scholarly journals The effectiveness and safety of LMWH for preventing thrombosis in patients with spinal cord injury: a meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ze Lin ◽  
Yun Sun ◽  
Hang Xue ◽  
Lang Chen ◽  
Chenchen Yan ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Venous Thrombosis ◽  
Meta Analysis ◽  
Therapeutic Effects ◽  
Significant Difference ◽  
Cord Injury ◽  
Review Manager ◽  
Evident Difference

Abstract Background Unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are commonly used for preventing venous thrombosis of the lower extremity in patients with traumatic spinal cord injury. Although, LMWH is the most commonly used drug, it has yet to be established whether it is more effective and safer than UFH. Further, a comparison of the effectiveness of LMWH in preventing thrombosis at different locations and different degrees of spinal cord injury has also not been clearly defined. Materials and methods Cohort studies comparing the use of LMWH and UFH in the prevention of lower limb venous thrombosis in patients with spinal cord injury were identified using PubMed. The risk of bias and clinical relevance of the included studies were assessed using forest plots. The Newcastle-Ottawa quality assessment scale was used to evaluate the quality of the included studies. The main results of the study were analyzed using Review Manager 5.3. Results A total of five studies were included in this meta-analysis. Four studies compared the effectiveness and safety of LMWH and UFH in preventing thrombosis in patients with spinal cord injury. No significant differences were found between the therapeutic effects of the two drugs, and the summary RR was 1.33 (95% CI 0.42–4.16; P = 0.63). There was also no significant difference in the risk of bleeding between the two medications, and the aggregate RR was 0.78 (95% CI 0.55–1.12; P = 0.18). When comparing the efficacy of LMWH in preventing thrombosis in different segments and different degrees of spinal cord injury, no significant differences were found. Conclusions The results of this analysis show that compared with UFH, LMWH has no obvious advantages in efficacy nor risk prevention, and there is no evident difference in the prevention of thrombosis for patients with injuries at different spinal cord segments.

scholarly journals Surgical management of penetrating spinal cord injury primarily due to shrapnel and its effect on neurological outcome: a literature review and meta-analysis

2018 ◽  
Vol 28 (1) ◽  
pp. 63-71 ◽  
Author(s):  
Michael H. Lawless ◽  
Evan J. Lytle ◽  
Andrea F. McGlynn ◽  
John A. Engler
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Meta Analysis ◽  
Neurological Recovery ◽  
Forest Plot ◽  
Odds Ratios ◽  
Significant Difference ◽  
Cord Injury

OBJECTIVEThis study was performed to determine whether decompression of penetrating spinal cord injury (SCI) due to explosive shrapnel leads to greater neurological recovery than conservative management.METHODSIn accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search using PubMed/MEDLINE, Web of Science, Google Scholar, and the Defense Technical Information Center public site was conducted on May 2, 2016. Studies that described penetrating SCI with shrapnel as an etiology, included surgical and/or conservative management, and demonstrated admission and follow-up neurological status were eligible for inclusion in this study. Odds ratios were calculated for the overall effect of surgical treatment on neurological recovery. Funnel plots were used to evaluate publication bias.RESULTSFive case series (Level IV evidence) met the study criteria, and 2 of them had estimable odds ratios for use in the Forest plot analysis. Among the patients from all 5 studies, 65% were injured by shrapnel, 25% by high-velocity bullet, 8% by low-velocity bullet, and 2% by an unknown cause. A total of 288 patients were included in the overall odds ratio calculations. Patients were stratified by complete and incomplete SCI. The meta-analysis showed no significant difference in outcomes between surgical and conservative management in the complete SCI cohort or the incomplete SCI cohort. Overall rates of improvement for complete SCI were 25% with surgery and 27% with conservative treatment (OR 1.07, 95% CI 0.44–2.61, p = 0.88); for incomplete SCI, 70% with surgery and 81% with conservative treatment (OR 1.67, 95% CI 0.68–4.05, p = 0.26).CONCLUSIONSThis study demonstrates no clear benefit to surgical decompression of penetrating SCI due predominantly to shrapnel. There is a considerable need for nonrandomized prospective cohort studies examining decompression and stabilization surgery for secondary and tertiary blast injuries.

scholarly journals A meta-analysis of exosome in the treatment of spinal cord injury

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 1043-1060
Author(s):  
Hanxiao Yi ◽  
Yang Wang
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Sequential Analysis ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Trial Sequential Analysis ◽  
Therapeutic Effects ◽  
Locomotor Function ◽  
Cord Injury

Abstract Context There are no recommended therapeutic agents for acute spinal cord injury (SCI) due to the pathophysiological complexity of the injury. Objective The objective of this study is to investigate the efficacy of various exosomes and potential factors impacting the efficacy of exosomes. Methods We searched the PubMed, EMBASE, Web of Science, Medline, Scopus, and Cochrane Library databases to systematically collect articles comparing the locomotor function of SCI rodents undergoing exosome treatment and untreated SCI rodents. No language was preferred. Results Pooled analysis revealed that the locomotor function recovery of SCI rodents receiving exosomes was greatly improved (583 rats, 3.12, 95% CI: 2.56–3.67, p < 0.01; 116 mice, 2.46, 95% CI: 1.20–3.72, p < 0.01) compared to those of control rodents. The trial sequential analysis demonstrated the findings of the meta-analysis with the cumulative Z-curve crossing the upper monitoring boundary for the benefit and reaching the adjusted required information size. However, the origin of the exosome, SCI model, and administration method determined the therapeutic effect to some extent. Conclusions Despite the proven therapeutic effects of exosomes on SCI rodents, the results should be interpreted cautiously considering the diversity in vivo and in vitro in relation to future trials.

scholarly journals External Powered Orthoses for Paraplegic Subjects: A Meta Analysis Review

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Mohammad Taghi Karimi ◽  
Amir Esrafilian
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Poor Quality ◽  
Energy Consumption Analysis ◽  
Cord Injury ◽  
Analysis Stability ◽  
Research Studies

Background. Various types of external powered orthoses have been designed to improve the function of paraplegic subjects; however it is not clear which one of them has better performance. Therefore, the aim of this paper is to evaluate the function of available external powered orthoses based on the research presented in the relevant literature. Method. An electronic search was done via the Pubmed, Embase, and ISI Web of Knowledge data from 1960 to 2010. The quality of the research studies was evaluated by use of Black and Down tool. The performances of the orthoses are evaluated based on the gait analysis, stability analysis, and energy consumption analysis. Results. Although various types of external powered orthoses have been designed to improve the performance of spinal cord injury individuals, there are a few research studies in this regard. Moreover, they have a poor quality. Conclusion. There is no research study regarding the performance of spinal cord injury subjects with the external powered orthoses. It is recommended to do clinical trial studies to evaluate the performance of these orthoses.

Chinese Herbal Medicine in Treatment of Spinal Cord Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 48 (07) ◽  
pp. 1593-1616
Author(s):  
Yang Zheng ◽  
Shangfeng Qi ◽  
Fengqing Wu ◽  
Jintao Hu ◽  
Ronglin Zhong ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Chinese Herbal ◽  
Sensory Score ◽  
Cord Injury

Spinal cord injury (SCI) is a catastrophic disease associated with damaged neurological structures and has become a significant social and economic burden for the health care system and patients’ families. The use of Chinese Herbal Medicine (CHM) to treat SCI has been increasing in recent years. This meta-analysis aimed to investigate the effectiveness of CHM for patients with SCI. Therefore, we included randomized controlled trials (RCTs) of CHM for SCI in seven databases. A total of 26 studies involving 1961 participants were included in this study. No serious heterogeneity or publication bias was observed across each study. The results showed that significant improvements of the American Spinal Injury Association (ASIA)-grading improvement rate ([Formula: see text], [Formula: see text]), clinical effective rate ([Formula: see text], [Formula: see text]), ASIA motor score ([Formula: see text], [Formula: see text]), ASIA sensory score (total) ([Formula: see text], [Formula: see text]), ASIA sensory score (light touch) ([Formula: see text], [Formula: see text]), ASIA sensory score (pinprick) ([Formula: see text], [Formula: see text]), and activities of daily living (ADL) score ([Formula: see text], [Formula: see text]) in CHM group compared with the control group. Among the CHM groups, Buyang Huanwu decoction was the most frequently prescribed herbal formula, while Astragalus membranaceus was the most commonly used single herb. In addition, there were no serious and permanent adverse effects in the two groups. The methodological quality of the most included RCTs was poor and the quality of evidence for the main outcomes was from very low to moderate according to the GRADE system. Current evidence suggests that CHM is an effective and safe treatment for SCI and could be treated as a complementary and alternative option with few side effects. However, considering the low quality, small size, and high risk of the studies identified in this meta-analysis, higher methodological quality, rigorously designed RCTs with large sample sizes are needed to confirm the results.

scholarly journals TRAUMATIC CERVICAL SPINAL CORD INJURY. IS URGENT INTERVENTION SUPERIOR TO DELAYED INTERVENTION? A META-ANALYSIS EVALUATION

2019 ◽  
Vol 8 (1) ◽  
pp. 12
Author(s):  
I Ketut Martiana ◽  
Donny Permana ◽  
Lukas Widhiyanto
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Procedure ◽  
Cervical Spinal Cord ◽  
Meta Analysis ◽  
Neurological Status ◽  
Trauma Patients ◽  
Cervical Trauma ◽  
Significant Difference ◽  
Cord Injury

Introduction: Cervical spine is the most mobile part of the human spine, thus making it the most vulnerable compared to all the other vertebral structures. Surgical procedures are usually performed within the first 24 hours, or 4-6 weeks after trauma in order to prevent any secondary trauma. The research was conducted to evaluate the amount of time of the surgical procedure towards the effectivity and improvement of the neurological status in the cervical injury or acute spinal cord injury (ASCI).Methods: A meta-analysis research which evaluate the effectivity of surgical procedure on cervical trauma/ASCI, with the database procured from PubMed, Embase, and Cochrane. The main parameter is the decompression procedure and the clinical outcome which were categorized. The time of surgery or decompression are categorized into “<24 hours” and “>24 hours”, the neurological outcome is categorized into “improvement” and “no improvement”. The data was presented in odd ratio (OR) and confidence interval (CI) and were further analyzed by forest plot.Results: From PubMed, there were 353 articles, Embase 2 articles, and Cochrane 594 articles, but only 3 articles which fulfilled the inclusion criteria. The comparison between the surgical procedure in the cervical <24 hours with the surgical procedure >24 hours was identified for this research. Statistically, there was a significant difference on the neurological status (OR=1,85; 95%CI=1,21-2,84; p<0,01).Conclusion: With meta-analysis background, early decompressive procedure <24 hours for cervical trauma patients produced a significantly better result in improving the neurological status compared to the late decompressive procedure >24 hours.

scholarly journals Effect of Metformin on Locomotor Function Recovery in Rat Spinal Cord Injury Model: A Meta-analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Qing Chen ◽  
Dong Xie ◽  
Qiuju Yao ◽  
Lili Yang
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Experimental Studies ◽  
High Quality ◽  
Locomotor Function ◽  
Function Recovery ◽  
Cord Injury

Background. Disorder of locomotor function is universal in patients with spinal cord injury (SCI) and has a severe impairment on their quality of life. Metformin, the first-line antidiabetic drug, has been used to improve locomotor function in SCI rats through antioxidative mechanisms recently. Methods. A search strategy was conducted from databases, including PubMed, Web of Science, MEDLINE, and Scopus database until April 2021. The methodological quality of the animal experimental studies was assessed according to the Systematic Review Centre for Laboratory animal Experimentation’s Risk of Bias tool. The weighted mean difference was calculated with the random-effects model. Results. Seven eligible studies on SCI and metformin were reviewed. The meta-analysis indicated that SCI rats receiving metformin therapy showed a significant locomotor function recovery. Limitations and no obvious publication bias were presented in the studies. Conclusion. Metformin can promote the recovery of the locomotor function of SCI rats. However, the use of this meta-analysis was influenced due to the not high quality of studies. Consequently, more high-quality studies are necessary for preclinical studies of SCI in the future.

Quality of Life After Spinal Cord Injury: A Literature Critique and Meta-analysis (1983–1992)

1994 ◽  
Vol 17 (2) ◽  
pp. 60-66 ◽  
Author(s):  
Ron L. Evans ◽  
Robert D. Hendricks ◽  
Richard T. Connis ◽  
Jodie K. Haselkorn ◽  
Karen R. Ries ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Meta Analysis ◽  
Cord Injury

scholarly journals Association between self-esteem, depression, social support, and quality of life among patients with cerebrovascular accidents and spinal cord injury

2018 ◽  
Vol 7 (1) ◽  
Author(s):  
Adebisi Isiak Hammed ◽  
Ebere Ugboh
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Short Form ◽  
Self Esteem ◽  
Stroke Patients ◽  
Significant Difference ◽  
Cord Injury

Study aim: The study determined the association between self-esteem, depression, social support and quality of life among patients with cerebrovascular accident (stroke) and spinal cord injury. Material and methods: The study adopted a cross-sectional survey research design. A total of 60 participants (30 stroke patients and 30 spinal cord injured patients) participated in this study. The selected psychosocial variables such as Depression and Self Esteem were assessed using Beck Depression Inventory Questionnaire (BDI) and Self Esteem Questionnaire (SE) respectively. Also, social support and quality of life were assessed using Social Support Questionnaire (SSQ6) and Short Form (SF-36) Health Questionnaire respectively. The association between social support, depression, self-esteem and quality of life in both spinal cord injury and stroke patients and the demographic variables were analyzed using Spearman rho. However, independent sample t-test was used to analyze the difference between social support, depression, self-esteem and quality of life in spinal cord injury and social support, depression, self-esteem and quality of life in stroke. Results: The outcome of this study showed that there is a significant difference in depression between both stroke and spinal cord injury patients (p<0.05). The findings also showed a significant association between depression, quality of life and age in stroke patients. Equally, there was a significant association between depression, social support, and age in spinal cord injury patients. Conclusion: It was therefore concluded that even though stroke patients receive more social support and have a higher quality of life, they are still more depressed and have lower self-esteem compared to spinal cord injury patients. It was thus recommended that physiotherapists and other health professionals should make an appropriate assessment of the quality of life, self-esteem, depression and social support of stroke and spinal cord injury patients to enable proper management of these individuals.

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