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| 1 | Cardioembolic stroke:everything has changed显示文摘Historically,because of the difficulty of using warfarin safely and effectively,many patients with cardioembolic stroke who should have been anticoagulated were instead given ineffective antiplatelet therapy(or no antithrombotic therapy).With the arrival of new oral anticoagulants that are not significantly more likely than aspirin to cause severe haemorrhage,everything has changed.Because antiplatelet agents are much less effective in preventing cardioembolic stroke,it is now more prudent to anticoagulate patients in whom cardioembolic stroke is strongly suspected.Recent advances include the recognition that intermittent atrial fibrillation is better detected with more prolonged monitoring of the cardiac rhythm,and that percutaneous closure of patent foramen ovale(PFO)may reduce the risk of stroke.However,because in most patients with stroke and PFO the PFO is incidental,this should be reserved for patients in whom paradoxical embolism is likely.A high shunt grade on transcranial Doppler saline studies,and clinical clues to paradoxical embolism,can help in appropriate selection of patients for percutaneous closure.For patients with atrial fibrillation who cannot be anticoagulated,ablation of the left atrial appendage is an emerging option.It is also increasingly recognised that high levels of homocysteine,often due to undiagnosed metabolic deficiency of vitamin B_(12),markedly increase the risk of stroke in atrial fibrillation,and that B vitamins(folic acid and B_(12))do prevent stroke by lowering homocysteine.However,with regard to B_(12),methylcobalamin should probably be used instead of cyanocobalamin.Many important considerations for judicious application of therapies to prevent cardioembolic stroke are discussed. | J David Spence | 2018 | Stroke & Vascular Neurology2018，3，2： | 10 |
| 2 | How to identify which patients with asymptomatic carotid stenosis could benefit from endarterectomy or stenting显示文摘Offering routine carotid endarterectomy(CEA)or carotid artery stenting(CAS)to patients with asymptomatic carotid artery stenosis(ACS)is no longer considered as the optimal management of these patients.Equally suboptimal,however,is the policy of offering only best medical treatment(BMT)to all patients with ACS and not considering any of them for prophylactic CEA.In the last few years,there have been many studies aiming to identify reliable predictors of future cerebrovascular events that would allow the identification of patients with high-risk ACS and offer a prophylactic carotid intervention only to these patients to prevent them from becoming symptomatic.All patients with ACS should receive BMT.The present article will summarise the evidence suggesting ways to identify these high-risk asymptomatic individuals,namely:(1)microemboli detection on transcranial Doppler,(2)plaque echolucency on Duplex ultrasound,(3)progression in the severity of ACS,(4)silent embolic infarcts on brain CT/MRI,(5)reduced cerebrovascular reserve,(6)increased size of juxtaluminal hypoechoic area,(7)identification of intraplaque haemorrhage using MRI and(8)carotid ulceration.The evidence suggests that approximately 10%-15%of patents with asymptomatic stenosis might benefit from intervention;this will become more clear after publication of ongoing studies comparing stenting or endarterectomy with best medical therapy.In the meantime,no patient should be offered intervention unless there is evidence of high risk of ipsilateral stroke,from modalities such as those discussed here. | Kosmas I Paraskevas Frank J Veith J David Spence | 2018 | Stroke & Vascular Neurology2018，3，2： | 10 |
| 3 | Blood pressure gradients in cerebral arteries:a clue to pathogenesis of cerebral small vessel disease显示文摘rationale The role of hypertension in cerebral small vessel disease is poorly understood.At the base of the brain(the‘vascular centrencephalon’),short straight arteries transmit blood pressure directly to small resistance vessels;the cerebral convexity is supplied by long arteries with many branches,resulting in a drop in blood pressure.Hypertensive small vessel disease(lipohyalinosis)causes the classically described lacunar infarctions at the base of the brain;however,periventricular white matter intensities(WMIs)seen on MRI and WMI in subcortical areas over the convexity,which are often also called‘lacunes’,probably have different aetiologies.Objectives We studied pressure gradients from proximal to distal regions of the cerebral vasculature by mathematical modelling.Methods and results Blood flow/pressure equations were solved in an Anatomically Detailed Arterial Network(ADAN)model,considering a normotensive and a hypertensive case.Model parameters were suitably modified to account for structural changes in arterial vessels in the hypertensive scenario.Computations predict a marked drop in blood pressure from large and medium-sized cerebral vessels to cerebral peripheral beds.When blood pressure in the brachial artery is 192/113 mm Hg,the pressure in the small arterioles of the posterior parietal artery bed would be only 117/68 mm Hg.In the normotensive case,with blood pressure in the brachial artery of 117/75 mm Hg,the pressure in small parietal arterioles would be only 59/38 mm Hg.conclusion These findings have important implications for understanding small vessel disease.The marked pressure gradient across cerebral arteries should be taken into account when evaluating the pathogenesis of small WMIs on MRI.Hypertensive small vessel disease,affecting the arterioles at the base of the brain should be distinguished from small vessel disease in subcortical regions of the convexity and venous disease in the periventricular white matter. | Pablo J Blanco Lucas O Müller J David Spence | 2017 | Stroke & Vascular Neurology2017，2，3： | 9 |
| 4 | Controlling resistant hypertension显示文摘Resistant hypertension(failure to achieve target blood pressures with three or more antihypertensive drugs including a diuretic)is an important and preventable cause of stroke.Hypertension is highly prevalent in China(>60%of persons above age 65),and only~6%of hypertensives in China are controlled to target levels.Most strokes occur among persons with resistant hypertension;approximately half of strokes could be prevented by blood pressure control.Reasons for uncontrolled hypertension include(1)non-compliance;(2)consumption of substances that aggravated hypertension,such as excess salt,alcohol,licorice,decongestants and oral contraceptives;(3)therapeutic inertia(failure to intensify therapy when target blood pressures are not achieved);and(4)diagnostic inertia(failure to investigate the cause of resistant hypertension).In China,an additional factor is lack of availability of appropriate antihypertensive therapy in many healthcare settings.Sodium restriction in combination with a diet similar to the Cretan Mediterranean or the DASH(Dietary Approaches to Stop Hypertension)diet can lower blood pressure in proportion to the severity of hypertension.Physiologically individualised therapy for hypertension based on phenotyping by plasma renin activity and aldosterone can markedly improve blood pressure control.Renal hypertension(high renin/high aldosterone)is best treated with angiotensin receptor antagonists;primary aldosteronism(low renin/high aldosterone)is best treated with aldosterone antagonists(spironolactone or eplerenone);and hypertension due to overactivity of the renal epithelial sodium channel(low renin/low aldosterone;Liddle phenotype)is best treated with amiloride.The latter is far more common than most physicians suppose. | J David Spence | 2018 | Stroke & Vascular Neurology2018，3，2： | 4 |
| 5 | China Stroke Statistics 2019: a wealth of opportunities for stroke prevention显示文摘The China Stroke Statistics published in this issue of the journal1 represent an enormous undertaking.It included data on 3010204 patients who had a stroke admitted in 2018 to 1853 tertiary care hospitals and compiled data from multiple sources on stroke and stroke risk factors in China.The authors and the huge team of workers who must have compiled the statistics are to be commended on this enormous effort.In the report is a wealth of data on what is wrong in China to cause such a high risk of stroke but also a wealth of opportunity to make a difference.The reason this is so important is that~80%of strokes are preventable. | J David Spence | 2020 | Stroke & Vascular Neurology2020，5，3： | 3 |
| 6 | Association of homocysteine and smoking with cerebral microemboli in patients with mechanical heart valves:a transcranial Doppler study显示文摘Objectives Microembolic signals(MES)on transcranial Doppler(TCD)predict stroke and cognitive decline.Plasma levels of total homocysteine(tHcy),a prothrombotic factor,are higher in patients with microemboli in carotid stenosis and in patients with paradoxical embolism.In this study we assessed the association between the level of tHcy and the number of MES in patients with mechanical heart valves(MHVs).Methods TCD monitoring was performed to detect MES before and after breathing 100% oxygen and repeated every 2-4 weeks up to six times.results Twenty-five patients with MHVs(mean age:63.60±10.15 years)participated in this study;15 were men(66.47±7.25 years)and 10 were women(59.30±12.60 years).In total,there were 126 study visits.In multiple regression,higher tHcy was associated with more MES in both preoxygenation(OR 1.34(95%CI 1.07 to 1.68,P=0.009))and postoxygenation(OR 1.40(95% CI 1.07 to 1.83,P=0.01))phases.Current smoking and the length of time between the operation and monitoring also correlated with a higher number of MES before and after breathing oxygen,particularly in women.conclusions Higher tHcy and smoking were associated with a higher MES count in both preoxygenation and postoxygenation phases.Because smoking can be stopped and hyperhomocysteinaemia is treatable,these are clinically important findings. | Alicia Mattia M Reza Azarpazhooh Claudio Munoz Chrysi Bogiatzi Mackenzie A Quantz J David Spence | 2017 | Stroke & Vascular Neurology2017，2，4： | 2 |
| 7 | Three-dimensional Ultrasound quantification of inten- sive statin treatment of carotid atherosclerosis显示文摘 | ADAM KRASINSKI BERNARD CHIU J DAVID SPENCE | 2009 | Ultra- sound in Medicine Biology2009，35，11： | 1 |
| 8 | Ultrasound measurement of carotid plaque as a surrogate outcome for coronary artery disease显示文摘 | David Spence J | 2002 | Am J Cardiol2002，，： | 1 |
| 9 | Nutrition and stroke prevention显示文摘 | Mare F Kennedy Lees David Spence J | 2006 | Stroke2006，37，： | 1 |
| 10 | Ultrasound measurement of carotid plaque as a surrogate outcome for coronary artery disesase显示文摘 | David Spence J | 2002 | Am J Cardio2002，，： | 1 |
| 11 | Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: a randomised controlled trial显示文摘 | D Wayne Taylor Henry JM Barnett R Brian Haynes Gary G Ferguson David L Sackett Kevin E Thorpe Denis Simard Frank L Silver Vladimir Hachinski G Patrick Clagett R Barnes J David Spence | 1999 | The Lancet1999，，9171： | 1 |
| 12 | Scan–rescan and intra-observer variability of magnetic resonance imaging of carotid atherosclerosis at 1.5 T and 3.0 T显示文摘 | Arvin Vidal Yves Bureau Trevor Wade J David Spence Brian K Rutt Aaron Fenster Grace Parraga | 2008 | Physics in Medicine and Biology2008，，23： | 1 |
| 13 | Absence of mi- croemboli on transcranial Doppler identifies low-risk patients with a- symptomatic carotid stenosis 显示文摘 | Spence J David Spence Tamayo Arturo Tamayo | 2005 | Stroke2005，36，11： | 1 |
| 14 | Ultrasound measurement of carotid plaque as a surrogate outcome for coronary artery disease显示文摘 | David Spence J | 2014 | Am J Cardiol2014，40，3： | 1 |
| 15 | Asymptomatic carotid stenosis: mainly a medical condition 显示文摘 | Spence J David Spence | 2010 | Vascular2010，18，3： | 1 |
| 16 | Two-color multiphoton in vivo imaging with a femtosecond diamond Raman laser显示文摘Two-color multiphoton microscopy through wavelength mixing of synchronized lasers has been shown to increase the spectral window of excitable fluorophores without the need for wavelength tuning.However,most currently available dual output laser sources rely on the costly and complicated optical parametric generation approach.In this report,we detail a relatively simple and low cost diamond Raman laser pumped by a ytterbium fiber amplifier emitting at 1055 nm,which generates a first Stokes emission centered at 1240 nm with a pulse width of 100 fs.The two excitation wavelengths of 1055 and 1240 nm,along with the effective two-color excitation wavelength of 1140 nm,provide an almost complete coverage of fluorophores excitable within the range of 1000–1300 nm.When compared with 1055 nm excitation,two-color excitation at 1140 nm offers a 90%increase in signal for many far-red emitting fluorescent proteins(for example,tdKatushka2).We demonstrate multicolor imaging of tdKatushka2 and Hoechst 33342 via simultaneous two-color two-photon,and two-color three-photon microscopy in engineered 3D multicellular spheroids.We further discuss potential benefits and applications for two-color three-photon excitation.In addition,we show that this laser system is capable of in vivo imaging in mouse cortex to nearly 1 mm in depth with two-color excitation. | Evan P Perillo Jeremy W Jarrett Yen-Liang Liu Ahmed Hassan Daniel C Fernée John R Goldak Andrei Bonteanu David J Spence Hsin-Chih Yeh Andrew K Dunn | 2017 | Light(Science & Applications)2017，6，1： | 1 |
| 17 | Ultrasound measurement of carotid plaque as a surrogate out come for coronary artery disease显示文摘 | | 2002 | Am J Cardiol2002，，： | 1 |
| 18 | Ultrasound measurement of carotid Plaque as a surrogate outcome for coronary artery disease显示文摘 | Spence J David R | 2002 | Am J Cardiol2002，，： | 1 |
| 19 | Ultrasound measurement of carotid plaque as a surrogate outcome for coronary artery disesase显示文摘 | David Spence J | 2002 | Am J Cardio2002，，： | 1 |
| 20 | Diet for stroke prevention显示文摘Lifestyle is far more important than most physicians suppose.Dietary changes in China that have resulted from increased prosperity are probably responsible for a marked rise in coronary risk in the past several decades,accelerating in recent years.Intake of meat and eggs has increased,while intake of fruits,vegetables and whole grains has decreased.Between 2003 and 2013,coronary mortality in China increased 213%,while stroke mortality increased by 26.6%.Besides a high content of cholesterol,meat(particularly red meat)contains carnitine,while egg yolks contain phosphatidylcholine.Both are converted by the intestinal microbiome to trimethylamine,in turn oxidised in the liver to trimethylamine n-oxide(TMAO).TMAO causes atherosclerosis in animal models,and in patients referred for coronary angiography high levels after a test dose of two hard-boiled eggs predicted increased cardiovascular risk.The strongest evidence for dietary prevention of stroke and myocardial infarction is with the Mediterranean diet from Crete,a nearly vegetarian diet that is high in beneficial oils,whole grains,fruits,vegetables and legumes.Persons at risk of stroke should avoid egg yolk,limit intake of red meat and consume a diet similar to the Mediterranean diet.A crucial issue for stroke prevention in China is reduction of sodium intake.Dietary changes,although difficult to implement,represent an important opportunity to prevent stroke and have the potential to reverse the trend of increased cardiovascular risk in China. | J David Spence | 2018 | Stroke & Vascular Neurology2018，3，2： | 1 |
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