bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP211: Fine Particulate Matter (PM2.5) and the Risk of Stroke in the REGARDS Cohort
Authors: McClure Leslie A , Loop Matthew S , Crosson William L , Kleindorfer Dawn O , Kissela Brett M , Al-Hamdan Mohammad Z
Published: July 2021

Introduction:
Recent work has suggested that there is some association between acute exposures to fine particulate matter with aerodynamic diameter less than or equal to 2.5 micrometers (PM2.5) and ischemic stroke; however, the evidence is conflicting. Thus, we assessed whether PM2.5 was associated with ischemic stroke in participants in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) cohort.

Methods:
We used a time-stratified case-crossover design to determine if exposure to PM2.5 was associated with an increased risk of ischemic stroke. We fit conditional logistic regression models to determine the odds ratio of ischemic stroke for those exposed to moderate (PM2.5 15-40 μg/m3) relative to good (PM2.5 ≤ 15 μg/m3) levels of PM2.5. We adjusted for temperature at the time of exposure, and assessed whether the association differed by region of residence (stroke belt vs. non-belt regions).

Results:
Among 442 participants who experienced an incident ischemic stroke in REGARDS, we found that there was no association with PM2.5 exposure (OR: 0.89, 95% CI: 0.69-1.15), and that there was no impact of region of residence on these results (p for interaction=0.14).

Conclusions:
We did not confirm earlier research indicating that there is an acute association between PM2.5 and ischemic stroke. More research is needed to understand these conflicting results, and to assess the impact of longer term exposures of PM2.5 on stroke incidence.
Abstract TP224: Risk Factors for Stroke in Infective Endocarditis
Authors: Kursun Oguzhan , Topcuoglu Mehmet A , Karatas Hulya , Buonanno Ferdinando S , Singhal Aneesh B
Published: July 2021

Background:
Stroke is a common, serious complication of infective endocarditis (IE). We investigated risk factors for IE-associated cerebrovascular disease.

Methods:
We retrospectively reviewed data of all inpatients with discharge ICD-9 codes of IE admitted to our tertiary care hospital from 1980-2011. The diagnosis of IE was confirmed using the original Duke Criteria. Stroke was confirmed on CT or MRI.

Results:
Of 1151 hospitalizations (1083 adults), 277 (24%) included IE-related stroke (76% ischemic, 13% hemorrhagic, 10% both). Stroke patients had mean age 56 yrs, 63% male, 93% ’Definite IE’ per Duke Criteria, and 83% Native Valve infection. Organism types were Staph 40%, Strep 30% and Other 30%. Trans-esophageal echo was performed in 53% and MRI in 57%. The Stroke and Non-Stroke Groups showed no significant difference in age, sex, traditional cardiovascular risk factors (Htn, DM, lipids, AFib etc), and type of infectious organism. Patients with Stroke had a significantly higher frequency of multiple vegetations (20% vs 8%, p<0.001), cardiac abscess (16% vs 10%, p<0.01), cardiac surgery (37% vs 26%, p<0.01), sepsis (24% vs 14%, p<0.01) and DIC (9% vs 2%, p<0.01) and a tended to have higher rates of cardiac rupture (19% v 15%, p=0.08) and lower admission platelet counts (224 vs 249 thousand/cmm, p=0.11). The Ischemic Stroke sub-group showed similar high rates for these variables. Multivariate regression analysis showed IE-related stroke to be significantly predicted by the presence of sepsis (O.R. 3.6, 95%CI 1.8-7.0), congestive heart failure (O.R. 2.1, 95%CI 1.3-3.4), prosthetic valve IE (O.R. 2.3, 95%CI 1.13-4.4), and vegetations in aortic (OR 2.4, 95%CI 1.3-4.3) or mitral (OR 6.6, 95%CI 3.5-12.2) valves. Tricuspid vegetations (OR 0.3, 95%CI 0.1-0.7) and higher platelet counts (OR 0.99, 95%CI 0.99-1.0) had a protective effect. Age, Htn, DM, AFib, multiple vegetations, organism type, antibiotic use, and echo findings of cardiac abscess/rupture, did not predict stroke. Stroke patients had significantly worse outcomes with 22% deaths vs. 9% in non-stroke patients (p<0.001).

Conclusion:
This large 31-year retrospective study shows that potentially treatable conditions such as CHF and sepsis are associated with a higher rate of IE-related stroke.
Abstract TP227: Three-dimensional Analysis Of Flow, Volume And Ejection Fraction Of The Left Atrial Appendage In Acute Stroke Patients With Paroxysmal Atrial Fibrillation
Authors: Tanaka Koji , Koga Masatoshi , Sato Kazuaki , Suzuki Rieko , Arihiro Shoji , Minematsu Kazuo , Toyoda Kazunori
Published: July 2021

Background and objective:
Decreased peak flow velocity (PFV) of the left atrial appendage (LAA) measured by transesophageal echocardiography (TEE) was reported to be associated with atrial fibrillation (AF) and thrombus formation in LAA. This study aimed to elucidate the association between flow, volume and ejection fraction (EF) of LAA measured by real-time three dimensional TEE (3D-TEE) and the presence of paroxysmal atrial fibrillation (PAF) in acute stroke.

Methods:
3D-TEE was performed using an iE 33 Ultrasound Machine and X7-2t TEE transducer (Philips Healthcare) in acute stroke patients with sinus rhythm at the examination. Patients were divided into those with a history or later documentation of PAF (PAF group) and others (sinus group). PFV was measured by pulse Doppler and LAA volume was measured off-line using QLAB software. LAA volume was measured twice before p wave (maximum LAA volume) and after p wave (minimum LAA volume) to calculate EF of LAA.

Results:
Of a total 97 patients (26 women, 72.7±10.6 years), 20 were allocated to the PAF group and the remaining 77 to the sinus group. LAA volume and EF were correlated with PFV (r=0.378, p=0.0002 and r = 0.374, p=0.0002; respectively). Patients in the PAF group had lower PFV (39.0cm/s, 29.4-57.0 vs. 63.9cm/s, 38.3-81.8, p=0.0006), larger LAA volume (median 7.6ml, IQR 3.6-10.45 vs. 2.3ml, 1.6-6.2, p=0.0033) and lower EF (38.2%, 21.4-49.8 vs. 58.1%, 44.1-71.8, p=0.0006) than those in the sinus group. Using receiver operating characteristic curve analysis, the optimal cutoff of PFV to predict PAF patients was ≤39cm/s, with a sensitivity of 58%, a specificity of 89%, and a c-statistic of 0.756. The cutoff of LAA volume was ≥7.5ml, with a sensitivity of 55%, a specificity of 84%, and a c-statistic of 0.714. The cutoff of EF was ≤47.9%, with a sensitivity of 75%, a specificity of 75%, and a c-statistic of 0.751. Using the combination of LAA volume ≥7.5ml or EF ≤47.9%, patients with PAF were detected with a sensitivity of 85% and a specificity of 67%.

Conclusions:
Because EF of LAA was associated with FV, it is a promising marker of LAA function. LAA enlargement and reduced LAA contraction, measured by 3-dimensional techniques, in addition to lower FV may help us to detect those with PAF in acute stroke.
Abstract TP238: Is There a "Stroke Hotspot" In New Orleans? A Preliminary Analysis of the Human Geography of Stroke Occurences
Authors: Herman Melissa P , Campanella Richard , Martin-Schild Sheryl
Published: July 2021

Objective:
The purpose of this study was to determine if New Orleans, a city with a bi-racial population and within the “stroke belt”, has certain areas with disproportionately high stroke occurrence.

Methods:
Stroke activation cases from January 2010 - November 2011 were mapped and analyzed after review of New Orleans Emergency Medical Services (NOEMS) patient care reports. Age, gender, race, and home location were compared to population density, race density, and socioeconomic status.

Results:
Of 686 cases, areas with high concentrations of stroke activations, named “stroke activation hotspots”, were mainly found where the Median Household Income (MHHI) in 2010 was less than $25,000, and the population was 80-100% African American. Some “hotspots”, such as fairly wealthy and medium-density areas in the Garden District and French Quarter, exist where 2010 MHHI exceeded $64,000. When compared to 2010 Census Data population density maps, discordance between population within a zip code and proportion of stroke activation cases was found.

Conclusion:
Strokes are not randomly or evenly distributed throughout Orleans Parish, nor are they purely by-products of population density. Social vulnerability, poverty, and lack of access to health care may explain some of these clusters; while clusters of elderly citizens and tourists may explain the hotspots in wealthy areas. Rational geography to stroke activation distribution may permit further investigation of racial disparities in stroke outcomes allow for targeted stroke education.
Abstract TP265: Microparticles Play A Role In Mediating Angiogenic Effect Of Mesenchymal Stromal Cells On Cerebral Vascular Endothelial Cells
Authors: Chen Ji , Xiao Xiang , Zhang Cheng , Chen Shuzhen , Chen Jianying , Zhao Bin , Chen Yanfang
Published: July 2021

Microparticles (MPs) represent a novel network for intercellular communication. Our previous works found that MPs from db/db diabetic mice impaired endothelial progenitor cell function. This study investigated the role of MPs from mesenchymal stromal cells (MSCs) in regulating cerebrovascular endothelial cell (cEC) function and gene expression. Male C57BL/6 mice and green fluorescent protein (GFP)-transgenic mice were used for cEC and MSC donors, respectively. The cECs were cultured on 6-well plates and MSCs were seeded on well inserts with a 0.4 μm pore sized filter for co-culture for 3 days before various measurements. MSC conditional medium (MSC-CM) was used for producing MPs and MSC-CM deprived of MPs (MSC-CM-dMP) by centrifuge. MPs deprived of mRNAs and miRNAs (MSC-MP-dRNA) were prepared by treating with RNAse. In some experiments, cECs were incubated with normal culture medium (control), MSC-CM, MSC-CM-dMP, MSC-MPs or MSC-MP-dRNA for 3 days. After different treatments, the cECs were used for confocal microscopy analysis of GFP level, real-time PCR analysis of angiogenic gene expression and functional analyses. The levels of angiogenic factors were measured by ELISA method. Results showed: 1) GFP-MPs were appeared in cEC culture medium, and GFP was detected in cECs after co-culture with MSCs; 2) Co-culture with MSCs or culture with MSC-CM significantly upregulated mRNA expression of VEGFR2 and CXCR4 in cECs and increased the angiogenic factors (VEGF and SDF-1) in culture supernatant; 3) Co-culture with MSCs or culture with MSC-CM increased cEC function (migration: 68.6 ± 3.2, 66.8 ± 2.6 and 48.8 ± 2.6 tubes/field for MSC, MSC-CM and control, respectively; tube formation: 52.8 ± 2.6, 48.8 ± 2.0 and 32.6 ± 1.2 tubes/field for MSC, MSC-CM and control, respectively; n=5/group,
P
<0.05 or 0.01, vs. control); 4) Whereas, incubation with MSC-CM-dMP or MSC-MP-dRNA aborted the effect on mRNA expression, and reduced the functional effects by about 50%. In conclusion, MPs mediate angiogenic effect of MSCs on cECs via RNA and/or protein deliveries, which represent a novel mechanism of cell communication, providing a potential therapeutic target for endothelial dysfunction and cerebrovascular diseases.
Abstract TP266: Platelet-Derived Glutamate Contributes to Neuronal Injury after Experimental Subarachnoid Hemorrhage
Authors: Bell Joshua D , Lass Elliot H , Wan Hoyee , Ai Jinglu , Thomas Theresa-Courrier , Lifshitz Jonathan , Baker Andrew J , Macdonald Robert L
Published: July 2021

Background:
Glutamate toxicity (excitotoxicity) is well-studied in the pathogenesis of brain damage after cerebral ischemia and traumatic brain injury. Patients with subarachnoid hemorrhage (SAH) also have increased intracerebral glutamate as detected by microdialysis. While neurons and glia are potential sources of glutamate, platelets also release glutamate as part of their recruitment and might mediate neuronal damage. Studies have shown that intraluminal platelets escape into brain parenchyma after SAH. Therefore, we studied the hypothesis that formation of platelet microthrombi after SAH, and their subsequent extravasation releases glutamate that mediates excitotoxic brain injury and neuron dysfunction after SAH.

Methods:
We used two models, primary neuronal cultures exposed to activated platelets, and a model of SAH created by injection of 300 μl of fresh, unheparinized arterial blood into the prechiasmatic cistern of Sprague-Dawley rats (300-350 g). Glutamate was measured using amperometric microelectrode arrays. Propidium iodide was used to evaluate neuronal viability in neuronal cultures, and surface glutamate receptor immunohistochemical staining was used to evaluate the phenotype of platelet-exposed cultured neurons and brain after SAH. Microthrombi were stained with anti-fibrinogen antibodies.

Results:
We first demonstrated that thrombin-activated platelet-rich plasma releases glutamate in concentrations that exceed 300 μmol/l. When applied to neuronal cultures, this activated plasma was neurotoxic, and neurotoxicity was attenuated by glutamate receptor antagonism. Exposure of cultured neurons to thrombin-activated platelets induced a marked downregulation of the surface glutamate receptor GluR2, a marker of excitotoxicity and a possible mechanism of neuron dysfunction. Microthrombi were detected in rat cerebral cortex 7 days after SAH and linear regression demonstrated a strong correlation between proximity to microthrombi and reduction of surface glutamate GluR2 receptors.

Conclusions:
These correlative data support the novel hypothesis that platelet-mediated microthrombosis contributes to neuronal glutamate receptor dysfunction and might therefore influence clinical outcome following SAH.
Abstract TP268: Huwe1 Is Neuroprotective Against Monkey Cerebral Ischemia-reperfusion Injury By Regulating P53- And Mcl1- Dependent Apoptotic Pathways
Authors: Yu Lihua , Guo Jian , He Guoqian , Zhang Jingjing , Chen Ning , He Li
Published: July 2021

Background:
Neural cell apoptosis is one of the dominated mechanisms of cerebral ischemia-reperfusion injury (IRI). Anti-apotosis factor Mcl1 and apotosis factor p53 have been confirmed to play crucial roles in the apoptotic regulation previously. Mcl1 and p53 are the substrates of the ubiquitin ligases Huwe1, and which has been suggested as a potent therapeutic target in regulating cell apoptosis. Our aim is to explore whether Huwe1 modulates neural apoptosis by degrading Mcl1, p53 in cerebral ischemia-reperfusion injury.

Methods:
Eight health male adult rhesus monkeys were recruited in our study and were randomly devided into four groups: sham, PBS, siRNA silencing Huwe1 lentiviral vector and empty vector group. Except the sham group, the other groups were received corespondant intracranial injections and transient right middle cerebral occlusion (MCAO). A series of neurological evaluation and MRI were ulitized to evaluate animals. GFP flurescence was used to test transfection efficiency and apoptosis was detected by TUNEL staining. The expression level of related factors in causatum, putamen, temporal lobe and hippocampus were analyzed with western blot, QPCR, and immunohistochemistry.

Results:
The neurological deficit was much more serious in the silencing Huwe1 group than both empty vector and PBS group. The expression of Huwe1, Mcl1 and P53 were appeared a tendency to upregulate in the right caudatum and putament in model group than sham group in both protein and nucleotides level. Moreover, the number of apoptosis cells tested by TUNEL was the highest in the silencing Huwe 1 group, induced by decreasing expression of Huwe1 and obviously upragulating P53 expression. However, none of them has significant difference in other remote positions.

Conclusion:
Our study provides a potential novel mechnism that Huwe1 palys an important role in regulating neural apoptosis by regadading Mcl1 and P53 in cerebral IRI. In addition, for the first time, we confirm that the anti-apoptosis factor Mcl1 engages in the pathogenesis of cerebral IRI. It is possible that Huwe1 can be a potential therapeutic target for cerebral ischemia.
Abstract TP269: Reduction of Human Brain Adenosine Levels Following Remote Ischemic Preconditioning
Authors: Dusick Joshua R , Bilgin-Freiert Arzu , Faull Kym F , Gonzalez Nestor
Published: July 2021

Introduction:
Prior studies demonstrate that ischemic preconditioning (IP) alters adenosine metabolism. The significance of this effect is not fully understood, but evidence suggests that reduction in extracellular adenosine may represent use as an alternative fuel. Transformation into AMP/ADP may also replenish intracellular total adenine nucleotides (TAN), improving the potential high-energy phosphate bonds available in cells facing ischemia. In both cases, adenosine supports cell energy requirements and may be a key component of IP’s protective mechanisms. There are no previous studies of brain adenosine in human patients undergoing remote IP.

Methods:
In adults with aneurysmal subarachnoid hemorrhage (SAH), 3-4 remote IP sessions were conducted on non-consecutive days, 4-12 days after hemorrhage. Each session consisted of 4 5-min cycles of lower extremity blood pressure cuff inflation to 30mmHg above systolic blood pressure, followed by 5-min reperfusion. Patients had microdialysis (MD) probes to compare brain adenosine, inosine, xanthine and hypoxanthine before, immediately after, and 24h after RIPC. MD samples from 4 SAH ICU patients without IP were used as controls.

Results:
Five RIPC sessions in 3 patients resulted in complete MD data for comparison over time. In all, brain adenosine levels dropped from their baseline (pre-RIPC) level. Average pre-RIPC adenosine went from 19.2 (SD 14.4) fmol/mg to 7.9 (SD 8.6) immediately following the session (p=0.095) and to 3.2 (SD 4.5) by 24h (p=0.048). Adenosine metabolites inosine, xanthine, and hypoxanthine decreased or did not change over the same period, suggesting adenosine consumption rather than non-energy related catabolism. These changes in adenosine were not reflected in CSF levels, which did not change (p=0.5). Brain adenosine in control subjects did not decrease (baseline 0.26±0.17, 24h 6.6±9.3, p=0.27).

Conclusion:
Remote IP leads to decreased brain adenosine in SAH patients by 24 hours. Failure to demonstrate a concomitant rise in levels of metabolites suggests that adenosine is consumed by cells in the brain, as previously shown in animal models. This shift toward the energetic metabolism of adenosine may play a key role in the mechanisms of protection induced by IP.
Abstract TP271: Novel Carbon-Based Particle Antioxidants in Reversible Hyperglycemic MCA Occlusion
Authors: Fabian Roderic H , Marcano Daniela , Samuel Errol L , Tour James , Kent Thomas A
Published: July 2021

Introduction:
We have demonstrated that nanoscale PEG-ylated oxidized carbon materials, which we refer to as hydrophilic carbon clusters (PEG-HCCs), have antioxidant characteristics favorable for their use in ischemia. These materials are rich in conjugated carbon double bond domains, and unlike conventional antioxidants, are able to quench rather than transfer oxidative radicals thus not requiring regeneration (Marcano et al, JNT in press). They have shown no acute or 6 week toxicity in rodents, excellent uptake into endothelial cells and protection against TBI-induced neurovascular dysfunction (Bitner et al, ACS Nano, 2012), but were not designed for blood-brain barrier (BBB) transport. We were able to synthesize PEG-HCCs bound to adamantane (ADM), a well characterized moiety that increases lipophilicity. We tested these agents in a severe example of oxidative stress, reversible middle cerebral artery occlusion (MCAO) in acutely hyperglycemic rats (Martini and Kent, JCBFM 2006).

Methods:
16 Male, Long Evans rats received an ip injection of streptozotocin or vehicle 2 days prior to 90 minutes MCAO using the suture technique. Physiological and post-op monitoring was performed. PEG-HCCs or ADM-PEG-HCCs were injected IV at suture removal. The endpoints investigated thus far are: mortality; nitric oxide (NO) expression, reflected in the ratio of perivascular DAF-2AC intensity in penumbra to contralateral region after 5 min. circulation (Fabian and Kent AJP 2008); and presence of the PEG-HCCs detected by reaction product from an anti-PEG antibody to the tightly bound PEG moiety.

Results:
Mortality by 24 hours was 100% in untreated hyperglycemic rats, 66% with PEG-HCCs and 33% after ADM-PEG-HCCs. Ratio of penumbral perivascular NO expression to control hemisphere was: untreated: 0.29; PEG-HCCs: 0.52; and ADM-PEG-HCCs: 0.59. There was considerable vascular and parenchymal staining with ADM-PEG-HCC but was restricted to the vasculature with PEG-HCCs.

Conclusion:
Addition of an ADM moiety to PEG-HCCs reduced mortality. This may have occurred because of BBB transport and partial recoupling of endothelial NO synthase, thought to be impaired in hyperglycemic stroke. Further characterization of the range of actions of these materials is underway.
Abstract TP275: Glucagon-Like Peptide-1 Is Increased In Blood Plasma and May Play Neuroprotective Roles After Ischemic Stroke In Human
Authors: Kuwashiro Takahiro , Ago Tetsuro , Kamouchi Masahiro , Matsuo Ryu , Kuroda Junya , Isomura Tetsu , Awano Hideto , Suzuki Kazuo , Sugimori Hiroshi , Kiyohara Yutaka , Kitazono Takanari
Published: July 2021

Introduction:
Glucagon-like peptide-1 (GLP-1) is an incretin peptide, which is secreted by intestinal L-cells after food intake and increases the insulin secretion in a glucose-dependent manner. Increasing evidence indicates that GLP-1 may play neuroprotective roles in animal stroke models; however, there have been few reports regarding the relationship between GLP-1 and stroke in human.

Hypothesis:
GLP-1 is increased in plasma and plays neuroprotective roles after ischemic stroke in human.

Methods:
We prospectively enrolled 171 patients with ischemic stroke and age- and gender-matched healthy controls. We measured GLP-1 in fasting blood plasma at five time points after the onset (days 0, 3, 7, 14 and 90) and investigated clinical information in the stroke patients.

Results:
Average GLP-1 values at day 0 were significantly higher in the stroke patients than the controls (2.7 ± 0.4 vs. 1.5 ± 0.2 pmol/L, p = 0.0107). In the patients, GLP-1 values at day 0 tended to be negatively associated with neurological severity as evaluated by National Institute of Health Stroke Scale (NIHSS) on admission (r = - 0.1264, p = 0.0565). Moreover, when the stroke patients were divided into 4 groups (Q1, Q2, Q3 and Q4 from milder to severer) according to the interquartile range of the NIHSS, Q1 (3.6 ± 0.9 pmol/L, p = 0.0014) and Q2 (2.6 ± 0.7 pmol/L, p = 0.0429) groups had significantly higher GLP-1 values than the controls (Figure). GLP-1 continued to be increased until the 90 days after the onset, compared to that of the controls (day 0 (2.7 ± 0.4 pmol/L, p = 0.0107), day 3 (6.0 ± 0.4, p < 0.0001), day7 (7.1 ± 0.6, p < 0.0001), day 14 (8.3 ± 0.8, p < 0.0001), day 90 (8.3 ± 0.7, p < 0.0001)). GLP-1 values tended to be higher in the good outcome group (modified Rankin Scale (mRS) ≤ 1 at 90 day) than the poor outcome group (mRS ≥ 2).

Conclusions:
GLP-1 is increased in blood plasma after ischemic stroke in human. The increase in the acute phase may be associated with the reduction of neurological severity in ischemic stroke.
Abstract TP277: Stroke Related Limb Weakness Confers Thrombotic Complications With PICC Lines
Authors: Ibrahim Mohammad , Sodhi Ravjot , Nizam Aaron , Khakoo Nabiha , Mehta Siddhart , Moussavi Mohammad , Kirmani Jawad F
Published: July 2021

Introduction:
A peripherally inserted central catheter (PICC line) is a form of intravenous access that can be used for a prolonged period, which lowers the rate of infection. Our study aims to prove that PICC line insertion predicts a higher rate of Deep Vein Thrombosis (DVT), especially in those receiving the PICC line in a weaker arm.

Methods:
We conducted a retrospective analysis of stroke patients admitted to NeuroICU between September 2010 and October 2011 at a community teaching hospital. Patient records were evaluated for PICC line placement, DVT, Pulmonary Embolism (PE) development, and anticoagulant status. Odds ratios were calculated for the development of DVT and PE for PICC patients, as well as the outcomes for PICC line patients based on arm strength as defined with motor strength scale using SPSS software version 20.

Results:
The study included a total of 307 patients (mean age = 62.5 +/- 17.2, 51% female). Ninety-nine patients had a PICC line inserted, 22 of which developed DVT, including 10 patients who appeared to have PICC Line Related Large Venous Thrombosis. The presence of a PICC line conferred an increased risk (OR= 5.18, 95% CI, 2.40-11.2) for the development of a DVT. Patients who had a PICC line placed in a weaker arm (mean strength = 2.17) were more likely to develop a DVT than patients with a PICC line in a stronger arm (mean strength = 3.07) p<0.05. Patients given DVT prophylaxis were less likely to develop a DVT (OR = 0.32, 95% CI, .004 - .252) p < 0.05. Twenty-one patients had a CT chest angiogram performed, including six patients who had evidence of a PE. Of these six patients, one patient had a PICC line placement with subsequent development of DVT followed by PE. PICC line placement and DVT had no predictive value on the development of PE due to the small sample size.

Conclusions:
Our data suggests that patients who had a PICC line placed into a weaker strength arm had an increased risk of DVT in the same arm and that DVT prophylaxis significantly decreases this risk. Further studies should evaluate the predictive value of PICC line insertion with the risk of developing PE in stroke patients.
Abstract TP278: Prevalence Of Systemic Inflammatory Response Syndrome and its Impact On Outcome In Acute Ischemic Stroke Patients Receiving IV tPA Therapy
Authors: Kapoor Niren , Boehme Amelia K , Albright Karen C , Lyerly Michael J , Shahripour Reza Bavarsad , Rawal Pawan V , Alvi Muhammad , Houston James T , Sisson April , Alexandrov Anne W , Alexandrov Andrei V , Miller David W
Published: July 2021

Background:
Systemic Inflammatory Response Syndrome (SIRS) is a generalized inflammatory state linked to a release of various pro- and anti-inflammatory cytokines and associated with fibrin deposition, platelet aggregation, and coagulopathies. Although SIRS is associated with various inflammatory and ischemic conditions, its prevalence and impact on patients with acute ischemic stroke (AIS) has not been extensively studied.

Methods:
A retrospective cross sectional study was used to look at the prevalence of SIRS and its impact on outcome in AIS patients treated with IV tPA between 2009-2011 at our tertiary care center. SIRS was diagnosed if two or more of the following were present: temperature < 36°C or > 38°C, heart rate > 90/min, respiratory rate >20/min or PaCO
2
<32 mmHg and WBC count <4000/mm
3
or >12000/mm
3
or 10% bands. Patients meeting the SIRS criteria for at least 24h were included in the study. Patients with signs of active infection such as pneumonia, UTI, bacteremia, and sinusitis or deep venous thrombosis were excluded from the study. The discharge modified Rankin score (mRS) was used to compare the short-term outcomes between patients with and without SIRS. An mRS of 4-6 was used to define poor functional outcome.

Results:
Out of the 212 patients screened, 44 met the SIRS criteria (21%). The median NIHSS for SIRS patients was 9 (range 0-32). SIRS patients were more likely to have a longer length of stay than non-SIRS patients (5 vs. 3 days; p<0.0001). Patients with SIRS had worse functional outcomes compared to patients without SIRS (OR=2.824, 95% CI, 1.358 - 5.871, p=0.0054). Adjusting for pre-tPA NIHSS, age and race, SIRS remained a predictor of poor outcome (OR= 2.581, 95% CI, 1.163 - 5.727, p=0.0197). Presence of SIRS did not have a significant effect upon in-hospital mortality (OR=1.978, 95% CI, 0.774 - 5.057, p=0.1545).

Conclusions:
One out of five AIS patients treated with IV tPA developed SIRS. The presence of SIRS is associated with poor short-term functional outcomes and prolonged length of stay.
Abstract TP281: Frequency and Predictors of Early Intubation for Acute Stroke Patients Presenting within 2 Hours of Stroke Symptom Onset
Authors: Sanossian Nerses , Liebeskind David S , Starkman Sidney , Hamilton Scott , Saver Jeffrey L ,   FAST-MAG Investigators and Coordinators
Published: July 2021

Background:
Stroke patients presenting acutely to the emergency department (ED) very early in their clinical course may require urgent intubation for failure to protect their airway or respiratory compromise. Intubated stroke patients are likely to represent the most severe cases and are likely to have the worst long-term outcomes. We aimed to characterize the rate and prehospital predictors of urgent ED intubation and intubation over 24 hours in stroke patients presenting within 2 hours of onset.

Methods:
Subjects were participating in the Field Administration of Stroke Therapy Magnesium (FAST-MAG) clinical trial of prehospital intravenous magnesium vs placebo initiated within 2 hours of symptoms onset. Intubation was recorded during nurses’ examination in the ED and 24 hours after admission.

Results:
Of 1200 consecutive cases there were 848 (71%) cerebral ischemia, 301 (25%) intracranial hemorrhage (ICH) and 68 (4%) stroke mimics. A total of 68 (6%) were intubated on ED evaluation (median (IQR) of 84 (62-107) minutes after arrival), and 123 (10%) were intubated at the 24 hour evaluation (23 (19-25) hours after arrival). Intubation was more common among patients with ICH (18% vs. 1% in ED, 30% vs. 4% at 24 hours, both p<0.001). Among patients with cerebral ischemia, those who were intubated at 24 hours (n=33) had lower prehospital and ED Glasgow Coma Scale scores (12.8 vs. 14.1, 9.8 vs. 14.22, both p<0.001), and higher ED NIHSS (29 vs 13, p<0.001) but were similar in age, gender, ethnicity, prehospital and ED blood pressure, and time from symptom onset to ED arrival. Among patients with ICH, intubation at 24 hours was associated with younger age (62 vs. 66, p=0.032), higher ED NIHSS (29 vs. 13, P<0.001), higher hospital arrival BP (185/102 vs. 173/94, p<0.001), lower prehospital and ED GCS (13.9 vs 14.6, 8 vs 14.0) but similar prehospital BP, time to ED arrival, gender, ethnicity.

Conclusions:
Patients with hyperacute intracerebral hemorrhage have high rates of intubation, which may have implications for processes of consent and data collection. Overall, more severe neurological deficit and lower GCS scores were associated with intubation. For ICH, blood pressure on ED arrival, and not prehospital blood pressure, was associated with intubation.
Abstract TP284: Association of Hemorrhagic Stroke with Recurrence Stroke caused by Infective Endocarditis
Authors: Ohtsuki Toshiho , Nomura Eiichi , Kato Amami , Matsumoto Masayasu
Published: July 2021

Objective:
Infective endocarditis causes not only brain infarcts and infection triggered by bacterial emboli, but also hemorrhagic stroke by inflamed arteries or aneurysms prone to rupture, when we make the requisite open-heart surgery delayed. We examined if hemorrhagic stroke caused by infective endocarditis and complicated microbleeds were associated with subsequent recurrent stroke.

Methods:
We conducted the observational study on 36 consecutive patients (19 men, aged 18-84, median 53) with acute symptomatic stroke caused by definite or possible infective endocarditis according to the Duke University criteria from October 2005 to April 2012. Brain hemorrhage/infarcts responsible for neurological signs and asymptomatic microbleeds were verified by CT and diffusion/T2*-weighted MRI. We had followed each patient as for recurrent symptomatic stroke for 3 months.

Results:
Out of 36, hemorrhagic stroke was noted in 15 patients, 13 of whom had simultaneous infarcts, and the other 21 patients showed pure ischemic stroke and TIA. Fifteen patients had asymptomatic microbleeds. Fourteen patients experienced recurrent stroke, which consisted of SAH in 4, hematoma/massive hemorrhagic transformation from infarcts in 4 and pure infarction in 6. Ten patients (71%) in the recurrent group had hemorrhagic stroke for initial attack, while 5 in 22 (23%) of the non-recurrent group did (p<0.01). The recurrent group had a higher average age (18-82 years, median 68 years) than the non-recurrent group (23-75 years, median 51 years). No statistically significant differences between the non-recurrent and the recurrent groups were observed of a proportion of patients that were female and had, infarction, microbleeds, hypertension, diabetes, antithrombotic treatment, attachment of 10-mm or larger vegetations to damaged valves, isolation of staphylococcus aureus from blood, embolization to other organs than the brain and complication of meningitis/abscess.

Conclusions:
Hemorrhagic stroke, but not asymptomatic microbleeds, was associated with recurrent stroke after infective endocarditis. Duration of waiting for the safe heart operation after symptomatic hemorrhagic stroke can be in face of recurrent stroke.
Abstract TP291: Hematoma Retraction and Perihematoma Hypodensity in Neutral Brain Model of Intracerebral Hemorrhage
Authors: Majidi Shahram , Rahim Basit , Gilani Sarwat I , Gilani Waqas I , Adil Malik M , Qureshi Adnan I
Published: July 2021

Background:
The temporal evolution of intracerebral hematomas and perihematoma edema in the ultra-early period on computed tomographic (CT) scans in patients with intracerebral hemorrhage (ICH) is not well understood. We aimed to investigate hematoma and perihematoma changes in “neutral brain” models of ICH.

Methods:
One human and 6 goat cadaveric heads were used as “neutral brains” to provide physical properties of the brain without any biological activity or new bleeding. ICH was induced by slow injection of 4 ml of fresh blood into the right basal ganglia of the goat brains. Similarly, 20 ml of fresh blood was injected deep into the white matter of the human cadaver head in each hemisphere. Serial CT scans of the heads were performed at 0, 1, 3, and 5 hours after inducing ICH. Analyze software (AnalyzeDirect, Overland Park, KS) was used to measure hematoma and perihematoma hypodensity volumes in the baseline and follow up CT scans.

Results:
The initial hematoma volumes of 11.6 ml and 10.5 ml in the right and the left hemispheres of the human cadaver brain gradually decreased to 6.6 ml and 5.4 ml at 5 hours, showing 43% and 48% retraction of hematoma, respectively. The volume of the perihematoma hypodensity in the right and left hemisphere increased from 2.6 ml and 2.2 ml in the 1 hour follow up CT scans to 4.9 ml and 4.4 ml in the 5 hour CT scan, respectively. Hematoma retraction was also observed in all six ICH models in the goat brains. The mean ICH volume in the goat heads was decreased from 1.49 ml in the baseline CT scan to 1.01 ml in the 5 hour follow up CT scan showing 29.6% hematoma retraction. Perihematoma hypodensity was visualized in 70% of ICH in goat brains, with an increasing mean hypodensity volume of 0.4 ml in the baseline CT scan to 0.8 ml in the 5 hour follow up CT scan.

Conclusion:
Our study demonstrated that substantial hematoma retraction and perihematoma hypodensity occurs in intracerebral hematomas in the absence of any new bleeding or biological activity of the surrounding brain. Such observations suggest that active bleeding is underestimated in patients with no or small hematoma expansion and our understanding of perihematoma hypodesity needs to be reconsidered.
Abstract TP296: Leukoaraiosis on MRI Correlates with Worse Outcomes after Intracerebral Hemorrhage
Authors: Caprio Fan Z , Maas Matthew B , Bernstein Richard A , Alberts Mark J , Prabhakaran Shyam , Kosteva Adam , Rosenberg Neil F , Naidech Andrew M
Published: July 2021

Background:
Leukoaraiosis (LA) is associated with aging, dementia, ischemic stroke, and intracerebral hemorrhage (ICH), but there are few data on how LA might impact outcomes after ICH. We tested the hypothesis that the severity of LA on MRI is related to worse functional outcomes after spontaneous ICH.

Methods:
We prospectively identified patients with spontaneous ICH. LA was identified on MRI and its severity graded using the Fazekas method to include a score for the deep white matter (DWM) and periventricular (PV) regions. Outcomes were obtained at 14 days, 28 days, and 3 months with the modified Rankin Scale (mRS, a validated scale from 0, no symptoms, to 6, dead), analyzed with multivariate ordinal and logistic regression.

Results:
Higher Fazekas total (PV+DWM) score correlated with higher mRS at 14 days (p=0.02) and 3 months (p=0.02). This relationship was driven by the PV score, for which higher score (more severe disease) correlated with higher NIHSS at 14 days (p=0.03), and higher mRS at 14 days (p<0.001), 28 days (p=0.004), and 3 months (p=0.005). The relationship persisted after correction for the ICH score (OR 1.8 for mRS>3 per point on Fazekas PV, 95% CI 1.02-3.2, p=0.04).

Conclusion:
Increased severity of LA in PV regions is an independent predictor of worse functional outcomes in patients after spontaneous ICH. The pathophysiology associating LA with worse outcomes requires further study. These data may improve prognostication and selection for clinical trials.
Abstract TP297: Predictors of Intracranial Hemorrhage in Patients with Atherosclerotic Vascular Disease: Observations from the TRA 2°P-TIMI 50 Trial
Authors: Bonaca Marc P , Mohr Jay P , Alberts Mark J , Ameriso Sebastian F , Hankey Graeme J , Murphy Sabina A , Scirica Benjamin M , Braunwald Euegene , Morrow David A
Published: July 2021

Intracranial hemorrhage (ICH) is a rare event that is difficult to predict and often has devastating consequences. Clinical predictors of ICH in stable patients with atherosclerosis are not well described.

Methods:
We evaluated the clinical correlates of ICH risk in patients randomized to placebo (N=13,166) in the TRA 2°P-TIMI 50 trial, a multinational trial of patients with atherothrombosis randomized to vorapaxar or placebo added to standard therapy. Eligible patients had a history of myocardial infarction, peripheral arterial disease, or recent ischemic stroke (2 wks to 12 mo.). ICH was adjudicated by an independent CEC.

Results:
A total of 53 ICH events (0.5% at 3 years) occurred during follow up in the placebo group. 94% of patients were receiving aspirin, 5% a thienopyridine alone, and 57% dual antiplatelet therapy. Overall, age, sex, prior ischemic stroke, and renal dysfunction were significantly associated with ICH (Table 1). After adjustment age, male gender, and prior ischemic stroke remained significantly associated with an increased hazard of ICH (Figure 1). Notably, the predictors differed between qualifying groups. After adjustment renal dysfunction (p=0.018) and diabetes (p=0.073) were associated with ICH in the MI/PAD group. In contrast, only male gender was associated with ICH in the CVD group (p=0.048).

Conclusions:
Advanced age, male gender, and history of ischemic stroke are associated with an increased hazard of ICH in patients with a history of atherothrombosis. Predictors of ICH vary depending on background vascular disease. In patients with MI/PAD and no recent stroke, traditional risk factors including diabetes and renal dysfunction are associated with ICH.
Abstract TP306: Impact of Medical Complications on Outcome Following Intracerebral Hemorrhage
Authors: Kellner Christopher P , Ortega-Gutierrez Santiago , McDowell Michael M , Guniganti Ridhima , Sussman Eric S , Bruce Sam S , Heuts Simon G , Bruce Rachel A , Claassen Jan , Mayer Stephan , Connolly E. S
Published: July 2021

Introduction:
Intracerebral hemorrhage (ICH) results in significant mortality and morbidity, half of which occurs in the first 6 hours. Patients surviving beyond the initial trauma are prone to medical complications during their stay in the neurological ICU (NICU). Prior studies have demonstrated increased mortality and morbidity in SAH and ischemic stroke related to medical complications. Here we report the major complications that occur during the acute care of ICH patients and how those complications impact outcome.

Methods:
Patients presenting with CT-identified ICH admitted to the NICU between 2009 and 2012 were prospectively enrolled in the Columbia Intra-Cerebral Hemorrhage Outcomes Project. All medical complications were identified prospectively by the NICU attending physician and adjudicated by a panel of neurologists and neurosurgeons. The modified Rankin Scale (mRS) was used to evaluate neurologic function at 3 months. Univariate analysis and stepwise logistic regression were used to identify predictors of poor 3-month outcome (mRS >3). All outcome measures were corrected for admission demographics and severity of presentation.

Results:
Out of 222 patients, 182 (81.9%) suffered from a medical complication. The mean number of complications was 1.92 (range 0-8). The most common complications were hyperglycemia (39.6%), pneumonia (26.6%), hyponatremia (24.8%), fever greater than 39.2% (19.4%), and catheter- associated urinary tract infection (UTI) (15.8%). Of the 164 surviving patients, 120 (73.2%) had available follow-up at 3 months. The mean follow-up mRS was 3.28. Multivariate analysis demonstrated an OR for poor outcome of 6.41 (1.33-48.16) with pneumonia, 8.05 (2.01-38.45) with UTI, and 12.99 (1.62-146.24) for acute renal failure.

Conclusions:
Medical complications are prevalent among ICH patients in the NICU. Protection against urological and respiratory diseases provides a reasonable target of morbidity reduction amongst ICH patients. Aggressive sterile procedure, frequent respiratory therapy, vigilant assessment of aspiration risk, and the use of antibiotic-impregnated catheters may reduce disease burden.
Abstract TP324: Testing the Effect of a Healthy Workplace Program for Workers with Metabolic Syndrome Using an e-Health Care System: A Pilot Study
Authors: LEE JONG-EUN
Published: July 2021

Background:
As wireless technology has been developed, recent studies have focused on strategies to improve self-care behavior using an e-health care system for patients with chronic diseases. However, none of these studies considered management of metabolic syndrome in work settings. The Healthy Workplace program adopting the concept of e-health care system is a workplace-based, behavioral intervention program.

Objectives:
The purpose of this article was to test the effectiveness of the Healthy Workplace program for metabolic syndrome using an e-health care system for workers in South Korea.

Methods:
A total of 226 workers from 12 companies completed baseline and 6-month follow-up with one group pre-post study design. We targeted workers with metabolic syndrome, as well as workers who were at risk of developing metabolic syndrome (potential group). The Healthy Workplace program consisted of a 4-week structured education, telephone counseling, mobile phone short message service, and e-mail service in the ensuing 6 months. A BP machine, pedometer, and body fat scale, and a laptop with USB ports, was set up as a “ubiquitous device” in each e-health zone.

Results:
In the potential group and metabolic syndrome group, waist circumference, systolic BP, and diastolic BP significantly decreased between baseline and 6-month follow-up. Results of blood tests showed only triglyceride levels in the potential group decreased, from 161.7 to 118.9mg/dL (
P
= .000). In the metabolic syndrome group, triglyceride also decreased from 247 to 212 mg/dL (
P
= .000) and fasting glucose decreased from 110 to 103mg/dL (
P
= .000).

Conclusions:
The study findings demonstrate the clinical effects of a tailored Healthy Workplace in significantly decreasing metabolic syndrome. Therefore, it is recommended that comprehensive Healthy Workplace programs be incorporated in occupational settings for workers with metabolic syndrome.
Abstract TP333: Stroke Survivors And Family Perspectives Of Risk/benefit: Developing Resolve (Rapid Evaluation For Stroke Outcomes using Lytics In Vascular Event)
Authors: Decker Carole , Spertus John A , Cheng Eric , Gialde Elizabeth , Chhatriwalla Emily , Summers Debbie , Ayad Miriam , Saver Jeff , Rymer Marilyn
Published: July 2021

Background:
Intravenous tissue plasminogen activator (IVtPA) is the only approved treatment for acute ischemic stroke (AIS), but is used in only 4-6% of potentially eligible patients. The
risk
of hemorrhage is fairly easy to communicate, but the
benefits
of treatment in reducing disability are difficult to estimate for individual patients. During development of an evidence-based tool to encourage participation of stroke survivors and families in tPA treatment decisions, we conducted qualitative interviews to learn how best to present risk/benefit data.

Methods:
We conducted 3 focus groups to determine effective strategies for presenting the beneficial outcome (modified Rankin Scale; mRS) and the risk of bleeding. Twelve stroke survivors (mean age = 54; 4 female) and 3 family members (mean age = 68; 3 female) participated at 2 different sites.

Results:
The majority of survivors do not recall being educated about acute stroke or treatment, though families provide vivid recollection. Four themes emerged as they expressed a need for more information (subject identified by Patient/Caregiver, gender, study number, and site):

A ‘good’ outcome is a mRS of 0,1, or 2
- “¼I think that 0-2 is REALLY a good outcome as [I’ve] seen severely disabled patients throughout recovery” (PM04LA).

Preferred both overall and personalized outcomes estimates:
“Tell me my individual risk and then show me how that compares to the general population. As far as the general population, maybe your risk is higher than others.” (PM07KC).

Present risk as ‘positive’ outcomes
(e.g. the likelihood of mRS 0-2, rather than 3-6): “’Bad outcome’, I don’t like those words. You’re talking about somebody I love, you know.” (CF10KC).

Present both risks and benefits of tPA:
“I would be open to take a risk if I thought there would be a good chance of a major improvement” (PM08KC).

Conclusions:
Stroke survivors and families desire more information at the time of acute stroke and agreed that mRS of 0-2 constitutes a good outcome. They articulated what information would be important for deciding about treatment with IVtPA and this will be used to create a decision aid to deliver individualized risk/benefit estimates in an understandable format that can support communication and shared medical decision-making.