Plant Introduction
Not a member yet
60263 research outputs found
Sort by
Abstract TP069: Role of Lifestyle Factors and Cognitive Function on the Association of Educational Attainment with Incident Hypertension in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
No full textIntroduction: Hypertension is one of the most important determinants of cardiac and brain health. We previously showed that higher educational attainment is associated with a lower risk of incident hypertension. The factors that mediate such an association have not been described.
Hypothesis: Higher education attainment reduces risk of incident hypertension both directly and indirectly through higher global cognitive scores and improved health behaviors.
Methods: Data from the Hispanic Community Health Study/Study of Latinos were analyzed. Education attainment was grouped into 3 categories: Less than High School (HS), HS, or greater than HS. Global cognition (GC) of non-hypertensive participants at Visit 1 was derived by averaging the z scores across four neurocognitive tests (Brief Spanish-English Verbal Learning Test Sum and Recall; Word Fluency; and Digit Symbol Substitution Test). Sociodemographic characteristics and unhealthy behaviors (smoking, obesity, sedentary life, lower diet quality, and presence of sleep apnea) were ascertained at Visit 1. Incident hypertension was investigated at Visit 2, conducted, in average, 6 years later. The association of education attainment at Visit 1 with incident hypertension at Visit 2 (defined as BP ≥130/80 mmHg or on treatment) was investigated using logistic regression analyses adjusted for sociodemographic characteristics and time between visits. We used multimodal analyses to assess whether unhealthy behaviors and GC were pathway variables between education attainment and incident hypertension.
Results: A total of 8,482 hypertension free participants (mean [IQR] age, 41[40-41] years; 62% female) were included. At Visit 2, 39% of individuals developed hypertension. In our final model, achieving greater than HS for education, was associated with lower odds of incident hypertension (OR=0.86; 95% CI 0.74- 0.99). In the pathway analysis, each level increase in the education attainment was associated with lower odds of incident hypertension, either directly or through higher global cognitive scores, which in turn led to lower rates of sedentarism, obesity, and sleep apnea (Figure).
Conclusions: Higher education attainment was associated with lower odds of incident hypertension six years later. Global cognitive scores were an important mediator between education attainment and unhealthy behaviors, which were pathways variables in the development of hypertension
Medicolegal Implications and Current Landscape of Artificial Intelligence in Plastic Surgery
No full textArtificial intelligence (AI) is increasingly integrated into plastic and reconstructive surgery. It supports preoperative prediction and imaging analysis, intraoperative visualization, and postoperative monitoring. While these advancements demonstrate AI's growing potential across the surgical continuum, their adoption also presents ethical, legal, and regulatory challenges. Concerns surrounding algorithmic bias, data privacy, and informed consent are particularly relevant in fields shaped by individualized anatomy, aesthetic nuance, and patient-specific goals. This analysis reviews the current landscape of AI in plastic surgery and medicolegal frameworks shaping its use. Existing legal doctrines, ranging from antidiscrimination and privacy protections to common-law informed consent, offer partial guidance for AI use in plastic surgery. Traditional liability models struggle to accommodate adaptive algorithms. Early litigation has focused largely on insurance decision-making rather than procedural use of AI. In the absence of clear precedent, regulatory efforts remain fragmented. The EU imposes strict oversight for high-risk medical AI, and US federal and state policies emphasize transparency and human oversight. However, there remains limited direction on liability or intraoperative use. These gaps highlight the need for more comprehensive, procedure-specific regulation as AI integrates into surgical care and plastic surgery more broadly. This analysis proposes a decision-making framework. We emphasize transparent informed consent, patient privacy protections, and clinician awareness of algorithmic bias, to guide safe integration of AI tools into active clinical practice. While AI may meaningfully enhance plastic surgery, its limited generalizability and susceptibility to bias reinforce its current role as an adjunct to, rather than a substitute for, a surgeon's expertise
Abstract WP366: Dose-Response Evaluation of Intra-Arterial Neural Stem Cell Therapy in Acute Ischemic Stroke Model
No full textIntroduction: Preclinical studies in the past two decades have shown promise in cell therapies for stroke. Intra-arterial (IA) delivery of stem cells is minimally invasive and uses similar techniques to endovascular thrombectomy making it attractive for clinical translation. Recent studies from our lab have shown the safety and efficacy of IA-Mesenchymal Stem Cells (MSC) treatment in rodent and canine ischemic stroke models primarily through anti-inflammatory mechanisms. However, there are sparse studies of IA neural stem cells (NSCs), which may have direct impact on neuronal survival and regeneration.
Methods: In this study we tested three different doses (1 x 105, 5 x 105, 1 x 106) of IA NSCs and compared their efficacy with PBS control and intra-arterial MSC groups in a rat model of reversible middle cerebral artery occlusion (rMCAO). Stem cell therapy was administered 24 hours after reperfusion. Behavioral and functional improvements, as well as postmortem histology were performed to evaluate the efficacy of different doses.
Results: Our findings showed significant improvements in stroke volume, surviving neurons, neurological deficit scoring, and other functional behavioral tests for the 5 x 105 NSC group at 7 days after stroke. Additionally, neurological deficit scoring showed significant improvements at the higher dose of 1 x 106 NSC as well. Significantly elevated expression of NeuN, Sox2, and Nestin markers were also detected in the ipsilateral dentate gyrus at 7 days after stroke in the 5 x 105 NSCs dose group.
Conclusions: These novel findings help us evaluate safe and optimally effective dose for IA-NSC in ischemic stroke post-reperfusion. They form the basis for developing future pre-clinical studies and designing a successful clinical translation of this novel approach
Abstract Th0028: Transcriptomic Dynamics of Mouse Arteriovenous Fistulas via Single-Cell RNA Sequencing Analysis
No full textAbstract WP184: The Impact of the Advanced Stroke Life Support® Simulation-Enhanced Course on Knowledge, Diagnosis, and Management of Stroke Patients
No full textIntroduction: Stroke is the second leading cause of death worldwide (7.3 million/year). Early detection and effective management are critical for survival and neurological recovery. Comprehensive stroke education for healthcare providers in prehospital and hospital settings can lead to improved outcomes. Advanced Stroke Life Support (ASLS®) is a simulation-based interprofessional course consisting of interactive instruction, including standardized patient-based cases where learners diagnose strokes and develop a management plan for the patients. This study evaluated the course's effect on participants' knowledge of stroke diagnosis and management, translation to patient care, and clinical outcomes.
Methods: We conducted an observational, mixed-methods study of participants completing the 11th ASLS version (2015-2022) at U.S. and international sites. All learners received the same educational intervention. A total of 40,434 prehospital and hospital providers participated. Outcomes were evaluated using the Kirkpatric model: Level 1 (Reactions), Level 2 (Learning), Level 3 (Application), and Level 4 (Impact). Knowledge was measured by validated 25-item pre-and post-course assessments. We used a comprehensive questionnaire to determine translation to clinical practice (Level 3) and its impact on outcomes (Level 4).
Results: ASLS course completion improved outcomes at all evaluation levels. Paired-samples t-tests showed significant knowledge gains (pretest mean 64.66, SD 13.17; posttest mean 89.51, SD 7.55; p < .001) (Image 1). Of 21,945 eligible survey recipients emailed 750 responded. Most (96%) reported applying ASLS skills in clinical practice. On a 5-point scale, 64% said participation improved stroke care and outcomes "a lot" or "a great deal." Hospital-based respondents estimated a 76.14% reduction in door-to-needle time (Images 2&3).
Conclusions: This large study demonstrates that a structured, simulation-based stroke curriculum significantly enhances providers' knowledge, skills, and application in patient care. Over eight years, data from 40,434 learners across 31 U.S. states and eight countries confirmed the ASLS course's impact on stroke diagnosis, management, and outcomes. Participants consistently reported using acquired skills and perceiving substantial improvements in patient care. Future work includes a multicenter analysis of tangible and intangible outcomes, including cost-benefit evaluation of ASLS implementation for stroke training
Abstract DP026: Interaction of Periprocedural Antiplatelets and Intravenous Thrombolysis in Intracranial Stenting for Acute Ischemic Stroke: RESISTANT Registry Subanalysis
No full textIntroduction: Intracranial stenting during endovascular thrombectomy (EVT) is a common practice in the setting of failed reperfusion or severe stenosis. Immediate stent patency requires periprocedural antiplatelet therapy (APT). How APT intensity interacts with prior intravenous thrombolysis (IVT) to influence hemorrhagic risk remains uncertain. We aimed to assess whether the APT regimen modifies the association of IVT with early intracranial hemorrhage after intracranial stenting during EVT.
Methods: This was a subanalysis of the RESISTANT registry, a multicenter, international, retrospective cohort (2016 to 2023) of adults with acute ischemic stroke who underwent intracranial stenting during EVT. APT regimens were categorized as conservative (intravenous or oral aspirin alone, or aspirin plus an oral P2Y12 inhibitor) and aggressive (any regimen including intravenous GPIIb/IIIa inhibitor or intravenous cangrelor). Four main groups were compared according to the APT regimen (conservative/aggressive) and the use of IVT (+/-). The primary outcome was a composite of sICH and parenchymal hematoma types 1 and 2 (sICH-PH2-PH1). Multivariable logistic regression models were used to evaluate the interaction between IVT and APT, adjusting for clinically relevant covariates.
Results: Among the 823 included patients, 44 (5.3%) received conservative APT with IVT, 130 (15.8%) received conservative APT without IVT, 145 (17.6%) received aggressive APT with IVT, and 504 (61.2%) received aggressive APT without IVT. Among patients who received IVT, sICH-PH2-PH1 rates were 9.3% with conservative APT and 10.7% with aggressive APT; among those without IVT, rates were 3.2% and 9.9%, respectively. Administration of IVT (adjusted odds ratio [aOR] 5.84, 95%CI 1.07 to 43.92; p=0.05) and aggressive APT (aOR 4.81, 95% CI 1.41 to 30.22; p=0.03) were each associated with higher odds of hemorrhagic complications, with a significant IVT by APT interaction (Pinteraction=0.05; Figures 1 and 2). Within the aggressive APT plus IVT subgroup, sICH-PH2-PH1 occurred in 20% of patients treated with cangrelor and 6.1% treated with a glycoprotein IIb/IIIa inhibitor (Figure 3).
Conclusion: Among patients requiring intracranial stenting, aggressive periprocedural APT and prior IVT are each associated with higher hemorrhagic risk, with the combination showing the worst observed crude outcome. Prospective evaluation of protocolized APT pathways in the IVT setting is warranted
Abstract DP183: Association between Cumulative Fasting Blood Glucose and Later-life Cognitive Decline
No full textBackground: Diabetes, particularly in midlife, is a risk factor for dementia. However, how cumulative fasting blood glucose (FBG) levels contribute to dementia risk is unclear.
Objective: To determine associations between cumulative FBG levels and cognitive decline.
Methods: We pooled data from 15,294 individuals aged 18 or older without dementia or stroke (55% women; mean [SD] age at first cognitive assessment 52 [21] years) from 6 cohorts (1971 to 2024): Atherosclerosis Risk in Communities Study (ARIC), Coronary Artery Risk Development in Young Adults (CARDIA) Study, Cardiovascular Health Study (CHS), Framingham Offspring Study (FOS), Multi-Ethnic Study of Atherosclerosis (MESA), and Northern Manhattan Study (NOMAS). Controlling for other known risk factors for dementia, we used linear mixed effects models to examine the association between time-dependent cumulative mean FBG level and trajectories of harmonized global cognition (primary outcome), memory, and executive function. Cognitive outcomes were standardized as T-scores (mean [SD], 50 [10]); a 1-point difference represents a 0.1-SD difference in cognition. Higher scores indicate better performance. Median (IQR) follow-up was 23 (9, 36) years. The median (IQR) number of FBG measurements was 5 (2, 7) and the median (IQR) time between first and last FBG measurement was 9 (5, 30) years.
Results: Higher time-dependent cumulative mean FBG level was associated with significantly faster declines in global cognition (-0.004 points per year faster per each 10 mg/dL increase [95% CI, -0.007 to -0.001]; P=0.006), memory (-0.014 points per year faster per each 10 mg/dL increase [95% CI, -0.021 to -0.008]; P<0.001), and executive function (-0.008 points per year faster per each 10 mg/dL increase [95% CI, -0.011 to -0.005]; P<0.001) (Table 1, Model A; Figure 1). Further adjustment for diabetes treatment at first cognitive assessment did not change the associations between FBG and cognitive decline, although diabetes treatment was associated with slower executive function decline (0.05 points per year slower [95% CI, 0.006-0.094]; P=0.03) (Table 1, Model B).
Conclusion: These results suggest that higher cumulative mean FBG levels may contribute to later-life cognitive decline. If causal, the declines in global cognition, executive function, and memory due to long-term mean FBG levels we observed, equivalent to 0.5 to 2.0 years of cognitive aging per 10 mg/dL higher mean FBG, would be clinically significant
Explainable radiomics with probability calibration for postoperative glioblastoma surveillance
No full textTo develop and validate a calibrated, explainable radiomics pipeline for classifying progression status in postoperative glioblastoma (GBM) patients using multiparametric MRI acquired at longitudinal follow-up scans.
We retrospectively analyzed the MU-Glioma-Post dataset, which includes serial post-treatment MRI (T1, T1-CE, T2, FLAIR). Volumes were corrected with N4, resampled at 1 mm³ resolution, co-registered to SRI24, skull-stripped, and segmented using nnU-Net into categories such as enhancing tissue, non-enhancing tumor core, pericavitary FLAIR hyperintensity, and resection cavity. Expert neuroradiologists refined these segmentations to ensure precise delineation for the extraction of radiomic features. Radiomics features were extracted on Pyradiomics, Laplacian-of-Gaussian (σ = 0.5–3.0 mm), and 3D wavelet sub-bands. Stability-aware ranking (variance/correlation filters, L1-logistic, permutation importance) was performed before classifier training. A LightGBM model was optimized with patient-aware 5-fold cross-validation and Optuna tuning, then Platt-calibrated on out-of-fold scores. Performance was assessed on a patient-held-out test set using AUC, confusion matrix, and Brier score, while SHAP provided cohort-level explanations.
The LightGBM model trained on 256 radiomics features achieved an AUC of 0.80 on the held-out patient test set, with a confusion matrix indicating sixteen false positives and six false negatives. Calibration improved the Brier score from 0.093 to 0.088. Global explanations showed that the model mainly relied on coarse-scale wavelet/LoG GLCM/GLSZM textures across all modalities, with little dependence on shape features. Risk-increasing attributions were often due to enhancing rim on T1-CE and pericavitary FLAIR textures.
A calibrated, explainable radiomics model trained on longitudinal post-operative MRI provides strong discrimination and well-calibrated probabilities for GBM progression prediction, supporting threshold-based decision-making in surveillance. Radiomic signatures emphasizing coarse-scale heterogeneity and enhancing texture patterns were most strongly associated with earlier progression. External, multi-centre validation and evaluation of diffusion/perfusion and delta-radiomics are warranted to establish generalizability.
•An explainable radiomics model classifies glioblastoma progression status after surgery.•Stability-aware feature selection improves robustness and reproducibility.•LightGBM classifier achieves strong performance with AUC = 0.80.•Probability calibration enhances reliability for clinical decision support.•Coarse-scale wavelet and LoG textures drive model predictions
Abstract TP089: Micro and Nano plastics in Cerebrovascular Health: A systematic Review of Current Evidence and Research Directions
No full textBackground: Microplastics (MPs) and nano plastics (NPs) are widespread environmental contaminants accumulating in humans. Emerging evidence connects their buildup to cardiovascular, cerebrovascular and neurological diseases. We synthesized recent human, animal, and mechanistic studies on MP/NP presence in biological tissues and implications for cerebrovascular health.
Methods: We conducted a literature review following PRISMA rules of peer-reviewed studies published from 2021 to mid-2025, focusing on MP/NP exposure, tissue accumulation, cardiovascular outcomes, and mechanisms relevant to stroke pathophysiology. Selected studies addressed MP/NPs in human or animal models with measurable endpoints like tissue/plaque presence, blood detection, neurovascular impairment, oxidative stress, and inflammation.
Results: Out of 47 reviewed studies, 10 reported relevant data for this review showing that humans ingest up to 5g of MPs weekly. A biomonitoring study detected MPs in 80% of healthy human blood samples (17 of 22), with a mean concentration of 1.6 μg/ml (Table). MPs were found in human carotid atheromas, correlating with adverse cardiovascular risk profiles. After a 34-month follow-up, non-fatal stroke was the most common adverse outcome in patients with MPs. Mechanistic studies in animal models show immune-mediated vascular occlusion and neurobehavioral impairments. A recent autopsy study found MPs/NPs in brain samples, with correlations to dementia cases, suggesting the brain may accumulate higher concentrations than other organs over time.
Conclusion: Our findings collectively establish a biologically plausible link between MPs in vascular and brain tissues and the promotion of inflammation, oxidative stress and cerebrovascular pathology, that may contribute to stroke and cardiovascular disease risk. The presence of MPs in human blood and carotid plaques confirms their systemic absorption and deposition in arteries, linking them to higher rates of non-fatal stroke and suggesting their role in disease progression. The finding of MPs/NPs in human brains raises concerns about direct impacts on cerebrovascular and neurodegenerative health. The ability of these particles to cross the blood-brain barrier and trigger inflammatory responses provides a plausible mechanism for neurovascular dysfunction.
Longitudinal human studies are needed to characterize dose-response relationships and effects on brain structure and function, as well as to establish exposure limits
Detection of Δ8-Tetrahydrocannabinol and Δ9-Tetrahydrocannabinol Urinary Metabolites in Human Performance Urine Specimens in Broward and Miami-Dade Counties, Florida
No full textWith the patchwork legalization of cannabis in the United States and the loopholes surrounding "legal" highs, the prevalence of Δ8-tetrahydrocannabinol (Δ8-THC) has been rising, requiring the development of methods to extract, differentiate, and detect it separately from Δ9-tetrahydrocannabinol (Δ9-THC) and its metabolites. The authors focused on developing a method to detect the primary metabolite Δ8-carboxy-tetrahydrocannabinol (Δ8-THC-COOH) separately from Δ9-carboxy-tetrahydrocannabinol (Δ9-THC-COOH) in urine, a commonly collected sample in human performance toxicology.BACKGROUNDWith the patchwork legalization of cannabis in the United States and the loopholes surrounding "legal" highs, the prevalence of Δ8-tetrahydrocannabinol (Δ8-THC) has been rising, requiring the development of methods to extract, differentiate, and detect it separately from Δ9-tetrahydrocannabinol (Δ9-THC) and its metabolites. The authors focused on developing a method to detect the primary metabolite Δ8-carboxy-tetrahydrocannabinol (Δ8-THC-COOH) separately from Δ9-carboxy-tetrahydrocannabinol (Δ9-THC-COOH) in urine, a commonly collected sample in human performance toxicology.Liquid-liquid extraction with hydrolysis was used to isolate and extract metabolites from forensic urine samples. After evaporation, the extract was flash-derivatized using an MTBSTFA:ACN (1:3) solution, followed by gas chromatography-mass spectrometry analysis. The results were tabulated and subjected to statistical analysis.METHODSLiquid-liquid extraction with hydrolysis was used to isolate and extract metabolites from forensic urine samples. After evaporation, the extract was flash-derivatized using an MTBSTFA:ACN (1:3) solution, followed by gas chromatography-mass spectrometry analysis. The results were tabulated and subjected to statistical analysis.Forensic human performance urine specimens (n = 127) were analyzed for ∆8-THC-COOH, ∆9-THC-COOH, and 7-carboxy-cannabidiol (7-COOH-CBD) between January 2023 and January 2024. In total, 52 samples contained only ∆9-THC-COOH, 70 contained both ∆8-THC-COOH and ∆9-THC-COOH, 3 contained only ∆8-THC-COOH, and 5 contained both 7-COOH-CBD and ∆9-THC-COOH, with 3 of these containing all 3 metabolites. The area abundances of their respective chromatographic peaks was used to calculate the ∆8:∆9 metabolite ratio when both ∆8-THC-COOH and ∆9-THC-COOH were detected. Despite a higher mean ratio in driving under the influence cases (13.87 versus 8.53), the difference between the mean values was not statistically significant (independent-sample t test: t (68) = -0.670, p = 0.505).RESULTSForensic human performance urine specimens (n = 127) were analyzed for ∆8-THC-COOH, ∆9-THC-COOH, and 7-carboxy-cannabidiol (7-COOH-CBD) between January 2023 and January 2024. In total, 52 samples contained only ∆9-THC-COOH, 70 contained both ∆8-THC-COOH and ∆9-THC-COOH, 3 contained only ∆8-THC-COOH, and 5 contained both 7-COOH-CBD and ∆9-THC-COOH, with 3 of these containing all 3 metabolites. The area abundances of their respective chromatographic peaks was used to calculate the ∆8:∆9 metabolite ratio when both ∆8-THC-COOH and ∆9-THC-COOH were detected. Despite a higher mean ratio in driving under the influence cases (13.87 versus 8.53), the difference between the mean values was not statistically significant (independent-sample t test: t (68) = -0.670, p = 0.505).This study and its methodology provide insight into the effective separation and analysis of the compounds of interest, and discuss the potential differentiation of ∆8-THC-dominant products from traditional cannabis, and underscore the prevalence of ∆8-THC and ∆8-THC-dominant products in the current market, while highlighting the need for further studies on this topic.CONCLUSIONSThis study and its methodology provide insight into the effective separation and analysis of the compounds of interest, and discuss the potential differentiation of ∆8-THC-dominant products from traditional cannabis, and underscore the prevalence of ∆8-THC and ∆8-THC-dominant products in the current market, while highlighting the need for further studies on this topic