Clinical efficacy analysis of surgical treatment for spinal metastasis under the multidisciplinary team using the NOMS decision system combined with the revised Tokuhashi scoring system: a randomized controlled study

OBJECTIVE

Despite advancements in spinal metastasis surgery techniques and the rapid development of multidisciplinary treatment models, we aimed to explore the clinical efficacy of spinal metastasis surgery performed by a combined NOMS decision system-utilizing multidisciplinary team and Revised Tokuhashi scoring system, compared with the Revised Tokuhashi scoring system.

METHODS

Clinical data from 102 patients with spinal metastases who underwent surgery at three affiliated hospitals of Zunyi Medical University from December 2017 to June 2022 were analysed. The patients were randomly assigned to two groups: 52 patients in the treatment group involving the combined NOMS decision system-utilizing multidisciplinary team and Revised Tokuhashi scoring system (i.e., the combined group), and 50 patients in the treatment group involving the Revised Tokuhashi scoring system only (i.e., the revised TSS-only group). Moreover, there were no statistically significant differences in preoperative general data or indicators between the two groups. Intraoperative and postoperative complications, average hospital stay, mortality rate, and follow-up observation indicators, including the visual analogue scale (VAS) score for pain, Eastern Cooperative Oncology Group (ECOG) performance status, Karnofsky Performance Status (KPS) score, negative psychological assessment score (using the Self-Rating Anxiety Scale, [SAS]), and neurological function recovery score (Frankel functional classification) were compared between the two groups.

RESULTS

All 102 patients successfully completed surgery and were discharged. The follow-up period ranged from 12 to 24 months, with an average of (13.2 ± 2.4) months. The patients in the combined group experienced fewer complications such as surgical wound infections 3 patients(5.77%), intraoperative massive haemorrhage 2 patients(3.85%), cerebrospinal fluid leakage 2 patients(3.85%), deep vein thrombosis 4 patients(7.69%),and neurological damage 1 patient(1.92%), than patients in the revised TSS-only group (wound infections,11 patients(22%); intraoperative massive haemorrhage, 8 patients(16%);cerebrospinal fluid leakage,5 patients(10%);deep vein thrombosis,13 patients (26%); neurological damage,2 patients (4%). Significant differences were found between the two groups in terms of surgical wound infections, intraoperative massive haemorrhage, and deep vein thrombosis (P < 0.05). The average postoperative hospital stay in the combined group (7.94 ± 0.28 days) was significantly shorter than that in the revised TSS-only group (10.33 ± 0.30 days) (P < 0.05). Long-term follow-up (1 month, 3 months, 6 months, and 1 year postoperatively) revealed better clinical outcomes in the combined group than in the revised TSS-only group in terms of VAS scores, overall KPS%, neurological function status Frankel classification, ECOG performance status, and SAS scores.(P < 0.05).

CONCLUSION

A multidisciplinary team using the NOMS combined with the Revised Tokuhashi scoring system for spinal metastasis surgery showed better clinical efficacy than the sole use of the Revised Tokuhashi scoring system. This personalized, precise, and rational treatment significantly improves patient quality of life, shortens hospital stay, reduces intraoperative and postoperative complications, and lowers mortality rates.

Experimental acute yellow-wood (Terminalia oblongata) intoxication in sheep

An aqueous suspension of air-dried, hammer-milled leaf of Terminalia oblongata (yellow-wood) was administered to sheep by gavage, as a single dose of 5 to 20 g (dry weight)/kg body weight. Doses of 15 g/kg, or more, caused depression, inappetence, abdominal pain and reduced ruminal movements within 24 to 48 h and some sheep also showed dyspnoea, opisthotonus and champing of the jaws. Haematology and blood gas and acid-base measurements were unaffected. In sheep given a dose of 12.5 g/kg, or more, plasma osmolality, aspartate aminotransferase activity and potassium and bilirubin concentrations increased while plasma total protein markedly decreased and plasma sodium concentration and alkaline phosphatase activity remained normal. Most sheep were necropsied 48 h after dosing. The liver showed zonal hepatocellular necrosis, the pattern of which varied with the dose given. No renal lesions were observed, although one sheep given a very high dose became azotaemic and hyperkalaemic. Hydrothorax, hydropericardium and ascites developed in sheep given doses of 15 or 20 g/kg.

Hepatotoxic and nephrotoxic principles in Terminalia oblongata

A study was conducted to identify and characterise the toxic principle in Terminalia oblongata, commonly known as yellow-wood. Crude aqueous extracts of yellow-wood leaf were found to produce the same liver lesion in mice as has been reported in ruminants. The hepatotoxic fraction was isolated and identified as a hydrolysable vegetable tannin called punicalagin. When given orally, the dose required to produce toxicity was at least 20 times greater than when given intraperitoneally. Following a given dose of punicalagin, the onset and severity of liver necrosis was found to be related to the time interval after dosing. In addition to punicalagin, an unidentified nephrotoxic substance was found which was capable of producing avascular renal necrosis without liver necrosis.

Periodontal conditions in 35-44-year-old factory workers in Shanghai

A periodontal survey applying CPITN was carried out in almost 500 male and female factory workers, 35-44 yr of age, in Shanghai, P.R. China. Calculus and shallow pockets were most frequent. Deep pockets of 6 mm and over were seldom found. The mean number of missing teeth was only 2.7 (out of 32). Problems associated with third molars seem to provide the largest immediate oral health problem.

Experimentally induced lactic acidosis in the goat

Lactic acidosis was produced experimentally twice in each of 4 adult, female goats, by giving sucrose orally at the rate of 18 g/kg bodyweight. Changes in pH, osmolality, lactic acid concentration, and other constituents in ruminal fluid, plasma and blood were monitored over a period of 48 h. Also changes in urinary pH and sediment were examined. To ameliorate the metabolic disturbance, calcium hydroxide and bicarbonate treatment was employed after the 24 h samples had been collected and their acid-base status determined. A feature of the disturbance in the goats was that a metabolic alkalosis preceded the onset of lactic acidosis.

Veterinary education in China

A brief history of the development of veterinary knowledge and education in China and a short account of present-day veterinary education are presented. In dealing with the latter, information on the number and structure of schools, the undergraduate curriculum, graduate numbers and employment on graduation are considered. Information on the staffing of veterinary teaching departments, academic staff salaries and pensions is also added.

Pharmacokinetics of cefaronide, ceftriaxone and cefoperazone in sheep

The pharmacokinetics of cefaronide (16 gm/kg dose), ceftriaxone and cefoperazone (47 gm/kg dose), after intravenous (i.v.) administration were determined in six Merino ewes. The mean values for terminal half life, steady state volume of distribution Vd(ss), renal clearance (ClR) and total body clearance (ClB) for cefaronide were 1.5 h, 0.39 l/kg, 0.06 l/h/kg and 0.16 l/h/kg, for ceftriaxone; 1.7 h, 0.30 l/kg, 0.08 l/h/kg, and 0.22 l/h/kg, and 0.7 h, 0.16 l/kg, 0.02 l/h/kg and 0.16 l/h/kg for cefoperazone, respectively. After 5.5 h, approximately 42% cefaronide, and after 8 h, approximately 37% ceftriaxone and 13% cefoperazone, was excreted in urine. The non-renal elimination of ceftriaxone and cefoperazone appeared to be more rapid in sheep than is reported in man. Cefaronide was excreted largely unchanged in the urine of sheep. Therefore, the elimination of cefaronide in sheep was similar to that found in man. Cefaronide was well distributed in sheep, whereas ceftriaxone and cefoperazone appeared to be distributed to a lesser degree. These findings underline the different disposition of drugs in different species.

Pharmacokinetics of probenecid in sheep

Six Merino ewes were given 1 g (27 g/kg) probenecid by the intravenous (i.v.), intramuscular (i.m.) and subcutaneous (s.c.) routes. After i.v. injection, the biological half-life was 1.55 h and apparent volume of distribution at the steady state (Vdss) 0.18 l/kg. Body clearance (ClB) and renal clearance (ClR) were 0.12 l/h/kg and 0.03 l/h/kg, respectively. Approximately 28% of unchanged probenecid was excreted in urine. Plasma probenecid concentrations after i.v., i.m. and s.c. injections were 133, 37, and 31 micrograms/ml, respectively, at 15 min; 76, 36, and 34 micrograms/ml at 1 h; and 43, 23 and 34 micrograms/ml at 2 h. The average bioavailability of probenecid given by i.m. and s.c. injection was 46% and 34%, respectively. However, after 2 h, probenecid plasma concentrations remained higher when it was given subcutaneously than when it was given intramuscularly. Urine output was correlated positively (P less than 0.05) with kel and ClB. Urine pH increased significantly (P less than 0.01) for the first 2 h, and then steadily declined over the subsequent 6 h. The results suggested that probenecid in sheep was rapidly eliminated because it was rapidly excreted in the normal but alkaline urine. Subcutaneous administration of probenecid in animals may be a useful alternative to oral or i.v. administration.

Effect of probenecid on the pharmacokinetics of cefotaxime in sheep

The effect of probenecid given by intravenous (i.v.), intramuscular (i.m.) and subcutaneous (s.c.) injection on the pharmacokinetics of cefotaxime was studied in six Merino ewes. When given intravenously, probenecid increased significantly (P less than 0.05) the plasma half-life of cefotaxime three-fold (to 0.94 +/- 0.32 h) and the area under the curve (AUC) approximately two-fold (to 41.1 +/- 16.8 micrograms.h/ml), and decreased plasma cefotaxime clearance (ClB) 45% (to 0.648 +/- 0.191 l/h/kg). When given with probenecid intravenously, renal clearance (ClR), volume of the central compartment (VC), volume of distribution steady state (Vd(ss], and the amount excreted in urine unchanged did not alter significantly. When given by i.m. injection, probenecid and cefotaxime were well tolerated and cefotaxime was well absorbed (101 +/- 45%). When given by s.c. injection, only 40 +/- 25% cefotaxime was absorbed. When given intramuscularly or subcutaneously, probenecid appeared to reduce the ClB and ClR of cefotaxime, probably because plasma probenecid concentrations are prolonged. Probenecid did not appear to affect the distribution of cefotaxime.

Pharmacokinetics of cefotaxime and probenecid in sheep with normal and reduced renal function

The pharmacokinetics of cefotaxime and probenecid, given by intravenous injection, were determined in six Merino ewes which had been subjected to a 75% reduction in renal mass. These results were compared with results previously determined in sheep with normal renal function. In the sheep with reduced renal mass, the following significant changes in parameter values for cefotaxime were observed. The elimination rate constant (kel) decreased by 47%, the apparent volume of the central compartment (Vc) decreased by 59%, the steady state volume (Vss) decreased by 50%, and the total body clearance (ClB) decreased by 78%. The rate constant for distribution of drug into tissues (k12) increased 6.9 times, the rate constant for distribution out of tissues (k21) increased 3.7 times, and the area under the plasma concentration-time curve (AUC) increased by a factor of 4.9. The parameter values, determined in sheep with reduced renal mass, for probenecid plasma half-life, Vss and the rate constants k12, k21, and kel were not significantly different from the values obtained previously in sheep with normal renal mass. However, the rate constant for renal excretion of probenecid (ke), renal clearance (ClR), ClB and Vc decreased by 79, 90, 54 and 36%, respectively. The results indicate that reduced renal mass increased the plasma half-life for cefotaxime as well as increasing its diffusion into tissue. In the case of probenecid the overall distribution and elimination kinetics were not altered by reduced renal mass; however, the rate of urinary excretion of the drug was reduced.