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Determining the optimal surgical method for cervical ossification of the posterior longitudinal ligament (OPLL) is challenging. The surgical indication should be made based on not only radiological findings, but also the patient’s age, preoperative neurological findings, social background, activities of daily life, and the presence or absence of comorbid diseases. Anterior resection for OPLL with or without wide corpectomy and fusion, posterior decompression with or without relatively long fusion, or anterior and posterior combined surgery may be considered. When evaluating the clinical condition of patients with cervical OPLL before surgery, various radiological parameters should be carefully considered, including the number of spinal segments involved, the cervical alignment or tilt angle, the relationship between OPLL and the C2–7 line (termed the “K-line”), the occupying ratio of OPLL, and the involvement of dural ossification. The objective of this article is to review the radiological parameters in current use for deciding upon the optimal surgical strategy and for predicting surgical outcomes, focusing on cervical OPLL.
Endometrial cancer (EC) is the most common gynecological cancer in developed countries, and it’s incidence is constantly increasing. Atypical endometrial hyperplasia (AEH) is the precursor of type 1 EC. EC and AEH sometimes occur before the age of 40. Risk factors for endometrial carcinoma include a history of nulliparity or infertility including polycystic ovarian syndrome (PCOS), irregular menstrual cycles, obesity, diabetes mellitus, and hypertension, and so on. Standard treatment for EC and AEH is total hysterectomy and bilateral salpingo-oophorectomy, however, young patients with early-stage EC and AEH in reproductive age often hope to preserve their fertility. Criteria for conservative treatment include well-differentiated (grade1) endometrioid adenocarcinoma, or AEH, no myometrial invasion, no extra-uterine involvement, no contraindications for medical management, and strong desire for preservation of fertility. However, the data of long-term and pregnancy-related outcomes are limited for fertility- preserving therapy for EC and AEH. Medroxyprogesterone acetate (MPA), megestrol acetate (MA), and intrauterine system-levonorgestrel (IUS-LNG) are often used for fertility-preserving therapy. KGOG2002 study retrospectively analyzed the long-term oncologic outcomes of a fertility-sparing management using oral progestin MPA or MA in 148 patients of presumed stage IA, grade 1, with no myometrial invasion, and showed 78% as complete response (CR) rate, 68% as 5-year recurrence- free survival (RFS) rate. A multicenter prospective phase II study in Japan enrolled 28 patients having EC at presumed stage IA and 17 patients with AEH, and revealed that CR rate was 55% in EC and 82% in AEH, and 47% recurred between 7 and 36 months. In Keio University hospital, we retrospectively reviewed the long-term outcomes of fertility-preserving hormonal therapy using MPA for 142 grade 1 EC patients, 4 grade 2 EC patients, and 102 AEH patients. Median follow-up period was 38 months. In initial MPA therapy, pathological CR rate was 97% in AEH, 90% in G1/G2. After MPA therapy, we experienced 116 times pregnancies in 84 patients, and got 84 alive children. The pregnancy rate was 34% in AEH, 32% in G1/G2. 5 year-RFS rate was 45% in AEH, 17% in G1/G2, and after delivery or abortion, 5 year-RFS rate was 65% in AEH, 38% in G1/G2. We experienced 15 double cancers, including 11 patients with ovarian cancers. Fertility-preserving hormonal therapy in young patients with early-stage endometrial cancer is highly effective and safe, however, careful management is needed during and after hormonal therapy, and even after successful pregnancy.
Objective: In dryland areas of China, alfalfa hay (AH) is a possible substitute for concentrate feed for beef cattle. To evaluate the potential benefits of this substitution, we studied the effect of the ratio of AH intake to total dry matter (DM) intake on average daily body-weight gain (ADG), dietary energy utilization status, and economic benefit in Gansu province. Methods: In each of two feeding trials in 2016 (trial 1 [T1], July 3 to 17; trial 2 [T2], August 15 to September 23), crossbred male Simmental calves were allocated to low AH (LA), medium AH (MA), and high AH (HA) feeding groups (n = 4 per group). The target ADG was set as 1 kg for both trials. In a one-way-layout design based on conventional feeding practices in the province, calves received diets containing the different AH amounts, with a constant ratio of corn stover:total DM and decreasing rations of concentrate feed proportional to the increase in AH. Calves in T1 received AH at 15% (T1-LA), 23% (T1-MA), or 31% (T1-HA) of their dietary DM allowances; those in T2 received 9% (T2-LA), 24% (T2-MA), or 34% (T2-HA) AH. Results: Among the T1 groups, both ADG and economic benefit were highest in T1-LA; whereas in T2, they were higher in the T2-LA and T2-MA groups than in T2-HA. Energy digestibility did not significantly differ among the groups in either trial. The dietary AH inclusion ratios of 14% in the warm season and 8% to 21% in the cool season appeared to yield optimal ADG, metabolizable energy intake, and economic benefit. Conclusion: Low-level inclusion of AH, ranging from 8% to 21%, is a practical approach for beef cattle feeding. This modified feeding regimen likely will promote increased growth performance during the fattening stage of beef steers in dryland areas of Gansu province, China.
Manual acupuncture at Yanglingquan (GB34) is reported to have a beneficial effect on chronic liver damage. We, therefore, studied the effect of manual acupuncture at GB34 on acute liver damage. Rats were administered carbon tetrachloride (CCl₄) or olive oil, and direct manual acupuncture was subsequently performed at GB34 or at a sham point (a nonacupoint). In rats administered with CCl₄, the serum levels of aspartate aminotransferase and alanine aminotransferase, the total cholesterol concentration, and the levels of hepatic thiobarbituric-acid-reactive substances were suppressed by acupuncture at GB34 when compared with acupuncture at the sham point. By contrast, there was little histological difference in the liver between acupuncture at GB34 and that at the sham point in rats administered with CCl₄. These results suggest that manual acupuncture at GB34 tends to improve acute liver damage but is not sufficient by itself to completely resolve the hepatic injury.