Various tomato cultivars display contrasting morphological and molecular responses to a chronic heat stress

Climate change is one of the biggest threats that human society currently needs to face. Heat waves associated with global warming negatively affect plant growth and development and will increase in intensity and frequency in the coming years. Tomato is one of the most produced and consumed fruit in the world but remarkable yield losses occur every year due to the sensitivity of many cultivars to heat stress (HS). New insights into how tomato plants are responding to HS will contribute to the development of cultivars with high yields under harsh temperature conditions. In this study, the analysis of microsporogenesis and pollen germination rate of eleven tomato cultivars after exposure to a chronic HS revealed differences between genotypes. Pollen development was either delayed and/or desynchronized by HS depending on the cultivar considered. In addition, except for two, pollen germination was abolished by HS in all cultivars. The transcriptome of floral buds at two developmental stages (tetrad and pollen floral buds) of five cultivars revealed common and specific molecular responses implemented by tomato cultivars to cope with chronic HS. These data provide valuable insights into the diversity of the genetic response of floral buds from different cultivars to HS and may contribute to the development of future climate resilient tomato varieties.

Physical activity trajectories are associated with the risk of all-cause and cardiovascular disease mortality in patients with coronary heart disease. A systematic review and meta-analysis

Background

Current guidelines recommend that adults with chronic health conditions should engage in regular physical activity (PA), and avoid inactivity. Yet, the exact role of PA trajectories in the mortality risk of patients with coronary heart disease (CHD) remains unclear.

Purpose

We aimed to perform a systematic review and meta-analysis on the association of longitudinal trajectories of PA with all-cause and cardiovascular disease (CVD) mortality in patients with CHD.

Methods

We performed a systematic review and meta-analysis based on PRISMA statement. Six electronic databases were searched for cohort studies that analysed the association of PA trajectories (inactive over time, active over time, increased activity over time, and decreased activity over time) with the risk of all-cause and CVD mortality in patients with CHD. Study quality was evaluated by the Newcastle Ottawa scale. We used the inverse variance weighted method to combine summary measures using random-effects models to minimize the effect of between-study heterogeneity. The study is registered in PROSPERO.

Results

We meta-analyzed nine longitudinal cohorts involving 33,576 patients (25010 acute CHD, 8566 chronic CHD, mean age 62.5 years, 34% women, median follow-up duration 7.2 years), according to four PA trajectories. All studies assessed PA through validated questionnaires. The definitions of activity and inactivity at baseline and follow-ups were in agreement with current PA guidelines. Trajectories were calculated based on comparison of activity status at baseline and follow-up. All the studies defined increased activity over time as moving from the inactive to the active category, and decreased activity over time as moving from the active to the inactive category. Compared to patients remaining inactive over time, the lowest risk of all-cause and CVD mortality was observed in patients remaining active over time (HR [95% CI]: 0.50 [0.39–0.63] and 0.48 [0.35–0.68], respectively), followed by patients who increased their PA over time (HR [95% CI]:0.55 [0.44–0.7] and 0.63 [0.51–0.78], respectively), and patients who decreased activity over time (HR [95% CI]: 0.80 [0.64–0.99] and 0.91 [0.67–1.24], respectively). These results were consistent both in the acute and chronic CHD settings. The overall risk of bias was low, and no evidence of publication bias was observed. Multiple sensitivity analyses provided consistent results.

Conclusions

In patients with CHD, the risk of all-cause and CVD mortality is progressively reduced from being inactive over time, to decreased activity over time, to increased activity over time, to being active over time. These findings highlight the benefits of adopting a more physically active lifestyle in patients with chronic and acute CHD, independent of previous PA levels. Future studies should clarify the complex interactions between motivations and disease severity as potential drivers for PA trajectories

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): University of Bern

COVID-19: Review of a 21st Century Pandemic from Etiology to Neuro-psychiatric Implications

COVID-19 is a severe infectious disease that has claimed >150,000 lives and infected millions in the United States thus far, especially the elderly population. Emerging evidence has shown the virus to cause hemorrhagic and immunologic responses, which impact all organs, including lungs, kidneys, and the brain, as well as extremities. SARS-CoV-2 also affects patients', families', and society's mental health at large. There is growing evidence of re-infection in some patients. The goal of this paper is to provide a comprehensive review of SARS-CoV-2-induced disease, its mechanism of infection, diagnostics, therapeutics, and treatment strategies, while also focusing on less attended aspects by previous studies, including nutritional support, psychological, and rehabilitation of the pandemic and its management. We performed a systematic review of >1,000 articles and included 425 references from online databases, including, PubMed, Google Scholar, and California Baptist University's library. COVID-19 patients go through acute respiratory distress syndrome, cytokine storm, acute hypercoagulable state, and autonomic dysfunction, which must be managed by a multidisciplinary team including nursing, nutrition, and rehabilitation. The elderly population and those who are suffering from Alzheimer's disease and dementia related illnesses seem to be at the higher risk. There are 28 vaccines under development, and new treatment strategies/protocols are being investigated. The future management for COVID-19 should include B-cell and T-cell immunotherapy in combination with emerging prophylaxis. The mental health and illness aspect of COVID-19 are among the most important side effects of this pandemic which requires a national plan for prevention, diagnosis and treatment.

In vitro inactivation of Mycobacterium avium subsp. paratuberculosis (MAP) by use of copper ions

Background

Mycobacterium avium subsp. paratuberculosis (MAP) is the causative agent of paratuberculosis, a contagious infectious disease that affects domestic and wild ruminants causing chronic inflammation of the intestine. MAP has proven to be very resistant to both physical and chemical processes, making it difficult to control this pathogen. Based on the recognized antimicrobial properties of copper, the objective of this study was to evaluate the effectiveness of copper ions to reduce MAP numbers and/or MAP viability in a fluid matrix. Besides, methicillin-resistant Staphylococcus aureus (MRSA), and Escherichia coli were used as controls of the effectiveness of copper ions. MAP-spiked PBS was subjected to copper ions treatment at 24 V for 5 min and the PBS suspensions were sampled before and after treatment. MAP viability and quantification were determined using three complementary techniques: a phage amplification assay, MGIT culture and qPCR.

Results

Moderate numbers (10³ CFU ml⁻¹) of the two control bacteria were completely eliminated by treatment with copper ions. For MAP, copper ions treatment reduced both the viability and numbers of this pathogen. Phage assay information quickly showed that copper ions (24 V for 5 min) resulted in a significant reduction in viable MAP. MGIT culture results over time showed statistically significant differences in time-to-detection (TTD) values between PRE and POST treatment. MAP genome equivalent estimates for PBS suspensions indicated that MAP numbers were lower in samples POST-treatment with copper ions than PRE-treatment.

Conclusions

The use of copper ions resulted in a significant reduction of MAP in a liquid matrix, although some MAP survival on some occasions was observed.

Induced ovule-to-flower switch by interfering with SlIMA activity in tomato

The INHIBITOR OF MERISTEM ACTIVITY in tomato (SlIMA) and MINI ZINC FINGER 2 in Arabidopsis (AtMIF2), two members of the MINI ZINC FINGER family (MIF), are involved in the regulation of flower and ovule development. MIF proteins possess a unique non-canonical zinc-finger domain that confers the capacity to interact with other protein partners. The characterization of SlIMA and AtMIF2 gain- and loss-of-function transgenic lines in Solanum lycopersicum and Arabidopsis thaliana respectively, allowed the demonstration of their conserved functional role in the termination of floral stem cell maintenance. During early floral development, the expression of SlIMA and AtMIF2 is induced by the MADS-Box transcription factor AGAMOUS (AG). Then, SlIMA or AtMIF2 protein recruits the C₂H₂ zinc finger KNUCKLES (KNU), in a transcriptional repressor complex together with TOPLESS (TPL) and HISTONE DEACETYLASE19 (HDA19). This complex binds to the WUSCHEL (WUS) locus leading to its repression. To further characterize the role of these interactions in flower development, we have investigated the effects of a dominant negative form of SlIMA, SlIMA^ch that leads to spectacular phenotypes, including ovule conversion into a floral meristem.

3D whole-brain vessel wall cardiovascular magnetic resonance imaging: a study on the reliability in the quantification of intracranial vessel dimensions

BACKGROUND

One of the potentially important applications of three-dimensional (3D) intracranial vessel wall (IVW) cardiovascular magnetic resonance (CMR) is to monitor disease progression and regression via quantitative measurement of IVW morphology during medical management or drug development. However, a prerequisite for this application is to validate that IVW morphologic measurements based on the modality are reliable. In this study we performed comprehensive reliability analysis for the recently proposed whole-brain IVW CMR technique.

METHODS

Thirty-four healthy subjects and 10 patients with known intracranial atherosclerotic disease underwent repeat whole-brain IVW CMR scans. In 19 of the 34 subjects, two-dimensional (2D) turbo spin-echo (TSE) scan was performed to serve as a reference for the assessment of vessel dimensions. Lumen and wall volume, normalized wall index, mean and maximum wall thickness were measured in both 3D and 2D IVW CMR images. Scan-rescan, intra-observer, and inter-observer reproducibility of 3D IVW CMR in the quantification of IVW or plaque dimensions were respectively assessed in volunteers and patients as well as for different healthy subjectsub-groups (i.e. < 50 and ≥ 50 years). The agreement in vessel wall and lumen measurements between the 3D technique and the 2D TSE method was also investigated. In addition, the sample size required for future longitudinal clinical studies was calculated.

RESULTS

The intra-class correlation coefficient (ICC) and Bland-Altman plots indicated excellent reproducibility and inter-method agreement for all morphologic measurements (All ICCs > 0.75). In addition, all ICCs of patients were equal to or higher than that of healthy subjects except maximum wall thickness. In volunteers, all ICCs of the age group of ≥50 years were equal to or higher than that of the age group of < 50 years. Normalized wall index and mean and maximum wall thickness were significantly larger in the age group of ≥50 years. To detect 5% - 20% difference between placebo and treatment groups, normalized wall index requires the smallest sample size while lumen volume requires the highest sample size.

CONCLUSIONS

Whole-brain 3D IVW CMR is a reliable imaging method for the quantification of intracranial vessel dimensions and could potentially be useful for monitoring plaque progression and regression.

A review of the diagnosis and management of vertebral basilar (posterior) circulation disease

We have reviewed the English literature published in the last 70 years on Diseases of the Vertebral Basilar Circulation, or Posterior Circulation Disease (PCD). We have found that errors have been made in the conduct and interpretation of these studies that have led to incorrect approaches to the management of PCD. Because of the difficulty in evaluating the PC, the management of PCD has been incorrectly applied from anterior circulation disease (ACD) experience to PCD. PCD is a common form of stroke affecting 20-40% patients with stroke. Yet, the evidence is strong that the Anterior Circulation (AC) and Posterior Circulations (PC) differ in their pathology, in their clinical presentations, in the rapidity of development of symptoms, in optimal imaging methods, and in available treatments. There appears to be two categories of patients who present with PCD. The first, acute basilar artery occlusion has a more rapid onset. The diagnosis must be made quickly and if imaging proves a diagnosis of Basilar Artery Occlusion (BAO), the treatment of choice is Interventional removal of the basilar artery thrombosis or embolus. The second category of PCD and the most commonly seen PCD disease process presents with non-specific symptoms and early warnings of PCD that now can be related to ischemic events in the entire PC vessels. These warning symptoms and signs occur much earlier than those in the AC. IA angiography is still the gold standard of diagnosis and is superior in definition to MR and CT angiography which are commonly used as a convenient screening imaging tool to evaluate PCD but are both inferior to IA angiography in definition for lesions below 3-4 mm. In at least two reported studies 7T MR angiography appears superior to other imaging modalities and will become the gold standard of imaging of PCD in the future. Medical treatments applied to the ACD have not been proven of value in specific forms of PCD. Interventional therapy was promising but of unproven value in Randomized Controlled Trials (RCT) except for the treatment of Basilar Artery Occlusion (BAO). Surgical revascularization has been proved to be highly successful in patients, who are refractory to medical therapy. These studies have been ignored by the scientific community basically because of an incorrect interpretation of the flawed EC-IC Bypass Trial in 1985 as applying to all stroke patients. Moreover, the EC-IC Bypass Study did not include PCD patients in their study population, but the study results were extrapolated to patients with PCD without any scientific basis. This experience led clinicians to an incorrect bias that surgical treatments are of no value in PCD. Thus, incorrectly, surgical treatments of PCD have not been considered among the therapeutic possibilities for PCD. QMRA is a new quantitative MR technique that measures specific blood flow in extra and intracranial vessels. QMRA has been used to select those patients who may benefit from medical, or interventional, or surgical treatment for PCD based on flow determinations with a high success rate. QMRA accurately predicts the flows in many large and small vessels in the PC and AC and clearly indicates that both circulations are intimately related. From medical and surgical studies, the longer one waits for surgical treatment the higher the risk of a poor outcome results. This observation becomes obvious when the rapidity of development of PCD is compared with ACD. Recent advances in endovascular therapy in the treatment of acute basilar thrombosis is a clear sign that early diagnosis and treatment of PCD will reduce the morbidity and mortality of these diseases. In this review it is evident that there are multiple medical and surgical treatments for PCD depending upon the location of the lesion(s) and the collateral circulation demonstrated. It is clear that the AC and PC have significant differences. With the exception of the large population studies from Oxford England, the reported studies on the management of PCD in the literature represent small selected subsets of the universe of PC diseases, the information from which is not generalizable to the universe of PCD patients. At this point in the history of PCD, there are not large enough databases of similar patients to provide a basis for valid randomized studies, with the exception of the surgical studies. Thus, a high index of suspicion of the early warning symptoms of PCD should lead to a rapid individual clinical assessment of patients selecting those with PCD. Medical, interventional, and/or surgical treatments should be chosen based on knowledge presented in this review. Recording the results in a national Registry on a continuing basis will provide the data that may help advance the management of PCD based on larger data bases of well documented patient information to guide the selection of future therapies for PCD treatments. It is also clear that the management of patients within the complex of diseases that comprise PCD should be performed in centers with expertise in the imaging, medical, interventional and surgical approaches to diseases of the PCD.

Posttransplant oxygen inhalation improves the outcome of subcutaneous islet transplantation: A promising clinical alternative to the conventional intrahepatic site

Subcutaneous tissue is a promising site for islet transplantation, due to its large area and accessibility, which allows minimally invasive procedures for transplantation, graft monitoring, and removal of malignancies as needed. However, relative to the conventional intrahepatic transplantation site, the subcutaneous site requires a large number of islets to achieve engraftment success and diabetes reversal, due to hypoxia and low vascularity. We report that the efficiency of subcutaneous islet transplantation in a Lewis rat model is significantly improved by treating recipients with inhaled 50% oxygen, in conjunction with prevascularization of the graft bed by agarose-basic fibroblast growth factor. Administration of 50% oxygen increased oxygen tension in the subcutaneous site to 140 mm Hg, compared to 45 mm Hg under ambient air. In vitro, islets cultured under 140 mm Hg oxygen showed reduced central necrosis and increased insulin release, compared to those maintained in 45 mm Hg oxygen. Six hundred syngeneic islets subcutaneously transplanted into the prevascularized graft bed reversed diabetes when combined with postoperative 50% oxygen inhalation for 3 days, a number comparable to that required for intrahepatic transplantation; in the absence of oxygen treatment, diabetes was not reversed. Thus, we show oxygen inhalation to be a simple and promising approach to successfully establishing subcutaneous islet transplantation.

Relevance of small GTPase Rac1 pathway in drug and radio-resistance mechanisms: Opportunities in cancer therapeutics

Rac1 GTPase signaling pathway has a critical role in the regulation of a plethora of cellular functions governing cancer cell behavior. Recently, it has been shown a critical role of Rac1 in the emergence of resistance mechanisms to cancer therapy. This review describes the current knowledge regarding Rac1 pathway deregulation and its association with chemoresistance, radioresistance, resistance to targeted therapies and immune evasion. This supports the idea that interfering Rac1 signaling pathway could be an interesting approach to tackle cancer resistance.

Abstract WP134: Quantitatively Monitoring Regression or Progression in Intracranial Atherosclerotic Plaques Using 3D Vessel Wall Imaging and Deep-learning-based Vessel Wall Analysis

Introduction: Intracranial atherosclerotic disease (ICAD) is one of the most common causes of ischemic stroke worldwide. Despite aggressive medical management, the rate of recurrent stroke is 13% at 1 year. Intracranial vessel wall imaging (VWI) is a noninvasive, “looking-beyond-the-lumen” imaging method that can directly characterize the geometric and signal features of ICAD lesions. The present work sought to assess the feasibility of quantitatively monitoring regression or progression of ICAD plaques using VWI-based methods.

Methods: Eight ischemic stroke patients (1F, 7M; age 27-66 ys) treated with intensive medical therapy underwent initial (4 days - 4 months of onset) and follow-up 3D VWI (6-13 months). Images were randomized and reviewed by two neuroradiologists to determine the culprit lesion in each subject. A custom-designed deep-learning-based intracranial vessel analysis method was used to segment vessel wall boundaries and quantify the following features of the culprit lesion, including peak normalized wall index (NWI), plaque volume, pre-contrast plaque-wall contrast ratio (CR), and post-contrast plaque enhancement ratio (ER).

Results: No subjects except for subject #4 had a recurrent stroke during the follow-up period. The four plaque features exhibited different change patterns as shown in Figure . Subject #1 and #4 demonstrated an increase in plaque ER, volume, and peak NWI; subject #7 demonstrated an increase in plaque CR, volume and peak NWI. Other patients had a decrease or no change in these features.

Conclusions: In this work, the interrogated plaque features demonstrated regression in most of patients after intensive medical therapy. Elevated values in some of these features appeared positively associated with stroke recurrence. Temporal changes in these features may have a strong indication on culprit lesions’ response to medical therapy. In conclusion, it is feasible to quantitatively monitor plaque-level treatment response.

Visual Aids for Patient, Family, and Physician Decision Making About Endovascular Thrombectomy for Acute Ischemic Stroke

BACKGROUND AND PURPOSE

Rapid decision making optimizes outcomes from endovascular thrombectomy for acute cerebral ischemia. Visual displays facilitate swift review of potential outcomes and can accelerate decision processes.

METHODS

From patient-level, pooled randomized trial data, 100 person-icon arrays (Kuiper-Marshall personographs) were generated showing beneficial and adverse effects of endovascular thrombectomy for patients with acute cerebral ischemia and large vessel occlusion using (1) automated (algorithmic) and (2) expert-guided joint outcome table specification.

RESULTS

For the full 7-category modified Rankin Scale, thrombectomy added to IV tPA (intravenous tissue-type plasminogen activator) alone had number needed to treat to benefit 2.9 (95% confidence interval, 2.6-3.3) and number needed to harm 68.9 (95% confidence interval, 40-250); thrombectomy for patients ineligible for IV tPA had number needed to treat to benefit 2.3 (95% confidence interval, 2.1-2.5) and number needed to harm 100 (95% confidence interval, 62.5-250). Visual displays of treatment effects on 100 patients showed: with thrombectomy added to IV tPA alone, 34 patients have better disability outcome, including 14 more normal or near normal (modified Rankin Scale, 0-1); with thrombectomy for patients ineligible for IV tPA, 44 patients have a better disability outcome, including 16 more normal or nearly normal. Displays also showed that harm (increased modified Rankin Scale final disability) occurred in 1 of 100 patients in both populations, mediated by increased new territory infarcts. The person-icon figures integrated these outcomes, and early side-effects, in a single display.

CONCLUSIONS

Visual decision aids are now available to rapidly educate healthcare providers, patients, and families about benefits and risks of endovascular thrombectomy, both when added to IV tPA in tPA-eligible patients and as the sole reperfusion treatment in tPA-ineligible patients.

Rho GTPases as therapeutic targets in cancer (Review)

Rho GTPases are key molecular switches controlling the transduction of external signals to cytoplasmic and nuclear effectors. In the last few years, the development of genetic and pharmacological tools has allowed a more precise definition of the specific roles of Rho GTPases in cancer. The aim of the present review is to describe the cellular functions regulated by these proteins with focus in deregulated signals present in malignant tumors. Finally, we describe the state of the art in search of different experimental therapeutic strategies with Rho GTPases as molecular targets.

Coil embolization through the Marathon microcatheter: Advantages and pitfalls

Due to technical limitations, small, distal, and tortuous intracranial pathology is sometimes out of reach of the current armamentarium of microcatheters designed for intracranial coil embolization. The Marathon microcatheter (Medtronic, Minneapolis, Minnesota, USA), designed specifically for the delivery of Onyx, is longer and more flexible than most coil delivery catheters. We report on nine patients (three with arteriovenous fistula, three with arteriovenous malformation, two with intracranial aneurysm, and one with tumor) where Marathon was used to deliver commercially available platinum coils. We also conducted laboratory compatibility testing and conclude that the Marathon can be used as a coil delivery catheter for Barricade coils (Blockade Medical, Irvine, California, USA) with diameter less than 0.012 in.

Reproduction of ICP Waveform Changes in a Mathematical Model of the Cerebrospinal Circulatory System

This study describes the establishment of a model of cerebral blood flow dynamics using cerebral blood flow velocity and intracranial pressure waveforms.

Predictors of thrombotic complications and mass effect exacerbation after pipeline embolization: The significance of adenosine diphosphate inhibition, fluoroscopy time, and aneurysm size

BACKGROUND

The mechanisms leading to delayed rupture, distal emboli and intraparenchymal hemorrhage in relation to pipeline embolization device (PED) placement remain debatable and poorly understood. The aim of this study was to identify clinical and procedural predictors of these perioperative complications.

METHODS

We conducted a retrospective review of consecutive patients who underwent PED placement. We utilized a non-commercial platelet aggregation method measuring adenosine diphosphate (ADP)% inhibition for evaluation of clopidogrel response. To our knowledge, this is the first study to test ADP in neurovascular procedures. Multivariable regression analysis was used to identify the strongest predictor of three separate outcomes: (1) thrombotic complications, (2) hemorrhagic complications, and (3) aneurysm mass effect exacerbation

RESULTS

Permanent complication-related morbidity and mortality at 3 months was 6% (3/48). No specific predictors of hemorrhagic complications were identified. In the univariate analysis, the strongest predictors of thrombotic complications were: ADP% inhibition<49 (p=0.01), aneurysm size (p=0.04) and fluoroscopy time (p=0.002). In the final multivariate analysis, among all baseline variables, fluoroscopy time exceeding 52 min was the only factor associated with thrombotic complications (p=0.007). Aneurysm size≥18 mm was the single predictor of mass effect exacerbation (p=0.039).

CONCLUSIONS

Procedural complexity, reflected by fluoroscopy time, is the strongest predictor of thrombotic complications in this study. ADP% inhibition is a reliable method of testing clopidogrel response in neurovascular procedures and values of <50% may predict thrombotic complications. Interval mass effect exacerbation after PED placement may be anticipated in large aneurysms exceeding 18 mm.

Early Loss of Immediate Reperfusion While Stent Retriever in Place Predicts Successful Final Reperfusion in Acute Ischemic Stroke Patients

BACKGROUND AND PURPOSE

Degree of stent retriever engagement with target thrombi may be reflected by (1) immediate reperfusion (IR) on first deployment, indicating displacement of clot toward the vessel wall, and (2) by early loss of IR (ELOIR), indicating penetration of retriever struts through the thrombus. The relation of these early findings to final reperfusion and clinical outcomes has not been well delineated.

METHODS

We investigated IR and ELOIR in patients undergoing stent retriever mechanical thrombectomy at an academic medical center between March 2012 and June 2014.

RESULTS

Among 56 patients, IR itself was not associated with final successful reperfusion, which occurred in 66.7% of IR patients and 71.4% of non-IR patients (P=0.999). However, ELOIR was associated with a higher rate of final successful reperfusion (92% versus 44%; P=0.046). Patients with ELOIR had a higher nominal rate of final favorable outcome (42% versus 22%; P=0.64).

CONCLUSIONS

ELOIR during the embedding period after deployment of stent retrievers is associated with successful final reperfusion, likely because of greater thrombus engagement with the stent retriever. ELOIR may be a useful finding to guide duration of embedding time in clinical practice and design of novel stent retrievers.

Prognostic severity scores for patients with COPD exacerbations attending emergency departments

SETTING

Reported predictors of the adverse evolution of patients with chronic obstructive pulmonary disease exacerbations (eCOPD) are various and inconsistent in the bibliography.

OBJECTIVE

To develop clinical prediction rules for short-term outcomes in eCOPD patients attending an emergency department (ED).

DESIGN

Prospective cohort study of patients with an eCOPD. Short-term outcomes were admission to an intensive care unit (ICU), admission to an intermediate respiratory care unit (IRCU) and death in these groups. Multivariate logistic regression models were developed for each of the outcomes.

RESULTS

Predictors of ICU or IRCU admission were use of long-term home oxygen therapy (LT-HOT) or non-invasive mechanical ventilation (NIMV), elevated PCO2 and decreased pH upon ED arrival (area under the curve [AUC] 0.87 in the derivation sample; 0.89 in the validation sample). Among those admitted to an ICU or IRCU, predictors of death were increased age, use at home of LT-HOT or NIMV, use of inspiratory accessory muscles upon ED arrival and altered Glasgow Coma Scale (<15 points) (AUC 0.78).

CONCLUSIONS

Three clinical predictors available in the ED can be used to create a simple score to predict the need for intensive treatment among eCOPD patients. Such a score can be a tool for clinical practice.

Sage (Salvia officinalis) and fennel (Foeniculum vulgare) improve cryopreserved boar epididymal semen quality study

The aim of this study was to evaluate the effect of fennel and sage extracts and the influence of the egg yolk source (fresh or pasteurized) on the success of freezing boar epididymal spermatozoa. In experiment 1, epididymal sperm was recovered by flushing and cryopreserved in a lactose-egg yolk solution supplemented with various concentrations (10, 5 and 2.5 g/L) of sage or fennel. Sperm quality was evaluated (motility, viability, HOST and acrosome integrity) at 0 h and 2 h after thawing. Fennel 10 g/L and sage 5 g/L and control (no extracts) were selected for experiment 2 which also compared fresh or pasteurized egg yolk in the freezing extender and measured DNA integrity of the frozen sperm. Results showed that the interaction between fennel and sage antioxidants with fresh egg yolk significantly improved post thaw sperm quality and protected boar epididymal spermatozoa from cryopreservation damage as a result of oxidative stress.

Abstract T MP25: Development of Patient Specific Computational Fluid Dynamics Model of Intracranial Arterial Stenosis

Introduction: Intracranial atherosclerotic steno-occlusive disease (ICASD) is a significant cause of stroke worldwide. A better understanding of the role of hemodynamic factors in the progression of ICASD is fundamental for the development of future treatment strategies. Prior studies have been limited to estimations of wall shear stress (WSS), turbulent kinetic energy (TKE), and flow velocity (FV) at single physiological states. We present a modeling technique for measuring hemodynamic parameters across a cardiac cycle using patient-specific vessel geometry and boundary conditions.

Methods: The geometry was obtained from a rotational angiogram of the symptomatic lesion. Transcranial Doppler (TCD) was used to digitally record the cerebral blood flow velocity (CBFV). The MOCAIP algorithm was used to calculate dominant, artifact-free CBFV waveforms for each vessel.

The mesh and boundary conditions were imported into the ANSYS: Simulation Technology software as a non-deformable mesh containing a Newtonian fluid with molar mass 64500g/mol, density 1.06g/cc, and viscosity 0.035 centipoise. A dynamic state (DS) simulation of one full cardiac cycle with 25ms timesteps and steady state (SS) simulations using the velocities at the systolic peak were performed. WSS, TKE, and FV within the stenosis were measured and compared between DS and SS simulations.

Results: When compared with the DS simulation, the mean WSS of the SS simulation was significantly higher (SS 30.6Pa DS 30.0Pa, p<0.0005). There were no significant differences between TKE (SS 0.074m2/s2 DS 0.073m2/s2) or FV (SS 2.68m/s DS 2.71m/s).

Conclusion: Incorporating individual-specific boundary conditions based on CBFV TCD measurements with patient-specific geometry intracranial arterial modeling is feasible and adds a spectrum of dynamic data that can significantly differ from SS simulations.

Abstract 40: Transcriptome and DNA Methylation Changes in Patients with Subarachnoid Hemorrhage Undergoing Remote Ischemic Preconditioning

Background: Remote ischemic conditioning (RIC) is a phenomenon by which brief periods of sublethal ischemia in one tissue confers protection from ischemia to distant tissues. We hypothesize that RIC triggers a cascade of integrated gene expression and methylation changes, leading to neuroprotection in subarachnoidal hemorrhage (SAH) patients. Our goal was to identify and compare changes in DNA methylation and gene expression profiles before and after RIC.

Methods: Patients enrolled in a clinical trial of RIC after SAH, receiving RIC by limb cuff transient ischemia sessions. Fourteen SAH patients (64% female, mean age 51) underwent 3-4 RIC sessions and gave a blood sample before and after RIC, seven days apart. The transcriptome analysis of whole blood was performed using paired-end, 100-bp RNA-sequencing. We employed STAR and HTSeq to align and count reads; EdgeR to normalize the counts and detect differential expression (DE); and David to search for functional categories of the DE genes. Genome-wide DNA methylation profiles were assessed using reduced representation bisulfite sequencing (RRBS); Bismark with Bowtie to align the RRBS data, and the differential methylation analysis package (DMAP) to call the methylation status of CpG sites. Bedtools was used to overlap the DE genes with differentially methylated regions.

Results: Of the 12,411 genes passing QC, 168 genes were differentially expressed after RIC (FDR<0.05). These genes were enriched for pathways involving mitosis and nuclear division (P50% after RIC in at least one individual. Of the 8,069 sites, 723 were differentially methylated (Bonferroni P<0.05). Our overlap analysis showed that 88 of the significantly altered methylation sites resided in 39 DE genes, including CEACAM8 and CRISP3, both implicated previously for stroke.

Conclusions: Our data suggest that RIC alters expression of a specific set of genes involved in stroke via changes in regional DNA methylation. Further studies are warranted to replicate these pilot results.

Abstract T MP28: Rigorous Anesthetic Management Protocol for Prevention of Perioperative Stroke in Patients with Intracranial Arterial Stenosis

Introduction: Perioperative ischemic stroke results in increased morbidity and mortality. As part of the ongoing EDAS Revascularization for Symptomatic Intracranial Arterial Stenosis (ERSIAS) Trial we have developed a strict anesthesia protocol to prevent fluctuations in patient parameters affecting cerebral perfusion: systolic blood pressure (SBP) and end-tidal CO2 (ETCO2). The hypothesis of this study is that the ERSIAS Anesthesia Management protocol reduces the variability of SBP and ETCO2 compared with a control group of non-stenosis-related vascular neurosurgical interventions.

Methods: This is a prospective matched controlled cohort study of patients undergoing EDAS surgery vs. standard neurovascular interventions. ERSIAS patients had strict perioperative management including intentional hypertension and normorcarbia, meticulous fluid balance management, and antiplatelets use. Control patients received routine anesthetic standard of care. Minute-by-minute intra-operative vitals were electronically collected. Heterogeneity of variance test was used to compare variance across groups. Vitals standard deviations were compared with Welch’s tests for unequal variances and mean values were compared with t-test and Wilcoxon rank sums as appropriate.

Results: Study population: 10 ERSIAS Trial patients (7 ICASD, 3 MMD) and 11 controls (7 aneurysm, 4 AVM), aged 27 to 75 (mean 51, SD: 15.0), 19 females (91%). There were significant reductions in the variability of SBP and ECO2 in the ERSIAS group below the permutation simulation computed lower boundary decision limit (p<0.05). There was a significant reduction in the SBP SD 31.45 vs. 34.97 (p=0.035), and a trend reduction in ETCO2 SD 2.65 vs. 3.35. As intended, the mean ERSIAS cases SBP and ETCO2 were higher (149.5 vs. 110.9, p<0.0001, and 36.5 vs. 31.2, p=0.0006, respectively). No patients in either group presented strokes.

Conclusions: The rigorous ERSIAS peri-operative management protocol was successful in reducing intraoperative fluctuations of blood pressure and ECO2. The protocol was also successful in achieving the intended hypertension and normocarbia.

Abstract W MP31: Thrombotic and Hemorrhagic Complications After Pipeline Embolization - A Platelet Aggregation and Transcranial Doppler Study

In this study, we sought to determine the correlation between the pre-treatment platelet aggregation, and the respective occurrence of thrombotic and hemorrhagic complications after pipeline embolization device (PED) for treatment of intracranial aneurysms. In addition, we evaluated the cerebral hemodynamics and the presence of silent emboli after PED placement in some patients utilizing transcranial Doppler (TCD).

Methods: We analyzed the clinical and imaging characteristics of 46 consecutive patients who underwent 48 PED procedures. All patients received double antiplatelet therapy with Clopidogrel 75mg and Aspirin 325mg daily for at least 3 days prior to the planned procedure. Platelet aggregation testing was performed in 41/48 (86%) procedures. Based on the initial ADP % inhibition, patients were divided in 3 groups in the present study: 1) poor responders: <50%, 2) satisfactory responders: 50-75%, and 3) over-responders: > 75%

Results: Hemorrhagic complications requiring escalation of care occurred in 15% (7/48) of all procedures, including 3 patients with symptomatic ICH. 2/3 ICHs occurred in a remote vascular territory in reference to the treated aneurysm, one of which was fatal. Thrombotic complications occurred at a rate of 13% (6/48), of which 3 (9%) were symptomatic. Permanent complication-related morbidity and mortality at 6 months was 4% (2/48).

Of all patients with available platelet aggregation testing (n=41), 13 (31%) were poor Clopidogrel responders. Of those, 6 were switched to an alternative antiplatelet regimen. Thrombotic complications occurred mostly in the poor responders group who had no change in their regimen (27% vs. 4%; p=0.05).

Intracranial hemorrhage occurred entirely in the over-responders group, (0% vs. 14%; p=0.08). None of the TCD demonstrated presence of silent emboli. In addition, 10/11 patients had elevated flow velocities after the PED placement.

Conclusions:

1. Pre-treatment Clopidogrel response, measured by ADP % inhibition may predict thrombotic and/or hemorrhagic complications after PED placement.

2. Distal embolization likely occurs mostly during, but not after the procedure as suggested by the TCD data in this study.

Abstract T P350: Phase I Clinical Feasibility &Safety Trial of Remote Ischemic Conditioning After Aneurysmal Subarachnoid Hemorrhage

Objective: Remote ischemic conditioning (RIC) is a phenomenon by which brief periods of sublethal ischemia in one tissue confers protection from ischemia to distant tissues. The safety and feasibility of RIC must be assessed before testing it in efficacy trials. We report a phase I feasibility and safety trial of RIC in aneurysmal subarachnoid hemorrhage (aSAH) patients.

Methods: Patients with aSAH received 2-4 RIC sessions on non-consecutive days. A complete session was defined as four rounds of 5 minutes of one sided lower limb ischemia with a thigh blood pressure cuff followed by 5 minutes of reperfusion (verified by pedal Doppler). Primary end-points were tolerance to the procedure and any complication attributable to RIC. Secondary end-points included cerebral infarction or hemorrhage.

Results: Twenty-one patients (67% female, mean age 52, Fisher 3.5, H&H 3.3) were enrolled. Seventeen had evidence of vasospasm during hospitalization. Of 76 RIC sessions performed, 75 (98.7%) were completed and tolerated. One session was incomplete due to poor cooperation secondary to delirium. No patients developed DVTs or other local complications within 2 weeks of their final RIC session. No patients suffered cerebral infarction or hemorrhage throughout the duration of RIC sessions and through 72 hours after their last complete session. Three had infarction confirmed on MRI at 3 and 5 days following the final RIC session. In conscious patients, there was a small increase in the analog pain scale upon inflation of the cuff (deflated: 0.5 inflated: 1.2, p<0.0005), but none requested to stop the session. There was no significant change in other vitals.

Conclusions: In aSAH patients, RIC was successfully applied and well tolerated with no procedure-related complications. No patient suffered ischemic stroke within 72 hours of RIC, consistent with our previous studies showing protective cerebral metabolic changes up to 48 hours after sessions. These results demonstrate that application of RIC is safe and feasible and suggest that RIC may be associated with transient tolerance to ischemia during the treatment period. The efficacy of RIC for neuroprotection should be investigated in larger controlled trials.

Abstract W P47: Recanalization After IV TPA Alone Among Acute Ischemic Stroke Patients Treated With Combined IV-Endovascular Recanalization: Impact of Arterial Occlusion Site

Background: Combined IV TPA and catheter-based reperfusion is an emerging treatment strategy for acute ischemic stroke. Both patient care and clinical trial design would be enhanced by delineation of which patients rapidly respond to IV TPA alone, before endovascular therapy can be initiated.

Methods: In a prospectively maintained registry of patients treated under a general policy of combined IV TPA and endovascular therapy, we analyzed subjects with MRA/CTA-confirmed anterior circulation occlusions prior to IV TPA start.

Results: Among 118 patients meeting study entry criteria, age was mean 71.5 (SD 14.5), 53.0% were female, and baseline NIHSS was 14.4 (SD 7.1). Confirmed sites of occlusion prior to IV TPA were internal cerebral artery (ICA) in 22.9%, M1 segment of middle cerebral artery (MCA) in 50.0%, and M2-3 in 27.1%. Among patients undergoing catheter cerebral angiography, median time from start of IV TPA to diagnostic catheter angiogram was 75 mins (IQR 50-113). A total of 48 (40.7%) patients achieved partial or complete recanalization (AOL 2-3) of the initial target artery with IV TPA alone (partial in 22 (18.6%) and complete in 26 (22.2%)); an additional 44 (37.3%) achieved partial or complete recanalization after endovascular therapy. Recanalization rates after IV TPA alone varied by target occlusion site: ICA - 22.2%, M1 - 40.7%, and M2-3 - 56.2%. In multivariate logistic regression analysis, independent predictors of recanalization with IV TPA alone were: M2-3 clot location, OR 3.04 (95% CI 1.20-7.73, p=0.019) and TOAST etiology large-artery atherosclerosis, OR 0.14 (CI 0.04-0.50, p = 0.003). Good outcome (mRS ≤ 3) rates at 3 months were 76.6% among recanalizers with IV TPA alone and 47.5% among recanalizers after both IV TPA and catheter therapy.

Conclusions: When combined IV-endovascular treatment is pursued, recanalization with IV TPA alone occurs in 4 out of 10 patients before catheter therapy is started, is more common with more distal clot location, and is associated with a high rate of excellent clinical outcomes.

Abstract T P33: Collateral Grade on MRI - Validation With Conventional Angiography is Key

Introduction: Collateral status may predict outcomes after endovascular therapy, yet a reliable noninvasive technique prior to angiography is needed. We developed a novel method for projection of perfusion imaging data and validated it with respect to DSA acquired immediately afterwards.

Methods: Consecutive acute ischemic stroke patients with M1 MCA occlusions with perfusion MR imaging prior to endovascular revascularization therapy were included. Collateral status on DSA was graded with the ASITN/SIR scale (0-4). 4-D dynamic susceptibility contrast concentration time images were constructed and projected in 2-D axial and sagittal planes at each time point. Independent review of the resulting MRI-based collateral sequences was conducted to generate a score analogous to the ASITN/SIR scale, followed by correlation studies between the two techniques.

Results: 47 patients were included with mean age 68.5 ± 16.3, 76.5% were female, baseline NIHSS was median 14 (range 3-31), and mean time from MRI to groin puncture was 109 min ± 95.5. DSA collateral grade was (0 (n=3); 1 (n=9); 2 (n=12); 3 (n=21); 4 (n=2)) with MRI collateral grade (0 (n=2); 1 (n=11); 2 (n=13); 3 (n=18); 4 (n=2)). MRI and DSA collateral scores were closely correlated, Spearman's rho = 0.91, weighted kappa = 0.82 (P <0.00001). Poor collateral status on MRI showed correlations with moderate to severe NIHSS (Spearman's rho = -0.31 (p< 0.039)). Figure depicts a panel version of MRI-based collateral sequences from a patient with a left M1 occlusion with a MR collateral grade of 1.

Conclusions: Novel post-processing of noninvasive MRI perfusion data based on routine acquisitions can reliably measure the degree of collaterals on DSA.