<International Circulation>： For my first question， there are a couple different stroke scales for moderating stroke and its consequences from mild to severe but you have recently come out with one called the SPAN-100 stroke score. Could you please discuss this?
Rabinstein：Actually this is the work of Doctor Gustavo Saposnik and colleagues. I wrote an editorial for the American Academy of Neurology so I had the opportunity to review the paper in detail for the job. The predictive model relies on using age and NIH Stroke Scale which is a score that rates the severity of clinical deficits in patients with acute ischemic stroke. By simply adding the age of the patient and the total NIH Stoke Scale they came up with a simple formula that gives you a number greater or equal to 100 or less than 100 which has a very powerful， predictive power for determining how a patient will do after the emergency administration of IV thrombolysis， which is the standard of care for patients with acute ischemic stroke within the first three to four-and-a-half hours. One of the advantages of this predictive model is that is uses the original population of NIH stroke study that essentially led to the approval of tPA in acute ischemic stroke in the United States and eventually it was the study that led to the approval of this treatment around the world subsequently. So in validating the SPAN-100 test， it essentially gave credibility to its usefulness. But there is no question that if you are SPAN-100 positive， meaning that your score is 100 or more， than you have a much higher chance of having a poor outcome， a much higher chance of having an intracerebral hemorrhage and thus a very， very low chance of good functioning and recovery. What I try to do with the editorial is to put this model in the context of several other models that have been recently described to predict the outcome after thrombolysis. There are those who try to predict the functional outcome and there are those that try to predict the risk of intracerebral hemorrhage following thrombolysis. The last advantage of the SPAN-100 is that it is very simple and therefore very practical， very easy to remember， and therefore has a very solid performance. At the end of the editorial I was trying to say that the simpler the model the more useful they are because you are supposed to use all these models in the emergency room with no time and under pressure. But， at the end of the day you have to use your clinical judgment as to whether thrombolysis is the best treatment for your patient and no model can completely overcome or replace your clinical judgment. And without going much farther， when you discuss these options with patient’s families they opt to get the treatment even if the risk of hemorrhage is higher for the patient than the general public and even if the risk of functional improvement may be very low because it’s the only thing to do. Even accepting odds that are entirely against the odds of the patient nonetheless the patients and families of patients often want to go with the treatment. So， I do not think that the scale is for everyone or that there are certain patients that absolutely you should not offer thrombolysis to but it does mean that when discussing the pros and cons treatment with patients and families you have to use this information to help them understand both the positives and negatives of the treatment.

　　<International Circulation>：我的第一个问题是，对缺血性卒中预后有预测作用的卒中评分量表很多，您最近提出SPAN-100卒中评分，能介绍一下吗？
Rabinstein：实际上这是Gustavo Saposnik博士和其团队的工作，我为美国神经病学会写了一篇评论，从而有幸详细浏览这项工作。这个预测模型依赖于年龄和NIH卒中量表（评估急性缺血性卒中患者临床神经功能缺陷严重性的量表），简单的加入年龄和整个NIH卒中量表，他们提出简单的公式给你一个数量大于或等于100或小于100，对急性静脉溶栓后（对急性缺血性卒中患者最初3～4.5小时内标准处理）决定患者如何处理具有强大的预测能力。这个预测模型的优点之一是使用NIH卒中研究原来的人群基本上支持美国急性缺血性卒中tPA治疗，研究最终会得到世界各地对此治疗的支持。因此，在SPAN-100测试验证中，本质上给予其实用性的可信度。但是毫无疑问，如果你是SPAN-100阳性，意味着你的评分大于等于100，预后差和颅内出血机会更大，从而功能良好和恢复的可能性非常低。我试图评论的是将此模型用于其他一些最近描述可预测溶栓预后的模型。有人试图预测功能预后，有人试图预测溶栓后颅内出血风险。SPAN-100另一个好处是简单而实用，易于记忆，性能稳定。评论最后，我尝试说模型越简单越有用，因为在急诊室有压力的情况下你没有时间来使用所有模型。但是，一天工作结束后，你会用临床标准判断溶栓对患者是否为最佳治疗，没有任何一个模型能完全克服或代替你的临床判断。为了避免偏颇，你会和患者家属讨论他们选择的治疗，即使患者出血风险比一般高，功能改善可能性很小，因为这是唯一能做的事情。尽管接受和反对的几率相当，家属还是愿意接受治疗。因此，我认为评分量表并非适用于所有人，或者有的患者绝对不应溶栓治疗，但不意味着和患者及家属讨论治疗利弊时你必须使用这个信息帮助他们理解治疗的优缺点。

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