Chronic Cerebrospinal Venous Insufficiency Research Articles

BODIES AGAINST MODERNITY: Politics of Slum Rehabilitations in India

AbstractIndia continues to modernize, and the legacy of political modernity rooted in the European Enlightenment continues to reify itself in India through the performative practices of the body politic. The body politic is a totalized conceptualization of a society imagined in the form of a body, with real exclusionary effects on those without citizenship rights. This body politic is made real through performances of popular sovereignty, bureaucratic state practices and liberal democratic electoral procedures performed during urban development processes. Ethnographic accounts of politics of slum rehabilitations in Pune show that the modern body politic is indeed performatively practised, and reshaped, by the very bodies that are expected to be alienated for the making of the body politic. Bodies meet one another in different spaces and times and generate the possibility of reshaping the liberal body politic into relational and affective bodily politics. Together, bodies become both the site and the means through which political modernity is reshaped in India.

Association between chronic cerebrospinal venous insufficiency and multiple sclerosis: a systematic review and meta-analysis

ObjectivesNumerous studies have indicated that chronic cerebrospinal venous insufficiency is a potential factor in causing multiple sclerosis in recent years, but this conclusion remains unconfirmed. This meta-analysis examined the correlation...

Cerebral Outflow Discrepancies in Recurrent Benign Paroxysmal Positional Vertigo: Focus on Ultrasonographic Examination.

This prospective pilot study aimed to evaluate whether cerebral inflow and outflow abnormalities assessed by ultrasonographic examination could be associated with recurrent benign paroxysmal positional vertigo (BPPV). Twenty-four patients with recurrent BPPV, affected by at least two episodes, and diagnosed according to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria, evaluated at our University Hospital, between 1 February 2020 and 30 November 2021, have been included. At the ultrasonographic examination, 22 of 24 patients (92%) reported one or more alterations of the extracranial venous circulation, among those considered for the diagnosis of chronic cerebrospinal venous insufficiency (CCSVI), although none of the studied patients were found to have alterations in the arterial circulation. The present study confirms the presence of alterations of the extracranial venous circulation in recurrent BPPV; these anomalies (such as stenosis, blockages or regurgitation of flow, or abnormal valves, as per the CCSVI) could cause a disruption in the venous inner ear drainage, hampering the inner ear microcirculation and then possibly causing recurrent otolith detachment.

The Negative Prognostic Role of Inflammatory Biomarkers in Patients With Chronic Cerebrospinal Venous Insufficiency.

The pathologic consequences of inflammatory responses in chronic cerebrospinal venous insufficiency (CCSVI) remains poorly understood. Hence, this study was aimed to evaluate the peripheral inflammatory biomarkers in patients with intracranial and extracranial CCSVI pathology. In addition, the relationship between inflammatory cytokine profile and CCSVI prognosis was also evaluated. Patients diagnosed with CCSVI between July 2017 and July 2019 were included and subsequently divided into 3 groups based on the location of stenosis. The inflammatory biomarker assay included neutrophil-to-lymphocyte ratios (NLRs), platelet-to-lymphocyte ratios (PLRs), red blood cell distribution widths (RDW), C-reactive protein (CRP) levels, interleukin-6 (IL-6) levels, and neuron-specific enolase levels. Clinical outcomes were assessed using the modified Rankin Scale and Patient Global Impression of Change score. Univariate and multivariate regression analyses were performed to identify significant prognostic factors for poorer outcomes. Finally, we established a nomogram based on the multivariate regression analysis. We enrolled 248 patients in total, including 102 males and 146 females, with an average age of 57.85±12.28 years. Compared with patients with internal jugular vein stenosis, cerebral venous sinus stenosis (CVSS) patients were mostly younger and had been suffering from headaches and severe papilledema. Higher levels of NLR, RDW, and CRP were also observed in the CVSS group. Multivariate analysis indicated that NLR, PLR, and IL-6 were the independent prognostic factors for poor CCSVI outcomes. The clinical presentations and increases in NLR, PLR, IL-6, and CRP levels could be distinctly marked in patients with CVSS-related CCSVI than that in internal jugular vein stenosis-related CCSVI, indicating poor prognostic outcomes in these patients. A proinflammatory state might be associated with CCSVI pathology.

Abnormal jugular valves are not the sole explanation of an impaired outflow from the cranial cavity through the internal jugular veins: results of <I>in silico</I> studies

Background. Currently, pathological jugular valves are thought to be the main cause of altered hemodynamics in the internal jugular veins, the so-called chronic cerebrospinal venous insufficiency. The alternative interpretation of flow disturbances in these veins is that the main source of abnormal outflow are nozzle-like strictures in their upper parts, at the level or just below the jugular foramen, for example, caused by an enlarged transverse process of the atlas and/or styloid process of the temporal bone.1 These in silico studies were aimed at validation of this hypothesis.
 Methods. With the use of computational fluid mechanics software: the Flowsquare+ and the COMSOL multiphysics, we simulated blood flow in the models of internal jugular veins that exhibited different morphologies (Figure 1). With the Flowsquare+ software, we performed 3-dimensional simulations for the assessment of relevance of the strictures at the level of jugular foramen, while the COMSOL multiphysics software, which was used in 2-dimensional mode, gave us more detailed insight into the behavior of the jugular valve. Results. There was a normal unidirectional flow, with the centrally positioned centerline velocity and no flow separation in modeled veins, which were not narrowed or presented with gradual narrowings. On the contrary, in a majority of models with nozzle-like strictures located at the beginning of the studied veins, abnormal flow patterns were revealed, with significant flow separation and regions with reversed flow. The most severe flow abnormalities were not seen in the models with nozzles of a small cross-sectional area, but rather in those positioned asymmetrically. Abnormal valves (with reversed or asymmetric leaflets) further impaired the flow in models with symmetrically positioned nozzles, but had no significant impact on the flow in a case of an already altered flow evoked by the asymmetric nozzles.1 Importantly, simulations performed with the COMSOL multiphysics revealed that flow disturbances evoked by significant stenosis in the upper part of the internal jugular vein distort leaflets of the jugular valve. This was not seen as a case of a minor stenosis.
 Conclusions. We demonstrated that our working hypothesis is credible and that impaired outflow from the brain through the internal jugular veins is likely to be primarily caused by pathological strictures in the upper parts of these veins, instead of pathological jugular valves that, as of yet, were the main target of clinical research. In addition, pathology of the jugular valves may be secondary to the strictures in the upper segments of the internal jugular veins.

The BE COOL Treatments (Batroxobin, oxygEn, Conditioning, and cOOLing): Emerging Adjunct Therapies for Ischemic Cerebrovascular Disease.

Ischemic cerebrovascular disease (ICD), the most common neurological disease worldwide, can be classified based on the onset time (acute/chronic) and the type of cerebral blood vessel involved (artery or venous sinus). Classifications include acute ischemic stroke (AIS)/transient ischemic attack (TIA), chronic cerebral circulation insufficiency (CCCI), acute cerebral venous sinus thrombosis (CVST), and chronic cerebrospinal venous insufficiency (CCSVI). The pathogenesis of cerebral arterial ischemia may be correlated with cerebral venous ischemia through decreased cerebral perfusion. The core treatment goals for both arterial and venous ICDs include perfusion recovery, reduction of cerebral ischemic injury, and preservation of the neuronal integrity of the involved region as soon as possible; however, therapy based on the current guidelines for either acute ischemic events or chronic cerebral ischemia is not ideal because the recurrence rate of AIS or CVST is still very high. Therefore, this review discusses the neuroprotective effects of four novel potential ICD treatments with high translation rates, known as the BE COOL treatments (Batroxobin, oxygEn, Conditioning, and cOOLing), and subsequently analyzes how BE COOL treatments are used in clinical settings. The combination of batroxobin, oxygen, conditioning, and cooling may be a promising intervention for preserving ischemic tissues.

Métastases osseuses rachidiennes : quand opérer ? Pourquoi ? Comment ?

Spinal metastases are not rare and require specialized management in order to avoid neurological complications that may lead to serious deterioration of patient’s general health status. Full spine imaging is ordered to analyze spinal compression zones and vertebral lytic lesions. In case of symptomatic spinal cord compression, a liberation procedure is performed in emergency, to avoid neurological sequelae. Instable lesions can be stabilized, by cementing, pedicle fixation or corpectomy, according to the magnitude of vertebral destruction and general health status of the patient. Surgical management is decided in collaboration with treating oncologist, radiologist and radiotherapist.1877-1203/© 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Equality, liberty, justice: Bobbio’s democratic vision, between liberalism and socialism *

ABSTRACT Bobbio’s democratic vision warrants scrutiny not simply as a theory of procedural democracy, but also for its critical study of political ideologies (historical and contemporary) and its ambition to reconcile some of their driving ideals. This article draws the attention of Anglophone scholars to Bobbio’s life-long endeavour to merge the competing agendas of liberalism and socialism and thus develop a democratic theory capable of merging productively the notions of equality, liberty, and justice. Rather than a cross-eyed theory of democracy, Bobbio’s encapsulated a vigorous attempt to alert rival partisans of both the limits and the potential of their respective projects. He urged socialists to appreciate the importance of liberal institutions and procedures vis-à-vis unconditional celebrations of direct democracy; at the same time, he warned liberals about the ‘broken promises’ of representative democracy and the oligarchic involution of parliamentarism. The article pursues three related goals. It situates Bobbio’s project in its historical context, charting the ways in which the political history of 20th-century Italy and Europe forged his “liberalsocialism”. It examines its similarities and differences with previous attempts to cross-fertilize the liberal and the socialist projects across the Atlantic. It explores its constitutive tensions through the lenses of one of its most perceptive interpreters in the Anglophone world – Perry Anderson. By doing so, the article seeks to provide a nuanced study of Bobbio’s democratic vision and shed light on its persistent relevance for thinking through the challenges of representative democracy in our present.

A Phlebectasia of Internal Jugular Vein as a Manifestation of Chronic Cerebrospinal Venous Insufficiency in Meniere Syndrome Patients

A Phlebectasia of Internal Jugular Vein as a Manifestation of Chronic Cerebrospinal Venous Insufficiency in Meniere Syndrome Patients

A Case Study on the Development and Operation of Competency－Based Liberal Arts Courses in a Modularized Non-Curriculum Program

The purpose of this study is to conduct a case study of the development and operation of the ‘G-MAP blueprint’, a competency-based liberal arts subject that has modularized the non-curricular program of W University. In order to achieve this goal, we conducted an analysis of the operation status of liberal arts and non-curricular programs, focus interviews with professors, and a satisfaction survey of education consumers. The results of this study are as follows. First, this course is absolutely necessary for new students to improve their understanding and adaptability to college life in general. Appropriate guidance is available, and opportunities are provided to prevent dropout of freshmen, Second, a feasible case of developing liberal arts subjects for nurturing dedicated human resources and expanding the number of credits required for graduation from liberal arts is presented even at universities that do not have an organization dedicated to liberal arts education within the university. Third, in order to raise awareness of the importance of liberal arts education at the university level, the scalability of liberal arts education is suggested by sharing practical case studies that can be operated together by professors in charge of liberal arts subjects and professors in charge of majors. Fourth, by introducing the competency-based liberal arts development process and procedure through modularization of the non-curricular program, it presented important basic data for diversifying the operation of university liberal arts education and seeking developmental directions in the future. Fifth, it has important educational significance in that it presents a case in which it is possible to expand the educational performance and effectiveness of liberal arts education through a three-year longitudinal study. Therefore, although this study may have limitations as a case study at a junior college, it is expected that it will be of value to be used as a continuous research data in the future.

Malunion fracture of supracondylar femur sinistra with post traumatic arthritis and stiffness at genu sinistra: a case report

Post-traumatic osteoarthritis could emerge immediately after an injury or one year after a bone fracture, ligament injury, and meniscal tears. In this case report, we present a 30 years old male who previously suffered from joint injury and thus lost the ability to flexion. This patient has already under went internal bone implantation surgery involving the implantation but was removed due to pain, and there was protruding implant on the left knee. On physical examination, there was varus deformity with flexion ranged between 0-5°. On radiological examination, malunion and narrowing of the joint surface were, as shown, clinically inhibit the flexion of the knee. We diagnose the patient with malunion supracondylar femur sinistra and post traumatic osteoarthritis genu sinistra. Liberation procedure (soft tissues release) and osteotomy of the distal femur were performed on this patient. On post-op radiological examination, the implant successfully widens the joint surface and holds the fracture fragment after it was reduced. The joint was immediately mobilize using the machine. It was shown that in a relatively short period, the range of motion could reach 90°. Three months post-op, evaluation was done, and it was clearly shown that the range of motion had not decreased.

Multiple sclerosis and venous angioplasty for chronic cerebrospinal venous insufficiency: a case control study with ten years follow-up with patients at their own control

Progressive Neurological Diseases (PND) and Chronic Cerebrospinal Venous Insufficiency (CCSVI) and Multiple Sclerosis (MS) have two terms in common: “progressive and chronic” and shortly mean that there is no definitive therapy, at the moment. The clinical aspects are built on symptoms, upon which the definition of “progression” is based and hence classified. Changement and worsening of symptoms, allow classification of the disease and adjustments are effectively an “up to date” of the disease itself. We here resume the ten-year survey of 482 Multiple Sclerosis (MS)-affected patients (314 females, 168 males; mean age =37.8), classified by their Neurology Physicians as Relapse-Remitting (RR), according to the Kurtzke Expanded Disability Status Scale (EDSS), monitoring the parallel presence of CCSVI with clinical MS progression. Results are present from two homogeneous Relapse-Remitting MS groups of patients divided as “treated and non-treated for CCSVI” with vein angioplasty (vPTA). Furthermore, a Patient’s self-classification based upon symptoms in presence of CCSVI, up to now never implemented, was developed on the basis of both clinical and Duplex vascular issues.

Хроническая церебральная венозная дисфункция: взгляд на проблему

В статье представлен аналитический обзор результатов отечественных и зарубежных исследований по проблеме хронических нарушений мозгового венозного кровообращения, которым уделяют меньше внимания в сравнении с патологией артериальной системы из-за нечеткости проявлений, особенно ранних, анатомической изменчивости венозного русла даже у здоровых, сложности верификации диагноза и т.д. Когда баланс артериального притока и венозного оттока нарушается и это нарушение прогрессирует, развиваются необратимые изменения в других структурах полости черепа — в первую очередь страдает головной мозг (что согласуется с концепцией Монро — Келли). Хронические нарушения церебрального венозного кровообращения могут иметь разные причины и разную степень выраженности. Синдром хронической церебральной венозной дисфункции, терминологически принятый у нас, в некоторых странах рассматривается как хроническая венозная цереброспинальная недостаточность, что подчеркивает патогенетическую связь нарушений церебрального венозного кровотока с внечерепными венами, что, на наш взгляд, является логичным и обоснованным. Признание хронической цереброспинальной венозной недостаточности вызвало значительный интерес к изучению роли внечерепной венозной патологии и вариантов ее развития. Несмотря на то, что диагноз изначально был основан на допплерографической сонографии, пока не установлено диагностических способов визуализации, неинвазивных или инвазивных, которые могут служить золотым стандартом для выявления венозных отклонений, свидетельствующих о хронической цереброспинальной венозной недостаточности. Обсуждаются результаты ряда исследований, в частности, гипотезы о роли хронической цереброспинальной венозной недостаточности в патогенезе рассеянного склероза и многих сопутствующих клинических проявлений. Анализируется общность по патогенезу идиопатической внутричерепной гипертензии, болезни Меньера, синдрома спондилогенной вертебрально-базилярной недостаточности. Акцентируется внимание и на другом мнении ученых, которые повышение венозного кровенаполнения головного мозга и других образований полости головы при определенных условиях рассматривают как компенсаторную реакцию. Рассматриваются анатомо-физиологические особенности венозной системы черепной полости, обосновывающие клинические проявления венозной дисфункции, способы диагностики и лечения патологии. Обобщая вышесказанное отметим, что хроническое нарушение циркуляции венозной крови в полости черепа в значительной степени связано с проблемами внечерепного венозного кровотока и не только само по себе является достаточно характерным синдромокомплексом, который негативно влияет не только на неврологические функции за счет гипоксии мозга и метаболических изменений, ухудшает качество жизни, но и на течение или имеет патогенетическую связь с другими заболеваниями, в частности, может сопровождаться различным уровнем артериального давления.

Inference for spatial regression models with functional response using a permutational approach

The aim of this work is to introduce an approach to null hypothesis significance testing in a functional linear model for spatial data. The proposed method is capable of dealing with the spatial structure of data by building a permutation testing procedure on spatially filtered residuals of a spatial regression model. Indeed, due to the spatial dependence existing among the data, the residuals of the regression model are not exchangeable, breaking the basic assumptions of the Freedman and Lane permutation scheme. Instead, it is proposed here to estimate the variance–covariance structure of the residuals by variography, remove this correlation by spatial filtering residuals and base the permutation test on these approximately exchangeable residuals. A simulation study is conducted to evaluate the performance of the proposed method in terms of empirical size and power, examining its behavior under different covariance settings. We show that neglecting the residuals spatial structure in the permutation scheme (thus permuting the correlated residuals directly) yields a very liberal testing procedures, whereas the proposed procedure is close to the nominal size of the test. The methodology is demonstrated on a real world data set on the amount of waste production in the Venice province of Italy.

The crisis of the classical concept of liberal democracy in the context of modern challenges


 
 
 The main aim of this paper is to examine the problem of the crisis of liberal democracy in the modern world, referring to the phenomenon of a loss of balance between social and personal good in a pluralistic society. There are several concepts of democracy in political science, including the classic liberal concept, which sees its core priorities collide with recent global challenges. Thus, the relevance of this problem refers to the recent disappointment in the idea of liberal democracy, which shows disillusionment in democracy as such. In response to this trend, some hybrid regimes offer an alternative in the form of so-called democracies with illiberal approaches. From the other side, the liberal democratic platforms are used by populist political forces, which results in dividing democratic societies about the questions hard to finally solve. The Brexit problem – the process of British exit from the European Union – shows recent examples of long-lasting social effects derived from the crisis of liberal democratic concept. The author of the article has come to the conclusion that when it comes to modern democratic processes, classic liberal approach brings the populism threat back to the table. When there is no balance between the totally free civil society with its direct democratic influences and the state structure with formal procedures aimed at total good of beneficial functioning, the liberal instruments would be used by populists. Populism can create severe divisions within liberal democratic societies providing dilemmas, such as Brexit, which are difficult to solve with the same liberal democratic procedures. This means that liberal democratic approach undermines itself with the very fact of the existing tendency to lose balance between the ideal personal freedom (that includes satisfying every citizen’s choice) and public good.
 
 

What are the ideal characteristics of a venous stent?

Historically, the stents used in the venous system were not dedicated scaffolds. They were largely adapted arterial stents. An essential feature of a venous stent is compliance, in order to adapt its crosssectional area to the vein. It should also be crush resistant, corrosion resistant and fatigue resistant. The material should be radiopaque, for follow-up. Another characteristic of the ideal venous stent is flexibility, to adapt its shape to the vein, not vice versa. The scaffold should be uncovered too, in order to avoid the occlusion of collaterals. The ideal venous stent should not migrate, so it is necessary a large diameter and a long length. The radial force is important to prevent migration. However, current stents derived from arterial use display high radial force, which could affect the patency of the thin venous wall. Alternatively, if the stent has an anchor point, that permits a passive anchoring, the radial force required to avoid migration will be lower. Dedicated venous stents were not available until very recently. Furthermore, there is a preclinical study about a new compliant nitinol stent, denominated Petalo CVS. Out of the commonest causes of large veins obstruction, dedicated venous stent could also treat other diseases described more recently, such as the jugular variant of the Eagle syndrome, JEDI syndrome and jugular lesions of the chronic cerebrospinal venous insufficiency that result unfavorable for angioplasty according to Giaquinta classification.

Clinical characteristics, inflammation and coagulation status in patients with immunological disease-related chronic cerebrospinal venous insufficiency.

BackgroundImmunological disease-related chronic cerebrospinal venous insufficiency (CCSVI) is rarely reported. This study aimed to analyze clinical characteristics, inflammation, and coagulation status in patients with immunological disease-related CCSVI.MethodsPatients with CCSVI were enrolled from 2017 to 2019 and divided into three cohorts based on their immunological disease backgrounds, including groups with confirmed autoimmune disease, with suspected/subclinical autoimmune disease, and with non-immunological etiology. Immunological, inflammatory, and thrombophilia biomarker assay in blood samples were obtained. Mann-Whitney U test or Fisher’s exact test was used to compare continuous variables or categorical variables between the CCSVI patients with or without the immunological etiology. Spearman’s correlation analysis was conducted among age, baseline neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), interleukin-6 (IL-6), C-reactive protein (CRP), and neuron-specific enolase (NSE) in the three groups.ResultsA total of 255 consecutive patients with CCSVI were enrolled, including three subgroups: CCSVI with confirmed autoimmune disease (n=41), CCSVI with suspected/subclinical autoimmune disease (n=116) and CCSVI with non-immunological etiology (n=98). In the first subgroup, a series of 41 cases was confirmed with eight different autoimmune diseases including antiphospholipid syndrome (n=18), Sjögren’s syndrome (n=8), immunoglobulin G4-related disease (n=7), Behçet’s disease (n=2), autoimmune hepatitis (n=2), Wegener's granulomatosis (n=2), systemic sclerosis (n=1) and AQP4 antibody-positive neuromyelitis optica spectrum disorder (n=1). Groups with immunological etiology did not show a higher incidence of thrombophilia or increased pro-inflammatory biomarkers (e.g., neutrophil, IL-6). However, patients with non-immunological etiology had a higher baseline level of CRP. Additionally, baseline PLR was moderately correlated to NLR and CRP in CCSVI patients with non-immunological etiology and suspected/subclinical autoimmune disease.ConclusionsThe formation of CCSVI may be based on the inflammatory process, facilitated by multiple risk factors, among which medical history of immunological diseases may play a significant role due to the intricate relationship between inflammation and coagulation. Moreover, CCSVI may also cause an independent inflammatory injury in venous walls, leading to focal stenosis or thrombus, without attacks from autoimmune antibodies.

Communication for "patient liberation". The role of new media in the case of chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis (MS)

Communication for "patient liberation". The role of new media in the case of chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis (MS)

A Systemic Understanding of Hybrid Peace: An Examination of Hybrid Political Orders in African Peace Governance

The idea of hybrid peace has gained prominence in both academic and policy literature, yet ongoing debates fail to explicitly address a key lacuna concerning the relationship between hybrid political orders and the enhancement of traditional peacemaking in the Global South. Using an integrative governance framework, this article examines the notion of hybridity from grassroots to regional peace practices in Africa. It argues that the efficacy and sustenance of traditional African peacemaking could be enhanced if a customary peace practice is systemically integrated with liberal procedures and that discussions on hybridity will gain more value and meaning if the debates (re)center on unpacking hybridity at key governance arenas/stages—and the implications for a national and international order. The article thus attempts to provoke a new conversation that disaggregates the possibilities, dilemmas, and implications of hybrid orders from grassroots through regional to a global level and what it contributes to future peacebuilding.

Neck And Brain Venous Lesions In Meniere’s Disease

Objectives: The authors evaluate the incidence of Chronic Cerebro-Spinal Venous Insufficiency (CCSVI) in patients with Meniere’s Disease (MD). Methods: Between April 2013 and April 2020, 622 patients with diagnosis of Meniere’s Disease were included, all were submitted to duplex ultrasound and Magnetic Resonance Angiography (MRI) with TOF 2D and 3D reconstruction and compared to a control population. Results: Chronic Cerebo-Spinal Venous Insufficiency (CCSVI) was demonstrated in 81.4% of patients with Meniere’s disease vs. 12.7% of the volunteers. Visible defects were present in 90% of the cases. There was a high correlation, round 90%, between ultrasound exam and MRI. Conclusion: Our results suggest that there is a high incidence of neck and brain veins in patients suffering of Menière's disease.