Advances in Stroke 2002: Introduction
Information grows exponentially, knowledge and wisdom more slowly. No one interested in stroke could possibly read, understand, and integrate the vast amount of information contained in the hundreds of relevant articles published in 2002, let alone put them into context. And yet, we need to know what is truly new, valid, and important.
The associate, assistant, and section editors of Stroke, some with the help of invited colleagues, have attempted to evaluate, summarize, and put into context the information from specialized publications in their area of interest into more general knowledge and understanding, and to show that where the evidence falls short, there still is room for wisdom.
The summaries of advances are both comprehensive and succinct. Comprehensive in that all relevant contributions are considered regardless of where they are published, or if unpublished, presented in a reliable forum. And succinct in that the articles are brief enough and clear enough that anyone interested can and should read them. Clinicians usually avoid reading about basic science, because it is perceived to be either irrelevant or too technical to garner their interest. However, the basic science of today leads to the clinical practice of tomorrow, and basic brain mechanisms are both intrinsically interesting and important; such as knowing how the brain regenerates and understanding the role of programmed death in development and disease. This area of research was graced in 2002 by a Nobel Prize in Medicine and Physiology awarded to Robert Horvitz. Another area of science that clinicians need to learn about is the basics about vasoprotection, as stroke in its micro and macro manifestations becomes more prevalent with the aging population. White matter makes up half of the human brain, and yet it seldom attracts the attention that it deserves. Despite this, steady advances are being made in both the basic and clinical aspects. Inflamed blood and infected arteries are drawing their share of attention, although the only certainty thus far is an association with atherosclerosis.
We also feature invited articles that look at subjects from both the basic science and clinical viewpoints, aiming to achieve an integrated view. The articles on the converging mechanisms of vascular and neurodegenerative dementia and the contribution on estrogen and stroke are examples. Genetics and imaging are revolutionizing our understanding of stroke, while thrombolysis, anticoagulants, antiplatelet agents, statins and ACE inhibitors, and interventional neuroradiology are changing how we treat and prevent stroke. A single item mentioned in an article on emerging therapies makes one wonder whether it portends things to come. It alludes to a trial with an astrocyte inhibitor. Given that astrocytes outnumber neurons in the human brain by a ratio of 10:1, will this mean increasing recognition of the crucial role of astrocytes in ischemia and a shift from our neuroncentrism to a more comprehensive approach to brain protection?
Critical care of stroke is becoming increasingly sophisticated, and the demonstration of the beneficial effects of hypothermia on global cerebral ischemia after cardiac arrest hold the promise of similar results for focal cerebral ischemia.
The empiric approach to stroke rehabilitation is being complemented by advances in understanding of brain recovery, aiming at integrated and individualized strategies. Prevention remains the most effective strategy of all, but huge gaps exist between what we know and what is being applied. We are growing more sophisticated in outcomes research, but what gets translated into results in the larger world very much depends on health policy and services delivery, areas of growing importance in an era of increasing demands and more competition for resources.
Controversies are the sparks of progress; they do not always shed light but can ignite action. Judging by the number of contested areas, stroke will be a lively field for a long time to come.
Throughout, we have tried to highlight and integrate advances across the broad field of stroke, for which our journal aspires to be the forum and the voice.