Adv Exp Med Biol
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Using broadband near-infrared spectroscopy (NIRS) and cerebral microdialysis (MD),we investigated cerebral cellular metabolism and mitochondrial redox states, following hypercapnoea in 6 patients with traumatic brain injury (TBI). In all patients hypercapnoea increased intracranial pressure and cerebral blood flow velocity measured with transcranial Doppler. ⋯ Although no obvious association was seen between the Δ[oxCCO] and the MD, measured changes in lactate and pyruvate concentrations. Further work using model informed data interpretation may be helpful in understanding the multimodal signals acquired in this heterogeneous patient group.
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Multicenter Study
Impaired cerebral autoregulation using near-infrared spectroscopy and its relation to clinical outcomes in premature infants.
The concordance between the change in the Mean Arterial Blood Pressure (MABP) and the Cerebral Blood Flow (CBF) is studied using the Correlation, Coherence and Partial Coherence methods in order to detect Impaired Cerebral Autoregulation in Neonates. The presence of impaired autoregulation is assessed by the use of the Critical Percentage of Recording Time (CPRT). The changes in CBF are reflected by the measurement of changes in cerebral intravascular oxygenation (HbD), regional cerebral oxygen saturation (rSO(2)), and cerebral tissue oxygenation (TOI), as measured by Near-Infrared Spectroscopy (NIRS) (INVOS4100 and NIRO300). The relation between impaired autoregulation and long term clinical outcomes in premature infants is studied.
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This chapter focuses on the role of sphingolipids in the regulation of sterol-regulatory element binding protein (SREBP) dependent lipid synthesis and ATP-binding cassette protein ABCA1 and ABCG1 mediated lipid efflux, key regulators of cellular lipid homeostasis. Sphingolipid synthesis activates SREBPs independently of whether sphingolipid synthesis occurs through recycling or de novo pathways. SREBPs are major transcription factors of lipid metabolism that regulate more than 30 genes of cholesterol, fatty acid and phospholipid synthetic enzymes and they required NADPH cofactors. ⋯ Animal studies support the findings made in cultured cells. Inhibition of sphingolipid de novo synthesis increases anti-atherogenic lipoproteins and decreases atherosclerosis in mouse models. Together, manipulation of sphingolipid synthetic pathways is a potentially promising therapeutic target for treatment of low-HDL dyslipidemia and atherosclerosis.
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Significant advances, especially in microbiologic diagnostics and brain imaging, have broadened our understanding of the etiology, pathogenesis, and natural history of acute encephalitis. In some instances this had led to specific therapies and preventive measures. The clinical hallmark of acute encephalitis is the triad of fever, headache, and altered mental status. ⋯ Beyond this there is another robust but not exhaustive list (Table 2) of important considerations in the differential diagnosis. These include infectious agents (bacterial, fungal, parasitic, and amebic) as well as non-infectious etiologies (parainfectious, post-infectious, autoimmune, neoplastic, cerebrovascular, systemic, and other conditions). The challenge for the clinician is to rapidly hone the list and make critical management decisions by considering the specific features of the setting of the patient's illness, host susceptibility, clinical and neurologic findings, and results of laboratory and imaging studies.