bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 10: Neuroendocrine Dysfunction and Functional Disability Following Stroke
Authors: Kreber Lisa A , Singh Charan K 
Published: June 2021

Comprehensive studies of the incidence of neuroendocrine dysfunction following stroke are lacking. The objectives of this study were to determine the incidence of neuroendocrine dysfunction in patients with stroke and to determine if growth hormone deficiency (GHD) contributes to disability following stroke.
Hormones were assessed in 130 patients with stroke (ischemic: n=65; hemorrhagic: n=65; M time since stroke=155 days; men=81; M age = 52). TSH, T3, T4, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, testosterone, cortisol, and insulin-like growth factor-1 were assessed. All patients underwent glucagon stimulation testing (GST) to assess growth hormone (GH). Patients were then classified as having severe GHD, moderate GHD or normal GH based on the results of the GST. Functional disability was assessed with the Disability Rating Scale, Independent Living Scale (ILS), and the Mayo-Portland Adaptability Inventory-IV.
The majority of stroke patients had GHD (30% severe; 29% moderate). Patients with ischemic stroke had a higher prevalence of GHD (34% severe; 33% moderate) compared to patients with hemorrhagic stroke (26% severe; 23% moderate). The severe GHD group had significantly lower levels of FSH than the moderate GHD and normal GH groups (p<0.01). The moderate GHD group had significantly lower levels of LH than the severe GHD and normal GH groups (p<0.05) and significantly lower levels of T3 than the severe GHD and normal GH groups (p<0.05). The severe GHD group performed worse on the Activities of Daily Living and Behavior subscales of the ILS than the moderate GHD and normal GH groups (p<0.05).
GHD was more prevalent in patients with ischemic stroke, indicating that type of stroke may influence neuroendocrine functioning. Additionally, FSH, LH and T3 were lower in patients with GHD than in patients with normal levels of GH. The implications of these findings suggest that routine, comprehensive neuroendocrine testing may be warranted in individuals who have sustained a stroke. Patients with GHD were more functionally disabled in their ability to perform activities of daily living and to engage in socially appropriate behavior. These findings suggest that hormone deficiencies can influence disability post-stroke.
Abstract TMP104: The Effect of Hypothetical Lifestyle Strategies on the Long-term Risk of Stroke
Authors: Jain Priyanka , Suemoto Claudia K , Rexrode Kathryn , Danaei Goodarz , Hernan Miguel A 
Published: June 2021

Randomized trials have examined the short-term effects of lifestyle interventions on the risk of stroke. Using observational data to estimate the long-term effect of such strategies requires valid adjustment for time-varying confounders- such as hypertension- that are affected by prior lifestyle risk factors.
We estimated the long-term effect of hypothetical lifestyle strategies on risk of stroke using data from the Nurses’ Health Study, a prospective cohort. We followed 60,390 women, aged 52 years on average at baseline, from 1986 to 2010. We used a Monte Carlo simulation to estimate the 24-year risk of stroke had all participants followed three non-dietary lifestyle strategies: smoking cessation, exercising (≥30 minutes/day), reducing body mass index (BMI) by 5% every two years if overweight/obese; as well as several dietary strategies including: eating ≥ 3 servings/week of fish, eating ≤ 3 servings/week of unprocessed red meat, eating no processed red meat, eating ≥ 5 servings/day of fruits and vegetables, among others. We used the parametric g-formula to adjust for baseline and time-varying confounders, comparing the estimated risk of stroke under our specified strategies of interest to the same had all participants followed a “do-nothing” strategy.
The observed 24-year risks of total, ischemic and hemorrhagic stroke in this cohort were 2.9%, 2.2% and 0.6%. The estimated risk of total stroke was 25% lower (95% CI: 5% to 46%) under a combination of all three non-dietary strategies, the most effective being exercise (19% lower risk) and smoking cessation (5% lower risk). Of the dietary strategies, eating ≤ 3 servings of unprocessed red meat reduced the estimated risk of total stroke by 4% (1% to 7%). The risk of ischemic stroke under all three non-dietary strategies was 36% lower (15% to 59%), but risk of hemorrhagic stroke did not materially change. Exercise reduced the estimated risk of ischemic stroke by 29% (7% to 56%) and lowering BMI by 4% (0% to 8%). Additionally, ischemic stroke risk was lowered by 9% (0% to 19%) by decreasing intake of processed red meat and 6% (2% to 10%) by decreasing intake of unprocessed red meat.
In summary, lifestyle modifications were estimated to reduce the 24-year risk of total stroke by up to 25% in this population of middle-aged women.
Abstract TP294: Effect of Educational Level on Atrial Fibrillation Patients’ Knowledge and Perceptions About Oral Anticoagulation Therapy: Results From an International Study
Authors: Lane Deirdre A , Meyerhoff Juliane , Rohner Ute , Lip Gregory Y 
Published: June 2021

Introduction:
Previous research has demonstrated that patients with atrial fibrillation (AF) have limited knowledge of AF, stroke and oral anticoagulant (OAC) treatment. This analysis assessed the effect of educational level on stroke knowledge, AF perception, concern about stroke, OAC treatment preferences and adherence.

Methods:
This was a cross-sectional, prospective survey of 936 adult patients (mean (SD) age 54.3 (16.6) yrs; 37.2% female) with AF on OACs in the USA, Canada, Germany, France and Japan. Three groups were included: AF with recent stroke (≤ 6 m); new onset AF (≤ 6 [ ≤ 12 m in Japan]) without recent stroke; established AF (7-24m [1-3yrs in Japan]) without recent stroke. Open-ended questions determined stroke knowledge, assessed according to a predefined scoring system. Patients were grouped according to educational level: no school-leaving certificate (low), high school diploma, community college and university/technical college.

Results:
Stroke knowledge was similar in all patients regardless of educational level.

A greater proportion of patients with college education were ‘always’ or ‘often concerned’ about stroke, whereas a greater proportion of those with low levels of education were ‘never concerned’ about stroke (or didn’t know).
Educational level had no effect on self-reported OAC adherence or patient preference to be involved in OAC treatment decisions. Patients with no school leaving certificate perceived taking medication (all drugs) as a ‘major burden’ (25.9%), while significantly more patients with college/university education did not view taking medication as burdensome (38.5% and 50.4% versus 37.0%, respectively; Table).

Conclusions:
Education influenced patients’ perceptions of the seriousness of AF, frequency of concern about stroke and perceived burden of medication. Educational attainment did not affect level of stroke knowledge, OAC adherence and desire to be involved in OAC treatment decisions.
Abstract TP437: Asymptomatic Carotid Stenosis is Associated With Cognitive Impairment in a Chinese Community Population
Authors: Jia Jiaokun , Zhao Xingquan 
Published: June 2021

Purpose:
This study aimed to investigate the effects of aCAS on cognitive functioning in a Chinese community population who were over 40 year-old and to find the domains of cognitive impairment which were mainly affected.

Methods:
Information was collected on the presence of CAS, which was assessed by Color Doppler Ultrasound, from the Asymptomatic Polyvascular Abnormalities Community study, and cognitive functioning was assessed by the score of the Montreal Cognitive Assessment (MoCA). Multivariate logistic regression was used to assess the relationships between aCAS and cognitive impairment.

Results:
A total of 812 (61.2% men, 55% of 40-60y) patients were included in this study. After adjusting for potential confounding factors, the associations between the aCAS and cognitive impairment remained significant [odds ratio(OR)(95% confidence interval, 95%CI)=1.812(1.049-3.127)]. Also, there were significant relationships between the aCAS and the domains of cognitive function like attention, language, abstraction and recall [OR(95%CI) 2.740(1.494-5.023), 2.005(1.184-3.396), 2.841(1.594-5.065), 4.674(2.478-8.818) respectively, P < 0.05). In addition, there were no interaction effects of age and other possible risk factors on the association.

Conclusion:
In the over 40 year-old Chinese community population, aCAS was an independent indicator of cognitive impairment, especially affecting the function of attention, language, abstraction and recall.

Table 1 Baseline demographic characteristics and cardiovascular risk factors between groups with/without cognitive impairment
Values are median (interquartile range) or number (percent).

Table 2 Unadjusted and Multivariate-adjusted OR (95% CI) for total and subtests of MoCA, according to groups with vs. without CAS.
*P<0.05;**P<0.001

OR: odd ratio; CI: confidence interval
Model 1: adjusted for age and gender.
Model 2: adjusted for age, gender, BMI, education, current smoking and alcohol consumption.
Model 3:adjusted for age, gender, BMI, education, current smoking, alcohol consumption hypertension, diabetes, hyperlipidemia, hs-CRP and Hcy.
Abstract TP50: Non-contrast CT Maximum Intensity Projections (MIPs) for the Detection of Large Vessel Occlusion (LVO)
Authors: Ho James P , Nguyen David T , Pirastehfar Mohsen , Narula Rajiv , Hailey Lovella , Mortin Melissa , Rapp Karen , Agrawal Kunal , Huisa-Garate Branko , Modir Royya , Meyer Dawn M , Hemmen Thomas M , Meyer Brett C 
Published: June 2021

Background:
Identification of LVO is becoming increasingly important with recent guidelines supporting endovascular therapy in selected patients with acute ischemic stroke (AIS).

Non-contrast CT scans are generally used to assess for stroke or hemorrhage in acute stroke code evaluations. CT angiograms (CTA) can be used to assess for LVO but require additional time and contrast administration. Some hospitals lack the resources to acutely obtain and interpret CTAs. Non-contrast CT MIPs may be an alternate modality to detect LVO.

Methods:
We retrospectively reviewed patients with AIS in our UCSD Stroke Registry, presenting between 6/2014-7/2016 that received a MIPs, generated from non-contrast CT scans, and a CTA. MIPs were evaluated by a group of stroke specialists (3 Faculty, 2 Fellows, 2 Acute Care Practitioners [ACPs]). No clinical information was provided. Gold standard comparison was to CTA. Results were stratified by subgroup based on level of training. Inter-rater agreement was assessed using Fleiss’ Kappa Coefficient.

Results:
24 scans were reviewed (12 with LVO, 12 without LVO).

Using MIPs for the detection of LVO, the Faculty subgroup had a sensitivity and specificity of 81% and 86% for any LVO, 95% and 92% for ICA/M1, 42% and 100% for M2 and 67% and 96% for basilar occlusions. The Fellows and ACPs subgroup had a sensitivity and specificity of 77% and 81% for any LVO, 61% and 94% for ICA/M1, 19% and 83% for M2 and 75% and 95% for basilar occlusions.
Inter-rater agreement among Faculty readers was k=0.58 for the detection of any LVO, k=0.75 for ICA/M1, k=0.79 for M2 and k=0.14 for basilar occlusions. Among Fellows and ACPs, k=0.48 for any LVO, k=0.57 for ICA/M1, k=0.40 for M2, and k=0.27 for basilar occlusions.

Conclusions:
Non-contrast CT MIPs have high sensitivity and specificity for the detection of LVO when compared to CTA. Inter-rater agreement between readers of MIPs is good. Better results in the Faculty subgroup were likely due to more experience reviewing imaging. These results support the use of non-contrast CT MIPs for the detection of LVO to both save time and contrast exposure in patients with AIS. Further studies investigating a larger dataset, optimizing MIP parameters, and examining the utility/cost-effectiveness of this technique are being pursued.
Abstract TP90: Casein Kinase 2 Inhibition Preserves Axonal Function Against Ischemia
Authors: Brunet Sylvain , Bastian Chinthasagar , Aquila Danielle , Baltan Selva 
Published: June 2021

Axonal injury and dysfunction are responsible for much of the disability observed following a stroke. Human brain comprises equal proportions of gray matter and white matter and white matter is injured in most strokes. Casein kinase 2 (CK2) is a protein kinase expressed in brain, including white matter, and is regulated by ischemia. We therefore hypothesized that transient CK2 inhibition would protect white matter from ischemic injury.
To assess the impact of CK2 inhibition on axonal electrical activity following oxygen glucose deprivation (OGD), mouse optic nerves (MONs), a pure white matter track, from C57BL/6J were subjected to OGD (1h) while eliciting compound action potentials (CAPs) and exposed to CX-4945, a selective CK2 inhibitor, or control artificial cerebrospinal fluid (ACSF). We observed that CX-4945 preserved CAPs when applied either before or after OGD. Then to determine the impact of CK2 inhibition on glial cell survival following OGD, MONs exposed to OGD that were treated with either CX-4945 or control ACSF were processed for immunohistochemistry. We observed that CX-4945 treatment protected oligodendrocytes from OGD. And finally, to determine if CK2 inhibition protected mitochondrial from OGD, MONs from Thy-1 mito-CFP mice were similarly subjected to OGD in the presence of either CX-4945 or control ACSF. We observed that CX-4945 maintained Thy-1 mito-CFP fluorescence following OGD.
In conclusion, our results suggest that CK2 inhibition preserves axonal function by preserving oligodendrocytes and mitochondrial function following ischemic injury. We propose that CK2 inhibitors, which are currently in phase II-III clinical trials for cancer therapy could be repurposed and provide a novel therapeutic target to protect white matter against ischemic injury, reducing mortality and morbidity and improving recovery following stroke.
Abstract WMP42: Neuro and Gliogenesis in a Nonhuman Primate Model of Ischemic Stroke with Impaired Dexterous Movements
Authors: Choudhury Gourav , Daadi Marcel 
Published: June 2021

Ischemic stroke is the leading cause of upper extremity motor impairments. Well-characterized experimental stroke models for upper extremity motor impairment remain underdeveloped. Cortical representation of dexterous movements in nonhuman primates (NHP) is functionally and topographically similar to that in humans. We recently reported the characterization of an NHP model of focal ischemia reperfusion with a defined syndrome, impaired arm function and finger dexterity. In this study, we investigated the cellular changes in the neural stem cell compartment and glial cell populations in this NHP model.
NHPs were subjected to transient cerebral ischemia by temporarily occluding the M3 segment of the left side middle cerebral artery (MCA). Motor and cognitive functions following the stroke were evaluated using the object retrieval task with barrier-detour. Postmortem analysis included magnetic resonance imaging (MRI) and immunohistopathology to map the infarct and characterize the neurogenic and gliogenic changes.
The MCA occlusion produced significant loss of fine motor function characterized by impaired dexterity. Immunocytochemical analysis revealed significant increase of Sox2+ neural stem cells in the subventricular zone, and of GFAP+ astrocytes (P<0.0001) and Iba-1+ microglia (P<0.0001) in the infarct region. In addition, there was a 42% increase in doublecortin positive cells (P<0.0001) compared to non-ischemic hemisphere.
This study describes the cellular composition of the endogenous changes in the neural stem cell compartment and in the stroke region. These data may help reveal the cellular identity mediating neural plasticity and the cellular mechanisms mediating behavioral deficits and post-stroke recovery.
Abstract WP174: Intensive Phonology Treatment Promotes Recovery in Reading in Chronic Aphasia Post Stroke
Authors: Shamapant Shilpa , Bennett Sarah 
Published: June 2021

Therapies specifically targeting naming deficits are common because these deficits remain one of the most common and pervasive deficits seen in post-stroke aphasia (Goodglass & Wingfield, 1997). Past studies have used single lexical item retrieval (Nickels, 2002) as the framework for both semantic and phonological treatment. The efficacy of this technique is unclear when applied to reading, writing, and lexical retrieval deficits (Boyle, 2004a, 2004b; Coelho, McHugh, & Boyle, 2000). This study aimed to resolve these issues by implementing an easy to replicate design with a randomized control trial.
12 subjects enrolled in intensive speech therapy at Austin Speech Labs were selected for the study. They were randomly assigned to a Semantic (ST) (n=6) or phonological treatment (PT) (n=6) group. Subjects received comprehensive pre and post-testing using the Western Aphasia Battery-Revised (WAB-R), Boston Naming Test (BNT). The subject’s phonological awareness was assessed using subtests of Psycholinguistic Assessment of Language Processing in Aphasia (PALPA).Each participant attended three hours of therapy for a total of 40 hours of therapy.
PT: The first eight weeks focused on mastering individual consonants and vowels and blending sounds to read single words. The second 8-week module focused on training consonants clusters, and spelling.
ST: The first and second module focused on describing object attributes to aid reading, naming, and writing.
An independent T-test (p-value of .05) was used to examine significant differences found in the post-test scores between each group. A paired t-test (p-value=. 05) was run to determine significant differences in pre and post-test scores across both treatment groups. The majority of
participants showed increases between pre and post-testing in all subtests. The phonology group showed significant increases in letter length spelling, letter sounding, spoken and written letter matching, and syllable length reading PALPA subtests. The Semantic group showed significant increases in the WAB verbal commands and repetition subtests as well as the PALPA and spoken and written letter matching subtest.

Conclusion:
Phonology focused treatment appears to be beneficial despite differences in underlying impairments.
Abstract WP46: Sex Differences in Therapeutic Targets in Ischemic Stroke
Authors: Dula Adrienne N , Luby Marie , King Ben , Davis Lisa A , Latour Lawrence L ,   NINDS LESION Investigators, Warach Steven J 
Published: June 2021

Sex differences exist in stroke epidemiology, acute presentation, treatment, and post-stroke clinical outcome. Neuroimaging can objectively identify potential pathological therapeutic targets and is reflective clinical observations. MCA occlusion (MCAO) is measurable by angiography and the presence of penumbra by diffusion-perfusion mismatch. We present evaluation of sex differences in the Lesion Evolution in Stroke and Ischemia On Neuroimaging (LESION) Project to determine if the probability of MCAO and penumbra depend on sex.
We hypothesize imaging-based evidence is consistent with clinical observations of sex differences in severity and interactions with age and race.

Methods:
Patients included in the LESION study were diagnosed with acute ischemic cerebrovascular syndrome, had a brain MRI obtained within 24 hours from last known well and NIHSS>3 or were treated with acute intervention with a pre-treatment MRI. MR imaging included DWI, FLAIR, MRA and PWI, which were co-localized over the entire brain. Patients with M1 or M2 abnormalities were graded as MCAO. The probability of having an MCAO or measurable pathological target was qualitatively evaluated as a function of sex with adjustment for age and race.

Results:
Women were more likely than men (all p<0.05) to have a measurable of MCAO (OR [CI’s]) = (1.43 [1.08-1.89]), perfusion defect (1.42 [1.02-2.0]), or a diffusion-perfusion mismatch (1.35 [1.02-1.80]) (Table). This sex difference remained after adjusting for time from onset, NIHSS and age. Women over 70 years are most likely to have a measurable therapeutic target and white women are more likely to have a penumbral pattern than men or non-white women (p<0.05).

Conclusion:
This preliminary imaging-based evidence is encouraging that sex differences in imaging biomarkers exist in a representative sample of acute stroke patients. This study shows that sex differences exist not only in the clinical phenotype, but in presence of a biological target.
Abstract 171: Endovascular Thrombectomy May Be Cost-Effective for Patients With Large Core Ischemic Strokes: A Cost-Utility Analysis From the SELECT Study
Authors: Pizzo Elena , Lobotesis Kyriakos , Albers Gregory W , Martin-Schild Sheryl , Hassan Ameer , Abraham Michael , Vora Nirav , Chen Peng R , Grotta James C , Sitton Clark , Blackburn Spiros , Dannenbaum Mark , Cai Chunyan , Parsha Kaushik , Reddy Sujan , Kamal Haris , Arora Ashish , Pujara Deep , Imam Bita , Shaker Faris , Barreto Andrew D , Hicks William J , Riascos Roy F , Haussen Diogo , Gupta Rishi , Lansberg Maarten , McCullough Louis D , Savitz Sean I , Sarraj Amrou 
Published: June 2021

Background:
Whether Endovascular Thrombectomy (EVT) is cost-effective in large ischemic core infarcts is unknown.

Methods:
In the prospective multicenter cohort study of imaging selection study (SELECT), large core was defined as CT ASPECTS < 6 or CTP ischemic core volume (rCBF<30%) ≥ 50 cc. A Markov model estimated costs, quality-adjusted life years (QALYs) and the Incremental Cost-effectiveness Ratio (ICER) of EVT compared to Medical Management (MM) over 20 years life expectancy. The lower and upper willingness to pay (WTP) per QALY were set at $50000 and $100000 and the Net Monetary Benefit (NMB) for EVT were calculated. A probabilistic sensitivity analysis (PSA) and cost-effectiveness acceptability curves (CEAC) assessed EVT cost-effective probability at WTP range values.

Results:
Of 361 enrolled, 105 had large core on CT or CTP (EVT 62, MM 43). 19 (31%) EVT patients achieved mRS 0-2 vs 6 (14%) MM (aOR: 3.27, 95% CI: 1.11-9.62;
P
= .03) with a shift towards better mRS (adj cOR: 2.12, 95% CI: 1.05-4.31,
P
= .04). Over 20 years EVT was associated with $26589 (C.I. $8672- $43978) incremental costs and a gain of 1.18 QALYs (C.I. 0.091- 2.2) per patient.

EVT could avert 75 deaths over a theoretical cohort of 1000 patients (MM 861 vs EVT 786) thus the ICER of EVT compared to MM was $22400 per QALY (CI. $10109 - $66140), which is <$50000/QALY, Tab 1.
EVT has a higher NMB compared to MM at the lower and upper WTP thresholds (EVT $86,3 and 271,4 million vs MM $53,6-$179,3 million), Tab 2.
The PSA confirmed the results (fig 1). The CEAC showed 94% and 97% cost-effectiveness probability of EVT at the lower and upper values respectively of the maximum WTP, fig 2.
EVT ICER in SELECT large core ($22400/QALY) was higher but still comparable to those in HERMES ($16882/QALY), DAWN ($7335/QALY) and DEFUSE3 ($14673/QALY), Tab 3.

Conclusion:
EVT may result in better outcomes and more lives saved in large core patients with higher QALYs, NMB and an acceptable ICER. The results were comparable to other EVT RCTs.