BACKGROUND Perinatal complications may result in life-long morbidities,among which cerebral palsy(CP)is the most severe motor disability.Once developed,CP is a nonprogressive disease with a prevalence of 1-2 per 1000 ...BACKGROUND Perinatal complications may result in life-long morbidities,among which cerebral palsy(CP)is the most severe motor disability.Once developed,CP is a nonprogressive disease with a prevalence of 1-2 per 1000 live births in developed countries.It demands an extensive and multidisciplinary care.Therefore,it is a challenge for our health system and a burden for patients and their families.Recently,stem cell therapy emerged as a promising treatment option and raised hope in patients and their families.AIM The aim is to evaluate the efficacy and safety of stem cell treatment in children with CP using a systematic review and meta-analysis METHODS We performed a systematic literature search on PubMed and EMBASE to find randomized controlled clinical trials(RCT)investigating the effect of stem cell transplantation in children with CP.After the review,we performed a randomeffects meta-analysis focusing on the change in gross motor function,which was quantified using the gross motor function measure.We calculated the pooled standardized mean differences of the 6-and/or 12-mo-outcome by the method of Cohen.We quantified the heterogeneity using the I-squared measure.RESULTS We identified a total of 8 RCT for a qualitative review.From the initially selected trials,5 met the criteria and were included in the meta-analysis.Patients’population ranged from 0.5 up to 35 years(n=282).We detected a significant improvement in the gross motor function with a pooled standard mean difference of 0.95(95%confidence interval:0.13-1.76)favoring the stem cell group and a high heterogeneity(I2=90.1%).Serious adverse events were rare and equally distributed among both intervention and control groups.CONCLUSION Stem cell therapy for CP compared with symptomatic standard care only,shows a significant positive effect on the gross motor function,although the magnitude of the improvement is limited.Short-term safety is present and further highquality RCTs are needed.展开更多
Background We investigated outcomes in patients with intracerebral haemorrhage(ICH)according to prior anticoagulation treatment with Vitamin K antagonists(VKAs),direct oral anticoagulants(DOACs)or no anticoagulation.M...Background We investigated outcomes in patients with intracerebral haemorrhage(ICH)according to prior anticoagulation treatment with Vitamin K antagonists(VKAs),direct oral anticoagulants(DOACs)or no anticoagulation.Methods This is an individual patient data study combining two prospective national stroke registries from Switzerland and Norway(2013–2019).We included all consecutive patients with ICH from both registries.The main outcomes were favourable functional outcome(modified Rankin Scale 0–2)and mortality at 3 months.Results Among 11349 patients with ICH(mean age 73.6 years;47.6%women),1491(13.1%)were taking VKAs and 1205(10.6%)DOACs(95.2%factor Xa inhibitors).The median percentage of patients on prior anticoagulation was 23.7(IQR 22.6–25.1)with VKAs decreasing(from 18.3%to 7.6%)and DOACs increasing(from 3.0%to 18.0%)over time.Prior VKA therapy(n=209(22.3%);adjusted ORs(aOR),0.64;95%CI,0.49 to 0.84)and prior DOAC therapy(n=184(25.7%);aOR,0.64;95%CI,0.47 to 0.87)were independently associated with lower odds of favourable outcome compared with patients without anticoagulation(n=2037(38.8%)).Prior VKA therapy(n=720(49.4%);aOR,1.71;95%CI,1.41 to 2.08)and prior DOAC therapy(n=460(39.7%);aOR,1.28;95%CI,1.02 to 1.60)were independently associated with higher odds of mortality compared with patients without anticoagulation(n=2512(30.2%)).Conclusions The spectrum of anticoagulation-associated ICH changed over time.Compared with patients without prior anticoagulation,prior VKA treatment and prior DOAC treatment were independently associated with lower odds of favourable outcome and higher odds of mortality at 3.展开更多
文摘BACKGROUND Perinatal complications may result in life-long morbidities,among which cerebral palsy(CP)is the most severe motor disability.Once developed,CP is a nonprogressive disease with a prevalence of 1-2 per 1000 live births in developed countries.It demands an extensive and multidisciplinary care.Therefore,it is a challenge for our health system and a burden for patients and their families.Recently,stem cell therapy emerged as a promising treatment option and raised hope in patients and their families.AIM The aim is to evaluate the efficacy and safety of stem cell treatment in children with CP using a systematic review and meta-analysis METHODS We performed a systematic literature search on PubMed and EMBASE to find randomized controlled clinical trials(RCT)investigating the effect of stem cell transplantation in children with CP.After the review,we performed a randomeffects meta-analysis focusing on the change in gross motor function,which was quantified using the gross motor function measure.We calculated the pooled standardized mean differences of the 6-and/or 12-mo-outcome by the method of Cohen.We quantified the heterogeneity using the I-squared measure.RESULTS We identified a total of 8 RCT for a qualitative review.From the initially selected trials,5 met the criteria and were included in the meta-analysis.Patients’population ranged from 0.5 up to 35 years(n=282).We detected a significant improvement in the gross motor function with a pooled standard mean difference of 0.95(95%confidence interval:0.13-1.76)favoring the stem cell group and a high heterogeneity(I2=90.1%).Serious adverse events were rare and equally distributed among both intervention and control groups.CONCLUSION Stem cell therapy for CP compared with symptomatic standard care only,shows a significant positive effect on the gross motor function,although the magnitude of the improvement is limited.Short-term safety is present and further highquality RCTs are needed.
文摘Background We investigated outcomes in patients with intracerebral haemorrhage(ICH)according to prior anticoagulation treatment with Vitamin K antagonists(VKAs),direct oral anticoagulants(DOACs)or no anticoagulation.Methods This is an individual patient data study combining two prospective national stroke registries from Switzerland and Norway(2013–2019).We included all consecutive patients with ICH from both registries.The main outcomes were favourable functional outcome(modified Rankin Scale 0–2)and mortality at 3 months.Results Among 11349 patients with ICH(mean age 73.6 years;47.6%women),1491(13.1%)were taking VKAs and 1205(10.6%)DOACs(95.2%factor Xa inhibitors).The median percentage of patients on prior anticoagulation was 23.7(IQR 22.6–25.1)with VKAs decreasing(from 18.3%to 7.6%)and DOACs increasing(from 3.0%to 18.0%)over time.Prior VKA therapy(n=209(22.3%);adjusted ORs(aOR),0.64;95%CI,0.49 to 0.84)and prior DOAC therapy(n=184(25.7%);aOR,0.64;95%CI,0.47 to 0.87)were independently associated with lower odds of favourable outcome compared with patients without anticoagulation(n=2037(38.8%)).Prior VKA therapy(n=720(49.4%);aOR,1.71;95%CI,1.41 to 2.08)and prior DOAC therapy(n=460(39.7%);aOR,1.28;95%CI,1.02 to 1.60)were independently associated with higher odds of mortality compared with patients without anticoagulation(n=2512(30.2%)).Conclusions The spectrum of anticoagulation-associated ICH changed over time.Compared with patients without prior anticoagulation,prior VKA treatment and prior DOAC treatment were independently associated with lower odds of favourable outcome and higher odds of mortality at 3.
