bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract NS14: Assessing Effects of Stroke Support Groups on Social Integration in Acute Stroke Patients
Authors: White Teresa S , Schweickert Patricia
Published: March 2022

Background and Purpose:
Stroke survivors need social support after a stroke since social support networks can influence the ability of the stroke survivor to return to their community in a functioning social role. The objective of this study was to determine if stroke survivors who attend a stroke support group reenter into community interaction/socialization sooner than those stroke survivors that do not attend a stroke support group.

Methods:
A non-experimental cross-sectional design using a purposeful sample was used. Using two survey instruments: a researcher developed demographic survey and the Subjective Index of Physical and Social Outcomes [SIPSO] tool, data was collected from 105 participants who were at least 3 months post stroke. At the end of the 30-day return period nonparametric statistics were used to evaluate the hypotheses that stroke survivors who attend a stroke support group will reenter into community interaction/socialization sooner that those stroke survivors that do not attend a stroke support group.

Results:
A statistically significant difference was found for participants who attend support groups as to those participants who do not attend support groups (
p
value < 0.001) and the SIPSO social subscale total. The results of the two factor analysis of variance showed attendance is the only significant factor (F=48.839, df=1,94, P<0.001). Neither gender nor the interaction between gender and attendance were significant (P=.749 and P=.879, respectively).

Conclusions:
Health disparities, such as stroke, leave devastating effects on individuals and their ability to return to society in a functioning capacity. This study demonstrated that stroke support groups were related to the stroke survivor’s resocialization outcomes. This suggests that stroke support groups can positively impact social functioning and reintegration into the community after a stroke. The potential of stroke support groups should be further studied for their impact on overall social functioning and quality of life in stroke survivors.
Abstract NS2: Post Stroke Assessment Tool for Nurses Validated
Authors: Stubits Debra , Silliman Scott , Hodges Wayne , Johnson Yvonne
Published: March 2022

Introduction:
Nurses who provide inpatient care to acute ischemic stroke (AIS) patients routinely perform neurologic assessments that are intended to monitor the stability of neurological deficit. A variety of assessment tools are used, however none of these tools have been validated as a stroke specific assessment tool for nurses. The purpose of this study was to evaluate the validity of a novel nurse performed stroke assessment tool, the Post Stroke Assessment Tool (PSAT).

Methods:
An interdisciplinary team, from a single certified primary stroke center devised the PSAT. The PSAT encompasses evaluation of 4 components of neurologic function (level of consciousness, cranial nerves, limb strength, and limb coordination). PSAT scores range from 0 (no deficits) to 63. A Clinical Nurse Educator trained neurology nurses on PSAT performance prior to study initiation. A nurse performed the PSAT on patients with AIS. A physician performed the National Institutes of Health Stroke Scale (NIHSS) within 30 minutes of PSAT completion. General linear regression and Pearson correlation was used to evaluate the relationship between scores. All analysis was done in SAS® Version 9.3 for Windows.

Results:
A total of 26 nurses conducted a PSAT on 46 patients. Mean NIHSS was 6.1 (S.D. +/- 6.9) and mean PSAT score was 10.2 (S.D. +/- 11.8). The r
2
was 0.8349. Overall, the model was significant (p-value < 0.0001). Both the regression model and Pearson correlation showed a significant relationship between PSAT and NIHSS (p <0.0001 for both). Spearman correlations showed a significant relationship between PSAT and NIHSS within each category (p < 0.003 for each category).

Conclusions:
In this exploratory study, the PSAT appears to be a reliable nursing assessment tool to monitor post stroke neurologic deficit. Total and categorical PSAT scores highly correlated with total and categorical NIHSS scores. No attempt to compare inter-rater reliability from one nurse to another was included in this study. Future research concerning the reliability of the PSAT will be necessary before this tool can become a standard nursing assessment for patients following AIS.
Abstract NS21: Identification of Opportunities to Improve Stroke Patients Transitions of Care Among a Subset of Hospitals in the Michigan Coverdell Stroke Registry
Authors: Roberts Stacey A , Nickles Adrienne V , Siwiec Elaine , Glaza Kathleen , Peplinski Christine , Lange Michael , Mitchell Marylou , Scorcia-Wilson Teri , Mitsias Panayiotis
Published: March 2022

Background:
Stroke patients are at high risk for complications and hospital readmissions, ranging from 6.5% to 24.3% 30 days post-discharge. Evidence-based interventions for prevention of stroke readmissions are not clearly defined and surveillance data for transitions of care (TOC) are lacking. The Michigan Coverdell Stroke Registry is conducting surveillance to understand the current processes in order to assist hospitals to develop, implement and evaluate strategies to improve stroke TOC.

Methods:
Data were collected from 395 cases from three hospitals from October 2013 to March 2014. Stroke nurses at each hospital collected data on selected transition of care elements via a combination of follow-up phone calls and chart review at different time intervals within 30 days of hospital discharge. Patients who died in-hospital or were discharged to a skilled nursing facility were excluded.

Results:
Of the 395 cases, 357 (90.3%) of patients had a recorded history of high blood pressure.

A total of 19.0% (N=68) were not monitoring BP at home, 45.1% (N=161) were, and 35.9% (N=68) had an unknown monitoring status.

Among patients living at the time of follow up, 61.8% (N=240) were recorded as taking a medication post discharge. Only about half of patients who were taking medications responded as having understood how to take them, why they were taking them, and what to do when they ran out. Of note, a large proportion of the data was missing for each of those questions (44.6%, 45.8%, and 45.4% respectively).

A total of 149 patients were referred for follow-up at the time of the post-discharge call.

Conclusions/Discussion:
TOC surveillance is a key component in the development and implementations of strategies to strengthen and evaluate the effectiveness of stroke care including: secondary adherence to prevention measures, patient/caregiver understanding of patient education, and hospital readmissions for complications following stroke. The data suggest that an there are opportunities to improve how patients are prepared for hospital discharge including teaching to monitor and report BP readings and prepare to manage medications after discharge. To our knowledge, this is the first multi-hospital stroke TOC surveillance program currently collecting data.
Abstract NS3: Oral Care Program Decreases Length of Stay (LOS) and Length of Time Oral Foods and Fluids are Withheld (NPO) in Stroke Patients
Authors: Talley Louise K , Harl Jami , Lamb Jennifer , Green Lindsey , Lorenz Heather
Published: March 2022

Background:
Nosocomial infections, specifically pneumonia have consequences financially for the hospital as well as physically and emotionally for the patient and their family. Consistent oral care, a fundamental standard of nursing care, and evaluation of ability to swallow are essential to allow patients to progress to wellness during their acute hospital stay after a stroke.

Purpose:
The purpose of this study was to determine the efficacy of an oral care program for stroke patients.

Research Questions:

1. In non-ventilated stroke patients, will an oral care program reduce the length of NPO status?

2. In non-ventilated stroke patients, what is the effect of an oral care program on LOS?

Methods:
This was a quasi-experimental study using a convenience sample. The impact of oral care for stroke patients on LOS and NPO status was reviewed pre- (n=33) and post- (n=51) implementation of an oral care program. The oral care program included a Hospital-acquired Pneumonia (HAP) Risk Assessment tool and specific interventions based on the score determined by the tool. Assessment included oral, chewing/swallowing , feeding/oral self-care, and conditions that resulted in a “high risk” score. Measures included length of NPO status per 100 patient days, LOS using descriptive statistics, and the difference in means from initial to final score using a Paired Samples t-Test.

Results:
The length of NPO status per 100 patient days decreased from 23.07 to 3.3 (85.7%). The LOS mean decreased from 9.45 to 6.92 days (26.8%). No HAP cases were present in the pre-or post-intervention groups. The initial HAP Risk Assessment scores improved from a 1.09 mean to 0.73 for the final HAP risk score (t =1.345,
p
=0.185 [2-tailed], SEM =0.264, n =45).

Conclusions:
The program showed improvement in NPO status, a decreased LOS and improved HAP risk scores from initial to final. Further testing of the tool and interventions is indicated using a larger sample.
Abstract NS5: Early Infection Worsens ICH
Authors: Barrios-Anderson Adriel , Amin Eva , Cung Anh , Wiese Jonathan , Belden Valerie , Espino Daniela , Volpi John J
Published: March 2022

Background:
Intracerebral hemorrhage (ICH) is a dynamic disease in which coagulopathy, early re-bleeds, and tissue ischemia account for potential decline. Infection is known to contribute to coagulopathy and ischemia and may be a significant source of early decline and worse initial clinical presentation.

Hypothesis:
Infection within 72 hours is an independent marker of early decline in hemorrhagic stroke.

Methods:
To validate our hypothesis, we retrospectively analyzed infection and ICH presentation in 53 ICH patients at Houston Methodist Hospital from 2011-2013. We used the Glasgow Coma Score (GCS) on admission and the ICH Score as the primary outcome data on the severity of the initial clinical presentation of ICH patients. We considered the following diagnostic measures to determine infection within 72 hours: fever, leukocytosis, positive blood culture, positive urinalysis, positive chest X-ray, and use of non-prophylactic antibiotics. If any one of the diagnostic measures was positive then we counted the patient as having an infection within 72 hours. Additionally, we developed an
Infection on Admission Score
as the sum of each measure to establish a scale for the certainty and possible severity of infection with higher scores suggesting greater certainty and severity.

Results:
Any marker of infection within 72 hours was independently associated with lower GCS on admission (
P
=0.0259). Using the
Infection on Admission Score
, we found that a higher score was also independently associated with higher (or more severe) ICH score (
P
= .0025) and with lower GCS (
P
= .0070).

Conclusions:
Any sign of infection within 72 hours correlates with a worse initial clinical presentation of hemorrhagic stroke. Furthermore, these data suggest a physiological influence, as the severity of ICH rose in relationship to the severity of infection. We suggest further studies into this relationship to determine if infection itself causes decline or is simply a marker of overall decline.
Abstract NS6: The Needs of Family Members of Stroke Patients at the Bedside During Inpatient Rehabilitation
Authors: Camicia Michelle , Catlin Anita
Published: March 2022

Stroke is an event that can cause disability and significantly impacts the family system. Given this, family members are usually at the patient’s bedside daily and play a large role in the patient’s recovery and the patient’s transition back into the community following rehabilitation (Clark and Smith, 1999). This study included twelve family members of stroke patients at a regional rehabilitation center in a Northern California healthcare delivery system. The study explored the needs of family members of stroke patients admitted to an acute inpatient rehabilitation hospital. Family member needs was determined through the use of the Family Needs Inventory (FIN) and qualitative semi-structured interviews. Descriptive statistical analysis of the FIN revealed five unmet needs: knowing what to expect at home, knowing what symptoms can occur, knowing when to expect symptoms, having someone care about the health of the family member, and being informed about changes in treatment. Qualitative analysis of the semi-structured interviews revealed five main thematic need categories: preparedness for discharge, a family-centered environment, caring for the family members, communication, trust and respect. These results indicate that family members of stroke patients in an acute inpatient rehabilitation hospital have a number of unmet needs in terms of caregiver preparedness and support. Investigation into the themes presented in this study could lead to the development of interventions targeted toward enhanced communication, increased support, and effective caregiver education by the trans-professional team.
Abstract T MP112: Physical Activity Improves Stroke Outcome Through Modulation of Neutrophil Polynuclear Mobilization
Authors: Bordet Regis , Vergriete Valentin , Bordet Anne-Marie , Cordonnier Charlotte , Labreuche Julien , Leys Didier
Published: March 2022

Introduction:
Physical activity has been previously reported to decrease severity of stroke in patient cohorts. Experimentally, in rats submitted to chronic physical activity, the infarct size is decreased and functional outcome is improved, with a decrease of neutrophil polynuclear mobilization.

Hypothesis:
We assessed the hypothesis that beneficial effect of physical activity observed in stroke could be related to neutrophil modulation.

Methods:
We recruited patients with supratentorial cerebral ischemia within 48 hours of symptom onset. We evaluated the presence, weekly duration and intensity (light, moderate, heavy) of previous physical activity. The primary end-point was the initial severity assessed by the NIHSS. The secondary end-point was neutrophil polynuclear count. Myeloperoxydase, chemokines (Monocyte Chemoattractant Protein-1, C-X-C chemokine 10), adhesion proteins (InterCellular Adhesion Molecule-1, vascular cell adhesion molecule1), von Willebrand factor, cytokines (interleukins-6, -8, -10) were dosed in plasma through Luminex methodology.

Results:
Of the 434 patients (mean age of 67 ± 15 years, 53% of men), 227 (52.3%) had a regular physical activity before ischemic event. Previous regular physical activity was independently associated with a lower severity of ischemic event assessed by the NIHSS (4.0 [1-9] vs 6.0 [2-15] ; p<0.002) and lower concentrations of neutrophil polynuclear (5.0 [3.8-6.4] vs 5.7 [4.1-7.7]; p<0.003), chemokines, interleukins, Von Willebrand factor, and myeloperoxydase. There was no strong evidence of difference in biological parameters according to duration of physical activity. Patients with moderate and heavy intensity had a lower level of chemokines, interleukins-8 and Von Willebrand factor.

Conclusion:
In conclusion, previous regular physical activity improves initial stroke severity through decrease of neutrophil polynuclear count. The decrease of attractant chemokines could suggest a decreased mobilization of neutrophils to parenchyma rather than an effect on neutrophil-endothelium interaction since adhesion proteins are not changed.
Abstract T MP15: Longitudinal Imaging Reveals Resilience of Thalamocortical and Intracortical Axonal Projections After Stroke
Authors: Tennant Kelly A , Taylor Stephanie L , Zamani Akram , Brown Craig E
Published: March 2022

Introduction:
The majority of stroke survivors must cope with chronic disability, often affecting the upper limbs. Improved use of the stroke-affected limb is accompanied by neuroplasticity in intact tissues surrounding the stroke and modulating this plasticity should promote further gains in recovery. Sub-cortical brain areas are also affected by cortical stroke, and may contribute to recovery of function. One unknown issue in stroke research involves the role of the thalamus, the brain’s relay center for sensory information en route to the cortex, in recovery from stroke in the forelimb area of the somatosensory cortex (FLS1). Thus, the aim of the current study was to elucidate the role of thalamocortical (TC) projections in recovery of function after stroke.

Hypothesis:
We hypothesized that peri-infarct TC axons are damaged by stroke, but undergo structural plasticity during recovery.

Methods:
Adult C57BL/6 mice underwent a surgical procedure to inject a green fluorescent protein tagged adeno-associated virus (AAV-GFP) into the ventroposteriolateral nucleus of the thalamus, which sends projections to FLS1. A separate group of mice received injections into the retrosplenial cortex, which also projects to FLS1, to compare TC and intracortical (IC) plasticity. Immediately following virus injection, an imaging window was implanted over FLS1. Axon terminals were imaged in vivo using two-photon microscopy before and at various times after stroke to assess acute and long-term changes in neuronal structure and function.

Results:
Preliminary data indicate that, surprisingly, a subset of TC, but not IC, axons survived within the infarct core, but suffered retraction and branch and bouton loss. TC axonal boutons in both the core and peri-infarct cortex underwent high rates of turnover in the first week after stroke, with later stabilization. IC turnover rates were less affected by stroke.

Conclusions:
Overall, peri-infarct axons seem relatively resilient to the effects of ischemia, maintaining most branches and boutons, which may provide a scaffold for functional recovery after stroke.
Abstract T MP17: Electrically Preconditioned Neural Stem Cells Improve Stroke Recovery
Authors: George Paul , Bliss Tonya M , Mehta Swapnil , Sun Guohua , Steinberg Gary K
Published: March 2022

Background:
Neural stem cells (NSCs) improve functional recovery after stroke, but the optimal method and conditions for delivery remain elusive. Tissue engineered scaffolds offer a unique method to manipulate and improve NSC function. We have developed a novel NSC delivery system utilizing an electrically conductive polymer scaffold to improve recovery and further elucidate repair mechanisms.

Methods:
Human NSCs were seeded onto an electrically conductive polymer scaffold. Electrical fields were applied to the NSCs to electrically “precondition” the cells prior to transplantation. One day after in vitro stimulation, the polymer scaffold was implanted into a distal MCA occlusion rat model 1 week post stroke, and functional recovery was assessed weekly for 4 weeks post-transplantation using the vibrissae-paw test. Control groups included unstimulated NSCs on the polymer and polymer without cells. To assess how electrical stimulation altered the cells, we performed qPCR analysis of genes of interest in stimulated and unstimulated cells on the polymer, and on NSCs on a plastic petri dish.

Results:
AC preconditioned NSCs improved the rate of neurologic functional recovery compared to unstimulated NSCs on the polymer (p<0.05) and significantly improved recovery compared to DC preconditioned cells and polymer alone (p<0.01). Preliminary results demonstrate that VEGF-A, -B and thrombospondin (TSP) -3 gene expression were upregulated in AC preconditioned cells compared to other groups.

Conclusions:
Our results demonstrate that electrically preconditioned NSCs enhance stroke recovery. Gene expression of the thrombospondins (a family of matricellular proteins thought to be involved with angiogenesis and inflammation) and VEGF (proteins critical to angiogenesis) were found to be modified by electrically stimulating NSCs, suggesting possible mechanisms for functional recovery.
Abstract T MP19: Optogenetic Stimulation of Cerebellar Dentate Nucleus Promotes Persistent Functional Recovery After Stroke
Authors: Cheng Michelle Y , Shah Aatman M , Wang Eric H , Ishizaka Shunsuke , Bautista Alex R , Sun Guohua , Steinberg Gary K
Published: March 2022

Objective:
Functional recovery after stroke has been observed in both human and animal studies. Post-stroke brain stimulations are promising neurorestorative techniques as they allow direct manipulation of the target area’s excitability. Previously we have demonstrated that optogenetic neuronal stimulation of the ipsilesional primary motor cortex promotes functional recovery. To determine an optimal brain stimulation target, we test whether optogenetic neuronal stimulation of the contralesional cerebellar dentate nucleus (cLCN) can promote recovery. We hypothesize that stimulation of cLCN may be more effective, as it sends excitatory outputs to multiple motor and premotor areas.

Methods:
Thy-1-ChR2-YFP line-18 transgenic male mice were used. Mice underwent stereotaxic surgery to implant a fiber cannula in cLCN, followed by an intraluminal middle cerebral artery suture occlusion. Three groups of mice were used: control non-stimulated stroke mice, short stim stimulated stroke mice (day5-14 post-stroke) and long stim stimulated stroke mice (day5-28 post-stroke). Sensorimotor behavior tests (rotating beam tests) were used to assess their recovery at day 0, 4, 7, 10, 14, 21 and 28 post-stroke.

Results:
Our data showed that stimulated stroke mice recovered quickly, with significant improvement in distance traveled as early as day7 (p<0.05), and faster speed at day14 post-stroke (p<0.001). To evaluate whether the effect of cLCN stimulation was persistent, we tested the effects of short stim (day5-14) and long stim (day5-28) on recovery. Interestingly, the short stim group continued to recover after day14 without further stimulations and the long stim group did not further enhance recovery, indicating that functional outcome of cLCN stimulation is persistent, and prolonged stimulations may not be necessary to achieve permanent recovery. Analysis of pCREB activation showed that cLCN stimulation activates the dentatothalamocortical pathway.

Conclusion:
Our data suggest that cLCN stimulations post-stroke can promote functional recovery, and this pro-recovery effect is persistent. Current studies examine the mechanisms of cLCN-induced recovery, including cortical excitability and synaptic/plasticity markers.
Abstract T MP20: Histone Methylation Patterns in Astrocytes are Influenced by Age Following Ischemia
Authors: Chisholm Nioka , Selvamani Amutha , Park Min Jung , Sohrabji Farida
Published: March 2022

Introduction:
In animal models, ischemia results in larger infarcts in middle-aged females as compared to adult females. This age difference in infarct severity is associated with reduced functional capacity of astrocytes, a critical support cell. Astrocytes from middle-aged females synthesize less IGF-1, a neuroprotective growth factor, and display reduced ability to clear glutamate. The impaired response of astrocytes following stroke in middle-aged females may be related to epigenetic alterations, including histone methylation, that occur during aging.

Hypothesis:
We evaluated the hypothesis that astrocytes from middle-aged females would have a distinctive pattern of histone methylation following ischemia as compared to astrocytes from younger females, resulting in differential protein expression.

Methods:
The middle cerebral artery was occluded in adult (6 month) and middle-aged (11+ month) female Sprague Dawley rats (n=9-15). Astrocytes were extracted from the ischemic hemisphere 48 hours after ischemia. ChIP-seq was used to measure H3K4 and H3K9 trimethylation (me3) across the genome. In a second set of astrocytes, the expression of genes/proteins with highly methylated promoters was measured with either qPCR or ELISA immunoassays (n=6-7).

Results:
Adult females had more H3K4me3 peaks (912 vs 72) and fewer H3K9me3 (4 vs 22) peaks than middle-aged females. Increased H3K4me3 was found at promoters for genes encoding the mir17-20 cluster and vascular endothelial growth factor (VEGF). In agreement with the methylation data, astrocytes from adult females had higher protein levels of VEGF and greater expression of mir20 than middle-aged females (p<.05).

Conclusions:
This study found more H3K4me3 and less H3K9me3 in astrocytes from adult females indicating a general increase in gene transcription following ischemia. Increased trimethylation of mir20 was accompanied with increased expression of mir20 in astrocytes from adult females. Importantly, trimethylation of lysine 4 on histone 3 results in increased gene transcription whereas mir20 negatively regulates translation. This complex interaction of epigenetic modifications provides insight into possible mechanisms for differences in stroke severity observed during aging.
Abstract T MP25: Development of Patient Specific Computational Fluid Dynamics Model of Intracranial Arterial Stenosis
Authors: Connolly Mark J , Scalzo Fabien , Hamilton Robert , Liou Raymond , Hu Xiao , Liebeskind David , Gonzalez Nestor
Published: March 2022

Introduction:
Intracranial atherosclerotic steno-occlusive disease (ICASD) is a significant cause of stroke worldwide. A better understanding of the role of hemodynamic factors in the progression of ICASD is fundamental for the development of future treatment strategies. Prior studies have been limited to estimations of wall shear stress (WSS), turbulent kinetic energy (TKE), and flow velocity (FV) at single physiological states. We present a modeling technique for measuring hemodynamic parameters across a cardiac cycle using patient-specific vessel geometry and boundary conditions.

Methods:
The geometry was obtained from a rotational angiogram of the symptomatic lesion. Transcranial Doppler (TCD) was used to digitally record the cerebral blood flow velocity (CBFV). The MOCAIP algorithm was used to calculate dominant, artifact-free CBFV waveforms for each vessel.

The mesh and boundary conditions were imported into the ANSYS: Simulation Technology software as a non-deformable mesh containing a Newtonian fluid with molar mass 64500g/mol, density 1.06g/cc, and viscosity 0.035 centipoise. A dynamic state (DS) simulation of one full cardiac cycle with 25ms timesteps and steady state (SS) simulations using the velocities at the systolic peak were performed. WSS, TKE, and FV within the stenosis were measured and compared between DS and SS simulations.

Results:
When compared with the DS simulation, the mean WSS of the SS simulation was significantly higher (SS 30.6Pa DS 30.0Pa, p<0.0005). There were no significant differences between TKE (SS 0.074m2/s2 DS 0.073m2/s2) or FV (SS 2.68m/s DS 2.71m/s).

Conclusion:
Incorporating individual-specific boundary conditions based on CBFV TCD measurements with patient-specific geometry intracranial arterial modeling is feasible and adds a spectrum of dynamic data that can significantly differ from SS simulations.
Abstract T MP3: Collaterals Predicts Imaging Evolution and Patient Outcomes in Acute Ischemic Stroke Patients
Authors: Sarraj Amrou , Boehme Amelia K , Sitton Clark W , Supsupin Emilio P , Datta Proleta , Bajgur Suhas S , Choi Jeanie M , Bonafante-Mejia Eliana E , Friedman Elliot , Denny Mary C , Wu Tzu-Ching , Barreto Andrew D , Dannenbaum Mark J , Chen Peng R , Sun Chung-Huan J , Gupta Rishi , Martin-Schild Sheryl , Grotta James C , Savitz Sean I
Published: March 2022

Background:
Collateral flow and early ischemic changes on CT are pivotal determinants of outcome in patients with large artery occlusion (LAO). Evolution of stroke occurs during inter-facility transfer. We sought to evaluate the association between collaterals and stroke evolution measured by ASPECTS decay and the relationship of these imaging findings with patient outcomes.

Methods:
In a cross-sectional multicenter study, we evaluated 313 transferred patients with AIS and LAO (MCA or ICA) from 01/08-04/14. The collateral score (CS) (Figure 1) and ASPECTS were measured. Good collaterals were defined as scores 2-3 (poor; scores 0-1). ASPECTS decay was defined as dichotomized deterioration in ASPECTS from good (8-10) to bad (0-7) during transfer. ASPECTS was also analyzed as an ordinal variable. Logistic regression and mediation analyses were performed to evaluate the association between the collaterals, ASPECTS and patients good and poor (mRS 0-2 and 4-6, respectively) outcomes.

Results:
Table 1 depicts baseline characteristics. Patients with poor CS had greater odds of ASPECTS decay during transfer (OR 13.4, 95%CI 7.5-24, p<0.0001), which was associated with higher odds of mRS 4-6 (OR 7.1, 95%CI 3.7-13.8, p<0.0001). The association between poor CS and poor outcome was maintained after adjustment for ASPECTS decay, stroke severity and IV tPA treatment (OR 10.9, 95%CI 4-34, p<0.0001). For every 30 minutes in transfer time, the odds of ASPECTS decay increased by 13% (OR 1.13, 95%CI 1.05-1.2, P 0.0004). With each 1 point drop in ASPECTS, the odds of good outcome were reduced by 42% (OR 0.58, 95%CI 0.54-0.66, P < 0.0001). On mediation analysis, ASPECTS decay explained 75% of the relationship between poor CS and poor outcome (Sobel 2.11, p 0.03) after adjusting for IV tPA treatment and stroke severity.

Conclusion:
Our cohort shows that stroke evolution is determined by transfer time and collateral flow, which are pivotal determinants of clinical outcome in patients with AIS and LAO.
Abstract T MP38: Impact of Community Stroke Education and Comprehensive Stroke Care in South Texas
Authors: Hassan Ameer E , Tekle Wondwossen G , Sanchez Christina , Jones-Fullingim Lisa , Sanchez Olive , Abantao Erlinda , Malik Ahmed A , Qureshi Adnan I
Published: March 2022

BACKGROUND AND PURPOSE:
The purpose of this study was to evaluate the impact of our coordinated stroke education programs and establishment of comprehensive stroke care in South Texas border town on the utilization of and outcomes associated with thrombolytic use. Previous studies have identified prominent disparities in health care delivery in these regions of the United States

METHODS:
We identified all patients who had a discharge diagnosis of ischemic stroke from January 2010 till July 2014 at one Primary

Stroke center in South Texas using ICD codes of 434.91, 433.31, 434.01 and 434.11. We studied the trend of growth in stroke care delivery over the last 5 years in the subset of patients who received intravenous recombinant tissue plasminogen activator (IV rt-PA) and those who were treated with endovascular interventions. Starting in July 2012, a public stroke education plan was implemented over an 18 month period. The plan included an annual stroke symposium, quarterly education with early response team members, quarterly lectures to surrounding emergency rooms, public radio and television advertisements in English and Spanish stressing the AHA F.A.S.T. acronym, billboards, and grand rounds with internal medicine, family practice and emergency room physicians at all of our referral hospitals.

RESULTS:
Total number of ischemic stroke patients per year grew linearly from 343 in 2010 to over 550, as projected, in 2014.

Proportion of patients treated with IV rt-PA increased from 3.2% in 2010 to 13.8% in 2014. The significant increase in thrombolytic use was due to a greater proportion of patients arriving to the emergency room within 4.5 hours , with no difference in rates of post thrombolytic intracerebral hemorrhages . A total of 14.5% of acute ischemic stroke patients received endovascular treatment in 2014 compared with 6.3 % in 2012 when endovascular service was established. The proportion of patients who had either IV or endovascular treatment was 25.7% in 2014 compared with only 3.2% in 2010.

CONCLUSIONS:
Intensified public stroke education and establishment of comprehensive stroke care significantly increased intravenous thrombolytic and endovascular treatment utilization in a South Texas border town over four fold within 18 months.
Abstract T MP42: Mitral Ratio of Peak Early to Late Diastolic Filling Velocity as a Predictor of Mortality in Acute Ischemic Stroke
Authors: Kim Yerim , Kim Chi Kyung , Jung Seunguk , Kim Tae Jung , Ko Sang-Bae , Yoon Byung-Woo , Lee Seung-Hoon
Published: March 2022

Background:
Diastolic dysfunction has a significant impact on symptoms, functional outcomes, and prognosis in ischemic stroke patients. The ratio of peak early to late diastolic filling velocity (E/A) is the simplest and most commonly used index to assess diastolic dysfunction.

Methods:
One thousand seven hundred seven patients with acute ischemic stroke who had a transthoracic echocardiogram during admission were identified. We classified patients into 3 groups by E/A ratios based on the previous literature search. We conducted binary logistic regression analysis for death, vascular death, and stroke death.

Results:
Among a total of 1707 patients, 261 (15.3%) had E/A <0.6 and 124 (7.3%) had E/A>1.5. All cause death was higher with E/A <0.6 or E/A >1.5 compared to E/A 0.6-1.5 (25.7% and 16.9% versus 15.1%), as was vascular death (10.2% and 8.5% versus 5.8%). After adjusting for age, gender, previous stroke history, hypertension, diabetes, smoking, dyslipidemia, atrial fibrillation, stroke subtype, left ventricular end-diastolic diameter, LA/Ao ratio, mitral E deceleration time, relative wall motion abnormality, and initial stroke severities, the relative risk of all-cause death with E/A >1.5 was 2.24 (95% CI, 1.14-4.33;
p=
0.02); the relative risk of vascular death with E/A>1.5 was 3.50 (95% CI, 1.39-8.80;
p<0.01
); the relative risk of stroke death with E/A >1.5 was 3.42 (95% CI, 1.21-9.69;
p=0.02
).

Conclusion:
The E/A>1.5 is associated with 2-fold increased all-cause mortality and 3-fold vascular and stroke mortalities independent of covariates in ischemic stroke patients.
Abstract T MP5: Factors Determining Consent in a Randomized Trial of Intra-Arterial Stem Cell Therapy for Sub-Acute Ischemic Stroke
Authors: Pafford Ryan N , Haussen Diogo C , Ramdas Kevin N , McBee Delmas , Rutledge J. N , Huang David Y , Hinson Jim , Savitz sean , Yavagal Dileep R
Published: March 2022

Background:
Obtaining consent from eligible patients in randomized stroke trials can be challenging. Stem cells are controversial in general and may add further hurdles to consent. We investigated the rate of patient and legally authorized representative (LAR) consent and factors determining consent in the first US intra-arterial autologous stem cell Phase 2 multicenter trial: RECOVER Stroke. Methods: In this trial, eligible patients were identified at one week from stroke onset. We performed a retrospective analysis of all eligible patients who were approached for consent at 2 out of 8 actively recruiting centers in the trial. Analyzed data including age, gender, race, NIHSS, lesion location, prior recanlization therapy and mode of consent (self-consent, LAR-consent). Results: Of the 44 patients approached for consent at the two centers, 22 (50%) agreed to participate in the clinical research trial. A trend for higher rate of consent refusal in older patients was noted (mean age of consented patients was 61±11 vs 69±12 on patients with declined consent; p=0.06). The mode of consenting (self-consent vs. LAR-consent) had no impact consenting/refusal rates. Males gender was associated with a significantly higher rate of consent, as well as patients with lower NIHSS. Race and lesion location had no impact on the rates of consent refusal. The multivariate logistic regression analysis revealed male gender as the only variable independently associated with higher rate of consent (OR 7.2; 95%CI 1.6-31.5; p=0.008). The only variable independently associated with LAR-consenting after multivariate binary logistic regression was NIHSS (OR 1.15; 95%CI 1.01-1.31; p=0.03).

Conclusions:
There was a high rate of consent among eligible patients in the first US intra-arterial trial of stem cell therapy for stroke. Male gender was significantly associated with higher overall consent rate and lower NIHSS with proxy consenting.
Abstract T MP53: Frequency Aad Features of Patients With Embolic Strokes of Underdetermined Source (esus): Esus Global Registry
Authors: Arauz Antonio , Vanassche Thomas , Bosch Jackie , Lavallee Phillippa , Cunha Luis , Ringleb Peter A , Gagliardi Rubens J , Hart Robert
Published: March 2022

Background:
Embolic stroke of undetermined source (ESUS) is a recently introduced clinical construct to define non-lacunar cryptogenic ischemic stroke and is the basis for two large international randomized trials recently underway. Diagnostic criteria are a visualized non-lacunar stroke on CT or MRI, absence of atrial fibrillation by history, ECG and at least 24 hours of rhythm monitoring, absence of intracardiac thrombus by echocardiography, no occlusive atherosclerosis based on imaging of the cervical and intracranial arteries, and no specific cause of stroke identified. The frequency and features of ESUS patients have not been characterized previously.

Methods:
Consecutive patients with recent ischemic stroke were retrospectively reviewed at 20 stroke research centers in 20 different countries to identify those meeting criteria for ESUS, as well as reasons not meeting criteria for the remaining patients.

Results:
Of 2.090 patients with recent ischemic stroke, 18% met ESUS criteria (range 2% to 36%). Of those not meeting ESUS criteria, major reasons were atrial fibrillation (26%), lacunar stroke (19%), incomplete diagnostic evaluation (18%), carotid artery stenosis >50% (17%), and intracranial stenosis (13%). Excluding those without the required diagnostic evaluation, 22% met criteria for ESUS. Of the 378 ESUS patients, the mean age was 64 years (vs. 68 years for non-ESUS), 56% were men (54% non-ESUS), 16% received tPA, and 33% were taking antiplatelet therapy at stroke onset. Hypertension, diabetes, and coronary artery disease were present in 66%, 26%, and 11%, respectively. At hospital discharge, 93% received antiplatelet therapy, 6% anticoagulant therapy, and 1% no antithrombotic therapy.

Conclusions:
Ischemic stroke patients meeting criteria for ESUS are not uncommon (22% of ischemic strokes) in stroke centers performing the required diagnostic evaluation. Antiplatelet therapy is overwhelmingly used for secondary prevention in these patients with non-lacunar cryptogenic stroke.
Abstract T MP61: Diagnostic Accuracy of Adult Bedside Stroke Recognition Tools in Childhood Stroke
Authors: Mackay Mark T , Churilov Leonid , Donnan Geoffrey , Yock-Corrales Adriana , Babl Franz , Monagle Paul
Published: March 2022

Objective:
Bedside stroke recognition tools improve diagnostic accuracy in adult stroke. Our aim was to assess the diagnostic utility of the CPSS and ROSIER tools in children presenting to the emergency department (ED) with brain attack symptoms.

Methods:
The Cincinnati Prehospital Stroke Scale (CPSS ) and the Recognition of Stroke in the Emergency Room (ROSIER) tool were retrospectively applied to 101 consecutive children with stroke, presenting from 2003-2010, and 279 children with mimics, presenting to the ED from 2009-2010. A positive CPSS was defined as ≥1 positive sign (face or arm weakness, speech disturbance). A positive ROSIER was defined as a score of ≥1. Diagnostic accuracy of the tools in determining the patients’ true status were estimated for arterial (AIS), hemorrhagic (HS) and combined stroke subtypes versus mimics.

Results:
The CPSS and ROSIER tools correctly discriminated combined stroke subtypes from mimics (diagnostic odds ratio (DOR) 5.6 and 4.7 respectively) and AIS from mimics (DOR 15.1 and 13.4 respectively) but not HS from mimics (DOR 1.2 for both tools). CPSS and ROSIER accuracy were fair for AIS versus mimics (ROC 0.79 and 0.77 respectively), fair to poor for combined stroke subtypes versus mimics (ROC 0.70 and 0.68 respectively) and failed for HS versus mimics (ROC 0.51 and 0.52 respectively). Reasons for limited accuracy include different spectrum of mimics, lower overall prevalence, higher proportion of HS subtype and common seizure occurrence in childhood stroke.

Conclusions:
Adult stroke recognition tools correctly discriminate combined stroke types and AIS subtype from mimics but their limited accuracy suggest further modifications are required to improve diagnostic utility for identification of childhood stroke in the ED.
Abstract T MP63: Cardiac Diagnosis is the Major Risk for Stroke in Neonates with Complex Congenital Heart Defects
Authors: Winters Madeline E , McCarthy Ann L , Lynch Jennifer M , Ko Tiffany , Bixler Elizabeth , Griffith Kaitlin , Busch David R , Xiao Rui , Gaynor William , Nicholson Susan , Montenegro Lisa M , Naim Maryam Y , Licht Daniel J
Published: March 2022

Background and Objectives:
Complex congenital heart defects (CHD), which occur in approximately 3 out of 1000 neonates, require invasive open-heart surgery during the first year of life. In a recent prospective study of infants with various forms of complex CHD, 40% of neonates acquired post-operative brain injury including stroke and periventricular leukomalacia (PVL). However, studies identifying specific risk factors of post-operative stroke have been limited. Herein we examine risk factors for post-operative stroke in a mixed cohort of infants with critical CHD.

Methods:
Term neonates born with critical CHD from 2009 to present were identified from a single-center prospective study. Exclusion criteria included birth weight less than 2 kg, neonatal depression, perinatal seizures, and evidence of end-organ injury. Magnetic resonance imaging (MRI) to assess pre- and post-operative brain injury was performed immediately prior to and within 10 days after surgery.

Results:
Of 102 subjects enrolled, 85 neonates were imaged both pre- and post-operatively. Neonates were diagnosed with either hypoplastic left heart syndrome (HLHS, n=41), transposition of the great arteries (TGA, n=29) or other (n=15). A total of 9 arterial ischemic strokes were observed (10.6%), of which 7/9 were post-operative only. The incidence of stroke was significantly higher in infants with HLHS (6/41, 14.6%) than in infants with TGA (0/29, p=0.03). Time-to-surgery, head circumference, birth weight, duration of deep hypothermic circulatory arrest, and volume of pre- or post-operative PVL were not significantly correlated with incidence of stroke.

Conclusion:
Neonates with HLHS have a higher prevalence of post-operative embolic stroke compared to infants with TGA. Although infants with HLHS have been shown to be at a high risk for both post-operative stroke and PVL, incidence of post-operative stroke is not correlated with volume of post-operative PVL.
Abstract T MP69: 12/15-LOX Inhibition or Knockout Effectively Reduces Warfarin-associated Hemorrhagic Transformation Following Experimental Stroke
Authors: Liu Yu , Zheng Yi , Karatas Hulya , Foerch Christian , Lo Eng H , Van Leyen Klaus
Published: March 2022

Background and Purpose:
A large number of patients with Atrial Fibrillation (AF) receive oral anticoagulant, most frequently Warfarin. Because of risk of increasing bleeding, these patients are not eligible for tPA treatment in case of stroke. The current study was designed to test if inhibition of the enzyme 12/15-lipoxygenase (12/15-LOX) protects against increased hemorrhage in Warfarin-treated mice subjected to experimental stroke.

Methods:
Warfarin was dosed orally in drinking water, and INR values were determined 24 hours later. C57BL6J mice were subjected to transient focal ischemia (filament MCAO) with either A) 3 hours of ischemia and 21h of reperfusion or B) 2h ischemia, followed by i.v. infusion of tPA 2 hours after reperfusion and sacrifice at 24 hours. The novel 12/15-LOX inhibitor ML351 (50 mg/kg) was given by i.p. injection; at the time of reperfusion in experiment A), concomitantly with tPA in experiment B). Hemorrhage was evaluated by measuring hemoglobin in the brain parenchyma, or by measuring hemorrhage areas in brain sections. In addition, 12/15-LOX knockout mice (ALOX15(-/-)) were compared to corresponding wild-type mice in the 3h MCAO model.

Results:
Reproducible INR values ranging from 2.9 - 3.5 were achieved in all mice, and Warfarin followed by MCAO led to significant hemorrhage in both models. In Experiment A), visible hemorrhage in brain sections was significantly reduced by administration of ML351, and this result was confirmed by the hemoglobin measurement. ML351 also reduced infarct size, and showed a trend toward reduced mortality. ALOX15(-/-) mice similarly developed less hemorrhage than wild-type mice. In Experiment B), the combination of tPA and Warfarin also led to severe hemorrhage, and again this was reduced in the presence of ML351.

Conclusions:
We and others have previously shown inhibition of 12/15-LOX protects against experimental stroke. The current study adds an important translational value to these studies by demonstrating a significant reduction in Warfarin-associated hemorrhagic transformation, both with and without tPA. These results suggest that ML351 or a similar 12/15-LOX inhibitor could be safely given to anticoagulated patients suffering a stroke, either alone or in conjunction with tPA.
Abstract T MP71: Estrogen Attenuates NLRP3 Inflammasome Activation Following Global Cerebral Ischemia
Authors: Zhang Quanguang , Dong Yan , Brann Darrell
Published: March 2022

NLRP3 inflammasome formation and activation have recently been reported to be involved in several types of ischemic injury, including middle cerebral artery occlusion (MCAO)-induced cerebral ischemia. However, it is unknown whether or not NLRP3 inflammasome is involved in brain injury following global cerebral ischemia (GCI) in ovariectomized rats, and whether its activation can be regulated by 17β-Estradiol (E2) replacement. As part of its activation, NLRP3 can bind the apoptosis speck protein (ASC) to assemble an NLRP3-ASC-Caspase-1 inflammasome and induce caspase-1 activation, followed by subsequent activation of IL-1β and IL-18. IL-1β and IL-18 are implicated in neurodegeneration in diverse forms of experimental brain injury, including ischemic brain injury. In this study, confocal microscopic analysis revealed that NLRP3 expression was initially highly induced in hippocampal CA1 neurons at 1-day reperfusion in the placebo-treated rats following 10-min GCI. Interestingly, at later time-points (3-7 days reperfusion) NLRP3 became highly expressed in GFAP-positive astrocytes in the hippocampal CA1 region. Additionally, ASC was similarly highly induced in astrocytes and co-localized with NLRP3 at the late reperfusion stage (3-7 day). E2 replacement initiated at the time of ovariectomy (7 days before GCI) blocked the induction of NLRP3 and ASC in astrocytes. In addition, caspase-1 activity was found to be highly induced at 1-day reperfusion, and significantly attenuated following E2 replacement. Cleaved-IL-1β expression was also enhanced in neurons at 1-day reperfusion and in astrocytes at 3-7 day reperfusion - effects that were blocked by E2 replacement. Taken as a whole, the results suggest that NLRP3 inflammasome formation and activation is markedly enhanced in the hippocampal CA1 region following GCI, which may contribute to neuronal injury. Furthermore, E2 replacement markedly attenuated NLRP3 inflammation activation and cytokine induction after GCI, which may contribute to E2 neuroprotective effects following GCI.