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This study aimed to investigate how the residential noises cluster based on spectral and temporal characteristics of the noises in apartment houses. The type of noise was floor impact, air-borne, plumbing, transmitted outdoor unit of air-conditioner, traffic (road, rail, and air-craft noise), and construction noise. Duration of sound was edited to 5 s and sound pressure level was adjusted to be equal to be 50 dBA. K-means clustering analysis was performed to classify various sound sources, and the elbow method was used to confirm the number of clusters. As a result, residential noise sources were classified into twelves clusters according to spectral and temporal characteristics and difference in psychoacoustic parameters between clusters was also found. In addition, perceptual aspect of each cluster was investigated through sematic differential test.

This study aimed to investigate the sound masking according to spectral and temporal characteristics of residential noise and natural sound through auditory experiment. Since there are various types of residential noise sources (maskee) and natural sounds (masker), stimuli to be used for experiment were selected by dividing the sound source groups through the k-means cluster method. The stimuli consisted of a total of 7 maskee including a brown noise, and 7 masker (birdsongs and water sounds). In the auditory experiment, the preference of masker and the annoyance and unpleasantness of single maskee and masker and mixed sources (maskee+masker) were investigated. Result showed that Phoenicurus auroreus and stream-Fast were the highest preference among masker, and masker preference were significantly correlated with masker annoyance. In addition, it was found that impact sound (children jumping and running and piledriver) show relatively higher annoyance than other sound sources. Relative annoyance of mixed sources (maskee+masker) to single maskee was analyzed and masking effect was discussed based on spectral and temporal and the Zwicker's parameters of each sound source.

Various antimicrobial peptides play important roles as barrier function against bacteria and as innate host immunity. Several major studies have shown reduced expression of human beta defensin (hBD-3) in atopic dermatitis, highlighting the importance of hBD-3. In course of our search for hBD-3 stimulatory herbal souces and biologically active components, we screened 400 oriental herbal extracts using a range of real-time PCRs in the human keratinocyte cell line, HaCaT cells. We found that only six herbal extracts from Rubi Fructus, Lysimachiae Foenumgraeci Herba, Ailanthi Radicis Cortex, Galla Rhois, Peucedani Radix and Albizziae Cortex showed significant hBD-3 stimulatory effects. Although it did not have antimicrobial activity due to the low cytotoxic effect of Ailanthi Radicis Cortex, we further identified hBD-3-stimulating active ingredient in this extract. Efficient activity profiling based on HPLC was performed to identify active components from the extract of Ailanthi Radicis Cortex, and an hBD-3 stimulatory quassinoid component, ailanthone was identified by spectroscopic analysis. The present results show that Ailanthi Radicis Cortex and ailanthone have the potential to stimulate the expression of hBD-3 in HaCaT cells. These findings suggest new possibilities to control bacterial over-colonization found in atopic dermatitis using hBD-3 stimulatory herbal sources and ailanthone.

Despite the increasing evidence of the association between breast cancer and meningioma in women, the relationship between these tumors remains improperly examined. In this study, we aim to identify the sociodemographic and clinicopathologic features of women with breast cancer associated with a higher risk of developing a meningioma.The SEER (Surveillance Epidemiology and End Results) database (18 registries) was used to identify women with breast cancer as their first neoplasm. The risk of subsequent meningioma was reported as the standardized incidence ratio (SIR) and was analyzed by sociodemographic and clinicopathologic subgroups. Results are given as SIR (95% confidence interval [CI]).A total of 564,516 women diagnosed with breast cancer between 2004 and 2016 were included for analysis. A 26% increased risk of meningioma development (SIR, 1.26; 95% CI, 1.19-1.33; P0.05) was found in the cohort compared with the general population. Patients aged between 18 and 49 years (SIR, 2.16; 95% CI, 1.78-2.61; P0.05) and those with a more advanced tumor stage (stage IV; SIR, 2.39; 95% CI, 1.71-3.25; P0.05) were at a higher risk. Hormone receptor expression and treatment modality subgroups were at a similar risk compared with the general population.Our study corroborated the known association between these tumors and found a 26% risk of meningioma development in women with breast cancer, with younger patients and those with a more aggressive disease having a higher than expected risk.

Growth differentiation factor (GDF) 11 levels decline with aging. The age-related loss of GDF 11 has been implicated in the pathogenesis of a variety of age-related diseases. GDF11 supplementation reversed cardiac hypertrophy, bone loss, and pulmonary dysfunction in old mice, suggesting that GDF11 has a rejuvenating effect. Less is known about the potential of GDF11 to improve recovery after an acute injury, such as stroke, in aged mice. GDF11/8 levels were assessed in young and aged male mice and in postmortem human brain samples. Aged mice were subjected to a transient middle cerebral artery occlusion (MCAo). Five days after MCAo, mice received and bromodeoxyuridine / 5-Bromo-2'-deoxyuridine (BrdU) and either recombinant GDF11 or vehicle for five days and were assessed for recovery for one month following stroke. MRI was used to determine cerebrospinal fluid (CSF) volume, corpus callosum (CC) area, and brain atrophy at 30 days post-stroke. Immunohistochemistry was used to assess gliosis, neurogenesis, angiogenesis and synaptic density. Lower GDF11/8 levels were found with age in both mice and humans (p

In this study, antioxidant activities of HeukHarang a novel Korean Lectuca sativa L.extracts compair with Red skirt lettuce. The highest total polyphenol contents was 60% ethanol extracts of HeukHarang and total flavonoid contents was 40% ethanol extracts, 84.70 ± 0.11 mg TAE/10 g DW and 63.82 ± 0.09 mg QE/10 g DW, respectively. The highest FRAP activity and PMA were 60% and 80% ethanol extracts of heuharang, 1,876.3 ± 0.01 mM TEAC/10 g DW and 26.2 ± 0.0 mM AAEAC/10 g DW, respectively. Radical scavenging activity also HeukHarang ethanol extracts was higher than Red skirt lettuce. The highest ORAC value was 76.0 ± 0.43 mM TEAC/10 g DWthehd, 100% ethanol extracts of HeukHarang. As a result, the all antioxidant activities of Heuhalang ethanol extracts were higher than that of Red skirt lettuce as a control.

In this study, antioxidant activities of extracts of 12 Korean strawberry cultivars were evaluated and validation of an analytical method for ellagic acid, a marker compound, was carried out. Cultivar 'Josaenghongshim' had the highest total polyphenol and flavonoid contents. In addition, cultivar 'Josaenghongshim' had the highest value and cultivar 'Seolhyang' showing the highest activity. Ellagic acid contents of 'Suhong', 'Okme', and 'Dahong' cultivars were the highest ellagic acid content. Correlation coefficient of the calibration curve was 0.9999, showing very high linearity. The HPLC-DAD method for the quantitation of ellagic acid content showed high linearity at various concentration ranges, with a limit of detection of 2.35 μg/mL. The limit of quantification was 7.13 μg/mL. Relative standard deviations from intra- and inter-day precision were less than 5.13%. Recovery rates of ellagic acid at 10, 50, and 100 μg/mL, respectively, were 99.0-100.1% with RSD values less than 5.30%. These results provide viable information for the validation of antioxidant capacities of 12 cultivars of Korean strawberries.

This study aims at characterization of the anti-cancer active compounds separated from stems and branches of Sambucus williamsii var. coreana Nakai (Caprifoliaceae). Bioactivity-guided fractionation of ethanol extracts from the S. williamsii was isolated of three triterpenoid compounds. S. williamsii fractions showed superior growth inhibitory activity against three cancer cells (HCT116, A549 and MDA-MB231). Active fraction was isolated and analyzed and led to the identification of three active triterpenoid compounds using HPLC, NMR, and LC-MS spectrometer, their structures were established as betulinic acid (1), oleanolic acid (2) and ursolic acid (3). The results of this study performed with S. williamsii will be helpful to develop new and efficient anti-cancer agents. Also, this research was supported the previous separations and isolations studies on active ingredients of S. williamsii.

BACKGROUND AND PURPOSE: The validity of CT perfusion (CTP) predictions of expected infarction volume (“at risk” tissue) without rapid recanalization remains poorly characterized. METHODS: From the MR CLEAN trial, we included patients who underwent CTP without successful recanalization. “At risk” volume was defined as T max > 6 seconds and ischemic core as relative CBF < 30 (Olea Sphere). Coprimary outcomes were follow-up infarct volume (FIV) on CT at 1-5 days and 90-day mRS. Data are presented as median [IQR] or OR [95% CI] unless otherwise specified. RESULTS: Among 37 patients who met criteria, 14 (38%) were women, median age was 61 years [52-69], NIHSS was 19 [15-21], ASPECTS was 8 [7-9], and onset to imaging was 160 minutes [39-200]. Occlusion location was M1 for 22 (59%), ICA-T in 10 (27%), and M2 in 4 (11%). In univariable analysis, “at risk” volume correlated poorly with FIV (r =.06, P =.77). Among patients with predicted “at risk” volume < 100 mL, 36% had FIV > 200 mL. In adjusted linear regression, NIHSS but not “at risk” volume was associated with FIV (Coef 12, P =.045; Coef –.15, P =.8). In adjusted logistic regression, NIHSS but not “at risk” volume was associated with mRS 0-2 at 90 days (OR.7 [.5-.99]; OR 1.0 [.99-1.04]). CONCLUSION: Predictions of “at-risk” tissue using CTP may underestimate the natural history of infarction from acute large vessel occlusions. NIHSS may perform better as a predictor of clinical outcomes in patients without rapid recanalization.

Background: Recent clinical trials have established the efficacy of endovascular stroke therapy and intravenous thrombolysis using advanced imaging, particularly computed tomography perfusion (CTP). The availability and utilization of CTP for patients and hospitals that treat acute ischemic stroke (AIS), however, is uncertain. Methods: We performed a retrospective cross-sectional analysis using 2 complementary Medicare datasets, full sample Texas and 5% national fee-for-service data from 2014 to 2017. AIS cases were identified using International Classification of Diseases , Ninth Revision and International Classification of Diseases , Tenth Revision coding criteria. Imaging utilization performed in the initial evaluation of patients with AIS was derived using Current Procedural Terminology codes from professional claims. Primary outcomes were utilization of imaging in AIS cases and the change in utilization over time. Hospitals were defined as imaging modality–performing if they submitted at least 1 claim for that modality per calendar year. The National Medicare dataset was used to validate state-level findings, and a local hospital-level cohort was used to validate the claims-based approach. Results: Among 50 797 AIS cases in the Texas Medicare fee-for-service cohort, 64% were evaluated with noncontrast head CT, 17% with CT angiography, 3% with CTP, and 33% with magnetic resonance imaging. CTP utilization was greater in patients treated with endovascular stroke therapy (17%) and intravenous thrombolysis (9%). CT angiography (4%/y) and CTP (1%/y) utilization increased over the study period. These findings were validated in the National dataset. Among hospitals in the Texas cohort, 100% were noncontrast head CT–performing, 77% CT angiography–performing, and 14% CTP-performing in 2017. Most AIS cases (69%) were evaluated at non-CTP–performing hospitals. CTP-performing hospitals were clustered in urban areas, whereas large regions of the state lacked immediate access. Conclusions: In state-wide and national Medicare fee-for-service cohorts, CTP utilization in patients with AIS was low, and most patients were evaluated at non-CTP–performing hospitals. These findings support the need for alternative means of screening for AIS recanalization therapies.

Introduction: Evaluation of infarct core by advanced neuroimaging has facilitated patient selection for endovascular stroke therapy (EST), however the accuracy of machine-learning analysis compared to these modalities remains unexplored. We test the performance of computed tomography-Alberta Stroke Program Early Computed Tomography Score (CT- ASPECTS) vs. Computed Tomography Perfusion (CTP)-RAPID, vs. an extension of our novel machine-learning model, Deep Symmetry-sensitive Network (DeepSymNet [ref]), using the final infarct volume (FIV) in patients with rapid and successful endovascular reperfusion as the gold standard. Methods and Materials: We identified consecutive patients with large vessel occlusion acute ischemic stroke that underwent EST with TICI 2b/3 reperfusion. FIV was determined by volumetric measurements on 24-48h DWI MRI. The DeepSymNet algorithm combines symmetric and absolute brain representations and had been trained to predict CTP-RAPID core size from CTA source images acquired at presentation. Performance at predicting FIV was determined by Pearson’s correlation for CT- ASPECTS, CTP-RAPID, and DeepSymNet. Data are presented as median [IQR]. Results: Among the 76 patients that met inclusion criteria, 55.2% were male, the median age was 68 years [54-77], and 32.8% were White. 71% of the patients demonstrated an MCA occlusion, and 55% of all occlusions were left-sided. Median ASPECTS on presentation was 8 [7-8.5] and the median FIV was 10 mL [2-37]. ASPECTS, CTP-RAPID and DeepSymNet all correlated with FIV, with comparable performances from ASPECTS (R 2 =-0.398) and CTP-RAPID (R 2 =0.403) and superior performance by DeepSymNet (R 2 =-0.606)(Table). Conclusions: The DeepSymNet machine learning model analyzing CTA source images demonstrated superior performance to ASPECTS and CTP-RAPID in FIV prediction. These findings suggest machine learning models may provide improved predictions of infarct core and selection for EST.

BackgroundPrior studies on rupture risk of brain arteriovenous malformations (AVMs) in women undergoing pregnancy and delivery have reported conflicting findings, but also have not accounted for AVM morphology and heterogeneity. Here, we assess the association between pregnancy and the risk of intracranial hemorrhage (ICH) in women with AVMs using a cohort-crossover design in which each woman serves as her own control.MethodsWomen who underwent pregnancy and delivery were identified using DRG codes from the Healthcare Cost and Utilization Project State Inpatient Databases for California (2005–2011), Florida (2005–2014), and New York (2005–2014). The presence of AVM and ICH was determined using ICD 9 codes. Pregnancy was defined as the 40 weeks prior to delivery, and postpartum as 12 weeks after. We defined a non-exposure control period as a 52-week period prior to pregnancy. The relative risks of ICH during pregnancy were compared against the non-exposure period using conditional Poisson regression.ResultsAmong 4 022 811 women identified with an eligible delivery hospitalization (median age, 28 years; 7.3% with gestational diabetes; 4.5% with preeclampsia/eclampsia), 568 (0.014%) had an AVM. The rates of ICH during pregnancy and puerperium were 6355.4 (95% CI 4279.4 to 8431.5) and 14.4 (95% CI 13.3 to 15.6) per 100 000 person-years for women with and without AVM, respectively. In cohort-crossover analysis, in women with AVMs the risk of ICH increased 3.27-fold (RR, 95% CI 1.67 to 6.43) during pregnancy and puerperium compared with a non-pregnant period.ConclusionsAmong women with AVM, pregnancy and puerperium were associated with a greater than 3-fold risk of ICH.

Introduction: Growth differentiation factor (GDF) 11 levels decline with aging. This age-related loss of GDF11 has been implicated in a variety of age-related diseases. Supplementation with GDF11 reverses cardiac hypertrophy, bone loss, and pulmonary dysfunction in old mice, suggesting a rejuvenation effect of GDF11. Hypothesis: Brain levels of GDF11 would decline in aged animals, and that stroke would accelerate the age-related loss of GDF11. Exogenous administration of GDF11 would improve stroke outcomes in old mice. Methods: GDF11/8 levels were assessed in young and old mice and in postmortem human brain samples. In older mice, five days after MCAO, GDF11, and BrdU were administered for five days. Neurobehavioral assessments were performed during stroke recovery. MRI was used to determine cerebrospinal fluid (CSF), corpus callosum (CC) area, and percentage of brain tissue loss. Ten days post MCAo, brain expression of claudin5, collagen IV, BDNF, VEGF, pSmad2/3, activin type IIb receptor was assessed by western blotting. We performed immunohistochemistry to investigate IBA1, GFAP, NeuN, doublecortin, BDNF, MBP, synaptophysin, and CD31 immunoreactivity 30 days post-MCAo. Results: A decline in brain GDF11/8 was seen with age and after stroke in both mice and humans (p Conclusions: Brain GDF11/8 levels are reduced with aging, and after stroke. Exogenous GDF11 supplementation reduced mortality, decreased brain tissue damage, improved sensorimotor deficits, reduced gliosis, and increased angiogenesis in old mice after stroke.

Background: In the US, one third of strokes occur among younger adults (< 65 years). While stroke incidence among elderly has declined, trends in younger adults by age, sex and region are unknown. We report recent trends in stroke incidence among commercially-insured young adults aged 20 - 64. Methods: Stroke incidence was estimated using 2011 - 2017 IBM MarketScan® Commercial Database stratified by age (20 - 34, 35 - 44, 45 - 54, 55 - 64), sex, and US Census region and was extrapolated to the US population using census data. Stroke cases were identified based on a primary diagnosis of either ischemic stroke (IS) or intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) using validated ICD-9 / 10 codes. We report incidence rates (IR) per 100,000 person-years, 95% confidence intervals and proportional change in IR between 2011 and 2017. Results: We identified 115,276 stroke admissions resulting in 172 million person-years. The overall stroke IR increased by 7% from 60.0 to 64.2 per 100,000 person-years between 2011 and 2017. The increase was greater among males as compared to females (9.8% vs 3.3%) and across both sexes the largest increase was observed for age category of 35 - 44 years (Table 1). Age-specific IR increased in all age categories except 20 - 34. Across US regions, the South showed the highest IR increase (10.0%) (Figure 1). IR for IS and ICH increased while a decrease in SAH IR was observed. The IR for IS was higher for males vs females (12.7% vs 5.4%), whereas it was higher for females vs males for ICH (14.5% vs 3.6%). Conclusions: Our analyses indicate an overall increase in stroke incidence for commercially-insured younger adults during a contemporary time period. Males between the ages of 35 - 44 have experienced the greatest increase in stroke incidence. Furthermore, the Southern US continues to experience highest increases in stroke incidence and there are gender differences in IR for stroke subtypes. Targeted strategies for stroke prevention may be warranted.

Introduction: Prior studies suggest that patients with large vessel occlusion (LVO) who undergo endovascular stroke therapy (EST) after inter-hospital transfer (IHT) have worse outcomes than those who present directly to EST centers. However, these studies were largely derived from clinical trials or registries and may not be representative of real-world clinical practice. Methods: We performed a multicenter, observational cohort study on acute ischemic stroke (AIS) patients with LVO that presented to EST-capable centers directly (LVO-D) or after IHT (LVO-T) between 1/1/2018 to 2/1/2019. The study included 11 hospitals in the Houston area, of which 4 are EST-capable. Clinical data were collected using our cerebrovascular data registry. All transfers were from non-EST capable hospitals to EST-capable hospitals. Logistic regression adjusted for age, NIHSS, occlusion location and direct vs transfer arrival was used to assess the likelihood of good outcome, defined as discharge to home or rehabilitation. Results are given as median [IQR] and OR [95% CI]. Results: Among 4,313 patients with AIS, 772 (18%) patients had LVO. Among LVO patients, median age was 68 [59-79], 47% were female, 51% were white, 378 (49%) were LVO-D and 394 (51%) were LVO-T. Median IHT time was 152 min [114-198]. LVO-D patients arrived at EST-treating hospitals with superior ASPECTS compared to LVO-T (9 [7-10] vs 7 [6-9], p Conclusion: In this real-world cohort of a multi-center stroke network, IHT was not associated with worse outcomes for patients with LVO, for both patients who did receive EST and those that did not.

Introduction: Estimation of infarct core (IC) is a critical component in the evaluation of patients with large vessel occlusion (LVO) for endovascular stroke therapy (EST), but the optimal method to determine IC is uncertain. Methods: From our prospectively maintained institutional registry, we identified acute ischemic stroke (AIS) patients with LVO between 1/2018 and 2/2019. Patients were included if they underwent consecutively and technically adequate non-contrast CT, CT angiography (CTA), and CT Perfusion (CTP). ASPECTS was assessed by an experienced neuroradiologist. CTP IC was determined using RAPID. Final infarct volume (FIV) was determined by manual volume segmentation on DWI sequences from 24h MRI, but this analysis was limited to patients who underwent EST with TICI 2b/3 reperfusion within 120 minutes of presentation CT imaging, to minimize IC growth affecting the results. Correlation between IC measurements was calculated using Spearman p. Results are provided as median [IQR]. Results: Among 772 patients with LVO, 199 patients met inclusion criteria. Median age was 69 [59-79], 47% were female and 57% were white. Median NIHSS was 15 [9-21], the most common occlusion site was M1 MCA (55%). Median CT ASPECTS was 7 [6-9], median CTA ASPECTS was 6 [5-7], and median CTP-RAPID IC volume was 11 [0-47]. Presentation CT ASPECTS correlated with CTP-RAPID IC (Fig. 1A, r=-0.57; p Conclusions: In patients with LVO in the anterior circulation, CTA ASPECTS correlated well with CTP-RAPID IC in the early and late time windows, and was more reflective of 24h MRI findings in patients who received EST.

Introduction: Recent randomized clinical trials have demonstrated benefit for treatment with endovascular stroke therapy (EST) and thrombolysis (IV-tPA) in late presenting acute ischemic stroke (AIS) patients using CT perfusion (CTP). The real-world utilization and availability of this advanced imaging modality is unknown. Methods: We identified all inpatient hospitalizations with a primary diagnosis of AIS using ICD-9/10 codes in Texas Medicare claims (2014-2017) and 5% national Medicare sample (2014-2017) and evaluated imaging utilization given at the Emergency Department (ED) prior to admission. Imaging and treatments were identified using CPT and procedure codes. Primary endpoint was ED-based imaging utilization. EST and CTP-capable hospitals were defined as those performing at least one EST or CTP within that calendar year. Results: In the Texas cohort, among 50,797 admissions for AIS, 54% were female, median age was 77 [IQR 69-84], and 78% were white. 2% received EST and 9% received IV-tPA. 76% of AIS patients and 80% of those with EST received ED-based neuro-imaging at the treating hospital (Fig. 1). 58% of all AIS patients were evaluated in EST-capable hospitals. 75% of all AIS patients, 54 % of those with EST, and 70% of those with IV-tPA were evaluated at non-CTP-capable hospitals. 9% of IV-tPA and 17% of EST-treated patients underwent CTP; rates of MRI were greater (Fig. 1). These findings were maintained in the nationwide sample. Among 37,507 admissions for AIS, CTA was performed in 17%, MRI in 30%, and CTP in 3%. Among the 3% of AIS patients treated with EST, CTA was performed in 65%, MRI in 66%, and CTP in 14%. Conclusion: In this population-based cohort, three out of four AIS admissions and half of EST procedures were at non-CTP performing hospitals. The limited availability and utilization of CTP suggest that an alternative imaging paradigm (e.g. MRI) may be beneficial in delayed time-window EST and thrombolysis.

Introduction: CT Perfusion (CTP) is frequently used to evaluate patients with large vessel occlusion (LVO) acute ischemic stroke (AIS) for possible endovascular stroke therapy (EST). However, the accuracy of its infarct core and penumbral predictions are uncertain, and as such, may rule out patients who would otherwise have received EST without CTP-based selection. Methods: From our prospectively maintained multicenter registry, we identified AIS patients between January 2018 and February 2019. Data were collected from 4 comprehensive stroke centers - one center often performs CTP on nearly all AIS evaluations (CTP-H) and 3 centers perform CTP for uncertain findings on non-contrast CT (CTP-L). All 4 CSCs are covered by a single group of Vascular Neurologists and NeuroInterventionists with standardization of quality practices. Logistic regression adjusted for age, NIHSS, CT ASPECTS as ordinal variables, time of presentation (0-6 hrs. vs 6-24 hrs.), and occlusion location was used to assess the likelihood of undergoing EST. Results are provided as median [IQR] and OR [95% CI]. Results: Among 2,317 patients with AIS, median age was 67 [57-78], 48% were female and 48% were white. The CTP rates at the 3 CTP-L centers were 18%, 31%, and 36%, while CTP rate at CTP-H center was 74% among all AIS patients (p0.05) and proportion of ICA/MCA occlusions (72% vs 77%; p>0.05), were comparable among centers, but LVO patients presenting at CTP-L centers had a lower NIHSS (11[4-18] vs 14[7-20]; p Conclusion: In this study of 4 CSCs staffed by the same group of physicians, routine utilization of CTP in EST patient selection was associated with reduced likelihood of EST in patients with LVO.

Introduction: Automated neuroimaging analysis is being used increasingly in the acute ischemic stroke (AIS) evaluation. However, current algorithms do not factor in an assessment of intracranial hemorrhage (ICH) in the workflow. In this study we present a machine learning (ML) algorithm that uses brain symmetry information to detect ICH. Methods: We prospectively collected non-contrast CT (NCCT) images on patients that presented to the Emergency Department for AIS evaluation between 2017 and 2019. Patients were included if they underwent technically adequate NCCT imaging. Diagnoses of ICH, AIS and non-stroke were confirmed by experienced neuroradiologists as well as review of the clinical record. A ML algorithm which integrates symmetry features as well as standard features for the whole brain was trained on 80% of the sample and validated on the remaining images. Training was performed without any prior segmentation. Evaluation of the model performance was conducted using receiver-operator curve and area under the curve (AUC) analysis. Results are given as median [IQR] and [AUC 95% CI]. Results: Among the 568 patients that met inclusion criteria, median age was 65 [55-76], 47% were female and 34% were white. 128 (23%) patients were determined to have ICH and 440 as non-ICH (70% AIS and 30% non-stroke). Among ICH patients, 108 (84%) had a supratentorial ICH. When analyzing the regions of the CT images that most strongly contributed to the algorithm’s diagnostic decisions, they corresponded with the regions of ICH (Fig. 1A). On the external validation data set, the algorithm successfully detected ICH (Fig. 1B) with high accuracy (AUC 0.99 [0.97-1.00]). Conclusion: We have developed a symmetry-sensitive ML method that can with very high fidelity identify ICH in an automated fashion. Without prior training, the algorithm autonomously was able to learn ICH location. These results may help contribute to an automated imaging workflow for all stroke evaluations, not just AIS.

Introduction: Activated T lymphocytes are present in the brain and play a detrimental role in aging and potentiate inflammation after ischemic injury. Previous studies have shown that T lymphocytes (T cells) synthesize and secrete catecholamines that modulate their activation. Tyrosine hydroxylase (TH), is a rate-limiting enzyme in catecholamine synthesis. Little is known about the role and contribution of TH synthesis specifically in T lymphocytes in aging and ischemic stroke injury. We hypothesized that aging will lead to increase TH + T cells in the brain that will have an activated phenotype and contribute to the progression of ischemic injury. Methods: Young (8-12 weeks) and old (22-24 months) C57BL/6 male mice were used. Spleen, bone marrow and brain were harvested and flow cytometry was used to immunophenotype the TH + T cells. Expression of TH on sorted CD4 + and CD8 + T cells was assessed by a real-time polymerase chain reaction. Splenic lymphocytes were stimulated with PMA/ionomycin and different T cell subsets were analyzed. The CD4 + T cells were purified from young and old mouse spleens and ex vivo stimulated to measure cytokine production. Finally, young and old mice underwent 60 minutes of middle cerebral artery occlusion (MCAo) and were euthanized 4 days later to determine the role of TH + T lymphocytes in stroke injury. Results: The percentage and MFI of TH was increased on CD4 + T cells with aging however, no change in TH percentage or MFI on CD8 + T cells was observed. TH RNA was increased in CD4 + T cells derived from old animals. The TH + CD4 + T cells were activated and had an effector memory phenotype in aging. On acute stimulation, old TH + CD4 + T cells increased the production of INF-γ, IL-4, and Il-17. After MCAo the percentage TH + CD4 + T cells increased in both young and old mice in the brain. The MFI IL-4/INF-γ ratio was higher in the young MCAo versus old MCAo reflecting a Th2 related response. Conclusion: TH + CD4 + T cells increase with age. These cells have an activated and effector memory phenotype and secrete inflammatory cytokines on acute stimulation. After MCAo, TH + CD4 + T cells demonstrated Th2 related protective responses in only in young mice.

In this study, psychoacoustic experiments are performed with sound stimuli simulating children running in order to investigate the psychoacoustic effect of the duration, number of impacts, and level variation of the impact sound. For the sound stimuli, the jumping sound of an eight-year-old child is recorded in a test building similar to a real apartment building. Using the recorded single impact sound (SIS), eight different multi-impact sources are produced, which simulate the sound of children running by varying the duration, number of impacts, and level variation. Additionally, a single-impact source with different A-weighted maximum sound pressure levels (57, 62, 67, 72, 77 dB in LiA,Fmax) and multi-impact source (57 dB in LiA,Fmax) are randomly paired. In the psychoacoustic experiment, subjects are asked to select the more annoying sound stimulus by comparing the multi-impact source and single-impact source. From the experiment, we note that for longer duration and larger number of repetitions of the impact sound, the sound is perceived as more annoying by the subjects. In the case of the level variation of the impact sound, the annoyance is determined by the total energy level rather than the maximum sound pressure level. These results revealed that findings in the previous studies using artificial noise or tone can be applied to impact sound generated in a real situation. This study suggests that rather than maximum level, evaluation indices that can reflect the duration and energy level of the impact sound are appropriate for impact sounds which exhibit random temporal patterns.

This study examines how Nongshim, a Korean instant noodle manufacturer, has expanded its operation globally within the concept of “open innovation” through its glocalization strategy, and how this strategy differs from the existing glocalization method enforced by global companies. The study shows how Nongshim used its unique glocalization strategy of “globalized localization”, outlining the three stages by which the company switched its “glocalization focus”, starting with “localizing”, moving through “globalizing”, then back to “localizing”, while retaining its ultimate purpose of globalization. From the basis of the case analysis, the study proposes a “pendulum theory” that can be applied to local companies that are planning to expand their business in a global market.

Background and Purpose— The availability of and expertise to interpret advanced neuroimaging recommended in the guideline-based endovascular stroke therapy (EST) evaluation are limited. Here, we develop and validate an automated machine learning-based method that evaluates for large vessel occlusion (LVO) and ischemic core volume in patients using a widely available modality, computed tomography angiogram (CTA). Methods— From our prospectively maintained stroke registry and electronic medical record, we identified patients with acute ischemic stroke and stroke mimics with contemporaneous CTA and computed tomography perfusion (CTP) with RAPID (IschemaView) post-processing as a part of the emergent stroke workup. A novel convolutional neural network named DeepSymNet was created and trained to identify LVO as well as infarct core from CTA source images, against CTP-RAPID definitions. Model performance was measured using 10-fold cross validation and receiver-operative curve area under the curve (AUC) statistics. Results— Among the 297 included patients, 224 (75%) had acute ischemic stroke of which 179 (60%) had LVO. Mean CTP-RAPID ischemic core volume was 23±42 mL. LVO locations included internal carotid artery (13%), M1 (44%), and M2 (21%). The DeepSymNet algorithm autonomously learned to identify the intracerebral vasculature on CTA and detected LVO with AUC 0.88. The method was also able to determine infarct core as defined by CTP-RAPID from the CTA source images with AUC 0.88 and 0.90 (ischemic core ≤30 mL and ≤50 mL). These findings were maintained in patients presenting in early (0–6 hours) and late (6–24 hours) time windows (AUCs 0.90 and 0.91, ischemic core ≤50 mL). DeepSymNet probabilities from CTA images corresponded with CTP-RAPID ischemic core volumes as a continuous variable with r =0.7 (Pearson correlation, P Conclusions— These results demonstrate that the information needed to perform the neuroimaging evaluation for endovascular therapy with comparable accuracy to advanced imaging modalities may be present in CTA, and the ability of machine learning to automate the analysis.

Introduction With the success of endovascular stroke therapy (EST), eligible acute ischemic stroke (AIS) patients must be appropriately screened. CT Perfusion (CTP) was the predominant imaging technique used to identify candidates in the recent trials of EST. However, the real-world utilization and availability of CTP is unknown. Methods Patients with AIS were identified by validated diagnosis codes from data on all discharges from hospitals and Emergency Departments (EDs) in Florida (FL, 2012 – 2016) and New York (NY, 2012–2014). The primary endpoint was ED imaging utilization, defined by the corresponding billing codes. CTP or EST-capable hospitals were defined as those performing at least one CTP or EST in the corresponding calendar year. Trends over time and by region were compared. Results In the FL cohort, among 226,051 admissions for stroke at 285 hospitals, median age was 72 [IQR 61–82] and 113,489 (50%) were female. 14,920 (7%) received IV tPA and 3,026 (1.3%) received EST. Nearly all strokes were treated at CTA and MRI-capable EDs, but 139,316 (62%) were treated at non-CTP-capable hospitals (figure 1). 28 (60%) of EST-capable hospitals were not CTP-capable, a trend that did not change over the study period (figure 2). In the NY cohort, among 91,193 admissions for stroke at 225 hospitals, 71,333 (78%) were evaluated at non-CTP-capable centers. 30 (13%) of hospitals treating AIS patients were CTP-capable. CTP-capable centers were concentrated in urban areas, with significant annual stroke rates in non-urban areas without CTP. Conclusions In this large cohort study, the majority of AIS patients and EDs treating AIS did not have access to CTP, a finding that did not immediately increase following 2015 trials. Use of CTP as a universal screening tool for EST may still be limited. Non-contrast CT remains the most important screening tool for EST in AIS patients under 6 hours from symptom onset. Disclosures A. Czap: None. S. Lee: None. V. Lopez-Rivera: None. J. Grotta: None. P. Chen: None. S. Blackburn: None. L. Giancardo: None. S. Savitz: None. L. McCullough: None. A. Bambhroliya: None. F. Vahidy: None. S. Sheth: None.

Acute Ischemic Stroke (AIS) is the second leading cause of death worldwide in 2015, and 5th in the United States. Neuro-imaging is routinely used in the diagnosis and management of these patients. To create a decision support method for AIS, we propose a convolutional neural network for automated detection of ischemic stroke from CT Angiography (CTA), an imaging technique that is widely available and used routinely in stroke evaluations. The network has a novel design that makes it sensitive to changes in symmetry of vascular and brain tissue texture which allows it to detect ischemic stroke from CTA brain images. The proposed model is inspired from the paradigm of Siamese networks and applied to the two brain hemispheres in parallel. We tested the model on a clinical dataset of 217 subjects, 123 controls and 94 subjects imaged less than 24 hours after stroke onset. First, we tested the ability of the network in recognizing strokes with the original images, which contain asymmetries in both vascular structures and brain tissues. Then, we digitally removed the vasculature in order to evaluate the ability of the network to recognize strokes by analyzing brain tissue only. We achieved AUC 0.914 (CI 0.88-0.95) and AUC 0.899 (CI 0.86-0.94) on the two experiments respectively. The qualitative analysis of the network activation confirms that the model efficiently learns the vasculature and brain tissue structures in one hemisphere that does not appear in the opposite hemisphere.

Background: Guideline-based acute ischemic stroke (AIS) evaluations require the use of advanced parenchymal imaging including CT perfusion (CTP) to determine the presence of large vessel occlusion (LVOs) and infarct core. The availability of CTP in all hospitals that receive patients with possible AIS is limited. An accurate method to evaluate possible AIS patients that does not require CTP is urgently needed. Methods: Consecutive patients from 3/2018 - 5/2018 evaluated emergently for possible AIS within 24 hours of onset at our institution were identified. Patients were included if they underwent contemporaneous non-contrast CT, CT angiogram (CTA) and CT Perfusion (CTP) with RAPID (IschemaView) post-processing. A linear Support Vector Machine (SVM) was created using CTA data alone and trained against the CTP-RAPID infarct core volume determinations, which was used as the “gold standard.” Performance parameters were calculated using 10-fold cross-validation. Results: Among 139 subjects, median age was 64 [54-73], 48% were female, 40% were white and 34% were African-American. From this population, 16 subjects (12%) were ultimately diagnosed with AIS. Median time from onset to imaging was 3.9 hours [1.7-10.1], NIHSS 16.5 [8-24], and RAPID infarct core and “at risk” volumes were 35.5 mL [13-72] and 128.5 mL [80-165]. The CTA-based SVM classified AIS versus stroke mimic with excellent discrimination (AUC 0.95 ± 0.08) and accuracy of 89% ± 3%. In patients with AIS, CTA-based SVM estimation of infarct core correlated well with the CTP-RAPID (Spearman's rho 0.82 (pFigure ). Conclusion: Our machine learning algorithm was able to accurately discriminate AIS versus stroke-mimic, and reproduce CTP-based infarct core measurements from CTA imaging alone. A complete AIS neuroimaging evaluation, for LVO as well as infarct core, may be obtainable from CTA, an imaging modality with much broader availability than CTP.

Supplemental material, Supplemental Material2 for 14th International Symposium on Thrombolysis, Thrombectomy and Acute Stroke Therapy: Proceedings and summary of discussions by Sunil A Sheth, Victor Lopez-Rivera, Songmi Lee, Sean I Savitz, David S Liebeskind, James C Grotta and for the Thrombolysis, Thrombectomy and Acute Stroke Therapy (TTST) group: on behalf of the Swiss IBD Cohort Study Group in International Journal of Stroke

Background and Purpose— We determined the effect of sex on outcome after endovascular stroke thrombectomy in acute ischemic stroke, including lifelong disability outcomes. Methods— We analyzed patients treated with the Solitaire stent retriever in the combined SWIFT (Solitaire FR With the Intention for Thrombectomy), STAR (Solitaire FR Thrombectomy for Acute Revascularization), and SWIFT PRIME (Solitaire FR With the Intention for Thrombectomy as Primary Endovascular Treatment) cohorts. Ordinal and logistic regression were used to examine known factors influencing outcome after endovascular stroke thrombectomy and study the effect of sex on the association between these factors and outcomes, including age and time to reperfusion. Years of optimal life after thrombectomy were defined as disability-adjusted life years and calculated by projecting disability through adjusted poststroke life expectancy by sex. Results— Among 389 patients treated with endovascular stroke thrombectomy, 55% were females, and median National Institutes of Health Stroke Scale was 17 (interquartile range, 8–28). There were no differences between females versus males in presenting deficit severity (National Institutes of Health Stroke Scale score, 17 versus 17, P =0.21), occlusion location (69% versus 64% M1, P =0.62), presenting infarct extent (Alberta Stroke Program Early CT Score 8 versus 8, P =0.24), rate of substantial reperfusion (Thrombolysis in Cerebral Infarction 2b/3, 87% versus 83%, P =0.37), onset to reperfusion time (294 versus 302 minutes, P =0.46). Despite older ages (69 versus 64, P P =0.002) for females compared with males, adjusted rates of functional independence at 90 days were similar (odds ratio, 1.0; 95% CI, 0.6–1.6). After adjusting for age at presentation and stroke severity, females had more years of optimal life (disability-adjusted life year) after endovascular stroke thrombectomy, 10.6 versus 8.5 years ( P Conclusions— Despite greater age and higher rate of atrial fibrillation, females experienced comparable functional outcomes and greater years of optimal life after intervention compared with males.

Background: Cell-based therapies such as mesenchymal stromal cells (MSCs) have increasingly shown great promise for ischemic stroke recovery. An understudied target of MSCs may be endothelial cells (ECs). Our study explored the interactions between MSCs and ECs and how this interaction alters EC functionality when exposed to an inflammatory cell stimulus. Methods: Primary brain ECs were isolated from postnatal 1-4 day old C57BL/6 mice. Primary MSCs were isolated from the bone marrow of C57BL/6 mice. At passage 3, both the primary cells were individually seeded at 50,000 cells per well. To simulate a stroke-like inflammatory environment, we exposed MSCs and ECs to Lipopolysaccharides (LPS) (doses ranging from 0.01ug/ml to 100ug/ml). 24 hours post-LPS exposure, conditioned media from MSCs was collected and added to the treated ECs. At 24 hours of incubation, media was collected from the ECs and IL-6 and VEGF concentrations were measured using ELISA. Viability of ECs following LPS exposure was measured using MTT assay. Results: Treatment of the ECs using MSC conditioned media significantly reduced the release of IL-6, a pro-inflammatory cytokine at dose ranges of 1ug/ml to 100ug/ml of LPS (Fig. 1A-B). The release of VEGF, a pro-angiogenic cytokine, was significantly increased (Fig. 1C-D). There was no significant change in viability of ECs following different LPS doses (data not shown). Conclusion: MSCs may release soluble factors that modulate the responses of endothelial cells. MSCs exert anti-inflammatory and pro-angiogeneic effects on ECs in a pro-inflammatory setting. These results identify new targets to better understand how MSCs improve recovery in stroke animal models.

Background: Rapid identification and transport of patients with large vessel occlusions (LVO) to endovascular-capable hospitals has become increasingly important. We previously demonstrated that brain-specific sphingolipids (SLs) serve as useful plasma markers of brain injury. Here, we test and validate SL biomarkers to differentiate LVO from non-LVO acute ischemic stroke (AIS) and stroke mimics. Methods: We enrolled consecutive patients with symptoms concerning for AIS and performed SL profiling using HPLC-MS/MS on blood samples obtained at hospital arrival. MS data were aligned and automated peak picking was performed using XCMS, and SLs were identified by exact mass. A classification method using SL plasma concentrations was created using step-wise logistic regression in a derivation arm, and then tested in an independent validation arm. Results: Among 184 patients with AIS or AIS-mimics, 84 (46%) were female and age was 73 years (IQR 63-84). 81 (44%) were diagnosed with AIS, 32 (17%) with TIA, and 71 (39%) as stroke mimics. Median time from last known well to blood collection was 124 minutes (IQR 65-275) and Los Angeles Motor Scale was 1 (IQR 0-2). Among patients with AIS, median NIHSS was 3 (IQR 2-8) and 33 (41%) had LVO on CTA or MRA. Among 24 SLs definitively identified, 3 (12.5%) were ceramides, 3 (12.5%) were sphingosines, and 18 (75%) were sphingomyelins. Using step-wise regression, a panel of 8 SLs differentiated LVO from non-LVO AIS or stroke mimic with very good accuracy (AUC 0.76 in derivation; 0.72 in validation), comparable to LAMS alone (AUC 0.73). Combining the SL panel with LAMS resulted in superior discrimination (AUC 0.84 in derivation; 0.79 in validation and Figure). Conclusions: Plasma levels of SLs accurately differentiate LVO from non-LVO AIS and stroke mimics at early time points. A point-of-care SL assay in the field may help triage LVO patients to appropriate centers.

The purpose of this study is to investigate relationships among career identity, satisfaction in major, andadjustment to college life for students who major in food and nutrition that is complex and has diversity of carrier and to serve as a guideline for career counselling and college life. After reliability and validity of the data collected were verified using IBM SPSS Statistics 22, difference in variables according to characteristics of students was examined using independent t-test, ANOVA, and chi-square test. The results showed that there was a positive correlation among career identity, satisfaction in major, and adjustment to college life and students who had prior knowledge of their major showed a higher level of career identity, satisfaction in major and adjustment to college life compared to those who did not. Therefore, it is suggested that guidance on Department of Food and Nutritionshould be provided to students before they decide on their major for their increased satisfaction in major, smooth adjustment to college life, and career decision. With this data, we recognize the gravity of psychological factor and carrer consciousness may provide base data to practical use of student life and carrer guidance.

To screen chaperone proteins from Schizosaccharomyce pombe (S. pombe), we prepared recombinant citrate synthase of the fission yeast as a substrate of anti-aggregation assay. Purified recombinant citrate synthase showed citrate synthase activity and was suitable for the substrate of chaperone assay. Several heat stable proteins including aspartyl aminopeptidase (AAP) for candidates of chaperone were screened from the supernatant fraction of heat-treated crude extract of S. pombe. The purified AAP migrated as a single band of 47 kDa on SDS-polyacrylamide gel electrophoresis. The native size of AAP was estimated as 200 kDa by a HPLC gel permeation chromatography. This enzyme can remove the aspartyl residue at N-terminus of angiotensin I. In addition, AAP showed the heat stability and protected the aggregation of citrate synthase caused by thermal denaturation. This study showed that S. pombe AAP is a moonlight protein that has aspartyl aminopeptidase and chaperone activities.