Ivy sign on FLAIR imaging is still not rare in patients with moyamoya disease, even when asymptomatic. Although optimal management is still under debate, ivy sign may be an indicator of misery perfusion, and patients with asymptomatic moyamoya disease and ivy sign on FLAIR imaging will benefit from more careful follow-up.
Collagen biomaterials are widely used for soft tissue augmentation. Cross‐linking techniques for collagen matrix (CM) achieve mechanical and volumetric stability; nevertheless, cross‐linking may compromise biocompatibility. The aim of the present study was to investigate two different three‐dimensional (3D) porcine‐derived CMs, noncross‐linked (ncl)_CM and cross‐linked (cl)_CM, for their effects on macrophages (Mφ) and gingival fibroblasts. The effects of the CMs on the cell viability, proliferation, and polarization of Mφ derived from human monocyte THP‐1 cells were assessed. The effects of paracrine factors from Mφ cultured on the CMs were further studied in human gingival fibroblasts (HGF‐1 cells). The spongy layer of ncl_CM was partially resorbed after 1 day of culture. cl_CM maintained increased numbers of viable cells when compared with ncl_CM on day 3 for both THP‐1 and HGF‐1 cells. Higher mRNA levels of M1 markers, including IL‐1 and IL‐6, were found in Mφ cultured on cl_CM, while no significant differences were observed in M2 marker expression levels, including Arg1 and CD206, for cells cultured on both CMs when compared with those of the control. Furthermore, the conditioned medium collected from Mφ cultured on both CMs decreased cell viability. Nevertheless, neither of the CM‐conditioned media influenced the mRNA levels of TGF‐β, COL1a2, and PDGF‐A in HGF‐1 cells when compared with the control media. A comparison showed that cl_CM tended to result in more viable cells than ncl_CM, while cl_CM polarized Mφ toward an M1 phenotype, which was confirmed by the observation of increased mRNA levels of pro‐inflammatory cytokines.
Case report A 4-year-old female was presented at our hospital with frequent right frontal headache attack. She was diagnosed with moyamoya disease and was conservatively followed up. One year later, the frequency of headache gradually decreased. However, follow-up MR imaging revealed that the disease stage markedly progressed in the right side and cerebral infarction occurred in the temporal lobe with atrophy of the right frontal lobe. She underwent direct and indirect revascularization on the right side. Conclusion Aware of this case, we would like to emphasize that headache may be one subtype of ischemic attacks and require frequent MR follow-up to see the disease course. If there is any sign of disease progression, immediate surgical intervention should be indicated to avoid irreversible brain damage.
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