Dysphagia is a common complication of ACDF. Causes of dysphagia include multilevel cervical spine and upper cervical spine surgeries. Use of methylprednisolone and careful operation can reduce the incidence and result in good prognosis.

In previous studies, the association between malignant tumors and the development of glomerular disease has been well documented. Malignant tumors that cause glomerular damage are mainly classified into two categories: Hematological tumors and solid tumors. Of them, the most common type is Hodgkin's lymphoma, while renal carcinoma is substantially infrequent. This study describes a 67-yearold Chinese male patient who was hospitalized for nephrotic syndrome with the symptoms of hypertension, edema and foamy urine, and has not taken any related drugs before. In the process of hospitalization, a renal carcinoma in the stage T1N0M0 was suspected by abdominal enhanced computed tomography scan.What is unique about this patient is the treatment-removing the tumor first may aggravate the kidney damage, which leads to further deterioration of renal function and using hormone drugs to treat nephrotic syndrome may cause tumor enlargement. Ultimately, the patient underwent the surgery of laparoscopic partial nephrectomy and took pathological examinations of the renal neoplasm and the normal tissue next to the tumor. Based on the pathological results, renal cell carcinoma with membranous nephropathy (MN) was verified. After reviewing the case reports of renal cancer with glomerular disease in the past 50 years, it is hoped to provide a basis for the standardized diagnosis and treatment of this combination disease in renal.

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Background: Questions still remain about the safest and most effective route of administration for tranexamic acid (TXA) in lumbar interbody fusion. As such, the goal of this randomized clinical trial was to assess the efficacy and safety of topical TXA compared with intravenous TXA in lumbar interbody fusion. Methods: This was a prospectively randomized trial that investigated the effectiveness and safety of the intravenous and topical administrations of TXA with regard to lumbar interbody fusion. Approval from Clinical Studies Ethical Committee in our hospital was obtained. The patients were randomized to 1 of 2 treatment options: Patients, surgeons, anesthesiologists, nurses, and research assistants collecting data were blinded to group allocation. The primary outcome measures were perioperative calculated blood loss, total drain output at 24 hours, and perioperative blood transfusion rate. Secondary outcomes included an analysis of complications, namely symptomatic venous thromboembolism, cerebrovascular accident, and arterio-occlusive events. Data were analyzed using the statistical software package SPSS version 25.0 (Chicago, IL). Results: There are several limitations to this study. We did not include a group of patients who did not receive TXA. Another potential limitation is that the study population contains heterogeneity such as varying patient diagnosis and surgical technique/approach. Despite these limitations, the validity of our results should be maintained, as the same methodology was applied to both treatment arms. Trial registration: This study protocol was registered in Research Registry (researchregistry5564).

Background: Postoperative cognitive dysfunction (POCD) is the decline in cognitive ability that occurs between one week and one year following surgery. POCD has been reported to occur in 5% to 26% of elderly surgical patients and its incidence varies with demographic, clinical, and surgical variables. Previous studies have shown that dexmedetomindine (DEX), a highly selective α2 adrenergic receptor agonist, has many effects that include opioid-sparing properties, decreased required anesthetic medication, and neuroprotection in animal models. Ultimately, DEX may benefit cognitive ability in the postoperative period. Therefore, we hypothesized that intraoperative infusion of DEX would reduce early POCD and interleukin-6 (IL-6) levels in elderly surgical patients compared to placebo. Methods: This randomized, double-blind, controlled trial enrolled 96 elderly patients that underwent video-assisted thoracoscopic lobectomy (VATL) between May 2017 and April 2018. The enrolled subjects were randomly assigned in a 1:1 ratio to receive intravenous dexmedetomidine (DEX Group) or placebo (0.9% normal saline, Saline Group) as a continuous infusion at a rate of 0.5μg/kg/hr starting at anesthesia induction until incision closure. All subjects received total intravenous anesthesia (TIVA) during surgery and patient controlled epidural analgesia (PCEA) following surgery. The primary outcomes were to determine the incidence of POCD and IL-6 expression at postoperative day (POD) 1, 2, and 7. The secondary outcomes were to evaluate the degree of pain on POD 1 and 2, as well as adverse events throughout the study. Results: 96 eligible subjects (48 per group) were randomized, dosed with study medication, and evaluated per protocol. There was a significant difference on POCD between the DEX and saline groups on POD 1 (6.3% vs. 20.8%, p-value <0.05) and POD 2 (4.2% vs. 16.7%, p-value <0.05). The IL-6 levels were significantly lower in the DEX group when compared with saline group during POD 1 and 2 (p-value <0.05). IL-6 returned to baseline levels on POD 7. There was no significant difference in POCD on POD7, and overall there were no significant differences in the incidence of adverse events between both groups.Conclusions: The administration of intraoperative DEX in elderly patients undergoing VATL decreased the incidence of early POCD. Clinical Trial Registry: This study was registered on Chinese Clinical Trial Registry with the ID ChiCTR-IPR-17010958.