Donald and Barbara Zucker School of Medicine at Hofstra/Northwell

BACKGROUND:Approximately one in three patients with acute ischemic stroke (AIS) suffer from a premorbid disability prior to their incident AIS. These patients have largely been excluded from clinical trials of endovascular thrombectomy (EVT) for the treatment of AIS and current literature remains unclear regarding the safety and efficacy of EVT in these patients. METHODS:We queried our prospectively maintained registry of patients with AIS from December 1, 2014 to October 31, 2023 to identify all patients who underwent EVT. Patients were stratified by their baseline modified Rankin Scale (mRS) score into those with (mRS 2-5) and without (mRS 0-1) baseline disability. Univariate analyses using the χ2 test for categorical variables and the Wilcoxon rank-sum test for continuous variables were performed to compare demographics between the two groups. Generalized logistic and linear regression models for multivariable analysis were used to compare outcomes between the groups. RESULTS:Of a total of 1489 patients, 367 (24.6%) had a pre-existing disability. Patients with baseline disability were older (79.6 years vs 67.7 years, P<0.001), more likely to be female (65.7% vs 45.9%, P<0.001), and had higher rates of stroke risk factors. There were higher odds of return to baseline (90-day ΔmRS =<0: OR 2.83, P<0.001) and 90-day ΔmRS =<1 (OR 2.94, P<0.001) for patients with baseline disability post-EVT compared with their healthier counterparts. There was no relative adjusted increase in symptomatic intracerebral hemorrhage or 90-day mortality. CONCLUSIONS:EVT appears to be safe and effective in patients with baseline disability, often associated with a return to their premorbid functional status at 90 days.

e18080 Background: Thyroid cancer epidemiology has shown distinct sex-related differences, with women historically having higher incidence rates than men in many regions. However, data from low- and middle-income countries (LMICs) such as Vietnam are limited. The objective of this study was to project sex differences in Thyroid cancer incidence over the next two decades. Methods: Thyroid cancer data (ICD-10 code C73) from 1990 to 2020 were obtained from the Hanoi Cancer Registry, alongside population data from the Vietnam General Statistics Office. Age-standardized rates (ASR) were calculated using the WHO World Standard Population (2000). Poisson regression models were performed to project future incidence for men and women. Future incidence was projected under the assumption that the estimated Annual Percentage Change (APC) from the most recently identified trend segment would remain constant through 2045. Results: Sex differences in disease burden were observed throughout the study period. In 1990, the ASR was similarly low for both sexes (men: 0.3; women: 0.8 per 100,000) (Table 1). Between 1990 and 2020, ASR among women increased to nearly seven times that observed in men (57.7 vs. 8.2 per 100,000 person-years). The highest risk among women was observed in those 49 years and younger. From 2020 to 2045, the gap between women and men is projected to remain unchanged (57.7 vs. 8.2 per 100,000). Conclusions: Thyroid cancer in Hanoi is predominantly a women's phenomenon, driven by a disproportionate surge in cases among young and middle-aged women. The incidence gap in thyroid cancer between women and men significantly widened from 1991 to 2020 and is projected to remain unchanged over the next two decades. However, the magnitude of their differences may be overestimated due to potential overdiagnosis among women. Public health strategies in Vietnam and other LMICs with similar population characteristics and thyroid cancer burden should prioritize care and treatment for women to narrow the gap. Two-decade projection of age-standardized thyroid cancer incidence rates per 100,000 person-years in Hanoi, Vietnam. Women Men Year Cases ASR (95% CI) Cases ASR (95% CI) 1990 9 0.8 (0.3-1.3) 4 0.3 (0.0-0.6) 2000 47 3.6 (2.6-4.7) 17 1.5 (0.8-2.2) 2010 352 10.4 (9.3-11.5) 80 2.6 (2.0-3.2) 2020 2,523 57.7 (55.4-59.9) 343 8.2 (7.3-9.1) 2025 2,822 57.6 (55.5-59.8) 385 8.2 (7.4-9.0) 2030 3,079 57.7 (55.6-59.7) 412 8.2 (7.4-9.0) 2035 3,309 57.7 (55.7-59.7) 435 8.2 (7.4-9.0) 2040 3,494 57.7 (55.7-59.6) 468 8.2 (7.5-9.0) 2045 3,617 57.7 (55.7-59.6) 497 8.2 (7.5-9.0)

Large language models (LLMs) capture long-range contextual structure in natural language and have recently been shown to align with the human brain's contextualized linguistic encoding. This makes them a promising computational probe for studying how context-dependent linguistic information is represented during natural speech perception. Speech perception often occurs in multi-talker environments, where attention must dynamically select among competing streams, yet how contextual information from attended and unattended speech is neurally encoded remains underexplored. Here, we investigate how auditory attention modulates neural tracking of context-dependent linguistic representations using electrocorticography (ECoG) and stereoelectroencephalography (sEEG) recordings from three epilepsy patients engaged in a two-conversation "cocktail party" paradigm. To model neural responses to attended and unattended speech streams, we used contextual word embeddings generated by large language models. We find that LLM-derived features reliably predict brain activity for the attended stream and that contextual information from the unattended stream also contributes to neural prediction. Importantly, these contributions extend beyond low-level acoustic features and shallow syntactic information, and depend on the surrounding linguistic context. Moreover, neural tracking of the unattended stream reflects shorter-range contextual integration than that of the attended stream. Together, these findings indicate that neural responses to speech reflect context-dependent linguistic representations from multiple concurrent speech streams, with attention modulating the depth and timescale of contextual integration. Our results highlight the utility of LLMs for probing higher-level linguistic representations in complex, naturalistic listening environments.

Background: SARS-COV2 infection has been linked to cardiovascular complications. Previously published data suggested that cardiac injury may be a common disease feature and contribute to morbidity and mortality in severe COVID-19. Since the early days of the pandemic, little data has emerged describing what cardiovascular complications arise from myocardial injury in severe COVID-19 and whether these complications contribute to mortality. Objectives: Describe the incidence and nature of cardiovascular complications in patients with severe COVID-19 infection and biochemical or imaging evidence of myocardial injury. Methods: We analyzed consecutive patients admitted for severe COVID-19 and presenting with biochemical or echocardiographic evidence of myocardial injury across 16 centers within the CARDIO-COVID investigator-initiated consortium. A light-GBM machine learning model was used to identify variables associated with mortality. Results: Our study included 1,328 patients. In hospital mortality was 29.4%. Factors most associated with mortality were age, SOFA Cardiovascular score, elevated troponin, intubation, high vasoactive-inotropic score (VIS), high PEEP, and high FiO2. Cardiovascular complications were rare and did not present significant association with mortality. Patients with high VIS and SOFA Cardiovascular scores had a significantly higher incidence of secondary bacterial pneumonias suggesting septic shock played a role in their physiology. Investigator-adjudicated cause of death data identified respiratory failure and septic shock as primary causes of mortality. Conclusions: Cardiovascular complications of severe COVID-19 are uncommon and do not seem to contribute significantly to mortality. Biochemical markers of myocardial injury or strain still carry significant prognostic value, but the value of these markers may indicate presence of high-risk ARDS phenotypes as opposed to significant myocardial injury. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The IRB of Stanford University gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.

Abstract Introduction Nontuberculous mycobacterial (NTM) pulmonary infections are difficult to treat due to the need for prolonged antibiotic regimens with multiple potential adverse effects. Clofazimine, an oral antimycobacterial agent, has been increasingly used as part of multidrug regimens in cases of refractory disease, drug resistance or intolerance. This study aims to evaluate the use of clofazimine as a component of NTM pulmonary disease treatment. Methods We conducted a cross-sectional, retrospective analysis of baseline data from patients with physician-reported NTM diagnoses enrolled in the US Bronchiectasis and NTM Research Registry (BRR). Patients not receiving NTM treatment during the baseline period were excluded, with baseline defined as the 2-year period prior to enrollment. Patients were grouped by treatment regimen: clofazimine-containing vs. non-clofazimine-containing. Patient clinical characteristics, culture results and susceptibility, treatment regimens, and treatment outcomes were summarized. Group differences were assessed using Wilcoxon-Mann-Whitney U tests for continuous variables and Chi-square or Fisher’s exact tests for categorical variables. Results 2,179 patients with NTM pulmonary disease receiving treatment were identified. 309 patients (14.2%) received a clofazimine-containing regimen, while 1,870 patients (85.8%) were treated with a non-clofazimine-containing regimen.Compared to patients on non-clofazimine regimens, those receiving clofazimine had lower median FEV1% predicted (67% [IQR 54–83] vs. 75% [IQR 60–90], p < 0.001), greater lobar involvement (median 4 lobes [IQR 2–6] vs. 3 lobes [IQR 2–6], p < 0.001), lower BMI and more reported symptoms. Clofazimine use was more prevalent among patients with drug-resistant NTM (Table 1). Adverse events and drug intolerance were reported in 48.8% of patients receiving clofazimine, a proportion similar to that observed with macrolides, ethambutol, and rifampin. Patients on clofazimine-containing regimens were more likely to remain culture-positive beyond 6 months of therapy (31.3% vs. 16.7%, p < 0.001) and less likely to achieve culture negativity for at least 12 months while on treatment (13.1% vs. 25.8%, p < 0.001). However, there was no significant difference in NTM disease recurrence between the two groups. Conclusion Although patients receiving clofazimine-containing regimens for NTM pulmonary infection were less likely to achieve culture conversion at 6 months and maintain culture negativity for 12 months on therapy, these findings are likely attributable to greater disease severity and higher prevalence of drug-resistant infections. The uneven sample sizes may limit the robustness of these conclusions. Reassuringly, recurrence rates did not differ between groups, and clofazimine demonstrated a comparable tolerability profile to that of other commonly used agents for NTM pulmonary infections. This abstract is funded by: None