Abstract MP9: Incidence and Outcomes of Posterior Circulation Involvement in Moyamoya Disease

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Seth S Tigchelaar ◽  
Allan Wang ◽  
Yiping Li ◽  
Gary Steinberg
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Arteries ◽  
Subsequent Development ◽  
Collateral Flow ◽  
Bilateral Disease ◽  
Operative Outcomes ◽  
Ischemic Complications ◽  
History Of ◽  
The Impact

Moyamoya disease (MMD) is a progressive, occlusive disease of the internal carotid arteries and their proximal branches, with the subsequent development of an abnormal vascular network of small, weak blood vessels that are prone to rupture. Steno-occlusive changes in the posterior cerebral arteries (PCA) may contribute to worse outcomes in MMD patients, however, there is a paucity of information on the incidence and natural history of MMD patients with PCA disease. We retrospectively reviewed the charts of patients with MMD treated between 1987 and 2019. Demographics, peri-operative outcomes, and radiological phenotypes were recorded for 450 patients. PCA disease was scored as either 0 (no disease), 1 (mild), 2 (moderate), or 3 (severe, or occluded). Out of 450 patients, 164 (34.4%) had concurrent PCA disease. In patients with PCA disease, the extent of occlussion was mild in 56 (34%), moderate in 41 (25%), and severe in 67 (40.9%) patients. In total, there were 319 females (70.9%), with a higher proportion of female MMD patients having severe or moderate PCA disease (p=0.038). Patients with severe and moderate PCA disease had higher Suzuki grades (p<0.0001), more extensive collateral angiopathy (p<0.0001), more frequent cerebrovascular accidents on presentation (p=0.012), higher hemodynamic scores (p=0.022), and a greater frequency of post-operative ischemic complications (p=0.019). Peak modified Rankin Scale (mRS) scores were higher in patients with any severity of PCA disease (p=0.0006). Over a mean follow-up of 6.94±4.16 years, 28 patients (8.86%) developed new or progressive PCA disease. Bilateral disease was present in 66 patients (14.7%) and was associated with higher Suzuki grades (p<0.0001), more extensive collateral angiopathy (p<0.0001), and greater post-operative ischemic complications (p=0.011). Peak mRS scores were higher in patients with bilateral disease compared to patients with no PCA disease (p<0.0001). PCA disease involvement is associated with higher rates of ischemic peri-operative complications and poor functional outcomes likely due to reduced collateral flow. Progression of PCA disease is not uncommon. Future studies are needed to assess the impact of PCA disease progression on long-term outcomes.

Abstract P568: Incidence and Progression of Posterior Circulation Involvement in Moyamoya Disease

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Yiping Li ◽  
Allan R Wang ◽  
Gary K STEINBERG
Keyword(s):  
Moyamoya Disease ◽  
Functional Outcomes ◽  
Posterior Circulation ◽  
External Carotid ◽  
Collateral Flow ◽  
Anterior Circulation ◽  
Bilateral Disease ◽  
Operative Complications ◽  
The Impact

Introduction: The incidence and natural history of posterior circulation moyamoya disease (PCMMD) is not well-characterized. Methods: Consecutive patients with moyamoya disease prospectively treated at our institution from 2015-2018 were reviewed. Results: 262 consecutive patients with moyamoya disease undergoing 370 revascularization procedures were enrolled. Concurrent PCMMD was identified in 68 (26%) patients – all of which were confined to the anterior circulation. There were no differences in age, sex, race, or rates of diabetes, hypertension, smoking, or symptoms upon presentation between patients with or without PCMMD. Patients with PCMMD were more likely to present with bilateral disease (p<0.001), higher Suzuki grade (p=0.001), more extensive collateral angiopathy (p<0.001), and pial-pial collaterals from the PCA territory (p=0.03). Patients with PCMMD were more likely to suffer from ischemic peri-operative complications in both the anterior (p=0.03) and posterior (p<0.001) circulation territories after anterior circulation revascularization. No differences were observed for hemorrhagic complications (p=1.0). Over a mean follow-up of 1.91±1.5 years, 19 (7.3%) developed new or progressive PCMMD. Patients with PCMMD progression had an Asian predilection and were less likely to present with sentinel symptoms such as headaches (p=0.05 and 0.01 respectively). Patients with bilateral disease (p=0.02), higher Suzuki (p<0.001) and collateral angiopathy grades (p=0.002), and more extensive external carotid artery supply (p=0.03) were also more likely to experience PCMMD progression. There was no association between PCMMD progression and delayed neurological events or functional outcomes, but patients with concurrent PCMMD upon presentation were associated with poor functional outcome (mRS >2) at last follow-up (p=0.02). Conclusions: Posterior circulation disease involvement often presents in the later stages of moyamoya and is associated with higher rates of ischemic peri-operative complications and poor functional outcomes likely due to reduced collateral flow. Progression of PCMMD is not uncommon. Future studies are needed to assess the impact of PCMMD progression on long-term outcomes.

Premature Adrenarche and its Association with Cardiovascular Risk in Females

2020 ◽  
Vol 26 (43) ◽  
pp. 5609-5616
Author(s):  
Sarantis Livadas ◽  
Christina Bothou ◽  
Djuro Macut
Keyword(s):  
Polycystic Ovary ◽  
Dehydroepiandrosterone Sulfate ◽  
Adrenal Androgen ◽  
Premature Adrenarche ◽  
Adrenal Hyperandrogenism ◽  
Long Term Follow Up ◽  
History Of ◽  
Hormonal Milieu ◽  
The Impact

Early activation of the adrenal zona reticularis, leading to adrenal androgen secretion, mainly dehydroepiandrosterone sulfate (DHEAS), is called premature adrenarche (PA). The fact that adrenal hyperandrogenism in females has been linked to a cluster of cardiovascular (CV) risk factors, even in prepubertal children, warrants investigation. Controversial results have been obtained in this field, probably due to genetic, constitutional, and environmental factors or differences in the characteristics of participants. In an attempt to understand, in depth, the impact of PA as a potential activator of CV risk, we critically present available data stratified according to pubertal status. It seems that prepubertally, CV risk is increased in these girls, but is somewhat attenuated during their second decade of life. Furthermore, different entities associated with PA, such as polycystic ovary syndrome, non-classical congenital adrenal hyperplasia, heterozygosity of CYP21A2 mutations, and the impact of DHEAS on CV risk, are reviewed. At present, firm and definitive conclusions cannot be drawn. However, it may be speculated that girls with a history of PA display a hyperandrogenic hormonal milieu that may lead to increased CV risk. Accordingly, appropriate long-term follow-up and early intervention employing a patient-oriented approach are recommended.

scholarly journals A case of Young Stroke due to Moyamoya Disease

2020 ◽  
Vol 15 (1) ◽  
pp. 110-113
Author(s):  
Md Abdur Razzak ◽  
Ghulam Kawnayn ◽  
Fateha Naznin ◽  
Quazi Audry Arafat Rahman
Keyword(s):  
Moyamoya Disease ◽  
Past History ◽  
Cerebral Arteries ◽  
Armed Forces ◽  
Cerebral Angiogram ◽  
Medical College ◽  
Middle Cerebral Arteries ◽  
History Of ◽  
Collateral Vessels ◽  
The Right

Moyamoya disease is a disease in which certain arteries in the brain are constricted. Blood flow is blocked by the constriction, and also by blood clots (thrombosis). A collateral circulation develops around the blocked vessels to compensate for the blockage, but the collateral vessels are small, weak, and prone to bleeding, aneurysm and thrombosis which may result in TIA, recurrent ischemic or hemorrhagic stroke or seizure. The disease may manifest in pediatric age or young adults. In May 2019 we have diagnosed a young lady with Moyamoya disease who presented with right sided hemiplegia, motor aphasia and dysphagia. She was labeled as hypertensive 6 months prior to this event and used to take anti-hypertensive irregularly and gave past history of occasional headache. Her CT scan and MRI of brain revealed left sided ischemic infarct involving frontotemporoparietal region and cerebral angiogram revealed narrowing of left MCA and non-visualization of distal part. There is extensive fine collaterals (Moyamoya vessels) giving the appearance of puffed smoke. The right ACA and MCA were also narrowed with appearance of early collateral vessels. She was treated with aspirin, PPI, NG feeding, antihypertensive medication, physiotherapy, rehabilitation therapy and other supportive care. His condition gradually improved and discharged on 2.7.19. He was referred to Department of Neurosurgery for cerebral revascularization by STA-MCA (superficial temporal and middle cerebral arteries) bypass surgery after stabilization and MR perfusion study. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 110-113

scholarly journals Colonial Values and Asylum Care in Brazil: Reclaiming the Streets Through Carnival in Rio de Janeiro

2020 ◽  
pp. 155-161
Author(s):  
Julia Evangelista ◽  
William A. Fulford
Keyword(s):  
Local Community ◽  
Well Being ◽  
Colonial History ◽  
Self Confidence ◽  
History Of ◽  
The Impact ◽  
Mental Well Being ◽  
The City

AbstractThis chapter shows how carnival has been used to counter the impact of Brazil’s colonial history on its asylums and perceptions of madness. Colonisation of Brazil by Portugal in the nineteenth century led to a process of Europeanisation that was associated with dismissal of non-European customs and values as “mad” and sequestration of the poor from the streets into asylums. Bringing together the work of the two authors, the chapter describes through a case study how a carnival project, Loucura Suburbana (Suburban Madness), in which patients in both long- and short-term asylum care play leading roles, has enabled them to “reclaim the streets,” and re-establish their right to the city as valid producers of culture on their own terms. In the process, entrenched stigmas associated with having a history of mental illness in a local community are challenged, and sense of identity and self-confidence can be rebuilt, thus contributing to long-term improvements in mental well-being. Further illustrative materials are available including photographs and video clips.

Long-term prognosis of patients withJ-wave syndrome

Heart ◽  
2019 ◽  
Vol 106 (4) ◽  
pp. 299-306
Author(s):  
Tsukasa Kamakura ◽  
Tetsuji Shinohara ◽  
Kenji Yodogawa ◽  
Nobuyuki Murakoshi ◽  
Hiroshi Morita ◽  
...  
Keyword(s):  
High Amplitude ◽  
Long Term Study ◽  
St Segment ◽  
History Of ◽  
Provocation Testing ◽  
Long Term Prognosis ◽  
Electrocardiographic Parameters ◽  
The Impact

ObjectiveLimited data are currently available regarding the long-term prognosis of patients with J-wave syndrome (JWS). The aim of this study was to investigate the long-term prognosis of patients with JWS and identify predictors of the recurrence of ventricular fibrillation (VF).MethodsThis was a multicentre retrospective study (seven Japanese hospitals) involving 134 patients with JWS (Brugada syndrome (BrS): 85; early repolarisation syndrome (ERS): 49) treated with an implantable cardioverter defibrillator. All patients had a history of VF. All patients with ERS underwent drug provocation testing with standard and high intercostal ECG recordings to rule out BrS. The impact of global J waves (type 1 ECG or anterior J waves and inferolateral J waves in two or more leads) on the prognosis was evaluated.ResultsDuring the 91±66 months of the follow-up period, 52 (39%) patients (BrS: 37; ERS: 15) experienced recurrence of VF. Patients with BrS and ERS with global J waves showed a significantly higher incidence of VF recurrence than those without (BrS: log-rank, p=0.014; ERS: log-rank, p=0.0009). The presence of global J waves was a predictor of VF recurrence in patients with JWS (HR: 2.16, 95% CI 1.21 to 3.91, p=0.0095), while previously reported high-risk electrocardiographic parameters (high-amplitude J waves ≥0.2 mV and J waves associated with a horizontal or descending ST segment) were not predictive of VF recurrence.ConclusionsThis multicentre long-term study showed that the presence of global J waves was associated with a higher incidence of VF recurrence in patients with JWS.

Ethics of Primate Fieldwork: Toward an Ethically Engaged Primatology

2018 ◽  
Vol 47 (1) ◽  
pp. 493-512 ◽  
Author(s):  
Erin P. Riley ◽  
Michelle Bezanson
Keyword(s):  
Best Practices ◽  
Field Research ◽  
Anthropogenic Factors ◽  
Ethical Practice ◽  
Theoretical Frameworks ◽  
Population Sizes ◽  
History Of ◽  
The Impact ◽  
Term Field

Field primatologists have ethical responsibilities that extend beyond study subjects to the local human communities living near primate populations and their surrounding ecosystems. In this review, we explore the history of ethical discussions within anthropological primatology and examine the best practices for an ethically engaged primatology that should be followed and role-modeled by primatologists. An increasing number of primates are showing reduced population sizes and are in imminent danger of extinction; thus, we need to carefully consider the ethics of intervening to ensure the survival of remaining populations, the impact of anthropogenic factors (e.g., climate change), and whether long-term field research results in conservation outcomes that consider local human communities. Because best practices change over time as theoretical frameworks and methodological tools advance and scientific goals change, field primatologists must continually reflect on what constitutes ethical practice and consider how research influences the overlapping dimensions of fieldwork: primates, people, and ecosystems.

scholarly journals An Introduction to Nicos Hadjinicolaou's “Art Centers and Peripheral Art” (1982)

ARTMargins ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. 112-118
Author(s):  
Terry Smith
Keyword(s):  
The United States ◽  
Political Art ◽  
Book Art ◽  
Hard Edge ◽  
War Of Independence ◽  
History Of ◽  
The 1960S ◽  
The Impact ◽  
First Time

Change in the history of art has many causes, but one often overlooked by art historical institutions is the complex, unequal set of relationships that subsist between art centers and peripheries. These take many forms, from powerful penetration of peripheral art by the subjects, styles and modes of the relevant center, through accommodation to this penetration to various degrees and kinds of resistance to it. Mapping these relationships should be a major task for art historians, especially those committed to tracing the reception of works of art and the dissemination of ideas about art. This lecture, delivered by Nicos Hadjinicolaou in 1982, outlines a “political art geography” approach to these challenges, and demonstrates it by exploring four settings: the commissioning of paintings commemorating key battles during the Greek War of Independence; the changes in Diego Rivera's style on his return to Mexico from Paris in the 1920s; the impact on certain Mexican artists in the 1960s of “hard edge” painting from the United States; and the differences between Socialist Realism in Moscow and in the Soviet Republics of Asia during the mid-twentieth century. The lecture is here translated into English for the first time and is introduced by Terry Smith, who relates it to its author's long-term art historical quest, as previously pursued in his book Art History and Class Struggle (1973).

scholarly journals Simulated retreat of Jakobshavn Isbræ since the Little Ice Age controlled by geometry

2018 ◽  
Vol 12 (7) ◽  
pp. 2249-2266 ◽  
Author(s):  
Nadine Steiger ◽  
Kerim H. Nisancioglu ◽  
Henning Åkesson ◽  
Basile de Fleurian ◽  
Faezeh M. Nick
Keyword(s):  
Little Ice Age ◽  
Ice Age ◽  
Climate Forcing ◽  
Relative Role ◽  
Regional Warming ◽  
History Of ◽  
The Impact ◽  
Term Response

Abstract. Rapid retreat of Greenland's marine-terminating glaciers coincides with regional warming trends, which have broadly been used to explain these rapid changes. However, outlet glaciers within similar climate regimes experience widely contrasting retreat patterns, suggesting that the local fjord geometry could be an important additional factor. To assess the relative role of climate and fjord geometry, we use the retreat history of Jakobshavn Isbræ, West Greenland, since the Little Ice Age (LIA) maximum in 1850 as a baseline for the parameterization of a depth- and width-integrated ice flow model. The impact of fjord geometry is isolated by using a linearly increasing climate forcing since the LIA and testing a range of simplified geometries. We find that the total length of retreat is determined by external factors – such as hydrofracturing, submarine melt and buttressing by sea ice – whereas the retreat pattern is governed by the fjord geometry. Narrow and shallow areas provide pinning points and cause delayed but rapid retreat without additional climate warming, after decades of grounding line stability. We suggest that these geometric pinning points may be used to locate potential sites for moraine formation and to predict the long-term response of the glacier. As a consequence, to assess the impact of climate on the retreat history of a glacier, each system has to be analyzed with knowledge of its historic retreat and the local fjord geometry.

Long-term natural history of hemorrhagic type moyamoya disease in 42 patients

2000 ◽  
Vol 93 (6) ◽  
pp. 976-980 ◽  
Author(s):  
Eiichi Kobayashi ◽  
Naokatsu Saeki ◽  
Hiromichi Oishi ◽  
Shinji Hirai ◽  
Akira Yamaura
Keyword(s):  
Risk Factors ◽  
Natural History ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Bleeding Episode ◽  
Content Type ◽  
History Of ◽  
Fine Print

Object. The purpose of this study was to delineate the long-term natural history of hemorrhagic moyamoya disease (MMD).Methods. A retrospective review was conducted among 42 patients suffering from hemorrhagic MMD who had been treated conservatively without bypass surgery. The group included four patients who had undergone indirect bypass surgery after an episode of rebleeding. The follow-up period averaged 80.6 months. The clinical features of the first bleeding episode and repeated bleeding episodes were analyzed to determine the risk factors of rebleeding and poor outcome.Intraventricular hemorrhage with or without intracerebral hemorrhage was a dominant finding on computerized tomography scans during the first bleeding episode in 29 cases (69%). During the follow-up period, 14 patients experienced a second episode of bleeding, which occurred 10 years or longer after the original hemorrhage in five cases (35.7%). The annual rebleeding rate was 7.09%/person/year. The second bleeding episode was characterized by a change in which hemisphere bleeding occurred in three cases (21.4%) and by the type of bleeding in seven cases (50%). After rebleeding the rate of good recovery fell from 45.5% to 21.4% and the mortality rate rose from 6.8% to 28.6%. Rebleeding and patient age were statistically significant risk factors of poor outcome. All four patients in whom there was indirect revascularization after the second bleeding episode experienced a repeated bleeding episode within 8 years.Conclusions. The occurrence of rebleeding a long time after the first hemorrhagic episode was not uncommon. Furthermore, the change in which hemisphere and the type of bleeding that occurred after the first episode suggested the difficulty encountered in the prevention of repeated hemorrhage.

scholarly journals Preprints & Pandemics: Interventions into the Dynamic Scholarly System of Scholarly Communication

2021 ◽  
Author(s):  
Micah Altman ◽  
Philip N. Cohen ◽  
Jessica Polka
Keyword(s):  
Public Health ◽  
Science Communication ◽  
Ad Hoc ◽  
Scholarly Communication ◽  
External Shocks ◽  
Scholarly Communications ◽  
History Of ◽  
Short And Long Term ◽  
The Impact

The COVID-19 pandemic is an exemplar of how scholarly communication can change in response to external shocks, even as the scholarly knowledge ecosystem is evolving rapidly, and many argue that swift and fundamental interventions are needed. However, it is much easier to identify ongoing changes and emerging interventions than to understand their immediate and long term impacts. This is illustrated by comparing the approaches applied by the scientific community to understand public health risks and interventions with those applied by the scholarly communications community to the science of COVID-19. There are substantial disagreements over the short- and long- term benefits of most proposed approaches to changing the practice of science communication, and the lack of systematic, empirically-based research in this area makes these controversies difficult to resolve. We argue that the methodology of analysis and intervention developed within public health can be usefully applied to the science-of-science. Starting with the history of DDT application, we illustrate four ways complex human systems threaten reliable predictions and blunt ad-hoc interventions. We then show how these four threats apply lead to the last major intervention in scholarly publication -- the article publishing charge based open access model -- to yield surprising results. Finally, we outline how these four threats may affect the impact of preprint initiatives, and we identify approaches drawn from public health to mitigate these threats.

Sign in / Sign up

Export Citation Format

Share Document