《国际循环》：国际卒中大会（ISC）是世界上规模最大的脑血管疾病科学和治疗会议，内容涵盖脑血管领域的各个方面。作为本届ISC主席，您认为今年会议的主要亮点包括哪些？有哪些重要的临床研究结果公布？
International Circulation：The International Stroke Conference (ISC) is the world’s largest meeting dedicated to the science and treatment of cerebrovascular disease which emphasizes basic， clinical and translational sciences in this field. As this year’s Chair， could you briefly introduce highlights?of the conference? What important clinical research results will be announced?
Dr Kyra J Becker：如你所说，本次会议是一场丰盛的学术盛宴，多项出色的临床试验将公布结果。可以说这一年是血管内试验年。 我们将回顾MR CLEAN研究及其新阶段研究成果。此外还将展示IA EXTEND研究、PRIME ESCAPE研究以及BRI BASKET研究。康复方面也有很有意思的研究，比如眼部护理、饮食限制对卒中的影响，以及地中海饮食和加利福尼亚州进行的研究。一级预防方面的研究将汇报J-Star研究。很多在论坛上展现的研究都将成为卒中治疗的亮点。
Kyra J Becker教授：As you mentioned this meeting is all about the science and there are amazingly wonderful clinical trials that are being presented this year. And I would say that this year is the year of the endovascular trial. We will review the results of Mr. Clean and new data from MR CLEAN’s study will be presented. In addition the results of IA extend with prime the Escape trial and the BRI Basket trial will be presented; so it really is the year of endovascular therapy. Also， there are interesting trials being presented in rehabilitation; the eye care study， trials on diets and its effect on stroke incidents， the Mediterranean diet and California teachers study. There are good primary prevention studies; the J-Star studies (Japan and Stratton study); so I think there are amazingly interesting clinical trial data being presented and then there is always our symposium that really highlights the state of the art stroke.
《国际循环》：神经重症是神经内外科和危重症医学交叉部分。作为神经重症方面的专家，您认为此类患者管理的重点是什么？脑保护期和脑复苏期的治疗策略有哪些不同？
International Circulation: NeuroIntensive stands at the intersection of neurology and critical care medicine. As an expert on critical care neurology， what do you think the keypoints of management of these patients are? What are the differences of therapeutic strategies between cerebral protective phase and cerebral resuscitation phase?
Kyra J Becker教授：这是个很好的问题。我们知道急性期治疗对改善卒中预后有重要影响，MR CLEAN研究数据将呈现静脉tPA和血管内治疗的结果。患者接受治疗后应住院进行护理，甚至大部分要住进重症监护室。所以在卒中发作后第一小时到第一天的时间的护理工作非常关键。目前已有足够的数据建议我们如何治疗患者尤其是急性期患者，测量患者体温、代谢功能等问题。急性期卒中治疗和重症医疗关系非常密切。
Dr Kyra J Becker：That is a great question! We know that acute therapy is very beneficial for improving outcome in stroke; be it iv-tPA or endovascular approach based on MR CLEAN’s data and data being presented here in this stroke meeting. After patients receive their treatment they have to be admitted to the hospital to be cared for and most of these patients will be admitted to the ICU. So it’s really the intensiveness of providing care in the first hours to days after the stroke. I think that ample data suggests how we care for the patients and the acute period does matter: What we do about their temperature; what we do about their metabolic issues of our patients. I think that’s really the nexus of the interaction between acute stroke therapy and critical care.
Kyra J Becker教授：另外，此次会议还关注全身麻醉对血管内治疗预后的影响，MR CLEAN研究在这方面呈现了重症医疗的典型，神经重症医疗与急性期卒中治疗密切相关，全身麻醉在手术过程中对患者会有一定影响。
Dr Kyra J Becker：The other thing we will be hearing about in this meeting is the effective general anesthesia on the outcome of endovascular interventions in the MR CLEAN study and that’s another example on how critical care， neuro-intensive care interacts with acute stroke treatment; how does general anesthesia and the way we take care of our patients during the procedure affect them.
《国际循环》：神经重症监护不仅要挽救生命，更重要的是挽救患者的脑功能，尽量避免继发性脑损害。而脑保护期是决定患者预后的关键时期，目前强调的是合理的脑灌注维持脑血流，适宜的体温（脑温），充分的镇静镇痛。这个时期，应如何把握镇静深度？亚低温对控制颅内压有一定帮助，但是否有脑保护作用？
International Circulation: NeuroIntensive Care aims at not only save lives， but also save patients’ brain function to avoid secondary brain damage. Cerebral protective phase is an important period that related to outcomes. Currently， this phase emphasizes reasonable cerebral perfusion to maintain cerebral blood flow， suitable temperature and adequate sedation analgesia. About?this， what and how is required to get the optimal degree of sedation? Subhypothermia is helpful for intracranial pressure control， is there any brain protection effect?
Kyra J Becker教授：已有大量数据表明，低体温可控制颅内压，但这对卒中预后的影响仍需更多数据。临床目前没有任何关于低体温对缺血性卒中影响的随机对照研究。有研究探索过心脏停搏对大脑的保护作用，早期研究确实显示了阳性结果，但最近更多研究可能会对以往研究提出很多质疑。所以低体温用于保护缺血性大脑尚未在人体得到验证。
Dr Kyra J Becker：So the question is whether hypothermia is neuro-protective and controls ICP. I think there are ample data to show that hypothermia does control ICP; I think the data that is lacking right now is how it affects the outcome of the stroke. We really don’t have the results on any of randomized controlled trials for ischemic stroke. We do have some data from the trials of cardiac arrest in brain protection. Early trials that were positive but more recent trials maybe cast some questions on the results of those earlier trials. So I think that hypothermia as a strategy to protect the ischemic brain is yet proved in humans.
《国际循环》： 近期有研究揭示了卒中和免疫系统之间存在相互影响。我们了解到您也发表了相关文章和研究。目前，对缺血性卒中进程及相关免疫状态的理解有哪些？免疫抑制是否可用于缺血性卒中的治疗？
International Circulation：Recent observations have?revealed that stroke also alters the function of the immune system and vice versa. We learned that you had published articles and studies on it. Could you summarize the current understanding of the immunological condition related to ischemic stroke process? Whether immune suppression could be applied to the treatment of ischemic stroke?
Kyra J Becker教授：这是个非常复杂的问题。重症卒中确实能带来异常免疫应答，可造成免疫系统衰退。大部分试验结果显示，症状性神经系统应答受卒中影响，可能伴随卒中后感染，这提示免疫力下降可能增加感染风险，所以医生在采取任何增强免疫抑制的治疗措施均可能增加感染风险。如果患者卒中后发生感染，预后通常更差。
Dr Kyra J Becker：This is a very complicated issue. It’s very clear that following a severe stroke the immune system is actually is inherited its ability to respond so there’s the systemic immune depression that is caused by the stroke; most of the data suggested that it is related to the sympathetic nervous system response to the stress of the stroke that coupled with the fact infection is really common in the post-stroke period which suggests that the immune depression may increase the likelihood of infection and that any therapies we do that actually enhances the immune suppression may increase the risk of infection and the data are very clear that if you have an infection in the post-stroke period your outcome is worse.
Kyra J Becker教授：复杂的情况是，很多炎症在卒中期间发生，炎症反应越多，卒中预后越差。其中有很多复杂的内在联系还未完全阐明。除非我们知道引发新免疫反应的所有细节，以及这种反应如何影响预后，否则很难具体采取干预免疫应答的措施。
Dr Kyra J Becker：The complicated side to all of this is there is a lot of inflammation that occurs during the stroke as well; the more inflammation the worse the stroke outcome. There is this complex interplay that I would suggest that we don’t fully understand. So I think it’s going to be difficult to know exactly how to intervene on that immune response until we understand all the nuances of what the reason for the new response is and how it affects the outcome.