Faculty Bibliography

During the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization recommended measures to mitigate the outbreak such as social distancing and confinement. Since these measures have been put in place, anecdotal reports describe a decrease in the number of endovascular therapy (EVT) treatments for acute ischemic stroke due to large vessel occlusion. The purpose of our study was to determine the effect on EVT for patients with acute ischemic stroke during the COVID-19 confinement. In this retrospective, observational study, data were collected from November 1, 2019, to April 15, 2020, at 17 stroke centers in countries where confinement measures have been in place since March 2020 for the COVID-19 pandemic (Switzerland, Italy, France, Spain, Portugal, Germany, Canada, and United States). This study included 1600 patients treated by EVT for acute ischemic stroke. Date of EVT and symptom onset-to-groin puncture time were collected. Mean number of EVTs performed per hospital per 2-week interval and mean stroke onset-to-groin puncture time were calculated before confinement measures and after confinement measures. Distributions (non-normal) between the 2 groups (before COVID-19 confinement versus after COVID-19 confinement) were compared using 2-sample Wilcoxon rank-sum test. The results show a significant decrease in mean number of EVTs performed per hospital per 2-week interval between before COVID-19 confinement (9.0 [95% CI, 7.8-10.1]) and after COVID-19 confinement (6.1 [95% CI, 4.5-7.7]), (P<0.001). In addition, there is a significant increase in mean stroke onset-to-groin puncture time (P<0.001), between before COVID-19 confinement (300.3 minutes [95% CI, 285.3-315.4]) and after COVID-19 confinement (354.5 minutes [95% CI, 316.2-392.7]). Our preliminary analysis indicates a 32% reduction in EVT procedures and an estimated 54-minute increase in symptom onset-to-groin puncture time after confinement measures for COVID-19 pandemic were put into place.

Background and aims: Machine learning (ML) may facilitate interpretation of histologic changes associated with treatment of chronic hepatitis B virus (HBV) infection. We developed ML models that identify and quantify histologic features in a clinical study of HBV patients receiving antiviral therapy.
Method(s): ML models were developed using H&E histology images from 330 patients enrolled in registrational studies for tenofovir disoproxil fumarate for HBV (GS-US-174-0102, GS-US-174-0103). Histological improvement and regression of cirrhosis were assessed by a central pathologist at baseline (BL) and weeks 48 and 240 according to the Ishak/Knodell necroinflammatory scoring and Ishak fibrosis staging systems. Images were split into training (N = 1090) and testing sets (N = 1061). Models were trained using the PathAI research platform (Boston, MA) to identify inflamed regions and immune cells (lymphocytes and plasma cells) using annotations from 40 board-certified pathologists. Additional annotations of steatosis and ballooning from previous models were included in training. Slide-level, quantitative ML features were computed and correlated with pathologist scores to assess accuracy. Regression analysis was performed to determine associations of ML features at BL and changes from BL with cirrhosis regression at week 240. Results were generated using the testing image set.
Result(s): ML % area of portal inflammation correlated strongly with Ishak portal inflammation scores (rho = 0.643; p < 0.001) and ML % area of interface inflammation correlated strongly with Ishak periportal necrosis scores (rho = 0.716; p < 0.001). Of the 48 patients in the testing set with cirrhosis at BL, 36 patients (75%) no longer had cirrhosis at week 240. Lower ML % area of steatosis (Figure) and greater ML % area of lobular inflammation at BL were predictive of cirrhosis regression (p = 0.006, p = 0.047, respectively), indicating the presence of underlying fatty liver in those who do not resolve cirrhosis. Change from baseline in ML % area of portal and lobular inflammation as well as change in lymphocyte density correlated with regression of cirrhosis at week 240 (p = 0.010, p = 0.026, p = 0.031 respectively). [Figure presented]
Conclusion(s): An ML approach accurately classified histopathologic features in H&E images from HBV clinical trial biopsies. ML features at BL and changes in ML features with treatment were significant associated with cirrhosis regression. An ML approach for evaluating liver histology in patients with HBV can provide mechanistic insight into both HBV disease pathogenesis and cirrhosis regression.
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INTRODUCTION/BACKGROUND:The prognostic role of racial and socioeconomic factors in patients with glioblastoma is controversially debated. We aimed to evaluate how these factors may affect survival outcomes in an overall and cause-specific manner using large, national cancer registry cohort data in the temozolomide chemoradiation era. METHODS:The National Cancer Institute's Surveillance, Epidemiology, and End Results database was queried for patients diagnosed with glioblastoma between 2005 and 2016. Overall survival was assessed using Cox proportional hazard models using disease intrinsic and extrinsic factors. Cause-specific mortality was assessed using cumulative incidence curves and modeled using multivariate cumulative risk regression. RESULTS:A total of 28,952 patients met the prespecified inclusion criteria and were included in this analysis. The following factors were associated with all-cause mortality: age, calendar year of diagnosis, sex, treatment receipt, tumor size, tumor location, extent of resection, median household income, and race. Asian/Pacific Islanders and Hispanic Whites had lower mortality compared to Non-Hispanic Whites. Cause-specific mortality was associated with both racial and socioeconomic groups. After adjusting for treatment and tumor-related factors, Asian/Pacific and black patients had lower glioblastoma-specific mortality. However, lower median household income and black race were associated with significantly higher non-glioblastoma mortality. CONCLUSIONS:Despite the aggressive nature of glioblastoma, racial and socioeconomic factors influence glioblastoma-specific and non-glioblastoma associated mortality. Our study shows that patient race has an impact on glioblastoma-associated mortality independently of tumor and treatment related factors. Importantly, socioeconomic and racial differences largely contribute to non-glioblastoma mortality, including death from other cancers, cardio- and cerebrovascular events.

Alzheimer's disease (AD) is a neurodegenerative brain disorder associated with relentlessly progressive cognitive impairment and memory loss. AD pathology proceeds for decades before cognitive deficits become clinically apparent, opening a window for preventative therapy. Imbalance of clearance and buildup of amyloid β and phosphorylated tau proteins in the central nervous system is believed to contribute to AD pathogenesis. However, multiple clinical trials of treatments aimed at averting accumulation of these proteins have yielded little success, and there is still no disease-modifying intervention. Here, we discuss current knowledge of AD pathology and treatment with an emphasis on emerging biomarkers and treatment strategies.

BACKGROUND AND PURPOSE/OBJECTIVE:Patients with the Coronavirus Disease of 2019 (COVID-19) are at increased risk for thrombotic events and mortality. Various anticoagulation regimens are now being considered for these patients. Anticoagulation is known to increase the risk for adverse bleeding events, of which intracranial hemorrhage (ICH) is one of the most feared. We present a retrospective study of 33 patients positive for COVID-19 with neuroimaging-documented ICH and examine anticoagulation use in this population. METHODS:Patients over the age of 18 with confirmed COVID-19 and radiographic evidence of ICH were included in this study. Evidence of hemorrhage was confirmed and categorized by a fellowship trained neuroradiologist. Electronic health records were analyzed for patient information including demographic data, medical history, hospital course, laboratory values, and medications. RESULTS:We identified 33 COVID-19 positive patients with ICH, mean age 61.6 years (range 37-83 years), 21.2% of whom were female. Parenchymal hemorrhages with mass effect and herniation occurred in 5 (15.2%) patients, with a 100% mortality rate. Of the remaining 28 patients with ICH, 7 (25%) had punctate hemorrhages, 17 (60.7%) had small- moderate size hemorrhages, and 4 (14.3%) had a large single site of hemorrhage without evidence of herniation. Almost all patients received either therapeutic dose anticoagulation (in 22 [66.7%] patients) or prophylactic dose (in 3 [9.1] patients) prior to ICH discovery. CONCLUSIONS:Anticoagulation therapy may be considered in patients with COVID-19 though the risk of ICH should be taken into account when developing a treatment regimen.

OBJECTIVE:The purpose of this study was to describe the development and validation of a personal growth scale in caregiving partners of persons with multiple sclerosis (MS). METHOD/METHODS:= 315), and the instrument's psychometric properties were assessed. RESULTS:Study 2 sample was suitable for principal component analysis (PCA), and PCA was performed with oblique rotation. A 6-component solution was deemed most parsimonious and interpretable. Subscales were formed and labeled as follows: Positivity, Appreciation, Acceptance, Insight, Independence, and Spirituality. Reliability analysis of the subscales showed acceptable to high internal consistency. A secondary PCA was performed on mean subscale scores. Five of the six subscales clustered together along one dimension, and the sixth, Spirituality, was found to be distinct as represented in a loading plot. This subscale was retained as an independent measure; the remaining subscale scores were summed to create a total score. Measures of convergent and discriminant validity evaluated against existing instruments yielded findings in the expected directions. CONCLUSIONS:The dimensionality and structure of personal growth in caregiving partners of persons with MS were delineated in a novel instrument. Future studies should confirm its structure, establish classification criteria, and standardize it as an assessment tool. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Many large-scale functional connectivity studies have emphasized the importance of communication through increased inter-region correlations during task states. In contrast, local circuit studies have demonstrated that task states primarily reduce correlations among pairs of neurons, likely enhancing their information coding by suppressing shared spontaneous activity. Here we sought to adjudicate between these conflicting perspectives, assessing whether co-active brain regions during task states tend to increase or decrease their correlations. We found that variability and correlations primarily decrease across a variety of cortical regions in two highly distinct data sets: non-human primate spiking data and human functional magnetic resonance imaging data. Moreover, this observed variability and correlation reduction was accompanied by an overall increase in dimensionality (reflecting less information redundancy) during task states, suggesting that decreased correlations increased information coding capacity. We further found in both spiking and neural mass computational models that task-evoked activity increased the stability around a stable attractor, globally quenching neural variability and correlations. Together, our results provide an integrative mechanistic account that encompasses measures of large-scale neural activity, variability, and correlations during resting and task states.