The Surgical Approaches of Cervical Spondylotic Myelopathy and the Predictive Factors for the Surgical Outcomes

Objective To explore the efficacy and safety of different surgical approaches of cervical spondylotic myelopathy, and the predictive factors for the outcome of surgery. Methods Clinical data of 68 consecutive patients who underwent surgical treatment from 2003-08-01 to 2006-12-01 were collected. The quantization of the efficacy of operation was made by applying Japanese Orthopedic Association (JOA) scoring system, based on which the recovery rate and satisfaction rate were calculated. In the patients who underwent anterior approach, we compared the recovery rate among the subgroups of different duration of symptoms, age at surgery and the severity of diseases. Any surgery-related complications were also noted. Results 73.5% (50/68) patients underwent anterior approach, with an average recovery rate of (68.21 ± 10.06)% and the satisfaction rate of 88.00%;20.6% patients (14/68) underwent posterior approach, with an average recovery rate of (64.03 ± 7.07)% and the satisfaction rate of 100%. The recovery rate had no significant difference in the two approaches. Only 4 patients (5.9%) underwent anterior and posterior combined approach, and the recovery rate and the satisfaction rate were 65.10% and 100%, respectively. In the group of patients who accepted anterior approach, no significant differences were found in the recovery rates of different age subgroups and different duration of symptom subgroups;the significant differences recovery rates between the moderate and severe subgroups were identified. Minor complications, such as asymptomatic screw misplacement, transient dysphagia/odynophagia, pain related to the donor site and axial syndrome, were observed in a few patients. Conclusion The JOA score can be improved by applying the appropriate approaches and the high recovery and satisfaction rates can be achieved at the same time. The efficacies of anterior and posterior approaches were similar. The complications of surgery were minor. In the patients who underwent anterior approach, the severity of diseases was a predictive factor for the outcome of surgery.

Nebulized Mycobacterium vaccae protects against asthma by attenuating the imbalance of IRF4/IRF8 expression in dendritic cells

Objective:To assess the effects of nebulized inhaled Mycobacterium vaccae on allergic airway inflammation,airway hyperresponsiveness,and Th1/Th2 cell imbalance in mice with ovalbumin(OVA)-induced asthma.Methods:Mice received OVA sensitization and challenge for establishment of the asthmatic model.For intervention,mice received Mycobacterium vaccae nebulization once every other day from the first day of sensitization to the day before challenge.After challenge,pulmonary histological analysis and airway responsiveness measurement were performed.In addition,Th1/Th2 cytokines and OVA-specific IgE levels in bronchoalveolar lavage fluid were measured by ELISA.Th1/Th2 subset ratios and the expression of interferon-regulatory factor 4(IRF4),IRF8 and Toll-like receptor 4(TLR4)in dendritic cells were evaluated by flow cytometry.Results:Severe inflammatory infiltration and airway hyperresponsiveness were observed in OVA-induced asthmatic mice.Asthmatic mice showed higher Th2 cytokine concentration and increased percentage of Th2 cells,along with lower Th1 cytokine concentration and reduced percentage of Th1 cells compared with the normal control.Moreover,an imbalance of IRF4^(+)and IRF8^(+)in dendritic cells was found in asthmatic mice.Nebulized inhaled Mycobacterium vaccae reduced airway hyperresponsiveness and inflammation in OVA-induced asthmatic mice.In addition,nebulized inhaled Mycobacterium vaccae enhanced TLR4 and IRF8 expression,and alleviated the imbalance of Th1/Th2 as well as IRF4^(+)and IRF8^(+)in dendritic cells.Conclusions:Nebulized inhaled Mycobacterium vaccae protects against asthma by alleviating the imbalance of Th1/Th2 and IRF4/IRF8 in OVA-induced asthmatic mice.