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Stroke, Volume 56, Issue Suppl_1, Page A25-A25, February 1, 2025. Background:Rehabilitation therapy is an important component of acute ischemic stroke (AIS) recovery. A major hinderance is the inability to predict which patients benefit from mobilization during the first 24 hours (ERehab). We hypothesize serum biomarker analyses during the hyperacute phase can bridge the gap.Methods:This is a single center study of 20 AIS patients&14 age/sex matched controls enrolled from 3/2022-6/2023. Serum samples were collected at 4 time points – angiography suite before cerebral reperfusion or Neuro ICU at hospital admission, 12, 24&72 hours. Biomarker candidates were identified using a DisGeNET search for AIS associated proteins; 70% achieved an Evidence Index cutoff score of 1, indicating all publications support human gene-disease or variant-disease associations. Time course of serum proteome changes was evaluated using aptamer-based SomaScan assay, measuring 1500 proteins. NIH Database for Annotation, Visualization&Integrated Discovery (DAVID) Gene Functional Classification Tool compared shared genes and biomarkers for stroke (vs healthy controls)&unfavorable (vs favorable) outcome, characterized by modified Rankin Scale (mRS) score of 3-6 (vs 0-2), at hospital discharge&90 days (90d).Results:The mean age of AIS patients was 59 years, 65% were male. Median NIHSS score was 11, Charlson Comorbidity Index score was 5.5 and the median last known well to hospital admission was 6.6 hrs. The average time to first mobilization was 39 hrs, 25% received ERehab. The mean rehab duration during AIS hospitalization was 438 min; median length of stay was 8.4 days, 40% received post-acute rehabilitation. Median AIS volume was 36mL, 65% of patients had ICA or M1/MCA involvement. Approximately 65% received IV thrombolysis, 80% underwent cerebral reperfusion therapy, 94% achieved modified thrombolysis in Cerebral Infarction score ≥ 2b. The median mRS was 4 at hospital discharge, 3 at 90d. Mortality rate was 10%. DAVID analyses resulted in 22 biomarkers at hospital discharge&35 biomarkers at 90d associated with favorable outcome. Gene expression differences were present at each time point (Figure).Conclusions:We identified multiple serum biomarkers and gene clusters associated with favorable outcomes at hospital discharge and 90d in AIS patients, indicating a need for several biologic targets to predict ERehab response during the hyperacute phase. These findings provide an early framework for tailored stroke recovery interventions.

Stroke, Volume 56, Issue Suppl_1, Page A23-A23, February 1, 2025. Background:Functional impairments following stroke remain a significant therapeutic challenge. Vivistim, FDA-approved since 2021, has shown consistent results, providing 2-3 more improvement in arm and hand function compared to intensive rehabilitation alone. At Atlantic Health System, 25 patients underwent Vivistim implantation and received Paired VNS rehabilitation.Methods:A multidisciplinary team at AHS identified, educated, and implanted Vivistim in 25 post-acute stroke patients with moderate-to-severe motor impairments in the arm and hand. Post-implantation, patients were referred to one of 11 sites. Regular follow-ups were conducted by the implanting team to monitor side effects, safety and efficacy of this novel intervention.Results:All 25 patients successfully underwent outpatient implantation, with no reported infections at the implant sites. One patient developed a hematoma that resolved without intervention. Another required device explantation approximately 410 days post-therapy due to tingling sensations near the implant site likely unrelated to the device. This patient maintained a 25-point improvement on the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) despite explantation, indicating sustained benefits. Of the 25, 22 completed the therapy protocol. The remaining three discontinued therapy due to unrelated complications: one experienced two grand mal seizures linked to changes in seizure medication, another sustained an arm injury from a fall, and the third developed double vision, impairing her ability to drive. Patient ages ranged from 40 to 80 years (mean 62.6), with time to implantation post-stroke ranging from 1 to 11 years (mean 3.6). The interval from implantation to therapy initiation varied from 8 to 32 days (mean 15.3). The baseline FMA-UE score averaged 33 (range 19-56), with an average post-therapy score of 43 (range 24-63), for a mean improvement of 9.53 points. Notably, the patient with the longest follow-up (22 months) showed continued progress, reducing her 9-Hole Peg Test time by 61.42 seconds over her assessment 6 months prior.Conclusion:This case series represents the largest cohort reported to date from a single implanting site in a real-world setting. Vivistim was implanted safely, with no infections or surgical complications. Patients showed positive responses to Paired VNS despite an average of 3.6 years post-stroke, supporting the efficacy of this innovative treatment in the chronic stroke population.

Stroke, Volume 56, Issue Suppl_1, Page A50-A50, February 1, 2025. Introduction:Hematoma expansion (HE) occurs in one-fourth of patients with acute intracerebral hematoma (ICH) and is associated with worse outcomes. Existing radiological markers of HE show modest predictive accuracy. We aim to investigate a novel radiological marker that co-localizes findings from non-contrast CT (NCCT) and CT angiography (CTA) to predict HE.Methods:We analyzed 200 consecutive acute ICH patients admitted at Foothills Medical Centre in Calgary, Canada (development cohort) and analyzed 304 patients from the multicenter observational study PREDICT (validation cohort). The Black-&-White (B&W) sign was defined as any visually identified spot sign on CTA co-localized with a hypodensity sign on the corresponding NCCT (Figure 1). The primary outcome was hematoma expansion (≥6mL or ≥33%). Secondary outcomes included absolute (

Stroke, Volume 56, Issue Suppl_1, Page AWMP53-AWMP53, February 1, 2025. Background:Treatment options and outcomes in stroke also depends on pre-hospital delays. The goal of this study is to describe onset-to-door times (ODT) across many countries and also investigate how the mode of arrival affects ODT.Methods:This is an analysis of the data from the Registry of Stroke Care Quality (RES-Q), years 2022&2023. RES-Q is used across the world for audit of clinical care. Data were stratified by the mode of arrival (EMS vs. non-EMS). Median ODT were analyzed, and 95% confidence intervals (CI) were calculated for each country and arrival mode.Results:Of 334,184 patients from 1,130 hospitals in 70 countries, 155,532 patients from 25 countries were diagnosed with acute ischemic stroke after excluding secondary transfers (n=32,349), cases from countries with fewer than 1,000 cases (n=128,660), and those with missing data or typing errors (n=17,643). The median ODT was 193 mins (95% CI: 164-223) for patients arriving by EMS and 309 mins (95% CI: 274-360) for those arriving by non-EMS. The percentage of EMS arrival by region was 34% (Africa), 30% (Asia), 39% (Latin America), and 87% (Europe). The percentage of EMS arrivals is shown in Figure 1. Compared to the patients who reached by non-EMS mode, patients who reached by EMS mode were more likely to receive intravenous thrombolysis (16% vs 44%,). The ODTs by mode of arrival and country are detailed in Figure 2.Conclusions:Transport via EMS was associated with a reduced arrival time nearly by 2 hours and tripled the chance of receiving thrombolysis as compared to non-EMS transportation. The percentage of patients arriving by EMS was higher in European countries as compared to Africa, Asia and Latin America and this is reflected by shorter ODT in many EU countries. Improvements in EMS infrastructure could improve stroke outcomes globally.

Stroke, Volume 56, Issue Suppl_1, Page AWMP64-AWMP64, February 1, 2025. Background and Objectives:Emerging literature suggests that non-stenotic carotid disease (

Stroke, Volume 56, Issue Suppl_1, Page A140-A140, February 1, 2025. Background:Nearly one-quarter of ischemic strokes (IS) in the U.S. are recurrent. We aimed to determine the risk of recurrent IS associated with reduced left ventricular ejection fraction (LVEF) in patients enrolled in the ARCADIA trial.Methods:We performed a post-hoc exploratory analysis in the ARCADIA trial, a phase III RCT of 1,015 cryptogenic stroke patients with atrial cardiopathy from February 2018 to February 2023. Those with LVEF

Stroke, Volume 56, Issue Suppl_1, Page ATP74-ATP74, February 1, 2025. Introduction:Extracranial-intracranial (EC-IC) bypass has evolved in recent years with more focus on indications, selection criteria, surgical methods, and postop management. Recent studies observed decreased utilization of EC-IC bypass and increased complications leading up to year 2015. In this study, we aim to study trends in EC-IC bypass throughout the years.Methods:Using the National Inpatient Sample 2016-2019, hospital admissions with carotid occlusive disease (COD), moyamoya, subarachnoid hemorrhage (SAH), unruptured intracranial aneurysm (UIA) were identified using ICD-10 diagnosis codes. Trends in ECIC-Bypass utilization, demographic and hospital characteristics, and unfavorable outcome were evaluated for each condition.Results:From 2016 to 2019, total number of EC-IC procedures increased significantly by 43% from 740 to 1060 weighted cases. Year after year, an increasing number of procedures were performed in urban teaching hospitals compared to rural or non-teaching hospitals for all indications. The most common indication was moyamoya, accounting for 58.1% in 2016, increasing to 60.8% in 2019. COD was the next common indication, comprising 26.4% in 2016, but slightly decreasing to 25.9% in 2019. Similarly, UIA accounted for 10.8% in 2016, declining to 8.5% in 2019. SAH remained stable at 4.7% in both 2016 and 2019 (Figure 1). Percentage of unfavorable outcome, including death, slightly increased for procedures in moyamoya and SAH cases and slightly decreased for COD and UIA.Conclusion:Overall number of EC-IC procedures increased significantly from 2016 to 2019. Urban teaching hospitals performed the increasing majority. Moyamoya was the primary indication for more than half of the procedures, exhibiting an increasing trend over the study period. While SAH did not show any significant changes, the percentage of procedures for COD and UIA decreased. The prevalence of unfavorable outcomes varied among different indications.

Trifluridine-tipiracil demonstrated promising efficacy in heavily pre-treated patients with MBC, despite prior exposure to a fluoropyrimidine. Clinically, this suggests that trifluridine-tipiracil holds potential as a viable oral later-line treatment option with a manageable toxicity profile while maintaining quality of life. Preparations for a phase 3 trial are underway.

Background
Breast cancer (BC) is the second most common cancer in the world. This study aimed to investigate the burden of BC due to some risk factors in the Middle East and North Africa (MENA) countries from 1990 to 2019.

Methods
This study is a secondary analysis based on the Global Burden of Disease 2019 data. In this study, we used data for disability-adjusted life years (DALYs) and mortality of BC in MENA countries. Also, we presented data for DALYs and mortality attributed to diabetes, smoking and passive smoking among women with BC.

Results
The age-standardised DALY due to BC in women increased slowly from 395 (95% CI: 357 to 458) per 100 000 in 1990 to 473 (95% CI: 409 to 544) per 100 000 in 2019. But Kuwait, Bahrain, Jordan and Turkey saw a decrease in age-standardised DALY trends between 1990 and 2019. In 1990, the age-standardised mortality rate was 12.3 (95% CI: 11.0 to 14.2) per 100 000 people, and by 2019, it had increased to 15.2 (95% CI: 13.3 to 17.3) per 100 000. The rate in 2019 varied between countries. Diabetes, smoking and passive smoking contribute significantly to the burden of disease and mortality from BC, with diabetes playing a more impactful role than the other risk factors. Across the MENA region, the burden and mortality attributed to diabetes vary among countries.

Conclusion
In the MENA region, the attributable fraction of risk factors such as diabetes, smoking and secondary smoking over BC deaths and DALY has increased in recent years.

Background
Cervical cancer (CC) is preventable through regular screening and vaccination against human papillomavirus (HPV). However, CC remains a significant public health issue in low-income and middle-income countries (LMICs) like Vietnam, where financial constraints hinder the widespread implementation of HPV vaccination and screening programmes. Currently, Vietnam lacks both a national CC screening intervention and an HPV vaccination programme for women and girls. To date, cost-effectiveness studies evaluating CC screening methods in Vietnam remain limited.

Objectives
To evaluate the cost-effectiveness of two CC screening strategies for Vietnamese women aged 25–55 years: (1) cotesting combining cytology and HPV testing conducted three times at 5 year intervals (intervention) and (2) cytology-based screening conducted five times at 2 year intervals (comparator). The objective is to provide evidence to inform policy and clinical practice in Vietnam.

Design
Cost-effectiveness analysis using a Markov model with 1 year cycles to simulate the natural progression of CC.

Setting
The Vietnamese healthcare system, modelled from the provider’s perspective, with parameters adapted to the local context through expert consultations.

Participants
A simulated cohort of Vietnamese women aged 25–55 years.

Interventions
The intervention involved cotesting (cytology and HPV testing) three times at 5 year intervals. The comparator was cytology-based screening conducted five times at 2 year intervals.

Primary and secondary outcome measures
The primary outcome measure was quality-adjusted life years (QALYs). Costs and cost-effectiveness ratios were assessed using Vietnam’s gross domestic product (GDP) per capita as the cost-effectiveness threshold (1–3 times GDP per capita). Sensitivity analyses (one-way deterministic and probabilistic) were conducted to account for uncertainties.

Results
The cotesting strategy was less effective and more costly than cytology-based screening across all age groups. Cotesting resulted in higher costs and fewer QALYs than the comparator. Probabilistic sensitivity analyses confirmed that cotesting was not cost-effective under current conditions in Vietnam.

Conclusions
Cytology-based screening conducted five times at 2 year intervals is a more cost-effective option for CC screening in Vietnamese women aged 25–55 years. The cotesting strategy cannot be recommended due to its higher cost and lower effectiveness.

Objectives
This study aims to report the trends in the certification of both sight impairment (SI) and severe sight impairment (SSI) in England and Wales during the period of 2010 to 2020, prior to the COVID-19 pandemic. The focus is on diabetic retinopathy/maculopathy as the key causative factor.

Design
Retrospective database analysis.

Setting
England and Wales.

Participants
Individuals certified as SI or SSI.

Outcome measures
Trends in certification of vision impairment in England and Wales due to any cause, with specific attention to diabetic retinopathy.

Methods
Certifications of vision impairment made by ophthalmologists in England and Wales were recorded and copies were sent to Moorfields Eye Hospital for epidemiological analysis. All certificates completed in England and Wales over an 11-year period, from April 2009 to March 2020, were queried and analysed on an annual basis. This analysis included all causes, and where both the main cause was diabetic eye disease or where diabetic eye disease was a contributory cause among multiple pathologies. Poisson regression was employed to analyse changes in trends over time for certifications of vision impairment.

Results
In England, from 2010 to 2020, there was a small but significant reduction (p

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New England Journal of Medicine, Volume 392, Issue 3, Page 239-248, January 16, 2025.

This study examines trends in cervical cancer mortality in US women aged younger than 25 years before and after the introduction of human papillomavirus vaccines.

Objectives
In order to estimate long-term trends of the years lived with disability (YLDs) for cataract due to high body mass index (BMI).

Design and participants
Data were retrieved from the Global Burden of Disease (GBD) 2019. The global cases, age-standardised rates (ASR) of YLDs for cataract attributable to high BMI were described by age, sex, geographical location and sociodemographic index (SDI). The estimated average annual percentage change (AAPC) was analysed to quantify the trends of ASR of YLD from 1990 to 2019.

Primary outcome measures
Years lived with disability.

Results
Globally, there were 370.4 (95% UI: 163.2 to 689.3) YLDs due to cataract attributed to high BMI in 2019, more than triple the number in 1990. Moreover, the ASR of YLD increased during 1990–2019, with AAPC of 1.54 (95% CI: 1.41 to 1.66). In 2019, the burden of cataract due to high BMI was higher in females and the elderly population. North Africa and the Middle East were the high-risk areas of cataract attributable to high BMI in 2019, with Saudi Arabia being the country with the heaviest burden. In terms of SDI, low-middle SDI regions had the greatest number of cataract-related YLDs due to high BMI in 2019.

Conclusion
The global YLDs for cataract due to high BMI have shown a notable increase from 1990 to 2019. Addressing BMI control may contribute to cataract prevention, highlighting a potential public health impact, particularly in low-SDI locations and among the elderly.