CE-MRA与3D-TOF MRA诊断椎基底动脉狭窄价值间接比较的Meta分析

目的以数字减影血管造影(digital subtraction angiography,DSA)为金标准,利用Meta分析方法评价并间接比较增强磁共振血管成像(contrast enhanced magnetic resonance angiography,CE-MRA)与三维时间飞跃法磁共振血管成像(three dimensional time of flight magnetic resonance angiography,3D-TOF MRA)诊断椎基底动脉狭窄的价值。方法计算机检索Pub Med、Embase、Web of Science、The Cochrane Library、CNKI、CBM、万方Data中关于CE-MRA、3D-TOF MRA诊断椎基底动脉狭窄的相关文献,检索日期截止至2017年5月。2名研究者按照纳入排除标准独立筛选文献、提取资料,使用QUADAS 2工具对所获文献进行质量评价。使用Stata12.1软件分别合并分析CE-MRA、3D-TOF MRA对椎基底动脉狭窄的敏感度(sensitivity,Sen合并)、特异度(specificity,Spe合并)、阳性似然比(positive likelihood ratio,+LR)、阴性似然比(negative likelihood ratio,-LR)、诊断比值比(diagnostic odds ratio,DOR)并绘制受试者工作特征曲线(summary receiver operating characteristic curve,SROC)计算曲线下面积(area under curve,AUC),利用相对比值间接比较二者诊断价值。结果纳入检索所获1418条记录中的10项研究,共13组数据。Meta分析结果显示,对于狭窄程度50%的椎基底动脉,CE-MRA与3D-TOF MRA的Sen合并、Spe合并、+LR、-LR、DOR、AUC值分别为0.89[95%可信区间(confidence interval,CI)0.75~0.95]、0.98(95%CI 0.91~0.99)、36.1(95%CI 10.3~126.2)、0.12(95%CI 0.05~0.27)、307(95%CI 102~922)、0.97(95%CI 0.96~0.98)与0.94(95%CI0.86~0.98)、0.93(95%CI 0.87~0.97)、14.4(95%CI 7.1~29.1)、0.06(95%CI 0.03~0.15)、226(95%CI 57~902)、0.98(95%CI 0.96~0.99)。CE-MRA与3D-TOF MRA间接比较结果RDOR为1.36(95%CI 0.23~7.94)。结论在诊断椎基底动脉狭窄方面,CE-MRA相较于3D-TOF MRA具有更高的诊断准确性。     

A2DS2评分诊断中国缺血性脑卒中相关性肺炎准确性的Meta分析

目的评价A2DS2评分诊断中国缺血性脑卒中相关性肺炎患者的准确性及临床适应性。方法通过检索Medline、PubMed、Embase、Cochrane、Web of Science、万方、中国知网、维普、中国生物医学数据库自建库至2020年2月发表的文献,筛选应用A2DS2评分预测中国缺血性脑卒中患者发生肺炎的相关文献,采用QUADAS-2风险评估标准对纳入文献进行质量评价,采用Meta分析评价A2DS2评分诊断中国缺血性脑卒中相关性肺炎患者的准确性,采用Deek检验评价文献发表偏倚,采用范根图评价A2DS2评分的临床适用性。结果最终纳入12篇文献,共7719例患者。Meta分析显示A2DS2评分的诊断比值比(DOR)为18(95%CI:12~27),合并灵敏度为0.76(95%CI:0.68~0.82),合并特异度为0.85(95%CI:0.80~0.88),合并阳性似然比为5.02(95%CI:3.91~6.44),合并阴性似然比为0.29(95%CI:0.22~0.38)。A2DS2评分诊断中国缺血性脑卒中相关性肺炎的综合受试者工作特征(SROC)曲线的曲线下面积(AUC)为0.88(95%CI:0.85~0.91)。Deek检验结果显示各纳入文献无明显发表偏倚(P>0.05)。范根图显示A2DS2评分的临床适用性较好。结论A2DS2评分对中国缺血性脑卒中相关性肺炎具有较好的诊断价值,可用于临床初步筛查缺血性脑卒中相关性肺炎患者。     

~(123)I-FP-CIT单光子发射计算机断层成像对路易体痴呆诊断价值的Meta分析

目的系统评价123I-FP-CIT单光子发射计算机断层成像(123I-FP-CIT SPECT,DaTSCAN)在路易体痴呆诊断中的价值。方法通过检索PubMed、EMbase、Cochrane、CBM和CNKI数据库相关文献,根据QUADAS评价量表对文献质量进行评价,采用MetaDisc软件对其诊断的敏感度、特异度等进行合并分析和异质性检验。Stata软件Harbord-Egger检验发表偏倚。结果 5篇文献符合纳入标准,合并分析结果显示DaTSCAN对路易体痴呆诊断敏感度为0.80(95%CI:0.73~0.86),特异度为0.93(95%CI:0.89~0.95),阳性似然比为10.10(95%CI:6.71~15.20),阴性似然比为0.22(95%CI:0.12~0.39)。合并敏感度经Q异质性假设检验存在显著差异,其他各项合并统计值Q检验无明显异质性。SROC曲线下面积(AUC)为0.967 1。Egger线性回归法检验发表偏倚提示纳入Meta分析的文献间无发表偏倚(P=0.089)。结论 DaTSCAN对路易体痴呆诊断具有较高的诊断价值。     

64层螺旋CTA和3D-DSA对颅内动脉瘤诊断价值比较的系统评价和Meta分析

研究背景目前尚无研究显示64层螺旋CT血管造影术(CTA)和三维数字减影血管造影术(3DDSA)诊断颅内动脉瘤的效能是否存在差异,本研究旨在评价64层螺旋CTA对颅内动脉瘤的诊断价值。方法分别以64层、64排、CT、颅内动脉瘤、脑动脉瘤、蛛网膜下腔(隙)出血等词组作为检索词,检索荷兰医学文摘(EMBASE)、美国国家图书馆医学在线(MEDLINE)、Cochrane图书馆、中国知网中国期刊全文数据库(CNKI)和万方数据知识服务平台学术期刊库,并辅助手工检索,收集以3D-DSA为金标准的关于64层螺旋CTA诊断颅内动脉瘤的中英文文献。采用诊断准确性研究质量评价工具和Metadisc Version1.4统计软件,对所纳入的临床试验进行质量评价和Meta分析。结果共纳入4项临床试验,经Meta分析显示,64层螺旋CTA诊断颅内动脉瘤的灵敏度和特异度分别为97%(95%CI:0.950～0.980)和91%(95%CI:0.860～0.950),诊断优势比为269.640(95%CI:137.250~529.720),汇总受试者工作特征曲线得出曲线下面积为0.993。结论多层螺旋CTA诊断颅内动脉瘤具有较高的敏感性和特异性,可以作为颅内动脉瘤的重要诊断方法。由于本研究所纳入的样本量较小,尚有待设计严谨且样本量更大的高质量研究进一步评价。     

我国综合医院患者抑郁焦虑障碍患病率的Meta分析

目的系统评价我国综合医院患者抑郁焦虑障碍患病率,为更准确地评估综合医院焦虑抑郁患病情况提供参考。方法以"综合医院""抑郁""焦虑""depression""anxiety""general hospitals""China"为检索词,分别检索Pub Med、中国期刊全文数据库(CNKI)、中国科技期刊数据库(维普,VIP)和万方数据库收录的有关我国综合医院患者焦虑抑郁患病率的文献,并对其进行筛选和质量评价,采用Meta Analyst3.13统计合并效应量,并对患者来源、诊断工具进行亚组分析。结果共纳入文献22篇,总样本51 626例,抑郁、焦虑、抑郁焦虑共病患病率分别为13.6%(95%CI:11.3%~16.4%)、8.1%(95%CI:6.3%~10.4%)、5.2%(95%CI:3.6%~5.7%)。亚组分析显示,门诊抑郁障碍患病率14.0%(95%CI:11.3%~17.3%)高于住院患病率10.2%(95%CI:6.7%~15.1%);不同的诊断标准,抑郁障碍患病率不同,MINI为16.2%(95%CI:13.5%~19.4%),高于SCID的8.8%(95%CI:5.5%~13.6%)。敏感性分析显示,高质量文献合并后与总的合并值接近。结论我国综合医院患者抑郁焦虑障碍患病率高。     

颅内动脉瘤介入术后再出血危险因素的Meta分析

目的探讨颅内动脉瘤介入术后再出血的危险因素。方法从CNKI、万方、PubMed等数据库中搜索与颅内动脉瘤介入术后再出血相关的临床研究文献,应用Meta分析的方法对纳入的文献进行综合分析,采用RevMan 5.1进行异质性检验及合并OR值和95%可信区间的计算。结果纳入本次Meta分析的文献共有5篇。性别、年龄、术后抗凝、动脉瘤大小、动脉瘤位置、合并脑血管痉挛及栓塞程度Meta分析的合并OR值及95%可信区间分别为0.80(0.49~1.31)、1.24(0.76~2.01)、3.91(2.20~6.95)、0.76(0.43~1.34)、0.99(0.60~1.62)、2.81(1.54~5.11)、1.08(0.63~1.84)。结论术后抗凝和脑血管痉挛是颅内动脉瘤介入术后再出血的危险因素。     

18FDG-PET术前评估骨与软组织肿瘤治疗效果的Meta分析

背景：18FDG-PET可为骨和软组织肿瘤的良恶性鉴别，病变定位，恶性程度评价，活检部位的确定，治疗效果评估和判断预后提供重要信息。 目的：采用Meta分析方法评价18FDG-PET在术前骨与软组织肿瘤治疗疗效评估方面的应用价值。 方法：检索PubMed、EMBASE、Cochrance、CNKI、万方数据库及维普中文科技期刊数据库获得PET用于骨与软组织肿瘤诊治方面的临床研究。 结果与结论：对符合纳入标准的9项临床非随机对照研究进行Meta分析，文献质量评价循证医学推荐级别3项研究为B级，6项为C级，检验提示无发表偏倚。将治疗前后最大标准摄取值SUV2/SUV1≤0.5作为预测术后肿瘤坏死率≥90%的敏感性和特异性分别为0.82(95%CI，0.72~0.89)和0.61(95%CI，0.49~0.71)。SROC为6.17(95%CI，2.84~13.39)。说明将化疗前后最大标准摄取值比值作为评价术前疗效的敏感性较好，但缺乏特异性；应综合18FDG-PET检查结果与其他辅助检查结果对术前疗效进行综合评估。     

血清S-100B对轻型颅脑损伤诊断价值的系统评价和Meta分析

目的系统评价血清学标志物S-100B对于轻型颅脑损伤（mTBI）患者颅内损伤的诊断价值。 方法计算机检索PubMed、EMbase、The Cochrane Library、中国知网、中国生物医学数据库、维普、万方数据库,筛选S-100B预测mTBI后颅内损伤的诊断性试验,检索时限为自建库至2022年5月27日。由2名研究员根据纳入和排除标准筛选文献、数据提取,并采用QUADAS-2工具评价纳入研究的偏倚风险,采用Meta-DiSc 1.4软件分析血清S-100B对mTBI的诊断价值。 结果共纳入21篇文献,包括8057例患者。Meta分析结果显示：S-100B诊断mTBI颅内损伤的诊断比值比为5.55（95%CI：3.47~8.87）,合并灵敏度为0.91（95%CI：0.88~0.93）,合并特异度为0.29（95%CI：0.28~0.30）,合并阳性似然比为1.35（95%CI：1.25~1.47）、合并阴性似然比为0.26（95%CI：0.16~0.44）。S-100B诊断mTBI颅内损伤的综合受试者工作特征曲线的曲线下面积为0.760。 结论S-100B对于mTBI患者颅内损伤有一定的诊断价值,可作为筛查工具辅助急诊医生进行筛查。     

CTLA-4+49A/G多态性与多发性硬化相关性的meta分析

目的探讨CTLA-4+49A/G多态性与多发性硬化(MS)的相关性。方法通过检索PubMed数据库收集有关CTLA-4+49A/G多态性与MS相关的病例-对照研究,文献检索时间从建库至2013-09期间。采用RevMan 4.2统计软件对其结果进行分析。结果共纳入25个以高加索和亚洲人群为研究对象的MS病例对照研究,包括高加索MS患者4663例和高加索健康对照4249例,亚洲MS患者563例和亚洲健康对照667例。各研究的等位基因和基因型频数结果未见明显发表偏倚。25个研究合并后,G/A、GG+GA/AA、GG/GA+AA合并的OR值分别为1.00(95%CI为0.96~1.06,P=0.91)、1.01(95%CI为0.93~1.10,P=0.73)、0.99(95%CI为0.88~1.10,P=0.81)。高加索人群的研究合并后,G/A、GG+GA/AA、GG/GA+AA合并的OR值分别为1.00(95%CI为0.94~1.06,P=0.99)、0.99(95%CI为0.91~1.08,P=0.85)、1.01(95%CI为0.90~1.14,P=0.83)。亚洲人群的研究合并后,G/A、GG+GA/AA、GG/GA+AA合并的OR值分别为1.03(95%CI为0.87~1.22,P=0.73)、1.22(95%CI为0.95~1.57,P=0.12)、0.83(95%CI为0.61~1.12,P=0.22)。结论 CTLA-4+49A/G多态性与MS无相关性。     

GeneXpert MTB/RIF对结核性脑膜炎诊断价值的 Meta分析

目的 系统评价 GeneXpert MTB/RIF 在结核性脑膜炎诊断中的应用价值。方法 通过计 算机检索 PubMed、Ovid、Embase、Scopus、Web of Science、Cochrane Library 及中国知网、维普数据库、万 方数据库等国内外数据库,收集建库至 2021 年 11 月发表的与 GeneXpert MTB/RIF 诊断结核性脑膜炎相 关的中英文文献。应用 RevMan 5.3 和 Meta-Disc 1.4 软件进行文献质量评价和 Meta 分析,计算汇总敏感 度、特异度、阳性似然比（PLR）、阴性似然比（NLR）、诊断比值比（DOR）,绘制汇总受试者工作特征（SROC） 曲线并计算曲线下面积（AUC）。结果 共纳入 28 篇文献,共包含 5 137 例临床标本。Meta 分析显示, GeneXpert MTB/RIF 用于诊断结核性脑膜炎的汇总敏感度为 0.412（95%CI：0.392～0.431）,特异度为 0.967 （95%CI：0.961～0.973）。以临床综合诊断标准为诊断标准,GeneXpert MTB/RIF 用于诊断结核性脑膜炎 的汇总敏感度和特异度分别为 0.362（95%CI：0.340～0.384）、0.973（95%CI：0.964～0.980）;以结核分枝 杆菌培养为标准,GeneXpert MTB/RIF 诊断结核性脑膜炎的汇总敏感度和特异度分别为 0.589（95%CI： 0.547～0.630）和 0.961（95%CI：0.950～0.970）。脑脊液离心处理后,GeneXpert MTB/RIF 诊断结核性脑膜 炎的汇总敏感度和特异度分别为 0.431（95%CI：0.405～0.456）、0.966（95%CI：0.957～0.973）。HIV 感染情 况下,GeneXpert MTB/RIF诊断结核性脑膜炎的汇总敏感度为0.405（95%CI：0.375～0.434）,特异度为0.967 （95%CI：0.956～0.976）。结论 脑脊液经离心处理后,GeneXpert MTB/RIF 检测对结核性脑膜炎有较高 的诊断价值,可作为快速诊断结核性脑膜炎的有效方法。     

Smoking and carpal tunnel syndrome: A meta‐analysis

Introduction: We assessed the association between smoking and carpal tunnel syndrome (CTS) and estimated the magnitude of the association with meta‐analysis. Methods: The PubMed, Embase, Scopus, and SciVerse databases were searched through December 2012. Thirteen studies were included in the meta‐analysis. Results: Cross‐sectional studies reported an association between current smoking and CTS (pooled odds ratio (OR) = 1.99, 95% confidence interval (CI) 1.38–2.60, I‐squared = 0%). Meta‐analyses of case–control studies did not, however, show an association between smoking and CTS (pooled OR = 1.04, 95% CI 0.95–1.12, I‐squared = 0.0%) or surgery due to CTS (pooled OR = 0.99, 95% CI 0.82–1.15, I‐squared = 0%). Moreover, smoking was not associated with CTS in the meta‐analysis of cohort studies (pooled OR = 0.97, 95% CI 0.45–1.50, I‐squared = 0%). Conclusions: We found an association between smoking and CTS in cross‐sectional studies. This association should be explored further in appropriately designed case–control and cohort studies. Muscle Nerve 49 :345–350, 2014     

Effects of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: a meta-analysis

Aim This research review and meta‐analysis presents an overview of the effects of hippotherapy and therapeutic horseback riding (THR) on postural control or balance in children with cerebral palsy (CP). Method To synthesize previous research findings, a systematic review and meta‐analysis were undertaken. Relevant studies were identified by systematic searches of multiple online databases from the inception of the database through to May 2010. Studies were included if they fulfilled the following criteria: (1) quantitative study design, (2) investigation of the effect of hippotherapy or THR on postural control or balance, and (3) the study group comprised children and adults with CP. The selected articles were rated for methodological quality. The treatment effect was coded as a dichotomous outcome (positive effect or no effect) and quantified by odds ratio (OR). The pooled treatment effect was calculated using a random‐effects model. Meta‐regression of the effect size was performed against study covariates, including study size, publication date, and methodological quality score. Results From 77 identified studies, 10 met the inclusion criteria. Two were excluded because they did not include a comparison group. Therapy was found to be effective in 76 out of 84 children with CP included in the intervention groups. The comparison groups comprised 89 children: 50 non‐disabled and 39 with CP. A positive effect was shown in 21 of the children with CP in the comparison group regardless of the activity undertaken (i.e. physiotherapy, occupational therapy, sitting on a barrel or in an artificial saddle). The pooled effect size estimate was positive (OR 25.41, 95% CI 4.35, 148.53), demonstrating a statistically significant effectiveness of hippotherapy or THR in children with CP (p<0.001). Meta‐regression of study characteristics revealed no study‐specific factors. Interpretation The eight studies found that postural control and balance were improved during hippotherapy and THR. Although the generalization of our findings may be restricted by the relatively small sample size, the results clearly demonstrate that riding therapy is indicated to improve postural control and balance in children with CP.     

Antibodies against aquaporin-4 in neuromyelitis optica: distinction between recurrent and monophasic patients

The detection of antibodies against aquaporin-4 (AQP4) has improved the diagnosis of neuromyelitis optica (NMO). We evaluated a recently established cell-based anti-AQP4 assay in 273 patients with inflammatory CNS demyelination. The assay had a specificity of 99% and a sensitivity of 56% to detect all NMO patients and of 74% to detect the recurrent NMO patients, similar to the initial studies reported. AQP4 antibodies were absent in monophasic NMO patients, while samples in recurrent cases remained positive during follow-up. We conclude that the pathogenesis of monophasic NMO may be different from that of relapsing NMO.     

Prognostic scores in status epilepticus: A systematic review and meta-analysis

The performance of prognostic scores of status epilepticus (SE) has been reported in very heterogeneous cohorts. We aimed to provide a summary of the available evidence on their respective performance. PubMed and EMBASE were searched for relevant articles. Studies were reviewed for eligibility for meta-analysis of the area under the receiver-operating characteristic curve (AUC) and for meta-analysis of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in predicting in-hospital mortality with scores in which at least two external evaluations had been published. This study was registered with PROSPERO (international prospective register of systematic reviews) (CRD42022325766). Study quality was assessed using Prediction model Risk Of Bias ASsessment Tool (PROBAST). In the meta-analysis of AUC, 21 studies were pooled for STESS (Status Epilepticus Severity Score), five for EMSE-EAC (Epidemiology-based Mortality Score in Status Epilepticus - Etiology, Age, level of Consciousness), five for EMSE-EACE (EMSE - Etiology, Age, level of Consciousness, EEG), and two for ENDIT (Encephalitis, nonconvulsive status epilepticus, Diazepam resistance, Imaging abnormalities, Tracheal intubation). The pooled AUC of STESS, EMSE-EAC, EMSE-EACE, and ENDIT was 0.74 (95% CI: 0.71–0.78), 0.68 (95% CI 0.63–0.72), 0.77 (95% CI: 0.72–0.81), and 0.78 (95% CI: 0.70–0.87), respectively. The pooled sensitivity of STESS-3, STESS-4, EMSE-EACE-64, and ENDIT-4 was 0.83 (95% CI: 0.80–0.86), 0.60 (95% CI: 0.55–0.65), 0.76 (95% CI: 0.67–0.83), and 0.70 (95% CI: 0.55–0.82), respectively. Their pooled specificity was 0.50 (95% CI: 0.48–0.52), 0.74 (95% CI: 0.72–0.76), 0.63 (95% CI: 0.59–0.67), and 0.65 (95% CI: 0.61–0.70), respectively. Their pooled PPV was 0.27 (95% CI: 0.24–0.30), 0.35 (95% CI: 0.29–0.41), 0.33 (95% CI: 0.24–0.43), and 0.20 (95% CI: 0.13–0.27). Their pooled NPV was 0.94 (95% CI: 0.93–0.96), 0.90 (95% CI: 0.89–0.92), 0.89 (95% CI: 0.80–0.98), and 0.95 (95% CI: 0.92–0.98). Variations in performance were observed in patients' subgroups, such as critically ill patients and refractory cases. Investigated scores only have acceptable AUC, sensitivity, and specificity for predicting in-hospital mortality, with the EMSE-EAC having a lower discriminative power. STESS-3 has the highest sensitivity, and STESS-4 the highest specificity, but neither combines acceptable sensitivity and specificity. All these scores had high NPV but very low PPV. Caution should be exercised in their clinical use. Further studies are required to develop more accurate scores.     

A square‐shaped wrist as a predictor of carpal tunnel syndrome: A meta‐analysis

Introduction: This meta‐analysis aims to assess an association between wrist ratio (wrist thickness/wrist width) and carpal tunnel syndrome (CTS). Methods: Sixteen studies qualified for a random‐effects meta‐analysis. Results: Mean wrist ratio was higher in individuals with CTS compared with those without CTS [pooled mean difference 0.036, 95% confidence interval (CI) 0.025–0.046]. Pooled odds ratio (OR) of CTS for mean wrist ratio was 4.56 (95% CI 2.97–6.99), and for wrist ratio ≥0.70 vs. <0.70 it was 2.73 (95% CI 1.49–5.01). In addition, the pooled OR for a 1‐unit (0.01) increase in wrist ratio was 1.12 (CI 1.09–1.16). The association between wrist ratio and CTS did not differ between men and women. Moreover, there was no evidence of publication bias. Conclusions: This meta‐analysis suggests that a square‐shaped wrist is a predictor for CTS in both men and women. Future studies should explore whether a square‐shaped wrist can potentiate the adverse effects of obesity and occupational workloads on CTS. Muscle Nerve 52 : 709–713, 2015     

Relationship between tumour location and preoperative seizure incidence in patients with gliomas: a systematic review and meta‐analysis

Aim. The aim of this meta‐analysis was to assess the relationship between tumour location and preoperative seizure incidence in patients with gliomas. Methods. Systematic computerised searches of PubMed and the Web of Knowledge were performed. The meta‐analysis of pooled odds ratio (OR) and 95% confidence interval (CI) for preoperative seizure risk, stratified by tumour location, were calculated. Results. Eleven studies with 2,047 patients were included for meta‐analysis. For gliomas with or without frontal lobe involvement, the preoperative seizure incidence ranged from 31.7% (19/60) to 85.7% (156/182) and 19.7% (12/61) to 85.7% (12/14), respectively; the pooled OR was 1.560 (95% CI: 1.266–1.923; Z: 4.17; p=0.000). For gliomas with or without temporal lobe involvement, seizure incidence was 22.6% (7/31) to 91.7% (11/12) and 26.7% (24/90) to 78.7% (174/221), respectively; the pooled OR was 1.070 (95% CI: 0.794–1.443; Z: 0.45; p=0.656). For gliomas with or without parietal lobe involvement, seizure incidence was 18.1% (3/16) to 100.0% (3/3) and 26.7% (28/105) to 80.4% (226/281), respectively; the pooled OR was 0.770 (95% CI: 0.570–1.040; Z: 1.71; p=0.088). For gliomas with or without occipital lobe involvement, seizure incidence was 0.0% (0/2) to 100.0% (2/2) and 26.8% (30/112) to 75.7% (56/74), respectively; the pooled OR was 0.336 (95% CI: 0.164–0.686; Z: 2.99; p=0.003). For gliomas with or without insula lobe involvement, seizure incidence was 34.8% (8/23) to 72.0% (77/107) and 34.3% (60/175) to 81.3% (247/304), respectively; the pooled OR was 1.058 (95% CI: 0.765–1.463; Z: 0.34; p=0.732). No significant publication bias was found. Conclusion. Our meta‐analysis indicates that frontal lobe gliomas are related to a higher preoperative seizure incidence, while occipital lobe gliomas are related to a lower incidence.     

The prevalence of neuromyelitis optica in South East Wales

Background and purpose: Neuromyeltis optica (NMO) is a neuroinflammatory disorder considered rare in Caucasian populations. However, accurate population‐based epidemiological data for NMO and NMO spectrum disorder (NMO‐SD) from Western populations employing validated diagnostic criteria remain limited. We sought therefore to estimate the prevalence and clinical features of NMO in a north European Caucasian population in South East Wales. Methods: Patients were identified by a comprehensive, multistage ascertainment strategy employing a regional neuroinflammatory disease register, hospital diagnostic databases personal physician referrals and regional requests for anti‐aquaporin‐4 antibodies (anti‐AQP4). Results: Fourteen Caucasian patients (11 patients with NMO and three with NMO‐SD) were identified in a population of 712 572 (19.6/million; 95% CIs: 12.2–29.7). There was an excess of females (female:male 12:2), 11/14 were anti‐AQP4 positive and 5/14 had disease onset under the age of 20 years. Conclusion: This study suggests that NMO and related spectrum disorders are at least as frequent in Northern European populations as in non‐Caucasian populations and that the demographic profile of prevalent patients differs from clinic‐based cohorts.     

Biomarkers in neuromyelitis optica

Recently, the disease-specific neuromyelitis optica (NMO) autoantibody NMO-IgG was detected in the sera of NMO patients, as the specific immunohistochemical pattern of human IgG on mouse brain slices. Aquaporin-4 (AQP4), mainly expressed in astroglial foot processes, was identified as the target for NMO-IgG. For diagnosing NMO, serological tests are mainly performed using a cell-based assay with HEK293 cells transfected with AQP4; this assay has the highest sensitivity (>70%) and specificity (>90%) for diagnosing NMO. However, several assays, such as immunoprecipitation assay, and ELISA systems, for detecting the AQP4 antibody have been reported. Several papers focus on inflammatory and pathological biomarkers, including cytokines, chemokines, and astrocyte markers, for NMO. Pleocytosis in the cerebrospinal fluid (CSF) and an increased CSF IgG: serum IgG/albumin ratio are useful markers of inflammation and blood-brain barrier leakage in NMO patients. Increased concentrations of cytokines such as IL-17, IL-6, and BAFF in the CSF may be key factors that induce the formation of NMO lesions, mainly by promoting the infiltration of neutrophils or plasma cells. Astrocytic damage, reflected by a marked increase in CSF-GFAP levels, was evident in NMO patients, but not in classical multiple sclerosis (MS) patients, indicating that CSF-GFAP is a good marker of lysis during autoimmune astrocytopathy. Therefore, the assessment of such useful biomarkers may become a supportive criterion for diagnosing NMO and NMO spectrum disorders.