tailieunhanh - Báo cáo y học: " Bench-to-bedside review: A possible resolution of the glucose paradox of cerebral ischemia"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Bench-to-bedside review: A possible resolution of the glucose paradox of cerebral ischemia. | Critical Care August 2002 Vol 6 No 4 Schurr Review Bench-to-bedside review A possible resolution of the glucose paradox of cerebral ischemia Avital Schurr Brain Attack Research Laboratory Department of Anesthesiology University of Louisville School of Medicine Louisville KY 40292 USA Correspondence Avital Schurr a0schu01@ Published online 7 June 2002 Critical Care 2002 6 330-334 This article is online at http content 6 4 330 2002 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X This article is based on a presentation at the Lactate Satellite Meeting held during the 8th Indonesian-International Symposium on Shock Critical Care Bali Indonesia 24 August 2001. Abstract The glucose paradox of cerebral ischemia namely the aggravation of delayed ischemic neuronal damage by preischemic hyperglycemia has been promoted as proof that lactic acidosis is a detrimental factor in this brain disorder. Recent studies both in vitro and in vivo have demonstrated lactate as an excellent aerobic energy substrate in the brain and possibly a crucial one immediately postischemia. Moreover evidence has been presented that refutes the lactic acidosis hypothesis of cerebral ischemia and thus has questioned the traditional explanation given for the glucose paradox. An alternative explanation for the aggravating effect of preischemic hyperglycemia on the postischemic outcome has consequently been offered according to which glucose loading induces a short-lived elevation in the release of glucocorticoids. When an episode of cerebral ischemia in the rat coincided with glucose-induced elevated levels of corticosterone CT the main rodent glucocorticoid an aggravation of the ischemic outcome was observed. Both the blockade of CT elevation by chemical adrenalectomy with metyrapone or the blockade of CT receptors in the brain with mifepristone RU486 negated the aggravating effect of preischemic hyperglycemia on the postischemic outcome. Keywords cerebral .

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