bluuebunny/crossref_metadata_2025 huggingface dataset:
Variability in Carcinus maenas Fecundity Along Lagoons and Estuaries of the Portuguese Coast
Authors: Monteiro João N. , Ovelheiro Andreia , Ventaneira Ana M. , Vieira Vasco , Teodósio Maria Alexandra , Leitão Francisco
Published: January 2022

Although Carcinus maenas as a species is widely studied, research focusing on fecundity is still scarce. The main objective of this study was to evaluate size-fecundity relationships across different lagoons and estuaries, along the Portuguese coast, to understand how the local environment affects reproductive patterns. Between 2019 and 2020, ovigerous females were collected from the Southern (Ria Formosa and Ria de Alvor), Central (Rio Sado) and Northern regions (Ria de Aveiro) of Portugal, and the fecundity of each female was estimated by counting and weighing eggs. Morphometric relationships (carapace width–egg counting; egg counting–egg weight; body wet weight–egg weight; carapace width–body wet weight) were inferred from 180 egg-bearing females with a carapace width between 26.96 and 61.25 mm. A positive correlation between fecundity and the morphological parameters was observed. Differences in fecundity were found among all systems, from northern to southern Portugal, varying between 22121 and 408538 eggs per female. Furthermore, a regional gradient was observed across regions, with lower temperature estuaries (Ria de Aveiro) displaying an increase in fecundity. The fecundity in Rio Sado was also affected by salinity. Fecundity differences across regions were associated with hydrodynamics, temperature, and salinity differences among systems. No statistically significant differences were observed between Carapace Width—Body Wet Weight regressions performed in each studied system, indicating that, contrary to fecundity, the somatic growth of C. maenas is not affected by latitudinal or environmental conditions.
Ferulic Acid Alleviates Atherosclerotic Plaques by Inhibiting VSMC Proliferation Through the NO/p21 Signaling pathway
Authors: Wu Xiaoyun , Hu Ziwei , Zhou Junjie , Liu Jin , Ren Ping , Huang Xi
Published: January 2022

The benefits and risks of inhibiting the proliferation and migration of vascular smooth muscle cells (VSMCs) in atherosclerosis (AS) remain a subject of debate. In this study, we investigated the effect of ferulic acid (FA) on the proliferation and migration of VSMCs induced by platelet-derived growth factor (PDGF) and the associated mechanism and used ApoE-/- mice to study whether the effect of FA on VSMC proliferation and migration is beneficial in alleviating AS plaques. It was found that FA not only reduced blood lipid levels but also promoted the production of nitric oxide (NO) by MOVAS cells through the endothelial nitric oxide synthase (eNOS) pathway, inhibited the migration and proliferation of VSMCs induced by PDGF, promoted the expression of p21 in VSMCs, and exerted a therapeutic effect against AS.
The Futures of Europe: Society 5.0 and Industry 5.0 as Driving Forces of Future Universities
Authors: Carayannis Elias G. , Morawska-Jancelewicz Joanna
Published: January 2022

The concept of Society 5.0 and Industry 5.0 is not a simple chronological continuation or alternative to Industry 4.0 paradigm. Society 5.0 aims to place human beings at the midpoint of innovation, exploiting the impact of technology and Industry 4.0 results with the technological integration to improve quality of life, social responsibility and sustainability. This ground-breaking perspective has common points with the objectives of the United Nations Sustainable Development Goals. It also has major implication for universities transformations. Universities are called upon producing knowledge for new technologies and social innovation. In our paper, we argue that digitalisation opens new perspectives for universities and can become one of the main drivers of their change. Incorporating the assumptions of Society 5.0 and Industry 5.0 into the universities practices and policies will allow both universities and societies to fully benefit from digital transformation. Making the human-oriented innovation as the universities trademark and developing new cooperative models will also help to achieve sustainable priorities. The use of the Quintuple Helix Model (QHM) might foster the process of necessary transformations capacities as it integrates different perspectives and sets the stage for sustainability priorities and considerations. As far as the practical goal is concerned, the paper proposes a set of recommendations for universities aiming at developing new forms and channels of distribution of education, research and innovation within in the context of QHM and Society 5.0. We call them socially and digitally engaged model.
Endoscopic and Robotic Stapes Surgery: Review with Emphasis on Recent Surgical Refinements
Authors: Sheppard Sean C. , Caversaccio Marco D. , Anschuetz Lukas
Published: January 2022

Purpose of Review

Stapes surgery has been established as the gold standard for surgical treatment of conductive hearing loss in otosclerosis. Excellent outcomes with very low complication rate are reported for this surgery. Recent advances to improve surgical outcome have modified the surgical technique with endoscopes, and recent studies report development of robotical assistance. This article reviews the use of endoscopes and robotical assistance for stapes surgery.

Recent Findings

While different robotic models have been developed, 2 models for stapes surgery have been used in the clinical setting. These can be used concomitant to an endoscope or microscope. Endoscopes are used on a regular base regarding stapes surgery with similar outcomes as microscopes. Endoscopic stapes surgery shows similar audiological results to microscopic technique with an advantage of less postoperative dysgeusia and pain. Its utility in cases of revision surgery or malformation is emphasized.

Endoscopic stapes surgery is used on a regular basis with excellent outcomes similar to the microscopic approach, while reducing surgical morbidity. Robotic technology is increasingly being developed in the experimental setting, and first applications are reported in its clinical use.
Neurochemical and Hormonal Contributors to Compulsive Sexual Behavior Disorder
Authors: Chatzittofis Andreas , Boström Adrian Desai E. , Savard Josephine , Öberg Katarina Görts , Arver Stefan , Jokinen Jussi
Published: January 2022

Purpose of Review

Compulsive sexual behavior disorder has been recently included in the 11th revision of the International Classification of Diseases (ICD-11), and the possible contribution of neurochemical and hormonal factors have been reported. However, relatively little is known concerning the neurobiology underlying this disorder. The aim of this article is to review and discuss published findings in the area.

Recent Findings

Evidence suggests that the neuroendocrine systems are involved in the pathophysiology of compulsive sexual behavior. The hypothalamus-pituitary adrenal axis, the hypothalamus-pituitary–gonadal axis, and the oxytocinergic system have been implicated.

Further studies are needed to elucidate the exact involvement of neuroendocrine and hormonal systems in compulsive sexual behavior disorder. Prospective longitudinal studies are particularly needed, especially those considering co-occurring psychiatric disorders and obtaining hormonal assessments in experimental circumstances with appropriate control groups.
Structural Racism as an Environmental Justice Issue: A Multilevel Analysis of the State Racism Index and Environmental Health Risk from Air Toxics
Authors: Alvarez Camila H.
Published: January 2022

Communities of color and poor neighborhoods are disproportionately exposed to more air pollution—a pattern known as environmental injustices. Environmental injustices increase susceptibility to negative health outcomes among residents in affected communities. The structural mechanisms distributing environmental injustices in the USA are understudied. Bridging the literatures on the social determinants of health and environmental justice highlights the importance of the environmental conditions for health inequalities and sheds light on the institutional mechanisms driving environmental health inequalities. Employing a critical quantitative methods approach, we use data from an innovative state racism index to argue that systematic racialized inequalities in areas from housing to employment increase outdoor airborne environmental health risks in neighborhoods. Results of a multilevel analysis in over 65,000 census tracts demonstrate that tracts in states with higher levels of state-level Black–white gaps report greater environmental health risk exposure to outdoor air pollution. The state racism index explains four-to-ten percent of county- and state-level variation in carcinogenic risk and noncarcinogenic respiratory system risks from outdoor air toxics. The findings suggest that the disproportional exposure across communities is tied to systematic inequalities in environmental regulation and other structural elements such as housing and incarceration. Structural racism is an environmental justice issue.
NETME: on-the-fly knowledge network construction from biomedical literature
Authors: Muscolino Alessandro , Di Maria Antonio , Rapicavoli Rosaria Valentina , Alaimo Salvatore , Bellomo Lorenzo , Billeci Fabrizio , Borzì Stefano , Ferragina Paolo , Ferro Alfredo , Pulvirenti Alfredo
Published: January 2022

Background

The rapidly increasing biological literature is a key resource to automatically extract and gain knowledge concerning biological elements and their relations. Knowledge Networks are helpful tools in the context of biological knowledge discovery and modeling.

Results

We introduce a novel system called NETME, which, starting from a set of full-texts obtained from PubMed, through an easy-to-use web interface, interactively extracts biological elements from ontological databases and then synthesizes a network inferring relations among such elements. The results clearly show that our tool is capable of inferring comprehensive and reliable biological networks.
GP.5 Entropy on routine EEG: an interictal marker of seizure
frequency?
Authors: Lemoine É , Tessier J , McDuff G , Robert M , Toffa D , Lesage F , Nguyen DK , Bou Assi E
Published: January 2022

Background: Sample entropy (SampEn) can quantify
the unpredictability of a physiological signal. We sought to assess if
SampEn on EEG could reflect recent seizure activity.
Methods: Charts of all patients undergoing an
outpatient EEG between January and March 2018 were reviewed to assess
seizure occurrences in the follow-up period between the two clinical visits
surrounding the EEG. 9s-EEG segments were extracted at pre-specified time
points. SampEn was calculated for all segments and values aggregated at the
25thpercentile. We performed a multivariate
zero-inflated analysis to test the association between SampEn and seizure
rate around the EEG, after controlling for age, presence of IED, presence of
abnormal slowing, and presence of a focal brain lesion.
Results: 269 EEGs were screened and 133 met
inclusion criteria (112 patients). 80 EEGs (60%) were from patients with
epilepsy, of which 47 had at least one seizure within the year preceding the
EEG. Remaining EEGs were from patients who were deemed not to have epilepsy
at last follow-up. Each 1SD decrease in SampEn was associated with a
3.93-fold increase in the rate of daily seizures (95% CI: 1.19–12.99, p =
0.02). Conclusions: Sample entropy of EEG is a
potential objective method to assess contemporary seizure
occurrence.
A.2 Clinical application of T1-w/T2-w ratio images for in vivo
comparisons of myelin content in patients with trigeminal neuralgia
Authors: Li C , Chu PP , Hung P , Mikulis D , Hodaie M
Published: January 2022

Background: Novel magnetic resonance (MR) imaging
techniques prompted the emergence of T1-w/T2-w images or “myelin-sensitive
maps (MMs)” to measure myelin in vivo. However,
acquisition-related variations in MR intensities prevent meaningful
quantitative comparisons between MMs. We propose an improved pipeline to
standardize MMs that is applied to patients with classic trigeminal
neuralgia (CTN) and trigeminal neuralgia secondary to multiple sclerosis
(MSTN). Methods: 3T scanner was used to obtain T1-w
and T2-w images for 17 CTN and 17 MSTN patients. Template images were
obtained from ICBM152 database. MS plaques and normal-appearing white matter
(NAWM) were labelled. A Gaussian curve-fit was applied to the histogram of
the intensity distribution of each patient image, and transformed to match
the Gaussian curve-fit of the template image.
Results: MM intensities were decreased within MS
plaques, compared to NAWM in MSTN patients
(p<0.001) and its corresponding regions in
CTN patients (p<0.001). Qualitatively, the
standardized patient image and its histogram better resembled the ICBM152
template. Conclusions: MM analysis revealed reduced
myelin content in MS plaques compared to corresponding regions in CTN
patients and surrounding NAWM in MSTN patients. The standardized MM serves
as a non-invasive, clinical tool for quantitative analyses of myelin content
between different brain regions and different patients in
vivo.
A.7 In vivo hippocampal mGluR5 abnormalities predict MTLE post-surgical
outcome
Authors: Lam J , DuBois JM , Rowley J , Rousset OG , González-Otárula KA , Soucy J , Massarweh G , Hall JA , Guiot M , Zimmermann M , Minuzzi L , Rosa-Neto P , Kobayashi E
Published: January 2022

Background: PET imaging of
[11C]ABP688 shows reduced hippocampal mGluR5
availability in mesial temporal lobe epilepsy (MTLE) patients, however the
relation with post-surgical outcomes is unclear. Here, we tested whether
[11C]ABP688 binding in hippocampal subfields
vulnerable to glutamate excitotoxicity is related to post-surgical outcome.
Methods: [11C]ABP688-PET was
obtained from 31 unilateral MTLE patients and 30 controls. Hippocampal
subfields were automatically segmented into 1) CA1-3, 2) CA4/dentate gyrus
(DG), and 3) Subiculum and manually corrected. Partial volume corrected
[11C]ABP688 non-displaceable binding potential
(BPND) was calculated in the subfields and compared
between seizure-free and non-seizure-free patients.
Results: [11C]ABP688
BPND was significantly reduced in ipsilateral CA1-3
& CA4/DG (p<0.001) compared to controls. No difference was seen in
Subiculum. Ipsilateral CA1-3 [11C]ABP688
BPND was lower in seizure-free (p=0.012; Engel Ia,
n=13) vs non-seizure-free (Engel Ic-III, n=10) patients, and this effect was
independent of subfield volume. In a subset of patients with
[18F]FDG-PET, CA1-3
[11C]ABP688 BPND was significantly
lower in seizure-free patients (p=0.03), while no difference was found for
[18F]FDG uptake.
Conclusions: Reduced CA1-3 mGluR5 availability
was associated with post-surgical seizure-freedom independent of atrophy and
hypometabolism. Thus, [11C]ABP688-PET may offer a
potential biomarker for surgical outcomes and may be particularly relevant
for pre-surgical workup in MRI- and [18F]FDG-negative
MTLE patients.
B.3 The incidence of perinatal stroke is 1:1200 births in Southern
Alberta: Population-based incidence of disease-specific perinatal
stroke
Authors: Dunbar M , Hodge J , Floer A , Kirton A
Published: January 2022

Background: Perinatal stroke encompasses six
cerebrovascular syndromes which occur between the 20th
week of gestation and the 28th post-natal day. Subtypes
are neonatal arterial ischemic stroke (NAIS), neonatal cerebral sinovenous
thrombosis (CSVT), neonatal hemorrhagic stroke (NHS), arterial presumed
perinatal ischemic stroke (APPIS), periventricular venous infarction (PVI),
and presumed perinatal hemorrhagic stroke (PPHS). Inconsistent terminology
and lack of population-based case series has limited accurate measurement of
disease-specific perinatal stroke incidence. Our objective was to define the
incidence of the subtypes of perinatal stroke using a population-based
cohort. Methods: The Alberta Perinatal Stroke Project
is a research cohort established in 2008 in Southern Alberta. Case
acquisition included retrospective hospital and ICD code searches
(1990-2008) and prospective enrollment from all NICU and neurology/stroke
clinics (2008-2017). Results: The overall incidence
of perinatal stroke in Southern Alberta was 9.0 cases per 10,000 births, or
1:1200 births. Per 10,000 births, the incidence of each subtype was: NAIS =
3.2 (~1:3000), APPIS =1.2 (~1:8500), PVI = 1.5 (~1:6500), CSVT = 1.0
(~1:9900), NHS = 1.4 (~1/7300), PPHS = 0.1 (1/82,000).
Conclusions: The overall incidence of perinatal
stroke in Southern Alberta is 1:1200 live births. Population-based sampling
of disease-specific states may explain why this rate is much higher than
previous estimates
B.4 Use of Health Care Resources by Pediatric Headache Patients: A
population-based cohort study In the Province of Alberta
Authors: Rajapakse T , Bakal J , Mailo J , Nabipoor M , Kassiri J , Richer L
Published: January 2022

Background: Headache is a prevalent and disabling
condition in children. It is a frequent cause of medication and health
resource use in children. We examined the incidence and nature of health
service use of the pediatric patient population in Alberta using provincial
linked administrative databases. Methods: We used
linked administrative data to identify patients under the age of 18 years
from 2010-2017 and ICD-10 headache type at diagnosis and health service
utilization including cost, medication use, outpatient/ED visits and
hospitalizations. Patient geographic location was mapped. We explored health
system use in the 3 years before and after diagnosis by identifying visits
to community physicians, outpatient clinics emergency departments an
inpatient admissions. Results: Over the 7 year study
period 45,454 patients were identified under 18 years, 60% of patients first
diagnosed with migraine, 11.7% (5308) with tension headache and 28.2
(12,833) with unspecified headache. Higher health system utilization seen
immediately before and after headache diagnosis, returning to pre-diagnosis
values within the 3 years following. Conclusions:
This is the first population based reporting of pediatric headache
prevalence and health resource utilization in Alberta. This contemporary
prevalence and health resource data use should help inform future policy and
headache care in the province of Alberta.
C.3 Activated Gene Pathways in Post-Infectious Hydrocephalus (PIH):
Proteogenomics and the PIH Expressome
Authors: Isaacs AM , Morton S , Movassagh M , Zhang Q , Hehnly C , Zhang L , Morales D , Townsend RR , Limbrick DD , Paulson JN , Schiff SJ ,   Control of
                        Neonatal Sepsis and Hydrocephalus in Africa (CONSHA) Group ()
Published: January 2022

Background: Proteogenomics, the integration of
proteomics and RNASeq expands the discovery landscape for candidate
expressed gene networks to obtain novel insights into host response in
post-infectious hydrocephalus (PIH). We examined the cerebrospinal fluid
(CSF) of infants with PIH, and case controlled against age-matched infants
with non-postinfectious hydrocephalus (NPIH) to probe the molecular
mechanisms of PIH, leveraging molecular identification of bacterial and
viral pathogens. Methods: Ventricular CSF samples of
100 infants ≤ 3 months of age with PIH (n=64) and NPIH (n=36) were analyzed
with proteomics and RNASeq. 16S rRNA/DNA sequencing and virome capture
identified Paenibacillus spp. and cytomegalovirus
as dominant pathogenetic bacteria implicated in our PIH cohort.
Proteogenomics assessed differential expression, gene set enrichment and
activated gene pathways. Results: Of 616 proteins and
11,114 genes, there was enrichment for the immune system, cell-cell junction
signaling and response to oxidative stress. Proteogenomics yielded 33
functionally and genetically associated gene sets related to neutrophil
activation, platelet activation, and cytokines (interleukins and interferon)
signaling. Conclusions: We identified PIH patients
with severe disease at time of hydrocephalus surgery, to have differential
expression of proteins/genes involved in neuroinflammation, ependymal
barrier integrity and reaction to oxidative stress. Further studies are
needed to examine those proteins/genes as biomarkers for PIH.
P.215 Tumor Heatmaps – Feedback Tool for Virtual Reality Neurosurgical
Simulation
Authors: Sawaya R , Yilmaz R , Bugdadi A , Winkler-Schwartz A , Azarnoush H , Alsideiri G , Del Maestro R
Published: January 2022

Background: Performance Heatmaps were designed to
visualize the spatial distribution of performance metrics during resection
of complex tumors. This novel methodology provides experts (neurosurgeons)
and trainees (residents and medical students) with visual feedback on their
neurosurgical performance during operative procedures.
Methods: Neurosurgeons (NS), senior residents
(SR), junior residents (JR) and medical students (MS) performed resection of
a complex tumor on the NeuroVR simulation platform. Metrics including time
spent, force applied, and tumor volume removed were used to create
Performance Heatmaps for each group. Results: During
complex operative procedures, greater expertise correlated increased time
spent in critical areas (NS = 121.0 s, SR = 103.0 s, JR = 86.1 s, MS = 84.9
s), increased force application (NS = 387 N, SR = 317 N, JR = 340 N, MS =
304 N), and increased tumor removal (NS = .096 cc, SR = .081 cc, JR = .074
cc, MS = .069 cc). Conclusions: Performance Heatmaps
further our understanding of neurosurgical expertise by identifying key
differences between experts (neurosurgeons) and trainees (residents and
medical students). With the adoption of competency-based curricula,
intuitive feedback tools will prove essential for trainees seeking surgical
mastery.
P.002 Successful Treatment of Supra-Refractory Status Epilepticus
Secondary to Anti-N-Methyl-D- Aspartate Receptor Encephalitis With
Electroconvulsive Therapy
Authors: AlSabah A , Alshukaili A , Teitelbaum JS
Published: January 2022

Background: Anti-N-Methyl-D-Aspartate (NMDA)
receptor encephalitis is an autoimmune disease associated with antibodies
against heteromers NR1 and NR2 subunits of the cell surface of the NMDA
receptors, causing many psychiatric and neurological symptoms. This includes
new-onset refractory status epilepticus. Methods: A
33-year-old previously healthy female developed new-onset refractory status
epilepticus caused by anti- NMDA receptor encephalitis without the presence
of tumours. Results: The clinical course was
complicated by prolonged status epilepticus, which was refractory to many
antiepileptic drugs (levetiracetam, phenytoin, carbamazepine, topiramate,
lacosamide, valproic acid), ketamine, propofol, midazolam, including
inhalation agents (isoflurane). Also, she received first (intravenous
immunoglobulin, intravenous methylprednisolone, and plasmapheresis),
second-line immunotherapy (rituximab) and prophylaxis bilateral oophorectomy
without clinical or electrographic improvement. However, the patient
drug-resistant status epilepticus markedly improved both clinically and
electrographically following seven sessions of electroconvulsive therapy.
Conclusions: Electroconvulsive therapy should be
considered as adjuvant therapy for the treatment of immunotherapy resistant
encephalitis.
P.020 The North American AED Pregnancy Registry: A Canadian Subgroup
Analysis (1997-2019)
Authors: Hébert J , Conant SN , Holmes LB , Bui E
Published: January 2022

Background: This study aims to provide data on
the care of pregnant women with epilepsy (pWWE) that is directly applicable
to the Canadian context. Methods: Between 1997 and
2019, pWWE from Canada and the USA who enrolled into the North American AED
Pregnancy Registry (NAARP) completed a questionnaire on their AED
(anti-epileptic drug) usage. Enrollment rates to NAARP were compared between
the two countries, and between the different Canadian provinces using
population-based enrollment rate ratios (PERR). The AED prescription pattern
among Canadian pWWE was analysed and compared with the USA.
Results: During the study period, 10,215 women
enrolled into NAARP : 4.1% (n=419) were Canadian, below the expected
population-based contribution (PERR=0.42; p<0.01). Within Canada, the
three northern territories (PERR=0; p<0.01), Prince-Edward Island
(PERR=0; p<0.01), and Quebec (PERR=0.41; p<0.01) had the lowest
enrollment rate ratios. Lamotrigine was the most commonly prescribed AED
among canadian pWWE; they were, however, more likely to be on polytherapy
(25%; p=0.13), on Carbamazepine (24%; p<0.01)
or valproic acid (21%; p<0.01) than their
American counterparts. Conclusions: Greater
enrollment of Canadian women to NAARP, through enhanced clinician referrals,
in particular from underrepresented provinces/territories, could lead to
more accurate population-specific data and help identify gaps in the care of
this vulnerable patient population.
P.021 Electdetect: An Artificial Neural Network for the Detection of
Artifacts in intracranial EEG Recordings From Patients with Epilepsy
Authors: Istasy M , Schjetnan AG , Talakoub O , Valiante T
Published: January 2022

Background: Intracranial electroencephalography
(iEEG) recordings are obtained from the sampling of sub-cortical structures
and provide extraordinary insight into the spatiotemporal dynamics of the
brain. As these recordings are increasingly obtained at higher channel
counts and greater sampling frequencies, preprocessing through visual
inspection is becoming untenable. Consequently, artificial neural networks
(ANNs) are now being leveraged for this task.
Methods: One-hour recordings from six patients
diagnosed with drug-resistant epilepsy at Toronto Western Hospital were
obtained alongside fiduciary ECG and EOG activity. R-wave peaks and local
maxima were identified in the ECG and EOG recordings, respectively, and were
time-mapped onto the iEEG recordings to delimit one-second epochs around 1.6
million cardiac and 600 thousand ocular artifacts. Epochs were then split
into train-test-evaluation sets and fed into an ANN as one-second
spectrograms (0 - 1,000 Hz) over 30-time steps.
Results: The ANN model achieved formidable
classification results on the evaluation set with an F1, positive predictive
value, and sensitivity scores of 0.93. Furthermore, model architecture
computed the classification probability at each time-step and enabled
insight into the spatiotemporal features driving classification.
Conclusions: We expect this research to promote
the public sharing of new ANN from multiple institutions and enable novel
automated algorithms for artifact detection in iEEG recordings.
P.022 The effect of vagus nerve stimulation on the quality of sleep in
medically refractory epileptic patients
Authors: Seth J , Suller-Marti A
Published: January 2022

Background: The quality of sleep is frequently
impacted in patients with epilepsy. Vagus Nerve Stimulation is a relatively
common treatment used in patients with medically resistant epilepsy. Some
studies show an improvement in quality of life, however, there is limited
data on the impact on sleep quality. Methods: A
database analysis was conducted on Medline, Embase, and Cochrane to find
studies that examined the VNS’s effect on quality of sleep in medically
resistant epilepsy. These studies included randomized clinical trails, case
studies or reports, cohort studies, and systematic reviews.
Results: 75 papers were reviewed and 16 studies
from eight countries were included in the analysis. A total of 93 patients
with ages ranged from 10 – 49 were included. Analyzing the change in the
quality of sleep after VNS was evaluated using Multiple Sleep Latency Test.
The literature showed that at low stimulus intensities, VNS treatment
improves daytime sleepiness in patients. However, VNS setting titration has
a dose-dependent effect on obstructive sleep apnea where higher VNS
frequencies are related to higher apnea events.
Conclusions: Limited data is available on the
impact of VNS on the quality of sleep. Further studies are required to
evaluate the improvement of sleep in patients with VNS.
P.024 A multi-faceted lifestyle intervention for mitochondrial A8344G
associated multiple symmetric lipomatosis (MSL): a successful patient
initiated novel therapy
Authors: Mezei MM , Nadeau E , Cresswell M , Dupuis I , Allin E , Mattman A
Published: January 2022

Background: A female carrying the common MERRF
mitochondrial DNA A8344G mutation had multiple symmetric lipomatosis (MSL)
as the primary disease manifestation. Methods: Case
report of a mitochondrial disease patient treating her severe lipomas by
lifestyle modifications including a modified ketogenic diet.
Results: The patient required lipoma reduction
surgery after a rapid rate of lipoma progression. Following a difficult
recovery, the patient independently researched an alternative therapy for
her disease. The intervention was multi-faceted (dietary, physical activity,
meditation) and progressive over two years. A carbohydrate reduced (5–10% of
calories) modified ketogenic diet was a major part of the treatment owing to
its incidental success in MSL management in her brother for management of
glioblastoma multiforme. The outcome of her intervention was positive:
weight loss, lipoma size reduction, improvement in physical
activity/strength, laboratory markers of insulin resistance, and sense of
well including a return to full time work.
Conclusions: A potential non-surgical therapy for
mitochondrial disease associated MSL appears feasible over the short term.
The success of the lifestyle intervention in MSL therapy is unprecedented
and, importantly, was fully patient initiated. This novel therapy provides
potential insight into the mechanism of MSL exacerbation: suggesting insulin
resistance or other lifestyle modifiable factors as mediators of disease
progression.
P.025 Efficacy and safety results of the avalglucosidase alfa phase 3
COMET trial in participants with late-onset Pompe disease (LOPD)
Authors: Tarnopolsky M , Attarian S , Borges J , Bouhour F , Choi Y , Clemens P , Day J , Díaz-Manera J , Erdem-Ozdamar S , Goker-Alpan O , Illarioshkin S , Kishnani PS , Kostera-Pruszczyk A , Kushlaf H , Ladha S , Mozaffar T , Roberts M , Straub V , Toscano A , van der Ploeg AT , An Haack K , Hug C , Huynh-Ba O , Johnson J , Zhou T , Dimachkie MM , Schoser B ,   on behalf of the
                        COMET Study Group ()
Published: January 2022

Background: Phase 3 COMET trial (NCT02782741)
compares avalglucosidase alfa (n=51) with alglucosidase alfa (n=49) in
treatment-naïve LOPD. Methods: Primary objective:
determine avalglucosidase alfa effect on respiratory muscle function.
Secondary/other objectives include: avalglucosidase alfa effect on
functional endurance, inspiratory/expiratory muscle strength, lower/upper
extremity muscle strength, motor function, health-related quality of life,
safety. Results: At Week 49, change (LSmean±SE) from
baseline in upright forced vital capacity %predicted was greater with
avalglucosidase alfa (2.89%±0.88%) versus alglucosidase alfa
(0.46%±0.93%)(absolute difference+2.43%). The primary objective, achieving
statistical non-inferiority (p=0.0074), was met. Superiority testing was
borderline significant (p=0.0626). Week 49 change from baseline in 6-minute
walk test was 30.01-meters greater for avalglucosidase alfa (32.21±9.93m)
versus alglucosidase alfa (2.19±10.40m). Positive results for
avalglucosidase alfa were seen for all secondary/other efficacy endpoints.
Treatment-emergent adverse events (AEs) occurred in 86.3% of avalglucosidase
alfa-treated and 91.8% of alglucosidase alfa-treated participants. Five
participants withdrew, 4 for AEs, all on alglucosidase alfa. Serious AEs
occurred in 8 avalglucosidase alfa-treated and 12 alglucosidase alfa-treated
participants. IgG antidrug antibody responses were similar in both. High
titers and neutralizing antibodies were more common for alglucosidase alfa.
Conclusions: Results demonstrate improvements in
clinically meaningful outcome measures and a more favorable safety profile
with avalglucosidase alfa versus alglucosidase alfa.
Funding: Sanofi Genzyme
P.031 A Rare Canadian Case of Cervical Pyomyosistis Presenting as
Occipital Neuralgia
Authors: Girgis H , Ziller M
Published: January 2022

Background: Pyomyositis is an infectious disease
usually encountered in tropical regions. It typically occurs in
immunocompromised hosts and most commonly affects lower limb muscles. Our
patient was a healthy Canadian with an atypical presentation of cervical
pyomyositis. Methods: We report a case of a healthy
22-year old woman presenting to the emergency department with unprovoked
severe bilateral cervico-occipital pain and nuchal rigidity. She remained
afebrile. Review of the literature was conducted to search for similar
presentations. Results: A Computed Tomography scan of
the head and neck demonstrated the presence of a ring enhancing lesion in
the semispinalis capitis muscle extending from the occiput to the C4 level.
The abscess was surgically drained and cultures grew staphylococcus aureus.
The patient rapidly improved on intravenous antibiotics. Literature review
revealed this to be the first Canadian case of cervical pyomyositis.
Conclusions: Cervical pyomyositis can be
complicated by local destruction of the vertebrae, septic shock,
endocarditis, septic emboli, brain abscess or rhabdomyolysis. Early
diagnosis and source control is necessary to reduce the risk of morbidity.
Therefore, it is important to consider this rare disease in the differential
diagnosis of cervicalgia even in healthy immunocompetent patients.
P.033 Eptinezumab reduced acute medication use in patients with chronic
migraine and medication-overuse headache: subgroup analysis of
Promise-2
Authors: Marmura MJ , Diener H , Hirman J , Cady R , Brevig T , Brunner E , Minhas S , Mehta L
Published: January 2022

Background: Eptinezumab is a preventive migraine
treatment approved in the US. We evaluated the impact of eptinezumab on
acute headache medication (AHM) use in patients diagnosed with chronic
migraine (CM) and medication-overuse headache (MOH) in PROMISE-2.
Methods: PROMISE-2 randomized patients with CM to
eptinezumab 100mg, 300mg, or placebo for 2 intravenous doses administered
every 12 weeks. Trained investigators diagnosed MOH at screening using
3-month medication history and ICHD-3b criteria. Endpoints included
days/month of any AHM use (days of ≥1 medication class), total AHM use
(summed days for each medication class), and triptan use over Weeks 1-12 and
13-24. AHM classes included triptan, ergot, opioid, simple analgesic, and
combination analgesic. Results: Of 1072 PROMISE-2
patients, 431 (40.2%) were diagnosed with MOH (100mg, n=139; 300mg, n=147;
placebo, n=145). During the 28-day baseline period, mean days of any AHM was
~16.4, total AHM was ~20.4, and triptan was ~8.9 across treatment arms. Over
Weeks 1-12, mean days/month of any AHM was 8.8 (100mg), 9.9 (300mg), and
11.8 (placebo); total AHM was 10.8, 12.2, and 14.8; triptan was 4.3, 4.4,
and 6.4. Similar or lower rates were observed over Weeks 13-24.
Conclusions: In patients diagnosed with both CM
and MOH, eptinezumab treatment reduced AHM use.
P.034 Eptinezumab Demonstrated Early Relief from Episodic and Chronic
Migraine: Consistency of Effect Across 4 Clinical Trials
Authors: Dodick DW
Published: January 2022

Background: Eptinezumab is approved in the US for
migraine prevention. We demonstrate the consistency in migraine reduction
from Day 1 across 4 weeks in patients with episodic (EM) or chronic migraine
(CM) treated with eptinezumab. Methods: Four
double-blind, placebo-controlled, randomized trials evaluated eptinezumab
for migraine prevention: NCT01772524 (EM); NCT02559895 (EM, PROMISE-1);
NCT02275117 (CM); NCT02974153 (CM, PROMISE-2). The percentage of patients
experiencing migraine was evaluated on Day 1, then as an averaged daily
occurrence weekly through Wk4; baseline was averaged over the 28-day
screening period. Results: Approximately 31% of EM
patients experienced migraine on any given day during baseline. PROMISE-1
percentages of patients with migraine on Day 1: 14.8% (100mg), 13.9%
(300mg), 22.5% (placebo); during Wk4: 17.1%, 15.8%, 20.5%. NCT01772524 on
Day 1: 4.8% (1000mg), 13.7% (placebo); during Wk4: 10.0%, 17.6%.
Approximately 58-59% of CM patients experienced migraine on any given day
during baseline. PROMISE-2 percentages on Day 1: 28.6% (100mg), 27.8%
(300mg), 42.3% (placebo); during Wk4: 31.8%, 28.8%, 36.0%. NCT02275117 on
Day 1: 29.3% (100mg), 26.5% (300mg), 48.7% (placebo); during Wk4: 30.2%,
30.1%, 41.0%. Conclusions: Across 4 migraine
prevention trials, eptinezumab consistently demonstrated rapid onset of
migraine preventive benefit, beginning Day 1 after initial treatment and
sustained through ≥4 weeks.
P.041 First Degree Movement Disorders Cases and Research
Authors: Rajput A , Eanes S , Rajput AH
Published: January 2022

Background: While researchers pursue the
etiology, pathophysiology and treatment of movement disorders, presently
there is no biological marker for the two most common disorders – essential
tremor (ET), and Parkinson’s disease and variants (Parkinson syndrome, or
PS). The diagnosis of each remains clinical, but definitive diagnosis is
made on brain pathology. Population epidemiological studies are hampered by
a lack of diagnostic precision. Twins with the same disorder are scarce, and
the next best option is studies of well-documented first-degree family
members. Methods: Patients were seen at the
Saskatchewan Movement Disorders Program (SMDP). All autopsied cases with
known clinicopathological diagnosis of a movement disorder between 1970 and
2019 were reviewed. Only those with a first-degree family member – parent,
child, and/or sibling - with a movement disorder were included.
Results: 671 cases with movement disorders seen
at SMDP have been autopsied. 29 cases including probands were found and
thirteen first-degree families were identified; eight families were multiple
(2 or more) siblings and five families included one parent/one child. In
seven families, the diagnosis was concordant.
Conclusions: Movement disorders in first degree
relatives with autopsied verified diagnosis are dissimilar in nearly half
the cases. Such small intensively studied groups offer unique research
opportunities.
P.219 The effect of peri-operative adverse events on long-term patient
reported outcomes after lumbar spine surgery
Authors: Ayling O , FIsher C
Published: January 2022

Background: Peri-operative adverse events (AE)
lead to patient disappointment and greater costs. There is a paucity of data
on how AEs affect long-term outcomes. The purpose of this study is to
examine peri-operative AEs and their impact on outcome after lumbar spine
surgery. Methods: 3556 consecutive patients
undergoing surgery for lumbar degenerative disorders enrolled in the
Canadian Spine Outcomes and Research Network were analyzed. AEs were defined
using the validated Spine AdVerse Events Severity system. Outcomes at 3,12,
and 24 months post-operatively included the Owestry Disability Index (ODI),
SF-12 Physical (PCS) and Mental (MCS) scales, visual analog scale (VAS) leg
and back, Euroqol-5D (EQ5D), and satisfaction.
Results: Adverse events occurred in 767 (21.6%)
patients, 85 (2.4%) suffered major AEs. Patients with major AEs had worse OD
(physical disability) scores and did not reach minimum clinically important
differences at 2 years (no AE 25.7±19.2, major: 36.4±19.1, p<0.001).
Major AEs were associated with worse ODI (physical disability) scores on
multivariable linear regression (p=0.011).
Conclusions: Major AEs after lumbar spine surgery
lead to worse functional outcomes and lower satisfaction. This highlights
the need to implement strategies aimed at reducing adverse events.
P.051 Do clinical confounders to the neurological examination modify the
diagnostic accuracy of CT-angiography for death by neurological
criteria/brain death?
Authors: Neves Briard J , Nitulescu R , Lemoine É , English S , McIntyre L , Knoll G , Shemie S , Martin C , Turgeon A , Lauzier F , Fergusson D , Chassé M
Published: January 2022

Background: CT-angiography is an ancillary test
used to diagnose death by neurological criteria (DNC), notably in cases of
unreliable neurological examinations due to clinical confounders. We studied
whether clinical confounders to the neurological examination modified
CT-angiography diagnostic accuracy. Methods:
Systematic review and meta-analysis of studies including deeply comatose
patients undergoing DNC ancillary testing. We estimated pooled sensitivities
and specificities using a Bayesian hierarchical model, including data on
CT-angiography (4-point, 7-point, 10-point scales, and no intracranial
flow), and performing a subgroup analysis on clinical confounders to the
reference neurological examination. Results: Of 40
studies included in the meta-analysis, 7 involve CT-angiography (n=586).
There was no difference between subgroups (Table). The degree of uncertainty
involving sensitivity estimates was high in both subgroups.
Conclusions: Statistical uncertainty in
diagnostic accuracy estimates preclude any conclusion regarding the impact
of clinical confounders on CT-angiography diagnostic accuracy. Further
research is required to validate CT-angiography as an accurate ancillary
test for DNC.

Table. Pooled sensitivities and specificities of
CT-angiography for death by neurological criteria
P.063 Endovascular Treatment of Acute Ischemic Stroke in Patients with
Pre-morbid Disability: A Meta-analysis
Authors: Bala F , Beland B , Ganesh A
Published: January 2022

Background: Practice-changing trials of
endovascular thrombectomy (EVT) for acute stroke excluded patients with
pre-morbid disability. Observational studies may inform the role of EVT in
this population. We performed a meta-analysis to estimate the effect of EVT
in patients with pre-morbid disability. Methods: We
adhered to PRISMA guidelines and searched Medline and Embase for studies
describing EVT in adults with and without pre-morbid disability with stroke.
Random-effects meta-analysis was used to pool outcomes, including favorable
outcomes (mRS=0-2 or return to baseline), no increase in disability at 90
days, symptomatic ICH (sICH) and 90-day mortality.
Results: We included 8 studies with 5570 patients
(mRS 3-5=863, mRS 0-2=4,707). Patients with pre-morbid disability were more
likely to return to their baseline mRS (aOR 2.53, 95% CI=1.47-4.36),
although they had higher 90-day mortality (aOR=2.21, 95% CI=1.66-2.93). aOR
for favorable outcome (aOR=0.83, 95% CI=0.67-1.03) or sICH (aOR=1.07, 95%
CI=0.74-1.54) was not significantly different between groups.
Conclusions: Observational studies suggest that
EVT is safe in patients with pre-stroke disability and may result in
comparable return to pre-stroke status as in patients without such
disability. These findings argue against the routine exclusion of patients
with pre-morbid disability from EVT and merit validation with randomized
controlled trials.
P.070 Introducing Stroke Endovascular Thrombectomy Into A Smaller
Canadian Site, Is It Safe?
Authors: Attwell-Pope K , Penn A , Henri-Bhargava A , Greek S , Penn M , LeRoy J , Bibok M
Published: January 2022

Background: Success of Endovascular Thrombectomy
(EVT) requires ultra-fast access to specialized neuro imaging, neurological
assessment and an angio suite with interventional radiologists. Prior access
was via transport to Vancouver and outcomes were poor, with a high rate of
disability or death. This appeared primarily due to long delays.
Methods: Quality control process, in parallel to
the introduction of a new intervention, EVT, to Vancouver Island, to
determine if this intervention could be delivered with reasonable safety and
good outcomes. Patients receiving EVT from May, 2016 until Sep, 2019 are
included, with 90-day outcomes. Data was collected by stroke nurses.
Results: The proportion of patients having a good
outcome was comparable to that of the major clinical trial involving
Canadian academic centres. The proportion sustaining a poor outcome was
comparable to the control group in that trial population (who still received
tPA treatment where possible). This was despite a median age 4.5 years
greater than in that trial. Conclusions: EVT required
coordination of multiple services. Victoria General Hospital performance in
terms of speed to treatment was slower than in the published trials. This is
a factor in determining outcome and is therefore an important quality
improvement target moving forward.
P.073 The Effect of Cancer on The Prevalence Of Stroke Survivorship In
Canada – A Cross-Sectional Study
Authors: Lun R , Shaw J , Roy DC , Chen Y , Dowlatshahi D
Published: January 2022

Background: In Canada, it’s unknown if the
prevalence of stroke survivorship differs in the population with active
cancer compared to those without cancer. Methods: We
analyzed the 2015-2016 iteration of the Canadian Community Health Survey.
The prevalence of stroke survivorship was compared across risk factors using
descriptive statistics. A multivariable logistic regression model was used
to assess the association between cancer and prevalence of stroke
survivorship. Covariates were assessed for effect modification and
confounding using the maximum likelihood estimation method.
Results: We analyzed 89,285 subjects. The
prevalence of cancer and the prevalence of suffering from the effects of a
stroke were 2.09% and 1.56%, respectively. Cancer was significantly
associated with an increased prevalence of stroke survivorship with an odds
ratio (OR) of 1.56 (95%CI: 1.24 – 1.98) after adjusting for age, sex,
smoking status, education, household income, dyslipidemia, hypertension,
diabetes. The association was stronger in younger age groups: the youngest
age group (18 – 49 years) had the highest OR (6.49, 95%CI:2.01 – 20.94) for
suffering from the effects of a stroke in association with the presence of
cancer. Conclusions: In Canada, the presence of
active cancer increases the odds of suffering from the effects of a stroke,
particularly in the youngest age group.
P.076 Hypertensive disorders in pregnancy are strongly associated with
future stroke and hypertension: A systematic review and
meta-analysis
Authors: Switzer AR , Smith EE , Ganesh A
Published: January 2022

Background: We aimed to evaluate the association
between hypertensive disorders in pregnancy (HDP) and future risk of stroke,
stroke death, and hypertension. Methods: Systematic
searches were performed in MEDLINE and EMBASE up to April
27th, 2020. Exposure of interest included the
different types of HDP. Outcomes of interest included hypertension
incidence, stroke incidence, stroke subtype, and stroke mortality.
Results: Eighteen cohort and 1 case-control
studies involving >10 million women were included in the meta-analysis.
Pooled hazard ratios with 95% confidence interval generally adjusted for age
at delivery, ethnicity, and vascular risk factors are listed in table 1.
Conclusions: Increasing severities of HDP carry
higher hazards of hypertension and stroke years later. HDP, including
gestational hypertension alone, are also associated with future stroke
mortality.