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L’azienda, impegnata nel campo della Human Health e della Animal Health, celebra quest’anno i 50 anni di attività nel nostro Paese confermando il proprio contributo allo sviluppo socio-economico italiano

Stroke, Volume 53, Issue 3, Page 636-642, March 1, 2022. There are stark inequities in stroke incidence, prevalence, acute care, rehabilitation, risk factor control, and outcomes. To address these inequities, it is critical to engage communities in identifying priorities and designing, implementing, and disseminating interventions. This issue ofStrokefeatures health equity themed lectures delivered during the International Stroke Conference and Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving meetings in 2021 as well as articles covering issues of disparities and diversity in stroke. Bruce Ovbiagele, MD, MSc, MAS, MBA, MLS, received the 2021 William Feinberg Award Lecture for his lifetime achievements in seeking global and local solutions to cerebrovascular health inequities. The second annual Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving symposium, which took place the day before the International Stroke Conference in February 2021, focused on community-engaged research for reducing inequities in stroke. Phil Gorelick, MD was awarded the Edgar J. Kenton III Award for his lifetime achievements in using community engagement strategies to recruit and retain Black participants in observational studies and clinical trials. Walter Koroshetz, MD, Director of the National Institute of Neurological Disorders and Stroke delivered the keynote lecture on stroke inequities and Richard Benson, MD, PhD, Director of the Office of Global Health and Health Disparities at National Institute of Neurological Disorders and Stroke, gave a lecture focused on National Institute of Neurological Disorders and Stroke efforts to address inequities. Nichols et al highlighted approaches of community-based participatory research to address stroke inequities. Verma et al showcased digital health innovations to reduce inequities in stroke. Das et al showed that the proportion of underrepresented in medicine vascular neurology fellows has lowered over the past decade and authors provided a road map for enhancing the diversity in vascular neurology. Clearly, to overcome inequities, multipronged strategies are required, from broadening representation among vascular neurology faculty to partnering with communities to conduct research with meaningful impact.

Stroke, Volume 53, Issue Suppl_1, Page A132-A132, February 1, 2022. Introduction:Endovascular (EVT) eligibility estimates using population-based, NIH-funded Greater Cincinnati Northern Kentucky (GCNK) Stroke Study 2010 data have been reported. Given the evolving EVT landscape, we present updated estimates of annual EVT eligibility using the 2015 GCNK epidemiological data and extrapolate to the 2021 US census. We project the potential increase in eligible patients in the US for each possible expanded indication with a randomized trial currently planned/underway.Methods:We ascertained all hospitalized AIS patients ≥18 years old in 2015 using ICD-9 430-436; ICD-10 I60-I67, G45-G46 within GCNK population; all cases were physician-reviewed. Patients presenting within 0-5 hrs of last known well (LKW) were considered EVT eligible if they had a pre-stroke mRS

Stroke, Volume 53, Issue Suppl_1, Page ATMP98-ATMP98, February 1, 2022. Objective:There are several challenges in implementing models for predicting stroke or stroke related outcomes. Most of these models have average concordance, and several of the important variables cannot be modified. In this study, we updated and performed a meta-analysis of commonly utilized models to predict stroke related outcomes. Our primary aim was to evaluate the discriminative ability of the concordance statistic by adding additional studies.Methods:Studies reporting c-index and SE (or 95% CI) for predicting stroke or related outcomes were included in our analysis. In addition to the c-index, total participants, year of publication, type of analytical method (survival, logistic regression, neural network, etc.) and type of outcome (predicting stroke or composite outcome) were utilized. Combined effect sizes with the random model, test for heterogeneity, and publication bias were considered. Egger’s test was used to assess funnel asymmetry.Results:Twenty-seven models were included (patients= 1762461; c-index=14, Harrell’s c-index= 13; only stroke =21, composite=6) in the analysis. Combined mean c-index was 0.76 (95% CI: 0.71, 0.81; 95% predictive interval: 0.59, 0.93). Combined mean Harrell’s c-index was 0.65 (95% CI: 0.61, 0.69; 95% predictive interval: 0.56, 0.74). Test of heterogeneity showed high variation between studies reporting c-index and Harrell’s c-index (I2=97.49% and 80.0% respectively). Egger’s test intercept was -2.1 (95% CI: -7.2, 3.0, P > .40) for c-statistic and 1.2 (95% CI: -1.2, 3.5, P > .32) for Harrell’s c-index studies.Conclusion:Current studies have not improved the prediction interval significantly as compared to our previous meta-analysis for predictive or explanatory model available for stroke risk. However, recent studies were found to be more inclusive of non-traditional biomarkers (e.g., genetic, or polygenic scores) and utilized various machine learning methods that were not used before.

Stroke, Volume 53, Issue Suppl_1, Page AWP56-AWP56, February 1, 2022. Background:Many countries/regions have formal Acute Ischemic Stroke (AIS) management guidelines. Variations between guidelines may showcase differences in demographic epidemiology and practice that correspond to the regional or national priorities.Methods:We systemically searched for guideline recommendations on AIS management published between January 1, 2004, and August 20, 2021. With only the latest guideline for each country selected, 11 guidelines from countries/regions of the world were identified and reviewed: United States (2018), Japan (2013), Europe (2018), Australia (2012), Brazil (2012), China (2019), Korea (2019), Canada (2018), India (2011), South Africa (2010), and Malaysia (2006).Results:Urgent imaging guidelines, such as CT or MRI, for initial evaluation are similar across countries; nevertheless, initial intravascular imaging guidelines greatly differ. Of the eleven countries reviewed, the majority recommend a standard tPA dose of 0.9mg/kg, while Japan and China recommend a lower tPA dose of 0.6mg/kg in select patients. While time to initiation of aspirin (ASA) post IV thrombolysis is widely accepted, consensus on the appropriate ASA dose, and possible addition of other antiplatelet therapies does not exist. Mechanical thrombectomy is overall endorsed within 6 hours or between 6-16 hours of symptom onset with causative occlusion, but countries such China and Canada have found validity extending the timeframe to 24hrs and beyond, using imaging modality recommendations. Inpatient management of nutrition, DVT prophylaxis, and rehabilitation differ between the various guidelines.Conclusion:Variations between guidelines exist that highlights those components with a lack of an evidence-based consensus. With further international collaboration, reconciliation of guidelines between countries or regions may be achievable.

Stroke, Ahead of Print. Global and local (“glocal”) disparities in stroke incidence, prevalence, care, and mortality are persistent, pervasive, and progressive. In particular, the disproportionate burden of stroke in people of African ancestry compared to most other racial/ethnic groups around the world has been long standing, is expected to worsen, and so far, has defied solution, largely because conventional risk factors likely account for less than half of the Black versus White disparity in stroke outcomes. While hypotheses such as a differential impact or inadequate evaluation of traditional risk factors by race have been suggested as potentially key factors contributing to lingering racial/ethnic stroke disparities, relatively understudied novel risk factors such as psychosocial stress, environmental pollution, and inflammation; and influences of the social determinants of health are gaining the most attention (and momentum). Moreover, it is increasingly recognized that while there is a lot still to understand, there needs to be a major shift from incessantly studying the problem, to developing interventions to resolve it. Resolution will likely require targeting multilevel factors, considering contemporaneous cross-national and cross-continental data collection, creating scalable care delivery models, jointly addressing care quality and community drivers of stroke occurrence, incorporating policy makers in planning/dissemination of successful interventions, and investing in robust transdisciplinary research training programs that address the interrelated issues of health equity and workforce diversity, and regional capacity building. To this end, our international multidisciplinary team has been involved in conducting several epidemiological studies and clinical trials in the area of stroke disparities, as well as executing career enhancing research training programs in the United States and Africa. This award lecture paper shares some of the lessons we have learnt from previous studies, presents objectives/design of ongoing initiatives, and discusses plans for the future.

Comunicato del 05/12/2021 n°76