bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP196: A Decade Later: Revisiting The Midlife Stroke Surge Among Women In The United States; Updated Results From The National Health And Nutrition Examination Surveys (NHANES)
Authors: Nguyen Christopher , Ovbiagele Bruce , Markovic Daniela , Towfighi Amytis
Published: February 2022

Background:
Previous data from NHANES 1999-2004 showed that women aged 45-54 years were more than twice as likely as men to report a prior stroke. Little is known about recent sex-specific trends in midlife stroke prevalence and risk factors for stroke.

Methods:
We assessed age- and sex- specific trends in stroke prevalence among individuals aged 35-64 years (n= 23,936; weighted n= 349,074,769) participating in NHANES across epochs in 6-year intervals (1999-2004, 2005-2010, 2011-2016) using survey weighted counts and proportions to reflect US national estimates. Stroke was self-reported. Survey adjusted logistic regression models compared odds of prior stroke by sex across time for each midlife decade adjusting for sociodemographic and clinical variables. Trends in prevalence of vascular risk factors were assessed over time.

Results:
In 1999-2004, women aged 45-54 years were over twice as likely as men to report prior stroke (OR 2.4, 95% CI 1.4-4.2, p=0.002). In 2005-2010 and 2011-2016, the differences were no longer significant (OR 1.5, 0.9-2.5, p=0.15 and OR 0.9, 0.5-1.6, p=0.71). There were no sex differences in stroke prevalence for those aged 35-44 and 55-64 years (Table). Among those aged 45-54 years, mean systolic blood pressure (SBP) were comparable between women and men in 1999-2004 (124, SE 0.7 mmHg vs 125, SE 0.6 mmHg, p= 0.27), but women’s mean SBP decreased to 121, SE 0.6 mmHg in 2011-2016, while men’s remained stable at 124, SE 0.6 mmHg. Diabetes prevalence increased in both men (9% to 13%) and women (8% to 10%). Obesity prevalence increased from 31% to 38% in men and 37% to 42% in women.

Conclusion:
A decade later the midlife stroke prevalence surge among women (vs. men) in the US has abated. However, it is unclear whether this change is due to shifts in incidence or case fatality and opportunities remain to address cardiometabolic risk factors for both sexes.
Abstract TP207: The Evolution Of NETosis Biomarkers And Their Relationship With Peripheral Immune Cells In A Preclinical Model Of Ischemic Stroke
Authors: Yin Junxiang , Wu Michael , Mohseni Tasha , Kindelin Adam , Ahmad Saif , Ducruet Andrew F , Ahmad Abdullah S , Waters Michael F
Published: February 2022

Introduction:
Reperfusion resistance is one major challenge encountered during the thrombolytic treatment of acute ischemic stroke. Neutrophil extracellular traps formation (NETosis) facilitates thrombosis and contributes to reperfusion resistance. However, the plasma biomarker profile of NETs following stroke is poorly understood.

Hypothesis:
Understanding the precise evolution of NETosis biomarkers and their relationship with peripheral immune cells may provide new insight into the therapeutic options of acute ischemia stroke.

Methods:
Three-month-old C57BL/6 mice were subjected to middle cerebral artery occlusion for 60 minutes followed by reperfusion (Ischemia-Reperfusion, IR). Peripheral blood was collected on day 1, 2, 3, 5, and 7 after IR and whole blood cell counts were assessed. The concentrations of NETosis biomarkers [Citrullinated histone 3 (CitH3), Neutrophil Elastase (NE), Myeloperoxidase (MPO), and deoxyribonucleic acid (DNA)] in plasma were measured. Pearson correlation analysis was used to determine the relationship between the levels of NETosis biomarkers, blood cell counts and the ratios of neutrophils, lymphocytes, and platelets.

Results:
Compared to control (Ctrl) mice, the IR-subjected mice exhibited a drastic increase in plasma CitH3 and NE on day 1 (p<0.05) while DNA and MPO reached their peak levels on day 3. IR-subjected mice also showed a significant increase in peripheral neutrophils and decline in peripheral leukocytes, lymphocytes, and monocytes on day 1 and day 2 (p<0.05). The ratios of neutrophil to lymphocyte, neutrophil to leukocyte, and lymphocyte to monocyte dramatically increased on day 1 (p<0.05). Plasma NE, CitH3 and MPO were positively correlated with peripheral neutrophil and the ratio of neutrophil to lymphocyte, but inversely correlated with peripheral lymphocyte (p<0.05).

Conclusions:
There are time dependent changes in plasma NETosis biomarkers and their relationship with peripheral immune cells post-stroke may inform effectiveness of potential treatments to prevent the expansion of cerebral infarction and functional deterioration. However, further investigation is needed to confirm this hypothesis and its clinical implication.
Abstract TP218: Migraine And Embolic Stroke Of Undetermined Source: Thinking Beyond Patent Foramen Ovale And Paradoxical Embolism
Authors: Alshaer Qasem N , RANGARAJU Srikant , Nahab Fadi B
Published: February 2022

Introduction:
The frequent presence of PFO in migraine patients with stroke has led to assumptions of paradoxical embolism. Normal markers of coagulation and hemostatic activation (MOCHA) effectively rule out active hypercoagulability and venous thromboembolism. We hypothesized that ESUS patients with PFO and migraine have low frequency of abnormal MOCHA.

Methods:
ESUS patients seen at the Emory Clinic from January 1, 2017 to December 31, 2020 underwent MOCHA testing (d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer) ≥14 days after stroke (median 47, IQR 15 - 90) and were considered positive if ≥2 markers were elevated.

Results:
Of 333 ESUS patients, 70 (21%) patients had a PFO. Migraineurs with PFO (n=23) were younger (median age 38 vs 61; p=0.002) and more likely to be female (70% vs 45%; p=0.05) compared to PFO patients without migraine. Migraineurs had significantly lower rates of abnormal MOCHA compared to PFO patients without migraine (17% vs 43%, p=0.035). After correcting for age or RoPE score in logistic regression analysis, migraine was not associated with abnormal MOCHA.

Conclusions:
ESUS patients with PFO and a history of migraine had a lower frequency of abnormal MOCHA compared with no migraine history. Our results suggest that migraine patients with PFO frequently have a stroke mechanism independent of paradoxical embolism. Further investigations are needed to understand the local effects of migraine on the brain.
Abstract TP220: Clinical And Demographic Characteristics Associated With Poor Posterior Circulation Stroke Outcomes: Greater Cincinnati/Northern Kentucky Stroke Study
Authors: Chervak Lina , Demel Stacie L , Sucharew Heidi , Opeolu Adeoye , Jasne Adam , Alwell Kathleen , Madsen Tracy , Woo Daniel , Flaherty Matthew , Ferioli Simona , Martini Sharyl , Star Michael , De Los Rios La Rosa Felipe , Coleman Elisheva , Walsh Kyle B , Slavin Sabreena , Mistry Eva , Mackey Jason , Haverbusch Mary , Kleindorfer Dawn O , Kissela Brett
Published: February 2022

Background:
Posterior circulation strokes (PCS) make up 20% of all strokes, yet there is poor understanding of what factors contribute to poor clinical outcomes. We investigated clinical and demographic characteristics associated with poor clinical outcomes in PCS using a population-based biracial cohort.

Methods:
Greater Cincinnati Northern Kentucky Stroke Study (GSNKSS) 2010 and 2015 data was utilized to identify 1842 patients who were >20 years old with MRI-proven PCS. Eligible patients were then stratified based on functional outcomes (modified Rankin Scale<3 vs >/= 3, with >= 3 considered poor) according to demographics, stroke risk factors, tPA treatment, stroke location, and stroke mechanism. A multivariable logistic model was used to identify the predictors for poor functional outcomes.

Results:
Age, higher NIHSS, higher baseline mRS, hypertension, temporal, thalamus, and brainstem location, and cardioembolic mechanism were associated with poor clinical outcomes (Table). After multivariable analysis, age, higher NIHSS, higher baseline mRS, hypertension, temporal, thalamus, and brainstem location, and cardioembolic mechanism remained associated with poor outcomes.

Conclusion:
Understanding these factors associated with poor prognosis after posterior circulation stroke will allow for better prognostication and family counseling.
Abstract TP234: Delayed Administration Of A Repurposed Drug With Sigma 1 Receptor Activity Improves Stroke Outcomes In Male Rats
Authors: Schreihofer Derek , Dalwadi Dhwanil , Oppong-Gyebi Anthony , Metzger Daniel , Kim Seongcheol
Published: February 2022

Sigma-1 receptor ligands including agonists and antagonists have been shown to improve outcomes from experimental stroke when administered at delayed time points. However, clinical trials for one such agonist, cutamesine, failed to demonstrate benefit. In the present study, we sought to identify approved drugs that could be repurposed for Sigma-1 activity and the delayed treatment of stroke. High-throughput screening was used to identify Sigma-1 receptor selective binding and stimulation of brain-derived neurotrophic factor (BDNF) release for several potential ligands that are already approved for other indications. Two lead compounds, promethazine (an antihistamine) and oxeladin (a cough suppressant), were advance to
in vivo
studies. Both compounds displayed favorable oral absorption into the brain and high dose tolerance in rats. Neither compound significantly altered thrombosis in an
in vitro
blood coagulation assay. Daily oral administration of oxeladin (3 doses) or vehicle was started 48 hours after 90-minute transient middle cerebral artery occlusion in adult male Sprague-Dawley rats (n=12/group) and continued for 10 days in a treatment-blind manner. Rats receiving the two highest doses showed significant (P<0.05, 2-way ANOVA and Dunnett’s test) improvements in Bederson scores (0.4±0.1 vs 1.5±0.2), an 11 point Neurological assessment (1.2±0.1 vs 3.9±0.2) , and the elevated body swing test (60% vs 90% bias) 1, 4, and 10 days after dosing compared to vehicle controls. A subset of rats was administered BrdU (50 mg/kg ip) every other day. However, there were no significant differences among groups in BrdU incorporation observed in the subventricular zone at 14 days after stroke. Additional studies are being performed to assess the mechanisms of neuroprotection. These data suggest that repurposing of approved/safe drugs with Sigma-1 receptor activity is a promising avenue for the treatment of chronic stroke.
Abstract TP243: Treatment With Vwf Inhibitor Dtri-031 In Combination With Rtpa Increases Thrombolytic Efficacy Compared To Rtpa Or Aspirin In Mouse, Canine, And Human Blood
Authors: Kini Aarushi , Stork Taggart , Carfora Arianna , Wheeler Debra , Joseph Matthew , Dornbos David L , Nimjee Shahid M
Published: February 2022

Introduction:
We demonstrated that VWF inhibition thrombolyses stabilized clots in and decreases infarct size after middle cerebral artery occlusion (MCAO) in pre-clinical models of stroke.

Objective:
To compare the thrombolytic efficacy of von Willebrand Factor (VWF) inhibition by DTRI-031 versus rTPA and aspirin utilizing an
ex vivo
Halo assay.

Hypothesis:
We hypothesized that DTRI-031 treatment, would result in greater combinatorial efficacy with aspirin or rTPA than any one treatment alone.

Methods:
Ex vivo Halo assay was performed with whole blood from male and female, 15-month-old wild-type C57BL/6J adult mice, 1-year-old hounds, and healthy control patients 40-60 years of age).

Results:
Healthy patients
The mean CLR
max
of the negative control group (n=6) was 0.024 ± 0.17 min
-1
. Addition of 250 nM DTRI-031 (n=8)
or
0.7 nM rtPA (n=8) increased the CLR
max
to 1.67 ± 1.56 min
-1
and 1.80 ± 1.41 min
-1
respectively. Addition of 500 nM DTRI-031
and
0.7 rtPA (n=4) resulted in a synergistic effect of both compounds with a CLR
max
of 10.15 ± 2.4 min
-1
(p=.0003).
Mice
The CLR
max
of the negative control (n=6) was 0.013 ± 0.011 min
-1
. Addition of 250 nM DTRI-031 (n=6) increased the CLR
max
to 1.19 ± 1.27 min
-1
. Addition of 7 nM rtPA (n=6) increased the CLR
max
to 0.13 ± 0.13 min
-1
, which was considerably muted compared to the assay with human blood. The synergistic effect of DTRI-031+rtPA was seen at doses of 250 nM DTRI + 7 nM rtPA (n=4) with a CLR
max
of 2.08 ± 1.45 min
-1
and 500 nM + 7 nM rtPA (n=6) with a CLR
max
of 4.3 ± 2.5 min
-1
compared to monotherapy (p<0.0001).
Canine
The CLR
max
of the negative control (n=33) was 2.611 ± 2.659 min
-1
. The addition of 250 nM DTRI-031 or 500 nM DTRI-031
and
0.7 rtPA (n=18) resulted in a synergistic effect of both compounds which were significantly greater than all monotherapies with a CLR
max
of 13.52 ± 8.985 min
-1
and 9.152± 6.943 min
-1
, respectively.

Conclusion:
VWF inhibition by DTRI-031 aptamer + rTPA significantly improves clot lysis rate compared to monotherapy with rTPA, DTRI-031, and aspirin in mouse, canine, and human blood.
Abstract TP245: Unfavorable Role Of Autotaxin Lysophosphatidic Acid Axis During Ischemic Reperfusion In Stroke.
Authors: Bhattarai Susmita , Sharma Sudha , Ara Hosne , Subedi Utsab , Bhuiyan Shenuarin , Sun Hong , Miriyala Sumitra , Panchatcharam Manikandan
Published: February 2022

Introduction:
Stroke is a leading cause of death, also serious cause of long-term disability in the US. r-TPA and mechanical thrombectomy apply to 5-10% of patients, while others have the risk of intracerebral hemorrhage. Ischemic reperfusion following stroke exacerbates the condition and initiates various molecular signals. However, with a better therapeutic regimen, the detrimental effects can be limited. Lysophosphatidic acid (LPA) is a bioactive phospholipid regulated in physiological and pathological conditions. LPA is formed by the enzyme Autotaxin (ATX). ATX-LPA axis affects endothelial permeability in ischemic stroke.

Hypothesis:
ATX-LPA axis favors endothelial permeability in ischemic stroke.

Methods:
Transient middle cerebral artery occlusion with 90 minutes of ischemia and 24 hours of reperfusion (I/R) was used as a stroke model in mice. LPA was analyzed in plasma with mass spectrometry and in tissue with immunohistochemistry. AR-2 probe fluorescence assay was used to measure ATX activity. Evans Blue Permeability in vivo was measured with infrared imager. Mitochondrial bioenergetics was measured with an XF24 analyzer. Permeability was studied using Electric Cell Substrate Impedance System (ECIS).

Results:
ATX enzymatic activity is prominently raised in I/R mice compared to sham mice. Increased ATX activity coheres with the Evans Blue permeability in the mice brain. Simultaneously LPA levels are elevated (P<0.01) in I/R mice. LPA was increased in brain tissue along the vasculature, indicating an unfavorable role of ATX in maintaining endothelial integrity. LPA receptors were regulated differentially following stroke. Permeability measured in MBMEC showed that LPA treatment increased the permeability in a time and concentration-dependent manner. LPA treatment also increased superoxide in MBMEC suggesting redox imbalance with LPA exposure. Mitochondrial superoxide elevated following I/R was limited with ATX inhibitors which also restricted the permeability compared to that of the I/R mice

Conclusion:
LPA produced by ATX plays a significant role in ischemic stroke, increasing BBB permeability and elevating mitochondrial dysfunction. Targeting the ATX-LPA axis could be a better therapeutic avenue for stroke management.
Abstract TP249: Early-lifechronic Intermittent Hypoxia Susceptibility For Anxiety-like Behaviors: Focus On Cerebrovascular Alterations
Authors: Coelho Santos Vanessa , Tieu Taryn , Kilby Madeline , Shih Andy Y
Published: February 2022

Premature birth is a major public health issue affecting 1 in 10 deliveries worldwide. One of the most common diagnoses in these infants is apnea of prematurity, with chronic intermittent hypoxia (CIH) as one hallmark, which includes interlacing hypoxia and normoxia episodes. The perinatal brain is vulnerable to hypoxia because it is a shifting landscape with marked growth and remodeling of the vasculature. Hypoxia provides a natural angiogenic stimulus during growth of cerebrovascular networks. However, it is unclear if exposure to CIH alters the structure and function of developing brain vascular networks. To further investigate this question, we used a neonatal mouse model that mimics the hypoxia/reoxygenation events occurring in CIH. From postnatal day P2 to P12, pups were exposed to 20.9% O
2
(normoxia) and 5.7% O
2
(hypoxia; 25-30 episodes of 5-7s per hour) for 8 hours a day during daylight hours. Our previous studies examining mouse pups (P8-P12) reared in normoxic conditions showed that ascending venules were a key locus for new vascular growth during brain capillary development. Concurrently, an initially amorphous plexus of pial venules on the cortical surface undergoes massive intussusceptive remodeling to create an optimized tree-like network for cortical blood drainage. During CIH,
in vivo
two-photon imaging revealed that angiogenic sprouts emerged not only from venules but also from cortical arterioles. CIH led to more active angiogenesis and increased brain capillary length and branching. In addition, arteriovenous shunts were present within the pial vasculature. Critically, we observed that mice exposure to CIH during the neonatal period presented anxiety and mood like-behaviors (interupted grooming and jump/scape behavior) at weaning age (P21). Curiously, mice exposed to CIH exhibited improved recognition memory (novel object recognition) at P30. These findings begin to clarify the vascular changes induced by CIH and their association with behavioral abnormalities after development with CIH.
Abstract TP25: Acute Stroke Patients With Low NIHSS Did Not Delay Hospital Presentation During COVID
Authors: Kaabi Ali , Mozumder Aaisha , Bandela Sujani , Cardentey Agnelio , Gealogo Brown Gretchel , Choi Byeongyeob , Figueroa Jeanette , Garza Ashley M , Birnbaum Lee
Published: February 2022

Hypothesis:
Hospital presentation for acute stroke may have been delayed during COVID-19. We hypothesize that stroke patients with mild symptoms (NIHSS <= 5) were more likely to present in a delayed fashion during the early days of the pandemic.

Methods:
Get with The Guidelines Stroke registry was used to identify stroke patients that presented between January 1 and August 31, 2020 to the University Hospital in San Antonio, Texas. The cohort was stratified by date of presentation (before COVID: Jan 1 - Mar 15; during COVID: Mar 16 - Aug 31) and presenting NIHSS (<=5 versus >5). We then analyzed by the thrombolytic exclusion criteria delay to arrival and the time interval of stroke symptoms discovery to hospital presentation. Subgroup analysis included age, sex, and ethnicity; race was excluded due to 90% Caucasian cohort.

Results:
A total of 294 subjects were included of which 115 were before and 179 were during COVID. There were no significant differences in the demographics for these two time periods, although a trend for greater male presentation was seen during COVID (Table 1). After both groups were dichotomized by NIHSS <=5, stroke symptoms discovery to hospital arrival and delay to arrival (Table 2) were not significantly different across subgroups.

Conclusions:
Regardless of NIHSS, a significant time delay in acute stroke presentation to our hospital was not seen when comparing before and during COVID. Although our study included a large Hispanic population, the cohort was primarily Caucasian; and therefore, the results have limited application. Whether men were more likely than women to present with stroke during COVID is unclear but warrants further study with a larger sample size.
Abstract TP257: Association Of Depressive Symptoms, Carotid Stenosis And The Co-occurrence Of Both With Inflammatory Markers In An Elderly Panamanian Cohort
Authors: Novarro-Escudero Nelson , Villarreal Alcibiades , Britton Gabrielle B
Published: February 2022

Objective:
The relationship between depressive symptoms (DS) and carotid stenosis (CS) in elderly individuals has received a lot of attention recently, with conflicting results. Attempts to look for several serum inflammatory markers that could correlate with both conditions have also been made, mainly in Caucasian population. The purpose of this study is to examine associations between DS, CS, and seven inflammatory markers in an elderly Panamanian cohort.

Methods:
A sample of 136 elder individuals underwent Doppler sonography to estimate the presence of CS. DS were assessed with the 30-item Geriatric Depression Scale (GDS-30). Blood samples were obtained and the following inflammatory markers were determined: Beta-2 microglobulin (B2M), fatty acid-binding protein (FABP), factor VII (FVII), I-309, intercellular adhesion molecule-1 (ICAM-1), thymus and activation-regulated chemokine (TARC), and pancreatic polypeptide (PP). Analyses of the relationship between functional abilities and biomarkers across different groups were conducted using multivariate analyses of covariance.

Results:
Participants with DS conserved fewer activities of daily living (ADL) abilities (p<0.000), had higher levels of B2M (p<0.000) and decreased levels of FABP (p=0.009). Patients with CS conserved fewer ADL abilities (p<0.000) and had higher levels of B2M (p=0.001). Subjects with DS and CS conserved fewer ADL abilities (p<0.000), had increased levels of B2M (p<0.000), and ICAM-1 (p=0.46). There were no significant multivariate effects for years of education, I-309, PP, factor VII, and TARC.

Conclusions:
In the present study, it was found that DS were associated with lower ADL abilities, increased levels of B2M, and decreased levels of FABP. CS was associated with lower ADL abilities and increased B2M, and significant associations were observed with the co-occurrence of CS and DS with lower ADL abilities, increased levels of B2M and ICAM-1. The implications of these significant effects could be pointing in the direction that inflammation may considerably modulate the association between CS and DS in non-Caucasian population.
Abstract TP260: Early Voluntary But Not Forced Exercise Improve Neural Remodeling After Cerebral Ischemia By Promotingmitochondrial Transport
Authors: Shen Jiamei , Geng Xiaokun , Ding Yuchuan
Published: February 2022

Introduction:
Neural remodeling occurs in the early stage after cerebral ischemia, and rehabilitation training promotes the recovery of neronal function to the greatest extent. Although the forced exercise within 6 hours after cerebral ischemia effectively promote long-term nerve remodeling, it enhanced the short-term ischemic injury. Instead, early voluntary exercise is relatively safe. The present study determined whether early voluntary exercise safely and effectively promote long-term functional recovery after stroke.

Methods:
A total of 60 adult male Sprague-Dawley rats were divided into 4 groups: 1) sham control, 2) stroke, 3) stroke with forced exercise from 6 hours to 28 days (30min every day), 4) stroke with voluntary exercise from 6 h to 28 d. Infarct volume and neurological deficit were evaluated. Long-term functional outcomes were determined by grid walk, rota-rod, adhesive tape touch, and Morris water maze. Levels of mRNA and proteins of neuroplasticity and synaptogenesis were determined by real-time PCR and Western blot. After 28 days of reperfusion, the rats were taken for measured with electron microscopy.

Results
. 1. Early forced exercise aggravated cerebral infarction, while early voluntary exercise reduced infarct volume. 2. As compared to forced exercise, voluntary exercise improved running time in rota-rod, shortened the time of removing adhesive tape and reduced the time of finding platform in water maze. 3. Voluntary exercise significantly stimulated production of irisin to brain and growth differentiation factor 10 (GDF10), suggesting voluntary exercise improve long-term function through release of GDF10. 4. Voluntary exercise promoted synaptophysin, brain-derived neurotrophic factorand postsynaptic density protein-95 expression, suggesting voluntary exercise improved neuroplastic and synaptogenic. 5. Electron microscopy showed that voluntary effectively improved the ultrastructure of mitochondria(32±3.1%) after stroke, alleviated swelling of mitochondria (20±2.5%).

Conclusions:
Voluntary exercise may become effective rehabilitation strategy, which not only induced short term neuroprotection by reducing infarct volume, but also promoted the long-term functional recovery after stroke.
Abstract TP263: Therapeutic Potential Of Intestinal Stem Cells For Stroke Recovery: Impact Of Age Of The Donor
Authors: Mani Kathiresh Kumar , El-Hakim Yumna , Pandey Sivani , Branyan Taylor , Sohrabji Farida
Published: February 2022

Nearly 50% of all stroke patients experience gastrointestinal complications that include gut microbiota dysbiosis, “leaky” gut, gut hemorrhage and gut epithelium damage. Evidence suggests that the gut signaling affects brain function and recovery from brain injury. Here we tested the hypothesis that “repairing of ischemic gut function by it’s stem cells may improve stroke outcome”.

Methods:
Adult and middle-aged Sprague-Dawley female and male rats were used for this study and assigned to the following groups: Control (sham), stroke with sham transplant (vehicle), or stroke with IESC transplantation. Rats were subjected to stereotaxic middle cerebral artery occlusion (MCAo) using Endothelin-1, a chemical vasoconstrictor. Primary IESCs were isolated from young or middle-aged female and male rats to prepare organoid cultures. Dispersed organoid cells were labeled with PKH67 and injected iv 4h/24h/48h to adult or middle aged hosts after stroke. Behavioral assays and saphenous blood draws were performed pre-stroke and at 2d and 4d after stroke. Trunk blood, brain tissue and a segment of small intestine were collected at termination. TTC staining was used to quantify infarct volume. Intestine samples were processed for the histomorphmetric analyses and immunohistochemistry to analyze specific markers of gut function (Lgr5+, Wnt3a, ZO-1,Ki67 and Villin). The blood-gut barrier was assessed by measuring serum levels of iFABP, LPS and Muc-2(surrogate markers of gut permeability).

Results:
PKH67-labelled IESC transplanted cells were observed in the basal part of the host crypt. Compared to vehicle group, MCAo-induced mortality and infarct volume were significantly reduced in middle-aged female and male rats that received IESCs from adult animals of the same sex. Sensory motor performance in the acute phase was also improved in transplanted animals as well as improved gut architecture and gut repair, and a reduction of intestinal permeability markers. However, no improvement was seen in adult animals that received senescent IESC from middle-aged animals.

Conclusion:
Overall, these data show that a novel stem cell population derived from the gut of young animals, but not middle-aged animals can significantly improve stroke outcomes.
Abstract TP27: Satisfaction Survey Reveals Participants Accepted Technology Solutions To Improve Participant Access During A Pandemic
Authors: Braunlin Jeri Lynn M , Fedder Wende , Gaines Kenneth
Published: February 2022

Background:
C3FIT (
C
oordinated,
C
ollaborative,
C
omprehensive,
F
amily-based,
I
ntegrated,
T
echnology-enabled Stroke Care) is a pragmatic, multi-centered. cluster-randomized trial to assess the superiority of patient outcomes when Joint Commission-certified Stroke Centers or Primary Stroke Center (CSC/PSC) are supplemented with an Integrated Stroke Practice Unit (ISPU) model of care at 9 of 18 hospitals across the United States. We describe participant satisfaction with technology solutions used to improve access during a Pandemic.

Methods:
Participating sites were randomized to the CSC/PSC or ISPU Model, enrolling 100/site (n=1800). Guided by Kotter’s process for leading change, ISPU patient-centric (patient/ caregiver) model provides care through two coordinated units addressing acute assessment/diagnosis/intervention (Stroke Central or SM) through hospital discharge to 1-year post-stroke (Stroke Mobile or SMT). SMT includes a Registered Nurse and Lay Health Educator working with participants for 12 monthly visits at home/facility post-stroke. A participant satisfaction tool was used to assess their ability and preference to use technology.

Results:
Enrollment began February 2020. March 2020 the Pandemic affected the study by: 1. Facilities altering visitation policies inhibiting SC/SMT interaction with participants to consent, 2. Facilities limited participant follow-up in their homes by SMT, 3. Participants limited in-home visits by SMT, 4. Institutional research programs were held. The Clinical Coordinating Center met challenges by adding phone visits, smart phone application and I-PADS for participant follow-up. ISPU sites increased phone/virtual visits to 89 %; home visits decreased to 9.9%. Participant’s survey found 94.7% were very or extremely satisfied with their “ability to use the virtual technology;” 28.4% preferred virtual follow-up; 40.9% preferred in-person; 30.7% preferred phone visits.

Conclusion:
Conducting this study during the Pandemic presented challenges to enrollment and follow-up. Participants reported satisfaction with technology as a possible solution to improve clinical access.>
Abstract TP42: Van- Training Of Emergency Medical Services To Identify LVO And Potential Thrombectomy Patients In The Field
Authors: Bonner Jennifer
Published: February 2022

Background and Purpose:
Stroke is a leading cause of disability and mortality in the United States. Rapid identification of stroke symptoms in the prehospital setting especially symptoms of a large vessel occlusion (LVO) may minimize the time to endovascular treatment and improve outcomes. Several stroke assessment tools are available to EMS identify symptoms of stroke and stroke severity. No one tool has proven to be superior to identify possible LVO. The primary objective of this study is to determine the accuracy of the VAN (vision, aphasia, and neglect) prehospital EMS assessment tool to predict LVO and identify patients potentially eligible for mechanical thrombectomy.

Methods:
Study investigators trained Central EMS and AirEvac personnel in use of the VAN screening tool over a 2-month period which consisted of instructional videos, oral presentations, and case scenarios. A post-training quiz was administered with a passing score of 80% required. Personnel were trained to assess and report the patient as “VAN positive” or “VAN negative” in the prehospital report and electronic document. This assessment was compared with CTA results and cerebral angiography for presence or absence of thrombus, as well as pre and post TICI result if thrombectomy was performed. Additionally, we compared door-to-groin puncture time for VAN positive patients with retrospective data from patients with LVO prior to VAN reporting.

Results:
An interim analysis of 147 patients evaluated with the VAN tool demonstrated 92.9% sensitivity in identifying LVO, 70.6% specificity, and 73.2% accuracy rate. Eligibility for thrombectomy demonstrated 91.7% sensitivity, 69.4% specificity, and accuracy rate of 71.5%.

Conclusions:
The VAN assessment tool, while still requiring further data, has shown promise in identifying LVO and eligibility for thrombectomy. The study will continue until 300 participants have been enrolled with full presentation of data at a future date.
Registration:
Registration-URL:
http://www.clinicaltrials.gov
; Unique identifier: NCT04951518
Abstract TP52: Identification Of Thrombophilia(primary And Secondary) In Cerebral Infarction And Tia In The National Inpatient Sample 2016-2018
Authors: Buchhanolla Prabandh Reddy , Bir Shyamal C , Kandregula Sandeep , Javalkar Vijayakumar , Chernyshev Oleg Y , Guthikonda Bharat , KELLEY Roger E
Published: February 2022

Objective:
To assess the identification of thrombophilia (primary and secondary) in cerebral Infarction and TIA in a nationwide database to determine the potential prevalence of this association

Methods and Results:
We assessed indicators of hypercoagulability in the National Inpatient Sample (NIS) database for all patients compared to those with cerebral Infarction and TIA from 2016 to 2018 to determine the potential diagnostic yield out of a sample size of 21 million subjects. During this timeframe, the frequency of thrombophilia was 0.6% in all patients compared to 1.2% in cerebral infarct patients. Grouping by age ≤45 compared to >45, thrombophilia was detected in 0.43% of those ≤45 compared to 0.67% in those >45. Despite the relatively low frequency of thrombophilia detected, the odds ratio (OR) was 13.5, 95% CI 12.7 - 14.18, (p <0.001) for cerebral infarction in those ≤45 compared to OR = 1.979, 95% CI 1.923 - 2.038, (p <0.001) in the >45 group. The OR was 12.4, 95%CI 11.916 - 12.95, (p <0.001) compared to 1.519, 95% CI 1.489 - 1.550, (p <0.001) for TIA patients in the ≤45 and >45 age groups, respectively. A higher prevalence of thrombophilia was seen in the Caucasians (68.9% p <0.001 in cerebral infarction, but not in TIA, 74.7% p <0.56. The prevalence was also higher in females (55.9%, OR = 1.29, 95% CI 1.207 – 1.373 p < 0.001) for cerebral infarction but not TIA, 65% p < 0.132.

Conclusion:
There is a greater propensity for thrombophilia in association with cerebral infarction and TIA in younger patients. Caucasians and females with thrombophilia were also observed to have a higher risk of cerebral infarction.
Abstract TP54: Prehospital Stroke Notification: No Record, Didn’t Happen
Authors: Chu Lucy , Dabhi Nisha , Pitchford Haydon , Roach Necrisha , Aldridge Chad M , Chapman Sherita N
Published: February 2022

Introduction:
Acute strokes necessitate streamlined communication between first responders and physicians regarding stroke signs ascertained in the field. Stroke alert protocols that dictate hospital resource activation contribute to the speed in which potential cases are assessed and treated. We studied associations between EMS stroke pre-notification and ED stroke alert activation behavior at a Comprehensive Stroke Center.

Methods:
This retrospective chart review identified patients who arrived via EMS and were ultimately stroke alerted from the ED between April 2020 and July 2021. Data was collected manually through a state-wide EMS record exchange and internal hospital databases to include EMS documentation of attempts to alert the ED to stroke, time of ED stroke alert activation, and final discharge diagnosis. Descriptive statistics are presented as counts and percentages.

Results:
Among the 472 cases of stroke alerted patients, 214 (45.3%) were discharged with a final diagnosis of acute stroke. There were 167 (35.4%) patients where EMS documented attempts to pre-notify the hospital of a potential stroke, versus 210 (45%) whose records lacked explicit note of pre-notification. EMS records could not be found in 94 (20.2%) cases. Among 167 known cases where EMS attempted hospital pre-notification, the ED activated a stroke alert prior to hospital arrival in 69 (41.3%). Among 210 cases where EMS did not record pre-notification, the ED stroke pre-alerted 23 (11.0%), suggesting gaps in EMS documentation of completed stroke pre-notifications. Of 94 patients who lacked EMS records, 29 (30.9%) were pre-alerted to stroke by the ED. Finally, among 214 patients discharged with acute stroke, 96 (44.9%) had documented EMS stroke pre-notifications, of which 46 (21.5%) received ED pre-alerts. An additional 24 (11.2%) stroke patients who lacked sufficient documentation were stroke alerted by the ED prior to hospital arrival.

Conclusions:
Quality in communications spanning from EMS to physicians is a crucial prerequisite to timely stroke care. Gaps in EMS records and ED stroke alert activation lend support to a need for standardization in stroke documentation and stroke alert protocols, which may streamline data access and improve patient experience of care.
Abstract TP55: Prehospital Stroke Scale: Classifying The Inconclusive Result
Authors: Dabhi Nisha , Chu Lucy , Pitchford Haydon , Aldridge Chad M , Roach Necrisha , Chapman Sherita N
Published: February 2022

Introduction:
The Cincinnati Pre-Hospital Stroke Scale (CPSS) is one of the most utilized, validated tools for stroke assessment by emergency medical services (EMS) providers. While the CPSS was developed to convey that a patient has a positive or negative finding, EMS providers designate some patients with “inconclusive” CPSS. To date, there is no data concerning the clinical presentation or stroke diagnosis of this cohort of patients.

Methods:
Retrospectively reviewed prehospital electronic medical records from 26 EMS agencies linked with hospital data of patients stroke alerted between April 1, 2020 to July 12, 2021 in our institution. The National Emergency Medical Services Information System Technical Assistance Center (NEMSIS TAC) 2020 Dataset was also evaluated. Data collected included CPSS, EMS chief complaint, EMS primary impression, and final discharge diagnosis.

Results:
At our institution 362 patients arrived by EMS and were stroke alerted at the hospital, of which 311 patients had a recorded prehospital CPSS. CPSS was recorded as inconclusive in 33.4% (104/311), positive in 52.1% (162/311), and negative in 14.5% (45/311) of patients. Neurological symptoms accounted for 76.9% (80/104) of EMS primary impression for those classified as inconclusive. Sixty percent (48/80) and 18.8% (15/80) of those were stroke-like symptoms and altered mental status, respectively. Stroke/TIA was the discharge diagnosis for 30.8% (32/104) of inconclusive, 63.6% (103/162) of positive, and 37.8% (17/45) of negative CPSSs. Nationally, 7.3% (142,422/1,955,591) of prehospital patients with recorded CPSS had an inconclusive finding. Among patients with primary impression of stroke-like symptoms with recorded prehospital CPSS, 17.3% (21,740/125,581) had an inconclusive label.

Conclusion:
Inconclusive CPSS designations in the prehospital setting are common. Although these patients present commonly with stroke-like symptoms, they have a low rate of stroke diagnosis. More studies with available prehospital linked hospital data are needed at a national level to understand the inconclusive prehospital CPSS designation and inform proper EMS education on in-practice use of stroke screening tools that reduce the number of inconclusive CPSS.
Abstract TP57: Effects Of Vitamin D Level On Stroke Clinical Severity - A Retrospective Study In Saudi Arabia.
Authors: Alharbi Abdullah ,   Faisal Alamri, Seraj Makkawi, Hussain Alqahtani, Amer Alali, Maan almaghrabi, Nouf
Published: February 2022

Authors:
Faisal Alamri, Seraj Makkawi, Hussain Alqahtani, Amer Alali, Abdullah Alharbi, Maan almaghrabi, Nouf Alghamdi, Esra Aldabbagh, Yahya Samman, Omar Albaradie, Anhar Bawashkhah, Saeed Alghamdi, Muhammad Alsalmi.

Background (objectives):
Stroke is the most common neurological condition globally, with significant rates of mortality and disability. Many studies focused on vitamin D as a risk factor, but only a limited number of studies focused on vitamin D as a predictor of stroke severity. The purpose of this study was to assess the relationship between serum vitamin D levels and stroke clinical severity.

Methodology:
A retrospective cohort study was conducted in 2021 in King Abdulaziz Medical City-Jeddah, Saudi Arabia. 774 ischemic stroke patients were screened over the last five years. However, the study enrolled only 372 patients who have their vitamin D baseline level measured. The National Institute of Health Stroke Scale (NIHSS) was assessed at admission to predict stroke clinical severity. The association between vitamin D level and stroke severity was assessed using multivariate logistic regression model.

Results:
Out of 372 participants, 11% , 22.1%, 66.9% had normal, insufficient, and deficient 25(OH)D serum levels, respectively. The mean age was 68.8 ±12.4 years, and 52.2% were male. The majority of patients (66,9%) had moderate NIHSS. The correlation coefficient test showed a significant inverse relationship between 25(OH)D serum level and NIHSS score (r=-0.117 p-value 0.024). After adjustment of the potential covariates, the study found that the relationship between deficient 25(OH)D serum level and NIHSS score has further strengthened with an OR (CI) for severe NIHSS 3.8 (1.2-4.7) P-value =0.001.

Conclusion:
Our finding adds to the evidence that vitamin D is a predictor of stroke clinical severity at admission. Limitation: The limitations of this study should be mentioned, NIHSS was calculated using admission notes only.
Abstract TP68: Guideline For Acute Stroke Discharge: A Tool Developed By Nebraska Mission: Lifeline Stroke Rehabilitation Taskforce
Authors: Malina Beth L , Goldman Amy , Jensen Lou , Nichols Lindsay , Christensen Stacie , Weissling Kristy , Sodawasser Kaylene , Little Miranda , Storer Tamara , McDowell Gene , Frans Rebecca , O'Connor Rebecca , Molacek Kylie , Reisher Peggy , Jorges Shelly , Cockle Sarah , Pietrzak Janna , Myers Gary , Jones Olivia N , Volkman Kathleen G
Published: February 2022

Introduction:
Nebraska Mission: Lifeline Stroke is a 4-year initiative to increase guideline-based treatment of acute stroke across the continuum of care. Guidelines advise post-stroke assessment by a multi-disciplinary team to guide discharge process and select ideal rehab setting.

Purpose:
To develop resources to facilitate the transition of Nebraskans with stroke to the most appropriate level of post-acute care.

Methods:
Healthcare Providers (HCPs) from various settings completed two surveys: hospital stroke rehab referral strategies and practices (N=23), and individual experiences related to stroke rehab (N=260). In addition, a literature review was conducted to find published guidelines and research on clinical decision making. Lastly, a focus group consisting of social worker/case managers was held to provide input on resources developed.

Results:
Hospitals (N=23) believe higher numbers of stroke patients should be referred to IRFs (42%) and stated that patients’ “health status” (91%), “opinions from hospital team members” (87%), and “opinions from patient, family, or caregivers” (78%) are most relevant in the decision process. Factors that impact referral process include: HCPs may not be familiar with all options for post-acute rehab care (17%) and patient or family/caregivers are not educated about options (30%). Most (57%) of HCPs surveyed and all focus group participants indicated discharge referral process could be improved with a standardized decision-making tool. Based on this input, two discharge planning guides were developed. The first assists HCPs in determining appropriate level of post-acute stroke care by comparing various types and settings in an easy-to-read format. The second is patient/caregiver focused and includes information to assist in decision-making process and a table comparing rehab settings. These guides have been disseminated through conference presentations, direct mailings, and web-based resources.

Conclusions:
Discharge tools with clear descriptions of options are necessary to assist HCPs and patients/caregivers in matching appropriate care with patient’s rehab needs. These care choices are key to patients achieving their highest level of independence.
Abstract TP69: Change Over Time Feature Of A Range Of The Recruited Motor Unit In The Recovery Period Of Hemispheric Stroke
Authors: Yoshida Mio , Ito Takanori , Funakoshi Hayase , Kokubun Takanori
Published: February 2022

The paralysis after the stroke makes loss adjustment of the force in the voluntary movement and disturbs the physical activity. The voluntary force is regulated by the motor unit (MU) recruitment and firing rate. Therefore, we should evaluate MU firing patterns to understand a part of the mechanism of the force adjustment disorders of the paralysis side. It might be possible to evaluate the change of the force adjustment function on the paralysis side in the convalescence if we considered a range of the recruited MU over time. This pilot study hypothesizes that a range of the recruited MU spreads depending on a recovery stage. Two-stroke patients participated in this study. We measured the muscle activity of the biceps using surface EMG with three-time points during the recovery period after stroke. The raw EMG data were decomposed into motor unit action potential (MUAP). Then mean firing rate (MFR) and peak amplitude of MUAP were calculated by decomposed MUAP. Additionally, coefficients of the regression line were calculated by MFR and MUAP's peak amplitude. The coefficient of the linear regression line was adopted as the outcome to evaluate a range of the recruited MU size. We also analyzed the change over time of a range of the recruited MU size. The range of the recruited MU of the recovery stage changed over time but became wide during the recovery stage. These data showed that it varied from a restrictive style to a comprehensive recruitment style over time. Therefore, a range of the recruited MU with the stroke of the recovery stage was suggested to be a tendency to enlarge over time. Expanding the diachronic range of the recruited MU may let you enrich a variation of the force in the recovery process.
Abstract TP76: The Impact Of Registries In Stroke Literature
Authors: Monteiro Andre , Bolanos Oscar , Baig Ammad A , Khawar Wasiq I , Siddiqui Adnan H
Published: February 2022

Introduction:
Registries represent a main source of data to the advances in medical literature. In stroke medicine, they serve as key points of discussion and elaboration for future clinical trials, as well as evaluation tools for several treatment modalities in different patient populations. We performed an analysis of recent stroke registries to evaluate their impact in literature.

Methods:
We performed PubMed and Google Scholar search using keywords with Boolean operators to identify studies deriving from stroke registries between January 2000 and June 2021. All registries identified were further characterized regarding study design, sample size, number of centers, number of peer reviewed articles or conference abstracts originating from it, with their respective number of citations and impact factor of journals.

Results:
A total of 51 registries were identified, comprising 43584 patients. Forty-three (84.3%) were prospective. Forty-five (88.2%) were multicenter. Sixteen (31.4%) focused in a specific device for mechanical thrombectomy. Twenty-seven (52.9%) were registered on clinicaltrials.gov. The most participating countries were United States in 16 (31.4%) and Germany in 8 (15.7%). Twenty-seven (52.9%) registries originated a total of 295 peer-reviewed articles, 6841 citations and a sum of impact factors of 1282.8. The median impact factor of journals publishing articles from registries was 5.51 (interquartile range, 3.27-7.91). The median number of citations per article was 13 (interquartile range, 4-37). Between registered and unregistered registries, there was no significant difference in the median number of publications (P=0.08), citations (P=0.158) or impact factor (P=0.124). Between registries specific and unspecific to a certain device, there was no significant difference in median number of publications (P=1.67), citations (P=0.631) or impact factor (P=0.509).

Conclusions:
Stroke registries provide a meaningful data source for literature regardless of registration or specificity to a certain device, and represent a key mechanism in the advances of stroke care. Contribution to stroke registries are key mechanism to elucidate clinical questions that require large sample size and should be incentivized.