Septic-associated encephalopathy - everything starts at a microlevel 英文参考文献.docVIP

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Septic-associated encephalopathy - everything starts at a microlevel 英文参考文献.doc

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Septic-associated encephalopathy - everything starts at a microlevel 英文参考文献

Sharsharetal.CriticalCare2010,14:199 /content/14/5/199 COMMENTARY OpenAccess Septic-associatedencephalopathy-everything startsatamicrolevel TarekSharshar1*,AndreaPolito1,AnthonyChecinski1,RobertDStevens2 SeerelatedresearchbyTacconeetal. ,/content/14/4/R140 Abstract Sepsis-associatedencephalopathyisassociatedwithincreasedmortalityandmorbidity.Itspathophysiologyremains insufficientlyelucidated,althoughthereisevidenceforaneuroinflammatoryprocesssequentiallyinvolving endothelialactivation,blood-brainbarrieralterationandcellulardysfunctionandalterationinneurotransmission. Experimentalstudieshaveshownthatmicrocirculatorydysfunction,aconsequenceofendothelialactivation,isan earlypathogenicstep.Todate,wedonotknowwhetheritispresentinsepticpatients,whetheritaccountsfor clinicalfeaturesandwhetheritistreatable. The experimental study by Taccone and colleagues Inflammatory mediators areabletoalter cellular meta- recently published in Critical Care [1] aims to deter- bolism by inducing oxidative stress and mitochondrial mine whether sepsis is associated with early cerebral dysfunction [7], resulting in pathologic abnormalities micro-circulatoryfailure,whichisbelievedtoplayarole that range from alterations of neurotransmission to inthepathophysiologyofsepsis-associatedencephalopa- apoptosis[8].Ithasbeenshownthatexperimentalsep- thy(SAE).SAEisafrequentandseverecomplicationof sis,viainflammatorymediators,altersbraincholinergic sepsis asitisassociated withincreased mortality, mor- [9],beta-adrenergic,gamma-aminobutyricacidandsero- bidityandplausiblywithdiminishedlong-termcognitive toninergic signalling, predominately in the neocortex performance [2,3]. Evidence suggests that SAE results andhippocampus[10].Thisfeaturemayaccountforthe from an alteration of neurotransmission, the mechan- electroencephalographicdisturbancesreportedinseptic ismsofwhichareinsufficientlyelucidated. patients [11]. Additional factors that compound this One pathophysiologic scenario