bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract T P344: Clopidogrel Resistance in Stroke Patients (The CRISP Trial)
Authors: Manoj Aravindakshan L , Fitzsimmons Paul R , Sharma Nikhil , Menezes Brian , Thachil Jecko , Greenhalf William , Oates Melanie , Lopez Paula , Fletcher Glyn , Cox Penelope 
Published: March 2022

Background:
Clopidogrel is a thienopyridine with ADP antagonising effects that is widely used in the secondary prevention of ischemic strokes and transient ischemic attacks (TIAs). Despite this some patients will go on to have recurrent strokes or TIAs.

Cardiology trials have identified patients with clopidogrel resistance, defined as a vasodilator-stimulated phosphoprotein (VASP) index of >50% after at least 7 days of clopidogrel treatment. This was associated with recurrent cardiac events.
The VASP-index measures phosphorylation of VASP in the resting state and activated states using flow cytometry techniques. As phosphorylation of VASP is dependent upon activation of the platelet P2Y12 receptor that is targeted by clopidogrel the difference in phosphorylation between the two states provides an indirect measure of platelet inhibition.
Previous trials have shown a prevalence of clopidogrel resistance in stroke patients of between 8 and 18%, but no study to date has shown whether this is associated with significantly more recurrent cerebrovascular events.
We are testing the hypothesis that amongst patients treated with clopidogrel for secondary prevention of cerebrovascular disease, those with resistance are more likely to have recurrent Strokes or TIAs.
Should this hypothesis be confirmed, then further research would be needed to identify treatment strategies that may minimise this risk.
Design A prospective cohort study recruiting 120 patients from the acute stroke unit at the Royal Liverpool hospital with a diagnosis of stroke or TIA that will be commenced on clopidogrel therapy and expected to continue it for at least one year. We will compare outcomes between those found to be 'clopidogrel responders' and 'clopidogrel resistant'.
A sample size of 120 patients was chosen based on the concept of 'reproducibility probability', taking into account the number of patients needed for similar studies in cardiology patients, the prevalence of 'clopidogrel resistance' amongst stroke patients and the potential for patients to later be excluded.
Outcome Recurrent cerebrovascular event within 6 months of entering trial.
Trial Status Recruitment ongoing.
Abstract T P91: Reversion of Cognitive Impairment by Carotid Revascularization in Asymptomatic Carotid Stenosis? A Nonrandomized Controlled Study
Authors: Lin Chun-jen , Chang Feng-Chi , Tu Pei-Chi , Lee I-Hui 
Published: March 2022

We previously reported that patients with asymptomatic severe stenosis of extracranial internal carotid artery (ICA) have worse dizziness and poorer cognitive performance than matched controls in association with distributed and long-range brain disconnections. There is currently a lack of evidence whether optimal medical treatment alone or with carotid revascularization could be the best treatment for cognitive impairment in these patients.
We consecutively followed 25 patients with asymptomatic severe stenosis (>70%) of ICA. Sixteen received carotid artery stenting (CAS) and optimal medical treatment and nine received optimal medical treatment alone. All subjects received a battery of neuropsychological tests as well as diffusion tensor imaging and resting-state functional magnetic resonance imaging, and were followed at three months after treatments.
We found that patients receiving CAS (100% success), but not those receiving medical treatment alone, had significant improvements in dizziness scores (P=0.001), immediate recall of verbal memory (P=0.002) and complex visuospatial perception (P=0.007) three month after intervention. The interval changes of whole-brain mean fractional anisotropy of both groups were insignificant, and the analysis of functional connectivity is undergoing.
The results may provide insight into whether the benefits of carotid revascularization, including mitigating thromboembolic events and cognitive impairment, outweigh perioperative risks including functional consequence of microemboli.
Abstract W P221: Argonaute 2 Mediates Sildenafil-Promoted Axonal Outgrowth
Authors: Zhang Yi , Chopp Micheal , Liu Xianshuang , Zhang Zheng Gang 
Published: March 2022

Molecular mechanisms are not fully known for the inhibitory effect of chondroitin sulfate proteoglycans (CSPGs) on axonal outgrowth. The present study investigated the effect of CSPGs on miRNA expression and the role of Argonaute 2 (Ago2) in mediating Sildenafil-induced axonal outgrowth under CSPG conditions.
Primary rat embryonic cortical neurons were cultured in a microfluidic chamber which separates somata and axons. Selective application of CSPGs within the axonal compartment markedly inhibited axonal outgrowth (567±15 μm vs 688 ± 21 μm in control, n=5, p<0.05). Axonal application of Sildenafil, a PDE5 inhibitor, completely reversed the inhibitory effect of CSPG on axonal outgrowth (671±17 μm, n=5). Analysis of miRNA PCR array showed that axonal application of CSPGs robustly changed miRNA profiles not only in axons but also in somata, indicating that axonal signals regulate soma miRNAs. Sildenafil inversely altered miRNA up- and down-regulated by CSPGs, including miR-29c, miR-9a, miR-20b, miR-298 and miR-34a. Attenuation of Ago2, a regulator of miRNA activity, in neurons by siRNA abolished Sildenafil-increased axonal outgrowth under CSPG conditions, suggesting that miRNAs are required for Sildenafil-enhanced axonal outgrowth. One of putative targets of miR-29c is integrin β1. Western blot analysis showed that CSPGs and Sildenafil reduced and increased, respectively, axonal integrin β1 and its downstream protein, focal adhesion kinase, suggesting that miR-29c regulates these protein levels. To examine cause-effect of integrin β1, we applied a neutralizing antibody against integrin β1 into the axonal compartment and found that the antibody attenuated the Sildenafil-reversed inhibitor effect of CSPGs on axonal outgrowth (523±34 μm vs 671±17 μm in Sildenafil, n=5, p<0.01).
In conclusion, the present study indicates that axonal signals induced by CSPGs and Sildenafil change miRNA profiles in the entire neuron and that Sildenafil abolishes the CSPG inhibitory effect on axons via Ago2.
Abstract W P297: Streamlining Processes to Decrease Arrival Time to Groin Puncture in the Neuroendovascular Suite
Authors: Connelly Kerrin M , Thomas Jacob 
Published: March 2022

Purpose:
To describe strategies to decrease the arrival to groin puncture time in the neuroendovascular suite of a Comprehensive Stroke Center

Background:
Non physician staff in the neuroendovascular suite of a Comprehensive Stroke Center sought to streamline processes within the neuroendovascular suite in order to facilitate faster patient arrival to groin puncture times.

Methods:
Strategies employed to decrease arrival time to groin puncture:

• Dedicated neuro angiography technologists
• Dedicated CT technologists
• Dedicated anesthesia staffing
• Neuro angiography technologists cross trained to perform CT scans
• RNs crosstrained to cover both angiography suite and ICU
• CT scan and angiography suite embedded in ICU
• Education of ED personnel regarding capabilities and protocols to trigger interventional consideration for Emergency Department (ED) patients
• Process for bypassing the ED for patients transferred from outside facilities
• Anesthesia education and response time
• Anesthesia supplies and vent set up at all times for immediate procedure start
• Communication tree for notification of off hours cases
• Angiography tray and patient table set up at all times to allow for immediate procedure start

Results/Conclusion
There are various methods available to decrease arrival time to groin puncture within the neuroendovascular suite. Response times over the past six months have been well under benchmark times of 30 minutes. Decreasing time to groin puncture increases the possibility of faster recanalization, potentially leading to more favorable outcomes.
Abstract 167: Exosomes Derived from Mesenchymal Stromal Cells Promote Axonal Outgrowth
Authors: Zhang Yi , Chopp Michael , Katakowski Mark , Liu Xianshuang , Zhang Zheng Gang 
Published: March 2022

Exosomes, small lipid microvesicles, transfer RNAs and proteins thereby mediating cell-cell communication. The present study investigated the effect of exosomes released from mesenchymal stromal cells (MSCs) on axonal outgrowth, that may play an important role in promoting brain repair after stroke.
Embryonic cortical neurons were cultured in a microfluidic culture device which separates somata and axons. Exosomes (3x109 particles/ml) harvested from MSCs were applied into the somal chamber. 24h in culture, exosomes increased axonal growth (396±8 vs 297±9 μm in non-treated axon, p<0.001, n=6). To examine whether miRNAs in exosomes mediate axonal growth, neurons were treated with exosomes with attenuated-Ago2, a key protein regulates miRNA biogenesis, derived from Ago2 knockdown MSCs. These exosomes abolished the axonal growth increased by exosomes from MSCs transfected with control siRNA (298±8 μm vs 396±11 μm in control, p<0.001, n=3), suggesting that miRNAs in exosomes mediate the exosome-enhanced axonal growth. We previously showed that the miR-17-92 cluster enhances axonal growth. Thus, we treated neurons with miR-17-92 cluster elevated-exosomes from MSCs transfected with a miR-17-92 vector. Compared to non-exosome treatment, neurons treated with exosomes from MSCs transfected with a control vector considerably increased axonal growth (406±8 μm, p<0.001, n=6). Moreover, neurons treated with miR-17-92 cluster elevated-exosomes exhibited further increases in axonal growth (595±10 μm, p<0.001, n=6). RT-PCR showed substantial elevation of individual members of the miR-17-92 cluster in axons of the neurons treated with the miR-17-92 cluster elevated-exosomes, which was associated with reduction of their target protein, PTEN, in axons. Western blots also showed that reduction of axonal PTEN by the miR-17-92 cluster elevated-exosomes activated PTEN downstream proteins mTOR and GSK3β, indicating that the miR-17-92 cluster delivered by exosomes targets the PTEN/GSK3β pathway in axons.

Conclusion:
The present study demonstrates that miRNAs in the exosomes can be delivered into neurons to promote axonal growth, which provides a novel therapy to enhance axonal growth.
Abstract 171: Four-dimensional Contrast-enhanced Ultrasonography for the Evaluation of Intraplaque Neovascularization in Carotid Artery Plaque
Authors: Oura Kazumasa , Ohba Hideki , Hitomi Jiro , Ogasawara Kuniaki , Kato Tadayoshi , Terayama Yasuo 
Published: March 2022

Purpose:
The presence of intraplaque neovascularization has been identified as a factor in unstable plaque.

Contrast-enhanced carotid artery ultrasonography has been used for evaluating such neovascularizations.
However, it is difficult to define the inflow routes of a contrast agent into carotid artery plaque with conventional 2-dimensional (2D) ultrasonography.
We aimed to evaluate the distribution of intraplaque neovascularization with 4-dimensional (4D) contrast-enhanced carotid arterial ultrasonography.

Subjects:
The study included 29 patients with internal carotid artery stenosis (M:F =26:3, mean age:70.4 years) who were inpatients or outpatients of the Department of Neurology and Gerontology or the Department of Neurosurgery, and who were candidates for carotid endarterectomy.

Methods:
Four-dimensional contrast-enhanced ultrasonography was performed using the contrast agent Perflubutane prior to the undertaking of a carotid endarterectomy. The presence or absence of inflow of the contrast agent from the intimal side and adventitial side was observed using 2D and 4D modes and compared with the number of neovessels on the luminal side and outer wall side in a 2.5 mm
2
window of a pathological specimen obtained by surgery.

Results:
The number of neovessels on the intimal side in the pathological specimens was significantly higher in patients with inflow of the contrast agent from the intimal side (14.83±10.06/2.5 mm
2
) than in those without such inflow (6.60±5.296/2.5 mm
2
) (p=0.025, Mann-Whitney
U
test). In addition, the number of neovessels on the medial side in the pathological specimens was significantly higher in patients with inflow from the adventitial side (11.93±8.147/2.5 mm
2
) than in those without such inflow (5.57±5.585/2.5 mm
2
) (p=0.036, Mann-Whitney
U
test).

Conclusions:
Four-dimensional contrast-enhanced ultrasonography can be used to evaluate the distribution of neovessels in carotid artery plaque.
Abstract 53: Multimodal CT Imaging: Time to Treatment and Outcomes in the Interventional Management of Stroke (IMS) III Trial
Authors: Vagal Achala , Foster Lydia , Menon Bijoy , Livorine Anthony , Shi Junzi , Qazi Emmad , Demchuk Andrew , Yeatts Sharon , Hill Michael , Tomsick Thomas , Goyal Mayank 
Published: March 2022

Introduction:
The importance of time in acute stroke is well established. Using the Interventional Management of Stroke (IMS) III trial data, we explored the effect of imaging on time to treatment and outcomes for subjects those receiving multimodal imaging [CT angiogram (CTA) + CT perfusion (CTP) versus CTA alone] versus those who did not.

Materials and Methods:
Multimodal CT was not a prerequisite for IMS III entry .We examined 3 subgroups; those with baseline CTA alone, CTA + CTP, versus those with no CTA or CTP. The baseline demographics and imaging and treatment time parameters of these 3 subgroups were studied.

Results:
Of the 656 subjects enrolled, 98 (14.9%) underwent baseline (pre-IV t-PA treatment) CTA+CTP. 8 out of these 98 patients received only CTP. 216 (32.9%) received CTA alone and 342 (52.1%) had neither.

Time parameters for the CTA+CTP, CTA alone, and no CTA/CTP groups were as follows: median from stroke onset to IV t-PA (120.5 vs. 117.5 vs 120 min; p=0.5869), median IV t-PA bolus to groin puncture (GP) (78 vs. 81 vs. 91 min; p=0.0043) and median GP to start of endovascular therapy (EVT) (31 vs. 38 vs. 44 min; p=0.0001). Pairwise comparison demonstrated no significant difference in time from IV tPA to GP and time from GP to IA therapy between CTA+CTP and CTA alone groups (p=0. 9883 and p=0.1421, respectively). With removal of drip n’ ship subjects, no statistical differences were seen between groups for time from onset to IV t-PA bolus (p=0.5509) or time from imaging to GP (p=0.8459). Time from GP to start of EVT was still shorter in the CTA+CTP and CTA alone paradigms (p =0.0019).
In the IV t-PA treatment arm, no differences in 90d mRS 0-2 outcome were seen in the 3 subgroups (36.4% versus 40.9% versus 38.2%; p=0.8941). In the EVT arm, differences in good outcome were seen (38.5% versus 52.0% versus 33.8%; p=0.0020). CTA alone remained strongly associated with good outcomes in EVT arm (adjusted OR, 2.117; 95% CI, 1.35- 3.30), irrespective of age, stroke severity and time from onset to IV tPA initiation.

Conclusion:
Multimodal imaging did not delay treatment times in IMS III. The CTA alone group was associated with favorable clinical outcomes in the endovascular arm. The CTA+CTP paradigm resulted in worse outcome over the CTA alone paradigm in the endovascular arm.
Abstract NS11: Missed Opportunities: Closing the Loop
Authors: Burns Jo-Ann , Donelly Rose , Thomas Calvin , Shoemake Anne 
Published: March 2022

In a Comprehensive Stroke Center, which admits 1200-1300 stroke patients annually, patients are leaving sooner due to many factors, including insurance and financial constraints. Many patients are admitted over the weekend and holidays and 15 to 20 % of all patients are admitted to a non-neurological floor, which resulted in no stroke education being completed. Some patients were not identified as strokes until the day of discharge, also resulting in no stroke education.
The purpose of this project was to ensure all patients discharged received comprehensive stroke education and that regardless of where the patient was in the facility, education was completed either during the hospitalization or post discharge.
A lean evaluation was performed to identify successes and missed opportunities. As a result, several initiatives were implemented. Tip sheets were designed outlining step by step the stroke education that is required and also included the stroke coordinators contact information. This was disseminated throughout the entire facility. Special float pool and float pool nurses were given stroke education, as they staff all through the facility. Stroke Coordinators review all stroke admissions every day and identify those who did not receive the required education, and then phone contact is made. Stroke education is reviewed in depth and stroke materials are mailed out to the patient. In the event the patient is unavailable, this education is done with a family member/significant other. This process is followed regardless of the patient’s discharge disposition.
In conclusion, our 7 day phone follow up post discharge indicated that the satisfaction with stroke education went from 40% to 95% within a 6 month period. The missed opportunities dropped from an average of 20 a month to 0, especially with the follow up by the Stroke Coordinators to ensure that stroke education was completed.
Abstract NS3: Oral Care Program Decreases Length of Stay (LOS) and Length of Time Oral Foods and Fluids are Withheld (NPO) in Stroke Patients
Authors: Talley Louise K , Harl Jami , Lamb Jennifer , Green Lindsey , Lorenz Heather 
Published: March 2022

Background:
Nosocomial infections, specifically pneumonia have consequences financially for the hospital as well as physically and emotionally for the patient and their family. Consistent oral care, a fundamental standard of nursing care, and evaluation of ability to swallow are essential to allow patients to progress to wellness during their acute hospital stay after a stroke.

Purpose:
The purpose of this study was to determine the efficacy of an oral care program for stroke patients.

Research Questions:

1. In non-ventilated stroke patients, will an oral care program reduce the length of NPO status?
2. In non-ventilated stroke patients, what is the effect of an oral care program on LOS?

Methods:
This was a quasi-experimental study using a convenience sample. The impact of oral care for stroke patients on LOS and NPO status was reviewed pre- (n=33) and post- (n=51) implementation of an oral care program. The oral care program included a Hospital-acquired Pneumonia (HAP) Risk Assessment tool and specific interventions based on the score determined by the tool. Assessment included oral, chewing/swallowing , feeding/oral self-care, and conditions that resulted in a “high risk” score. Measures included length of NPO status per 100 patient days, LOS using descriptive statistics, and the difference in means from initial to final score using a Paired Samples t-Test.

Results:
The length of NPO status per 100 patient days decreased from 23.07 to 3.3 (85.7%). The LOS mean decreased from 9.45 to 6.92 days (26.8%). No HAP cases were present in the pre-or post-intervention groups. The initial HAP Risk Assessment scores improved from a 1.09 mean to 0.73 for the final HAP risk score (t =1.345,
p
=0.185 [2-tailed], SEM =0.264, n =45).

Conclusions:
The program showed improvement in NPO status, a decreased LOS and improved HAP risk scores from initial to final. Further testing of the tool and interventions is indicated using a larger sample.
Abstract T P113: Structural Changes In The Corticospinal Tract After 10 Days Of Combined Physical Therapy And Transcranial Direct Current Stimulation
Authors: Schlaug Gottfried , Zheng Xin 
Published: March 2022

A few studies have shown that long-term skill acquisition can lead to changes in white matter tracts. Studies examining structural changes in the corticospinal tract in patients recovering from a stroke have yielded mixed results. The current study examines whether 10 days of combined physical therapy (PT) and non-invasive brain-stimulation (using dual transcranial direct current stimulation) can lead to changes in the corticospinal tract (CST) on the affected hemisphere.
Seven stroke patients participated in an intense 10-day long treatment of physical therapy (1 hour/day) and tDCS (30 minutes per session) with anodal stimulation applied over the affected motor cortex and cathodal stimulation over the unaffected motor cortex. Each patient also underwent Fugl-Meyer assessments (UE-FM) and diffusion tensor imaging (DTI) before and after the treatment phase. A control group of seven patients were also scanned at two time points and assessed without any intervening therapy. The DTI images were processed using the standard algorithms provided by FSL and normalized to FSL's FA template. We used a section of the CST derived from the JHU atlas, between the internal capsule (below each patient’s lesion) and upper brain stem as our region of interest to extract FA and other diffusivity values before and after therapy.
All patients showed an increase in proportional UE-FM scores (+21%; SD 10%) and an increase in average FA (+0.013; SD 0.01) of the descending CST below the lesion after the intervention and no significant change was seen in the patient that were assessed two times but had no treatment. In addition, we found a strong correlation between the change in FA and a proportional improvement in the UE-FM score (r=0.689). These findings support the notion that focal white matter changes can be detected with DTI and that an intense course of an experimental treatment (2x5 days of combined PT+tDCS) induced structural changes in the descending CST that were not seen in patients scanned twice without treatment.
Abstract T P162: Predicting Recurrent Stroke: Comparison of CHADS2 to CHA2DS2-VASC Scale Among Patients With and Without Atrial Fibrillation at a Designated Primary Community Hospital Stroke Center
Authors: Jain Ash , Sheikh Lamiya , Van Houten Douglas 
Published: March 2022

Background:
CHADS2 and CHA2DS2-VASC are predictors of thromboembolic events for atrial fibrillation (AF). There is limited data on using CHA2DS2-VASC to evaluate stroke recurrence in community hospitals. This study compared the utility of CHADS2 and CHA2DS2-VASC to predict recurrent stroke risk in a community hospital setting.

Methods:
• The study population included all ischemic stroke cases from July 2006 to July 2014.

• Demographics including age, gender, ethnicity; co-morbidities including hypertension, dyslipidemia and diabetes and neurological-impairment-on-arrival were considered as confounders. The outcome was number of recurrent strokes over the eight year period.
• CHADS2 and CHA2DS2-VASC were analyzed as continuous variables.

Results:
• Of 1,986 ischemic stroke patients, 468 had AF either prior to hospitalization, at admission or at discharge.

• In our patient population, CHADS2 was a more sensitive predictor recurrent stroke predictor compared to CHA2DS2-VASC (c-statistic: 0.85 and 0.78 respectively).
• Average CHADS2 score of patients with recurrent stroke was 2.9 vs. 1.4 in patients with no recurrent stroke.
• Average CHA2DS2-VASC score of patients with recurrent stroke was 4.2 vs. 2.7 in patients with no recurrent stroke.
• With every one point increase in CHADS2 patients were six times as likely to have a recurrent stroke, while with every one point increase in CHA2DS2-VASC, patients were 2.5 times as likely to have a recurrent stroke. o Vascular disease (p=0.62) and gender (p=0.87) did not affect recurrent stroke. Hypertension (p<0.0001) and congestive heart failure (p<0.0001) were most significant predictors of recurrent stroke.

Conclusion:
• At our community hospital, CHADS2 was the better predictor of recurrent strokes.

• While composite scores are clinically useful, vascular disease and gender were not strong predictors of recurrent stroke in our population.