We conducted a retrospective study to determine whether the presence of moyamoya collaterals influenced the risk of recurrence of cerebrovascular events (CVEs: stroke or transient ischemic attack) in patients with sickle cell disease placed on chronic transfusions after a stroke. Forty-three patients with homozygous sickle cell anemia (HbSS) and 1 with HbSO Arab (16 females, 28 males) who had suffered strokes while under the age of 18 were studied. All patients had been on transfusions aimed at maintaining the sickle hemoglobin (HbS) level below 30%. They were followed for a mean of 6.6 years (2.2 to 20.4 years). The presence of collaterals was diagnosed based on either magnetic resonance angiography or conventional angiography. Eighteen (41%) of the 44 patients suffered recurrent CVEs. Nineteen (43%) (6 females, 13 males) patients had moyamoya collaterals. Eleven (58%) of these 19 experienced 21 total recurrent CVEs, including 4 strokes in 4 patients (21%). In comparison, 7 (28%) of 25 patients without moyamoya collaterals experienced 9 recurrent CVEs (P < .05) with only 1 recurrent stroke (4%). Moyamoya patients were also more likely to have 2 recurrent CVEs (42% vs 8%,

There are currently more than 2 million end-stage kidney disease (ESKD) patients who require kidney replacement therapy worldwide, 1 and this is estimated to rise to over 5 million by 2030. 2 While a kidney transplant is the ideal therapy, hemodialysis (HD) is used by the majority (60-70%) of ESKD patients. 3 HD requiresvascular access via a central vascular catheter, an arteriovenous fistula, or a synthetic graft. Hemodialysis with a fistula or graft requires the insertion of two needles to access the blood flow; venous needle dislodgement can happen when the venous needle becomes dislocated out of the vascular access, resulting in blood loss. At typical hemodialysis blood flow rates of 400-500 mL/minute, it can take only minutes for the patient to lose over 40% of his or her blood volume (the point at which hemorrhagic shock occurs). 4 VND represents a potentially life-threatening situation and a real cost to the patient and the health service, with interventions required including ICU or emergency department admissions, increased erythropoietin use, pathology testing and blood transfusions. 5

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Mechanical instability of the spinopelvic junction is a suspected cause of abnormal gait in high-grade spondylolisthesis. Computerized three-dimensional gait analysis was performed on a 10-year-old with grade III spondylolisthesis at L-5. Preoperatively, the gait pattern was characterized by posterior pelvic tilt, decreased hip flexion, increased knee flexion, and decreased stride length and walking speed. All temporal and kinematic parameters of gait normalized after laminectomy and instrumented, in situ arthrodesis (L-4-S-1). The absence of any neurologic abnormalities on preoperative imaging, intraoperative somatosensory-evoked potentials (SSEP) monitoring, and nerve-root exploration, together with the observed improvement after stabilization of the spinopelvic junction, suggests a mechanical basis for the gait changes in high-grade spondylolisthesis.