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The “Brain Stress Timing” phenomenon and other misinterpretations of randomized clinical trial on aneurysmal subarachnoid hemorrhage

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Neural Regeneration Research 2019年第8期14卷 1364-1366页

作者： Rafael Martinez-Perez Natalia Rayo Agustin Montivero Jorge Marcelo Mura division of Neurosurgery Institute of Clinical Neurosciences Universidad Austral de Chile Valdivia Chile division of cerebrovascular and Skull Base Neurosurgery Institute of Neurosurgery Dr Asenjo Santiago Chile Western University London ON Canada

Clipping and coiling are currently the two alternatives in treatment of ruptured cerebral aneurysms. In spite of some meritorious analysis, further discussion is helpful to understand the actual state of art. Retreatment and rebleeding rates clearly favors clipping, although short-term functional outcome seems to be beneficial for clipping, while this different is not such if we perform the comparison at a longer follow up. Longterm follow ups and cost analysis are mandatory to have a clear view of the current picture in treatment of subarachnoid hemorrhage. Treatment strategy should be made by a multi-disciplinary team in accredited centers with proficient experience in both techniques.

关键词： sAH subarachnoid hemorrhage coiling clipping ruptured aneurysm timing intracranial

Neurotransmitter receptors on microglia

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Stroke & Vascular Neurology 2016年第2期1卷 52-58页

作者： Huan Liu Rehana K Leak Xiaoming Hu Center of cerebrovascular Disease Research University of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA division of Pharmaceutical Sciences Duquesne UniversityPittsburghPennsylvaniaUSA

As the resident immune cells in the central nervous system,microglia have long been hypothesised to promote neuroinflammation and exacerbate neurotoxicity.However,this traditional view has undergone recent revision as evidence has accumulated that microglia exert beneficial and detrimental effects depending on activation status,polarisation phenotype and cellular context.A variety of neurotransmitter receptors are expressed on microglia and help mediate the bidirectional communication between neurons and microglia.Here we review data supporting the importance of neurotransmitter receptors on microglia,with a special emphasis on glutamate,γ-aminobutyric acid(GABA),norepinephrine,cannabinoid and acetylcholine receptors.We summarise evidence favouring a significant role for neurotransmitter receptors in modulating microglial activation,phagocytic clearance and phenotypic polarisation.Elucidating the effects of neurotransmitter receptors on microglia and dissecting the underlying mechanisms may help accelerate the discovery of novel drugs that tap the therapeutic potential of microglia.

关键词： drugs inflammation supporting

The role of small vessel disease in development of Alzheimer's disease

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Neural Regeneration Research 2010年第4期5卷 310-320页

作者： Marta Grau-Slevin Adria Arboix John Gaffney Mark Slevin School of Biology Chemistry and Health ScienceManchester Metropolitan University cerebrovascular division Department of NeurologyHospital Universitari del Sagrat CorUniversitat de Barcelona

Classically Alzheimer＇s disease and vascular dementia have been considered as two different entities, with their own clinical criteria, but relatively recent epidemiological and clinicopathological studies suggest an overlap between them sharing not only most of the risk factors and some clinical aspects but also pathophysiological mechanisms. cerebrovascular lesions, especially small vessel disease （lacunar infarcts, white matter hyperintensities and microbleeds）, may magnify the effects of mild Alzheimer＇s disease pathology and promote the progression of cognitive decline and may also be a precursor of neuronal damage and dementia. ＂Vascular hypothesis＂ of Alzheimer＇s disease would open a window for new approaches and treatments.

关键词： Alzheimer＇s disease small vessel disease development risk factors diagnosis neuroimaging studies histopathological studies neurodegenerative disease neural regeneration

Complementary examinations other than neuroimaging and neurosonology in acute stroke

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World Journal of Clinical Cases 2017年第6期5卷 191-202页

作者： Adrià Arboix Víctor Obach Maria José Sánchez Joan Massons cerebrovascular division Department of Neurology Hospital Universitari del Sagrat Cor University of Barcelona Acute Stroke Unit Department of Neurology Hospital Clínic University of Barcelona

The etiologic diagnosis of cerebrovascular diseases requires non-routine complementary examinations to be performed. Thus, in specific cases, after neuroimaging(computed tomography/magnetic resonance imaging cerebral scan sequences) and neurosonology(Doppler test of the supra-aortic trunks, transcranial echography and echocardiography), which academically allow us to classify the patients according to their etiologic stroke subtype, further examinations must be used to make a correct etiologic diagnostic. The present review aims to update knowledge about the usefulness of the different tests of blood and urine, plain chest radiography, X-ray of the spine, skull and abdomen, lumbar puncture, electroencephalography, evoked potentials, polysomnography, and pathologic examination after biopsy of the artery, skin, muscles, nerves, meninges, and brain, in the management of patients who have suffered an acute stroke.

关键词： Complementary examinations cerebrovascular disorders Acute stroke Diagnostic techniques Blood biochemistry Polysomnography

Bayés syndrome and acute cardioembolic ischemic stroke

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World Journal of Clinical Cases 2017年第3期5卷 93-101页

作者： Adrià Arboix Lucía Martí Sebastien Dorison María José Sánchez division of cerebrovascular Universitat de Barcelona Department of Neurology Hospita Universitari del Sagrat Cor Medicine School Universidad de los Andes 111711 Bogotá Medical Library Hospital Universitari Sagrat Cor

Bayés syndrome is an under-recognized clinical condition characterized by advanced interatrial block.Bayés syndrome is a subclinical disease that manifests electrocardiographically as a prolonged P wave duration>120 ms with biphasic morphology±in the inferior leads.The clinical relevance of Bayés syndrome lies in the fact that is a clear arrhythmological syndrome and has a strong association with supraventricular arrhythmias,particularly atypical atrial flutter and atrial fibrillation.Likewise,Bayés syndrome has been recently identified as a novel risk factor for non-lacunar cardioembolic ischemic stroke and vascular dementia.Advanced interatrial block can be a risk for embolic stroke due to its known sequelae of left atrial dilation,left atrial electromechanical dysfunction or atrial tachyarrhythmia(paroxysmal or persistent atrial fibrillation),conditions predisposing to thromboembolism.Bayés syndrome may be responsible for some of the unexplained ischemic strokes and shall be considered and investigated as a possible cause for cryptogenetic stroke.In summary,Bayés syndrome is a poorly recognized cardiac rhythm disorder with important cardiologic and neurologic implications.

关键词： Bayés syndrome Cardioembolic stroke Electrophysiological processes Cardiovascular risk factors Heart conduction system

Patent foramen ovale closure in non-lacunar cryptogenic ischemic stroke:where are we now?

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Journal of Geriatric Cardiology 2021年第1期18卷 67-74页

作者： AdriàARBOIX Olga PARRA Josefina ALIÓ cerebrovascular division Department of NeurologyHospital Universitari del Sagrat CorUniversitat de BarcelonaBarcelonaCataloniaSpain Department of Pneumology Hospital Universitari del Sagrat CorUniversitat de BarcelonaBarcelonaCataloniaSpain Department of Cardiology Hospital Universitari de BellvitgeL’Hospitalet de LlobregatBarcelonaCataloniaSpain

Patent foram ovale(PFO)is the most common anatomical cause of an interarterial shunt.It is usually asymptomatic but may cause paradoxical embolism and is a risk factor for non-lacunar cryptogenic cerebral ischemia in young adults.Although the first clinical trials did not show a significant superiority of PFO closure in the secondary prevention of cerebral ischemia as compared with standard antithrombotic treatment,six subsequent randomized clinical trials(CLOSURE I,PC Trial,RESPECT,CLOSE,REDUCE,and DEFENSE-PFO)performed in a sample of cryptogenic stroke in patients aged 60 years or younger provided evidence of a significant reduction of recurrent cerebral ischemia after percutaneous PFO closure.However,the use of percutaneous PFO closure cannot be generalized to the entire population of patients with cerebral ischemia and PFO,but it is indicated in highly selected patients with non-lacunar cryptogenic cerebral infarction with a large right-to-left shunt,an atrial septal aneurysm and no evidence of atrial fibrillation,as well as in association with antithrombotic treatment for an optimal secondary prevention of cerebral ischemia.

关键词： PFO Patent foramen ovale closure in non-lacunar cryptogenic ischemic stroke where are we now

Predictive clinical features of cardioembolic infarction in patients aged 85 years and older

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Journal of Geriatric Cardiology 2019年第11期16卷 793-799页

作者： Ana Maria Carbajo-García Jonatan Cortés AdriàArboix Joan Massons Laura Díez Enric Vergés Jordi Arboix-Alió Luís García-Eroles cerebrovascular division Department of NeurologyHospital Universitari del Sagrat CorUniversitat de BarcelonaBarcelonaCataloniaSpain Department of Sports Sciences Ramon Llull UniversityFPCEE BlanquernaBarcelonaCataloniaSpain Director d’Organitzaciói Sistemes d’Informació Gerència Territorial Metropolitana NordInstitut Catalàde la SalutBarcelonaCataloniaSpain

Objective To assess predictive clinical factors of cardioembolic infarction in very old patients(85 years of age and older).Methods Prospective hospital-based stroke registry("The Sagrat Cor Hospital of Barcelona Stroke Registry")is an acute-care teaching hospital in Barcelona,Catalonia,Spain.From 956 first-ever cardioembolic stroke patients included in the stroke registry over a 24-year period,639 were younger than 85 years of age and 317 were 85 years or older(mean age:88.9 years).Demographics,clinical characteristics,risk factors and early outcome were compared.Predictors of cardioembolic infarction in the oldest age group were assessed by multivariate analyses.Results In a logistic regression model based on demographics,risk factors,clinical features and complications,female gender(odds ratio[OR]=1.74,95%confidence interval[CI]:1.27–2.39),heart failure(OR=2.27,95%CI:1.46–3.56),altered consciousness(OR=1.76,95%CI:1.28–2.42),and infectious complications(OR=2.01,95%CI:1.39–2.91)were predictors of cardioembolic stroke in the oldest age group.By contrast,heavy smoking,heart valve disease,hypertension,headache,early seizures,sensory deficit,and involvement of the posterior cerebral artery were independently associated with cardioembolic stroke in the younger group.Conclusions Identification of a differential clinical profile of cardioembolic stroke between patients aged 85 years or more and those younger than 85 years helps clinicians to the optimal management of ischemic infarction in the oldest segment of the population.

关键词： Cardioembolic stroke Clinical features Ischemic infarction Stroke Very old patients

Stroke and sleep-disordered breathing: A relationship under construction

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World Journal of Clinical Cases 2016年第2期4卷 33-37页

作者： Olga Parra Adrià Arboix Service of Pneumology Hospital Universitari del Sagrat CorUniversity of Barcelona cerebrovascular division Service of NeurologyUniversity of Barcelona Hospital del Sagrat Cor

The association between sleep-disordered breathing(SDB) and cardiovascular risk has been the focus of attention in recent years.Sleep disorders are emerging risk factors for cardiovascular disease and have been related to the whole spectrum of stroke,including transient ischemic attack,ischemic cerebral infarction and intracerebral haemorrhage.It has been shown that lacunar stroke or lacunar infarctions affecting the internal capsule or the protuberance are associated with a higher frequency of SDB.Acute stroke patients with associated SDB have a worse prognosis and a higher mortality as compared to patients with first-ever stroke without SDB.Preliminary studies provide evidence of the usefulness of treatment with continuous positive airway pressure when SDB is present in stroke patients.

关键词： Apnea-hypopnea index Cardiovascular risk factors Continuous positive airway pressure Ischemic stroke Lacunar infarction Sleep disordered

Fruit and vegetable intake and the risk of arterial hypertension in China:A prospective cohort study

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Chronic Diseases and Translational Medicine 2023年第4期9卷 309-319页

作者： Zhi He Yanhui Jia Jianxin Li IJie Cao Fangchao Liu Hongfan Li Jichun Chen Dongsheng Hu Chong Shen Yingxin Zhao Xiaoqing Liu Ling Yu Jianfeng Huang Xiangfeng Lu Dongfeng Gu Shufeng Chen Key Laboratory of Cardiovascular Epidemiology Department of EpidemiologyFuwai HospitalChinese Academy of Medical Sciences&Peking Union Medical College/National Center for Cardiovascular DiseasesBeijingChina Department of Epidemiology and Health Statistics Cllege of Public HealthZhengzhou UniversityZhengzhouHenanChina Department of Biostatistics and Epidemiology School of Public HealthShenzhen UniversityShenzhenGuangdongChina Department of Epidemiology and Biostatistics Center for Global HealthSchool of Public HealthNanjing Medical UniversityNanjingJiangsuChina Cardio-cerebrovascular Control and Research Center Institute of Basic MedicineShandong First Medical University(Shandong Academy of Medicine Sciences)JinanShandongChina division of Epidemiology Guangdong Provincial People's Hospital and Cardiovascular InstituteGuangzhouGuangdongChina Department of Cardiology Fujian Provincial HospitalFuzhouFujianChina

Background:Population-based epidemiological evidence regarding the association between fruit and vegetable intake and the incidence of hypertension is inconsistent.This prospective cohort study aimed to investigate the association between fruit and vegetable intake and the risk of new-onset hypertension.Methods:Based on the project of Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR),58,981 Chinese adults without hypertension at baseline were included.Information on fruit and vegetable intake was collected using a food-frequency questionnaire.Cox proportional hazards models were performed to estimate the hazard ratios(HRs)and 95%confidence intervals(CIs)of incident hypertension.Results:During 640,795 person-years of follow-up,21,008 new cases of hypertension were recorded.Compared with participants in the lowest quintile(Q1)of total fruit and vegetable(TFV)intake,the HRs(95%CIs)of incident hypertension were 0.90(0.86-0.95),0.85(0.81-0.90),0.82(0.78-0.86),and 0.83(0.78-0.88)for the Q2 to Q5 group(ptrend<0.001),respectively.In further analyses categorizing participants according to the recommended intake level(500 g/day),we found that increasing the intake of TFV,even though it was still insufficient for the recommendation,also had a protective effect against the incident hypertension.When considering the intake of fruit or vegetable separately,we found similar trends as the TFV intake.Conclusion:These results suggest that a higher intake of fruit and vegetable is beneficial for preventing hypertension in Chinese adults.

关键词： fruit and vegetable hypertension prospective study