bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract TP112: Post-conditioning with Isoflurane Reduces Ischemia-induced Hemorrhage and Brain Injury Following MCAO in Rats: A Longitudinal Study with MRI
Authors: Taheri Saeid , Shunmugavel Ananda 
Published: March 2022

The objective of this study was to use multimodal MR imaging to evaluate the effect of isoflurane on short-term and long-term neuronal tissue damage and neurological deficits after focal brain ischemia in rats and correlate the improvement with the behavioral outcome.
Male Wistar/Kyoto rats were divided into 4 experimental groups; Control (Group I, n=5), Sham (Group II, n=5), MCAO (Group III, n=20) and MCAO with isoflurane treatment (Group IV, n=20). Animals were anesthetized with 5% isoflurane and maintained on 2% isoflurane during surgery. MCA was transiently occluded (90 min) using intra-luminal thread. After surgery, group IV was kept under 2% isoflurane for 90 min period. Other groups were allowed to recover immediately after the surgery. Animals were subjected to MRI to measure, infract volume, edema and blood flow in 8 in vivo imaging sessions performed at 6, 12, 24, 48, 72h (short term) and 7, 14 and 21d (long term) post MCAO. Anatomical, diffusion and arterial spin labeling (ASL) were performed with 7T MR Scanner. The following parameters were used in DTI; TE/TR=23/5000 ms, diffusion directions 30, b=100, 850, and 1850 s/mm2, FOV 4.0 x 4.0 cm, 12 slices with thickness 1 mm, and matrix 128 x 128. Standard ASL sequence was used to calculate the regional blood flow. Diffusion images were processed to generate diffusion parameter maps. Mean diffusion parameters calculated in the infarct regions were manually drawn on T2 maps. Behavioral improvement was measured in terms of latency on rotarod and beam walk.
Rats post-conditioned with isoflurane did not show hemorrhage during short term or long term post MCAO, while non-conditioned rat develop hemorrhage after short term post MCAO. Lesion in the cortical area was noticed since 6h post MCAO. However, cortical lesion was significantly reduced in the treatment group. Post-conditioned rats had significantly higher latency on rotarod and lesser number of foot faults on beam walk test measured on day 3,7,14 and 21 of MCAO, implying isoflurane mediated functional protection.
Our results for the first time, at the longitudinal level show that maintaining MCAO rats under isoflurane environment before reperfusion offers enhanced neuroprotection and recovery from behavioral dysfunction through reduced brain hemorrhage.
Abstract TP258: Oleic Acid Decreased Brain Infarct Volume In Middle Cerebral Artery Occlusion Rats By Peroxisome Proliferator-Activated Receptor γ Activation
Authors: Lee DongHwan , Lee Hoyeon , Lee Donghun , Choi Jingyu , Song Jungbin , Gaire Bhakta , Kim Hocheol 
Published: March 2022

OA, a monounsaturated ω-9 fatty acid, is most abundant in all dietary fats and oils, especially olive oil, canola oil and high-oleic sunflower and safflower oil. OA was reported to have an anti-inflammatory effect by inhibiting reactive oxygen species (ROS), p38 MAPK, and Akt/IKK/NF-κB signaling pathways in LPS-stimulated BV2 microglia. The accumulation of FFAs after cerebral ischemia has been thought to contribute to injury-associated secondary brain damage by direct and indirect mechanisms. However, the role of OA has not been paid attention or known for exacerbating neuronal cell death in ischemic conditions.
We hypothesized that OA may exert important role on the neuroprotective effect in ischemic rat brain and this effect exert through PPARγ activation. The infarct volume of systemic administration of OA in transient middle cerebral artery occlusion (MCAo) rat was measured after pretreatment of the PPARγ antagonist, GW9662 in order to determine whether PPARγ activation is critical for this effect, and the effect was compared with non-treated group. The expression of COX-2 and MMP-9 was investigated and the induction of HO-1 was also investigated by immunohistochemistry, RT-PCR and zymography in order to confirm the mechanism via activation of PPARγ.
OA decreased infarct size induced by MCAo as late as 3 h after the injury, and the effect of OA was inhibited by the pretreatment of GW9662, a PPARγ antagonist. OA also inhibited the COX-2 and MMP-9 expression and induced HO-1 gene in MCAo rats.
In conclusion, OA significantly reduces the infarct volume of MCAo rats through anti-inflammatory and anti-oxidative effect by acting, at least partly, as a PPARγ agonist. Given that this compound was administered as late as 3 h after the onset of the ischemic damage, OA might be very useful for stroke therapy.
Abstract TP415: Implementation of a Secondary Stroke Prevention Program: Effect on Medication Adherence
Authors: Damush Teresa , Myers Laura , Anderson Jane , Yu Zhangsheng , Ofner Susan , Schmid Arlene , Williams Linda 
Published: March 2022

We targeted both providers and patients for medication and lifestyle modification to reduce secondary stroke risk factors after stroke.
The specific aim of this study was to:

Conduct a quasi-experimental feasibility test of implementing the adapted VA stroke prevention program (VSPP) at two VA sites to evaluate the impact on medication adherence.

Program sessions targeted stroke risk factor management. The key stroke risk factors of interest were: 1) hypertension, 2) diabetes, 3) hypercholesterolemia. Medication possession ratios based upon patient medication refills were calculated to evaluate medication compliance for the randomized subjects using PBM data pre (6 months prior to the acute event) and post (6 months after the event). Based upon the literature standard of 80% compliance, we used this rate to dichotomize and model the data using logistics regression.

Results:
The final sample included 174 veteran patients with an acute stroke/TIA who were randomized to receive either the intervention (n=87) or a control program (n=87). In the intervention group, the odds of compliance to diabetes meds post stroke were significantly larger than the odds of compliance prior to the stroke (odds ratio=3.45 (1.08, 10.96) p <0.04). The control group saw a decrease in the likelihood of compliance from pre to post stroke hospitalization (odds ratio =0.51 (0.10, 2.70), p<.42). The comparison between groups was marginally significant (odds ratio=6.74 (0.88, 51.31), p=0.06) which indicates an intervention effect on compliance of DM drug. Both the intervention and control groups had significant increases in the odds of compliance to statin medications; however, there were no significant difference between groups. For compliance to hypertension medications, the intervention group showed significantly greater odds of compliance post intervention than pre intervention (odds ratio=3.68 (1.81, 7.48), p<.0004) but no difference in the control group. We observed over a threefold increase in diabetes medication compliance among stroke survivors who were diabetic and assigned to the intervention group and we observed a significant decrease in diabetic medication compliance among those assigned to the control group. Funded by VHA HSRD IAB 05-297-2
Abstract TP91: Post-Stroke Assessment of Kinaesthesia with and without Vision using Robotics
Authors: Semrau Jennifer , Herter Troy , Scott Stephen , Dukelow Sean P 
Published: March 2022

Stroke can lead to damage of brain regions and pathways involved in sensory processing of limb afferent and visual signals. While stroke rehabilitation research often focuses on motor recovery, there is limited knowledge about the prevalence of proprioceptive deficits and their impact on sensorimotor capabilities. The present study characterizes the presence of kinaesthetic (sense of motion) deficits and the ability of individuals to correct for these deficits with vision after stroke.
Individuals with subacute stroke (N = 107, median age = 59) and non-disabled controls (N = 101, median age = 47.5) performed a kinaesthetic matching task with and without vision using a robotic exoskeleton. The robotic exoskeleton passively moved the stroke patients’ affected arm at a preset speed, direction and magnitude of movement. Subjects were instructed to mirror-match the speed, direction and magnitude of the movement as soon as they felt the robot begin to move their affected arm. Stroke subjects also completed a standardized clinical assessment including vision screening, Behavioural Inattention Test (median ± SD = 141 ± 29.71), Chedoke McMaster Stroke Assessment - Impairment Inventory of Arm (5 ± 2.61) and Hand (5 ± 2.49) and Functional Independence Measure (FIM) (95.21 ± 23.54).
As compared to controls, 49% of subjects with stroke displayed larger initial direction errors when performing the task without vision. When vision was provided 25% of these subjects now performed within the control range. Surprisingly, 24% of subjects performed worse with vision. A similar pattern of impairments were observed for movement reaction time. As a group, subjects with field defects and/or hemineglect displayed significantly greater impairments than the rest of the subjects with stroke.
Our results suggest that kinaesthetic deficits are highly prevalent amongst patients who have had a stroke. The quantification and identification of these sensory deficits using the robotic technology has significant potential for improving diagnosis and prognosis of sensory and motor deficits and performance in daily activities.
Abstract WP222: Non-invasive Monitoring Of Cortical Activity Post-reperfusion. A Powerful Tool To Improve The Prediction Of Early Clinical Improvement Immediately After Recanalization
Authors: Flores Alan , Ribó Marc , Rubiera Marta , Pagola Jorge , Rodriguez-Luna David , Muchada Maria Angeles , Kallas Julia , Meler Pilar , Sanjuan Estela , Montaner Joan , Alvarez-Sabín Jose , Molina Carlos A. 
Published: March 2022

Background
Although baseline stroke severity is a powerful outcome predictor, in some patients the NIHSS score does not reflect the degree of reperfusion (stunning brain) or it is simply unreliable. Currently the use of BIS(bispectral index) is restricted to monitoring level of consciousness in critical care patients and patients under anaesthesia. Real-time assessment of cortical activity after reperfusion may refine the predictive accuracy of stroke severity on patients outcome and be useful as surrogate of reperfusion success. We aimed to evaluate the impact of BIS monitoring before and shortly after reperfusion on stroke outcome.

Methods
Consecutive patients with anterior acute ischemic stroke who received reperfusion therapy were monitored with bicortical BIS in the first 6 hours of the admission. We registered the initial and final BIS number on the affected and contralateral side and determined asymmetry and changes in relation with recanalization and other clinical variables. We defined clinical improvement as an decrease of > or = 4 points between NIHSS baseline and the NIHSS at discharge or 5 day.

Results
28 patients were monitored by bicortical BIS.

The median age was 72 years, baseline NIHSS 16.
In all patients, median BIS number in the affected side varied baseline 83 and 85 final (p=0.34). The final BIS number was associated inversely with the NIHSS at discharge or 5 day (p=0,013) and the infarct volume (p= 0.031). Patients with clinical improvement had higher final number BIS (88,4 vs 78,9 p=0,007). A ROC curve identified a Final BIS number of >82 as the better predictor of further clinical improvement with a Sensitivity 88% and Specificity 89% p=0.02. After adjusting for recanalization, post recanalization NIHSS and age, a logistic regression showed that final BIS emerged as the only independent predictive factor of clinical improvement(p=0.024 OR1.41 IC95%: 1.01-1.28)

Conclusion
Our study demonstrates that some parameters of BIS are related to clinical and radiological variables in acute stroke patients. The final BIS number emerged a powerful independent predictor of further clinical improvements. Larger studies are needed to assessment of post reperfusion cortical activity measured by BIS
Abstract WP279: Can We Reduce Door-to-Needle Times and Improve Outcome by Giving tPA on the CT Suite?
Authors: Kallas Julia A , Rodriguez-Luna David , Muchada Marian , Flores Alan , Pagola Jorge , Sanjuan Estela , Meler Pilar , Ribo Marc , Rubiera Marta , Molina Carlos A 
Published: March 2022

Objectives:
The time to administration of intravenous (iv) tPA has a relevant impact on patients outcome. Our treatment protocol has been modified in order to improve our latency times by starting iv tPA bolus in the computed tomography room (CT-tPA). We aimed to evaluate the impact of CT-tPA on door-to-needle times and functional outcome in patients with acute ischemic stroke.

Material and methods:
We consecutively evaluated 70 patients treated in accordance with the CT-tPA protocol from June 2011 to June 2012. Those patients were compared to 130 patients from the previous year who received iv tPA bolus in the Stroke Unit (conventional protocol). Demographic data, baseline stroke severity, and inpatient latency times were evaluated. The primary outcome was the modified Rankin scale (mRS) at 3 months. Functional independency was considered when mRS≤2.

Results:
Two-hundred patients were evaluated, with mean age of 74.4±11.5 years and median NIHSS of 13 (IQR 11). There was no difference in baseline clinical characteristics at admission between CT-tPA and conventional protocol. The door-to-CT times were similar in both groups.

Mean door-to-needle time was 57.1 min in the conventional protocol, and was reduced to 53.4 after CT-tPA protocol implantation. We analyzed the number of patients who received iv tPA bolus bellow 30 and 50 minutes in each group. The CT-tPA group had 9% more patients treated in <30 min (16% vs. 25%) and 11% more treated in <50 min-window (50% vs. 61%) after arrival to the emergency department.
Clinically, there was a trend toward a better functional outcome in the CT-tPA protocol, with an increase of 10.7% of patients with mRS≤ 2 at 3 months compared with the conventional protocol (56.9% vs 46.2%). We also observed a reduction of 3-months mortality in patients treated according to the CT-tPA protocol (19% vs. 23%).
The application of CT-tPA was not associated with the increase of ICH nor with tPA protocol violations.

Conclusions:
The CT-tPA protocol reduces door-to-needle times, increasing the number of patients treated bellow the <50 and <30 minutes time-window. We hypothesized that this time-reduction would improve functional outcome in a larger number of patients.
Abstract WP366: Secondary Stroke Prevention Program: Effect on Stroke Specific Quality of Life
Authors: Damush Teresa , Anderson Jane , Yu Zhangsheng , Ofner Susan , Myers Laura , Schmid Arlene , Williams Linda 
Published: March 2022

We conducted an evaluation of the implementation of a Veteran Secondary Stroke Prevention Program at two VA medical center sites. We prospectively recruited patients hospitalized for stroke/TIA and randomized to either an intervention or a control group. Each site locally tailored the intervention. The program targeted stroke self-management and risk factors or a placebo telephone call program that mimicked the intervention schedule. The self-management program followed a standardized manual (control call simply asked how the patient was doing), and interviews were conducted at baseline during hospital visit, 3 and 6 months. To address veteran preferences, both sites implemented the ASA Sharegiver peer support program to subjects in the intervention.We assessed stroke health-related quality of life with the SS-QOL and depression with the PHQ9.

Results:
The final sample included 174 veteran patients with an acute stroke/TIA and were randomized to receive either a VSPP (n=87) or a control program (n=87) stratified by stroke/TIA and by receipt of inpatient rehabilitation to control for stroke severity. A random subject effect was used to correlate observations from the same subject. Subgroup analyses were run with subgroups defined as diagnosed TIA or Stroke at acute event. On the SSQoL overall score and the Language subscale, those with a TIA in the intervention group reported an improved score while those in the control group reported a declined score at 3 mos. For those with Stroke in the intervention group, improvements in the Energy subscale were reported compared to declines in the control group at 3 months. For those with TIA in the intervention reported less depression than those in the control group and this effect was maintained at 6 months. Self-efficacy increased among those with stroke in the intervention group while decreased among the control group; although not significant.

Our results indicate the feasibility of delivering a local, secondary stroke prevention program. We report better stroke specific quality of life at 3 months among stroke/TIA survivors and less depression among those with TIA 6 months after the intervention suggesting that a post stroke program may enhance recovery.
Funded by Veterans Health Administration HSRD IAB 05-297-2
Abstract 194: BDNF Knockdown Abrogates AT1 Blockade -Induced Improvement in Stroke Outcome
Authors: Alhusban Ahmed , Fouda Abdelrahamn , Pillai Bindu , Ergul Adviye , Fagan Susan C 
Published: March 2022

Background:
Brain derived neurotrophic factor has been shown to play an important role in long term functional recovery after stroke. Unfortunately, the clinical exploitation of this protein is limited due to the lack of pharmacological interventions that regulate its expression. Angiotensin II receptor blockers (ARBs) increase BDNF expression in both normotensive and hypertensive animals. We investigated the possible interaction between acute ARB treatment and BDNF in terms of long term functional recovery after stroke.

Methods:
Male normotensive wistar rats received bilateral ICV injections with lentiviruses expressing either BDNF shRNA or vector. 14 days after injection, animals were subjected to 90 minutes MCAO and randomized to either candesartan 1mg/kg or saline at the time of reperfusion. Functional recovery was assessed 24 hours after stroke and every 72 hours for 14 days using a blinded battery of validated behavioral tests. Animals were then sacrificed and their brains processed for immunohistochemistry.

Results:
Bilateral injection with shRNA reduced the expression of BDNF by more than 70% (p=0.0045). Acute ARB administration ameliorated stroke induced functional deficits throughout the follow-up period after stroke in all used tests and Day 14 data is shown on the Table. This pro-recovery effect was totally ablated in BDNF knocked down animals. Acute ARB therapy also increased the number of new brain blood vessels (CD31/Ki67 positive cells) which was also BDNF dependent.

Conclusion:
1.

Acute ARB- induced functional recovery after stroke is BDNF dependent.
2.
This pro-recovery effect is associated with a BDNF dependent proangiogenic state.
Table 1: Experimental data summary. SD are shown in parenthesis. a,b,c. Pairs of means with different letters are significantly different from each other
Abstract T P126: Cerebral Microbleeds and Functional Outcomes at Discharge and 6 Months after Acute Ischemic Stroke
Authors: Kim Tae-Won , Koo Jaseong , kim Joong-Seok , Choi Hyun Seok , Lee Kwang Soo 
Published: March 2022

Introduction:
Whether preexisting cerebral microbleeds (CMB) are associated with poor functional outcome after ischemic stroke has not been reported before. We examined the associations between CMB and functional outcome at discharge and 6 months after ischemic stroke.

Method:
We studied 207 consecutive patients with acute ischemic stroke within 1 week after symptom onset who admitted to our hospital for 1 year. Assessment of stroke severity (by NIHSS) was made at the time of admission, at 24 hours after admission, at discharge and 6 months after admission. Functional outcomes (by modified Rankin scale) were evaluated at discharge and 6 months after admission. Patients’ outcomes were dichotomized into good and poor functional outcome groups with the mRS score cutoff 1 (no significant disability)/2 (slight disability). Microbleeds of each patient were analyzed by an experienced neuroradiologist. Demographic and clinical characteristics, the presence of CMB were compared between two groups. Then, logistic multivariable regression analysis was performed including all variables with a probability value <0.2 in the univariate analysis.

Results:
More patients with poor functional outcome had CMB (45.6% vs. 27.4%; p=0.008) and they had more number of CMB (2.8±5.7 vs. 1.3±4.0; p=0.034) compared with patients with good functional outcome.

After multivariable regression analysis, there were no independent associations between CMB and functional outcome with adjustment for age, sex, history of diabetes, WMH and initial scores on NIHSS at discharge.
At 6 months after ischemic stroke, CMB were significantly associated with poor functional outcomes after adjustment for age, history of previous stroke and hypertension, WMH and initial scores on NIHSS (OR 2.1 95% CI: 1.0-4.5, p= 0.046). When patients were subdivided into those with lobar CMB and those with deep or infratentorial CMB, we found significant association between infratentorial CMB and poor functional outcome (OR 3.8 95% CI: 1.4-10.4, p= 0.009) and an associated trend between lobar CMB and poor outcome (OR 2.1 95% CI: 0.9-4.7, p= 0.067).

Conclusion:
CMB, especially infratentorial area, were significantly associated with worse functional outcomes at 6 months after stroke.
Abstract T P162: Cardio-Ankle Vascular Index (CAVI) predicts Cardioembolic Stroke in Patients with Atrial Fibrillation
Authors: Yamaura Gensai , Nishiyama Satoshi , Watanabe Tetsu , Wanezaki Masahiro , Sasaki Shintaro , Takahashi Hiroki , Arimoto Takanori , Shishido Tetsuro , Miyashita Takehiko , Miyamoto Takuya , Kubota Isao 
Published: March 2022

Arteriosclerosis has shown to be a definite risk factor of atrial fibrillation, which is an important cause of cardioembolic stroke. The cardio-ankle vascular index (CAVI) has been reported as a novel parameter for arterial stiffness, and high CAVI implies progression of carotid and coronary arteriosclerosis. However, it remains to be determined whether CAVI is associated with cardioembolic stroke.
We performed CAVI and transesophageal echocardiography in 219 patients with paroxysmal or chronic atrial fibrillation (165 males, 64 ± 12 years), including 53 patients with the history of cardioembolic stroke.

CAVI was higher in patients with hypertension, diabetes mellitus, chronic atrial fibrillation and the history of heart failure compared with those without them. CAVI showed a good correlation with age, systolic blood pressure, pulse pressure, fasting blood glucose, high-sensitivity CRP, fibrinogen and von Willebrand factor. CAVI was also associated with left atrial dimension, left atrial volume index, left atrial emptying fraction, left ventricular diastolic function and left atrial appendage emptying flow velocity. CAVI was significantly increased with advancing grade of spontaneous echo contrast and increasing CHADS
2
score and CHA
2
DS
2
VASc score. Furthermore, CAVI was significantly different between patients with score 0 and score 1 in CHADS
2
and CHA
2
DS
2
VASc. CAVI was significantly higher in patients with left atrial appendage thrombus than in those without (10.3 ± 2.4 vs. 8.5 ± 1.6, P<0.0001). CAVI was also significantly higher in patients with cardioembolic stroke than in those without (10.6 ± 2.2 vs. 8.3 ± 1.2, P<0.0001). Logistic regression analysis revealed that CAVI was an important risk factor for cardioembolic stroke after adjustment of age and heart rhythm (odds ratio 2.16, 95% confidence interval 1.55-3.01). The patients with CAVI ≥ 9 had 12 times higher risk for cardioembolic stroke compared with those with CAVI < 9 after adjustment of age and heart rhythm.

In conclusion, CAVI is a novel parameter to predict cardioembolic stroke in patients with atrial fibrillation.