bluuebunny/crossref_metadata_2025 huggingface dataset:
Palliative care need screening and specialised referrals fell during the COVID-19 pandemic: a nationwide register-based study
Authors: Hansen Maiken Bang Bang , Groenvold Mogens , Adsersen Mathilde , Jensen Henry , Ibfelt Else Helene , Petersen Morten Aagaard , Neergaard Mette Asbjørn , Møller Henrik , Olesen Tina Bech
Published: April 2023

Objectives

Few studies have examined whether access to, and quality of, specialised palliative care changed during the COVID-19 pandemic. This study investigated changes in access to and quality of specialised palliative care during the pandemic in Denmark compared to previously.

Methods

An observational study using data from the Danish Palliative Care Database combined with other nationwide registries was conducted, including 69 696 patients referred to palliative care services in Denmark from 2018 to 2022. Study outcomes included number of referrals and admissions to palliative care, and the proportions of patients fulfilling four palliative care quality indicators. The indicators assessed admissions among referred, waiting time from referral to admission, symptom screening using the European Organisation for Research and Treatment of Cancer Quality of Life Questionaire-Core-15-Palliative Care (EORTC QLQ-C15-PAL) questionnaire at admission, and discussion at multidisciplinary conference. Logistic regression analysed whether the probability of fulfilling each indicator differed between the pandemic period and pre-pandemic, while adjusting for possible confounders.

Result

Number of referrals and admissions to specialised palliative care were lower during the pandemic. The odds for being admitted within 10 days of referral was higher during the pandemic (OR: 1.38; 95% CI: 1.32 to 1.45) whereas the odds for answering the EORTC questionnaire (0.88; 95% CI: 0.85 to 0.92) and for being discussed at multidisciplinary conference (0.93; 95% CI: 0.89 to 0.97) were lower compared with pre-pandemic.

Conclusions

Fewer patients were referred to specialised palliative care during the pandemic, and fewer were screened for palliative care needs. In future pandemics or similar scenarios, it is important to pay special attention to referral rates and to maintain the same high level of specialised palliative care.
Facing the challenge of permafrost thaw in Nunavik communities: innovative integrated methodology, lessons learnt, and recommendations to stakeholders
Authors: Allard Michel , L’Hérault Emmanuel , Aubé-Michaud Sarah , Carbonneau Andrée-Sylvie , Mathon-Dufour Valérie , B.-St-Amour Arianne , Gauthier Sarah
Published: April 2023

To support climate change adaptation in the communities of Nunavik, an innovative multitechnique approach to map permafrost conditions and assess risks of geohazards at the community-scale level was applied. Four maps were produced for each community: (1) a surficial geology map, (2) a map of permafrost conditions based on ground-ice content and depth to bedrock, (3) a map of potential for construction, and (4) a geohazard risk assessment map. Local ground temperature data from thermistor cables were used to calibrate 1D numerical models to estimate future permafrost temperature changes and probable rates of degradation in different environmental settings within the communities and under different climate change scenarios for the 2019–2100 period. Throughout this project, abundant consultations were held in communities and with stakeholders to better understand their concerns and to provide pragmatic recommendations for improving construction methods and land-use planning to face the challenges of permafrost thaw. Specific recommendations were made to the higher levels of government for improving construction practices. Inuit aspirations, culture, and leadership remain essential in integrating permafrost geotechnical knowledge in planning a safe future for the communities.
Routing Among Convex Polygonal Obstacles in the Plane
Authors: Inkulu R. , Kumar Pawan
Published: April 2023

Given a set [Formula: see text] of [Formula: see text] pairwise disjoint convex polygonal obstacles in the plane, defined with [Formula: see text] vertices, we preprocess [Formula: see text] and compute one routing table at each vertex in a subset of vertices of [Formula: see text]. For routing a packet from any vertex [Formula: see text] to any vertex [Formula: see text], our scheme computes a routing path with a multiplicative stretch [Formula: see text] and an additive stretch [Formula: see text], by consulting routing tables at only a subset of vertices along that path. Here, [Formula: see text] is the number of obstacles of [Formula: see text] the routing path intersects, and [Formula: see text] depends on the geometry of obstacles in [Formula: see text]. During the preprocessing phase, we construct routing tables of size [Formula: see text] in [Formula: see text] time, where [Formula: see text] is an input parameter.
STOCHASTIC PERMANENCE AND EXTINCTION OF AN EPIDEMIC MODEL WITH SATURATED TREATMENT
Authors: MAHATO PRASENJIT , DAS SUBHASHIS , MAHATO SANAT KUMAR
Published: April 2023

We propose and study the transmission dynamics of susceptible-exposed-infected-recovered [Formula: see text] epidemic model with saturated treatment function. We consider saturated treatment function in the epidemic system to understand the effect of delayed treatment on the disease transmission. The indiscriminately perturbation which is considered as a type of white noise is proportional to the distance of state variables from the values of endemic equilibria. Choosing the suitable Lyapunov function and using the It[Formula: see text]’s formula, the existence and the uniqueness of the positive solution of the system are examined. Stochastic boundedness, permanence and extinction of the epidemic model are investigated with proper conditions. Numerical simulations are performed to illustrate our results. The sensitivity analysis of the basic reproduction number is performed. The effect of control parameter is determined on the model dynamics. It is our main finding that the different intensities of white noises can fluctuate the susceptible, exposed, infected, recovered individuals around its equilibrium points.
A Chinese Short Text Classification Method for Tax Audit Reports based on Word Importance and Syntactic Enhancement BERT
Authors: Shi Yaning , Wang Lukun , Tian Chunpeng , Wang Rujia , Pei Jiaming , Hussian Amir , Bashir Ali Kashif
Published: April 2023

Tax audit is an important part of the tax collection and management system, which directly affects the economic interests of the country and taxpayers. Therefore, reducing the enforcement risk in tax audit is crucial to continuously improve the tax collection and management system. Recently, the research of using deep learning to classify Chinese tax audit data to achieve this goal has attracted much attention. Inspired by BERT, this paper proposes a syntactic enhancement BERT (SE-BERT). It can improve BERT’s text understanding ability by learning input features and grammatical structure of text from text content and location embeddings. In addition, we weight the word importance calculated by TF-IDF with SE-BERT to improve the ability of recognizing local salient features. Through comparative experiments on our Chinese tax audit dataset, our method achieves better performance.
A Case of Pituitary Apoplexy and Cavernous Sinus Syndrome during Hemodialysis
Authors: Jamal Yusra , Camacho Yudi , Hanft Simon , Chiarolanzio Patrick , Goldberg Michael D. , Mullally Jamie A.
Published: April 2023

Background. Pituitary apoplexy (PA) is a clinical syndrome of pituitary hemorrhage or infarction and can result in hypopituitarism as well as compression of adjacent brain structures. Visual loss occurs frequently, as a result of tumor expansion and compression of the optic chiasm and optic nerves. Additionally, with pituitary tumor invasion into the fixed space of the cavernous sinus, compression of multiple cranial nerves can result in cavernous sinus syndrome (CSS). We describe a case of an undiagnosed pituitary tumor manifesting as abrupt PA with CSS during hemodialysis (HD). Clinical Case. A 77-year-old male with end-stage renal disease (ESRD) presented with acute onset of severe headache, decreased vision, ophthalmoplegia of the left eye, and hypotension during HD. MRI of the brain revealed a 2.5 cm pituitary adenoma with acute hemorrhage, compression of the left prechiasmatic optic nerve, and invasion into the left cavernous sinus (CS). The hormonal profile was consistent with multiple pituitary hormone deficiencies. The patient was treated with glucocorticoids and underwent transsphenoidal resection of the tumor. He had an uneventful postoperative hospital course, and his left visual acuity stabilized, although there was no immediate improvement in his other ocular symptoms. Conclusion. Our case highlights a rare constellation of a pituitary adenoma with CS invasion complicated by PA and CSS during HD. The pathophysiology of PA is not well understood, and there are very limited data regarding PA in patients with end-stage renal disease (ESRD) on HD. Prompt recognition of PA in a patient presenting with CSS, particularly in the HD setting, is essential to ensure appropriate care is provided for this medical emergency.
Electrochemical Performance of Spongy Snowballs of O3-NaFeO2@SnO: Cathodes for Sodium Ion Batteries
Authors: Joshua J. Richards , Sharmila V. , Viji A. , Alam Mir Waqas , BaQais Amal , Shajahan Shanavas , Haija Mohammad Abu , Acevedo Roberto
Published: April 2023

Electrode materials for large-scale applications from the earth-abundant material need to be developed in the energy storage system. Based on earth-abundant material, sodium-based batteries with Fe system-based positive electrodes seem attractive for a cost-effective system for large-scale storage applications. Instead of partial substitution of transition metals with Fe, in the present work, we choose surface coating to analyze the electrochemical performance of NaFeO2. SnO was coated on the NaFeO2 surface, and the electrochemical characteristic property is studied in detail. Spongy nanoball coating is confirmed on the surface of NaFeO2. The reversible capacity of SnO-coated NaFeO2 is about 158 mAh·g-1 at 0.25 C. The SnO coating greatly enhances electron transport during cycling, and 80% of capacity is retained after 1000 cycles. The enhanced electrode can be used as a cost-effective, eco-friendly natured electrode with high performance for large-scale energy storage applications.
DNAH11 and a Novel Genetic Variant Associated with Situs Inversus: A Case Report and Review of the Literature
Authors: Sodeifian Fatemeh , Samieefar Noosha , Shahkarami Sepideh , Rayzan Elham , Seyedpour Simin , Rohlfs Meino , Klein Christoph , Babaie Delara , Rezaei Nima
Published: April 2023

Background. Primary ciliary dyskinesia (PCD), also known as the immotile-cilia syndrome, is a clinically and genetically heterogeneous syndrome. Improper function of the cilia causes impaired mucociliary clearance. Neonatal respiratory distress, rhinosinusitis, recurrent chest infections, wet cough, and otitis media are respiratory presentations of this disease. It could also manifest as infertility in males as well as laterality defects in both sexes, such as situs abnormalities (Kartagener syndrome). During the past decade, numerous pathogenic variants in 40 genes have been identified as the causatives of primary ciliary dyskinesia. DNAH11 (dynein axonemal heavy chain 11) is a gene that is responsible for the production of cilia’s protein and encodes the outer dynein arm. Dynein heavy chains are motor proteins of the outer dynein arms and play an essential role in ciliary motility. Case Presentation. A 3-year-old boy, the offspring of consanguineous parents, was referred to the pediatric clinical immunology outpatient department with a history of recurrent respiratory tract infections and periodic fever. Furthermore, on medical examination, situs inversus was recognized. His lab results revealed elevated levels of erythrocyte sedimentation rate (ESR) and C reactive protein (CRP). Serum IgG, IgM, and IgA levels were normal, while IgE levels were elevated. Whole exome sequencing (WES) was performed for the patient. WES demonstrated a novel homozygous nonsense variant in DNAH11 (c.5247G > A; p. Trp1749Ter). Conclusion. We reported a novel homozygous nonsense variant in DNAH11 in a 3-year-old boy with primary ciliary dyskinesia. Biallelic pathogenic variants in one of the many coding genes involved in the process of ciliogenesis lead to PCD.
Individual, Social, and Environmental Factors Associated with Different Patterns of Stimulant Use: A Cross-Sectional Study from Five European Countries
Authors: Rosenkranz Moritz , O'Donnell Amy , Martens Marcus-Sebastian , Zurhold Heike , Degkwitz Peter , Liebregts Nienke , Barták Miroslav , Rowicka Magdalena , Verthein Uwe
Published: April 2023

Introduction: Amphetamine-type stimulants (ATSs) are the second most commonly consumed class of illicit drugs globally, but there is limited understanding of the precise factors associated with problematic versus controlled ATS consumption. This exploratory study aimed to identify which individual, social, and environmental factors are associated with different patterns of ATS use over time. Methods: Cross-sectional surveys were conducted in Germany, England, The Netherlands, Poland, and the Czech Republic via face-to-face computer-assisted personal interviews to collect data on different user groups. 1,458 adults (18+) reported exposure to but no ATS use (n = 339); former rare/moderate ATS use (n = 242); current rare/moderate ATS use (n = 273); former frequent/dependent ATS use (n = 201); current frequent/dependent ATS use (n = 403). Extent of ATS/other substance use was assessed by number of consumption days (lifetime, past year, past month) and Severity of Dependence Scale. To identify factors associated with group membership, data were also collected on previous injecting drug use (IDU) and consumption setting/rules. Psychological distress was measured using the Brief Symptom Inventory, with additional data collected on self-reported adverse life events and physical/mental health. Results: Currently, using frequent/dependent ATS users experienced more frequent unstable living conditions (27.5%) and psychological distress (59.8%) compared to other groups. A multinomial logistic regression showed that currently abstinent rare/moderate users were more likely to abstain from methamphetamine use {odds ratio (OR) = 2.48 (confidence interval [CI] = 1.32–4.68)} and from IDU (OR = 6.33 [CI = 2.21–18.14]), to avoid ATS use during working hours (OR = 6.67 [CI = 3.85–11.11]), and not to use ATS for coping reasons (OR = 4.55 [CI = 2.50–6.67]) compared to the reference group of currently using frequent/dependent users. Conclusions: People who use ATS frequently and/or at dependent levels are more likely to have experienced social and economic adversity compared to infrequent ATS users. On the other hand, there is a substantial share of users, which show a controlled use pattern and are able to integrate ATS use into their lives without severe consequences.
Predicting the Users’ Level of Engagement with a Smartphone Application for Smoking Cessation: Randomized Trial and Machine Learning Analysis
Authors: Vera Cruz Germano , Khazaal Yasser , Etter Jean-François
Published: April 2023

Introduction: Studies of the users’ engagement with smoking cessation application (apps) can help understand how these apps are used by smokers, in order to improve their reach and efficacy. Objective: The present study aimed at identifying the best predictors of the users’ level of engagement with a smartphone app for smoking cessation and at examining the relationships between predictors and outcomes related to the users’ level of engagement with the app. Methods: A secondary analysis of data from a randomized trial testing the efficacy of the Stop-Tabac smartphone app was used. The experimental group used the “full” app and the control group used a “dressed down” app. The study included a baseline and 1-month and 6-month follow-up questionnaires. A total of 5,293 participants answered at least the baseline questionnaires; however, in the current study, only the 1,861 participants who answered at least the baseline and the 1-month follow-up questionnaire were included. Predictors were measured at baseline and after 1 month and outcomes after 6 months. Data were analyzed using machine learning algorithms. Results: The best predictors of the outcomes were, in decreasing order of importance, intention to stop smoking, dependence level, perceived helpfulness of the app, having quit smoking after 1 month, self-reported usage of the app after 1 month, belonging to the experimental group (vs. control group), age, and years of smoking. Most of these predictors were also significantly associated with the participants’ level of engagement with the app. Conclusions: This information can be used to further target the app to specific groups of users, to develop strategies to enroll more smokers, and to better adapt the app’s content to the users’ needs.
Long-Term Effects of a COMPASS Program on the Caregiving Journey: 1-Year Follow-Up in a Randomized Controlled Trial
Authors: Han Eun-Jeong , Park Myonghwa , Giap Thi-Thanh-Tinh
Published: April 2023

Introduction: The number of older adults requiring long-term care (LTC) is increasing rapidly worldwide. The primary family caregivers of LTC recipients experience ongoing burdens and various challenges in their caregiving that adversely affect their own health and also the quality of caring that they provide to their loved ones. As a country becoming a super-aged society, South Korea has been making considerable efforts to improve the long-term effects on caregivers by providing them with support intervention programs. Methods: This study was designed to assess the long-term effects of a COMPASS program at a national level. The short-term and long-term benefits were compared for the full COMPASS program (comprising 6 individual visits, 3 group-support sessions, and 2 telephone calls) provided to 203 caregivers, as were the long-term benefits between the full COMPASS program and its short form (comprising 3 individual visits and 1 group-support session) provided to 213 caregivers. The effects of the program on the family caregivers were evaluated by measuring their levels of social support received, self-efficacy, depression, burden, and risk to health. Results: The long-term effects of the COMPASS program were greater than those of its short-term effects in reducing depression and risk to health (p = 0.013 and p = 0.002, respectively), whereas there were no significant differences between the short-term and long-term effects of the full COMPASS program on social support, self-efficacy, or burden. Comparing the long-term effects between the two forms of the COMPASS program revealed that the depression of caregivers was improved more by the full program than by the short form (p = 0.022), while there were no significant differences for social support, self-efficacy, burden, or risk to health. Conclusion: This study supports providing COMPASS programs to obtain long-term benefits for family caregivers of LTC recipients. Potential approaches that could optimize the long-term benefits of the COMPASS program include supporting caregivers to participate in arts-related hobbies and maintaining follow-up telephone calls after program completion.
Which Patients Need Chemotherapy? From Pathological Risk Factors to Gene Signatures and Evaluation of Endocrine Response
Authors: Schmidt Marcus
Published: April 2023

Background: Chemotherapy, used either before or after surgery, has significantly improved survival in early breast cancer. Accurate risk assessment is essential to avoid both overtreatment and undertreatment. This review provides an overview of the evolution of chemotherapy as well as risk factors for tailored systemic therapies in early breast cancer – from pathologic risk factors to gene expression signatures to endocrine response assessment. Summary: Chemotherapy has improved dramatically in recent decades from its beginnings with conventionally dosed cyclophosphamide plus methotexate plus 5-fluorouracil to dose-dense anthracycline- and taxane-containing regimens. Similarly, risk assessment has evolved starting from traditional pathologic risk factors such as tumor size, axillary nodal status, and grading. In recent decades, gene expression signatures have improved prognostic accuracy with a high level of evidence. In turn, these signatures can be further improved by incorporating the aforementioned pathologic factors. As an important step away from this static assessment, dynamic assessment of proliferation factor Ki-67 after short-term preoperative endocrine treatment has gained interest to improve risk assessment in early hormone receptor-positive breast cancer. Key Message: This review highlights advances in chemotherapy and risk assessment in early breast cancer, from pathologic risk factors for recurrence to gene expression signatures and endocrine response assessment. These developments are leading to better risk stratification and thus better adaptation of therapies.
Key Stages in the Development and Establishment of Paediatric Endocrinology: A Template for Future Progress
Authors: Savage Martin O. , Donaldson Malcolm D.C. , Davies Justin H. , Storr Helen L.
Published: April 2023

Background: Paediatric endocrinology became recognised in Western European countries in the 1960s and 1970s. It is now a thriving paediatric sub-speciality in many countries but remains non-existent or in its infancy in others. We have had the privilege to work in Western centres of excellence, and this review outlines the key stages in the development of modern centres, discussing the human and organisational issues that have underpinned progress in the establishment of this paediatric sub-speciality. Summary: Human determination, vision, and ambition to create a modern centre and become a national flag bearer in the field are key components of success. The realisation that learning by spending time as a fellow away from one’s home institution, so that knowledge can be acquired and brought back home, is also a key factor. Career structures should be designed to mentor and guide the trainee returning from a fellowship abroad. Scientific societies such as the European Society for Paediatric Endocrinology (ESPE) are key resources for networking, support, and discussion with experienced colleagues who may have faced similar challenges. Training and acquisition of knowledge through on-site or e-learning initiatives are beneficial and numerous examples exist, including the telemedicine model of store-and-forward consultations. Leadership skills can be learnt, and good working relationships with adult endocrinology colleagues result in benefits and political support. Key Messages: The development of paediatric endocrinology in a region with hitherto no such facilities constitutes a major contribution to local, regional, and, in all likelihood, national patient care.
Práticas tradutórias em TAVA: a associação de Libras, LSE, AD e audiolegendagem no vídeo de divulgação do XIV SEPESQ
Authors: Silva Manoela Cristina da , Jesus Manoela Nunes de , Soares Elaine Alves
Published: April 2023

Este artigo se constitui no relato de uma experiência formativa em Tradução Audiovisual Acessível (TAVA). O grupo de pesquisa Tradução e Acessibilidade (TrAce) produziu a legendagem para Surdos e ensurdecidos (LSE), a audiodescrição (AD) e a audiolegendagem do vídeo de divulgação do XIV Seminário de Pesquisa Estudantil em Letras (XIV SEPESQ), evento anual do Instituto de Letras da Universidade Federal da Bahia (ILUFBA). Durante o projeto, no entanto, o grupo enfrentou vários desafios, como, por exemplo, a tradução da Libras para o português, a AD de sinais com movimento, a sincronização das legendas com a sinalização em Libras, entre outros. A fim de superar esses obstáculos, recorreu-se a diferentes estratégias, incluindo a criação da AD a partir dos cinco parâmetros da Libras, a segmentação cuidadosa das legendas e a utilização de vários recursos de edição.
Abstract Number ‐ 7: Final Angiographic, Clinical and Thrombus Composition Results of 1000 Patients in the EXCELLENT Registry
Authors: Nogueira Raul G , Andersson Tommy , Yoo Albert J , Hanel Ricardo A , Zaidat Osama O , Hacke Werner , Jovin Tudor , Fiehler Jens , De Meyer Simon F , Brinjikji Waleed , Doyle Karen , Liebeskind David S , Haussen Diogo , Inoa Violiza , Humphries William , Woodward Keith B , Jabbour Pascal M , Francois Olivier , Bozorgchami Hormozd , Levy Elad I , Boor Stephan , Cohen Jose , Dashti Shervin R , Taqi Muhammad A , Budzik Ronald F , Schirmer Clemens M , Hussain Shazam , Estrade Laurent , De Leacy Reade A , Puri Ajit S , Chitale Rohan V , Brekenfeld Caspar , Siddiqui Adnan H
Published: April 2023

Introduction

EXCELLENT (NCT03685578; Cerenovus) is a large, prospective, international, real‐world registry of endovascular clot removal in acute ischemic stroke (AIS) with EmboTrap as the first line mechanical thrombectomy (MT) device, which included collection and analysis of the retrieved thrombus material.

Methods

Between September 2018 and March 2021, 1000 “all‐comer” patients were enrolled at 34 global sites (27 US, 5 EU, 1 UK, 1 Israel) and treated according to standard of care at each center (with Embrotrap as first line). The study employed blind endpoint evaluation, including a core imaging lab and an independent 90‐day mRS assessment. Retrieved clot was collected per each MT maneuver from 538 subjects across 26 sites and clot analysis was performed by independent central labs blinded to clinical data.

Results

mITT population included 998 subjects. Mean age was 69.9±14.18 years (range 18–102), 51.8% (517/998) subjects were female and 9.9% (97/997) had a pre‐stroke mRS 3–5. Baseline NIHSS was 15.6±6.87 (range 0–36); 10.1% (82/815) subjects had a large core (ASPECTS 0–5); 5.8% (57/990) had posterior stroke; 56.3% (523/929) underwent MT ≤ 6hrs of onset and 38.1% (380/998) received IV‐tPA prior to MT. First pass eTICI 2c‐3 was achieved in 38.3% (377/984) and final 2b‐3 in 94.5 % (930/984; median number of passes = 1) of subjects. 90‐day mRS≤2 or ≤pre‐stroke was 46.9% (429/915) and 90‐day all‐cause mortality was 19.0% (175/921). The univariate analysis of clot components showed high red blood cell and low platelet content were significant predictors of good mRS outcome (p < 0.001 and 0.009) and negative predictors of 90‐day mortality (p < 0.001 and 0.017, respectively).

Conclusions

This large multi‐center, all‐comer cohort reflects the population undergoing thrombectomy today in a real world‐setting. Final angiographic, clinical and thrombus composition results, along with multivariate analysis of predictors of clinical outcomes, will be presented at the time of the conference.
Abstract Number ‐ 20: Predictors of Outcomes for Patients with Malignancy and Acute Ischemic Stroke Undergoing Endovascular Therapy
Authors: Dawod Giana , Desai Harsh , Lin Ning , Boddu Srikanth , Knopman Jared , Navi Babak B , Ramos Alexander
Published: April 2023

Introduction

Patients with active cancer face an increased risk for stroke. Randomized trials studying the efficacy of endovascular therapy for patients with large vessel occlusions generally excluded patients with cancer. Herein, we sought to better understand predictors of outcome for active cancer patients undergoing mechanical thrombectomy for acute ischemic stroke.

Methods

We conducted a retrospective cohort study of stroke thrombectomy cases performed at our institution from January 2010 to November 2021. Baseline clinical characteristics (age, gender, cancer type, use of anticoagulation, NIHSS, use of tPA, time to reperfusion) were recorded. Study outcomes were successful endovascular reperfusion (≥ TICI 2b) and poor clinical outcome, defined as inpatient death or disposition to hospice. Pearson Chi‐square test and Fisher’s exact test were used to analyze categorical variables, and Mann‐Whitney U tests were used for continuous variables. Multivariable logistic regression analyses were performed to evaluate for independent associations between baseline characteristics and study outcomes.

Results

Between 2010–2021, we identified 49 patients with active cancer who underwent mechanical thrombectomy for stroke. Their mean age was 63 years (SD, 12), and 43% were men. The leading cancer types were lung (33%) and colorectal (14%). Successful reperfusion was achieved in 78% (95% CI, 66–90%) of patients, and 49% (95% CI, 34–63%) ultimately had a poor clinical outcome. Multivariable analyses yielded no significant predictors for successful reperfusion, while higher NIHSS (1.03, 95% CI, 1.01‐1.06, p = 0.011) and higher cancer stage (1.19, 95% CI, 1.04‐1.34, p = 0.014) were found to be predictors for poor clinical outcome.

Conclusions

The link between cancer and stroke has become increasingly appreciated. As tPA is often contraindicated in cancer patients with stroke because of recent bleeding or anticoagulant use, thrombectomy may be the only intervention to preserve one’s quality of life. However, we found that despite a high successful reperfusion rate, nearly half of these patients died or were made hospice during the index hospitalization. Future studies should investigate the reasons for poor clinical outcomes in these patients and whether different antithrombotic, blood pressure, or anti‐neoplastic strategies after thrombectomy could improve outcomes.
Abstract Number ‐ 21: Mechanical Thrombectomy versus Medical Management in Patients with acute LVO and Pre‐morbid Disability: Meta‐analysis
Authors: Galecio‐Castillo Milagros , Rodriguez‐Calienes Aaron , Vivanco‐Suarez Juan , Zevallos Cynthia B , Ortega‐Gutierrez Santiago , Farooqui Mudassir
Published: April 2023

Introduction

Actual guidelines offer little guidance for endovascular treatment of patients with acute ischemic stroke (AIS) and pre‐morbid disability (PMD). Often, patients with a mRS >2 are not considered for mechanical thrombectomy (MT) and might not be given the best chance of achieving recovery. Three recent meta‐analysis have showed conflicting results regarding the benefit of MT, while persistently showing a significant increase in mortality.

Methods

We conducted a systematic search in Embase, Medline, and Web of Science for studies of patients with AIS and PMD who were treated with MT or MM. We included all definitions of PMD, main outcomes were favorable functionality at 90‐days (mRS 0–2 or return to baseline mRS), symptomatic ICH, and mortality. We performed meta‐analyses using a random‐effect model, and I2 to evaluate heterogeneity. Subgroup analyses were used when appropriate.

Results

2 studies contained data comparing PMD patients treated with MT versus MM, 14 studies contained data only of patients treated with MT, and 10 only of patients treated with MM; they provided data of 1071 patients in the MT group and 4547 in the MM group. Pooled rates in the MT group were 28% (95% CI 0.24‐0.32) for favorable functionality, 7% (95% CI 0.04‐0.12) for sICH, 43% (95% CI 0.36‐0.51) for 90‐days mortality, 18% (95% CI 0.14‐0.23) for intra‐hospital mortality, and pooled reperfusion rate (mTICI 0–2) of 80% (95% CI 0.72‐0.86). In a meta‐analysis of proportion with the treatments modalities as subgroups, including only studies with a similar definition of PMD, we obtained: for favorable functionality, MT = 26% (95% CI 0.23‐0.30) vs. MM = 35% (95% CI 0.22‐0.51); for sICH, MT = 6% (95% CI 0.05‐0.08) vs. MM = 6% (95% CI 0.05‐0.08); for 90‐days mortality, MT = 48% (95% CI 0.44‐0.52) vs. MM = 34% (95% CI 0.27‐0.41); and for in‐hospital mortality, MT = 18% (95% CI 0.14‐0.23) vs. MM = 22% (95% CI 0.17‐0.28). Additionally, meta‐analysis for 90‐days mortality in MT studies, showed a pooled rate of 49% (95% CI 0.45‐0.53) for the high tPA rate subgroup, and 30% (95% CI 0.19‐0.44) for the low tPA rate subgroup.

Conclusions

Up to one third of PMD patients who undergo MT might achieve favorable functionality, without increasing the risk of sICH and with rates similar to those obtained with MM. Furthermore, we observed a high 90‐day mortality rate, in both MT and MM groups. In subgroups exploration, there is trend of high tPA rates to be associated with the increased mortality. It is urgent to identify PMD patients who will benefit from MT and factors associated with poor outcomes.
Abstract Number ‐ 34: Basal ganglia infarct volume and risk of hemorrhagic transformation after endovascular thrombectomy
Authors: Regenhardt Robert W , Bonkhoff Anna K , Schirmer Markus D , Das Alvin S , Dmytriw Adam A , Vranic Justin E , Gupta Rajiv , Rabinov James D , Stapleton Christopher J , Patel Aman B , Rost Natalia S
Published: April 2023

Introduction

As more large vessel occlusion stroke patients are treated with endovascular thrombectomy (EVT), understanding the pathophysiology of reperfusion injury and the risks of hemorrhagic transformation (HT) are increasingly important. Pre‐EVT infarct topography may have implications for acute interventional treatments such as stenting, and post thrombectomy care such as antithrombotic choice. We sought to quantify region‐specific volumes of infarcted tissue on pre‐EVT MRI, understand their importance for HT, and identify associations with clinical and imaging characteristics.

Methods

Patients with pre‐EVT MRI were identified retrospectively from a prospectively maintained database. Each patient’s diffusion weighted sequence underwent manual infarct delineation and was registered to a standard space for overlay with cortical, subcortical, and white matter atlases. Structure‐specific lesion volumes were determined. HT was defined as PH1 or PH2 hemorrhage by ECASS criteria. Variables with p< 0.10 in univariate analyses were included in multivariable models. Logistic regression was performed for associations with hemorrhagic transformation and linear regressions for infarct volumes.

Results

165 participants [median age 69 years (interquartile range, IQR 56–79), 56% women] were identified. Risk factors included hypertension (70%), diabetes (20%), atrial fibrillation (34%), and prior stroke/TIA (13%). 52% were treated with intravenous alteplase; 70% achieved TICI 2b‐3 reperfusion. HT occurred in 8%. Pre‐EVT infarct volumes [median (IQR)] were 22 cc (12‐43 cc) for total, 11 cc (6‐19 cc) for white matter, 5 cc (1‐19 cc) for cortex, and 3 cc (1‐6 cc) for basal ganglia. Pre‐EVT infarcts [median (IQR)] were made up of 48% (38‐60%) white matter, 23% (6‐47%) cortex, and 15% (4‐28%) basal ganglia. Paramagnetic sequences showed 3% had petechial hemorrhage and 40% had susceptibility vessel sign. Basal ganglia infarct volume was independently associated with HT (OR = 1.342, 95%CI = 1.002,1.797) in a model including white matter infarct volume, cortex infarct volume, smoking, and puncture‐recanalization time. Basal ganglia infarct volume was linked to susceptibility vessel sign (Beta = 0.233, p = 0.006) and NIHSS (Beta = 0.220, p = 0.012), when controlling for total infarct volume.

Conclusions

In this cohort, greater basal ganglia infarct volume was associated with a higher risk of hemorrhagic transformation, even when accounting for infarct volume in other regions. Susceptibility vessel sign was associated with basal ganglia infarct volume, which may be related to acute middle cerebral artery thrombus occlusion of perforators. These findings require further study in larger cohorts.
Abstract Number ‐ 66: Symptomatic Chronic Internal Carotid Artery Occlusion Managed With Bilateral Common Carotid Angioplasty: A Case Report
Authors: Frade Heitor Cabral , Banerjee Pankhuri , Abdullah Danny , Rane Schweta , Patel Anand , Chhabra Arun , Memon Muhammad Z , Shaltoni Hashem
Published: April 2023

Introduction

Several guidelines have addressed symptomatic or asymptomatic carotid artery stenosis treatment with intensive medical management and surgical management based on the severity of stenosis [1]. In acute occlusions, endovascular treatment (EVT) and carotid endarterectomy (CEA) with or without prior thrombolytics provide the best recanalization and functional outcomes when compared to intravenous or intra‐arterial thrombolysis alone. There is, however, less robust evidence on management of symptomatic chronic internal carotid artery (ICA) occlusion occurring in tandem with significant contralateral ICA stenosis [2]. In chronic ICA occlusion (ICAO), EVT and carotid endarterectomy (CEA) are technically unfeasible, but indirect procedures have been arising as safe and effective alternatives, notably CEA or stenting of contralateral stenotic ICA [3] and CEA or stenting of ipsilateral external carotid artery (ECA) [4]. We hereby report a case of symptomatic chronic ICAO that was managed with staggered angioplasty and stenting of bilateral common carotid artery (CCA) bifurcations.

Methods

We hereby present a case report.

Results

A 62‐year‐old male with atrial fibrillation and hypertension woke up with sudden dysarthria and right upper extremity and facial weakness. NIHSS at presentation was 4. Last seen normal 9 hours prior. Non‐contrast head computerized tomography (CT) did not show acute intracranial abnormality, CT angiogram of head and neck showed severe right ICA stenosis and complete occlusion of the left ICA at cervical, petrous and cavernous segments, with distal reconstitution at the supraclinoid segment with left proximal middle cerebral artery (MCA) thrombus. CT perfusion showed a core infarct volume of 8cc in left MCA territory, mismatch volume of 78cc and ratio of 10.8. Risks of acute neuro‐intervention were deemed to outweigh benefits. Given favorable perfusion imaging, and in concordance with the EXTEND trial [5], tPA was administered. The patient remained stable without hemorrhagic complications with residual deficits of mild right upper extremity weakness and mild expressive aphasia. MRI confirmed left ICA territory ischemic infarcts. Patient underwent stenting of the asymptomatic right ICA at the CCA bifurcation first, followed by left CCA stent after one month with impressive improvement in subsequent perfusion imaging.

Conclusions

Our case encourages consideration of well‐timed angioplasty and stenting in cases of chronic bilateral carotid artery disease especially when the asymptomatic side is also significantly stenotic
Abstract Number ‐ 68: Thrombectomy Through Persistent Trigeminal Artery In A Patient With P2 Occlusion: Case Report
Authors: Kashif Zain , Yashar Parham , Khatibi Kasra
Published: April 2023

Introduction

Mechanical thrombectomy for distal medium vessel occlusions (DMVO) of the posterior circulation has been shown to be safe and technically feasible. Additionally, mechanical thrombectomy through a persistent trigeminal artery (PTA) for occlusions near the superior bifurcation of the basilar artery has been described before. However, the safety and efficacy of such procedures for DMVO remain unclear. We present a case of thrombectomy through a Saltzman type 1 PTA in an acute P2 occlusion.

Methods

A woman in her 80s with atrial fibrillation was admitted after undergoing a thrombectomy for a left M1 occlusion. Two days post‐procedure, she developed a right P2 occlusion with severe motor deficit secondary to thalamic hypoperfusion. She underwent mechanical thrombectomy through a right PTA. A balloon guide catheter (BGC) was placed in the right internal carotid artery (ICA). Initially, a 4F catheter over a 0.014 microwire was introduced but failed to navigate through the PTA. Afterward, the system was exchanged for a 5F aspiration catheter over a 0.021 microcatheter and 0.014 microwire which successfully tracked up through the PTA to the face of the clot. Aspiration alone was attempted initially, followed by the combined technique of aspiration with stent‐retriever.

Results

Our initial attempt to navigate the 4F catheter over the microwire through the PTA and up the basilar artery was unsuccessful as it continued to herniate into the cavernous ICA. Switching to the triaxial approach with the 5F catheter over the microsystem allowed navigation to the clot, however, aspiration alone was not sufficient to recanalize the occlusion and led to significant vasospasm which later self‐resolved. Instead, the combined technique resulted in successful thrombectomy with no untoward emboli into the right anterior circulation. The post‐procedural MRI showed multiple, scattered infarcts which were not evident on the MRI after the patient’s initial M1 thrombectomy. These infarcts involved the cerebellar and cerebral hemispheres bilaterally as well as the right thalamus. There was no evidence of subarachnoid hemorrhage on MRI. The patient continued to have significant left‐sided hemiparesis and could not be extubated, at which point the decision was made to transition to comfort measures until she passed.

Conclusions

Mechanical thrombectomy of a posterior circulation DMVO through a Saltzman type 1 PTA using the combined technique can be performed safely and effectively.
Abstract Number ‐ 76: Bow hunter’s syndrome‐ a rare case of hearing loss associated with co‐dominant vertebral artery compression
Authors: Miremadi Brian B , Alexopoulos Georgios , Coppens Jeroen
Published: April 2023

Introduction

Bow hunter’s syndrome (BHS), also known as rotational vertebral artery syndrome, refers to symptomatic vertebrobasilar insufficiency (VBI) caused by mechanical compression and severe stenosis or occlusion of the vertebral artery (VA) during neck and head rotation. Etiologies include bony spurs and osteophytes, or hypertrophic muscles and ligaments compressing typically on the dominant vertebral artery. Upon turning their head, patients experience posterior circulation symptoms such as vertigo, dizziness, syncope, nausea, tinnitus, or headache. These patients are at risk of stroke due to repetitive mechanical damage to the vessel and thromboembolism. [1] We present a rare case of BHS associated with hearing loss that was caused by bony spurs compressing on a left co‐dominant vertebral artery seen on turning head to both sides.

Methods

A woman in her 50s presented with sporadic progressive episodes of dizziness which started about 4 years. In addition, she reported experiencing episodic tinnitus in her left ear, frequent headaches, neck pain, and syncopal episodes. She was diagnosed with severe left ear sensorineural hearing loss (SNHL). Vestibular therapy and multiple neuropathic medications (nortriptyline, gabapentin) only provided her with minimal relief.

Results

Examination showed left SNHL and neck tenderness. X‐ray of cervical spine showed bony hypertrophy adjacent to the dens and inferior to the anterior arch of C1, suggestive of large osteoarthritic bony spurs. CT angiogram showed narrowing of the left vertebral artery at C1 due to severe hypertrophic arthropathy of the lateral mass articulation. It also showed impingement of the left VA in the left transverse foramen. The intradural portion of the VA (V4) appeared to be co‐dominant with normal size. Dynamic cerebral angiogram revealed near occlusion of the left VA at the level of C1‐C2 with head to the right. Left VA remained patent in neutral position, and experienced reduction in flow with head rotation to the left. The dynamic stenosis of VA caused by mechanical compression upon head turn leading to VBI, and reversal of stenosis when rotating head to neutral position was consistent with diagnosis of Bow hunters syndrome.

Conclusions

This case report highlights a rare presentation of VBI caused by dynamic stenosis of VA as a sequela of mechanical compression of a co‐dominant VA upon head turn to both sides. Only about 2% of the BHS patients experience symptoms during head turn to both sides [2], which was the finding in our patient. Furthermore, this case illustrates an association between BHS and SNHL. Hearing loss is previously described in vertebral artery atresia [3]; however, we present a novel association between acquired BHS and SNHL. Although we could not prove the causality, the coexistence of the two conditions in this patient may help to elicit further clinical consideration and evaluation in patients with SNHL of unknown etiology.
Abstract Number ‐ 77: A Large Vessel Occlusion in Short Gut Syndrome‐ An Acquired Catastrophe of Hyper‐Homocysteinemia
Authors: Pervez Hira , Oostra Drew , Robbins Sarah , Rao Rahul
Published: April 2023

Introduction

Strokes secondary to large vessel occlusions (LVO) are frequently caused by either atherosclerotic or thromboembolic sources (1). Both genetic and acquired etiologies can lead to elevated serum homocysteine levels causing LVO as recognized in our patient (2). Measuring homocysteine levels and vitamin B12, B6, and folate replacement can reduce the future risk of stroke by ∼25% (3).

Methods

A 42‐year‐old male with acute onset right‐sided facial droop, ataxia, gait instability, nausea, and vomiting. PMH: 11 weeks preterm with subtotal colectomy and short gut syndrome, and mild hypertension. No family h/o blood clots. LKW: >24 hours, initial NIHSS 6, required rapid sequence intubation with repeat NIHSS 28, decreased responsiveness, non‐reactive pupils, and ventilatory compromise. PE: decreased arousal and depressed mentation, facial asymmetry, flaccid right upper and lower extremity.

Results

Non‐contrast head CT: a hyperdense basilar artery (fig 1). CT angiogram of head and neck: Left vertebral artery stenosis with diminutive basilar artery. A diagnostic cerebral angiogram with mechanical thrombectomy was performed with TICI 2b recanalization (fig 2). A subsequent MRI brain further confirmed an acute bi‐cerebellar and left pontine ischemic infarct with diffusion restriction on DWI and ADC reversal (fig 1). Lab work: B12 < 50, homocysteine 50.08, methylmalonic acid 38,038, and folate wnl. A transthoracic, transesophageal ECHO with bubble study and a lower extremity doppler ruled out peripheral sources of stroke. He developed malignant cerebral edema requiring decompressive sub‐occipital craniectomy with external ventricular drain (EVD) placement and remained in the Neuro ICU until discharge.

Conclusions

•A build‐up of hcy (an intermediate product of methionine and cysteine metabolism) can occur de novo via or iatrogenically •This can cause arterial occlusion leading to ischemic strokes and venous thrombosis as seen in our patient. •Serial monitoring of Hcy, MMA, and replacing the deficient vitamins like B12, B6, and folate in these patients can help prevent the chance of ischemic CNS injuries