bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP265: Anti-inflammatory Effects Of Ceria Nanoparticles In Experimental Intracerebral Hemorrhage Models
Authors: Kim Chi Kyung , Kang Dong-Wan , Choi In-Young , Ki Seul-Ki , Soh Min , Kim Do Yeon , Pyun Jung Min , Jeong Han-Gil , Kim Jun Yup , Lee Seung-Hoon
Published: March 2022

Aim:
Ceria nanoparticles (NPs) are potent anti-oxidants because of their small size and surface characteristics. In addition to this, they have anti-inflammatory effects. However, their effects on post-stroke inflammation have not been evaluated in experimental intracerebral hemorrhage (ICH).

Methods:
Ceria NPs were made by a modified double-decomposition method. RAW 264.7 macrophages (MΦs) were activated by 30% hemolysate from blood by checking morphology and inflammatory products. They were treated by 0.125 mM ceria NPs or not. Overall reactive oxygen species (ROS) after the activation of MΦs were measured by oxidized DCF-DA in FACS. Inflammatory cytokines, IL-1β and TNF-α, were evaluated by ELISA, and inflammatory end-products, COX2 and iNOS, were done by Western blots. Animal ICH was induced by the stereotactic injection of collagenase into the rat brain, and ceria NPs were injected intravenously. Water contents were measured by wet and dry weights of brain after induction of ICH. We calculated hematoma volumes by an image-analyzer and the recruitment of MΦs in perihematomal area by the immunofluorescent staining using CD68 antibody.

Results:
Ceria NPs were made as 3-nm small sized, uniform round-shaped, and well-dispersed agents, which were suitable for biomedical applications. Ceria NPs reduced oxidized DCF-DA (a marker of overall ROS) after hemolysate-induced activation of MΦs (ceria-treated group, 391 unit vs. control, 567 unit, P=0.03). In this in vitro hemorrhage model, MΦs secreted less cytokines, IL-1β and TNF-α, in ceria-treated group than control, and in Western blots, the expression of COX2 and iNOS decreased in ceria group compared to control. In rat ICH model, ceria NPs reduced water contents in hemorrhagic hemisphere, which is closely related to perihematomal inflammation (0.5 mg/kg ceria group, 79,9% vs. control, 81.1%, P=0.01). Although hematoma volumes were not different between two groups, the CD68-positive MΦs in immunofluorescent staining were less recruited into the perihematomal area in ceria-treated group than control.

Conclusion:
Ceria NPs decreased inflammation after ICH in both in vitro and in vivo models. From these anti-inflammatory effects, they could be potential therapeutic agents in acute period after ICH.
Abstract WP279: Disruption of Cortico-hippocampal Functional Connectivity Underlies the Memory Impairment Following Experimental Stroke
Authors: Rabiller Gratianne , Nishijima Yasuo , He Jiwei , Leinekugel Xavier , Bontempi Bruno , Liu Jialing
Published: March 2022

Introduction:
The cognitive consequences and the underlying mechanisms leading to cognitive impairments after cerebrovascular occlusive diseases are still unclear. Previously we have shown that distal middle cerebral artery occlusion (dMCAO) led to hippocampal hypofunction and spatial memory impairment in the absence of direct hippocampal injury.

Hypothesis:
In light of the importance of interactions between the cortex and hippocampus during memory processing, we hypothesize that cortical stroke disrupts afferent excitatory input from the lesioned cortical area to other remote brain regions such as the hippocampus, which can be mimicked by pharmacological inactivation of the cortex.

Methods:
Adult male rats were subjected to either dMCAO or cortical inactivation with AMPA receptor antagonist CNQX, compared to controls by sham-operation or injection with artificial CSF, respectively. Hippocampal function was determined by the social transmission of food preference (STFP) test, activity mapping by Fos imaging and in vivo electrophysiology by multi-channel extracellular recording.

Results:
dMCAO and cortical inactivation both induced impaired memory performance as measured in the STFP task and reduced hippocampal activation. The memory impairment was not attributed to change in olfaction by stroke or inactivation, since it was not detected in either experimental group. An increase in the bursts of sharp-wave associated ripples (SPW-Rs) was detected during reperfusion after stroke and after CNQX injection. Further, cortical inactivation also induced a shift of the theta phase, suggesting an alteration in the dynamics of hippocampal-cortical interactions.

Conclusions:
Given the crucial role of hippocampal theta and SPW-Rs in memory function, our results suggest that cortical stroke leads to memory impairment by disrupting the functional connectivity between the cortex and hippocampus, albeit without causing direct injury to the latter.
Abstract WP281: Plasma Kallikrein Inhibition Reduces Tissue Plasminogen Activator-induced Stroke Damage and Hemorrhage Transformation
Authors: Simão Fabricio , Clermont Allen C , Feener Edward P
Published: March 2022

Introduction and Hypothesis:
Tissue plasminogen activator (tPA) remains the only approved treatment for acute ischemic stroke, but its use is limited by serious risk of hemorrhage transformation over time resulting in enhanced brain injury. Plasma kallikrein (PK) has been implicated in both ischemic and hemorrhagic stroke, however its role during tPA-mediated thrombosis is not yet available. We hypothesized that plasma kallikrein inhibition could increase the safety of tPA thrombolysis in stroke.

Methods:
Male C57Bl6 mice were subjected to middle cerebral artery occlusion (MCAO) by photothrombotic laser, and then treated with tPA (10 mg/kg; via jugular vein) at 2 h in the absence or presence of pretreatment with the selective PK inhibitor BCBPC (1-Benzyl-N-(4-carbamimidoylbenzyl)-1H-pyrazole-4-carboxamide) at doses of 1, 3, 10, 20 mg/kg administered for 15 min before tPA. Male PK-deficient (Klkb1-/-) mice were used to further evaluate the role of PK in tPA-induced brain injury following MCAO. Mice were sacrificed at 24 h post-stroke and brains perfused with saline for evaluation of infarct size, edema and cerebral hemorrhage. Western blot was used to evaluate levels and the cleavage of the PK substrate high molecular weight kininogen (HK).

Results:
Acute tPA administration at 2 hours post MCAO increased infarct volume (2.1 fold), edema (1.8 fold) and hemorrhage transformation (2.7 fold) when compared with the untreated stroke group (p<0.05). Pretreatment of mice with BCBPC decreased tPA-induced infarct volume, edema and hemorrhage to 1.7 fold, 2.7 fold and 2.1 fold, respectively, in a dose dependent manner (p<0.05). Klkb1-/- mice with MCAO were also protected from tPA-induced brain infarct volume by 39% (P<0.05) and hemorrhage by 41% (P<0.05) when compared with wild-type mice subjected to both MCAO and tPA. Cleaved HK levels were higher in WT mice with stroke plus tPA compared with Klkb1-/- mice with stroke plus tPA.

Conclusions:
Plasma kallikrein contributes to the adverse effects of thrombolytic therapy with tPA on infarct volume, edema, and hemorrhagic transformation during ischemic stroke. Co-administration of a plasma kallikrein inhibitor with tPA may improve safety and efficacy of thrombolysis.
Abstract WP305: Impact Of Metformin on Survival Following Ischemic Stroke in Patients With Diabetes: The Greater Cincinnati Northern/Kentucky Stroke Study (GCNKSS)
Authors: Yeramaneni Samrat , Kleindorfer Dawn , Sucharew Heidi , Alwell Kathleen , Moomaw Charles , Flaherty Matthew , Woo Daniel , Adeoye Opeolu , Ferioli Simona , de Los Rios La Rosa Felipe , Martini Sharyl , Mackey Jason , Khatri Pooja , Kissela Brett , Khoury Jane
Published: March 2022

Introduction:
Metformin, an oral antidiabetic drug, is associated with reduced risk of diabetic related endpoints, including stroke. Evidence from animal studies show neuroprotective properties of metformin via the AMP-activated protein kinase pathway. We examined if these neuroprotective effects of metformin may extend into improved survival among stroke patients.

Methods:
All stroke patients within the Greater Cincinnati/Northern Kentucky catchment area of ∼ 1.3 million were identified using ICD-9 discharge codes (430-436) in 2005 and 2010. Cases were abstracted by study nurses and verified by physician review. Patients surviving to hospital discharge with a history of diabetes or diagnosed with diabetes during hospitalization (DM) were categorized into four groups based on recorded medication use: metformin monotherapy, metformin combotherapy, other antidiabetic drug therapy, and no antidiabetic medications. The primary outcome was all cause case fatality at 3 years following stroke. Covariates considered were age at onset, sex, race, BMI, baseline NIHSS and mRS, smoking status, history of comorbidities, and glucose level on admission. Cox proportional hazard models were used to estimate the risk of case fatality.

Results:
Overall, 37% (1,471) of the 4,015 ischemic stroke patients (>= 20 years of age) met criteria for DM. Patients with DM (vs non DM) were 65 (vs 66) years of age, 55% (vs 56%) female, and 27% (vs 18%) black. Of patients with DM, 10% were on metformin monotherapy, 28% metformin combotherapy, 50% other antidiabetic drugs, and 13% no antidiabetic drugs. In adjusted analysis, at 3 years post stroke, patients on metformin monotherapy or combotherapy had similar risk of case fatality compared with non-DM and had lower risk of case fatality compared with DM on no drug therapy (Table).

Conclusions:
Use of metformin, either alone or in combination with other antidiabetic drugs may provide a long term survival benefit among stroke patients with diabetes.
Abstract WP318: Racial Differences in the Prevalence of Falls among Stroke Survivors
Authors: Wing Jeffrey J , Skolarus Lesli E , Clarke Philippa J , Feng Chunyang , Burke James F
Published: March 2022

Background:
National data shows that African Americans (AA) are less likely to fall than whites. However, the reasons for this difference and whether it is true amongst stroke survivors are unknown. We hypothesized that AA stroke survivors fall less than white stroke survivors, and sought to understand which risk factors drive racial differences.

Methods:
Data from the 2011 wave of National Health and Aging Trends Study (NHATs), a nationally representative population of community-dwelling adults over 65, were used. We compared the prevalence of self-reported falling in the past year between AA and white stroke survivors using Poisson regression models. Models were adjusted for groups of variables that may predict race-based differences in falls: sociodemographic, comorbidity, capacity, fall risk factor, fall access, and environment. Race-specific predictive margins and prevalence ratios (PR) were calculated.

Results:
The sample included 806 stroke survivors; 581 white and 228 AA. AAs had lower income, physical and cognitive capacity, were less likely to be married, to go outside, to have osteoporosis, and lived in worse neighborhood environments compared to white stroke survivors. Unadjusted, prevalence of falling in the past year was similar comparing AA to whites (PR: 0.89, p=0.2). Adjustment for sociodemographic variables produced a marginal racial difference, which became statistically significant after adding physical and cognitive capacity measures (Table). After full adjustment, AA were 30% less likely to have reported a fall compared to whites (p=0.004).

Conclusions:
African American stroke survivors are significantly less likely to report falling in the previous year compared to whites. Differences in sociodemographics and capacity may be most influential, yet other factors did not account for differences in fall prevalence. Further study of falls among AA stroke survivors may provide insight to decrease falls among other racial/ethnic groups.
Abstract WP319: Relationship Between Hospital Process Performance and Mortality Among Patients With Acute Ischemic Stroke
Authors: Li Zixiao , Wang Yilong , Xian Ying , Li Linzi , Zhao Xingquan , Bao Xiaolei , Liu Liping , Wang Chunjuan , Li Hao , Wang Chunxue , Yang Qing , Bettger Janet , Wang Yongjun
Published: March 2022

Background:
Guideline-recommended care processes are increasingly being used to measure hospital quality of stroke care. However, data regarding the association between hospital process performance and outcomes are limited. We use the China National Stroke Registry (CNSR) to examine how hospital performance measures are correlated with each other and identify whether hospital’s overall composite guideline adherence was associated with risk standardized adjusted 30-days and 1-year mortality after stroke.

Methods:
We assessed hospital individual nine performance metrics as well as overall composite adherence rates using 2007-2008 data from 131 hospitals participating in the CNSR and correlated these measures with each other and with hospital-level, risk-standardized, 30 day and 1-year mortality rates.

Results:
We found moderately correlations (correlation coefficients≥0.40, P values<0.001) between antithrombotic use at discharge and admission, lipid-lowering drug, antihypertensive medication, antidiabetic medication, smoking cessation at discharge, antihypertensive medication and antidiabetic medication at discharge, smoking cessation and antidiabetic medication at discharge. Composite guideline adherence rate was modestly associated with hospital-level, risk-standardized, 30 day and 1-year mortality rates (correlation coefficients=0.23 and 0.34; P values<0.01), explained only 5.24% and 11.80% of hospital-level variation in risk-standardized, 30 day and 1-year mortality rates for patients with acute ischemic stroke.

Conclusion:
There were various correlations in guideline-recommended hospital performance among the individual process metrics. A modestly strong association between care process and hospital short- and long-term risk-adjusted mortality rates was found, indicating the use of more broader, guideline-based performance metrics as a means of assessing hospital quality.
Abstract WP327: Implementation of a Pharmacist Driven Comprehensive Stroke Education Program
Authors: Nguyen Viet-Huong V , Wen Mary M , Clarito Lyn A , Bukovskaya Yana , Minassian Grace L , Panizzon Kimberly , Dergalust Sunita , Wallis Roi Ann
Published: March 2022

Background:
Stroke education (SE) is an important quality measure that has been shown to be inconsistently provided and ineffectively delivered. In response we have developed a pharmacist driven stroke education program (SEP) for patients admitted with stroke/TIA. Here, we describe the development, implementation, and encounters from this initiative.

Methods:
A stroke service team (SST) consisting of a board-certified cerebrovascular physician, cerebrovascular fellows, and a clinical pharmacist specialist (CPS) was established at the VA Greater Los Angeles Healthcare System. The CPS is alerted when any stroke/TIA patients are admitted and follows the patient until time of transfer/discharge. At that time, most diagnostic studies are complete and a likely stroke etiology has been determined, allowing for the development of a patient centered comprehensive stroke care and prevention plan based on individualized stroke risk factor analyses with input from interdisciplinary fields including the SST, rehabilitation specialists, and speech therapists. SE is provided at the time of discharge and addresses risk factors for stroke, stroke warning signs, activation of emergency medical services, need for follow-up after discharge and medications prescribed. The CPS also reviews stroke location, nature and quality of the stroke, and relays the initial patient centered comprehensive care plan to the patient in patient-level language. Visual aids assist in educating patients and a personalized education sheet is provided. The CPS is also responsible for documentation of SE for future evaluation of process measures.

Results:
Consistent implementation of the pharmacist driven comprehensive stroke education program (SEP) began in July 2013. To date, there have been 172 SE encounters documented. Quality improvement audits indicate close to 100% of all patients admitted for stroke receive SE.

Conclusions:
Here we show the successful implementation of a pharmacist driven comprehensive SEP designed to improve patient satisfaction/knowledge and improve hospital adherence to stroke quality measures. As pharmacists are trained to communicate with medical personnel and patients, they may be the ideal candidate to provide comprehensive and quality SE.
Abstract WP331: The Effect of ABCD2 Score as a Triage Tool for TIA Patients on 90 Day Hospital Re-Admission
Authors: Sevilis Theresa B , Sangha Navdeep , Tu Grace , Valdovinos Cristina , Lui Catherine , McCartney David , Bider Zoe , Ajani Zahra
Published: March 2022

Introduction and Objectives:
After a transient ischemic attack, there is a 90 day increased risk of stroke that can be predicted by ABCD2 score. A TIA clinic for low risk (ABCD2 score <4) was established at Kaiser Permanente. We hypothesized that patients seen in this clinic would have the same 90 day re-admission rate as those evaluated inpatient.

Methods:
At Kaiser Permanente LAMC, a TIA clinic was established in November 2, 2010. TIAs were triaged by a Neurologist who calculated the ABCD2 score. Patients were referred to the TIA clinic with a score <4 and evaluated inpatient if score ≥4. Patient data was abstracted for all patients with a TIA clinic referral placed between November 2, 2010 and February 28, 2013 (182 charts) and 148 were included in the analysis. Patients were excluded if the ABCD2 score could not be calculated or referral was inappropriate. The ICD-9 code was used to abstract patients with TIA for the same time period (145 charts) and 58 patients were included. Non-Kaiser members and patients for which a Neurologist was unable to calculate ABCD2 score were excluded. All charts were reviewed for 90 day re-admission. Data was analyzed using chi-squared testing of independence and Fischer’s exact test to assess for a difference in all cause and stroke only 90 day re-admission rates for patients with ABCD2 scores <4 and ≥4 who were evaluated in TIA clinic vs. inpatient.

Results:
No significant difference in the rate of re-admission for all cause with ABCD2 score ≥4 in TIA clinic (20%) vs inpatient (28.2%) was found (p= 0.379), but a significant rate of re-admission for stroke was found with TIA clinic (0%) vs inpatient (10.3%) (p= 0.042). A significant rate of re-admission for all cause with ABCD2 score <4 in TIA clinic (14.4%) vs inpatient (5.6%) was not found (p = 0.462) and re-admission for stroke in TIA clinic (2.9%) vs inpatient (0%) was not found (p=1.00).

Limitations:
Non-members were excluded due to inability for follow up, and there may have been variability in documentation of pertinent information for calculating ABCD2 scores.

Conclusion:
TIA clinic evaluation of low risk patients (ABCD2 score <4) does not increase the risk for 90 day re-admission for all causes or stroke only.
Abstract WP334: American Indian Participation in Clinical Research: A Cultural Perspective Survey from a CREST-2 Site
Authors: Robb Delilah , de Havenon Adam , Bennett Alicia , Aitken Kinga , Longbottom Mary , Brown Robert D , Majersik Jennifer
Published: March 2022

Introduction:
Participation by American Indian and Alaska Natives (AI/AN) in clinical research may improve AI/AN health outcomes and generalizability of the research.

Hypothesis:
Cultural beliefs have a strong impact on willingness of AI/AN to participate in research.

Methods:
We developed a survey to identify if cultural beliefs impact perception of clinical research and the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) protocol. Stroke neurologists and CREST-2 investigators participated in the design of the survey. Participants were stratified based on AI/AN self-identification and level of education. Likert-scale responses were tested with the Mann Whitney-U test and dichotomous responses with the Chi-Square test.

Results:
There were 102 participants: 61% female, mean age 39, and 37% AI/AN. Eight questions evaluated understanding of research concepts within CREST-2; 89% of these responses were correct, with no significant difference in responses between AI/AN and non-AI/AN or between low (n=42) and high (n=60) education. Compared to other ethnic groups, AI/AN identify more with their culture (p=0.002) and consider cultural beliefs when making health care decisions (p=0.005), including participating in a research study (p=0.002). Using the same questions, we found no difference between respondents with low or high education.(Figure 1)

Conclusion:
These data support our hypothesis that cultural beliefs have a strong impact on AI/AN willingness to participate in research. It is important for researchers to consider cultural beliefs when designing recruitment strategies for AI/AN populations. Future work will address
how
cultural beliefs affect AI/ANs’ understanding of and willingness to participate in clinical research.
Abstract WP357: The Impact of Specific Neuroanatomical Location in Deep Supratentorial Intracerebral Hemorrhage (ICH): Findings From the Ethnic/Racial Variations of ICH Study
Authors: Sheth Kevin N , Moomaw Charles J , Osborne Jennifer , Martini Sharyl , Katz Brian , Charidimou Andreas , Comeau Mary , Langefeld Carl D , Vashkevich Anastasia , Woo Daniel
Published: March 2022

Background:
Recently early phase clinical trials have targeted individual anatomical locations. However, information regarding ICH characteristics and outcomes of specific deep locations of ICH is limited.

Methods:
ERICH is a multi-center, prospective, case-control study of a racially mixed population with ICH. ICH locations were systematically designated by a central imaging core. Subjects with supratentorial deep ICH based on initial head CT originating in the caudate, thalamus, or putamen were included. Those with pre-morbid modified Rankin Scale (mRS) > 2, positive drug screen, or missing 3-month mRS were excluded. Differences in baseline characteristics and medical interventions were examined by anatomic location, stratified by intraventricular hemorrhage (IVH) presence. Receiver operating curve analysis was performed to determine ICH volume specificity for poor outcome (mRS 4-6).

Results:
A total of 945 subjects met inclusion criteria for the analysis: caudate (n=62), putamen (n=394), thalamus (n=489). Significant differences were noted for presence of IVH (caudate 89%, putamen 23%, thalamus 64%, p<.0001), ventriculostomy (caudate 52%, putamen 14%, thalamus 27%; p<.0001), and surgery (caudate 2%, putamen 10%, thalamus 2%, p<.0001). In multivariable analysis, subjects with thalamic ICH without IVH (compared with putaminal ICH without IVH) were more likely to be younger (OR 1.02; 95%CI 1.00-1.04, p=.0130, have history of hypertension (OR 2.82, 95%CI 1.24-6.39), and lower ICH volume (OR 0.28, 95%CI 0.21-0.38, p<.0001). Subjects with thalamic ICH and IVH (compared with putaminal ICH and IVH) were less likely to have surgery for evacuation (OR 0.14, 95%CI 0.04-0.46, p=.0012) and have lower ICH volume (OR 0.13, 95%CI 0.08-0.22, p<.0001). Receiver operating curve analysis identified 5.39 mL volume in thalamic ICH without IVH and 18.68 ml in putaminal ICH without IVH as having 95% specificity for poor outcome.

Conclusion:
In patients with deep supratentorial ICH, IVH is significantly more common in caudate and thalamic ICH compared with putaminal ICH. ICH volume cut-offs highly specific for poor outcome were identified. These findings may have implications for prognosis and clinical trial design.
Abstract WP359: Incidence and Outcome of Direct Oral Anticoagulant-related Intracranial Bleeding
Authors: Basir Ghazala , Shamy Michel , Stotts Grant , Dowlatshahi Dar
Published: March 2022

Background:
In recent years, direct oral anticoagulants (DOAC) have been approved and included in guidelines as alternatives to warfarin for the prevention of stroke in patients with non-valvular atrial fibrillation, in part due to because of better safety profile. Prior to the introduction of DOACs, studies showed that anticoagulation with warfarin carries high risk of bleeding. The goal of this study is to examine the incidence of DOAC- related intracranial bleeding (ICB) in a single center retrospective registry of patients admitted with bleeding events.

Methods:
This is a single Centre observational/descriptive study. We identified consecutive patients presenting to a tertiary care stroke center in Ottawa, Canada between Oct 2010-Feb2015 with any bleeding event using ICD-10 criteria. We included patients taking DOACs at the time of admission, and abstracted demographic, clinical, laboratory and outcome data from the medical record.

Results:
From a total of 9291 patient presenting with hemorrhage, 100 patients were confirmed to be taking DOACs. Twenty two (22%) patients had ICB (mean age 83years), of whom 6 (27%) were taking Aspirin at time of bleeding. There were 4 intraparenchymal hemorrhages (IPH); (3 spontaneous and 1 traumatic) and the remaining 18 were traumatic SAH and SDH. All patients with ICB were on Dabigatran except one which was on Rivaroxaban. Five of them required reversal agents; 2 received PCC and 3 both PCC and activated PCC. Mean length of stay was 14 days and 12 were discharged to home, 3 to rehabilitation facility, 3 to long term care facility and 4 died. All 4 patients with IPH either died or discharged to long-term care

Conclusion:
In this descriptive retrospective study, spontaneous DOAC-related IPH was rare and outcomes following traumatic DOAC-related ICB appear better than spontaneous IPH
Abstract WP364: Diabetes Mellitus and Spontaneous Intracerebral Hemorrhage: Clinical Features and Mortality
Authors: Liebkind Ron , Gordin Daniel , Strbian Daniel , Meretoja Atte , Thorn Lena , Groop Per Henrik , Tatlisumak Turgut , Putaala Jukka
Published: March 2022

Our previous findings suggest that ischemic stroke patients with either type 1 (T1D) or type 2 diabetes mellitus (T2D) exhibit a distinct risk factor and etiologic profile, and a worse vascular prognosis than do nondiabetic patients. We also showed that nonaneurysmal subarachnoid hemorrhage is rather a microvascular than macrovascular complication in T1D. Here, we aimed to compare risk factors, hematoma characteristics, and long-term mortality between diabetic and nondiabetic patients with spontaneous intracerebral hemorrhage (ICH) to provide information for patient management, counseling, and future research in these patient groups. Furthermore, we compared theses features between T1D and T2D patients.

Methods:
We included patients with first-ever ICH enrolled in the Helsinki ICH Study and in the Finnish Diabetic Nephropathy Study. Patients were followed using the national death registry. A Cox proportional hazards model adjusting for age at ICH onset, sex, and known ICH prognosticators_Glasgow Coma Scale (GCS) on admission, hematoma volume, infratentorial location, intraventricular hematoma_was constructed to assess, whether diabetes stands as an independent prognosticator.

Results:
A total of 972 patients were included, of which 813 (83.6%) were nondiabetic, 45 (4.6%) had T1D, and 120 (12.3%) T2D. Compared with nondiabetic patients, diabetic patients more often men, and they had more frequently hypertension and coronary heart disease. No difference emerged in GCS or hematoma volume, but diabetic patients more often had infratentorial ICH than nondiabetic patients. T1D patients were younger at ICH onset and they more often had brain stem ICH, but less often lobar ICH, than did T2D patients. Cumulative mortality at 12 months for nondiabetic patients was 34.0% (95% confidence interval 30.1-37.9%), for T1D 47.0% (31.3-62.7%), and for T2D 46.0% (36.2-55.8%). In multivariate Cox regression, diabetes was independently associated with higher risk of death (hazard ratio 1.42, 95% confidence interval 1.11-1.82, P=0.005).

Conclusions:
ICH patients with diabetes exhibit a distinct pattern of comorbidities and ICH characteristics compared with nondiabetic patients. Diabetes independently decreases the likelihood for survival after an ICH.
Abstract WP390: The UTHealth Stomp Out Stroke Festival- A City Wide Public Education Initiative
Authors: Noser Elizabeth A , Ifejika Nneka L , Grotta James C , Savitz Sean I
Published: March 2022

Introduction:
TJC certification for comprehensive stroke centers requires two annual public education activities on stroke prevention. One of our stroke faculty designed a multidisciplinary and multicultural program to educate the region and involved local businesses by establishing the UTHealth Stomp Out Stroke Festival.

Hypothesis:
We analyzed the benefits to the community of sponsoring a city wide, multicultural stroke educational event

Methods:
Implementation included establishing leadership and health screening providers, engaging educators and community stakeholders, recruiting volunteers and healthcare workers from hospital affiliates, pharmacy, rehabilitation and the schools of public health, nursing, dentistry, and medicine and developing a marketing and communication plan. Three areas for the event were created for Stroke Prevention, Stroke Recovery and a Kids Zone.

Results:
1st Festival was in 2013 with 100 participants, the 2nd in 2014 with 609 participants and the 3rd in 2015 with 1,261 participants. Over the 3 years, we have progressively increased the number of attendees, volunteers, health educators and community partners. Table 1 shows demographics for year 3. In year 3, we provided over 20,000 patient education materials, conducted 224 blood pressure screenings, completed 145 stroke risk scorecards, and provided FAST education to 109 children. Other assessments included BMI, cholesterol, bone density, fall risks, sleep apnea. We had 23 Chinese, 25 Spanish, and 10 Vietnamese health worker-translators.

Conclusion:
We implemented a city wide public health initiative providing medical education, health screenings, and risk assessments to a highly ethnically diverse population in Houston. Major challenges include funding, needing volunteers and translators, engaging media, and maximizing community participation. Next steps will focus on determining the effectiveness to improve health literacy and behavioral health changes.
Abstract WP406: The Importance of Pediatric Stroke Family Support
Authors: Knapp-Clevenger Rhonda , Kenny Amanda , Boada Richard , Bernard Timothy , Armstrong-Wells Jennifer
Published: March 2022

Introduction:
Insufficient social support has been linked to increased morbidity and mortality within adult medical conditions, including stroke. There is little evidence about the influence of support groups in pediatric stroke survivors and their families.

Hypothesis:
We hypothesized that pediatric stroke survivors and their families would report several common psychosocial themes surrounding their recovery, and would derive benefit from a structured support group.

Methods:
Our pediatric stroke support group - associated with a large, regional, pediatric stroke program - was established in 2011. Qualitative and quantitative data from this group were collected via standardized questionnaires during three support group sessions over a 1 year period (2013-14). Data were clustered by survivor, parent, sibling, and other family members. A concurrent triangulation mixed methods approach was used for analysis with a P-value of < 0.05 considered significant.

Results:
Participants reported primary themes of fear, anxiety, and frustration about 1) recovery (i.e., future disabilities, regaining milestones); 2) recurrence; 3) limited resources to aid in recovery; 4) medical and family decision-making; and 5) normalcy in the community. Time interval from stroke (r= 0.49) and disability (r=0.71) were inversely correlated with fear, anxiety, and frustration (p<0.01). In addition, perception of sufficient family support (r=0.56) and longer participation in rehabilitation (r=0.63) were emotionally beneficial (p<0.01). All participants reported the importance of the support group; of significance to parents was reassurance and knowledge offered from families with similar experiences.

Conclusion:
Pediatric stroke not only impacts the patient’s life experience, but that of their family members. The stroke experience is very individualized, but common themes exist. Sharing these experiences is valuable to survivors and their families.
Abstract WP409: Analysis of the KID Inpatient Sample Demonstrates Improvements in Care for Children Hospitalized With Moyamoya From 1997-2015
Authors: Titsworth W. Lee , Smith Edward R
Published: March 2022

Introduction:
Annual admissions for moyamoya have steadily increased from 4.9 to 15.4/1,000,000 since 1997. Here we report changes in treatment and complications during this period as derived from a national database.

Hypothesis:
We assessed the hypothesis that increasing volume of moyamoya admissions over time would correlate with decreased hospital complications and length of stay.

Methods:
The Kids Inpatient Database (KID) was queried for all pediatric admissions with a diagnosis of moyamoya from 1997, 2000, 2003, 2006, 2009, and 2012. Patient safety indicators (PSIs) and hospital acquired conditions (HACs) were identified using ICD-9 codes for procedures or secondary diagnoses. Trends in utilization and outcomes were determined by multivariate regression analysis.

Results:
2,452 admissions for moyamoya were identified. After controlling for patient and hospital factors, total use of MRI and cerebral angiography was stable (9.9-14.2% and 14-22% of admissions, respectively), but CT use decreased from 7.1% to 2.8% (p<0.0001). A 38.5% reduction in total procedures performed during each admission was observed (2.6 vs 1.6; p<0.0001). The percentage of admissions undergoing ECIC bypass increased significantly from 10.3% in 1997 to 22.4% in 2006, and remained stable through 2012 (22.1%, p<0.0001). PSIs and HACs have stayed stable at 4.8-7.9% and 2.0-4.0% per year, respectively. Comparing complications between operative and non-operative admissions, ECIC bypass patients experienced more accidental lacerations (0.44 vs 0.05%; p<0.02) and anesthetic complications (0.22 vs 0.15%; p<0.04), while nonoperative admissions had more respiratory failures (2.25 vs 0.44%, p<0.004). For all patients, an 85% decrease in meningitis (1.2% to 0.2%; p<0.001), a 29.2% decrease in inpatient stroke (13.6 vs 9.6%; p<0.0001), and a 32.7% decrease in inpatient seizures (29.0 vs 19.5%; p<0.0001) were observed. Length of stay decreased by 21.2% since 1997 (7.0 vs 5.6 days; p<0.0001).

Conclusions:
Over the 15-year study period, inpatient treatment of moyamoya has improved significantly, including decreased utilization of ionizing radiation, stable rates of PSIs and HACs, decreased prevalence of inpatient strokes, meningitis, seizures and shorter length of stay.
Abstract WP435: Changes in Pulsatility and Resistance Indices of Cerebral Arteriovenous Malformation Feeder Arteries After Embolization and Surgery
Authors: Shakur Sophia F , Amin-Hanjani Sepideh , Abouelleil Mohamed , Aletich Victor , Charbel Fady , Alaraj Ali
Published: March 2022

Introduction:
Embolization reduces flow in cerebral arteriovenous malformations (AVMs) before surgical resection, but changes in pulsatility and resistance indices (PI, RI) are unknown. Here, we measure PI, RI in AVM arterial feeders pre- and post-embolization/surgery.

Methods:
Records of patients who underwent AVM embolization and surgical resection at our institution between 2007-2014 and had PI, RI, and flows obtained using quantitative magnetic resonance angiography were retrospectively reviewed. PI = [(systolic - diastolic flow velocity)/mean flow velocity] and RI = [(systolic - diastolic flow velocity)/systolic flow velocity]. Hemodynamic parameters were compared between the feeder and contralateral artery pre- and post-embolization/surgery.

Results:
32 patients with 48 feeder arteries underwent embolization (mean 1.3 sessions). 32 patients with 49 feeder arteries had surgery with/without preoperative embolization. Before any treatment, flow volume rate and mean, systolic, diastolic flow velocities were significantly higher in feeders versus contralateral counterparts (
P
<0.001 for each parameter), and PI, RI were significantly lower in feeder compared to contralateral vessels (
P
=0.003,
P
=0.002). After embolization, flow velocities within feeders were significantly higher than in the normal contralateral vessels, but PI, RI did not change significantly (Table). However, after surgery flow velocities within feeders decreased significantly and PI, RI normalized to match the indices of their contralateral counterparts (Table).

Conclusions:
Following partial AVM embolization, PI, RI are unchanged and flow velocities in feeder arteries increase significantly likely due to redistribution of flow through residual nidus. Complete surgical resection results in normalization of PI, RI and a concomitant decrease in flow velocities.

Table:
Changes in PI, RI after embolization and surgery.
Abstract WP47: Dynamic Changes in MR-Defined Collateral Flow After Acute Ischemic Stroke is Associated With Larger Penumbral Signature and Improved Clinical Outcomes
Authors: Loftspring Matthew C , Eldeniz Cihat , Lin Weili , Ford Andria L , An Hongyu , Lee Jin-Moo
Published: March 2022

Introduction:
Collateral flow is postulated to play an important role in maintaining tissue viability during acute ischemic stroke (AIS), but its direct influence on the ischemic penumbra and eventual tissue outcome is not well understood.

Hypothesis:
We hypothesized that collateral flow is dynamic during the first 24h after AIS and that successful collateralization is associated with improved outcomes.

Methods:
We retrospectively analyzed data from a prospectively collected observational MRI study of AIS patients serially imaged at 3h (n=51), 6h (n=45), 24h (n=26), and 1 month (n=36) after stroke onset. Collateral flow was assessed with dynamic susceptibility contrast-enhanced MRI for all time-points, utilizing a previously validated method (Kim et al, 2014; grade 1=poor - grade 4=excellent). Clinical outcome (NIHSS, mRS) and tissue outcome were based on 1-month assessments and FLAIR imaging.

Results:
Collateral flow was dynamic during the first 24h after stroke onset, changing in 33% of patients between 3-6h, and 68% between 6-24h. Moreover, the majority of patients (62%) showed improved collaterals during the first 24h (at 3h, 12% of patients had grade 1 and 22% grade 4; at 24h, 8% had grade 1 and 35% had grade 4). At 3 and 6h there was an inverse relationship between collateral grades 1 and 4 and percent diffusion-perfusion mismatch (p= 0.0006 and 0.0015, respectively). Patients with grade 4 collaterals at 3h had greater relative improvement in NIHSS at one month compared to grade 1 (p= 0.0363). In addition, those with improving collaterals within the first 24h were more likely to have a good outcome (mRS 0-2; p= 0.0171; Figure).

Conclusions:
Collateral flow is dynamic in the first 24h post-stroke, and improved collateralization is associated with better radiographic and clinical outcomes
Abstract WP67: VESCA: Semi-Automated Segmentation of Cerebral Vasculature in Angiograms
Authors: Stier Noah , Garduno Cristopher , Sheth Sunil , Duckwiler Gary , Saver Jeffrey , Liebeskind David , Scalzo Fabien
Published: March 2022

Background:
Imaging the cerebrovasculature using digital subtraction angiography (DSA) is a critical step in the diagnosis and treatment of acute stroke. Interpretation and scoring of these DSA images is usually performed by visual review, introducing inter-reader variability that causes inconsistency in clinical trials. Recently, methods have been introduced to automatically quantify various metrics in DSA images, such as revascularization and blush score, and vessel extraction algorithms are often used as part of these methods. However, the results of those algorithms have not been thoroughly evaluated against manually determined groundtruth extraction results, due to a lack of tools for determining the ground truths.

Methods:
We present a dedicated software tool, VESCA (Vessel Segmentation for Cerebral Angiograms), for manually determining the groundtruths of DSA images to better evaluate vessel detection methods. VESCA interface allows the user to view and segment DSA images, producing a segmented, binary representation of the vasculature. The segmentation process is semi-automated thanks to the livewire segmentation technique, whereby user-selected points along vessel boundaries are automatically connected via the lowest cost path.

Results:
We have segmented angiograms from a database of 115 biplane DSA, resulting in a set of binary representations of the vessels. We are constructing a web-based system through which other researchers may access the database, and through which they may use the software to contribute segmented images.

Conclusion:
VESCA is simple to operate and requires minimal instruction. We anticipate that it will facilitate the development and improvement of automatic methods for quantitative DSA image analysis.
Abstract WP93: Predictors of Unruptured Cerebral Aneurysms in Patients with Headache : Findings from the National Inpatient Survey (NIS) 2011 Database
Authors: Jadeja Neville M , Nalleballe Krishna , Deshmukh Shilpa , Ramesh Atul , Mabie Peter , Ocava Lenore
Published: March 2022

Introduction:
To investigate the association of demographic, cardiovascular and metabolic factors with unruptured cerebral aneurysms in hospitalized patients with headache from a large nationwide registry.

Hypothesis:
The presence of certain demographic, cardiovascular and metabolic factors may be associated with unruptured cerebral aneurysms in hospitalized patients with headache.

Methods:
Hospitalized patients included in the nationwide inpatient sample (NIS) 2011 database with a confirmed discharge diagnosis of headache , as per the ICD-9-CM code 784.0 were identified. NIS is the largest all-payer inpatient database in the United States. Regression models were used to determine statistical associations.

Results:
From 8,023,590 admissions in the NIS 2011 database, 88,953 patients with headache were identified. Patients had a mean age of 50.87(± 20.0 SD) years, 66.23% (58,919) were women. We used weighted analysis to estimate the national values. 411,054 Headache patients were thus analyzed with unruptured cerebral aneurysms identified in 2547 (0.62%) patients. Model was adjusted for Age, sex, race, income, residence, hypertension, cocaine use, smoking, renal cystic disease, hyperlipidemia, PVD, renal failure, liver failure, subarachnoid hemorrhage, head injury, hyponatremia, RA, obesity, heart failure, dehydration, diabetes, diabetic eye disease & neuropathy, abdominal aortic aneurysms, TAA, RAA, ILA and neck aneurysms.

Conclusions:
Female sex, Non Caucasian Race, Median incomes, Hypertension, Cocaine abuse, Smoking, PVD , Rheumatoid Arthritis, and aneurysms of the thoracic aorta, renal and iliac arteries were independently associated with risk of unruptured cerebral aneurysms (P<0.05). Further prospective studies are needed to understand if causative relationships exist.
Abstract WP98: Intra-Arterial Transplantation of Low-Dose Stem Cells Provides Functional Recovery Without Adverse Effects After Stroke
Authors: Yamaguchi Susumu , Horie Nobtaka , Fukuda Yuhtaka , Satoh Katsuya , Matsuo Takayuki
Published: March 2022

Cell transplantation therapy for cerebral infarction has emerged as a promising treatment to reduce brain damage and enhance functional recovery. We previously reported that intra-arterial delivery of bone marrow mesenchymal stem cells (MSCs) enables superselective cell administration to the infarct area and results in significant functional recovery after ischemic stroke in a rat model. However, to reduce the risk of embolism caused by the transplanted cells, an optimal cell number should be determined. At 24 h after middle cerebral artery occlusion and reperfusion, we administered human MSCs (low dose: 1 x 104 cells; high dose: 1 x 106 cells) and then assessed functional recovery, inflammatory responses, cell distribution, and mortality. Rats treated with high- or low-dose MSCs showed behavioral recovery. At day 8 post-stroke, microglial activation was suppressed significantly, and interleukin (IL)-1beta and IL-12p70 were reduced in both groups. Although high-dose MSCs were more widely distributed in the cortex and striatum of rats, the degree of intravascular cell aggregation and mortality was significantly higher in the high-dose group. In conclusion, selective intra-arterial transplantation of low-dose MSCs has anti-inflammatory effects and reduces the adverse effects of embolic complication, resulting in sufficient functional recovery of the affected brain
BİLGİSAYAR DESTEKLİ NİTEL VERİ ANALİZİNDE GÖMÜLÜ TEORİ DESENİNİN KULLANIMI: ÇALIŞMA VE SOSYAL GÜVENLİK BAKANLIĞI DIŞ İLİŞKİLER EBÜLTENLERİ ÜZERİNE BİR ARAŞTIRMA
Authors: METE Hakan
Published: March 2022

Bilimsel literatür içerisinde fazlaca uygulama alanı bulan nitel veri analizi çalışmaları, çeşitli kaynaklardan toplanan bilgileri sınıflandırma, yorumlama ve yeniden anlamlandırma süreçlerini barındırmaktadır. Araştırmacılar analiz içerisinde mevcut varsayımların analiz ya da test edilmesi temeline dayanan tümden gelimci bir anlayış veya toplanan verilerin derinlemesine analiz edilerek temel teorilerin ilk kez keşfedildiği ve yeniden yorumlandığı tüme varımcı bir anlayış tercih etmektedir. Bu çalışma, veri seti ya da bilgi yığını içerisindeki temel kuramı ortaya çıkarmayı hedefleyen bir nitel araştırma deseni olarak Gömülü Teori’nin, bilgisayar destekli nitel veri analizi yazılım programlarıyla kullanılmasını araştırmaktadır. Bilgisayar destekli nitel veri analizi yazılımları, araştırma süreçlerinin tek bir uygulama üzerinden takip edilmesi, birlikte çalışabilirlik ve raporlama gibi konularda çalışmalara önemli katkılar sağlamaktadır. Bu çalışma, Nvivo Nitel Veri Analizi Yazılımı kullanılarak veri setinin oluşturulması, sınıflandırılması, kodlanması, analiz edilmesi ve raporlanması süreçlerinin örnek bir uygulama üzerinden incelemesini amaçlamaktadır. Araştırmanın veri setini Çalışma ve Sosyal Güvenlik Bakanlığı Dış İlişkiler Genel Müdürlüğü tarafından 2021 yılı içerisinde yayınlanan E-bültenler oluşturmaktadır. Araştırma sonucunda okuyucular, bilgisayar destekli nitel veri analizi uygulaması kullanarak gerçekleştirilen Gömülü Teori desenindeki bir araştırmanın aşamalarını adım adım izleme ve uygulama imkânı bulacaktır.
The Ancient Greek Pharmakos Rituals
Authors: Eidinow Esther
Published: March 2022

This article examines the role of mistrust – especially in constructions of purity, impurity, and purification – in ancient Greek religion. It begins by examining so-called scapegoat or pharmakos rituals, in which an individual was expelled from the city, apparently as a purificatory offering to the gods. Recent analyses have argued that these rituals were outlets for community aggression, and/or were resonant with myths of self-sacrifice. This article will suggest a different analysis of the evidence. I offer an alternative way of interpreting these rituals that sets them in a wider context of Greek ritual and belief: it suggests that the ritual of the pharmakos arose in a context of social and spiritual insecurity. This created, I argue, a prevailing dynamic of social and spiritual mistrust, within which the pharmakos ritual emerged – and which it exacerbated.
The Discovery of Principles in Prior Analytics 1.30
Authors: Malink Marko
Published: March 2022

In Prior Analytics 1.27–30, Aristotle develops a method for finding deductions. He claims that, given a complete collection of facts in a science, this method allows us to identify all demonstrations and indemonstrable principles in that science (1.30, 46a21–7). This claim has been questioned by commentators. I argue that the claim is justified by the theory of natural predication presented in Posterior Analytics 1.19–22. According to this theory, natural predication is a non-extensional relation between universals that provides the metaphysical basis for demonstrative science.