bluuebunny/crossref_metadata_2025 huggingface dataset:
Supplementary Figure 2 from The Salivary Microbiome and Predicted Metabolite Production Are Associated with Barrett's Esophagus and High-Grade Dysplasia or Adenocarcinoma
Authors: Solfisburg Quinn S. , Baldini Federico , Baldwin-Hunter Brittany , Austin George I. , Lee Harry H. , Park Heekuk , Freedberg Daniel E. , Lightdale Charles J. , Korem Tal , Abrams Julian A.
Published: March 2024

Supplementary Figure 2: (A) When separated into individual groups, there was a significant trend towards lower alpha diversity with stages of progression to EAC (p=0.006). (B) On Jaccard UMAP beta diversity analyses, there was clear visual clustering across stages of progression, and this was confirmed statistically (PERMANOVA p<0.001).
Surveys from The NUTRIENT Trial (NUTRitional Intervention among myEloproliferative Neoplasms): Results from a Randomized Phase I Pilot Study for Feasibility and Adherence
Authors: Mendez Luque Laura F. , Avelar-Barragan Julio , Nguyen Hellen , Nguyen Jenny , Soyfer Eli M. , Liu Jiarui , Chen Jane H. , Mehrotra Nitya , Huang Xin , Kosiorek Heidi E. , Dueck Amylou , Himstead Alexander , Heide Elena , Lem Melinda , El Alaoui Kenza , Mas Eduard , Scherber Robyn M. , Mesa Ruben A. , Whiteson Katrine L. , Odegaard Andrew , Fleischman Angela G.
Published: March 2024

Surveys used in the study
Supplementary Table 4 from The NUTRIENT Trial (NUTRitional Intervention among myEloproliferative Neoplasms): Results from a Randomized Phase I Pilot Study for Feasibility and Adherence
Authors: Mendez Luque Laura F. , Avelar-Barragan Julio , Nguyen Hellen , Nguyen Jenny , Soyfer Eli M. , Liu Jiarui , Chen Jane H. , Mehrotra Nitya , Huang Xin , Kosiorek Heidi E. , Dueck Amylou , Himstead Alexander , Heide Elena , Lem Melinda , El Alaoui Kenza , Mas Eduard , Scherber Robyn M. , Mesa Ruben A. , Whiteson Katrine L. , Odegaard Andrew , Fleischman Angela G.
Published: March 2024

Supplementary Table 4. Longitudinal lipid values.
Supplementary Table 2 from The NUTRIENT Trial (NUTRitional Intervention among myEloproliferative Neoplasms): Results from a Randomized Phase I Pilot Study for Feasibility and Adherence
Authors: Mendez Luque Laura F. , Avelar-Barragan Julio , Nguyen Hellen , Nguyen Jenny , Soyfer Eli M. , Liu Jiarui , Chen Jane H. , Mehrotra Nitya , Huang Xin , Kosiorek Heidi E. , Dueck Amylou , Himstead Alexander , Heide Elena , Lem Melinda , El Alaoui Kenza , Mas Eduard , Scherber Robyn M. , Mesa Ruben A. , Whiteson Katrine L. , Odegaard Andrew , Fleischman Angela G.
Published: March 2024

Supplementary Table 2. Representativeness of Study Participants.
FIGURE 6 from The NUTRIENT Trial (NUTRitional Intervention among myEloproliferative Neoplasms): Results from a Randomized Phase I Pilot Study for Feasibility and Adherence
Authors: Mendez Luque Laura F. , Avelar-Barragan Julio , Nguyen Hellen , Nguyen Jenny , Soyfer Eli M. , Liu Jiarui , Chen Jane H. , Mehrotra Nitya , Huang Xin , Kosiorek Heidi E. , Dueck Amylou , Himstead Alexander , Heide Elena , Lem Melinda , El Alaoui Kenza , Mas Eduard , Scherber Robyn M. , Mesa Ruben A. , Whiteson Katrine L. , Odegaard Andrew , Fleischman Angela G.
Published: March 2024

Fecal microbiome composition. A, A line plot displaying the microbial diversity, as measured by the Shannon index, of individuals over time. B, A line plot displaying the microbial composition of individuals over time. The y-axis is the first principal coordinate produced by Bray–Curtis dissimilarity ordination of the microbiome. In both A and B, the orange shaded area depicts the active intervention period and the SE is represented by error bars.
FIGURE 4 from The NUTRIENT Trial (NUTRitional Intervention among myEloproliferative Neoplasms): Results from a Randomized Phase I Pilot Study for Feasibility and Adherence
Authors: Mendez Luque Laura F. , Avelar-Barragan Julio , Nguyen Hellen , Nguyen Jenny , Soyfer Eli M. , Liu Jiarui , Chen Jane H. , Mehrotra Nitya , Huang Xin , Kosiorek Heidi E. , Dueck Amylou , Himstead Alexander , Heide Elena , Lem Melinda , El Alaoui Kenza , Mas Eduard , Scherber Robyn M. , Mesa Ruben A. , Whiteson Katrine L. , Odegaard Andrew , Fleischman Angela G.
Published: March 2024

Baseline and week 9 BMI. Baseline BMI was calculated using height and weight at enrollment, with no significant differences between USDA and MED groups. Weight was followed throughout the study, no significant changes in BMI were observed in either group.
Dietary Interventions in Atopic Dermatitis: A Comprehensive Scoping Review and Analysis
Authors: Lim Jun Jie , Liu Mei Hui , Chew Fook Tim
Published: March 2024

Background: This scoping review aims to critically assess gaps in the current literature on atopic dermatitis (AD) by evaluating the overall effectiveness of dietary interventions. Through a comprehensive analysis that follows the Preferred Reporting Item for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, we conducted a thorough search on the Web of Science database in May 2023 using specific search strategies to identify all relevant studies on the research topic. Summary: A total of 104 full-text articles were included for review. Our synthesis identified seven notable categories of dietary interventions for AD, showcasing the diversity of interventions utilized. This includes vitamin supplementation, probiotic and prebiotic supplementation, dietary fat, biological compounds, foods from natural sources, major nutrients, and diet-related approaches. Further analyses stratified by targeted populations revealed a predominant focus on pediatrics, particularly in probiotic supplementation, and on adults, with an emphasis on vitamin D and E supplementation. Key Messages: Despite most dietary interventions demonstrating overall effectiveness in improving AD severity and its subjective symptoms, several significant gaps were identified. There was a scarcity of studies on adults and whole-diet interventions, a prevalence of short-term interventions, heterogeneity in study outcomes, designs, and population, occasional disparity between statistical significance and clinical relevance, and a lack of a comprehensive multidisciplinary approach. Nonetheless, these findings offer valuable insights for future AD research, guiding additional evidence-driven dietary interventions and informing healthcare professionals, researchers, and individuals, advancing both understanding and management of AD.
Comprehensive Study of Chromosomal Copy Number Variations and Genomic Variations Predicting Overall Survival in Myelodysplastic Syndromes
Authors: Maurya Nehakumari , Shanmukhaiah Chandrakala , Dhangar Somprakash , Madkaikar Manisha , Vundinti Babu Rao
Published: March 2024

Introduction: Myelodysplastic syndrome (MDS) is a heterogeneous disease characterized by cytopenia, marrow dysplasia and has a propensity to develop into acute myeloid leukemia. The disease progression is majorly affected by genetic defects. However, about 40–50% of patients with MDS present with a normal karyotype and develop different courses of disease. Hence, there remains a room to advance the biological understanding and find molecular prognostic markers for cytogenetically normal MDS. Methods: We performed a high-resolution CGH + SNP array along with next-generation sequencing (NGS) of 77 primary diagnosed MDS patients, and also they were clinically followed up. Results: Our study revealed 82 clinically significant genomic lesions (losses/gains) in 49% of MDS patients. CGH + SNP array reduced the proportion of normal karyotype by 30%. SNP array in combination with NGS confirmed the biallelic loss of function of the TP53 gene (2/6), which is a clinically relevant biomarker and new genetic-based MDS entity, i.e., MDS-biTP53, as per the new WHO classification 2022. Genomic region 2p22.3 presented with frequent lesions and also with a more hazard ratio (2.7, 95% CI: 0.37–21) when analyzed by Kaplan-Meier survival analysis. Conclusion: CGH + SNP array changed the cytogenetic and IPSS-R risk group in 18% and 13% of patients, respectively, with an improved prediction of prognosis. This study emphasizes the cytogenetic heterogeneity of MDS and highlights that abnormality with chromosome 2 may have a diagnostic and prognostic impact.
Prevalence of Sarcopenia in Chronic Heart Failure and Modulating Role of Chronic Kidney Disease
Authors: Formiga Francesc , Moreno-Gónzalez Rafael , Corsonello Andrea , Mattace-Raso Francesco , Carlsson Axel C. , Ärnlöv Johan , Kostka Joanna , Freiberger Ellen , Roller-Wirnsberger Regina , Tap Lisanne , Sołtysik Bartłomiej K. , Artzi-Medvedik Rada , Kob Robert , Yehoshua Ilan , Wirnsberger Gerhard H. , Fabbietti Paolo , Lattanzio Fabrizia , Chivite David ,   on behalf of SCOPE Investigators
Published: March 2024

Introduction: Sarcopenia, heart failure (HF), and chronic kidney disease (CKD) are common among the older people. Our objective was to evaluate the frequency of sarcopenia, among community-dwelling older adults with HF, possible causative factors, and the additive factor of CKD. Methods: A cross-sectional analysis of 1,420 older people living in the community was carried out. Participants (aged 75 years and more) came from a European multicenter prospective cohort (SCOPE study). Global geriatric assessment including short physical performance battery, handgrip strength test, and bioelectrical impedance analysis was performed. Previous known HF was defined as physician-diagnosed HF registered in the patient’s medical record or the use of HF-related medications, regardless of left ventricular ejection fraction (LVEF). Sarcopenia was defined by the updated criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). Estimated glomerular filtration rate was calculated using Berlin Initiative Study (BIS) to define the stages of CKD. Two-year mortality was also collected. Results: A total of 226 (15.9%) participants had a prior chronic HF diagnosis, with a median age of 80.0 (5.0), and 123 (54.4%) were women. Using EWGSOP2 definition, 11.5% HF and 10.7% in non-HF participants met diagnostic criteria for sarcopenia. In multivariate analyses, only a lower body mass index (BMI) (odds ratios [OR], 0.82; 95% confidence interval [CI], 0.73–0.93) and lower short physical performance battery score (OR, 0.81; 95% CI, 0.69–0.96) were associated with sarcopenia. Patients with HF and sarcopenia have a similar all-cause mortality risk but higher 2-year cardiovascular mortality risk (p = 0.047). Discussion/Conclusion: One out of ten community-dwelling older adults with concurrent clinical stable chronic HF, without considering LVEF, have sarcopenia. Lower BMI and poor physical performance are associated with sarcopenia in this population, but not CKD.
Antioxidant and Anti-Inflammatory Activities of Lindera glauca Extracts
Authors: Park Yi-Na , Lee Hyun Ju , Ohk Seung-Ho
Published: March 2024

Introduction: The current study investigated the antioxidant and anti-inflammatory effects of ethanol extracts from Lindera glauca twig (LGT) and leaf/stem (LGLS). Methods: The antioxidant activities were measured by total content of polyphenol and flavonoid, DPPH radical scavenging, and ABTS+ radical scavenging activity. To evaluate the anti-inflammatory effect in the LPS-induced RAW 264.7 cells, protein and mRNA expression of major inflammatory factors were analyzed using Western blot analysis and RT-PCR. Results: The total polyphenol content of LGT and LGLS was 88.45 ± 11.74 and 115.75 ± 7.87 GA mg/g, respectively. The total flavonoid content was 66 ± 2.89 and 74.33 ± 2.89 QE mg/g. Both LGT and LGLS showed high DPPH and ABTS+ radical scavenging activities. Neither LGT nor LGLS was cytotoxic to RAW 264.7 cells. The anti-inflammatory activities were measured by LPS-induced RAW 264.7 cells. LGT and LGLS showed inhibition of the LPS-induced production of nitric oxide (NO), inducible NO synthase, cyclooxygenase-2 at the protein and mRNA levels, as determined by Western blotting and RT-PCR, respectively. In addition, the release of tumor necrosis factor-α and interleukin-6 mRNA expression levels of these cytokines was reduced by LGT and LGLS. Conclusion: These results suggest that LGT and LGLS extracts have potential for use as a functional antioxidant and anti-inflammatory ingredient in cosmetic industry.
Manywheres: In Pursuit of Social Justice in Developmental Science
Authors: Velez Gabriel M. , Power Séamus A.
Published: March 2024

In this article, we articulate an innovative framework, manywheres, and argue that it can advance the work of fostering youth-led change and progressive world-making. We first root psychological and development science in an applied framework of developing more just, harmonious, and tolerant social worlds. Then, we introduce manywheres, a guiding framework of propositions of attending to the complexity and nuance of meaning-making across individuals without becoming lost in nihilism, relativism, or ethnocentric views of social justice. This leads to the construction of a more holistic developmental lens considering the age-related, contextual, and internal factors that shape meaning-making individual trajectories and societal outcomes. Manywheres can thus structure thinking and research with an end goal of understanding the diversity of young people’s engagement, activism, and disconnection. We end with mapping a research agenda applying these ideals, incorporating the methodological approaches that can be taken, concrete examples, and implications that can be applied to salient social issues.
Horizontal Gaze Palsy and Ipsilateral Facial Nerve Palsy in Older Patient as Initial Manifestation of Very Late-Onset Multiple Sclerosis Successfully Treated with Oral Corticosteroids: A Case Report
Authors: Tjoanda Tjoa Debby Angela , Kartika Antonia , Ginting Dianita Veulina , Sari Rusti Hanindya , Yollamanda Prettyla
Published: March 2024

Introduction: Multiple sclerosis (MS) is a demyelinating condition of the central nervous system (CNS) that primarily affects young adults. Very late-onset multiple sclerosis (VLOMS) is an uncommon form of MS, accounting for only 0.5 percent of all MS patients. Eye movement impairments such as internuclear ophthalmoplegia are common in MS, while horizontal gaze palsy is an uncommon occurrence. Case Presentation: We report a case of a patient diagnosed with VLOMS who presented with left horizontal gaze palsy and ipsilateral facial nerve palsy. Brain magnetic resonance imaging showed Dawson’s fingers in the left and right periventricular white matter; multiple small, round, hyperintense lesions in the left and right cortex and juxtacortical cerebellar hemisphere; and small hyperintense lesion in the left paramedian pontine reticular formation, suggesting the diagnosis of MS. Oral corticosteroids led to complete resolution of ocular movement and ipsilateral facial nerve palsy. Conclusion: We propose that neuroimaging should be performed in ophthalmoplegia with a pattern representing CNS lesion and oral corticosteroids may be an effective alternative to high-cost intravenous corticosteroids.
Multifocal Insulinoma as the Unique Presenting Feature of Multiple Endocrine Neoplasia Type 1 in an Adolescent
Authors: Murray Alison , Rodas Marquez Sonia Priscila , Krishnamurthy Mansa , Lopez-Nunez Oscar , Gurria Juan P. , Trout Andrew T. , Almazan Susan , Mutyala Krishnamallika , Grisotti Gabriella , Shah Amy , Howell Jonathan
Published: March 2024

Introduction: Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant inherited disorder defined by the presence of two of the following endocrinopathies: primary hyperparathyroidism, anterior pituitary tumors, and duodenopancreatic neuroendocrine tumors (NETs). NETs, which can secrete hormones including insulin, gastrin, and glucagon, among others, are common in patients with MEN1 and are a major cause of morbidity and premature death. NETs are more common later in life, with very few cases described in children. Here, we describe a unique case of an adolescent with multifocal pancreatic NETs as the single presenting feature of MEN1. Case Presentation: A 13-year-old healthy male presented with severe weakness, altered mental status, and syncope in the setting of a venous blood glucose (BG) of 36 mg/dL. Workup showed an elevated insulin level (14 μIU/mL) when BG was 39 mg/dL with positive response to glucagon, concerning for hyperinsulinism. Diazoxide and chlorothiazide were started but not well tolerated secondary to emesis. Three suspected NETs were identified by magnetic resonance imaging and 68-Ga DOTATATE PET-CT imaging, including the largest, a 2.1 cm mass in the pancreatic head. A fourth mass in the pancreatic tail was identified via intraoperative ultrasound. All lesions were successfully enucleated and excised, and glucose levels normalized off diazoxide by post-op day 2. While the primary lesion stained for insulin and somatostatin by immunofluorescence (IF), consistent with his clinical presentation, the additional tumors expressed glucagon, somatostatin, pancreatic polypeptide, and chromogranin A but were negative for insulin. Genetic testing confirmed a pathogenic heterozygous mutation in MEN1 (c.969C>A, p.Tyr323). He had no other signs of MEN-associated comorbidities on screening. Discussion/Conclusion: This case demonstrates that young patients with MEN1 can present with multifocal NETs. These NETs may have polyhormonal expression patterns despite a clinical presentation consistent with one primary hormone. Our patient had clinical symptoms and laboratory evaluation consistent with an insulinoma but was found to have four NETs, each with different IF staining patterns. Advanced preoperative and intraoperative imaging is important to identify and treat all present NETs. Moreover, serum hormone levels pre- and posttreatment could help evaluate whether NETs are actively secreting hormones into the bloodstream or simply expressing them within the pancreas. Finally, this case highlights the importance of genetic testing for MEN1 in all young patients with insulinomas.
Prosedur TEVAR pada Diseksi Aorta Klasik tipe B Kronis
Authors: Herbani Merlita , Kurnianingsih Novi
Published: March 2024

Introduksi : Diseksi aorta tipe B masih menjadi beban kesehatan yang dapat merugikan kualitas hidup. Dalam kasus ini, prosedur TEVAR masih menjadi pengobatan pilihan jika diindikasikan. Namun TEVAR pada diseksi aorta tipe B kronis masih sering dipertanyakan antara keuntungan dan komplikasinya.

Ilustrasi Kasus : Laki-laki 42 tahun dengan nyeri dada, didiagnosis dengan Diseksi Aorta tipe B Kronis. Prosedur TEVAR dilakukan pada pasien, dengan indikasi klinis dan radiologis. CT scan evaluasi dilakukan 3 bulan kemudian dan didapati penutupan false lumen, serta ginjal kiri menerima vaskularisasi kolateral dengan pengecilan ukuran. Saat ini pasien tidak mengeluhkan gejala apapun.

Diskusi : Prosedur TEVAR pada diseksi aorta tipe B kronis sesuai indikasi dapat meningkatkan harapan hidup pasien. Evaluasi berkala tetap diperlukan untuk deteksi awal komplikasi dan evaluasi vascular sekitar stent-graft.

Kesimpulan : Prosedur TEVAR pada pasien diseksi aorta tipe B kronis dapat dipertimbangkan untuk meningkatkan harapan hidup pasien.
Sweetened Beverages, Genetic Susceptibility, and Incident Atrial Fibrillation: A Prospective Cohort Study
Authors: Sun Ying , Yu Bowei , Yu Yuefeng , Wang Bin , Tan Xiao , Lu Yingli , Wang Yu , Zhang Kun , Wang Ningjian
Published: March 2024

BACKGROUND:

An association between sweetened beverages and several cardiometabolic diseases has been reported, but their association with atrial fibrillation (AF) is unclear. We aimed to investigate the associations between consumption of sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB), and pure fruit juice (PJ) and risk of consumption with AF risk and further evaluate whether genetic susceptibility modifies these associations.

METHODS:

A total of 201 856 participants who were free of baseline AF, had genetic data available, and completed a 24-hour diet questionnaire were included. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS:

During a median follow-up of 9.9 years, 9362 incident AF cases were documented. Compared with nonconsumers, individuals who consumed >2 L/wk of SSB or ASB had an increased risk of AF (HR, 1.10 [95% CI, 1.01–1.20] and HR, 1.20 [95% CI, 1.10–1.31]) in the multivariable-adjusted model. A negative association was observed between the consumption of ≤1 L/wk of PJ and the risk of AF (HR, 0.92 [95% CI, 0.87–0.97]). The highest HRs (95% CIs) of AF were observed for participants at high genetic risk who consumed >2 L/wk of ASB (HR, 3.51 [95% CI, 2.94–4.19]), and the lowest HR were observed for those at low genetic risk who consumed ≤1 L/wk of PJ (HR, 0.77 [95% CI, 0.65–0.92]). No significant interactions were observed between the consumption of SSB, ASB, or PJ and genetic predisposition to AF.

CONCLUSIONS:

Consumption of SSB and ASB at >2 L/wk was associated with an increased risk for AF. PJ consumption ≤1 L/wk was associated with a modestly lower risk for AF. The association between sweetened beverages and AF risk persisted after adjustment for genetic susceptibility to AF. This study does not demonstrate that consumption of SSB and ASB alters AF risk but rather that the consumption of SSB and ASB may predict AF risk beyond traditional risk factors.
Relationship Between Social Support and Clinical Outcomes: An Evaluation of Participant-Nominated Treatment Supporters in the HOPE 4 Intervention
Authors: Drakos Anastasia , McCready Tara , Lopez-Jaramillo Patricio , Islam Shofiqul , McKee Martin , Yusuf Salim , Schwalm JD
Published: March 2024

BACKGROUND:

The HOPE 4 trial (Heart Outcomes Prevention and Evaluation 4) investigated the effectiveness of a comprehensive, collaborative model of care, implemented in Colombia and Malaysia, which aimed to reduce cardiovascular disease risk in individuals with hypertension. One component of this intervention was the nomination of a treatment supporter, where participants could select a family member or friend to assist them with their care. The purpose of this study was to investigate the impact of these individuals on participant outcomes, as well as the relationship dynamics between participants and their treatment supporter.

METHODS:

Participants in the HOPE 4 intervention group with baseline and 12 months of follow-up were included for analysis. They were divided into Every Visit (n=339) and <Every Visit (n=268) groups based on whether they had a treatment supporter for all 5 or for <5 follow-up visits, respectively. Outcomes were stratified between groups and tested for significance using a generalized linear mixed-effects model. A survey investigating participant satisfaction with their treatment supporter was administered at 12 months.

RESULTS:

Groups were majority female (53% versus 62%) with a mean age of 63 and 66 years. Country of origin differed between groups (22% versus 86%; Colombia). A 15.5% ([95% CI, 6.2%–24.8%]
P
=0.004) greater increase in statin medication use was reported in the Every Visit group at 12 months compared with the <Every Visit group. Sixty-one percent versus 48.2% of participants reported high medication adherence at 12 months (
P
<0.003). The difference in change in systolic blood pressure between groups was not found to be significant at 12 months, though it favored the Every Visit group (−2.3 [95% CI, −6.1 to 1.5];
P
=0.045). The majority of survey respondents from either study group strongly agreed that having a treatment supporter positively influenced their health.

CONCLUSIONS:

Long-term support from a nominated treatment supporter was associated with improved adherence, risk factor management, and medication use among individuals with hypertension.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01826019.
Abstract 020: Undulating Flow Velocities as an Induced Test of Autoregulation After Thrombectomy for Acute Ischemic Stroke
Authors: Mikkawi Aya , Alshaer Qasem N , Mohammaden Mahmoud , Haussen Diogo , Anderson Aaron
Published: March 2024

Introduction

Loss of autoregulation after endovascular therapy (EVT) for large‐artery acute ischemic stroke (AIS) is well documented. [1] This might result in worse outcomes, despite successful recanalization, from hyper‐ or hypoperfusion with a risk for hemorrhagic conversion or larger stroke volume, respectively. Transcranial doppler (TCD) was previously used to document this phenomenon using spontaneous fluctuations in reactivity. Herein, we present a patient with suspected obstructive sleep apnea (OSA) with undulating flow velocities on TCD, serving as a test for induced vasoreactivity with pre‐ and post‐EVT TCD.

Methods

A case‐report.

Results

A middle‐aged patient was admitted with acute left cerebellar stroke (figure 1A). An Embolic etiology was suspected and a 20‐minuteTCD was done for spontaneous emboli detection on bilateral middle cerebral arteries (MCA). The patient fell asleep during the study and it incidentally revealed a bilaterally symmetric undulating velocity, which is a pattern that was previously described with OSA as a result of vasomotor response to multiple apnea and hypopnea episodes occurring in succession (Figure 1D – Pre‐EVT). [2] This pattern indicates intact vasomotor reactivity to fluctuating O2 and CO2 levels during episodes of apnea. Six days later, the patient developed acute right MCA stroke (Figure 1B) and was treated with EVT with successful reperfusion (TICI 2B67) (Figure 1C). TCD was repeated after EVT, and the previously seen undulating pattern was lost with significantly reduced variability on the right MCA compared to the contralateral side (figure 1E – Post‐EVT). This indicates a significant reduction in vasomotor reactivity and autoregulatory capacity of the right MCA. Follow up imaging revealed hemorrhagic conversion in the bed of the stroke with intraparenchymal bleeding (PH1) (Figures 1F‐H).

This case is unique since it provides an induced test of autoregulation and compares pre‐ and post‐EVT autoregulatory function. Prior reports did not use any stressors to test for autoregulation. While in this case, apnea served as a natural test for autoregulation allowing for easier detection. This can serve as a future marker that can be easily quantified and might guide post‐EVT care. Using breath holding maneuvers or medication (e.g., Acetazolamide) might be considered in the future to quantify the autoregulatory response. Further studies are required to investigate the utility of induced, instead of spontaneous, autoregulation assessment post‐EVT to guide blood pressure goals and the duration of strict blood pressure control after endovascular intervention.

Conclusion

Induced tests for autoregulation using TCD might be feasible and should be considered in the future as an easy method for quantifying autoregulation post‐EVT. Further studies are required to clarify the utility of this biomarker in guiding post‐EVT care.
Abstract 027: Adjunctive Intra‐Arterial Tenecteplase Following Mechanical Thrombectomy. (ALLY) Pilot Trial
Authors: Alhajala Hisham , Castonguay Alicia , Jumaa Mouhammad , Rao Rahul , Sheth Sunil , Oliver Marion , Burgess Richard , Jadhav Ashutosh , Haussen Diogo , Zaidat Osama O , Zaidi Syed Fazal
Published: March 2024

Introduction

Intraarterial thrombolytic treatment after mechanical thrombectomy (MT) in patients with large vessel occlusion ischemic stroke may improve the odds of achieving complete reperfusion and favorable functional outcome at 90 days. This study evaluated the safety and efficacy of intraarterial Tenecteplase (IA TNK) as an adjunctive therapy to mechanical thrombectomy in patients with anterior circulation large vessel occlusion. The primary safety endpoint is the rate of symptomatic ICH within 24 hours of treatment with IA TNK. The primary efficacy endpoint is the proportion of patients with improvement of reperfusion. The secondary endpoints included final revascularization grade, discharge mortality, and any intracranial hemorrhage.

Methods

ALLY is a prospective, single‐center, single‐arm pilot study (ClinicalTrials.gov Identifier: NCT05172934). The study enrolled adult patients ≥18 and ≤85 years with large vessel (ICA or MCA) occlusion, with pre‐morbid mRS ≤3 who underwent mechanical thrombectomy and achieved incomplete reperfusion with a final TICI score of 2b and 2C. All enrolled subjects received at least one dose of 1.5 mg IA TNK. Additional treatments were administered at the discretion of the operator to a maximum of 4.5 mg IA TNK. Treatments were administered as a bolus in 3 divided doses given 5 minutes apart, with angiographic runs obtained before and after the final treatment. All patients had imaging follow up (MRI of CT) after 24 hours of treatment. Clinical assessment was completed with NIHSS and mRS scales. Angiographic and imaging data were adjudicated by an independent core laboratory.

Results

ALLY is a prospective, single‐center, single‐arm pilot study (ClinicalTrials.gov Identifier: NCT05172934). The study enrolled adult patients ≥18 and ≤85 years with large vessel (ICA or MCA) occlusion, with pre‐morbid mRS ≤3 who underwent mechanical thrombectomy and achieved incomplete reperfusion with a final TICI score of 2b and 2C. All enrolled subjects received at least one dose of 1.5 mg IA TNK. Additional treatments were administered at the discretion of the operator to a maximum of 4.5 mg IA TNK. Treatments were administered as a bolus in 3 divided doses given 5 minutes apart, with angiographic runs obtained before and after the final treatment. All patients had imaging follow up (MRI of CT) after 24 hours of treatment. Clinical assessment was completed with NIHSS and mRS scales. Angiographic and imaging data were adjudicated by an independent core laboratory.

Conclusion

Ally pilot study demonstrated that adjunctive intraarterial Tenecteplase to mechanical thrombectomy was safe and feasible without major complications. Although there was no change in final reperfusion TICI score, there was evidence of improved distal perfusion on angiographic images.
Abstract 031: Onyx versus nBCA in MMA Embolization for cSDH: A Single Center Experience of 234 hemispheres
Authors: Doheim Mohamed F , Kuybu Okkes , Salem Mohamed M , Ruiz Aldo Mendez , Fadhil Ali , Sultany Abdullah , Narayanan Sandra , Lang Michael , Al‐Bayati Alhamza , Nogueira Raul G , Gross Bradley
Published: March 2024

Introduction

There is growing evidence supporting endovascular treatment with middle meningeal artery embolization (MMAE) for the treatment of chronic subdural hematoma (cSDH). We aimed to compare Onyx vs. N‐Butyl cyanoacrylate (n‐BCA) as liquid embolic materials for MMAE.

Methods

We included all eligible patients undergoing MMAE for cSDH at University of Pittsburgh Medical Center from April 2019 to December 2022. The main outcomes included radiographic resolution of cSDH with at least 50% reduction of hematoma thickness as a surrogate for treatment success in addition to the need for rescue surgical intervention. Additional outcomes including complication rates and hematoma thickness at the last available follow up.

Results

A total of 195 patients underwent embolization of 234 hemispheres including 39 bilateral procedures and had available data for final analysis (168 (71.8%) in Onyx group vs. 66 (28.2%) in n‐BCA group). There were no significant differences in age, sex, co‐morbidities, prior SDH/evacuation, pre‐operative cSDH thickness, or use of antithrombotic therapy(P>0.05) while concurrent surgical intervention and midline shift showed a statistically significant difference (P<0.05). On last follow‐up imaging, radiographical treatment success defined as ≥ 50% reduction in hematoma thickness was comparable in Onyx and the n‐BCA groups (50.9% vs 54.8%, P=0.6). Similarly, there was no statistically significant difference in the proportion of patients requiring rescue surgery between both groups (4.8% vs. 7.6%, P=0.4). Excluding concurrent surgical intervention patients yielded similar comparable results. Hematoma thickness at late follow‐up was not statistically significant between both group (8.25 (4.8‐12) mm vs 6.9 (3.1‐11) mm, P =0.11). There was no statistically significant difference in procedural complications between both groups (1.2% vs 1.5%, P=0.84).

Conclusion

Onyx and n‐BCA in MMAE seem to have comparable outcomes when used in the endovascular treatment of cSDH treatment. Further prospective studies with larger sample sizes are needed to confirm these findings.
Abstract 034: Value of Immediate Flat Panel Perfusion Imaging After Endovascular Therapy: A proof of concept study
Authors: Mujanovic Adnan , Kurmann Christoph , Manhart Michael , Piechowiak Eike , Pilgram‐Pastor Sara , Serrallach Bettina , Boulouis Gregoire , Meinel Thomas , Seiffge David , Jung Simon , Arnold Marcel , Nguyen Thanh , Fischer Urs , Gralla Jan , Dobrocky Tomas , Mordasini Pasquale , Kaesmacher Johannes
Published: March 2024

Introduction

Clinical utility and diagnostic sensitivity of new‐generation flat‐panel computed tomography perfusion imaging (FPCTP) performed immediately after mechanical thrombectomy (MT) is unknown. We aimed to assess whether FPCTP obtained directly after MT could provide additional potentially relevant information on tissue reperfusion status.

Methods

Qualitative, single‐center analysis of all consecutive acute stroke patients admitted between 06/2019 and 03/2021 who underwent MT and post‐interventional FPCTP (n=26). A core‐lab blinded to technical details and clinical data performed reperfusion grading on post‐interventional digital subtraction angiography (DSA) images and time‐sensitive FPCTP maps. All patients were classified according to agreement between DSA and FPCTP.

Results

In 10/26 patients FPCTP revealed new, potentially clinically relevant information. Core‐lab adjudicated dichotomized detection of hypoperfusion (present/absent) was concurring in 21/26 (81%) patients. Of these, reperfusion findings showed perfect agreement on location and size in 16 (62%) patients, while in 5 (19%) patients with incomplete reperfusion, FPCTP showed additional hypoperfused areas missed on DSA. Of the remaining five patients subject to disagreement regarding the presence or absence of hypoperfusion, three showed complete reperfusion on DSA but hypoperfusion was noted on FPCTP, whereas two showed incomplete reperfusion on DSA without detectable hypoperfusion on FPCTP. FPCTP findings could have avoided Thrombolysis in Cerebral Infarction (TICI) overestimation in all false‐positive operator‐rated TICI3 cases.

Conclusion

In both core‐lab and real‐world operator assessment, FPCTP may provide additional clinically relevant information in a considerable percentage of patients undergoing MT. Hence, FPCTP may constitute a new standard for evaluating reperfusion efficacy and informed decision making in the angiography suite.
Abstract 035: Workflow Improvements from Automated LVO Detection Algorithms Are Dependent on Care Team Engagement
Authors: Azeem Hussain M
Published: March 2024

Introduction

Automated machine learning (ML)‐based large vessel occlusion (LVO) detection algorithms have been shown to improve in‐hospital workflow metrics including door to groin time (DTG). The degree to which care team engagement and interaction are required for these benefits remains incompletely characterized.

Methods

This analysis was conducted as a pre‐planned post hoc analysis of our multicenter, prospective randomized clinical trial (NCT05838456). ML‐based LVO detection software was implemented at 4 comprehensive stroke centers in the greater Houston area in a stepped fashion between Jan 2021 and March 2022. Patients were included in this analysis if they underwent EVT for LVO AIS. Patients were excluded if they presented as inter‐hospital transfers or inpatient stroke alerts, as these workflows diverge considerably from ER‐based ones. ML‐software utilization quantified as the number of software interactions including imaging viewing and/or HIPAA‐compliant text messaging and was trichotomized at the hospital level into low/medium/high. Primary outcome was the reduction in DTG relation to pre‐ML implementation by hospital utilization level. Secondary outcomes included CT to groin puncture time, and sensitivity analyses in subsets of patients who did and did not have an LVO alert sent.

Results

Among 243 patients that met inclusion criteria, median age was 70 (IQR 58‐79), 50% were female and median NIHSS was 17 (IQR 11‐22). ML‐software utilization varied considerably with high‐utilization centers (n=2) interacting with mean 160 times, medium (n=1) 64 times and low center (n=1) 42 times during the study period. We observed a reduction on DTG of 11 minutes in the high‐interaction center (p<0.01) but no significant reduction in DTG in the medium or low‐interaction centers. Similarly, time from CT scan initiation to groin puncture fell in the high‐utilization centers by 32 minutes (p<0.05) but no significant change in others. Without adjusting for hospital‐level software utilization, there was no statistically significant reduction in DTG for patients analyzed by the ML software versus those that were not (p=0.35).

Conclusion

ML‐based workflow improvements are dependent on care team adoption and utilization.
Abstract 039: Angiographic Outcomes of Woven EndoBridge and Balloon‐Assisted Coiling for the Treatment of Ruptured Wide‐Necked Aneurysms
Authors: Calienes Aaron Rodriguez , Vivanco‐Suarez Juan , Galecio‐Castillo Milagros , Gross Bradley , Farooqui Mudassir , Algin Oktay , Feigen Chaim , Altschul David , Ortega‐Gutierrez Santiago
Published: March 2024

Introduction

The optimal endovascular approach for wide‐neck intracranial aneurysms (IAs) during the acute phase of bleeding remains uncertain, and the use of stent‐assisted coiling or flow diversion is controversial due to antiplatelet therapy requirements and potential risks (1, 2). Various techniques have been developed to address these challenges, including balloon‐assisted coiling (BAC) and intrasaccular flow‐disruption. The Woven EndoBridge (WEB) is a flow disrupter that has gained popularity in treating ruptured IAs due to its effectiveness in occluding aneurysms with minimal rebleeding (3, 4). The aim of this study is to provide outcome comparisons between WEB and BAC in a specific cohort of patients with ruptured wide‐necked IAs.

Methods

In this international cohort study, we included consecutive patients treated for ruptured wide‐neck IAs with either WEB or BAC at three neurovascular centers. The primary effectiveness outcome was complete aneurysm occlusion at the final imaging follow‐up using the Raymond‐Roy (RR) occlusion classification. Secondary outcomes included favorable functional outcome and periprocedural hemorrhagic/ischemia‐related complications. Comparisons were performed using multivariable logistic and ordinal regressions.

Results

One hundred four patients treated with WEB and 107 patients treated with BAC were included. The mean length of imaging follow‐up was 17.5 (± 17.6) months in the WEB group and 11.8 (± 10.3) months in the BAC group (p = 0.142). Of the patients, 60.5% in the WEB group and 53% in the BAC group achieved complete occlusion, with no significant difference between the two groups after adjusting for covariates (adjusted OR [aOR] = 1.02; 95% CI 0.46 – 2.25; p = 0.964). The odds of favorable functional outcome did not significantly differ between the WEB (74.8%) and BAC groups (77.4%, aOR = 1.45; 95% CI 0.65 – 3.24; p = 0.368). Procedure‐related complications were similar in both groups (WEB: 9.6%, BAC: 10.3%, p = 0.872). There was no statistically significant difference observed in the rates of ischemic events (WEB: 6.7% vs. BAC: 2.8%, p = 0.180) and hemorrhagic events (WEB: 3.8% vs. BAC: 7.5%, p = 0.255) between the two groups.

Conclusion

In conclusion, both WEB and BAC techniques showed similar effectiveness and safety outcomes in treating ruptured wide‐neck IAs. Further research and direct comparative studies are needed to better guide treatment decisions for this patient population.
Abstract 048: The Tigertriever 13 for Primary Distal Vessel Occlusions (DVO) ‐ Multicenter Experience
Authors: Nordmeyer Hannes , Fischer Sebastian
Published: March 2024

Introduction

Objective: To evaluate the safety and efficacy of the Tigertriever 13 stent retriever in acute ischemic stroke (AIS) patients with primary distal and medium vessel occlusions (DMVO). Tigertriever 13 is a low profile stentriever that enables using a small microcatheter for safer procedures.

Methods

This is a retrospective data analysis of consecutive 59 cases performed between 04/19‐12/22 in two German comprehensive stroke centers. These patients were either ineligible or failed thrombolysis.

Mean age was 75 and pre‐procedure NIHSS was 8,2 (SD 5,1), 55,9% Male, 37,2% were treated and failed thrombolysis treatment. These patients were admitted with disabling deficits that localize to the territory of the distal vessels. The occluded locations were 58,0% MCA M3, 0,0% MCA M4, 22,0% ACA, 20,0% PCA. All patients were treated with Tigertiever 13 with a mean of 1,7 passes where 100% under general anesthesia. Successful recanalization of the occluded vessel was measured by TICI score and intraoperative complications were recorded for safety evaluation.

Results

The mean time from symptoms onset to groin puncture was 200 minutes, and a successful recanalization rate of TICI 2b‐3 was observed in 72,8% of the patients while NIHSS was improved from 8,2 at baseline to 5,7 at discharge. There were 11,8% asymptomatic intracranial hemorrhages (ICH) and 0,5% symptomatic ICH.

Conclusion

The Tigertriever 13 device with operator controllability and high fluoroscopy visibility and its small size can potentially provide a safe and effective clot removal in patients with distal vessels occlusion. The effectiveness and safety profile in these patients with distal occlusions is comparable to those of patients with proximal occlusions.
Abstract 050: Intraarterial cooling combined with mechanical thrombectomy in acute stroke patients: systematic review and meta‐analysis
Authors: Eskian Mahsa , Miller Ronald , Sharashidze Vera , Heit Jeremy , Gould Grahame
Published: March 2024

Introduction

Mechanical thrombectomy (MT) plays an important role in the treatment of intracranial large vessel occlusion (LVO) with recanalization success rate of 60%‐95%. Although the restoration of blood flow can ensue excess generation of reactive oxygen species (ROS) and inflammation which leads to cellular damage known as reperfusion injury. Recent studies have shown promising neuroprotection by reducing body temperature with the mechanism of limiting ROS and immune cells’ response. Although systemic hypothermia is associated with several adverse events and limited hypothermia affecting the specific ischemic brain tissue. Intra‐arterial cooling (IAC) combined with mechanical thrombectomy is a novel method for localized cooling.

Methods

Embase, and Web of Science were screened for English‐language papers including case reports/series, cohort studies and clinical trials. Studies were reviewed by 2 independent reviewers for inclusion criteria as patients with the age of >18 years old who had LVO and underwent mechanical thrombectomy combined with cold Saline infusion during mechanical thrombectomy (before or after recanalization). Statistical analyses were performed using R software version R‐4.3, P Value of <0.05 was considered significant.

Results

Four studies were included from initial 1177 studies, including 204 cases with MT combined with IAC (intra‐arterial 4°C saline infusion before or after recanalization) and 219 control with MT. Patients with MT+IAC had lower final infarct volume (MD=25, 95%CI [‐34.02, ‐15.98], P <0.0001), and better modified Rankin scale (mRS) after 90 days (RR=1.42, 95%CI [1.14, 1.77, P= 0.0015). There was no significant difference between MT+IAC and IAC group regarding deterioration of NIHSS in 24 hours(RR=1.09, 95%CI [0.42, 1.3, P=0.287), recanalization at 24 hours (RR=1.03, 95%CI [0.93, 1.14], P= 0.622), vascular spasm in 10 minutes (RR=2.90, , 95%CI [0.78, 10.80], P= 0.111), symptomatic intracranial hemorrhage (RR=0.78, 95%CI [0.48, 1.27], P= 0.322), coagulation abnormality (RR=0.94, , 95%CI [0.35, 2.54], P= 0.902), pneumonia (RR=1.09, 95%CI [0.79, 1.50], P= 0.585), and mortality in 90 days (RR=0.78, 95%CI [0.51, 1.20], P= 0.265).

Conclusion

Preliminary data is showing Intraarterial cooling combined with mechanical thrombectomy in acute stroke is a feasible and safe method for localized brain tissue cooling to prevent reperfusion injury and maximize long term outcome of MT.
Abstract 052: External Validation of the Prediction Model For Delayed Reperfusion in Patients with Incomplete Reperfusion: EXTEND‐PROCEED
Authors: Mujanovic Adnan , Ng Felix , Branca Mattia , Meinel Thomas , Churilov Leonid , Mitchell Peter , Yassi Nawaf , Parsons Mark , Sharma Gagan , Arnold Marcel , Piechowiak Eike , Kleinig Timothy , Seiffge David , Dobrocky Tomas , Gralla Jan , Fischer Urs , Campbell Bruce , Kaesmacher Johannes
Published: March 2024

Introduction

The benefit of additional reperfusion attempts in patients with partial angiographic reperfusion (TICI2b) is unknown. The PROCEED model predicts subsequent favorable occurrence of complete reperfusion (i.e. delayed reperfusion [DR]) at 24 hours after initial incomplete angiographic reperfusion at the conclusion of thrombectomy. This study aims to externally validate the PROCEED model using pooled data from multiple international trials that systematically performed follow‐up perfusion imaging.

Methods

Individual patient data for external validation were obtained from the EXTEND‐IA, EXTEND‐IA TNK part 1 and 2 trials (clinicaltrials.gov, unique‐identifier: NCT01492725, NCT02388061 and NCT03340493). The model’s primary outcome of interest was the occurrence of DR, defined as the absence of any focal perfusion deficit on follow‐up CT or MRI perfusion imaging maps, despite initial incomplete angiographic reperfusion on the final thrombectomy angiography series. The updated model’s performance was evaluated with discrimination, calibration and clinical decision curves.

Results

We analyzed 267 patients for the external validation, with median age of 74 (IQR 64 – 80), 44.2% were female and 62% had DR. The externally validated model had good discrimination (C‐statistic 0.81, 95% CI 0.72 – 0.86) and was well calibrated (intercept 0.22, 95% CI 0.18‐0.33 and slope 0.96, 95% CI 0.81‐1.23). With threshold probability of R=12% (i.e. 88% chance of having DR), pursuing additional reperfusion attempts to pursue complete angiographic reperfusion in a patient with high‐likelihood of DR were seven times worse (Cost:Benefit Ratio 1:7, Figure 1) than no further endovascular maneuver. In terms of standardized net reduction, the PROCEED model could reduce one in five unnecessary interventions without missing an intervention for any patient who would eventually have DR. Across a wide range of threshold probabilities, the model outperformed the scenario of the typical decision‐making process in the angiography suite, based on the current treatment guidelines.

Conclusion

The externally validated model had good predictive accuracy and discrimination. Depending on the acceptable risk threshold, the model may compliment clinical judgment of the treating physicians and inform on natural progression of untreated incomplete reperfusion.