Factors associated with the laterality of Cardio-Embolic stroke.

OBJECTIVE: Understanding the lateralization factors, including the anatomic and hemodynamic mechanisms, is essential for diagnosing cardio-embolic stroke. This study aims to investigate the elements, for the first time together, that could affect the laterality of stroke. METHODS: We performed a monocentric retrospective case-control study based on prospective registries of acute ischemic stroke patients in the comprehensive stroke center of the RWTH University hospital of Aachen for three years (June 2018-June 2021). We enrolled 222 patients with cardioembolic stroke (136 left stroke and 86 right stroke) admitted for first-ever acute ischemic stroke with unilateral large vessel occlusion of the anterior circulation. The peak systolic velocity (PSV) asymmetry of middle cerebral artery (MCA) was assessed by doppler as well as internal carotid artery (ICA) angle, aortic arch (AA) branching pattern and anatomy were assessed by CT-Angiography. RESULTS: We found that the increasing left ICA angle (p = 0.047), presence of bovine type AA anatomy (p = 0.041) as well as slow PSV of the right MCA with a value of >15% than left (p = 0.005) were the predictors for left stroke lateralization, while the latter was an independent predictor for the left stroke (OR=3.341 [1.415-7.887]). Inter-Rater Reliability ranged from moderate to perfect agreement. CONCLUSION: The predictors for left stroke lateralization include the higher values of left ICA angle, presence of the bovine type AA and the slow right MCA PSV.

Serum plasminogen activator inhibitor-1 levels in patients with major depressive disorder vs. healthy controls: a systematic review and meta-analysis.

INTRODUCTION: Major depressive disorder (MDD) is a severe mental health condition that affects millions of people worldwide. Etiologically, several factors may play a role in its development. Previous studies have reported elevated plasminogen activator inhibitor-1 (PAI-1) levels in patients with depression, suggesting that PAI-1 levels might be linked to the etiology of MDD. METHODS: We systematically searched the following online databases: MEDLINE, Scopus, and Web of Science up to September 10, 2020, to identify studies in which PAI-1 levels were reported in subjects with MDD. Subsequently we used RevMan 5.3 to perform a meta-analysis of data extracted from the included studies using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PICO criteria for the search and analysis. RESULTS: Six studies that reported mean ± standard deviation (SD) were included in the analysis, with a total of 507 MDD patients and 3,453 controls. The overall standardized mean difference (SMD) was 0.27 (95% confidence interval [95% CI] 0.01-0.53). PAI-1 serum levels were 0.27 SDs higher in MDD patients than in controls. The test for overall effect was significant (z = 2.04, p = 0.04). Substantial heterogeneity was detected among the studies, demonstrated by the inconsistency test (I² = 72%) and the chi-square test (χ² = 18.32; p = 0.003). CONCLUSIONS: This systematic review and meta-analysis showed that MDD might be related to elevated PAI-1 levels. We propose larger prospective clinical studies to further investigate this clinical correlation and validate the clinical significance of these observations.

Sonographic reference values of nerve size in children: A systematic review and meta-analysis.

INTRODUCTION/AIMS: Nerve ultrasound is useful in the diagnosis and follow-up of peripheral nerve disorders in children. The aim of this study was to explore and analyze the current literature on nerve cross-sectional area (CSA) in healthy children, with the goal of presenting reference values and discussing their implications. METHODS: We performed a systematic review and meta-analysis of studies that reported ultrasound measurements of the upper or lower limb nerves in healthy children through a search of Web of Science, PubMed, Embase, and Scopus. RESULTS: Sixteen studies with measurements of 10 nerves covering a total of 5149 nerves measured in 823 healthy children (445 boys and 378 girls) were included. Mean nerve CSA increased with age in the median nerve at the middle and lower third of the upper arm, mid-forearm, and distal wrist crease, the ulnar nerve at the middle third of the upper arm and elbow, the radial nerve at the spiral groove, and the tibial nerve at the popliteal fossa. Growth charts for nerve CSA for different age groups were developed. DISCUSSION: This meta-analysis provides robust reference values for nerve CSA at different sites in children, and this can inform clinical practice and assist in identifying nerve enlargement. Moreover, it identifies the strength and quality of the current published data. We recommend future studies divide their samples into smaller age subgroups and standardize the anatomic site of measurement.

Serum plasminogen activator inhibitor-1 levels in patients with major depressive disorder vs. healthy controls: a systematic review and meta-analysis

Abstract Introduction Major depressive disorder (MDD) is a severe mental health condition that affects millions of people worldwide. Etiologically, several factors may play a role in its development. Previous studies have reported elevated plasminogen activator inhibitor-1 (PAI-1) levels in patients with depression, suggesting that PAI-1 levels might be linked to the etiology of MDD. Methods We systematically searched the following online databases: MEDLINE, Scopus, and Web of Science up to September 10, 2020, to identify studies in which PAI-1 levels were reported in subjects with MDD. Subsequently we used RevMan 5.3 to perform a meta-analysis of data extracted from the included studies using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PICO criteria for the search and analysis. Results Six studies that reported mean ± standard deviation (SD) were included in the analysis, with a total of 507 MDD patients and 3,453 controls. The overall standardized mean difference (SMD) was 0.27 (95% confidence interval [95% CI] 0.01-0.53). PAI-1 serum levels were 0.27 SDs higher in MDD patients than in controls. The test for overall effect was significant (z = 2.04, p = 0.04). Substantial heterogeneity was detected among the studies, demonstrated by the inconsistency test (I2 = 72%) and the chi-square test (χ2 = 18.32; p = 0.003). Conclusion This systematic review and meta-analysis showed that MDD might be related to elevated PAI-1 levels. We propose larger prospective clinical studies to further investigate this clinical correlation and validate the clinical significance of these observations.

Sonographic Reference Values of Vagus Nerve: A Systematic Review and Meta-analysis.

PURPOSE: To establish the first comprehensive and standardized set of vagus nerve (VN) sonographic reference values across all the published studies that can be used to standardize and guide clinical practice and research. METHODS: This systematic review includes all possible available data from a total of 27 studies and 21 of them were included in the meta-analysis having a total of 864 participants. RESULTS: The overall mean cross-sectional area ranged from 2.29 to 2.76 mm2 for the right VN and from 1.83 to 2.23 mm2 for the left VN with 95% confidence interval. Sonographic reference values of VN at common carotid artery bifurcation, thyroid gland, and cartilage as well as other anatomic landmarks were provided. CONCLUSIONS: The mean cross-sectional area of the right VN of 2.53 mm2 and the left one of 2.03 mm2 can be considered as sonographic reference values in healthy adults. This review provides these reference values to be considered in the further sonographic evaluation of VNs.

Vagus nerve ultrasonography in Parkinson's disease: A systematic review and meta-analysis.

OBJECTIVES: Vagus nerve (VN) has been suggested as one of the major routes of Parkinson's disease (PD) progression from enteric nervous system to brain. Therefore, the recent studies have investigated the VN structurally, with a focus on the changes in its size in PD patients using high-frequency ultrasonography. This systematic review and meta-analysis aims to evaluate VN size via ultrasound in PD compared to controls. METHODS: Totally, five studies were included with a total of 238 participants (128 PD patients and 111 controls). RESULTS: The estimate mean difference in four studies showed that the VN CSA was smaller in PD patients with 0.29 mm2 (95% CI, -0.52 to -0.06) and 0.23 mm2 (95% CI, -0.42 to -0.05) for right and left VNs respectively. The test for overall effect was significant for both measurements (p = 0.01). CONCLUSIONS: This review reveals that there is a degree of vagus nerve atrophy in PD which could be detected sonographically with high confidence, thus can be used as a marker for vagus neuronal lesion or neuropathy. Further studies are needed to examine its clinical correlation thoroughly.

Motor and visual cortical excitability in migraineurs patients with or without aura: transcranial magnetic stimulation.

BACKGROUND AND PURPOSE OF STUDY: Controversy surrounds measures of visual and motor cortical excitability in migraineurs: some authors report that interictal excitability is increased, others decreased. The aim of this work was to provide further evidence about motor and visual cortical excitability in migraineurs between attacks. PATIENTS AND METHODS: Twenty-eight migraineurs patients, 18 with aura and 10 patients without aura and 20 healthy right-handed, age and sex matched volunteers were included in the study. Each subject underwent transcranial magnetic stimulation and was submitted to the following: determination of resting motor threshold (rMT), silent period (SP), MEP input-output curves, phosphene threshold (PT). RESULTS: Patients had lower rMT, shorter SP, and increased MEP recruitment compared with control group. There was an increased prevalence of phosphene (85%) as well as lower PT (63% of the stimulator output) in migraineurs compared with control group (75%, and 72%, respectively). There was a significant negative correlation between duration of attacks and PT (P = 0.02). No significant differences between patients with aura and without aura in different parameters of cortical excitability. CONCLUSION: Our findings confirm that the motor and visual cortexes are hyperexcitable and this appears partly to be consequent upon a failure of inhibitory circuits.