World Neurosurg
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Degenerative spondylolisthesis is a disease characterized by the displacement of a vertebra above the underlying vertebra. Lumbar arthrodesis is currently the most frequently performed surgical option for treatment due to the use of various approaches and techniques. The disease is characterized by low back pain, a clinical and public health problem, which in addition to having a socio-economic burden, severely affects functional status, quality of life (QoL), activity impairment, and health services. The study aims to investigate the benefits, in terms of pain, disability, andQoL, of lumbar arthrodesis surgery in patients with degenerative spondylolisthesis, at the latest follow-up. ⋯ The results show significant improvement in all measured variables, demonstrating that there are different surgical treatments to cure degenerative spondylolisthesis. However, residual pain impacting the QoL remains, regardless of the technique used. Therefore, the development of personalized pain management for patients with residual chronic pain is indicated.
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Programmed cell death (PCD) in the development of spinal cord injury (SCI) is complicated, including apoptosis, necroptosis, pyroptosis, ferroptosis, cuproptosis, and autophagy. It is necessary to make clear the expression levels of PCD and potential molecular targets after SCI for formulating relevant treatment strategies. ⋯ PCD occurs differently in different stages after SCI. To inhibit apoptosis, necroptosis, pyroptosis, and ferroptosis after injury and induce autophagy may be the therapeutic strategy. In addition, intervention therapy based on related HUB genes may be the therapeutic target of SCI.
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To determine if dexamethasone administration reduced narcotic consumption during hospitalization and to evaluate if patients who received dexamethasone refilled fewer opioid prescriptions postoperatively. ⋯ Administration of perioperative dexamethasone does not reduce in-hospital or home opioid usage regardless of weight-based dose. Analgesia should not be the primary driver of dexamethasone administration for anterior cervical discectomy and fusion.
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To identify the risk factors for developing postoperative pulmonary infection in patients with acute cervical spinal cord injury (CSCI), and to develop a nomogram prediction model. ⋯ Age, American Spinal Injury Association grade, steroid pulse, CSCI site, smoking history, number of surgical levels, and surgical duration are correlated with the development of postoperative pulmonary infection in patients with CSCI. The risk prediction model of postoperative pulmonary infection has a good prediction efficiency and accuracy.
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A 45-year-old woman with chronic depression and currently receiving dual serotonergic therapy was transferred to our department with sudden dysbasia; she also reported an antecedent thunderclap headache. Magnetic resonance imaging (MRI) revealed a symmetrical bilateral acute infarction in the medial parietal lobe and severe vasoconstriction in the cerebral arteries. We diagnosed reversible cerebral vasoconstriction syndrome (RCVS) and stopped the serotonergic drug regimen. ⋯ Cerebral infarctions developed in 30%-40% of reversible cerebral vasoconstriction syndrome (RCVS) cases, mostly within watershed regions; however, these atypical infarctions were bilateral and symmetrical, potentially because of hypoperfusion caused by long-lasting severe vasoconstriction in the anterior cerebral arteries. Rare bilateral neurologic deficits can be mistaken for hypochondriac delusions, particularly in patients with depression. Since serotonergic drugs are the main cause of RCVS, primary care psychiatrists must be aware of drug-induced RCVS.