Scale Score Research Articles

Abstract TP153: Review of Hospital Outcomes for Aneurysm Securement in SAH at a Midwest Comprehensive Stroke Center

Background: According to the 2023 guidelines for the management of patients with aneurysmal subarachnoid hemorrhages (SAH), early treatment of ruptured aneurysms reduces the risk of repeated bleeds and facilitates treatment of delayed cerebral ischemia. Efficient aneurysm securement in the hospital setting is critical to survival; however, analysis of aneurysm timing and care in the pre-hospital setting is difficult. In this quality improvement study, we reviewed hospital data to improve our outcomes for patients with aneurysmal SAH. Methods: We conducted a retrospective analysis of hospital outcomes and stroke metrics for 72 patients with last known well times who underwent securement for aneurysmal SAH at a comprehensive stroke hospital in upper Midwest from Jan 2016 to Jul 2024. Data were compiled from multiple resources including Get-With-The-Guidelines®, chart abstraction, and internal healthcare databases. We compared 0-24 hours (n=49) and >24 hours (n=23) ‘Onset to Treatment’ groups using appropriate statistical tests and significance was determined using a two-sided alpha of 0.05. Results: Demographics (age, sex), cerebrovascular risk factors (hypertension) were similar between both groups. No differences were noted in the size or location of aneurysm. Interestingly, the symptom presentation (altered level of consciousness [48% (0-24), 26% (>24)]) and severity were higher in 0-24 group, including the NIH stroke scale (p-0.04), Hunt and Hess score (p-0.06), and Glascow Coma Scale (p-0.05). Modified Rankin scale (mRS) least favorable outcomes (5 and 6) were higher in 0-24 group (33% [0-24],17.3% [>24]) and more external ventral drains were placed (70% [0-24], 57% [>24]), though no change in overall hospital outcomes was noted, including mRS at discharge and discharge disposition between the groups. No differences were noted in ‘Door to Treatment’ times between the groups (12 [0-24] vs 14 hours [>24], p-0.16). Conclusion: At our hospital, there were no significant differences in overall outcomes for patients treated before or after 24 hours of symptom onset for aneurysmal SAH. Additionally, no impact of ‘onset to door’ times on hospital metrics for securement was noted. Lastly, an interesting trend in patients who arrived within 24 hours of symptom onset had a higher severity of symptoms, greater complications, and an increase in least favorable outcomes, suggesting the importance of early recognition and education regarding SAH presentations.

Subthalamic nucleus versus globus pallidus internus deep brain stimulation in the treatment of dystonia: A systematic review and meta-analysis of safety and efficacy.

This systematic review and meta-analysis aimed to compare the efficacy and safety of deep brain stimulation (DBS) targeting subthalamic nucleus (STN) versus the globus pallidus internus (GPI) in the treatment of dystonia. A comprehensive search strategy was implemented up to July 2024, across five databases, identifying studies relevant to STN-DBS and GPI-DBS in dystonia. Eligibility criteria included randomized controlled trials (RCTs) and observational studies comparing the two interventions. Two independent reviewers conducted the screening and data extraction. The risk of bias was assessed using RoB-2 for RCTs and the Newcastle-Ottawa Scale for cohort studies. Statistical analysis involved meta-analysis using Review Manager, with heterogeneity assessed by I2 and Chi-square tests. Subgroup and sensitivity analyses were performed. Five studies, involving 154 patients, were included. No significant difference was found between STN-DBS and GPI-DBS in Burke-Fahn-Marsden Dystonia Rating Scale motor and disability (BFMDRS-M and BFMDRS-D) scores at 1months, 6 and 12months. STN-DBS showed significant improvement in mental health (SMD = 0.43, 95% CI: [0.05, 0.8], P = 0.03). STN-DBS also showed significant improvement in Hamilton Anxiety Rating Scale (HAMA) (SMD = -2.7, 95% CI: [-5.38, -0.02], P = 0.05). No significant difference was found in Hamilton Depression Rating Scale (HAMD) scores. Both STN-DBS and GPI-DBS can improve motor symptoms in dystonia, with STN-DBS potentially resulting in more superior mental health benefits. Future research should address long-term outcomes, and regional effectiveness, and include diverse populations to enhance generalizability.

Abstract TMP107: Midlife Vascular Risk Factors are Associated with Late-life Depression in the ARIC Study

Objective: Late-life vascular health and cerebrovascular disease have been identified as potential risk factors for late-life depression (LLD). However, the impact of midlife vascular health, which is strongly linked with other aspects of brain function, on LLD is less understood. This study examined associations of midlife vascular risk factors (VRFs), and the cumulative burden of these factors, with LLD. Methods: Individuals from the Atherosclerosis Risk in Communities (ARIC) Study were evaluated for VRFs (smoking, hypertension, diabetes, hypercholesterolemia, and obesity) at midlife (ages 44-66). To assess cumulative vascular risk burden, the number of VRFs were counted and categorized as 0, 1, 2, or ≥3. Approximately 20 years later, LLD was assessed at late-life (ages 66-90) as a Center for Epidemiological Studies Depression Scale (CES-D) score ≥9. The association between VRFs and LLD was examined using logistic regression models adjusted for age, race-center, sex, education, and APOEε4 carrier status. Models were stratified by race; interaction terms were evaluated to assess effect modification. Results: Among 6,198 participants, the mean age was 52 years, 58.7% were female, and 22.2% were of self-reported Black race. At midlife, 20.2% had 0 VRFs, 41.3% had 1 VRF, 27.2% had 2 VRFs, and 11.3% had 3 or more VRFs. In the overall sample, smoking (OR: 1.68, 95% CI: 1.32-2.12), diabetes (1.41, 95% CI: 1.00-1.98), hypertension (OR: 1.29, 95% CI: 1.02-1.61), and obesity (OR: 1.51, 95% CI: 0.79-1.20) were associated with LLD when combined in one model; hypercholesterolemia was not. Compared to individuals with 0 VRFs in midlife, individuals with 2 VRFs had greater odds of LLD (OR: 1.69, 95% CI: 1.21-2.38), and individuals with 3 or more VRFs had even greater odds of LLD (OR: 2.34, 95% CI: 1.62-3.41). There was effect modification by race: midlife diabetes was associated with LLD in White individuals (OR: 2.18, 95% CI: 1.42-3.25) but not Black individuals (OR: 0.69, 95% CI: 0.36-1.25, p-interaction: 0.0005). Further, having 3 or more VRFs was associated with LLD in White individuals (OR: 3.57, 95% CI: 2.31-5.56), but not in Black individuals (OR: 1.46, 95% CI: 0.75-3.03, p-interaction: 0.01). Conclusion: Midlife vascular risk factors, and the cumulative burden of these factors, were associated with late-life depression (LLD), especially among White individuals. Further studies should evaluate mechanisms for these associations.

Clinical study on low-energy semiconductor laser treatment in the promotion of wound healing after maxillofacial fracture surgery.

This study aims to evaluate the clinical effect of low-energy semiconductor laser treatment on the promotion of wound healing after maxillofacial fracture surgery. A prospective randomized controlled study was conducted. Patients with maxillofacial fractures who were hospitalized in the Department of Trauma and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, from August 2021 to June 2023 were selected as the study subjects and randomly divided into experimental and control groups. The experimental group was treated with a low-energy semiconductor laser once a day for six consecutive days after daily routine dressing change on the first day after surgery. The control group only underwent routine dressing change treatment and did not receive low-energy semiconductor laser treatment. Wound healing times, wound healing conditions, modified Stony Brook scar evaluation scale (mSBSES) scores, pain indices, and wound infection rates were compared between the two groups. A total of 211 patients were included in this study. A total of 104 and 107 cases comprised the experimental and control groups, respectively. A total of 128 males and 83 females were included. After low-energy semiconductor laser treatment, the facial skin wound healing time of the experimental group was found to be significantly shorter than that of the control group (P<0.05). Moreover, the wound grade A healing rate of the experimental group was higher than that of the control group on the seventh day after surgery (P<0.05). Among postoperative facial skin wound evaluation indices, the mSBSES scores of the experimental group at all observation points were higher than those of the control group (P<0.05), and the scores of the experimental group were higher than those of the control group in terms of wound width reduction, height reduction, color lightening, and incision line loss (P<0.05). In postoperative wound pain evaluation, the pain index of the experimental group after low-energy semiconductor laser treatment was significantly lower than that of the control group (P<0.05). No significant difference in wound infection rates was found between the two groups (P>0.05). For facial skin wounds in maxillofacial fracture surgery, low-energy semiconductor laser treatment can effectively promote wound healing, improve wound healing quality, fade scars, and relieve wound pain.

Risk Factors for Incontinence-Associated Dermatitis in Adults: A Systematic Review and Meta-Analysis.

A meta-analysis was conducted to comprehensively identify risk factors of incontinence-associated dermatitis (IAD) in adults and provide evidence-based support for healthcare professionals to formulate IAD preventive interventions and bundled interventions. Systematic review and meta-analysis of pooled findings. Two researchers independently searched databases PubMed, EBSCO, Cochrane Library, Embase, Medline, Web of Science and Scopus and 4 Chinese databases (CNKI, Wanfang Data, VIP and CBM) for relevant studies published from their inception to March 15, 2023. Two researchers independently extracted relevant data and literature characteristics and evaluated the quality of the included studies. Twenty-seven studies that collectively enrolled 4046 participants were included in our systematic review. Five were written in English, 1 was written in Spanish, and the other 21 were written in Chinese. The odds ratios (ORs) and 95% confidence intervals (CIs) of the risk factors for IAD were determined. Fecal incontinence, an etiologic factor (OR=5.79; 95% CI=[1.88-17.87]), stool characteristics (OR=5.28; 95% CI=[2.51-11.07]), and daily frequency of bowel movements (OR=5.76; 95% CI=[4.48-7.42]) were associated with an increased likelihood of IAD. The following risk factors: fever (OR=4.23; 95% CI=[1.89-9.46]), age (OR=1.04; 95% CI=[1.01-1.09]), hypoproteinemia (OR=3.30; 95% CI=[1.90-5.72]), impaired consciousness (OR=2.43; 95% CI=[1.66-3.54]), days of antibiotic use (OR=4.13; 95% CI=[3.11-5.49]), diabetes mellitus (OR=2.90; 95% CI=[1.73-4.86]), and a higher overall Perineal Assessment Tool (PAT) score (OR=2.56; 95% CI=[1.23-5.30]) emerged as independent risk factors for IAD in adult patients. In contrast, a higher serum albumin level (OR=0.88; 95% CI=[0.84-0.93]), a higher Braden Scale for Predicting Pressure Score Risk (Braden Scale) score (OR=0.66; 95% CI=[0.56-0.77]), and a higher Braden Scale mobility subscale score (OR=0.86; 95% CI=[0.74-1.00]) were protective factors that reduced the likelihood of IAD. Identification of risk factors for IAD may be used to identify patients at risk and in need of preventive interventions. Identification of modifiable risk factors may be used to design novel preventive interventions.

LncRNA-MEG3 Mediated Diabetic Cerebral Ischemia-Reperfusion Injury-Induced Apoptosis via Modulating Interaction Between Annexin A2 and Akt in Mitochondria.

In clinical domains, encompassing neurosurgery and macrovascular cardiac procedures, certain interventions result in cerebral ischemia- reperfusion injury (CIRI). Diabetes mellitus (DM) increases the risk of CIRI and worsens the severity of neurological impairment. It was documented that lncRNA-MEG3 contributed to the pathogenesis of CIRI. However, the pivotal significance of lncRNA-MEG3 in diabetic CIRI has never been studied. This study's aims were two-fold, to (1) figure out the influence of lncRNA-MEG3 on neurological dysfunction subsequent to diabetic cerebral ischemic injury, (2) elucidate its potential role in mitochondria-related apoptosis via modulating the Anxa2 signaling pathway. We mainly collected plasma from clinical patients to measure the expression of lncRNA-MEG3, and explored the molecular mechanism of lncRNA-MEG3 in CIRI combined with DM by immunofluorescence, western blot, co-ip and other molecular biology experiments in rat MACO+DM model and cellular OGD/R+HG model. LncRNA-MEG3 expression in DM+AIS cases was remarkably higher than that in cases with AIS and healthy controls. Moreover, lncRNA-MEG3 expression was strongly linked to the National Institutes of Health Stroke Scale (NIHSS) score. Additionally, the findings unveiled that lncRNA-MEG3 depletion alleviated neurological impairments following CIRI in diabetic rats, and cellular death resulted from Oxygen-glucose deprivation (OGD) plus hyperglycemic reperfusion in rat brain microvascular endothelial cells (RBMVECs) that was concomitant with the increased phosphorylation of Annexin A2 (Anxa2) at Tyr23. Meanwhile, over expression of Anxa2, identified as a lncRNA-MEG3-associated mitochondrial protein, remarkably suppressed mitochondria-derived apoptosis. Importantly, lncRNA-MEG3 knockdown enhanced the mitochondrial translocation of Anxa2 via promoting its phosphorylation at Tyr23 in OGD+HG-treated RBMVECs. Furthermore, Anxa2 enhanced Akt phosphorylation at Ser473 and bound to Akt in mitochondria, which was involved in lncRNA-MEG3 depletion-induced neuroprotection. However, lncRNA-MEG3 mobilized to mitochondria in a Plectin-dependent manner and subsequently impeded the interaction between p-Anxa2 and p-Akt. The outcomes provided clinical evidence that lncRNA-MEG3 appeared as an unfavorable prognostic factor for diabetic CIRI and revealed that lncRNA-MEG3 knockdown could be protective against diabetic CIRI-induced mitochondria-related apoptosis through modulating Anxa2 binding to Akt in mitochondria.

Abstract 12: High HDL Cholesterol Is Associated With Reduced Reperfusion Injury And Favorable Functional Outcome Following Thrombectomy For Ischemic Stroke

Introduction: Animal research suggests that HDL cholesterol (HDL-C) ameliorates reperfusion injury, a phenomenon that worsens clinical outcome following recanalization therapy for ischemic stroke. Hypothesis: We hypothesized that higher HDL-C levels have a guarding effect against cerebral reperfusion injury in human stroke survivors treated with thrombectomy. Methods: We included patients with anterior circulation large vessel occlusion (acLVO) stroke who underwent thrombectomy from 01/2017 to 01/2023 at a tertiary stroke center in Germany into a prospective registry study with retrospective analysis. We assessed the association of HDL-C serum levels and imaging indices of post interventional reperfusion injury (any intracerebral or subarachnoid bleeding involving the ischemic brain region on CT or MRT), functional outcome quantified via modified Rankin scale (mRS) at 90 days and neurological outcome via National Institutes of Health Stroke Scale (NIHSS) score at discharge using multivariable lasso logistic and linear regression adjusted for demographic, clinical and imaging characteristics. We performed sensitivity analysis applying propensity score matching and shift analysis using ordered logistic regression. Results: In our study population of 811 acLVO patients treated with thrombectomy (420 females, median age 77 years [66-84, interquartile range]) reperfusion injury was associated with detrimental functional outcome (adjusted OR 2.87; 95% CI [1.86;4.41]; p=0.000). Higher HDL-C was associated with lower odds of reperfusion injury (adjusted OR 0.57; 95% CI [0.35;0.95]; p=0.03) and emerged as predictor of favorable functional outcome defined as 90-day mRS 0-2 (adjusted OR 0.57; 95% CI [0.34;0.99]; p=0.04) and alleviated neurological deficits with lower NIHSS score at discharge (ß=-2.51; 95CI% [-4.88; -1.30]; p=0.04). On propensity score analysis an HDL-C level exceeding the median (1.15 mmol/L) was associated with a 13.8 % decrease in the probability of reperfusion injury (ß=-0.14; 95CI% [-0.23; -0.05]; p=0.003). A significant shift of 90-day mRS distribution favoring high HDL is shown in the figure. Conclusions: In patients undergoing thrombectomy for acLVO a higher level of HDL-C reduced the odds of reperfusion injury, which translated into improved functional and neurological outcome, hence constituting a possible target of adjunctive neuroprotective treatment.

Temporal Trends in Serum Homer1 Levels and Their Prognostic Implications in Aneurysmal Subarachnoid Hemorrhage: A Prospective Cohort Study.

Homer scaffold protein 1 (homer1) may harbor neuroprotective effects against acute brain injury. This study aimed to investigate the prognostic role of serum homer1 in human aneurysmal subarachnoid hemorrhage (aSAH). A total of 209 patients with aSAH and 100 controls were encompassed in this prospective cohort study. Serum homer1 levels were quantified at admission in all patients, on post-aSAH days 1, 3, 5, 7, 10, and 14 in 83 patients and at recruitments in controls. The modified Fisher scale (mFisher) and World Federation of Neurological Surgeons Scale (WFNS) were used for severity assessment. Glasgow Outcome Scale (GOS) scores of 1-3 at post-aSAH 90 days indicated poor prognosis. Serum homer1 levels of patients were abruptly elevated at admission, peaked at day 3, and afterwards decreased from day 5 until day 14 after aSAH, and were markedly higher during 14 days than those of controls. Serum homer1 levels were linearly and independently correlated with WFNS scores, mFisher scores, continuous GOS scores, ordinal GOS scores, poor prognosis risk and delayed cerebral ischemia (DCI) likelihood. DCI partially mediated association of serum homer1 levels with poor prognosis. The prognosis model was composed of the four independent predictors, that is serum homer1 levels, DCI, WFNS scores and mFisher scores. As demonstrated by a series of statistical methods, the model had a good performance. Serum homer1 levels are significantly elevated in acute phase after aSAH, and are strongly related to heightened bleeding intensity, poor 90-day prognosis and DCI. Nevertheless, associational mechanism of serum homer1 and poor prognosis mediated by DCI needs to be further deciphered.

The value of fixed segment mobility in posterior dynamic stabilization: a single-center retrospective study

PurposeThis study aims to compare the effects of two generations of the Isobar dynamic fixation system—Isobar TTL (first-generation, less mobile) and Isobar EVO (second-generation, more mobile)—on the surgical and adjacent intervertebral disc segments, based on MRI findings.MethodsA retrospective analysis was conducted on 29 patients treated with fenestrated decompression and Isobar EVO stabilization and 34 patients treated with fenestrated decompression and Isobar TTL stabilization. Clinical outcomes and radiographic parameters, including the disc height index (DHI) and range of motion (ROM) of the surgical and upper adjacent segments, lateral neural foraminal protrusion value (LNPV) of the upper adjacent segment, and Pfirrmann grading of disc degeneration, were evaluated and compared between the two groups.ResultsAt the 48-month follow-up, no significant differences in Visual Analog Scale (VAS) scores or Oswestry Disability Index (ODI) were observed between the two groups (P > 0.01). The EVO group demonstrated significantly higher surgical segment DHI and ROM compared to the TTL group (P < 0.01). Meanwhile, the upper adjacent segment ROM was significantly lower in the EVO group compared to the TTL group at the final follow-up (P < 0.01). Additionally, the upper adjacent segment LNPV was larger in the EVO group than in the TTL group (P < 0.01). Pfirrmann grading revealed greater degeneration in surgical segments treated with TTL compared to EVO (P = 0.008).ConclusionCompared to the first-generation, less mobile Isobar TTL, the second-generation, more mobile Isobar EVO offers superior preservation of the surgical segment and slows the progression of degeneration in the upper adjacent segments. These findings highlight the benefits of greater mobility in posterior dynamic stabilization devices.

Abstract TP117: Efficacy And Safety Of Ambulance-Based Prehospital Transdermal Glyceryl Trinitrate In Patients With Acute Presumed Stroke. A Meta-Analysis Of Randomized Controlled Trials.

Background: Uncontrolled high blood pressure is a risk factor for acute stroke and a predictor of poor stroke outcomes. Less is known about the efficacy and safety of early ambulance-delivered blood pressure reduction on clinical and functional outcomes in patients with undifferentiated acute stroke. Methods: PubMed, Scopus, and Cochrane databases were searched for randomized controlled trials that compared intervention (with glyceryl trinitrate) to usual blood pressure care or sham in patients with undifferentiated acute stroke; the outcomes of day 90 modified Rankin scale (mRS) maximum score of 6, EuroQol-5D score, National Institutes of Health Stroke Scale (NIHSS ) score at hospital admission, death within 90 days, Barthel index at 90 days, and home time. Heterogeneity was examined using I 2 statistics. Results: We included 3 RCTs with 3547 Patients, of whom 388 received intervention with glyceryl trinitrate. The pooled results of the included 3 RCTs comparing Intervention with glyceryl trinitrate to usual care or sham treatment showed that the death within 90 days (21.9% vs 21.1% respectively; OR = 1.05; 95% CI [0.89, 1.24]; I 2 = 0%; p = 0.546), EuroQol-5D-5L score (MD = -0.00; 95% CI [-0.03, 0.03]; I 2 = 0%; p = 0.98), NIHSS score at hospital admission (MD = 0.18; 95% CI [-0.70, 1.06]; I 2 = 0%; p = 0.69), day 90 mRS maximum score at 6 (MD = 0.01; 95% CI [-0.25, 0.27]; I 2 = 0%; p = 0.94), NIHSS score at 24 hours (MD = 0.56; 95% CI [-0.16, 1.27]; I 2 = 0%; p = 0.13), Barthel index at 90 days (MD = -2.56; 95% CI [-7.90, 2.78]; I 2 = 0%; p = 0.35), and home time (MD = 0.22 days; 95% CI [-5.02, 5.46]; I 2 = 0%; p = 0.93) were not statistically different between the intervention and the usual care groups. Conclusion: These findings suggest that early ambulance-delivered blood pressure reduction does not have superior efficacy and safety profiles for clinical and functional outcomes compared with usual care or sham treatment in patients with undifferentiated acute stroke.

Abstract TP160: Deep tiny flow voids on high-resolution magnetic resonance imaging predict a favorable prognosis in patients with acute middle cerebral artery occlusion

Background and Purpose: Deep tiny flow voids (DTFVs) are a specific type of collaterals surrounding chronic steno-occlusive middle cerebral artery (MCA), which can be identified on high-resolution magnetic resonance imaging (HR-MRI). This study aimed to investigate the presence of DTFVs in patients with acute MCA occlusion and their relevance to clinical outcomes. Methods: Using data from two multicenter cohort studies, we examined the presence of DTFVs in patients with acute MCA occlusion and analyzed their clinical and imaging characteristics. Univariable and multivariable logistic and linear regression analyses were conducted to assess the correlation between DTFVs and the 90-day modified Rankin Scale (mRS) scores. We further studied the mediating effect of residual flow distal to MCA occlusion on the relationship between DTFVs and 90-day mRS scores using mediation analysis. Results: One hundred and twenty-three patients with acute MCA occlusion were included. The median age was 61 years (interquartile range [IQR], 51-67 years), and 73.73% of the patients were male. The median time from symptom onset to imaging was 44 hours (IQR, 25-67 hours). Sixty-six patients (53.66%) exhibited DTFVs on HR-MRI. Lower baseline NIHSS scores (4.5 [2-8] vs. 10 [4-14]) and smaller infarct volumes (5.76 [2.79-15.34] cm 3 vs. 19.01 [7.16-83.59] cm 3 ) were observed in patients with DTFVs compared to those without. Both multivariable logistic regression (odds ratio [OR]: 6.22, 95% confidence interval [CI]: 1.82 to 21.29, p = 0.004) and linear regression analysis (β: -0.60, 95% CI: -1.06 to -0.14, p = 0.012) indicated that patients with DTFVs exhibited better 90-day functional outcomes. The mediating effect analysis showed that the effect of DTFV on 90-day mRS scores was partially mediated by residual flow distal to MCA occlusion, with a proportion of 30.66% (95% CI: 8.97 to 69.29, p = 0.002). Conclusions: In our study population, the presence of DTFVs was associated with a favorable outcome in patients with acute MCA occlusion, which may exert a protective effect partly by contributing to the formation of distal residual flow at the occlusion sites. Future studies are needed to investigate the potential of DTFVs in guiding individualized treatment strategies.

Early Single-Stage Curettage and Autogenous Bone Grafting for Enchondroma in the Hand with Minimally Displaced Pathologic Fracture.

Enchondroma is a common benign bone tumor in the hand, often leading to delayed diagnosis due to its asymptomatic nature. The surgical treatment strategy for enchondroma, particularly in pathologic fractures, remains unclear. This study aimed to evaluate the outcomes of treatment for non- or minimally displaced pathologic fractures in enchondroma using autogenous bone grafts alone, without metal fixation. A retrospective analysis was conducted on 34 patients who underwent surgery for enchondroma and pathologic fractures. Clinical and radiographic outcomes were assessed, including pain scores, range of motion (ROM), Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, fracture union time, and complications. All patients reported pain at the fracture site preoperatively. The preoperative pain visual analog scale (VAS) score was 4.5. Postoperatively, the pain VAS score improved significantly to 2.3. The postoperative average total ROM was 253.8°. The average DASH score was 5.1, and grip strength was 97.8% compared to the unaffected side. Bony union was achieved in all cases with an average union time of 10.9 weeks. No complications were observed except for 1 suspected recurrence. Early single-stage surgical treatment with curettage and autogenous bone grafts without fixation yielded satisfactory results for non- or minimally displaced pathologic fractures in enchondroma. This non-fixative technique offers a viable option with reduced treatment duration and implant-related complications.

Abstract TMP62: Early Intensive Blood Pressure Lowering within 6 hours of Intracerebral Hemorrhage Onset is Associated with Improved Functional Outcomes in Larger Trials, but Inconclusive Evidence Overall: A Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials

Background: Elevated blood pressure (BP) is common after Intracerebral Hemorrhage (ICH) and is linked with increased morbidity and mortality, partly due to hematoma expansion. We conducted a systematic review and meta-analysis to determine the effect of BP lowering within 6 hours of ICH onset on functional outcome at 90 days, including a subgroup analysis of undifferentiated stroke patients. Methods: We searched PubMed, Embase, Cochrane Central, Google Scholar, and Clinicaltrials.gov for randomized controlled trials (RCTs). Odds ratio (ORs) with 95% CI were pooled across trials using a random-effects model for the outcomes of 1) change in modified Rankin Scale (mRS) score at 90 days; 2) 90-day death; 3) combined death or disability (mRS&gt;2); 4) significant hematoma expansion (&gt;6ml or &gt;33% of baseline) and 4) serious adverse events (SAEs). The above analyses were replicated in the patients with undifferentiated (radiologically unconfirmed) stroke who recieved pre-hospital BP lowering. Trial sequential analysis (TSA) was performed to determine cumulative evidence strength. Results: We included 9 RCTs with 11,773 patients; 5884 (49.9%) of whom received early BP control within 6 hours of ICH onset. Early BP lowering therapy was associated with a favorable change in 90-day mRS scores (OR 0.88; 95% CI 0.78-0.98; Fig.1A), a reduced risk of death (OR 0.86; 95% CI 0.75-0.98; Fig.1B), a lower risk of death or disability (OR 0.85; 95% CI 0.73-0.99; Fig.2A) and reduced risk of significant hematoma expansion (OR 0.74; 95% CI 0.58-0.95; Fig.2B) in larger trials. On pooling the results of smaller RCTs (&lt;100 patients) with those from larger trials, none of the above outcomes were significant. The same was true for prehospital BP management in undifferentiated stroke. No increased risk of SAEs was observed. TSA indicated that the current evidence is inconclusive to reach definitive conclusions for both the 90-day death outcome and the combined death or disability at 90 days in the primary analysis. Conclusion: Early BP lowering within 6 hours ICH of onset had no increased risk of SAE and is associated with improved 90-day mRS scores, reduced mortality, lower combined death or disability rates, and reduced risk of hematoma expansion in larger trials, which becomes non-significant on pooled analysis of larger and smaller trials. TSA indicated the need for additional trials with larger sampling sizes to confirm these findings.

Challenges in maintaining remission after ECT - Insights from a six-month follow up study.

Electroconvulsive therapy (ECT) is a widely recognized treatment for severe depressive disorders, particularly in cases of inadequate response to pharmacological interventions or when rapid symptom relief is essential. Although ECT demonstrates high efficacy, a notable proportion of patients relapse after a successful ECT course. This study investigated clinical baseline characteristics and residual depressive symptoms associated with relapse - defined as a Montgomery-Åsberg Depression Rating Scale (MADRS) score >15, restart of ECT, or suicide attempt - within six months after successful ECT. Data were obtained from the PROTECT study, a single-site, prospective cohort study conducted at the University Psychiatric Center Duffel, Belgium. - Among the 65 patients who completed the ECT course, 40 patients (62%) achieved remission. At six months, 32 patients were reassessed, and 18 (56%) of them experienced relapse. No significant associations were identified between relapse and baseline factors, including age, social circumstances, baseline depression severity, psychomotor symptoms, cognitive functioning, treatment resistance, lithium use, or the presence of psychotic or melancholic features. Residual depressive symptoms at the end of the ECT course also did not predict relapse. - The observed high relapse rate underscores the critical need for robust continuation and maintenance strategies following ECT. Future research should prioritize larger cohorts to better identify predictors of relapse and optimize post-ECT treatment protocols.

Efficacy and Prognosis of ROSA Robot-Assisted Stereotactic Intracranial Hematoma Removal in Patients with Cerebral Hemorrhage in Basal Ganglia Region: Comparison with Craniotomy and Neuroendoscopy.

This study compares the clinical efficacy and outcomes of three surgical techniques-robot-assisted stereotactic assistance (ROSA), neuroendoscopy, and craniotomy-in the removal of intracranial hematomas in patients with cerebral hemorrhage affecting the basal ganglia. This retrospective study included 110 patients, who were grouped based on the surgical method used: 40 patients in the ROSA group, 50 in the craniotomy group, and 20 in the endoscopy group. We then compared the outcomes of the ROSA group with those of the craniotomy and endoscopy groups. Compared with the craniotomy group, the ROSA group had a significantly shorter operation time, higher hematoma clearance rate, lesser intraoperative blood loss, fewer postoperative pulmonary infections, and lower modified Rankin Scale (mRS) score at discharge and > 3months after discharge. Compared with the endoscopy group, the ROSA group had a shorter operation time, lesser intraoperative blood loss, and fewer intraoperative blood transfusions. The ROSA robot provided superior surgical outcomes and patient prognoses compared to craniotomy and neuroendoscopy for the removal of intracranial hematomas in patients with basal ganglia cerebral hemorrhage.

Screening prediction models using artificial intelligence for moderate-to-severe obstructive sleep apnea in patients with acute ischemic stroke.

Obstructive sleep apnea (OSA) is common after stroke. Still, routine screening of OSA with polysomnography (PSG) is often unfeasible in clinical practice, primarily because of how limited resources are and the physical condition of patients. In this study, we used several artificial intelligence techniques to predict moderate-to-severe OSA and identify its features in patients with acute ischemic stroke. A total of 146 patients with acute ischemic stroke underwent PSG screening for OSA. Their baseline demographic characteristics, including age, sex, body mass index (BMI), Epworth Sleepiness Scale (ESS) score, and stroke risk factors, were recorded. Logistic regression analysis was conducted to identify significant features associated with moderate-to-severe OSA in patients with stroke. These significant features were used with six machine learning and ensemble learning algorithms, namely decision tree, support vector machine, random forest, extreme gradient boosting (XGBoost), adaptive boosting (AdaBoost), and gradient boosting, to compare the performance of several predictive models. Multivariate logistic regression analysis revealed that age, sex, BMI, neck circumference, and ESS score were significantly associated with the presence of moderate-to-severe OSA. According to the machine learning and ensemble learning results, the XGBoost model achieved the highest performance, with an area under the receiver operating characteristic curve of 0.89 and an accuracy and F1 score of 0.80. This study identified key factors contributing to moderate-to-severe OSA in patients with ischemic stroke. The XGBoost model exhibited high predictive performance, indicating it has potential as a supporting tool for decision-making in health-care settings.

Abstract 25: Discovery of Serum Biomarkers to Inform Early Rehabilitation after Acute Ischemic Stroke

Background: Rehabilitation therapy is an important component of acute ischemic stroke (AIS) recovery. A major hinderance is the inability to predict which patients benefit from mobilization during the first 24 hours (ERehab). We hypothesize serum biomarker analyses during the hyperacute phase can bridge the gap. Methods: This is a single center study of 20 AIS patients&amp;14 age/sex matched controls enrolled from 3/2022-6/2023. Serum samples were collected at 4 time points – angiography suite before cerebral reperfusion or Neuro ICU at hospital admission, 12, 24&amp;72 hours. Biomarker candidates were identified using a DisGeNET search for AIS associated proteins; 70% achieved an Evidence Index cutoff score of 1, indicating all publications support human gene-disease or variant-disease associations. Time course of serum proteome changes was evaluated using aptamer-based SomaScan assay, measuring 1500 proteins. NIH Database for Annotation, Visualization&amp;Integrated Discovery (DAVID) Gene Functional Classification Tool compared shared genes and biomarkers for stroke (vs healthy controls)&amp;unfavorable (vs favorable) outcome, characterized by modified Rankin Scale (mRS) score of 3-6 (vs 0-2), at hospital discharge&amp;90 days (90d). Results: The mean age of AIS patients was 59 years, 65% were male. Median NIHSS score was 11, Charlson Comorbidity Index score was 5.5 and the median last known well to hospital admission was 6.6 hrs. The average time to first mobilization was 39 hrs, 25% received ERehab. The mean rehab duration during AIS hospitalization was 438 min; median length of stay was 8.4 days, 40% received post-acute rehabilitation. Median AIS volume was 36mL, 65% of patients had ICA or M1/MCA involvement. Approximately 65% received IV thrombolysis, 80% underwent cerebral reperfusion therapy, 94% achieved modified thrombolysis in Cerebral Infarction score ≥ 2b. The median mRS was 4 at hospital discharge, 3 at 90d. Mortality rate was 10%. DAVID analyses resulted in 22 biomarkers at hospital discharge&amp;35 biomarkers at 90d associated with favorable outcome. Gene expression differences were present at each time point (Figure). Conclusions: We identified multiple serum biomarkers and gene clusters associated with favorable outcomes at hospital discharge and 90d in AIS patients, indicating a need for several biologic targets to predict ERehab response during the hyperacute phase. These findings provide an early framework for tailored stroke recovery interventions.

Psychometric Properties of the Persian Version of the Evaluation of Ankylosing Spondylitis Quality of Life (EASi-QoL) and Ankylosing Spondylitis Disease Activity Score (ASDAS) Questionnaires: A Cross-Sectional Study.

Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects quality of life (QoL) due to its impact on physical and emotional well-being. Accurate and reliable tools are needed to assess disease activity and QoL in different cultural contexts. This study aimed to evaluate the psychometric properties of the Persian versions of the Evaluation of Ankylosing Spondylitis Quality of Life (EASi-QoL) and Ankylosing Spondylitis Disease Activity Score (ASDAS) scales in Iranian AS patients. A cross-sectional study was conducted on 70 AS patients referred to a tertiary hospital in Tehran. Patients completed the EASi-QoL, and 39 also completed the ASDAS questionnaire. The translation followed the forward-backward method. Reliability was assessed using Cronbach's α for internal consistency and intraclass correlation coefficient (ICC) for test-retest reliability. Content validity was evaluated using the content validity ratio (CVR) and Content Validity Index (CVI). Test-retest reliability was examined using Spearman's rank correlation for non-normally distributed data. The ICC values for EASi-QoL ranged from 0.71 to 0.82, while Spearman's correlation coefficients ranged from 0.63 to 0.80. For ASDAS, all items except Question 1 had ICC and Spearman's correlation coefficients above 0.8, indicating high test-retest reliability. The average CVR for EASi-QoL was 0.56, and for ASDAS it was 0.68. The CVI for relevance, clarity, and simplicity ranged from 0.86 to 0.96 for both scales, confirming good content validity. The Persian versions of the EASi-QoL and ASDAS scales demonstrate adequate reliability and validity. These tools are suitable for assessing QoL and disease activity in Iranian AS patients, providing culturally relevant measurements for clinical and research settings.

Cardiovascular Risk and Knowledge, Attitudes and Beliefs of Football Referees Towards Acute Coronary Syndrome Events

Although exercise is protective against cardiovascular disease, a transient increase in acute coronary syndrome (ACS) exists during heavy exertion. Psychological stressors are also known to precipitate ACS events. Football (soccer) referees are exposed to both physical and emotional stress when officiating a match, as well as being potential first responders for cardiovascular events among players. However, there has been limited research into cardiovascular risk and knowledge among football referees. To evaluate cardiovascular risk factors in Australian football referees and assess their knowledge, attitudes and beliefs towards symptoms of ACS. An anonymous, online survey administered using REDCap was completed by Australian football referees at all levels of football, from grassroots to professional level. Participants were asked to select which risk factors they had from a pre-existing list. A modified version of the ACS Response Index assessed referees' knowledge of ACS symptoms and their attitudes and beliefs regarding response to ACS symptoms RESULTS: Overall, 134 participants completed the survey, with a majority male (87.3%) and a median age of 47.0 years. Participants had refereed for an average of 12.5 (±8.9) years, with most officiating at the grassroots/amateur level (62.7%). Risk factors included hypercholesterolaemia (17.2%), hypertension (9.7%), diabetes mellitus (3.7%), peripheral vascular disease (2.2%) and tobacco smoking (0.8%). Overall 30.5% had a positive family history of cardiac disease and 9.7% had been previously diagnosed with a heart condition (including a heart attack or angina). Participants had only a moderate knowledge of ACS symptoms (12.9 [±3.0] with a maximum scale score of 21), scoring well for typical symptoms but less well for atypical symptoms or distinguishing from cerebrovascular events. Almost all would stop play immediately if a player complained of chest pain (95.9%), however, two-thirds (65.0%) would continue for at least 5 minutes if they had unusual chest pain in themselves. A majority were not sure they could recognise a heart attack in themselves or someone else (70.8%). They were supportive of further education to improve knowledge regarding ACS symptoms and interventions (90.9%). Football referees are both at risk of ACS events and potentially first responders to events in players. This population of sampled referees had moderate knowledge of ACS symptoms, with a strong willingness to receive further education.

Impaired Glymphatic Function in Acute Spontaneous Intracerebral Hemorrhage.

Alterations in glymphatic function during the acute phase of acute spontaneous intracerebral hemorrhage (sICH) remain poorly understood. The aim of this study was to investigate whether, compared to healthy controls (HCs), the glymphatic system is impaired in patients with sICH, and to assess its association with hemorrhage and edema severity and outcome. Fifty-five sICH patients (including 46 supratentorial sICH and 9 ) and 97 age- and sex-matched HCs underwent conventional MRI and diffusion tensor imaging. The diffusion along the perivascular space (DTI-ALPS) index, serving as a marker for glymphatic function, was computed, with supratentorial cases being categorized into ipsilateral and contralateral ALPS. Volumes of hemorrhage and edema were evaluated using susceptibility-weighted imaging (SWI) and T2-weighted magnetic resonance images, and the relative edema ratio was calculated. Clinical outcomes were categorized as favorable or poor based on a modified Rankin scale score of ≤ 2 or > 2 at 90 days. sICH patients showed significantly lower DTI-ALPS values on the ipsilateral side compared to the average in the HC group (1.34 ± 0.24 vs. 1.46 ± 0.22, p = 0.003), whereas contralateral DTI-ALPS values in sICH patients did not differ significantly from HCs (1.48 ± 0.21 vs. 1.46 ± 0.22, p = 0.524). The ipsilateral DTI-ALPS was notably associated with both hemorrhage and relative edema volumes (both p < 0.05). A higher ipsilateral DTI-ALPS was independently associated with a favorable outcome at 90 days (odds ratio = 1.686 per 0.1 increase, p = 0.038). The DTI-ALPS index, which reflects glymphatic functionality, is notably diminished on the ipsilateral side in acute sICH, correlating significantly with increased volumes of hemorrhage and edema. This study suggests that glymphatic dysfunction may contribute to the severity of clinical outcomes, and highlights the potential role of the glymphatic system in the pathophysiology of sICH.