There is some evidence that postoperative drainage is effective in reducing the symptomatic recurrence of CSDH. Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Due to the low quality of the evidence for the secondary outcomes, the effect of drainage on the occurrence of surgical complications, mortality and poor functional outcome is uncertain. This uncertainty can be clarified with data from high-quality studies which may be conducted in the future. There is no strong evidence of any increase in complications when drains are used.
Objective.Spontaneous spinal epidural hematoma (SSEH) is an uncommon but serious condition with a high morbidity rate. Although SSEH is related to numerous risk factors, its etiology remains unclear. There is a paucity of data on its prognostic factors. We aim to evaluate prognostic factors for SSEH in the current study.Method.A retrospective study was performed on patients who were admitted for SSEH in three academic neurosurgical centers from Jan 2010 to June 2021. Clinical parameters, including clinical condition on admission, anticoagulants use, imaging modality, the timing and type of surgery performed, and outcomes, were collected. Prognostic factors were analyzed. The Frankel scale was used to assess the clinical condition.Results.A total of 105 patients with SSEH were retrieved from medical records, with a mean age of 51.3 years. Eighty three patients (79%) complained of acute onset of severe neck or back pain. Eighty two patients (78%) suffered from moderate to severe neurologic deficits (Frankel scale A-C). Anticoagulation usage was found in 20% of cases. Lower thoracic spine (p=0.046), use of anticoagulants (p=0.019), sphincter function disfunction (p=0.008), severe neurologic deficits at admission (p <0.001), and rapid deterioration (< 1 hour, p=0.004) were found to be associated with poor outcomes. Surgical decompression was performed in 74 (70%) cases. The univariate and multivariate analysis revealed that pre-operative severe neurologic deficits (p=0.005) and extended paraplegia time (>12 hours, p=0.004) were independent adverse prognostic factors. The univariate analysis revealed that lower thoracic spine location (p=0.08) and rapid progression (<6 hours, p=0.005) were correlated with poor prognosis, but the multivariate analysis failed to identify them as independent prognostic factors.Conclusion.Adverse prognostic factors for SSEH might include thoracic segment location, use of anticoagulation, severe neurologic deficits on admission, sphincter dysfunction, and rapid progression. Preoperative neurologic deficit and extended paraplegia time were strongly correlated with the prognosis in the subset of patients that underwent surgical decompression. Timely surgical decompression is recommended for patients with moderate/severe neurologic deficits or progressive neurological deterioration.
Aim: To evaluate the prevalence and influencing factors of anxiety and depression symptoms in surgical nurses during the COVID-19 epidemic in Anhui, China. Methods:A cross-sectional, multic'entre quantitative study was conducted among surgical nurses in Anhui province. SAS, SDS and SSRS scales were used for the investigation. Data were collected between 3 March 2020 to 19 March 2020.Results: A total of 3,492 surgical nurses completed the survey. The average level of anxiety and depression of surgical nurses were higher than that of the Chinese norm.Levels of social support for surgical nurses were significantly negatively associated with the degree of anxiety and depression. Fertility status, participation in care for COVID-19 patients, likelihood of being infected with COVID-19 and social support were significantly influencing surgical nurses' anxiety degree. Similarly, these characteristics were significantly associated with the odds of depression symptoms in surgical nurses. Conclusion:These findings suggest that targeted psychological interventions to promote mental health of surgical nurses need to be immediately implemented.
Brain cancer is the most aggressive one among various cancers. It has a drastic impact on people's lives because of the failure in treatment efficacy of the currently employed strategies. Various strategies used to relieve pain in brain cancer patients and to prolong survival time include radiotherapy, chemotherapy, and surgery. Nevertheless, several inevitable limitations are accompanied by such treatments due to unsatisfactory curative effects. Generally, the treatment of cancers is very challenging due to many reasons including drugs’ intrinsic factors and physiological barriers. Blood-brain barrier (BBB) and blood-cerebrospinal fluid barrier (BCSFB) are the two additional hurdles in the way of therapeutic agents to brain tumors delivery. Combinatorial and targeted therapies specifically in cancer show a very promising role where nanocarriers’ based formulations are designed primarily to achieve tumor-specific drug release. A dual-targeting strategy is a versatile way of chemotherapeutics delivery to brain tumors that gets the aid of combined ligands and mediators that cross the BBB and reaches the target site efficiently. In contrast to single targeting where one receptor or mediator is targeted, the dual-targeting strategy is expected to produce a multiple-fold increase in therapeutic efficacy for cancer therapy, especially in brain tumors. In a nutshell, a dual-targeting strategy for brain tumors enhances the delivery efficiency of chemotherapeutic agents via penetration across the blood-brain barrier and enhances the targeting of tumor cells. This review article highlights the ongoing status of the brain tumor therapy enhanced by nanoparticle based delivery with the aid of dual-targeting strategies. The future perspectives in this regard have also been highlighted.
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