No abstract

Critical Care 2017, 21(Suppl 1):P349 Introduction Imbalance in cellular energetics has been suggested to be an important mechanism for organ failure in sepsis and septic shock. We hypothesized that such energy imbalance would either be caused by metabolic changes leading to decreased energy production or by increased energy consumption. Thus, we set out to investigate if mitochondrial dysfunction or decreased energy consumption alters cellular metabolism in muscle tissue in experimental sepsis. Methods We submitted anesthetized piglets to sepsis (n = 12) or placebo (n = 4) and monitored them for 3 hours. Plasma lactate and markers of organ failure were measured hourly, as was muscle metabolism by microdialysis. Energy consumption was intervened locally by infusing ouabain through one microdialysis catheter to block major energy expenditure of the cells, by inhibiting the major energy consuming enzyme, N+/K + -ATPase. Similarly, energy production was blocked infusing sodium cyanide (NaCN), in a different region, to block the cytochrome oxidase in muscle tissue mitochondria. Results All animals submitted to sepsis fulfilled sepsis criteria as defined in Sepsis-3, whereas no animals in the placebo group did. Muscle glucose decreased during sepsis independently of N+/K + -ATPase or cytochrome oxidase blockade. Muscle lactate did not increase during sepsis in naïve metabolism. However, during cytochrome oxidase blockade, there was an increase in muscle lactate that was further accentuated during sepsis. Muscle pyruvate did not decrease during sepsis in naïve metabolism. During cytochrome oxidase blockade, there was a decrease in muscle pyruvate, independently of sepsis. Lactate to pyruvate ratio increased during sepsis and was further accentuated during cytochrome oxidase blockade. Muscle glycerol increased during sepsis and decreased slightly without sepsis regardless of N+/K + -ATPase or cytochrome oxidase blocking. There were no significant changes in muscle glutamate or urea during sepsis in absence/presence of N+/K + -ATPase or cytochrome oxidase blockade. ConclusionsThese results indicate increased metabolism of energy substrates in muscle tissue in experimental sepsis. Our results do not indicate presence of energy depletion or mitochondrial dysfunction in muscle and should similar physiologic situation be present in other tissues, other mechanisms of organ failure must be considered. , and long-term follow up has shown increased fracture risk [2]. It is unclear if these changes are a consequence of acute critical illness, or reduced activity afterwards. Bone health assessment during critical illness is challenging, and direct bone strength measurement is not possible. We used a rodent sepsis model to test the hypothesis that critical illness causes early reduction in bone strength and changes in bone architecture. Methods 20 Sprague-Dawley rats (350 ± 15.8g) were anesthetised and randomised to receive cecal ligation and puncture (CLP) (50% cecum length, 18G needle single pass through anterior and posterior wa...

The human brain operates in large-scale functional networks, collectively subsumed as the functional connectome1-13. Recent work has begun to unravel the organization of the connectome, including the temporal dynamics of brain states14-20, the trade-off between segregation and integration9,15,21-23, and a functional hierarchy from lower-order unimodal to higher-order transmodal processing systems24-27. However, it remains unknown how these network properties are embedded in the brain and if they emerge from a common neural foundation. Here we apply time-resolved estimation of brain signal complexity to uncover a unifying principle of brain organization, linking the connectome to neural variability6,28-31. Using functional magnetic resonance imaging (fMRI), we show that neural activity is marked by spontaneous "complexity drops" that reflect episodes of increased pattern regularity in the brain, and that functional connections among brain regions are an expression of their simultaneous engagement in such episodes. Moreover, these complexity drops ubiquitously propagate along cortical hierarchies, suggesting that the brain intrinsically reiterates its own functional architecture. Globally, neural activity clusters into temporal complexity states that dynamically shape the coupling strength and configuration of the connectome, implementing a continuous re-negotiation between cost-efficient segregation and communication-enhancing integration9,15,21,23. Furthermore, complexity states resolve the recently discovered association between anatomical and functional network hierarchies comprehensively25-27,32. Finally, brain signal complexity is highly sensitive to age and reflects inter-individual differences in cognition and motor function. In sum, we identify a spatiotemporal complexity architecture of neural activity — a functional "complexome" that gives rise to the network organization of the human brain.