16 research outputs found
Fibrin Sealants in Dura Sealing: A Systematic Literature Review
<div><p>Background</p><p>Fibrin sealants are widely used in neurosurgery to seal the suture line, provide watertight closure, and prevent cerebrospinal fluid leaks. The aim of this systematic review is to summarize the current efficacy and safety literature of fibrin sealants in dura sealing and the prevention/treatment of cerebrospinal fluid leaks.</p><p>Methods</p><p>A comprehensive electronic literature search was run in the following databases: Cochrane Database of Systematic Reviews, Cochrane Central Resister of Controlled Trials, clinicaltrials.gov, MEDLINE/PubMed, and EMBASE. Titles and abstracts of potential articles of interest were reviewed independently by 3 of the authors.</p><p>Results</p><p>A total of 1006 database records and additional records were identified. After screening for duplicates and relevance, a total of 78 articles were assessed by the investigators for eligibility. Thirty-eight were excluded and the full-text of 40 articles were included in the qualitative synthesis. Seven of these included only safety data and were included in the safety assessment. The remaining 33 articles included findings from 32 studies that enrolled a total of 2935 patients who were exposed to fibrin sealant. Among these 33 studies there were only 3 randomized controlled trials, with the remaining being prospective cohort analysis, case controlled studies, prospective or retrospective case series. One randomized controlled trial, with 89 patients exposed to fibrin sealant, found a greater rate of intraoperative watertight dura closure in the fibrin sealant group than the control group (92.1% versus 38.0%, p<0.001); however, post-operative cerebrospinal fluid leakage occurred in more fibrin sealant than control patients (6.7% versus 2.0%, p>0.05). Other clinical trials evaluated the effect of fibrin sealant in the postoperative prevention of cerebrospinal fluid leaks. These were generally lower level evidence studies (ie, not prospective, randomized, controlled trials) that were not designed or powered to demonstrate a significant advantage to fibrin sealant use. Two small case series studies evaluated the effect of fibrin sealants in persistent cerebrospinal fluid leak treatment, but did not establish firm efficacy conclusions. Specific adverse reports where fibrin sealants were used for dura sealing were limited, with only 8 cases reported in neurosurgical procedures since 1987 and most reporting only a speculative relationship/association with fibrin sealant exposure.</p><p>Conclusions</p><p>A major finding of this systematic literature review is that there is a paucity of randomized studies that have evaluated the effectiveness and safety of fibrin sealants in providing intraoperative watertight dura closure and post-operative cerebrospinal fluid leakage. Among the limited studies available, evidence from a single randomized, controlled trial indicates that fibrin sealants provide a higher rate of intraoperative watertight closure of the dura suture line than control, albeit with a higher rate of postoperative cerebrospinal fluid leakage. Evidence from non-randomized, controlled trials suggests that fibrin sealants may be effective in preventing cerebrospinal fluid leaks with an acceptable safety profile. There is a substantial need for randomized, controlled clinical trials or well-designed prospective observational trials where the conduct of a randomized trial is not feasible to fully assess the impact of fibrin sealant utilization on the rates of intraoperative dura closure, postoperative cerebrospinal leakage, and safety.</p></div
Literature Search: Summary of Studies with Results on Efficacy and Safety.
<p>Literature Search: Summary of Studies with Results on Efficacy and Safety.</p
Defined Levels of Evidence in Literature Search Articles.
<p>Defined Levels of Evidence in Literature Search Articles.</p
Appraisal of Study Quality for Three Randomized Controlled Trials<sup>*</sup>.
<p>Appraisal of Study Quality for Three Randomized Controlled Trials<sup><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151533#t006fn004" target="_blank">*</a></sup>.</p
Literature Search: Specific Reported Adverse Events, in Alphabetical order by first author.
<p>Literature Search: Specific Reported Adverse Events, in Alphabetical order by first author.</p
PRISMA Flow Diagram of the Selection Process to Identify Studies for Review.
<p>PRISMA Flow Diagram of the Selection Process to Identify Studies for Review.</p
Article Inclusion and Exclusion Criteria.
<p>Article Inclusion and Exclusion Criteria.</p
Search Strategy for the MEDLINE/PubMed Database.
<p>Search Strategy for the MEDLINE/PubMed Database.</p
Literature Search: Summary of Levels of Evidence of the Included Studies.
<p>Literature Search: Summary of Levels of Evidence of the Included Studies.</p
Enhanced Mechanical and Electromechanical Properties of Compositionally Complex Zirconia Zr<sub>1–<i>x</i></sub>(Gd<sub>1/5</sub>Pr<sub>1/5</sub>Nd<sub>1/5</sub>Sm<sub>1/5</sub>Y<sub>1/5</sub>)<i><sub>x</sub></i>O<sub>2−δ</sub> Ceramics
Compositionally complex oxides (CCOs)
or high-entropy
oxides (HEOs)
are new multielement oxides with unexplored physical and functional
properties. In this work, we report fluorite structure-derived compositionally
complex zirconia with composition Zr1–x(Gd1/5Pr1/5Nd1/5Sm1/5Y1/5)xO2−δ (x = 0.1 and 0.2) synthesized in solid-state reaction
route and sintered via hot pressing at 1350 °C. We explore the
evolution of these oxides’ structural, microstructural, mechanical,
electrical, and electromechanical properties regarding phase separation
and sintering mechanisms. Highly dense ceramics are achieved by bimodal
mass diffusion, composing nanometric tetragonal and micrometric cubic
grains microstructure. The material exhibits an anomalously large
electrostriction response exceeding the M33 value of 10–17 m2/V2 at room temperature
and viscoelastic properties of primary creep in nanoindentation measurement
under fast loading. These findings are strikingly similar to those
reported for doped ceria and bismuth oxide derivates, highlighting
the presence of a large concentration of point defects linked to structural
distortion and anelastic behavior, which are characteristics of nonclassical
ionic electrostrictors