bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP421: Optimization of Risk Stratification for Anticoagulation-Associated Intracerebral Hemorrhage
Authors: Lioutas Vasileios-Arsenios , Katsanos Aristeidis , Goyal Nitin , Krogias Christos , Zand Ramin , Sharma Vijay , Varelas Panayiotis , Malhotra Konark , Paciaroni Maurizio , Karapanayiotides Theodore , Sharaf Aboubakar , Chang Jason , Pandhi Abhi , Palaiodimou Lina , Schroeder Christoph , Tsantes Argyrios , Kargiotis Odysseas , Boviatsis Efstathios , Mehta Chandan , Serdari Aspasia , Vadikolias Konstantinos , Mitsias Panayiotis , Selim Magdy H , Alexandrov Andrei V , Tsivgoulis Georgios
Published: June 2021

Introduction:
With more widespread anticoagulant use, anticoagulation-associated intracerebral hemorrhage (ICH) represents an increasing proportion of all ICH. We hypothesized that
c
ombining ischemic and hemorrhagic stroke risk estimation can guide treatment decisions, with more precision than ischemic risk estimation alone.

Methods:
We enrolled consecutive patients with anticoagulation-associated ICH in 15 centers in USA, Europe and Asia from 2015-2017. Each patient was assigned annual baseline ischemic stroke and hemorrhage risk based on their CHA
2
DS
2
-VASc and HAS-BLED scores without and with index ICH taken into account. We computed a net risk by subtracting the hemorrhagic from the ischemic risk. If the sum was positive the patient was assigned a “Favorable” indication for anticoagulation; if negative an “Unfavorable”. We compared clinical and neuroimaging characteristics between the two groups.

Results:
Our cohort comprised 357 patients (59% male, median age 76 [68-82] years). 69% used vitamin-K antagonists (VKA), 31 % Non vitamin K antagonist (NOAC). 191 (53.5%) of patients had a favorable indication for anticoagulation prior to their ICH event; the rest 166 (46.5%) had an unfavorable indication. Those with an unfavorable indication were younger (72[66-80] vs 78[73-84] years, p=0.001, had a lower CHA
2
DS
2
-VASc score (3[3-4] vs 5[4-6], p<0.001) and higher HAS-BLED score (3[2-4] vs 2[2-3], p=0.025). Those with favorable indication had a significantly higher prevalence of all major cardiovascular risk factors and were more likely to use NOAC (35% vs 25%, p=0.045). After including ICH into the HAS-BLED score estimation, 77 of the 191 patients with favorable profile were rendered unfavorable; leaving 114 patients (32% of the cohort) with favorable profile.

Conclusions:
In this anticoagulation-associated ICH cohort, baseline hemorrhage risk exceeded ischemic risk in ~50% of patients. This finding highlights the need for careful consideration of risk/benefit ratio prior to anticoagulation decisions. The remaining ~ 50% suffered an ICH although their baseline risk of ischemia exceeded that of hemorrhage which stresses the need for imaging, serum or other biomarkers to allow more precise estimation of hemorrhagic complication risk.
Abstract WP424: Challenges of Participation in Life Activities Post-Stroke: A Qualitative Study
Authors: Chau Janita P , Lo Suzanne Hoi Shan
Published: June 2021

Background and Purpose:
Our previous study of 265 stroke survivors recruited immediately before discharge from two regional rehabilitation hospitals found state self-esteem, social support satisfaction, discharge location (home, residential care facility), and gender significantly accounted for 49% of the variance in depressive symptoms. The purpose of this study is to explore the challenges of promoting participation in life activities for stroke survivors.

Methods:
A qualitative study with individual face-to-face semi-structured interviews were conducted. Adult managerial persons who were responsible for the development of community, rehabilitation or residential care services for stroke survivors were recruited. All participants were asked to share the mission of their institutions, types of care services for stroke survivors, perceived importance of, barriers to and facilitators of promoting participation in life activities, and opportunities for enhancing stroke care services. All interviews were audio recorded and transcribed verbatim for thematic analysis.

Results:
A total of 11 participants were interviewed. Five were in-charge persons of stroke support groups, two were legislators, two from residential care facilities, and two from community-based organisations. Four key themes were generated: (1) Being institutionalized was found associated with lower levels of psychosocial health, (2) Stroke survivors’ physical and cognitive limitations were perceived as key challenges in promoting participation in life activities, (3) Healthcare providers placed more emphasis on promoting physical rehabilitation than social participation, and (4) Physical environment particularly in residential care facilities posed greater challenges to promoting participation in real life activities.

Conclusions:
This highlights major challenges for healthcare professionals who care for stroke survivors in residential care facilities. Further studies that investigate the associations between environmental barriers, psychological morbidity and participation restriction is needed.
Abstract WP425: Code Stroke Improves Access to Nurse Led Evidence-based Stroke Interventions: Subgroup Analysis of the Code Stroke 2.0 Feasibility Study
Authors: Jones Brett , Dale Simeon , McInnes Elizabeth , Fasugba Oyebola , Burrows Chris , John Manju , Doncillo Mary , Wright Simogne , Lueck Christian , D'Este Catherine , McElduff Ben , Middleton Sandy
Published: June 2021

Introduction:
Fever, Sugar and Swallow (FeSS) protocols following stroke reduce death and dependency. Introduction of the protocols in the T
3
Trial did not improve Emergency Department (ED) stroke care processes. The CodeStroke2.0 study involved expansion of the acute stroke nurse role to include FeSS implementation but not all post-intervention cohort patients received a CodeStroke2.0 activation. Our secondary analysis determined how effective the intervention was compared to patients who did not receive a CodeStroke2.0 activation.

Methods:
This single-centre, pre-test/post-test feasibility study compared patients who received the CodeStoke2.0 activation with those who did not as measured by: ED length of stay, uptake of FeSS processes of care, and thrombolysis metrics. Differences between groups were examined using logistic regression, adjusting for age, sex and stroke severity.

Results:
Of the 117 patients recruited to the post-intervention cohort, 72 (61.5%) received a CodeStroke2.0 activation. CodeStroke2.0 patients had a non-significant higher proportion of temperatures taken (77.8% vs 66.7% P=0.260) and significantly higher finger prick blood glucose tests (43.1% vs 17.8% P=0.030). Oral medications prior to screening was significantly lower in the CodeStroke2.0 group (4.2% Vs 28.9% P=0.001) who also were more likely to be screened for thrombolysis eligibility (93.1% Vs 60.0% P=0.001) and receive thrombolysis (19.4% Vs 2.2% P=0.052). ED length of stay was reduced with a higher proportion of patients transferred to the Stroke Unit within 4 hours of arrival (51.4% Vs 24.4% P=0.036).

Conclusion:
CodeStroke2.0 activation was associated with improved FeSS processes of care, thrombolysis and ED length of stay. This novel expansion of the acute stroke nurse role as part of routine stroke care demonstrated improved evidence translation - vital for better patient care.
Abstract WP435: Post Procedural Monitoring Tool Improves the Joint Commission Comprehensive Stroke Center Standard Compliance
Authors: Gaffney Denise , Punsalang Lorina , Mkrtumyan Alvina , Dhanji Raeesa , McCartney David , Ajani Zahra , Le Duy , Sangha Navdeep
Published: June 2021

Background:
The Joint Commission (TJC) Comprehensive Stroke Center standard requires monitoring of patients after IV tPA administration, diagnostic angiography, aneurysm coiling, carotid angioplasty and stenting, mechanical endovascular reperfusion (MER) and carotid endarterectomy. Meeting 100% compliance of the standard is challenging. In 2018, monitoring and documentation were among the TJC’s top ten cited survey findings.

Purpose:
To determine if an electronic tool can improve documentation compliance and reduce delays in monitoring of vital signs, and neurologic, pedal pulse and skin site assessments.

Methods:
The initiative was implemented in 2018 with the objective for all patients to have 100% of their post procedural monitoring completed. A documentation tool was created and introduced to nursing units via annual stroke education updates. The tool was added to an online nursing resource SharePoint website and application, which was accessible to all nurses within the hospital. The procedure end time was entered in the tool, which automatically calculated the documentation times. Data was compared 12 months pre and post intervention. Analysis and reporting of data were conducted monthly via the program’s quality oversight committee. Data was analyzed using T-Test.

Results:
In post-IV tPA patients, more patients had 100% complete documentation (79% post vs. 29% pre-implementation; p=0.006). For all post neuro-interventional radiology procedures, more patients had 100% complete documentation (68% post vs. 17% pre-implementation; p<0.001). For post carotid endarterectomy revascularization, there was a trend toward more patients with 100% complete documentation (83% vs 38%; p=0.07).

Conclusion:
Utilization of an electronic monitoring tool for post procedural documentation adherence can improve the percentage of patients who have 100% completed assessments and help meet the TJC standard.
Abstract WP439: "You Gotta Troll to Enroll!" Nurses Actively Scouting Patients for Clinical Trials
Authors: Robertson Betty , Levesque Denise , Wolber Nicole , Steiner Nili , Nunez Nancy , Guerra Sonia , Paletz Laurie
Published: June 2021

Problem/ Background:
Evidence- based practice is the cornerstone in delivery of stroke care to optimize outcomes for patients. Research is the foundation to build and advance clinical practice. As a Comprehensive Stroke Center, we are charged with participating in IRB approved research. In 2016 the SUCCEED trial was stopped here as a result of low enrollment. The stroke nurses were not directly involved in that trial. In 2017, the stroke nurses partnered with our physicians and began the ARAMIS trial. This is a multicenter study of acute stroke patients taking anticoagulation therapy prior to admission and suffering a stroke. We recognized the need for our stroke nurses to collaborate, participate and use their expertise in identifying appropriate research patients for this study.

Quality Question:
Will tasking Stroke Nurses with identifying patients improve the enrollment of patients in ARAMIS trial?

Methods:
Stroke nurses attended an ARAMIS training session for physicians. Included in the meeting was review of inclusion/exclusion criteria for patient enrollment. A group e-mail was created for all participating in the study to help identify potential patients. When a patient was discovered an email was sent to the group alerting those responsible for obtaining consent for the study and data collection for the registry.

Results:
After one trial was ended due to low enrollment, the new ARAMIS trial opened. The stroke team nurses took the lead on identifying patients. Reviewing retrospective data starting in November 2017 until March 2019, 56 patients were enrolled in Aramis. Stroke nurses identified 43 patients (77%), Neurology fellows 10 (18%) and Faculty physicians 3 (5%).

Conclusion:
When including expert nurses in the patient identification process, the nurse plays a pivotal role in identifying appropriate patient for the MDs to enroll, thus, increasing enrollment in clinical trials. While additional tracking and trending needs to take place as new trails open, this trial makes clear the need for nurse involvement in identifying appropriate patients.
Abstract WP442: Process Improvement for Stroke/Cardiovascular Risk Factor Screening
Authors: Campbell Margie , Lee Jessica , Watts Tammy
Published: June 2021

Background and Purpose:
Despite advances in the acute treatment of stroke, many patients are delayed in seeking care. While many factors contribute to delays, the principle factor continues to be a lack of public knowledge regarding stroke signs and symptoms. For several years, our Comprehensive Stroke team had been completing community stroke screenings independent of our CV team partners. As the risk factors for Stroke and myocardial infarction (MI) are very similar, we explored the possibility of combining our resources with our Neurological Institute staff and the Heart Institute staff. The purpose behind our process improvement project was to improve collaboration, enhance utilization of resources, and provide more comprehensive risk factor assessment and risk factor education for our participants. An additional goal included teaching the participants the signs/symptoms of Stroke and MI and the importance of calling 911 immediately.

Methods:
The first step was to create a team that included Neurological Institute and Heart Institute team members. We developed educational materials to be used during the events, including a comprehensive Stroke and Cardiovascular disease booklet, a Risk Factor Scorecard and other visual aids. As the project progressed, additional team members were added to meet the expanded needs identified during the screenings completed. Physician referral was incorporated for appropriate patients.

Results:
In 2017, the Stroke team completed 3 events and screened 180 participants with a total of 14 volunteers. In 2018, the Neurological/Heart teams completed 5 events with 180 participants screened by 57 volunteers. Thus far in 2019, the Neurological/Heart team has completed 5 events with 333 participants screened and 38 volunteers participating.

Conclusions:
An interdisciplinary team approach resulted in more comprehensive risk factor screening for participants, increased number of events and greater community outreach. In addition, 4 participants were referred for Cardiology appointments.
Abstract WP465: Effect of Chocolate Containing 86% Cacao and Much Polyphenol to Improve Level of Alertness in Acute Stroke Patients
Authors: Mori Takahisa , Yoshioka Kazuhiro , Chiba Nozomi
Published: June 2021

Introduction:
Level of alertness in acute stroke patients is often deteriorated during hospitalization, even though they can orally eat food on admission and their stroke is not severe. Then, it is difficult to improve their level of alertness. If their level of alertness is not improved, their nutritional status is probably deteriorated.

Hypothesis:
Dark chocolate 5g tablet containing 86% cacao and 147mg polyphenol can improve level of alertness and prevent deterioration of nutritional status.

Methods:
We included acute stroke patients for retrospective analysis who 1) were admitted between August 2017 and July 2018, 2) presented alert consciousness on admission and orally eat food then, 3) underwent blood examination on admission, the 3rd day and 7th day, 4) presented mild deterioration of level of alertness during hospitalization and 5) took dark chocolate 5g containing 86% cacao and 147mg polyphenol twice a day. We evaluated patients’ features, Glasgow Coma Scale (GCS) as level of consciousness, albumin (Alb), prealbumin (PreAlb), high-sensitivity C-reactive protein (hs-CRP) on admission, on the initial chocolate day and on the 7th day.

Results:
Eighteen patients met our inclusive criteria and were analyzed. The median age, GCS score, body mass index, blood glucose (BG), hs-CRP, Alb and PreAlb were 85 years, 14, 21.8 kg/m2, 119 mg/dl, 0.1165 mg/dl, 3.9 g/dl and 20.4 mg/dl, respectively. They started to eat 86% cacao chocolate 5g supplementation twice a day median on the 3rd day. On the 3rd day when chocolate was started, their median GCS score, Alb and PreAlb decreased to13 (p<0.0001), 3.45 mg/dl (p<0.0001) and 19.1 mg/dl (p<0.001), respectively, and their median hs-CRP increased to 0.4325 mg/dl (p<0.05). On the 7th day, their median GCS increased to 14 (0.0001), median Alb, PreAlb and hs-CRP levels were 3.45 mg/dl (ns), 16.5 g/dl (ns) and 0.506 mg/dl (ns).

Conclusion:
Dark chocolate containing 86% cacao and 147mg polyphenol probably improved level of alertness and prevented further deterioration of nutritional status in patients who could orally eat food.
Abstract WP468: Follow Up After Stroke, Screening and Treatment Clinic: Advancing Post-Stroke Care
Authors: Naqvi Imama A , Andres Jennifer , Ruchalski Charles , Cleymaet Sean V , Kim Seung , Combs Sandra , Denny M. Carter , Johnson Brenda J , Sharrief Anjail Z
Published: June 2021

Objective:
To assess feasibility and replicability of a multidisciplinary, specialized clinic in optimization of secondary stroke prevention and stroke related complications.

Background:
Recommendations exist for secondary stroke prevention, but it is unclear which outpatient model of care optimizes vascular risk factor control and decreases post-stroke complications most effectively. Designed after the Stroke Transitions, Education, and Prevention clinic in Houston, TX, the Follow up After Stroke, Screening and Treatment (FASST) clinic is an integrated, multidisciplinary, specialized clinic designed to optimize secondary stroke prevention. It provides post discharge stroke education and medication adherence counseling by Pharmacists, as well risk factor and complications management by Vascular Neurologists. Validated patient reported surveys screen for complications: depression, anxiety, sleep disorders, cognitive impairment, disability, social support, quality of life and functional status. Our approach and the characteristics of patients enrolled in the clinic is described.

Methods:
Patients attending one FASST clinic visit are included. Institutional Board Review approved consent is obtained. Demographic and clinical data are recorded including risk factors, surveys and outcome scores. Data is entered in Redcap and analyzed through the Statistical Analysis Software (SAS) program.

Results:
Of the 25 patients enrolled in the clinic, 83.3% are African American. A high prevalence of hyperlipidemia (100%) and hypertension (100%) exists, with 44% of patients having concomitant diabetes mellitus. Overall 26.7% screened positive for depression with PHQ-9, and 20% screened positive for anxiety with GAD-7. These patients were started on medications and referred for psychotherapy. Abnormal ESS scores were noted in 31.3% and directed for sleep apnea evaluation. Eighteen medical and pharmacy trainees rotated through the clinic.

Conclusion:
The FASST clinic represents a reproducible model for an integrated approach to post-stroke care. Adapted to academic centers across the country, a collaborative network would provide best practices, and measure patient reported outcomes to optimize stroke care.
Abstract WP492: Differential Effects of Iron Chelation With Deferoxamine on Post-Stroke Neurovascular Inflammation: Disease and Sex Interactions
Authors: Wolf Victoria L , Li Weiguo , Abdul Yasir , Dong Guangkuo , Ward Rebecca , Jamil Sarah , He Lianying , Fagan Susan , Ergul Adviye
Published: June 2021

We have shown that 1) poor recovery in diabetes is associated with greater hemorrhagic transformation and significant loss of the cerebrovasculature, and 2) iron chelation therapy with deferoxamine (DFX) improves sensorimotor and cognitive outcomes while preventing vasoregression in male diabetic animals after stroke. This study tested the hypotheses that 1) diabetes mediates pathological post-stroke neovascularization in females and 2) DFX attenuates microglial activation and pathological neurovascular remodeling in both sexes. Control and diabetic animals were subjected to embolic middle cerebral artery occlusion (MCAO). DFX (100 mg/kg) or vehicle was given 1hour after MCAO and repeated every 12h for 7 days after stroke. Functional outcomes were assessed over time. Vascular indices, microglial morphology (activation), and neurovascular integrity (IgG and unpolarized Aquaporin-4) were measured at Day 14. Male and female microvascular endothelial cells (BMVECs) treated with iron and/or DFX were tested for viability and endothelial mesenchymal transition (EndMT) markers. DFX preserved vascular volume post-stroke in diabetic males. Stroke did not cause vasoregression in diabetic female animals; however, DFX reduced vascular indices while improving sensorimotor but not cognitive outcomes in both control and diabetic females. Ischemic injury amplified microglial activation and neurovascular remodeling in diabetes while DFX treatment restored these changes to control levels in male diabetic animals but not in females (Table). Female BMVECs grown under diabetic conditions expressed α-SMA and N-cadherin while VE-cadherin was decreased, indicative of EndMT (p<0.05 vs normal glucose). Data suggest that DFX treatment has sex- and disease-dependent effects on post-stroke neovascularization. Additional studies will aim to address the mechanisms by which DFX exerts these differential effects on functional outcomes and neurovascular remodeling.
Abstract WP500: Long-Term Cognitive Outcome Among Aneurysmal Subarachnoid Hemorrhage Survivors: Need for Cognitive Rehabilitation?
Authors: Samkutty Danny , Delpirou Nouh Claire , Chandrashekhar Swathy , Ford Lance , Xu Chao , Ray Bappaditya
Published: June 2021

Introduction:
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high in-patient mortality and with long-term cognitive deficits among survivors. With widespread adoption of standard neurocritical care practice in-hospital mortality has decreased while long-term cognitive impairment (CI) among survivors is not well characterized.

Hypothesis:
To investigate whether temporal change in practice has resulted in improvement in long-term CI.

Methods:
Single-center retrospective chart review of aSAH patients admitted to a comprehensive stroke center between January 2012 and December 2016, were identified from a prospective database. Cognitive status was evaluated between January and December 2018 using Telephone Interview of Cognitive Status (TICS). The study cohort was divided into two 2.5 year periods and TICS score of >32, 28-32 and <28 were classified as normal cognitive function, mild and moderate-to-severe CI respectively. The median TICS scores by groups were examined by Wilcoxon or Kruskal-Wallace tests. Categorical variables compared using Chi-squared or Fisher’s exact tests.

Results:
252 patients were admitted during the study period of which 46 patients could be reached and consented to participate in TICS. Median TICS score was lower in earlier study period compared to later period [31.5 (IQR 22, 36) vs. 33 (IQR 27, 38), p=0.038]. Similarly, TICS score <28 was seen more often in earlier period as compared to later period [7/22 (6%) vs. 1/24 (0.7%), p=0.044]. Patient who were smokers and had hyperlipidemia had lower TICS score compared to other groups in multivariate model (p=0.007). We found no statistical association between duration of time between discharge date and date of cognitive assessment and TICS groups (Kruskal-Wallace test; p-value=0.074). However, if we treat TICS as a continuous variable in a linear model we observed a significant association between time elapsed and overall TICS score (p=0.0197). For every month increase, there is a decrease in overall TICS by 0.09.

Conclusion:
Smoking and hyperlipidemia are identified as risk factors for CI among aSAH survivors alluding to a role of vascular pathogenesis. Progressive CI over time might justify long-term cognitive rehabilitation in this population of patients.
Abstract WP79: The Value of Pre-Training for Deep Learning Acute Stroke Triaging Models
Authors: Yu Yannan , Xie Yuan , Gong Enhao , thamm Thoralf , Ouyang Jiahong , Christensen Soren , Lansberg Maarten , Albers Gregory , Zaharchuk Greg
Published: June 2021

Objective:
We investigated if deep learning models are able to define the penumbra and ischemic core by comparing models from two training strategies (with and without pre-training) and clinical thresholding criteria (MRI parameter time-to-peak of the residue function [Tmax] and apparent diffusion coefficient [ADC]).

Methods:
We selected patients from two multicenter stroke trials, with baseline perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI) and 3-7 day T2-FLAIR. Based on reperfusion rate calculated from baseline and 24 hr PWI, patients were grouped into unknown (no 24 hr PWI scan), minimal (≤20%), partial (20%-80%), and major (≥80%) reperfusion. Attention-gated U-net structure was selected for training, with eight image channels from baseline PWI/DWI as inputs and the infarct lesion manually segmented on T2-FLAIR as ground truth. Two training strategies were used: (1) training two models separately in minimal and major reperfusion patients; (2) pre-training a model using patients with partial and unknown reperfusion, then fine-tuning two models using minimal and major reperfusion patients, respectively. Prediction was evaluated by Dice score coefficient (DSC), and lesion volume error at an optimal threshold. In minimal and major reperfusion patients, the deep learning models and Tmax and ADC thresholding were compared using paired sample Wilcoxon test.

Results:
182 patients were included (85 males, age 65±16 yrs, baseline NIHSS 15 IQR 10-19), with a breakdown of minimal/major/partial/unknown reperfusion status of 32/65/43/42 patients, respectively. The pre-training approach performed the best among all approaches (Table 1, Figure 1).

Conclusion:
Deep learning models to predict penumbra and ischemic core are best trained using general pre-training on a wide range of stroke cases followed by fine-tuning on the extreme cases. This method outperforms conventional DWI-PWI mismatch inspired thresholding approaches.
Abstract WP84: MRI Based Scores Outperform CTA Based Scores in Predicting Outcome After Basilar Artery Occlusion
Authors: Dakay Katarina , Ng Amanda , Fraser Justin F , Mahta Ali , Reznik Michael , Boyanpally Anusha , Jayaraman Mahesh , Mc Taggart Ryan A , Jindal Gaurav , Wendell Linda C , Thompson Bradford B , Furie Karen , Yaghi Shadi , Cutting Shawna
Published: June 2021

Introduction:
Clinical outcomes in patients with acute basilar occlusion (BAO) vary widely; several prognostic scores based on noninvasive imaging have been proposed. We aimed to compare the predictive value of several noninvasive neuroimaging scores in patients with BAO.

Methods:
We performed a single-center retrospective cohort study including all patients with acute BAO from 2015-2019. Using available clinical radiographic data, we calculated the following scores based on computed tomography (CT) and CT angiogram: Goyal posterior communicating artery score, posterior circulation collateral score, Basilar Artery on Computed Tomography Angiography (BATMAN) score, pc-ASPECTS score, and pons-midbrain index. We also calculated the following scores based on diffusion-weighted (DWI) magnetic resonance imaging (MRI): Bern DWI score, MRI pc-ASPECTS, and pons-midbrain index on DWI. We then used logistic regression with area under the ROC curve analysis to determine the accuracy of each score in predicting favorable 3-month outcome (modified Rankin Scale 0-2).

Results:
Of 39 patients in our cohort, 92.3% underwent endovascular treatment (n=36) and 35.8% (n=14) had a favorable 3-month outcome. The Bern DWI score (AUC 0.790, 95% CI 0.619-0.960), pc-ASPECTS on MRI (AUC 0.880, 95% CI 0.601-0.958), and pons-midbrain index on MRI (AUC 0.764, 95% CI 0.594-0.934) accurately predicted 3-month outcome when analyzed as raw scores
(Figure 1).:

Conclusion:
MRI scores more strongly predict outcome in BAO as compared to CTA collateral scores. Larger prospective studies are needed to confirm our findings.
Some methodological issues in reading oracle-bone inscriptions
Authors: Takashima Ken-ichi
Published: June 2021

This paper discusses hermeneutics arising from a fastidious reading of Adam C. Schwartz (2019) which is an English translation with commentary of the Oracle-Bone Inscriptions from Yinxu Huayuanzhuang Locus East, one of the most contextually cohesive, and archeologically well-documented, collection of OBI (acronym of “oracle-bone inscriptions”) unearthed to date. The paper underscores the importance of methodology of reading OBI. It will be seen that Schwartz’s book suffers from the lack of disciplined application of any particular persuasion. It is, in this sense, disappointing, though there is much else in the book that offers original ideas. As for the English translations Schwartz provides for each and every inscription of the collection, many are questionable (even unreliable), a few incomprehensible, and this is due mainly to failure of procuring a relevant bibliography and acquiring technical (linguistic) finesse to grasp and assess some important issues in the literature written in English.
Description of the adult of the thread-legged assassin bug Eugubinus araneus (Hemiptera: Reduviidae) from India, with comments on other congeneric species
Authors: GHATE HEMANT V. , BOYANE SWAPNIL S. , WEBB MICHAEL D.
Published: June 2021

The thread-legged assassin bug Eugubinus araneus Distant, 1903 (Hemiptera: Heteroptera: Reduviidae: Emesinae: Emesini) was described from India on the basis of two nymphs. This paper provides the first description of the adult with illustrations of both the adult and the nymph. A checklist of and a key to species of Eugubinus Distant, 1903, and images of the type material of six additional species of the genus, i.e., E. intrudans Distant, 1915, E. reticolus Distant, 1915, E. canalanus (Distant,1914), E. annulatus (Villiers, 1948), E. forsteri Wygodzinsky, 1953 and E. papuensis Wygodzinsky, 1966, are provided.
Investigation on Potential of Novel Carrier System Containing Silver and Gold Nanoparticles for Burn Surgery: Evaluation in Rat Model
Authors: Gao Cong , Diao Jianjun , Jia Jun , Zhang Lei
Published: June 2021

The main aim of the study was to optimization and evaluation of a suitable dosage form i.e., tropical gel containing silver and gold nanoparticles which are synthesized by green synthesis as this is the rapid and better alternative to chemical synthesis. For burn injury systemic route
of administration is not suitable due to damaged skin hence tropical route selected to provide controlled effects, low systemic toxicity and easy application. Silver nanoparticles were synthesized by green synthesis by use of neem leaves and gold nanoparticles by Aloe vera. Characterization
was done by UV spectroscopy, particle size distribution, TEM and zeta potential. Gel was formulated by simple mixing and stirring method and evaluated for color, homogeneity, Spreadability, viscosity, in vitro release, antimicrobial study and in vivo study. In this study, the
combination of Carbopol 934 P and HPMC (ratio 1:3) was found to be ideal formulation (Formulation F5) with optimum viscosity and Spread-ability i.e., 4459 cP and 5.7 gmcm/sec resp. in vitro release was found to be 98.66% in 12 hours. in vitro antimicrobial study and in vivo
study on rat showed maximum effects than standard formulations. From this study it can be concluded that, tropical gel is the superior dosage form containing silver and gold nanoparticles which acts as the antimicrobial agents and is effective in treatment of burn surgery.
Application of Inferior Vena Cava Nanofilter Combined with Thrombolytic Catheter for Intravenous Thrombolysis in Deep Vein Thrombosis of Lower Extremities
Authors: Liao Hongwei , Wang Yi
Published: June 2021

Deep vein thrombosis (DVT) of the lower extremities has a high incidence and is insidiously fatal. Detachment of the thrombus can quickly cause death. Early detection and timely treatment are key to the treatment of DVT. This study is the first to report the clinical value of an inferior
vena cava nanofilter combined with thrombolytic catheter for intravenous thrombolysis in DVT. The study found that the inferior vena cava nanofilter combined with the thrombolytic catheter has a significant effect on the treatment of DVT, which greatly reduces the circumference difference
of the upper and lower legs, reduces the levels of fibrinogen, high-sensitivity C-reactive protein, and D-dimer, reduces the occurrence of complications, and is safe and worthwhile promotion.
Maxillofacial Horse Trauma: A 10-Year Retrospective Study at a UK Major Trauma Center
Authors: Sritharan Rajeevan , Blore Christopher David , Gahir Daya Singh
Published: June 2021

Introduction/Objecive:

There are very few studies that have investigated equestrian-related maxillofacial injuries. A retrospective review was performed to investigate maxillofacial horse trauma at a Level 1 Trauma Centre at the Royal Stoke Hospital over the last 10 years between 2010 and 2020.

Study Design/Methods:

Search of the hospital’s major trauma database as well as ED records showed 51 patients who sustained maxillofacial injuries related to horses. Statistical analysis was performed using Chi Squared tests.

Results:

41 patients were female and the remaining 10 were male. 43% of patients were female and aged 30 and under. Kicks from horses accounted for 64.4% of equine-related maxillofacial injuries. A total of 90 injuries were recorded. Hard tissue injuries which include all fractures accounted for 66.3% of injuries sustained. 70.5% patients sustained isolated maxillofacial trauma. There was an association between patients sustaining non-isolated maxillofacial trauma and hard tissue maxillofacial injuries ( P = 0.04). 65.6% of injuries were managed operatively. Patients aged 30 and under were more likely to be managed operatively ( P = 0.03).

Conclusion:

Equestrian related maxillofacial trauma represents a proportion of trauma workload. The safety aspect of horse riding should be considered and education in safe riding and the use of appropriate safety equipment is vital.
Measures to reduce red cell use in patients with sickle cell disease requiring red cell exchange during a blood shortage
Authors: Uter Stacey , An Hyun Hyung , Linder Grace E. , Kadauke Stephan , Sesok-Pizzini Deborah , Kim Haewon C. , Friedman David F. , Chou Stella T.
Published: June 2021

The COVID-19 pandemic has created major disruptions in health care delivery, including a severe blood shortage. The inventory of Rh and K antigen–negative red cell units recommended for patients with hemoglobinopathies became alarmingly low and continues to be strained. Because patients with sickle cell disease requiring chronic red cell exchange (RCE) incur a large demand for red cell units, we hypothesized that implementation of 2 measures could reduce blood use. First, obtaining the pretransfusion hemoglobin S (HbS) results by procedure start time would facilitate calculation of exact red cell volume needed to achieve the desired post-RCE HbS. Second, as a short-term conservation method, we identified patients for whom increasing the targeted end procedure hematocrit up to 5 percentage points higher than the pretransfusion level (no higher than 36%) was not medically contraindicated. The goal was to enhance suppression of endogenous erythropoiesis and thereby reduce the red cell unit number needed to maintain the same target HbS%. These 2 measures resulted in an 18% reduction of red cell units transfused to 50 patients undergoing chronic RCE during the first 6 months of the COVID-19 pandemic. Despite reduction of blood use, pretransfusion HbS% target goals were maintained and net iron accumulation was low. Both strategies can help alleviate a shortage of Rh and K antigen–negative red cells, and, more generally, transfusing red cell units based on precise red cell volume required can optimize patient care and judicious use of blood resources.
Reflections on the genetics-first approach to advancements in molecular genetic and neurobiological research on neurodevelopmental disorders
Authors: Arnett Anne B. , Wang Tianyun , Eichler Evan E. , Bernier Raphael A.
Published: June 2021

Background

Neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD) and intellectual disability (ID), are common diagnoses with highly heterogeneous phenotypes and etiology. The genetics-first approach to research on NDDs has led to the identification of hundreds of genes conferring risk for ASD, ID, and related symptoms.

Main body

Although relatively few individuals with NDDs share likely gene-disruptive (LGD) mutations in the same gene, characterization of overlapping functions, protein networks, and temporospatial expression patterns among these genes has led to increased understanding of the neurobiological etiology of NDDs. This shift in focus away from single genes and toward broader gene–brain–behavior pathways has been accelerated by the development of publicly available transcriptomic databases, cell type-specific research methods, and sequencing of non-coding genomic regions.

Conclusions

The genetics-first approach to research on NDDs has advanced the identification of critical protein function pathways and temporospatial expression patterns, expanding the impact of this research beyond individuals with single-gene mutations to the broader population of patients with NDDs.
Family interaction among young Chinese breast cancer survivors
Authors: Xu Jiehui , Wang Xiyi , Chen Mengjie , Shi Yiwen , Hu Yun
Published: June 2021

Background

Family interaction is an important factor contributing to the quality of survivorship among breast cancer survivors. The dearth of studies involving young females with breast cancer has limited the understanding of family interaction in this increasingly large population.

Methods

The aim of this study was to explore family interaction patterns among young Chinese breast cancer survivors. We conducted in-depth interviews with seventeen young breast cancer survivors (YBCSs) in China between May 2019 and December 2019. A content analysis was performed to identify the characteristics of family interaction in this population. Conceptualizations of feminism and social support were used to guide the data analysis.

Results

Family interaction patterns were categorized into 5 domains from the perceptions of Chinese YBCSs: (1) adjustment of parenthood (changes in child-rearing approaches, perception of children’s care) (2) ambivalence towards intimacy (desire for intimate relationships, perceived relationship insecurity); (3) concerns regarding fertility; (4) return to work (coping with gratitude and guilt by working, readapting to family and society by working); (5) activation of the support system in a large family (instrumental support from core family members, instrumental, informational, and appraisal support from relatives).

Conclusions

The study provides a deeper understanding of the interactions between young breast cancer survivors and their family members in China. These findings can support health professionals in developing female-sensitive, culturally specific interventions to assist Chinese YBCSs and their families in increasing positive interactions and family resilience as well as quality of life. In addition, the findings are highly applicable to other female cancer survivors and their vulnerable families exposed to similar social and cultural contexts.
Genetic association of TOLLIP gene polymorphisms and HIV infection: a case-control study
Authors: Wang Ming-Gui , Wang Jing , He Jian-Qing
Published: June 2021

Background

Previous studies have indicated that host genetic factors play an essential role in immunity to human immunodeficiency virus (HIV) infection. We aimed to investigate the association between the toll-interacting protein (TOLLIP) and mannose-binding lectin 2 (MBL2) genes and HIV infection susceptibility among Chinese Han patients.

Methods

This is a case-control study. A total of 435 HIV-infected patients and 1013 seronegative healthy individuals were recruited. DNA was extracted from whole blood. Two SNPs in the MBL2 gene (rs7096206 and rs1800450) and three SNPs in the TOLLIP gene (rs5743899, rs3750920, and rs5743867) were selected and genotyped using a SNPscan Kit (Cat#: G0104, Genesky Biotechnologies Inc., Shanghai, China). Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated using unconditional binary logistic regression.

Results

A significant association between the minor alleles rs5743899 (C allele) and rs5743867 (G allele) in the TOLLIP gene and susceptibility to HIV infection was found in this study after adjusting for age and sex (Pa = 0.011 and < 0.001, respectively). The rs5743867 in the TOLLIP gene was significantly associated with the risk of HIV infection in dominant, recessive, and additive models when adjusted for age and sex (Pa < 0.05). No significant association was found between MBL2 gene polymorphisms and HIV infection.

Conclusion

Our study found a statistically significant association between the two SNPs (rs5743867 and rs5743899) in the TOLLIP gene and susceptibility to HIV infection in a Chinese Han population.
Assessing research misconduct in Iran: a perspective from Iranian medical faculty members
Authors: Shamsoddin Erfan , Torkashvand-Khah Zahra , Sofi-Mahmudi Ahmad , Janani Leila , Kabiri Payam , Shamsi-Gooshki Ehsan , Mesgarpour Bita
Published: June 2021

Background

Research misconduct is a global concern in biomedical science. There are no comprehensive data regarding the perception and situation of scientific misconduct among the Iranian medical faculty members. We conducted a nationwide survey to assess the research misconduct among the medical faculty members in Iran.

Methods

We used the Persian version of the research misconduct questionnaire (PRMQ) on the Google Forms platform. We sent the survey link to a systematic random sample of medical faculty members in Iran (N = 4986). Descriptive analyses were performed on the individual items of the PRMQ, with frequencies and percentages for categorical and Likert-type response items, and means and standard deviation (S.D.) for continuous variables. Chi-square analysis was conducted to test hypotheses examining differences in the frequency of responses related to factors influencing misconduct. We also defined four tenure categories (TC) based on the working years of the participants as tenured faculty members. All the analyses were performed using R 3.6.0.

Results

The response rate was 13.8% (692 responses). Nearly 70% of the respondents agreed that their publication output would be of higher quality if there were no publication pressure. Approximately three-quarters (N =499, 72.1%) of the respondents had been aware of some instances of research misconduct during the previous year according to their understanding of misconduct. Among the participants, 18.5% perceived the effectiveness of their associated organisation’s rules for reducing research misconduct to be high or very high. Pressure for tenure was identified as the item most frequently perceived with a strong behavioural influence on engaging in research misconduct (80.2%).

Conclusions

This study confirms that research misconduct needs to be actively addressed among the medical faculty members. Making policies with a focus on boosting awareness regarding the occasions of scientific misconduct and its management seems to be indispensable in the future in Iran.
Pharmacokinetics and tolerance of repeated oral administration of 5-fluorocytosine in healthy dogs
Authors: Béguin Jérémy , Kohlhauer Matthias , Laloy Eve , Degorce Frédérique , Moreau Baptiste , Quéméneur Éric , Erbs Philippe , Klonjkowski Bernard , Maurey Christelle
Published: June 2021

Background

5-fluorocytosine is a pyrimidine and a fluorinated cytosine analog mainly used as an antifungal agent. It is a precursor of 5-fluorouracil, which possesses anticancer properties. To reduce systemic toxicity of 5-fluorouracil during chemotherapy, 5- fluorocytosine can be used as a targeted anticancer agent. Expression of cytosine deaminase by a viral vector within a tumor allows targeted chemotherapy by converting 5-fluorocytosine into the cytotoxic chemotherapeutic agent 5-fluorouracil. However, little is known about the tolerance of 5-fluorocytosine in dogs after prolonged administration.

Results

In three healthy Beagle dogs receiving 100 mg/kg of 5-fluorocytosine twice daily for 14 days by oral route, non-compartmental pharmacokinetics revealed a terminal elimination half-life of 164.5 ± 22.5 min at day 1 and of 179.2 ± 11.5 min, after 7 days of administration. Clearance was significantly decreased between day 1 and day 7 with 0.386 ± 0.031 and 0.322 ± 0.027 ml/min/kg, respectively. Maximal plasma concentration values were below 100 µg/ml, which is considered within the therapeutic margin for human patients. 5-fluorouracil plasma concentration was below the limit of detection at all time points. The main adverse events consisted of depigmented, ulcerated, exudative, and crusty cutaneous lesions 10 to 13 days after beginning 5-fluorocytosine administration. The lesions were localized to the nasal planum, the lips, the eyelids, and the scrotum. Histological analyses were consistent with a cutaneous lupoid drug reaction. Complete healing was observed 15 to 21 days after cessation of 5-fluorocytosine. No biochemical or hematological adverse events were noticed.

Conclusions

Long term administration of 5-fluorocytosine was associated with cutaneous toxicity in healthy dogs. It suggests that pharmacotherapy should be adjusted to reduce the toxicity of 5-fluorocytosine in targeted chemotherapy.
Zinc transporter SLC39A13/ZIP13 facilitates the metastasis of human ovarian cancer cells via activating Src/FAK signaling pathway
Authors: Cheng Xinxin , Wang Jie , Liu Chunling , Jiang Tianduo , Yang Ningzhi , Liu Dan , Zhao Huanhuan , Xu Zhelong
Published: June 2021

Background

Zinc transporters have been found to be associated with the pathogenesis of numerous human diseases including cancer. As the most lethal gynecologic malignancy, ovarian cancer is characterized by rapid progression and widespread metastases. However, the function and underlying mechanism of zinc transporters in ovarian cancer metastasis remain unclear.

Methods

The relationship between zinc transporter gene expressions and clinical outcomes of ovarian cancer was assessed with the online database Kaplan-Meier plotter (http://kmplot.com/analysis/). Immunohistochemistry was performed to investigate the prognostic importance of ZIP13. The expression of ZIP13 in ovarian cancer cell lines was depleted to explore its effect on proliferation, adhesion, migration, and invasion both in vitro and in vivo assays. RNA-Seq, quantitative RT-PCR, and western blot analysis were performed to explore ZIP13-regulated downstream target genes.

Results

The expressions of several zinc transporters were highly associated the clinical outcomes of ovarian cancer patients. Among them, high ZIP13 expression was an independent prognostic factor for poor survival in patients with ovarian cancer. ZIP13 knockout suppressed the malignant phenotypes of ovarian cancer cells both in vitro and in vivo. Further investigation revealed that ZIP13 regulated intracellular zinc distribution and then affected the expressions of genes involved in extracellular matrix organization and cytokine-mediated signaling pathway. This led to the activation of Src/FAK pathway with increased expressions of pro-metastatic genes but decreased expressions of tumor suppressor genes.

Conclusions

ZIP13 is shown to be a novel driver of metastatic progression by modulating the Src/FAK signaling pathway, which may serve as a promising biomarker for prognostic evaluation and targeted therapy in ovarian cancer.
Correction to: Hans Asperger, National Socialism, and “race hygiene” in Nazi-era Vienna
Authors: Czech Herwig
Published: June 2021

An amendment to this paper has been published and can be accessed via the original article.