Limb-Shaking Transient Ischemic Attacks in Patients with Carotid Occlusion or Stenosis: A Systematic Review and Individual Patient Data Meta-Analysis.

BACKGROUND: Limb-shaking transient ischemic attack (LSTIA) is a rare neurological condition which presents with involuntary jerky movements of the arm or leg, often because of carotid stenosis or occlusion. Due to the rarity of the condition, the epidemiology of LSTIA is poorly understood and the disease is frequently misdiagnosed. There is no standard treatment to date. The purpose of this study was to provide an overview of the epidemiology of LSTIA and its current treatment options. METHODS: Embase, MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials for randomized controlled trials, and Google Scholar were searched from database inception to December 30, 2023 for articles containing information on the epidemiology and treatment of LSTIA. An individual patient data meta-analysis (IPD-MA) was performed using data extracted from the included articles. Inclusion criteria were description of both the epidemiology and treatment of LSTIA in patients over the age of 18 with carotid stenosis/occlusion, confirmed by radiographic imaging. Exclusion criteria were studies focusing on pediatrics, no epidemiological data, internal carotid artery (ICA) stenosis/occlusion not radiologically confirmed, full text unavailable, full text not in English or Dutch, and non-original articles. RESULTS: Of the 8,855 articles screened, 55 articles containing 251 patients were included. Fifty articles harboring 81 patients were included in the IPD-MA, and 7 articles harboring 187 patients were included in the cohort analysis. The results of the IPD-MA showed that LSTIA was caused by unilateral ICA stenosis/occlusion in 29 patients (36%) and most often from bilateral ICA stenosis/occlusion in 52 patients (64%). Limb-shaking was unilateral in 66 patients (83%) and was accompanied by weakness in 27 patients (33%). The intervention with the highest success rate was endovascular intervention (carotid stenting or balloon angioplasty), as all 10 patients remained asymptomatic after treatment. The cohort analysis showed that LSTIA can be caused by both unilateral and bilateral carotid stenosis or occlusion. The prevalence within cohorts of TIA patients of LSTIA varied considerably from 3.5 to 29%. CONCLUSION: A large international clinical registry is warranted to gain a better understanding of the epidemiology of LSTIA. There is insufficient evidence available to suggest a standard treatment.

Outcomes Associated With Intracranial Aneurysm Treatments Reported as Safe, Effective, or Durable: A Systematic Review and Meta-Analysis.

Importance: Testing new medical devices or procedures in terms of safety, effectiveness, and durability should follow the strictest methodological rigor before implementation. Objectives: To review and analyze studies investigating devices and procedures used in intracranial aneurysm (IA) treatment for methods and completeness of reporting and to compare the results of studies with positive, uncertain, and negative conclusions. Data Sources: Embase, MEDLINE, Web of Science, and The Cochrane Central Register of Clinical Trials were searched for studies on IA treatment published between January 1, 1995, and the October 1, 2022. Grey literature was retrieved from Google Scholar. Study Selection: All studies making any kind of claims of safety, effectiveness, or durability in the field of IA treatment were included. Data Extraction and Synthesis: Using a predefined data dictionary and analysis plan, variables ranging from patient and aneurysm characteristics to the results of treatment were extracted, as were details pertaining to study methods and completeness of reporting. Extraction was performed by 10 independent reviewers. A blinded academic neuro-linguist without involvement in IA research evaluated the conclusion of each study as either positive, uncertain, or negative. The study followed Preferring Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Main Outcomes and Measures: The incidence of domain-specific outcomes between studies with positive, uncertain, or negative conclusions regarding safety, effectiveness, or durability were compared. The number of studies that provided a definition of safety, effectiveness, or durability and the incidence of incomplete reporting of domain-specific outcomes were evaluated. Results: Overall, 12 954 studies were screened, and 1356 studies were included, comprising a total of 410 993 treated patients. There was no difference in the proportion of patients with poor outcome or in-hospital mortality between studies claiming a technique was safe, uncertain, or not safe. Similarly, there was no difference in the proportion of IAs completely occluded at last follow-up between studies claiming a technique was effective, uncertain, or noneffective. Less than 2% of studies provided any definition of safety, effectiveness, or durability, and only 1 of the 1356 studies provided a threshold under which the technique would be considered unsafe. Incomplete reporting was found in 546 reports (40%). Conclusions and Relevance: In this systematic review and meta-analysis of IA treatment literature, studies claiming safety, effectiveness, or durability of IA treatment had methodological flaws and incomplete reporting of relevant outcomes supporting these claims.

Detection of Helicobacter pylori seropositivity in hyperemesis gravidarum and correlation with symptoms.

The aim of this study was to investigate whether there was a relationship between H. pylori (Helicobacter pylori) infection positivity and characteristics (time and duration) of hyperemesis gravidarum (HG) symptoms. Forty-seven pregnant women with HG and 39 pregnant controls at the same gestational weeks without any gastrointestinal symptoms were included in this prospective study. H. pylori serum Immunoglobulin (Ig) G concentrations were determined by enzyme-linked immunoadsorbent assay (ELISA) in patients with HG and controls. Positive serology for H. pylori was correlated with the duration of symptoms in patients with HG. The prevalence of H. pylori infection was 85.1% (40 of 47) and 64.1% (25 of 39) in patients with HG and controls, respectively (p <0.05, chi (2) test). Mean values of H. pylori IgG (+/- standard deviation) were significantly higher in patients with HG than in controls (22.66 aIU/mL +/- 22.34 vs. 11.54 aIU/mL +/- 13.89, p <0.01, Student's t-test). In HG group, time (gestational weeks) and the duration (weeks) of HG symptoms for patients serologically positive and negative for H. pylori were 6.95 +/- 1.55 versus 6.58 +/- 1.78 weeks, (p >0.05, Student's t-test) and 8.35 +/- 5.28 versus 11.40 +/- 7.17 weeks (p >0.05, Mann-Whitney U-test), respectively. There was no correlation between duration of HG symptoms and serum H. pylori IgG concentrations. Although a majority of pregnant women with HG were serologically positive for H. pylori infection, there was no correlation between positive serology and duration of symptoms, which is not suggestive of a direct causal relationship between H. pylori infection and HG.

Immunohistochemical localization of endothelin-1 in human placenta from normal and growth-restricted pregnancies.

The purpose of this study was to investigate whether the localization of endothelin-1 (ET-1) immunoreactivity differs in human placental tissues from third-trimester normal and intrauterine growth restricted (IUGR) pregnancies. Immunohistochemistry for ET-1 was performed on human placentas from 30 IUGR and 30 uncomplicated pregnancies matched for gestational age. The distribution and intensity of ET-1 immunoreactivity was assessed by a semiquantitative scoring system. Doppler flow velocity waveform analysis of the umbilical artery was performed in each patient before delivery. ET-1 was localized diffusely in placental specimens from normal and IUGR pregnancies. The localization of ET-1 immunoreactivity was significantly higher in the capillary endothelial cells of villi as well as in the endothelial, decidual, and trophoblastic cells of the basal plate in placentas from normal pregnancies than from IUGR pregnancies. There was no significant difference in placental ET-1 immunoreactivity between IUGR pregnancies with normal and abnormal umbilical artery Doppler flow velocity waveforms. Placental ET-1 immunoreactivity was significantly higher in the decidual and trophoblastic cells of the basal plate and the capillary endothelial cells of villi in normal pregnancies than in IUGR pregnancies with normal umbilical artery Doppler flow velocity waveforms. However, only the decidual and trophoblastic cells of the basal plate demonstrated significantly higher abundant localization of ET-1 immunoreactivity in normal pregnancies than in IUGR pregnancies with abnormal umbilical artery Doppler flow velocity waveforms. In conclusion, our findings suggest that the lower expression of ET-1 in placental tissues from IUGR pregnancies might be secondary to an adaptive mechanism to reduce the vasoconstrictor effect of ET-1.

Maternal and fetal plasma endothelin levels in intrauterine growth restriction: relation to umbilical artery Doppler flow velocimetry.

The objective of this study was to examine maternal and fetal endothelin-1 (ET-1) in pregnancies complicated with intrauterine growth restriction (IUGR) and to correlate these data with umbilical artery Doppler flow velocity waveforms (FVW). Higher mean maternal (13.8 +/- 6.4 vs 9.2 +/- 3.4 pmol/L, p < 0.05) and fetal (18.5 +/- 9.6 vs 11.7 +/- 6.9 pmol/L, p < 0.05) ET-1 levels were found in pregnancies complicated with IUGR than in controls. Fetal ET-1 level was related to birth weight percentile for gestational week. Maternal and fetal ET-1 concentrations were not related to umbilical artery Doppler flow S/D ratio, PI and RI. Maternal or fetal ET-1 concentrations were also not related to umbilical artery pH, PO2 and PCO2. Pregnancy-induced hypertension was significantly associated with an elevated fetal and maternal ET-1 concentration. In conclusion, increased production and secretion of ET-1 may play a role in the pathophysiology of idiopathic IUGR. Over-production of ET-1 in IUGR is not associated with increased placental resistance as reflected in abnormal umbilical artery Doppler FVW.