Neurological research
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Neurological research · Dec 2008
ReviewThe application of viral vectors to enhance regeneration after peripheral nerve repair.
Despite great advancements in surgical repair techniques, a considerable degree of functional impairment remains in the majority of patients after peripheral nerve reconstruction. New concepts to promote regeneration of the peripheral nerve are needed since it is generally held that surgery has reached an optimal technical refinement. Several neurotrophic factors stimulate regeneration of the peripheral nerve, but the effects of the exogenous application of these factors have so far been limited, possibly as the result of their fast degradation and unwanted side effects after systemic application. These problems can be resolved with the recent development of non-toxic, non-immunogenic viral vectors that drive local, long-term transgene expression. ⋯ In the near future, viral vectors will increasingly be used to study a wide range of neurotrophic factors and other potentially therapeutic proteins for their effect on peripheral nerve regeneration in animal models. If this approach leads to beneficial effects on regeneration and functional recovery, the safety and clinical applicability of these viral vectors will allow the rapid translation of basic research to clinical trials. This makes the use of viral vectors a highly attractive concept that holds great promise as a novel adjuvant therapy to peripheral nerve reconstruction.
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Neurological research · Oct 2007
ReviewA synopsis of brain pressures: which? when? are they all useful?
In addition to intracranial pressure (ICP) and cerebral perfusion pressure (CPP), there are many more brain-related measures defined as 'pressures'. Cerebral intra-tissue pressure, critical closing pressure, 'optimal' CPP, non-invasive CPP (nCPP) and non-invasive ICP (nICP), interhemispherical pressure gradients are the modalities which currently attract more attention in the management of head injured patients. ⋯ Most of the derived brain pressures cannot be assessed at the bedside without a dedicated computer tool. Some practical and theoretical aspects about the measurement, signal analysis, estimation process, accuracy and interpretation need further researching and refinement.
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Neurological research · Oct 2007
ReviewPropofol and barbiturates for the anesthesia of refractory convulsive status epilepticus: pros and cons.
To discuss mainly the use of propofol and barbiturates in the anesthesia of refractory status epilepticus (RSE). ⋯ The use of propofol, barbiturates or midazolam in the anesthesia of RSE can be justified. When using propofol, the duration of high doses should be limited to 48 hours and the risk of propofol infusion syndrome should be kept in mind. High doses of barbiturates terminate effectively seizures but recovery from anesthesia prolongs ventilator treatment and intensive care.
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Alteration of sensorium or an encephalopathy is a common diagnostic dilemma in critically ill patients and can be caused by a number of conditions. Sepsis associated encephalopathy (SAE) is now the most common encephalopathy encountered among intensive care unit (ICU) patients. ⋯ It is important to recognize SAE for its therapeutic and prognostic aspects. SAE worsens morbidity and mortality among ICU patients. Most therapeutic options center around aggressive treatment of the underlying infection.
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Neurological research · Apr 2007
ReviewPituitary dysfunction after aneurysmal subarachnoid hemorrhage.
Patients recovering from aneurysmal SAH often complain about weakness, fatigue and impaired cognitive skills. Pituitary dysfunction might be one possible reason for these complaints, as in patients with traumatic brain injury, hypopituitarism is known to be a common complication. ⋯ But anterior pituitary lobe disturbances might not be the only one responsible for some complaints or complications in patients suffering from aneurysmal SAH. Hyponatremia in the early state after SAH could be a hint for posterior pituitary lobe dysfunction.