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Autorregulació cerebral; Malaltia cerebrovascular; Òptica difusa Autorregulación cerebral; Enfermedad cerebrovascular; Óptica difusa Cerebral autoregulation; Cerebrovascular disease; Diffuse optics Background The cortical microvascular cerebral blood flow response (CBF) to different changes in head-of-bed (HOB) position has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS) technique. However, the relationship between these relative ΔCBF changes and associated systemic blood pressure changes has not been studied, even though blood pressure is a major driver of cerebral blood flow. Methods Transcranial DCS data from four studies measuring bilateral frontal microvascular cerebral blood flow in healthy controls (n = 15), patients with asymptomatic severe internal carotid artery stenosis (ICA, n = 27), and patients with acute ischemic stroke (AIS, n = 72) were aggregated. DCS-measured CBF was measured in response to a short head-of-bed (HOB) position manipulation protocol (supine/elevated/supine, 5 min at each position). In a sub-group (AIS, n = 26; ICA, n = 14; control, n = 15), mean arterial pressure (MAP) was measured dynamically during the protocol. Results After elevated positioning, DCS CBF returned to baseline supine values in controls (p = 0.890) but not in patients with AIS (9.6% [6.0,13.3], mean 95% CI, p

Objective To determine the general and specific utility in diagnosis and/or treatment of induced sputum (IS) inflammatory cell counts in routine clinical practice. Methods Retrospective study of 171 patients referred for clinical sputum induction over a 1-year period in the pulmonology department of a referral hospital. Independent observers established whether the information provided by IS inflammatory cell count was useful for making diagnostic and therapeutic decisions. Results The most frequent reasons for determination of IS inflammatory cell count were: asthma 103 (59.20%); uncontrolled asthma 34 (19.54%); chronic cough 19 (10.9%), and gastroesophageal reflux 15 (8.6%). In 115 patients (67.3%) it was generally useful for diagnosis and/or treatment; in 98 patients (57.3%) it provided diagnostic information and in 85 patients (49.7%) it assisted in therapeutic decision-making. In asthma, uncontrolled asthma, chronic cough and gastroesophageal reflux, the results were useful in 71.8%, 67.6%, 47.4% and 60%, respectively. Conclusion The information provided by IS inflammatory cell count is extremely useful in clinical practice, especially in asthma and chronic cough. These results may justify the inclusion of the IS technique in pulmonology departments and asthma units of referral centers.

Resumen Objetivos Determinar la utilidad general y especifica (diagnostica y/o terapeutica) del recuento de las celulas inflamatorias (RCI) del esputo inducido (EI) en situacion de asistencia clinica real. Metodos Estudio retrospectivo que incluyo a los 171 pacientes que durante un ano se les recogio un EI para determinar su RCI en un servicio de Neumologia de un hospital de referencia. Observadores independientes al equipo medico habitual establecieron si la informacion proporcionada por el RCI del EI fue util en la toma de decisiones diagnosticas y terapeuticas. Resultados Las causas mas frecuentes que motivaron la solicitud del RCI del EI fueron: asma 103 (59,20%); asma de control dificil 34 (19,54%); tos cronica 19 (10,9%), y reflujo gastroesofagico 15 (8,6%). En 115 (67,3%) pacientes el RCI del EI resulto clinicamente util (valoracion general); en 98 (57,3%) proporciono informacion diagnostica, y en 85 (49,7%), informacion terapeutica relevante. En el asma, asma de control dificil, tos cronica y reflujo gastroesofagico fue util en el 71,8, el 67,6, el 47,4 y el 60%, respectivamente. Conclusiones La informacion proporcionada por el RCI del EI resulta de gran utilidad en la practica clinica, particularmente en el asma y la tos cronica. Estos resultados podrian proporcionar argumentos para recomendar la incorporacion de la tecnica en los servicios de Neumologia de referencia y en las unidades de excelencia de asma.

Background and aims: Previously, microvascular cerebral blood flow (CBF) response to a mild head-of-bed (HOB) elevation has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS). We have hypothesized that early CBF response is related to the functional outcome. Methods: Patients with a non-lacunar AIS in the anterior circulation were monitored by DCS to measure relative CBF (ΔrCBF) on the frontal lobes bilaterally during a 0°–30° HOB elevation at early (≤ 12) or late (> 12) hours from symptom onset. National Institutes of Health Stroke Scale (NIHSS) scores were recorded at baseline at 24 and at 48 h. Functional outcome was measured by the modified Rankin Scale (mRS) at 3 months. Results: Thirty-eight (n = 38) AIS patients [baseline NIHSS = 19 (interquartile range: 16, 21)] were studied. ΔrCBF decreased similarly in both hemispheres (p = 0.4) when HOB was elevated and was not associated with baseline and follow-up NIHSS scores or patient demographics. At the early phase (n = 17), a lower or paradoxical ΔrCBF response to HOB elevation was associated with an unfavorable functional outcome (mRS > 2) in the ipsilesional (but not in the contralesional) hemisphere (p = 0.010). ΔrCBF response in the late acute phase was not related to mRS. Conclusions: Early CBF response to mild HOB elevation in the ipsilesional hemisphere is related to functional outcome. Further studies may enable optical monitoring at the bedside to individualize management strategies in the early phase of AIS. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

Altres ajuts: The authors thank Dr. Arjun Yodh, Dr. John A. Detre, Dr. Janos Lückl, and Rosa Maria Miralda for their useful discussions. They acknowledge the support from Redes Temáticas de Investigación Cooperativa (RETICS-INVICTUS RD012/0014 and RETICS-INVICTUS PLUS RD16/0019/0010), the "Severo Ochoa" Programme for Centres of Excellence in R&D (SEV-2015-0522), the Obra Social "la Caixa" Foundation (LlumMedBcn) LASERLAB-EUROPE IV (EU-H2020 654148), "Fundació La Marató TV3" (201709.31), Marie Curie initial training network (OILTEBIA 317526), Societat Catalana de Pneumologia (SOCAP), and Sociedad Española de Neumología y Cirugía Torácica (SEPAR). In a pilot study on acute ischemic stroke (AIS) patients, unexpected periodic fluctuations in microvascular cerebral blood flow (CBF) had been observed. Motivated by the relative lack of information about the impact of the emergence of breathing disorders in association with stroke on cerebral hemodynamics, we hypothesized that these fluctuations are due to apneic and hypopneic events. A total of 28 patients were screened within the first week after stroke with a pulse oximeter. Five (18%) showed fluctuations of arterial blood oxygen saturation (=3%) and were included in the study. Near-infrared diffuse correlation spectroscopy (DCS) was utilized bilaterally to measure the frontal lobe CBF alongside respiratory polygraphy. Biphasic CBF fluctuations were observed with a bilateral increase of 27.1% 17.7% and 29.0% 17.4% for the ipsilesional and contralesional hemispheres, respectively, and a decrease of -19.3% 9.1% and -21.0% 8.9% for the ipsilesional and contralesional hemispheres, respectively. The polygraph revealed that, in general, the fluctuations were associated with apneic and hypopneic events. This study motivates us to investigate whether the impact of altered respiratory patterns on cerebral hemodynamics can be detrimental in AIS patients.

Introduction: The microvascular cerebral blood flow response (rCBF) to orthostatic stress has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS). However, its relevance to the outcome is unknown. Hypothesis: CBF response to head-of-the-bed (HOB) elevation within the first hours after AIS is related to outcome. Methods: Patients with a large anterior circulation stroke of less than 48h from the stroke onset were monitored with DCS to follow rCBF in the frontal lobes during a HOB elevation from supine to 30°. All patients were placed flat during the first 24 hours and later, mobilization was initiated depending on the clinical condition. We categorized measurements as early (12h) from stroke onset. NIHSS was recorded at baseline, during HOB, at 24h and 48h. The modified Rankin scale (mRS) score was utilized as the outcome measure (favorable when 0-2). Results: We studied 34 patients (age 78±13y, male 47%, median NIHSS 19 (14-21)) at 16±11 hours from stroke. Ipsilateral extracranial and/or intracranial occlusion was present in 61%. Frontal CBF decreased in both hemispheres after HOB (-5±14%). A paradoxical response (increase/no change) was observed in 18%. rCBF was not correlated to NIHSS and age. Unfavorable outcome was found in 85%. Only at early hours (HOB (p=0.008) were associated with poor outcome. Conclusions: This result suggests that paradoxical CBF response to a mild HOB elevation in the early hours of stroke onset is associated with a poor outcome in patients with AIS. Optical continuous monitoring in the bedside may help to individualize management strategies in the early hours of AIS. Figure 1: rCBF due to HOB elevation versus mRS for the ipsi-lateral side in patients measured

Background: The BHQ is a new health-related quality of life questionnaire, developed in British English for patients with bronchiectasis. Objectives: The objectives of this study were to present the results of the translation of the BHQ into 11 languages, i.e., 9 Indo-European (Dutch for Belgium and The Netherlands, English for the USA, French for Belgium and France, German, Italian, and Spanish for Spain and the USA), one Japonic (Japanese), and one Sino-Tibetan (Mandarin). Methods: In each country, the following translation method (i.e., linguistic validation) was used: 1. In-depth analysis of the original (i.e., concept definition) and suggestion of translation alternatives; 2. Forward/backward translation step (or adaptation for English and Spanish versions); and 3. Review by a clinician. Results: The translation process did not reveal any cultural issues since most of the concepts assessed were cross-culturally relevant. The main difficulties consisted in finding conceptual equivalents to the response choices designed as Likert-type scales in 7 points (e.g., “All of the time” to “None of the time”). In all countries, translators ensured that the continuity of time was kept between all versions using either adverbs or synonyms (e.g., “Always” for “All of the time”). Items 2, 5 and 10 generated most discussion across languages for idiomatic or syntactic reasons. The clinicians9 review proved useful to clarify the concept of “clear chest” in item 4, i.e., meaning “chest clear of sputum or congestion,” and led to changes in wording. Conclusion: The rigorous translation methodology was essential in producing 11 translations of the BHQ conceptually equivalent to the original.

Obstructive sleep apnea (OSA) causes profound changes in brain hemodynamics increasing cerebrovascular risk. Severe OSA patients were measured with hybrid diffuse optics during sleep, characterizing brain hemodynamics of each obstructive apnea event.

Obstructive sleep apnea (OSA) impairs cerebral vasoreactivity (CVR). CVR was evaluated in severe OSA patients and a control group before and after two years of continuous positive air pressure treatment demonstrating improvements in vasoreactivity.

Changes in cerebral blood flow in response to orthostatic stress in obstructive sleep apnea patients were measured using diffuse correlation spectroscopy. Clinical indices derived from arterial oxygen saturation alter the cerebrovascular response.