Corticosteroid Administration to Prevent Complications of Anterior Cervical Spine Fusion: A Systematic Review.

Study Design: Systematic review. Objectives: Anterior cervical approach is associated with complications such as dysphagia and airway compromise. In this study, we aimed to systematically review the literature on the efficacy and safety of corticosteroid administration as a preventive measure of such complications in anterior cervical spine surgery with fusion. Methods: Following a systematic literature search of MEDLINE, Embase, and Cochrane databases in July 2016, all comparative human studies that evaluated the effect of steroids for prevention of complications in anterior cervical spine surgery with fusion were included, irrespective of number of levels and language. Risk of bias was assessed using MINORS (Methodological Index for Non-Randomized Studies) checklist and Cochrane Back and Neck group recommendations, for nonrandomized and randomized studies, respectively. Results: Our search yielded 556 articles, of which 9 studies (7 randomized controlled trials and 2 non-randomized controlled trials) were included in the final review. Dysphagia was the most commonly evaluated complication, and in most studies, its severity or incidence was significantly lower in the steroid group. Although prevertebral soft tissue swelling was less commonly assessed, the results were generally in favor of steroid use. The evidence for airway compromise and length of hospitalization was inconclusive. Steroid-related complications were rare, and in both studies that evaluated the fusion rate, it was comparable between steroid and control groups in long-term follow-up. Conclusions: Current literature supports the use of steroids for prevention of complications in anterior cervical spine surgery with fusion. However, evidence is limited by substantial risk of bias and small number of studies reporting key outcomes

Clinical application of ceramics in anterior cervical discectomy and fusion: A review and update

Study Design: Narrative review. Objectives: Anterior cervical discectomy and fusion (ACDF) is a reliable procedure, commonly used for cervical degenerative disc disease. For interbody fusions, autograft was the gold standard for decades; however, limited availability and donor site morbidities have led to a constant search for new materials. Clinically, it has been shown that calcium phosphate ceramics, including hydroxyapatite (HA) and tricalcium phosphate (TCP), are effective as osteoconductive materials and bone grafts. In this review, we present the current findings regarding the use of ceramics in ACDF. Methods: A review of the relevant literature examining the clinical use of ceramics in anterior cervical discectomy and fusion procedures was conducted using PubMed, OVID and Cochrane. Result: HA, coralline HA, sandwiched HA, TCP, and biphasic calcium phosphate ceramics were used in combination with osteoinductive materials such as bone marrow aspirate and various cages composed of poly-ether-ether-ketone (PEEK), fiber carbon, and titanium. Stand-alone ceramic spacers have been associated with fracture and cracks. Metallic cages such as titanium endure the risk of subsidence and migration. PEEK cages in combination with ceramics were shown to be a suitable substitute for autograft. Conclusion: None of the discussed options has demonstrated clear superiority over others, although direct comparisons are often difficult due to discrepancies in data collection and study methodologies. Future randomized clinical trials are warranted before definitive conclusions can be drawn. © The Author(s) 2017

Measurement of the photon and thermal neutron doses of contralateral breast surface in breast cancer radiotherapy

Introduction and purpose:During the radiation therapy of tumoral breast, the contralateral breast (CB) will receive scattered doses. In the present study, the photon and thermal neutron dose values received by CB surface during breast cancer radiation therapy were measured.Materials and methods:The right breast region of RANDO phantom was considered as CB, and the measurements of photon and thermal neutron dose values were carried out on this region surface. The phantom was irradiated with 18 MV photon beams, and the dose values were measured with thermoluminescent dosimeter (TLD-600 and TLD-700) chips for 11 � 13, 11 � 17 and 11 � 21 cm2 field sizes in the presence of physical and dynamic wedges.Results:The total dose values (photon + thermal neutron) received by the CB surface in the presence of physical wedge were 12·06, 15·75 and 33·40 of the prescribed dose, respectively, for 11 � 13, 11 � 17 and 11 � 21 cm2 field sizes. The corresponding dose values for dynamic wedge were 9·18, 12·92 and 29·26 of the prescribed dose, respectively. Moreover, the results showed that treatment field size and wedge type affect the received photon and thermal neutron doses at CB surface.Conclusion:According to our results, the total dose values received at CB surface during breast cancer radiotherapy with high-energy photon beams are remarkable. In addition, the dose values received at CB surface when using a physical wedge were greater than when using a dynamic wedge, especially for medial tangential fields. © Cambridge University Press 2019

Prognostic factors for esophageal squamous cell Carcinoma-A Population-Based study in Golestan province, Iran, a high incidence area

Golestan Province in northern Iran is an area with a high incidence of esophageal squamous cell carcinoma (ESCC). We aimed to investigate prognostic factors for ESCC and survival of cases in Golestan, on which little data were available. We followed-up 426 ESCC cases participating in a population-based case-control study. Data were analyzed using the Kaplan-Meier method and the Cox proportional hazard models. Median survival was 7 months. Age at diagnosis was inversely associated with survival, but the association was disappeared with adjustment for treatment. Residing in urban areas (hazard ratio, HR = 0.70; 95 CI 0.54-0.90) and being of non-Turkmen ethnic groups (HR = 0.76; 95 CI 0.61-0.96) were associated with better prognosis. In contrast to other types of tobacco use, nass (a smokeless tobacco product) chewing was associated with a slightly poorer prognosis even in models adjusted for other factors including stage of disease and treatment (HR = 1.38; 95 CI 0.99-1.92). Opium use was associated with poorer prognosis in crude analyses but not in adjusted models. Almost all of potentially curative treatments were associated with longer survival. Prognosis of ESCC in Golestan is very poor. Easier access to treatment facilities may improve the prognosis of ESCC in Golestan. The observed association between nass chewing and poorer prognosis needs further investigations; this association may suggest a possible role for ingestion of nass constituents in prognosis of ESCC. © 2011 Aghcheli et al

Ecological species groups in the rural heritage museum of Guilan Province, Iran

The objective of this research was to identify and describe the different Ecological Species Groups (vegetation types) present in the Rural Heritage Museum of Guilan. The study area was approximately 260 ha, which is located in the Saravan Forest Park in Guilan province, north of Iran. Sampling procedure was performed with a systematic random technique. A total of 89 plots were sampled. Classification of vegetation carried out using the Two Way Indicator Species Analysis (TWINSPAN) method showed that there were five ecological species groups in three layers; three groups in the shrub layer, nine groups in the herb layer and six ecological species groups in the regeneration layer. The results suggest improved protection and management of this area and that it can be proposed as a protected area on the basis of the numerous important species. The information obtained from the current study about this forest is useful for the design and management of this site because of its aesthetic values

Free vibration analysis of sandwich plates with compressible core in contact with fluid

In this paper, the extended higher-order sandwich plate's theory (EHSAPT) is used to analyze the free vibration of the sandwich plate with compressible core and different boundary conditions in contact with fluid. First-order shear deformation theory is adopted for the top and bottom face sheets, while the in-plane and transverse displacements of the core are considered to be cubic and quadratic functions of the transverse coordinate, respectively. A single series is considered with two-variable orthogonal polynomials as a set of admissible functions satisfying the boundary conditions. Besides, the fluid is considered to be irrotational, inviscid and incompressible. By taking into account the boundary conditions and compatibility conditions, the fluid velocity potential is acquired. The natural frequencies of the system are calculated by the Rayleigh-Ritz method. An excellent accuracy is obtained between the results in the available literature and the present method. Finally, the effects of various parameters including boundary conditions, side-to-thickness ratio, thickness of the core to thickness of the face sheets ratio, face sheet to core flexural modulus ratio, dimensions of the container, and aspect ratios on the natural frequencies of the sandwich plate are presented and discussed in detail