Association between elevated brain tissue glycerol levels and poor outcome following severe traumatic brain injury.

Object: Glycerol is considered to be a marker of cell membrane degradation and thus cellular lysis. Recently, it has become feasible to measure via microdialysis cerebral extracellular fluid (ECF) glycerol concentrations at the patient's bedside. Therefore the aim of this study was to investigate the ECF concentration and time course of glycerol after severe traumatic brain injury (TBI) and its relationship to patient outcome and other monitoring parameters.

Effect of bacterial meningitis complicating severe head trauma upon brain microdialysis and cerebral perfusion.

Introduction: This article describes changes in regional cerebral perfusion and brain metabolism in a case of bacterial meningitis complicating severe traumatic brain injury.

Case Report: As part of clinical monitoring of patients with severe head injury, cerebral microdialysis was performed and extracellular concentration of glucose, lactate, glutamate, and pyruvate was determined. A thermal diffusion probe was used for bedside monitoring of cerebral blood flow.

Incidence of neural tube defects in the least-developed area of India: a population-based study.

Hospital-based records from major cities of India, where roughly a quarter of the population resides, identified the frequency of neural tube defects (NTDs) as ranging from 3.9 to 8.8 per 1000 births, but the incidence in rural areas is unknown.

Rivastigmine and donepezil treatment in moderate to moderately-severe Alzheimer's disease over a 2-year period.

Objectives: Randomised controlled trials that directly compare cholinesterase inhibitors for the treatment of Alzheimer's disease have been characterised by significant methodological limitations. As a consequence, they have failed to establish whether there are differences between agents in this class. To help address this question, a double-blind, randomised, controlled, multicentre trial was designed to evaluate the efficacy and tolerability of cholinesterase inhibitor treatment in patients with moderate to moderately-severe Alzheimer's disease over a 2-year period.

Concurrent monitoring of cerebral electrophysiology and metabolism after traumatic brain injury: an experimental and clinical study.

Multiparameter cerebral monitoring has been widely applied in traumatic brain injury to study posttraumatic pathophysiology and to manage head-injured patients (e.g., combining O(2) and pH sensors with cerebral microdialysis).

Cognitive performance in patients with Alzheimer's disease receiving cholinesterase inhibitors for up to 5 years.

The cholinesterase inhibitors (ChE-Is)--rivastigmine, donepezil and galantamine--demonstrated efficacy in large, 6-month, double-blind, placebo-controlled trials, and are widely used for the symptomatic treatment of patients with mild-to-moderate Alzheimer's disease (AD). Over the past few years, data have emerged, suggesting that these agents may have long-term benefits. These data have been summarized in this study, followed by an interpretation of clinical relevance.

Effect of awake Carotid Endarterectomy under local anaesthesia on peri-operative blood pressure: blood pressure is normalised when carotid stenosis is treated under local anaesthesia.

Background: Carotid Endarterectomy can be performed under local, regional or general anaesthesia. One of the most important effects of the type of anaesthetic used is on the systemic blood pressure. Although variations in blood pressure during and following carotid endarterectomy have been studied previously, the effects of awake carotid endarterectomy under local anaesthesia on blood pressure and its comparison with similar procedures under similar types of anaesthesia have not.

Treatment of behavioural and psychiatric symptoms in dementia: implications of recent safety warnings.

Atypical antipsychotics are commonly used off-label to treat behavioural and psychiatric symptoms in dementia (BPSD), particularly in elderly care homes. Much of this use is inappropriate, and trials have shown an increased likelihood of serious cerebrovascular adverse events (CVAEs) such as stroke and transient ischemic attack (TIA) in elderly patients. The aetiology of this risk is not known, but may be related to metabolic effects and excess weight gain.

Galantamine: use in Alzheimer's disease and related disorders.

Galantamine (Reminyl) has long been used as a traditional medicine and has an interesting pharmacology as it is both a reversible acetylcholinesterase inhibitor and an allosteric potentiator of nicotinic cholinergic receptors. The efficacy of galantamine has been studied in an extensive development program in Alzheimer's disease, and mixed and vascular dementia. Randomized, double-blind, placebo-controlled trials of up to 6 months duration and subsequent open-label follow-up studies have produced a broad spectrum of beneficial effects on cognitive and noncognitive disease symptoms.

Prediction of fetal anemia in pregnancies with red-cell alloimmunization: comparison of middle cerebral artery peak systolic velocity and amniotic fluid OD450.

Objective: To compare the accuracy of Doppler velocimetry (middle cerebral artery peak systolic velocity, MCA-PSV) and amniocentesis (amniotic fluid delta optical density 450 (OD450)) for the detection of fetal anemia against the gold standard of fetal blood sampling (FBS).

Methods: Thirty-eight pregnancies were identified to be at risk of fetal anemia from immune causes between January 2000 and May 2002. In a cross-sectional diagnostic accuracy study, MCA-PSV and amniotic fluid delta OD450 values were plotted on reference charts and compared to an FBS obtained within the subsequent 7 days.

Bispectral index monitoring may not reliably indicate cerebral ischaemia during awake carotid endarterectomy.

Background: Intraoperative ischaemia during carotid cross-clamping in patients undergoing carotid endarterectomy (CEA) is a major complication and prompt recognition of insufficient collateral blood supply is crucial. Electroencephalogram (EEG) is believed to be one of the useful forms of monitoring cerebrovascular insufficiency during CEA. The aim of this study was to evaluate the utility of bispectral index (BIS) monitoring, a processed EEG parameter, for the reliable detection of intraoperative cerebral ischaemia during awake CEA.

SGS-742 Novartis.

SGS-742, a GABA(B) antagonist, is being developed by Saegis, under license from Novartis, for the potential treatment of mild cognitive impairment and Alzheimer's disease (AD). In May 2004, Saegis began enrollment in a phase II trial of SGS-742 in mild-to-moderate AD patients.

Evaluation of the safety and immunogenicity of synthetic Abeta42 (AN1792) in patients with AD.

Background: Abeta42-immunization reduces plaque burden and improves cognition in transgenic mouse models of Alzheimer disease (AD). This phase 1 study evaluated the safety, tolerability, and immunogenicity of AN1792 (human aggregated Abeta42) in patients with mild to moderate AD.

Methods: Twenty patients were enrolled into each of four dose groups and randomly assigned to receive IM AN1792 (50 or 225 microg) with QS-21 adjuvant (50 or 100 microg) or QS-21 only (control) in a 4:1 active:control ratio on day 0 and at weeks 4, 12, and 24.

Vascular cognitive disorder: a new diagnostic category updating vascular cognitive impairment and vascular dementia.

Vascular cognitive impairment (VCI) was proposed as an umbrella term to include subjects affected with any degree of cognitive impairment resulting from cerebrovascular disease (CVD), ranging from mild cognitive impairment (MCI) to vascular dementia. VCI may or may not exclude the host of "focal" circumscribed impairments of specialized functions such as language (aphasia), intentional gesture (apraxia), or categorical recognition (agnosia), among others, that may result from a stroke. Therefore, there are no universally accepted diagnostic criteria for VCI.

Alveolar and plasma concentrations of interleukin-8 and vascular endothelial growth factor following oesophagectomy.

The acute respiratory distress syndrome occurs in approximately 10% of all patients undergoing elective oesophagectomy. Local increases in lung pro-inflammatory cytokines have been previously detected in high-risk patients before the development of the acute respiratory distress syndrome. We hypothesised that similar changes would occur following oesophagectomy.

Influence of oxygen therapy on glucose-lactate metabolism after diffuse brain injury.

Object: Severe traumatic brain injury (TBI) imposes a huge metabolic load on brain tissue, which can be summarized initially as a state of hypermetabolism and hyperglycolysis. In experiments O2 consumption has been shown to increase early after trauma, especially in the presence of high lactate levels and forced O2 availability. In recent clinical studies the effect of increasing O2 availability on brain metabolism has been analyzed.

Molecular and cellular mechanisms in the pathophysiology of severe head injury.

The pathophysiological process following traumatic brain injury is extremely complex and not fully understood. Recent developments have further advanced our knowledge of the cellular and molecular mechanisms that cause this damage. The excitotoxic damage, alterations in calcium homeostasis and free radical induced damage are thought to be the key pathways in this process.

The needs of the caregiver in the long-term treatment of Alzheimer disease.

The long-term well-being of caregivers should be included as part of the treatment of patients with Alzheimer disease (AD). Throughout the process of caring for patients with AD, caregivers frequently experience social, emotional, physical, and financial losses, which become more significant as the disease progresses. Minimizing these losses is a goal in the overall management of AD.

Executive function: the core feature of dementia?

Links between Alzheimer's disease (AD) and vascular dementia (VaD) have been examined, and this paper investigates the role of executive control function (ECF) within the dementia syndrome. 307 AD patients, 168 VaD patients and 208 controls were compared on tests of cognitive function. Results indicated that controls outperformed both patient groups (p < 0.

Catalytic ionic hydrogenations.

Catalytic ionic hydrogenation of ketones occurs by proton transfer to a ketone from a cationic metal dihydride, followed by hydride transfer from a neutral metal hydride. This contrasts with traditional catalysts for ketone hydrogenation that require binding of the ketone to the metal and subsequent insertion of the ketone into a M-H bond. Ionic hydrogenation catalysts based on the inexpensive metals molybdenum and tungsten have been developed based on mechanistic understanding of the individual steps required in the catalytic reaction.

Future directions in the treatment of Alzheimer's disease.

Alzheimer's disease (AD) remains the most common of the neurodegenerative disorders. In the elderly, it represents the most frequently occurring form of dementia, especially if considered alongside concomitant cerebrovascular disease. Current treatment involves the use of acetylcholinesterase inhibitors, which have shown symptomatic benefits in the recognised domains of cognition, function and behaviour.