Moyamoya disease versus moyamoya syndrome: comparison of presentation and outcome in 338 hemispheres

OBJECTIVEPhenotypic differences between moyamoya disease (MMD) and moyamoya syndrome (MMS) remain unclear. The purpose of this study was to evaluate whether such differences exist when presentation, procedure-related, and outcome variables are compared quantitatively.METHODSThe study cohort included 185 patients with moyamoya presenting to the Johns Hopkins Medical Institutions between 1994 and 2015. Baseline demographic, angiographic, and clinical characteristics were compared between patients with MMS and MMD, in addition to procedure-related complications and length of stay (LOS) after surgery. Stroke-free survival was compared between both disease variants after diagnosis. Kaplan-Meier analysis and Cox proportional hazards regression were used to compare stroke-free survival between surgically treated and conservatively managed hemispheres in both types of disease, while evaluating interaction between disease variant and management.RESULTSThe cohort consisted of 137 patients with MMD (74%) with a bimodal age distribution and 48 patients with MMS (26%) who were mostly under 18 years of age (75%). Underlying diseases included sickle cell disease (48%), trisomy 21 (12%), neurofibromatosis (23%), and other disorders (17%). Patients with MMS were younger (p < 0.001) and less likely to be female (p = 0.034). Otherwise, baseline characteristics were statistically comparable. The rate of surgical complications was 33% in patients with MMD and 16% in patients with MMS (p = 0.097). Both groups of patients had a similar LOS after surgery (p = 0.823). Survival analysis (n = 330 hemispheres) showed similar stroke-free survival after diagnosis (p = 0.856) and lower stroke hazard in surgically managed patients in both MMD (hazard ratio [HR] 0.29, p = 0.028) and MMS (HR 0.62, p = 0.586). The disease variant (MMD vs MMS) did not affect the relationship between management approach (surgery vs conservative) and stroke hazard (p = 0.787).CONCLUSIONSMMD and MMS have largely comparable clinical and angiographic phenotypes with analogously favorable responses to surgical revascularization.

Is there a memory bias for high calorie food images?

It is unclear if, and to what extent, the human memory system is biased towards food and food relevant stimuli. Drawing upon existing demonstrations of attentional biases to high calorie food images, and findings that evolutionarily relevant stimuli are preferentially remembered, we hypothesized that images of high calorie foods would be better remembered than images of low calorie foods and nonfood items. Investigating this is important because a general bias towards remembering high calorie images might facilitate greater incentive learning towards these images which could result in cue-induced overconsumption. We tested this in two pre-registered, within-subject studies (ns = 38). In Experiment 1, using a rapid stream visual presentation procedure and recognition memory test, we found no effect of image type (high calorie, low calorie, nonfood) on recognition for previously seen images (F &lt; 1.0). However, we did observe fewer correct rejections (i.e. more false memories) for novel low calorie images. In Experiment 2, we used a longer encoding procedure and free recall memory test and similarly failed to observe an effect of image type on recall (F &lt; 1.0). We did discover several other factors that correlate with image memory which we discuss along with the implications of these results and directions for future research.

Anastomotic Leaks after Gastrointestinal Operations- A Prospective Cohort Study

Introduction: Anastomotic leak is the release of intestinal contents into the abdomen at the site of surgical stitch line, where two ends of the bowel have been joined for restoration of the gastrointestinal continuity. There are considerable variations in incidence of anastomotic leaks following gastrointestinal operations which have motivated the present study. Aim: To prospectively follow all the patients who underwent gastrointestinal surgeries and look for clinical signs of anastomotic leak in postoperative period. Materials and Methods: Study population comprised of 613 patients who underwent gastrointestinal operation at a Tertiary Care Hospital during the period from September 2011 to September 2013. After taking Institutional Ethical Committee Clearance enrolment in the study was done with written and informed consent. The site of leak, postoperative day of leak was diagnosed and noted based on clinical examination and radiological investigations.It was a prospectively designed descriptive study so no specific tests were applied. Statistical analysis and percentages were calculated using SPSS 16.0 software. Results: Most of the leaks occurred between eighth to ninth postoperative day and most of the obstruction occurred on sixth and seventh postoperative day. Incidence of anastomotic leaks in the study group was 3.26%. Incidence of anastomotic leaks in small bowel anastomosis is 0.489% compared to large bowel leaks reported to be 0.815%. Peritonitis was present in majority of patients presenting with leak. Incidence of obstruction in recto sigmoid anastomosis was 1.957%. Conclusion: The study suggests that as we move distally in Gastrointestinal Tract (GI) the incidence of anastomotic leak increases and it becomes maximum for colorectal surgeries. Anastomotic complication depends on various factors like age, sex, mode of presentation, procedure done, Hb%, dehydration, nutrition, blood sugar, albumin, peritonitis etc.

1689. Active, Invasive Fungal Infection, and Hematopoietic Cell Transplantation (HCT) in Chronic Granulomatous Disease (CGD): Presentation, Procedure, and Outcomes

Background Individuals with CGD develop invasive fungal infections which are often refractory to medical therapy. Disease caused by Aspergillus nidulans (An), Scedosporium apiospermum (Sa), and Aspergillus viridinutans (Av), can be fatal due to involvement of structures contiguous to the primary pulmonary infection. Protocols for managing an active fungal infection during HCT are lacking. Here we describe 5 patients transplanted with active fungal infection and the treatments ancillary to HCT that led to successful outcomes. Methods Four males and one female underwent peripheral blood HCT utilizing 3 different transplant platforms. Granulocyte transfusions (GCT) were used in 4 cases. Results Antifungal treatment and transplant outcomes are reported in Table 1. Patients 1 (Figure 1) and 4 (previously reported) had Sa infection of the lung and spine and lung and pericardium, respectively. Patients 2 (Figure 2) and 5 had An pneumonia with spinal and sternal involvement, respectively. Patient 3 had Av pneumonia involving the lower lung and diaphragm (Figure 3). The transplant protocol was modified to include a high stem cell dose to facilitate engraftment and post-transplant cyclophosphamide GVHD prophylaxis. No GCTs were used proximal to or during HCT due to the development of antineutrophil antibodies. Conclusion Active fungal infection can be managed during HCT. Combination therapy (GCTs and antifungals) lessened the burden of disease prior to and during HCT. All patients had clinical resolution of their infection post-HCT and successful engraftment. Bone disease stabilized post-HCT and remineralization occurred. One patient was successfully transplanted without GCT and its potential complications. The authors have no conflicts to report. Disclosures All authors: No reported disclosures.

To the issue of research work presentation by foreign students (part 2 – answering the questions)

The article deals with the methods of forming communicative skills of public defense of a diploma or anessay project (the second part of the presentation – answering the questions of the audience). The factors that are necessary for a successful presentation of foreign-language research papers written by foreign students have been determined. The types of questions that are specific for this type of speech interaction have been analyzed. Recommendations for the system of exercises aimed at the development of dialogical professionally-oriented communication, the basis of which is strict compliance with the standard norms of the official sphere of communication, have been developed. The necessity of foreign students of senior courses for public professional communication has been proved. It has been emphasized that observation of the standard norms by participants of speech interaction ensures standardization of the presentation procedure, which positively influences the result of protection. The author scientifically substantiates the importance of forming foreign students' abilities to provide feedback both verbal and non-verbal levels. The results of the study provide the opportunity to use the recommended methodology for improving the communicative competence of students in the process of studying the Ukrainian language as a foreign language. Recommendations can serve as the basis for the development of methodological guidelines for the defense of diploma and essay project, as well as for the creation of teaching aids that facilitate the formation and improvement of communicative skills that ensure the effectiveness of a presentation speech act.

Rapid Serial Auditory Presentation

The Rapid Serial Visual Presentation procedure is a method widely used in visual perception research. In this paper we propose an adaptation of this method which can be used with auditory material and enables assessment of statistical learning in speech segmentation. Adult participants were exposed to an artificial speech stream composed of statistically defined trisyllabic nonsense words. They were subsequently instructed to perform a detection task in a Rapid Serial Auditory Presentation (RSAP) stream in which they had to detect a syllable in a short speech stream. Results showed that reaction times varied as a function of the statistical predictability of the syllable: second and third syllables of each word were responded to faster than first syllables. This result suggests that the RSAP procedure provides a reliable and sensitive indirect measure of auditory statistical learning.

Characterizing the Spatio-temporal Dynamics of the Neural Events Occurring prior to and up to Overt Recognition of Famous Faces

Although it is generally acknowledged that familiar face recognition is fast, mandatory, and proceeds outside conscious control, it is still unclear whether processes leading to familiar face recognition occur in a linear (i.e., gradual) or a nonlinear (i.e., all-or-none) manner. To test these two alternative accounts, we recorded scalp ERPs while participants indicated whether they recognize as familiar the faces of famous and unfamiliar persons gradually revealed in a descending sequence of frames, from the noisier to the least noisy. This presentation procedure allowed us to characterize the changes in scalp ERP responses occurring prior to and up to overt recognition. Our main finding is that gradual and all-or-none processes are possibly involved during overt recognition of familiar faces. Although the N170 and the N250 face-sensitive responses displayed an abrupt activity change at the moment of overt recognition of famous faces, later ERPs encompassing the N400 and late positive component exhibited an incremental increase in amplitude as the point of recognition approached. In addition, famous faces that were not overtly recognized at one trial before recognition elicited larger ERP potentials than unfamiliar faces, probably reflecting a covert recognition process. Overall, these findings present evidence that recognition of familiar faces implicates spatio-temporally complex neural processes exhibiting differential pattern activity changes as a function of recognition state.

Multiple routes of chemosensitivity to free fatty acids in humans

Selected free fatty acids (FFAs) are documented effective somatosensory and olfactory stimuli whereas gustatory effects are less well established. This study examined orthonasal olfactory, retronasal olfactory, nasal irritancy, oral irritancy, gustatory, and multimodal threshold sensitivity to linoleic, oleic, and stearic acids. Sensitivity to oxidized linoleic acid was also determined. Detection thresholds were obtained using a three-alternative, forced-choice, ascending concentration presentation procedure. Participants included 22 healthy, physically fit adults sensitive to 6- n-propylthiouracil. Measurable thresholds were obtained for all FFAs tested and in 96% of the trials. Ceiling effects were observed in the remaining trials. Greater sensitivity was observed for multimodal stimulation and lower sensitivity for retronasal stimulation. There were no statistically significant correlations for linoleic acid thresholds between different modalities, suggesting that each route of stimulation contributes independently to fat perception. In summary, 18-carbon FFAs of varying saturation are detected by multiple sensory systems in humans.