bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐Term Outcomes of Acute Kidney Injury After Different Types of Cardiac Surgeries: A Population‐Based Study
Authors: Chen Jia‐Jin , Chang Chih‐Hsiang , Wu Victor Chien‐Chia , Chang Shang‐Hung , Hung Kuo‐Chun , Chu Pao‐Hsien , Chen Shao‐Wei
Published: June 2021

Background

Dialysis‐requiring acute kidney injury (D‐AKI) is a major complication of cardiovascular surgery that results in worse prognosis. However, the incidence and impacts of D‐AKI in different types of cardiac surgeries have not been fully investigated.

Methods and Results

Patients admitted for cardiovascular surgery between July 1, 2004, and December 31, 2013, were identified from the National Health Insurance Research Database of Taiwan. The patients were grouped into D‐AKI (n=3089) and non–D‐AKI (n=42 151) groups. The outcome was all‐cause mortality and major adverse kidney event. The long‐term outcomes were worse in the D‐AKI group than the non–D‐AKI group (hazard ratio [HR], 3.89; 95% CI, 3.79–3.99 for major adverse kidney event; HR, 2.89; 95% CI, 2.81–2.98 for all‐cause mortality). Patients who underwent aortic surgery had higher risk for D‐AKI than other types of surgeries, but they were also more likely to recover. The long‐term dialysis rate for the patients who recovered from D‐AKI was also lowest in those who underwent aortic surgery. Among all types of cardiac surgeries with D‐AKI, patients who had heart valve surgery exhibited the greatest risks of all‐cause mortality (HR, 6.04; 95% CI, 5.78–6.32).

Conclusions

Compared with other heart surgeries, aortic surgery resulted in a higher incidence of D‐AKI but better renal recovery, better short‐term outcome, and lower incidences of long‐term dialysis.
Short‐Term Effects of Inhaled Nitric Oxide on Right Ventricular Flow Hemodynamics by 4‐Dimensional–Flow Magnetic Resonance Imaging in Children With Pulmonary Arterial Hypertension
Authors: Schäfer Michal , Frank Benjamin S. , Ivy D. Dunbar , Abman Steven H. , Stenmark Kurt R. , Mitchell Max B. , Browne Lorna P. , Barker Alex J. , Hunter Kendall S. , Kheyfets Vitaly , Miller‐Reed Kathleen , Ing Richard , Morgan Gareth J. , Truong Uyen
Published: June 2021

Background

Pulmonary arterial hypertension (PAH) manifests with progressive right ventricular (RV) dysfunction, which eventually impairs the left ventricular function. We hypothesized that 4‐dimensional–flow magnetic resonance imaging can detect flow hemodynamic changes associated with efficient intracardiac flow during noninvasive inhaled nitric oxide (iNO) challenge in children with PAH.

Methods and Results

Children with PAH (n=10) underwent 2 same‐day separate iNO challenge tests using: (1) 4‐dimensional–flow magnetic resonance imaging and (2) standard catheterization hemodynamics. Intracardiac flow was evaluated using the particle tracking 4‐flow component analysis technique evaluating the
direct flow
,
retained inflow
,
delayed ejection flow
, and
residual volume
. Respective flow hemodynamic changes were compared with the corresponding catheterization iNO challenge results. The RV analysis revealed decreased direct flow in patients with PAH when compared with controls (
P
<0.001) and increase in residual volume (
P
<0.001). Similarly, the left ventricular analysis revealed decreased direct flow in patients with PAH when compared with controls (
P
=0.004) and increased proportion of the residual volume (
P
=0.014). There was an increase in the RV direct flow during iNO delivery (
P
=0.009), with parallel decrease in the residual volume (
P
=0.008).

Conclusions

Children with PAH have abnormal biventricular flow associated with impaired diastolic filling. The flow efficiency is significantly improved in the RV on iNO administration with no change in the left ventricle. The changes in the RV flow have occurred despite the minimal change in catheterization hemodynamics, suggesting that flow hemodynamic evaluation might provide more quantitative insights into vasoreactivity testing in PAH.
Abstract TP41: Prevalence and Factors Associated with Early Ischemic Changes on Non-contrast CT Obtained Less Than 90 Minutes After Symptom Onset
Authors: Noroozi Jared , Liebeskind David S , Saver Jeffrey L , Starkman Sidney , Villablanca Juan Pablo , Hamilton Scott , Shkirkova Kristina , Sanossian Nerses ,   FAST-MAG Trial Investigators
Published: June 2021

Background:
Usually early infarct signs on imaging take a few hours to develop in ischemic stroke. There may be a subset of patients manifesting early infarct signs on imaging hyperacutely.

Objective:
To determine the prevalence and factors associated with very early infarct signs on ASPECTS among patients with cerebral ischemia who were imaged <90 minutes after symptom onset.

Methods:
Subjects participating in the NIH Field Administration of Stroke Therapy- Magnesium (FAST-MAG) phase 3 clinical trial with a final diagnosis of cerebral ischemia (TIA or Stroke) and initial imaging performed <90 minutes from last known well time (LKWT) were included. ASPECTS was graded by a neuroradiologist (JPV) blinded to all clinical information. Individual subjects were characterized as having no early ischemic changes (ASPECTS 10) vs. early ischemic changes (ASPECTS 0-9). We describe the prevalence of early ischemic signs in this prospectively enrolled cohort, clinical factors associated with early ischemic changes as well as outcomes.

Results:
There were 566 cases imaged a mean of 71 (SD 11) minutes after LKWT. Mean age was 69 (SD 13), 43% women, 93% ischemic stroke, 7% TIA, median emergency department NIHSS 8 (IQR 3-16), median ASPECTS score of 10 (IQR 7-10, range 1-10). There were 200 cases with early ischemic findings (35%). Early ischemic changes were not related to age, blood pressure, history of hypertension, diabetes, dyslipidemia, coronary artery disease, or time to imaging (71 vs. 71 mins). Early ischemic changes were more commonly noted in women (50% vs. 39%, p=0.015) and associated higher presenting NIHSS (14 [IQR 7-20] vs 5 [IQR 2-11], p<0.001). The presence of any hyperacute ischemia change was associate with worse 90-day outcome (modified Rankin score 3 [IQR 1-5] vs 1 [IQR 0-3, p<0.001).

Conclusions:
Early ischemic changes were noted on about 1/3
rd
of imaging obtained <90 minutes after symptom onset. The presence of hyperacute ischemic changes is associated with more severe stroke and poor clinical outcomes.
Abstract TP89: Reactive Gliosis Improves Outcome in an Aged Rat Model of Embolic Stroke
Authors: Morris Daniel , Chopp Michael , Cheung Wing Lee , Zhang Talan , Lu Mei , Zhang Zheng G
Published: June 2021

Introduction:
Ischemic damage after stroke results in reactive gliosis leading to formation of the glial scar. Controversy exists whether reactive gliosis promotes or impedes recovery after stroke. Thymosin β4 (Tβ4) is a 5K peptide that improves functional outcome after stroke in young rats. In aged rats, however, Tβ4 reduced infarct volume but did not improve functional outcome.

Hypothesis:
We hypothesized that Tβ4 treatment would alter the glial scar in our aged rat model of embolic stroke.

Methods:
Aged Male Wistar rats (Charles River, 18-21 months, n=15) were subjected to embolic middle cerebral artery occlusion (MCAO). Rats were randomized to receive Tβ4 (12 mg/kg, Regenerx Biopharmaceuticals, Inc.) or control 24 hrs after MCAO and then every 3 days for 4 additional doses. Modified Neurological Severity Score (mNSS) was measured and all rats were sacrificed 56 days after MCAO. Infarct volume was measured and reactive gliosis was analyzed by measuring GFAP immunoreactive cells along the ischemic boundary zone (IBZ). Data are presented as the % in density along the IBZ compared with the contralateral homologous region on the same section. GLIMMIX was used to test the treatment effect in each section. Correlation was calculated between GFAP, infarct volume and mNSS.

Results and Conclusions:
GFAP immunoreactivity was significantly inversely correlated with mNSS (p<0.01), suggesting that rats with greater gliosis have better functional improvement. Moreover, increased GFAP immunoreactivity was marginally inversely correlated with a reduction in infarction volume (p=0.067). Tβ4 did not significantly alter reactive gliosis (213 ± 104% vs 145 ± 45 % in control, mean ±std) (p=0.09). Although these data did not show a Tβ4 treatment effect on reactive gliosis, a significant correlation exists on reactive gliosis and improvement on functional outcome, suggesting that the glial scar may improve functional outcome in the aged rat.
Abstract WMP24: CT Angiography Collateral Gradient Mapping: Validation of a Novel Imaging Technique in Acute Ischemic Stroke
Authors: Liebeskind David S , Agbayani Elijah , Woolf Graham W , Jia Baixue , Sanossian Nerses , Hinman Jason D , Raychev Radoslav , Sharma Latisha K , Kim Doojin , Rao Neal M , Starkman Sidney , Saver Jeffrey L , Jahan Reza , Szeder Viktor , Tateshima Satoshi , Duckwiler Gary R , Scalzo Fabien ,   for the UCLA Stroke Investigators
Published: June 2021

Background:
CT angiography (CTA) is routinely acquired in acute ischemic stroke, providing data on extent of collaterals yet current techniques compromise either spatial or temporal resolution. We developed and validated a novel imaging technique from standard or single-phase CTA to discriminate both the spatial and temporal blood flow features in leptomeningeal collaterals.

Methods:
Consecutive acute ischemic stroke patient data, including single-phase CTA (sCTA) followed immediately by digital subtraction angiography (DSA), in the setting of ICA or proximal MCA occlusions were analyzed. Three-dimensional (3D) reconstruction and surface mapping of collateral flow gradients on sCTA was performed. Quantitative output of flow gradients in individual collateral vessels was correlated with DSA ASITN collateral grade.

Results:
75 consecutive cases of acute stroke due to ICA or proximal MCA occlusion were analyzed with contemporaneous sCTA and DSA. Automatic post-processing of collateral gradient maps and generation of quantitative data output followed 3D reconstruction and segmentation of sCTA. sCTA collateral gradient mapping was feasible in all cases, compared to limitations in availability of DSA collateral grades. Poor collateral status on DSA (ASITN 0-1) was evident as limited extent and color-mapped gradients on sCTA. In contrast, sCTA gradient mapping provided more detailed distinction between subjects of intermediate or partial DSA collaterals (ASITN 2) and also amongst complete, but delayed DSA collaterals (ASITN 3). sCTA gradient mapping provided quantitative data on the delay of collateral flow in individual cortical vessels.

Conclusions:
CTA collateral gradient mapping can routinely provide detailed data on both the extent and delay of collaterals, using standard sCTA acquisition. This novel imaging technique may provide key information to distinguish the wide variability of ASITN grades 2-3, most commonly encountered in acute stroke.
Abstract WMP59: Premorbid Blood Pressure Control of Incident Transient Ischaemic Attacks and Strokes; Prevalence and Determinants; Analysis of Individual Patient Data over 10 Years
Authors: Mettananda Chamila , Li Lixin , Lau Gary , Wharton Rose , Bull Linda , McCulloch Ellen , Welch Sarah , Mehta Ziyah , Gutnikov Sergei , Silver Louise , Rothwell Peter ,   Oxford Vascular Study
Published: June 2021

Background:
Uncontrolled blood pressure is the most important modifiable risk factor for strokes.

Aims and Methods:
We determined the prevalence and determinants of blood pressure control in patients with incident transient ischaemic attacks(TIA) and strokes from 2002-2012 in a population-based cohort(Oxford Vascular Study). Controlled blood pressure(BP) was defined as having BP<140/90mmHg and was studied in different cardiovascular risk groups according to the Framingham 10-year general cardiovascular risk(CV-Risk) predicted at time of event and 10years pre-event; low(≤ 10%), moderate(11-19%) and high(≥ 20%) risk. We also studied the associations of controlled BP adjusted for age and sex.

Results:
Among 1741 patients with incident TIA/strokes, 1051 (60.4%) had known hypertension, of which 891 (84.8%) were on anti-hypertensive treatment. However, only 698 (40.1%) of all and 306 (29.1%) of treated patients had controlled BP. On predicted 10-year CV-Risk at event, 861 (72.5%) of 1188 (77.0%) in high risk group had known hypertension, of which 758 (88.0%) were on treatment. However, only 346 (29.1%) of all in high-risk group and 190 (25.1%) of treated high risk patients had controlled BP. In contrast, 120 (88.2%) of 136 (8.8%) in low risk group had controlled BP. Risk stratification without scoring for BP showed consistent results except the number in high-risk group dropped to 863 (55.9%). Analysis with CV-risk 10years pre-event also showed similar trends. Age(adjusted OR=0.97, 95%CI=0.97-0.98, p<0.001), high CV-risk at event/10years pre-event (0.97, 0.95-0.99, p<0.013, 0.95-0.99, p=0.008), being treated for hypertension(0.43, 0.35-0.52, p<0.001), BMI≥ 30Kg/m2(0.72, 0.55-0.92, p=0.010) and high total cholesterol(0.91, 0.84-0.99, p<0.026) were negatively associated with controlled BP. However history of atrial fibrillation(1.35, 1.03-1.77, p=0.030) and physical dependency(modified-Rankin-Scale>2; 1.54, 1.15-2.06, p<0.001) were positively associated with controlled BP.

Conclusions:
Premorbid blood pressure control in patients with incident TIA/strokes was inadequate especially in high-risk patients. Controlling BP to targets in elderly and high CV-risk patients would be important in reducing incident TIA/strokes.
Abstract WP140: Imaging of Clot Porosity Prior to Endovascular Thrombectomy
Authors: Liebeskind David S , Agbayani Elijah , Woolf Graham W , Jia Baixue , Sanossian Nerses , Hinman Jason D , Raychev Radoslav , Sharma Latisha K , Kim Doojin , Rao Neal M , Starkman Sidney , Saver Jeffrey L , Jahan Reza , Szeder Viktor , Tateshima Satoshi , Duckwiler Gary R , Scalzo Fabien ,   for the UCLA Stroke Investigators
Published: June 2021

Background:
Clot characteristics and porosity at the proximal portion of an arterial occlusion may influence potential recanalization. Thrombus permeability may be a factor in intravenous thrombolysis, whereas such features of clots prior to endovascular thrombectomy remains largely unexplored. We developed a technique to image clot porosity and yield quantitative measures that may predict mechanical recanalization.

Methods:
Consecutive cases of large artery occlusion (ICA or proximal M1 MCA) with single-phase CT angiography (CTA) acquired immediately prior to endovascular thrombectomy were analyzed. 3D-reconstruction, vessel segmentation, centerline extraction, signal intensity gradient calculations and surface mapping of CTA yielded porosity images and quantitative measures. Porosity measures were correlated with angiography parameters and procedural details.

Results:
53 consecutive cases of acute stroke with contemporaneous sCTA and DSA were used to generate porosity images. Technical limitations precluded image processing in 9 cases, due to diminished contrast conspicuity in close proximity to bone interfaces. Porosity features on resulting images and the quantitative measures of clot penetration varied markedly, even within the subset of M1 or ICA occlusions, respectively.

The occlusions often exhibited long segments (mean 18 ± 11 mm) of luminal narrowing before complete occlusion. Current analyses examine whether higher porosity or greater proximal contrast penetration of the clot is associated with faster recanalization and fewer device passes during endovascular thrombectomy.

Conclusions:
Clot porosity images and quantitative measures of proximal contrast penetration may be generated from routine CTA. Imaging of clot porosity may be a useful adjunct in planning of endovascular procedures and future strategies may focus on distinguishing atherosclerotic versus thromboembolic large artery occlusions.
Abstract WP227: Association Of Anemia With Stroke Recurrence In Acute Ischemic Stroke: An Analysis From The Clinical Research Center For Stroke-5th Division Registry In Korea
Authors: Chang Jun-Young , Han Moon Ku , BAE Hee-Jun , Yum Kyu Sun , Lee Sang Kil , Jeong Won Joo , Park Tai Hwan , Lee Soo Joo , Lee Kyung Bok , Lee Jun , Park Jong-Moo , Choi Jay Chol , Kim Dong-Eog , Kim Joon-Tae , Cha Jae-Kwan , Lee Byung-Chul , Lee Juneyoung , Cho Yong-Jin , Hong Keun-Sik , Kim Wook-Joo , Shin Dong-Ick , Sohn Sung-Il ,   CRCS-5 investigators
Published: June 2021

Background:
We have evaluated whether anemia at admission is associated with ischemic stroke recurrence and composite outcome events (stroke, myocardial infarction, and vascular death) according to the age, presence of cerebral artery stenosis, stroke subtype, and initial severity of stroke.

Methods:
All 27145 patients with transient ischemia attack or acute ischemic stroke admitted between April 2008 and November 2014 from the stroke registry of the fifth section of the Clinical Research Center for Stroke (CRCS-5) were selected. The association between anemia and 1-year stroke recurrence, composite outcome events according to age, presence of cerebral artery stenosis, stroke mechanism, and initial severity of stroke were evaluated.

Results:
The cumulative 1-year stroke recurrence rate, composite outcome events were significantly higher in patients with anemia than without anemia ( 7.2% vs. 4.8%, p<0.01 for stroke recurrence, 11.8% vs.7.3%, p<0.01 for composite event). Anemia was still an independent predictor of 1-year stroke recurrence and composite vascular event after adjustment (adjusted HR 1.35, 95% CI 1.09-1.66, p<0.01 for stroke recurrence, adjusted HR 1.21, 95% CI 1.03-1.43, p=0.03 for composite outcome events). Anemia significantly increase the stroke recurrence risk in patients with mild to moderate neurological deficit (NIHSS <16, p for interaction=0.04), with stroke of other determined etiology (p for interaction=0.06). Anemia substantially increase the risk of composite outcome events in patients with mild to moderate stroke severity (NIHSS <16, HR 1.84, 95% CI 1.53-2.21, p for interaction<0.01), without cerebral artery stenosis ≥50% (HR 2.02, 95% CI 1.57-2.59, p for interaction=0.03), with stroke of small vessel occlusion (HR 2.74, 95% CI 1.34-5.63, p for interaction=0.09), and with stroke of other determined etiology (HR 2.95, 95% CI 1.69-5.14, p for interaction=0.02).

Conclusion:
Anemia is an independent predictor of 1-year ischemic stroke recurrence, composite outcome events of stroke, myocardial infarction, and vascular death. Our data suggests that more attention should be paid to the anemic patients with mild to moderate neurological deficit, small vessel occlusion subtype, and stroke of other determined etiology.
Abstract WP257: Accuracy of Pre-enrollment Last Known Well Time in a Large Prehospital Stroke Clinical Trial
Authors: Sanossian Nerses , Balouzian Emma , Ramirez Lucas , Liebeskind David S , Starkman Sidney , Eckstein Marc , Stratton Samuel , Pratt Franklin D , Hamilton Scott , Restrepo Lucas , Valdes-Sueiras Miguel , Conwit Robin , Saver Jeffrey L ,   FAST-MAG Trial Investigators
Published: June 2021

Background:
Clinical trials of stroke therapies require accurate documentation of last known well time (LKWT) to account for injury accumulation prior to treatment start. For prehospital studies, this requirement is particularly challenging, as paramedic-determined and final-determined LKWTs in routine practice are concordant (within 15 mins) in only half of cases. We sought to determine the accuracy of LKWT obtained in the field by a two-tier enrollment system of study-trained paramedics and cellphone-connected physician-investigators.

Methods:
Paramedics screened consecutive transports for participation in the NIH Field Administration of Stroke Therapy-Magnesium (FAST-MAG) clinical trial. Paramedic screening criteria included LKWT <2 hours. Physician-investigators by cellphone confirmed or refined the LKWT after conversation with paramedics and patients or legally authorized representative. Prehospital LKWT was compared with post-arrival LKWT determined by trained study nurses after ED arrival by speaking with patients, family and other sources. We describe the number of enrollment calls with inaccurate LKWT at the paramedic-screening level and at the post paramedic plus physician-investigator telephone screening level.

Results:
A total of 4458 post-screening enrollment calls were made by paramedics from January 2005 to December 2012 of which 539 (12%) were determined by physician-instigators to have inaccurate LKWT leading to non-enrollment. Of the remaining 3919 calls, 1700 led to enrollments in the study and 2219 were not enrolled for a reason other than inaccurate LKWT. Among enrolled cases, exact congruence between prehospital and post-arrival LKWTs occurred 72% (n=1220), concordance within 15 minutes in 87%, within 30 minutes in 93%, and within 1 hour in 97%. Among enrolled cases, final-determined LKWT was within the study entry window of 2h in 96.3%.

Conclusions:
A 2-tiered system of paramedic screening followed by physician-investigator cellphone assessment led to high congruence between prehospital-determined and post-arrival-determined of LKWT. This system can be used in future trials of prehospital, paramedic-in initiated stroke therapy when accuracy of LKWT is important for intervention evaluation.
Abstract WP415: Desirable LDL-cholesterol Levels For Preventing Stroke Recurrence -Subanalysis of J-STARS
Authors: Hosomi Naohisa , Nagai Yoji , Kitagawa Kazuo , Aoki Shiro , Nezu Tomohisa , Kagimura Tatsuo , Origasa Hideki , Minematsu Kazuo , Uchiyama Shinichiro , Matsumoto Masayasu ,   the J-STARS collaborators
Published: June 2021

Background & Aims:
The risk reduction of major vascular events per 1.0 mmol/L further reduction in LDL-cholesterol did not depend on the baseline LDL-cholesterol concentration. However, the desirable LDL-cholesterol level for preventing stroke recurrence has still not been defined. To define desirable LDL-cholesterol levels for preventing stroke recurrence, subanalysis was made on J-STARS.

Methods:
In J-STARS, patients with non-cardioembolic ischemic stroke (atherothrombotic infarction, lacunar infarction, infarction of undetermined etiology) were randomized into the pravastatin group (10 mg/day, n=793) or the control group (n=785) received no statin treatment. The primary endpoint was the recurrence of stroke and transient ischemic attack (TIA). The subjects were divided based on tertile of LDL-cholesterol at enrollment, mean during observation period, just before the event, and their differences. Adjusted hazard ratio (HR) (95% confidence interval [CI]) were analyzed for each tertile adjusting the factors that showed inter-group differences, including age, body mass index, hypertension, diabetes mellitus, duration until an enrollment following stroke events, and the usage of statin. Reference was set at the highest tertile.

Results:
Adjusted HR of stroke and TIA lowered in accordance with the reduction of LDL-cholesterol from enrollment both to mean during observation period and to just before the event (p<0.001 and <0.001 for trend). The occurrence of intracranial hemorrhage showed a significantly low relative risk in the middle tertile of LDL-cholesterol reduction (2.0 to 28.0 mg/dl) from enrollment to just before the event (adjusted HR 0.15 [95%CI 0.03, 0.68]). But, this risk reduction of intracranial hemorrhage was diminished in the lowest tertile. And, a relatively high risk of intracranial hemorrhage was observed in the lowest tertile of LDL-cholesterol (less than 101.0 mg/dl) just before the event (2.68 [0.82, 8.77]).

Conclusions:
The composite risk of stroke and TIA reduced according to the reduction of LDL-cholesterol adjusting the statin usage. The risk of intracranial hemorrhage reduced with mild reduction of LDL-cholesterol, but not when LDL-cholesterol reduced more than 28.0 mg/dl. (NCT00221104)
Abstract WP6: Real-World Data on Reperfusion: Evidence of Good Outcomes in the International Trevo Retriever Registry
Authors: Liebeskind David S , Woolf Graham W , Xiang Bin , Shields Ryan , Veznedaroglu Erol , English Joey , Baxter Blaise W , Budzik Ronald F , Bartolini Bruno M , Krajina Antonin , Sarraj Amrou , Narata Ana Paula , Miller Tim , Grobelny Thomas , Nogueira Raul G , Gupta Rishi , Jadhav Ashutosh ,   for the Trevo Retriever Registry Investigators
Published: June 2021

Background:
Endovascular thrombectomy trials established efficacy in acute ischemic stroke, yet real-world data on device effectiveness is warranted. Core lab adjudication of angiography is required to validate reperfusion, providing evidence and detailed data beyond randomized, controlled trials. We report the largest endovascular therapy registry data linking independent core lab data on reperfusion with clinical outcomes.

Methods:
The Trevo Retriever Registry is a prospective, open-label, consecutive enrollment, multicenter, international registry with more than 65 enrolling sites worldwide. An independent Imaging Core Lab, blind to all other data, evaluates the angiography with a battery of various TICI scores (mTICI, oTICI, oTICI2C) to define reperfusion. Statistical analyses examined TICI reperfusion and association with clinical outcomes considering expansive data collected in the registry.

Results:
506 enrolled subjects (mean age 68.2 ± 14.2 yrs; 53% female) had core lab adjudicated angiography as of July 2016, including 21.5% > 80 years old. Baseline NIHSS was median 15.0 (9.0, 20.0) with time from onset to CT of median 4.0 (1.7, 9.7) hrs. Core lab adjudicated arterial occlusion sites were: 53% M1, 24% ICA, 16% M2, 4% Basilar and 2% other. Time to reperfusion (oTICI ≥ 2A) was median 30.0 (19.0, 42.0) min. Core lab adjudicated revascularization was mTICI ≥ 2B in 90.4% (95%CI 87.4, 92.9), oTICI ≥ 2B in 82.3% (95%CI 78.6, 85.6) and oTICI2C ≥ 2C in 45.0% (95%CI 40.5, 49.6). mRS of 0-2 at 90 days was achieved in 57.3% (95%CI 52.5, 62.1). Extensive clinical, laboratory and stroke workflow variables were considered, yet only male sex (OR 0.62 (95% CI 0.38, 0.99) was an independent predictor of successful reperfusion (oTICI ≥ 2B) while age (OR 0.96 (95% CI 0.94, 0.97), NIHSS (OR 0.91 (95% CI 0.88, 0.94) and diabetes (OR 0.54 (95% CI 0.33, 0.88) predicted mRS 0-2 at 90 days.

Conclusions:
Proven reperfusion rates after endovascular stroke therapy excel in the real-world translation of thrombectomy devices around the globe, leading to good outcomes after stroke.
Abstract 114: Diverse Patients Show Physiologic Benefit From Refined Sphenopalatine Ganglion Electrode Placement and Stimulation Level Selection to Augment Blood Flow and Neurologic Function in Acute Ischemic Stroke (The IMPACT-24M Trial)
Authors: Saver Jeffrey L , Kharaishvili Nino , Janelidze Tamar , Beridze Maia , Zarqua Natia , Solberg Yoram , Bornstein Natan ,   for the IMPACT-24M Trial Investigators
Published: June 2021

Background:
Two large RCTs have indicated sphenopalatine ganglion (SPG) stimulation reduces 3m disability in acute ischemic stroke patients with confirmed cortical involvement. The current trial evaluated two refinements in SPG stimulation technique: 1) SPG electrode placement with real-time optical tracking guidance; and 2) stimulation intensity comfortable tolerance level (CTL) selection using non-noxious facial physiologic markers.

Methods:
Single, active arm trial at 4 centers, enrolling patients with anterior circulation ischemic stroke <24h, NIHSS 1-6, not receiving recanalization therapies. Stimulation level was based on ipsilateral facial tingling sensation or lacrimation. SPG stimulation effects were assessed by volumetric blood flow in the ipsilateral common carotid artery (ultrasound) and affected hand grasp and pinch strength before and during stimulation, and by NIHSS change by day 7.

Results:
Among 50 enrolled patients, age was median 66y (IQR 60-74), 44% female, NIHSS median 5 (IQR 4-5), and median onset-to-screening time 18h (IQR 9-20). Median implantation skin-to-skin time was 4 minutes (IQR 3-7) and all 50 implants were placed correctly. CTL was found based on physiological biomarkers in 96% of patients, including 86% in the optimal, low-medium intensity range. SPG stimulation significantly increased common carotid artery peak systolic and end diastolic blood flow (up 44%, p<0.0001; and up 52%, p<0.0001) and improved pinch strength (up 42%, p<0.0001) and grasp strength (up 26%, p<0.0001). Degree of NIHSS recovery by day 7 was greater than in matched historic controls, median 75% vs 50%, p=0.0003. Forest plot analysis showed benefits were homogenous across the subgroups of: sex, age, time from onset, stroke side, NIHSS, and ASPECTS score.

Conclusion:
SPG stimulator placement with real-time optical tracking guidance was fast and accurate, and selection of optimal stimulation intensity levels based on non-noxious facial tingling and lacrimation was feasible in nearly all patients. SPG activation led to cranial blood flow augmentation and improved hand motor function during stimulation, and neurologic deficit reduction at 1 week, consistently across broad patient subsets of age, sex, side, severity, and time to treatment.
Abstract 127: Radiosurgery for Unruptured Intervention-Naïve Pediatric Brain Arteriovenous Malformations
Authors: Chen Ching-jen , Lee Cheng-Chia , Kano Hideyuki , Kearns Kathryn , Ding Dale , Kondziolka Douglas , Ironside Natasha , Starke Robert , Lunsford Dade , Sheehan Jason ,   IRRF
Published: June 2021

Background and Purpose:
To evaluate, in a multicenter, retrospective cohort study, the outcomes after stereotactic radiosurgery (SRS) for unruptured, intervention-naïve pediatric brain arteriovenous malformations (AVM).

Methods:
We retrospectively analyzed the International Radiosurgery Research Foundation pediatric AVM database from 1987-2018. Pediatric patients with unruptured, previously untreated AVMs who underwent SRS were included. The primary endpoint was a composite of hemorrhagic stroke, death, or permanently symptomatic radiation-induced changes (RIC).

Results:
The study cohort comprised 101 patients (mean follow-up 80.8 months). The primary endpoint occurred in 14%, comprising hemorrhage stroke, death, and permanent RIC in 6%, 3%, and 8%, respectively. Estimated probabilities of the primary endpoint were 5.2%, 10.8%, and 23.0% at 2, 5, and 10 years, respectively (Figure 1). Estimated probabilities of AVM obliteration at 5 and 10 years were 64% and 82%, respectively (Figure 2). Single SRS treatment (p=0.007) and higher margin dose (p=0.005) were predictors of obliteration. Subgroup analysis of Spetzler-Martin grade I-III AVMs estimated primary endpoint probabilities of 3.7%, 8.4%, and 18.7% at 2, 5 and 10 years, respectively.

Conclusion:
Treatment of unruptured, intervention-naïve AVMs in the pediatric population with SRS carries an approximately 2% annual risk of morbidity and mortality, which appears to plateau after 10 years. The poorly described natural history of pediatric AVMs makes any comparison of SRS versus conservative management imperfect. However, due to the young age at diagnosis and excessive cumulative life hemorrhage risk of an untreated AVM in a child, SRS is likely to have a favorable long-term risk-benefit profile for appropriately selected unruptured pediatric AVMs.
Abstract TP38: Efficacy of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma
Authors: Kulhari Ashish , Singh Amrinder , Mehta Siddhart , Fourcand Farah , Kirmani Jawad.F. , Zacharatos Haralabos
Published: June 2021

Background:
Symptomatic chronic subdural hematoma (SDH) is treated with surgical evacuation. SDH has a high incidence of recurrence despite evacuation, reported between 2% and 37%. Multiple case reports and case series demonstrate embolization of the Middle Meningeal artery (MMA) for the treatment of chronic SDH to be an adjunct treatment and a possible alternative to surgical evacuation.

Method:
Retrospective analysis of patients with chronic SDH who underwent MMA embolization at our community based, Comprehensive Stroke Center between April and August 2019 was done. MMA embolization was performed using 100-300 or 300-500 μm Embospheres.

Results:
18 patients presented with chronic SDH, 55% female. Mean age and modified Rankin score was 70 (range: 48-95 years) and 1 (range: 0-3), respectively. 17 patients (94%) required a total of 20 MMA embolizations. 83% had unilateral MMA embolization and 17% had bilateral MMA embolizations. 100-300 μm Embospheres were used for the MMA embolization in 82% of the patients and 300-500 μm Embospheres in 18% of the patients. 33% had Burr hole prior to the procedure. 5% ( n= 1) patient had Burr hole evacuation after embolization due to Neurosurgeon preference, not neurological deterioration. 56 % patient received treatment to resume anticoagulation/antiplatelet and 44% received prophylactic embolization to prevent reaccumulation after Burr hole evacuation. Mean size of maximum diameter of SDH was 16.9 mm and 4.6 mm of midline shift on admission CT. Mean SDH size and midline shift at discharge was 13 mm and 2.27 respectively. 50% patients had 1 month follow up CT with mean SDH size was 8.2 mm (in comparison to 19.7 in these patients). 17 % (n=3) patients had complete resolution on 3 month follow up. The one patient treated with 300-500 μm Embospheres had an acute on chronic asymptomatic SDH on 1 month follow up CT, requiring accessory meningeal artery embolization with 100-300 μm Embospheres ultimately resulting complete resolution of the SDH at 1 month post embolization.

Conclusion:
Despite limited data available, Middle Meningeal artery embolization using 100-300 μm Embospheres leads to reproducible results to prevent recurrence of chronic subdural hematoma. A large randomized controlled study is needed to verify our results.
Abstract WP282: Use of Emergent Ambulance Transport With Lights and Siren Leads to Significant Time Savings for Inter-Facility Transfers of Patients With Large Vessel Occlusion
Authors: Hunt Nathaniel R , McDermott Mollie , Dye Scott F , Sozener Cemal B
Published: June 2021

Introduction:
When emergency medical services (EMS) responds to a field call for a patient experiencing stroke symptoms, the response is emergent, necessitating the use of lights and siren (L&S) to allow for expedited transport to a stroke-capable center. With the expanded use of endovascular therapy (EVT) for large-vessel occlusion (LVO), many stroke-capable centers are transferring larger numbers of LVO patients to EVT-capable centers for definitive care. Interestingly, many EMS systems do not respond to or transport inter-facility transfers emergently with L&S. This can potentially lead to delays in care and worse clinical outcomes. Given increased scrutiny surrounding the safety and utility of L&S transport among EMS providers, we investigated the difference between emergent and non-emergent transfer of confirmed LVO stroke patients from two institutions with varied distances and traffic patterns.

Methods:
A retrospective analysis was performed of 127 consecutive inter-facility transfers for LVO from two facilities, Hospital A (38.5 miles) and Hospital B (5.5 miles), to the University of Michigan Comprehensive Stroke Center over 3 years and 2 years respectively. Transfers by helicopter (17/127; 13.4%) and those without available EMS data (9/127; 7.1%) were excluded. Final review included 50 cases from Hospital A and 51 from Hospital B. Run times and use of L&S during transport were collected. A t-test was used to examine whether the observed differences in transport times were statistically significant.

Results:
Of the 50 transfers from Hospital A, 22 were transported without L&S use and 28 with L&S. The mean transport time was 44 minutes versus 35 minutes, respectively. From Hospital B, there were 14 transfers transported without L&S use and 37 with L&S. The mean transport time was 15 minutes versus 9 minutes, respectively. For both samples, p-value was <0.01.

Conclusion:
Despite a small sample size, this analysis demonstrates significant time savings using L&S during inter-facility transfer of stroke patients with confirmed LVO. While inherent risk is associated with the use of L&S during EMS transport, judicious use for confirmed time-sensitive indications seems warranted.
Liogenys Guerin-Méneville, 1831 (Coleoptera: Scarabaeidae: Melolonthinae: Diplotaxini) of northern South America and Central America: taxonomic overview with four new species
Authors: CHERMAN MARIANA A. , BASÍLIO DANIEL S. , MISE KLEBER M. , FRISCH JOHANNES , SMITH ANDREW B.T. , ALMEIDA LÚCIA M.
Published: June 2021

The biodiversity of northern South American and Central American Liogenys Guérin-Méneville, 1831 (Coleoptera: Scarabaeidae: Melolonthinae: Diplotaxini) is reviewed. Four new species are described: L. clipeosetosa Cherman, new species; L. genieri Smith & Cherman, new species; L. granadina Cherman, new species; and L. schneiderae Cherman, new species. The male of L. quadridens (Fabricius, 1798) and the female of L. quadridentata Blanchard, 1851 are described for the first time. Liogenys gebieni Moser, 1921 is a new junior subjective synonym of L. macropelma Bates, 1887. The northernmost record of Liogenys is emended to Trinidad and Tobago for L. granadina Cherman, new species and L. schneiderae new species. Diplotaxis puberea cuprascens (Bates, 1887) new combination, Diplotaxis puberea puberea (Bates, 1887) new combination, and Diplotaxis pubisternis (Bates, 1887) new combination are all transferred from Liogenys to Diplotaxis Kirby, 1837. Lectotypes are designated for Liogenys gebieni Moser, 1921; Melolontha quadridens Fabricius, 1798; and Liogenys quadridentatus Blanchard, 1851. An identification key to northern South American Liogenys is presented.
A new species of Spinicauda (Nematoda: Heterakidae) from Gonocephalus kuhlii (Reptilia: Agamidae) of Ciremai Mountain, Java-Indonesia
Authors: DEWI KARTIKA , PURWANINGSIH ENDANG , RIYANTO AWAL , BURSEY CHARLES R.
Published: June 2021

Spinicauda ciremaiensis sp. nov. (Nematoda: Heterakidae) from the large intestine of Gonocephalus kuhlii (Reptilia: Agamidae) collected in Gunung Ciremai National Park, West Java, Indonesia is described and illustrated. Of the five described species of Spinicauda from the Oriental region, Spinicauda ciremaiensis sp. nov. comes closest to S. sumatrana in having 14 pairs of caudal papillae and the presence of a tail filament. However, the new species differs from S. sumatrana in the longer spicula, smaller eggs, and weak sclerotization of the gubernaculum. S. ciremaiensis sp. nov. is also the only species belonging to the genus Spinicauda which has a sclerotized accessories piece of gubernaculum. A key to the species of Spinicauda is also provided. [http://zoobank.org/urn:lsid:zoobank.org:act:785F2D63-E5EB-4E4C-A7E1-7F7E7AD7C392]
The Short Non-Coding RNA 1251-5p Regulates Stemness Transformation and Inhibits Aggression of Lung Malignant Tumor Cells
Authors: Ping Mei , Wang Shumin , Chen Yan , Jia Junmei
Published: June 2021

Our study investigated the effect of short-chain non-coding RNA 1251-5p on the movement and permeation of pulmonary carcinoma stem cells. LCSC in pulmonary carcinoma cells was determined and isolated by flow cytometry. After cell transfection, qRT-PCR and immunoblotting measured the
level of MiR-1251-5p, MiR-650, SLC34A2, Oct4 and CD133. Spherometric mensuration was used to assess sphericity formation situation. Transwell analyzed the movement and permeation of cells, detected the relationship among MiR-1251-5p, MiR-650 and SLC34A2 by fluorescein enzyme report gene, and
the results were verified by RIP and RNA pull-down detection methods. Knock-down of MiR-1251-5p can enhance the stem cell-like characteristics of LCC, promote cell migration and invasion, upregulate the level of MiR-650, Oct4 and CD133, and downregulate the level of SLC34A2, while MiR-650
inhibitor can restore the effect of the knock-down on the hyperplasia, movement and permeation of LCSC cells. Si-Mir-1251-5p promoted stem cell like characteristics of pulmonary carcinoma cell lineage H1299 and downregulated the expression of Oct4 and CD133, and upregulated the level of SLC34A2.
SLC34A2 expression was negatively correlated with MiR-650 expression and positively correlated with MiR-1251-5p in LCSC cellular tissues. MiR-1251-5p regulates LCC stem cell-like state, and inhibits the movement and permeation of pulmonary carcinoma cells via MiR-650/SLC34A2 axis.
Videofluoroscopic Swallow Study Findings and Correlations in Infancy of Children with Cerebral Palsy
Authors: Narawane Amit , Rappazzo Christina , Hawney Jean , Eng James , Ongkasuwan Julina
Published: June 2021

Objectives:

Cerebral palsy (CP) in infants can affect global motor function and lead to swallowing difficulties. This study aims to characterize oral and pharyngeal swallowing dynamics in infancy of patients later diagnosed with CP and to determine if swallow study performance in early infancy is associated with later CP severity and characteristics.

Methods:

This is a retrospective chart review of infants who underwent videofluoroscopic swallow studies (VFSS) between 6/2008 and 10/2018 at a tertiary children’s hospital, and were later diagnosed with CP. Demographic data, CP characteristics and metrics, and VFSS findings were collected and analyzed.

Results:

There were 66 patients included in this study. The average age at the time of VFSS was 4 months (range: 0.3-12 months), 42% of patients were female, and 50% of patients were born premature. In our sample, 86% of patients presented with oral dysphagia, and 76% with pharyngeal dysphagia. Laryngeal penetration in isolation was seen in 39% of patients, and tracheal aspiration was seen in 38% of patients. Of these tracheal aspiration events, 64% were silent. At the time of VFSS, 58% of patients had a nasogastric tube, 12% had a gastrostomy tube, and 3% had a prior hospitalization for pneumonia. Rates of penetration and aspiration in early infancy did not consistently correlate with prematurity, type of CP (spastic, non-spastic, or mixed), degree of paralysis (quadriplegic, hemiplegic, or diplegic), or severity of Gross Motor Function Classification System (GMFCS) score.

Conclusion:

While there was not a consistent correlation of swallowing dynamics in infancy with later gross motor categorizations of CP, the results of this retrospective review highlight the essential role of early clinical and videofluoroscopic swallowing evaluations to identify oral and pharyngeal swallowing dysfunction in this patient population.
Oscar Robertson, Antitrust, and the Fight Against Monopsony Power in the NBA
Authors: Berri David
Published: June 2021

Labor markets in sports have historically been dominated by the monopsony power enjoyed by owners. In the 1970s, Oscar Robertson argued in front of Congress that “…it’s terribly wrong for anyone to limit anyone’s ability to earn more money.” The data make it clear that Robertson’s wages—and the wages of other National Basketball Association (NBA) players—were indeed limited by the NBA’s reserve clause. Robertson, though, didn’t just make speeches. As the head of the NBA’s Player Association, he delayed a merger between the American Basketball Association and NBA and eventually created the NBA’s free agent market. His work dramatically increased the wages paid to NBA players. These victories, though, didn’t last forever. The many limits today on player wages in the NBA’s labor market suggest that Robertson’s fight has largely been forgotten by today’s NBA players.
Biomineralization of Enamel and Dentin Mediated by Matrix Proteins
Authors: Moradian-Oldak J. , George A.
Published: June 2021

Biomineralization of enamel, dentin, and bone involves the deposition of apatite mineral crystals within an organic matrix. Bone and teeth are classic examples of biomaterials with unique biomechanical properties that are crucial to their function. The collagen-based apatite mineralization and the important function of noncollagenous proteins are similar in dentin and bone; however, enamel is formed in a unique amelogenin-containing protein matrix. While the structure and organic composition of enamel are different from those of dentin and bone, the principal molecular mechanisms of protein–protein interactions, protein self-assembly, and control of crystallization events by the organic matrix are common among these apatite-containing tissues. This review briefly summarizes enamel and dentin matrix components and their interactions with other extracellular matrix components and calcium ions in mediating the mineralization process. We highlight the crystallization events that are controlled by the protein matrix and their interactions in the extracellular matrix during enamel and dentin biomineralization. Strategies for peptide-inspired biomimetic growth of tooth enamel and bioinspired mineralization of collagen to stimulate repair of demineralized dentin and bone tissue engineering are also addressed.
Perceptions of an ageing agricultural workforce and farmers’ productivity strategies: Evidence from Prachinburi Province, Thailand
Authors: Szabo Sylvia , Apipoonanon Chidchanok , Pramanik Malay , Leeson Kevin , Singh Devendra Raj
Published: June 2021

Thailand’s agriculture is facing an ageing workforce, which could negatively influence agricultural production. Yet, there is still limited evidence regarding the perception of the ageing agricultural labour force in the country and a lack of insights into farmers’ strategies to improve agricultural output. To fill this gap, we analysed primary data from questionnaire-based surveys of 365 households in Prachinburi Province, Thailand. The results show that household poverty, farm experience, retirement, health concerns, and farm accidents are positively associated with the farmers’ perception on the ageing workforce, whereas education level, having an ageing farmer in the family, farm size, mentoring and access to new technology have a negative influence on the perception of the ageing workforce. Given the anticipated implications of the population ageing in Thailand, the government should consider establishing policy options to encourage younger entrants into the agricultural sector and prioritising policies related to intergenerational support.
Farms worldwide: 2020 and 2030 outlook
Authors: Erenstein Olaf , Chamberlin Jordan , Sonder Kai
Published: June 2021

Rural development objectives are often framed relative to a targeted number of beneficiary farms and farm households. Yet the data available on the number and distribution of the world’s farms has been surprisingly fragmented and coherent estimates of the number of farms in a given region for a given year have not been available. We take a set of simple rules to use existing data sources to generate a harmonized set of farm number estimates at the national level. We estimate there are 656 million farms globally in 2020, with a projected decline to 624 million farms globally by 2030. These estimates can be used to better inform policy and large-scale investment programming and design. We also articulate the need for further investments in basic agricultural census data, and outline an agenda for the generation of farm distribution data that would be most useful for further policy guidance.