bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 79: Sex-dependent Role of Macrophage-derived Insulin-like Growth Factor-1 in Body Growth, Cardiac Homeostasis and Responses to Cardiac Tissue Stress
Authors: Ilinykh Alexei , Chan Christopher , McLellan Micheal A , Squiers Galen T , Branca Jane , Drummond Grant R , Rosenthal Nadia A , Pinto Alexander R 
Published: March 2022

Biological sex is a key factor influencing the development and progression of cardiovascular disease. While sexual dimorphism has been identified in cardiac physiology and sex-based differences are observed in clinical contexts, the molecular and cellular bases for these differences are not understood.
Recently, we found for the first time that female and male hearts are different in their cellular composition. Female hearts comprise significantly greater numbers of resident mesenchymal cells, including cardiac fibroblasts, compared to male hearts, and female hearts consist of differing proportions of multiple leukocyte subsets. We found that these differences are regulated by gonadal hormones.
Extending on our previous work, this study investigates sexual dimorphism in cell-specific IGF-1 production and its impact on cardiac inflammatory responses. IGF-1 is a growth factor that is essential for development and injury responses, and that has been previously shown to function in a sex-dependent manner.
Using genetic, transcriptomic and high-dimensional flow cytometry approaches, we found that macrophages and fibroblasts are the principle IGF-1 producing cells in the heart, with macrophages from female mouse hearts producing twice as much IGF-1 as in males. This contributed to a ~20% greater level of IGF-1 found in the hearts of females compared to males. Furthermore, constitutive genetic ablation of macrophage-derived IGF-1 resulted in ~30% reduction in total IGF-1 in hearts of female mice, whereas no reduction was observed in male hearts. Surprisingly, we also found that ablation of macrophage-derived IGF-1 reduces body weight in female mice by ~10%. Finally, we found that macrophage-derived IGF-1 regulates cardiac inflammatory responses in a sex-dependent manner.
To our knowledge, this is the first study to demonstrate that a macrophage-derived growth factor is essential for normal body growth and plays a sex-dependent role in cardiac inflammatory responses. Our observations provide a cellular and molecular basis for the sexual dimorphism observed in cardiac physiology and pathology, and underscore the importance of considering biological sex in experimental models of cardiac development and disease.
Microangiopathic Hemolytic Anemia and the Development of the Malignant Phase of Hypertension
Authors: GAVRAS HARALAMBOS , BROWN WILLIAM C. B. , BROWN JEHOIADA J. , LEVER ANTHONY F. , LINTON ADAM L. , MACADAM ROBERT F. , MCNICOL GEORGE P. , ROBERTSON J. IAN S. , WARDROP CHARLES 
Published: March 2022

Evidence of microangiopathic hemolytic anemia (MHA) was found in 14 of 22 patients with malignant phase hypertension, and in one of these, a patient with proliferative glomerulonephritis, MHA and malignant hypertension developed together during a three-month period of observation.
Among 61 rats subjected to unilateral nephrectomy, injected with DOCA, and given 1% saline to drink, 42 developed evidence of MHA. Eighty-four per cent of these also had fibrinoid necrosis and/or plasmatic vasculosis in the remaining kidney at autopsy. Blood pressure rose to 150 mm Hg or more in 72% of these DOCA-injected animals. In 29 control rats subjected to unilateral nephrectomy only, blood pressure rose to 150 mm Hg or more in 21%, MHA developed in 14%, and fibrinoid lesions were found in none.
The significance of these observations is discussed in relation to the possibility that MHA is either a consequence of malignant hypertension or a contributory factor in its pathogenesis.
Abstract NS8: Colorado’s First Nurse Facilitated Transient Ischemic Attack Clinic: The New Paradigm for Transient Ischemic Attack Treatment
Authors: Kimminau Kryssy , Woodard Jim 
Published: March 2022

The risk of a disabling stroke after a Transient Ischemic Attack (TIA) is suggested to be highest within the first 48 hours after the TIA event and nearly half of recurrent stroke events ensue within the first 7 days. The TIA Clinic at Porter Adventist Hospital was developed to promote timely, efficient, and comprehensive treatment services for patients, allowing for targeted long term follow-up. Patients presenting with a TIA have limited options for receiving efficient evaluation and follow-up care. They can be admitted to hospitals for further diagnostic testing, seek care at their PCP or attempt to find a neurologist. Unfortunately these options are often expensive and can be the cause of treatment delays. Patients admitted to the hospital often incur higher out of pocket expenses, lost work time and exposure to hospital acquired conditions.
The interdisciplinary service provides evaluation of TIA etiology and enables secondary stroke-prevention interventions to be initiated the day of patient’s evaluation. Once diagnostic procedures are completed, the neurologist finalizes the TIA etiology, risk-factor profile, and recommended secondary prevention strategies.
Measurement strategies are obtained through patient satisfaction survey at the end of clinic, ninety day phone call follow-up and physician e-mail follow-up. The clinical nurse coordinator collects post-clinic data on this group of patients. After evaluation of 54 patients since the clinics inception there was no recurrence of TIA or stroke symptoms with 90 day follow-up in any patient. In addition, the clinic has proven to provide (1) expedited consultations and diagnosis as available to hospitalized patients; (2) identification and treatment of patients who have actually had a stroke rather than TIA; (3) identification and treatment of “stroke-mimicking” diagnoses such as migraine with aura, seizure, hypoglycemia, arrhythmias, intracerebral hemorrhage and intracranial tumor; and (4) identification of stroke risk factors and rapid implementation of specific interventions in the most vulnerable period for disabling stroke (i.e., the first 2-7 days).
Abstract TMP16: Hypoperfusion Severity Is Associated With Poor Collaterals And Progresses Over Time
Authors: Olivot Jean Marc , Marks Michael P , Mlynash Michael , Wheeler Hayley M , Inoue Manabu , Kemp Stephanie , Straka Matus , Zaharchuk Gregory , Bammer Roland , Lansberg Maarten G , Albers Gregory W ,   DEFUSE 2 Investigators
Published: March 2022

Background:
We hypothesized that cerebral perfusion deficits are more severe in acute stroke patients with poor collaterals and that the severity would increase over time if reperfusion does not occur.

Methods:
This is a substudy of DEFUSE 2. Collaterals were assessed on conventional angiography and dichotomized as poor vs. good flow. DWI and PWI were performed before and within 12 hrs after endovascular therapy; PWI lesion volumes were determined using a Tmax>6sec threshold. The hypoperfusion ratio (HR) was calculated by determining the proportion of the PWI lesion that had severe Tmax delay (>10sec). Acute lesion growth was defined as the difference between the baseline and follow-up DWI volume.

Part 1: In patients with an ICA or M1 occlusion we compared the HR to the collateral score. An ROC curve assessed whether the HR predicts the collateral score.
Part 2: Among patients who did not experience early reperfusion, the difference between the baseline and follow-up HR was assessed and correlated with early infarct growth.

Results:
Part 1: Fifty six patients were eligible. Poor collateral flow was associated with larger baseline PWI lesion volume, p=0.012 and a higher HR compared to patients with good flow [median HR 45% (IQR: 35-52%) vs. 34% (IQR 14-41), p=0.003]. A HR > 41% predicted poor collateral flow with an AUC=0.73 (sensitivity 65%, specificity 78%, p=0.003).

Part 2: Thirty two patients who did not achieve reperfusion were included; PWI Tmax >6sec lesions volumes at baseline and follow-up were similar (median volume 75 mL at both time points). The median HR at follow-up was significantly higher than baseline [46% IQR (34-65) vs. 40% (24-48), p=0.007; median difference = 13% (IQR: 3.5-17)]. Patients who had worsening of their HR between baseline and follow-up were more likely to experience early ischemic lesion growth (R=0.53, p=0.002).

Conclusion:
The size and severity of Tmax lesions are associated with angiographic collateral scores. Patients who have a high percentage of their PWI lesion comprised of severe Tmax delays are likely to have poor collaterals. When early reperfusion is not achieved, the severity of hypoperfusion progresses and this progression is associated with early infarct growth.
Abstract TP360: Starting a Stroke Post-Discharge Clinic on a Shoestring Budget
Authors: Westbrook Trish 
Published: March 2022

A hospital admission for stroke is a very stressful event and often too short for meaningful education. Stress and emotional levels are high and the stroke itself may result in cognitive challenges. Once at home, much information is forgotten and subtle cognitive and physical dysfunctions may become evident. A follow-up discharge clinic is one possible solution to improving post-discharge care, medication adherence, and lifestyle modification.
While discussing post-discharge challenges at our facility, a nurse practitioner and a speech therapist conceived the idea of a post-discharge stroke clinic. The purpose was to reinforce information taught in the hospital, detect functional disabilities that appeared once home, assure appropriate medical follow-up, and communicate that information to the Primary Care Provider. The clinic was ultimately named “Life After Stroke.”
At “Life After Stroke,” each patient is assessed for physical, occupational, speech, social, financial, and neuropsychological needs. Their logistical and financial ability to obtain follow-up medical care and medications are also evaluated. If financial challenges exist, they are referred to the charitable clinic/pharmacy in their county of residence. Medications are reviewed to assure all secondary prevention measures are addressed and there are no duplications or omissions. The need to continue the medication regimen and follow up care is strongly emphasized. Details of the visit and any referral needs are faxed to the Primary Care Provider at the completion of the visit.
The idea for the clinic was conceived shortly after a new budget year began. Therefore, funds had not been budgeted for the clinic. We had to be very creative to begin a clinic without any financial funding. Forms were developed by the work group, equipment loaned from departments, manpower was donated by some departments, and volunteers filled in the other areas. This has truly been a collaborative and interdisciplinary process with everyone focused on the best patient outcomes. Follow-up has shown an improvement in medication compliance, follow-up care, and patient/family satisfaction.
Abstract WP16: Stentrievers Increase Recanalization Rate But Not Good Outcome After Large Vessel Stroke.
Authors: Simonsen Claus Z , Søen Leif H , Karabegovic Sanja , Juul Niels , Andersen Grethe 
Published: March 2022

Ischemic stroke is a common cause of death and disability in the western world. Intraveneous (iv) recombinant tissue plasminogen activator (t-PA) has proven efficacious as acute treatment. Intraarterial treatment with t-PA and/or instrumentation of the vessel with the attempt to manipulate the clot and remove it (called Intra Arterial Therapy (IAT)) is emerging as a tool for treating patients with contraindications to iv t-PA or for patients with large clot burden, where iv t-PA is often unsuccessful. IAT is also potentially hazardous and in large series, 10% of patients suffer symptomatic Intracerebral Hemorrhage (ICH).
Stentreivers (a new form of removable stent) have shown promise in improving recanalization and outcome in IAT.
At our institution 153 patients underwent IAT from 2004-2011. Stentreivers (ST) were used as part of the recanalization procedure in 42 patients. In the ST group, mean age was 63.7 years and mean presenting NIHSS was 16.6. In the non-ST group the same numbers were 63.3 years old and an NIHSS of 15.9. Using an unpaired t-test, there were no statistical differences in neither age nor NIHSS at presentation. Time to groin puncture was 257 minutes in the ST group and 275 minutes in the non-ST group, again no statistical difference.
Recanalization (defined as TICI 2b or 3) was achieved among 35 of the 42 = 83.3% in the ST group and in 47/111 = 42.3% of the patients in the non-ST group, giving an odds ratio (OR) for recanalization using ST on 6.81 (p<0.001, Fischers exact test.) Good outcome defined as a modified Rankin Score of 0-2 90 days after the stroke was achieved among 16/42 = 38.1% in the ST group and among 47/111 = 42.3 % in the non-ST group. There was no statistical difference in these numbers.
Recanalization was important for good outcome in both groups. OR for good outcome given recanalization was 5.89 in the ST group (p=0.03) and 6.97 in the non-ST group (p<0.001).
Recanalization is important for good outcome, but even though recanalization was achieved much more often in the ST group, this did not translate into better outcomes. One explanation could be, that recanalization seems more obvious when using stentrivers.
Abstract WP193: Secular Trends in Ischemic Stroke Subtypes
Authors: Bogiatzi Chrysi , Hackam Daniel G , Spence J David 
Published: March 2022

Background:
In the past it was thought that ~ 20-25% of ischemic strokes were cardioembolic, ~ 20% from large artery disease and ~ 20% from small vessel disease. With the aging of the population, and with increasing prevalence of therapy for hypertension and hyperlipidemia, it might be expected that stroke subtypes would be changing over time.

Purpose and Methods:
We studied the change over time of ischemic stroke subtypes from 2000-2012, among 2300 patients referred to the Urgent TIA Clinic at University Hospital, London, Canada. We divided the patients into 3 eras that were approximately equal in numbers: Era 1 (2000-2004), Era

2 (2005-2007) and Era 3 (since 2008). Ischemic stroke subtypes were defined by clinical and imaging criteria into evident, probable and possible causes.

Results:
Mean age + SD was 63.39 + 17.47 years; 50% were women, 17.7% were diabetic, 19.6% current smokers. The proportion of patients with known atrial fibrillation increased from 4.2% in Era 1 to

6.6% in Era 2, to 9.6% in Era 3 (p-0.001). Among patients thought to have cardioembolic stroke, atrial fibrillation accounted for 95.8% in Era 1,
93.4% in Era 2 and 90.4% in Era 3 (p=0.001). Among patients whose stroke subtype was regarded as evident or probable (n=1699), stroke subtypes changed over time, as shown in Table 1:

Similar trends were observed If all patients (evident, probable, possible) were included. Stroke subtypes have changed significantly since 2000 (Chi-Square 2p=0.0001), with a marked increase in cardioembolic stroke, and a decline in large artery stroke.

Conclusion:
In recent years, the proportion of patients with cardioembolic stroke has increased significantly. This has important implications for treatment to reduce the risk of recurrent stroke
Abstract WP369: Doctorate of Nursing Practice-led Transitions of Care Model for Stroke and Transient Ischemic Attack
Authors: Haynes Helena N , Smith Carol J , Haenchen Steven D , Drake Kendra , Reel Sally J , Ritter Leslie S 
Published: March 2022

Background and Purpose:
The chances of experiencing a second event are significantly increased in those with recent stroke or transient ischemic attack (TIA). Gaps in care due to the movement of patients between health settings and/or practitioners, also known as transitions of care (TOC), may contribute to secondary events. The impact of TOC on stroke/TIA outcomes has not been thoroughly examined. The Doctorate of Nursing Practice (DNP) is a relatively new role within the nursing profession that provides advanced practice nursing care, leadership and research expertise. As the first phase of a long term goal to evaluate a DNP-led TOC model specific to the stroke/TIA population in Southeastern Arizona, the purpose of this study was to identify the essential elements of a model specific for stroke/TIA using data from one urban primary stroke center.

Methods:
1) Existing TOC models such as PRISMA, Hospital to Home, and STEPS were identified with applicability to the stroke/TIA patient.

2) Get With The Guidelines [GWTG®]-stroke database from a primary stroke center located in an urban setting in Southern Arizona was used to identify patient demographics and the essential elements that best reflect TOC.

Results:
We found 1) the Care Transitions Intervention model best suits a DNP-led TOC model for stroke-TIA. Key elements of this model include an interdisciplinary team approach utilizing case-management strategies, discharge planning, and patient self-management education. In addition, the advanced practice nurse has been found to be most successful in leading TOC models aimed at reducing readmissions.

2) Key outcome variables in a stroke specific TOC model include frequency of admission/readmission, patient demographics, prior hospitalizations, length of stay, discharge disposition, presence of stroke risk factors and urban vs. rural settings.
3) Post-discharge phone interviews may be needed to explore gaps in care not captured in GWTG.

Conclusions:
While TOC models have been described for other diagnoses, models for stroke/TIA are lacking. The use of the Care Transitions Intervention model for stroke/TIA could yield important reductions in the burden, morbidity, and mortality of stroke/TIA in Southeastern Arizona and thus, deserves further study.
Abstract WP80: Cocaine Use and Aneurysmal Subarachnoid Hemorrhage
Authors: Normen-Smith Ingrid O , Gandhi Chirag D , Hidalgo Andrea , Prestigiacomo Charles J 
Published: March 2022

INTRODUCTION:
There have been many reports of aneurysmal subarachnoid hemorrhage (aSAH) associated with cocaine, but few studies that actually address cocaine’s influence on aSAH. [3] Hypertension is an accepted contributor to aneurysm rupture and has been associated with the prevalence of rupture in a younger, cocaine-using, population. [1-3] A literature search revealed only one study that correlated aneurysm size at rupture and cocaine use. [2] This study will retrospectively evaluate the relationship between cocaine use and aneurysm size at rupture in our aSAH patient population.

METHODS:
All aSAH patients from September of 2009 through May of 2011 were reviewed at our hospital for 22 parameters that included sex, age, race, cocaine use, aneurysm size, carotid stenosis, diabetes mellitus, heart failure, hypertension, previous stroke, sickle cell disease, smoker, etc. To date only average aneurysm size was compared between the the cocaine and non-cocaine-using population using measurements from angiography reports.

RESULTS:

In this period, 91 aSAH patients were seen at our hospital with seven positive screens for cocaine. Average aneurysm size for cocaine users was 3.7mm and 6.2mm for non-cocaine users. This was statistically significant.

CONCLUSION:
Our cocaine-using patient population had an average aneurysm size much smaller than the non-cocaine-using patients. For the future, a retrospective meta-analysis using our covariates will be conducted to determine whether cocaine presents an independent risk factor for aSAH.

BIBLIOGRAPHY:

1. Oyesiku, N.M., et al., Cocaine-induced aneurysmal rupture: an emergent negative factor in the natural history of intracranial aneurysms? Neurosurgery, 1993. 32(4): p. 518-25; discussion 525-6.
2. Nanda, A., et al., Intracranial aneurysms and cocaine abuse: analysis of prognostic indicators. Neurosurgery, 2000. 46(5): p. 1063-7; discussion 1067-9.
3. Howington, J.U., et al., Cocaine use as a predictor of outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg, 2003. 99(2): p. 271-5.
Abstract 116: Migraineurs Are More Susceptible to Infarct Growth in Acute Stroke
Authors: Eikermann-Haerter Katharina , Park Kwangyeol , Helenius Johanna , Velioglu Murat , Daneshmand Ali , Arsava Murat , Pearlman Lea , Ross Avery , Negro Andrea , Ayata Cenk , Ay Hakan 
Published: March 2022

Epidemiological data indicate that migraine is an independent stroke risk factor. Recent data suggest that migraine mutations increase brain vulnerability to ischemia via excitatory mechanisms (Circulation 2012; 125:335). Migraine mutant mice developed higher number of ischemic depolarizations and accelerated infarct growth during hyperacute stroke, with worse tissue and neurological outcomes.
Here, we retrospectively assessed acute stroke evolution in patients with a reliably documented migraine history. In a blinded fashion, we analyzed the lesion volume on diffusion-weighted imaging (DWI), and the volume of perfusion defect on perfusion-weighted imaging (PWI) using mean transit time (MTT), from consecutive patients during the years 2003-2012 in the Massachusetts General Hospital stroke database. DWI-PWI mismatch was calculated on spatially co-registered DWI and MTT maps, as a marker for viable tissue at risk for infarction.
A total of 155 stroke patients had reliably documented presence or absence of a migraine history. Stroke patients with a history of migraine were younger and more often female, compared to stroke patients who never suffered from migraine. Migraineurs less frequently had coronary artery disease or diabetes. The frequency of posterior circulation lesions was significantly higher in migraineurs. Otherwise, groups were comparable.
In migraineurs with aura, a larger proportion of the perfusion defect showed DWI changes, resulting in smaller DWI/PWI mismatches. A significantly larger proportion of migraineurs with aura showed no mismatch (i.e., DWI/PWI>0.9), indicating that the entire perfusion defect was already infarcted (Table).
Our data show that a history of migraine, particularly with aura, is associated with accelerated acute infarct growth, consistent with data obtained in migraine mutant mice.

[Table. Diffusion-perfusion mismatch. *p=0.011 migraine vs no migraine,
†
p=0.002 migraine with aura vs no migraine]