A New Posterior Extensor Attachment-Point Reconstruction Technique for Cervical Spondylotic Myelopathy Involving C2 Segment: Clinical Outcome and Safety.

BACKGROUND AND STUDY AIM: Cervical spondylotic myelopathy (CSM) is a common degenerative disease that mainly occurs in elder patients, leading to different degrees of neurological dysfunction. Spinal cord involvement is mainly distributed at the C3-C7 segments, but it may also involve up to the C2 level. This study aimed to assess the clinical efficacy and safety of open-door laminoplasty using a new extensor attachment-point reconstruction technique for treating CSM involving the C2 segment. PATIENTS AND METHODS: Fifty-nine patients with CSM involving the C2 segment and undergoing open-door laminoplasty were included in this retrospective study. Based on the titanium plate used in the operation, patients were divided into two groups, a reconstructed titanium plate fixation (RPF) group (n = 28) and a conventional titanium plate fixation (CPF) group (n = 31). Improvements in neurological function, cervical range of motion (ROM), cervical curvature index (CCI), preservation of posterior cervical muscle mass, and axial symptoms were compared between the two groups. RESULTS: There were no significant differences in operative time and intraoperative blood loss between the groups (p > 0.05). The Japanese Orthopaedic Association (JOA) score significantly increased in both groups postsurgery (p < 0.05); the neurological recovery rate was similar between the two groups (64.1 ± 13.3% vs. 65.9 ± 14.7%, p > 0.05). There was no significant loss of cervical ROM in either group (p > 0.05). The anteroposterior dural sac diameter at the C2 level was significantly enlarged in both groups (p < 0.05). Alternatively, CCI was significantly reduced in the CRP group (p < 0.05) but unchanged in the RPF group (p > 0.05). The cross-sectional area of the posterior cervical muscles was also significantly reduced in the CPF group (p < 0.05) but maintained in the RPF group (p > 0.05). Finally, axial symptoms were more severe in the CPF group than in the RPF group (p < 0.05). CONCLUSION: Laminoplasty is an effective surgical procedure for CSM involving the C2 segment. The reconstructed titanium plate achieved superior maintenance of cervical curvature and reduced both muscle atrophy and severity of axial symptoms compared with titanium conventional plates.

Transcatheter arterial chemoembolization combined with microwave coagulation therapy and the perioperative care for patients with hepatocellural carcinoma.

PURPOSE: To explore the value of artificial hydrothorax microwave coagulation combined with transcatheter arterial chemoembolization (TACE) therapy in the treatment of ultrasound-invisible malignant tumors in the hepatic dome (mainly hepatocellular carcinoma/HCC) and the perioperative care for the patients. METHODS: Sixty-eight patients with malignant liver tumors in the hepatic dome were treated with a combination therapy of TACE and microwave coagulation via an artificially induced hydrothorax. Their perioperative condition was under close observation and the nursing care was intensified. Paracentesis of the chest was successfully carried out via the positioning of ultrasound and guidance of microwave to the tumor site, so that the tumor could be treated with cold cycle microwave coagulation therapy. RESULTS: After treatment, 3/68 patients (4.4%) achieved complete tumor ablation, while 59/68 (86.8%) achieved tumor ablation >50% or tumor shrinkage >30%. Another 6/68 patients (8.8%) achieved tumor ablation <50% or tumor shrinkage <30%. Of 45 patients, 42 (93.3%) obtained a reduction of AFP level >50% post-therapy, 28/37 patients (75.7%) achieved a reduction of CEA level >50%, 23/29 patients (79.3%) achieved a reduction of CA19-9 level> 50%; 3/68 patients (4.4%) survived for 4 to 6 months, 31/68 (45.6%) survived >6 months and 34/68 (50%) survived >12 months. No bleeding, liver failure, infection or needle tract seeding occurred after the operation, and no treatment-related deaths occurred. CONCLUSION: Microwave coagulation combined with TACE for HCC in the hepatic dome is safe and effective. Perioperative observation and nursing care can not only reduce the complications but also improve the therapeutic effect and the patient quality of life.

Expression of interleukin-17A in lung tissues of irradiated mice and the influence of dexamethasone.

PURPOSE: To investigate the expressions of IL-17A in different phases of radiation-induced lung injury and the effect of dexamethasone. METHODS: The thorax of C57BL/6 mice was irradiated with 15 Gy rays. Mice from dexamethasone-treated group were injected intraperitoneally with dexamethasone (0.42 mg/kg/day) every day for the first month after irradiation. IL-17A in lung tissues was detected by immunohistochemistry. IL-17A, TGF-ß1, and IL-6 in bronchoalveolar lavage fluid were detected by ELISA. Lung inflammation and collagen deposition were observed by H&E and Masson methods. The degree of alveolitis and fibrosis was judged according to scoring. RESULTS: IL-17A expression was appreciable at 1 week, peaked at 4 weeks, and subsequently declined at 8 weeks after irradiation. IL-17A was reduced after dexamethasone application at all the observation periods. Dexamethasone also inhibited expressions of TGF-ß, IL-6, and TNF-α in bronchoalveolar lavage fluid. Moreover, dexamethasone attenuated the severity of lung injury by reducing the infiltration of inflammatory cells and collagen deposition. Terms of survival and the time of death in mice of treatment group were postponed and survival rate was improved. CONCLUSIONS: IL-17A plays an important role in the process of radiation-induced lung injury. And dexamethasone may provide a protective role in lung injury induced by radiation.