22. European Stroke Conference 903 Meta-analysis and reviews Efficacy of acute stroke units: updated meta-analysis R.O. Saka1, Y. Sun2, J. Maervoet3, D. Michiels4, V. Thijs5, D. Hemelsoet6, M. Eyssen7, D Paulus8 Deloitte, Diegem, BELGIUM1, Deloitte, Diegem, BELGIUM2, Deloitte, Diegem, BELGIUM3, University Hospital Leuven, Leuven, BELGIUM4, University Hospital Leuven, Leuven, BEL-GIUM5, University Hospital Ghent, Ghent, BELGIUM6, Belgian Health Care Knowledge Centre, Brussels, BELGIUM7, Belgian Health Care Knowledge Centre, Brussels, BELGIUM8 Background A Cochrane review (2009) has concluded that the provision of care in stroke units (SU) improves stroke outcomes significantly. This study aimed to update the Cochrane review on acute SU care. We performed a meta-analysis on the benefit of acute SUs against alternatives. Methods Clinical trials published before 2006 were identified via the Cochrane review. Trials after 2006 were identified through a thorough electronic database search. For meta-analysis dichotomous outcomes were estimated by odds ratio (OR) and continuous outcomes were estimated by standardized mean difference. Weight of a study was calculated based on inverse variance. Results After two screenings 20 trials were included in the study: 12 compared SUs with alternative, 5 com-pared SUs with a specific protocol versus conventional SU care, 3 compared SUs followed by spe-cific interventions versus SUs followed by conventional follow-up. Acute SU care significantly im-proved patient outcomes in terms of institutional care (OR=0.61, 95% confidence interval (CI) 0.47 to 0.79, P=0.0002); death or institutional care (OR=0.70, 95% CI 0.60 to 0.83, P<0.0001), death or dependency (OR=0.81, 95% CI 0.69 to 0.96, P=0.01; (4) length of hospital stay, standardized mean difference=-0.27 day, 95% CI -0.36 to -0.19, P<0.0001). The effect of SUs on mortality was around bottom-line statistical significance (OR=0.84, 95% CI 0.71 to 1.00, P=0.05). The benefit of SUs on mortality can be easily altered by changing the inclusion criteria (e.g. randomized controlled trials only, use of unpublished data). Effect of SUs on dependency was not significant (OR=0.92, 95% CI 0.74 to 1.13, P= 0.42). Conclusion This update confirmed the findings of the previous Cochrane review in general. Yet it showed that the benefit of SUs was more significant on composite outcomes (e.g. death or dependency, death or institutional care) than on individual outcomes (e.g. death, dependency). 824 © 2013 S. Karger AG, Basel Scientific Programme 904 Meta-analysis and reviews Scaffolds for intracerebral grafting of neural progenitor cells after experimental focal cerebral infarction: a systematic review M.B. Jensen1, L.D. Jager2, L.K. Cohen3 University of Wisconsin, Madison, USA1, University of Wisconsin, Madison, USA2, University of Wisconsin, Madison, USA3 Background: Intracerebral grafting of neural progenitor cells is a promising potential treatment to improve recovery after stroke, but the structural disruption and cavitation of brain tissue that occurs creates an unfavorable environment for graft cell survival. To overcome this obstacle, scaffold ma-terials have been used as substitute extracellular matrix to provide structural support for the trans-planted cells. Many materials could potentially be used as scaffolds for this application, but the ex-tent of current comparative data is unclear. Methods: We performed a systematic review to determine the available evidence supporting specific scaffolds for intracerebral neural progenitor cell grafting after experimental focal cerebral infarction. Results: Of 560 search results, five studies matched our selection criteria. The reports described the use of scaffolds tested in rats and mice after focal cerebral infarction, with co-delivered cell grafts at the time of scaffold placement. Tested scaffold materials were composed of polyglycolic acid, poly- lactic-co-glycolic acid particles, hyaluronan-heparin-collagen hydrogel, Matrigel, and extracellular matrix derived from porcine brain and urinary bladder. Beneficial effects were seen with the scaf-folds, including filling of the lesion cavity with embedded surviving graft cells, decreased inflamma-tion and microglial infiltration, decreased astrocytosis and glial scarring, increased angiogenesis, and biodegradation of the scaffold material as it was replaced by host tissue elements. Conclusions: While multiple beneficial effects were reported, the optimal scaffold for this applica-tion is unclear as we found no direct comparisons. We conclude that multiple scaffolds appear prom-ising for neural progenitor cell grafting after stroke, but further research is needed to optimize this neurorestorative approach.
Karger_ESC London_2013
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