bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP114: Younger Age and Diagnosis of Schizophrenia Increase Door to Needle Times in Acute Ischemic Stroke Patients
Authors: Figurelle Morgan , Bargouthi Tamara T , Bushnell Cheryl D , Guzik Amy K , Vu Quang D , El Husseini Nada K , Reynolds Patrick S , Tegeler Charles , Bishop Laura E
Published: January 2019

Introduction:
Faster treatment time for acute ischemic stroke is associated with better outcome. We hypothesized that patient factors such as young age, female sex, premorbid mental health (depression, anxiety, schizophrenia, bipolar) or other conditions (fibromyalgia, chronic pain), may confound making the diagnosis of stroke and thus delay door to needle (DTN) time.

Methods:
Consecutive patients who received intravenous tPA in our comprehensive stroke center emergency department between January 2015 and June 2018 were reviewed regardless of discharge diagnosis. The primary outcome was DTN time, and secondary outcomes were door to CT imaging (DTI) time and CT read to needle time. Univariate analyses were done using parametric and non-parametric tests and linear regression model was developed with variables with p values <0.15.

Results:
A total of 225 patients (mean age 63.7 ±15.5 y, 48% women, 67% white, 32% African American, 1.8% other) were identified. Mean DTN was 63 minutes. Patients < 60 y had a mean DTN time of 67.2 minutes vs 60.9 minutes in those
>
age 60 y (p=0.093). Age <60 was associated with increased mean DTI time (28.6 minutes vs 21.6 minutes in patients
>
60; p=0.0068; mean difference of 7 minutes, 95%CI of 2.0, 12.1). There was no significant difference in CT to needle time by age (p=0.77). A known mental health diagnosis or other confounding condition was present in 37%. Four of 225 (1.7%) had schizophrenia, with median DTN time of 91 vs 56 minutes in those without (p=.14). Linear multivariate regression model showed that younger age (p=0.018) and schizophrenia (p=0.009) were independently associated with longer DTN times.

Conclusion:
Longer DTI times were associated with age less than 60, and longer DTN times were associated with younger age and presence of schizophrenia. Recognition of younger age and schizophrenia by clinicians as confounders could help reduce stroke treatment times.
Abstract TP123: Inhibition of Tropomyosin-related Kinase B (trkb) Reduces the Benefit of Cortical Stimulation Combined With Motor Rehabilitation in Experimental Stroke
Authors: Kinley-Cooper Serena-Kaye , Adkins DeAnna , Rizzo Aitana , Kinley-Howard Kern
Published: January 2019

Motor impairments are one of the more debilitating and persistent functional deficits following stroke. Several clinical and experimental studies suggest that combining impaired limb rehabilitation (RT) with low-frequency inhibitory contra-lesion or high-frequency excitatory ipsi-lesion motor cortical stimulation (CS) can improve motor recovery and increase neural remodeling. However, results have been mixed and there is no consensus on which CS approach is more beneficial. Further, the mechanism by which excitatory CS (ECS) and inhibitory CS (ICS) alter motor recovery after stroke are unknown. One theory is that CS may alter the expression of neurotrophic factors. Brain-derived neurotrophic factor (BDNF) and its receptor tropomyosin-related kinase B (TrkB) are important for motor learning and neural plasticity in healthy brains may be involved in motor recovery after stroke. In this study, we compared the efficacy of motor RT alone to ECS or ICS combined with RT following experimental motor cortical stroke in adult male rats. Additionally, we investigated whether inhibiting the TrkB receptor during treatment would block behavioral recovery and alter neural remodeling in the motor cortex.

Methods:
Adult male rats received an endothelin-1 induced unilateral focal stroke to the caudal forelimb area of the motor cortex. Bipolar electrodes were then implanted either over remaining peri-lesion motor cortex or over the contra-lesion motor cortex. Four days after stroke, rats received daily RT on a reaching task without CS or concurrent with 100 Hz ECS or 1 Hz ICS 6 days per week for 3 weeks. Three hours prior to RT, animals were injected with ANA-12 (.5mg/kg, i.p.), a small molecule TrkB antagonist, or vehicle. Preliminary results indicate that ANA-12 injections resulted in decreased functional improvements in rats receiving ECS+RT and RT compared to rats receiving these treatments with vehicle injections. Alternatively, ANA-12 had no effect on motor performance in the ICS+RT group. These data suggest that ECS and RT may be, at least in part, dependent upon TrkB receptor signaling. However, contra-lesion ICS induced functional recovery is likely not dependent upon TrkB signaling.
Abstract TP130: Transcriptome Analysis of Mononuclear Cell Responses After Ischemic Stroke in Type 2 Diabetic Mice
Authors: Omodaka Shunsuke , Kanoke Atsushi , Hsieh Christine , Eckalbar Walter L , Liu Jialing
Published: January 2019

Introduction:
Type 2 diabetes mellitus (T2DM) is a major risk factor of ischemic stroke and is associated with poor outcome after stroke. However, the mechanisms underlying the detrimental effects of diabetes are largely unclear. We used single-cell RNA sequencing (scRNA seq) to determine the transcriptome profiles of blood peripheral mononuclear cells (BPMNs) under diabetic and ischemic conditions using T2DM mouse model.

Hypothesis:
The altered gene expression under diabetic condition affects the normal differentiation of BPMNs, resulting in the aggravation of ischemic brain injury.

Methods:
We performed scRNA seq for BPMNs from four groups of mice, consisting of
db/db
mice with or without stroke and
db/+
mice with or without stroke. Stroke was induced by distal middle cerebral artery occlusion. We specified the cell types of BPMNs and compared the transcriptome among the groups of mice. We assessed the biological role of identified differentially expressed genes (DEGs) by enrichment analysis.

Results:
In the comparison between
db/db
and
db/+
groups, 168 up-regulated and 245 down-regulated DEGs were identified. The
db/db
group was composed of a larger population of macrophages and a smaller population of lymphocytes compared to
db/+
group. The gene
Cebpa
, known to be associated with myeloid maturation, was significantly down-regulated in monocytes/macrophages, indicating the adverse effect of diabetes on the normal differentiation of myeloid cells. In addition, enrichment analysis revealed that up-regulated DEGs were related to the gene ontology term translation in B cells and innate immune response in monocytes. On the other hand, the down-regulated DEGs were related to antigen processing and presentation in macrophages. In the comparison between stroke and non-stroke groups, 21 up-regulated and 223 down-regulated DEGs were identified, in which down-regulated DEGs were related to cellular oxidant detoxification in T cells.

Conclusions:
The present study demonstrated altered gene expression profile and molecular network across various cell types in PBMCs in response to diabetic and ischemic conditions by scRNAseq, providing a clue to the underlying mechanism of the adverse effect of T2DM on native immunity and response to stroke.
Abstract TP131: SNRI Atomoxetine and SSRI Fluoxetine Promote Motor Recovery After Photothrombotic Stroke in Mice
Authors: Alamri Faisal F , Al Shoyaib Abdullah , Paul Anisha , Jayaraman Srinidhi , Arumugam Thiruma V , Karamyan Vardan T
Published: January 2019

The aim of this study was to evaluate the potential of pharmacological modulation of adrenergic and serotoninergic systems in post-stroke motor recovery in mice. For this purpose, the effects of selective norepinephrine reuptake inhibitor atomoxetine (1 mg/kg, once a day, i.p.) and selective serotonin reuptake inhibitor fluoxetine (10 mg/kg, once a day, i.p.) were studied on recovery of motor function in adult male mice after photothrombotic stroke. Vehicle or drug treatments were initiated on day 5 after photothrombosis and lasted until post-stroke day 16. In addition to pharmacological therapy, mice were allowed to voluntarily run on a wheel in their home cage starting from day 9 after stroke. Motor function was assessed in grid walking and cylinder tests 3 days before and 3, 7, 14, 28 and 42 days after stroke. On post-stroke day 42, mouse brains were fixed by cardiac perfusion and collected for sectioning and evaluation of infarct volume (cresyl violet staining) and molecular markers (immunofluorescence). The results of both sensorimotor tests indicated that all groups had substantial and comparable motor impairment on post-stroke day 3 (p < 0.01 compared to respective baselines), and that voluntary running started 9 days post-stroke did not significantly facilitate motor recovery after stroke (p > 0.05, vehicle-treated vs. stroke alone). However, treatment of mice with atomoxetine or fluoxetine significantly potentiated motor recovery by day 42 after stroke (p < 0.05 compared to vehicle-treated and stroke alone groups). The average total distance run by mice receiving vehicle or either of the drugs was comparable (1653 ± 110 meters). Infarct volumes measured at day 42 post-stroke were also comparable in experimental groups (1.7 ± 0.2 mm
3
). Our data indicate that moderate voluntary running starting 9 days after stroke does not facilitate motor recovery after stroke in mice. However, pharmacological modulation of adrenergic or serotoninergic systems, in addition to moderate voluntary running, enhances motor recovery in mice. Our ongoing studies focus on evaluation of the dose-dependence of atomoxetine and fluoxetine effects, and elucidation of molecular signaling pathways responsible for the observed effects of these drugs.
Abstract TP136: Mitochondrial Mechanisms of Resilience Revealed by Arctic Ground Squirrel Neural Cells
Authors: Singhal Neel S , Bai Meirong , Luo Shuo , Ma Dengke K
Published: January 2019

Arctic ground squirrels (AGS) are extreme hibernators capable of withstanding months of freezing temperatures. Curiously, AGS do not experience ischemic or reperfusion injuries despite limited cardiac output and cerebral blood flow during hibernation. Indeed, in simulated stroke or cardiac arrest, AGS also demonstrate marked resilience independent of the season or metabolic state of the animal. We found that AGS neuronal stem and progenitor cells (NSC/NPCs) demonstrate dramatic tolerance to multiple mitochondrial insults including oxygen glucose deprivation, rotenone treatment (Complex I inhibition), or FCCP treatment (uncoupling agent) in vitro. We sought to characterize the mitochondrial adaptations mediating this resilient phenotype. The AGS resilient phenotype is associated with altered mitochondrial dynamic regulation of fusion/fission and reduced oxidative metabolism. Overexpression of key AGS nuclear-encoded mitochondrial subunits such as Cox7a2l in mouse NSC/NPCs recapitulated the resilient phenotype and mitochondrial morphological and functional changes. AGS mitochondrial proteins are uniquely adapted to withstand metabolic stressors and contribute to the ability of AGS to dynamically regulate mitochondrial function. Development of therapeutic agents targeting mitochondrial structural properties may induce a protective phenotype and promote neuronal survival in patients with acute stroke.
Abstract TP137: Suppression of Microrna Let-7a Expression Promotes Neurogenesis in Arginine Decarboxylase-neural Stem Cells After Ischemia
Authors: Oh Yumi , Kim Jong Youl , Kim Jae Young , Barua Sumit , Lee Jong Eun
Published: January 2019

Introduction:
Neural stem cells (NSCs) have been studied as promising novel treatments for central nervous system (CNS) disorders due to the potential of differentiation into neuron. To increase the therapeutic efficiency of NSCs, we have focused on microRNA
let-7a
(
let-7a
), known as the regulator of diverse cellular mechanisms and agmatine, an endogenous primary amine synthesized from decarboxylation of L-arginine catalyzed by arginine decarboxylase (ADC) and a neurotransmitter reported to affect neuroprotection in CNS. The purpose of this study is to investigate the role of arginine metabolic enzyme which regulated
let-7a
in neural stem cell differentiation.

Methods:
Cortical NSCs were isolated from pregnant imprinting control region mice and used for experiments after 2-3 passages. After
let-7a
mimic and agmatine treatment, we performed by RT-PCR, western blot and immunocytochemistry. To confirm the effects of arginine metabolic enzyme and
let-7a
in vivo
, mice were subjected to distal middle cerebral artery occlusion (dMCAO). Following dMCAO, mice were treated agmatine by intraperitoneal injection,
let-7a
mimic by osmotic pump and human ADC gene delivery into the NSCs using retroviral vector (
vh
ADC)-NSCs via intracranial injection at the corpus callosum.

Results:
In vitro
study suggested that high levels of
let-7a
promoted the expression of TLX and c-Myc, as well as repressed DCX and ERK expression. In addition, agmatine attenuated the expression of TLX and increased the expression of ERK by negatively regulating
let-7a
. Also, after dMCAO, we found that
vh
ADC-NSC and
let-7a
co-treatment group reduced the infarct volume, increased the expression of DCX, Neurogenin2, Olig2, and attenuated the expression of GFAP.

Conclusion:
In the present study, we found that agmatine can enhance NSC differentiation into neurons by modulating expression of
let-7a
.
In vivo
study showed that
vh
ADC-NSC and
let-7a
co-treatment promoted neurogenesis and inhibited glial differentiation in the treatment of neural stem cell transplantation in ischemic condition. Therefore, our study suggests that the therapeutic efficiency of the
vh
ADC-NSC on neural stem cell differentiation through suppression of
let-7a
of the CNS diseases.
Abstract TP138: Succinate Dehydrogenase and Complex I Downregulation Contribute to the Therapeutic Effect of Hypothermia in Oxygen-Glucose Deprivation
Authors: Wei Wenjing , Stone Christopher , Guan Longfei , Wu Di , Ji Xunming , Ding Yuchuan
Published: January 2019

Introduction:
Reperfusion injury is a significant mechanism of cellular damage in the wake of ischemic stroke. This damage is mediated by succinate, an intermediate in the citric acid cycle. Rapidly accumulated by tissues during the ischemic phase, succinate is re-oxidized by succinate dehydrogenase (SDH) upon reperfusion: this, through reverse transport of electrons at mitochondrial Complex I, is responsible for the profuse production of reactive oxygen species (ROS). Therapeutic hypothermia (TH) is a well-established neuroprotective strategy for ischemic stroke that is known, moreover, to act in part through post-ischemic suppression of ROS. In this study, we sought to elaborate the mechanism of this suppression by investigating the effects of TH on SDH and Complex I expression, and thus to assess the ability of TH to protect mitochondria against post-ischemic oxidative damage.

Methods:
Human neural SH-SY5Y cells were divided into 9 groups: 1) sham, 2) 2 h oxygen-glucose deprivation (OGD) without treatment, and 3-9) OGD with one of the following 7 treatments: TH (34°Cfor 4 h), pre-treatment with succinate (SDH substrate, 5 mM), with malonate (SDH inhibitor, 5 mM), with rotenone (Complex I inhibitor, 1 μM) or with a combination of succinate plus either inhibitor (malonate or rotenone) or TH. After 4 or 22 h reoxygenation, OGD cell survival was determined by cell viability and levels of ROS and LDH generation. SDH and Complex I protein expression were assessed by Western blot.

Results:
TH, malonate, and rotenone monotherapy significantly decreased succinate concentration, ROS production, LDH release, and increased cell viability. SDH and Complex I expression were decreased by TH. Pre-treatment with succinate yielded increased ROS production and LDH release as well as decreased cell viability. These effects were reversed following treatment with malonate, rotenone, or TH, however, suggesting that the SDH and Complex I pathway is involved in TH-regulated succinate transformation.

Conclusion:
TH exerts its neuroprotective effect in part by mitigating the ROS-generating oxidation of succinate during reperfusion. Our study suggests a new mechanism underlying this mitochondrial protection: downregulation of the SDH and Complex I molecular pathway.
Abstract TP144: Preclinical Translation and Validation of C3a Receptor Antagonist in Thromboembolic Stroke
Authors: Ahmad Saif , Chaudhary Rafay , Kindelin Adam , Pandya Chirayu , Hoda Md N , Ducruet Andrew F
Published: January 2019

Background:
Activation of complement component C3 and expression of cerebro-endothelial C3a receptor (C3aR) occur after stroke regardless of the dynamics of cerebral blood flow (CBF) changes. Moreover, intravenous tissue plasminogen activator (IVT) cleaves C3 to generate C3a anaphylatoxin which promotes hemorrhagic transformation. We reported that C3aR antagonist (C3aRA) therapy is neuroprotective in a model of mechanical reperfusion simulating ET (endovascular thromboectomy) but is not beneficial following permanent ischemia. Although the majority of ischemic strokes are thromboembolic (TE), C3aRA has not been tested in TE-stroke models.

Hypothesis:
We hypothesized that TE-stroke upregulates the C3a/C3aR axis to exacerbate stroke injury, and C3aRA therapy is neuroprotective with and without IVT in TE-stroke.

Methods:
Plasma C3a level and brain C3aR expression were assessed following TE-stroke induced either with photothrombosis (PT) in young C57/B6 male mice or with a ~1-cm long partially humanized embolic thrombus (eMCAo) in C57/B6 aged male mice. Post-ischemic C3aRA therapy was tested in both models, as well as with late IVT (4-hrs) after eMCAo. Behavioral outcome, infarct volume and HT were assessed.

Results:
Plasma C3a and brain C3aR expression levels were significantly elevated acutely in both PT- and eMCAo stroke models. Interestingly, brain C3aR remained chronically elevated 4-wks after TE-stroke. Flow cytometry demonstrated that C3aR expression was primarily increased in cerebro-endothelial cells following eMCAo. When administered 1-hr after PT-stroke, C3aRA improved sensorimotor function as determined by the adhesive tape removal and corner tests, reduced infarction volume, and suppressed inflammatory responses. Furthermore, late IVT 4-hrs after eMCAo does not reduce infarction volume but worsens neurological deficit score likely due to increased HT. C3aRA therapy given 2-hr after eMCAo prior to IVT improved neurological outcomes and reduced both infarction volume and HT.

Conclusion:
C3aRA represents a promising adjuvant therapy with or without IVT following TE-stroke. These findings must be extended to comorbid TE-stroke and through chronic treatment to prevent post-stroke vascular dementia.
Abstract TP150: Neuroprotective Effect of Intra-Arterial Administration of Isolated Mitochondria was Enhanced by Local Cooling Infusion (LCI) in Ischemic Rats
Authors: Wei Wenjing , Stone Christopher , Guan Longfei , Wu Di , Ji Xunming , Ding Yuchuan
Published: January 2019

Introduction:
Intercellular mitochondrial transfer is an emerging cell-therapeutic technique that has shown success in the abatement of ischemic damage across multiple cellular models, including in neurons following experimentally-induced stroke. The neuroprotective efficacy of this technique has been limited, however, by the low efficacy of mitochondrial internalization into neurons. This study investigated the neuroprotective consequences of a more effective delivery method: intra-carotid arterial delivery via microcatheter, with or without micro-environmental augmentation of mitochondrial homing and function using LCI-mediated hypothermia.

Methods:
Sprague-Dawley rats were subjected to 90 min middle cerebral artery occlusion (MCAO), followed by 24 h reperfusion. Rats were treated with mitochondria isolated from MSCs using the PIERCE kit (300μg/kg) and delivered precisely into the infarct area by carotid artery microcatheterization, LCI (cold saline, 0.6ml/min, 5min), or both. After 24 h reperfusion, infarct volume and neurological deficit were examined. After 28 days, long-term functional outcomes were evaluated using foot-fault and rota-rod testing. In parallel, human neural SH-SY5Y cells were investigated
in vitro
using 2 h oxygen-glucose deprivation (OGD), followed by mitochondria, with or without 4h hypothermia (34°C). Cell survival-related intracellular ATP, cell viability, and cell death related to reactive oxygen species (ROS) were evaluated 6 and 24 h after reoxygenation.

Results:
After 24 h reperfusion, mitochondrial transfer and LCI-mediated hypothermia treatment groups demonstrated significant decreases in infarct volume and neurologic deficits. After 28 days, the combination therapy group showed greater long-term recovery than either of the monotherapy groups. Cell culture results verified the amplified neuroprotective effect of this mitochondrial transfer and hypothermia combination: intracellular ATP and cell viability were increased, and ROS were decreased at 6 and 24 h reoxygenation.

Conclusion:
We found that delivery of mitochondria directly to the infarcted area in ischemic stroke is a viable neuroprotective strategy that is enhanced when combined with hypothermia.
Abstract TP156: A Novel and Logical Strategy for Prevention of Hyperperfusion Syndrome; Intentional Residual Stenosis After Carotid Artery Stenting of an Extremely High-Grade Stenosis
Authors: Mori Takahisa , Tanno Yuhei , Nakai Noriyoshi , Yoshioka Kazuhiro
Published: January 2019

Introduction:
Hyperperfusion syndrome (
HPS
) probably occurs after carotid artery stenting (
CAS
) of an extremely high-grade carotid artery stenosis (ex-CS). However, it has not been established how to prevent HPS.

Hypothesis:
Intentional residual stenosis
(iRS
) after CAS not followed by balloon dilatation (bD) can prevent HPS in patients with an ex-CS and spontaneously dilates thereafter.

Methods:
We included in our study patients with an ex-CS who underwent elective CAS not followed by bD for iRS from 2015 to 2018. We defined an ex-CS as a stenosis of more than NASCET 70% which caused delayed filling of contrast material in an internal carotid angiogram and reduced signal intensity (ratio of less than 0.9) of the ipsilateral middle cerebral artery (MCA) compared to the contralateral MCA on magnetic resonance angiograms (MRA), and defined a residual stenosis (rS) as angiographic stenosis of more than NASCET 30% or peak systolic velocity (PSV) of more than 80 cm/s by Doppler ultrasonography. We defined hyperperfusion phenomenon (HPP) as increase of cerebral blood flow in single photon emission computed tomography scans or cerebral metabolic rate of oxygen by measuring blood oxygen content. We evaluated patients’ baseline characteristics, rS just after CAS, incidence of HPS and HPP. Three months after CAS, they underwent conventional angiographic investigation.

Results:
During the study period, 26 CAS met our inclusive criteria. Their median carotid stenosis was NASCET 81.8%. Signal intensity ratio of MRA was 0.75. Median PSV before and just after CAS was 311.5 and 76.1 cm/s (p<0.0001). Just after CAS, median stent diameter stenosis was 33.3%. Seventeen patients (65.4%) had angiographic rS. Twelve patients (46.2%) had PSV of more than 80 cm/s. Ten patients had both. Comprehensively nineteen (73.1%) patients had significant rS. Among 26 patients with an ex-CS, no one experienced HPS, although comprehensively 15 patients (57.7%) presented asymptomatic HPP. Among 26 patients, 23 patients finished 3-month angiography and their stents significantly spontaneously dilated (p<0.0001).

Conclusion:
Intentional residual stenosis after CAS of an ex-CS probably prevented hyperperfusion syndrome and spontaneously dilated at 3 months after CAS.
Abstract TP173: Feasibility and Utility of Home-Based Gait Analysis Using Body-Worn Sensors
Authors: Huang Emily , Sharp Michael T , Osborn Elizabeth , MacLellan Adam , Mlynash Michael , Kemp Stephanie , Buckwalter Marion S , Lansberg Maarten G
Published: January 2019

Background:
Gait impairment is one of the most common post-stroke deficits and an important rehabilitation target for patients. Standardized gait assessments typically capture a brief snapshot of a patient’s gait in the clinical setting, but do not provide information about the trajectory of gait recovery in daily life. We assessed the feasibility of home-based gait analysis in patients with stroke-related gait impairment using the Sensoplex “Rover”, a small device worn on the ankles that measures leg movement.

Methodology:
Thirty-four chronic stroke patients were included in a prospective cohort study. Patients could elect 1 or 4 weeks of gait monitoring and were instructed to wear one device on each ankle during waking hours in this period. Patients completed a timed 10-meter walk test (10m) at the start of the monitoring period. Performance on the 10m was correlated with average gait speed at home assessed with the Rover during the entire monitoring duration. Patients completed a user experience survey at the end of the study.

Results:
Reliable gait monitoring data for at least 1 day was obtained in 22 of the 34 patients. In this group, there was a good correlation between walking speed measured at home and in clinic (R
2
=0.58), but walking speed measured at home was slower than in clinic (p<0.0001; figure). Sixteen out of 34 patients (47%) wore the device for the entire chosen monitoring duration. This compliance was higher for patients who chose to wear the device for only 1 week (13 of 19; 68%) compared to patients who chose 4 weeks (3 of 15; 20%). On the user survey, 45% of patients reported having trouble donning/doffing the device, 60% wanted a slimmer design, and 60% wanted a mobile app to track progress.

Conclusion:
Home-based gait monitoring with the Rover device is feasible and correlates well with clinic-based assessments. Design improvements are needed to increase compliance and make home-based gait monitoring a useful additional outcome measure in studies of stroke recovery.
Abstract TP177: The Concept of Interdisciplinary Stroke Clinic With Physical Therapy: A Single Institution Experience
Authors: Musalo Michelle M , Kraus Alison R , Olasoji Esther B , Rose Dorian K , Youn Teddy S , Nagaraja Nandakumar
Published: January 2019

Background:
Stroke survivors need therapy services to recover; however, coordination of therapy may not occur over time. An interdisciplinary stroke clinic (ISC) can improve communication and identify patients who have not reached their full recovery potential. We instituted an ISC with physical therapy (PT) to evaluate post-stroke or TIA survivors on the same day of the stroke clinic visit to determine if patients needed additional therapy.

Methods:
Patients with diagnosis of stroke or TIA seen in the ISC from 05/17 - 05/18 were included. Based on recommendations from the American Physical Therapy Association and AHA/ASA, the PT evaluation included the Berg Balance Scale (BBS), Ten Meter Walk Test (10MWT), Six Minute Walk Test (6MWT), Short Form Stroke Impact Scale (SF-SIS) and assessment of the patient’s knowledge of stroke risk factors and prevention. The physical therapist determined if the patient met criteria for additional therapy.

Results:
Among 161 patients in the study, 84% were ischemic stroke, 12% hemorrhagic stroke, and 4% TIA. The mean age was 63±14 years and there were 56% women and 75% Whites. At the time of therapy evaluation, 38% of patients were in the acute phase of recovery (0-6 months) and 62% in chronic phase (>6 months) of recovery from stroke or TIA. BBS was performed in 86%, median score 50 (41-54); 6MWT in 81%, median percent impaired 27(11-46), comfortable 10MWT in 86%, median 0.93 (0.72-1.11)m/s; fast 10MWT in 83%, median 1.31 (0.96-1.60)m/s; SF-SIS in 86%, median 33 (28-38), and SF-SIS stroke recovery rating in 81%, median 80% (50-90). Follow-up services were recommended for 62% of patients - PT (53%), occupational therapy (20%), and speech therapy (9%). Follow-up therapy recommendations were not associated with type of stroke (p=0.80, 68% hemorrhagic stroke, 61% ischemic stroke, and 67% TIA) or when stroke/TIA occurred in the past [p=0.24, 68% among patients in acute phase and 59% among patients in chronic phase of recovery].

Conclusion:
In our pilot study, there was a need for follow-up services in 62% of patients due to functional limitations as determined by PT evaluation. It included patients in acute and chronic phase of recovery. Frequent therapy assessments may be needed for stroke survivors to help reach their best recovery potential.
Abstract TP180: Comprehensive Assessment of Disability Post-stroke using the Newly Developed miFUNCTION Scale
Authors: Zerna Charlotte , Burley Tyler , Green Theresa L , Dukelow Sean P , Demchuk Andrew M , Hill Michael D
Published: January 2019

Background and Purpose:
The modified Rankin Scale (mRS) is the most widely used primary outcome measure in acute stroke trials. However, substantial inter-observer variability impairs outcome assessment and reduces power of clinical trials. Guided by the International Classification of Functioning, Disability and Health (ICF), we developed a comprehensive, hierarchical assessment tool (miFUNCTION) to address the shortcomings of the mRS and deliver a more thorough understanding of disability following stroke (figure 1).

Methods:
The construct validity of miFUNCTION was initially established in a pilot study of patients at an outpatient stroke prevention clinic that had been diagnosed with stroke within 60 days. To further assess criterion validity, miFUNCTION was compared against the mRS and other outcome measures within the ESCAPE trial. Logistic regression analysis with miFUNCTION as an outcome was used to demonstrate the benefit of endovascular treatment.

Results:
The pilot study showed moderate inter-observer agreement (k=0.585, p<0.005) but near perfect correlation between miFUNCTION and mRS (ρ=0.821, p<0.05). The correlation of miFUNCTION and mRS was near perfect again in the ESCAPE trial (ρ=0.944). Effect size of multivariable models using mRS (adjusted OR 3.45, 95% CI 2.05 – 5.78) and miFUNCTION (adjusted OR 3.32, 95% CI 1.99 – 5.55) as an outcome measure for the ESCAPE trial patients was similar.

Conclusions:
miFUNCTION is strongly associated with the degree of disability following stroke both in an outpatient setting and clinical trial. Further work remains to assess sensitivity to change and to improve the inter-observer reliability of the scale.
Abstract TP181: Community Based Outpatient Stroke Rehabilitation Program Achieve Excellent Outcomes Including Return to Work, Driving, Stroke Education Knowledge, and Other Rehabilitation Outcomes
Authors: Andrusin Jeanne , Breen Joan C , Keenan Julia , Monico Samantha , Garth Hannah
Published: January 2019

Background:
Return to driving and employment are goals for many stroke survivors. There are few reports of patient centered outcomes including return to employment, driving, self efficacy, functional outcomes, stroke knowledge or characteristics of patients who achieve these goals.

Methods:
Prospective observational study of stroke patients treated in an interdisciplinary outpatient rehabilitation program addressing physical, cognitive, communicative, risk factors/stroke knowledge, self efficacy, psychosocial, driving and vocational issues.

Results:
168 consecutive patients(104 men, 64 women, average age 62(18-90),61 aphasic)with baseline modified Rankin Scores of 5( 1%); 4(27%); 3(55%); 2(13%); 1(4%), and average NIHSS score of 6(range 0-16) were treated between 12/2011-7/2018. 116 patients suffered ischemic strokes(53 Left, 63 right, 24 bilateral hemisphere, 28 brainstem) and 52 had hemorrhages. 41% of patients had MCA territory strokes. Of 91 patients working pre-stroke, (47%) returned to work and and an additional 6% were work capable upon completion of program. 96% of patients driving pre-stroke could not drive at time of admission. After training, 45%(65/143) returned to driving. Patients had improvement in all 9 domains of Stroke Impact Scale with SIS total score improving an average of 26%. Patients received an average of 33 physical therapy visits with average percent improvement of 70% and 76% on 6 " walk and Berg Balance scores. Average Stroke Self Efficacy Scores improved from 74% to 82%. After individualized cardiovascular/stroke, and medication education sessions with the Nurse Practitioner based on AHA guidelines and Life's Simple 7's curriculum, Stroke Knowledge Quiz and risk factor knowledge scores improved 13% and 18%. Average length of stay was 5(range .5-20) months. Multiple other demographic and outcome measures are collected.

Conclusions:
Outcome data show a community-based team rehabilitation program can successfully combine cardiovascular education and rehabilitation services to maximize patient centered outcomes including return to work, driving, overall stroke recovery, physical functioning, stroke knowledge, and self efficacy for many types of stroke survivors with moderate to severe disability.
Abstract TP192: Trends in Hospital Admissions for Stroke Among Patients With Sickle Cell Disease
Authors: Esenwa Charles , Lekoubou Alain , Bishu Kinfe , Ovbiagele Bruce
Published: January 2019

Introduction:
Sickle cell disease (SCD) is a major risk factor for ischemic and hemorrhagic stroke. Approximately 10% of children with SCD will have a stroke, a rate that increases to nearly 25% by age 45. In adults with SCD, stroke management guidelines are limited and recent national trends in hospital admission and mortality are not known. We sought to describe the recent trends in national hospital admissions for ischemic stroke, associated mortality and other socio-demographic traits, among adult patients with SCD.

Methods:
The National Inpatient Sample (NIS) is a healthcare database that approximates a 20 percent stratified sample of all hospital discharges in the US. We queried the NIS from 2006-2014 using ICD-9 codes for a primary diagnosis of ischemic stroke and any secondary diagnosis of SCD. Our primary outcomes were hospital admission rates and mortality. We stratified admissions by presence of SCD and accounted for race (AA, Hispanic, NHW and other), sex, age, hospital characteristics, US region, household income, insurance type, disease severity and other factors using multivariable logistic regression.

Results:
We found a total of 1,052,442 observations for ischemic stroke from 2006-2014, of which 743 had a secondary diagnosis of SCD. Ischemic stroke and SCD accounted for 0.32% of all hospitalization in blacks, compared to 0.04 in whites and Hispanics each. Patients with both diagnoses were also much more likely to be younger, accounting for 0.57% of all admission in those 18-44 compared to only 0.02% in those older than 65. In the adjusted model, stroke admission rates among patients with SCD steadily declined from 2006-2008 compared to 2012-2014 (OR 0.82, CI 0.789-0.86). There was no difference in hospital mortality for patients with SCD compared to those without it (OR 1.2, CI 0.84-1.6). Having medicaid was associated with increased in mortality (OR 1.43, CI 1.37-1.51) and so was income, with the first quartile in income having the highest mortality OR 1.03, CI 1.01-1.05).

Conclusion:
Hospital admissions for ischemic stroke in adults with SCD have declined from 2006 to 2014. SCD remains an under-recognized stroke risk factor in young AA. Insurance type and income were associated with increased mortality.
Abstract TP201: Characterizing Left Atrial Mechanics and the Associations With Stroke Severity
Authors: Johansen Michelle C , Doria De Vasconcellos Henrique , Wright Amy E , Gottesman Rebecca F
Published: January 2019

Introduction:
The importance of left atrial (LA) function in cardioembolic stroke is increasingly recognized, but the associations between LA phasic function and ischemic stroke severity (admission NIH stroke scale (NIHSS)) is unknown. Two-dimension speckle tracking echocardiography (STE) allows an accurate, reproducible, and detailed assessment of the 3 components of the LA cycle.

Methods:
LA STE analysis was quantified using a post-processing wall motion tracking software according to standard definitions. Strain/strain rate curves for the 3 components of the LA cycle: 1) Reservoir (Maximum Global longitudinal strain (Smax)/strain rate (Srmax), total LA emptying fraction (tEF)) 2) Conductive (Early LA Strain rate (Sre), passive emptying fraction (pEF)) 3) Active (Late LA Strain rate (Sra), active emptying fraction (aEF)) were evaluated. The association of NIHSS (quintiles) with LA strain/strain rate was tested using ordinal logistic regression adjusted for covariates (Table 1)

Results:
Average participants (N=62) were middle aged, normotensive men. Incremental increases in Sre (worse LA conduction) was nonsignificantly associated with increased odds of higher NIHSS (OR 1.13 , 95%CI 0.67-1.88). Incremental increases in Sra (worse LA contraction) was associated with decreased odds of higher NIHSS that persisted after adjustment for demographics and LV function (OR 0.68, 95%CI 0.46-1.00). Better LA reservoir function (incremental Smax increases) was suggestive of decreased odds of worse stroke.

Conclusions:
This study suggest that odds of a more severe stroke is lower in patients with better LA reservoir function and worse LA contraction, but higher in participants with worse LA conductive function, mirroring the dynamic changes in diastolic dysfunction (impaired LA conduction, compensatory increase in contractile phase). Additional work to increase power and further characterize these associations is ongoing.
Abstract TP205: Higher Vascular Risk and Poorer Outcomes in Young Black and Hispanic Stroke Patients
Authors: Jones Erica M , Okpala Munachi , Parsha Kaushik , Keser Zafer , Kim Christina , Wang Austin , Okpala Nnedinma , Jagolino Amanda , Savitz Sean , Sharrief Anjail
Published: January 2019

Introduction:
Recent studies show rising incidence of stroke in the young, for which risk factors are not well characterized. There is evidence of increased risk in certain race and ethnic groups. We sought to assess racial differences in risk factors, stroke etiology, and outcomes among young stroke patients.

Methods:
Using data from our inpatient registry for ischemic stroke, we reviewed patients aged 18-50 who were admitted 01/2013 to 04/2018. Race/ethnicity were characterized as non-Hispanic White (NHW), non-Hispanic Black(NHB), Hispanic(HIS) and other groups were excluded given small numbers (<6%). For univariate comparisons chi-square, ANOVA and Kruskal-Wallis tests were performed as appropriate. Multivariate logistic regression was used to assess impact of race on day 7 modified Rankin score (mRS) .

Results:
Among 862 patients admitted in the study period, mean age was 40.9 (SD 7.8), 57.3% were male, and 36.4% NHW, 42.8% NHB, 20.8% HIS. History of hypertension (HTN), type II diabetes (DM II), smoking, heart failure (CHF), prior stroke, end stage renal disease, and triglycerides varied significantly by race (Table 1). Compared to NHW, NHB had higher odds of HTN (OR 2.2, CI 1.6-3.0), CHF (OR 2.3, CI 1.1-4.6), and DMII (OR 1.81, CI 1.2-2.7) while HIS had higher odds of DMII (OR 2.26, CI 1.4-3.6) and lower odds of smoking (OR 0.5, 0.3-0.8). Arrival NIHSS was higher in NHB, but etiology and rates of tpA treatment and thrombectomy did not vary by race. Compared to NHW patients, NHB (OR 0.5, CI 0.3-0.9 ) and HIS (OR 0.4 CI 0.2-0.9) were less likely to have good functional outcome (mRS <2) at day 7 in adjusted analyses.

Conclusions:
In this study, there was a higher prevalence of several modifiable risk factors in NHB and HIS young stroke patients and early functional outcome was worse in these groups. This suggests a need for targeted prevention efforts for younger populations at highest risk. The findings regarding outcomes deserve further study.
Abstract TP22: A Comparison of Clinical Outcomes Among Patients Receiving Mechanical Thrombectomies and tPA
Authors: Lei Stephanie , Cowperthwaite Matthew , Owunna Abigail , Nadasdy Zoltan , Shpak Max
Published: January 2019

Introduction:
The two treatment options for acute ischemic stroke (AIS) are tissue plasminogen activator (tPA), or mechanical thrombectomy (MT) for large-vessel occlusions. This study compares clinical outcomes among patients treated with tPA and MT, and the relationship between outcomes and the time to treatment.

Hypothesis:
Patients receiving MT and tPA have superior outcomes to those receiving no thrombolytic therapy, and the effects are greatest when treatment is administered shortly after admission.

Methods:
De-identified clinical data was obtained from 2191 stroke patients admitted to St. David’s Medical Center (Austin, TX), of whom 239 received tPA and 137 received MTs (45 received both). Acute ischemic stroke (AIS) patients were stratified into 4 groups defined by their admission NIH Stroke Scale (mild 0-5, moderate 6-15, moderate-severe 16-21, severe 21-42). Discharge modified Rankin Scores (mRS) were used to compare outcomes in 4 treatment groups: MT, tPA, both, neither, with significance assessed using t-tests. The relationships between outcomes and door to needle/groin time (DNT, DGT) were determined using linear regression.

Results:
Shorter DGT and DNT times are associated with lower mRS at discharge (DGT: partial correlation ρ
c
=0.040, p > 0.05; DNT: ρ
c
=0.258, p << 0.001). Among moderate and moderate-severe strokes, treatment with both MT and tPA was associated with significantly lower mRS scores than those treated with neither (p << 0.001), only MT (p = 0.005), or only TPA (p = 0.03). In moderate-severe strokes, MT alone was associated with significantly lower discharge mRS scores relative to untreated strokes (p = 0.03), whereas tPA was not. In mild and severe strokes, the differences in outcomes among the 4 treatment groups were small and not significant.

Conclusions:
This study suggests that strokes treated with both tPA and MT have better outcomes than strokes only one treatment, and that strokes treated with either tPA or MTs have better outcomes than untreated strokes. Shorter DNT times significantly improve outcomes for patients receiving tPA, whereas shorter DGT times are less strongly associated with improved outcomes. Our results highlight the importance of timely administration of stroke treatments to outcome improvement.
Abstract TP223: Increasing Stroke and MI Awareness in School Children
Authors: Vondrackova Lucie , Pokorna Hana , Svobodova Veronika , Grecu Andreea M , Jankujova Marie , Gatchalian Ezekiel J , Mikulik Robert
Published: January 2019

Background:
Lack of response to stroke symptoms is one of the most important reasons for patients late arrival to hospital. After we documented that stroke awareness campaign have very little effect on adults, we have developed program aiming to increase response to stroke symptoms in school children. Our study previously showed that, after one 45-minutes lesson, knowledge in stroke and MI in children increases, but does not retain at 3 months. Here we present results after additional lesson at 6 month was introduced.

Methodology:
Computer based 45 minutes lesson includes a) educational e-learning part and b) video records demonstrating different symptoms of stroke or MI to pretest and posttest the knowledge. Effect of two lessons at baseline and 6 months was tested as % of correct response to 8 questions/simulation video records.

Results:
Knowledge of 429 participating children increased by 8% (baseline pretest=62%; baseline posttest=70%, p<0.05) after the first lesson. The knowledge decreased after 6 months but increased again by 6% after the repeated lesson at 6 month (from 67% to 73 %, p<0.05).

Conclusion:
Retention at 6 months was moderate and second lesson at 6 month further but modestly improved children’s knowledge/response to stroke symptoms. One lesson is not enough; two lessons are better but still have moderate cumulative effect.
Abstract TP225: Prevalence and Impact of Intravascular Thrombosis in Patients With Cancer-Associated Stroke
Authors: Ha Jongmok , Lee Mi Ji , Kim Suk Jae , Chung Jong-Won , Seo Woo-Keun , Kim Gyeong-Moon , Chung Chin-Sang , Bang Oh Young , Ahn Myung-Ju
Published: January 2019

Background:
Increased risk of acute ischemic stroke is observed among cancer patients. Hypercoagulability is commonly observed in cancer-associated stroke, and is thus considered as a possible mechanism. In this study, we aimed to demonstrate intravascular thrombosis and its clinical impact in patients with cancer-associated stroke.

Methods:
We enrolled consecutive patients with embolic stroke of unknown source (ESUS) with or without active cancer in Samsung Medical Center from August 2014 to March 2018. We evaluated the presence of intravascular thrombosis, i.e. intravenous and intra-arterial thrombosis, by investigating the presence of deep vein thrombosis (DVT), microembolic signal (MES) and coagulation abnormalities in all patients. Infarct volumes on diffusion-weighted imaging and death dates were also collected.

Results:
Of 142 patients screened, 118 were included in this study (cancer group, n=37; non-cancer group, n=81). Cancer group had a higher prevalence of intravascular thrombosis compared to non-cancer group (62.2% vs. 19.8%, p <0.001). In patients with cancer-associated stroke, only intravenous thrombosis was associated with higher infarct volume (Beta = 13.14, 95% CI = 1.62 - 24.66, p = 0.028). Both intravenous and intra-arterial thrombosis were independently associated with poor survival (multivariable HR = 11.55, 95% CI = 1.82 - 73.41, p = 0.010 and multivariable HR = 6.45, 95% CI = 1.28 - 32.40, p = 0.024, respectively).

Conclusion:
Our study results provide evidences of increased intravascular thrombosis and their clinical impact in patients with cancer-associated stroke. Our findings may enhance the understanding of cancer-associated stroke and risk stratification of patients.
Abstract TP229: High Neutrophil-to-Lymphocyte Ratio Predicts Early Neurological Deterioration in Ischemic Stroke Patients
Authors: Kim Tae Jung , Nam Ki-Woong , Yoon Byung-Woo , Ko Sang-Bae
Published: January 2019

Introduction:
Ischemic stroke patients experienced frequent early neurological deterioration (END) events. Since ischemic stroke has also been shown as inflammatory disease, the neutrophil-to-lymphocyte ratio (NLR) may associated with END events. However, the direct study regarding this association has not been addressed.

Hypothesis:
We evaluated the association between NLR and END in ischemic stroke patients.

Methods:
We included consecutive ischemic stroke patients between 2010 and 2015. END was defined as an increase ≥ 2 on the total National Institutes of Health Stroke Scale (NIHSS) score or ≥ 1 on the motor NIHSS score within 72 hours of admission. The NLR was calculated as the ratio of the absolute neutrophil count to the absolute lymphocyte count.

Results:
A total of 1,152 patients were included. END occurred in 154 (13%) patients and the median NLR value was 2.47 [1.59-3.97]. In multivariate analysis, NLR remained an independent predictor of END [adjusted odds ratio (aOR) = 1.071, 95% confidence interval (CI) = 1.025 to 1.119,
P
= 0.002]. Age, initial thrombolysis treatment, fasting blood sugar, and total cholesterol levels were also significant, being independent of NLR values. These results were more prominent in large artery atherosclerosis group (aOR = 1.107, 95% CI = 1.031 to 1.188,
P
= 0.005), while stroke patients with small vessel occlusion (aOR = 1.114, 95% CI = 0.895 to 1.387,
P
= 0.335) or cardioembolic (aOR = 1.028, 95% CI = 0.912 to 1.159,
P
= 0.649) mechanisms did not show statistical significance.

Conclusions:
A high NLR level was associated with END in ischemic stroke patients, especially in large artery atherosclerosis patients. The NLR may hep to identify high-risk patients in time and provide clues for further studies about inflammatory pathophysiology of ischemic stroke.