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BackgroundIntracranial atherosclerotic disease (ICAD) is a common cause of ischemic stroke with a high risk of clinical stroke recurrence. Multiple mechanisms may underlie cerebral ischemia in this condition. The study's objective is to discern the mechanisms of recurrent ischemia in ICAD through imaging biomarkers of impaired antegrade flow, poor distal perfusion, abnormal vasoreactivity, and artery-to-artery embolism.MethodsThis prospective multicenter observational study enrolled patients with recent (≤21 days) ischemic stroke or transient ischemic attack (TIA) caused by ICAD with 50-99% stenosis treated medically. We obtained baseline quantitative MRA (QMRA), perfusion MRI (PWI), transcranial Doppler vasoreactivity (VMR), and emboli detection studies (EDS). The primary outcome was ischemic stroke in the territory of the stenotic artery within 1 year of follow-up; secondary outcomes were TIA at 1 year and new infarcts in the territory on MRI at 6-8 weeks.ResultsAmongst 102 of 105 participants with clinical follow-up (mean 253±131 days), the primary outcome occurred in 8.8% (12.7/100 patient-years), while 5.9% (8.5/100 patient-years) had a TIA. A new infarct in the territory of the symptomatic artery was noted in 24.7% at 6-8 weeks. A low flow state on QMRA was noted in 25.5%, poor distal perfusion on PWI in 43.5%, impaired vasoreactivity on VMR in 67.5%, and microemboli on EDS in 39.0%. No significant association was identified between these imaging biomarkers and primary or secondary outcomes.ConclusionsDespite intensive medical management in ICAD, there is a high risk of clinical cerebrovascular events at 1 year and an even higher risk of new imaging-evident infarcts in the subacute period after index stroke. Hemodynamic and plaque instability biomarkers did not identify a higher risk group. Further work is needed to identify mechanisms of ischemic stroke and infarct recurrence and their consequence on long-term physical and cognitive outcomes.Trial registrationClinicalTrials.gov: NCT02121028.

BackgroundThere are limited data on the specific mechanisms of stroke in patients with intracranial atherosclerotic stenosis (ICAS). We undertook this study to describe infarct patterns and likely mechanisms of stroke in a large cohort of patients with ICAS, and to evaluate the relationship of these infarct patterns to angiographic features (collaterals, stenosis location and stenosis severity).MethodsWe evaluated infarct patterns in the territory of a stenotic intracranial artery on neuroimaging performed at baseline and during follow-up if a recurrent stroke occurred in patients enrolled in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. We defined the likely mechanism of stroke (artery-to-artery embolism, perforator occlusion, hypoperfusion or mixed) according to the site of ICAS and based on the infarct patterns on neuroimaging. Collaterals were assessed using American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grades, and stenosis severity using the WASID trial's measurement technique. We evaluated the association of infarct patterns with angiographic features using χ(2) tests.ResultsThe likely mechanisms of stroke based on the infarct patterns at baseline in the 136 patients included in the study were artery-to-artery embolism (n = 69; 50.7%), perforator occlusion (n = 34; 25%), hypoperfusion (n = 12; 8.8%) and mixed (n = 21; 15.5%). Perforator-occlusive infarcts were more frequent in the posterior circulation, and mixed patterns were more prevalent in the anterior circulation (both p < 0.01). Most of the mixed patterns in the anterior circulation combined small pial or scattered multiple cortical infarcts with infarcts in border-zone regions, especially the cortical ones. Isolated border-zone infarcts were not significantly associated with a poor grading for collaterals or the severity of stenosis. Among 47 patients with a recurrent infarct during follow-up, the infarct patterns suggested an artery-to-artery embolic mechanism in 29 (61.7%).ConclusionsArtery-to-artery embolism is probably the most common mechanism of stroke in both the anterior and the posterior circulations in patients with ICAS. An extension of intracranial atherosclerosis at the site of stenosis into adjacent perforators also appears to be a common mechanism of stroke, particularly in the posterior circulation, whereas hypoperfusion as the sole mechanism is relatively uncommon. Further research is important to accurately establish the specific mechanisms of stroke in patients with ICAS, since preliminary data suggest that the underlying mechanism of stroke is an important determinant of prognosis.

This study considers intergroup attitudes in the Bible and compares relationships between God or Jesus and (a) Torah non-Israelites; (b) New Testament people who were not followers of Jesus; and (c) New Testament people who were not Jewish. Torah non-Israelites belonged to an out-group with respect to the Hebrew Torah, New Testament people who were not followers of Jesus belonged to an out-group with respect to the Christian New Testament, and New Testament people who were not Jewish were an in-group with respect to Christians. Results were that God or Jesus' relationships were very negative with people in the Torah who were non-Israelites and with people in the New Testament who were not followers, while relationships were positive with people in the New Testament who were not Jewish. Thus, in conclusion, results indicate that both the New Testament and the Torah portray negative relationships between God or Jesus and members of out-groups. Relationships portrayed in New Testament narratives about God and people who were not followers were sometimes more negative than observed for other groups in the New Testament and the Torah; for people who were viewed as outsiders, the New Testament could sometimes be more negative than the Torah. An aim of this study was to identify patterns of relationships between God or Jesus and different types of people in narratives of the Torah and in the New Testament. One of the characteristics of different types of people, including people described in biblical narratives, is whether they are members of in-groups or out-groups. Our focus in this report is on biblical narratives about people who are members of out-groups. The results contribute a clinical-quantitative assessment of out-groups in the Torah and New Testament that is focused on relationship with God, a central issue in the psychology of religion and the Bible.

IN AN EARLIER study on the first five books of the Bible, the Torah or Pentateuch, relationships between God and people were assessed with the use of a clinical-quantitative method, the core conflictual relationship theme (CCRT) method. Here, the study is extended to God or Jesus's relationships with people in the New Testament, to obtain the first description of those relationships based on an established measure of relationships. In the New Testament, many different kinds of relationship themes were observed, with benevolent and positive themes as the most frequent. Other results included that: (a) relationships in the New Testament often appeared more positive than in the Torah; (b) New Testament relationships between Jesus and people were less positive than between God and people; and (c) God's relationship with Jesus was more positive than God's relationship with Moses. Relationships with Paul, Peter, and women were also assessed. Relationship patterns were considered within the context of attachment theory, and biblical CCRT patterns were consistent with depiction of both secure and anxious attachments. Biblical relationships portray a variety of models for interpersonal relationships, ranging from the very positive to the very negative.

The most widely known images of God are from the Bible. An important characteristic of these images is their portrayal of God's interactions with people. Although there have been many religious and literary discussions of God's relationships with people in the Bible, no systematic psychological assessment has been reported. Therefore, the aim of this study was an innovation: to identify patterns of relationship between God and people portrayed in the first five books of the Bible, the Pentateuch or Torah, by using the core conflictual relationship theme (CCRT) method, a widely used scoring system for the assessment of interpersonal relationships. Reliability for the application of the CCRT method to relationship episode narratives in the Pentateuch/Torah was assessed and found to be very good. Results show that the most frequent theme in relationship episode narratives about God and people is that God is helpful. Two less frequent but also highly repetitive themes are that God controls or hurts the other person. Many differences were found between relationship themes defined by the type of person with whom God interacted: patriarch, Moses, woman, non-Israelite, or not a non-Israelite. Thus, the CCRT results identify several different patterns of relationship between God and people.