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We investigated differences in the anatomical distribution of cerebral microbleeds (CMBs) on MRI, hypothesized to indicate the type of underlying cerebral small vessel disease (SVD), between Eastern and Western general populations.MethodsWe analyzed data from 11 studies identified by a PubMed search between 1996 and April 2014 according to the Preferred Reporting Items for a Systematic Review and Meta-analysis of Individual Participant Data. Study quality measures indicated low or medium risk of bias. We included stroke-free participants from populations aged between 55 and 75 years, categorized by geographic location (Eastern or Western). We categorized CMB distribution (strictly lobar, deep and/or infratentorial [D/I], or mixed [i.e., CMBs located in both lobar and D/I regions]). We tested the hypothesis that Eastern and Western populations have different anatomical distributions of CMBs using multivariable mixed effects logistic regression analyses adjusted for age, sex, and hypertension and clustering by institution.ResultsAmong 8,595 stroke-free individuals (mean age [SD] 66.7 [5.6] years; 48% male; 42% from a Western population), 624 (7.3%) had CMBs (strictly lobar in 3.1%; D/I or mixed in 4.2%). In multivariable mixed effects models, Eastern populations had higher odds of D/I or mixed CMBs (adjusted odds ratio 2.78, 95% confidence interval [CI] 1.77-4.35) compared to Western populations. Eastern populations had a higher number of D/I or mixed CMBs (adjusted prevalence ratio 2.83, 95% CI 1.27-6.31).ConclusionsEastern and Western general populations have different anatomical distributions of CMBs, suggesting differences in the spectrum of predominant underlying SVDs, with potential implications for SVD diagnosis and treatment.Copyright © 2019 American Academy of Neurology.

Background: The distribution of cerebral microbleeds (CMBs) on MRI is hypothesized to indicate the pattern of underlying small vessel disease (SVD), with CMBs in deep regions reflecting hypertensive arteriopathy, and CMBs in strictly lobar regions reflecting cerebral amyloid angiopathy (CAA). Objective(s): We investigated whether prevalence of CMBs and CAA differs between stroke-free populations of East and West. Patients and Methods / Material(s) and Method(s): We obtained individual participant data from published studies identified by a PubMed search between 1996 and 2014. Using a multivariable mixed effects logistic regression model, we investigated CMBs distribution, CMBs number, and prevalence of CAA, in relation to Eastern or Western population origin (n=13,578 from 8 Eastern cohorts [Eastern group] and 3 Western cohorts [Western group]; median age, 68 years; 49% Western group). Result(s): Of all included participants, 1108 subjects (8.2%) showed CMBs: strictly lobar CMBs (3.8%), strictly deep or infratentorial (D/I) CMBs (3.3%), and Mixed CMBs (1.1%). The multivariable mixed effects models suggested that Western group more likely to have strictly lobar CMBs (odds ratio [OR] 2.33; 95% confidence interval [CI] 1.25-4.36, p=0.008) and CAA (possible CAA: OR 2.27, 95%CI 1.19-4.35, p=0.013; probable CAA: OR 2.67, 95% CI 1.14-6.23, p=0.023) than those of Eastern group. Eastern group more likely to have strictly D/I CMBs (OR 2.80, 95%CI 1.89-4.17, p<0.001) and larger number of deep CMBs (incidence rate ratio 5.90, 95%CI, 2.83-12.33, p<0.001) compared to Western group. Conclusion(s): Eastern and Western stroke-free populations are associated with different anatomical patterns of CMBs, and CAA prevalence, suggesting differences in the spectrum of predominant underlying SVDs.

The CFMIP Diagnostic Codes Catalogue assembles cloud metrics, diagnostics and methodologies, together with programs to diagnose them from general circulation model (GCM) outputs written by various members of the CFMIP community. This aims to facilitate use of the diagnostics by the wider community studying climate and climate change. This paper describes the diagnostics and metrics which are currently in the catalogue, together with examples of their application to model evaluation studies and a summary of some of the insights these diagnostics have provided into the main shortcomings in current GCMs. Analysis of outputs from CFMIP and CMIP6 experiments will also be facilitated by the sharing of diagnostic codes via this catalogue. Any code which implements diagnostics relevant to analysing clouds - including cloud-circulation interactions and the contribution of clouds to estimates of climate sensitivity in models - and which is documented in peer-reviewed studies, can be included in the catalogue. We very much welcome additional contributions to further support community analysis of CMIP6 outputs.

Background: The distribution of cerebral microbleeds (CMBs) is hypothesised to indicate different underlying small vessel disease (SVD): CMBs in deep regions share risk factors with hypertensive microangiopathy, whereas CMBs in strictly lobar regions are associated with cerebral amyloid angiopathy (CAA). We investigated whether CMBs distribution differs between stroke-free population-based cohorts of Eastern (Asia) and Western (Caucasian) ethnicities. Method(s): We searched PubMed between 1996 and 2014 using a combination of search terms: CMBs, healthy, or their appropriate synonyms/MeSH terms. CMBs distribution was classified as: strictly lobar; strictly deep or infra-tentorial (D/I); or mixed. Using CMB distribution or CAA diagnosis (possible or probable based on Boston criteria) as the dependent variable and ethnicity as the independent variable, multivariable logistic regression analyses was per-formed to compare the association of CMBs distributional patterns and CAA diagnosis between the ethnicities, adjusting for age, sex, hypertension, magnetic field strength, and echo time. Result(s): In multivariable logistic regression analysis, including 13,578 individual data (mean age 67.8 years, 49% Western subjects) from 11 centers, a strictly lobar CMBs pattern was associated with Western ethnicity (OR 1.67, 95%CI 1.23-2.26), and a strictly D/I CMBs pattern was associated with Eastern ethnicity (OR 2.32, 95%CI 1.67-3.22). A mixed CMBs pattern showed no association with ethnicity. Both possible and probable CAA diagnosis were associated with Western ethnicity (OR 1.60, 95%CI 1.18-2.19; OR 2.17, 95% CI 1.11-4.24). Conclusion(s): In stroke-free populations, Eastern and Western ethnicity are associated with different anatomical patterns of CMBs, suggesting that the spectrum of the predominant underlying SVD differs.

The aim of this article is to review the published cases of nephrogenic systemic fibrosis (NSF) in Japan. The Japanese medical literature database and MedLine were searched using the keywords NSF and nephrogenic fibrosing dermopathy (January 2000 to March 2009). Reports in peer-reviewed journals and meeting abstracts were included, and cases with biopsy confirmation were selected. 14 biopsy-verified NSF cases were found. In seven of eight patients reported after the association between gadolinium-based contrast agent (GBCA) and NSF was proposed, GBCA administration was documented: five received only gadodiamide; two received both gadodiamide and gadopentetate dimeglumine. In four cases, the amounts of contrast agent were registered: two received only a single dose (0.1 mmol kg(-1) body weight) whereas the other two received 7-15 ml (the body weight was not disclosed) for each MR examination. Five patients had multiple injections of GBCA before NSF developed. Except for one patient in whom renal assessment was not reported, none of the patients had an estimated glomerular filtration rate >30 ml min(-1) 1.73 m(-2) and all received dialysis. 5 of the 8 patients (63%) in whom GBCA exposure was confirmed were treated with peritoneal dialysis. Skin lesion of the lower extremity was the first symptom in 12 patients (86%), whereas 2 patients had primarily symptoms from the upper extremity. In three cases, GBCA was administered even after onset of the NSF symptoms because of the physicians' lack of knowledge about the possible association between GBCA and NSF. NSF is found among Japanese end-stage renal failure patients even after examinations using a single dose.