Clinical validity of cerebral oxygen saturation measured by time-resolved spectroscopy during carotid endarterectomy.

BACKGROUND: Near-infrared spectroscopy has been used clinically to continuously and noninvasively monitor cerebral oxygen saturation (ScO2). However, there is no gold standard for measuring absolute values of ScO2. Although time-resolved spectroscopy (TRS) is one of the most reliable algorithms that reliably calculate absolute values of ScO2, there are very few clinical studies available. To evaluate the clinical relevance of ScO2 measurements using TRS, we compared ScO2 with jugular venous oxygen saturation (SjO2) during carotid endarterectomy. We also investigated factors associated with cerebral oxygen desaturation during clamping of the carotid artery. METHODS: Sixty patients who underwent carotid endarterectomy were enrolled. ScO2 was measured by TRS-20 using TRS at 10 minutes before and after clamping of the carotid artery and 10 minutes after unclamping. SjO2 was measured simultaneously. The relationship between ScO2, SjO2, and estimated ScO2 (0.75×SjO2+0.25×SaO2) were examined by simple regression and the Bland-Altman analysis. Factors related to ScO2<60% were investigated by logistic regression analysis. RESULTS: There was a significant correlation between ScO2 and SjO2 (r=0.49, P<0.002). Bland-Altman analysis revealed narrow limits of agreement between ScO2 and SjO2 (bias, 9.2%; precision, 12.6%), as well as ScO2 and estimated ScO2 (bias, -1.3%; precision, 9.7%). Impaired cerebral hemodynamics (Powers stage 2 or Kuroda type 3) was significantly associated with ScO2<60%. CONCLUSIONS: ScO2 measured by TRS and SjO2 showed narrow limits of agreement. Reduced ScO2 was significantly associated with impaired cerebral hemodynamics.

Functional dissection of a mercuric ion transporter, MerC, from Acidithiobacillus ferrooxidans.

Topological analysis with a phoA gene fusion suggested that Acidithiobacillus ferrooxidans MerC, a mercury transporter, has two periplasmic loops and four transmembrane domains. Cys-23 and Cys-26 of the protein were involved in Hg(2+)-recognition/uptake, but Cys-132 and Cys-137 were not. Escherichia coli cells producing the MerC were hypersensitive to CdCl(2). In this case, mutation of His72 rendered the host cells less CdCl(2) sensitive, whereas none of the Cys residues affected it. E. coli cells expressing the gene encoding a mercuric ion transporter (merC)-deletion mutant, in which the coding-sequence of the carboxy-terminal cytoplasmic region was removed, retained Hg(2+) hypersensitivity and showed about 55% HgCl(2) uptake ability compared to that of the one expressing the intact merC, indicating that the region is not essential for Hg(2+) uptake. Coexpression of A. ferrooxidans the gene encoding mercuric reductase (merA) and the merC deletion mutation conferred HgCl(2) tolerance to E. coli host cells. Under this condition, the merC deletion gene product was exclusively present as a monomer.