Amirmohammad Toloui

Systematic review and meta-analysis of preclinical studies. To evaluate the efficacy of biomaterial scaffold... Asian Spine Journal 2026;():-.

An Umbrella Review and Meta-analysis. This umbrella review and meta-analysis aims to evaluate the efficacy of stem cell therapy for locomotion recovery and neuropathic pain alleviation in rodent models of spinal cord injury (SCI). A comprehensive literature search was conducted in Medline, Embase, Scopus, and Web of Science until May 2024 to identify systematic reviews/meta-analyses on stem cell therapy for SCI. Original studies from these reviews were screened based on the predefined inclusion criteria. Data on locomotion, thermal hyperalgesia, and mechanical allodynia were extracted. Standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated and pooled to determine overall effect sizes. Subgroup analyses and meta-regressions were performed to investigate the optimal conditions for efficacy in each stem cell type. 31 systematic reviews/meta-analyses with 323 original studies (516 experiments, 11,290 rodents) were included. Significant locomotion recovery was observed across stem cell types, with umbilical cord-derived mesenchymal stem cells (U-MSCs) (SMD = 2.34, 95% CI 1.76-2.93) and oligodendrocyte progenitor cells (OPCs) (SMD = 2.14, 95% CI 1.24-3.03) demonstrating superior efficacy. Only bone marrow-derived mesenchymal stem cells (BM-MSCs) alleviated mechanical allodynia (SMD = 1.33, 95% CI 0.61-2.05). Subgroup analysis showed that the efficacy of stem cell therapy is dependent on injury models, injury to treatment interval, stem cell dosage, and use of antibiotics/immunosuppressants. The certainty of evidence assessment showed high certainty for U-MSC in locomotion recovery, medium for BM-MSC in pain alleviation, and low for OPCs in locomotion recovery. With moderate-to-high certainty, our study demonstrated superior efficacy of mesenchymal stem cells, particularly U-MSCs, when administered immediately post-injury at lower doses without antibiotics for locomotion recovery and BM-MSCs for pain alleviation. These findings suggest further clinical investigation of these stem cell types under optimal conditions.

Background: Sacroiliac joint dysfunction contributes to a significant proportion of lower back and leg pain and associated functional deficiencies. Following failure of conservative methods, lateral fusion approaches have previously provided the mainstay for surgical stabilization of the joint. In recent years there are multiple devices available for sacroiliac fusion via posterior or posterolateral oblique approaches, thereby reducing neurovascular complications of the lateral approach.Objectives: To provide a comprehensive review of the evidence for pain and functional outcomes in patients treated with posterior or posterolateral oblique sacroiliac joint fusion devices.Methods: The primary outcome was improvement in pain following posterior or posterolateral oblique sacroiliac joint fusion in publications between 2020 and 2024, with the authors' previous review conducted up to 2020. Three authors assessed studies identified from multiple databases (PubMed, SCOPUS, Embase, MEDLINE, Cochrane, and Google Scholar).Results: Out of 740 initial publications, 12 studies fulfilled inclusion criteria. These peer‐reviewed articles included two prospective and 10 retrospective observational studies, with two studies providing direct comparisons to lateral fusion approaches. Overall average improvement of VAS/NRS pain scores at final follow‐up for intra‐articular fusion via posterior approach and posterolateral oblique fusion ranged 35%–75% and 28%–89%, respectively. Cohort outcomes were nearly all statistically significant. Complications were minimal and typically resolved with revision fusion. The heterogeneity of studies prohibited proper meta‐analysis.Conclusion: There is increasing evidence for the effectiveness and safety of posterior and posterolateral oblique sacroiliac joint fusion. Future randomized, controlled trials are needed to guide specific device and approach selection, and elucidation of patient long‐term outcomes.

Introduction: Exosomes function as cell signaling carriers and have drawn much attention to the cell-free treatments of regenerative medicine. This meta-analysis aimed to investigate the efficacy of mesenchymal stem cell-derived (MSCderived) exosomes in animal models of spinal cord injuries (SCI). Methods: A comprehensive search was conducted in Medline, Embase, Scopus, and Web of Science to attain related articles published by January 31, 2023. The eligible keywords were correlated with the spinal cord injury and MSC-derived exosomes. The evaluated outcomes were locomotion, cavity size, cell apoptosis, inflammation, neuro-regeneration, and microglia activation. A standardized mean difference was calculated for each sample and a pooled effect size was reported. Results: 65 papers fully met the inclusion criteria. Treatment with MSC-derived exosomes ultimately improved locomotion and shrunk cavity size (p<0.0001). The administration of MSC-derived exosomes enhanced the expression of beta-tubulin III, NF200, and GAP-43, and increased the number of NeuN-positive and Nissl-positive cells, while reducing the expression of glial fibrillary acidic protein (p<0.0001). The number of apoptotic cells in the treatment group decreased significantly (p<0.0001). Regarding the markers of microglia activation, MSC-derived exosomes increased the number of CD206- and CD68-positive cells (p=0.032 and p<0.0001, respectively). Additionally, MSC-derived exosome administration significantly increased the expression of the anti-inflammatory interleukin (IL)-10 and IL-4 (p<0.001 and p=0.001, respectively) and decreased the expression of the inflammatory IL-1b, IL-6, and TNF-a (p<0.0001). Conclusions: MSC-derived exosome treatment resulted in a significantly improved locomotion of SCI animals through ameliorating neuroinflammation, reducing apoptosis, and inducing neuronal regrowth by facilitating a desirable microenvironment.

Introduction: The present systematic review and meta-analysis was designed to investigate platelet-rich plasma (PRP) as an effective treatment for spinal cord injury in animal models. Methods: An extensive literature search was conducted using electronic databases. The included studies were summarized based on the investigated outcomes, including functional recovery and cavity ...

Purpose This systematic review aimed to summarize the literature regarding the prognostic accuracy of the emergency surgery score (ESS). Method PubMed, Embase, Web of Science, and Scopus were comprehensively searched by May 30, 2023. Two independent researchers performed the initial screening by reviewing the titles and abstracts of the non-duplicate records and selecting the full text of articles meeting our inclusion criteria. Finally, original studies that reported the prognostic accuracy of ESS in any emergency surgeries were included. Data from the included studies were extracted into a checklist designed based on the PRISMA guidelines. The area under the curve (AUC) was used to compare the prognostic accuracy of ESS in different settings. Results Twenty-six studies met the inclusion criteria. ESS performed excellently in 30-day post-op mortality (AUC 0.84–0.89) and incidence of cardiac arrest (AUC 0.86–0.88) in emergency general surgeries. The AUC of ESS in overall 30-day morbidities varied from 0.72 to 0.82 in five cohort studies. In predicting the need for ICU admission, the study with the largest sample size reported the best sensitivity of ESS at 80% and the specificity at 85%. Moreover, an outstanding accuracy was observed for the prediction of 30-day sepsis/septic shock in emergency general surgeries (AUC 0.75–0.92). Conclusion Despite the acceptable prognostic accuracy of ESS in 30-day mortality, morbidities, and in-hospital ICU admission in different emergency surgeries, the high number of required variables and the high probability of missing data highlight the need for modifications to this scoring system.

Objective: The objective of this systematic review and meta-analysis was to assess the efficacy of exercise in neuropathic pain following traumatic spinal cord injuries.Methods: The search was conducted in MEDLINE, Embase, Scopus, and Web of Science by the end of 2022. Two independent researchers included the articles based on the inclusion and exclusion criteria. A standardized mean difference was calculated for each data and they were pooled to calculate an overall effect size. To assess the heterogeneity between studies, I2 and chi-square tests were utilized. In the case of heterogeneity, meta-regression was performed to identify the potential source.Results: Fifteen preclinical studies were included. Meta-analysis demonstrated that exercise significantly improves mechanical allodynia (standardized mean difference [SMD], -1.59; 95% confidence interval [CI], -2.16 to -1.02; p < 0.001; I2 = 90.37%), thermal hyperalgesia (SMD, 1.95; 95% CI, 0.96–2.94; p < 0.001), and cold allodynia (SMD, -2.92; 95% CI, -4.4 to -1.43; p < 0.001). The improvement in mechanical allodynia is significantly more in animals with a compression model of SCI (meta-regression coefficient, -1.33; 95% CI, -1.84 to -0.57; p < 0.001) and in mild SCI (p < 0.001). Additionally, the improvement was more prominent if the training was started 7 to 8 days postinjury (coefficient, -2.54; 95% CI, -3.85 to -1.23; p < 0.001) and was continued every day (coefficient, -1.99; 95% CI, -3.07 to -0.9; p < 0.001). Likewise, voluntary exercise demonstrated a significantly more effect size (coefficient, -1.45; 95% CI, -2.67 to -0.23; p = 0.02).Conclusion: Exercise is effective in the amelioration of neuropathic pain. This effect in mechanical allodynia is more prominent if voluntary, continuous training is initiated in the subacute phase of mild SCI.

Purpose In this study, we will compare the diagnostic values of head CT decision rules in predicting the findings of CT scans in a prospective multicenter study in university emergency departments in Iran. Methods The primary outcome was any traumatic lesion findings in brain CT scans, and the secondary outcomes were death, the need for mechanical ventilation, and neurosurgical intervention. Decision rules including the Canadian CT Head Rule (CCHR), New Orleans Criteria (NOC), National Institute for Health and Clinical Excellence (NICE), National Emergency X-Radiography Utilization Study (NEXUS), and Neurotraumatology Committee of the World Federation of Neurosurgical Societies (NCWFNS) were compared for the main outcomes. Results In total, 434 mild TBI patients were enrolled in the study. The NCWFNS had the highest sensitivity (91.14%) and the lowest specificity (39.42%) for predicting abnormal finding in CT scan compared to other models. While the NICE obtained the lowest sensitivity (79.75%), it was associated with the highest specificity (66.67%). All model performances were improved when administered to predict neurosurgical intervention among patients with GCS 13–15. NEXUS (AUC 0.862, 95% CI 0.799–0.924) and NCWFNS (AUC 0.813, 95% CI 0.723–0.903) had the best performance among all evaluated models. Conclusion The NCWFNS and the NEXUS decision rules performed better than the CCHR and NICE guidelines for predicting any lesion in the CT imaging and neurosurgical intervention among patients with mTBI with GCS 13–15. For a subset of mTBI patients with GCS 15, the NOC criteria have higher sensitivity for abnormal CT imaging, but lower specificity and more requested CTs.