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Background Moyamoya disease is characterized by progressive narrowing of the internal carotid artery (ICA). Symptomatic patients typically undergo cerebrovascular intervention via extracranial-intracranial (EC-IC) bypass, most often with the use of the superficial temporal artery. This case of Moyamoya disease is of particular interest as the patient presented with a unilateral atherosclerotic external carotid artery (ECA) stenosis after EC-IC bypass that eliminated the benefit of his original surgery, resulting in a symptomatic presentation. Clinical presentation A 53-year-old man presenting with Moyamoya disease and known left ICA occlusion had received a bilateral encephaloduroarteriosynangiosis (EDAS) bypass 10 years previously. He re-presented complaining of right-sided tingling, weakness, and numbness radiating up the arm. CT angiography indicated significant stenosis of the left ECA. ECA angioplasty and stenting with a distal protection device resulted in resolution of his symptoms. Conclusions This case illustrates that a patient presenting with Moyamoya disease and concurrent symptomatic ECA stenosis post-EDAS can be effectively and safely treated with ECA stenting. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate Cookin' Up Health, a computer-based inter- active nutrition intervention. Methods: After randomization to intervention and control groups, 262 women in rural clinics in West Virginia completed both a baseline and 3-month follow-up survey. Results: Compared to the control group, the intervention group had significantly improved scores on knowledge of dietary fats, food label reading, and readiness to eat 5 fruits and vegetables a day and foods lower in fat. Conclusions This brief interactive nutrition intervention shows potential as a strategy to begin the process of change, but follow-up may be needed for actual behavior change to occur. [ABSTRACT FROM AUTHOR]

Pregnant women are at high risk for venous thromboembolism, including pulmonary embolism ( PE), given expected changes in coagulation, fibrinolysis, and venous blood flow. In fact, PE is the leading cause of maternal death in the United States. Nonpregnant patients who develop PE with hypotension or show signs of deterioration after anticoagulation receive thrombolytics as a standard of care. Pregnant women, however, have been excluded from clinical trials with thrombolytics, and all data available in this population are published as case reports or case series. We reviewed all reports of thrombolytics, systemic or catheter directed, used in pregnant patients with massive PE. This article summarizes the risks for thromboembolism in pregnancy, compares and contrasts thrombolytic agents in this setting, and provides a recommendation for management of massive PE in this special population. Overall, reports suggest that the use of these agents is associated with beneficial outcomes and a relatively low risk of complications. The quality of this evidence is low, and clinical judgment is required to assess individual patients for risks versus benefits of thrombolysis. [ABSTRACT FROM AUTHOR]

Large vessel ischemic stroke represents the most disabling subtype. While t-PA and endovascular thrombectomy can recanalize the occluded vessel, good clinical outcomes are not uniformly achieved. We propose that supplementing endovascular thrombectomy with superselective intra-arterial (IA) verapamil immediately following recanalization could be safe and effective. Verapamil, a calcium channel blocker, has been shown to be an effective IA adjunct in a pre-clinical mouse focal ischemia model. To demonstrate translational efficacy, mechanism, feasibility, and safety, we conducted a group of translational experiments. We performed in vivo IA dose-response evaluation in our animal stroke model with C57/Bl6 mice. We evaluated neuroprotective mechanism through in vitro primary cortical neuron (PCN) cultures. Finally, we performed a Phase I trial, SAVER-I, to evaluate feasibility and safety of administration in the human condition. IA verapamil has a likely plateau or inverted-U dose-response with a defined toxicity level in mice (LD50 16-17.5 mg/kg). Verapamil significantly prevented PCN death and deleterious ischemic effects. Finally, the SAVER-I clinical trial showed no evidence that IA verapamil increased the risk of intracranial hemorrhage or other adverse effect/procedural complication in human subjects. We conclude that superselective IA verapamil administration immediately following thrombectomy is safe and feasible, and has direct, dose-response-related benefits in ischemia. [ABSTRACT FROM AUTHOR]

Seasonal trawling was conducted randomly in coastal (depths of 4.6-17 m) waters from St. Augustine, Florida, (29.9°N) to Winyah Bay, South Carolina (33.1°N), during 2000-03, 2008-09, and 2011 to assess annual trends in the relative abundance of sea turtles. A total of 1262 loggerhead sea turtles (Caretta caretta) were captured in 23% (951) of 4207 sampling events. Capture rates (overall and among prevalent 5-cm size classes) were analyzed through the use of a generalized linear model with log link function for the 4097 events that had complete observations for all 25 model parameters. Final models explained 6.6% (70.1-75.0 cm minimum straight-line carapace length [SCLmin]) to 14.9% (75.1-80.0 cm SCLmin) of deviance in the data set. Sampling year, geographic subregion, and distance from shore were retained as significant terms in all final models, and these terms collectively accounted for 6.2% of overall model deviance (range: 4.5-11.7% of variance among 5-cm size classes). We retained 18 parameters only in a subset of final models: 4 as exclusively significant terms, 5 as a mixture of significant or nonsignificant terms, and 9 as exclusively nonsignificant terms. Four parameters also were dropped completely from all final models. The generalized linear model proved appropriate for monitoring trends for this data set that was laden with zero values for catches and was compiled for a globally protected species. Because we could not account for much model deviance, metrics other than those examined in our study may better explain catch variability and, once elucidated, their inclusion in the generalized linear model should improve model fits. [ABSTRACT FROM AUTHOR]

Satellite transmitters were attached to 25 reproductively active and four inactive adult male loggerhead sea turtles (86.6-107.0 cm SCLmin) captured from the Port Canaveral, FL, USA shipping channel to assess horizontal and vertical distributions. During the breeding period, male loggerheads aggregated (44% of 755 turtle days) in a 117.6 km core area that encompassed the shipping channel. Median dive duration during the breeding period was 27 min (IQR = 15-42 min) and males spent 4% (IQR = 3-5%) of the time at the surface, with significantly shorter dives associated with reproductively active males. Migrant and resident males dispersed concurrently, with residents shifting > 30 km east across the continental shelf over a more protracted departure schedule than migrants. Dive duration and time spent at the surface increased through the fall. Cluster analysis revealed the strongest association for dive duration with sea state during and after the breeding period, with significantly longer dives during more turbulent conditions. In contrast, univariate associations with surface interval duration were not elucidated. [ABSTRACT FROM AUTHOR]

Sixteen satellite-tagged adult male loggerhead sea turtles ( Caretta caretta) dispersed widely from an aggregation near Port Canaveral, Florida, USA (28°23′N, −80°32′W) after breeding. Northbound males migrated further (990 ± 303 km) than southbound males (577 ± 168 km) and transited more rapidly (median initial dive duration = 6 (IQR = 4-16) versus 19 (IQR = 10-31) min, respectively).. Migration occurred along a depth corridor (20-40 m) except where constricted by a narrow continental shelf width. Males foraged in areas 27 ± 41 km day at locations <1-80 km from shore for 100.1 ± 60.6 days, with variability in foraging patterns not explained by turtle size or geography. Post-breeding dispersal patterns were similar to patterns reported for adult female loggerhead sea turtles in this region and adult male loggerhead sea turtles elsewhere in the northern hemisphere; however, foraging ground distributions were most similar to adult female loggerhead sea turtles in this region. [ABSTRACT FROM AUTHOR]

Thirty-four juvenile loggerhead sea turtles captured by trawling from the Charleston, South Carolina (USA), shipping channel (32°42′N; −79°47′W) between May 2004 and August 2007 were tagged with satellite transmitters to assess the extent to which they remained near the capture location given their collection along a seasonal migratory corridor. Seventy-five percent of juveniles were classified as seasonal residents. Migrants predominantly swam north in the spring and nomads wandered south in the summer, but predictive indicators for non-resident status were not identified. All but one juvenile generally remained south of 34°N, within 40 km of shore, and in waters <30 m deep throughout the year. Nine of 14 loggerhead sea turtles monitored during the winter remained exclusively over the continental shelf, three briefly occurred in oceanic habitats, and two foraged extensively in oceanic habitats. Residents distributed >15 km from shore between spring and autumn were three times as likely to occur in oceanic habitats in winter. Modest seasonal movements contrasted with adults tagged at similar latitudes and with juveniles tagged further north and suggest distinct foraging groups within a regional foraging ground. [ABSTRACT FROM AUTHOR]

Background: This study assessed the validity of several self-reported cardiovascular risk factors among low-income women aged 40–64 years in West Virginia. Methods: A cross-sectional survey was conducted of 733 women participating in the Well Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) project in West Virginia to examine agreement between self-report and clinical screenings in the prevalence of risk factors related to coronary heart disease (CHD). Women participating in the study were interviewed face-to-face before administration of clinical screenings that assessed height, weight, Quetelet's index, high blood pressure (systolic ≥140 mm Hg or diastolic ≥90 mm Hg), and elevated total cholesterol concentrations (≥200 mg/dL and ≥240 mg/dL). Results: The overall results showed high sensitivity and specificity for each of the risk factors examined; for overweight/obesity, the sensitivity was 96% and specificity was 93%; for cholesterol ≥240 mg/dL, sensitivity was 85% and specificity was 67%; for hypertension, sensitivity was 77% and specificity was 86%. Using a threshold value of ≥240 mg/dL for hypercholesterolemia led to higher sensitivity but a lower specificity than for a value of ≥200 mg/dL. Conclusions: This study found that among low-income women at higher risk for cardiovascular disease (CVD), self-reported values for high body mass index (BMI), hypercholesterolemia, and hypertension were well correlated with clinical measures, as indicated by high sensitivity values. Thus, self-reported values can be used for surveillance, targeted screenings, and health promotion activities, including lifestyle changes. [ABSTRACT FROM AUTHOR]