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Liu P, Wang J, Wang Y, Bai Y, Zhou H, Yang L. Pregelatinized hydroxypropyl distarch phosphate-reinforced calcium sulfate bone cement for bleeding bone treatment. Biomater Sci 2024; 12:3193-3201. [PMID: 38747322 DOI: 10.1039/d4bm00195h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Considering the shortcomings of known medical hemostatic materials such as bone wax for bleeding bone management, it is essential to develop alternative bone materials capable of efficient hemostasis and bone regeneration and adaptable to clinical surgical needs. Thus, in the current work, a calcium sulfate hemihydrate and starch-based composite paste was developed and optimized. Firstly, it was found that the use of hydroxypropyl distarch phosphate (HDP) coupled with pregelatinization could generate an injectable, malleable and self-hardening paste with impressive anti-collapse ability in a dynamic aqueous environment, suggesting its potential applicability in both open and minimally invasive clinical practice. The as-hardened matrix exhibited a compressive strength of up to 61.68 ± 5.13 MPa compared to calcium sulfate cement with a compressive strength of 15.16 ± 2.42 MPa, making it a promising candidate for the temporary mechanical stabilization of bone defects. Secondly, the as-prepared paste revealed superior hemostasis and bone regenerative capabilities compared to calcium sulfate cement and bone wax, with greatly enhanced bleeding management and bone healing outcomes when subjected to testing in in vitro and in vivo models. In summary, our results confirmed that calcium sulfate bone cement reinforced with the selected starch can act as a reliable platform for bleeding bone treatment, overcoming the limitations of traditional bone hemostatic agents.
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Affiliation(s)
- Peng Liu
- School of Materials Science and Engineering, Hebei University of Technology, Tianjin, 300130, China
| | - Jinwen Wang
- School of Materials Science and Engineering, Hebei University of Technology, Tianjin, 300130, China
| | - Yinan Wang
- Center for Health Science and Engineering, Hebei Key Laboratory of Biomaterials and Smart Theranostics, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, 300130, China.
| | - Yanjie Bai
- Department of Chemical Engineering, Hebei University of Technology, Tianjin, 300130, China.
| | - Huan Zhou
- Center for Health Science and Engineering, Hebei Key Laboratory of Biomaterials and Smart Theranostics, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, 300130, China.
| | - Lei Yang
- Center for Health Science and Engineering, Hebei Key Laboratory of Biomaterials and Smart Theranostics, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, 300130, China.
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Liu X, Zhang F, Qiu Y, Yin Y, Lv X, Gao M, Shen H, Liu L. Reconstruction of the Large Frontal Sinus Defect With the Small Supporting Bone Pieces in Neurosurgical Anterior Skull Base Surgery. World Neurosurg 2024; 186:e125-e133. [PMID: 38521218 DOI: 10.1016/j.wneu.2024.03.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Large defects of frontal sinus (FS) might be difficult to manage effectively. Mismanagement of the large defects could lead to serious postoperative complications in anterior skull base surgery. This study introduces a simple and reliable method applying small supporting bone pieces to cover or insert into large FS defects, then the large defect of FS was transformed into the small defects which was sealed by bone wax successfully. METHODS Eleven patients underwent anterior skull base surgery for lesions or aneurysms, with the reconstruction of large FS defects by small supporting bone pieces. During craniotomy, mild violations of the FS mucosa were spared and sterilized, while severe violations required mucosal removal. Small supporting bone pieces were obtained from the inner plate of the bone flap and carefully covered or inserted into the large defects. The large defects were transformed into some small ones, which could be sealed effectively by bone wax. Demographic, intraoperative, and postoperative complication data were collected. RESULTS Four patients had severe mucosal violations requiring removal, while 7 had mild violations sparing the mucosa. All underwent effective reconstruction with small supporting bone pieces. Median follow-up was 6 months. All cases showed effective FS morphology reconstruction, with no FS-related complications. CONCLUSIONS Applying the small supporting bone pieces for large FS defect reconstruction can restore the FS morphology, preserve physiological function, and avoid postoperative complications.
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Affiliation(s)
- Xi Liu
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fan Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yankai Qiu
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yibo Yin
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xing Lv
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Mengyu Gao
- Department of Cardiology, Fourth Hospital of Harbin, Harbin, China
| | - Hong Shen
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li Liu
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
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Do K, Vachirakorntong B, Kawana E, Do J, Phan TD, Phan TD. The Use of Bone Wax in Hemostatic Control for Total Knee and Hip Arthroplasties: A Systematic Review. J Clin Med 2024; 13:2752. [PMID: 38792294 PMCID: PMC11122341 DOI: 10.3390/jcm13102752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 04/27/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Blood loss can be a serious complication in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Various methods are used by surgeons to achieve hemostatic control in these patients. Complications are associated with perioperative blood loss. In this systematic review, we examined the efficacy of using bone wax to control bleeding in patients undergoing THA and TKA. Methods: The PRISMA model was used to systematically identify and aggregate articles for this study. The PubMed and EMBASE databases were used to search individual studies that examined the use of bone wax in THA or TKA. After applying the search term "bone wax", 2478 articles were initially identified. After inclusion and exclusion criteria were applied, three articles were aggregated for this systematic review. Results: The use of bone wax in THA and TKA decreased blood loss in patients undergoing these operations. Postoperative blood loss following surgery was lower in the bone wax groups compared to the control groups as well. Patients in the bone wax groups also required fewer blood transfusions than those who did not receive bone wax. Conclusions: Bone wax appears to be another modality that can be used by physicians to maintain hemostatic control in THA or TKA patients. Reduced blood loss and transfusion rates in surgery can increase patient outcomes. More studies are needed to examine the efficacy of bone wax in comparison with other hemostatic tools.
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Affiliation(s)
- Kenny Do
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89106, USA;
| | | | - Eric Kawana
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89106, USA;
| | - Jenifer Do
- School of Life Sciences, University of Nevada, Las Vegas, NV 89154, USA;
| | - Thinh Dat Phan
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700100, Vietnam; (T.D.P.); (T.D.P.)
- Department of Internal Medicine, 115 People’s Hospital, Ho Chi Minh City Quận 10, Vietnam
| | - Thinh Dai Phan
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700100, Vietnam; (T.D.P.); (T.D.P.)
- Department of Internal Medicine, 115 People’s Hospital, Ho Chi Minh City Quận 10, Vietnam
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Teegala R. Design and Development of a Cost-Effective Transnasal Skull Base Bone Wax Applicator: A Technical Note. Neurol India 2024; 72:626-628. [PMID: 39041984 DOI: 10.4103/neuroindia.ni_564_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/13/2020] [Indexed: 07/24/2024]
Abstract
Bone wax is an important hemostatic agent used in neurosurgical practice from more than a century. It acts by mechanical tamponade effect to stop the oozing from cancellous bone. Bone wax application over the skull surface over the vertex is easy and can be applied with fingers. In deeper areas, one uses dissector to apply the bone wax; however, it becomes difficult at times to apply in transnasal surgery using the same dissectors. Author designed a cost-effective 20-cm-long different angled bone wax applicator for skull base transnasal surgery. This applicator is cost-effective and not described previously in English literature.
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Affiliation(s)
- Ramesh Teegala
- Professor of Neurosurgery, ASRAM Medical College, ELURU, Andhra Pradesh, India
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Hashikata H, Maki Y, Terada Y, Yoshimoto N, Goto M, Ishibashi R, Miki Y, Ikeda N, Hayashi H, Nishida N, Taki J, Iwasaki K, Toda H. Risk of Bone Wax Migration During Retrosigmoid Craniotomy for Microvascular Decompression: Case-Control Study. Oper Neurosurg (Hagerstown) 2024; 26:406-412. [PMID: 37934925 DOI: 10.1227/ons.0000000000000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/26/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Bone wax is a flexible hemostatic agent commonly used for surgery in the posterior cranial fossa to control bleeding from the mastoid emissary vein. A large amount of bone wax can migrate into the sigmoid sinus through the mastoid emissary canal (MEC). We aimed to identify clinical factors related to intraoperative bone wax migration through the MEC during microvascular decompression (MVD) surgery, which may result in sigmoid sinus thrombosis. METHODS We retrospectively collected the clinical data of patients with trigeminal neuralgia, hemifacial spasm, or trigeminal neuralgia accompanied by painful tic convulsif who underwent MVD. Basic information and the residual width and length (from the bone surface to the sigmoid sinus) of the MEC on computed tomography images were collected. We compared the collected clinical data between 2 groups of cases with and without intraoperative bone wax migration in the sigmoid sinus. RESULTS Fifty-four cases with intraoperative bone wax migration and 187 patients without migration were enrolled. The t -test revealed significant differences in the width and length of the MEC ( P = .013 and P = .003, respectively). These variables were identified as significant factors in predicting intraoperative bone wax migration using multivariate logistic regression analysis. CONCLUSION The large size of the MEC may be related to intraoperative bone wax migration into the sigmoid sinus in MVD. Neurosurgeons should be aware of these risks. Bone wax should be applied appropriately and hemostasis should be considered to control bleeding from the mastoid emissary vein in patients with a large MEC.
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Affiliation(s)
- Hirokuni Hashikata
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Yoshinori Maki
- Department of Neurosurgery, Hikone Chuo Hospital, Hikone City , Shiga , Japan
- Department of Rehabilitation, Hikari Hospital, Otsu City , Shiga , Japan
| | - Yukie Terada
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Naoya Yoshimoto
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Masanori Goto
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Ryota Ishibashi
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Yoshihito Miki
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Naokado Ikeda
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Hideki Hayashi
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Namiko Nishida
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Junya Taki
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Koichi Iwasaki
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Hiroki Toda
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
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Moss C, Fyfe E, McColl E. Top tips for managing the bleeding patient in primary care. Br Dent J 2024; 236:586-589. [PMID: 38671099 DOI: 10.1038/s41415-024-7383-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Affiliation(s)
- Claire Moss
- Clinical Lecturer and Module Lead in Oral Surgery MSc, Peninsula Dental School (University of Plymouth), Exeter Dental Education Facility, Exeter, EX2 4DG, UK.
| | - Eithne Fyfe
- Consultant Oral Surgeon and Program Lead in Oral Surgery MSc, Peninsula Dental School (University of Plymouth), Exeter Dental Education Facility, Exeter, EX2 4DG, UK.
| | - Ewen McColl
- Director of Clinical Dentistry, Peninsula Dental School (University of Plymouth), Derriford Dental Education Facility, Plymouth Science Park, Research Way, Plymouth, PL6 8BT, UK.
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Javed S, Asad Asif M, Yaqoob E, Mushahid Z, Mohsin Arshad M, Farooq M, Chaurasia B. Neurosurgical landscape in Pakistan: Past, present and future perspectives. J Clin Neurosci 2024; 120:115-119. [PMID: 38237489 DOI: 10.1016/j.jocn.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 02/12/2024]
Abstract
Intricate fields have always posed a challenge for the healthcare department all over the world, particularly in developing countries. This article elaborates on the history of neurosurgery in a developing country like Pakistan. In addition, it provides a summary of a roadmap that a young healthcare practitioner, who inspires to become a respectable neurosurgeon may need. After Pakistan gained its independence, Dr. Omer Wali Jooma became the first healthcare practitioner who planted the seed of an official department of Neurosurgery in Jinnah hospital, Karachi. Various challenges include the absence of a non-standardized curriculum, a non-updated syllabus, severe deficiency of neurosurgeons in a country facing massive growth spurt, lack of facilities for a young trainee etc. These factors contribute to the bleeding of the department from various sites and the wounds needs to be addressed and stitched as soon as possible to make the department successful.
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Affiliation(s)
- Saad Javed
- Department of Neurosurgery, Holy Family Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Muhammad Asad Asif
- House Surgeon, Department of Neurosurgery , RMU and Allied Hospitals, Rawalpindi
| | - Eesha Yaqoob
- MSPH Scholar Health Services Academy, Islamabad, Pakistan
| | | | | | - Minaam Farooq
- Department of Neurosurgery, Weill Corneill Medicine, Presbyterian Hospital, NY, USA
| | - Bipin Chaurasia
- Consultant Neurosurgeon, Neurosurgery Clinic, Birgunj, Nepal.
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Rapaport B, Burnside G, Parks C, Duncan C, Richardson D, Ellenbogen J, Sinha A, Craig R, Diwan R, Hennedige A. Part II: Blood Transfusion and Donor Exposure in the Surgical Management of Trigonocephaly Patients: A Protocol From Alder Hey Craniofacial Unit. J Craniofac Surg 2024; 35:114-118. [PMID: 38063395 DOI: 10.1097/scs.0000000000009878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 09/02/2023] [Indexed: 02/01/2024] Open
Abstract
Trigonocephaly is a craniofacial malformation caused by premature fusion of the metopic suture. Surgical correction frequently results in the need for blood transfusion. Transfusion complications include transfusion-transmitted infections (TTIs), immune-mediated reactions, and volume overload. Donor exposure (DE) describes the number of blood products from unique donors with increasing DE equating to an increased risk of TTI. We evaluate data on 204 trigonocephaly patients covering 20 years of practice with respect to blood transfusions and DE. This represents the largest series from a single unit to date. A protocol based on our experiences has been devised that summarizes the key interventions we recommend to minimize blood transfusions and DE in craniofacial surgery. Patients operated on between 2000 and 2020 were included. DE and a range of values were calculated including estimated red cell loss (ERCL) and estimated red cell volume transfused (ERCVT). Groups were established by relevant interventions and compared using the Mann-Whitney U test. Mean DE fell from 1.46 at baseline to 0.85 ( P <0.05). Median allogenic transfusion volume fell from 350 mL at baseline to 250 mL ( P <0.05). Median ERCL fell from 15.05 mL/kg at baseline to 12.39 mL/kg and median ERCVT fell from 20.85 to 15.98 mL/kg. Changes in ERCL and ERCVT did not reach statistical significance. DE can be minimized with the introduction of key interventions such as a restrictive transfusion policy, preoperative iron, cell saver, tranexamic acid, and use of a matchstick burr for osteotomies.
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Affiliation(s)
| | - Girvan Burnside
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Chris Parks
- Craniofacial Centre, Alder Hey Children's Hospital
| | | | | | | | - Ajay Sinha
- Craniofacial Centre, Alder Hey Children's Hospital
| | | | - Rishi Diwan
- Craniofacial Centre, Alder Hey Children's Hospital
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Delawan M, Sharma M, Ismail M, Algabri MH, Abdalridha RH, Alawadi MN, Alayyaf AS, Alrawi MA, Andaluz N, Hoz SS. Methods of Hemostasis in Cranial Neurosurgery: An Anatomy-Based Stepwise Review. World Neurosurg 2023; 178:241-259.e3. [PMID: 37586555 DOI: 10.1016/j.wneu.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Hemostasis is crucial in preventing hemorrhage during cranial neurosurgical procedures and maintaining visualization of the surgical field. There is significant variation in the availability of hemostatic methods across different settings and hemostatic techniques are being continuously developed over the decades of practicing neurosurgery. The aim of this article is to provide an outline of the potential methods to achieve hemostasis based on the sequential operative anatomy of a cranial operation. METHODS A systematic review was conducted following the PRISMA guidelines. The PubMed database was searched from inception of the database to July 18, 2023. A total of 64 studies were identified fulfilling predefined inclusion criteria, and the risk of bias was assessed using the Joanna Briggs Institute checklists. RESULTS Seventy-one hemostatic agents, techniques, tools, and devices were identified, which were then categorized according to the operative phase for which they are indicated. Nine operative anatomic targets were addressed in the sequence in which they are involved during a cranial procedure. For each anatomic target, the following number of hemostatic techniques/agents were identified: 11 for scalp, 3 for periosteum, 10 for skull bone, 11 for dura mater, 9 for venous sinuses, 5 for arteries, 6 for veins, 12 for brain parenchyma, and 4 for cerebral ventricles. CONCLUSIONS Depending on the phase of the surgery and the anatomic structure involved, the selection of the appropriate hemostatic method is determined by the source of bleeding. Surgeon awareness of all the potential techniques that can be applied to achieve hemostasis is paramount, especially when faced with operative nuances and difficult-to-control bleeding during cranial neurosurgical procedures.
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Affiliation(s)
- Maliya Delawan
- College of Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | - Mayur Sharma
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mustafa Ismail
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | | | | | | | - Abdulaziz Saad Alayyaf
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Riyadh, Saudi Arabia
| | - Mohammed A Alrawi
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Samer S Hoz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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Kim JG, Ham DW, Zheng H, Kwon O, Kim HJ. Evaluating the Efficacy of Water-Soluble Bone Wax (Tableau Wax) in Reducing Blood Loss in Spinal Fusion Surgery: A Randomized, Controlled, Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1545. [PMID: 37763664 PMCID: PMC10535280 DOI: 10.3390/medicina59091545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/08/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Lumbar decompression with fusion surgery is an effective treatment for spinal stenosis, but critical postoperative hematoma is a concern. Bone wax has been widely used to control bone bleeding but it has some drawbacks. This study aimed to evaluate the efficacy of Tableau wax, a bioabsorbable hemostatic material, in patients undergoing spinal fusion surgery through a pilot study design. Materials and Methods: A total of 31 patients were enrolled in this single-surgeon, single-institution study. The participants underwent transforaminal lumbar interbody fusion surgery and were randomly assigned to the control group (Bone wax) or test group (Tableau wax). Demographic data, pre- and post-operative hemoglobin levels, blood loss volume, surgical time, Oswestry Disability Index, and EQ-5D scores were recorded. Results: The study showed no significant difference in preoperative and postoperative hemoglobin levels, Oswestry Disability Index, and EQ-5D scores between the groups. However, the Tableau wax group had a significantly lower reduction in hemoglobin levels (1.3 ± 1.0 g/dL) and blood loss (438.2 mL) compared to the Bone wax group (2.2 ± 0.9 g/dL and 663.1 mL, respectively; p = 0.018 and p = 0.022).
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Affiliation(s)
- Jung Guel Kim
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam 463-707, Republic of Korea; (J.G.K.); (H.Z.); (O.K.)
| | - Dae-Woong Ham
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 102, Heukseok-ro, Seoul 06973, Republic of Korea;
| | - Haolin Zheng
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam 463-707, Republic of Korea; (J.G.K.); (H.Z.); (O.K.)
| | - Ohsang Kwon
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam 463-707, Republic of Korea; (J.G.K.); (H.Z.); (O.K.)
| | - Ho-Joong Kim
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam 463-707, Republic of Korea; (J.G.K.); (H.Z.); (O.K.)
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11
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Nagi S, Rekik A, Drissi C, Zammel I. Bone wax causing a middle trunk plexopathy following vertebral artery injury: a neuroradiological pitfall. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023. [DOI: 10.1186/s41983-023-00619-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Abstract
Background
Bone wax is a hemostatic agent widely used in surgery. Since it is neither absorbed nor metabolized, its use remains risky and a potential cause of complications. Even though its MRI radiological characteristics are distinguishable, it is generally misinterpreted as postoperative hematoma or trapped air. We report the first case in literature of brachial plexopathy due to the compressive mass effect of bone wax and the main clues that led us to establish this diagnosis prior to its surgical resection.
Case presentation
A 20-year-old male, victim of stabbing presented with an open wound of the right latero-cervical region with a vascular injury of the V2 segment of the right vertebral artery on CT angiography. He was first admitted for bleeding from the neck uncontrollable with external pressure. The patient underwent an emergency surgical vertebral artery ligation. Forty-eight hours later, he reported a feeling of paresthesia of right arm with right-sided weakness. Neurologic examination revealed a motor deficit of the right triceps and wrist extensor muscles and absence of the triceps reflex. A postoperative compression of the C7 cervical root or the middle trunk of brachial plexus was initially suspected. A cervical MRI demonstrated a T1- and T2-weighted images well-defined right mass located laterally to the spinal cord in the epidural space at the level of C6–C7 vertebrae with a signal-intensity void on both sequences. T2*-weighted images showed no signal attenuation. It did not enhance after contrast administration. An epidural hematoma was less probable since acute hematoma is typically hypointense on T2*-weighted images. Computed tomography helped rule out residual postoperative air trapped in the epidural space based on the density study of the mass compared to air. Finally, a residual surgical foreign material used for packing during the procedure was suspected. The massive use of bone wax was ultimately confirmed by the surgeon and surgically removed with complete immediate postoperative recovery.
Conclusions
This case highlights the importance of a nuanced critical approach of neurosurgeons and neuroradiologists when interpreting postoperative neuroimaging scans of the spine. It is crucial to always consider foreign body-related complications and to review the per-operative procedure in details.
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Duan Q, Liu H, Zheng L, Cai D, Huang G, Liu Y, Guo R. Novel resorbable bone wax containing β-TCP and starch microspheres for accelerating bone hemostasis and promoting regeneration. Front Bioeng Biotechnol 2023; 11:1105306. [PMID: 36741749 PMCID: PMC9892855 DOI: 10.3389/fbioe.2023.1105306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
Traditional non-resorbable bone wax has been used in clinical surgery for more than 100 years. However, residual bone wax has been proven to cause numerous complications. In this study, a novel resorbable bone wax was designed to overcome the disadvantages of traditional non-resorbable bone wax. Alkylene oxide copolymers were used as the main component of resorbable bone wax; additionally, β-tricalcium phosphate and starch microspheres were added to enhance bone regeneration and hemostatic ability. This novel resorbable bone wax has a high potential for clinical translation and is expected to be developed as a substitute for traditional bone wax.
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Affiliation(s)
| | - Huiling Liu
- Guangzhou Beogene Biotech Co., Ltd., Guangzhou, China
| | - Lixia Zheng
- Guangzhou Beogene Biotech Co., Ltd., Guangzhou, China
| | - Daozhang Cai
- Department of Joint Surgery and Sports Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Guangxin Huang
- Department of Joint Surgery and Sports Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China,*Correspondence: Guangxin Huang, ; Yu Liu, ; Rui Guo,
| | - Yu Liu
- Guangzhou Beogene Biotech Co., Ltd., Guangzhou, China,*Correspondence: Guangxin Huang, ; Yu Liu, ; Rui Guo,
| | - Rui Guo
- Guangzhou Beogene Biotech Co., Ltd., Guangzhou, China,*Correspondence: Guangxin Huang, ; Yu Liu, ; Rui Guo,
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Butler AJ, Donnally CJ, Goz V, Basques BA, Vaccaro AR, Schroeder GD. Symptomatic Postoperative Epidural Hematoma in the Lumbar Spine. Clin Spine Surg 2022; 35:354-362. [PMID: 34923504 DOI: 10.1097/bsd.0000000000001278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/15/2021] [Indexed: 01/25/2023]
Abstract
A symptomatic postoperative epidural hematoma (SPEH) in the lumbar spine is a complication with variable presentation and the potential to rapidly cause an irrecoverable neurological injury. Significant heterogeneity exists among current case series reporting SPEH in the literature. This review attempts to clarify the known incidence, risk factors, and management pearls. Currently, literature does not support the efficacy of subfascial drains in reducing the incidence of SPEHs and possibly suggests that medication for thromboembolism prophylaxis may increase risk. Acute back pain and progressing lower extremity motor weakness are the most common presenting symptoms of SPEH. Magnetic resonance imaging is the mainstay of diagnostic imaging necessary to confirm the diagnosis, but if not acutely available, an immediate return to the operative theater for exploration without advanced imaging is justified. Treatment of a SPEH consists of emergent hematoma evacuation as a delay in repeat surgery has a deleterious effect on neurological recovery. Outcomes are poorly defined, though a significant portion of patients will have lasting neurological impairments even when appropriately recognized and managed.
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Affiliation(s)
- Alexander J Butler
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL
| | - Chester J Donnally
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Vadim Goz
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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The effect of ethyl acetate mediated silver nanoparticles from Urtica diocia on hemostasis; in-vitro and in-vivo study. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Guo Y, Fu X, Yin W, Jiang Z, Kuang Y, Wu Z, Cao Y, Tan J, Jiang XJ. A practical and economical method for frontal sinus reconstruction after frontal craniotomy: A single-center experience with 140 patients. Front Surg 2022; 9:919276. [PMID: 35937594 PMCID: PMC9346075 DOI: 10.3389/fsurg.2022.919276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/30/2022] [Indexed: 11/22/2022] Open
Abstract
Background Frontal sinus exposure is a common consequence of frontal craniotomy. Cerebrospinal fluid leakage and infection are the major postoperative complications that may occur as a result of the open frontal sinus. The successful filling of the open frontal sinus provides an approach to prevent significant complications caused by frontal sinus exposure. Objective This article describes a new technique to reconstruct the exposed frontal sinus cavity with the combined application of gelatin sponge and a vascularized pericranial flap. Methods A total of 140 patients underwent frontal sinus reconstruction using gelfoam and vascularized pericranial flaps from 2016 to 2021. Gelatin sponge was used to fill the frontal sinus, and a vascularized pericranial flap was used to cover the frontal sinus when the bone flap was retracted. Results Postoperative cerebrospinal fluid leakage and infection did not occur in any patient. Conclusion Our results validated the effectiveness of our technique in the prevention of exposed frontal sinus-related postoperative complications.
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Affiliation(s)
- Youwei Guo
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Xianyong Fu
- Department of Neurosurgery, Hospital of the Chinese People’s Liberation Army, Third Military Medical University, Chongqing, China
| | - Wen Yin
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhipeng Jiang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yirui Kuang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhaoping Wu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yudong Cao
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Jun Tan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Jun Tan Xing-jun Jiang
| | - Xing-jun Jiang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Jun Tan Xing-jun Jiang
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Wladis EJ, Stavropoulos G, Marous CL. Intraoperative hemostatic agents in orbital surgery. Orbit 2022; 41:535-538. [PMID: 35607910 DOI: 10.1080/01676830.2022.2079676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE While preoperative optimization and post-operative management of hemorrhagic complications are increasingly clear, intraoperative control of bleeding during orbital surgery has received less attention. Thanks to advances in other fields, new technologies may be employed during these interventions. This review was designed to discuss these modalities. METHODS A literature search was performed to identify manuscripts that are related to the management of intraoperative bleeding. The bibliographies of these studies were also assessed to identify additional references. Data was abstracted from these studies. RESULTS Multiple hemostatic agents are currently used in orbital surgery, and related surgical fields have carefully assessed these interventions. Direct mechanical, flowable, and pro-thrombotic medications may all play key roles in achieving hemostasis. CONCLUSIONS Orbital surgeons have several potential technologies to facilitate hemostasis, and the armamentarium continues to grow. Future investigations will yield more targeted medications that may be delivered in novel manners to enhance the intraoperative experience.
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Affiliation(s)
- Edward J Wladis
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Lions Eye Institute, Albany Medical College, Slingerlands, New York, USA.,Department of Otolaryngology, Albany Medical College, Albany, New York, USA
| | - George Stavropoulos
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Lions Eye Institute, Albany Medical College, Slingerlands, New York, USA
| | - Charlotte L Marous
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Lions Eye Institute, Albany Medical College, Slingerlands, New York, USA
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Boukebous B, Maillot C, Hachache BE, Rousseau MA. Tiny but risky: the reasons why the Caspar pin distractor causes suffocating cervical hematoma - two cases and a literature review. Neurochirurgie 2022; 68:518-524. [DOI: 10.1016/j.neuchi.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/26/2022] [Accepted: 04/03/2022] [Indexed: 11/17/2022]
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The Honey Bee Apis mellifera: An Insect at the Interface between Human and Ecosystem Health. BIOLOGY 2022; 11:biology11020233. [PMID: 35205099 PMCID: PMC8869587 DOI: 10.3390/biology11020233] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 02/04/2023]
Abstract
Simple Summary Apis mellifera Linnaeus (1758), a honey bee, is a eusocial insect widely known for its role in pollination, an essential ecosystem service for plant biodiversity, and quality of vegetables and fruit products. In addition, honey bees and bee products are valuable bioindicators of pollutants, such as airborne particulate matter, heavy metals, and pesticides. In this review, we explore the provisioning, regulating, and cultural services provided by the honey bee, an insect at the interface between human and ecosystem health. Abstract The concept of ecosystem services is widely understood as the services and benefits thatecosystems provide to humans, and they have been categorised into provisioning, regulating, supporting, and cultural services. This article aims to provide an updated overview of the benefits that the honey bee Apis mellifera provides to humans as well as ecosystems. We revised the role of honey bees as pollinators in natural ecosystems to preserve and restore the local biodiversity of wild plants; in agro-ecosystems, this species is widely used to enhance crop yield and quality, meeting the increasing food demand. Beekeeping activity provides humans not only with high-quality food but also with substances used as raw materials and in pharmaceuticals, and in polluted areas, bees convey valuable information on the environmental presence of pollutants and their impact on human and ecosystem health. Finally, the role of the honey bee in symbolic tradition, mysticism, and the cultural values of the bee habitats are also presented. Overall, we suggest that the symbolic value of the honey bee is the most important role played by this insect species, as it may help revitalise and strengthen the intimate and reciprocal relationship between humans and the natural world, avoiding the inaccuracy of considering the ecosystems as mere providers of services to humans.
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Shi J, Wei W, Wang Z, Ren H, Jia C, Dong L, Li Z, Zhang J, Feng Y, Huang K, Li X, Chen J. Evaluation of Bone Wax Coated Bipolar Coagulation Forceps: Performance and Safety Assessment. Front Surg 2022; 8:816295. [PMID: 35127808 PMCID: PMC8810544 DOI: 10.3389/fsurg.2021.816295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundImproving the performance of bipolar coagulation forceps is crucial for safer and more accurate neurosurgery. In our department, we found that bone wax (BW) melted by thermal effect of bipolar electrocoagulation can achieve more efficient hemostasis and reduce the amount of BW in neurosurgical procedures associated with bleeding from emissary and diploic veins. Nevertheless, relevant studies are still lacking to verify our finding.ObjectiveThe study objectives were to evaluate the performance and safety in electrocoagulation: (1) compare the performance of BW coated bipolar coagulation forceps and the conventional anti-stick forceps in vivo, and (2) assess the safety of electrocoagulation with BW coated bipolar coagulation forceps in rat primary motor cortex.MethodsTissue adhesion was evaluated by comparing the wetting tension and the amount of protein adhered to the forceps tips after electrocoagulation. Thermal damage was assessed by analyzing the thermography and H&E staining of coagulated rat brain tissues. The hemostatic efficiency was reflected by the number of electrocoagulation until complete hemostasis and the condition of damaged common carotid arteries. The safety of BW coated forceps in electrocoagulation was assessed by evaluating the inflammation of coagulated rat primary motor cortex and the motor functions at the 7th day postoperatively.ResultsBone wax coated forceps had a significantly higher contact angle and adhered less coagulum. Thermography was acquired at 3 s, 6 W units in rat primary motor cortex in vivo. The highest temperature recorded during BW coated tips application was significantly lower than the uncoated. In addition, there was a relatively smaller tissue injury area produced by the BW coated forceps. Additionally, BW coated forceps improved the hemostatic efficiency and caused fewer injuries on the damaged arteries (3 s, 10 W units). More importantly, electrocoagulation with BW coated forceps led to no significant motor function impairments and less glial and microglia responses.ConclusionThis study reveals that BW coated bipolar coagulation forceps can provide a convenient, cost-efficient, safer, and more efficient way for hemostasis. More research is needed to evaluate the electrocoagulation with BW in the long term and verify our finding in human beings.
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Affiliation(s)
- Jichun Shi
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Wei
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhen Wang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Haobin Ren
- Cognitive Neuroepigenetics Laboratory, Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Chenguang Jia
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lixin Dong
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhengwei Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jianjian Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yu Feng
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kaixin Huang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiang Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
- Frontier Science Center for Immunology and Metabolism, School of Medicine, Medical Research Institute, Wuhan University, Wuhan, China
- Xiang Li
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
- *Correspondence: Jincao Chen
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Lubnin AY. [Sitting position in neurosurgery: realizing the risks]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:99-108. [PMID: 35758085 DOI: 10.17116/neiro20228603199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The author discusses potential intraoperative complications following neurosurgical interventions in sitting position: venous air embolism and paradoxical air embolism, postural hypotension, pneumocephalus, cervical flexion neuropathy, positional damage to peripheral nerves and others. Naturally, prevention of these complications is also considered, and the most effective approach is surgery in lying position.
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Affiliation(s)
- A Yu Lubnin
- Burdenko Neurosurgical Center, Moscow, Russia
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21
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Oh J, Jo D, Park K, Kang P, Shin Y. Experimental Rat Model of Bony Defects in the Facet Joint Maintained with Bone Wax for the Study of Spinal Pain. J Pain Res 2022; 15:171-180. [PMID: 35125888 PMCID: PMC8807867 DOI: 10.2147/jpr.s344810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/11/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Studies using experimental rat models for low back pain due to facet-joint defects are scarce. This study used a novel experimental rat model to determine whether bony defects induced by facetectomy could be maintained by bone wax, thus mimicking spondylolysis, and to analyze the effect of the facetectomy on rat behavior. Patients and Methods Twelve 10-week-old male Wistar rats weighing 300–350 g were divided into group A (n = 6) that underwent unilateral facetectomy of the right L5-6 facet joint and group B (n = 6) that additionally applied water-soluble bone wax at the facetectomy site. The difference in the left and right stride length, detected by the footprint test, and change in the left and right facet joint area were compared before and 4 weeks after the experiment. Results Even though the difference between the left and right stride lengths of groups A and B was not statistically significant, in contrast to group A, group B showed a shorter stride length on the right side (p = 0.22 and 0.46, in group A and group B, respectively). The right facet joint area, where the facetectomy was performed, was significantly smaller in group B 4 weeks after surgery, but not in group A (p = 0.50 and < 0.01, in group A and group B, respectively). Conclusion Based on the results, we concluded that the bony defects, induced by facetectomy at the L5-6 facet joint, were maintained with bone wax. This study will provide an experimental model for bony defects in the facet joint.
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Affiliation(s)
- Jinyoung Oh
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Daehyun Jo
- Jodaehyun Pain Center, Jeonju, Republic of Korea
| | - Kicheol Park
- Clinical Research Institute, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Posoon Kang
- Department of Anesthesiology and Pain Medicine, Konynang University Hospital, Daejeon, Republic of Korea
| | - Youngsup Shin
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- Correspondence: Youngsup Shin, Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, 282, Munhwa-ro, Junggu, Daejon, 35015, Republic of Korea, Tel +82-42-280-7840, Fax +82-42-280-7968, Email
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Topical hemostatic agents in neurosurgery, a comprehensive review: 15 years update. Neurosurg Rev 2021; 45:1217-1232. [PMID: 34734343 DOI: 10.1007/s10143-021-01684-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/26/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022]
Abstract
Hemostasis in neurosurgery is of utmost importance. Bleeding management is one of the crucial steps of each neurosurgical procedure. Several strategies, namely thermal, mechanical, electric, and chemical, have been advocated to face blood loss within the surgical field. Over time, countless hemostatic agents and devices have been proposed. Furthermore, the ever-growing recent technological innovation has made available several novel and interesting tools. Pursuant to their impact on surgical practice, we perceived the imperative to update our previous disclosure paper. Therefore, we reviewed the literature and analyzed technical data sheets of each product in order to provide an updated and comprehensive overview in regard to chemical properties, mechanisms of action, use, complications, tricks, and pitfalls of topical hemostatic agents.
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The role of hemostatic devices in neurosurgery. A systematic review. J Clin Neurosci 2021; 89:151-157. [PMID: 34119260 DOI: 10.1016/j.jocn.2021.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/15/2021] [Accepted: 05/02/2021] [Indexed: 11/23/2022]
Abstract
Hemostasis represents a fundamental step in every surgical procedure. During neurosurgical procedures, proper and robust hemostasis into confined spaces can significantly reduce the odds of perioperative complications. Over the decades, multiple methods have been applied, and several medical devices have been developed to promote and guarantee proper hemostasis. This study presents a systematic review of the most used intraoperative hemostatic methods and devices in neurosurgery. Insightful research was performed on the PubMed database according to the PRISMA guidelines. This comprehensive review of scientific literature represents a synoptic panel where the most used intraoperative hemostatic methods and devices available today in neurosurgery are classified and described.
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Obata S, Hayama M, Maeda Y, Nakatani A, Inohara H. A slowly progressive lesion of frontal sinus with bone destruction. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:266-268. [PMID: 33845187 DOI: 10.1016/j.jormas.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Sho Obata
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Masaki Hayama
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - Yohei Maeda
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Ayaka Nakatani
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
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Yan F, Lv M, Zhang T, Zhang Q, Chen Y, Liu Z, Wei R, Cai L. Copper-Loaded Biodegradable Bone Wax with Antibacterial and Angiogenic Properties in Early Bone Repair. ACS Biomater Sci Eng 2021; 7:663-671. [PMID: 33502176 DOI: 10.1021/acsbiomaterials.0c01471] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Traditional bone wax has lots of shortcomings such as the risk of infection and inflammation and the ability to hinder osteogenesis that limit its clinical applications. In this study, we designed a novel biodegradable bone wax with desirable angiogenic and antibacterial ability and low foreign body reaction by mixing calcium sulfate, poloxamer, and cupric ions. To evaluate its biocompatibility and angiogenetic effect in vitro, we cultured human umbilical vein endothelial cells (HUVECs) with the indicated bone wax to observe cell viability and vessel-like tubular formation. The bone wax was then implanted in a critical-sized bone defect rat model for 4 and 8 weeks to successfully stimulate angiogenesis in vivo. Finally, the bone wax extract was incubated with Gram-positive Staphylococcus aureus to confirm its antibacterial ability. The copper-loaded biodegradable bone wax overcomes the drawbacks of traditional bone wax and provides a new approach for the treatment of bone injuries.
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Affiliation(s)
- Feifei Yan
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuhan 430071, China
| | - Minchao Lv
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuhan 430071, China
| | - Tie Zhang
- Hubei Osteolink Biomaterial Co., Ltd. (Wuhan Hi-tech Research Center of Medical Tissues), No. 379, Gaoxiner Road, Wuhan 430100, China
| | - Qi Zhang
- Hubei Osteolink Biomaterial Co., Ltd. (Wuhan Hi-tech Research Center of Medical Tissues), No. 379, Gaoxiner Road, Wuhan 430100, China
| | - Yan Chen
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuhan 430071, China
| | - Zhibo Liu
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuhan 430071, China
| | - Renxiong Wei
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuhan 430071, China
| | - Lin Cai
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuhan 430071, China
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Gomes da Silva VT, Figueiredo EG. Commentary: Tentorial Peeling: Surgical Extradural Navigation to Protect the Temporal Lobe in the Focused Combined Transpetrosal Approach. Oper Neurosurg (Hagerstown) 2020; 19:E510-E511. [PMID: 32629462 DOI: 10.1093/ons/opaa195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/05/2020] [Indexed: 11/13/2022] Open
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Shin KH, Choe JH, Jang KM, Han SB. Use of bone wax reduces blood loss and transfusion rates after total knee arthroplasty. Knee 2020; 27:1411-1417. [PMID: 33010755 DOI: 10.1016/j.knee.2020.07.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/18/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unnecessary costs and complications can be reduced by minimizing blood loss and allogeneic blood transfusion in cases of total knee arthroplasty (TKA). This study evaluated the effectiveness of bone wax in reducing blood loss and transfusion rates after TKA. METHODS A total of 674 consecutive TKAs performed for degenerative osteoarthritis were retrospectively reviewed. Propensity score-matching and inverse probability of treatment weighting analyses were performed for demographics, comorbidities, use of medications, preoperative laboratory findings and radiologic prosthetic coverage of osteotomy surface. In the bone wax group, bone wax (2.5 g) was applied to the uncovered bone section around the prostheses along with the topical administration of tranexamic acid, whereas hemostasis was achieved in the control group with the topical administration of tranexamic acid. Intergroup comparisons of estimated blood loss, decreases in hemoglobin (Hb) levels, and transfusion rates were performed. RESULTS The mean estimated blood loss and volume of postoperative drainage were reduced in the bone wax group. The maximum decreases in Hb levels on postoperative days 1, 3, 5, and 7 were 1.8 ± 0.7 ml, 2.5 ± 0.8 ml, 2.7 ± 0.8 ml, and 2.8 ± 0.8 ml in the bone wax group and 2.1 ± 1.0 ml, 3.0 ± 1.2 ml, 3.1 ± 1.1 ml, and 3.2 ± 1.1 ml in the control group, respectively. The postoperative transfusion rates decreased markedly from 8.8% to 2.0% when bone wax was used. CONCLUSIONS The use of bone wax significantly reduced blood loss, decreased Hb levels, and the risk of transfusion. LEVEL OF EVIDENCE Level III, Therapeutic studies.
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Affiliation(s)
- Kyun-Ho Shin
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jeong-Hun Choe
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
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A Technique for Minimizing the Need for Hemotransfusion in Non-Syndromic Craniosynostosis Surgery. J Craniofac Surg 2020; 32:247-251. [PMID: 32868732 DOI: 10.1097/scs.0000000000006949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Surgery for craniosynostosis is associated with excessive blood loss, as well as morbidity and mortality risks. This study investigated the effectiveness of a surgical technique for nonsyndromic craniosynostosis intervention in controlling bleeding, assessed based on the volume of blood transfused. The cohort included 73 children who underwent nonsyndromic craniosynostosis surgery during a 3-year period. Retrospective evaluation of patient parameters included sex, weight, and age at the time of surgery; type of craniosynostosis; duration of surgery; hemoglobin concentration before and after surgery; rate of transfusion; and volume of transfused blood (mL/kg). The surgical technique involved skin incision and subgaleal dissection using electrocautery with a Colorado needle tip. The pericranium was not removed but instead kept in situ, and orbiectomy was performed using piezosurgery. Of the 73 children in the cohort, 75.3% underwent fronto-orbital advancement and were included in the analysis. The average age was 10.9 months (range: 4-96 months), with 68.5% boys and 31.5% girls (P < 0.001). The most common type of craniosynostosis was trigonocephaly (57.5%), followed by scaphocephaly (19.2%). The mean duration of the surgery was 2 hours and 55 minutes. Blood transfusion was needed in 56.2% of patients, with a mean volume of 8.7 mL/kg body weight transfused intraoperatively. No complications or fatalities were observed. These results suggested that meticulous, continuous control of homeostasis is paramount in minimizing blood loss during surgical repair of nonsyndromic craniosynostosis.
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Pennington Z, Ehresman J, Westbroek EM, Lubelski D, Cottrill E, Sciubba DM. Interventions to minimize blood loss and transfusion risk in spine surgery: A narrative review. Clin Neurol Neurosurg 2020; 196:106004. [DOI: 10.1016/j.clineuro.2020.106004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 12/26/2022]
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Zhou H, Ge J, Bai Y, Liang C, Yang L. Translation of bone wax and its substitutes: History, clinical status and future directions. J Orthop Translat 2019; 17:64-72. [PMID: 31194062 PMCID: PMC6551357 DOI: 10.1016/j.jot.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 12/25/2022] Open
Abstract
Bone wax, primarily composed of beeswax and softening agent, is a century-old material used to control bleeding of disrupted bone surfaces by acting as a mechanical barrier to seal the wound. The current bone wax products are commonly packed in easy-to-open foil in the form of sterile sticks or plates, with excellent malleability and smooth consistency, enabling cost-effective and easy handling approach for bleeding control. It has also been reported that the inert nature of bone wax causes complications including foreign body reaction, infection promotion and bone healing inhibition. With the advances in biomaterials and the market boost of bone haemostatic materials, the arena of bone wax substitute research has expanded to a wide spectrum of material formulations and forms. However, the development of substitutes of bone wax for translation is a pivotal yet challenging topic because currently a potential candidate is recommended to be just as simple to use, effective and inexpensive to produce as traditional bone wax but also be absorbable and osteogenic. This review provides an overview of bone wax including its history, clinical applications and associated complication. In addition, emerging substitutes of bone wax and outlooks of future directions including the standardised evaluation methods are also discussed as an effort to catalyse the innovation and translation of bone haemostatic agents in the near future. The translational potential of this article: Occurrence of osseous haemorrhage is common in surgically incised or traumatically fractured bone. It is essential to stop bone bleeding to avoid further pathologic consequences such as tissue necrosis and eventually mortalities due to blood loss. Medical sterile bone wax is a classical material for haemostasis of bone during orthopaedic surgeries, thoracic surgeries, neurological surgeries and so on. Along with its widespread use, complications such as foreign body reaction, bone healing inhibition and infection promotion associated with bone wax are observed. With the growing knowledge in biomaterials and the boost of market of bone haemostatic materials, bone wax substitute research is thriving. An overview of bone and its substitutes together with evolution of their design criteria is carried out in this work, providing information for the innovation and translation of bone haemostatic agents in the near future.
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Affiliation(s)
- Huan Zhou
- Center for Health Science and Engineering, Tianjin Key Laboratory of Materials Laminating Fabrication and Interface Control Technology, School of Materials Science and Engineering, Hebei University of Technology, Tianjin 300130, China
- School of Mechanical Engineering, Jiangsu University of Technology, Jiangsu 213001, China
- International Research Center for Translational Orthopaedics (IRCTO), Jiangsu 215006, China
| | - Jun Ge
- Orthopedic Institute, Department of Orthopedics, The First Affiliated Hospital of Soochow University, Jiangsu 215006, China
| | - Yanjie Bai
- Key Laboratory of Hebei Province for Molecular Biophysics, Institute of Biophysics, School of Sciences, Hebei University of Technology, Tianjin 300401, China
| | - Chunyong Liang
- Center for Health Science and Engineering, Tianjin Key Laboratory of Materials Laminating Fabrication and Interface Control Technology, School of Materials Science and Engineering, Hebei University of Technology, Tianjin 300130, China
| | - Lei Yang
- Center for Health Science and Engineering, Tianjin Key Laboratory of Materials Laminating Fabrication and Interface Control Technology, School of Materials Science and Engineering, Hebei University of Technology, Tianjin 300130, China
- Orthopedic Institute, Department of Orthopedics, The First Affiliated Hospital of Soochow University, Jiangsu 215006, China
- International Research Center for Translational Orthopaedics (IRCTO), Jiangsu 215006, China
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Naser AI. The effect of the new hemostatic agent Ostene® on bone healing: An experimental study in rabbits. JOURNAL OF ORAL RESEARCH 2018. [DOI: 10.17126/joralres.2018.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: Ostene® is a water-soluble wax-like alkylene oxide copolymer preparation for use as a mechanical hemostatic agent. This study aims to evaluate the effects of Ostene® on bone healing. Materials and Methods: Twenty albino rabbits were divided into four groups according to post-treatment follow-up (24 hr, 3 days, 7 days, 14 days) with five rabbits in each group. Each rabbit in all groups was treated with two study materials (Ostene® and Gelfoam®). Three holes were made in the mandibular bone of each rabbit using 5mm surgical bur; two holes were made on right side: one for testing Ostene® and another for Gelfoam®. A third hole, on the left side of mandible, was not treated, and was used as a control. Finally, the incision was closed. The specimens were collected at different days post-treatment and examined by histopathology. Result and Discussion: This study showed that there is a significant difference (p-value≤ 0.05) between the Ostene® group and the other groups (Gelfoam® and control). At 24 hr post intervention, there is a significant difference in osteoblast cell formation (p-value=0.03), and osteoclast cell formation (p-value=0.05). New blood vessel formation, osteoblast and osteoclast cell formation for Ostene® group at 3 days post-intervention were also significantly different (p-values = 0.05, 0.03, 0.04, respectively). At 7 days post-intervention p-values were 0.05 for osteoblast formation and 0.04 for osteoclast formation, respectively. After 14 days of healing p-value for osteoblast cell formation in the Ostene® group was 0.05 and 0.04 for osteoclast cell formation. Conclusions: The bone hemostatic agent Ostene® is an effective at enhancing osteogenesis by initiating proliferation of osteoblast and osteoclast cells.
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Cao W, Peng Y, Zhang Y, Qiu F, Li M, Tang J, Wu Z. Novel bone wax based on tricalcium silicate cement and BGs mixtures. Biomed Mater 2018; 13:065001. [DOI: 10.1088/1748-605x/aad73c] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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