Statistical principles in neurointervention part 2. Multivariable analysis: generalized linear models, modification, confounding, and mediation.

This two part series on statistical principles in neurointervention offers a comprehensive foundation for neurointerventionalists to engage with both fundamental and advanced statistical principles. This series aims to equip neurointerventionalists with essential statistical knowledge for critically reviewing literature and conducting methodologically sound research. Part one of this series covered fundamental concepts such as frequentism, study types, data types, summarization, visualization, hypothesis testing, and univariable analysis.

Statistical principles in neurointervention part 1: basic principles, descriptive statistics and univariable analysis.

Neurointervention has seen significant advancements in recent decades with the adoption of myriad new technologies and techniques. Initially reliant on case reports and small case series, we now benefit from multicenter studies and randomized trials that can provide robust practice-changing evidencea and often employ sophisticated statistical methods. This two-part series on statistical principles in neurointervention aims to equip neurointerventionalists with essential statistical knowledge for critically reviewing literature and conducting methodologically sound research.

Collaterals at angiography guide clinical outcomes after endovascular stroke therapy in HERMES.

Background: Robust collateral circulation has been linked with better reperfusion and clinical outcomes. It remains unclear how individual assessments of collateral circulation may be translated into clinical practice.

Methods: The pooled Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES) angiography dataset was analyzed by a centralized, independent imaging core blinded to other clinical data.

What Is a Meaningful Difference When Using Infarct Volume as the Primary Outcome?: Results From the HERMES Database.

Background: Ischemic stroke lesion volume at follow-up is an important surrogate outcome for acute stroke trials. We aimed to assess which differences in 48-hour lesion volume translate into meaningful clinical differences.

Methods: We used pooled data from 7 trials investigating the efficacy of endovascular treatment for anterior circulation large vessel occlusion in acute ischemic stroke.

Endovascular therapy in acute ischemic stroke with poor reperfusion is associated with worse outcomes compared with best medical management: a HERMES substudy.

Background: Functional outcomes in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) undergoing endovascular treatment (EVT) with poor reperfusion were compared with patients with AIS-LVO treated with best medical management only.

Methods: Data are from the HERMES collaboration, a patient-level meta-analysis of seven randomized EVT trials. Baseline characteristics and functional outcomes (modified Rankin Scale (mRS) score at 90 days) were compared between patients with poor reperfusion (defined as modified Thrombolysis in Cerebral Infarction Score 0-1 on the final intracranial angiography run as assessed by the central imaging core laboratory) and patients in the control arm with multivariable logistic ordinal logistic regression adjusted for pre-specified baseline variables.

Functional Outcomes of Patients ≥85 Years With Acute Ischemic Stroke Following EVT: A HERMES Substudy.

Background: Observational studies have shown endovascular treatment (EVT) for acute ischemic stroke to be effective in the elderly, despite resulting in poorer outcomes and higher rates of mortality compared with younger patients. Randomized data on the effect of advanced age on outcomes following EVT are, however, lacking. Our aim was to assess the EVT effect for ischemic stroke in patients aged ≥85 years and the influence of age on outcome in a large, randomized trial dataset.

Correlation Between Computed Tomography-Based Tissue Net Water Uptake and Volumetric Measures of Cerebral Edema After Reperfusion Therapy.

Background: Cerebral edema after large hemispheric infarction is associated with poor functional outcome and mortality. Net water uptake (NWU) quantifies the degree of hypoattenuation on unenhanced-computed tomography (CT) and is increasingly used to measure cerebral edema in stroke research. Hemorrhagic transformation and parenchymal contrast staining after thrombectomy may confound NWU measurements.

Risk factors of unexplained early neurological deterioration after treatment for ischemic stroke due to large vessel occlusion: a post hoc analysis of the HERMES study.

Background: Early neurological deterioration (END) after endovascular treatment (EVT) in patients with anterior circulation acute ischemic stroke (AIS) is associated with poor outcome. END may remain unexplained by parenchymal hemorrhage (UnEND). We aim to analyze the risk factors of UnEND in the medical management (MM) and EVT arms of the HERMES study.

Cerebral Edema in Patients With Large Hemispheric Infarct Undergoing Reperfusion Treatment: A HERMES Meta-Analysis.

Background And Purpose: Whether reperfusion into infarcted tissue exacerbates cerebral edema has treatment implications in patients presenting with extensive irreversible injury. We investigated the effects of endovascular thrombectomy and reperfusion on cerebral edema in patients presenting with radiological evidence of large hemispheric infarction at baseline.

Methods: In a systematic review and individual patient-level meta-analysis of 7 randomized controlled trials comparing thrombectomy versus medical therapy in anterior circulation ischemic stroke published between January 1, 2010, and May 31, 2017 (Highly Effective Reperfusion Using Multiple Endovascular Devices collaboration), we analyzed the association between thrombectomy and reperfusion with maximal midline shift (MLS) on follow-up imaging as a measure of the space-occupying effect of cerebral edema in patients with large hemispheric infarction on pretreatment imaging, defined as diffusion-magnetic resonance imaging or computed tomography (CT)-perfusion ischemic core 80 to 300 mL or noncontrast CT-Alberta Stroke Program Early CT Score ≤5.

Halogenated phenolic compounds in wild fish from Canadian Areas of Concern.

Concentrations of halogenated phenolic compounds were measured in the plasma of brown bullhead (Ameiurus nebulosus) from 4 Canadian Areas of Concern (AOCs), to assess exposure to suspected thyroid-disrupting chemicals. Hydroxylated polychlorinated biphenyls (OH-PCBs) were detected in every sample collected in 3 of the AOCs; the detection frequency was lower in samples from the Detroit River AOC. The OH-PCBs most frequently detected were pentachloro, hexachloro, and heptachloro congeners, which are structurally similar to thyroid hormones.

Polychlorinated biphenyls and their hydroxylated metabolites in wild fish from Wheatley Harbour Area of Concern, Ontario, Canada.

Whole-body polychlorinated biphenyls (ΣPCBs) and plasma hydroxylated PCBs (OH-PCBs) concentrations were determined in brown bullhead (Ameiurus nebulosus) from Wheatley Harbour, Ontario, Canada. Elevated ΣPCBs in Wheatley Harbour are suspected to have originated from industrial waste disposal and/or discharges from nearby fish processing through discarding of fish remains. Mean ΣPCB concentrations in brown bullhead from Wheatley Harbour were approximately 250 ng/g wet weight compared with approximately 40 ng/g wet weight for brown bullhead from the reference sites, Hillman Marsh and Turkey Creek (both in Ontario, Canada).

Assessment of the health status of wild fish from the Wheatley Harbour Area of Concern, Ontario, Canada.

The overall health and endocrine function of wild brown bullhead (Ameiurus nebulosus) and goldfish (Carassius auratus) from the Wheatley Harbour Area of Concern (Lake Erie, Ontario, Canada) was assessed using a suite of physiological and biochemical endpoints. Smaller gonads were detected in female brown bullhead and goldfish from Wheatley Harbour compared with Hillman Marsh (Ontario, Canada) reference fish. Female brown bullhead exhibited decreased in vitro synthesis of 17β-estradiol.

Thiamine deficiency effects on the vision and foraging ability of lake trout fry.

The exact causes of the historical recruitment failures of Great Lakes lake trout Salvelinus namaycush are unknown. Thiamine deficiency has been associated with neurological abnormalities in lake trout that lead to early mortality syndrome (EMS) in salmonine swim-up fry, and EMS-related mortality at the swim-up stage is a factor that contributes to the reproductive failure of lake trout populations in the Great Lakes. The potential for adverse effects of thiamine deficiency beyond the swim-up stage is unknown.

Influence of thiamine deficiency on lake trout larval growth, foraging, and predator avoidance.

Diet-related thiamine deficiency increases the acute mortality, known as early mortality syndrome, of salmonines from some of the Great Lakes. The consequences of thiamine deficiency as measured at the egg stage for other important early life stage processes like growth, foraging efficiency, and predator avoidance that may also result in mortality, are unknown. Accordingly, we investigated the impacts of low thiamine on the specific growth rate (SGR) of first-feeding fry, the ability of first-feeding fry to capture Daphnia, fry emergence in the presence of a potential predator (round goby Apollina [formerly Neogobius] melanostomus), and predation by slimy sculpin Cottus cognatus.

Egg fatty acid composition from lake trout fed two Lake Michigan prey fish species.

We previously demonstrated that there were significant differences in the egg thiamine content in lake trout Salvelinus namaycush fed two Lake Michigan prey fish (alewife Alosa pseudoharengus and bloater Coregonus hoyi). Lake trout fed alewives produced eggs low in thiamine, but it was unknown whether the consumption of alewives affected other nutritionally important components. In this study we investigated the fatty acid composition of lake trout eggs when females were fed diets that resulted in different egg thiamine concentrations.

Gizzard shad thiaminase activity and its effect on the thiamine status of captive American alligators Alligator mississippiensis.

Adult mortality and low egg hatch rate were observed among American alligators Alligator mississippiensis in Lake Griffin, Florida, between 1998 and 2003. Previous studies show that the alligator mortality is due to neurological impairment associated with thiamine (vitamin Bt) deficiency. This study determined the rate of thiaminase activity in gizzard shad Dorosoma cepedianum, a fish often eaten by alligators, and examined the thiamine status of captive adult alligators fed only gizzard shad.

Variations of thiaminase I activity pH dependencies among typical Great Lakes forage fish and Paenibacillus thiaminolyticus.

The source of thiaminase in the Great Lakes food web remains unknown. Biochemical characterization of the thiaminase I activities observed in forage fish was undertaken to provide insights into potential thiaminase sources and to optimize catalytic assay conditions. We measured the thiaminase I activities of crude extracts from five forage fish species and one strain of Paenibacillus thiaminolyticus over a range of pH values.

Evaluating the effect of stressors on thiaminase activity in alewife.

No consistent explanation has been found for the variability in the thiaminase activity of alewives Alosa pseudoharengus despite the role of alewife thiaminase in large-scale salmonine mortality in the Laurentian Great Lakes. We conducted experiments to evaluate the effect of two stressors, reduced salt content in the water and food limitation, on alewife thiaminase activity. Alewives were subjected to treatments in replicated tanks in which conductivity was lowered (< 100 microS/cm) for 8 d and feeding was limited for 39 d.

PCBs can diminish the influence of temperature on thyroid indices in rainbow trout (Oncorhynchus mykiss).

The influence of PCBs on the thyroid status of rainbow trout was assessed at various temperatures to identify if PCB mixtures, as well OH-PCBs produced via biotransformation of parent PCBs, can illicit thyroid effects in fish. Juvenile rainbow trout (Oncorhynchus mykiss) held at 8, 12 or 16 degrees C were exposed to dietary concentrations of an environmentally relevant mixture of PCBs for 30 days followed by a depuration phase. Two additional treatments at 12 degrees C included higher concentrations of PCBs (congeners 77, 126 and 169) known to induce CYP1A in fish (referred to as CYP1A treatment) and PCBs (congeners 87, 99, 101, 153, 180, 183 and 194) known to induce CYP2B in mammals (referred to as CYP2 treatment), to assess the influence of more biologically relevant PCB congeners on thyroid indices in fish.

Role of temperature and enzyme induction in the biotransformation of polychlorinated biphenyls and bioformation of hydroxylated polychlorinated biphenyls by rainbow trout (Oncorhynchus mykiss).

Hydroxylated PCBs (OH-PCBs) are metabolites of polychlorinated biphenyls (PCBs) that have recently been found in the plasma of Great Lakes fish. Studies have shown that the ability of laboratory-held rainbow trout (Oncorhynchus mykiss) to bioform OH-PCBs from dietary mixtures of PCB congeners is complex and may be attributed to factors such as temperature and/or enzyme induction. Past studies have also suggested that CYP1A- and 2B-like enzymes are the likely mechanism for forming OH-PCBs, but this has not been directly studied in a controlled setting.

Biotransformation of polychlorinated biphenyls (PCBs) and bioformation of hydroxylated PCBs in fish.

Hydroxylated PCBs (OH-PCBs) are a class of organic contaminants that have been found recently in the plasma of Great Lakes fish, the source of which is either bioformation from PCBs or accumulation from the environment. To address the potential for fish to biotransform PCBs and bioform OH-PCBs juvenile rainbow trout (Oncorhynchus mykiss; approximately 80 g) were exposed to dietary concentrations of an environmentally relevant mixture of PCBs. Eight OH-PCBs were found in the plasma of rainbow trout after 30 days of exposure to the PCBs, the relative pattern of which was similar to those observed in wild lake trout (Salvelinus namaycush) from Lake Ontario.

Effects of maternally transferred organochlorine contaminants on early life survival in a freshwater fish.

Laboratory research has shown that female fish can pass toxic organochlorines (OCs) from their bodies to their eggs, killing their offspring if sufficient quantities are transferred. We conducted a controlled incubation study using gametes from a wild, OC-contaminated walleye (Sander vitreus) population (Bay of Quinte, Lake Ontario, Canada) in order to assess among-female variation in offspring early life survival in relation to ova concentrations of planar OCs (polychlorinated dibenzo-p-dioxins and furans and planar polychlorinated biphenyls) and a suite of other maternal and ova characteristics. Equal volumes of ova from each female were fertilized, pooled, and incubated together as an experimental cohort.

Development of a short-term in situ caging methodology to assess long-term effects of industrial and municipal discharges on salmon smolts.

Trial experiments to develop an in situ method for determining effects of short-term exposure to contaminants on salmon during the sensitive smolt stage were carried out. Wild Atlantic salmon (Salmo salar) smolts were caged at various estuarine locations in northeast New Brunswick, Canada at different levels of anthropogenic impact in 2000 and 2001. Survival, growth (weight and K), and feeding (delta(13)C and delta(15)N) parameters were measured following summer grow-out at a hatchery.

Dietary retinoic acid induces hindlimb and eye deformities in Xenopus laevis.

This study investigated the effects of dietary retinoic acid (RA) on frog hindlimb development. Xenopus laevis (African clawed frog) tadpoles were fed a diet supplemented with 0, 1, 10, or 100 microg of RA/g of food for 2 or 5 d at different stages of metamorphosis. Hindlimb deformities were induced in the group fed 100 microg of RA/g of diet for 5 d.