The association between intramedullary increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) and surgical outcome in thoracic ossification of the ligamentum flavum (OLF) remains controversial. We aimed to determine the impact of signal change ratio (SCR) on thoracic OLF surgical outcomes. We retrospectively reviewed 96 cases of thoracic OLF surgery and investigated myelopathy severity, symptom duration, MRI and computed tomographic findings, surgical technique and postoperative recoveries. Surgical outcomes were evaluated according to the modified Japanese Orthopaedic Association (JOA) score and recovery rate. JOA recovery rate <50% was defined as a poor surgical outcome. By multivariate logistic regression analysis, we identified risk factors associated with surgical outcomes. Forty patients (41.7%) had a recovery rate of <50%. In receiver operating characteristic (ROC) curves, the optimal preoperative SCR cutoff value as a predictor of poor surgical outcome was 1.54. Multivariate logistic regression analysis revealed that a preoperative SCR ≥1.54 and symptom duration >12 months were significant risk factors for a poor surgical outcome. These findings suggest that preoperative SCR and duration of symptoms were significant risk factors of surgical outcome for patients with thoracic OLF. Patients with preoperative SCR ≥1.54 can experience poor postoperative recovery.Thoracic ossification of the ligamentum flavum (OLF) is a relatively rare cause of myelopathy that generally requires surgical treatment owing to its progressive nature and its poor response to conservative therapy. Reportedly, the prevalence of OLF ranges from 3.8% to 26% 1,2 . Patients with thoracic OLF have various symptoms, such as sensory abnormality of the trunk or lower extremities, gait disturbance, and urinary dysfunction 3 . Although decompressive surgery is an available treatment option for this disease, the surgical outcome is not always satisfactory. Prognostic guidelines are still unclear and it is very difficult for the surgeon to predict postoperative recovery.Magnetic resonance imaging (MRI) is a valuable tool before surgical decompression because it allows the visualisation not only of the magnitude of spinal cord compression but also of intramedullary signal intensity. The presence of intramedullary increased signal intensity (ISI) on T2-weighted imaging (WI) in patients with thoracic OLF reflects chronic spinal cord compression. However, the significance of ISI on T2-WI for postsurgical prognosis remains controversial [4][5][6][7][8][9][10][11][12][13][14][15] . Definitive information is not available because most descriptions of signal changes are qualitative in nature. Wang et al. 16 first used signal change ratio (SCR) as a quantifiable measure of signal intensity in cervical compressive myelopathy. This quantitative method may also be used to evaluate the signal change of the spinal cord in thoracic OLF. The purpose of this study was to assess the risk factors associated with poor surgical outcome, pa...
Background and Objectives There has been reports on fractional CO2 laser successfully improving contracture scars that impair the function of a joint. It seems that certain contracture problems could be solved by laser instead of surgery. However, the clinical application could be difficult when the efficacy of the method remains unknown. The purpose of this study is to report the releasing capacity of the fractional CO2 laser on contracture scars based on a defined treatment method. Study Design/Materials and Methods We conducted a retrospective study in patients with limited function in joints caused by contracture scars. Fractional CO2 laser and our “3D mesh releasing” protocol were applied. The primary outcome was the improvement measured in range of motion (ROM) of the relevant joint before all intervention and 6 months after the last treatment. Result From November 2016 to January 2018, 11 joints of 10 cases were treated by the fractional CO2 laser. Patients went through 2.27 (standard deviation [SD] 1.42, 1‐5) sessions. The average progress of ROM before and 6 months after all treatments was 19.13° (SD 10.25, P < 0.02). In six cases, we recorded that there was an 8.53° (SD 5.81, P < 0.02) of increase in ROM immediately after the laser session, and the average improvement reached up to 13.58° (SD 8.15, P < 0.02) after 2–3 months during the next follow‐up. Conclusion The fractional CO2 laser could achieve functional improvement in contracture scars and it maintained its effect for at least 6 months. The “3D Mesh Releasing” protocol would help to standardize the treatment procedure. This modality has minimal‐invasiveness and potentially could become a supplement to the current treatment choices for mild contracture scars. Lasers Surg. Med. © 2020 Wiley Periodicals LLC
With various cloud services emerging in data center networks, network congestion and load imbalance are seriously caused by elephant flows. To resolve this problem, a load balancing mechanism based on software defined networking (SDN) for elephant flows is proposed. The mechanism obtains the topology and status of the entire network via global view of SDN. Then it splits and sends elephant flows through multiple paths based on the ratios which are dynamically computed by taking account of the states of links. Finally, the system prototype is implemented in OpenFlow testbed. The results show the proposed mechanism can significantly enhance the performance of the network by improving the network throughput and link utilization.
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