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Objective To assess the cognitive function of adult patients with Moyamoya disease (MMD) and the changes during long-term follow-up, and to explore the influencing factors of cognitive decline in adult patients with MMD. Methods A prospective cohort study was used to continuously include 64 adult patients with MMD admitted to the First Affiliated Hospital of Naval Medical University from January 2015 to June 2016, of whom 42 patients underwent revascularization (16 patients underwent combined revascularization and 26 patients underwent indirect revascularization), and 22 patients did not receive surgical treatment. Baseline characteristics of all patients were collected, and cognitive function was assessed by the MoCA at baseline, short-term [(6±1) months] follow-up, and long-term [(10±1) years] follow-up. Emotional status was assessed by patient health questionnaire-9 (PHQ-9) and generalized anxiety disorder-7-item (GAD-7). The changes in cognitive function and emotional status were analyzed in all patients, as well as in patients receiving different treatment approaches, during short- and long-term follow-ups. The reliable change index (RCI) was used to determine whether there was a decline in function with the following formula: RCIMoCA= (X2-X1) /standard deviation (SD). It was defined as cognitive decline when RCIMoCA＜-1. The binary logistic regression model was used to explore the independent influencing factors of long-term cognitive decline in adult patients with MMD. Results A total of 53 patients completed the long-term follow-up, including 13 patients who underwent combined revascularization, 22 patients who underwent indirect revascularization, and 18 patients who did not undergo surgery. The MoCA scores of the overall population tended to stabilize during the long-term follow-up period (P=0.694). Patients who underwent combined revascularization [21 (18-25) points vs. 19 (17-24) points, P=0.035] and indirect revascularization [20 (17-22) points vs. 19 (16-22) points, P =0.047] showed improvement in MoCA scores at short-term follow-up, but tended to stabilize relative to baseline at long-term follow-up. There was no significant decrease in MoCA scores in patients who did not undergo surgery at short-term follow-up, but there was a decrease in MoCA scores compared with baseline at long-term follow-up [15 (11-24) points vs. 18 (14-26) points, P=0.039]. Over time, the cognitive function of adult patients with MMD tended to worsen, while the anxiety and depression status tended to improve. There was a significant difference in the proportion of surgical treatment between the two groups with and without cognitive decline during the long-term follow-up (P=0.037), but logistic regression did not find it as an independent influencing factor (P>0.05). Conclusions During long-term follow-up, the cognitive function of adult patients with MMD generally remain stable, and the anxiety and depression status tends to improve. Revascularization may have a positive effect on maintaining long-term cognitive stability, and future studies with larger sample sizes are needed. [ABSTRACT FROM AUTHOR]

Objective To explore the sleep quality and influencing factors in patients with chronic cerebral ischemia represented by Moyamoya disease without stroke, and analyze the correlation between sleep quality and postoperative ischemic symptoms and stroke. Methods A total of 138 Moyamoya disease patients without stroke confirmed by imaging were prospectively included, and clinical data including gender, age, initial symptoms, and comorbidities were collected. The Pittsburgh sleep quality index scale was used to assess the patient’s preoperative sleep quality, and the HAMD-17 and MoCA were used to evaluate preoperative depression status and cognitive function, respectively. Clinical characteristics, cognitive function, and depression status were compared between the normal sleep quality group and the decreased sleep quality group. Multivariate logistic regression analysis was used to analyze the risk factors affecting patient’s sleep quality. Patients who underwent cerebral revascularization were followed up to determine the differences in the incidence of postoperative ischemic events and stroke between the normal and decreased sleep quality groups. Results A total of 52(37.7%) patients with Moyamoya disease experienced decreased sleep quality. Patients with decreased sleep quality were older (P=0.002), had poorer cognitive function (P=0.017), and exhibited more significant depressive tendencies (P=0.012) than those with normal sleep quality. Multivariate analysis suggested that age (OR 1.05, 95%CI 1.01-1.09, P=0.021) and HAMD-17 score (OR 1.11, 95%CI 1.01-1.23, P=0.035) were independent risk factors for decreased sleep quality. Additionally, during the postoperative follow-up, patients with a preoperative decrease in sleep quality had a higher incidence of ischemic symptoms (P=0.008). There was no significant difference in stroke recurrence rates between the two groups. Conclusions Patients with Moyamoya disease without stroke have a higher proportion of sleep disorders, which are associated with postoperative ischemic events, highlighting the need for enhanced assessment and intervention of sleep quality in clinical practice. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects and reliability of different temporary occlusion techniques in end-to-side anastomosis of the superficial temporal artery-middle cerebral artery. Methods A retrospective analysis was conducted on the data of patients with Moyamoya disease who underwent direct bypass surgery in the Department of Neurosurgery, Nanfang Hospital, Southern Medical University, from January 2015 to April 2023. The patients were divided into three groups according to the different temporary occlusion strategies: ①multi-clips+rubber pad group (M+R group); ②multi-clips group (M group); and ③single-clip group (S group). Temporary occlusion time, presence of errhysis after recipient artery incision, intraoperative perforator vessel injury, and postoperative novel cerebral infarction were compared among the three groups. Results A total of 355 patients and 360 cerebral hemispheres were included in the analysis, and 360 patients were counted according to the number of cerebral hemispheres, including 188 males and 172 females, with an average age of (43.8±0.7) years. There were 45 cases in the M+R group, 191 cases in the M group, and 124 cases in the S group. The average occlusion time were (37.9±9.8) minutes in the M+R group, (20.9±9.0) minutes in the M group, and (11.0±3.5) minutes in the S group, with significant differences between the groups (P<0.001). The incidence of intraluminal errhysis of the recipient artery after occlusion and intraoperative perforator vessel injury was 8.89% in the M+R group (4 cases of recipient artery errhysis after occlusion), 14.66% in the M group (19 cases of recipient artery errhysis after occlusion, 8 cases of intraoperative perforator vessel injury, and 1 case of thrombosis at the temporary occlusion site), and 5.65% in the S group (7 cases of recipient artery errhysis after occlusion), with no significant difference between the groups (P>0.05). There was no significant difference in the incidence of novel cerebral infarctions postoperatively (P>0.05). Conclusions The single-clip occlusion strategy is safe and effective, which significantly shortens the temporary occlusion time, and should be prioritized as the temporary occlusion technique in end-to-side anastomosis of the superficial temporal artery-middle cerebral artery. [ABSTRACT FROM AUTHOR]

Objective To explore the correlation between CT perfusion and DSA collateral compensation and the risk factors affecting cerebral hemisphere perfusion in patients with Moyamoya disease. Methods A total of 115 adult Moyamoya disease patients with 230 cerebral hemispheres were enrolled in this study, and their DSA and CT perfusion data were collected. The ASPECTS was used to divide the brain regions and score four perfusion hemodynamic indicators including time to peak (TTP), mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV), and to score the cerebrovascular collateral compensation displayed by DSA. Spearman correlation analysis and multiple linear regression analysis were performed on the four perfusion hemodynamic indicators and the DSA collateral compensation score. Results In 115 patients with Moyamoya disease, MTT score (r=0.41, P<0.01) was positively correlated with the DSA collateral compensation score. The DSA collateral compensation score (β=0.31, P=0.02), gender (β=1.20, P=0.01), clinical type (β=2.94, P<0.01), and history of stroke (β=-1.19, P=0.02) were independent influencing factors for cerebral perfusion changes. Female patients had better perfusion than male patients (P=0.02), hemorrhagic patients had better perfusion than ischemic patients (P=0.01), and patients without a history of stroke had better perfusion than those with a history of stroke (P=0.03). Conclusions The DSA collateral compensation score was correlated with the MTT score. Moreover, the DSA collateral compensation score, gender, clinical type, and history of stroke were independent influencing factors for cerebral hemisphere perfusion. CT perfusion should be considered when evaluating bypass vessels, neovascularization, and postoperative prognosis. [ABSTRACT FROM AUTHOR]

Moyamoya disease is a chronic progressive cerebrovascular disease of unknown etiology, which is most prevalent in children and young adults in East Asia. Over the past two decades, there have been rapid advancements in basic and clinical research on Moyamoya disease, leading to groundbreaking developments, particularly in susceptible gene studies. However, while progress has been made, there are still many problems and challenges. Is genetic testing necessary? What are the differences between Moyamoya disease in children and adults? Are asymptomatic patients truly asymptomatic? Can Moyamoya disease be clearly distinguished from Moyamoya syndrome? Can patients with hemorrhagic Moyamoya disease benefit from surgery? A series of questions continue to perplex clinicians in the field. In the future, researchers need to conduct high-quality basic and clinical research to dispel the “fog” surrounding the diagnosis and treatment of Moyamoya disease. [ABSTRACT FROM AUTHOR]

目的 本研究对烟雾病患者血管样本的差异表达基因（differentially expressed genes，DEGs）进行生物信息学鉴定和分析，旨在探讨烟雾病的潜在发病机制。 方法 本研究以烟雾病和颈内动脉瘤患者大脑血管样本为研究对象。利用R语言线性模型微阵列数据（linear models for microarray data，limma）分析包对基因表达综合数据库（gene expression omnibus，GEO）中的GSE141025数据集进行分析，该数据集涵盖4例烟雾病患者和4例颈内动脉瘤患者的大脑中动脉和颞浅动脉样本各1个，共计16个样本。选择烟雾病患者的大脑中动脉、颞浅动脉及颈内动脉瘤患者的颞浅动脉共12个样本进行DEGs筛选。通过R语言功能富集分析工具包clusterProfiler，对筛选出的DEGs进行基因本体（gene ontology，GO）富集分析和京都基因与基因组百科全书（Kyoto encyclopedia of genes and genomes，KEGG）通路分析。利用STRING数据库构建蛋白质-蛋白质相互作用（protein-protein interaction，PPI）网络，并使用网络可视化软件Cytoscape进行蛋白质网络的可视化和枢纽基因筛选。 结果 本研究在烟雾病患者的大脑中动脉与颞浅动脉样本间鉴定出138个DEGs，包括18个上调基因和120个下调基因。GO富集分析显示，以上DEGs在细胞外基质、受体配体活性和生长因子活性等方面显著富集，可能与烟雾病相关的血管病变和神经保护机制有关。KEGG通路分析提示，DEGs主要在酪氨酸代谢通路中富集。通过PPI网络分析，共筛选出9个枢纽基因，包括骨膜蛋白（periostin，POSTN）、脑源性神经营养因子（brain derived neurotrophic factor，BDNF）、血小板衍生生长因子受体α（platelet derived growth factor receptor alpha，PDGFRA）、Thy-1细胞表面抗原（Thy-1 cell surface antigen，THY1）、ⅩⅤ型胶原蛋白α1链（collagen type ⅩⅤ alpha 1 chain，COL15A1）、成纤维细胞生长因子7（fibroblast growth factor 7，FGF7）、光蛋白聚糖（lumican，LUM）、层粘连蛋白α2亚基（laminin subunit alpha 2，LAMA2）和RELN（reelin）。此外，上调基因delta样典型Notch配体4（delta like canonical Notch ligand 4，DLL4）在本研究中首次被发现可能在烟雾病中扮演重要角色，或与烟雾病的病理性血管生成有关。 结论 细胞外基质、生长因子及其受体的表达失调等可能参与烟雾病的发病过程。DEGs分析筛选出的枢纽基因（POSTN、BDNF、PDGFRA、THY1、COL15A1、FGF7、LUM、LAMA2、RELN）以及DLL4可能在烟雾病的病理形成过程中发挥作用。 Abstract: Objective In this study, bioinformatics analysis of differentially expressed genes (DEGs) between blood vessel samples of patients with moyamoya disease were conducted to explore the potential pathogenesis of moyamoya disease. Methods The cerebral blood vessel samples from patients with moyamoya disease and internal carotid aneurysm were taken as research subjects. The linear models for microarray data (limma) package in R was used to analyze the GSE141025 dataset downloaded from the gene expression omnibus (GEO). The dataset included samples from 4 moyamoya disease patients and 4 internal carotid aneurysm patients, providing a total of 16 samples including one middle cerebral artery and one superficial temporal artery from each patient. A total of 12 samples of middle cerebral artery and superficial temporal artery from moyamoya disease patients and superficial temporal artery from internal carotid aneurysm patients were selected for DEGs screening. Gene ontology (GO) enrichment analysis and Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis on the DEGs were conducted using the clusterProfiler package in R. The STRING database was utilized to construct the protein-protein interaction (PPI) network, and the network visualization software Cytoscape was used to visualize the protein network and to filter hub genes. Results In the comparison between middle cerebral artery and superficial temporal artery samples from patients with moyamoya disease, 138 DEGs were identified, including 18 up-regulated genes and 120 down-regulated genes. GO enrichment analysis revealed that these DEGs were significantly enriched in extracellular matrix, receptor ligand activity, and growth factor activity, suggesting their potential involvement in vasculopathy and neuroprotective mechanisms associated with moyamoya disease. KEGG pathway analysis indicated that DEGs were primarily enriched in the tyrosine metabolic pathway. Through PPI network analysis, 9 hub genes were filtered, including periostin (POSTN), brain derived neurotrophic factor (BDNF), platelet derived growth factor receptor alpha (PDGFRA), Thy-1 cell surface antigen (THY1), collagen type ⅩⅤ alpha 1 chain (COL15A1), fibroblast growth factor 7 (FGF7), lumican (LUM), laminin subunit alpha 2 (LAMA2) and reelin (RELN). Additionally, the up-regulated gene delta like canonical Notch ligand 4 (DLL4) was firstly founded possibly associated with pathological angiogenesis of moyamoya disease in this study, suggesting that it may play a significant role in moyamoya disease. Conclusions The study indicates that the dysregulation of the expression of extracellular matrix components, growth factors and their receptors might be involved in the pathogenesis of moyamoya disease. The hub genes selected by DEGs analysis (POSTN, BDNF, PDGFRA, THY1, COL15A1, FGF7, LUM, LAMA2, RELN) and DLL4 may play a role in the pathological process of moyamoya disease.

Objective To explore the clinical efficacy of superficial temporal artery dressing for Moyamoya disease(MMD) in children. Methods From January 2020 to August 2022, the clinical data were retrospectively reviewed for 18 hospitalized MMD children at Affiliated Children's Hospital of Shandong University. Clinical efficacies were evaluated by success rate, postoperative complication rate, improvements of clinical symptoms and changes of imaging features. Results A total of 28 operations were completed successfully. During hospitalization, there was no occurrence of such serious complications as cerebral hemorrhage, cerebral infarction or seizure. However, one child of motor aphasia failed to open mouth. One case of had brief slurred speech after an initial operation and developed transient facial tics after contralateral operation. And another child developed transient weakness of right upper arm due to emotional agitation. Cranial MRA after Month 3 hinted at neovascularization. Cerebral perfusion significantly improved. During a follow-up period of(3-31) month, mRS grade was 0 ( n=13), 1 ( n=3), 2 ( n=1) and 4 ( n=1). Conclusions For MMD in children, superficial temporal artery patching offers a high success rate, few complications, obvious symptomatic improvements and a definite efficacy. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Anomalous paraventricular anastomosis is a new nomenclature for collateral vessels in the study of moyamoya disease(MMD). It mainly includes choroidal anastomosis, thalamic anastomosis and lenticulostriate anastomosis. According to reports, it is associated with the high risk of intracranial hemorrhage in adult patients with MMD, causing significant harm to patients and their families. In recent years, significant progress has been made in the study of collateral vessels of MMD, including the imaging features, the relationship between collateral vessels and clinical symptoms, the natural history of collateral vessels and their changes after revascularization. This review aims to analyze the recent researches on paraventricular anomalous anastomosis in MMD, explore the treatment strategies, and put forward its research challenges and future research directions. [ABSTRACT FROM AUTHOR]

Moyamoya disease (MMD) is a chronic cerebrovascular disease of unknown etiology characterized by progressive stenosis or occlusion of unilateral or bilateral terminal internal carotid arteries, accompanied by the abnormal cerebrovascular network (moyamoya vessels) at the skull base. In recent years, with the continuous improvement of medical technology and research level, the detection rate of peri-operative cognitive changes in MMD patients has gradually increased. This paper reviews the clinical manifestations, pathogenesis and influencing factors of peri-operative cognitive changes in patients with ischemic MMD, and focuses on the electroencephalogram (EEG) and magnetic resonance imaging (MRI) features associated with cognitive impairment in patients with MMD. [ABSTRACT FROM AUTHOR]

烟雾病是一种原因不明的慢性血管性疾病，其特征为颅内血管进行性狭窄、闭塞及异常血管网形成。临床可表现为缺血性或出血性卒中、头痛、癫痫等，治疗包括外科手术及药物治疗。本文通过对1例烟雾病所致缺血性卒中患者治疗前后的临床疗效比较并观察不良反应的发生情况，探讨金纳多序贯治疗的疗效及可行性，以供临床参考。 Abstract: Moyamoya disease is a chronic vascular disease of unknown cause, characterized by progressive intracranial vascular stenosis, occlusion and abnormal vascular network formation. It can be clinically manifested as ischemic or hemorrhagic stroke, headache, epilepsy, etc. Treatment includes surgery and drug therapy. In this paper, the clinical efficacy of a case of ischemic stroke caused by moyamoya disease was compared before and after treatment, and the occurrence of adverse reactions was observed, so as to explore the efficacy and feasibility of sequential therapy of Ginaton for clinical reference.

烟雾病(moyamoya disease，MMD)的特征性病变为双侧颈内动脉终末段及大脑中动脉、大脑前动脉起始段进行性狭窄闭塞，导致脑缺血及缺血后脆弱的血管破裂引起脑出血。基于脑-颈血管一体化，颅外及颅内不同节段血流状态相互影响，可通过检测特定节段血流参数提示疾病发展进程，从而指导临床策略的选择。深入了解烟雾病不同节段血流状态及疾病发展进程对疾病诊疗有重要作用。本文对烟雾病颅外及颅内不同节段血管参数、侧支循环及其与临床预后的相关性进行综述，为后续针对颅内动脉狭窄或闭塞引起的缺血性及出血性相关脑血管病诊疗与研究提供参考。 Moyamoya disease (MMD) is characterized by progressive stenosis and occlusion of the terminals of bilateral internal carotid artery, the initial segment of middle cerebral artery and anterior cerebral artery, which leads to cerebral ischemia and hemorrhage due to fragile vessels rupture after ischemia. The blood flow of different segments of intracranial and extracranial vessels can influence each other, and the detection of blood flow parameters in specific segments can reveal the progression of disease, which can guide clinical decision making. It is important for diagnosis and treatment of MMD to understand and master blood flow changes of different segments and progression of MMD. This article reviewed the correlation of different extracranial and intracranial vascular parameters, collateral circulation and clinical prognosis of MMD, providing reference for the diagnosis and treatment of ischemic and hemorrhagic cerebrovascular diseases caused by intracranial artery stenosis or occlusion.

Moyamoya disease (MMD) is a chronic progressive occlusive cerebrovascular disease, the pathogenesis of which is still unclear. There is growing evidence that immunoinflammatory factors are involved in the development of MMD. Immune-related genes, inflammatory markers, and immune cells are expressed aberrantly in MMD. This paper reviews the recently progressed research on immune inflammation in the pathogenesis of MMD [ABSTRACT FROM AUTHOR]

烟雾病是一种以双侧颈内动脉末端及大脑前动脉、大脑中动脉起始部慢性进行性狭窄或闭塞为特征，并继发颅底异常血管网形成的脑血管疾病。甲状腺功能亢进继发烟雾病的发病机制尚不清楚，可能与甲状腺功能、免疫与炎症、遗传因素等有关。免疫和炎症相关的分子变化对血管内皮细胞和平滑肌细胞的影响，可能在颅内大动脉狭窄、闭塞和烟雾血管的形成中起着重要作用。本文对甲状腺功能亢进继发烟雾病的可能病理生理学机制、免疫与炎症、遗传因素等发病机制进行综述。 Abstract: Moyamoya disease is a kind of cerebrovascular disease characterized by chronic progressive stenosis or occlusion at the end of bilateral internal carotid arteries and the beginning of anterior cerebral arteries and middle cerebral arteries, followed by abnormal vascular network formation at the skull base. The pathogenesis of moyamoya disease secondary to hyperthyroidism is still unclear, and may be related to the thyroid function, immunity and inflammation, and genetic factors. The effects of immunity and inflammation related molecular changes on vascular endothelial cells and smooth muscle cells, may play a key role in the formation of moyamoya vessels and large intracranial artery stenosis and occlusion. This paper summarized the pathogenesis of moyamoya disease secondary to hyperthyroidism by reviewing the available literature.

Objective To investigate the preventive effect of aspirin on cerebral infarction after vascular bypass grafting in moyamoya disease（MMD）. Methods Clinical data of 565 patients with MMD who received vascular bypass grafts in the Department of Neurosurgery, the First Affiliated Hospital of Nanchang University from January 2014 to October 2019 were analyzed retrospectively. They were divided into aspirin group（406 cases） and non-aspirin group（159 cases, control group） according to whether aspirin was used after surgery. In order to clarify the role of aspirin in the occurrence of cerebral infarction after MMD, the incidence of cerebral infarction during perioperative period and cerebral hemorrhage within 3 months after surgery in the two groups was statistically analyzed. Neurological function at admission, discharge, and 3 months after surgery was assessed by using modified Rankin scale（mRS） score. Results Among the 565 patients, 26 were diagnosed with postoperative cerebral infarction. The incidence of perioperative cerebral infarction was 3.2%（13/406） in the aspirin group,and the incidence of cerebral hemorrhage was 1. 2%（ 5/406） within 3months after surgery. In the control group,the incidence of cerebral infarction in the perioperative period was 8. 2%（ 13/159）,and the incidence of cerebral hemorrhage in the 3 months after surgery was 0. 6%（ 1/159）. There were no significant differences in gender,age and history of hypertension between 2 groups（ all P ＞ 0. 05）. There were statistically significance in perioperative cerebral infarction,transient ischemic attack,mRS Score at discharge and neurological deterioration at discharge between the two groups（ all P ＜ 0. 05）. There were no significant differences in cerebral hemorrhage 3 months after surgery,mRS score 3 months after surgery and neurological function 3months after surgery between the two groups（ all P ＞ 0. 05）. Univariate analysis showed that patients’ age,history of hypertension and diabetes,and posterior cerebral artery stenosis or occlusion were possible influencing factors for cerebral infarction after MMD（ all P ＜ 0. 05）. Multivariate Logistic regression analysis showed that history of hypertension（ OR = 0. 204,95% CI: 0. 067-0. 623,P = 0. 005）,infarct MMD（ OR = 0. 084,95% CI: 0. 025-0. 277,P ＜ 0. 001）,left vascular bypass（ OR = 0. 234,95% CI: 0. 076-0. 720,P = 0. 011）,posterior cerebral artery stenosis OR occlusion（ OR = 0. 008,95% CI: 0. 002-0. 037,P ＜ 0. 001） was a risk factor for cerebral infarction after MMD,and postoperative aspirin（ OR = 2. 897,95% CI: 1. 024-8. 197,P = 0. 045） was a protective factor for preventing cerebral infarction after MMD. Conclusion Routine use of aspirin after vascular bypass surgery can reduce the incidence of acute cerebral infarction in patients with MMD. [ABSTRACT FROM AUTHOR]

Objective To investigate the efficacy and safety of hyperbaric oxygen therapy（HBOT） in the treatment of patients with moyamoya disease（MMD）. Methods The clinical data of 26 patients with MMD admitted to Nanjing Zijin Hospital from January 2020 to December 2021 were analyzed retrospectively. The analysis indicators mainly included age, after onset course, blood pressure, HBOT frequency and pressure, primary disease, surgical choice, consciousness in admission and discharge, limb function, and the adverse cerebrovascular disease events. Results The average age of the enrolled patients was（45.2±15.2）years old. The patients were admitted to the hospital for treatment within 1 month of the onset. The blood pressure of most patients fluctuated in the normal range when they were admitted to the hospital, and the blood pressure of a few patients fluctuated and stabilized after treatment. Of 26 patients, 13 had ischemic MMD, and 13 had hemorrhagic MMD. Of 26 patients, 21 received HBOT for 20 to 60 times, and 5 received more than 60 times. The pressure of HBOT was mainly 1.6 ATA or 1.6/2.0 ATA. No cerebrovascular events occurred during treatment. Among 26 patients, 21 improved significantly, 4 improved, and 1 remained unchanged. Conclusions HBOT can be used in children and adults with ischemic and hemorrhagic MMD, especially in the patients treated with intracranial revascularization and/or hematoma removal. No adverse cerebrovascular disease events such as rebleeding and reinfarction are observed during HBOT. Before and during HBOT, the patient’s blood pressure and intracranial pressure must be under good control, and different pressure therapies should be given according to different patients. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

目的 研究烟雾病脑血管重建术后出现过度灌注综合征患者的血压及液体控制护理方案的效果。 方法 前瞻性连续入组2019年9月-2022年1月在首都医科大学附属北京天坛医院行颅内外脑血管重建术后7 d内合并过度灌注综合征的成人烟雾病患者为研究对象，采用数字法将患者随机分为对照组和研究组。对照组进行常规护理，研究组在常规护理基础上进行动态血压调整、液体管理的个体化护理措施，使用mRS、Barthel指数和纽卡斯尔护理满意度量表（Newcastle satisfaction with nursing scale，NSNS）分别评价两组患者出院时神经功能预后和护理满意度，以mRS 0～1分为神经功能预后良好。 结果 共入组112例患者，对照组和研究组各56例，两组的基线资料差异无统计学意义。出院时研究组神经功能预后良好比例优于对照组（48.2% vs. 26.8%，P=0.036）；研究组Barthel指数高于对照组（82.5±7.1分 vs. 78.2±9.5分，P=0.007）；研究组的护理满意度也高于对照组（96.4% vs. 83.9%，P=0.026）。 结论 对烟雾病颅内外脑血管重建术后过度灌注患者实施个体化血压和液体管理可改善患者的神经功能预后，提高日常生活能力，且患者对护理的满意度较高。 Abstract: Objective To explore the effect of blood pressure and liquid control in moyamoya disease (MMD) patients with cerebral hyperperfusion syndrome after extracranial-intracranial (EC-IC) bypass. Methods The MMD patients with hyperperfusion complication within 1 week after EC-IC bypass in Beijing Tiantan Hospital, Capital Medical University between September 2019 and January 2022 were prospectively enrolled in this study. Participants were randomly divided into control group and observation group. The control group received routine nursing care, while the observation group received individualized nursing with dynamic management of blood pressure and liquid control based on routine nursing. The mRS, Barthel index (BI), and Newcastle satisfaction with nursing scale (NSNS) were used to evaluate the functional prognosis and nursing satisfaction at discharge. The favorable prognosis was defined as a mRS score of 0-1. Results A total of 112 eligible patients were included, with 56 cases in each group. There was no statistical difference in baseline data between the two groups. The percentage of favorable prognosis in observation group was higher than that in control group (48.2% vs. 26.8%, P=0.036). The BI in observation group at discharge was higher than that in control group (82.5±7.1 points vs. 78.2±9.5 points, P=0.007). Nursing satisfaction in observation group was higher than that in control group (96.4% vs. 83.9%, P=0.026). Conclusions Individualized management of blood pressure and liquid control for MMD patients with hyperperfusion syndrome after direct revascularization can improve the patients’ functional prognosis, and enhance their activities of daily living.

烟雾病（moyamoya disease，MMD）是一种颈内动脉末端及其分支起始处进行性狭窄伴颅底异常血管网形成的脑血管疾病，临床上常将其分为缺血型、出血型和无症状型。随着诊疗技术的进步，对MMD临床分型的流行病学特征认识也在不断发展。在成年患者中，缺血型MMD占有重要地位，无症状型亦呈逐渐增多的趋势。不同临床分型MMD的发病年龄、遗传背景、病理生理机制、侧支血管代偿、受累血管分布及其预后存在显著差异。本文总结了对MMD临床分型流行病学特征认识的历史演变，不同临床分型可能的遗传背景、病理生理机制和影像学表现上的差异，为基于不同临床分型的MMD治疗决策提供新的思路。 Abstract: Moyamoya disease (MMD) is a cerebrovascular disease characterized by progressive stenosis of internal carotid arteries and their proximal branches with abnormal vascular network at skull base, which is clinically divided into ischemic, hemorrhagic and asymptomatic types. With the progress of diagnosis and treatment technology, the understanding of epidemiological characteristics of different clinical classification of MMD has developed. The majority of adult patients are ischemic type and the asymptomatic type is gradually increasing. The age of onset, genetic background, pathophysiological mechanism, collateral vascular compensation, distribution of involved vessels and prognosis of MMD were significantly different among different types. This article summarized the historical evolution of epidemiological characteristics, the possible genetic background, pathophysiological mechanism and imaging manifestations of different clinical classification of MMD, to provide new ideas for clinical treatment strategy of MMD.

目的 探索青年烟雾病患者的卒中类型及临床特征，分析青年烟雾病患者发生卒中的危险因素。 方法 回顾性纳入2020年1月-2021年12月解放军总医院第五医学中心收治的青年（18～45岁）卒中型烟雾病患者，将患者分为出血性卒中组和缺血性卒中组进行亚型分析，对比不同卒中类型患者的临床及影像学特征。并以同期未发生卒中的烟雾病患者作为对照组，应用多因素logistic回归分析青年烟雾病患者发生出血性或缺血性卒中的危险因素。 结果 共入组108例卒中型烟雾病患者，其中出血性卒中22例（20.4%），缺血性卒中86例（79.6%）。出血性卒中组中脑室出血12例（54.5%），脑实质出血7例（31.8%），蛛网膜下腔出血3例（13.6%）。缺血性卒中组中大动脉梗死型21例（24.4%），血流动力学梗死36例（41.9%），穿支动脉梗死29例（33.7%）。出血性卒中组与缺血性卒中组性别和合并动脉瘤者比例的差异有统计学意义。无卒中对照组共104例，多因素logistic回归分析结果显示，合并动脉瘤（OR 10.569，95%CI 1.524～73.274，P=0.017）为青年烟雾病患者发生出血性卒中的独立危险因素；增龄（OR 1.058，95%CI 1.004～1.115，P=0.034）、合并糖尿病（OR 4.005，95%CI 1.766～9.080，P=0.001）、高铃木分期（OR 1.363，95%CI 1.037～1.793，P=0.027）为青年烟雾病患者发生缺血性卒中的独立危险因素。 结论 青年烟雾病患者的卒中类型以缺血性卒中为主。血流动力学梗死和脑室出血分别是缺血性卒中和出血性卒中的主要类型。增龄、高铃木分期、合并糖尿病和颅内动脉瘤是引起青年烟雾病患者卒中的独立危险因素。 Abstract: Objective To explore the stroke types and clinical characteristics of in young patients with moyamoya disease, and to analyze the risk factors of stroke in young patients with moyamoya disease (MMD). Methods The clinical and imaging data of MMD with stroke patient (age 18 to 45 years old) between January 2020 and December 2021 who were admitted to the Fifth Medical Center of PLA General Hospital were retrospectively analyzed. The MMD patients with stroke were divided into hemorrhagic stroke and ischemic stroke groups, imaging and clinical features of patients with different stroke types were compared. The MMD patients without stroke during the same period were selected as the control group, and multivariate logistic regression analysis was used to analyze the risk factors of hemorrhagic stroke and ischemic stroke in young MMD patients. Results A total of 108 patients with stroke were enrolled, including 22 cases (20.4%) of hemorrhagic stroke and 86 cases (79.6%) of ischemic stroke. A total of 104 subjects in control group were included. In hemorrhagic stroke group, there were 12 cases (54.5%) intraventricular hemorrhage, 7 cases (31.8%)of parenchymal hemorrhage, 3 cases (13.6%) of subarachnoid hemorrhage. In ischemic stroke group, there were 21 cases (24.4%) of larger artery infarction type, 36 cases (41.9%) of hemodynamic infarction type, and 29 cases (33.7%) of perforating artery infarction type. There were statistical differences in gender and the percentage of aneurysms between hemorrhage stroke group and ischemic stroke group. Multivariate logistic regression analysis showed that aneurysm was a risk factor for hemorrhagic stroke in young MMD patients (OR 10.569, 95%CI 1.524-73.274, P=0.017); age increasing (OR 1.058, 95%CI 1.004-1.115, P=0.034), Suzuki stage (OR 1.363, 95%CI 1.037-1.793, P=0.027) and diabetes mellitus (OR 4.005, 95%CI 1.766-9.080, P=0.001) were independent risk factors for ischemic stroke in young MMD patients. Conclusions The main type of stroke in young MMD patients is ischemic stroke. For MMD patients with stoke, hemodynamic infarction type was the main type of ischemic stroke, and ventricular hemorrhage was the main type of hemorrhagic stroke. Age, Suzuki stage, diabetes mellitus and intracranial aneurysm were independent risk factors for stroke in young MMD patients.

目的 探索烟雾病（moyamoya disease，MMD）患者血运重建术后非感染性发热的发病率、临床特点及其影响因素。 方法 回顾性分析2019年11月-2021年2月连续接受血运重建术治疗的MMD患者，收集患者人口学信息、MMD发病类型、既往病史、Suzuki分期、烟雾血管（前后循环）、手术类型和侧别、手术时长、术后血常规检查、术后体温和出院时mRS（＞2分为预后不良）等临床信息。以术后14 d内的是否出现非感染性发热（1次体温>38 ℃且无系统性感染证据）分为发热组和无发热组，采用多因素logistic回归分析术后发热的影响因素。 结果 共纳入110例MMD患者，累及143个大脑半球，91例次（63.6%）出现术后非感染性发热，其中81例次（89.0%）发生于术后2 d内。单因素分析发现，术后发热组中成人比例（74.7% vs. 88.5%，P=0.049）、男性比例（37.4% vs. 63.5%，P=0.003）、术后红细胞压积[（33.6±4.2）% vs.（35.8±4.3）%，P=0.004）]、红细胞计数[（3.9±0.5）×1012/L vs.（4.1±0.5）×1012/L，P=0.004]和白细胞计数[（11.4±3.6）×1012/L vs.（12.8±3.5）×1012/L，P=0.031]低于无发热组，后循环受累比例（35.2% vs. 11.5%，P=0.002）高于无发热组，另外，术后发热组出院预后不良率低于无发热组（4.4% vs. 15.4%，P=0.049）。logistic回归显示后循环受累的患者更易出现术后非感染性发热（OR 3.731，95%CI 1.265～10.998，P=0.017）。 结论 MMD患者在血运重建手术治疗后非感染性发热较常见，其中后循环受累的患者更易出现术后发热。 Abstract: Objective To investigate the incidence and risk factors of postoperative non-infective fever (POF) after cerebral revascularization in moyamoya disease (MMD). Methods This retrospective study enrolled the consecutive patients with MMD who received revascularization surgery at Beijing Neurosurgical Institute between November 2019 and February 2021. Clinical information were collected and analyzed. The poor prognosis at discharge was defined as a mRS score >2. POF was defined as postoperative temperature > 38℃ without systematic infection evidence within 14 days after surgery. A multivariate logistic regression analysis was conducted to determine the risk factors for POF. Results A total of 110 patients including143 hemispheres were included in the final analysis. POFs occurred in 91 patients (63.6%), 81 (89.0%) of whom had a fever within 2 days after surgery. Univariable analysis showed the proportion of adults (74.7% vs. 88.5%, P=0.049) and males (37.4% vs. 63.5%, P=0.003) and poor prognosis at discharge (4.4% vs. 15.4%, P=0.049), and postoperative hematocrit [(33.6±4.2)% vs. (35.8±4.3)%, P=0.004], red blood cell counts [(3.9±0.5)×1012/L vs. (4.1±0.5)×1012/L, P=0.004)], and white blood cell counts [(11.4±3.6)×1012/L vs. (12.8±3.5)×1012/L, P=0.031)] were lower in patients with POF than those in patients without POF, while the proportion of posterior circulation involvement (35.2% vs. 11.5%, P=0.002) was higher in patients with POF than that in ones without POF. Logistic regression analysis showed that the patients with posterior circulation involvement were more likely to have POF (OR 3.731, 95%CI 1.265-10.998, P=0.017). Conclusions POF was more common in MMD patients after cerebral revascularization, especially ones with posterior circulation involvement.

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

缺血性脑血管病主要是由于脑血管动脉粥样硬化造成的急性, 慢性脑损害.动脉粥样硬化造成的血管壁 损害是缺血性脑血管病最主要的病因.正电子发射断层显像术（PET）利用放射性核素标记的化合物作为探针，可 以从炎症, 乏氧, 微钙化及新生血管生成多个方面评估动脉粥样硬化斑块破裂的风险，可以从脑血流量阈值, 乏氧状 态, 葡萄糖代谢情况评估急性脑梗死患者的缺血半暗带和梗死核心，可以从神经细胞内线粒体功能状态, 神经元γ 氨基丁酸的含量, 小胶质细胞的活化情况评估急性脑梗死后神经细胞损伤和周围炎症反应，还可以从脑血流灌注情 况, 脑血管储备功能及脑氧代谢方面评估脑动脉粥样硬化性狭窄闭塞和烟雾病造成的慢性脑损害的严重程度及 预后. [ABSTRACT FROM AUTHOR]

Objective To observe the efficacy and prognosis after superficial temporal artery- middle cerebral artery anastomosis combined with encephalo-duro-myo-synangiosis compared with encephalo-duro-myo-synangiosis. Methods The clinical data of 166 patients with moyamoya disease (MMD) treated with combined superficial temporal artery-middle cerebral artery anastomosis and encephalo-duro-myo-synangiosis (STA-MCA + EDMS) or indirect encephalo-duro-myo-synangiosis (EDMS) from June 2018 to June 2021 at the Affiliated Brain Hospital of Nanjing Medical University were analyzed retrospectively. The postoperative efficacy, surgical complications and their long-term prognosis of the two groups were observed. Results Postoperative angiographic scores were superior to indirect procedures for patients with ischemic and hemorrhagic MMD (P = 0.009) for combined procedures. Further ROC curve analysis of symptomatic patients showed that the combined operation when the age was > 49.5 years had a certain predictive effect on the poor ability of postoperative angiogenesis (P<0.001). When the age was more than 42.5 years old, indirect surgery had a certain predictive effect on the poor ability of postoperative angiogenesis (P = 0.046). (P > 0. 05). Conclusion This study suggests that combined operation is better than indirect operation in the neovascularization after operation, and patients should be diagnosed and treated with early intervention. [ABSTRACT FROM AUTHOR]

Objective To study and evaluate the clinical effects of Dl-3-N-butylphthalide (NBP) soft capsule on perioperative stroke and neurological function recovery in patients with moyamoya disease (MMD). Methods 101 patients (121 hemispheres underwent STA-MCA revascularization) with ischemic MMD who were admitted to the Department of Neurosurgery of Drum Tower Hospital Affiliated to Nanjing University Medical School from January 2018 to August 2019 were analyzed retrospectively. 43 cases of them received 90 days of NBP treatment after surgery. A subgroup analysis was performed based on the type of disease and preoperative nervous system status to determine the specific characteristics of patients who may benefit from NBP. Results Baseline characteristics were different in preoperative stroke and modified Rankin scale (mRS) scores for patients treated with NBP and those not treated with NBP throughout the cohort. There were 11 cases of postoperative stroke and 21 cases of TND between the two groups, and there was no significant difference in incidence between the two groups. However, TND in the NBP group was less severe than that in the treatment group (P = 0.01). One month after the operation, NBP patients had a better neurological prognosis (P = 0.001) and a higher disableless recovery rate (P & LT; 0.001). As measured by mRS, the number of patients with improved neurological function was greater in the NBP group than in the NBP group (P & LT; 0.001). Multivariate analysis revealed reduced NBP and TND severity (OR 0. 28, P = 0.02), improved neurological function (OR 65. 29, P=0.04), and decreased postoperative mRS score (OR 0.06, P & LT; 0.001). These beneficial effects of NBP remained significant in patients with ischemic MMD and in patients with a preoperative mRS score of 2 or higher. The scores of nerve function defect in the treatment group were significantly better than those in the control group after 2 weeks and 1 month(P & LT; 0.05). The quality of life scores of the treatment group after 1 month of treatment and 3 months of treatment were significantly better than the control group (P&LT; 0.05). Conclusion Butylphthalide soft capsule has a positive effect on the recovery of perioperative neurological deficits in patients with MMD, and can improve patients' self-care ability, which is worthy of clinical application. [ABSTRACT FROM AUTHOR]

Objective To explore the pathogenic mechanism and management of moyamoya disease (MMD) concurrent with intracranial dural arteriovenous fistula (DAVF). Method The clinical data of 1 patient with MMD accompanied by intracranial DAVF was analyzed retrospectively. Results The patient was a young woman with ventricular hemorrhage as the primary symptom. DSA diagnosed MMD complicated with left transverse sigmoid DAVF. Six months after the right extracranial and extracranial vascular anastomosis, the reexamination showed that the bridging vessels were unobstructed and the fistula disappeared. Combined with literature review, MMD complicated with DAVF could be divided into two types: concurrent or secondary. The clinical manifestations were mostly cerebral ischemia or cerebral hemorrhage related to MMD. Intracranial and extracranial vascular anastomosis was often used, while most DAVFs were treated conservatively. Conclusions MMD with DAVF is rare and the etiology is unknown, which may be related to the increase of angiogenic factors. The treatment strategy depends on the clinical manifestation and classification of DAVFs. [ABSTRACT FROM AUTHOR]

Objectives To study the advantages and disadvantages of combined revascularization versus conservative treatment for medium-stage moyamoya disease (MMD) and to analyse the risk factors of long-term stroke. Methods A total of 67 patients with stage Ⅲ and IV MMD admitted to the Department of Neurosurgery, the First Affiliated Hospital of Kunming Medical University from August 2016 to August 2020 were analyzed retrospectively. They were divided into operation group and conservative treatment group according to different treatment methods. The average follow-up period was (22. 9 ± 14. 7) months. The modified Rankin scale (mRs) score, neurological outcome after treatment, treatment efficiency, treatment satisfaction rate, and long-term stroke were compared, and the risk factors of patients with long-term stroke were analyzed. Results The improvement in the mRS score of haemorrhagic MMD patients was more remarkable than that of ischaemic MMD patients (P =0. 01), and the long-term stroke rate was also lower (P =0. 044). In the conservative treatment group,the changes in the mRS score of ischemic MMD patients were more obvious than those of haemorrhagic MMD patients (P = 0. 02). A regression analysis showed that ischaemic MMD (P =0. 028) and transient ischaemic attack (TIA) ＞ 1/week before admission (P = 0. 006) were risk factors for long-term stroke. Conclusions For medium-stage MMD, surgery for haemorrhagic MMD can improve the mRS score when compared with conservative treatment. Patients with ischemic MMD and patients with TIA ＞ 1/week before admission are at a higher risk of long-term stroke. [ABSTRACT FROM AUTHOR]

Moyamoya vasculapathy includes moyamoya disease and moyamoya syndrome. In recent years, the incidence of moyamoya vasculapathy has gradually increased, mostly involving children and young adults. It can cause cerebral ischemia and cerebral hemorrhage, which is extremely harmful to society. Cerebral revascularization is the main method to treat the disease. Among them, combined operation is the first choice for adult patients. However, the indirect part of this operation has relative poor effect with great trauma, which leads to some patients giving up operation due to psychological burdens such as fear. The minimally invasive keyhole bypass can supplement the maximum cerebral blood flow for the affected cerebral hemisphere on the premise of minimal damage. On the basis of previous studies, the author further narrowed the bone window through the preoperative plan of 3D imaging, and proposed three important factors to improve the blood supply efficiency of the direct bypass, namely, the integrity of the recipient vascular network, the pressure difference between the donor and recipient arteries and the blood flow direction. By taking these factors into consideration, it is expected that the safety and efficacy of keyhole bypass will be further improved. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of dexmedetomidine combined with intraoperative monitoring of pulse pressure variation in patients with moyamoya disease (MMD) undergo vascular bypass. Methods 90 patients undergoing MMD for vascular bypass operation were randomly divided into three groups (n = 30). Patients in group S received dexmedetomidine alone, patients in group P received dexmedetomidine combined with pulse pressure variation, and patients in group C received the same dose of normal saline. SpO2, HR, SBP, MAP and SjvO2 were recorded at these time points: baseline (T0), 5 min after tracheal intubation (T1), skin incision (T2), opening the dura mater (T3), 1 h after dura mater (T4), occluding the dura mater (T5), operation finished (T6), and calculate the systolic blood pressure variability (SPV). The total amount of intraoperative fluid input, urine volume, bleeding volume, consciousness recovery time and tracheal tube extubation time, the proportion and total amount of noradrenaline, new cerebral infarction and cerebral hyperperfusion syndrome were recorded. Results SBP and MAP at T2 – T6 - in three groups were higher and PPV at T2 – T6 in both groups were lower than that at T0 (P < 0.05). Compared with group C, the total amount of intraoperative infusion, the recovery time of anesthesia, extubation time of tracheal tube, the proportion and total amount of noradrenaline, the incidence of recurrent cerebral infarction and cerebral hyperper fusion syndrome in group S and group P(P <0.05), group P was significantly lower than group S(P<0.05). The hemodynamic SPV was lower at T2 – T6 and SjvO2 was higher at T4 - T6 in group S and group P(P < 0.05). - Compared with group S, the hemodynamic SPV in group P was lower at T2 − T6 (P <0.05), while SjvO2 in group P at T4 - T6 has no statistical difference. Conclusions Dexmedetomidine combined with intraoperative monitoring of pulse pressure variation is safe and effective in elderly patients with MMD for vascular bypass. The time of recovery from anesthesia and extubation of tracheal tube were shorter, the hemodynamic and cerebral oxygen metabolism were more stable, and the incidence of postoperative recurrent cerebral infarction and cerebral hyperperfusion syndrome were lower. [ABSTRACT FROM AUTHOR]

甲状腺功能亢进合并颅内大动脉狭窄引起的青年急性脑梗死在临床上并不多见, 尤其甲亢合 并烟雾病更少见。该文回顾性分析3例甲状腺功能亢进合并颅内大动脉狭窄致青年急性脑梗死患者的临床表 现、影像学特点及诊治过程。 [ABSTRACT FROM AUTHOR]

Objective To investigate the changes of cerebral perfusion after superficial temporal artery (STA) - middle cerebral artery (MCA) bypass graft surgery in patients with moyamoya disease. Methods 31 patients (20 men, 11 women, mean age: 33 years) with clinically diagnosed moyamoya disease involving 44 cerebral hemispheres underwent non-contrast CT (NCCT), CT angiography (CTA) and CT perfusion (CTP) examination before and 3 months-3 years after bilateral (13) or unilateral (18) STA-MCA bypass graft surgery. Regions of interest were placed in the white matter and cerebral cortex of the MCA territory from the level of basal ganglia to the centrum semiovale. The perfusion parameters including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (ITP), and delay TIP were obtained on the post-processing CTP images before and after surgery. The changes of CTP perfusion parameters were quantitatively analyzed. Results In the white matter, there was significant difference between pre- and postoperative TIP ((15.13±4.72) s, (12.99±2.42) s, P=0.007], delay TIP ((4.11±2.21) s, (322±150) s, P=0.024], MTI ((4.37±0.94) s, (4.02±0.73) s, P=0.022)], and CBV ((2.74±0.90) ml/100 mg, (2.38±0.67) ml/100 mg, P<0.001]. The CBF showed a downward trend from (38.08±10.24) ml/100 mg· min to (36.66±9.08) ml/100 mg· min without statistical significance. Similar significant decrease was noted in the cortical TIP ((14.34±4.68) s, (11.81±2.51) s, P=0.003), delay TIP [(3.45±2.40) s, (2.40±1.29) s, P=0.012) whereas the MTI, CBF and CBV decreased slightly after surgery without statistical significance. Based on the literature and previous studies, we found that cerebral perfusion decreased to the lowest level in 6-8 months and returned to the preoperative level in about 1 year after surgery. Conclusion One-stop NCCT, CTA and CTP can evaluate the changes of brain, bypass vessels and cerebral perfusion in patients with moyamoya disease after bypass surgery. Cerebral perfusion decreased to the lowest level in 6-8 months and returned to the preoperative level in about 1 year after surgery. [ABSTRACT FROM AUTHOR]

分析烟雾病（MMD）患者搭桥手术后发生脑梗死的影响因素。方法选择行直接搭桥或直接联合 间接搭桥手术的MMD患者220例，其中术后发生脑梗死21例、未发生脑梗死199例。记录患者的一般资料（性别、 手术方式、搭桥侧别，既往是否合并高血压、糖尿病、高脂血症、脑梗死、脑出血，吸烟、饮酒史，手术前后的收缩压、舒 张压）及术中血压相关资料（收缩压、舒张压、脉压差、动脉平均压、动脉收缩压、动脉舒张压、心率），对术后发生与未 发生脑梗死患者的上述资料进行单因素及多因素Logistic回归分析。结果术后发生脑梗死患者既往合并高血压、 脑梗死的比例及术中收缩压、术中舒张压、术中动脉收缩压、术后舒张压均高于未发生脑梗死患者（P 均<0. 05）。术 后发生与未发生脑梗死患者性别、手术方式、搭桥侧别、吸烟、饮酒及合并糖尿病、高脂血症、脑出血的比例比较差异 均无统计学意义，二者术前收缩压、舒张压、术后收缩压及术中脉压差、动脉平均压、动脉舒张压、心率、脉搏比较差 异均无统计学意义（P 均>0. 05）。单因素Logistic回归分析结果显示，术后发生脑梗死者术前合并高血压、脑梗死的 比例及术后舒张压、术中收缩压均明显升高（P 均<0. 05）。多因素Logistic回归分析结果显示，术中收缩压升高是 MMD患者搭桥手术后发生脑梗死的独立危险因素（P 均<0. 05）。结论术中收缩压升高是MMD患者搭桥手术后 发生脑梗死的危险因素。 [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To explore the effect of superficial temporal artery-brain middle artery branch anastomosis combined with brain-dural-muscle fusion(STA-MCA+EDMS) and conservative treatment of moyamoya disease(MMD) and its effect on Vm and PI. MethodsA total of 160 patients with MMD between May 2015 and May 2018 were randomly divided into two groups, 80 in each group. The control group was treated with conservative therapy and the observation group was treated with STA-MCA + EDMS. The clinical efficacy of the two groups was compared. The mean velocity and pulse index values of the two groups were detected and compared, and the prognosis and mortality of the two groups were followed up. ResultsThe Matsushima classification results of the observation group were better than the control group (P＜0.05). There was no significant difference in Vm and PI levels between the two groups before treatment(P＞0.05). There was a significant improvement in the 3 months after treatment(all P＜0.001), in which the Vm of the observation group was significantly higher than that of the control group(P＜0.001). There was no significant difference in mRS score between the two groups before treatment(P＞0.05). There was a significant improvement in the 3 months after treatment, and the mRS score of the observation group was significantly lower than that of the control group(P＜0.001). The rebleeding and mortality in the observation group were significantly lower than those in the control group（all P＜0.001). ConclusionCompared with conservative therapy, STA-MCA+EDMS has a better clinical effect on MMD, and is more conducive to the improvement of the intracranial branch microcirculation, reducing the symptoms of patients and reducing the occurrence of rebleeding and death. [ABSTRACT FROM AUTHOR]

Objective To discuss the optimum operation time for ischemic moyamoya disease. MethodsThe clinical data of 41 patients with ischemic moyamoya disease underwent revascularization at the Department of Neurosurgery, Renmin Hospital of Wuhan University from June 2016 to May 2018 were analyzed retrospectively. Considering the time interval between acute onset of moyamoya disease and surgery, all patients were divided into early group and later group(＞90 days between MMD onset and surgery). The post-operation complication(Cerebral hemorrhage, Cerebral infarction, Cerebral hyperperfusion), and the effective of operation(the score of NIHSS, the improvement of perfusion) were compared between groups to estimate optimum operative time of revascularization. Results Compared with the later group, the difference was statistically significant in early group about the improvement of perfusion and neurofunction(P＜0.05), the values were 0.00 and 0.01, respectively. There was no obvious difference about post-operation complication between early group(52.9%) and later(54.2%) group. ConclusionsIt seems more reasonable to operate for early revasculization for patients with ischemic moyamoya disease.It can improve surgical efficacy and the risk of postoperative hyperperfusion, cerebral infarction and cerebral hemorrhage may not increase. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Modern Laboratory Medicine is the property of Journal of Modern Laboratory Medicine Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To assess the value of high-resolution MRI in evaluation of the bl00d vessel wall of moyamoya disease. Methods Forty-six patients with moyamoya disease (31 bilateral and 15 unilateral) underwent high-resolution MRI. The clinical features and the vessel wall characteristics were compared to that of patients with middle cerebral artery atherosclerosis stenosis. Results Hyperlipidemia and diabetes mellitus were more common in atherosclerosis group. The outer wall diameter, wall thickness and concentric stenosis of atherosclerosis were all higher than that of moyamoya disease. There was no significant difference in outer wall diameter and concentric stenosis, whereas the vessel wall of unilateral moyamoya disease (0.30±0.01 mm) was significantly thinner (P<.001) than that of bilateral moyamoya disease (0.51 ±0.12 mm). Moyamoya disease more commonly involved the internal carotid artery bifurcation than atherosclerosis. Vessel wall enhancement was more obvious and more eccentric in atherosclerosis. Conclusion Bl00d vessel wall characteristics of moyamoya disease differ from that of atherosclerosis with thinner wall in unilateral than bilateral moyamoya disease. [ABSTRACT FROM AUTHOR]

Objective To evaluate noninvasive 4D dynamic volume computed tomography angiography (CTA) compared to digital subtraction angiography (DSA) in vascular assessment of adult moyamoya disease using the modified Suzuki scoring system. Methods 101 patients underwent 4D CTA and DSA within 1 week interval between both examinations. The images were evaluated by 2 neuroradiologists using the modified Suzuki scoring system. Consistency test with calculation of k value and 95% confidence interval as well as correlation analysis was performed on the scores of 4D CTA and DSA. Results The 4D CTA and DSA scores were consistent (k =0.714，95% confidence interval: 0.649-0.778) with significant (P=0) correlation coefficient of 0.843. Conclusion 4D CTA is comparable to DSA in assessing the severity of moyamoya disease. [ABSTRACT FROM AUTHOR]

Objective To observe and analyze the surgical treatment of ischemic moyamoya disease （IMMD） in adult patients．Method The clinical data of 22 patients with surgical treatment of ischemic moyamoya disease （IMMD） from January， 2014 to December， 2015 were analyzed retrospectively， 15 cases with Encephalo-STA-STF-synangiosis （E-STA-STF-S） surgery and 7 cases with superficial temporal artery-middle cerebral artery bypass （STA-MCA） surgery. Results Follow-up was conducted 3－9 months after the operation. In 15 cases with E-STA-STF-S surgery， digital subtraction angiography （DSA） showed good compensatory blood supply of external carotid artery to brain and relieved symptoms in 12 patients and no obvious compensation was found in another 3 cases . In 7 cases with STA-MCA surgery， no obvious compensation was found 1 case. After the review of DSA， the compensatory blood supply rate was 81.82% and symptoms were improved in all the cases. Conclusions Surgical treatment can effectively improve the clinical symptoms in adult patients with IMMD. To develop individualized surgical plan is an important clinical measure for IMMD treatment in adult patients. [ABSTRACT FROM AUTHOR]

Objectives To discuss the endovascular management strategies and experiences of the intracranial aneurysm associated with moyamoya disease( MMD). Methods The clinical and angiographic records of 6 patients diagnosed as the intracranial aneurysm associated with moyamoya disease were retrospectively reviewed. Of 3 patients presented with intracranial hematoma,incidental aneurysm was found in 2 patients. Each was treated with conventional embolization. One pseudoaneurysm was found to be blame for hematoma in the third patient and was occluded by internal trapping with 20% Glubran. The patient with asymptomatic ophthalmic aneurysm was treated with stent assisted coiling successfully. For 2 patients with SAH,ruptured aneurysm along the territory of Willis circle was shown by CTA and was embolized emergently. Results 6 patients surgical success. Of 5 patients with coilings,1 reached complete obligation and maintained stable at follow-ups. Conclusions Considering the high risk for periprocedural ischemic events with moyamoya disease,endovascular treatment for intracranial aneurysm associated with moyamoya disease is efficacious,and might be a safer option compared with microneurosurgery. [ABSTRACT FROM AUTHOR]

Objective To discuss clinical features and therapeutic effects of moyamoya diseasetreated by encephalo-duro-arterio-synangiosis(EDAS).Methods The clinical data of 25 patientswith Moyamoya disease (MMD) treated in our department from Journay 2005 June 2014 wereanalyzed retrospectively.All patients were adults, including 12 male and 13 female cases.Clinicalpresentation was ischemic in 19 patients and hemorrhagic in 6.According to Suzuki's criteria,14 patients were in stage 3,8 in stage 4 and 3 in stage 5.Indirect revascularization(Encephalo-duroarterio-synangiosis,EDAS)was performed in all these patients,with 16 on the right side, 9 on theleft side, and 3 on the other side 6 months after first operation.Cerebral angiogram, as well as mRSscore, were reviewed and compared preoperatively and postoperatively (6 months) to determineoperative effects.Results The improvement rate of blood flow was 85.7% on the operatedhemisphere at postoperative DSA examination 6 months later.Neurological function showedsignificant improvement in ischemic type patients (P <0.05) 6 months postoper-atively,but not inhemorrhagic type patients(P >0.05).The patients were followed up for median 3.2 years and onepatient in ischemic group experienced TIA.No patient suffered from hemorrhage in the hemorrhagicgroup.Conclusion Indirect revascularization by EDAS is a simple, minimal invasive and effectivetechnique for treatment of adult MMD. [ABSTRACT FROM AUTHOR]

目的 观察烟雾病(MMD)患者颞浅动脉—大脑中动脉(STA-MCA)搭桥术中朝向大脑中动脉近心端实施血管吻合的疗效。方法 MMD患者59例,STA-MCA搭桥术中朝向大脑中动脉近心端实施血管吻合,应用mRS评分方法评估术前1 d及术后3个月患者的神经功能。TCD测量术中血管吻合前MCA流速及流向;血管吻合后,分别测量吻合口MCA近心端、MCA远心端流速及流向。结果 术前1 d与术后3个月mRS评分分别为(1.12±0.892)、(0.41±0.698)分,手术前后比较,P <0.05。术前MCA流速、术后MCA近心端流速、术后MCA远心端流速分别为(8.00,6.00)、(52.00,50.00)、(21.00,31.00),两两比较,P均<0.05。结论 烟雾病患者STA-MCA搭桥术中朝向大脑中动脉近心端实施血管吻合疗效较好,是一种安全有效的搭桥方法。 [ABSTRACT FROM AUTHOR]

Objective To study the value of magnetic resonance perfusion imaging in the treatment of moyamoya disease. Methods The MR perfusion imaging data of 24 cases of moyamoya disease treated by superficial temporal artery-middle cerebral artery bypass + temporalis muscle attachment( STA-MCA bypass + EMS) were analyzed retrospectively. The value of relative cerebral blood flow( r CBF),relative cerebral blood volume( r CBV),relative mean transit time( MTT) before the operation,after 1 week and after 3 months,were collected and compared. Results The MRI perfusion imagine of all patients before the operation showed that frontal and temporal lobe hypo perfusion in varying degrees. We found that perfusion of the frontotemporal lobe of the operative sides improving after 1 week,but more obviously after 3 months. Each parameter mean variance analysis were performed. The variable analysis of variance was significant,further LSD-test showed that there were no significant difference between the MTT of frontal lobes before and 1 week after operation( P> 0. 05) and that there was no significant difference between the r CBV of frontal lobes before and 1week after the operation( P > 0. 05),while compared with which 3 months after operation there were significant between them( all P < 0. 05). There was significant differences of occipital lobe r BV before and after sugery,but no significance compaired 1 week with 3 months after operation( P >0. 05). Conclusions MR resonance perfusion imaging could demonstrate the cerebral hemodynamic changes in patients before and after surgery,it could assess the treatment effectively. [ABSTRACT FROM AUTHOR]

Objective To study the outcomes of patients with hemorrhagic type moyamoya disease(MMD) and the effects of arterial anastamoses treatment in order to reduce its re-bleeding rate. Methods 82 patients with haemorrhagic type MMD were diagnosed with DSA and CT scan . There were 10 cases(12.2%) of aneurysms,18 (21.9%) intracerebral hemorrhage (ICH) without aneurysms,20 (24.4%) intraventricular hemorrhage (IVH), 38(46.3%) ICH and IVH,6 (7.3%) subarachnoid hemorrhage (SAH). Surgical treatment was performed in 48 patients and conservative treatment was done in 34. The data of clinical, imaged and situation of re-bleeding in all patients were analyzed. Results This group patients were followed up over a period ranging from 0.6 to 12 years (mean 7.8 years).The outcomes were excellent in 56 cases(68.3%),good in 8(9.8%),poor in 4 (4.9%) and 12 (14.6%) died. During the follow-up period,recurrent bleeding occurred in 14 cases (17.1%).The interval to recurrent bleeding ranged from 0.3 ~10 years. The rate of recurrent bleeding was 17.1%. The mortality of which was 85.7%. Conclusion The most important cause of death is cerebral hemorrhage in patients with MMD. Recurrent bleeding was a major cause of poor prognosis, mobility and mortality in patients with the haemorrhagic type MMD patients. Direct and indirect arterial anastamoses reduced the risk of re bleeding, and the long-term prognosis of surgical treatment was better than conservative treatment. [ABSTRACT FROM AUTHOR]

Objective To assess efficacy of one-stop CT for evaluation of brain ischemia, cerebral vascular stenosis, and dynamic changes of Moyamoya disease before and after revascularization surgery. Methods 74 patients scheduled for direct (25), indirect (35) and combined (14) revascularization surgery for Moyamoya disease underwent CT before, 1 week and 3 months after surgery. The images were evaluated regarding the bridge vessel and collateral circulation. The rCBV , rTTP, rCBF, rMTT and rDT in the cortical areas were calculated. Paired t test and general linear model of repeated measurement data analysis of variance were used to compare the parameters before and after revascularization surgery. Results Of 31 bridge vessels in 25 patients undergoingdirect revascularization surgery, 29 were visualized on 4-D CTA with 1 occluded vessel. The 4-D CTA showed gradual increase in neovascularity and collaterals similar to digital subtraction angiography in patients with indirect and combined revascularization surgery. With direct revascularization surgery, only the rTTP and rDT were decreased at 1 week, the rTTP, rMTT and rDT were continually decreased whereas rCBV and rCBF were increased at 3 months after surgery. The rTTP and rDT were decreased whereas rCBV, rCBF and rMTT were increased at 3 months after indirect revascularization surgery. The rTTP and rDT were decreased at 1 week; rTTP and rDT were decreased, rCBV, rCBF and rMTT were increased at 3 months after combined revascularization surgery. The differences of rCBV, rTTP, rCBF and rDT between the two follow-up periods as well as the differences of rCBV, rCBF and rMTT between different types of surgery were significant. There were interactions of rCBV, rTTP, rCBF and rMTT between follow-up time and types of surgery. Conclusion One-stop CT can assess changes of cerebral vessels and evaluate the short- and long-term postoperative cerebral hemodynamics in adult Moyamoya disease. [ABSTRACT FROM AUTHOR]

Copyright of China Journal of Oral & Maxillofacial Surgery is the property of Shanghai Jiao Tong University, College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

目的：观察支架、弹簧圈栓塞术治疗烟雾病合并基底动脉尖动脉瘤的效果。方法典型烟雾病合并基底动脉尖动脉瘤5例，采全脑血管造影＋基底动脉动脉瘤支架辅助弹簧圈介入栓塞术治疗，观察治疗效果。结果术后病情好转3例，术前评分分别为2、1、0分，术后评分均为0分，未遗留临床症状；分别于6个月及1a复查均未见动脉瘤复发以及临床症状，且NIHSS评分均为0分。术后病情恶化1例，术前评分为0分，术后第5天评分2分，术后第5天出现右侧肢体力弱，肌力Ⅲ级，病理征阴性，余正常；术后6个月随访复查，肌力正常，NIHSS评分0分。术后死亡1例，此例术前NIHSS评分为1分。结论临床上应高度警惕烟雾病合并基底动脉尖动脉瘤，并且此类疾病不应使用开颅夹闭动脉瘤的方式处理，而应该尽可能的行介入手术治疗。 [ABSTRACT FROM AUTHOR]

目的烟雾病是一种慢性进行性闭塞性脑血管疾病。遗传因素在烟雾病发生发展过程起关键作用。内科保守治疗主要是对症处理,并不能延缓烟雾病的进展,手术治疗为其主要治疗方式,直接血管重建术、间接血管重建术及联合血管重建术各有利弊。本文通过综合分析,阐述了导致烟雾病可能的病因,并对其治疗进展进行了全面综述。 [ABSTRACT FROM AUTHOR]