bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP456: Using An Electronic Dashboard To Improve Communication On Stroke Core Measure Compliance
Authors: Froehlich Anne , Anderson Marret , Bender Lawrence , Rosenberg Antonieta , Calandra Colleen , Kabacinski Andrea A
Published: June 2021

Background and Purpose:
Several years ago, an excel spreadsheet was created to improve real time communication about stroke core measure compliance to all the inpatient units. This daily spreadsheet was sent to the nursing leadership to be shared with the nurse or MD to ensure the stroke orders were carried out and patient education provided. The process to review each chart daily for compliance with the core measures, enter it into the spreadsheet, send it to the nursing leadership daily took approximately 3 hours or more a day. This was not an efficient use of time. We decided to create an electronic dashboard that would extract all of the stroke core measure information from the electronic patient record automatically, eliminating manual abstraction, thus making the process more efficient while allowing effective communication throughout the organization.

Methods:
Our IT department, working alongside our Stroke Care Team, developed data extraction processes pertinent to Stroke Core Measures to allow for an hourly extraction into a Tableau dashboard. This software allows for logic to be applied to the various elements to evaluate the successful completion of each core measure for patients currently admitted to our institution for Stroke-related diagnoses and conditions.

Results:
The key stake holders for each unit review the dashboard which is refreshed hourly to identify areas that have not met the measure. After the review, the leadership implements a plan to improve attainment for these measures. The dashboard has also allowed for correction of documentation in real time but has limitations because it depends on the data within the electronic medical record and the programing to extract that data. The team communicates with our IT department to correct the issues with the data displayed in tableau.

Conclusions:
The tableau dashboard is an effective and efficient tool providing a snapshot of the current attainment of the primary and comprehensive stroke core measures. The implementation of this dashboard has increased awareness of the stroke core measure compliance and has improved communication among the clinical staff.
Abstract WP457: Safety and Effect of Medium-Chain Triglycerides Oil to Prevent Deterioration of Nutritional Status in Acute Stroke Patients With Severe Renal Dysfunction
Authors: Mori Takahisa , Yoshioka Kazuhiro , Chiba Nozomi
Published: June 2021

Introduction:
When nutritional status in acute stroke patients with renal dysfunction is deteriorated, it is difficult to prevent further deterioration and improve nutritional status, because protein-enriched diet probably causes deterioration of renal function.

Hypothesis:
Medium-chain triglycerides (MCT) oil composed of caprylic acid (C8) and capric acid (C10) may safely prevent further deterioration and improve nutritional status in acute stroke patients with severe renal dysfunction, because medium-chain fatty acids do not deteriorate renal function.

Methods:
We included acute stroke patients who 1) were admitted between August 2016 and December 2018, 2) presented creatinine (Cre) of more than 1.5 mg/dl on admission, 3) underwent blood examination on admission, the 3rd day and 7th day, 4) presented prealbumin of less than 20 mg/dl on the 3rd day and 4) who took daily 15g of MCT from the 3rd to the 6th day. We evaluated patients’ features, albumin (Alb), PreAlb, high-sensitivity C-reactive protein (hs-CRP) and Cre on admission, 3rd day and the 7th day.

Results:
Thirteen patients met our inclusive criteria and were analyzed. The median age, body mass index, Cre, creatinine clearance (Ccr), blood glucose (BG), hs-CRP, Alb and PreAlb were 86 years, 23.2 kg/m2, 1.93 mg/dl, 19.2 mL/min, 117 mg/dl, 0.433 mg/dl, 3.6 g/dl and 17.3 mg/dl. Their Ccr was less than 15 mL/min in 4 (30.8%) of 13 patients, 15 or more and less than 30 mL/min in 7 (53.8%) of 13 patients and 30 or more and less than 40 mL/min in 2 patients (15.4%). Eleven patients received enteral feeding and two patients ate food orally. Their median calorie intake was 1,000 kcal/day except MCT supplementation. On the 3rd day, their median Alb and PreAlb levels decreased to 2.7 mg/dl (p<0.001) and 10.8 mg/dl (p<0.01), respectively, their median hs-CRP increased to 4.01 mg/dl (p<0.01) and Cre was 2.0 mg/dl (ns). On the 7th day following MCT supplementation, their median Alb was 2.7 mg/dl (ns) and median PreAlb increased to 12.2 g/dl (ns), their median hs-CRP decreased to 2.379 mg/dl (ns) and Cre decreased to 1.79 mg/dl (p<0.05).

Conclusion:
Four-days MCT supplementation of 15g per day probably prevented further deterioration of nutritional status, attenuated inflammation early and had no adverse effect on renal function.
Abstract WP46: Patient Characteristics, Quality and Outcomes After Endovascular Therapy for In-Hospital Ischemic Stroke
Authors: Akbik Feras , Xu Haolin , Xian Ying , Shah Shreyansh , Smith Eric E , Bhatt Deepak L , Matsouaka Roland A , Fonarow Greg C , Schwamm Lee H
Published: June 2021

Introduction:
A significant number of acute ischemic strokes occur while patients are hospitalized for other reasons. No national data have been reported on endovascular therapy (EVT) for in-hospital onset stroke. Here we compare the patient characteristics, process measures of quality, and outcomes for in-hospital onset vs. community-onset of strokes in a large US national registry.

Methods:
We performed a retrospective cohort study of Get With The Guidelines-Stroke (GTWG-Stroke) from January 2008 to June 2018 from 2,333 participating sites that included 2,428,178 patients with acute ischemic stroke. Among 67,493 in-hospital onset strokes, 2494 (3.7%) underwent EVT. We examined the association between key patient characteristics (in-hospital onset, demographics, comorbidities, treatment with EVT) and functional outcomes using multivariable logistic regression models.

Results:
The rate of EVT increased from 2.5% in 2008 to 6.4% in 2018 (p<0.001), with a significant and sustained increase in EVT after the second quarter of 2015 (p<0.0001). Compared with patients with community-onset strokes, patients with in-hospital onset stroke had longer times to cranial imaging and arterial puncture but similar median NIHSS (16 (9 - 21) vs. 16 (10 - 21) Std Diff 1.9). Patients with in-hospital onset stroke were less likely to undergo EVT within 120 mins of symptom recognition, have symptomatic intracranial hemorrhage, or ambulate independently at discharge. They were more likely to die or be discharged to hospice.

Conclusions:
Though use of EVT in GWTG-Stroke for in-hospital stroke remains low, it more than doubled in the past decade. Compared with community onset stroke, these patients have longer intervals to CT and arterial puncture, with associated worse functional outcomes. While there may be important differences in baseline patient characteristics between the groups, efforts must still be made to shorten time to reperfusion for in-hospital strokes.
Abstract WP464: The Pull Technique: A Solution to Stroke Intervention Transfers
Authors: Talley Joshua D , Fleming Ryan D , Sharma Jitendra
Published: June 2021

Background and Purpose:
This stroke center has neuro-interventional capabilities and is part of a five hospital network surrounding a metropolitan area. As the center that offers mechanical thrombectomy, patients are received for this procedure from the other hospitals in the network in addition to other outside facilities. The time to transfer these patients was taking too long, sometimes hours, and a way to shorten that time was needed to improve patient outcomes.

Methods:
The stroke team decided to use the Code Stroke nurse to facilitate this process. A process was put into place in which the receiving facility pulls the patient in rather than waiting for the sending facility to push the patient out. The Code Stroke nurse, once learning of the acceptance of the patient by the interventionalist, proactively calls the sending facility to get report, instructs that facility to call EMS for transfer, and records an estimated time of arrival (ETA) for the patient. This information is then disseminated to the rest of the stroke team to prepare for the patient’s arrival.

Results:
Before implementation of this process, the average time to receive these transfers was approximately 120 minutes. After the Pull Technique was implemented, the average time of transfer is 40 minutes. This is a reduction of 67% of time to transfer.

Conclusion:
Decreasing the time of transfer can significantly impact the outcome for these patients. This process has shown a lot of promise and is continuing to be evaluated. Not only has the time of transfer decreased, the sending facilities are happier because some of the burden of facilitating the transfer is taken by the receiving facility, and the receiving facility is even more prepared to receive the patient leading to decreased door-to-device (DTD) times.
Abstract WP471: Significant Factors for Early Independent Toilet Activities in Acute Stroke Patients
Authors: Sawada Yuki , Mori Takahisa , Hosaka Yuna
Published: June 2021

Introduction:
Acute stroke patients have problems with toilet activities. Independent toilet activity in hospitalized patients is important for dischargee to home.

Hypothesis:
Lower limbs function, trunk control and cognitive function are important factors of early independent toilet activities and discharge to home within 7 days.

Methods:
We included acute ischemic stroke patients who 1) were admitted from June 2017 to May 2018 and 2) received early rehabilitation treatment. Patients with disturbed level of consciousness were excluded. Functional independence measure (FIM) scale of 6 or 7 was defined as independence and FIM scale of 5 or less as dependence. We evaluated Brunnstrom Recovery Stage (BRS) of arms, fingers and lower limbs, trunk control test (TCT), Mini-Mental State Examination (MMSE) and investigated significant factors of early independent toilet activities and discharge to home within 7 days.

Results:
One-hundred twenty-four patients met our inclusive criteria. Their average age was 75.8 years, male gender of 63.7%, median BRS of arms, fingers and lower limbs was 5, 5 and 5, median TCT score and MMSE score were 94 and 24.7, respectively. Fifty-three patients were independent in toilet activity and 73 patients were dependent. All patients with independent toilet activity discharged to home within 7 days. In independent and dependent toilet activity patients, an average age was 73.6 and 77.4 (p<0.05), median BRS of arms was 5 and 5 (p<0.01), median BRS of fingers was 6and 5 (p<0.01), median BRS of lower limbs was 5 and 5 (p<0.01), median TCT score was 100 and 61 (p<0.01), and median MMSE score was 27.8 and 22.5 (p<0.01), respectively. Multiple logistic regression analysis showed that MMSE score (p<0.01), TCT score (p<0.01), and BRS of lower limbs (p<0.05) were independent factors for independent toilet activity and discharge to home. Receiver operating characteristic (ROC) curve for early discharge to home demonstrated that cut-off values of MMSE score, TCT score and MRS of lower limbs were 27 or more, 87 or more and 5 or more, respectively.

Conclusion:
BRS as lower limbs function, TCT as trunk control and MMSE as cognitive function were important factors of early independent toilet activities and early discharge to home.
Abstract WP474: Improvement of Cognitive Function and Reorganization of Brain Networks Following Carotid Endarterectomy and Carotid Artery Stenting
Authors: Kohta Masaaki , Fujita Atsushi , Hosoda Kohkichi , Kohmura Eiji
Published: June 2021

Background:
Internal carotid artery stenosis (ICS) can lead to cognitive impairment as well as ischemic stroke. Although carotid revascularization surgery, such as carotid endarterectomy (CEA) and carotid artery stenting (CAS), can prevent future strokes, the effect of revascularization on cognitive function is controversial. In this study, we examined the resting-state functional connectivity (FC) in ICS patients undergoing revascularization surgery, with a special focus on the Default Mode Network (DMN).

Methods:
We prospectively enrolled 24 ICS patients, who were expecting the intervention of CEA (14 cases) or CAS (10 cases). Cognitive assessment, including the Mini-Mental State Examination (MMSE), the Frontal Assessement Battery (FAB), and the Japanese version of the Montreal Cognitive Assessment (MoCA-J) and rs-fMRI were administered ≤ 1 week preoperatively and postoperatively at 1 week. For the analysis of FC, a seed was placed in the region associated with DMN.

Results:
After revascularization surgery, significant improvement in the score of MMSE (27.4 vs 28.4, P = 0.03) and MoCA-J (23.1 vs 25.0, P = 0.0001) was found. As for the analysis of the CAS and CEA groups, the MoCA-J score of the CEA group (24.1 vs 26.1, P = 0.001) and the MMSE score of the CAS group (26.0 vs 28.4, P = 0.01) showed statistically significant improvements. In both CAS and CEA groups, Seed-to-Voxel focusing on DMN revealed increased connectivity between medial prefrontal cortex and precuneus.

Conclusion:
Both CEA and CAS are associated with an improvement in neurocognitive performance and reorganization of functional connectivity, including DMN.
Abstract WP475: Pro-neurotensin/neuromedin N is Associated With Incident Cognitive Impairment in Women
Authors: Nicoli Charles D , Howard Virginia J , Struck Joachim , Manly Jennifer J , Cushman Mary
Published: June 2021

Introduction:
Neurotensin (NT) is a neuropeptide implicated in cardiovascular and metabolic disease. As such, it is a candidate risk factor for cognitive impairment. We are not aware of studies reporting the relationship of NT and incident cognitive impairment (ICI). NT can be estimated in plasma by measuring its stable equimolar precursor, pro-neurotensin/neuromedin N (pro-NT/NMN).

Hypothesis:
Higher fasting plasma pro-NT/NMN is associated with risk of ICI.

Methods:
Prospective nested case-control study in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. REGARDS enrolled 30,239 Black and White adults aged ≥45 from 2003-2007. Baseline pro-NT/NMN was measured by immunoassay in 497 controls and 399 cases of ICI over 3.5 years follow up. ICI was identified using a 3-test cognitive battery biannually. Multivariable logistic regression was used to calculate odds ratios (OR) of ICI by pro-NT/NMN quartiles. Race and sex differences were studied with stratified models and interaction testing (with p <0.10 significant).

Results:
There was no association of 4
th
vs. 1
st
-quartile proNT/NMN with ICI in the overall group (see table), nor significant associations of the 2
nd
and 3
rd
quartiles with ICI in any group The OR differed significantly by sex; women had a 90% increased odds in the demographic-adjusted model, only slightly attenuated by risk factor adjustment. There was no race difference in associations.

Conclusions:
Higher circulating pro-NT/NMN was associated with ICI in women but not men. This could be due to cerebral vasoconstrictive effects of NT and estrogen-mediated differences in transcription. Confirmatory study is required.
Abstract WP481: Regional Differences in Hospital Setting and Insurance Coverage in Patients Included in the National Inpatient Sample Database 2006-2014 With Vascular Dementia
Authors: Buchwald Natalie , Elfasi Aisha , Yu Crystal , Simpkins Alexis N
Published: June 2021

Introduction:
Evaluation of healthcare utilization in patients hospitalized with vascular dementia (VD) in the United States (US) and regionally have not recently been reported. Patients with VD have higher healthcare utilization and costs than other forms of dementia. We previously found regional differences in frequency at which VD patients were hospitalized in the National Inpatient Sample (NIS), with lower frequency being found in the West. Thus, we hypothesized that payor/insurance type and hospital setting may vary regionally.

Methods:
The Healthcare Cost and Utilization Project Nationwide Inpatient Sample Database from 2006-2014 was used to query patients with primary or secondary ICD-9 for VD using ICD-9 codes 290.40, 290.41, 290.43. Regional differences in frequency of VD diagnosis were evaluated within the NIS dividing the US into four hospital regions (Northeast, Midwest, South, and West). Comparison of the observed distribution of insurance status and hospital type were performed with Chi-square analysis and patient demographics with Mann Whitney test.

Results:
There were no significant regional differences in patient demographics. Nationally, 88% of patients were insured with Medicare, 6% private, 4% Medicaid, 1% self-pay, and 1% were not charged. There were no significant differences in the distribution of insurance coverage by region. In contrast, the distribution of patients admitted with VD in the Northeast (p=0.00790) and West (p=0.0018) were significantly different from the national distribution, which included 15% in rural, 42% urban non-teaching, and 43% teaching hospital setting. In the Northeast 7% were admitted to rural hospitals, 36% urban non-teaching, and 57% teaching hospitals. In the West 6% were admitted to rural hospitals, 58% urban non-teaching, and 36% teaching hospitals.

Conclusion:
While payor and insurance status did not vary regionally, the hospital type did vary regionally. A significant proportion were covered with Medicare. This is likely related to the age at which the patients progress from mild cognitive impairment to vascular dementia. More research is needed to determine if healthcare utilization by hospital type impacts costs and clinical outcome.
Abstract WP491: HUCBC Treatment Promotes White Matter Remodeling and Improves Glymphatic Function and Cognitive Outcome in Rats With Vascular Dementia
Authors: Venkat Poornima , Zacharek Alex , Chopp Michael , Chen Jieli
Published: June 2021

Aim:
Vascular Dementia (VaD) accounts for nearly 20% of all dementia. We have investigated the therapeutic effects of human umbilical cord blood cells (HUCBCs) treatment of VaD and tested mechanisms such as that white matter (WM) remodeling and glymphatic function that contribute to improving cognitive outcome.

Methods:
Male rats (6-8m old) were subjected to a multiple microinfarct model (MMI, 500-800 cholesterol crystals injected into the internal carotid artery) of VaD, and 3 days later treated with PBS or HUCBC (5х10
6
, i.v.) n=6/group. Cognitive tests were conducted and rats sacrificed at 28 days after MMI. To evaluate glymphatic function, fluorescent tracers (Texas Red dextran, MW: 3 kD and FITC-dextran, MW: 500 kD) were injected into the cisterna magna over 30min at 14 days after MMI. Rats (6/group/time point) were sacrificed at 30min, 3h, and 6h and tracer movement analyzed using laser scanning confocal microscopy.

Results:
HUCBC treatment significantly improves short term memory (Novel object recognition test discrimination index: MMI: 35.6±3.6%; MMI+HUCBC: 74.2±4.3%; p<0.0001), long term memory (odor test discrimination index: MMI: 49.9±5.8%; MMI+HUCBC: 69.2±4.8%; p<0.01) and spatial learning and memory (Morris water maze test: decreased latency and increased % of time in target quadrant, p<0.05) compared to control MMI rats. HUCBC treatment significantly increases axon and myelin density, increases oligodendrocyte and oligodendrocyte progenitor cells number, and increases Synaptophysin expression in the brain compared to control MMI rats. HUCBC treatment of MMI in rats significantly improves glymphatic function by reversing MMI induced delay in cerebrospinal fluid penetration into the brain parenchyma via paravascular pathways as well as delayed waste clearance from the brain. HUCBC treatment significantly decreases serum protein expression of BACE1, S100, MCP-1, and TGF-β which may contribute to HUCBC induced therapeutic effects.

Conclusions:
HUCBC treatment of an MMI rat model of VaD promotes WM remodeling, anti-inflammatory effects and improves glymphatic function which in concert may contribute to the improvement in cognition and memory. Thus, HUCBC treatment warrants further investigation as a potential therapy for VaD.
Abstract WP493: Post-Stroke Chinese Pure Alexia: Prominent Shape-Similar Errors and Associated Neuropsychological Profiles
Authors: Yang Shilin , Kuang Shenyi , Dong Qiang , Han Xiang
Published: June 2021

Objective:
To describe the characteristics of post-stroke Chinese pure alexia and associated neuropsychological profiles.

Methods:
All patients with post-stroke pure alexia from the neurology department of our hospital were enrolled from June 2018 to July 2019. Brain MRI was performed to evaluate the stroke radiologically. The Aphasia Battery of Chinese (ABC) was used to evaluate the general language functions. A Chinese individual character reading test including 68 commonly used characters was used to evaluate the ability to read individual Chinese characters. The numbers of correct reading and misreading were recorded, and the error types of misreading were analyzed. MMSE, auditory verbal learning test, cube copying task, clock drawing test, and picture copying tests were performed to evaluate other cognitive impairments.

Results:
A total of 5 male patients were included, with a median age of 58 years (50-64 years). They all had Chinese pure alexia with intact verbal comprehension and speech and relatively preserved writing skills. The etiologies were all acute infarction involving the left temporo-parietal lobe and splenium of corpus callosum. In the Chinese individual character reading test, the median number of correct reading was 21 (18-44) out of 68 characters, with many shape-similar errors (one character was read as another one with a similar shape but different meaning and pronunciation). The percentage of shape-similar errors among all type errors was 81.5%, 60.0%, 23.7%, 18.5%, and 57.9% respectively, and 43.1% overall, much higher than other type errors. All the patients had obvious impairment in memory and visuospatial function with an exception that one patient had relatively preserved visuospatial ability.

Conclusion:
Shape-similar error is a remarkable feature of Chinese pure alexia. Chinese pure alexia is associated with impaired visuospatial function, but visuospatial dysfunction is not necessary for the development of Chinese pure alexia.
Abstract WP5: Effect of Complete Reperfusion on Outcome in Patients Undergoing Endovascular Therapy For Large Vessel Occlusion Stroke
Authors: Kitano Takaya , Todo Kenichi , Uchida Kazutaka , Yamagami Hiroshi , Nakamura Hajime , Kishima Haruhiko , Mochizuki Hideki , Morimoto Takeshi , Sakai Nobuyuki , Yoshimura Shinichi
Published: June 2021

Introduction:
We investigated how the degree of reperfusion affects functional outcomes according to the puncture-to-reperfusion time and preoperative condition in patients with acute large vessel occlusion.

Methods:
A post-hoc analysis of the RESCUE-Japan Registry 2, a prospective multicenter registry enrolling patients with acute cerebral large vessel occlusion from 46 centers in Japan between October 1, 2014 and September 30, 2016, was conducted. Among the 2,420 patients in the RESCUE-Japan 2 registry, 1,073 patients who achieved successful reperfusion with endovascular therapy were analyzed. We compared the functional and safety outcomes between patients with modified thrombolysis in cerebral infarction grades 3 (mTICI-3) and 2b (mTICI-2b).

Results:
The proportion of patients with favorable outcomes (modified Rankin Scale scores of 0 to 2 at 90 days after onset) was higher among patients with mTICI-3 than among those with mTICI-2b (52% versus 38 %; adjusted OR, 1.96; 95% CI, 1.49-2.56). Compared to those in the patients with mTICI-2b within 30 minutes after puncture, favorable outcomes tended to be more common in patients who achieved mTICI-3 within 90 minutes after puncture (0-29 minutes: adjusted OR, 2.60; 95% CI, 1.24-5.46, 30-59 minutes adjusted OR, 1.65; 95% CI, 0.85-3.21, 60-89 minutes: adjusted OR, 1.61; 95% CI, 0.77-3.37; Figure). mTICI-3 reperfusion was associated with favorable outcomes in both anterior (adjusted OR, 1.81; 95% CI, 1.34-2.44) and posterior vessel occlusion (adjusted OR, 2.40; 95% CI, 1.06-5.44). There was no heterogeneity in the effect of mTICI-3 reperfusion on the outcomes with respect to age, NIHSS score, use of alteplase, late-presenting, distal vessel occlusion, or ASPECTS.

Conclusions:
mTICI-3 reperfusion, possibly even when reperfusion delays slightly, was superior to mTICI-2b. Achieving complete reperfusion, not only early reperfusion, is important to improve the outcomes regardless of preoperative condition.
Abstract WP52: Defining and Predicting Fast Progression of Infarct Growth in Large Vessel Occlusion Strokes
Authors: Bouslama Mehdi , Ravindran Kishnan , Pisani Leonardo , Rodrigues Gabriel , Haussen Diogo , Al-Bayati Alhamza , Frankel Michael , Nogueira Raul
Published: June 2021

Background and Purpose:
Identification of patients with failing collaterals and rapid progression of infarct growth (fast progressors) is crucial when assessing patients for potential transfer from primary to comprehensive stroke centers endovascular therapy (ET).

Methods:
Review of a prospectively collected database of endovascular patients with anterior circulation Large vessel occlusion strokes from 09/2010-11/2018. Patients with adequate CTP maps and follow-up final infarct volume (FIV) measurements who achieved full reperfusion (mTICI 2c-3) were included.Infarct growth rate was calculated as the difference between FIV and the acute CTP core volume, divided by time from CTP to reperfusion in hours. Receiver operating characteristic analysis was used to identify the optimal infarct growth rate that better discriminated 90-day good outcome(mRS 0-2). Fast progression was defined as having an infarct growth rate above the identified threshold.

Results:
461 patients qualified for the study. The optimal infarct growth rate threshold to predict good outcome was 3.9 ml/h (sensitivity 79%, specificity 47%). 286 (62%) were subsequently categorized as fast progressors. There were no differences in baseline characteristics between fast and slow progressors except for higher NIHSS(16[12-21]vs16[11-21],p=0.02), longer Last known normal to CT times (367 mins [219-679]vs 269.5[111.5-570],p<0.001) and smaller CTP core volumes (3.8cc[0-20] vs 8[0-25.5],p=0.02). Fast progressors had larger FIV (36.7[18.6-66.9] vs 7[3.5-16],p<0.001), lower rates of good outcome (52.8% vs 77.4%, p<0.001), higher mortality rates (17.5% vs 6%,p=0.02). There was a trend toward higher rates of parenchymal hematomas in fast progressors (5.1% vs 1.7%,p=0.07). On multivariate analysis, only ASPECTS was an independent predictor of fast progression (aOR 0.7 95%CI[0.54-0.91,p=0.007) while CTP parameters did not reach statistical significance.

Conclusions:
Fast progression of infarct growth is associated with poorer clinical outcomes. ASPECTS may help triage transfers when assessing patients for ET. Larger studies are warranted.
Abstract WP76: Artificial Intelligence CTA Vessel Density Mapping to Enhance Identification of Large Vessel Occlusions in Mobile Stroke Unit
Authors: Brown Kevin , Villareal Bryan , Harrell Kenneth , Bahr Hosseini Mersedeh , Restrepo-Jimenez Lucas , Bosson Nichole , Liebeskind David S , Gaushe-Hill Marianne , Ghurabi Walid , Kazan Clayton , Saver Jeffrey , Nour May
Published: June 2021

Background:
Equipped with CT scanners capable of imaging the brain parenchyma and vasculature, Mobile Stroke Units (MSU) have the ability to image, diagnose and treat stroke patients in the prehospital setting. Automated CTA vessel density mapping could enhance frontline neurologist scan review in identifying large vessel occlusion (LVO), ensuring appropriate patient diagnosis and routing.

Methods:
We analyzed consecutive acute ischemic stroke patients undergoing CTA imaging in a regional Mobile Stroke Unit. Automated CTA vessel density mapping was performed in the field immediately after scan completion. CTA source images were wirelessly transferred to an off-site processing server (RAPID.Ai, IschemiaView) for artery reconstruction and color-coded density mapping, with blue, green, yellow, and red color shading indicating vessel density decreases of 70%-85%, 60%-75%, 45%-60%, and <45%.

Results:
Among all 16 patients, median processing time was 186 secs, and all images were available in time to aid clinical decision-making. Overall, automated processing yielded evaluable images in 94% (suboptimal contrast opacification precluded analysis of 1). Of the 15 diagnostically adequate exams, 100% (15/15) showed concordance for identification of anterior circulation occluded/abnormal vessel territories between automated CTA vessel density mapping and expert physician final CTA interpretation. Cases included true positives in 7, and true negatives in 8. Among true positives, CTA vessel density mapping identified the symptomatic occlusion in 6/6 and also correctly identified a severe cervical ICA stenosis unrelated to the clinical presentation in 1/1. Correctly detected intracranial occlusions included: ICA-17%. M1-17%, M1-M2 junction-17%, and M2-50%. Degree of vessel density diminution correlated with proximal-distal occlusion location.

Conclusion:
CTA vessel density mapping can feasibly and efficiently be conducted in Mobile Stroke Units and shows high accuracy in detection of large and medium intracranial vessel occlusions. Extension of mapping to the intracranial posterior circulation and algorithmic adjustment for proximal cervical stenoses/occlusions would further improve utility in aiding prehospital routing.
Abstract WP87: Renal Safety of Multimodal Brain Imaging Followed by Endovascular Therapy
Authors: Cereda Carlo W , Mlynash Michael , Heit Jeremy , Kemp Stephanie , Cippà Pietro , Marks Michael P , Lansberg Maarten , Albers Gregory W
Published: June 2021

Introduction:
Contrast-enhanced non-invasive angiography and perfusion imaging are recommended to identify eligible patients for endovascular therapy (EVT) in extended time windows (>6h or wake-up). If eligible, additional IA contrast exposure will occur during EVT. In this emergency setting, where the use of IV contrast often occurs prior to laboratory confirmation of renal function, renal safety concerns have been raised.

Hypothesis:
We hypothesized that in the DEFUSE 3 study population, patients who received additional IA contrast during EVT would not have evidence of acute contrast-associated kidney injury compared with the medical control group and that there would also be no differences in renal function between the CT perfusion and MR perfusion selected patients.

Methods:
In the randomized DEFUSE 3 trial population
,
we compared changes in serum creatinine between baseline (prior to randomization to EVT vs medial therapy) and 24 hours later. The primary outcome was the relative change in creatinine level between baseline and 24 hours in the EVT vs. medical arm. The secondary outcome was a comparison between CT vs. MRI selection in the EVT arm.

Results:
In the DEFUSE 3 population (n=182, age 69±13, 51% female), mean creatinine decreased from a baseline of 0.98±0.33 mg/dL to 0.88±0.28 mg/dL at 24 hours (p<0.001). There was no difference in change between treatment groups: absolute decrease -0.08±0.18 in EVT vs. -0.12±0.18 in medical, p=0.135; relative to baseline there was a 6.3% reduction in the EVT group vs. 9.2% in medical, p=0.294. Among patients treated with EVT, there was no difference in 24-hour creatinine level changes between patients who were selected with CTA/CTP (-0.08±0.18) vs. MRI (-0.07 ±0.19), p=0.808; or 6.8% reduction vs. 4.8%, p=0.700. The maximum increase in Cr in an EVT treated patient was 0.42 mg/dL in the CT group and 0.58 mg/dL in the MRI group.

Conclusions:
Perfusion imaging prior to EVT was not associated with evidence any decline in renal function.
500 years of Old Chinese phonology
Authors: Zhao Xin
Published: June 2021

This article introduces research on Old Chinese phonology before the Qing dynasty by reviewing the important relevant literature of recent intellectual historians. The article has six parts. The first section is an introduction. The second through fourth parts review the views and arguments over how to understand the works of several important linguists, treating respectively the Southern Song (§ 2, containing Wú Yù 吳棫, Zhū Xī 朱熹 etc.), the Yuan (§ 3, containing Dài Tóng 戴侗, Liú Yùrǔ 劉玉汝, Xióng Pénglái 熊朋來 etc.), and the Ming (§ 4, containing Yáng Shèn 楊慎, Jiāo Hóng 焦竑, Chén Dì 陳第 etc.). Section 5 discusses several methodological issues that concern researchers today, including the historical emergence of three methodologies and methodological issues in researching the history of scholarship. Finally, I point out those topics in need of further investigation.
A new cormopsocid from mid-Cretaceous Burmese amber (Psocodea: Trogiomorpha: Cormopsocidae)
Authors: HAKIM MARINA , AZAR DANY , FU YAN-ZHE , CAI CHEN-YANG , HUANG DI-YING
Published: June 2021

Cormopsocus neli Hakim, Azar & Huang sp. nov., a new cormopsocid species from the mid-Cretaceous Burmese amber is characterized, described, and illustrated. Its taxonomic position is discussed. This is the second species of the Cormopsocidae, the most recently discovered trogiomorphan family in the Burmese amber.
The Targeting Function of CIRC-0005519 to miR-625-5p as Well as Its Effects on Bronchial Epithelial Cell Injury in Children with Severe Asthma
Authors: Ma Weining , Wu Jiaying , Zhou Xiaojian , Qin Zhen
Published: June 2021

This work was intended to explore the effect of circ-0005519 on the apoptosis of bronchial epithelial cells in children with severe asthma and its molecular mechanism. To this end, asthma’s inflammatory environment was simulated by using 1 mg/L lipopolysaccharide (LPS) to induce human bronchial epithelial 16HBE cells, which were considered the 16HBE model cells. After transfection, these 16HBE model cells were divided into following groups: control group, model+si-NC group, model+si-circ-0005519 group, model+miR-NC group, model+miR-625-5p group, model+si-circ-0005519+anti-miR-NC group, and model+si-circ-0005519+anti-miR-625-5p group. A series of experiments were then carried out, including RT-qPCR assay for testing circ-0005519 and miR-625-5p expressions, flow cytometry assay for analyzing cell apoptosis, western blot for testing protein expression, ELISA assay for detecting IL-6. TNF-α, IL-13, IL-8 expression, and dual-luciferase reporter confirm the targeted functions of circ-0005519 to miR-625-5p. The results displayed highly expressed circ-0005519 and lowly expressed miR-625-5p in 16HBE model cells induced by lipopolysaccharide. Furthermore, we also found increases in apoptosis, Bax expression, and levels of IL-6, TNF-α, IL-13, and IL-8, as well as a decrease in Bcl-2 expression. Additionally, our data revealed that silencing circ-0005519 or overexpressing miR-625-5p would affect these 16HBE model cells, including decreases in apoptosis, Bax expression, and levels of IL-6, TNF-α, IL-13, and IL-8, as well as an increase in Bcl-2 expression. The targeted binding function of circ-0005519 to miR-625-5p was also confirmed, in which interference miR-625-5p would weaken the influences of silencing circ-0005519 on 16HBE cells. These results suggested that silencing circ-0005519 could inhibit apoptosis of lipopolysaccharide-induced bronchial epithelial cells via targeted binding functions to miR-625-5p.
Influence of Indwelling Lacrimal Drainage Tube on the Curative Effect of Endonasal Endoscopic Dacryocystorhinostomy
Authors: Gou Wenjun , Li Heng , Yang Xu , Long Bo , Qiu Yuyan , Kang Haijun , Liu Siyuan
Published: June 2021

Endonasal endoscopic dacryocystorhinostomy (EES-DCR) has gradually become the main surgical method for treating chronic dacryocystitis. Whether the placement of the lacrimal drainage tube during the operation can improve the operation’s success rate is an issue. This study observes the effect of an indwelling lacrimal drainage tube on the curative effect of EES-DCR in patients with chronic dacryocystitis. The cure rate of the Lacrimal duct drainage tube non-indwelling group A was 93.8% (46/49). The 3 cases failed because of the nasal cavity’s inflammation, which resulted in the adhesion of the anastomotic stoma and the middle turbinate. The cure rate of the Lacrimal drainage tube indwelling group B was 85.7% (42/49). The 7 cases failed because of the excessive proliferation of the tissue around the anastomosis, the hyperplasia of granulation tissue, the shedding of the lacrimal duct drainage tube, the crack of the lacrimal duct, and the premature removal of the lacrimal duct drainage tube caused the contraction of the mucosa around the anastomosis, resulting in the anastomosis obstruction. There was no obvious difference between the two groups (P> 0.05). At 6 months, 46 cases of the EES-DCR group A had gradually epithelialized anastomoses without granulation tissue growth with the follow up time extension. In the EES-DCR group B, 42 cases of anastomoses were gradually epithelialized without granulation tissue growth. Nasal endoscopic dacryocystorhinostomy combined with an indwelling lacrimal duct drainage tube can be used to treat chronic dacryocystitis, but an indwelling lacrimal duct drainage tube has no significant effect on the efficacy of chronic dacryocystitis.
Isolation and characterization of lytic phage TUN1 specific for Klebsiella pneumoniae K64 clinical isolates from Tunisia
Authors: Eckstein Simone , Stender Jana , Mzoughi Sonia , Vogele Kilian , Kühn Jana , Friese Daniela , Bugert Christina , Handrick Susann , Ferjani Mustapha , Wölfel Roman , Millard Andrew , Ben Moussa Mohamed , Bugert Joachim J.
Published: June 2021

Background

Multidrug-resistant Klebsiella pneumoniae spp. (kp) are emerging agents of severe infections of the respiratory, urinary tract and wounds that can progress to fatal septicemia. The use of bacteriophages is currently being considered as an effective alternative or adjuvant to antibiotic therapy.

Results

In this study, we report capsule (K)-typing of 163 carbapenem-resistant Kp (CRKP) isolated 2014–2018 at the Military Hospital of Instruction of Tunis (MHT), Tunisia, by partial amplification and sequencing of the Kp wzi gene. The most prevalent K-type overall was K64 with 50.3% followed by K17 and K27 (22.7 and 11.0%, respectively). K64 Kp strains were most common and associated with increased case/fatality rates, especially at the intensive care unit (ICU). Using a K64 Kp strain we isolated and characterized a lytic Kp phage, vB_KpP_TUN1 (phage TUN1), from wastewater samples of the ICU at the MHT. TUN1 belongs to the Autographiviridae family and specifically digests K64 Kp capsules most probably via a depolymerase encoded by gp47. Furthermore, we successfully assembled phage TUN1 in a non-replicative host (E. coli) raising the possibility of in vitro assembly in the absence of live bacterial hosts. We propose that phage TUN1 is a promising candidate to be used as an adjuvant or an alternative to antibiotic therapy in CRKP infections, facilitating regulatory approval of phage therapy.

Conclusions

K64, K17 and K27 are the most common wzi capsule types in this geographical location in Northern Africa. The lytic phage TUN1 efficiently lyses K64 Kp strains associated with increased case/fatality rates at body temperature. Together with its ability to be rescued in a non-replicative host these features enhance the utility of this phage as an antibacterial agent.
The impact of personalized clinical decision support on primary care patients’ views of cancer prevention and screening: a cross-sectional survey
Authors: Saman Daniel M. , Chrenka Ella A. , Harry Melissa L. , Allen Clayton I. , Freitag Laura A. , Asche Stephen E. , Truitt Anjali R. , Ekstrom Heidi L. , O’Connor Patrick J. , Sperl-Hillen JoAnn M. , Ziegenfuss Jeanette Y. , Elliott Thomas E.
Published: June 2021

Background

Few studies have assessed the impact of clinical decision support (CDS), with or without shared decision-making tools (SDMTs), on patients’ perceptions of cancer screening or prevention in primary care settings. This cross-sectional survey was conducted to understand primary care patient’s perceptions on cancer screening or prevention.

Methods

We mailed surveys (10/2018–1/2019) to 749 patients aged 18 to 75 years within 15 days after an index clinical encounter at 36 primary care clinics participating in a clinic-randomized control trial of a CDS system for cancer prevention. All patients were overdue for cancer screening or human papillomavirus vaccination. The survey compared respondents’ answers by study arm: usual care; CDS; or CDS + SDMT.

Results

Of 387 respondents (52% response rate), 73% reported having enough time to discuss cancer prevention options with their primary care provider (PCP), 64% reported their PCP explained the benefits of the cancer screening choice very well, and 32% of obese patients reported discussing weight management, with two-thirds reporting selecting a weight management intervention. Usual care respondents were significantly more likely to decide on colorectal cancer screening than CDS respondents (p < 0.01), and on tobacco cessation than CDS + SDMT respondents (p = 0.02) and both CDS and CDS + SDMT respondents (p < 0.001).

Conclusions

Most patients reported discussing cancer prevention needs with PCPs, with few significant differences between the three study arms in patient-reported cancer prevention care. Upcoming research will assess differences in screening and vaccination rates between study arms during the post-intervention follow-up period.

Trial registration

clinicaltrials.gov, NCT02986230, December 6, 2016.
Factors of involvement, in the activity in the structure of service loyalty of cadets in educational institutions of the Ministry of Internal Affairs of Russia
Authors: Sarsenova Asel
Published: June 2021

The article discusses theoretical and practical issues of personnel involvement research and defines the role of involvement factors in the structure of service loyalty of persons studying in an educational organization of the Russian Ministry of Internal Affairs. The significance of service loyalty in providing moral and psychological training for law enforcement agencies is discussed. On the basis of analysis of different theoretical statements it is found out that involvement and loyalty provide positive results of professional activity and increase its efficiency. The essence characteristics of involvement, which is a stable attribute that implies long-lasting concentration of an employee on the tasks and contributes to increase the professional dedication of an employee, are discussed. The empirical research using comparative and longitudinal methods has revealed reliable changes of involvement and loyalty indices of cadets during the whole period of training in a higher educational institution. The most significant changes are noted in the adaptation period of training, which is manifested in low values of professional and organizational loyalty, affective and normative loyalty. The study establishes an inverse proportional relationship between training time and cadets' involvement in activities. The results of the study suggest that the indicators of involvement and loyalty factors serve as predictive markers in managerial activity, when assessing the level of service loyalty of internal affairs officers. The empirical data obtained can be recommended for the organization of moral and psychological training of internal affairs officers.
Do online courses provide an equal educational value compared to in-person classroom teaching? Evidence from U.S. survey data using quantile regression
Authors: Ojha Manini , Rahman Mohammad Arshad
Published: June 2021

Education has traditionally been classroom-oriented with a gradual growth of online courses in recent times. However, the outbreak of the COVID-19 pandemic has dramatically accelerated the shift to online classes. Associated with this learning format is the question: what do people think about the educational value of an online course compared to a course taken in-person in a classroom? We address this question and present a Bayesian quantile analysis of public opinion using a nationally representative survey data from the United States. We find that previous participation in online courses and full-time employment status favor the educational value of online courses. We also find that the older demographic and females have a greater propensity for online education. In contrast, highly educated individuals have a lower willingness towards online education vis-à-vis traditional classes. Regional variations in the propensity to value online classes also exist. Besides, covariate effects show heterogeneity across quantiles which cannot be captured using probit or logit models.
Decorative Drawings in Rhythmically Organized Drawings, as a Form of Building Motor Skills and Feelings of Coherence in Preschool Children
Authors: Dimitrova Yoanna
Published: June 2021

When creating decorative drawings, preschool children build stylized forms – elements and
ornaments, rhythmically connected in decorative compositions. The use of rhythm as the main mean of expression is the basis for the improvement of controlled motor skills, which are a necessary condition for the construction of written speech. Developing a sense of coherence between the individual elements and connecting them into a single whole is the challenge in building a decorative composition. The use of an exact number of decorative elements and their logical and rhythmic alternation in the composition help to build a sense of coherence and perfection in the decorative drawings of preschool children.
Library and Information Science (LIS) Education in Nigeria: Emerging Trends, Challenges and Expectations in the Digital Age
Authors: Magaji Abubakar Bappah
Published: June 2021

In Nigeria, formal university-based Library and Information Science (LIS) educational programme began in 1959 at the Institute of Librarianship,University College, Ibadan (as it was then called) now University of Ibadan Library School. Since then, LIS education in Nigeria has passed through certain developmental trends in its chequered history and has seen steady progression, notably in terms of expansion. Considering the recent transformations in all sectors which have resulted in globalization that is accompanied with massive radical changes in all spheres of human endeavor, LIS educational programmes globally are expected to be amenable to such radical changes. Therefore, changes in curriculum, teaching and learning methods as well as assessment systems are inevitable and desirable. This paper, based on relevant literature, examines LIS education in Nigeria, its emerging trends, challenges and expectations in the digital age. It provides a historical antecedent of LIS education in the country. The paper also discusses contemporary global trends and developments in LIS education and the responses of LIS education towards these changes. It examines the present Nigerian perspective in LIS education and stresses that total reformation is desirable through ensuring that curricula and teaching facilities are always up to date for meaningful training. The paper further explores the major challenges/constraints confronting LIS education in Nigeria that include among others; perennial failure of the government to fund education properly, and LIS education in particular, paucity of infrastructure and learning resources as well as the general deficit of faculty members especially those with PhD degrees. It then explores the expectations of LIS education in the digital age, and as well offers suggestions on how to mitigate the identified challenges, notably through developing impact-oriented operational strategies by the LIS schools and galvanizing support to attract more funds. The paper concludes by emphasizing that LIS education in Nigeria can be more significant in this digital age if curricula and relevant teaching aids/infrastructure are in line with the current emerging global trends and perspectives.