bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP350: Pumping Against Gravity - Cardiac Function Affects Fluctuations in Cerebral Blood Flow Caused by Head Position Change in Acute Ischemic Stroke
Authors: Miller Joseph , Thompson Richard , Akhtar Sarah , Jackson Philip , Goldberg Jared , Bitrus Randy , Lewandowski Christopher
Published: July 2021

Introduction:
Acute ischemic stroke (AIS) patients often have the head-of-bed (HOB) elevated to 30
0
while in the Emergency Department (ED). Flat HOB positioning has been shown to impact cerebral flow. Whether this holds true in undifferentiated, ED stroke patients is unknown.

Hypothesis:
We tested the hypothesis that 0
0
HOB positioning improves middle cerebral artery (MCA) mean flow velocity (MFV) in AIS compared to 30
0
. We secondarily tested the hypothesis that lower cardiac output (CO) is associated with greater fluctuation of MFV.

Methods:
This was a quasi-experimental study with repeat measurements of MCA MFV at 30
0
and 0
0
HOB position. Patients > 18 years presenting to the ED within 12 hours of symptom onset and a NIHSS ≥ 4 were eligible. After applying non-invasive monitoring of mean arterial pressure (MAP) and CO, an investigator used transcranial Doppler to obtain bilateral MCA MFV at 30
0
and 0
0
HOB position. If a signal was unobtainable on the ischemic side, the contralateral MFV was used for analysis. The primary analysis comprised all subjects with confirmed stroke on subsequent imaging and included student t-test for continuous measures. Secondary analysis used multiple linear regression to test if baseline NIHSS, age, MAP and CO were associated with changes in MFV.

Results:
There were 38 subjects enrolled, of whom 32 had confirmed AIS and were included in analysis. The mean age was 66 (±15) years and NIHSS 7 (±6). Stroke location was mixed (50% lacunar, 25% posterior and 25% anterior circulation). Averaged across all subjects, the MFV did not significantly increase when changing the HOB position from a 30
0
to 0
0
(+0.7 cm/s, 95% CI -1.6 to 3.1). Nevertheless, 16% (95% CI 5-33%) of subjects had a ≥ 20% increase and 47% (95% CI 29-65%) had any increase in MFV at 0
0
compared to 30
0
HOB. Adjusting for age, NIHSS and MAP, lower CO was associated with greater change in MFV (+2 cm/s [95% CI 0.2-3.7 cm/s] for every 1 L/min lower cardiac output, p=0.03).

Conclusions:
In conclusion, in a mixed sample of ED AIS patients, lower HOB position does not significantly impact cerebral flow on average, yet a considerable proportion of individuals may benefit from lower HOB position. Low cardiac output may identify those that benefit most.
Abstract WP355: Intracerebral Hemorrhage Care in a Stroke Unit is Safe and Associated With Lower Costs
Authors: Fehnel Corey R , Wendell Linda C , Potter N. Stevenson , Glerum Kimberly , Jones Richard N , Khan Muhib , Silver Brian , Furie Karen L , Thompson Bradford B
Published: July 2021

Background:
There is little data to support level of care decisions for lower risk intracerebral hemorrhage (ICH) patients. The addition of a dedicated stroke unit (SU) at our institution allowed for a comparison of such patients cared for in the intensive care unit (ICU) or SU. We hypothesized that SU care of select ICH patients would not change functional outcome, and result in reduced costs.

Methods:
Two retrospective cohorts of consecutive patients with small (<20 cc) supratentorial ICH and the absence of anticoagulation were enrolled. In the first study period from August 1, 2008 to February 1, 2011, patients were admitted to the neurological or medical ICU (historical control). In the second study period from August 1, 2012 to January 30, 2014, patients were admitted to a dedicated SU. Intubated patients, those requiring vasopressors, osmotic therapy, or ventriculostomy were excluded. Primary outcomes were discharge modified Rankin Score (mRS) and total hospital charges. Multivariate analyses were used for predicting mRS and early complications.

Results:
There were 104 patients included in the analysis (41 ICU, 63 SU). Mean age, gender and race did not differ significantly between groups. Mean ICH volume was 6cc in the SU group and 8cc in the ICU group (P>.05). Prior antiplatelet use, ICH location, and ICH score did not differ between groups. Intraventricular hemorrhage and hydrocephalus were more common in the ICU group (P<.001). Two SU patients transferred to the ICU for pneumonia and acute myocardial infarction. There were no significant differences in complications such as ICH expansion, use of osmotic therapy, seizures, or pneumonia. There was no difference in discharge mRS between groups (P>.05). Median hospital length of stay was 6 days in the ICU group and 3 days in SU group (P<.001). Median direct costs for the ICU group were $5,859 (IQR 4,782-9,733) and were $4,078 (IQR 2,861-6,865) for the SU group (P<.001). Unit of admission was not a significant predictor of early complication (P=.73) or discharge mRS (P=.43) in multivariate analysis.

Conclusions:
This preliminary retrospective study provides support for select low-risk ICH patients to be safely cared for in a lower intensity setting with potential for reducing costs.
Abstract WP365: Role of Enhanced CT Findings in Endoscopic Surgery for Intracerebral Hematoma
Authors: Saito Atsushi , Kon Hiroyuki , Nakamura Taigen , Jia Wenting , Sasaki Tatsuya , Nishijima Michiharu
Published: July 2021

Objective:
In our institute, endoscopic aspiration of hematoma is often performed for acute treatment of intracerebral hematoma (ICH). In some cases, hemostasis is technically difficult to perform during endoscopy, and post-operative hemorrhage may occur. We examined the association between perioperative complications associated with endoscopic surgery for acute ICH, and radiological findings on enhanced computed tomography (CT).

Methods:
Subjects were 471 patients diagnosed with hypertensive ICH who had been admitted and treated in our institute within 72 hours from onset, between 2012 and 2015. Enhanced CT imaging was performed at admission, and radiological enhancement signs (RES) were defined as CT angiography spot signs in the arterial phase, or contrast extravasation in the parallel phase. RES-positive subjects were grouped and compared with an equal number of RES-negative subjects, and the association between perioperative complications and RES was analyzed.

Results:
The RES-positive group included 39 subjects; endoscopic surgery was performed in 16 of the 39 subjects. Postoperative hemorrhage occurred in 6 of the 16 subjects. No hemorrhagic complications were found in the RES-negative group. Follow-up CT after 24 hours showed hematoma expansion in 20 of 26 subjects in the RES-positive group and in only 1 of the 39 subjects of the RES-negative group. Statistical analyses showed that the RES-positive group had a significantly shorter duration between the onset of ICH and CT scan and significantly larger hematoma volume, compared with the RES-negative group. Multivariate analysis identified the presence of RES as a significant risk factor of postoperative hemorrhage or hematoma expansion on follow-up CT.

Conclusion:
CT angiography spot signs or contrast extravasation positive signs were observed with a shorter duration between ICH onset and CT scan, and larger hematomas. These signs may be an important predictive factor for hematoma expansion, as well as a significant risk factor of postoperative hemorrhage after endoscopic surgery for ICH.
Abstract WP367: Comparison of Standard Emergency Room Care with Tele-Stroke Evaluation in Acute Intracerebral Hemorrhage Management
Authors: Ford Sierra C , Ajani Zahra A , Chen Qiaoling , Sorreda Vedasto S , Tu Grace M , McCartney David L , Valdovinos Christina , Lui Catherine L , Sharp Adam L , Sangha Navdeep S
Published: July 2021

Introduction:
Intracerebral hemorrhage (ICH) management includes rapid blood pressure (BP) control and correction of any coagulopathy. It is unknown if the addition of tele-medicine (TM) assessment by vascular neurologists would improve time to intervention of these factors. We hypothesized that TM assessment would improve the time to BP control and anticoagulation reversal compared to standard emergency physician management with telephone neurosurgical consultation (ED).

Methods:
Charts were retrospectively reviewed for all patients with a primary ICD-9 diagnosis of ICH who presented directly to the ED between 8/15/2013 and 5/30/2015, in three urban primary stroke centers in a Southern California integrated healthcare system that utilizes a internalized tele-stroke system. Patients who were transferred from outside hospitals were excluded. Data collected were patient demographics and specific time points to assess door to BP reduction and anticoagulant reversal initiation. These were compared for patients evaluated by ED vs TM using Fisher’s exact test, Chi-squared test, and Wilcoxon test.

Results:
Data for 105 ED and 19 TM patients were compared. There was no difference in gender (54.8% male), median age (67 yrs {IQR 58.5-80 yrs}), and median presenting BP (180/93 {IQR 157-207/79.5-108}). Patients seen by TM had a significantly shorter median time from onset to presentation (102.5 min {IQR 37-191 min}) compared to patients evaluated by ED (171 min {IQR 60-492 min}). Patients seen by TM were more likely to have NIHSS documented, faster times to CT head completion and interpretation, higher rates of BP agent administration with faster times to BP agent order and administration, faster time to BP control (both less than systolic 160 and 140), and faster times for anticoagulation reversal order and administration.

Conclusion:
TM assessment of patients with ICH improves time to BP control and anticoagulation reversal agent initiation.
Abstract WP369: Long Sleep Duration as a Risk Factor for Intracerebral Hemorrhage: a Nationwide, Multicenter Case-control Study
Authors: Kim Tae Jung , Kim Chi Kyung , Kim Yerim , Jeong Han-Gil , Nam Kiwoong , An Sang Joon , Ko Sang-Bae , Yoon Byung-Woo
Published: July 2021

Introduction:
Sleep duration has been regarded as a potential risk factor for cardiovascular disease and stroke. Short sleep duration is linked with higher stroke incidence, and mortality. Moreover, and paradoxically, long sleep duration is also reported to be positively associated with stroke incidence. However, the impact of sleep duration on the intracerebral hemorrhage (ICH) risk remains unclear.

Hypothesis:
We assessed the relationship between sleep duration and the risk of ICH.

Methods:
We performed a nationwide, multicenter matched case-control study to investigate the risk factors for hemorrhagic stroke, using patients from 33 hospitals in Korea. We enrolled a total of 490 patients with ICH and 980 age- and sex-matched controls. We obtained information regarding sleep, sociodemographic factors, lifestyle, and medical history before ICH onset, using qualified structured questionnaires. Sleep duration was categorized as ≤5, 6, 7, 8, and ≥9 hours. We chose sleep duration of 7 h as the reference duration.

Results:
The included patients were mostly male (58.2%) with a mean age of 57 years. The number of subjects with long sleep duration, more than 8 h, was significantly greater in the ICH group than in the control group (≥8 h, 30.4% vs. 22.6%, P = 0.002). Compared to 7 h, long sleep duration participants tended to be older, be more hypertensive, and be more likely to have blue collar jobs, lower education levels, and poorer marital status (i.e., unmarried or divorced/separated). After controlling for confounding factors, we found that longer sleep duration was independently associated with the risk of ICH in a dose-response manner (8 h: Odds ratio, 1.44; confidence interval, 1.01-2.07; ≥9 h: Odds ratio, 2.60; confidence interval, 1.50–4.49).

Conclusions:
In conclusion, our study suggested that long sleep duration is positively related to ICH risk in a dose-dependent manner. In this context, our data might suggest that sleep duration is a modifiable risk factor for ICH.
Abstract WP383: Does Test-enhanced Learning Improve Retention of Patient/Family Stroke Education?
Authors: Johnson Brenda , Urrutia Victor C , Alexandrov Anne W
Published: July 2021

Background:
Despite delivery of hospital-required stroke education, retention by patients/families is poor. We examined knowledge retention using a test-enhanced learning strategy for provision of stroke education.

Methods:
An experimental study was conducted, enrolling consecutive consenting English-speaking, literate patients/family members from a comprehensive stroke center to two groups: Control group (routine individual teaching, time for questions, and provision of written materials); or, a Test-Enhanced Stroke education Target (TEST) group (informed on enrollment about a discharge written test requirement, along with provision of the same routine education). Prior to discharge both groups completed a written stroke knowledge test to gauge content retention. Demographic data and correct test items were analyzed using descriptive statistics, Fisher’s Exact test, and Mann-Whitney U.

Results:
We enrolled and prospectively randomized 30 patients to either the control or TEST group. Patient characteristics were similar between groups: 80% and 93% ischemic strokes, 53% and 47% females, 67% and 53% African Americans, with a median LOS of 3 days in the control and TEST groups respectively. However, patients in the TEST group were significantly older at 64 (range 35-84; p=0.03) vs. 52 (range 24-70) years in controls. Overall median scores for all test items were significantly higher in the TEST group compared to controls (p=0.02), with TEST patients understanding their personal risk factors for stroke (p=0.02) and medication for secondary prevention (p=0.04) significantly better than controls patients (Table).

Conclusions:
Stroke knowledge retention is improved when patients are alerted to a formal testing requirement. Test-enhanced learning may play an important role in preparing stroke patients and family members for assumption of self-care post-hospitalization.
Abstract WP389: Understanding the Clinicians’ Experiences in Collecting Stroke Rehabilitation Intensity Data Within Ontario
Authors: Linkewich Elizabeth , Theben Janine , Maebrae-Waller Amy , Huffman Shelley , Fearn Jenn , White Jennifer , Beal Jennifer , Brown Gwen , Hall Ruth , Murray Judy , Sooley Donelda , Willems Deb , Quant Sylvia
Published: July 2021

Background and Issues:
The collection and reporting of Rehabilitation Intensity (RI) in a national rehabilitation database was mandated on April 1, 2015 for all stroke patients within Ontario, to support evaluation of stroke best practice implementation. RI includes minutes of direct task-specific therapy patients experience per day. This requires a shift in thinking from capturing the clinician’s time spent in therapy to the patient perspective. To ensure that high quality data is collected, it was important to understand clinicians’ experiences in collecting RI data.

Purpose:
To identify enablers and barriers to RI data collection in order to inform the development of resources to support clinicians.

Methods:
A 12-item electronic survey was developed by an Ontario Stroke Network (OSN) task group to evaluate the clinician experience of RI data collection (including: demographics, barriers, enablers, education, resources, and practice change). The survey was distributed via SurveyMonkey® and sent to clinicians from 48 hospitals, 3 weeks post implementation of RI data collection. Analyses involved descriptive statistics and thematic analysis.

Results:
Three hundred and twenty-one clinicians from 47 hospitals responded to the survey. Survey results suggest RI data collection is feasible; seventy-one percent of clinicians report it takes 10 minutes or less to enter RI data. Thematic analysis identified: 5 common challenges with most frequently reported relating to data quality, 30% (N=358) and 6 common enablers with most frequently reported relating to ease of collecting RI data through workload measurement systems, 50% (N=46). Suggestions for educational resources included tools for identifying what is included in RI and the provision of education (e.g. webinars).

Conclusions:
RI data collection is feasible for clinicians. Education and resources developed should support key challenges and enablers identified by clinicians - to enhance data quality and the consistency of RI collection. As RI data fields are available through a national rehabilitation database, this work sets the foundation for other provinces interested in the systematic collection and reporting of RI data.
Abstract WP427: Cognitive Function of Ten-year Stroke Survivors Compared to Non-stroke Individuals: the Lund Stroke Register
Authors: Delavaran Hossein , Jönsson Ann-Cathrin , Lövkvist Håkan , Iwarsson Susanne , Elmståhl Sölve , Norrving Bo , Lindgren Arne
Published: July 2021

Introduction:
Post-stroke cognitive impairment (PSCI) has a considerable impact on patients and society. However, the characteristics and prevalence of long-term PSCI may be influenced by assessment methods and selection bias. We therefore used two cognitive screening methods to assess PSCI in ten-year stroke survivors, made comparisons with non-stroke individuals, and compared these screening methods.

Methods:
The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were administered and compared in a population-based consecutive sample of ten-year stroke survivors. In addition, age- and sex-matched non-stroke controls were assessed with the MMSE. Regression analyses adjusting for education compared the stroke survivors’ MMSE performance with the controls. Moderate/severe cognitive impairment, approximating to dementia, was defined using MMSE<24 and MoCA<20 as cut-offs. To detect those with mild cognitive impairment, alternative cut-offs of MMSE<27 and MoCA<25 were also used.

Results:
In total, 127 of 145 stroke survivors participated. The total MMSE-scores were similar for stroke survivors (median 27) and 354 controls (median 27;
p
=0.922); as well as proportions with MMSE<24 (23% vs. 17%;
p
=0.175) or MMSE<27 (47% vs. 49%;
p
=0.671). After adjustment for education, stroke survivors showed an increased risk for moderate/severe cognitive impairment defined by MMSE<24 (OR=1.82;
p
=0.036). Executive dysfunction was seen in 42% of the stroke survivors vs. 16% of the controls as evaluated by MMSE (
p
<0.001). According to MoCA, moderate/severe cognitive impairment (MoCA<20) was observed in 28% of the stroke survivors; any degree of cognitive impairment (MoCA<25) was seen in 61%; and 45-61% displayed executive function deficits.

Conclusions:
PSCI including executive dysfunction is common among ten-year stroke survivors, who have an increased risk of moderate/severe cognitive impairment compared to non-stroke controls. The prevalence of long-term PSCI may have been previously underestimated, and MoCA may be more suitable for post-stroke cognitive assessment.
Abstract WP54: Evaluation of the e-ASPECTS Automated Software for Detection of Acute Ischemic Stroke
Authors: Grunwald Iris Q , Sinha Devesh , Roffe Christine , Walter Silke
Published: July 2021

Objective:
The Alberta Stroke Program Early CT score (ASPECTS)method is a validated score for identifying patients more likely to benefit from either thrombolytic or endovascular therapy. The e-ASPECTS software is a new, commercially available, standardized and fully automated ASPECTS scoring tool. e-ASPECTS assesses signs of early ischemic change on plain CT scans of stroke patients by applying the ASPECTS method. We compared the performance of e-ASPECTS to CT perfusion in detecting early ischemic signs.

Methods:
e-ASPECTS was run on the plain CT scans of 20 patients with acute ischemic stroke. CT perfusion, CT angiography and 24h CT was also available. The ischemic damage identified by e-ASPECTS was compared to the ischemic core as depicted on CBV on CT perfusion and the established infarct core on plain CT at 24h.

Findings:
e-ASPECTS reliably depicted established ischemic damage as compared to CT-Perfusion, both on an region-based and ASPECTS-based analysis.

Conclusion:
This is the first report demonstrating that e-ASPECTS correctly identified infarct on plain CT, similar to CT perfusion.
Abstract WP56: Volume of Contrast Staining After Intra-arterial Thrombectomy is Predictive of Stroke Volume
Authors: Bulic Sebina , Mack William , Lin Michelle , Amar Arun , Tenser Matthew , Sanossian Nerses , Kim-Tenser May , Sung Gene , Renda Natalie , Emanuel Benjamin
Published: July 2021

Introduction:
Intra-arterial thrombectomy (IAT) has become the standard of care for large vessel ischemic stroke. Contrast staining seen on CT scan (CT-CS) obtained immediately after IAT has been well described as a result of contrast leakage/ extravasation into the brain parenchyma. Imaging typically shows deep contrast staining (DCS) or cortical contrast staining (CCS). There is very little data describing the relationship between DCS, CCS, and final MRI DWI stroke volume (DWI-SV).

Hypothesis:
Immediate post-IAT contrast staining on noncontrast CT head can predict final DWI-SV

Methods:
Charts were reviewed for sixty-five patients who underwent IAT between 07/01/10 and 06/30/15. Thirty-six subjects with immediate post-IAT CT, and MRI were included in the analysis. Patients were categorized into subgroups according to CT-CS: 1) absent CT-CS (n=4); 2) present CCS (n=27); 3) present DCS/absent CCS (n=5); Pearson correlation was used to evaluate the association between CT-CS and final DWI-SV.

Results:
Mean age was 66.5±14.28 (41% female, 58% male; 44% Caucasian, 11% African-American, 25% Hispanic and 19% Asian). Infarct territories included MCA (85%), ICA (11%), and basilar artery (3%). In the entire cohort, total contrast volume was associated with final DWI-SV (R
2
= 0.5045); There was significant correlation between CCS and final DWI-SV (R2 = 0.87236, P<0.001) but not present DCS/absent CCS and final DWI-SV (R
2
= 0.36547). . Absence of contrast staining does not translate to absence of stroke.

Conclusions:
Cortical contrast staining on immediate post-IAT noncontrast CT head can reliably predict final DWI stroke volume
Abstract WP80: Impact of Lipoic Acid Use on Stroke Outcome After Thrombolysis in Patients With Diabetic Polyneuropathy
Authors: Choi Kangho , Kim Jahae , Kang Seungho , Nam Taeseung , Choi Sungmin , Lee Seunghan , Park Manseok , Kim Byungchae , Kim Myungkyu , Cho Kihyun
Published: July 2021

Background:
Alpha-lipoic acid (aLA) is a strong antioxidant commonly used for treatment of diabetic polyneuropathy (DPNP). Previously, we demonstrated the neurorestorative effects of aLA after cerebral ischemia in rats. However, its effects on stroke patients remain unknown. This study investigated whether patients treated with aLA for acute ischemic stroke (AIS) after reperfusion therapy have a better functional outcome than aLA-naïve patients.

Methods:
In a prospective observational cohort study of 172 patients with DPNP and AIS treated with tissue plasminogen activator (tPA), we investigated the relationship between aLA use and functional outcome at 3 months and 1 year, the occurrence of hemorrhagic transformation (HT), early neurological deterioration (END), and early clinical improvement (ECI). The functional outcomes of patients were categorized as favorable (modified Rankin Scale [mRS] score 0-2) or unfavorable (mRS score 3-6). We defined END as an increase of ≥1 point in motor power or an increase of ≥2 points in the total National Institute of Health Stroke Scale (NIHSS) score and ECI as a decrease of ≥4 points in NIHSS score within 7 days. Ischemic stroke subtypes were defined according to the TOAST classification.

Results:
Of the 172 AIS with DPNP patients included, 47 (27.3%) used aLA for DPNP. In the entire cohort, those treated with aLA had a significantly higher rate of a favorable outcome at 3 months (55.3 vs. 33.6%, p < 0.01) and 1 year (57.4 vs. 34.4%, p < 0.01) compared with their counterparts. The risks of END and HT were significantly lower and the percentages of ECI were significantly higher in those treated with aLA. In the multivariable analysis, aLA use was associated with favorable outcome at 3 months (OR = 2.13, 95% CI = 1.01-4.51, p = 0.048) and 1 year (OR = 2.26, 95% CI = 1.06-4.84, p = 0.036). Age, HT, and increasing NIHSS scores were negative predictors of favorable outcome.

Conclusions:
aLA use for AIS with DPNP patients treated with tPA is associated with favorable outcome. These results indicate that aLA could be a useful intervention for the treatment of AIS after reperfusion therapy.
Abstract WP94: Clinical Outcomes of Unruptured Cerebral Aneurysms Treated With Clipping or Coiling in Japan: The J-aspect Study
Authors: Nishimura Ataru , Nishimura Kunihiro , Kada Akiko , Kamitani Satoru , Kurogi Ryota , Sayama Tetsuro , Nakagawara Jyoji , Ogasawara Kuniaki , Ono Junichi , Shiokawa Yoshiaki , Aruga Toru , Miyachi Shigeru , Toyoda Kazunori , Matsuda Shinya , Yoshimura Shinichi , Okuchi Kazuo , Nakamura Fumiaki , Iihara Koji ,   J-ASPECT Investigators
Published: July 2021

Background:
Evaluation of the overall clinical outcomes of stroke care is important for improving institutional quality of care. We performed a nationwide survey in Japan to analyze cases of unruptured cerebral aneurysms using the diagnostic procedure combination (DPC).

Methods and Results:
Certified neurosurgical training institutions in Japan provided data from the DPC database on patients hospitalized with neurosurgical diseases between April 1, 2012 and March 31, 2013. Patients hospitalized owing to unruptured cerebral aneurysms were identified from the DPC database based on the International Classification of Diseases (ICD)-10 diagnosis code (I671). We excluded patients with emergency admissions. We compared the mortality rates, modified Rankin Scale (mRS) scores, postoperative complications of patients who underwent clipping and coiling. With respect to postoperative complications, we evaluated the ratio of an event of complication (brain infarction, brain hemorrhage and cardiac infarction) and the number of complications (scored using patient safety indicators: PSIs and hospital-acquired conditions: HACs). We used hierarchical logistic regression models to estimate the odds ratios (ORs) for in-hospital mortality and complications. We identified 6329 patients with unruptured cerebral aneurysms (3710 clipping, 2619 coiling). Patient characteristics, mortality rates, and mRS were similar between groups. Patients who underwent coiling had a significantly lower number of complications than patients who underwent clipping (PSIs: OR = 0.40; P < 0.001, HACs: OR = 0.47; P = 0.001). Adversely, there was an increased likelihood of ischemic stroke in coiling patients compared with clipping patients (coiling: 7.2%; clipping: 4.7%; OR = 1.37; P = 0.011). 83.2% of coiling patients underwent MRI after the operation, compared with 37.3% of clipping patients.

Conclusions:
Our data demonstrated that coiling patients had lower number of post-operative complications and higher number of ischemic stroke than clipping patients. But the cause that higher number of coiling patients had ischemic stroke than clipping patients because higher number of coiling patients were underwent MRI after operation compared with clipping patients.
Abstract WP96: The Role of T-Lymphocytes in Neuroregeneration After Cerebral Ischemia
Authors: Diederich Kai , Schmidt Antje , Strecker Jan-Kolja , Schäbitz Wolf-Rüdiger , Minnerup Jens
Published: July 2021

Introduction:
Inflammation plays a critical role in the pathogenesis of ischemic stroke. The CNS responds to ischemic injury with an inflammatory process, characterized by an infiltration of inflammatory cells. Particularly T cells exhibit a great impact on early stroke outcome as recent studies showed that ablation of these cells decrease infarct size and improve neurological deficits in the acute phase after stroke. However, the role of T cells in the sub-acute and chronic phase after stroke is unknown. T cells are essential for effective neurogenesis and angiogenesis, mechanisms that are integral for successful regeneration after stroke. We assessed the hypothesis that T cells influence cellular mechanisms of post-ischemic neuroregeneration and consequently affect functional and structural recovery.

Methods:
24 wild type (wt) and 11 RAG1 -/- mice were subjected to photothrombotic ischemia, a subset of 12 wt and 6 RAG1 -/- animals underwent training in motorized running wheels starting at day 3 following ischemia until the end of the experiment on day 28. Sensorimotor and cognitive testing was applied to quantify the recovery process. To label newly generated neurons, 5-Chloro-2′-deoxyuridine (CldU) and iododeoxyuridine (IdU) were administered at days 1 and 2 (CldU) and once weekly until day 28 (IdU) after ischemia. In a subsequent experiment, 17 RAG1 -/- mice were subjected to photothrombotic ischemia and underwent training, a subset of 10 animals received an adoptive transfer of T cells. Functional testing and cellular labeling were carried out in analogy to the first experiment.

Results:
Training improved recovery from sensorimotor and cognitive deficits following cortical ischemia in wt animals and increased the generation of new neurons in the ischemic brain. Rehabilitative training did not induce functional recovery in RAG1 -/- animals and had no effect on the generation of neurons. Adoptive transfer of T cells into the immunodeficient mice restored the ability for regeneration.

Conclusion:
T cells play an essential role in the functional and structural regeneration following ischemic brain injury. These results provide new clues on the complex mechanism by which immune cells impact different stages of the pathogenesis of ischemic stroke.
Greek polydefinites revisited
Authors: Tsiakmakis Evripidis , Borràs-Comes Joan , Espinal M.Teresa
Published: July 2021

This article focuses on the interpretation of the adjectives that appear in Greek polydefinite DP s. It provides empirical support to the established position that restrictive modifiers are preferred in polydefinite environments (Kolliakou 1995). At the same time, it shows that non-restrictively modified polydefinites are not excluded by grammar (Manolessou 2000). To reconcile the facts, a novel syntactic analysis of polydefiniteness as involving modification by either restrictive or non-restrictive reduced relative clauses is formulated. We extend Alexopoulou’s (2006) analysis of resumption in full relatives to polydefinites and defend that what looks like a preadjectival definite article is a resumptive clitic pronoun that values the unvalued definiteness feature of a null relative complementizer. We further defend that, while the prenominal definite article is interpreted as d-linked, the resumptive clitic is a dependent expression that is interpreted as a referentially bound anaphora.
The Place of Fault in Grotius’s Conception of Liability for Wrongdoing
Authors: Sampson Joe
Published: July 2021

This article compares Grotius’s treatments of liability for wrongdoing in natural law and the law of Holland to emphasise the conceptual centrality of fault in both, and places Grotius’s analyses in their historical context by tracing the treatment of strict liability in those intellectual traditions upon which he drew. It focuses in particular on the formulation of obligations quasi ex maleficio to show how the absence of fault rendered the obligation something other than delictual.
Eternity Made Temporal
Authors: Faruque Muhammad U.
Published: July 2021

This study investigates the Deobandī engagement with classical Sufi thought through the writings of one of modern South Asia’s most influential Sufi thinkers, namely Ashraf ʿAlī Thānavī (d. 1943). The article brings to focus Thānavī’s contributions to South Asian Sufism by showing how he sought to preserve, defend, revive, and disseminate classical Sufi teachings in a climate of social reform. The article documents how Deobandī scholars such as Thānavī – far from being propagators of shallow fundamentalist discourses – immersed themselves in the ocean of some of the most sophisticated strands of Islamic learning such as Sufi metaphysics that often employ rational methods of argumentation, alongside symbols and imageries to articulate complex metaphysical doctrines in both prose and poetry.
Alternative chemoradiotherapy in anal carcinoma patients with mutations in thymidylate synthase and dihydropyrimidine dehydrogenase genes
Authors: Saif MW , Hamal Ruchi , Siddiqui Nauman , Maloney Antonia , Smith Melissa
Published: July 2021

Background:

5-fluorouracil (5-FU) and mitomycin-C (MMC) with radiotherapy (RT) remain an established treatment for patients with anal cancer (AC). Genetic mutations in two major metabolizing enzymes for 5-FU; dihydropyrimidine dehydrogenase ( DPYD and thymidylate synthetase ( TYMS), have been associated with clinical response and toxicity. However, their place in the treatment of AC remains undetermined.

Methods:

We retrospectively reviewed 21 patients with AC, including T2-4, N0-1, M0 or T1-4, N2-3, and M0 treated between 2012 and 2018. All patients were treated with 5-FU 1,000 mg/m2/day via continuous intravenous (IV) infusion 1–4 and 29–32, MMC 10 mg/m2 IV bolus days 1 and 29 plus RT. Patients who developed ⩾3 grade toxicities were tested for the DPYD and TYMS genes. Treatment was either modified with reduced doses or changed to MMC 10 mg/m2 day 1 and 29 with cisplatin 25 mg/m2/week plus RT. Toxicities and responses were collected.

Results:

Six out of 21 patients who developed ⩾3 grade toxicities including pancytopenia, neutropenia, thrombocytopenia, mucositis, nausea, rash, and nephritis were found to have genetic mutations: TYMS 2RG/3RC ( n = 2), 3RG/3RC ( n = 1), 2R/2R ( n = 2), T YMS 3′UTR del/Ins ( n = 2), and DPYD c.2864A > T heterozygous ( n = 1). Two patients received 5-FU at a 50% reduced dose on days 29–32; one patient refused to receive 5-FU (continued with MMC and RT); one patient received only radiation therapy due to persistent pancytopenia despite the use of growth factors; two patients received an alternative regimen consisting of MMC 10 mg/m2 on day 29 with cisplatin (CDDP) 25 mg/m2/week plus RT; and two patients received cisplatin/MMC with RT from the beginning as they were prospectively detected to have TYMS abnormalities prior to dosing the chemotherapy. These patients tolerated treatment very well with only grade 2 toxicities. All the patients (4/4) on cisplatin/MMC achieved clinical complete response (cCR), while four patients (4/15) on 5-FU/MMC reached cCR at the first assessment. Radiological response showed complete response at the end of 24 weeks assessment.

Conclusions:

Molecular testing for DPYD and TYMS genes can allow us to identify patients who are most likely to respond or face severe toxicity to 5-FU in a potentially curable cancer. Combining radiation with CDDP with MMC in patients with AC is feasible. A prospective study based on pharmacogenetic testing comparing MMC/cisplatin with MMC/5-FU is indicated in patients with AC.
TAD cliques predict key features of chromatin organization
Authors: Liyakat Ali Tharvesh M. , Brunet Annaël , Collas Philippe , Paulsen Jonas
Published: July 2021

Background

Mechanisms underlying genome 3D organization and domain formation in the mammalian nucleus are not completely understood. Multiple processes such as transcriptional compartmentalization, DNA loop extrusion and interactions with the nuclear lamina dynamically act on chromatin at multiple levels. Here, we explore long-range interaction patterns between topologically associated domains (TADs) in several cell types.

Results

We find that TAD long-range interactions are connected to many key features of chromatin organization, including open and closed compartments, compaction and loop extrusion processes. Domains that form large TAD cliques tend to be repressive across cell types, when comparing gene expression, LINE/SINE repeat content and chromatin subcompartments. Further, TADs in large cliques are larger in genomic size, less dense and depleted of convergent CTCF motifs, in contrast to smaller and denser TADs formed by a loop extrusion process.

Conclusions

Our results shed light on the organizational principles that govern repressive and active domains in the human genome.
Maternal cold exposure induces distinct transcriptome changes in the placenta and fetal brown adipose tissue in mice
Authors: Ghosh Sujoy , Park Chul-Hong , Lee Jisu , Lee Nathan , Zhang Rui , Huesing Clara , Reijnders Dorien , Sones Jennifer , Münzberg Heike , Redman Leanne , Chang Ji Suk
Published: July 2021

Background

Brown adipose tissue (BAT) is specialized to dissipate energy in the form of heat. BAT-mediated heat production in rodents and humans is critical for effective temperature adaptation of newborns to the extrauterine environment immediately after birth. However, very little is known about whether and how fetal BAT development is modulated in-utero in response to changes in maternal thermal environment during pregnancy. Using BL6 mice, we evaluated the impact of different maternal environmental temperatures (28 °C and 18 °C) on the transcriptome of the placenta and fetal BAT to test if maternal cold exposure influences fetal BAT development via placental remodeling.

Results

Maternal weight gain during pregnancy, the average number of fetuses per pregnancy, and placental weight did not differ between the groups at 28 °C and 18 °C. However, the average fetal weight at E18.5 was 6% lower in the 18 °C-group compared to the 28 °C-group. In fetal BATs, cold exposure during pregnancy induced increased expression of genes involved in de novo lipogenesis and lipid metabolism while decreasing the expression of genes associated with muscle cell differentiation, thus suggesting that maternal cold exposure may promote fetal brown adipogenesis by suppressing the myogenic lineage in bidirectional progenitors. In placental tissues, maternal cold exposure was associated with upregulation of genes involved in complement activation and downregulation of genes related to muscle contraction and actin-myosin filament sliding. These changes may coordinate placental adaptation to maternal cold exposure, potentially by protecting against cold stress-induced inflammatory damage and modulating the vascular and extravascular contractile system in the placenta.

Conclusions

These findings provide evidence that environmental cold temperature sensed by the mother can modulate the transcriptome of placental and fetal BAT tissues. The ramifications of the observed gene expression changes warrant future investigation.
Pre-existing cardiovascular disease rather than cardiovascular risk factors drives mortality in COVID-19
Authors: O’Gallagher Kevin , Shek Anthony , Bean Daniel M. , Bendayan Rebecca , Papachristidis Alexandros , Teo James T. H. , Dobson Richard J. B. , Shah Ajay M. , Zakeri Rosita
Published: July 2021

Background

The relative association between cardiovascular (CV) risk factors, such as diabetes and hypertension, established CV disease (CVD), and susceptibility to CV complications or mortality in COVID-19 remains unclear.

Methods

We conducted a cohort study of consecutive adults hospitalised for severe COVID-19 between 1st March and 30th June 2020. Pre-existing CVD, CV risk factors and associations with mortality and CV complications were ascertained.

Results

Among 1721 patients (median age 71 years, 57% male), 349 (20.3%) had pre-existing CVD (CVD), 888 (51.6%) had CV risk factors without CVD (RF-CVD), 484 (28.1%) had neither. Patients with CVD were older with a higher burden of non-CV comorbidities. During follow-up, 438 (25.5%) patients died: 37% with CVD, 25.7% with RF-CVD and 16.5% with neither. CVD was independently associated with in-hospital mortality among patients < 70 years of age (adjusted HR 2.43 [95% CI 1.16–5.07]), but not in those ≥ 70 years (aHR 1.14 [95% CI 0.77–1.69]). RF-CVD were not independently associated with mortality in either age group (< 70 y aHR 1.21 [95% CI 0.72–2.01], ≥ 70 y aHR 1.07 [95% CI 0.76–1.52]). Most CV complications occurred in patients with CVD (66%) versus RF-CVD (17%) or neither (11%; p < 0.001). 213 [12.4%] patients developed venous thromboembolism (VTE). CVD was not an independent predictor of VTE.

Conclusions

In patients hospitalised with COVID-19, pre-existing established CVD appears to be a more important contributor to mortality than CV risk factors in the absence of CVD. CVD-related hazard may be mediated, in part, by new CV complications. Optimal care and vigilance for destabilised CVD are essential in this patient group. Trial registration n/a.
Haemolymphangioma of the small bowel mesentery in adults: two case reports and a literature review
Authors: Du Yao , Zhang Jiang Nan , Zhu Lu Lu , Wang Yi , Li Wei Ping
Published: July 2021

Background

Haemolymphangioma arising from the small bowel and its mesentery is extremely rare in the clinical setting. To date, only 8 cases of small bowel haemolymphangioma have been reported, and there have been no previously reported cases of haemolymphangioma in the small bowel mesentery (PubMed). The formation of this tumour is mostly congenital, but the exact mechanism is still unclear. As a benign tumour, the presentation of the disease may vary from a simple well-defined cystic lesion to an aggressive ill-defined lesion mimicking malignancy. However, there are no typical symptoms, and preoperative diagnosis is difficult.

Case presentation

We present two cases of haemolymphangioma in the small bowel mesentery in a 54-year-old man and a 52-year-old woman. Both of them came to the hospital due to an abdominal mass. In the first case, a cystic teratoma in the left abdominal area was considered after abdominal plain computed tomography (CT) and magnetic resonance imaging (MRI) scans. After taking an enhanced CT scan, a lipoma was considered based on the images. In the second case, cystic masses of the left upper and middle abdomen were observed on abdominal ultrasonography. An abdominal plain CT scan showed an irregular low-density mass in the left upper and middle abdomen. With an enhanced CT scan, haemolymphangioma was considered based on the images. After complete surgical removal, the masses were found to originate from the small bowel mesentery and had not invaded into the peripheral lymphatic tissue. In case 1 in this study, the routine pathology diagnosis was lymphangioma, while in case 2, the diagnosis was haemangioma. The final diagnosis was confirmed to be haemolymphangioma by immunohistochemistry in both cases. No recurrence was evident during 4 months of follow-up. We review the previous case reports of haemolymphangioma in the abdominal cavity and discuss their clinical features, diagnosis, treatment and prognosis.

Conclusions

The clinical manifestations of abdominal haemolymphangiomas can vary for both location and size. Abdominal CT examination has important clinical value for haemolymphangioma in the abdominal cavity. The final diagnosis of haemolymphangioma depends on a postoperative pathological examination. In addition, postoperative regular follow-up is necessary.
Is multimorbidity associated with risk of elder abuse? Findings from the AHSETS study
Authors: Kshatri Jaya Singh , Bhoi Trilochan , Barik Shakti Ranjan , Palo Subrata Kumar , Pati Sanghamitra
Published: July 2021

Background

With an increasing number of older adults in low- and middle-income countries (LMIC), the burden of multimorbidity and functional dependence is on the rise. At the same time, a higher prevalence of elder abuse is observed in these populations. There is scarce evidence on the interplay between elder abuse and multimorbidity with no reports from LMIC settings yet. Present study examined the association of multimorbidity with the risk of elder abuse and its correlates in a rural elderly population of Odisha, India.

Methods

The data for this study was collected as a part of our AHSETS study comprising of 725 older adults residing in rural Odisha, India. Multimorbidity was assessed by the MAQ PC tool while Hwalek-Sengstock elder abuse screening test (HS-EAST) was used to assess the risk of elder abuse. Functional dependence was measured by the Lawton IADL questionnaire. We used ordinal logistic regression models to identify the correlates of elder abuse and test for mediation by functional dependence.

Results

Around 48.8 % (95 % CI:45.13–52.53 %) older adults had multimorbidity while 33.8 % (95 % CI:30.35–37.35 %) had some form of dependence. Out of 725, 56.6 % (CI 52.85–60.19 %) were found to be at low-risk elder abuse and 15.9 % (CI 13.27–18.72 %) being at high-risk. The prevalence of higher risk of elder abuse was greater among females, non-literates, widowed persons, those not currently working and those belonging to lower socio-economic strata. The risk of elder abuse was significantly associated with multimorbidity (AOR = 1.68; 95 %CI: 1.11–2.57) and functional dependence (AOR = 2.08; 95 %CI: 1.41–3.06). Additionally, we found a partial mediation mechanism of functional dependency between the pathway of multimorbidity and elder abuse.

Conclusions

Elder abuse and multimorbidity are emerging as issues of significant concern among rural elderly in Odisha, India. Multimorbidity and functional dependence are associated with significantly higher odds of elder abuse among rural older adults. Further, we report the role of functional dependence as a partial mediator between multimorbidity and elder abuse. Therefore, potential interventions on reducing the economic, physical and care dependence among multimorbid patients may reduce the risk of elder abuse.
Limb-shaking TIA: a case of cerebral hypoperfusion in severe cerebrovascular disease in a young adult
Authors: Richardson Tom E. , Beech Paul , Cloud Geoffrey C.
Published: July 2021

Background

Limb-shaking transient ischaemic attacks (TIAs) are an under recognised presentation of severe cerebrovascular disease resulting from cerebral hypoperfusion. Patients present with jerking, transitory limb movements precipitated by change in position or exercise that are often confused with seizure. Cerebral perfusion imaging studies are an important tool available to aid diagnosis.

Case presentation

We present the case of a young female who developed limb-shaking TIA in the context of progressive severe intracranial atherosclerotic disease (ICAD). Previous cortical infarction raised suspicion for seizure as a cause of her symptoms. However, single photon emission CT (SPECT) with CT acetazolamide challenge identified severe left hemisphere cerebral hypoperfusion and a diagnosis of limb-shaking TIA was made. Symptoms improved with maximal medical management.

Conclusions

This case highlights the importance of cerebral perfusion imaging for diagnostic confirmation as well as therapeutic options available to alleviate symptoms and reduce stroke risk in patients with limb-shaking TIA.