bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP2: Benefit Of Alteplase And Lacunar Stroke: A Post-hoc Analysis Of The Shine Trial
Authors: Mandel Daniel , De Havenon Adam H , Johnston Karen C , Yaghi Shadi , Goldstein Eric D
Published: February 2023

Introduction:
Small subcortical infarcts, synonymous in the literature with lacunar or small vessel disease infarcts, occur in roughly a quarter of all ischemic stroke. While the use of alteplase and other thrombolytics is well known to improve outcomes for acute ischemic stroke, the role of thrombolytics in the acute management of this infarct subtype is not entirely proven. We hypothesized that the use of alteplase in the hyperacute management of small vessel infarcts improved long-term outcomes.

Methods:
We performed a post-hoc analysis of the Stroke Hyperglycemia Insulin Network Effort (SHINE) dataset. We included only those with an etiologic diagnosis of lacunar stroke. The primary exposure was guideline-based administration of alteplase. The primary outcome was 90-day functional outcome by mRS 0 - 2 (good) versus 3 - 6 (poor). Insulin treatment arms were combined as no differential treatment effect was demonstrated in the original SHINE publication. Standard descriptive and logistic regression analysis, adjusted for age, arrival blood glucose, and NIH Stroke Scale, were used for data interpretation.

Results:
We included 258 SHINE participants who were diagnosed with a lacunar infarct: mean age 65 ± 13 years, 53% (138/258) were men, and 57.7% (150/258) received alteplase. Demographic data including age, sex, and presenting variables including NIH Stroke Scale score, systolic blood pressure, and blood glucose levels did not differ between those who received alteplase and those who did not. Those who received alteplase were more likely to be within the good outcome group (OR 1.89, 95%CI 1.03 - 3.47,
p
= 0.039).

Conclusion:
The administration of intravenous alteplase for reported lacunar stroke increased the likelihood of a good outcome by nearly 2-fold. Lacunar infarcts, a radiographic outcome of small subcortical infarcts, are unique in pathogenesis compared to cardioembolic and large-artery atheromatous disease. Despite these differences, our findings support the use of acute thrombolytic therapy within this patient population. Future studies are needed to assess the response between small subcortical infarcts subtypes (e.g. branch atheromatous disease, subcortical microembolism, lipohyalinosis) and acute reperfusion therapy.
Abstract WP203: Stroke Occurrence Is Associated With Abnormal Sleep Duration In The United States
Authors: Hassani Sara , Ovbiagele Bruce , Markovic Daniela , Towfighi Amytis
Published: February 2023

Background and Purpose:
Inappropriate sleep duration (<7 or >8 hours/night) is associated with cardiovascular events. Given its importance, the new American Heart Association Life’s Essential 8 construct of ideal cardiovascular health includes sleep duration. Yet, studies of sleep duration in relation to stroke are scarce. Our objective was to compare sleep duration among individuals with and without prior stroke in a nationally representative U.S. sample.

Methods:
Using the National Health and Nutrition Examination Surveys database (2005-2018), individuals >=18 years were identified (n=37,987 without self-reported stroke; n=1,572 with self-reported stroke). Prevalence of normal sleep duration (7-8 hours/night) was compared between persons with and without self-reported history of stroke using the Rao-Scott χ;
2
test. Multinomial logistic regression analysis was used to evaluate the relationship between prior stroke and abnormal sleep before and after adjusting for demographic and clinical variables.

Results:
Compared to individuals without prior stroke, prevalence of normal sleep duration was lower in individuals with prior stroke (18-44 years: 32% vs 54%; 45-64 years: 47% vs 55%; >=65 years: 45% vs 54%). Factors associated with >8 hours/night sleep included female sex, older age, non-White race, lower education, poverty, and obesity. Factors associated with <7 hours/night sleep were male sex, younger age, Black race, lower education, poverty, and obesity. Compared to individuals without stroke, those with prior stroke were more likely to report >8 hours/night (unadjusted OR 2.03, 95% CI 1.64-2.51) and <7 hours/night (1.29, 1.08-1.53). These associations were respectively attenuated after adjustment for demographic and clinical variables (adjusted OR 1.54, 95% CI 1.22-1.94 and 1.15, 0.96-1.38).

Conclusion:
Stroke survivors in the United States are more likely to have abnormal sleep duration compared to those without a prior stroke. Future research should explore the causal links between stroke by type and duration of sleep.
Abstract WP209: Changes In Serum Superoxide Dismutase 3 (sod3) Following Acute Ischemic Stroke: A Pilot Study
Authors: Khezri Nicole , Frontario Ariana , Li Yinghui , Reinsel Ruth , Halterman Marc W
Published: February 2023

Introduction:
Acute ischemic stroke (AIS) elicits peripheral immune activation and reactive inflammatory changes within the lung that contribute to cerebral reperfusion injury. Expression of the antioxidant SOD3 within the lung exerts an intrinsic anti-inflammatory bias on the systemic vasculature. In preclinical models, lung and serum SOD3 levels decline acutely following AIS, while enforced lung SOD3 expression blunts post-stroke inflammation and reperfusion injury. Linking changes in serum SOD3 with stroke severity in a clinical context could have important diagnostic and therapeutic implications.

Objectives:
1) Compare serum SOD3 levels among AIS patients vs. controls at initial hospital presentation; 2) Evaluate changes in serum SOD3 in AIS patients during hospitalization; 3) Establish whether serum SOD3 levels correlate with stroke severity.

Methods:
Inclusion criteria
: patients (≥18 years) presenting with AIS (n=7) not treated with either tPA or thrombectomy. Patients with MRI-negative TIA or stroke mimics served as controls (n=8).
Exclusion criteria
: history of stroke or ICH, seizure at presentation, infection or trauma in the past 30 days, malignancy, autoimmune disease, or major surgery within 90 days.
Analyses:
Baseline (12-24 hours from LKN) and serial serum samples (1-7 days) were analyzed by automated capillary Western for total SOD3 and compared against the presenting NIH stroke scale score.

Results:
Analyses revealed 35% (range +9% to -53%) lower initial SOD3 levels in patients with acute ischemic stroke vs. controls, with NIHSS scores ranging from 0 to 10 (median 0.5). Median SOD3 levels in AIS patients were 45,204, 31214, and 41,133 AUC (area under curve) at 12, 24, and 72 hours, respectively. While differences between median peak to nadir SOD3 levels were significant (52117 ± 16052 vs. 27798 ± 7529, p=0.015, two-tailed t-test) in AIS patients, serum SOD3 levels did not correlate with stroke severity.

Conclusion:
These results suggest minor ischemic stroke is associated with acute reductions in serum SOD3. While further study is required, this finding has potential clinical implications when considering the potential utility of SOD3 as a disease marker and potential therapeutic in the setting of AIS.
Abstract WP216: Intraperitoneal Delivery Of Capsinoids (Non-pungent TRPV1 Agonists) Promotes Mild Hypothermia And Improved Long-term Outcome Following Stroke
Authors: Andersohn Alexander , Jarret Bob , Cantrell Charles , Marrelli Sean P
Published: February 2023

Intro:
Mild hypothermia has been shown to improve outcomes in cardiac arrest and experimental stroke models. Unfortunately, hypothermia protocols in awake subjects are hampered by inconsistent temperature management due to incomplete suppression of cold defense mechanisms (e.g. shiver response). To address a need for better strategies for cooling conscious subjects, we sought to promote mild hypothermia by pharmacological activation of heat-sensing nerve fibers in the thermoregulatory system. We hypothesize that capsinoids - non-pungent agonists of the transient receptor potential vanilloid 1 (TRPV1) channel - activate vagal afferents, triggering thermoregulatory regions of the brain to induce mechanisms of whole-body cooling, protecting the brain and preventing injury progression after a stroke.

Methods:
C57BL6 male mice of 11wks underwent permanent distal middle cerebral artery occlusion (pdMCAO) or sham. Mice recovered for 2hrs in warming cages to maintain normal body temperatures during post-stroke recovery before being administered capsinoids or vehicle (4 IP injections, 90 min interval) to produce 6 hours of mild hypothermia (or normothermic control). After 1 month, mice underwent functional tests and brains were collected for histological analysis.

Results:
Capsinoids provided a significant and consistent hypothermia whereas vehicle maintained a baseline temperature (two-way ANOVA, n=7, p=0.0036). Capsinoid-treated mice showed ~50% infarct volume reduction 1 month after stroke, measured by cresyl-violet staining (0.7% ± 0.1% SEM vs 1.5% ± 0.2% SEM, n=7, two-tailed unpaired t-test: p=0.0046). Additionally, a stroke-induced breathing dysfunction (decrease in tidal volume by plethysmography) was significantly restored toward normal in the capsinoid-treated group (7.7e-3 ± 5.6e-4 SEM vs 5.8e-3 ± 2.4e-4 SEM, n=8, one-way ANOVA: p=0.033).

Conclusion:
Capsinoids delivered to TRPV1-containing visceral afferents promotes reversible mild hypothermia in freely moving conscious mice. Application of this form of cooling in the pdMCAO model provides significant reduction of stroke injury volume and long-term improvement in functional outcome.
Abstract WP218: Intraperitoneal Igf1 Treatment Ameliorates The Chronic Impact Of Ischemic Stroke In Reproductively Senescent Female Rats And Repairs The Gut While Icv-igf-1 Does Not
Authors: El-Hakim Yumna , Mani Kathiresh Kumar , Samiya Nadia T , Sohrabji Farida
Published: February 2023

Background:
Our previous studies have shown that reproductively senescent (RS) female rats, who have lower circulating levels of the peptide hormone Insulin-like Growth Factor (IGF-1), display worse outcomes after a stroke event than young adult female rats. ICV administration of IGF-1, decreases infarct volume, improves sensory motor performance, and reduces cytokine levels in the ischemic hemisphere of RS females as compared to vehicle-treated controls. Yet, icv IGF1 administration failed to attenuate peripheral inflammation and depressive behaviors in the chronic phase of stroke. In view of the evidence that stroke induces gut dysbiosis, and that gut dysfunction is implicated in depressive and cognitive behaviors, we hypothesize that, unlike icv administration of IGF-1, which is restricted to the brain, systemic i.p. administration of IGF1 would repair the gut, attenuate peripheral cytokine levels and improve long-term behavior outcomes.

Methods:
Acyclic middle-aged Sprague Dawley female rats (9-11 mos) were subjected to endothelin-1 induced middle cerebral artery occlusion (MCAo) or sham operation. Animals received IGF1 via i.p. injections 4h post MCAo and 24 h post MCAo, or icv infusions, while controls received vehicle. Sensory motor tests, blood and gut samples were acquired pre and post MCAo. Animals were terminated either in the acute phase (2d) or chronic phase (30d). The latter group was also subject to tests of cognition and depressive-like behavior.

Results:
In contrast to icv treatment, i.p.-IGF-1 did not reduce infarct volume or acute sensory motor impairment, but significantly attenuated circulating levels of several inflammation associated cytokines. In addition, ip-IGF-1 significantly attenuated post stroke gut dysmorphology, by preserving villus:crypt ratio and the mucin barrier. Furthermore, in the chronic phase, i.p.-IGF1 attenuated cognitive decline post stroke in the NORT and Barnes Maze tasks, while icv IGF-1 did not.

Conclusion:
Since long term disability after stroke is correlated with elevated levels of peripheral cytokines, our data suggest that systemic IGF1 may be a better therapeutic option for long term outcomes.Supported by NS074895 to FS. YEH is supported by a generous gift from the WoodNext Foundation.
Abstract WP233: Sex Differences In The Impact Of Focal Ischemia On Cognitive Impairment In Middle-aged Rats And The Effect Of Iv Mir20a-3p Treatment
Authors: Sampath Dayalan , Branyan Taylor , Markowsky Kylee , Gunda Rithvik , Singer Jacob M , Samiya Nadia T , Sohrabji Farida
Published: February 2023

Introduction:
Our previous studies show that the small non-coding RNA, mir20a-3p, is neuroprotective for stroke in the acute phase (Branyan et al., 2021). Here we used a battery of tests to assess the integrated functioning of affective and cognitive circuits in the chronic phase of stroke and the impact of mir20a-3p.

Methods:
Middle-aged (12-month-old) female and male Sprague-Dawley rats were subject to middle cerebral artery occlusion (MCAo) using endothelin-1. Mir20a-3p mimic or scrambled oligo was administered i.v. 4h, 24h, and 60d after stroke. Cognitive changes (30-100d after stroke) were assessed by contextual fear conditioning (CFC) and the novel object recognition test (NORT). Blood samples were collected at 60 and 100d to assess cytokines and short chain fatty acids.

Results:
MCAo impaired sensory motor performance in the acute phase, which was ameliorated by Mir20a-3p treatment. At 30, 60 and 100d after stroke, retrieval of fear memory was significantly reduced over time in sham and stroke males and females. However, the rate of decline of fear memory was significantly accelerated in the scramble treated female stroke group, but not in the scramble treated male stroke group. Similarly, declarative memory (NORT) declined in all female groups at 30 days post stroke and continued to worsen only in the stroke+ scrambled treated group. Male rats did not show any change in performance due to stroke or its treatment at comparable time points of testing. Hyperintensities in the forebrain of T2 weighted MRI images were decreased in mir20a-3p treated stroke females compared to males. Correlation analysis showed that in females at 60d post stroke, the extent of Remote Fear memory recall was highly positively correlated with the levels of the SCFA butyric acid (+0.81) and valeric acid (+0.61), as well as the pro-inflammatory cytokine IL-12p70 (+0.64), and the serine hydrolase, butyrylcholinesterase (+0.71).

Conclusion:
Although acute sensory-motor impairment is seen to a similar extent in males and females, stroke significantly affected cognitive function in females but not males, and this was associated with alterations in inflammatory mediators. Mir20a-3p, which is predicted to repress inflammatory analytes, abrogated stroke effects in females.
Abstract WP238: Glymphatic System Dysfunctions Contributes To The Progression Of Cognitive Decline In A Rat Model Of Alzheimer's Disease
Authors: Zhang Li , Chopp Michael , Luo Hao , Jiang Quan , Ding Guangliang , Zhang Zheng Gang
Published: February 2023

Introduction:
The aquaporin-4 (AQP4)-dependent glymphatic system mediates β-amyloid (Aβ) clearance. Using TgF344-AD rats that recapitulate clinical hallmarks of Alzheimer’s disease (AD), we examined longitudinal alterations of the AQP4-glymphatic system during the progression of Aβ deposition and cognitive decline.

Methods:
Male and female TgF344-AD rats (n=34, 18 male and 16 female) and wildtype (WT) littermates (n=30, 15 male and 15 female) rats at the ages of 6, 10, and 20 months (M) were subjected to an array of cognitive function tests. Aβ and AQP4 were measured using immunohistochemistry and the glymphatic system was measured using magnetic resonance imaging (MRI).

Results:
Compared to age-matched WT rats, TgF344-AD rats showed progressive cognitive deficits measured by odor recognition, social interaction, and Morris water maze tests starting from 10M and declining through 20M with worse cognitive deficit in female rats. Compared to WT rats, a significant reduction of para-arteriole AQP4 started at 6M (21±7%) and progressed to microvessels (55±12%) in the hippocampus and cortex through 20M, while Aβ deposition nearby reduced AQP4 started at 6M (6±2%) and widely expanded during 10M (31±9%) to 20M (42±7%). Aβ deposition was significantly correlated to cognitive deficit with R
2
of 0.95. During 10M to 20M extravascular albumin deposition was detected. MRI analysis revealed that TgF344-AD rats exhibited significantly decreased glymphatic clearance rate of Gd-DTPA starting at 10M, which was further aggravated at 20M.

Conclusion:
Our data demonstrate that female TgF344-AD rats have worse cognitive deficits and increased loss of AQP4 prior to cognitive deficits, Aβ deposition, and dysfunction of the glymphatic system. These data support that the AQP4-dependent glymphatic system plays an important role in mediating the progression of AD pathologies in the rat.
Abstract WP25: Up-front Vascular Imaging At A Primary Stroke Center: Impact On Door In Door Out Time For Patients With Acute Ischemic Stroke And Large Vessel Occlusion
Authors: Victor Patricia , Mohamed Ghada , Aboul Nour Hassan Osama Mostafa , Miller Kenneth , Singh Kush , Patel Sumir , Segovis Colin M , Nahab Fadi B
Published: February 2023

Background:
AHA/ASA guidelines recommend obtaining early vessel imaging with CT angiography (CTA) or MR angiography (MRA) only in a select group of acute ischemic stroke (AIS) patients suspected to have large vessel occlusion (LVO). There is limited data on the utility of early cerebrovascular imaging in all suspected AIS patients presenting within 24 hours and its impact on door in-door out (DIDO) time.

Methods:
In January 2020, our Primary Stroke Center implemented a protocol to obtain upfront head and neck CTA simultaneously with a non contrast head CT for all suspected ischemic stroke patients screening positive for BE-FAST stroke symptoms within 24 hours from last known normal time. We retrospectively reviewed patients before (January 1-December 31, 2019) and after protocol implementation (January 1, 2020-June 30, 2022) to assess time metrics for patients receiving IV thrombolysis and/or transfer for thrombectomy.

Results:
A total of 86 AIS patients were evaluated during the study period. Time metrics before and after protocol implementation for thrombectomy eligible patients are shown in the figure. Compared to 2019, up-front CTA was associated with significant reductions in Door-to-CTA start (median 37 vs 14 minutes, p=0.05), Door-to-CTA interpretation (median 83 vs 52 minutes, p=0.02) and DIDO times (median 150 vs 106 minutes, p=0.02) in the final 12 months of the study period. There was no significant difference in door-to-needle time before and after protocol implementation (median 48 vs 43 minutes, p=0.40).

Conclusion:
In conclusion, up-front cerebrovascular imaging with CTA in suspected AIS patients presenting within 24 hours resulted in shorter DIDO times without delaying door-to-needle times. Primary Stroke Centers should consider this approach to detect LVO early and accelerate patient transport to thrombectomy capable centers.
Abstract WP34: Collaboration Between Acute Care Hospitals And Rehabilitation Hospitals Reduces 30-day Readmission And Mortality After Ischemic Stroke Hospital Discharge
Authors: Blaginykh Elena , Uchino Ken , Khawaja Zeshaun , Druin Erica , Lee John , Hall Geoffrey , Man Shumei
Published: February 2023

Background:
To improve transitions of care from an acute hospital to an acute rehabilitation hospital, monthly multidisciplinary case review meetings among these hospitals' staff were implemented in 2020. This study aimed to determine whether this effort improved the outcomes of stroke patients.

Methods:
Monthly online meetings among the acute stroke care team and 3 rehabilitation hospital team leaders were implemented in a large healthcare system. The goal of these meetings was to review all readmissions in-depth, promote communication, and establish best practice protocols to reduce adverse events. We compared patient outcomes before (2018-2019, n=360) and after (2020-2021, n=264) the intervention using multivariate logistic regression models. The primary outcomes were all-cause mortality and readmission within 30 days after acute hospital discharge. Secondary outcomes were 30-day mortality, readmission, and ED visits. The models were adjusted for patient demographics, comorbidities, stroke severity assessed with the National Institute of Health Stroke Scale (NIHSS), and hospital stroke certification status.

Results:
The median patient age was 70 (interquartile range [IQR]: 60;79), and 297 (48%) were females. The patients in the post-intervention period had longer hospital stays (median 6 vs. 5 days, p<.0001) and higher median NIHSS scores (6 vs. 4, p=0.03). The intervention was associated with lower 30-day all-cause mortality and readmission (12% vs. 22%, Adjusted odds ratio [aOR], 0.562; 95% confidence interval [CI], 0.344-0.920). Readmissions alone were reduced (11% vs. 22%, aOR, 0.557; 95% CI, 0.338-0.918). No significant associations between the intervention and mortality (aOR, 1.00; 95% CI, 0.21-4.85) or ED visits (aOR, 0.86; 95% CI, 0.52-1.40) were found.

Conclusion:
The multidisciplinary case review meetings among neurology and rehabilitation staff may greatly reduce 30-day hospital readmissions and mortality after acute stroke hospital discharge.
Abstract WP36: Transcranial Electrical Stimulation (tdcs) In Stroke Early After Onset Clinical Trial (tesseract)
Authors: Bahr-Hosseini Mersedeh , Nael Kambiz , Iacoboni Marco , Liebeskind David S , Bikson Marom , Saver Jeffrey L
Published: February 2023

Background:
In preclinical studies of acute ischemic stroke (AIS), cathodal transcranial direct current stimulation (C-tDCS) provides neuroprotection by inhibiting peri-infarct depolarization, apoptotic and inflammatory cascades, and by enhancing collateral perfusion. We undertook the first-in-human feasibility study of high-definition (HD) C-tDCS as an individualized treatment strategy in AIS.

Method:
The study design was a randomized, sham-controlled, 3+3 dose-escalation feasibility trial. Key entry criteria were patients within 24hr from AIS onset, imaging evidence of cortical-supplying vessel occlusion and substantial penumbra, and ineligibility for reperfusion therapies. HD C-tDCS was delivered to the penumbra using individualized montages. Current flow models showed the specificity of electrical field coverage to ischemic regions.

Results:
Among 10 enrolled patients, 7 were allocated to active C-tDCS and 3 sham. Age in active/sham patients was 75 (±19.6) vs 77 (±12); entry NIHSS in active/sham patients was 8 (±8.5) vs 7(±2.6). The first 4 patients (3 active and 1 sham) received 1mA-20min (Tier1) and the subsequent 6 (4 active and 2 sham) 2mA-20min (Tier2) of C-tDCS. All patients completed the stimulation with no significant intolerability. C-tDCS met the study primary feasibility endpoint, with speed of tDCS implementation median 12.5 min (IQR 9-15) in the last 4 patients. One symptomatic intracranial hemorrhage occurred due to a ruptured mycotic aneurysm for which Tier 2 was extended. Median penumbral salvage proportion in the active C-tDCS group was 66% (IQR 29-80.5) compared to 0% (IQR 0-0) in sham. Recanalization rate was 83% in active vs 33% in sham (Figure).

Conclusion:
High-definition C-tDCS is a feasible non-invasive targeted treatment for AIS and showed strong signals of beneficial effects upon penumbral salvage and vessel recanalization. These data warrant conduct of large efficacy and safety trials of C-tDCS as an AIS therapy.
Abstract WP4: Intravenous Thrombolysis And Outcomes In Patients With Large-vessel Stroke Directly Admitted Or Transferred To A Thrombectomy-capable Center
Authors: Garcia-Tornel Garcia-Camba Alvaro , Lozano Prudencio , Requena Manuel , Rodriguez-Luna David , Rodriguez-Villatoro Noelia , Rubiera Marta , Muchada Marian , Olive-Gadea Marta , Rizzo Federica , boned sandra , Ribo Marc , Molina Carlos A , Pagola Jorge , Juega Jesús , Dorado Laura , Jimenez-Fabrega Xavier , Cardona Pedro , Urra Xabier , Purroy Francisco , Terceño Mikel , Flores Alan F , Chamorro Angel , Silva Yolanda , Ustrell Xavier , Zaragoza Jose , Roquer Jaime , Krupinski Jerzy , Cocho Dolores , Palomeras Ernest , Gomez-Choco Manuel J , Canovas David , Martí-Fàbregas Joan , Mas Natalia , Fagundez Olga , Abilleira Sonia , Molina Carlos A , Perez de la Ossa Natalia
Published: February 2023

Objective:
To assess whether the effect of intravenous thrombolysis in patients with large-vessel occlusion differed between patients directly admitted to thrombectomy-capable centers and patients transferred from local stroke centers without thrombectomy capabilities.

Methods:
We included 3206 patients with an acute ischemic large-vessel stroke with first imaging within 7 hours after onset that were directly admitted to thrombectomy-capable centers and treated with thrombectomy, or transferred from local stroke centers for thrombectomy evaluation, between 2017 and 2021 in Catalonia, Spain. Primary outcome was the degree of disability at 90 days, as evaluated by the shift analysis on the mRs score. Secondary outcomes included mortality at 90 days and the rate of parenchymal hemorrhage and successful reperfusion. Inverse-probability weighting clustered at the type of stroke center was used to estimate the effects.

Results:
The analysis included 2268 patients (975[49%] treated with thrombolysis) directly admitted to thrombectomy-capable centers and 938 patients (580[66%] treated with thrombolysis and 616[67%] treated with thrombectomy) transferred from local stroke centers (mean age 72±13 years, median NIHSS score 17[IQR 12-21], 1363 female[48%]). Patients treated with intravenous thrombolysis were younger, had shorter time from onset to first image acquisition, and higher rates of wake-up stroke, atrial fibrillation and anticoagulation intake. The effect of intravenous thrombolysis on the primary outcome was similar in patients directly admitted to thrombectomy-capable centers (acOR 1.50, 95% CI 1.24-1.81) and patients transferred from local stroke centers (acOR 1.44, 95% CI 1.04 to 2.01)(p
interaction
=0.68). Patients treated with intravenous thrombolysis had lower mortality rate, higher rate of parenchymal hematoma and similar rate of successful reperfusion, with no difference according to type of center (p
interaction
>0.1).

Conclusion:
Administration of intravenous thrombolysis in patients with a large-vessel stroke with intention to thrombectomy was associated with higher odds of good functional outcome and higher rates of parenchymal hematoma, independently of the type of stroke center were it was administered.
Abstract WP6: Strokes Averted by Intravenous Thrombolysis: A Secondary Analysis of the BEST-MSU Trial
Authors: Bach Ivo , Czap Alexandra L , Parker Stephanie A. , Jacob Asha P , Mir Saad , Wang Mengxi , Yamal Jose-Miguel , Rajan Suja S , Saver Jeffrey L , Gonzalez Michael O. , Singh Noopur , Jones William , Alexandrov Anne W , Alexandrov Andrei V , Nour May , Spokoyny Ilana , Mackey Jason , Fink Matthew E , English Joey , Barazangi Nobl , Volpi John J , Venkatasubba Rao Chethan P , Kass Joseph S , Griffin Laura J , Persse David , Grotta James C , Navi Babak B
Published: February 2023

Introduction:
While the goal of IV tissue plasminogen activator (TPA) is to prevent infarction, few data exist on averted stroke.

Methods:
Secondary analysis of a multicenter trial from 2014-2020 comparing outcomes between patients treated for stroke by mobile stroke unit (MSU) vs standard care (SC). The analytical cohort were patients with suspected stroke treated with IV TPA. The primary outcome was a time-defined averted stroke diagnosis, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours. The secondary outcome was a tissue-defined averted stroke diagnosis, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours and no acute infarction/hemorrhage on imaging. We used multivariable logistic regression to evaluate associations between study exposures (demographics, comorbidities, stroke characteristics) and outcomes.

Results:
Among 1009 patients with a median last known well-to-TPA time of 87 minutes, 276 patients (27%) had a time-defined averted stroke (31% MSU, 21% SC) and 159 patients (16%) had a tissue-defined averted stroke (18% MSU, 11% SC). Factors independently associated with time-defined averted stroke were younger age (OR, 0.98; 95% CI, 0.96-0.99), female sex (0R, 0.51; 95% CI, 0.36-0.74), hyperlipidemia (OR, 1.81, 95% CI, 1.24-2.64), normal premorbid function (0R, 2.22; 95% CI, 1.37-3.67), lower glucose (OR, 0.996; 95% CI, 0.993-0.999), lower MAP (OR, 0.991; 95% CI, 0.983-0.998), MSU care (OR, 1.77; 95% CI, 1.21-2.62), lower NIH stroke scale (OR, 0.89; 95% CI, 0.86-0.93), and no large vessel occlusion (LVO) (OR, 0.52; 95% CI, 0.32-0.83). For tissue-based averted stroke, younger age, female sex, hyperlipidemia, lower MAP, MSU treatment, lower NIH stroke scale, and no LVO were significantly associated.

Conclusion:
In a modern acute stroke trial, one-in-four patients treated with TPA for stroke recovered within 24 hours and one-in-six had no demonstrable brain injury on imaging. Younger age, female sex, hyperlipidemia, lower MAP, MSU care, lower stroke severity, and no LVO may increase the odds of averting stroke.
Abstract WP7: Mstu Validation Of A Pre-reperfusion Map For Better Thrombectomy Outcomes
Authors: Hake Joshua , Willis Corbin , Killedar Amogh , Shah Sarthak , Fuchs Vadeem , Hicks William J , Katz Brian S , Rai Vivek , Jennings Nate , Hill Michelle , Loochtan Aaron , Budzik Ronald , Pema Peter J , Alhajeri Abdulnasser , Vora Nirav
Published: February 2023

Background:
We sought to determine and validate a pre-reperfusion blood pressure threshold for MCA occlusions patients with better thrombectomy outcomes.

Methods:
We reviewed patients from 2013 to 2015 treated with thrombectomy for a MCA M1 occlusion at our center. Blood pressure measurements from available records at the time of EMS activation to the time of reperfusion were used to calculate an averaged pre-reperfusion mean arterial pressure (MAP). All patients in our analysis had successful reperfusion. Our endpoint was a mRS ≤2 at 90 days. The averaged MAP was grouped as follows: ≥85mmHg, ≥90mmHg, ≥95mmHg, ≥100mmHg, ≥110 mmHg and ≥115mmHg. We considered hourly epochs from symptom onset to reperfusion, pre-treatment ASPECTS, thrombolytics, and collateral status. Significant parameters from a univariate analysis were included into a multivariate logistic regression to determine independent predictors of outcome. The multivariate findings were then validated with a prospective set of similar patients evaluated with our mobile stroke treatment unit.

Results:
We reviewed 52 patients. Mean age was 70; NIHSS was 16±6; 40% (21) received t-PA; median ASPECTS score was 10; TICI 3 score was achieved in 63% (33), and 67% (35) had a good outcome. The number of patients having a mean arterial blood pressure threshold were as follows: ≥85mmHg (96%), ≥90mmHg (83%), ≥95mmHg (73%), ≥100mmHg (58%), ≥110mmHg (31%) and ≥115mmHg (15%). Reperfusion occurred as follows: ≤3hrs (4%), ≤4hrs (21%), ≤5hrs (39%), ≤6hrs (52%), ≤7hrs (67%), ≤8hrs (79%), ≤9hrs (87%), and ≤12hrs (90%). Our multivariate logistic regression model identified an average pre-reperfusion MAP ≥95mmHg as the sole factor statistically associated with a better outcome post successful thrombectomy [OR 15.1, CI 1.3-170.1,p=0.02]. Good clinical outcome in those patients with an averaged MAP ≥95mmHg was 76% and 43% in those below the threshold [OR 5.2, p=0.02]. Our validation cohort consisted of 32 patients, and a pre-reperfusion averaged MAP ≥ 95 mmHg had a sensitivity of of 93% for a good outcome.

Conclusion:
Our analysis suggests with validation that a pre-reperfusion averaged MAP ≥ 95mmHg results in better outcomes with successful thrombectomy and may be used as a therapeutic target in the pre-hospital setting.
Abstract WP80: The Heart-brain Connection: Implementing Strategies To Reduce The Rate Of Perioperative Stroke For Patients Undergoing Coronary Artery Bypass Graft Surgery
Authors: Westover Deborah , Wright Wendy , Aziz Iman , Goyal Abhinav , Keeling W B , Grubb Kendra J , Paone Gaetano , Shoffstall Julie , Giebler Antasia , Groff Robert , Lacey Dee , Benameur Karima , Yaw Sylvia , Nahab Fadi B
Published: February 2023

Background:
Stroke is a known complication of cardiac surgery. The objective of this study was to implement a systemwide strategy to reduce perioperative stroke after isolated coronary artery bypass graft (CABG) surgery utilizing best practices from cardiothoracic surgery and neurology expertise.

Methods:
A prospective, quality improvement study of all isolated CABG patients at three hospitals within a multicenter academic healthcare system, in a large metropolitan area, was completed from January 1, 2021 to June 30, 2022. Utilizing Lean methodology, a multidisciplinary team of cardiothoracic surgeons, neurologists, anesthesiologists, certified stroke nurses, and process improvement specialists conducted a gap analysis to identify interventions to decrease the observed to expected (O/E) ratio of risk-adjusted perioperative strokes. The team developed a pre-operative evaluation process for patients with a history of stroke, formalized the utilization of intra-operative epiaortic ultrasound, and deployed education on BE-FAST symptoms and the purpose of stroke alerts to providers, nurses, and ancillary staff caring for the patient population.

Results:
During the study period, 1175 patients underwent isolated CABG. Risk adjusted perioperative stroke rates in the first 6 months of 2021 compared to 2022 declined from an O/E ratio of 1.32 to 0.78. Among patients with new post-operative stroke symptoms, the time frame from last known well to symptom recognition decreased from 704 to 486 minutes. Following the implementation of the protocol, one site saw the utilization of inpatient stroke alerts after CABG increase from 81.3% to 100% for patients with new BE-FAST symptoms.

Conclusion:
Multidisciplinary implementation of best practices was associated with lower risk adjusted perioperative stroke rates, reductions in time to new symptom recognition, and increased utilization of inpatient stroke alert processes. Further study is needed to monitor the effects of the pre-operative evaluation process and the standardization of epiaortic ultrasound. Future goals are to standardize the methods and assess the benefit to other types of cardiac surgery.
Abstract WP81: Validation Of Artificial Intelligence To Limit Delays In Acute Stroke Treatment And Endovascular Therapy (VALIDATE)
Authors: Sevilis Theresa , Figurelle Morgan , Avila Amanda , Boyd Caitlyn , Gao Lan , Heath Gregory W , Ayub Hira , Devlin Thomas
Published: February 2023

Introduction:
Analyses from early- and late-window thrombectomy trials for acute large vessel occlusion (LVO) stroke have consistently demonstrated a strong time-dependent treatment effect for best outcomes. The utilization of an artificial intelligence (AI)-based care coordination platform to support LVO diagnosis and treatment has the potential to assist in reducing door to puncture times and improve outcomes.

Hypothesis:
Utilization of an AI-based care platform in the management of LVO patients may significantly decrease door to Neurointerventionalist (NIR) notification time.

Methods:
Acute stroke consultations seen by TeleSpecialists, LLC physicians in the emergency department in 166 facilities (17 states) that utilized VIZ.AI software or did not have an AI software from December 1, 2021 through March 31, 2022 were extracted from the Telecare
TM
database. Facilities that neurology does not initiate contact with NIR were excluded. The encounters were analyzed by age, ethnicity, last known normal, arrival time, initial telemedicine stroke code activation time (TCA), candidacy for thrombolytics, door to needle time (DTN), advanced imaging, presence of LVO, time NIR accepted, premorbid modified Rankin Score, and NIHSS score. Patients were divided into two groups (utilization and non-utilization of the AI platform) and median door to NIR notification times were compared. There was a 4 minute shorter time to TCA at AI hospitals.

Results:
A total of 14,116 patients (8,557 AI and 5,559 non-AI) were included. The median door to NIR notification time for AI was 50 minutes (40, 82) and non-AI was 89.5 minutes (59.3, 122), p <0.001. There was a small but significantly shorter time (3 minutes) from door to TCA at AI hospitals. Median DTN times for thrombolytics was also lower with AI, 40 minutes (30, 52) vs 44 minutes (32, 57.5) for non-AI, p=0.018. The AI group had more advanced imaging performed, a higher percentage of LVOs identified, and a higher percentage accepted by NIR.

Conclusion:
Hospital utilization of an AI-based care coordination platform was associated with a significant decrease of 39.5 minutes in the time to NIR contact, increase in patients taken for intervention, and lower DTN times for thrombolytics.
Revision of the Afrotropical species of the genus Anterhynchium de Saussure (Hymenoptera: Vespidae: Eumeninae)
Authors: SELIS MARCO , CARPENTER JAMES M.
Published: February 2023

A taxonomic study on the Afrotropical species in the genus Anterhynchium de Saussure, 1863 is presented. Some subspecies are elevated to specific rank (Anterhynchium argenteopilosellum (Giordani Soika, 1937) stat. nov., A. bugandanum Giordani Soika, 1987 stat. nov., A. cariosum Giordani Soika, 1987 stat. nov., A. denticulatum (Mocsáry, 1903) stat. nov., A. sulphureomaculatum (von Schulthess, 1928) stat. nov.). New synonymies are proposed for Anterhynchium fallax (de Saussure, 1852) (=Rhynchium luctuosum Gerstäcker 1857 syn. nov.), Anterhynchium grandidieri (de Saussure, 1890) (= Epiodynerus grandidieri limbatulus Giordani Soika, 1991 syn. nov.), Anterhynchium grayi (de Saussure, 1855) (= Synagris inermis var. atrata Mocsáry, 1903 syn. nov.; = Rhynchium grayi var. sumptuosum Gribodo, 1895 syn. nov.), Anterhynchium mephisto (Gribodo, 1892) (= Anterhynchium beninum Gusenleitner, 2018 syn. nov.; = Odynerus rufoniger Bequaert, 1918 syn. nov.; = Synagris uncata Tullgren, 1904 syn. nov.); Anterhynchium synagroide (de Saussure, 1852) (=Rhynchium synagroides var. alpha von Schulthess, 1923 syn. nov.; Rhynchium synagroides var. beta von Schulthess, 1923 syn. nov.), Anterhynchium andreanum (de Saussure, 1890) (= Odynerus andreanus discolor Giordani Soika, 1941 syn. nov.); Anterhynchium synagroide gamma (von Schulthess, 1924) is considered as a doubtful synonym of A. argenteopilosellum syn. nov. The nominal subgenus is redefined and divided into the following species-groups: grayi species-group, mephisto species-group, osborni species-group and synagroide species-group. The Malagasy species are transferred from Epiodynerus Giordani Soika to the nominal subgenus but considered as incertae sedis in it. Odynerus natalensis de Saussure, 1855 and Anterhynchium uniforme Gusenleitner, 2012 are transferred to Antodynerus de Saussure, 1855 (Antodynerus natalensis comb. nov. and Antodynerus uniforme comb. nov.), Rhynchium histrionicum Gerstäcker, 1857 is transferred to Euodynerus Dalla Torre, 1904 (Euodynerus (Euodynerus) histrionicus comb. nov.), Rhynchium holomelas André, 1895 is transferred to Pseudagris de Saussure, 1863 (Pseudagris holomelas comb. nov.; = Rhynchium junodianum von Schulthess, 1899 syn. nov.; = Synagris aterrima Maidl, 1914 syn. nov.), Anterhynchium obscurum Gusenleitner, 2007 is transferred to Tricarinodynerus Giordani Soika, 1952 (Tricarinodynerus obscurus comb. nov.). Anterhynchium dahomeyicus Gusenleitner, 2018 is a junior synonym of Aethiopicodynerus punctiventris (Gusenleitner, 2002) syn. nov. Lectotypes for Odynerus andreanus de Saussure, 1890 and Rhynchium sulphureomaculatum von Schulthess, 1928 are designated. A key to the species is provided.
Zn(II) compound with blue luminescence and activity evaluation on tendon bone healing
Authors: Zhou Peng , Li Huan , He Tian-Da , Yu Wan-Tao , Jiang Zhe-Cheng , Xu Peng
Published: February 2023

Mixed ligand of H2ip and L assembled with Zn(NO3)2 ·6H2O under solvothermal conditions provided a novel Zn(II) compound formulated as [Zn(ip)(L)] (1, H2ip = isophthalic acid, L is 4-[4-(1H-imidazol-1-yl)phenyl]-2,
6-bis(pyridin-4-yl)pyridine). This compound’s emission performances in solid state were also explored at RT. In the biological section, the as-created complex’s application values against tendon bone healing were discussed, and the mechanism was researched simultaneously. First,
activation of the Wnt signaling pathway in bone tissue was examined by real-time reverse transcription-polymerase chain reaction. Second, quantitative computed tomography was performed to measure the bone density of the animal after compound treatment.
Pterostilbene regulates endothelial cells activation and expression of adhesion molecules through HIF-1α in cerebral vessels with hypoxic injury
Authors: Xu Chan , Jiang Ting , Liu Yinni , Zou Jing
Published: February 2023

This study assessed mechanism of pterostilbene in regulating endothelial cells activation and expression of adhesion molecules in cerebral vessels with hypoxic injury. These endothelial cells in cerebral vessels were cultivated in vitro and model of hypoxic injury was prepared.
Cells were assigned into control group, model group and group with pterostilbene. The action of pterostilbene on proliferative and apoptotic activity was tested. Expression of HIF-1α, VCAM-1 and ICAM-1 was detected, and change of SOD activity and MDA content and VEGF level were
tested. Results revealed that, activity of endothelial cells and proliferation was increased in the pterostilbene group, while apoptosis and expression of HIF-1α were reduced. The expressions of VEGF and SOD activity were increased, while that of VCAM-1 and ICAM-1 were reduced,
including the MDA content. The expression of HIF-1α was reduced while that of VEGF was increased by pterostilbene. Redox activity was also improved and adhesion molecules was restrained. Endothelial cells activation in cerebral vessels with hypoxic injury was thus improved by
pterostilbene.
Accuracy of non-contrast enhancement multiparametric MRI to diagnose liver tumor compared to conventional MRI sequences
Authors: Chen Wen-Chang , Ho Yen-Hung , Lin Wei-Ming
Published: February 2023

Magnetic resonance imaging is widely used to create detailed images of the organs and tissues. In daily clinical practice of diagnosing liver cirrhosis, it is still a challenge to find the best clinical diagnosis for detection hepatic lesions like hemangioma or hepatoma. In this study,
we tried to compare the accuracy of method non-contrast enhancement multiparametric MRI (mpMRI) with conventional liver MRI. A total of 120 patients with liver cirrhosis were enrolled and were divided into two groups, 60 patients with hepatic hemangioma (HH, group A) and 60 patients with hepatocellular
carcinoma (HCC, group B). MRI was first used for different diagnosis hepatic lesions without any invasive procedure or surgical treatment. All acquired MRI images were divided into 2 parts: the first part was the non-contrast enhancement multiparametric MRI (mpMRI), and the second part named
the conventional liver MRI, was covered all images including non-contrast enhancement and dynamic contrast material-enhanced. The MRI images were interpreted by two experience gastrointestinal radiologists (I and II). Before analysis, the clinical manifestations, laboratory data, tissue biopsy
results were not known. Paired samples t-test was used to analyze the significant difference of two-tailed probability (P < 0.05), and its Hemangioma and Hepatoma of receiver operating characteristic curve and area under the ROC curves values were evaluated. In the results,
two-tailed probability of non-contrast enhancement mpMRI sequences and the conventional liver MRI in group A was found to be P = 0.109, while that in group B was found to be P = 0.115. After Wilcoxon sign-ranked test, the two-tailed probability reached 0.557 in group A, while
that of group B reached 0.624; both showed not difference between the two groups. In conclusion, the non-contrast enhancement mpMRI that included the half-Fourier single-shot turbo spin-echo (HASTE) with fat suppression T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), apparent
diffusion coefficient (ADC) and susceptibility-weighted imagining (SWI) sequence can provide reliable information for effectively differentiate HH and HCC without using contrast materials. This study is expected to provide a reference for the application of MRI in clinical diagnose for a better
enhanced method.
Rho-associated coiled-coil kinase contributes an important role in Xingnaojing injection-induced adverse drug reactions
Authors: Han Jiayin , Pan Chen , Wang Dunfang , Tang Xuan , Yang Yifei , Li Yanning , Ran Qingsen , Zhang Yushi , Liang Aihua
Published: February 2023

Xingnaojing injection (XNJI) is widely used for acute cerebral hemorrhage. However, the adverse drug reactions (ADRs) caused by XNJI have attracted broad attention. In this study, mice were intravenously administrated with a single dose of XNJI (10 or 20 mL/kg) to evaluate the vascular
permeability. Then, pathological examinations on ears and lungs were performed to further determine the characteristics of ADRs induced by XNJI. In addition, human umbilical vein endothelial cells (HUVECs) were stimulated with XNJI (1/128, 1/64, and 1/32 XNJI pure product dilution) and stained
with rhodamine-phalloidin to analyze the alterations on cytoskeleton. In addition, endothelial monolayer was incubated with XNJI and the effect on permeability was tested. Western blot testing was conducted to measure the involvement of Rho-associated coiled-coil kinase (ROCK) in XNJI-induced
ADRs and fasudil hydrochloride was applied to additionally confirm the contribution of ROCK. The results indicated that XNJI may lead to dose-associated vascular leakage. None visibly abnormal symptom was noticed in the mice treated with XNJI at 10 mL/kg, while inflammation in ears and lungs
was observed in the mice administrated with 20 mL/kg XNJI. In in vitro experiment, stimulation with high concentration of XNJI (1/32 XNJI pure product dilution) could enhance the permeability of confluent endothelial monolayer and induce rearrangement of actin cytoskeleton. Activation
of ROCK, which was shown as augmented expressions of p-MLC2 and p-MYPT1, was observed in cells and mice treated with XNJI. ROCK inhibitor could attenuate XNJI-induced dysfunction of endothelial barrier in in vitro experiment and alleviate the vascular leakage and inflammation noticed
in mice treated with XNJI. This study indicates that overdose of XNJI can destroy vascular endothelial function and induce increased vascular permeability, which may cause ADRs in clinical practice. Meanwhile, ROCK plays an important role in XNJI-induced ADRs.