Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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The purpose of this study was to perform a systematic review and meta-analysis on the effect of desmopressin on hematoma expansion (HE) in antiplatelet-associated intracerebral hemorrhage (AA-ICH). Secondary outcomes examined were the rate of thrombotic complications and neurologic outcome. Three databases were searched (Pubmed, Scopus, and Cochrane) for randomized clinical trials and controlled studies comparing desmopressin versus controls in adult patients with AA-ICH. ⋯ Qualitative analysis of included studies for each outcome revealed low to moderate risk of bias. The available literature does not support the routine use of desmopressin in the setting of AA-ICH. Until larger prospective trials are performed, the administration of desmopressin should be judiciously considered on a case-by-case basis.
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Endovascular thrombectomy (EVT) is the first-line treatment for patients with acute ischemic stroke (AIS). However, the optimal anesthetic modality during EVT is unclear. Therefore, this systematic review and meta-analysis is aimed to summarize the current literatures from RCTs to provide new clinical evidence of choosing anesthetic modality for AIS patients when receiving EVT. ⋯ GA was superior over CS in successful recanalization and functional independence at 3 months when performing EVT in AIS patients. However, GA was associated with higher risk of MAP drop and pneumonia. Therefore, results of ongoing RCTs will provide new clinical evidence of anesthetic modality selection during EVT in the future.
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The objective of the research was to compare the efficacy of lateral and bilateral PKP approaches for OVCFs. A comprehensive literature search was performed from the PubMed, Cochrane Library and Embase between January 2008 and May 2017. The clinical efficacy of the two approaches was evaluated by comparing perioperative outcomes (operation time, the volume of injected cement, X-ray exposure times and mean radiation dose), clinical outcomes (kyphotic angle reduction, restoration rate, visual analogue scale [VAS], Oswestry Disability Index [ODI] and SF-36), and operation-related complications (cement leakage and adjacent vertebral fracture). ⋯ However, the pooled results revealed no significant difference in X-ray exposure times, kyphotic angle reduction, restoration rate, VAS, ODI, SF-36 and adjacent vertebral fracture. Our study presented that patients with OVCFs could obtain similar satisfactory clinical results via both unilateral and bilateral PKP approaches. Considering less operation time, less cement volume, lower mean radiation dose of patients, a lower rate of cement leakage and less surgery-related costs, we suggest that a unilateral PKP approach is advantageous.
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Review Meta Analysis
Efficacy and safety of etanercept in the treatment of sciatica: A systematic review and meta-analysis.
Etanercept might be promising to alleviate sciatica caused by lumbar disc herniation and spinal stenosis. However, the results remained controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy of etanercept in patients with sciatica. ⋯ Etanercept showed no increase in Oswestry Disability Index (ODI) compared with placebo (Std. mean difference=-0.83; 95% CI=-2.03 to 0.37; P=0.18) and steroids (Std. mean difference=-0.19; 95% CI=-1.15 to 0.77; P=0.70). Etanercept treatment was associated with a significantly reduced pain in leg and back compared to placebo and may possibly improve leg pain relief compared to steroids, but failed to improve ODI. Etanercept should be recommended for sciatica with caution because of heterogeneity.
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Review Meta Analysis
Outpatient anterior cervical discectomy and fusion: A meta-analysis.
Anterior cervical discectomy and fusion (ACDF) performed as an outpatient has become increasingly common for treating cervical spine pathology, largely due to its cost savings compared with inpatient ACDF. Nearly all outpatient ACDF patient reports have originated from single-center studies, with the procedure yet to be addressed via a meta-analysis of the peer-reviewed literature. The Entrez gateway of the PubMed database was used to conduct a comprehensive literature search for articles published in English up to 3/9/16. ⋯ Nearly two-thirds of outpatient ACDFs underwent single-level fusion, with virtually none undergoing 3+ level ACDF. Outpatient ACDF is safe, with a low readmission rate and complication rates comparable to those (2-5%) associated with inpatient ACDF. These findings support an argument for increasing ACDFs performed on an outpatient basis in appropriately selected patients.