While providing superior benefits for a cadre of diverse diseases, the prevalence of Immunosuppressive use often brings to question possible additional risks caused by these therapies in the setting of surgical procedures. Specifically, is the risk of impaired wound healing or increased chance of infection worth avoiding the possible side effects associated with temporary cessation during the perioperative period. The appropriate use of immunosuppressants (IS) during elective surgery has been debated extensively with conflicting results, through the current body of literature. Herein, we aim to provide a comprehensive, yet streamlined, overview of the common IS medications that surgeons are likely to encounter in practice in a wide variety of patients. This discussion includes an overview of the pharmacology and use of eight of the common IS medications: azathioprine, cyclosporine, hydroxychloroquine, infliximab, leflunomide, methotrexate, methylprednisolone, and mercaptopurine.
Objective: To assess the effect of dysphagia on patient satisfaction following anterior cervical discectomy and fusion.Background: Difficulty with swallowing is a common complaint following anterior cervical spine surgery. The exact impact of this issue on the patient's overall satisfaction is unknown because of its often-transient nature.
Materials and Methods:A prospective evaluation of all patients from a single surgeon undergoing an anterior cervical spine surgery. Dysphagia was evaluated both preoperatively and postoperatively at set intervals via a combination of 3 validated scoring systems. Mean satisfaction scores at 6 months was evaluated at 6 months via modified CSRS survey. Comparative analysis was performed to determine if there was any relationship between the 2 outcomes.Results: A total of 96.77% (68/71) of enrolled patients completed all of their follow-up surveys. The prevalence of dysphagia was 32.4% at 2 weeks after surgery, 20.6% at 6 weeks, 13.2% at 3 months, and 13.2% at 6 months. In total, 82.35% (56/68) of patients were satisfied with their surgical outcome and only 5.88% (4/68) were dissatisfied with their outcome. There was no relationship between a patient's overall satisfaction level and the presence of dysphagia at any postoperative interval. The absence of neck pain at 6 months was the only significant predictor of patient satisfaction (P = 0.003).
Conclusion:Dysphagia is a common but often transient complaint following anterior cervical spine surgery. Fortunately, its presence does not seem to correlate with a patient's overall satisfaction level following surgery.
dehydrogenase-15 gene (HPGD-15) was the most upregulated gene (1.79 and 1.74 relative expression Fc; 1.77 6 0.035 [mean 6 SD]; P ¼ .033). Chromosome 2 Open Reading Frame 40 (C2orf40,) was the highest ranked downregulated gene 3.01(P < .001) relative expression Fc. Collagen type 13a (COL13A1) and collagen type 27a-1 genes (COL27A1) were 1.72 (P ¼ .029) and 1.54 (P ¼ .031) downregulated, respectively. Gene ontology enrichment analysis showed that metabolic pathways of arachidonic acid, prostanoid metabolism, and prostaglandin biosynthesis (respective enrichment scores: 109.41, 47.58, and 47.58) were regulated by differently expressed genes.Conclusions: Relative gene expressions significantly differ in CVI patients. Regulatory genes of arachidonic acid metabolism and mediators of the inflammatory reaction are overexpressed in CVI patients. Regulatory genes for collagen production are downregulated in CVI. Further research is warranted to gain more data for CVI genomics.
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