms founded can then be applied in designing of constructed wetland for arsenic treatment from gold mine drainage with similar site/soil characteristic.

A hybrid operating room (OR) equipped with robotic angiographic fluoroscopy system has become prevalent in neurosurgery. The level of necessity of the hybrid OR in treating cerebrovascular diseases (CVD) is rarely discussed. The authors proposed a scoring and classification system to evaluate the cerebrovascular procedures according to the level of treatment necessity for CVD in a hybrid OR and shared our 5-year experiences. From December 2009 to January 2016, the registry of cerebrovascular procedures performed in the hybrid OR was retrieved. A scoring system was used to evaluate the importance of the surgical and interventional components of a cerebrovascular procedure performed in the hybrid OR. The score of either component ranged from 1, 1.5, to 2 (1 = no role, 1.5 = supplementary or informative, 2 = important or therapeutic). The total score of a procedure was by multiplying two individual scores. Levels of necessity were classified into level A (important), level B (beneficial), and level C (replaceable). A total of 1027 cerebrovascular procedures were performed during this period: diagnostic angiography in 328, carotid artery stenting in 286, aneurysm coiling in 128, intra-operative DSA in 101, aspiration of ICH under image guidance in 79, intra-arterial thrombolysis/thrombectomy in 51, intracranial angioplasty/stenting in 30, hybrid surgery/serial procedures in 19, and rescue surgery during embolization in 5. According to the scoring system, hybrid surgery and serial procedures scored the highest points (2 × 2). The percentages distributed at each level: levels A (2.3%), B (17.5%), and C (80.2%). This study conveys a concept of what a hybrid OR equipped with robotic angiographic fluoroscopy system is capable of and its potential. For cerebrovascular diseases, hybrid OR exerts its value via hybrid surgery or avoiding patient transportation in serial procedures (level A), via providing real-time high-quality angiography and image guidance (level B), which constituted about 20% of the cases. The subspecialty of the group using the hybrid OR directly reflects on the number of procedures categorized in each level. In a hybrid OR, innovative treatment strategies for difficult-to-treat CVD can be developed.

Selective reduction of nitrate over nanoscale zero–valent iron (nFe0) modified metals (Pd and Cu) was investigated. Parameters of modified metal loading, metallic ratio (Pd:Cu), and H2 gas supplying were investigated on the influence of nitrate reduction. Metal (Cu, Pd) deposited onto nanoiron was proven to be effective in promoting the formation of nitrogen gas and, on the other hand, suppressing the NH4+ formation. Hydrogen gas feeding appeared to have a synergistic effect on nitrate removal and on nitrogen gas selectivity in all types of catalytic reductants. A catalyst with a loading of 10% of (Pd–Cu)–nFe0 with a ratio of Pd:Cu of 2:1, and H2 feeding showed the highest selective to N2: NH4+ formation (51:42), compared to the others ((Cu–Pd)–nFe0, Cu–nFe0, Pd–nFe0 and nFe0). The significant improvement in initiating the formation of N2, on the other hand suppressing the formation of NH4+, was referred to an indirect electron–transferring process of nFe0 to Cu and to Pd, consequently. In addition, kinetic evaluations on each catalyst was evaluated and used to postulate the selective reduction of nitrate phenomena.

Objective To demonstrate the feasibility and efficacy of reduction of high-grade lumbosacral spondylolisthesis via a minimally invasive approach. Summary of background data Reduction of high-grade spondylolisthesis remains controversial and technically challenging. Although minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has gained wide acceptance in recent years, it still has not been reported to achieve complete reduction of high grade slips. Methods In this technical note, the authors present a case of L5/S1 Meyerding Grade III fixed spondylolisthesis managed by MI-TLIF with percutaneous screws. Surgical techniques and key steps for reduction are described in detail. Results A 50-year-old woman had low back pain for 8 years. She also presented with radiculopathy of lower limbs and frequency/urgency of urination. The radiographs and computed tomography (CT) of the lumbar spine demonstrated degenerative spondylolisthesis, Meyerding grade III, at the level of L5/S1. The slippage was fixed on dynamic radiographs and there was neuroforaminal stenosis on the magnetic resonance image. The patient underwent MI-TLIF with percutaneous pedicle screw-rod fixation for arthrodesis at L5/S1. Her symptoms subsided after the operation. The one-and-half year follow-up radiographs, including CT, demonstrated complete reduction of the high-grade slippage and fusion of the lumbosacral spondylolisthesis. Conclusion Minimally invasive TLIF is a viable option for reduction of high-grade spondylolisthesis at L5/S1.

Arsenic removal was investigated by nanoscale zero valent iron (NZVI) under CO2–air bubbling system. The measure of gas bubbling was to acidify the solution and oxygenate NZVI adsorbent. Effects of carbonation and aeration periods were studied in four different scenarios. The most favorable condition was as follows; pretreatment step: CO2 bubbling (300 mL/min for 5 min) and air bubbling (300 mL/min for 10 min), and treatment step: Continuous air bubbling (300 mL/min). In the condition of having an initial concentration of 1000 μg/L, As(III) and As(V) could be removed by 78 and 99%, respectively. When we applied this conditions to the field groundwater spiked with arsenic, the removal efficiency was a little higher than the system both without gas- and acidic chemical-pretreatment. The X-ray absorption near edge spectroscopy (XANES) suggested the apparent valence states of the activated NZVI to be 2+ and 3+.

The pollutant removal performance of traditional horizontal subsurface flow (HSSF) constructed wetlands (CWs) is limited because of the dissolved oxygen (DO) supply is insufficient. The aeration of HSSF CWs usually improves their pollutant removal performance, but a high DO induces the accumulation of nitrate-nitrogen (NO3−-N) and suppresses the improvement of total nitrogen (TN) removal. In this study, an integrated solution that involved in-tank front aeration and internal recirculation (FAIR) was used to improve the pollutant removal performance of HSSF CWs. Based on the experimental results, the FAIR system significantly increased the removal efficiencies of biochemical oxygen demand (BOD) from 53.8–76.0% to 82.0–91.7% and reduced the BOD concentration in the effluent to below 10 mg L−1. The removal efficiency of ammonia-nitrogen (NH3–N) increased from 15.1–78.3% to 98.5–98.6% while the removal efficiencies of the total Kjeldahl nitrogen (TKN) of the control and FAIR HSSF CWs were 18.2–77.1% and 93.5–94.3%, respectively. HSSF CWs with FAIR outperformed aerated HSSF CWs in the removal of NH3–N and TKN. The effects of two recirculation flow ratios (Rr = recirculation flow rate/influent flow rate), 14.3 and 3.0, on the improvement of pollutant removal performance were investigated. The lower Rr did not significantly affect the improvement of BOD, NH3–N, and TKN, but a higher Rr resulted in more severe accumulation of NO3−-N. The removal efficiency of TN in control HSSF CWs ranged from 20.4% to 75.5%, and in the FAIR HSSF CW was 71.6% for Rr = 14.3 and 81.3% for Rr = 3.0. However, the FAIR system did not enhance the removal performance of total phosphorus, suggesting that the DO level and internal recirculation were not dominant mechanisms for the removal of phosphorous. The easy maintenance of the FAIR system made it a superior modification for improving the pollutant removal performance of HSSF CWs.

Background The effectiveness of microvascular decompression (MVD) has made trigeminal neuralgia (TN), hemifacial spasm (HFS), glossopharyngeal neuralgia, and other cranial nerve rhizopathy diseases treatable by surgery. To ensure hearing preservation and surgical success, we have presented our experience in the application of brainstem auditory evoked potential (BAEP) monitoring and neuro-endoscopy during MVD. Methods From July 2007 to October 2012, a total of 93 patients in our institution received MVD for cranial nerve rhizopathies. Among these patients, 43 had both BAEP monitoring and endoscope-assisted microsurgery for their MVD. None of the patients had undergone previous surgical treatment. Postoperative outcomes were assessed based on the medical records and clinical follow-up. Results This study included 32 women and 11 men. There were 36 HFS cases and seven TN cases, and the median patient age at the time of MVD was 48 years. The median duration of symptoms before MVD was 4.2 years, and the median follow-up duration was 3.5 years (range 1.5 months–5 years). All of the patients had either immediate or delayed complete relief from the symptoms after MVD. One TN patient underwent gamma knife radiosurgery 3 years after MVD, and two HFS cases had recurrent slight spasms, which warranted no further treatment. There was no surgical mortality. The major complications included one HFS patient with delayed and permanent hearing loss and facial palsy, which occurred 1 week after MVD. The surgical success rate was 100%, and the hearing complication rate was 2%. Conclusion The results of this retrospective study emphasized the importance of BAEP monitoring and neuro-endoscopy during MVD. It is well known that BAEP monitoring can preserve hearing function, and the endoscope offers neurosurgeons a second look to identify the nerve root entry zone and confirms the position of the Teflon felt. These two tools are especially useful in difficult cases.

A 57-year-old man presented with acute changes in mental status. Brain CT showed a high-density lesion at the pons. Brain MRA revealed a very slow-flow vascular lesion at the right aspect of the pons, about 3.9 ⋅ 3.0 ⋅ 3.0 cm3, compatible with a pontine cavernous malformation (CM). Gross-total removal was achieved. In this approach, a wider surgical corridor was obtained by opening the Meckel’s cave and cutting the tentorium. For a midline attack point on the pons, additional removal of the posterior clinoid process can meet the goal. In the authors’ opinion, this approach is safe and effective in selected ventrolateral pontine CMs.The video can be found here: https://youtu.be/moHqEkp5eCA.

We present a patient with an isolated primary central nervous system lymphoma (PCNSL) of the fourth ventricle. A 77-year-old man had a 1 week history of intermittent vertigo, nausea, vomiting, and progressively unsteady gait. CT scans of the brain showed a fourth ventricle tumor. MRI revealed a 2.5 cm dumbbell-shaped avidly-enhancing tumor in the fourth ventricle. Metastasis or high-grade glioma was suspected. The neuropathological findings were compatible with a diffuse large B-cell lymphoma. A slit lamp examination, bone marrow biopsy, and imaging studies for extracranial lesions were unremarkable. We suggest that PCNSL be listed in the differential diagnosis of fourth ventricle tumors with well-circumscribed margins and homogenous contrast enhancement.

Morphologic characteristics of angiographic doughnut-shaped aneurysms of the intracranial internal carotid artery (ICA) have been rarely reported in the literature and were discussed only radiologically. In this case, surgical clipping was performed, and the specimen from the aneurysm was examined to correlate the pathologic findings and morphologic characteristics. A 59-year-old male presented with diffuse subarachnoid hemorrhage secondary to a ruptured vascular lesion originating from the intracranial portion of the right ICA. Digital subtraction angiography showed a 1.5-cm doughnut-shaped aneurysm at the junction of the ICA and the posterior communicating artery. The aneurysm was successfully clipped in a neurosurgical hybrid operating room. The pathologic findings of the content inside the aneurysm revealed only fibrinoid exudates, materials from thrombosis. This is the first report to prove that the mechanism of a doughnut-shaped aneurysm formation is central thrombosis inside the aneurysm, possibly related to its complex hemodynamic flow.

Background Intraprocedural arterial perforation (IPAP) is a potentially dismal complication of neuroendovascular therapy with high mortality and morbidity rates. The management of IPAP with the techniques described has been well established, but rescue results from the dual-trained endovascular neurosurgeon in the neurosurgical hybrid operating room (OR) are rarely reported. Here, we report five cases of successful rescue of IPAP in the neurosurgical hybrid OR and compare them with other series. Methods Between December 2009 and December 2013, 146 intracranial neuroendovascular procedures were performed in the hybrid operating room of Taichung Veterans General Hospital. A total of five patients with IPAP were identified. Postoperative clinical outcome was evaluated by Glasgow Coma Scale scores and postoperative 3-month modified Rankin Scale. Results The causes of the IPAP were coil protrusion ( n = 3), microcatheter perforation ( n = 1), and microwire penetration ( n = 1). Two cases involved emergent ruptured aneurysms, while three cases occurred during elective procedures. Salvage treatment with emergent external ventricular drainage (EVD) was applied in all five cases. The average time-to-first-EVD was 16.25 min, and the average time-to-patent-EVD was 32.5 min. Postoperative 3-month outcome was good recovery (mRS ≤ 2) in all five cases. The zero mortality rate in our series is the most encouraging result in the published literature. Conclusion IPAP can be rescued successfully with an aggressive approach and quick conversion to backup surgery by a dual-trained endovascular neurosurgeon in the hybrid OR. The value of the hybrid OR in neuroendovascular therapy should be further investigated in the future.

Environmental chemical agents such as pesticides can be purchased easily at a relatively low price, and this has resulted in high concern of environmental toxicity to human health, due to their persistence in various environmental bodies. Hence, this study aims to propose important factors influencing pesticide purchase intentions, including consumers' perceptions of the brand image and the ecological health risk. Since consumers are primary users, the seller knows the product's features but not the psychology of those who purchase it. Therefore, we attempted to clarify purchase intentions and perceptions using structural equation modeling techniques to empirically analyze survey data from 324 pesticide consumers in Taiwan. Our results demonstrate that perceived brand image positively affects perceived quality of a product, whereas perceived risk negatively affects perceived quality and purchase intentions. Furthermore, this study provides evidence that perceived quality positively affects purchase intentions. These relationships suggest that perceived quality mediates both the positive association between brand image and purchase intentions and the negative association between perceived risk and purchase intentions. Based on such outcomes, we propose that consumers need to be informed of pesticides related to costs and environmental benefits.

Background Microvascular decompression (MVD) of trigeminal neuralgia (TN) or hemifacial spasm (HFS) caused by an elongated, tortuous or enlarged vertebral or basilar artery has a higher rate of incomplete cure. Objective We used an easily applied and adjustable method of vertebrobasilar artery transposition and fixation to improve the immediate surgical outcome of MVD of TN or HFS due to compression by an ectatic vertebrobasilar artery system. Methods Vertebral or basilar artery transposition was performed using the vascular sling with a strip of unabsorbable dural tape. The vertebrobasilar artery-sling complex was then fixed to the dura over the petrous bone by aneurysm clip through the dural bridge. The direction and angle of traction on the vertebrobasilar artery was adjustable using different lengths of clip or the horizontal level of the dural bridge. Results The sling and clip fixation method has been applied in 7 cases of MVD associated with vertebral or basilar artery compression. All 3 patients with TN and one with HFS had total remission of symptoms right after the procedure; one patient was completely free of spasm within 1 week after MVD and one had achieved 80% improvement of spasm in his last clinical visit 3 months after MVD. There was no major surgical complication in these 7 patients. Surprisingly, refractory hypertension was unexpectedly cured in one patient with TN following the procedure. Conclusion The vertebrobasilar artery transposition and fixation method used in the present study provided surgeons an easy and adjustable way to perform MVD safely and effectively.