Case Report: A rare presentation of rapidly progressive moyamoya disease refractory to unilateral surgical revascularization.

Moyamoya disease (MMD) is a chronic, occlusive cerebrovasculopathy typified by progressive steno-occlusive disease of the intracranial internal carotid arteries (ICAs) and their proximal branches. Moyamoya syndrome (MMS) categorizes patients with characteristic MMD plus associated conditions. As such, the most usual presentations are those that occur with cerebral ischemia, specifically transient ischemic attack, acute ischemic stroke, and seizures. Hemorrhagic stroke, headaches, and migraines can also occur secondary to the compensatory growth of fragile collateral vessels propagated by chronic cerebral ischemia. While the pathophysiology of MMD is unknown, there remain numerous clinical associations including radiation therapy to the brain, inherited genetic syndromes, hematologic disorders, and autoimmune conditions. We describe the case of a 31-year-old woman who presented with recurrent ischemic cerebral infarcts secondary to rapidly progressive, bilateral MMD despite undergoing early unilateral surgical revascularization with direct arterial bypass. She had numerous metabolic conditions and rapidly decompensated, ultimately passing away despite intensive and aggressive interventions. The present case highlights that progression of moyamoya disease to bilateral involvement can occur very rapidly, within a mere 6 weeks, a phenomenon which has not been documented in the literature to our knowledge.

Impact of baseline lymphopenia on outcomes of definitive treatment for locally advanced cervical cancer.

Objectives: The purpose of this study is to evaluate the association between lymphopenia and survival in women with locally advanced cervical cancer (LACC) treated with definitive chemoradiation (CRT). Methods: We retrospectively reviewed patients with LACC treated at a single institution from 2004 to 2021. Patient and treatment characteristics were recorded along with baseline absolute lymphocyte counts (ALC). Overall survival (OS), progression free survival (PFS), and local control (LC) were calculated from start of treatment to date of last follow-up. Cox regression and competing risks regression model were performed to evaluate whether baseline ALC was associated with OS, PFS, or LC. Results: 246 patients met study inclusion criteria with stage IB - IV disease with a median follow up of 2.8 years (range 0.2-13.4 years). 5-year OS, PFS, and LC were 68.4 % (95 % CI 61.7-75.9), 57.2 % (95 % CI 50.4-64.8), and 79.0 % (95 % CI 73.0-84.4), respectively. Baseline lymphopenia (ALC < 1000 cells/mm3) was present in 12.5 % of patients. OS was improved in the patients without lymphopenia, with a 5-year OS of 69.0 % (95 % CI 61.6-77.3) versus 63.0 % (95 % CI 47.6-83.3)in the lymphopenia group (p = 0.233), though this did not meet statistical significance. PFS also trended towards improvement in patients without baseline lymphopenia, with a 5-year PFS of 58.5 % (95 % CI 51.2-66.8) versus 48.5 % (95 % CI 32.8-71.7), p = 0.220. No significant difference was found for LC in the patients without lymphopenia, p = 0.745. Conclusions: In this single institution experience of LACC treated with definitive CRT, we found that baseline lymphopenia trends toward inferior OS and PFS.

Early access to language supports number mapping skills in deaf children.

The ability to associate different types of number representations referring to the same quantity (symbolic Arabic numerals, signed/spoken number words, and nonsymbolic quantities), is an important predictor of overall mathematical success. This foundational skill-mapping-has not been examined in deaf and hard-of-hearing (DHH) children. To address this gap, we studied 188 4 1/2 to 9-year-old DHH and hearing children and systematically examined the relationship between their language experiences and mapping skills. We asked whether the timing of children's language exposure (early vs. later), the modality of their language (signed vs. spoken), and their rote counting abilities related to mapping performance. We found that language modality did not significantly relate to mapping performance, but timing of language exposure and counting skills did. These findings suggest that early access to language, whether spoken or signed, supports the development of age-typical mapping skills and that knowledge of number words is critical for this development.

Mathematics anxiety in deaf, hard of hearing, and hearing college students.

While mathematics anxiety (MA) has been widely researched in recent decades, this study addresses significant gaps: namely, research that explores the relationship between MA and self-reported mathematics experiences; samples adults with a range of MA levels; and controls for general anxiety. Additionally, the study sampled deaf and hard of hearing (DHH) students, whose diverse life and educational experiences often differ from hearing students'. We investigated whether DHH students' experiences with mathematics (i.e., parental behaviors, school environment, and mathematics feelings) and demographic variables (i.e., hearing status, age, and gender) predict their MA, and whether these relationships differ from those in hearing students. Self-report questionnaires were completed by 296 DHH and hearing college students. Linear regression analyses controlling for general anxiety led to the following inference: DHH students who reported more positive attitudes toward mathematics and school environments demonstrated higher MA. Also, the relationships between mathematics feelings, parental behaviors, and MA differed between DHH and hearing students. Logistic regression analyses showed no contribution of MA to students' likelihood of pursuing STEM degrees in either DHH or between DHH and hearing groups. Overall, this work breaks new ground in the study of MA in DHH students and challenges standard views of the relationships between MA and individual experiences.

Language not auditory experience is related to parent-reported executive functioning in preschool-aged deaf and hard-of-hearing children.

Much research has found disrupted executive functioning (EF) in deaf and hard-of-hearing (DHH) children; while some theories emphasize the role of auditory deprivation, others posit delayed language experience as the primary cause. This study investigated the role of language and auditory experience in parent-reported EF for 123 preschool-aged children (Mage  = 60.1 months, 53.7% female, 84.6% White). Comparisons between DHH and typically hearing children exposed to language from birth (spoken or signed) showed no significant differences in EF despite drastic differences in auditory input. Linear models demonstrated that earlier language exposure predicted better EF (ß = .061-.341), while earlier auditory exposure did not. Few participants exhibited clinically significant executive dysfunction. Results support theories positing that language, not auditory experience, scaffolds EF development.

Creating the Capacity to Screen Deaf Women for Perinatal Depression: A Pilot Study.

OBJECTIVE: Compared to hearing women, Deaf female sign language users receive sub-optimal maternal health care and report more dissatisfaction with their prenatal care experiences. As healthcare providers begin to regularly screen for perinatal depression, validated screening tools are not accessible to Deaf women due to severe disparities in English literacy and health literacy. DESIGN AND SETTING: We conducted a one-year, community-engaged pilot study to create an initial American Sign Language (ASL) translation of the Edinburgh Postnatal Depression Scale (EPDS); conduct videophone screening interviews with Deaf perinatal women from across the United States; and perform preliminary statistical analyses of the resulting pilot data. PARTICIPANTS: We enrolled 36 Deaf perinatal women between 5 weeks gestation up to one year postpartum. MEASUREMENTS AND FINDINGS: Results supported the internal consistency of the full ASL EPDS, but did not provide evidence of internal consistency for the anxiety or depression subscales when presented in our ASL format. Participants reported a mean total score of 5.6 out of 30 points on the ASL EPDS (SD = 4.2). Thirty-one percent of participants reported scores in the mild depression range, six percent in the moderate range, and none in the severe range. KEY CONCLUSIONS AND IMPLICATIONS: Limitations included small sample size, a restricted range of depression scores, non-normality of our distribution, and lack of a fully-standardized ASL EPDS administration due to our interview approach. Informed by study strengths, limitations, and lessons learned, future efforts will include a larger, more robust psychometric study to inform the development of a Computer-Assisted Self-Interviewing version of the ASL EPDS with automated scoring functions that hearing, non-signing medical providers can use to screen Deaf women for perinatal depression.

Perceived problem-solving deficits and suicidal ideation: Evidence for the explanatory roles of thwarted belongingness and perceived burdensomeness in five samples.

Perceived social problem-solving deficits are associated with suicide risk; however, little research has examined the mechanisms underlying this relationship. The interpersonal theory of suicide proposes 2 mechanisms in the pathogenesis of suicidal desire: intractable feelings of thwarted belongingness (TB) and perceived burdensomeness (PB). This study tested whether TB and PB serve as explanatory links in the relationship between perceived social problem-solving (SPS) deficits and suicidal thoughts and behaviors cross-sectionally and longitudinally. The specificity of TB and PB was evaluated by testing depression as a rival mediator. Self-report measures of perceived SPS deficits, TB, PB, suicidal ideation, and depression were administered in 5 adult samples: 336 and 105 undergraduates from 2 universities, 53 homeless individuals, 222 primary care patients, and 329 military members. Bias-corrected bootstrap mediation and meta-analyses were conducted to examine the magnitude of the direct and indirect effects, and the proposed mediation paths were tested using zero-inflated negative binomial regressions. Cross-sectionally, TB and PB were significant parallel mediators of the relationship between perceived SPS deficits and ideation, beyond depression. Longitudinally and beyond depression, in 1 study, both TB and PB emerged as significant explanatory factors, and in the other, only PB was a significant mediator. Findings supported the specificity of TB and PB: Depression and SPS deficits were not significant mediators. The relationship between perceived SPS deficits and ideation was explained by interpersonal theory variables, particularly PB. Findings support a novel application of the interpersonal theory, and bolster a growing compendium of literature implicating perceived SPS deficits in suicide risk. (PsycINFO Database Record

Spiritual Well-Being and Psychological Adjustment: Mediated by Interpersonal Needs?

Spiritual well-being has been shown to reduce suicidal behavior, depressive symptoms, and hopelessness. Thwarted interpersonal needs have been shown to increase risk of suicidal behavior. This paper aims to explore the interrelationships among spiritual well-being, thwarted interpersonal needs, and negative outcomes including suicidal ideation, hopelessness, and depressive symptoms among African American women. Sixty-six African American women (M = 36.18; SD = 11.70), from a larger study of women who had experienced interpersonal violence within the past year, completed self-report questionnaires. Mediation analyses revealed that thwarted belongingness, but not perceived burdensomeness, significantly mediated the relations between spiritual well-being and the three outcomes. This study provides the first examination of the role of thwarted interpersonal needs on the link between spiritual well-being and negative psychological outcomes. Spiritual well-being serves a protective role against feelings of social isolation, which may reduce one's risk of negative psychological outcomes. Treatments that bolster a sense of spirituality and social connectedness may reduce suicidal ideation, hopelessness, and depressive symptoms.

Family criticism and depressive symptoms in older adult primary care patients: optimism and pessimism as moderators.

OBJECTIVE: Depression is a significant global public health burden, and older adults may be particularly vulnerable to its effects. Among other risk factors, interpersonal conflicts, such as perceived criticism from family members, can increase risk for depressive symptoms in this population. We examined family criticism as a predictor of depressive symptoms and the potential moderating effect of optimism and pessimism. METHODS: One hundred five older adult, primary care patients completed self-report measures of family criticism, optimism and pessimism, and symptoms of depression. We hypothesized that optimism and pessimism would moderate the relationship between family criticism and depressive symptoms. RESULTS: In support of our hypothesis, those with greater optimism and less pessimism reported fewer depressive symptoms associated with family criticism. CONCLUSION: Therapeutic enhancement of optimism and amelioration of pessimism may buffer against depression in patients experiencing familial criticism.

The relationship between negative life events and suicidal behavior: moderating role of basic psychological needs.

BACKGROUND: Individuals who experience negative life events may be at increased risk for suicidal behavior. Intrapersonal characteristics, such as basic psychological needs, however, may buffer this association. AIMS: To assess the potential moderating role of overall basic psychological needs, and the separate components of autonomy, competence, and relatedness, on the association between negative life events and suicidal behavior. METHOD: Our sample of 439 college students (311 females, 71%) completed the following self-report surveys: Life Events Scale, Basic Psychological Needs Scale, Beck Depression Inventory - II, and the Suicide Behaviors Questionnaire-Revised. RESULTS: In support of our hypotheses, negative life events were associated with greater levels of suicidal ideation and attempts, and satisfaction of basic psychological needs, including autonomy, relatedness, and competence, significantly moderated this relationship, over and above the effects of the covariates of age, sex, and depressive symptoms. CONCLUSIONS: Suicidal behavior associated with the experience of negative life events is not inevitable. Therapeutically bolstering competence, autonomy, and relatedness may be an important suicide prevention strategy for individuals experiencing life stressors.

Illness burden and symptoms of anxiety in older adults: optimism and pessimism as moderators.

BACKGROUND: We assessed the association between medical illness burden and anxiety symptoms, hypothesizing that greater illness burden would be associated with symptoms of anxiety, and that optimism would buffer, while pessimism would exacerbate, this relationship. METHODS: We recruited 109 older adults, aged 65 years and older, from primary care and geriatric clinics to participate in this cross-sectional, interview-based study. Participants completed the Snaith Clinical Anxiety Scale and the Life Orientation Test - Revised, a measure of optimism/pessimism. A physician-rated measure of illness burden, the Cumulative Illness Rating Scale, was also administered. RESULTS: Supporting our hypotheses, greater levels of overall optimism weakened, and pessimism strengthened, the association between illness burden and anxiety symptoms, after accounting for the effects of demographic, cognitive, functional, and psychological covariates. CONCLUSIONS: Bolstering positive and reducing negative future expectancies may aid in the prevention of psychological distress in medically ill older adults. Therapeutic strategies to enhance optimism and reduce pessimism, which may be well-suited to primary care and other medical settings, and to which older adults may be particularly amenable, may contribute to reduced health-related anxiety.

Hallucinations, pseudohallucinations, and severity of suicidal ideation among emergency psychiatry patients.

AIMS: This study investigated relative relationships between auditory hallucinations and nonpsychotic hallucinations (pseudohallucinations), and suicidal risk. METHODS: A sample of 206 consecutive patients seen in an emergency psychiatric service was evaluated for the presence and intensity of hallucinatory experiences (the hallucination item of the Positive and Negative Symptoms Scale), suicidal intensity (the suicide item of the Montgomery Asberg Depression Rating Scale), and cumulative suicide risk (the total number of risk factors). RESULTS: Individuals with nonpsychotic hallucinations experienced greater intensity of suicidal ideation versus subjects with no hallucinations or subjects with psychotic hallucinations (p = .0001). CONCLUSIONS: Pseudohallucinosis is associated with higher intensity of suicidal ideation compared with psychotic hallucinations or no hallucinations.

Hallucinations, psuedohallucinations, and parahallucinations.

BACKGROUND: There are several clinical phenomena that resemble hallucinations which are inadequately studied because the terminology defining them is inadequate. METHODS: A review of the relevant literature, identified by searches of Ovid and PubMed databases. RESULTS: A historical review reveals that the term pseudohallucination has been used to describe several separate and unrelated phenomena. Herein this term is redefined, and an additional term, parahallucinations, is introduced. Hallucinations are defined as sensory perceptions that have the compelling sense of reality of true perceptions but that occur without external stimulation of the relevant sensory organ and are experienced as following the sensory path, that is, can be localized in three-dimensional space outside the body. Pseudohallucinations are defined as hallucinatory phenomena that do not follow the sensory path and are experienced predominantly by psychiatrically ill subjects. Parahallucinations are defined as hallucinatory phenomena that occur due to an injury or abnormality to the peripheral nervous system. Insight into the reality of these experiences-the realization that they are not real-is not felt to be important in their phenomenology. CONCLUSION: Utilization of this classification system during clinical investigations will yield greater insight into the pathophysiology, course, treatment, and prognosis of psychiatric and neurologic disorders.

Contribution of arginine-glutamate salt bridges to helix stability.

Peptide side chain interactions were studied by molecular dynamics simulation using explicit solvent on a peptide with the sequence AAARAAAAEAAEAAAARA. Three different protonation states of the glutamic acid side chains were simulated for four 20 ns runs each, a total simulation time of 240 ns. Two different salt bridge geometries were observed and the preferred geometry was found to depend on Glu - Arg residue spacing. Stable charge clusters were also observed, particularly in the fully charged peptide. Salt bridges were selectively interrupted upon protonation, with concomitant changes in secondary structure. The fully charged peptide was highly helical between residues 9 and 13, although protonation increased helicity near the N-terminus. The contribution of salt bridges to helix stability therefore depends on both position and relative position of charged residues within a sequence.