Burr hole locations are associated with recurrence in single burr hole drainage surgery for chronic subdural hematoma

Hashimoto H., Maruo T., Kimoto Y., et al. Burr hole locations are associated with recurrence in single burr hole drainage surgery for chronic subdural hematoma. World Neurosurgery: X 19, 100204 (2023); https://doi.org/10.1016/j.wnsx.2023.100204.Background: Various factors have been reported as risk factors for chronic subdural hematomas (CSDH) recurrence. However, few studies have quantitatively evaluated the impact of CSDH locations and burr hole positions on recurrence. This study aimed to reveal the relation between CSDH recurrence and the locations of CSDH and burr holes. Methods: Initial single burr hole surgeries for CSDH with a drainage tube between April 2005 and October 2021 at Otemae Hospital were enrolled. Patients’ medical records, CSDH volume, and CSDH computed tomography values (CTV) were evaluated. The locations of CSDH and burr holes were assessed using Montreal Neurological Institute coordinates. Results: A total of 223 patients were enrolled, including 34 patients with bilateral CSDH, resulting in 257 surgeries investigated. The rate of CSDH recurrence requiring reoperation (RrR) was 13.5%. The RrR rate was significantly higher in patients aged ≥76 years, those with bilateral CSDH, and those with postoperative hemiplegia. In RrR, the preoperative CSDH volume was significantly larger, and CTV was significantly smaller. The locations of CSDH had no influence on recurrence. However, in RrR, the locations of burr holes were found to be more lateral and more ventral. Multivariate Cox proportional hazards regression analysis showed that bilateral CSDH, more ventral burr hole positions, and postoperative hemiplegia were risk factors for recurrence. Conclusions: The locations of burr holes are associated with CSDH recurrence. In RrR, CSDH profiles tend to show a larger volume and reduced CTV. Hemiplegia after burr hole surgery serves as a warning sign for RrR

Burst spinal cord stimulation for the treatment of cervical dystonia with intractable pain: A pilot study

Shimizu, T.; Maruo, T.; Miura, S.; Kimoto, Y.; Ushio, Y.; Goto, S.; Kishima, H. Burst Spinal Cord Stimulation for the Treatment of Cervical Dystonia with Intractable Pain: A Pilot Study. Brain Sci. 2020, 10, 827

The association between diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score and the outcome following mechanical thrombectomy of anterior circulation occlusion

Hashimoto H., Maruo T., Kimoto Y., et al. The association between diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score and the outcome following mechanical thrombectomy of anterior circulation occlusion. Interdisciplinary Neurosurgery: Advanced Techniques and Case Management 33, 101758 (2023); https://doi.org/10.1016/j.inat.2023.101758.Background: Although preoperative diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) is well known as a predictor of outcomes after mechanical thrombectomy (MT) for large-vessel occlusion (LVO), assessment of changes in DWI-ASPECT from before to after MT is rare. Therefore, we clarified the relationship between the change in DWI-ASPECTS and clinical outcomes. Methods: In this retrospective single-center study, we enrolled 63 cases of anterior LVOs treated with MT between April 2015 and March 2022. Preoperative and postoperative DWI-ASPECTSs were calculated. DWI-ASPECTSs were categorized into cortical-ASPECTSs (c-ASPECTSs) and subcortical ASPECTSs and assessed. Additionally, medical variables related to patients, such as sex, age, National Institutes of Health Stroke Scale (NIHSS) score, and premorbid modified Rankin Scale (mRS) score, were evaluated. A good outcome was defined as an mRS score of 0–2 at 3 months. Results: Forty-five patients met the inclusion criteria. Nine (20 %) had a good outcome. The good outcome group showed significantly higher postoperative DWI-ASPECTs (median 8 vs. 5, p = 0.012) and c-ASPECTSs (median 4 vs. 3, p = 0.020) than the poor outcome group. No difference in DWI-ASPECTSs and c-ASPECTSs from before to after MT were significantly associated with the good outcome (p = 0.017, p = 0.016, respectively). The cut-off values for the good outcome on receiver operating characteristic curve analysis for differences between DWI-ASPECTSs and c-ASPECTSs were 0 [area under the curve (AUC) 0.77] and 0 [AUC 0.74]. Logistic regression analyses showed that baseline NIHSS score (odds ratio, 0.69; 95 % confidence interval 0.48–1.00; p = 0.046) and postoperative DWI-ASPECTS (odds ratio, 2.27; 95 % confidence interval 1.02–5.04; p = 0.039) were independent factors for the good outcome. Conclusions: The good outcome of patients with anterior LVO was associated with no difference in DWI-ASPECTSs and c-ASPECTSs from before to after MT

Can poor treatment of workers be legitimated when they have passion for work?: Reexamining findings of Kim et al. (2020)

In Japan, overwork has often been reported and criticized by the media as well as the public. Jobs are, however, often regarded as giving workers a sense of fulfilment and enjoyment, leading to their willingness to work extra hours. Based on the findings of Kim et al. (2020), we conducted two studies to investigate whether poor treatment of a worker can be legitimated when he/she is passionate about his/her work. In line with previous research, we found that a passionate worker was perceived to be volunteering to do extra jobs without compensation if given the chance and to regard the work as a reward in and of itself. However, unlike Kim et al., we did not find any mediating effects of these two perceptions on legitimating poor treatment of passionate workers. The reason why we failed to replicate the findings of Kim et al. are discussed in terms of Japanese people’s awareness of the hardship and unfairness of overwork.本論文は，2020年度に広島大学教育学部で開講された心理学実験において，第1著者の指導により第2著者から第5著者が実施した研究をもとに執筆したものである。また，本研究はJSPS科研費JP18K03007の助成を受けた

Evaluation of calibration factor of OSLD toward eye lens exposure dose measurement of medical staff during IVR

The eye lens is a sensitive organ of which an x‐ray exposure dose should be managed during interventional radiology (IVR). In the actual situations, the eye lens is exposed to scattered x‐rays; they have different from the standard x‐ray energies which are used for general dose calibration of the dosimeter. To perform precise dose measurement, the energy dependence of the dosimeter should be properly accounted for when calibrating the dosimeter. The vendor supplies a calibration factor using 80‐kV diagnostic x‐rays under a free‐air condition. However, whether it is possible to use this calibration factor to evaluate the air kerma during the evaluation of the eye lens dose is unclear. In this paper, we aim to precisely determine calibration factors, and also examine the possible application of using a vendor‐supplied calibration factor. First, the x‐ray spectrum at the eye lens position during fluoroscopy was measured with a CdTe x‐ray spectrometer. We mimicked transfemoral cardiac catheterization using a human‐type phantom. Second, we evaluated the doses and calibration factors at three dosimetric points: front and back of protective goggles, and the front of the head (eye lens position). We used the measured x‐ray spectrum to determine the incident photon distribution in the eye lens regions, and x‐ray spectra corresponding to the dosimetric points around the eye lens were estimated using Monte Carlo simulation. Although the calibration factors varied with dosimetric positions, we found that the factors obtained were similar to the vendor‐supplied calibration factor. Furthermore, based on the experiment, we propose a practical way to calibrate an OSL dosimeter in an actual clinical situation. A person evaluating doses can use a vendor‐supplied calibration factor without any corrections for energy dependences, only when they add a systematic uncertainty of 5%. This evidence will strongly support actual exposure dose measurement during a clinical study

Practical method for determination of air kerma by use of an ionization chamber toward construction of a secondary X-ray field to be used in clinical examination rooms

We propose a new practical method for the construction of an accurate secondary X-ray field using medical diagnostic X-ray equipment. For accurate measurement of the air kerma of an X-ray field, it is important to reduce and evaluate the contamination rate of scattered X-rays. To determine the rate quantitatively, we performed the following studies. First, we developed a shield box in which an ionization chamber could be set at an inner of the box to prevent detection of the X-rays scattered from the air. In addition, we made collimator plates which were placed near the X-ray source for estimation of the contamination rate by scattered X-rays from the movable diaphragm which is a component of the X-ray equipment. Then, we measured the exposure dose while changing the collimator plates, which had diameters of 25–90 mmϕ. The ideal value of the exposure dose was derived mathematically by extrapolation to 0 mmϕ. Tube voltages ranged from 40 to 130 kV. Under these irradiation conditions, we analyzed the contamination rate by the scattered X-rays. We found that the contamination rates were less than 1.7 and 2.3 %, caused by air and the movable diaphragm, respectively. The extrapolated value of the exposure dose has been determined to have an uncertainty of 0.7 %. The ionization chamber used in this study was calibrated with an accuracy of 5 %. Using this kind of ionization chamber, we can construct a secondary X-ray field with an uncertainty of 5 %