bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP407: Therapeutic Window of Red Cell Microparticles in Limiting Hematoma Growth in a Rat Model of Intracerebral Hemorrhage
Authors: Rehni Ashish K , Cho Sunjoo , Navarro Quero Hever , Koch Sebastian , Ahn Yeon S , Perez-Pinzon Miguel A , Jy Wenche , Dave Kunjan R
Published: June 2021

Spontaneous intracerebral hemorrhage (sICH) is a serious form of stroke without any effective therapy. Limiting hematoma growth is a promising therapeutic strategy. Published data showed that red blood cell-derived microparticles (RMPs) enhance both primary and secondary hemostasis. Previously, we observed that RMPs lower hematoma growth in a rat model of sICH. The goal of our present study was to determine the optimal therapeutic time window for RMP administration. Optimal therapeutic dose and treatment paradigm were used based on our previous studies. RMPs were prepared from human RBCs using high-pressure extrusion. sICH was induced in young male rats by injecting collagenase into the right striatum. Rats were treated with either saline (vehicle) or RMP (2.55х10
10
particles/kg, b.w. i.v.) starting at 2, 3, 4.5, or 6 h post-sICH induction. Rats were randomly assigned to each treatment group (n=10 for each RMP treatment time window, n=5 for each vehicle time window). Neurological scores (12 indicates maximum impairment) were evaluated ~24 h post-collagenase injection, and then, the rats were perfused using saline. Brains were collected and sectioned for hematoma volume assessment using ImageJ by a blinded investigator. The hematoma volumes (mm
3
) of 2 (53±4, p<0.01), 3 (51±6, p<0.005), and 4.5 h (55±5, p<0.05) post-sICH RMP treatment groups were significantly lower than the vehicle group (72±4, pooled for all time windows). Similarly, the neurological scores in the 2 (8.8±0.5, p<0.001), 3 (9.0±0.3, p<0.001), and 4.5 h (8.8±0.4, p<0.001) post-sICH RMP treatment groups were significantly lower than the vehicle group (10.9±0.2). However, the hematoma volume (65±5) and neurological score (10.2±0.4) in the 6 h post-sICH RMP treatment group were not significantly different from the vehicle group. Our results indicate that RMPs were effective in lowering post-ICH hematoma volume when administrated up to 4.5 h after ICH induction. Together with our earlier results with optimal dose treatment paradigm and long-term outcome studies, these results further support the use of RMPs as a potential therapeutic option to lower hematoma growth in sICH patients.
Abstract WP409: Utilization of Open Cranial Surgery Following Surgical Trial in Lobar Intracerebral Haemorrhage I & II
Authors: Garcia Roxanna M , Metcalf-Doetsch William , Weiss Hannah , Golnari Pedram , Naidech Andrew , Jahromi Babak , Prabhakaran Shyam
Published: June 2021

Introduction:
The impact of randomized controlled trials (RCTs) on clinical practice remains an important topic in medical research. Several landmark RCTs have tested the role of neurosurgical management following spontaneous intracerebral hemorrhage (ICH). Studies have found discordant trends in utilization of open cranial surgery following the publication of Surgical Trial in Lobar Intracerebral Haemorrhage (STICH) I & II but national trends have not been assessed.

Hypothesis:
We hypothesize that recent RCTs have had limited impact on cranial utilization patterns for ICH.

Methods:
Hospitalizations from 2000 to 2014 were identified from the National Inpatient Sample. A time trend analysis evaluated open cranial surgery utilization by three ICD9CM procedure codes (01.2 “Craniotomy/Craniectomy”, 01.24 “Other Craniotomy”, and 01.25 “Other Craniectomy”), stratified by teaching status, before and after 2005, following publication of STICH I. The impact on patient outcomes was also assessed.

Results:
Based on a total of 241,160 hospitalizations with 6,984 (2.9%) open cranial surgeries, approximately 33,616 (95% confidence interval (CI): 31,582-35,650) have been performed in the United States since 2000. There was a temporal increase in cranial surgeries (OR 1.04, 95% CI: 1.03-1.05, p<0.0001) between 2000 and 2014 but when stratified by study period (before or after 2005), the increase was only significant after 2005 (OR 1.05, 95% CI: 1.03-1.06, p<0.0001). The effect was greater at teaching hospitals (OR 1.15, 95% CI: 1.10-1.20, p<0.0001) than at non-teaching hospitals (OR 1.10, 95% CI: 0.99-1.21, p=0.07). There was no differences in patient mortality and discharge disposition (p-values >0.15).

Conclusion:
Utilization of open cranial procedures has increased after STICH I, an effect that was strongest at teaching hospitals. These findings suggest that recent RCTs did not influence utilization of open cranial surgery for management of ICH.
Abstract WP411: Asymptomatic Hemorrhage Predicts Delayed Symptomatic Hemorrhage After Alteplase in Acute Ischemic Stroke
Authors: Dakay Katarina , Ricci Brittany , Chang Andrew D , Cutting Shawna , Mac Grory Brian , Burton Tina M , Thompson Bradford , Reznik Michael , Mahta Ali , Jayaraman Mahesh , Lord Aaron , Khatri Pooja , Furie Karen , Yaghi Shadi
Published: June 2021

Background:
Predictors of alteplase associated symptomatic intracranial hemorrhage (sICH) have been identified but there are very limited data on predictors of delayed sICH (> 24 hours from infusion). We hypothesize that asymptomatic hemorrhage on 24 hour brain imaging predicts delayed sICH and that delaying antithrombotic treatment in these patients reduces this risk.

Methods:
This is a retrospective analysis of a prospective quality improvement database of a comprehensive stroke center. We included all patients with a discharge diagnosis of ischemic stroke who received alteplase. Patients with sICH occurring within 24 hours from alteplase and those whose code status was changed to comfort measures only were excluded. Delayed sICH was defined as any hemorrhage causing neurological deterioration. We compared baseline characteristics, asymptomatic hemorrhage on 24 hour brain imaging, and median time to initiating antithrombotic therapy between patients with and without delayed sICH.

Results:
Among 606 patients who met our inclusion criteria; mean age was 70 years and 52% were men; 23.8% had asymptomatic hemorrhage on 24 hour brain imaging (CT or MRI) and 12 patients (2%) had delayed sICH. Aspirin was the most common initial antithrombotic (91.2%) followed by plavix (2.6%), and others (3.8%). After adjusting for confounders, asymptomatic hemorrhage on 24 hour brain imaging was associated with increased odds of delayed sICH (OR 5.5, 95% CI 1.52 - 19.87, p = 0.009) but the median time (days) to starting antithrombotic therapy did not differ between those with asymptomatic hemorrhage who developed delayed sICH vs. those who did not [2 (3) vs. 3 (5), p = 0.447).

Conclusion:
Delayed sICH in patients receiving alteplase is uncommon and asymptomatic hemorrhage is a strong predictor. Delaying initiation of antithrombotic treatment in patients with asymptomatic hemorrhage on 24 hour imaging was not associated with reduced delayed sICH risk. It is possible that other factors such as reperfusion and blood brain barrier disruption are more important determinants of delayed sICH risk as opposed to timing of antithrombotic therapy initiation.
Abstract WP416: Specific Transcriptome Response in Neutrophils, Monocytes and Whole Blood in Human Intracerebral Hemorrhage and Ischemic Stroke of Different Etiologies
Authors: Carmona-Mora Paulina , Ander Bradley P , Jickling Glen C , Zhan Xinhua , Hamade Farah , Hull Heather , Ferino Eva , Amini Hajar , Knepp Bodie , Sharp Frank R , Stamova Boryana S
Published: June 2021

Understanding transcriptome changes following intracerebral hemorrhage (ICH) and ischemic stroke (IS) of different etiologies, can lead to a better understanding of the molecular and cellular pathways involved in the response to acute brain injury caused by ICH and IS. We characterized the transcriptomic profiles from ICH and different IS etiologies to identify acute molecular changes in isolated monocytes, neutrophils and in whole blood. Peripheral blood was drawn from ICH (6) and IS (33) cases (cardioembolic, large vessel and lacunar) in the first 30 ± 20 hours post-onset of symptoms. We performed whole-genome RNA sequencing of whole blood (WB), and isolated neutrophils and monocytes. Control cases (10) with vascular risk factors (diabetes and/or hypertension and/or hypercholesterolemia) were also included (VRFC). A linear regression model including the interaction diagnosis x sample subtype with p<0.05 and overlap with FDR<0.2, (fold-change>1.2) was used for identifying differentially expressed (DE) genes. Gene ontology and pathway enrichment were performed for investigating the biological context of the DE. We observed specific transcriptional responses for ICH and IS, and within IS etiologies in monocytes, neutrophils and WB. Neutrophils’ response was the strongest with highest number of DE genes in both ICH and IS and its etiologies when compared to VRFC. Most of the changes were cell-type specific and involved immune response and signal transduction pathways. For example, in ICH compared to VRFC, about half of the over-represented pathways were unique to either monocytes or neutrophils. Many pathways over-represented in WB were not over-represented in monocytes or neutrophils, signifying the importance of additional blood cell types in the immune response to ICH and IS. A T-cell receptor gene was DE in WB only, and in opposite directions in ICH and IS when compared to VRFC, thus is a good biomarker candidate. The unique expression changes in neutrophils and monocytes after ICH and IS and its subtypes underscore their involvement in IS and ICH pathophysiology. The large number of unique genes and pathways in whole blood not detected in monocytes or neutrophils signify the contribution of other peripheral blood cell types to the ICH and IS responses.
Abstract WP431: Comparing EMS and Emergency Department Last Known Well Times in Ohio
Authors: Zatreh Mussa , Richardson Melissa
Published: June 2021

Introduction:
During the hyperacute phase of acute stroke management, time the patient was last known well (LKW) is a critical data element. Hospital Emergency Department (ED) personnel rely on accurate information reported by Emergency Medical Services (EMS) prior to arrival, which triggers the intensity of resources organized to determine patient eligibility for revascularization therapy. Over-triage can cause “alarm fatigue”, provider burnout, and/or overutilization of valuable resources. Conversely, under triage may cause a delay in, or lack of, revascularization therapy, which can have significant negative impact on the patient’s outcome. A review of the literature revealed contradictory data about the accuracy of LKW as reported by EMS.

Purpose:
The purpose of this project is to determine frequency and magnitude of discrepancies between LKW as reported by EMS and ED. The data was analyzed for trends that may influence discrepancies, such as hospital size, location, and patient demographics.

Methods:
Data on 2,092 patients from 49 hospitals was analyzed from Get With The Guidelines®-Stroke. The difference in the LKW (ΔLKW) was calculated based on source of documentation from EMS or ED. Three datasets were created based on the magnitude of the ΔLKW. For each dataset, the mean, median and patient demographics such as mean age, race, and stroke type were calculated.

Results:
Of 2,092 patients, 951 (45%) showed an exact match between LKW as reported by EMS and ED (ΔLKW=0), whereas 1,141 patients (55%) showed a discrepancy in the LKW (ΔLKW>0). Discrepancies were not influenced by hospital location or size. Of the overall population, 54% were male, 18% were black, and 73% were diagnosed with an ischemic stroke. The mean age was 72 years. Further collaboration is needed between EMS and ED personnel to improve the accuracy of LKW, and thereby improve patient care and provider efficiency.
Abstract WP45: Outcomes of Patients With Cerebral Large Vessel Occlusions Undergoing Mechanical Endovascular Revascularization Based on the Quantification of Pial Collateral Perfusion
Authors: Tahir Rizwan , Marin Horia , Affan Muhammad , Ahmad Ayesha , Bazydlo Michael , Kole Max
Published: June 2021

Introduction:
Patient outcomes after Mechanical Endovascular Revascularization (MER) are dependent on both patient-specific and procedure-specific factors. The pial collateral perfusion to the ischemic penumbra during a cerebral large vessel occlusion (LVO) is one of the most important factors in overall patient outcome. Using our technique of Quantifying of Pial Collateral Perfusion (QPCP) previously described, patient outcomes after MER for cerebral LVO were assessed.

Methods:
Fifty consecutive patients with proximal middle cerebral artery M1 occlusions for whom QPCP were recorded were included in the study. In addition to patient demographics, the primary outcomes investigated were National Institutes of Health Stroke Scale (NIHSS) scores post-procedure reduction compared to pre-procedure score, and modified Rankin Scale (mRS) score at 30-day and 3-month follow-up. In addition, overall stroke volume, time spent in hospital, and the incidence of hemorrhagic conversion were also assessed. Regression models were used to estimate the association between pial collateral perfusion pressure and the above outcomes.

Results:
Patients demonstrated for every 5-unit increase in pial collateral perfusion pressure (measured in mmHg) an association with a 0.54-unit decrease in the post-procedure NIHSS score with a P-value of 0.07 (β= -0.54; 95% CI -1.12,0.03). A 5-unit increase in pial collateral perfusion pressure was also associated with 11% lower odds of having a 30-day mRS of 4-5 vs. 0-1 or 2-3 with a P-value of 0.18 (OR=0.89; 95% CI 0.75,1.06). A higher pial collateral perfusion pressure was also associated with a 0.07-unit decrease in the log of the stroke volume (P-value - 0.32). There was no association with higher pial collateral perfusion pressure and incidence of hemorrhagic conversion on post-procedure imaging.

Conclusions:
The QPCP is an objective measure for predicting patient outcomes after MER for cerebral LVO. Higher pial collateral perfusion pressures are associated with greater improvements in post-reperfusion NIHSS scores and 30-day mRS scores.
Abstract WP461: Stop in the Name of Falls
Authors: Marstrell Kimberly , Gundelfinger Jillynn
Published: June 2021

Background and Purpose:
One of OhioHealth’s strategic priorities includes improving patient safety by eliminating preventable patient harm. The Integrated Stroke Unit (ISU) at Riverside Methodist Hospital worked to achieve this goal by reducing falls by 20%. The ISU consistently experienced a higher fall rate compared to like units across the nation. The ISU averaged over 7 falls per month with injury falls steadily increasing. The ISU experienced inconsistencies related to fall risk assessment and fall prevention interventions. As a result, a Fall Risk Scorecard was created to streamline interdisciplinary team work, increase patient safety, and improve safe patient handling and mobility.

Methods:
A multidisciplinary approach was used to improve patient safety and determine the root cause for patient falls. A team of nurses, rehab therapist, and patient support assistants was established. Inconsistencies were identified related to recognition of patients at risk for falls, types of fall interventions in place, and bed alarm knowledge and utilization. A need for visual management to standardize practice was seen. A Fall Risk Scorecard was created to help identify fall risk patients, standardize fall prevention interventions, and provide knowledge to staff regarding the patient’s activity level. The PDSA cycle was used to create standard work for the care team. Educational materials were developed and one-on-one training was provided to staff. The multidisciplinary approach helped to create a standardized process for each therapist coming to the ISU. The Fall Risk Scorecard was piloted for 3 months.

Results:
During the pilot, the unit saw a 57% reduction in falls. Current state, the ISU has continued to utilize the Fall Risk Scorecards and has sustained a 57% reduction in falls. With the utilization of lean methodology, members of the care team were able to ensure the right patient received the right intervention at the right time. With these results, the pilot has been selected for a system-wide roll-out over 11 different care sites.

Conclusion:
By taking a collaborative approach, utilizing lean methodology, and real-time problem solving, the ISU has successfully reached their goal to increase patient safety and improve safe patient handling and mobility.
Abstract WP466: Optimism Reduces Stroke Severity and Inflammation
Authors: Lai Yun-Ju , Morales-Scheihing Diego , Blixt Frank W , Munshi Yashasvee , Bui Brina V , McCullough Louise D
Published: June 2021

Introduction:
Post-stroke inflammation is detrimental to the brain and leads to impaired recovery. Optimism has been associated with lower inflammation and better health outcomes among people with medical conditions, but no studies have assessed this association in stroke population. The overall goals were to examine the relationship between optimism, stroke severity, physical disability, and inflammation during hospitalization and to evaluate this relationship over the three-month post-stroke period.

Hypothesis:
Patients with higher levels of optimism have lower stroke severity on presentation, less physical disability, decreased inflammation, and better recovery during the first three months after stroke compared to those with lower levels of optimism.

Methods:
This pilot study is a secondary analysis of data prospectively collected from the BioRepository of Neurological Diseases biobank. Outcomes included optimism level measured by the revised Life Orientation Test (LOT-R), stroke severity evaluated via the NIHSS, physical recovery defined by the mRS, and levels of inflammatory markers (IL-6, TNFα, and CRP) assessed by ELISA. Spearman’s correlation, Wilcoxon signed-rank test, multiple linear regression, and mixed-effect regression model were used to determine the relationship among the variables.

Results:
The sample consisted of 49 subjects at baseline and 13 subjects at 3-month follow-up. LOT-R scores were negatively correlated with NIHSS (ρ= -.41, p=.003), mRS (ρ= -.30, p=.05), and inflammatory markers IL-6 (ρ= -.44, p=.008) and CRP (ρ= -.40, p=.02), but not with TNFα. After adjusting for potential confounders, NIHSS and CRP remained negatively correlated with the optimism level. For every unit increase of LOT-R, subject’s NIHSS scores decreased by .27 point (p=.001), mRS decreased by .11 point (p=.03), and level of CRP decreased 148.6 ng/ml (p=.02). However, LOT-R was not correlated with mRS the three-month follow-up.

Conclusion:
Optimistic stroke survivors showed lower inflammation, less stroke severity, and less physical disability. Although the number of patients was low in this initial cohort, understanding this relationship may provide a scientific framework whereby new strategies for stroke recovery can be developed.
Abstract WP470: Stroke’s Pathways of Patients Transported by Advanced Life Support Ambulance: A 26 Years Registry
Authors: Ozguler Anna , Baer Michel , Boutet Jeremie , Altar Adrien , Loeb Thomas
Published: June 2021

Introduction:
Since mid-2000, stroke guidelines were revised and 18 stroke units (SU) settled in Paris area (France). Our Emergency Medical Service (EMS) in a catchment of 500 000 inhabitants registered all acute strokes where dispatch of an Advanced Life Support (ALS) ambulance was decided since 1993.

Methods:
Data were collected from an EMS registry (1993-2019). The study included patients 16 years old and over, with an acute stroke requiring an ALS ambulance. Collected data were gender, age (by quartile), time periods (1993-99, 2000-04, 2005-09, 2010-14, 2015-19) and receiving care facility: SU, neurosurgery, intensive care unit (ICU), emergency department (ED), radiology department (MRI or scanner) or left on scene (LOS dead or alive). Comparisons were performed with Chi-2 test.

Results:
This study included 2955 stroke patients, mean age was 70.7 years old, sex ratio was 0.93. Table 1 and graphic 1 results show the emergence of SU during mid-2000, with a decrease of ED transfers, while neurosurgery and ICU remained steady (p<10
-3
). This decrease of ED was more important for older age groups (≥ 75 years old).

Conclusion:
Older age groups benefitted more from specialized pathways including ICU and SU, with less transports to ED, but never clearly from neurosurgery. Development of SU probably explains the decreased number of younger patients in neurosurgery. Literature shows that direct pathway to SU significantly improved prognosis of stroke patients. This registry of ALS transports shows its growing use in EMS dispatch, as for ST+ myocardial infarction, while transports to ED decrease. It would be interesting to compare these results with those of faster Basic Life Support transports.
Abstract WP53: Safety and Efficacy of Mechanical Thrombectomy in Acute Stroke Patients on New Oral Anticoagulants
Authors: Karim Nurose , Castonguay Alicia C , Salahuddin Hisham , Shawver Julie , Zaidi Syed , Jumaa Mouhammad
Published: June 2021

Background:
Limited data exists on the benefits of mechanical thrombectomy (MT) in acute ischemic stroke patients on new oral anticoagulants (NOAC). The aim of our study is to examine the safety and efficacy of MT in NOAC patients at our center.

Methods:
A retrospective review of our prospective MT database was performed for this study. Baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) score, revascularization rate, symptomatic intracranial hemorrhage rate (sICH), and 90-day mortality and favorable outcomes were compared in MT patients on NOAC (MT-NOAC) versus those who were not on NOAC (MT).

Results:
From July 2012 to December 2018, 553 AIS patients underwent treatment with MT, with 36 patients on NOAC (6.5%). Median age was similar (73 versus 74), with 52.8% and 52.0% (p=0.8) female in the MT-NOAC and MT groups, respectively. Median baseline NIHSS score (17 IQR10-21 versus 17 IQR 12-21, p=0.75) and ASPECTS (9 IQR 8-9, p=0.80) were similar between the groups. Atrial fibrillation was more prevalent in the MT-NOAC group (80.6% versus 37.7%, p=<0.0001). No difference was seen in occlusion site between the group, with M1 occlusions the most common site (44.4% versus 43.3%, p=0.9). Median onset to revascularization times did not differ between the cohorts (146 minutes versus 206, p=0.61). Successful revascularization (mTICI≥2b) was 87.5% and 81.8% in the MT NOAC and MT groups, respectively. Rates of symptomatic intracerebral hemorrhage per ECASS III criteria were similar between the two groups (5.5% versus 4.6%, p=0.68). No difference was seen in 90-day favorable outcomes (mRS 0-2) (48.3% versus 41.1%, p=0.44) or mortality (27.6% versus 27.1%, 0.95).

Conclusion:
MT in patients on NOAC appears to be safe and efficacious. As our study is limited by sample size, larger prospective studies are needed to understand the safety and efficacy of MT in AIS patients on NOAC.
Abstract WP61: Artificial Intelligence for Automated Detection of Large Vessel Occlusion Strokes
Authors: Perry da Câmara Catarina , Rodrigues Gabriel M , Barreira Clara , Bouslama Mehdi , Pisani Leonardo , Mohammaden Mahmoud , Alhamza Al-Bayati , Haussen Diogo C , Chung Charlotte , Bianchi Nicolas , Belagaje Samir , Liberato Bernardo , Bhatt Nirav R , Anderson Aaron , Frankel Michael , Nogueira Raul
Published: June 2021

Introduction:
Identification of Large Vessel Occlusion (LVO) in acute ischemic stroke (AIS) patients is critical for proper decision-making. Limited availability of trained experts and delays in LVO recognition can have a detrimental effect on outcomes. We sought to evaluate an artificial intelligence-based algorithm for LVO detection in AIS.

Methods:
A retrospective analysis of a prospectively-collected database of AIS patients admitted to a large volume stroke center between 2014-2018 was performed. Experienced vascular neurologists graded CTA for presence and site of LVO. Concurrently, studies were analyzed by the Viz-LVO Algorithm® version 1.4 (GA) - a convolutional neural network programmed to detect occlusions from the internal carotid artery terminus (ICA-T) to the sylvian fissure, which would include all MCA M1-segment and most M2-segment lesions. CTA readings were categorized as LVOs (ICA-T, MCA-M1, MCA-M2) versus non-LVOs/more distal occlusions. Comparisons between human and AI-based readings were done by accuracy analysis and calculating Cohen’s kappa.

Results:
A total of 610 CTAs were analyzed. The AI algorithm rejected 3.4% of the CTAs due to poor quality. Viz-LVO identified LVOs with an overall sensitivity of 81.3%, specificity of 87.8%, and accuracy of 83.2% (AUC 0.845 (95%CI:0.81-0.88, p<0.001). Table 1 shows the results per occlusion site. Accuracy was higher for ICA-T and M1 occlusions as compared to M2 occlusions. The mean run time of the algorithm was 2.78±0.5minutes.

Conclusion:
Our study demonstrates that automated AI reading allows for fast and accurate identification of LVO strokes. Future efforts should be made to improve the detection of the more distal occlusions.
Abstract WP65: Clinical and Radiographic Characterization of Cerebral Hyperdensities on Post-thrombectomy Conventional Non-contrast Ct Brain: Differentiating Between Contrast Staining and Post-thrombectomy Hemorrhage
Authors: Kang Hyung K , Ourfalian Raffi , Nguyen Emilie T , Torres Fernando A , Feng Lei T , Sangha Navdeep S
Published: June 2021

Background:
Post-interventional cerebral hyperdensities (PCHD) are present 31.2 to 87.5% of the time on post-thrombectomy (PT) CT. It can be difficult for radiologists to differentiate if PCHD represents intracerebral hemorrhage (ICH) or contrast staining using conventional CT. The ability to accurately determine the etiology of PCHD may be important for a patient’s outcome.

Methods:
We retrospectively investigated clinical risk factors, imaging findings, and interventional technique of patients who had a thrombectomy from 2011-2017 (n=238) at a Comprehensive Stroke Center. 112 patients with anterior circulation infarcts and immediate PT CTs as well as either a PT MRI or follow-up CT within 48 hours were included. Two experienced neuroradiologists interpreted all imaging. Baseline demographics and imaging characteristics were collected. The presence of ICH was determined by dephasing on gradient echo or by its persistence > 2 days on repeat CT. Chi-square and Fisher’s exact tests were used for statistical significance, and logistic regression to determine risk estimates.

Results:
84% of patients had PCHD, of which 56% had ICH. Patients had similar demographics (ICH: median age 69, 47.5% female; non-ICH: median age 71, 42.5% female). Higher pre-thrombectomy ASPECTS score (OR 0.62, p < 0.05) decreased the risk of ICH, and higher Hounsfield units (HU) of PCHD both on immediate (OR 1.04, p < 0.05) and intermediate (OR 1.1, p < 0.0005) PT CT increased the risk of ICH. PCHDs in the deep grey matter (OR 2.84, p < 0.05) and demonstrating a confluent pattern (OR 3.9 p < 0.05) increased the likelihood of ICH. 10% increase risk of ICH was seen for every HU increase in density on PT CT at 24 or 48 hours. A 50% decrease in ICH was observed for each unit increase of the pre-thrombectomy ASPECTS score. ROC revealed the optimal cut-off for predicted probability as 0.64, sensitivity 70.2% and specificity 69.2%. The AUC for the predicted model was 0.84 (95%CI= (0.75- 0.92, p <0.0001).

Conclusion:
Several imaging characteristics of PCHDs and ASPECTS score can help differentiate between the PT ICH and contrast staining. Application of these variables to patients in the immediate PT period may change clinical management.
Abstract WP75: Comparison of Automated CT Perfusion Software for Prediction of Final Infarct Volume
Authors: Pisani Leonardo , Perry Camara Catarina , Mohammaden Mahmoud , Martins Rodrigues Gabriel , Bouslama Mehdi , Liberato Bernardo B , Bianchi Nicolas A , Peterson Ryan , Prater Adam , Al-Bayati Alhamza , C Haussen Diogo , Frankel Michael , Nogueira Raul
Published: June 2021

Introduction:
CT Perfusion (CTP) has been increasingly used in patient selection for acute reperfusion therapies. Perfusion software allow for automated and faster processing using standardized approaches. We aim to compare the perfusion parameters and final infarct volume (FIV) predictability of two commercially available CTP packages (RAPID and Viz.ai).

Methods:
Retrospective analysis of a mechanical thrombectomy database of mechanical thrombectomy between 9/ 2018-
6/
2019. Patients without a technically adequate baseline CTP were excluded. Ischemic core was defined as CBF<30%. Patients with (1) complete post-treatment reperfusion (mTICI 2c-3) and (2) absence of parenchymal hematoma that could confound FIV calculation were used to derive the correlations between baseline core and FIV. FIV was measured on MRI (n=150) and CT (n=14).

Results:
A total of 164 patients were included (mean age, 66±13.14 years; baseline NIHSS, 14.93±6.73; median time from CTP to reperfusion; median 86.5 IQR [61.25-111.75] min). The median baseline rCBF<30% lesion was 4.5 [0-21]cc and 10.4 [0-36]cc on Rapid and Viz.ai, respectively. There was a strong correlation across all baseline perfusion parameters: rCBF<30%: R=0.813; Tmax>6: R=0.879, Tmax>8: R=0.866, Tmax>10: R=0.852. In addition, there was a highagreement rate for binary values for qualification for the DAWN (core≤21 cc: 88.9%; ≤31cc: 82.4%; ≤51cc: 89.1%), DEFUSE-3 (93%), and EXTEND (91) trials. A total of 148 patients were fully reperfused (mTICI2c-3). Their median FIV was 23.72 [11.0-78.2] cc. There was only a marginal correlation between rCBF<30% and FIV which not significantly different across the two platforms (RAPID: R=0.456; Viz.ai R=0.437, p<0.001).

Conclusion:
The RAPID and Viz-AI software have a strong correlation in terms of the overall baseline parameters and reperfusion treatment eligibility. In fully reperfused patients, the prediction of FIV was only marginal with both softwares.
Abstract WP78: Intracranial Calcification is Predictive for Hemorrhage Transformation and Prognosis After Intravenous Thrombolysis
Authors: Yu Yao , Zhang Fu-Liang , Qu Yin-Meng , Zhou Hong-Wei , Guo Zhenni , Yang Yi
Published: June 2021

Introduction:
Hemorrhage transformation is the major complication of intravenous thrombolysis, which can deteriorate the prognosis of ischemic stroke patients. Calcification is widely used as an imaging indicator of atherosclerotic burden and cerebrovascular function. The relationship between intracranial calcification and hemorrhage transformation has not been fully explained. Here, we aimed to identify and quantify calcification in the main cerebral vessels to investigate the correlations between quantitative calcification parameters, hemorrhage transformation, and prognosis.

Methods:
Acute noncardiogenic ischemic stroke patients with anterior circulation who received intravenous thrombolysis therapy in the First Hospital of Jilin University from July 2015 to June 2017 were retrospectively consecutively included. All the patients included underwent a baseline CT before intravenous thrombolysis and a follow-up CT at 24 hours. A third-party software, ITK-SNAP, was used for segmentation and measurement of the calcification volume. A vascular non-bone component with a CT value >130 HU was judged to be calcified. The criterion for poor prognosis was an mRS score > 2 at 3 months.

Results:
A total of 146 patients were included, among which 128 patients were identified to have calcification. Twenty-one patients developed hemorrhage transformation. The risk of hemorrhage transformation in the extreme group of calcification volume on the lesion side was 10.018 times that of the none to mild groups (OR=10.018, 95% CI: 1.030-97.396). Sixty-one patients had poor prognosis. The risk of poor prognosis increased by 54.7% for each additional calcified vessel (OR=1.547, 95% CI: 1.038-2.305).

Conclusions:
High calcification volume burden on the lesion side is associated with hemorrhage transformation after intravenous thrombolysis. The higher the number of calcified vessels, the greater is the risk of poor prognosis.
Abstract WP9: Impact of Sex Differences on the Treatment Effect of Mechanical Thrombectomy: A Subgroup Analysis of the RESILIENT Trial
Authors: Pontes-Neto Octavio M , Abud Daniel G , Castro-Afonso Luis , Martins-Filho Rui Kleber , Nakiri Guilherme , Montalverne Francisco J , Rebello Leticia , Silva Gisele S , Lima Fabricio O , Frudit Michel , de Souza Ana Claudia , Fiorot José A , Faria Mario , Liebeskind David , Bezerra Daniel , Dabus Guilherme , de Freitas Gabriel R , Wagner Mario , Broderick Joseph , Molina Carlos , Oliveira-Filho Jamary , Nogueira Raul , Martins Sheila
Published: June 2021

Background:
Despite evidence supporting the overall efficacy of mechanical thrombectomy (MT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) of the anterior circulation, it is unclear whether the treatment effect of MT differs by sex in different populations. We assessed the impact of sex differences in the treatment effect of MT in the RESILIENT trial.

Methods:
RESILIENT was a prospective, multicenter, randomized phase III trial that was designed to assess the safety, efficacy, and cost-effectiveness of mechanical thrombectomy as compared to medical treatment alone in patients treated under the less than ideal conditions typically found in the public healthcare system of a developing country.

Results:
Among 221 patients enrolled in the trial, 104 (47,1%) were female. Baseline characteristics were well balanced between sexes, except for a higher prevalence of hypertension (76% vs. 57.4%; p=0.004) and diabetes (34.3% vs. 21.7%; p=0.039) and a lower frequency of alcohol abuse (4% vs. 28.9%; p=0.001) in females. After adjustment for baseline characteristics, we found a significant interaction (p=0.026) between sex and the effect of MT with a lower efficacy of MT for functional independency at 90 days among women (aOR=1.13;95%CI:0.42-3.02) compared to men (aOR=4.78; 95%CI:1.88-12.15).

Conclusions:
In our study population of patients with AIS caused by LVO of the anterior circulation, women were less likely to benefit from MT than men. Further studies are necessary to investigate these findings.
Abstract WP91: Cerebral Small Vessel Disease Burden Predicts Poor Collateral Flow in Acute Ischemic Stroke Patients With Large Artery Atherosclerosis
Authors: Wang Yueming , Yang Lumeng , Hong Lan , Lin Longting , Parsons Mark , Cheng Xin , Dong Qiang
Published: June 2021

Aim:
We sought to determine whether the extent of chronic white matter hyper-intensities (WMH) and white matter hypo-perfusion (WMHP), as markers of cerebral small vessel disease (CSVD), were associated with poor collateral flow in acute ischemic stroke as a potential cause of unfavorable functional outcome.

Methods:
Acute ischemic stroke patients within 12 hours of symptom onset with complete baseline and follow-up clinical data, who: (1) had large vessel occlusion in anterior circulation, (2) underwent baseline perfusion CT (CTP), (3) had 24-hour MRI were prospectively recruited. The volume of WMH was measured in the unaffected hemisphere on MRI semi-automatically. WMHP was measured as Delay Time (DT)>2s in white matter of unaffected hemisphere on CTP. Quality of Collateral flow was defined by the volume ratio of DT>3s/DT>6s on CTP. Unfavorable functional outcome was 90-day modified Rankin Scale (mRS)>2. The association between volumes of WMH, WMHP, and collateral flow were evaluated using univariate and multivariate generalized linear models. We also assessed the relationship between WMH, WHMP, and functional outcome with logistic regression.

Results:
There were 96 (66.6±12.81 years old, 35 female) ischemic stroke patients, and 51 were due to large artery atherosclerosis (LAA). In all patients, after multivariate adjustment, WMH volume (5.6±7.11ml) did not correlate with collateral flow (coefficient -0.01, 95% CI -0.03 to 0, P=0.09), although it was marginally associated with unfavorable outcome (Odds Ratio: 1.08, p=0.06, 95% CI 1 to 1.17). In all patients, WMHP volume (8.6±8.54ml) did not correlate with collateral flow (coefficient -0.01, 95% CI -0.01 to 0, P=0.29). However, in the LAA subgroup, WMH volume was strongly related to poorer collateral flow, i.e. lower DT>3s/DT>6s ratio(coefficient -0.03, 95% CI -0.04 to -0.01, P=0.01). WMHP volume was also correlated with poor collateral flow (coefficient -0.01, 95% CI -0.02 to 0, P=0.02).

Conclusion:
CSVD may contribute to poor collateral flow in acute stroke, especially in patients with LAA. This potentially explains the association between CSVD and poor acute stroke outcomes.
Abstract WP92: Deep Learning Approach for Diagnosis of Hemorrhagic Transformation in MRI: A Pilot Study
Authors: Jackson Samantha N , Latour Lawrence L , Hsia Amie W , Lynch John K , Luby Marie
Published: June 2021

Introduction:
Several successful mechanical thrombectomy (MT) clinical trials in acute ischemic stroke (AIS) patients have dramatically increased the use of MT, which is also associated with increased risk of Hemorrhagic Transformation (HT). Yet, the reliability and agreement across multiple raters using the ECASS-II HT classification has been mixed. In this study, we introduce a residual 3D CNN for classification of HT in MRI gradient recalled echo (GRE) images.

Methods:
Ninety-nine patients diagnosed with AIS, treated with MT, and imaged with a 3.0T MRI scanner 24 hours post MT were included. After pre-processing, GRE images were separated into training (79), validation (10), and test (10) sets, all consisting of comparable numbers of no HT versus HT. Presence and classification of HT for all 99 patients using ECASS-II criteria were documented initially by the treating clinical team and reviewed by an independent image reader.

Results:
The model achieved 100% accuracy on the training set, 80% on the validation set, and 70% on the test set. The algorithm reliably classified parenchymal HT but erred in some cases of petechial HT or identified similar imaging features such as large vessels or microbleeds (Figure).

Conclusions:
Developments on this algorithm could lead to an automated tool for real-time identification of HT using acute stroke MRI.

Figure:
Images and automated prediction for the test set: A) accurate prediction of HT presence, B) accurate prediction of HT absence, and C) inaccurate prediction in which the algorithm predicted No HT in a case with both acute and chronic HT on contralateral sides, No HT in a case with small HT, and HT in a case with a particularly prominent thrombus.
The Making of the Muslim Brotherhood’s Faith Brand
Authors: Mellor Noha
Published: June 2021

This article sheds light on the use of narrative within the realm of political Islam, taking the Muslim Brotherhood as a topical case study. The argument is that the Brotherhood media served as a faith brand that was based on a narrative aimed at mobilizing voters and supporters, both within Egypt and regionally. The article questions whether the Brotherhood media represent a coherent voice of the movement, and how the media have helped sustain, preserve, and distinguish the Brotherhood’s brand for nine decades. It is argued that the Brotherhood’s narrative and brand attributes have come under scrutiny with the ongoing fissures within the movement post-2013, particularly between the old and new guard with regards to the re-assessment of the Brotherhood’s ideology and mission. These controversies attest to the gradual fragmentation of the Brotherhood brand, raising doubts about the movement’s ability to resuscitate this brand in the future.
Additions to Karst Fungi 5: Sardiniella guizhouensis sp. nov. (Botryosphaeriaceae) associated with woody hosts in Guizhou province, China
Authors: CHEN YA-YA , DISSANAYAKE ASHA J. , LIU JIAN-KUI
Published: June 2021

During an investigation of ascomycetous fungi in Karst formations of the Asian region, three interesting taxa were found on dead aerial stems of woody hosts in Guizhou province, China. Their morphology assigned them as typical botryosphaeriaceous species. Phylogenetic analyses based on a combined DNA dataset of large subunit (LSU), internal transcribed spacer (ITS) and part of the translation elongation factor 1-α (tef1) gene confirmed their placement within Botryosphaeriaceae. In the phylogenetic tree, the three isolates formed a well-supported monotypic clade as a distinct lineage within the genus Sardiniella. Therefore, a new species Sardiniella guizhouensis sp. nov. is introduced to accommodate these taxa and detailed, illustrated descriptions of the asexual and sexual morphs are provided. This study reveals the first sexual morph of Sardiniella, which it is characterized by 2–4(–6)-spored asci with hyaline to brown, aseptate to 1-septate, ovate to subclavate ascospores.
The Novel Target of Liver Cancer: MicroRNA-4324 Regulates Cell Proliferation and Migration via Targeting Neuraminidase 3
Authors: Jiang Ruiyuan , Xie Jiacheng , Hong Xiaohua , Man Tingting , Yang Mengna , Qin Yanchun , Tang Cuijuan , Lan Qiaoyu , Rong Zhen , Mo Chunmei
Published: June 2021

Background: MicroRNA-4324 has been reported to regulate various biological malignant cancer. Nonetheless, the expression and molecular mechanism of miR-4324 in liver cancer remain rarely known. This study aimed to investigate the effect miR-4324 on the proliferation, invasion
and migration of hepatoma cells. Methods: The mRNA level of miR-4324 was assessed in four hepatoma cell lines (HepG2, Huh7, MHCC97, HB611) and human embryonic liver cell, HHL5. MiR-4324 was over-expressed in hepatoma cells. Subsequently, the effects of miR-4324 on cell proliferation,
migration and invasion and the underlying molecular mechanisms were detected. Results: Our data indicated that miR-4324 was down-regulation in hepatoma cell lines compared with HHL5. Overexpression of miR-4324 inhibits cellular proliferation, colony-formation, migration and invasion
abilities of hepatoma cells. However, the biological effects of miR-4324 overexpression on hepatoma cells were reversed after overexpressing NEU3. Conclusions: Our findings concluded that miR-4324 inhibits biological functions of hepatoma cells by targeting NEU3 and it might be a potential
target for the treatment of liver cancer.
Morphology Comparison Between Goat Bone Marrow Mesenchymal Stem Cells and Adhesive Fibrin for the Repair of Annulus Fibrosus Defect of Intervertebral Discs
Authors: Xiang Xu , HePing Yin , YiMin Wu , ShuWen Li , JunFeng Wang , Jian Zhao , ZhiCai Du , YingNan Yu , Yuan Zhang
Published: June 2021

Introduction: The purpose of this study was to compare the histological findings of goat bone marrow mesenchymal stem cell (BMSC) transplantation and adhesive fibrin repair for annulus fibrosus defects in intervertebral discs. Material and methods: The goats were spanided
into three groups: the control group, the adhesive group and the transplantation group. In the control group, surgical instruments were used to create a fibrous ring defect in the intervertebral disc of the goats. In the adhesive group, a 1.5*1.5-cm defect was also created by surgical intervention,
and the broken fiber ring was then bonded with adhesive fibrin. In the transplantation group, a gelatine sponge containing the goat BMSCs was implanted into the broken annulus fibrosus, and the wound was closed layer by layer. At 6 weeks and 12 weeks after the operation, the damaged tissues
were removed, and haematoxylin and eosin (HE), trichrome gelatine (Masson), Alcian blue periodic acid-Schiff (AB-PAS) and Collagen II staining was performed. Then, the tissues from the different groups were histologically compared and analyzed. Results: Goat BMSCs have a better ability
to repair defects in the fibrous ring than adhesive fibrin. Over time, the number of cells or the amount of tissue following cell transplantation was greater, indicating that the degree of repair is greater with BMSCs than with adhesive fibrin. Conclusion: Histologically, repair of
the defect of the fibrous ring and prevention of nucleus pulposus protrusion were more effective in the cell transplantation group than in the other two groups.
Supporting Students With Disabilities With Positive Behavioral Interventions and Supports in the Classroom: Lessons Learned From Research and Practice
Authors: Meyer Katherine , Sears Sandra , Putnam Robert , Phelan Crystal , Burnett Alicia , Warden Susannah , Simonsen Brandi
Published: June 2021

Positive behavioral interventions and supports (PBIS) is a widely adopted framework to support the social, emotional, and behavioral growth of all students. This article addresses two key questions related to supporting students with disabilities through PBIS: (a) Why focus on universal classroom PBIS practices?—without support, students with disabilities experience poor outcomes—and (b) How do you implement PBIS in classrooms that support all students?—differentiate and intensify supports.
Hyaloronidase as a Treatment for Cutis Verticis Gyrata
Authors: Patrick Chaghouri , Maria H Elahi , Mohammed M Elahi
Published: June 2021

A unique case of patient with primary essential CVG is presented. The patient has no underlying medical conditions. A series of hyaluronidase injections spaced out in 6 week intervals was injected into the subcutaneous tissues overlying the scalp deformities. The end result after 3 sessions of injections demonstrated significant improvement which has been maintained over the 12 month follow up period. This is the first case report of the successful use of hyaluronidase injections to treat CVG in Canada.
Inflammasome activation promotes venous thrombosis through pyroptosis
Authors: Zhang Yan , Cui Jian , Zhang Guoying , Wu Congqing , Abdel-Latif Ahmed , Smyth Susan S. , Shiroishi Toshihiko , Mackman Nigel , Wei Yinan , Tao Min , Li Zhenyu
Published: June 2021

Crosstalk between coagulation and innate immunity contributes to the progression of many diseases, including infection and cardiovascular disease. Venous thromboembolism (VTE), including pulmonary embolism and deep vein thrombosis (DVT), is among the most common causes of cardiovascular death. Here, we show that inflammasome activation and subsequent pyroptosis play an important role in the development of venous thrombosis. Using a flow restriction–induced mouse venous thrombosis model in the inferior vena cava (IVC), we show that deficiency of caspase-1, but not caspase-11, protected against flow restriction–induced thrombosis. Interleukin-1β expression increased in the IVC following ligation, indicating that inflammasome is activated during injury. Deficiency of gasdermin D (GSDMD), an essential mediator of pyroptosis, protected against restriction-induced venous thrombosis. After induction of venous thrombosis, fibrin was deposited in the veins of wild-type mice, as detected using immunoblotting with a monoclonal antibody that specifically recognizes mouse fibrin, but not in the caspase-1–deficient or GSDMD-deficient mice. Depletion of macrophages by gadolinium chloride or deficiency of tissue factor also protected against venous thrombosis. Our data reveal that tissue factor released from pyroptotic monocytes and macrophages following inflammasome activation triggers thrombosis.