bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 113: Nuclear Translocation of Neuronal Histone Deacetylase 4 (HDAC4) is Detrimental in Stroke
Authors: Yuan Hui , Benashski Sharon , Denton Kyle , Li Xue-jun , McCullough Louise , Li Jun 
Published: March 2022

HDAC4 has been identified as a transcriptional corepressor that catalyzes local histone deacetylation. It is highly expressed in neurons and usually trapped in cytosol. In vitro, translocation of HDAC4 from cytosol into nucleus induced neuronal death in response to glutamate toxicity. Here we assessed the hypothesis that accumulation of nuclear HDAC4 occurs after stroke, this translocation is detrimental in stroke outcome and regulated by calcium/calmodulin-dependent protein kinase IV (CaMK IV).
Wild type (WT) and CaMK IV knockout (KO) mice were subjected to transient middle cerebral artery occlusion and were sacrificed 6 hours for molecule assessments or 72 hours post stroke for outcome assessments. Primary cortical neurons underwent oxygen-glucose deprivation (OGD) and viability was measured 24 hours after OGD. Lentiviral vectors were utilized in culture and mice.
Stroke induced HDAC4 nuclear translocation in WT mice as assessed by both Western blots and immunohistochemistry. Knockdown of HDAC4 improved cell viability after OGD (HDAC4 SiRNA: 87.19±7.57% vs. control: 68.09±3.83%, p<0.05, n=6). Expression of a nuclear restricted HDAC4 mutant (Nuc) reduced cell viability after OGD (p<0.05), in contrast, no effect was seen for a cytoplasmic mutant HDAC4 (Cyto) (Nuc: 50.32±1.36% and Cyto: 68.95±2.17% vs. GFP control: 73.25±1.28%, n=6). In vivo nuclear HDAC4 mutant expression increased hemispheric infarcts (Nuc: 57.54±1.67% vs. Cyto: 36.98±3.26%) and worsened mice performance in rotarod test (Nuc: 12.38±3.50 seconds vs. Cyto: 33.65±2.98 seconds) compared with expression of cytoplasmic HDAC4 mutant after stroke (p<0.05, n=8-10). Percentage of nuclear HDAC4 positive neurons in penumbra was increased in CaMK IV KO mice (KO: 66.28±4.28% vs. WT: 37.08±2.44%, p<0.05, n=4) when compared to WT after stroke. Finally, overexpression of CaMK IV increased neuronal viability after OGD; however, this effect was lost when HDAC4 was inhibited by SiRNA.
In conclusion, we showed that ischemia induces HDAC4 nuclear shuttling in neurons and this translocation is deleterious in stroke outcome. Our data suggested CaMK IV inhibits HDAC4 nuclear accumulation in stroke.
Abstract 17: Development of High Risk TCD in Sickle Cell Disease
Authors: Adams Robert , Fullerton Heather , Kwiatkowski Janet , Voeks Jenifer 
Published: March 2022

Background:
The Stroke Prevention Trial in Sickle Cell Anemia (STOP) and Optimizing Primary Stroke Prevention in Sickle Cell Anemia (STOP 2) established routine transcranial Doppler ultrasound (TCD) as standard of care. Some information on conversion from low to high risk was derived from the STOP/2 studies but information is needed from “real world” practice to improve TCD screening guidelines.

Subjects and Methods:
During STOP and STOP2, 3,837 children, ages 2 to 16 y with SCD-SS or SCD-SBeta-0-thalassemia, underwent screening TCD. The POST-STOP study was designed to follow-up all children who participated in one or both of these trials. 19 of the 26 original study sites participated in POST-STOP, contributing a total of 3,541 (92%) of STOP/STOP2 subjects. Data abstractors visited the clinical sites to extract TCD, neuroimaging and neurological outcome information.

Results:
Of the 3,541 subjects, follow-up data were available for 2834 (80%). The mean age at the last TCD STOP/2study was 9.5 years, the mean age at last follow-up in POST-STOP was 19.6 years and the mean duration of follow-up after exiting STOP/STOP2 was 9.2 years. STOP TCD risk stratification was used: normal < 170 cm/sec; conditional 170-199 cm/sec; abnormal >200 cm/sec. Subjects were classified by their highest risk TCD in STOP/STOP 2. The population was divided on this basis into normal (1813 --64%), conditional (478 --17%), abnormal (357-- 13%) or inadequate (186 --7%). Among the 478 with conditional TCD studies in STOP/STOP2, the mean age at last follow-up in POST-STOP was 19.2 years (range 4.9-33.1) and follow-up TCD was obtained on 252 (53%) from 11 months to 16 years after STOP/2 (median 10.4) . Forty three of these had an abnormal TCD (mean age at abnormal was 8.5 years from 3 months to 8.4 years after STOP/2 (median 1.97 years).

Conclusions:

1) We could find evidence of follow up TCD for about of half of these children indicating that more needs to be done to insure regular and consistent surveillance of these children who have some elevated risk.
2) Conversions to abnormal TCD were documented. Treatment decisions as well as stroke outcomes for all the 479 with conditional TCD will be derived from adjudication of the complete data set (in progress).
Abstract 47: Renal Function, MRI Brain Changes and Post-stroke Cognitive Impairment
Authors: Auriel Eitan , Kliper Efrat , Shenhar-Tsarfaty Shani , Mike Anat , Ben-Bashat Dafna , Shopin Ludmila , Korczyn Amos D , Bornstein Natan M , Ben-Assayag Einor 
Published: March 2022

Background and Purpose:
Limited data exist regarding the relationship between chronic kidney disease (CKD) and post-stroke cognitive impairment. We aimed to evaluate the impact of impaired renal function on markers of cerebral small vessel disease, brain pathology and cognitive decline in a longitudinal post-stroke cohort.

Methods:
The TABASCO study is a prospective cohort of mild-moderate ischemic stroke/TIA patients, who underwent a 3T MRI, and were assessed for their cognitive function at hospital admission, 6, 12 and 24 months following stroke, using the Montreal Cognitive Assessment (MoCA) and a computerized cognitive testing battery. Estimated renal function was evaluated at admission using the Cockcroft Gault creatinine clearance (CCl) equation. The volume and integrity of preexisting white matter hyperintensity (WMH), ischemic lesions and brain atrophy on MRI were measured.

Results:
Baseline data were available for 462 subjects (mean age 67.4 years, 60.4% males). Participants with a CCl <60 ml/min performed significantly worse in all cognitive tests over time (p<0.001) than those with a CCl ≥60 ml/min. CKD was also associated with enlarged WMH volume (p<0.001), cortical atrophy (p=0.002) and smaller hippocampal volume (p<0.001).

After the 2-years follow-up, 16% of the participants developed cognitive impairment.
Multiple logistic regression analysis controlling for traditional risk factors, including cardiovascular, showed a significant association of CCl <60 ml/min at baseline with development of cognitive impairment at the end of follow-up [odds ratio: 2.99 (95% confidence interval: 1.08-8.27), p = 0.035].

Conclusions:
Decreased renal function is associated with increased WMH volume and cortical atrophy, known biomarkers of the aging brain, and is a predictor of lower performances in cognitive tests and cognitive decline 2 years after stroke/TIA. CKD may contribute to cerebral small vessel disease that underlies post-stroke cognitive decline, suggesting a new target for early intervention.
Abstract T MP98: Stroke Coordinator Boot Camp: Training the Troops
Authors: Block Starr , Censullo Eileen , Dentel Steve , Jackson Tawny , Loechler Abigail 
Published: March 2022

Background and Issues:
The role of a Stroke Coordinator is multifaceted; demanding expertise in a number of areas including clinical competence, administrative aptitude, collaboration, team management, enhanced education skills, quality improvement, and data analysis proficiency. Few nurses possess all of these skills, and without them, are often frustrated and at risk to fail. Finding appropriate educational opportunities for professional development in this unique role is quite challenging.

Purpose:
To validate that new, as well as seasoned, stroke coordinators benefit from an intensive boot camp style conference geared to their diverse role. Conference content was designed to enhance programmatic skills, role development, provide best practices for improving their stroke organization, and promote networking with fellow professionals.

Methods:
Established a volunteer committee of national experts from the five state region with expertise in stroke program management and implementation:

•
Developed a pre-event survey to assess educational needs
•
Conducted an educational gap analysis
•

Conceptualized:
& designed a comprehensive educational experience

•
Conducted a one-day intensive boot camp-style program at 3 different locations with following presentations: o
ISC
2014 Hot Topics o
Traditional and emerging role of the stroke coordinator o

Quality:
improvement/data analysis o

Validating the stroke coordinator role o
CMS, Affordable
Care Act, Meaningful Use

Results:
Boot camp attendees were asked to complete a ten question post-event survey with six possible responses: No change, Strongly Disagree, Disagree, Agree, Strongly Agree, and N/A. Of the 325 attendees an impressive 74% response rate (240) was achieved. Our success was measured by those with a score of Agree or Strongly Agree. Overall for the 10 topics, we had a success rate of 95.56%. Attendees requested that this be repeated annually.

Conclusions:
The role of the stroke coordinator continues to evolve. It is imperative that those individuals not only have the clinical skills to perform those roles but also the key components described above in order to effectively lead quality stroke programs. This educational format was successful and can be replicated in other parts of the country.
Abstract T P101: Incidence of Dissection and Vasospasm Related to Distal Embolic Protection Devices During Elective Carotid Artery Stenting: 5 Year Retrospective Review
Authors: Satti Sudhakar R , Traylor Katie , Anzilotti Kert 
Published: March 2022

Hypothesis:
•We assessed the hypothesis that the Abbott Vascular Nav6 DEP, was associated with the lowest risk of dissection and vasospasm.

•Identify the overall incidence of vasospasm and dissection associated with distal embolic protection device during elective carotid artery stenting

BACKGROUND:
•Carotid angioplasty and stenting has been show to have an increased risk of embolic stroke compared to carotid endarterectomy. To minimize this risk, distal embolic protection devices are considered the standard of care for all carotid stenting procedures.

• At Christiana Care Health System over 225 carotid stents have been placed in the last 5 years.
• No prior study has compared distal embolic protection devices to determine which were associated with lower complication rates.

Methods:
•Electronic query of all carotid stenting procedures was performed between 1/2/2009 and 12/30/13; total of 244 patients included

Results:
• Distal embolic protection devices were associated with angiographic vasospasm in 31% and dissection in less than 1% of patients.

The Nav 6 device was found to associated with the lowest incidence of vasospasm and no dissections.

Discussion:
• Research that improves equipment or techniques during carotid artery stenting should be aggressively pursued to further improve clinical outcomes and reduce the risk of procedural complications.

Conclusion:
On the basis of this single center retrospective five year analysis, the Abbott Vascular Nav 6 distal embolic device was associated with the lowest incidences of vasospasm.

Clinical Implications:
• More research and study of complications associated with distal embolic protection devices is warranted. This may lead to a lower complication rate in elective carotid artery stenting
Abstract T P157: The Effect of Paroxysmal Atrial Fibrillation on Stroke Outcomes Among Ischemic Stroke/TIA Patients: An Eight Year Cohort Study
Authors: Jain Ash , Van Houten Douglas , Sheikh Lamiya 
Published: March 2022

Background:
Paroxysmal atrial fibrillation (PAF) is more prevalent than chronic AF in the general population. It may also be more prevalent in ischemic/TIA patients. It is difficult to diagnose PAF prior to event and most studies focus on chronic AF (CAF). In this study we evaluate the effect of PAF on stroke outcomes and highlight the need to focus on this treatable condition to ensure appropriate care.

Methods:
• The study population included ischemic/TIA cases with AF status known from July, 2006-July, 2014 (n=2951). AF status (n=573) was classified as paroxysmal (31.4%) or chronic (68.6%). o PAF was diagnosed with telemetry during hospitalization.

• Outcomes included discharge disposition (alive/expired) and neurological impairment at discharge, quantified using the National Institutes of Health Stroke Scale (NIHSS). CHADS2 score was evaluated as a continuous variable.
• Patient demographics and co-morbidities including diabetes, hypertension, smoking and dyslipidemia were considered as confounders in logistic regression.
• Analysis was done using R-based statistical tools. Bi-variate analysis included t-tests for continuous variables and chi-square tests for categorical variables. Multivariable analysis was done using logistic regression. Results were determined to be statistically significant within a 95% confidence interval.

Results:
• PAF patients were more likely to be female (61.3%) than CAF (56.7%), although not significantly more likely, p=0.38. PAF patients were mean age of 76 (± 12.4) years.

• PAF patients were two times as likely as non-AF patients and three times as likely CAF patients to expire (R.R. 2.2, 95% C.I. 1.17-10.9; R.R. 3.1, 95% C.I. 0.55-17.97).
• There were no significant differences in recurrent stroke rate between PAF and CAF patients or PAF patients and non-AF patients.
• Admission NIHSS and CHADS2 for PAF patients were higher than for non-AF patients (p<0.0001 for both). There were no significant differences between PAF and CAF patients.

Conclusion:
• PAF patients had a significantly higher mortality rates compared to CAF patients, despite no significant differences in CHADS2 or admissions NIHSS.

• Careful evaluation is important for PAF patients since they are higher risk of poor outcomes.
Abstract T P238: Evaluating the Stent-Wall Interaction in a Hemodynamically Induced Swine Model of Carotid Atherosclerosis: Correlation of Pre-Treatment Black-Blood 3T MRI with Post-Stenting Histopathology
Authors: Raychev Radoslav , Fujimoto Motoaki , Tateshima Satoshi 
Published: March 2022

Introduction:
We evaluated the histopathologic characteristics of the stented arterial segments in a swine model of carotid atherosclerosis.

Methods:
Atherosclerotic plaque was created by inducing 80% stenosis via partial surgical ligation (without endothelial balloon injury) in combination with dietary hypercholesterolemia in a single Yucatan minipig (Fig A). High-resolution black-blood 3T MRI of both carotid arteries was obtained at 6 months. Stenting was performed immediately after imaging. The animal was sacrificed 4 weeks after stenting. Histopathologic and morphometric analysis was performed.

Results:
MRI: Figure A. Contrast-enhanced MRA. B. Cross-sectional 2mm views of proton density (PD), T2, T1, T1 post contrast, and time-of-flight (TOF) sequences of the stenotic segments of the R (top) and L (bottom) carotid arteries.

The image characteristics of the R carotid stenosis are consistent with an American Heart Association Lesion Type IV/V. No athermoatous features are seen in the L carotid.

Histopathology:
Moderate lymphocyte proliferation was noted in the narrowest mid-section (N-Mid) from the right carotid, corresponding to the depicted lesion on MRI. This segment had the smallest neointimal/thrombus thickness (Table). Only mild residual atherosclerosis was appreciated within the stent.

EEL - external elastic lamina
IEL - internal elastic lamina

Conclusions:
Our findings indicate histologic reversibility of the MRI-defined carotid atherosclerotic lesion four weeks after stenting, possibly due to improved flow within the hemodynamically-induced plaque. Unlike prior studies, neointimal proliferation was least prominent at the pre-existing atheroma.
Abstract T P251: Overseeing a Multicenter Clinical Trial: Our Experience in Creating a New Model
Authors: Burks Bree , Oravec Chesney , Smith Stephanie , Gilchrist Emily , Mocco J , Froehler Michael 
Published: March 2022

The model for overseeing multicenter clinical research trials continues to evolve. In the late 1990’s electronic medical records became more common across institutions. Subsequently, the integration of the World Wide Web into clinical care enhanced the ability to connect clinical and research data across multiple sites. For years, research data has been handled in a hybrid fashion with the use of hard-copy and electronic sources for data entry and verification. Recently, leaders behind multicenter clinical trials have incorporated electronic data capture (EDC) systems in an effort to store multicenter clinical trial data in a secure and structured environment. The implementation of EDC’s has led to better control and accuracy of data; however, many aspects of multicenter clinical trial workflow are still captured in a hard-copy format. Therefore, the oversight of these additional components is still subject to an in-person, on-site review.
While the paper-based model focuses on reviewing hard-copies of patient records long after the data originates at the point of care, new models must allow for real-time oversight of clinical trial data. In conjunction, the source documentation needed to recreate the clinical trial data, as well as the ongoing regulatory and compliance documentation associated with a clinical trial, should be readily available for remote review. In order to promote best practice and effectively utilize current technology, the Food and Drug Administration released guidance in August of 2013 encouraging sponsors to focus on risk-based and centralized monitoring techniques.
The Cerebrovascular Clinical Research Office (CCRO) at Vanderbilt University has recently implemented a risked-based monitoring model that incorporates a comprehensive electronic trial infrastructure. The CCRO has identified many advantages with the incorporation of this new method. These advantages have led to a significant cost-savings, increased protocol and regulatory compliance, a heightened level of accountability for all involved parties, and a more streamlined approach to ensuring data accuracy. In conclusion, the CCRO’s experience incorporating a new monitoring model has been one full of exciting challenges and opportunities for originality.
Abstract T P332: Stroke Patient Education -A Story of Improvement
Authors: Daansen Patricia A , Beauchamp Joan , Wood Cheryl 
Published: March 2022

Background:
Rochester General Hospital (RGH) is a 559 bed acute care community hosp. in Rochester, N.Y. Designated as a Stroke Center in 2003, the Hosp. discharges 850 stroke & TIA pts. annually.

The Stroke Coalition Team consists of members of the stroke pt. care areas & supporting depts. Group's purpose- provide a collaborative forum for sharing outcomes to improve stroke care.
Each dept. has a core group to review actionable data for their areas. The Acute Stroke Unit (7800) Team’s purpose is to act on unit process improvement opportunities.
May 2013- a negative trend with the Core Measure for pt. education was identified for the Coalition group. As a result, the 7800 leaders began investigating for root cause.
Purpose of this QI program was to assure all pts. receive designated pt. education and documentation is complete. A secondary purpose was to improve the quality of the education.

Methods:
Four main barriers were identified:

1. RNs not understanding expectations
2. Novice RNs not comfortable in educating pts. and families
3. Electronic Medical Record (EMR)complexity - launched 11/12
4. Education complete but lacking documentation

Action plan:

1 & 2. RN education
A.Self-learning packet (SLP) that included:
• Requirements of pt. education
• How to document the education
B. 1:1 support from CNS & Nurse Manager
C. Daily chart audits to ID further opportunities & barriers to compliance
D. RNs educated on teaching tools:
•Welcome binder
• AHA/ASA brochures for Stroke/TIA/diagnostic tests
• Pt. educational TV offerings
•Medical/nursing database
3. Complexity of EMR- Collaborated to make changes to the EMR templates.
A. Automatic entry of the education template upon stroke order set
B. Required education flagged
C. Individualization of pt. education
D. Standardized admission & discharge nursing notes
4. Lack of Documentation
A. Discharge checklists made available
B. Chart compliance audits (decreasing to random as compliance rose)

Results:
Rapid turn-around achieved. Recognized as best practice by Joint Commission during the Center’s 3/2014 re-designation.

Conclusion:
Rapid improvement possible with action upon data. Team approach allows for appropriate action to occur.

Efforts continue to enhance compliance & pt. experience.
Abstract T P409: Experimental Chronic Cerebral Hypoperfusion Results in Decreased Pericyte Coverage and Increased Blood Brain Barrier Permeability in the Corpus Callosum
Authors: Liu Qinghai , Radwanski Ryan , Babadjouni Robin , Baumbacher Peter , Russin Jonathan , Zhao Zhen , Mack William 
Published: March 2022

Murine chronic cerebral hypoperfusion (CCH) results in white matter (WM) injury and behavioral deficits. Underlying mechanisms remain unclear. Pericytes influence blood-brain barrier (BBB) integrity and cerebral blood flow. Under hypoxic conditions, perictyes detach from perivascular locations increasing blood vessel permeability and secondary neuronal injury.
This study aims to characterize the time course of BBB dysfunction and pericyte coverage following murine experimental CCH. White matter injury and behavioral deficits have been reported consistently on post-operative day 30 in this model.
C57BL/6J mice underwent either CCH (n=12) or sham operation (n=9). BBB permeability in the corpus callosum (CC) was characterized on post-procedure days 1, 3, 7, and 30 using Evans blue (EB) extravasation and IgG staining. Pericyte coverage (CD 13/CD31 ratio) in the paramedian region of the corpus callosum was calculated on post-procedure days 1, 3, 7, and 30.
The CCH cohort demonstrated increased EB extravasation (integrate density) on postoperative days 1,3,7 and 30 when compared to the sham cohort (CCH: 583.58 ±98.28, 1529.32 ±448.87, 366.02 ±34.51, 5.85 ±1.80; SHAM: 44.51, 230.22, 24.03, 2.55 on postoperative days 1, 3, 7, and 30 respectively.) Further EB extravasation was significantly greater (p<0.05 ) at day 3 (peak level) than at days 7 and 30 in CCH mice. Positive IgG staining was seen at post-procedure days 3, 7, and 30 in the CCH group, but not in the sham operated mice. The CCH mice demonstrated a nadir in pericyte coverage on post-operative day 3 (30.88 ±10.27%). These values were significantly lower (p<0.05) than those on postoperative days 7 (89.36 ±5.11%), and 30 (74.97 ±2.39%). The post-operative day 3 pericyte coverage ratios were also significantly decreased compared to those in the sham mice (72.09 ±3.89%; p<0.01).
Decreased pericyte coverage and increased BBB permeability are most pronounced on postoperative day 3 following murine experimental CCH. This precedes any notable WM injury or behavioral deficits (post-op. day 30). Morphologic pericyte changes are concordant with BBB breakdown. Neurotoxic macromolecule extravasation may contribute to the pathogenesis of WM lesions and resultant behavioral deficits in this model system.