World Neurosurg
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Epidural fibrosis is a challenging topic in spinal surgery. This phenomenon constitutes one of the main reasons behind postlaminectomy syndrome or failed back surgery syndrome, which leads to persistent back and leg pain in association with compression and/or stretching the nerve root or the dura. The exact mechanism of action in epidural fibrosis is complex and remains uncertain. Excessive deposition of collagen, fibronectin, and dermatan sulfate, known as the "extracellular matrix," and decrease of tissue cellularity results in epidural fibrosis. The most investigated and important actor in epidural fibrosis as well as in other forms of aberrant wound healing is presumed to be transforming growth factor-1β formation. Tamoxifen (TAM), a synthetic nonsteroidal antiestrogen used in breast cancer, is also effective in inhibiting fibroblast proliferation via downregulation of transforming growth factor-1β. ⋯ Tamoxifen reduced epidural fibrosis, dural thickness, and inflammatory response after laminectomy in rats.
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Few studies have demonstrated detailed physical risk factors of hemorrhagic complications (HCs) associated with the Angio-Seal closure device. This retrospective study aimed to identify the risk factors of HC due to Angio-Seal use. ⋯ Patients with a BMI <21 may require careful hemostasis monitoring, and it is better not to undergo arterial puncture site closure using Angio-Seal for those with a femoral artery depth <11.1 mm.
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The total number of citations of a research article can be used to determine its impact on the scientific community. We aimed to identify the top-100 articles published on ischemic stroke and evaluate their characteristics. ⋯ Our list of top-100 citation classics specific to ischemic stroke provide a detailed insight into academic achievements, historical perspective and serves as a guide for the scientific progress in stroke.
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To evaluate the effect of pulsed radiofrequency (PRF) stimulation of the thoracic medial branch of the dorsal ramus in patients with chronic thoracic facet joint (TFJ) pain who were refractory to medial branch block (MBB). ⋯ The author suggests that PRF on the thoracic medial branch is an effective and safe interventional technique for the control of chronic TFJ pain.
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Lumbar disc herniation complicated with nerve root anomaly presents great challenges to diagnosis and treatment. Improper selection of surgical procedures may cause inferior outcomes and neurologic injury. ⋯ Lumbosacral nerve root anomaly should be remembered and ruled out before selecting surgical methods. Inappropriate procedures can not alleviate the symptoms associated with the anomalous roots and may expose such patients to the risk of neural injury. In clinical practice, surgeons should select percutaneous endoscopic lumbar discectomy with caution, and stop the procedure instantly when unexplainable radicular irritation is evoked.