Significant Differences In Outcomes Research Articles

Virtual Teaching Together: engaging parents and young children in STEM activities.

Early informal learning experiences are essential for sparking long-term interest in science, technology, engineering, and math (STEM). In a prior study, we found more promising parent involvement outcomes when families of young children were provided with STEM family education events along with home STEM activity kits compared to providing workshops alone. This study was a conceptual replication using the same program-Teaching Together STEM-to deliver educational workshops plus home activity kits; however, we varied the delivery method by using virtual "funshops" to evaluate if parents perceived this modality as feasible and useful. Museum informal science educators introduced four units via virtual video chat sessions linked to 12 hands-on STEM activities that were mailed to families randomly assigned to the treatment group. Half of the families were assigned to a waitlist control group that received a portion of the virtual program after the posttest. Participants included 60 families with children aged 3 to 5 years from diverse linguistic and socioeconomic backgrounds. Our results indicate no significant group differences in the primary outcome of parents' involvement in informal STEM but a small, positive effect size (ES = 0.18) that was similar in magnitude to the prior, in-person study. Although parents mostly perceived the remote delivery as convenient and the materials as engaging for their child, there were no significant program impacts on children's general science interests (ES = -0.19). Despite the convenience, parents reported time was a barrier to doing STEM activities at home. Parents with lower education levels were less likely to attend, suggesting virtual approaches are not sufficient for ensuring broad access to family engagement programs for populations underrepresented in STEM.

(222) Simultaneous Inflatable Penile Prosthesis and Adjustable Male Sling: A Step-by-Step Surgical Technique

Abstract Introduction Erectile dysfunction (ED) and urinary incontinence (UI) are common complications following radical prostatectomy (1). At twenty-four months post-surgery, approximately 43% of men experience some degree of ED, while UI affects around 15% of patients between twelve to twenty-four months (2, 3). Notably, nearly 20% of patients experience both ED and UI complications (4). Initial conservative management strategies include the use of PDE-5 inhibitors, intercavernosal injections, or a vacuum erectile device for ED and pelvic floor muscle training for UI (5). However, symptoms that persist or worsen beyond six months can be considered for surgical intervention (6). Surgical options include penile prosthesis implantation for ED and diverse techniques such as the Artificial Urinary Sphincter (AUS) or adjustable male urethral sling, depending on symptom severity, for UI management. Limited evidence suggests that a simultaneous surgical approach addressing both conditions can be a cost-effective and a safe alternative to separate surgeries (7, 8). Objective In this context, the objective of this video presentation is to illustrate a detailed, step-by-step technique for the simultaneous implantation of an inflatable penile prosthesis (IPP) and an adjustable male sling (AMS), while also discussing its feasibility, safety, and functional outcomes. Methods The combined IPP and AMS surgery is a safe, viable, and cost-effective option for patients who need to address both ED and UI. Rhee (2005) initially described the concurrent placement of a penile prosthesis (PP) and male sling (MS) in a series of four post-prostatectomy patients. Results The results demonstrated successful restoration of erections and complete continence in all patients, with no postoperative complications. Our previous systematic review, comparing the outcomes of simultaneous surgical placement of PP and MS versus PP and artificial urethral sphincter (AUS), found no clinically significant differences in outcomes between the two groups (Raheem 2021). Therefore, the simultaneous placement of IPP and AMS should be considered an option for patients, as it shows comparable effectiveness to other concurrent surgical interventions. Dual implantation of PP and male sling have also demonstrated cost savings of approximately $9,000 for patients, further enhancing its advantages in managing both ED and UI (Gorbatiy 2010). Ultimately, a collaborative discussion between patients and their urologist is crucial in determining the most suitable approach for patient individual needs. Conclusions The simultaneous surgical placement of an inflatable penile prosthesis (IPP) and adjustable male sling (AMS) presents a favorable and viable solution for managing erectile dysfunction (ED) and urinary incontinence (UI) in patients who exhibit an inadequate response to conservative management following prostatectomy. Disclosure No.

Postanesthesia Care Unit and Anesthetic Management Outcomes Among Patients Undergoing Noncardiac Surgery: Differences by Race and Ethnicity

To investigate the association of patient race and ethnicity with postanesthesia care unit (PACU) outcomes in common, noncardiac surgeries requiring general anesthesia. Single tertiary care academic medical center retrospective matched cohort. We matched 1:1 1836 adult patients by race and/or ethnicity undergoing common surgeries. We compared racial and ethnic minority populations (62 American Indian, 250 Asian, 315 Black or African American, 281 Hispanic, and 10 Pacific Islander patients) to 918 non-Hispanic White patients. The primary outcomes were: the use of an appropriate number of postoperative nausea and vomiting (PONV) prophylactics; the incidence of PONV; and the use of a propofol infusion as part of the anesthetic (PROP). Secondary outcomes were: the use of opioid-sparing multimodal analgesia, including the use of regional anesthesia for postoperative pain control; the use of any local anesthetic, including the use of liposomal bupivacaine; the duration until readiness for discharge from the PACU; the time between arrival to PACU and first pain score; and the time between the first PACU pain score of ≥4 and administration of an analgesic. Logistic and linear regression were used for relevant outcomes of interest. Overall, there were no differences in the appropriate number of PONV prophylactics, nor the incidence of PONV between the two groups. There was, however, a decreased use of PROP (OR=0.80; 95% CI: 0.69, 0.94; P=.005), PACU length of stay was 9.56minutes longer (95% CI: 2.62, 16.49; P=.007), and time between arrival to PACU and first pain score was 2.30minutes longer in patients from racial and ethnic minority populations (95% CI: 0.99, 3.61; P=.001). There were no statistically significant differences in the other secondary outcomes. The rate of appropriate number of PONV prophylactic medications as well as the incidence of PONV were similar in patients from racial and ethnic minority populations compared to non-Hispanic White patients. However, there was a lower use of PROP in racial and ethnic minority patients. It is important to have a health equity lens to identify differences in management that may contribute to disparities within each phase of perioperative care.

An investigation of the role of estradiol in fear reduction during a single session of exposure therapy

ABSTRACT Research suggests that estradiol may moderate fear extinction. It is unclear whether these results generalize to exposure therapy. The aim of the current study was to determine whether estradiol moderates outcomes in exposure therapy among women with anxiety disorders. Participants were 35 women with a primary diagnosis of an anxiety disorder who participated in the study as part of routine care at an anxiety specialty clinic. Endogenous estradiol was assessed via saliva. They provided subjective distress ratings before (pre) and after (post) an exposure session, as well as after a brief delay (recall). Contrary to predictions, there were no significant differences in exposure outcomes between the high and low estradiol groups. However, among participants with primary obsessive-compulsive disorder (OCD), results were partially consistent with the hypotheses. Women with lower estradiol initially demonstrated more improvement in subjective distress from pre- to post-exposure, but after the delay, significantly greater distress (attenuated extinction recall). Results suggest that women with lower estradiol may respond less favorably to exposure therapy for OCD relative to women with higher estradiol. These findings await replication in larger samples with longer recall delays. Should replication occur, these results may inform the use of estradiol to augment exposure therapy.

Comparison of Fusion Rates among Various Demineralized Bone Matrices in Posterior Lumbar Interbody Fusion.

Background and Objectives: Posterior lumbar interbody fusion (PLIF) plays a crucial role in addressing various spinal disorders. The success of PLIF is contingent upon achieving bone fusion, as failure can lead to adverse clinical outcomes. Demineralized bone matrix (DBM) has emerged as a promising solution for promoting fusion due to its unique combination of osteoinductive and osteoconductive properties. This study aims to compare the effectiveness of three distinct DBMs (Exfuse®, Bongener®, and Bonfuse®) in achieving fusion rates in PLIF surgery. Materials and Methods: A retrospective review was conducted on 236 consecutive patients undergoing PLIF between September 2016 and February 2019. Patients over 50 years old with degenerative lumbar disease, receiving DBM, and following up for more than 12 months after surgery were included. Fusion was evaluated using the Bridwell grading system. Bridwell grades 1 and 2 were defined as 'fusion', while grades 3 and 4 were considered 'non-fusion.' Clinical outcomes were assessed using visual analog scale (VAS) scores for pain, the Oswestry disability index (ODI), and the European quality of life-5 (EQ-5D). Results: Fusion rates were 88.3% for Exfuse, 94.3% for Bongener, and 87.7% for Bonfuse, with no significant differences. All groups exhibited significant improvement in clinical outcomes at 12 months after surgery, but no significant differences were observed among the three groups. Conclusions: There were no significant differences in fusion rates and clinical outcomes among Exfuse, Bongener, and Bonfuse in PLIF surgery.

Outcomes with enfortumab vedotin in patients with advanced urothelial carcinoma and histology variants: Analysis of the UNITE study.

652 Background: Enfortumab vedotin (EV) is approved for patients (pts) with advanced urothelial carcinoma (aUC) but outcomes in pts with histology variants (HV) have not been well described. We hypothesized that presence of HV would impact EV treatment outcomes. Methods: UNITE is a multi-site retrospective study of pts with aUC treated with targeted agents, including 650 pts treated with EV regimens. We compared outcomes to EV monotherapy in pts with pure UC (pUC) relative to pts with any HV and with specific HVs. In pts with scans after > 1 cycle of EV, observed response rate (ORR) was assessed using χ2 test and logistic regression. Median progression-free survival (PFS) and overall survival (OS) from EV start were measured using the Kaplan Meier method and Cox proportional hazard test. Results: A total of 566 pts (366 with pUC; 200 with HV) from 17 US sites were treated with EV monotherapy. Median age was 70 years, 71% men, 87% Caucasian, 74% with ECOG PS 0/1 and 28% with liver mets. Median follow up was 21 mos from EV start, ORR was 49%, mPFS and mOS were 5.8 mos (95% CI: 5.29-6.67) and 12.2 mos (95% CI: 11.5 – 13.8), respectively. Pts with pUC had more visceral mets (69% vs 60%, p = 0.04) and liver mets (32% vs 21%, p =0.003) than pts with HV. No significant difference in outcomes were seen between pUC and pts with HV component (1-100%). Pts with predominant HV (50-99%; N=35), had numerically lower ORR relative to pUC pts (36% vs 52% OR 0.31, p <0.09), but no difference in mPFS or mOS. Pts with pure HV (pHV) (100%: N=14) had inferior outcomes relative to pts with pUC (ORR 0% vs 52%, p<0.001; mOS HR: 2.96 (95% CI: 1.60 – 5.46), p <0.001; mPFS HR: 1.9 (95% CI: 1.06 – 3.39), p=0.03). ORRs for specific HV are listed in the table. No significant difference in treatment outcomes were seen in pts with pUC vs any specific HV, except for NE HV which had inferior ORR (0% vs 52%; p=0.003). Conclusions: Responses to EV are noted in some aUC pts with HV, except for NE (any component) and pHV. Certain HV notable for poor outcomes, such as sarcomatoid and plasmacytoid, demonstrated responses to EV. These hypothesis-generating findings require further validation in studies with adequate sample size for specific HV, and in particular pHV. Evaluation of biomarkers, including Nectin4 expression, in HV is paramount. [Table: see text]

Abstract WP167: Clinical Characteristics and Outcomes of Mixed Cerebral Small Vessel Disease According to the CLAS-ICH Classification

Objectives: Mixed location intracerebral hemorrhages/ microbleeds (CMBs) (mixed ICH) is referred to as potential hypertensive arteriolosclerosis/cerebral amyloid angiopathy (CAA) combination, reflecting small vessel disease (SVD) burden. We assess the clinical features in patients with mixed ICH. Methods: We utilized data from a prospective registry, which consecutively enrolled patients diagnosed with acute ICH between January 2011 and December 2021. Patients with ICH were classified into subtypes according to the CLAS-ICH classification: hypertensive arteriolosclerosis ([HTN]-ICH), CAA-ICH, mixed ICH, genetic SVD, and secondary causes. The clinical data of patients with mixed ICH were compared to those with HTN-ICH or CAA-ICH. The outcome measure was unfavorable functional outcomes defined as mRS score of 5-6 at 90-day. Results: Of 2127 patients with ICH (mean age 70±13 years, 57% male), 1374 (65%) had HTN-ICH, 141 (6%) had CAA-ICH, 409 (19%) had mixed ICH, none (0%) had genetic SVD, 203 (10%) had secondary causes. Patients with mixed ICH were older (75±11 vs. 69±13 years) and had a high frequency of CMBs (68% vs. 25%), had lower initial SBP (176±32 vs. 184±30 mmHg) and initial NIHSS (12 [4-21] vs. 14 [7-23]) and more hematoma volume (17 [6–52] vs. 11 [4–24] ml), compared to those with HTN-ICH (all P<0.001). There were no significant differences in hypertension, dyslipidemia, and diabetes. When comparing patients with mixed ICH to those with CAA-ICH, they were younger (75±11 vs. 78±8 years) and had a high frequency of male (54% vs 33%), hypertension (95% vs. 36%) and diabetes (14% vs. 5%) and had higher initial SBP (176 ± 32 vs. 160 ± 29 mmHg) and less hematoma volume (17 [6–52] vs. 44 [18–84] ml)(all P<0.001). There was no significant difference in unfavorable outcomes between mixed ICH and HTN-ICH (32% vs. 31%, p>0.1), while the outcomes for mixed ICH were lower than those for CAA-ICH (32% vs. 44%, p=0.004). In multivariate analysis adjusting for covariates, there was no significant difference in unfavorable outcomes between mixed SVD-ICH and CAA-ICH (odds ratio 1.19 [95% CI, 0.66–2.13]). Conclusions: Mixed ICH harbors similar features of hypertensive SVD rather than CAA. The rates of disability and mortality were comparable across the groups.

Abstract WP211: Mechanical Thrombectomy in Patients With Mild Thrombocytopenia is Safe and Effective; a Systematic Review and Meta-Analysis

Background: MT is a effective treatment for AIS patients with LVO, but MT on TP patients is risky due to lack of data and potential hemorrhage. Methods: Our review followed the PRISMA guidelines for systematic review and meta-analysis. We defined thrombocytopenia as platelet count ≤150х109/L, with further sub-classification into two groups: 1) Mild TP (Platelet count 100,000 - 149,000x109/L); 2) Moderate/severe TP (platelet count <100х109/L). A favorable outcome was 90-day functional independence (mRS) ≤ 2). Unfavorable outcomes were mortality at 90 days and (sICH). Results: Compared to patients with normal platelets, patients with TP had no significant difference in outcomes (mRS >2) at 90 days (RR 0.80 [95% CI: 0.69 - 0.94] p = 0.006). Further analysis based on sub-groups, the difference in mRS score was not statistically significant in patients with mild TP group (RR 0.84 [95% CI: 0.70 - 1.00] p = 0.05) and moderate/severe TP group (RR 0.71 [95% CI: 0.48 - 1.06] p = 0.09) when compared to patients with normal platelets. However Mortality was found to be higher in the TP group (RR 1.95 [95% CI: 1.62 - 2.36] p < 0.00001), with similar trends of increased mortality in the mild and severe TP group (RR 1.88 [ 95% CI: 1.34 - 2.63] p = 0.0002 and RR 2.07 [95% CI: 1.46 - 2.92] p < 0.0001). There was an overall slight increase in the incidence of sICH in the TP group (Relative Risk [RR] 2.47 [95% CI: 1.51 - 4.05], p = 0.0003) compared to patients with normal platelet counts, however subgroup demonstrated no significant higher risk in the mild thrombocytopenia group (RR 2.34 [95% CI: 1.24 - 4.40], p = 0.008) Conclusions: Mechanical thrombectomy for LVO in patients with mild thrombocytopenia is safe and does not increase the risk of sICH or worse outcomes. However, caution is advised in cases of moderate to severe thrombocytopenia, as there is a slightly higher risk of sICH and mortality. Nonetheless, we recommend thrombectomy for LVO patients with thrombocytopenia.

Canonical Wnt signaling pathway (WSP) alterations in metastatic prostate cancer.

221 Background: WSP aberrations have been implicated in the progression and treatment resistance of metastatic prostate cancer (mPCa). Sustained exposure of PCa to androgen deprivation has been shown to regulate the canonical WSP, induce beta-catenin expression and stabilization, and promote androgen independence. This study interrogates a large dataset to characterize the molecular and immune landscape of canonical WSP-altered mPCa and associations with survival outcomes. Methods: We examined PCa patients who underwent tissue-based DNA and RNA sequencing through a CLIA-certified commercial assay (Caris Life Sciences). Comprehensive genomic profiling included next-generation sequencing (NGS) of DNA (592-gene panel or whole exome) and RNA (whole transcriptome), on tissue samples from primary prostatic and/or metastatic sites. Tumor samples were categorized as having aberrant canonical Wnt signaling (WSP-act) if they harbored activating mutations in CTNNB, pathogenic RSPO2 fusions, or inactivating mutations in either APC or RNF43. Subset analysis was conducted in mPCa samples with microsatellite stability (MSS), after excluding those with RNF43 (p.G659fs*) mutations which are passenger events in MSI-high cancers. Statistical significance was determined using Fisher's Exact or X2 tests with Benjamini–Hochberg correction. Overall survival (OS) data was obtained from insurance claims and was analyzed using Kaplan-Meier estimation. Results: Of all PCa samples (4,150) (N = 4,150), 17.4% (n = 722) were classified as WSP-act; 299 (41.4%) were from the primary tumor and 423 (58.6%) were from metastatic sites. WSP-act tumors were more prevalent in brain (46%), liver (31%), lung (31%) and bone (25%) metastases compared to primary prostate cancers (10%). The MSS mPCa subgroup (N=1,638) comprised 321 WSP-act and 1,317 WSP-WT tumors. WSP-act mPCa exhibited more SPOP mutations (14.2% vs. 6.3%, p < 0.001) as well as higher mRNA expression of CST1, NKD1, and ODAM (known canonical WSP activators) compared to WSP-WT cases. M2 macrophages predominated the tumor microenvironment, with a higher median fraction in WSP-act tumors compared to WSP-WT (7.2 vs. 6.1%, p < 0.001). ROR1 gene expression was significantly elevated in WSP-act tumors from both primary and metastatic sites. There was no significant difference in OS outcomes between WSP-act and WSP-WT mPCa patients. Conclusions: WSP-act prostate cancer demonstrated a pronounced upregulation of ROR1 gene expression, underscoring its potential involvement in the crosstalk between the canonical and non-canonical Wnt signaling pathways. Additionally, the augmented levels of M2 macrophages in WSP-act tumors, combined with the reported role of ROR1 in tumor immunosuppression, suggests that ROR1 may contribute to immune evasion in WSP-act mPCa. Our findings may provide rationale for developing novel therapeutic strategies targeting Wnt-activated prostate cancers.

Peri-operative and long-term outcomes of kidney transplantation in patients with cystic fibrosis.

There is a lack of data regarding the peri-operative and long-term outcomes of kidney transplantation in cystic fibrosis (CF) patients. Herein, we report the peri-operative and long-term outcomes of kidney transplantation in CF patients. All CF patients who received a kidney transplant at the national kidney transplant center between 1993 and 2022 were identified. Recipients of the contralateral donor kidney were selected as a control group. Primary outcomes included 1-, 5-, and 10- year death-censored graft survival and overall survival. Secondary outcomes included peri-operative morbidity, acute graft rejection, delayed graft function (DGF), and length of stay (LOS). Fourteen patients received a kidney transplant over the study period. Median age at transplantation was 35 (IQR 31, 40) years. The 1-, 5-, and 10-year death-censored graft survival was 92, 74, and 74% in the CF group compared to 100, 92, and 92% in the control group (p=.44). The 1-, 5-, and 10-year overall survival in the CF group was 85, 66, and 57% compared to 100, 92, and 82% in the control group (p=.036). There was no significant difference in peri-operative outcomes including LOS (10vs. 11 days, p=.84), ICU admission (1vs. 0 patients, p>.99), acute rejection episodes (2vs. 1 patients, p>.99), and DGF (1vs. 2 patients, p=.60). CF patients have good long-term graft survival, however, overall survival was worse compared to a matched cohort. These data provide important information for transplant surgeons when considering suitable donor allografts in this unique patient population.

Abstract WMP9: Comparative Analysis of Endovascular Treatment Outcomes in Acute Large Vessel Occlusion Strokes: Intracranial Atherosclerotic vs. Non- Intracranial Atherosclerotic Occlusions

Introduction: Intracranial atherosclerotic disease (ICAD) is a common cause of ischemic stroke worldwide. We assessed the clinical outcomes of endovascular treatment in acute large vessel occlusion (LVO) strokes caused by ICAD and compared them with large vessel occlusion strokes not associated with intracranial atherosclerosis (non-ICAD LVO). Methods: Our study comprised 1390 adult patients diagnosed with LVO stroke that underwent endovascular therapy at Rhode Island Hospital from July 2015 to March 2023 and data collected retrospectively. Among these, 68 patients exhibited Intracranial Atherosclerotic Disease Large Vessel Occlusion (ICADLVO), while 1322 individuals were categorized as non-ICADLVO. In the ICADLVO group, 23 out of 68 patients underwent angioplasty, whereas 38 patients received stenting. We aim to compare treatment outcomes, including recurrent in-hospital large vessel occlusion, disability, and mortality between these two distinct groups, while also assessing demographic characteristics and medical risk factors. T-Test, Chi square and fisher’s exact tests were used for the comparison of groups. Results: The study findings highlight significant differences between the ICADLVO group and the non-ICADLVO group. The ICADLVO group had younger age (mean 66.6 ± 12.64 vs. 71.92 ± 14.56, p < 0.001) , higher proportion of individuals with Asian ethnicity (5.2% vs. 0.8%, p = 0.019), higher incidence of prior strokes (43.3% vs. 23.9%, p=0.000), higher prevalence of smokers (35.6% vs. 22.7%, p = 0.022), and a lower association with known atrial fibrillation (23.9% vs. 42.3%, p=0.003) compared to the non-ICADLVO group. Additionally, the ICADLVO group had a higher occurrence of recurrent large vessel occlusion during hospitalization (11.8% vs. 4%, p = 0.008). This analysis finds no significant difference in good 90-dayfunctional outcome (mRS <= 2) between the ICADLVO and NON-ICADLVO groups (OR = 0.62, 95% CI 0.34-1.13, p=0.118). Conclusion: Our study showed a higher incidence of recurrent large vessel occlusion during hospitalization in the ICADLVO group following endovascular therapy. However, we did not observe any statistically significant differences in long-term outcomes, including measures of disability and mortality.

Abstract WP165: Meth Use and Intracerebral Hemorrhage: Really "Breaking Bad"

Background: Unlike other stimulants, methamphetamine (meth) is highly addictive and can be injected, snorted, smoked, or ingested orally. Due to increased access, its use has increased globally. Recent studies have shown that there was no significant difference in hospital outcomes between ICH positive patients who utilize meth versus those who do not. However, there has not been a comprehensive evaluation of methamphetamine related ICH in recent times. Our objective is to determine if meth use impacts ICU length of stay/need for sedating agents, and if meth use varies by ethnicity in the ICH population. Methods: This is an IRB approved retrospective review of all patients with acute ICH at a large academic stroke center from 2017 to 2023. Data collected and analyzed include demographics, ICH score/size, intraventricular hemorrhage, location of hematoma, surgical intervention, GCS/NIHSS scores, ICU length of stay (LOS), and discharge destiny. Statistics used include Pearson’s Chi-squared test and Wilcoxon rank sum test. Results: Of 70 ICH patients with all data elements, 32 (46%) were meth users, with an average age of meth positive patients at 59. In our Hispanic population, significant meth use was seen (41% v 13%, p = 0.009). ICH patients had significant NICU LOS (10.1 v 6.1 days, p < 0.001), with longer hospital mean LOS (12.4 v 7.8 days, p = 0.007). They also required more sedatives (63% v 37%, p = 0.032). Meth use was not associated with larger ICH size (15.7 v 29.2, p = 0.406), but was associated with higher discharge mRS (4.7 v 4.3, p = 0.788). Conclusions: Our study demonstrates that in ICH positive patients, meth-use was associated with increased use of sedatives and increased length of stay, as well as higher discharge mRS. However, it was not associated with larger ICH size. Hispanic ethnicity and ICH also appear to have a relationship, although that relationship needs to be further elucidated. Discussion: Methamphetamine is easily and relatively inexpensive to make, with over-the-counter ingredients such as pseudoephedrine. With over 35 million people using meth worldwide, our data found that the average user was older than previously thought. As ICH is one of the major complications of meth use, ICH has a major impact on complexity of care and health economics.

Abstract 50: Sodium-Glucose Cotransporter 2 Inhibitors Use in Diabetic Patients With Acute Ischemic Stroke is Linked to Favorable Neurological Outcomes

Background: The benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in acute ischemic stroke (AIS) have been demonstrated preclinically. Here, we evaluated the neurological effects of SGLT2i use after stroke in patients with diabetes and AIS. Methods: Using a prospective stroke registry, we reviewed consecutive diabetic patients with AIS. Patients with and without SGLT2i use were 1:4 propensity score-matched for clinical variables. Clinical outcomes, including early neurological deterioration (END) during admission, National Institutes of Health Stroke Scale (NIHSS) score at discharge, and modified Rankin Scale (mRS) scores at discharge and at 3 months, were compared. The impact of SGLT2i on metabolic activity of various organs was examined in another cohort using 18 F-fluorodeoxyglucose positron emission tomography post-stroke. Results: Among the 820 eligible patients, 90 (11.0%) were prescribed SGLT2i on admission, and 76 continued the prescription at discharge. Seventy-four patients with and 266 patients without SGLT2i use were propensity score-matched and analyzed. SGLT2i did not increase the END risk (adjusted odds ratio [aOR] 0.48, 95% confidence interval [CI] 0.20-1.19). There was no significant difference in clinical outcomes at discharge between the two groups (NIHSS: B [standard error] -1.321 [0.952], p=0.17; mRS: aOR for favorable mRS 1.47, 95% CI 0.93-2.32). SGLT2i demonstrated significant improvement in the 3-month mRS (aOR 1.73, 95% CI 1.10-2.74). The positron emission tomography cohort showed that SGLT2i prescription was associated with elevated brown and subcutaneous adipose tissue metabolism. Conclusions: SGLT2i may be a priority for diabetic patients with AIS because of its potential benefits on long-term outcomes.

Abstract WP166: Bleeding Risks Among Hemorrhagic Stroke Patients Started on Serotonergic Antidepressants During Subacute Recovery

Background: Early initiation of antidepressants (ADs) are associated with improved functional recovery, but are associated with an increased risk of major bleeds among hemorrhagic stroke (HS) patients. Our objectives were to determine if increased bleeding risk remained if ADs were initiated during subacute recovery and if bleed risks were comparable between AD classes. Methods: A cohort of AD naive first time HS patients (ICD-10 codes 160-162) were identified from Electronic Medical Records of 70 large healthcare organizations (2003-2023). Patients without AD use were considered “No AD” whereas patients started on ADs during subacute recovery (i.e., at least 3 months after the indexed HS) were grouped as Selective Serotonin/Serotonin & Norepinephrine Reuptake Inhibitors (SSRI/SNRI) or “Other AD” (i.e., Mirtazapine, bupropion, trazodone, or tricyclic ADs). Baseline differences were adjusted for using 1:1 matched propensity score (PS). Outcomes included the 1-year risk of a major bleeding event (e.g., gastrointestinal/intracranial bleed or shock), recurrent HS, fall, ischemic stroke (IS) and death Results: The cohort consisted of n=257,595 patients split into 3 groups: No AD (n=250,103), SSRI/SNRI (n=4,180) or Other AD (n=3,312). Matching resulted in good covariate balance for both the SSRI/SNRI vs. No AD (n=8,250 patients) and Other AD vs. SSRI/SNRI (n=6,380 patients) comparisons. SSRI/SNRIs (vs. No AD) were associated with a 33% increase in the risk of a major bleed (RR: 1.33, 95%CI: 1.22-1.45) and significantly higher risks of recurrent HS, fall, IS and death. There were no significant differences in adverse outcomes between AD classes. Discussion: Increased risk of major bleeds and recurrent HS remains if ADs are started during subacute recovery, a time period which aligns with community-based recovery. Our findings may inform care practices of primary care providers and rehabilitation professionals to decrease preventable adverse outcomes.

Short-term and long-term outcomes of submucosal dissection for residual or recurrent colorectal tumors after endoscopic resection: Analysis of a multicenter prospective study.

We previously demonstrated that a favorable long-term prognosis indicated that endoscopic submucosal dissection (ESD) could be the standard treatment for large colorectal epithelial neoplasms, but the usefulness of ESD for local residual or recurrent tumors with submucosal fibrosis has not been fully demonstrated. The aim of the present study was to assess the usefulness of ESD for local residual or recurrent colorectal tumors. We conducted a nationwide multicenter prospective study to evaluate the outcomes of ESD for colorectal tumors. In this post hoc analysis, a total of 54 local residual or recurrent colorectal tumors in 54 patients were included, and we analyzed the short-term and long-term outcomes of ESD for these lesions. The median size of the lesions was 16.0 (interquartile range [IQR] 11-25) mm. ESD was completed in 53 cases (98.1%) with a median procedure time of 65.0 min, but it was discontinued in one case because of submucosal cancer invasion. En bloc resection was achieved in 52 cases (96.3%), whereas R0 resection was achieved in 45 cases (83.3%). Intraoperative perforation was observed in four cases (7.4%) and delayed perforation in one (1.9%), but all cases could be managed conservatively. Delayed bleeding was not observed. There were no significant differences in short-term outcomes between the rectal and colonic lesions. There was no recurrence of the tumor during the median follow-up period of 60 (IQR50-64) months. An analysis of our multicenter prospective study suggests that ESD is an effective salvage management for local residual or recurrent colorectal lesions.

No Differences in Clinical Outcomes Between Hip Arthroscopy With Versus Without Capsular Closure in Patients With Cam- or Mixed-Type Femoroacetabular Impingement: A Randomized Controlled Trial

PurposeTo compare two-year clinical outcomes of primary hip arthroscopy with versus without capsular closure after interportal capsulotomy in patients with cam- or mixed- type femoroacetabular impingement (FAI). MethodsPatients with cam- or mixed-type FAI undergoing primary hip arthroscopy with interportal capsulotomy were prospectively enrolled in this randomised controlled trial (RCT) and allocated into either capsular closure or no capsular closure groups. Patients were blinded to group allocation. Clinical outcomes were assessed preoperatively and at 2 years follow-up using the International Hip Outcome Tool (iHOT-12), modified Harris Hip Score (mHHS), and six subsections of the Copenhagen Hip and Groin Outcome Score (HAGOS). Complications and reoperations were noted. ResultsEighty-four patients (100 hips) were enrolled, 49 hips in the capsular closure group and 51 in the no capsular closure group, with no significant differences in age (28.5±7.5 vs 30.4±8.4, p=0.261), BMI (23.5±3.0 vs 23.4±1.9, p=0.665), and sex distribution (F: 10.2% vs 13.7%, p=0.760). Four patients were lost to follow-up (2.0% vs 5.9%, p=0.618) and 6 had reoperations (6.1% vs 5.9%, p=1.000), which left 45 hips per group for clinical assessment. There were no significant differences between groups in the net change of iHOT-12 (28.3±19.6 vs 32.5±22.7, p=0.388), mHHS (7.6±13.1 vs 7.5±10.2, p=0.954), and subsections of HAGOS (p>0.05). Complication rates were also similar between groups (p>0.05). ConclusionThe present RCT compared primary hip arthroscopy with versus without capsular closure after interportal capsulotomy in a male-dominated, non-dysplastic, non-arthritic cohort with cam- or mixed- type FAI, and found no significant differences in patient-reported clinical outcomes, complication rates, or reoperation rates. Level of EvidenceLevel I, Randomised Controlled Trial

Safety of pregnancy after cerebral venous thrombosis: A case-control study.

Since pregnancy is considered one of the major risk factors of cerebral venous thrombosis (CVT), the safety of pregnancy in women of childbearing age and a previous history of CVT, is concerning in terms of prevention, family planning, and management. This study aims to estimate the prevalence of pregnancies among women of childbearing age with previous CVT, evaluate the pregnancy-associated risk of CVT recurrence, and explore the maternal and fetal outcomes among CVT women in comparison with pregnant women without a history of CVT. A retrospective, case-control study was conducted at the Obstetrics Departments of King Fahad Medical City Hospital, Saudi Arabia. It included all women with a history of CVT diagnosed in the last 5 years (cases), as well as CVT history-free pregnant women (control). The prevalence of pregnancy after CVT was estimated and the prepartum and postpartum parameters of the two groups were compared. Fifty women with CVT and 100 controls were included. Among the 50 CVT cases, 28 (56.0%) have been pregnant. The incidence of pre-eclampsia was significantly more frequent in CVT women (7.1% vs. 0.0%, p = 0.047); however, only one case of deep vein thrombosis (3.6%) was reported in CVT patients versus none in controls (p = 0.219). CVT women delivered at a lower gestational age (mean [SD] = 36.9 [3.5] weeks) compared with controls (38.3 [1.4] weeks) (p = 0.006). No significant differences in other pregnancy or delivery outcomes were observed between the two groups. More than half of women of childbearing age with a history of CVT opt for pregnancy after the CVT episode, with no major additional risk for pre or postpartum complications.

Repeat placental growth factor-based testing in women with suspected preterm pre-eclampsia (PARROT-2): a multicentre, parallel-group, superiority, randomised controlled trial

Placental growth factor (PlGF)-based testing has high diagnostic accuracy for predicting pre-eclampsia needing delivery, significantly reducing time to diagnosis and severe maternal adverse outcomes. The clinical benefit of repeat PlGF-based testing is unclear. We aimed to determine whether repeat PlGF-based testing (using a clinical management algorithm and nationally recommended thresholds) reduces adverse perinatal outcomes in pregnant individuals with suspected preterm pre-eclampsia. In this multicentre, parallel-group, superiority, randomised controlled trial, done in 22 maternity units across England, Scotland, and Wales, we recruited women aged 18 years or older with suspected pre-eclampsia between 22 weeks and 0 days of gestation and 35 weeks and 6 days of gestation. Women were randomly assigned (1:1) to revealed repeat PlGF-based testing or concealed repeat testing with usual care. The intervention was not masked to women or partners, or clinicians or data collectors, due to the nature of the trial. The trial statistician was masked to intervention allocation. The primary outcome was a perinatal composite of stillbirth, early neonatal death, or neonatal unit admission. The primary analysis was by the intention-to-treat principle, with a per-protocol analysis restricted to women managed according to their allocation group. The trial was prospectively registered with the ISRCTN registry, ISRCTN 85912420. Between Dec 17, 2019, and Sept 30, 2022, 1253 pregnant women were recruited and randomly assigned treatment; one patient was excluded due to randomisation error. 625 women were allocated to revealed repeat PlGF-based testing and 627 women were allocated to usual care with concealed repeat PlGF-based testing (mean age 32·3 [SD 5·7] years; 879 [70%] white). One woman in the concealed repeat PlGF-based testing group was lost to follow-up. There was no significant difference in the primary perinatal composite outcome between the revealed repeat PlGF-based testing group (195 [31·2%]) of 625 women) compared with the concealed repeat PlGF-based testing group (174 [27·8%] of 626 women; relative risk 1·21 [95% CI 0·95-1·33]; p=0·18). The results from the per-protocol analysis were similar. There were four serious adverse events in the revealed repeat PlGF-based testing group and six in the concealed repeat PlGF-based testing group; all serious adverse events were deemed unrelated to the intervention by the site principal investigators and chief investigator. Repeat PlGF-based testing in pregnant women with suspected pre-eclampsia was not associated with improved perinatal outcomes. In a high-income setting with a low prevalence of adverse outcomes, universal, routine repeat PlGF-based testing of all individuals with suspected pre-eclampsia is not recommended. Tommy's Charity, Jon Moulton Charitable Trust, and National Institute for Health and Care Research Guy's and St Thomas' Biomedical Research Centre.

Effects of Solitaire AB stent thrombectomy with tirofiban and butylphthalide on neurological function and inflammatory factors in acute cerebral infarction patients

Background Acute cerebral infarction profoundly affects patients’ neurological function and quality of life. This study explores the impact of Solitaire AB stent thrombectomy, combined with tirofiban and butylphthalide, on neurological function and inflammatory factors in patients with acute cerebral infarction. Methods Seventy-three eligible patients treated between 2021 and 2023 were divided into a control group (Solitaire AB stent thrombectomy) and a treatment group (Solitaire AB stent thrombectomy with tirofiban and butylphthalide). Postoperative neurological function scores and inflammatory factor levels were analyzed. Results The treatment group demonstrated a higher clinical effective rate, lower National Institutes of Health Stroke Scale scores at one day and seven days and higher Mini-Mental State Examination and Montreal Cognitive Assessment scores post-treatment. Inflammatory factor levels (Neuron Specific Enolase (NSE), S100-β, TNF-α and IL-6) were lower in the treatment group. No significant differences in adverse outcomes were observed. Conclusion Solitaire AB stent thrombectomy with tirofiban and butylphthalide shows superior efficacy, improving neurological function and inflammatory factors without increasing adverse outcomes. This offers valuable insights for clinical treatment of acute cerebral infarction.

Abstract TP187: Comparison of Balloon Guide Catheter versus Non-Balloon Guide Catheter for Mechanical Thrombectomy in Distal Medium Vessel Occlusion

Introduction: While balloon guide catheters (BGCs) enhance safety and efficacy of mechanical thrombectomy in large vessel occlusions, their impact on distal medium vessel occlusion (DMVO) remains underexplored. This study aimed to compare the outcomes of BGC vs non-BGC in DMVO thrombectomy. Methods: This retrospective study focused on DMVO cases defined as occlusions in M2-M4 middle cerebral artery, anterior cerebral artery, and posterior cerebral artery. Baseline characteristics and technical and clinical outcomes were compared between the two groups, with subgroup analysis in first-line thrombectomy techniques, including ADAPT, stent retriever, and Solumbra. First pass effect (FPE) was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score ≥ 2C after the first pass. Results: A total of 1,508 patients were included, of whom 231 (15.3%) were in the BGC group and 1,277 (84.7%) were in the Non-BGC group. The BGC group was associated with a lower mTICI score ≥ 2C (overall: 43.2% vs. 52.7%, p = 0.01; ADAPT: 42.2% vs. 57.1%, p = 0.01; Solumbra: 32.4% vs. 51.4%, p = 0.005), longer puncture to intracranial access time (overall: 15 vs. 8 min, p < 0.001; ADAPT: 17 vs. 8 min, p < 0.001; Solumbra: 12 vs. 8 min, p = 0.02), and longer puncture to recanalization time (overall: 97 vs. 35 min, p < 0.001; ADAPT: 100 vs. 28 min, p < 0.001; Solumbra: 78 vs. 46 min, p < 0.001; Stent retriever: 95 vs. 45 min, p < 0.001 ). The BGC group also had a lower FPE rate (17.4% vs. 30.7%, p = 0.03) in the Solumbra subgroup. In terms of clinical outcomes, the BGC group had a lower rate of distal embolization (overall: 8.8% vs. 14.9%, p = 0.02), but there were no significant differences in other clinical outcomes between the two groups in first-line thrombectomy techniques. Conclusions: Our findings showed that the use of BGC in DMVO had a lower mTICI score, reduced FPE rates, decreased distal embolization, and longer procedure times. Figure 1: Figure 2: