bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP323: Switching To Rosuvastatin Plus Ezetimibe In Statin-treated Stroke Patients With Low-density Lipoprotein Cholesterol Levels Above 70 mg/dL (SWITCH)
Authors: Yang Wookjin , LEE YEONG-BAE , Kim Eung-Gyu , Cho Han-Jin , Yu Sungwook , Kim Joon-Tae , Shin Jong Wook , Lee Soo Joo , Kim Beom Joon , Hong Ji Man , Koh Seong-Ho , An Sang Joon , Cho A-Hyun , Jung Jin-Man , Cho Hyun-Ji , Kim Chulho , Lee Seung-Hoon
Published: January 2025

Introduction:
Proper lipid management is vital for secondary prevention of ischemic stroke; however, not a few patients fail to reach target low-density lipoprotein cholesterol (LDL-C) levels with statin monotherapy. This study aimed to provide real-world data on LDL-C target achievement using rosuvastatin plus ezetimibe combination therapy (R+E) in stroke patients who did not achieve an LDL-C level of <70 mg/dL with statins alone.

Methods:
This multicenter, prospective, observational study enrolled adult stroke patients with baseline LDL-C ≥70 mg/dL on statin monotherapy from 16 stroke centers in Korea. Participants were switched to R+E at doses of 5/10 mg, 10/10 mg, or 20/10 mg, at the investigators’ discretion. Lipid profiles were assessed at 3 and 6 months after initiating the combination therapy. The main outcome of interest was the proportion of participants achieving LDL-C <70 mg/dL at 6 months.

Results:
Among the 1,519 participants enrolled between May 2021 and March 2023, 1,431 were eligible for analysis. The mean age was 65.3 ± 10.6 years, with 66.8% (n=956) being men. Of the 994 participants who completed follow-up, with a mean baseline LDL-C of 98.9 ± 22.4 mg/dL, 708 (71.2%) achieved LDL-C <70 mg/dL at 6 months. The mean LDL-C decreased to 62.7 ± 22.1 mg/dL at 3 months and to 62.0 ± 22.0 mg/dL at 6 months with R+E. The effectiveness of R+E remained consistent across three different dosages. R+E was particularly effective in participants with diabetes (OR [95% CI], 1.85 [1.32-2.59]; p<0.001) and those with baseline LDL-C 70-99 mg/dL (2.71 [2.04-3.59]; p<0.001). Other demographic and clinical factors, including prior statin dosages, did not affect the LDL-C lowering effect of R+E. Fewer participants met stricter targets, such as LDL-C <70 mg/dL plus 50% reduction (n=253, 25.5%) or LDL-C <55 mg/dL (n=395, 39.7%).

Conclusions:
R+E effectively reduced LDL-C level to <70 mg/dL in stroke patients on statin monotherapy with baseline level above 70 mg/dL. For achieving stricter LDL-C targets, additional therapy may be necessary.

Funding:
Hanmi Pharmaceutical.
Abstract WP324: Predicting Stroke as a Cause of Death in Black Cancer Patients Using Ensemble Machine Learning Models
Authors: alrawashdeh raghad wesamah ahmad , Alrawashdeh Nour
Published: January 2025

Previous studies identified black race as a risk factor for stroke in cancer settings. Yet, no studies have sought to identify the risk factors associated with stroke as a cause of death in black cancer patients. This study aimed to use advanced machine learning techniques to predict stroke mortality in black cancer patients and to identify significant risk factors. We utilized The Surveillance, Epidemiology, and End Results 17 registry to predict stroke as a cause of death in Black cancer patients from January 1, 2000, to December 31, 2020. Various machine learning models were employed, including Random Forest, Logistic Regression, XGBoost, LightGBM, and Gradient Boosting. The dataset included features such as age, sex, cancer type, year of diagnosis, and treatment modalities. Data preprocessing involved cleaning, feature selection, and 80-20 stratified train-test splitting. The models were combined into a voting ensemble to leverage their strengths. The performance of each model was evaluated using metrics including accuracy, AUC (macro, micro, weighted), precision, recall, and F1 scores. Feature importance was analyzed to identify the most contributing variables in predicting stroke death. A total of 292,680 black cancer patients were included, with a mean age of 57.36 ± 13.68 years. The cohort comprised 152,991 males (52.27%) and 139,689 females (47.73%). Among them, 5,874 patients (2.01%) died from stroke, while 286,806 patients are alive. The voting ensemble model achieved an accuracy of 0.98, with an AUC macro of 0.88, AUC micro of 0.99, and AUC weighted of 0.88. The average precision scores were 0.64 (macro), 0.99 (micro), and 0.98 (weighted). The F1 scores were 0.64 (macro), 0.98 (micro), and 0.97 (weighted). The precision scores were 0.78 (macro), 0.98 (micro), and 0.97 (weighted). Significant predictors of stroke death included an earlier year of diagnosis, older age, lack of any cancer treatment, and specific cancer types (notably gastrointestinal and male genital cancers). Our findings suggest that the voting ensemble machine learning model can effectively predict stroke mortality in black cancer patients, with high accuracy and robust performance metrics. These insights could inform targeted interventions to reduce stroke risk in this population, contributing to improved clinical outcomes and survival rates. Future studies should assess the impact of immunotherapy on stroke risk to further refine treatment approaches.
Abstract WP337: Aged Maternal Microbiome Plays a Significant Role in Offspring’s Recovery from Neonatal Hypoxic Ischemic Encephalopathy
Authors: Rebeles Kristen , Blixt Frank , Chen Yu-Ju , McCullough Louise
Published: January 2025

Background:
The microbiome and the metabolites it produces, influences homeostasis in the host. A disruption of gut biome composition, or dysbiosis, can be a risk factor or a consequence of disease. The maternal biome is known to play a vital role in brain and immune development of the offspring by shaping the metabolic environment during early development. Neonatal hypoxic ischemic encephalopathy (nHIE) is one of the leading causes of death and disability among neonates. We investigated if the presence of an aged dysbiotic maternal biome influenced the response to neonatal nHIE in offspring and worsened outcomes after injury.

Method:
Young female C57B6 mice 3-month (M) of age had their host gut bacteria cleared via antibiotic treatment prior to recolonization via fecal microbiome transplants with the microbiota from 3M (control), or 14M (middle aged) female mice. The dams were subsequently bred with a young male and delivered pups. At 10 days post birth, the pups received either a sham surgery or were subjected to the Rice-Vannucci model of nHIE and were monitored 7 days post-surgery. The pups were aged to 2-3 months for behavioral testing and longitudinal fecal samples collection.

Results:
The maternal biome had a significant impact on offspring biome and on recovery from nHIE during both the acute and chronic phases of recovery. From Day 3 post-surgery to Day 7, 14M male sham mice had a significant increase in their weight from baseline compared to 3M HIE males and 14M HIE males (p< 0.05, 0.01). 14M females had a significantly higher percent change from baseline weights on Day 1, Day 3 and Day 7 post surgery compared 3M HIE females and 14M HIE shams (p= 0.0132, 0.0495, and 0.0025 respectively). At 2-3 months of age, HIE males from dams recolonized with 14M biome weighed significantly less than HIE males from dams recolonized with 3M biome (p= 0.0305); females had no significant weight differences at this time. Upon assessment of chronic motor functional impairment, HIE males born from dams recolonized with 14M biome had significantly lower grip strength compared to 3M HIE males (p= 0.469). This was also seen in female offspring from dams recolonized with 14M biome, HIE females had significantly lower grip strength compared to HIE females from dams with 3M biome (p= 0.0021).

Conclusion:
The maternal biome had a significant impact on offspring recovery from nHIE during both the acute and chronic phases of recovery. Sex and injury specific changes were seen.
Abstract WP35: Neutrophil Extracellular Traps As a Biomarker for Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage
Authors: Zeineddine Hussein , Dienel Ari , Thomas Sithara , Wroe William , Torres Kiara , Thankamani Pandit Peeyush , Choi H , Blackburn Spiros , McBride Devin
Published: January 2025

Neutrophils are reported to be critical mediators of to poor outcome after subarachnoid hemorrhage (SAH). Following SAH, neutrophils cause vascular occlusion via neutrophil extracellular traps (NETs) and NETs have been identified as a therapeutic target to prevent delayed cerebral ischemia in mice (DCI) with SAH. In this study, our hypothesis was that markers of NETs are higher in aneurysmal SAH patients developing DCI compared to SAH patients not developing DCI. Moreover, we hypothesized NETs occlude blood vessels in the brain of SAH patients developing DCI. Using aneurysmal SAH patient blood collected at 1, 2, 4, 7, and 10 days post-SAH, we used ELISA kits to measure three markers of NETs: neutrophil elastase, citrullinated histone H3, and H3.1 nucleosome. We collected autopsy samples to examine for the presence of NETs in the brain vessels. Finally, as neutrophil counts (and the ratio of neutrophils to lymphocytes) are reported to be a biomarker for DCI, we assessed these measures too. Two hundred and sixty-nine aneurysmal SAH patients were included in our analyses: 193 patients did not develop DCI and 76 patients developed DCI. In our study, neutrophil elastase and citrullinated histone H3 were NETs markers that were able to distinguish between SAH patients who developed DCI and those who did not develop DCI. Specifically, neutrophil elastase was elevated in SAH patients developing DCI (compared to that of patients not developing DCI) and neutrophil elastase levels could predict which SAH patients were at high-risk for developing DCI as early as day 2 post-SAH. Citrullinated histone H3 displayed an elevated level in DCI patients vs no DCI patients on day 10. Moreover, NETs were observed occluding the brain blood vessels in SAH patients. None of the other measures had any predictive value for identifying which SAH patients were likely to develop DCI: neutrophil count, neutrophil to lymphocyte ratio, H3.1 nucleosome. The findings of this study suggest NETs factors may be useful biomarkers to predict which aneurysmal SAH patients are at-risk for DCI. As NETs were observed occluding brain vessels, NETs may also be a therapeutic target.
Abstract WP351: Severely diminished collateral formation and incomplete recovery of cerebral perfusion in aging mice after unilateral common carotid artery occlusion
Authors: Sasaki Yuichi , Jin Xuyan , Imai Takahiko , Aykan Sanem A , Morais Andreia , Chung David , Ayata Cenk
Published: January 2025

Collateral development plays an important role in maintaining cerebral blood flow (CBF) in the presence of critical stenosis or occlusion of large cerebral arteries. Age is a non-modifiable risk factor for ischemic stroke associated with collateral rarefaction. Here, we studied the influence of aging on collateral development and cerebral hemodynamic impairment using 114 mice (56 male and 58 female, C57/BL6) of two age groups (young: 20 ± 2 weeks; aged: 71 ± 9 weeks). We permanently occluded the right common carotid artery (RCCAO) via suture ligation and compared these to sham-operated animals. We quantified the diameters of major branches of the circle of Willis and pial collaterals using black ink angiograms 4 weeks after the procedure. In a separate cohort, CBF was measured in the dorsal cortex using laser speckle imaging 3 hours (acute) and 4 weeks (chronic) after RCCAO or sham. Regions of interest were placed on both hemispheres in the major arterial territories and watersheds. To evaluate cerebrovascular reserve, we induced hypotension by controlled exsanguination. In young mice, compared with sham, RCCAO led to a significant increase in the diameters of the right anterior cerebral artery (ACA), the left anterior cerebral artery (ACA), and the right posterior communicating artery (PCommA), suggesting collateral growth (increase rate 30%, 27%, and 66%, respectively). The diameters of pial collaterals were also increased bilaterally. In aged mice, the circle of Willis and pial collateral growth were both diminished after RCCAO compared with sham (increase rate 14% right ACA, 19% left ACA, and 10% right PCommA). Laser speckle imaging revealed a reduction in CBF upon acute RCCAO in both age groups, which was slightly worse in aged mice. In young mice, baseline CBF recovered completely 4 weeks after RCCAO, but cerebrovascular reserve appeared mildly reduced during hypotension. In aged mice, recovery of baseline CBF was incomplete in all vascular territories, and cerebrovascular reserve appeared markedly diminished during hypotension. In conclusion, our study reveals that aging causes diminished collateral growth potential, which is a strong determinant of hemodynamic impairment at baseline and cerebrovascular reserve during hypotension. The molecular underpinnings of this collateral deficit remain to be elucidated.
Abstract WP36: CTA versus DSA for the Detection of Mycotic Aneurysms in Infective Endocarditis
Authors: Kumar Neha , Abdalkader Mohamad , Cervantes-arslanian Anna , Feske Steven
Published: January 2025

Background:
Up to 5% of patients with infective endocarditis (IE) develop intracranial mycotic aneurysms (MA) with nearly 25% of these patients having multiple intracranial aneurysms. Mortality rates have been reported up to 30% for unruptured and 80% for unruptured MA. Therefore, accurate diagnosis of intracerebral aneurysms is critical. CT angiography (CTA) is widely used to detect mycotic aneurysms (MA), yet data are sparse in the literature regarding diagnostic accuracy of CTA compared with the gold standard of 3D rotational digital subtraction angiography (DSA). In this study, we compare CTA to DSA particularly focusing on how the size of aneurysms may change sensitivity of CTA. Based on these results, we offer a practical strategy for the detection and monitoring of MAs.

Methods:
This retrospective chart review included all patients admitted to Boston Medical Center between January 1, 2014 and December 31, 2023. 883 patients with IE were identified by ICD-9 and ICD-10 code. 77 intracranial aneurysms were identified by DSA with accompanying CTA within 1 month. An experienced neuroradiologist reviewed each CTA and DSA. Using DSA as the gold standard, sensitivity, specificity, positive and negative predictive values, and likelihood ratios were calculated. To avoid bias and increase clinical relevance, these calculations were based on the final clinical interpretation at the time of the study. For the analysis based on aneurysm size, the review of our study neuroradiologist was used.

Results:
Of the 77 aneurysms identified by CTA or DSA, test results were as follows: 53 true negative (CTA -, DSA-), 13 true positive (CTA +, DSA +), 5 false positive (CTA +, DSA -), and 8 false negative (CTA -, DSA +). Including all aneurysms, the sensitivity of CTA was (62%), and the specificity was (91%). The positive and negative predictive values were 72% and 87%, respectively. The sensitivity of CTA for aneurysms ≥ 5mm was 100%. For aneurysms ≥ 4, the sensitivity was 88%. For aneurysms ≤ 3mm, the sensitivity of CTA was 46%.

Conclusions:
Sensitivity of CTA for intracranial aneurysms is low, however, it varies depending on size and is excellent for aneurysms ≥ 5mm. Based on this information, we present a strategy that uses a combination of DSA and CTA to detect and monitor MAs.
Abstract WP370: Platelet morphology but not coagulation markers predicts delayed cerebral ischemia after subarachnoid hemorrhage
Authors: Dienel Ari , Hong Sungha , Torres Kiara , guzman jose , Thankamani Pandit Peeyush , Choi Alex , Blackburn Spiros , McBride Devin
Published: January 2025

Approximately 30% of aneurysmal subarachnoid hemorrhage (aSAH) patients who survive the rupture develop delayed cerebral ischemia (DCI) 4 to 10 days following aSAH. Multiple clinical studies indicate the cause of DCI is multifactorial, but identifying which patients are at-risk for developing DCI is lacking. Previous studies have identified numerous biomarkers, such as coagulation and platelet factors, which may predict patients at-risk for DCI, but to-date, no markers are widely utilized in the clinical setting. Thus, we sought to investigate various biomarkers of platelets to identify which factors are predictive of patients at-risk for DCI. aSAH patients were prospectively enrolled and had blood collected 1, 2, 4, 7, and 10 days post-aSAH. DCI was adjudicated by three independent clinicals. Blood was used from 148 aSAH patients (n=101 no DCI, N=47 DCI) for analysis of TEG, platelet receptors for activation (CD62p) and aggregation (PAC-1) via flow cytometry, platelet aggregation via Chrono-log, and 22 aSAH (n=17 no DCI, n=5 DCI) patients were used to analyze the platelet activation status (i.e. morphology, see Figures) via microscopy. Six healthy patients were used as controls. aSAH caused hypercoagulability in all aSAH patients. However, neither TEG nor Chrono-log parameters were reliable in predicting which aSAH patients would develop DCI. Similarly, the markers for platelet activation (CD62p) and aggregation (PAC-1) were not able to distinguish which aSAH patients would get DCI. Interestingly, morphological analysis of platelets revealed significantly higher platelet activation two days after aSAH in the aSAH patients who later developed DCI (see Figure). Although this preliminary study involves a small sample size of 22 patients, the results suggest that platelet morphology rather than other platelet tests may identify individuals at-risk for DCI following aSAH. However, further research with a larger patient cohort is necessary to validate these findings.
Abstract WP373: Physical Exercise Post-Cardiac Arrest Mitigates Long- and Short-Term Memory Deficits
Authors: Ferrier Fernando , Saul Isabel , Dave Kunjan , Perez-Pinzon Miguel
Published: January 2025

Cardiac arrest (CA) often leads to severe memory impairment, largely due to extensive neuronal loss in brain areas critical for cognitive function, including the hippocampus and amygdala. We demonstrated that physical exercise (PE) following asphyxia CA (ACA) mitigates contextual memory deficits in male rats. Intriguingly, this effect occurs without direct protection of the hippocampus and amygdala, as evidenced by significant cell death in both regions. Instead, PE post-ACA reduces neuronal loss in the medial septum (MS), a forebrain structure essential for regulating limbic system oscillations, and thus memory. This study aims to investigate whether PE post-ACA preserves oscillatory activity within the limbic circuitry and whether it ameliorates other forms of cognitive deficits in both sexes.

Methods:
Male and female rats are subjected to 8’ ACA. After 5 days of recovery, the animals undergo 5 consecutive days of treadmill running, followed by a battery of cognitive tests. Approximately one-month post-ACA, the animals are anesthetized with urethane for in vivo oscillatory recordings.

Results:
Having acquired fear conditioning (Figs. 1a and 1d), the animals were tested for cued fear memory and extinction two days later. Post-ACA exercised animals displayed a significant increase in freezing levels compared to non-exercised animals in response to a single re-exposure to the tone, indicating preserved cued fear memory (Fig. 1c). After continuous tone presentations, only the exercised animals displayed a significant decrease in freezing, suggesting they were able to extinguish their fear response (Fig. 1f). The Y-maze test revealed a significant increase in spontaneous alternation in exercised animals (Fig. 1g), indicating improved working memory. These outcomes were not influenced by locomotion (Fig. 1h) or anxiety (Fig. 1i), as confirmed by the open field test. We are currently performing the oscillatory recordings in different limbic system regions.

Conclusion:
PE post-ACA mitigates different forms of long- and short-term memory deficits in both sexes. This improvement is likely mediated by the preservation of oscillatory power in the MS and hippocampus (to be confirmed), highlighting a potential mechanism by which PE exerts its neuroprotective effects.
Abstract WP382: New Insights from Time-Frequency Analysis of Electroencephalogram throughout Ischemic Stroke in Rats
Authors: Alavi Rashid , Li Jiajun , Dai Wangde , Carreno Juan , Arakaki Xianghong , Pahlevan Niema , Gharib Morteza , Kloner Robert
Published: January 2025

Background:
Ischemic stroke remains a major cause of mortality and disability, significantly affecting patient quality of life despite advancements in treatment. Analysis of electroencephalogram (EEG) is crucial for assessing brain activity, offering insights into different physiological states. While ischemic stroke induces notable changes in EEG signals, the specific patterns and their implications are not fully understood. Here, we use the Hilbert-Huang transform (HHT) to analyze the EEG signal before, during, and after ischemic stroke in rats.

Methods:
The standard intraluminal filament middle cerebral artery (MCA) occlusion model was used to induce ischemic stroke in 16 male Sprague Dawley rats (8-10 weeks old). A suture was advanced into the internal carotid artery to occlude the MCA for 1 hour, followed by 3 hours of reperfusion (Fig. 1). Cerebral infarction was confirmed post-surgery using TTC staining technique. EEG signals were continuously recorded throughout the procedure. We applied the Hilbert-Huang Transform (HHT) to analyze the EEG signals. HHT involves two main steps: 1) empirical mode decomposition (EMD), to decompose the EEG signal into a set of intrinsic mode functions (IMF); 2) the Hilbert Transform, which is applied to each IMF to obtain analytic signals. These analytic signals are represented in the complex plane, where they often exhibit circular or elliptical forms (Fig. 2). The area of these circles in the complex plane reflects unique information on variations in the signal properties. We computed the HHT area metric for the first 4 IMFs at three timepoints: baseline, 1 hour post-MCA occlusion (pre-reperfusion), and 3 hours post-reperfusion. 2-minute EEG recordings were used at each timepoint for the HHT analysis.

Results and Conclusions:
Significant changes (P<0.05) were observed in the HHT area metric after the ischemic stroke occurrence (Fig. 3). For all IMFs, the HHT area metric reduced significantly from baseline to pre-MCA-reperfusion. However, it increased significantly from pre-MCA-reperfusion to 3 hours post-reperfusion. Comparing the baseline with post-reperfusion timepoint, significant reduction was still observed. Our results showed for the first time that the HHT can effectively analyze EEG signals to capture changes induced by ischemic stroke. Our new finding highlights the potential of HHT in providing insights into stroke-related changes in EEG, offering a valuable tool for detection or monitoring ischemic stroke.
Abstract WP401: Selenium deficient diet induces neuroinflammatory changes in aged mice which are compensated after chronic deficiency
Authors: Khan Romeesa , Patel Riya , Devlin Patrick , Do Trang , Mohapatra Swati , McCullough Louise , Ritzel Rodney
Published: January 2025

Introduction:
Aging is accompanied by a gradual increase in inflammation, oxidative stress and immune system dysfunction. Our previous work with heterochronic parabiosis, in which the circulatory systems of young and aged mice are shared, provided insights into how systemic factors influence brain aging. Notably, our findings revealed that aged blood induces a reactive oxygen species-induced senescence pathway in the young brain, while young blood activates a selenium network pathway in the aged brain. We
hypothesize
that selenium deficiency increases oxidative stress and ROS-induced senescence in microglia, thereby contributing to neuroinflammation and cognitive decline.

Methods:
We fed aged (16-month) C57BL/6 male mice either a selenium deficient or control diet (n = 9-10/grp) for 3 months. Cognition and motor activity were assessed at 1- and 3-months with the novel object recognition test (NORT) and open field (OF). Brain and spleen were harvested after 3 months for flow cytometric (FC) analysis and immunohistochemistry (IHC). Additionally, we explored the potential therapeutic effects of selenium supplementation on senescence markers in primary microglial cell cultures, which were assessed by qPCR and stained for senescence activity (beta-galactosidase).

Results:
After one month, selenium deficient mice had significantly impaired locomotor activity in the OF (p=.0010) and an increase in cognitive impairment in the NORT (p=.0792). Surprisingly, these deficits normalized to levels seen in the control group after 3 months of selenium deficient diet, raising the possibility of an adaptive or compensatory redox signaling mechanism in the aged brain. FC analysis at 3 months revealed only mild alterations in microglia, brain endothelial cells, and splenic neutrophils, consistent with the behavioral outcomes.
In vitro
experiments demonstrated that treatment with selenomethionine (p=.0134) and selenium nanoparticles (p=.0176) alleviated senescence-associated phenotypes in microglia post-H2O2 stimulation.

Conclusion:
We have established an important role for dietary selenium in healthy brain aging and novel evidence for a delayed compensatory redox mechanism to mitigate the detrimental effects of chronic selenium deficiency in aged mice. By elucidating the role of dietary selenium in brain aging, this study aims to identify novel therapeutic targets for preventing or delaying the cognitive decline associated with aging.
Abstract WP41: Impact of Time to Endovascular Securement on Outcomes in Aneurysmal Subarachnoid Hemorrhage
Authors: Chuck Carlin , Wang Diana , Oldam Joseph , Taman Mazen , Duong Anna , Voong Viva , Gupta Sahil , Haq Rakin , Feler Joshua , Torabi Radmehr , Moldovan Krisztina , Furie Karen , Wolman Dylan , Jayaraman Mahesh , Mahta Ali
Published: January 2025

Introduction:
Guidelines for aneurysmal subarachnoid hemorrhage (aSAH) suggest attempting aneurysm securement within 24 hours from arrival; the optimal treatment window within that timeframe is under investigation. We studied the association between time from hospital arrival to aneurysm treatment and outcomes in aSAH.

Methods:
We performed a retrospective study of patients with aSAH presenting from 2015 to 2023 to a single academic center. Both multivariate logistic regressions (MLR) and multivariate generalized additive models (MGAM) were created to analyze both logistic and nonlinear relationships between time interval from arrival to endovascular treatment, with poor neurologic outcome at 3 months defined as modified Rankin scale (mRS) scores of 4-6 as the primary outcome. In addition, subgroup analyses were performed for arrival-to-treatment times among patients with Hunt and Hess (HH) grades ≥3. Finally, we analyzed arrival-to-treatment time and risk of preprocedural aneurysmal rebleeding.

Results:
We reviewed 434 patients with ruptured aSAH and excluded 96 patients who died prior to cerebral angiogram, required emergent surgery, or were beyond 95% of all arrival-to-treatment times, resulting in a cohort of 338 aSAH who received endovascular aneurysm treatment in final analysis (mean [SD] age, 57.5 [13.9]; 64.2% female, 71.0% white), of which 94.9% (n=321) patients were treated within 24 hours of hospital arrival, and 5.1% (n=17) had preprocedural aneurysm rebleeding. In MLR, longer arrival-to-treatment time was not associated with neurologic outcome at 3-months (OR 0.69, 95%CI [0.43, 1.09], p=0.12). MGAM was also not associated with differences in mRS ≥3 at 3-month follow-up (estimated degrees of freedom [edf] 1, p=0.11). Restricting to patients with high HH, both MLR and MGAM demonstrated longer arrival-to-treatment intervals were associated with decreased odds of unfavorable 3-month neurologic outcome (OR 0.56, 95%CI [0.33, 0.95], p=0.036],
graphic 1
for MLR and edf=1, p=0.040,
graphic 2
for MGAM). Longer arrival-to-treatment was not associated with increased risk of preprocedural aneurysmal rebleeding on MLR (OR 1.56, 95%CI [0.72, 3,83] p=0.3).

Conclusions:
We found that longer time-to-treatment within the recommended timeframe was associated with better neurologic outcomes among patients with higher HH grade. This may underscore the need for thorough resuscitation before aneurysm securement among critically ill patients.
Abstract WP43: Factors related to major recanalization after second coiling for recanalized aneurysms: a multicenter experience over 20 years during long-term follow-up
Authors: Fuga Michiyasu , Ishibashi Toshihiro , KAN ISSEI , aoki ken , Tachi Rintaro , Irie Koreaki , Kato Naoki , Hataoka Shunsuke , Nagayama Gota , Sano Tohru , Murayama Yuichi
Published: January 2025

Objective:
Recanalized aneurysms may still recanalize despite a second coiling to prevent rupture. Factors related to recanalization following a second coiling for recanalized aneurysms have not yet been fully explored. This study examined a large multicenter dataset accumulated over a 20-year period to identify factors related to major recanalization following a second coiling for recanalized aneurysms.

Methods:
A total of 185 patients with 188 aneurysms who underwent second coiling for saccular unruptured cerebral aneurysms at three institutions between November 2003 and December 2023 were retrospectively reviewed. Patients were categorized into a group with major recanalization (R group) and a group without major recanalization (NR group). To identify factors related to major recanalization, clinical, anatomic, and procedural factors were comparable between groups by multivariate logistic regression analysis and stepwise selection.

Results:
During the follow-up period (mean, 62.3 ± 51.2 months), 72 (38.3%) of 188 recanalized aneurysms developed major recanalization. Compared with the NR group, the R group had significantly larger aneurysm size, neck size, and aneurysm volume at initial coiling and significantly lower rates of stent-assisted coiling, use of an intermediate catheter, and complete occlusion at second coiling. Stepwise multivariate logistic regression analysis identified neck size at initial coiling (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.03–1.32) as an independent risk factor for major recanalization and stent-assisted coiling (OR 0.34; 95%CI 0.14–0.85), use of an intermediate catheter (OR 0.38; 95%CI 0.17–0.86), and complete occlusion at second coiling (OR 0.16; 95%CI 0.034–0.72) as independent protective factors for major recanalization.

Conclusions:
Second coiling of recanalized aneurysms may decrease the risk of major recanalization by using a stent in combination with an intermediate catheter to achieve complete occlusion.
Abstract WP59: Migraine In Female Patients With Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts And Leukoencephalopathy
Authors: Zayat Roaa , Mendis Dinith , Shourav Md Manjurul Islam , Fermo Olga , Meschia James
Published: January 2025

Introduction:
Migraine with aura may be the earliest symptom in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Female patients have a higher incidence of migraine with an increased associated disability. In this study, we systematically evaluate the clinical features and management of migraine in female patients with CADASIL in a multi-center health system.

Methods:
Clinical data was extracted from the electronic medical records of female patients diagnosed with CADASIL and managed at Mayo Clinic Enterprise. Diagnosis was confirmed by a pathogenic NOTCH3 mutation or granular osmiophilic material on skin biopsy.

Results:
Forty-three female patients with CADASIL were identified. Twenty-two patients (51.2%) had a diagnosis of migraine with aura and eight patients (18.6%) had a diagnosis of migraine without aura. The most common type of aura was visual (81.8%). Nineteen patients (63.3%) required at least one acute medicine and/or one preventive medicine. Acute therapy helped in 18 cases (94.7%) and preventive therapy helped in 13 cases (68.4%). Six patients (20%) tried at least three forms of acute therapy, and eleven patients (36.7%) tried at least three forms of preventive therapy. The presence of visual aura was associated with higher likelihood of need for acute therapy (OR = 3.0, 95% CI = 1.6 - 5.8, P = 0.015). However, the presence of any type of aura was associated with lower likelihood of need for or resistance to preventive therapy (OR = 0.08, 95% CI = 0.01 - 0.57, P = 0.005). Also, headache onset after age of 45 years was associated with higher likelihood of need for or resistance to preventive therapy (OR = 38.0, 95% CI = 2.7 - 528.0, P <0.001). The most common acute therapy was nonsteroidal anti-inflammatory drugs (NSAIDs) (14, 73.7%). Classes of preventive therapy involved anticonvulsants (15, 78.9%), antidepressants (11, 57.9%), Botox injections (7, 36.8%), beta blockers (6, 31.6%), calcium channel blockers (3, 15.8%), and calcitonin gene-related peptide (CGRP) inhibitors (3, 15.8%).

Conclusion:
Half of female patients with CADASIL had a diagnosis of migraine with aura. Around two thirds of them tried at least one form of acute therapy, most commonly NSAIDs, or preventive therapy, most commonly anticonvulsants. Resistance to preventive therapy was seen in more than 30% of the cases, highlighting the need for advances in migraine management in CADASIL.
Abstract WP69: The effect of caregiver engagement in feeding practices on oral feeding resumption in rehabilitation among stroke survivors
Authors: Ye Ting , Wenmin Wan , Zhou Huijun , Suo Jianjun , Han Xiang , Hongyan Ding , Dong Qiang
Published: January 2025

Objective:
Stroke patients with tube feeding have a high probability of feeding problems when they had regained oral intake ability. Assisting patients with eating is a major task for caregivers and they require better training. We developed an intervention to engage caregiver in feeding patients prior to feeding tube removal and examined the impact on oral feeding resumption in rehabilitation among stroke survivor.

Methods:
A total of 61 stroke patients with dysphagia recovery were enrolled in rehabilitation hospital from Jan. 2021 to Jul. 2024. They all recovered from tube feeding to complete oral feeding before discharge. Inclusion criteria included 1) Stroke patients with feeding tube. 2) Impaired oral intake which was defined as viscosity of pudding ≥5 ml and sum of three viscosities ≤15 ml based on the modified Volume-viscosity Swallow Test (V-VST). An intervention for caregivers, which engaged them on feeding practices was introduced from Jan 2023 to Jul 2024. The intervention program for feeding practices was primarily carried out by ward nurses. It consisted of thickener preparation and feeding patients skills training. Outcomes were compared between an intervention group of 28 patients and a historical control group of 33 patients recruited between Jan 2021 to Jul 2022. We compared the baseline characteristics and the length of oral feeding resumption between the groups. Volume change of three viscosities was represented by bar graphs.

Results:
The length of patients who could remove the tube feeding and completed oral feeding resumption was significantly shorter in the intervention group compared with the control group (24.57±11.04 days vs 31.09±12.61 days, P=0.038). 22/28 (78.6%) patients in the intervention group had their feeding tubes removed within one week. The volume growth of three different viscosities was demonstrated following the intervention. Swallowing function of stroke patients in the intervention group improved more quickly compared

Conclusion:
Our data indicated that effective caregiver engagement is necessary. Successful caregiver engagement has the potential to reduce costs and enhance patient outcomes.
Abstract WP71: Video-based Mental Health Education for Persons who have had a Stroke: A Quality Improvement Initiative
Authors: Broussard Jordan , Leal Andrea , De La Mora Miguel , Kearney Kelly , Sharrief Anjail , Savitz Sean , Beauchamp Jennifer
Published: January 2025

Background:
Guidelines for secondary stroke prevention focus on vascular risk factor modification. Efforts to optimize stroke prevention begin with patient awareness of mental health and the connection between psychology and stroke risk. In addition to improved psychoeducation, culturally and linguistically diverse post-stroke education is needed.
Purpose:
The purpose of this quality improvement initiative was (1) to provide English or Spanish video-based mental health education (VMHE) to ≥ 75% of eligible patients treated in an outpatient stroke clinic and (2) to increase patient-provider mental health (PPMH) dialogue by ≥ 30%.

Methods:
A VMHE intervention was created in English and Spanish by modifying an existing stroke recovery education video. The VMHE YouTube video was made available in an outpatient stroke clinic over a 3-month period to eligible patients. Participants included 169 English-speaking patients and 37 Spanish-speaking patients, for a total of 206 individuals. Measures included the number of VMHE views from YouTube as well as provider electronic health record documentation (EHR) of PPMH dialogue (e.g., discussion of mental health, psychotherapy referral). Prior to the start of the project, PPMH dialogue data was captured over a 3-month period to be used as a comparison. Descriptive statistics were used to summarize demographic and outcome measures.

Results:
Of the participants that visited the clinic in the 3-month period, VMHE YouTube views averaged 68% and 66% for English-speaking and Spanish-speaking patients respectively. A pre-post project 45.3% increase in PPMH dialogue was noted in EHR documentation for the English-speaking participants as well as a significant association (p = 0.03) between the VMHE intervention and increased PPMH dialogue. No increase in PPMH dialogue was found for the Spanish-speaking participants.

Conclusions:
Culturally and linguistically diverse VMHE has the potential to improve PPMH dialogue and to decrease disparities in stroke prevention. Multi-modal delivery strategies should be considered to improve the number of views and ways to improve PPMH dialog between Spanish-speaking patients and providers should be studied. Evaluation of the effects of VMHE on improving post-stroke mental health knowledge attainment and retention and its impact on the management of mental health outcomes (e.g., depression and anxiety) is needed.
Abstract WP8: Targeted versus High-Intensity Monitoring Following Intravenous Thrombolysis in Acute Ischemic Stroke
Authors: Valcinord Carl-Lewis , Roberts Rebecca , Bindra Sohum , Milani Marcus , Staugaitis Abbey , Tessmer Megan , Streib Christopher
Published: January 2025

Introduction:
Current guidelines recommend 24-hours of high-intensity monitoring (HIM) for acute ischemic stroke patients post-intravenous thrombolysis (IVT) due to risk of bleeding complications including symptomatic intracranial hemorrhage (sICH). We report the outcomes of a 12-hour targeted-intensity monitoring (TIM) pathway for low-risk post-IVT patients.

Methods:
Post-IVT patients were considered low-risk if their NIHSS < 10, blood pressure < 180/105 without medical intervention, level of consciousness was preserved, and no high-risk vessel stenosis/occlusion was present. All patients meeting these criteria between Oct 2020-April 2024 were included in our study; those who presented prior to March 2022 utilized the conventional HIM pathway and those presented afterwards utilized the TIM pathway. In the TIM pathway neurological exams and vital sign assessments were conducted every 15 minutes for the first hour, every 1 hour for the next 3 hours, every 2 hours for the next 8 hours, and every 4 hours for the next 12 hours (14 total neurochecks/vital sign assessments over 24 hours compared to 36 neurochecks/vital sign assessments with HIM). Patients utilizing the TIM pathway were admitted to an intermediate care unit bypassing the ICU.

We examined the number of TIM patients who required transfer from IMC to the ICU and the duration of time in the ICU for HIM patients. Additionally, we compared the length of hospital admission, rate of sICH, 24-hour NIHSS scores, and 90-day mRS scores in matched post-IVT HIM and TIM patients.

Results:
A total of 95 patients were included in the study: 47 HIM (median age 71 [IQR 56-75.5], median NIHSS 4) and 48 TIM (median age 65, [IQR 60-81.25], median NIHSS 4). There were no significant differences in age, presenting blood pressure, or NIHSS between the two groups. The mean length of ICU-stay for the HIM group was 32.8 hours. No patient in the TIM pathway required transfer to the ICU for a higher level of care. The median length of hospital stay for the HIM group was 49.8 hours [IQR: 43.8-83.3] and 49.6 hours [IQR: 32.6-99.7] for the TIM group (p=0.716). No sICH was noted in either group. Median discharge NIHSS = 1 for both groups (p=0.125) and 90-day mRS = 2 for both groups (p=0.599)

Conclusion:
In our study, post-IVT TIM was feasible without safety concerns. Post-IVT TIM pathways may conserve healthcare resources and increase ICU bed availability. Further studies defining the optimal post-IVT TIM criteria are indicated.
Abstract WP88: Association of renal biomarkers with fast progressor phenotype and related outcomes in anterior circulation large vessel occlusion stroke
Authors: Rios Rocha Lucas , Kayyali Mohammad , Mahat Bishow , Al-Qudah Abdullah , Doheim Mohamed , Al-Bayati Alhamza , Bhatt Nirav , Starr Matthew , Song Shlee , Nogueira Raul , Rocha Marcelo
Published: January 2025

Background:
The effect of renal dysfunction on early infarct growth rate (IGR) in anterior circulation large vessel occlusion (ACLVO) stroke is not well studied. This study aimed to explore the association between creatinine-based biomarkers of renal dysfunction, fast or slow progressor phenotypes of infarct growth in ACLVO stroke, and related clinical outcomes.

Methods:
This retrospective study examined patients with acute intracranial internal carotid artery or middle cerebral artery M1 occlusions admitted between 2014 and 2019. Patients were included if they received baseline MRI or CTP on presentation within 24 hours after stroke onset. Infarct growth rate (IGR) was determined by ischemic core volume divided by time from stroke onset to imaging and used to stratify fast progressors (IGR ≥10 mL/h) and slow progressors (IGR < 10 mL/h). Renal dysfunction was assessed based on serum creatinine and estimated glomerular filtration rate (eGFR) on presenting laboratories. Logistic regression models, adjusted for significant covariates, identified independent associations between renal dysfunction biomarkers, progressor status, and clinical outcomes based on modified Rankin Scale (mRS) at 90 days.

Results:
Among 230 patients with ACLVO, 29% were fast progressors, with median serum creatinine levels higher than slow progressors (1.1 vs. 0.9 mg/dL, p < 0.05) and lower median eGFR (66.2 vs. 69.0 mL/min/1.73m2, p < 0.05). Elevated creatinine (≥1.2 mg/dL) was independently associated with fast progressor status (adjusted OR 2.37, 95% CI 1.18-4.77), worse 90-day mRS (adjusted OR 1.88, 95% CI 1.01-3.51) and mortality (adjusted OR 2.57, 95% CI 1.14-5.79). Reduced eGFR (<60 mL/min/1.73m2) was independently associated with fast progressor status (adjusted OR 2.38, 95% CI 1.14-4.94), but not with 90-day mRS or mortality.

Conclusion:
Serum creatinine-based biomarkers of renal dysfunction were associated with faster progressor phenotype of ACLVO stroke, higher mRS, and mortality at 90 days. These findings suggest that point-of-care creatinine measurements may help identify patients with rapid ischemic core growth and highest risk for worse clinical outcomes on first emergency contact, aiding in the inter-facility transfer for high-risk patients.
The Effects of Adopting a Value Added Tax on Firms
Authors: Agrawal David R. , Zimmermann Laura V.
Published: January 2025

This paper studies the effects of transitioning from a system of sales taxes to a value-added tax (VAT) on firm-level outcomes. We construct a dataset of product- and state-specific tax rates before and after India gradually switched from a sales tax to a VAT. Exploiting staggered state-level adoptions, we first show that following the transition, effective tax rates declined substantially and complexity as measured by various proxies generally also fell. We then show that sales increased by 57% in the medium run. The reform resulted in increased earnings for workers and higher amounts of capital and digital accounting.
Stigma in Welfare Programs
Authors: Celhay Pablo , Meyer Bruce D. , Mittag Nikolas
Published: January 2025

Stigma of welfare participation is important for policy and survey design, because it reduces program take-up and increases misreporting. Stigma is also relevant to the literature on social image concerns, yet empirical evidence is scant because stigma is difficult to empirically identify. We use a novel approach to studying stigma by examining the relationship between program participation in a recipient's local network and underreporting program participation in surveys. We find a robust negative relationship and provide evidence against explanations other than stigma. Stigma decreases when more peers engage in the stigmatized behavior and when such actions are less observable.
The Macroeconomic Consequences of Natural Rate Shocks
Authors: Schmitt-Grohé Stephanie , Uribe Martín
Published: January 2025

This paper studies the effects of natural rate shocks on output and inflation. It estimates a semi-structural model inspired by the DSGE literature. A decline in the natural rate is found to lower trend output and to be contractionary and deflationary in the short run. When the economy is constrained by the zero lower bound (ZLB), these results are consistent with the secular stagnation hypothesis. However, negative natural rate shocks are found to depress the trend of output even outside of the ZLB, calling for a more general theory. A model with liquidity scarcity is proposed as a first step.
Rate of decline and survival of root-knot and lesion nematodes under cold storage conditions
Authors: Mkorongwe Gelson A. , Sumaya Noriel Jude , Been Thomas H. , Teklu Misghina G.
Published: January 2025

Storage of nematode-infected soil, roots and nematode suspensions is important in nematological research. The available storage methods are based on potato cyst nematodes, where cysts with viable eggs can be stored for long periods at 4°C. When dealing with other nematode species, understanding the effect of storage temperature is crucial. This study was designed to investigate the decline rate and survival of four root-knot and a lesion nematode of both temperate and tropical origin, when stored at 4°C in three substrates: water, soil and roots. The starting density () for each substrate was determined at and survival of all nematode species was estimated at 10-day intervals for 100 days. During storage, population densities of all species declined in all substrates exponentially. A slower decline rate ( = 0.988-0.999) was observed for juveniles of Meloidogyne fallax in water, soil and roots compared to juveniles of M. hapla and Pratylenchus penetrans. Meloidogyne incognita was seriously affected by cold storage with the highest decline rate ( = 0.919-0.977) observed in all substrates. Only data on the root substrate were obtained for M. javanica with a decline rate of ( = 0.977) predicting zero survival at days. Notable is the higher fraction of surviving P. penetrans ( = 0.238-0.545) in all substrates during the storage period, compared with all other species. Based on the results, it is recommended to process nematode samples in the three substrates as quickly as possible, as underestimation of the actual population densities is likely. Consequences of cold storage in handling and processing of samples from different substrates are discussed.