bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TMP90: Frequency and Risk Factors for Early Neurological Deterioration Among Hyperacute Cerebral Ischemia Patients Treated With and Without Thrombolysis
Authors: Brown Christa D , Avila-Rinek Gilda , Sanossian Nerses , Starkman Sidney , Hamilton Scott , Liebeskind David S , Sharma Latisha , Young-Saver Dashiell F , Gornbein Jeffrey , Eckstein Marc , Stratton Samuel , Conwit Robin , Saver Jeffrey L ,   on behalf of the FAST-MAG Trial Coordinators and Investigators
Published: June 2021

Background:
Early neurological deterioration (END) is a feared complication of acute cerebral ischemia. However, estimates of END frequency vary widely, rates have not been systematically examined in hyperacute patients presenting within the first 2h of onset, nor separately in patients treated with and without thrombolysis, and risk factors for END have not been well delineated.

Methods:
We analyzed patients with a final diagnosis of acute cerebral ischemia in the NIH FAST-MAG Phase 3 multicenter clinical trial. END was defined as worsening post-admission by ≥ 4 NIHSS points up to Day 4. We separately analyzed patients who did and did not receive IV tPA.

Results:
Among 1245 acute cerebral ischemia patients transported by EMS to 55 stroke centers, time from last known well (LKW) to ED arrival was median 59 mins (IQR 80-46), and 36.1% received IV tPA. Overall, 211 (16.9%) experienced END by Day 4, with a greater proportion of END in tPA than non-tPA patients (21.2% vs 14.5%, p=0.003). In multivariate analysis, from 26 candidate variables, among tPA recipients, independent predictors of END were: age (OR 1.03/year, 95%CI 1.01-1.05), diastolic BP (OR 1.01/mm Hg, 95%CI 1.00-1.03), prior stroke (OR 1.65, 95%CI 0.98-2.77), glucose (OR 11.06/10 fold increase, 95%CI 1.90-64.44), and worse ASPECTS score (OR 0.85/point, 95%CI 0.78-0.92). Among non-tPA recipients, independent predictors of END were: more severe NIHSS (OR 1.08/point, 95%CI 1.05-1.11), glucose (OR 8.88/10 fold increase, 95%CI 1.83-43.12), and h/o hypertension (OR 2.62/mm Hg, 95%CI 1.25-5.48), with Akaike information criteria identifying SBP, shorter LKW-to-ED time, and absence of anticoagulant agents as additional contributors. C statistics for these models were 0.68 for tPA patients and 0.73 for non-tPA patients.

Conclusions:
Among hyperacute cerebral ischemia patients, END occurs in 1 in 5 who receive tPA, and 1 in 7 who do not receive tPA. Greater initial stroke severity (on neurologic exam or imaging), higher glucose, and hypertension increase risk of END for both lytic and non-lytic patients, with older age and prior stroke additionally increasing END risk with tPA. Models based on these risk factors show fair to good performance identifying patients who will experience END after hospital admission.
Abstract TP12: The Trend of Successful First Pass in M2 Segment Stroke Thrombectomy- Insights From the STAR Collaboration
Authors: Almallouhi Eyad , Al kasab Sami , Alawieh Ali , Chalhoub Reda M , Psychogios Marios , Arthur Adam , Kim Joon-Tae , De Leacy Reade , Rai Ansaar , Keyrouz Salah , Fargen Kyle , Dumont Travis , Kan Peter , Starke Robert , Spiotta Alejandro M ,   STAR collaborators
Published: June 2021

Introduction:
Stroke thrombectomy devices and the experience of neurointerventionists have improved significantly over the last few years making targeting distal occlusions such as of the M2 segment of the middle cerebral artery more feasible. We aimed to study the trend in the successful first pass (SFP) of M2 occlusions over time using the data from a contemporary multicenter registry.

Methods:
We reviewed the data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which included data from 11 thrombectomy-capable stroke centers to identify stroke patients who underwent mechanical thrombectomy of M2 segment occlusion. SFP was defined by achieving modified Thrombolysis in Cerebral Infarction (mTICI) score≥2b with a single thrombectomy device pass. We analyzed the linear trendline of the rate of SFP over time. Then, we used a logistic regression model to assess predictors of SFP of M2 segment occlusion.

Results:
We included 401 patients who underwent stroke thrombectomy of M2 occlusion; median age was 71 (IQR 60-80), 212 (52.9%) were females, 174 (43.4%) were white, National Institute of Health stroke scale (NIHSS) was 14 (IQR 8-19), Alberta Stroke Program Early CT (ASPECT) score on presentation was 9 (IQR 7-10) and onset wot groin time was 287 (IQR 181-454). SFP was achieved in 118 (29.4%) patients (linear trendline over time is in Figure 1). Presenting after 2014 was an independent predictor of SFP (OR 1.9, 95% CI 1.1-3.2, P=0.019) after controlling for age, sex, NIHSS on presentation, intravenous alteplase (IV-tPA), and onset to groin time.

Conclusion:
SFP rate of M2 segment occlusion has increased after 2014 likely secondary the improvement in stroke thrombectomy devices and neurointerventionists experience.
Abstract TP216: Identifying Common Genetic Variants Associated With Fatal Stroke in Incident Ischemic Stroke Patients
Authors: Abedi Vida , Li Jiang , Khan Ayesha , Mishra Aniket ,   Regeneron Genetic Cntr, Debette Stéphanie , Griessenauer Christoph , Zand Ramin
Published: June 2021

Introduction:
There is an unmet need to understand the genetic factors associated with stroke outcome. The purpose of this study is to identify the common genetic variants, if any, associated with incident of ischemic stroke in a community-based population and to determine if any genetic risk can be enriched in fatal stroke patients.

Methods:
Cases and controls of ischemic stroke were identified by leveraging the comprehensive Electronic Health Record, and endophenotypes, e.g. the fatal or nonfatal stroke was defined by those dying within one month (fatal incidence) or surviving to 12 months (nonfatal incidence) of their first-ever stroke incident. The GWAS was carried out in a nested case-control design by considering all patients with age >79 and without any stroke-related diagnostic codes as low-risk control. A linear mixed regression model (SAIGE) with saddlepoint approximation, adjusted for covariates was conducted to account for the relatedness and case-control imbalance.

Results:
No genome-wide significant association was identified for ischemic stroke (n=1,179) versus control (n=7,489). When stratifying stroke patients by the fatality (n=61/1,118), rs80094021 (MAF = 0.038; OR=3.332±0.635; p=9.04E-11) and SNPs in LD with, located at an intronic region of TIAM1, were the top associated signal. All these SNPs served as eQTL for TIAM1(β=0.144, p=5.8E-13, eQTLGen). Rs79694970, the second top SNP (MAF = 0.020; OR=4.179±0.931; p=9.27E-09), is located near GPD1L and functions as eQTL for GPD1L(β=-0.279, p=6.1E-28). GPD1L plays a role in the DPD1L-dependent SCN5A phosphorylation pathway, thereby regulating cardiac sodium current. Dysfunction of sodium current can cause fatal ventricular arrhythmia. According to PheWAS data from UK Biobank, rs80094021 showed a moderate association with high cholesterol (p=0.0045), coronary atherosclerosis (p=0.0075), and angina (p=0.012), with the same direction for the minor allele which increased the risk for fatal stroke. rs79694970 were associated with ischemic stroke (large artery atherosclerosis) with p=0.0016.

Conclusion:
Through stratification of ischemic stroke by fatality some genetic risk factors and genes with biological relevant to the pathogenesis of stroke could be identified.
Abstract TP286: The Study of the Role and Mechanism of TRPM7 in Acute Cerebral Ischemia-Reperfusion Injury
Authors: Xu Jie , Chen Li , Zeng Li , Li Chunrong , Yang Xiangyu , Zhang Ji , Wang Su , Tan Song
Published: June 2021

Although the NMDA receptor was identified to mediate excitotoxicity for ischemia-reperfusion (IR) injury, its antagonists have not shown clinical efficacy. Unrelated to NMDA, the transient receptor potential cation channel, subfamily M, member 7 (TRPM7) has been reported to cause intracellular Ca
2+
overloading, oxidative stress and neuronal apoptosis. We postulated that TRPM7 could be a target for treatment of IR injury. To investigate the potential neuroprotective role of TRPM7 in IR injury, 1) qRT-PCR, Western blot and immuno-staining were used to identify the expression and localization of TRPM7 in normal rat forebrain cortex and cultured primary cortical neurons; 2) the oxygen glucose deprivation and reperfusion (OGD/R) model of primary cortical neurons was used to detect changes in TRPM7 expression and study the effect of two TRPM7 ion channel inhibitors, carvacrol and 2-Aminoethoxydiphenyl borate (2-APB), on neurons in OGD/R; 3) the rat middle cerebral artery (MCAO/R) model was used to study TRPM7 involvement and the effect of its inhibitor during the course of IR. Our results showed that: 1) TRPM7 was expressed in normal neurons and astrocytes mainly as a cell membrane protein in the rat cortex; 2) TRPM7 expression was enhanced in OGD/R treated neurons; treatment with carvacrol or 2-APB reversed the overexpression of TRPM7 in OGD/R neurons and reduced the level of Ca
2+
overload in neuronal IR injury and neuronal apoptosis; 3) TRPM7 expression was also augmented in rat cortical tissues during MCAO/R and peaked between 24-48 hours during the reperfusion stage; 4) treatment with TRPM7 inhibitors reversed TRPM7 overexpression, alleviated neuronal apoptosis, and improved neurobehavioral scores in MCAO/R rats. Our conclusions are: 1) TRPM7 is expressed in normal rat forebrain cortex and functions mainly as a cell membrane protein in neurons and astrocytes; 2) TRPM7 is overexpressed during cerebral ischemia-reperfusion in rats; 3) TRPM7 ion channel inhibitors carvacrol and 2-APB can alleviate OGD/R injury in neurons in vitro as well as cortical damage by MCAO/R in rat forebrain; 4) the mechanism of TRPM7 on neuronal injury in OGD/R and MCAO/R can contribute to its role in neuronal apoptosis and Ca
2+
influx toxicity.
Abstract TP298: Measuring Quality of Care for Acute Ischemic Stroke Treated With Acute Reperfusion Therapy in Japan: A Nationwide Quality Improvement Initiative of the J-aspect Study
Authors: Ren Nice , Nishimura Ataru , Nishimura Kunihiro , Arimura Koichi , Kurogi Ai , Matsuo Ryu , Kurogi Ryota , Nakashima Naoki , Nohara Yasunobu , Kitazono Takanari , Iihara Koji ,   J-ASPECT study group
Published: June 2021

Background and Purpose:
There is no consensus about efficiently measuring quality indicators (QIs) of acute ischemic stroke (AIS) in Japan. To evaluate feasibility and reliability of measuring QIs for AIS patients who received intravenous recombinant tissue plasminogen activator (rt-PA) or endovascular therapy (ET), by combining information from health insurance claims database and medical chart.

Methods:
AIS patients who received rt-PA or ET between 2013 and 2015 were identified from the J-ASPECT Diagnosis Procedure Combination (DPC) database. The 17 and 8 QI measures for primary and comprehensive stroke centers (PSCs and CSCs) were selected for AIS, respectively. More than 60% of data for calculating the QIs were obtained from the DPC database and preset in the tool. Responsible physicians were asked to review accuracy of preset data and add necessary information from medical chart. Adherence rates or performance measures for each QI were calculated for patient- and hospital-levels. Associations between adherence rates and hospital characteristics were analyzed using hierarchical logistic regression analysis.

Result:
In total, data of 8,506 patients (rt-PA 83.5%, ET 34.9%) from 173 hospitals were obtained. The median age was 76 (interquartile range 65–83) years, and 42.1% were women. Median National Institute of Health Stroke Scale (NIHSS) score at admission was 14 (7-21). All of the target QIs were successfully measured. Among PSC QIs, adherence rates were low (<50%) (e.g. door-to-needle time
<
60 minutes 37.9%) and intermediate (50-75%) (e.g. stroke unit care 58.7%) in 4 each. For CSC QIs, median door-to-puncture time was 105 (76-147) minutes and TICI grade 2b and 3 recanalization were achieved in 73%. A higher number of stroke discharge was associated with greater adherence to stroke unit care, early rehabilitation and stroke education.

Conclusion:
Measuring QIs of AIS by this novel approach was feasible and reliable to provide a national benchmark.
Abstract TP416: Comparative Effectiveness of Addition of Antiplatelet to Oral Anticoagulant in Acute Ischemic Stroke With Atrial Fibrillation
Authors: Kim Joon-tae , Bae Hee-Joon ,   CRCS-K Investigators
Published: June 2021

Introduction:
Atrial fibrillation (AF) and large artery diseases (LAD) share several risk factors and often coexist in the same patient. Optimal treatments for acute ischemic stroke (AIS) patients with concomitant AF and LAD have not been extensively studied so far.

Objective:
This study aimed to compare the effectiveness of the addition of antiplatelet (AP) to oral anticoagulant (OAC) with that of OAC alone in AIS with AF according to the LAD.

Methods:
Using a multicenter stroke registry, acute (within 48h of onset) and mild-to-moderate (NIHSS score ≤15) stroke patients with AF were identified. Propensity scores using IPTW were used to adjust baseline imbalances between the OAC+AP group and the OAC alone group in all patients and in each subgroup by LAD. The primary outcome was major vascular events, defined as the composite of recurrent stroke, MI, and all-cause mortality at up to 3 months after index stroke.

Results:
Among the 5469 patients (age, 72±10yrs; male, 54.9%; initial NIHSS score, 4 [2-9]), 79.0% (n=4323) received OAC alone, and 21.0% (n=1146) received OAC+AP. By weighted Cox proportional hazards analysis, a tendency of increasing the risk of 3-months primary composite events in the OAC+AP group vs the OAC alone (HR 1.36 [0.99-1.87], p=0.06), with significant interaction with treatments and LAD (Pint=0.048). Briefly, among patients with moderate-to-severe large artery stenosis, tendency of decrease in 3-months primary composite events of the OAC+AP group, compared with OAC alone group, was observed (HR 0.54 [0.17-1.70]), whereas among patients with complete occlusion, the OAC+AP group markedly increased the risk of 3-months composite events (HR 2.00 [1.27-3.15]), compared with the OAC alone group. No interaction between direct oral anticoagulant and warfarin on outcome was observed (Pint=0.35).

Conclusion:
In conclusion, treatment with addition of AP to OAC had a tendency to increase the risk of 3-months vascular events, compared with OAC alone in AIS with AF. However, the effects of antithrombotic treatment could be modified according to the LAD, with substantial benefits of OAC alone in subgroup of large artery occlusion. Our results address the need for the further study to tailor the optimal treatment in AIS with concomitant AF and LAD.
Abstract WMP106: Why Are Women Less Represented in ICH Trials?
Authors: Norton Casey , Yeatts Sharon , Foster Lydia , Thornhill Andre , Griffin Jessica , Wang Jeffrey , McVey Courtney , Selim Magdy ,   iDEF Investigators
Published: June 2021

Background:
Fewer women than men tend to be enrolled in clinical trials of intracerebral hemorrhage (ICH). It is unclear whether this reflects lower prevalence of ICH in women, selection bias, poor recruitment efforts, or other factors. We undertook this study to examine differences between women and men in the reasons for exclusion from the iDEF (Intracerebral hemorrhage Deferoxamine) trial.

Methods:
The screen failure log included 29 different reasons for exclusion. Chi square statistics and p-values were used to evaluate whether women and men differed with regard to reason for screen failure.

Findings:
The iDEF trial enrolled 294 subjects; 38.5% were women. A total of 8776 subjects were screen failures. Sex was missing in 58. The remaining 8718 were included in this analysis; 3982 women (45.7%) and 4736 men (54.3%) (p<0.0001). The enrollment rates were 2.8% in women vs. 3.7% in men (p=0.01). We were unable to obtain consent in 1.3% of women vs 1.7% of men (p=0.1), and patients/families declined participation in 1.3% of women vs. 1.3% of men (p=0.9). More women than men failed screening because of age >80 (22.4% vs 12.6%) and pre-existing DNR/DNI (3.7% vs. 2.8%). Conversely, fewer women than men failed screening because inability to administer study drug within 24 hour due to late presentation (6.6% vs 7.8%), admission NIHSS score <6 (10.2% vs 13.2%), coagulopathy (5.3% vs 7.5%), inability to comply with the protocol (0.7% vs 1.3%), abnormal renal function (1.9% vs 2.9%), drug/alcohol abuse (1.7% vs 3.7%), and presentation with confirmed aspiration or pneumonia (1.1% vs 1.8%).These differences were statistically significant.

Interpretation:
Results from this multi-center, prospective, ICH trial indicate that lower rates of women enrollment may be attributed to older age and higher rates of pre-existing DNR/DNI orders. Inability to obtain consent or declining participation was similar between women and men, arguing against selection bias. Our findings should be confirmed in other ICH trials to determine if additional efforts are needed to improve women’s participation in future studies.

Funding:
US National Institutes of Health and US National Institute of Neurological Disorders and Stroke (U01NS074425)
Abstract WMP27: PAT Model Accurately Predicts Aneurysm Enlargement in 16 Growing Aneurysm Cases
Authors: Chien Aichi , Hildebrandt Michelle , Colby Geoffrey , Chang Victor , Duckwiler Gary , Viktor Szeder , Jahan Reza , Tateshima Satoshi , Anthony Wang , Villablanca Juan , Salamon Noriko , Vinuela Fernando ,   Aneurysm Genetics Investigators
Published: June 2021

Objective:
Imaging technology for unruptured intracranial aneurysms (UIA) has improved detection of such aneurysms. However, there is limited information on UIA change over time, and how to predict the rate of enlargement. The objective of this study was to quantify the accuracy of the Predicted Aneurysm Trajectory (PAT) model recently developed by Chien et al. (J Neurosurgery. 2019; Mar 1:1-11).

Methods:
Patients diagnosed with UIA were prospectively enrolled at the UCLA Medical Center, and followed through serial imaging. 16 UIA cases exhibiting growth across multiple follow-ups were included in this study. Prior images and medical records were collected. Characteristics relevant to the PAT model (mean ± stdev), including initial UIA size (7.26 ± 6.38), patient age (67.4 ± 9.48 yrs.), sex (4 male), history of smoking (n=5), hypothyroidism (n=4), and follow-up duration (36.5 ± 50.0 mos.) were used to predict UIA size at each follow-up. Predicted and actual UIA sizes at follow-up were compared using symmetric mean absolute percentage error (SMAPE) with percentage error ranging from 0-100%.

Results:
The 16 UIA cases were split by initial UIA size. For UIA smaller than 7 mm (10 cases, 23 follow-up), SMAPE = 11.13%. For UIA greater than 7 mm (6 cases, 15 follow-up), SMAPE = 8.07%. For all UIA cases (16 cases, 38 follow-up), SMAPE = 9.92%.

Conclusions:
The PAT model predicts the rate of enlargement for UIA, as opposed to whether or not UIA will grow. With this new sample of data, we found the predicted UIA size at follow-up to be quite accurate, deviating in the range of 10% from the actual, measured size. Patient characteristics such as the demographics and behavior included in the model influence the growth of UIA, which allows prediction of growth to optimize treatment and management in future cases.
Abstract WMP61: RNA Expression Signature to Diagnosis Stroke Etiology by Atrial Fibrillation versus Large Artery Atherosclerosis Cause: A BASE Clinical Trial Analysis
Authors: Jickling Glen , Sharp Frank , Jauch Edward ,   BASE Investigators
Published: June 2021

Background:
Identifying atrial fibrillation in embolic stroke of ischemic stroke populations would be of significant clinical utility. Using the Biomarkers of Acute Stroke Etiology (BASE) trial (NCT02014896) dataset, our goal was to determine if blood gene expression signatures accurately differentiated patients with atrial fibrillation from large artery stroke patients.

Methods:
The BASE trial enrolled suspected stroke patients presenting to 20 hospitals within 24 hrs of symptom onset. Final gold standard diagnosis and stroke etiology were determined by an adjudication committee using all hospital data but blinded to RNA test results. Whole blood, obtained in PAXgene tubes, was frozen at -20C within 72 hrs and analyzed at a core lab (Ischemia Care, LLC, Dayton, OH) using Affymetrix HTA micro arrays. Approximately 38,000 genes on the HTA microarray were filtered to eliminate genes with low expression or high CV (> 10%) when run on replicate samples leaving 9,513 potential signature genes. A two-way random forest classifier was built through cross validation of the training data resulting in a 23 gene diagnostic signature.

Results:
There were 58 patients enrolled between 18 and 24 hours of symptom onset, with NIHSS>5, 27 (47%) with atrial fibrillation cause of stroke and 31 (53%) with large artery stroke; 64% were male, and median (IQR) age was 69.7 (62.8, 81.0). Median (IQR) time from symptoms to sample collection was 1323.5 (1208.8, 1381.3) minutes. Coexistent pathology at presentation was high blood pressure 49 (84%), hyperlipidemia 28 (48%), diabetes 9 (16%), and coronary artery disease 15 (26%). The panel was able to distinguish atrial fibrillation from large vessel stroke with a C-statistic 0.92 (0.55-1.0, 95% CI), sensitivity 0.90 (0.51-1.0, 95% CI) and specificity of 0.85.

Conclusion:
RNA expression differentiates strokes due to atrial fibrillation from large artery stroke and may have therapeutic and outcome implications in ischemic stroke populations.
Abstract WP350: National Trends in Outcomes of Ischemic Stroke and Prognostic Influence of Stroke Center Capability in Japan
Authors: Kurogi Ai , Kada Akiko , Nishimura Kunihiro , Onozuka Daisuke , Kurogi Ryota , Ren Nice , Nishimura Ataru , Arimura Kouichi , Iihara Koji ,   on behalf of the J-ASPECT Study Collaborators
Published: June 2021

Background:
Limited national-level information on temporal trends in comprehensive stroke center (CSC) capabilities and their effects on acute ischemic stroke (AIS) patients exists.

Aims:
To examine trends in in-hospital outcomes of AIS patients and the prognostic influence of temporal changes in CSC capabilities in Japan.

Methods:
This retrospective study used the J-ASPECT Diagnosis Procedure Combination database and identified 372,978 AIS patients hospitalized in 650 institutions between 2010 and 2016. Temporal trends in patient outcomes and recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy (MT) usage were examined. Facility CSC capabilities were assessed using a validated scoring system (CSC score: 1-25 points) in 2010 and 2014. The prognostic influence of temporal CSC score changes on in-hospitalmortality and poor outcomes (modified Rankin Scale: 3-6) at discharge were examined using hierarchical logistic regression models.

Results:
Over time, stroke severity at admission decreased, whereas median age, sex ratio, and comorbidities remained stable. During the study period, usage of rt-PA and MT in rural areas remained lower than that of urban areas, but in 2016, the differences in their use were within 1%. The median CSC score increased from 16 to 17 points. After adjusting for age, sex, comorbidities, consciousness level, and facility CSC score, proportion of in-hospitalmortality and poor outcomes at discharge decreased (from 7.6% to 5.0%, and from 48.7% to 43.1%, respectively). The preceding CSC score increase (in 2010-2014) was independently associated with reduced in-hospital mortality and poor outcomes, and increased rt-PA and MT use (odds ratio (95% confidence interval): 0.97(0.95-0.99), 0.97(0.95-1.00), 1.07(1.04-1.10), and 1.21(1.14-1.28) , respectively).

Conclusions:
This nationwide study revealed six-year trends in better patient outcomes and increased use of rt-PA and MT in AIS. In addition to lesser stroke severity, preceding improvement of CSC capabilities was an independent factor associated with such trends, suggesting importance of CSC capabilities as a prognostic indicator of acute stroke care.
Abstract WP361: Characteristics And Outcomes Among Younger And Older Acute Stroke Patients, 2012-2018
Authors: Tong Xin , Coleman King Sallyann , Odom Erika ,   PCNASP
Published: June 2021

Introduction:
Limited studies exist comparing characteristics and outcomes among younger (35-64 years) and older (≥65 years) acute stroke patients.

Method:
We identified 559,831 admissions with a clinical diagnosis of stroke, ages ≥35 years, from 617 participating hospitals in the Paul Coverdell National Acute Stroke Program (PCNASP) from 2012-2018. We compared demographic and clinical features of those aged 35-64 years with those aged ≥65 years by stroke type.

Results:
Among stroke admissions identified in PCNASP between 2012 and 2018, 194,063 (34.7%) patients were aged 35-64 years. Among younger adults, there were 26,603 (13.7%) intracerebral hemorrhages (ICH), 14,722 (7.6%) subarachnoid hemorrhages (SAH), and 152,738 (78.7%) ischemic strokes (IS). Among 365,768 patients aged ≥65, the corresponding prevalence was 12.4%, 2.5%, and 85.1% respectively. Compared to those aged ≥65, more men and black patients were identified among those aged 35-64 years in all stroke subtypes (32.1% of ICH patients aged 35-64 were black, compared to 12.7% of those aged ≥65, 20.7% vs. 11.5% of SAH patients, and 28.3% vs. 13.3% of IS patients respectively). Patients aged 35-64 years were less likely to arrive by EMS, and more likely to be admitted as a transfer from another hospital, compared to those aged ≥65 years. The prevalence of current smokers was significantly higher among younger adults compared to those aged ≥65 years across all stroke subtypes. In addition, patients aged 35-64 years had more favorable outcomes in higher percent of ambulation at discharge and discharge to home, and lower in-hospital death rate, compared to older patients.

Conclusion:
Relative to whites, younger blacks had a higher proportion of strokes than older blacks, regardless of subtype. This information might be helpful in developing prevention strategies, and promoting targeted stroke awareness messaging among younger adults.
Abstract WP455: Memorial Hermann Hospital System Stroke Coordinators: Working as One
Authors: Shaw Sandi G , Gonzales Isabel , Indupuru Hari , Harrison Nicole , Savitz Sean , Toumbs Randi , Sharrief Anjail , Vahidy Farhaan ,   The Memorial Hermann Hosp System Stroke Coordinators
Published: June 2021

Background:
Many hospital stroke programs fail to meet or maintain the certification requirements of The Joint Commission (TJC) as a Primary Stroke Center (PSC) or Comprehensive Stroke Center (CSC). The most common reason is the absence of a dedicated stroke program coordinator. There are opportunities for improvement to promote stroke coordinator growth and retention.

Purpose:
We created The Memorial Hermann Hospital System Stroke Coordinator Alliance to combine resources, reduce workload, and support stroke coordinators in order to promote adherence to best practice and maintain TJC stroke certification.

Methods:
The Memorial Hermann Hospital System Stroke Coordinator Alliance was developed in 2015. It includes 14 nurses who represent 11 acute care hospitals within a large hospital system in Houston (Figure1). Four of the hospitals are CSCs, five are PSCs, and two are not certified. Monthly meetings are conducted to create standardized access to resources, stroke coordinator orientation, education, medical power plans, process improvement, and data development. Coordinator work groups, a central email and shared drive, biweekly data meetings, and a buddy system were created to reduce work load, improve electronic communication, and streamline data review procedures. A partnership was created to onboard new coordinators and to prepare for mock and real time survey visits. In 2018 data abstraction was standardized across hospitals with use of a homegrown database Stroke Program Registry (REGIS).

Results:
Of the 14 Stroke Coordinators in place during fiscal years 2015 - 2019, retention was 100%. A total of 19 stroke surveys were completed and recognized as successful by The Joint Commission. A total of 17,148 stroke patients were received with PSC measures averaging greater than 95% and CSC measures above 90%.

Conclusion:
Implementing program development support for stroke coordinators improves retention and quality care in a high volume stroke system.
Naming for Kin during World War I: Baby Names as Markers for War
Authors: Todd Nicolas , Coulmont Baptiste
Published: June 2021

The choice of baby names can reveal how rapidly individuals adapt to new circumstances. A French genealogy database of 5.5 million individuals born between 1905 and 1925 permits an analysis of name transmission from father to son/daughter and uncle to nephew/niece as a reaction to the family disruptions caused by the exigencies of World War I. Immediately following mobilization, the rate of paternal name transmission increased by about 50 percent for both males and females, enhanced by a father’s level of risk as a soldier. Transmission of an uncle’s name increased following his death regardless of whether he died at war, though the phenomenon was significantly more sustained if he did so.
Morphology and distribution of species of the family Cucurbitaceae in Akwa Ibom State, Nigeria
Authors: UMOH OMODOT TIMOTHY , BASSEY MARGARET EMMANUEL
Published: June 2021

A study of the family Cucurbitaceae in Akwa Ibom State, Nigeria, was carried out in 15 Local Government Areas in different ecological zones across the State, where collections were made between May 2017 and June 2018. A total of eleven species in nine genera were collected: Citrullus lanatus, Citrullus mucosospermus, Cucumis sativus, Cucurbita maxima, Lagenaria siceraria, Lagenaria sphaerica, Luffa aegyptiaca, Momordica charantia, Siraitia africana, Telfairia occidentalis, and Trichosanthes cucumerina. Variation in morphology were seen in the investigated species in the stem shape that were cylindrical or angular, the compound or simple types of leaves, the indumentum of the leaf, the acute or acuminate leaf apices, the yellow or white petals, the cylindrical, spherical or irregular fruit shape, the lanceolate or irregular seed shape, and the pubescent or smooth seed. Cultivated cucurbits collected were 65% of the species investigated, while 35% occurred in the wild. A survey of the Cucurbitaceae collections in the Forest Herbarium Ibadan showed only four species recorded for Akwa Ibom State, of which only Luffa aegyptica was identified and collected in the course of this work. More cultivation should be encouraged, as this will serve as a conservation measure for cucurbits in the State.
A new species of Bosmina (Liederobosmina) Brték, 1997 (Cladocera: Bosminidae) from high mountain lakes of Colombia
Authors: GARIBIAN PETR G. , JURAČKA PETR JAN , KOTOV ALEXEY A.
Published: June 2021

Insufficient attention has been recently paid by the taxonomists to the family Bosminidae Baird (Crustacea: Cladocera). Here we describe a new species of Bosmina (Liederobosmina) Brték from high mountain water bodies of Colombia which is unique among all bosminids having heavily striated valves. Most probably, this taxon has a narrow distribution area in the Andean high mountains. It is obvious that the Andean highlands must be studied in detail, i.e. using molecular methods, and more new taxa might be detected in the future.
Remarks on the genus Dolicholobosa Bian, Zhu & Shi, 2017 (Orthoptera: Tettigoniidae: Meconematinae) with one new species from Guizhou, China
Authors: LI YUN , MAO SHAOLI , SHI FUMING
Published: June 2021

The paper reports one new species of the genus Dolicholobosa Bian, Zhu & Shi, 2017 from Leigongshan, Guizhou, China, i.e. Dolicholobosa bisofurcula sp. nov., and provides the high-quality multifocused montage images of the new species, two known species and distribution map for the genus.
microRNA-939 Promotes the Vitality of Human Breast Cancer Cells via Inhibition of E2F1/P73 Signaling
Authors: Wang Shuaibing , Qi Xiuheng , Liu Hong
Published: June 2021

We assessed miR-939’s role in breast cancer (BC) and its molecular mechanism. PCR was performed to detect miRNA levels. Correlations between miR-939 and patients’ pathological information were analyzed. After transfection of E2F1 plasmid, P73 plasmid, si-E2F1, si-P73, miR-939
mimic or si-miR-939, cell proliferation and apoptosis were measured. The miR-939 target gene was proved by a luciferase assay. Protein and mRNA levels of E2F1 and P73 were detected by immunoblotting and PCR, and corresponding proliferation or apoptosis were assessed. MiR-939 expression was
significantly increased in BC and associated with TNM staging, Ki-67 enhancement, and shorter disease-free survival time. In BC clinical samples, E2F1 expression is negatively correlated with miR-939 expressions. Overexpressing miR-939 stimulated growth but suppressed cell apoptosis. Functional
analysis indicated E2F1 is the target gene of miR-939, and overexpression of miR-939 significantly downregulated E2F1 and P73. Silencing of E2F1 or P73 significantly promoted MDA-MB-231 cell proliferation and inhibited apoptosis. Overexpression of E2F1 plasmid or P73 plasmid significantly
inhibited MDA-MB-231 cell proliferation but induced apoptosis. Transfection of P73 or E2F1 plasmid abolished miR-939’s effects on proliferation and apoptosis. miR-939 promotes breast cancer progression by downregulation of E2F1 to inhibit P73 pathway, thereby promoting proliferation
and inhibiting apoptosis.
Bond Integrity of Titanium Surface to Resin Cement After Conditioning with Different Photobiomodulataion Therapy (PBT)
Authors: Al Ahdal Khold , Al Deeb Laila , Bin-Shuwaish Mohammed S. , Al-Hamdan Rana S. , Al Deeb Modhi , Maawadh Ahmed M. , Alhenaki Aasem M. , AlHelal Abdulaziz , Alresayes Saad , Al-Aali Khulud A. , Vohra Fahim , Abduljabbar Tariq
Published: June 2021

The aim of the present study was to evaluate the efficacy of interfacial bonding between resin cement and titanium alloy conditioned with different Photobiomodulataion Therapy (PBT) in comparison with conventional regimes. Seventy-five samples of titanium bar were segmented polished;
and based on conditioning regime divided into five groups (15 each specimens). Group 1: No treatment (control), Group 2: Sand blasting with 120 µm Al2O3, Group 3: Er,Cr:YSGG (ECL), Group 4: Er:YAG laser (EYL), Group 5: Nd:YAG laser (NYL). After different
conditioning regimes, resin cement was mixed and applied. All specimens were thermocycled for 500 cycles and positioned on universal testing machine for shear bond strength testing. Modes of failure was assessed by a single examiner using stereomicroscope at 40× magnification. Three
pairs of specimens in each group were sputter coated and scanning electron microscope (SEM) images were taken at 1000× magnification using 20 Kv. The highest SBS values were observed in group 2 (14.25±2.29 MPa) and the lowest bond values were displayed in group 1 (6.98 ±0.59
MPa). Titanium alloy abutments conditioned with different laser prototypes ECL (11.22±1.40 MPa), EYL (9.29±1.22 MPa) and NYL (9.12 ±1.84 MPa) exhibited comparable SBS (p > 0.05). Adhesive failures were primarily dominant among all experimental groups. Photo-biomodulation
in the form of ECL lasers has the potential to be used as a supplement to sandblasting procedure in conditioning of cement retained titanium alloy implant abutments.
Clinical Study of Ultrasonic Extreme Velocity Imaging Pulse Wave Technique in Carotid Elasticity in Patients with Type II Diabetes Mellitus
Authors: Ma Fang , Xu Jimei , Yang Weiwei , Bian Fuqin
Published: June 2021

In this study, extreme velocity ultrasonic imaging pulse wave technology was used to detect the main indices of atherosclerosis such as carotid intima-media thickness (IMT) and carotid elasticity, and biochemical indices such as glycated hemoglobin, blood glucose and blood lipids in
one hundred twenty 18–60-year-old patients with type II diabetes mellitus (T2DM) and 120 healthy controls. We analyzed the correlations between carotid elasticity, carotid IMT, and a range of biochemical indices. The results indicated that when the carotid IMT in young and middle-aged
patients with T2DM was within the normal range (0.56±0.03 mm), the carotid artery elasticity was abnormal [Pulse wave propagation velocity (PWV)-BS = 7.69± 1.26 m/s; PWV-ES = 8.34±1.51 m/s; P < 0.05]. Additionally, PWV-BS was positively correlated with age, course
of the disease, glycated hemoglobin (HbA1c), and fasting blood glucose (FBG) (r = 0.297, 0.377, 0.369, 0.382), and PWV-ES was positively correlated with age, course of the disease, HbA1c, and FBG (r = 0.318, 0.386, 0.392, 0.339). This finding provides a basis for extreme velocity
ultrasonic imaging pulse wave technology to become a new method for the early screening of atherosclerosis in patients with T2DM; this is important for timely clinical intervention in patients with T2DM.
Circular RNA Circ_0008450 Regulates the Invasion, Migration, and Proliferation of Oral Squamous Carcinoma Human Oral Squamous Cell 3 Cells by Targeting miR-1294
Authors: Wu Jiangen , Hou Jun , Li Chengjing
Published: June 2021

To determine the role of the circ_0008450/miR-1294 molecular axis in the proliferation, migration, and invasion of oral squamous cell carcinoma (OSCC) cells, the expression levels of circ_0008450 and miR-1294 in OSCC and neighboring non-cancerous tissues were detected by real-time quantitative
polymerase chain reaction. Human OSCC HSC3 cells were transfected with negative control (NC) small interfering (Si) RNA (Si-NC), Si-circ_0008450, micro RNA (miR)-NC, miR-1294 mimics, anti-miR-1294, anti-Si-circ_0008450, or anti-miR-NC. The activity of HSC3 cells was detected with the CCK-8
assay. The transwell assay was used to assess the invasion and migration of HSC3 cells. The targeted relationship between miR-1294 and CIRc_0008450 was detected with the dualluciferase report assay. Western blot analysis was performed to measure the protein expression levels of matrix metalloproteinase
(MMP)-2, MMP-9, and Ki-67 (also known as MKI67). As compared to neighboring non-cancerous tissues, the expression levels of circ_0008450 in OSCC tissues were significantly increased (P < 0.05), while miR-1294 levels were significantly decreased (P < 0.05). As compared to
the Si-NC group, cell activity was significantly decreased (P < 0.05), the numbers of migrating and invading cells were significantly decreased (P < 0.05), and the protein levels of Ki-67, MMP-2, and MMP-9 were significantly decreased (P < 0.05) in the Si-circ_0008450
group. The results of the double luciferase assay confirmed targeted binding of circ_0008450 to miR-1294. As compared to the miR-NC group, cell activity was significantly decreased (P < 0.05) in the miR-1294 group, as were the numbers of migrating and invading cells (P <
0.05), and the protein levels of Ki-67, MMP-2, and MMP-9 (P < 0.05). As compared to the Si-circ_0008450+anti-miR-NC group, cell activity was significantly increased (P < 0.05) in the Si-circ_0008450+anti-miR-1294 group, as were the numbers of migrating and invading cells
(P < 0.05), and the protein levels (P < 0.05) of Ki-67, MMP-2, and MMP-9. Interference with circ_0008450 reduced the invasion, migration, and proliferation of OSCC cells on account of upregulation via binding with miR-1294.
miR-1825 Accelerates Cell Proliferation and Inhibits Cell Apoptosis of Prostate Cancer via Targeting Suppressor of Cancer Cell Invasion
Authors: Bai Jun-Chao , Huang Guang-Yi
Published: June 2021

Prostate cancer (PC) is one major carcinoma threat to the health of males. microRNAs (miRNAs) are short non-coding transcripts with about 23 nt in length. Booming evidence has verified the various roles of miRNAs in human tumors. miR-1825 was once demonstrated to be highly expressed in PC, but the potential role of miR-1825 in PC has never been clarified yet. This work aimed to explore the function of miR-1825 and reveal the underlying modulation mechanism in PC. First, miR-1825 was detected to be elevated in PC cells compared with normal prostate cells, as proved by RT-qPCR. After miR-1825 expression was inhibited, cell proliferation was hindered and cell apoptosis was promoted, which was observed by CCK8, colony formation, TUNEL staining and western blot assays. Bioinformatics tools discovered the targeting of suppressor of cancer cell invasion (SCAI) by miR-1825, which was further confirmed by luciferase reporter assay. Then the suppression of miR-1825 on SCAI protein expression was verified by western blotting. Eventually, rescue assays were implemented and affirmed the miR-1825/SCAI axis in PC cells. In conclusion, our present research disclosed the oncogenic role of miR-1825 and the miR-1825/SCAI pathway in PC. These findings gave new clues for the therapy of PC.
The Efficiency of (videolaryngo) stroboscopy in Detecting T1a Glottic Carcinoma and Its Preliminary Stages
Authors: Heyduck Adrienne , Brosch Sibylle , Pickhard Anja , Hoffmann Thomas K. , Reiter Rudolf
Published: June 2021

Objective:

The efficiency of laryngovideostroboscopy (LVS) in detecting premalignancies of the vocal fold and early glottic cancer was determined in a prospective monocentric study. In addition, the recovery rate of the mucosal membrane on the vocal fold after surgical intervention was determined by LVS.

Methods:

We included 159 patients with a leukoplakia of the vocal folds and 50 healthy controls. Clinicopathological data and LVS characteristics (amplitude, mucosal wave, nonvibratory segment, glottic closure, phase symmetry, periodicity) at the lesion site were obtained and compared with the histopathological results. LVS parameters were recorded before cordectomy and in a 12-month follow-up interval. Patients who had prior laryngosurgery, radiotherapy, or laryngeal scarring were excluded.

Results:

Absent or greatly reduced mucosal waves were found in all patients with an invasive carcinoma, in 94% with a severe intraepithelial neoplasia (SIN III), in 38% with a moderate squamous intraepithelial neoplasia (SIN II), in 32% with a mild squamous intraepithelial neoplasia (SIN I), and in 23% with a hyperkeratosis without dysplasia. The sensitivity and specificity of LVS in predicting an invasive carcinoma based on the absence or reduction of mucosal waves was 0.96 and 0.90, respectively. Following surgical intervention, the recovery rate of the mucosal wave and amplitude was 12% in the invasive carcinoma group, 36% in the SIN III group and up to 80% for both these parameters in the SIN I, SIN II, and hyperkeratosis groups.

Conclusion:

LVS is a valid tool to identify early glottic carcinoma and its high risk premalignancy carcinoma in situ (CIS). Even when there is no definitive differentiation between SIN I and II, the invasive character of a CIS and an invasive glottic carcinoma can be identified. Especially strobosopic signs of abnormal amplitude and/or mucosal waves, particularly phoniatric halt, are an early indication for a CIS or an invasive carcinoma.
The Clinical Challenges Experienced by New Graduate Occupational Therapists: A Matrix Review
Authors: Moir Elizabeth M. A. , Turpin Merrill J. , Copley Jodie A.
Published: June 2021

Background.

The transition from student to new graduate occupational therapist is recognized as stressful. Current literature has not specifically drawn together the challenges new graduates face when learning to work with clients.

Purpose.

This review aimed to synthesize common challenges that new graduate occupational therapists face when working with clients.

Methods.

Searches of online scholarly databases located research articles. Content related to working with clients in practice was charted using the Matrix Method.

Findings.

From 21 articles, four categories of challenges were identified: “reasoning and decision-making,” “using knowledge and skills in practice with clients,” “the context of service provision,” and “managing caseload and priorities.” “Having self-doubt” was a theme that pervaded the data.

Implications.

New graduates often do not feel fully prepared for all aspects of occupational therapy practice. As they may not have access to substantial workplace support, exploring personal resources and professional support may assist this challenging transition.
Guilt by lottery: Criminal failure to prevent facilitation of tax evasion under the Criminal Finances Act 2017
Authors: Stratton Harry
Published: June 2021

The corporate criminal offences of failure to prevent facilitation of tax evasion punish the unlucky, unpopular, and large more than genuine tax evaders or facilitators. This article argues the offences’ broad scope and the unpredictability of the ‘reasonable prevention procedures’ defence means that rather than operating as a deterrent, the provisions effectively assign guilt by lottery, impose fines that become just another cost of doing business, and punish British companies for doing business in the developing world where their investment is most needed.
Honors College Faculty Support for High-Impact Practice Participation
Authors: Miller Angie L. , Silberstein Samantha M. , BrckaLorenz Allison
Published: June 2021

Much of the existing research on honors colleges or programs is focused on the student experience, with less information offered concerning the faculty perspective. This study presents findings from the Faculty Survey of Student Engagement (FSSE), comparing support for high-impact practices between faculty who teach honors courses and those who do not. Along with core FSSE items, this study uses responses from 1,487 faculty members at 15 institutions on two experimental items about teaching honors courses. A series of ordinary least squares and binary logistic regression analyses suggest that faculty who teach honors courses are more likely to supervise undergraduates on research and internships and to think that it is important for students to participate in learning communities, study abroad, and research with faculty. These findings are interpreted within the context of previous research and current theory, bridging knowledge from the fields of higher education and gifted education.
Double, triple or quadruple hits? Exploring the impact of cybercrime on victims in the Netherlands
Authors: Notté Raoul , Leukfeldt E.R. , Malsch Marijke
Published: June 2021

This article explores the impact of online crime victimisation. A literature review and 41 interviews – 19 with victims and 22 with experts – were carried out to gain insight into this. The interviews show that most impacts of online offences correspond to the impacts of traditional offline offences. There are also differences with offline crime victimisation. Several forms of impact seem to be specific to victims of online crime: the substantial scale and visibility of victimhood, victimisation that does not stop in time, the interwovenness of online and offline, and victim blaming. Victims suffer from double, triple or even quadruple hits; it is the accumulation of different types of impact, enforced by the limitlessness in time and space, which makes online crime victimisation so extremely invasive. Furthermore, the characteristics of online crime victimisation greatly complicate the fight against and prevention of online crime. Finally, the high prevalence of cybercrime victimisation combined with the severe impact of these crimes seems contradictory with public opinion – and associated moral judgments – on victims. Further research into the dominant public discourse on victimisation and how this affects the functioning of the police and victim support would be valuable.