Endoscopic surveillance for colitis-associated colorectal neoplas

Endoscopic surveillance for colitis-associated colorectal neoplasia (CRN) and colorectal cancer (CRC) is recommended by multiple national and international gastrointestinal (GI) societies.1, 2, 3, 4, 5, 6, 7 and 8 The goal of endoscopic surveillance is to reduce the morbidity and mortality of CRC, by either GW-572016 detecting and resecting dysplasia or detecting CRC at earlier, potentially curable stages.9 Randomized controlled trials (RCTs) assessing the efficacy of surveillance colonoscopy in IBD have not been performed, and likely will

not be performed.6 Case series, case-control studies, and population-based cohort studies suggest that use of surveillance colonoscopy is associated with an earlier stage of cancer diagnosis and improved CRC-related survival in IBD patients.10, 11, 12, 13 and 14 Although a Cochrane analysis from 2006 concluded that there is no clear evidence that surveillance colonoscopy prolongs survival

in patients with extensive colitis,15 a subsequent cohort study of 149 patients with IBD-associated CRC from the Netherlands, not included in selleck products the Cochrane analysis, found a 100% 5-year survival of 23 patients enrolled in a surveillance program before CRC detection, compared with 74% in a nonsurveillance group (P = .042). 14 Of 30 CRC-related deaths during the study period (January 1, 1990 to July 1, 2006), only 1 patient was in the surveillance group compared with 29 in the nonsurveillance group (P = .047). It was also noted that 52% of patients in the surveillance group had Stage 0 to 1 CRC, compared with 24% in the nonsurveillance group (P = .004). 14 In an exploratory cost-effectiveness model performed by the National Institute for Health and Clinical Excellence (NICE), colonoscopy surveillance

was determined to be cost-effective for high-risk groups, which included IBD patients with any history of dysplasia, extensive active colitis, primary sclerosing cholangitis (PSC), strictures within the last 5 years, or family history of CRC before 50 years of age. 6 Thus, surveillance colonoscopy in patients with ulcerative colitis (UC) and Crohn’s colitis has been 3-oxoacyl-(acyl-carrier-protein) reductase recommended by multiple societies in the United States (American Gastroenterological Society [AGA],2 American Society for Gastrointestinal Endoscopy multiple European societies (British Society for Gastroenterology [BSG],1 NICE,6 European Crohn’s and Colitis Organization [ECCO]7), the [ASGE],5 American College of Gastroenterology [ACG],4 Crohn’s and Colitis Foundation of America [CCFA],3 multiple European societies [British Society for Gastroenterology (BSG),1 NICE,6 European Crohn’s and Colitis Organization (ECCO)],7 the Cancer Council of Australia [CCA],8 the New Zealand Guidelines Group,16 and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition [NASPGHN]).

Self-directed strategy training is recommended for the remediatio

Self-directed strategy training is recommended for the remediation of mild memory deficits after TBI. For impairments of higher cognitive functioning after TBI, interventions that promote self-monitoring and self-regulation for deficits in executive functioning (including impaired self-awareness) and social communication skills interventions for interpersonal and pragmatic conversational problems are recommended after GW-572016 TBI. Comprehensive-holistic neuropsychologic rehabilitation is recommended to improve postacute participation and quality of life after moderate or severe TBI. A number of recommended Practice Standards reflect the lateralized nature

of BTK inhibitor clinical trial cognitive dysfunction that is characteristic of stroke. Visuospatial rehabilitation

that includes visual scanning training for left visual neglect is recommended after right hemisphere stroke. Cognitive-linguistic interventions for aphasia and gestural strategy training for apraxia are recommended after left hemisphere stroke. The Practice Standards for metacognitive strategy training for executive deficits and comprehensive-holistic neuropsychologic rehabilitation after TBI represent upgraded recommendations from our prior reviews. The Practice Options for errorless learning for memory deficits after TBI and for group treatments for cognitive and communication deficits after TBI or left hemisphere stroke represent new recommendations since our prior reviews. Together with our prior reviews, we now have evaluated a total of 370 interventions (65 class I or Ia, 54 class II, and 251 class III studies) that provide evidence for the comparative effectiveness of cognitive rehabilitation.

Among the 65 class I and Ia studies, there were 15 comparisons (which included 3-oxoacyl-(acyl-carrier-protein) reductase 550 participants) of cognitive rehabilitation with no active treatment. In every one of these comparisons, cognitive rehabilitation was shown to be of benefit. There were 17 comparisons (with 696 participants) between cognitive rehabilitation and conventional forms of rehabilitation. Cognitive rehabilitation was shown to be of greater benefit than conventional rehabilitation in 94.1% of these comparisons. Examining this evidence base, there is clear indication that cognitive rehabilitation is the best available form of treatment for people who exhibit neurocognitive impairment and functional limitations after TBI or stroke. Additional research needs to elucidate the mechanisms of change underlying the efficacy of cognitive rehabilitation and the comparative effectiveness of different interventions. Although not the primary focus of our reviews, there are some indications regarding consideration of patient characteristics in cognitive rehabilitation.

825 ng of sample and reference cRNA was mixed and fragmented cRN

825 ng of sample and reference cRNA was mixed and fragmented. cRNA was hybridized to whole mouse genome (4 × 44 K) microarrays (Agilent Technologies Inc.) in stainless steel chambers. A block design was used with three samples and one control placed on each slide. Hybridization was carried out in a rotating hybridization oven in the dark at 65 °C and 10 rpm for 17 h. The slides were then washed for 1 min in each of Agilent’s Gene Expression Wash Buffers 1 and 2. Arrays were scanned on an Agilent DNA Microarray Scanner at 5 μ resolution using Agilent Scan Control software and data were extracted using Agilent Feature Extraction 9.5. A reference

design (Kerr, 2003 and Kerr and Churchill, 2001) with arrays as blocks of size 2 (each block containing the corresponding reference: XL184 Cy3 = green and sample: Cy5 = red channels) was used to analyze the median signal intensities of the two-color microarray data. The experiment included main effects of dose (4

levels, including control), time (2 levels) and dose-by-time interaction. Five biological replicates per condition were used for each of the eight conditions, for a total of 80 microarrays. Six MSC and four TSC “outlier” microarrays were removed based on quality control checks (i.e., poor signal intensity, high background, etc.), leaving a minimum of 3 replicates per group. The background signal intensity for each array was estimated using the 153(−)3xSLv1 negative controls present on each array. All pre-processing of the data was conducted L-gulonolactone oxidase using R (R Development CoreTeam, 2005 and Yang et al., 2002). The data were normalized using the LOWESS normalization method in the R library “MAANOVA”. Differential Adriamycin concentration expression

between the control and exposed samples for each of the three dose levels at each of the two time points was tested using the MAANOVA library (Wu et al., 2003). The ANOVA model was fitted to include the main effects of dose and time, with a dose by time interaction term and the array as a blocking variable. The Fs statistic ( Cui et al., 2005), a shrinkage estimator, was used for the gene-specific variance components, and the associated p-values for all the statistical tests were estimated using the permutation method (30,000 permutations with residual shuffling). These p-values were then adjusted for multiple comparisons using the false discovery rate approach ( Benjamini and Hochberg, 1995). The least squares mean ( Goodnight and Harvey, 1978 and Searle et al., 1980), a function of the model parameters, was used to estimate the fold change for each pairwise comparison of the six pairwise comparisons of interest among the eight treatment-by-time groups. The microarray data for this experiment has been submitted to the Gene Expression Omnibus (GEO) repository and can be accessed under record number GSE44603. Visualization and analysis of significantly changing genes was performed using GeneSpring GX 7.3 (Agilent Technologies).

, 2011) Results are expressed as a percentage of fluorescence in

, 2011). Results are expressed as a percentage of fluorescence intensity with respect to the control. An oxidation system comprising 2,2′-azino-di (3-ethylbenzthiazoline-6-sulfonic

acid) (ABTS), myoglobin and hydrogen peroxide (H2O2) has been used for TAC assay to determine Trolox equivalent antioxidant capacity (Kambayashi et al., 2009 and Yu and Ong, 1999). We used this assay to assess the antioxidant capacity of PFT. Briefly, 90 μL of 10 mM phosphate buffered saline (pH 7.2), 50 μL of myoglobin solution, 20 μL of 3 mM ABTS solution, and 20 μL of PFT or Trolox solution were added to 96-well selleck products microplates. Reactions were started by addition of H2O2 (final concentration: 250 μM), and were followed at 600 nm with a microplate reader for 10 min. Cells were seeded into the Lab-Tek® 8-well chambered cover glass system (Thermo Fisher Scientific, Inc.) at densities of 2 × 104, and were incubated overnight under standard culture conditions. Cells

were pre-treated with or without PFT at 20 μM for 1 h, followed by incubation with DHA at 120 μM for the indicated times. Chambered slides were washed twice with phosphate buffered saline (PBS). For detection of protein 1 light chain 3 (LC3), cells were fixed in ice-cold 1:1 methanol:acetone for 30 min. Slides were immersed for 50 min in 1% goat serum and 0.1% Triton X-100 in PBS, and were then transferred to 10% goat serum/PBS for 20 min. Following the click here PBS rinse, slides were selleck chemicals llc incubated with primary antibody (anti-LC3; MBL, Nagoya, Japan) at 1:1000 in PBS for 1 h at room temperature, washed with PBS, and then incubated with fluorescein isothiocynate (FITC)-conjugated anti-rabbit secondary antibody (Beckman Coulter, Brea, CA) for 30 min. For detection of cytochrome c, after incubation with reagents, the medium was removed and cells were fixed in Mildform® (Wako, Osaka, Japan) for 10 min. Slides were immersed for 5 min in 0.1% Triton X-100 in PBS and were then transferred to 3% FBS/PBS for 30 min. After washing with PBS, slides were incubated with Alexa Fluor® 555 mouse anti-cytochrome c antibody (BD Pharmingen™, San Jose, CA)

at 1:40 in PBS for 1 h. After incubation with antibodies, rinsing with PBS and a drop of UltraCruz™ Mounting Medium with DAPI (Santa Cruz Biotechnology, Inc., Dallas, TX) was added to each well. Cells were observed under a confocal fluorescence microscope (C-1; Nikon, Tokyo, Japan) for blue fluorescence intensity (405 nm) indicating the nucleus, green fluorescence intensity (488 nm) indicating LC3-positive cells (indicative of autophagy), or red fluorescence intensity (562 nm) indicating expression of cytochrome c. In order to detect the effects of PFT and DHA on mitochondrial membrane potential (ΔΨM) in HepG2 cells, we used the Cell Meter JC-10 mitochondrial membrane potential assay kit (AAT Bioquest®, Inc., CA).

Unfortunately, SDS-PAGE and Western blotting detection of the ind

Unfortunately, SDS-PAGE and Western blotting detection of the induced α-gliadin fusion proteins expressed in E. coli confirmed Pexidartinib datasheet that the high-level expression of α-gliadin in vitro was still difficult, although

the T7 promoter induced by IPTG was a suitable promoter for inducing the expression of α-gliadin genes in E. coli. Consequently, such potential contributions to gluten quality were not successfully identified by functional analysis in vitro. Fortunately, the functionality of a protein is determined largely by its three-dimensional structure, produced by folding secondary structures into one or several domains. Knowledge of the secondary structure of a protein may provide clues to its molecular function [34].

Generally, X-ray crystallography and nucleic magnetic resonance spectroscopy (NMR) are the two major experimental methods to determine protein structures accurately, but owing to their complexity, high cost, and time-consuming nature, progress on protein structure determination can be slow. As a result, over the last few years, computer-based automatic methods including GOR, PSIPRED, YASPIN and HNN have been developed for the rapid prediction, evaluation, and visualization of protein structures [34] and [35]. Of the most frequently used online software, PSIPRED is find more the most popular program and has several advantages over other programs including higher prediction accuracy, graphical and colored output of results, description of the confidence score values of each secondary structure element, and

the facility to download results in PDF format [34] and [36]. However, at present, the prediction of the secondary structures of α-gliadins is still very limited. Using PSIPRED version 2.6, Xie et al. [23] predicted the secondary structures of 19 full-ORF α-gliadins that they isolated from common wheat cultivars and Aegilops tauchii accessions and Bumetanide found that the numbers of α-helices and β-strands were not evenly distributed in the different proteins: a high content of β-strands and most of the α-helices and β-strands were found in the two unique domains, and in particular, more secondary structures were present in the C-terminal unique domain II. In addition, few or even no secondary structures were distributed in the N-terminal repetitive domain and glutamine repeat I. They accordingly inferred the C-terminal unique domain II to be the most important domain for the formation of intermolecular disulfide bonds with HMW and LMW glutenins. To ensure the accuracy and comparability of the results, the secondary structure of a total of 198 deduced typical α-gliadins, including the 22 genes cloned in this study, as well as the abovementioned 19 full-ORF genes, were predicted in the present study.

1) After 24 h, ConA at concentrations of 5, 25, and 50 μg/ml inh

1). After 24 h, ConA at concentrations of 5, 25, and 50 μg/ml inhibited BrdU incorporation by 47.66 ± 2.79%, 72.45 ± 1.95%, and 87.58 ± 2.16%, respectively, in MOLT-4 cultures (Fig.

1A), and 39.12 ± 2.69%, 61.18 ± 3.68%, and 78.95 ± 2.66%, respectively, in HL-60 cultures (Fig. 1B). Leukemic cell cultures exposed to ConBr showed an inhibition of BrdU incorporation equal to 47.78 ± 4.52%, 69.31 ± 3.53%, and 86.60 ± 1.80% for MOLT-4 cells treated at 5, 25, and 50 μg/mL, respectively, and 28.65 ± 2.95%, 58.10 ± 3.01%, and 66.81 ± 3.49% for HL-60 cells treated at 5, 25, and 50 μg/mL, respectively. PD0325901 cell line The positive control, etoposide, strongly inhibited the BrdU incorporation, as expected. Etoposide exhibited A1210477 potent cytotoxicity against HL-60 and MOLT-4 cell lines, as expected. The results presented in Fig. 2 demonstrate that ConA and ConBr are not cytotoxic for normal cells (PBMC) at 200 μg/ml using MTT assay. Fig. 3A and B show the effects of ConA and ConBr on DNA damage index and frequency (tailed cells) as measured by DNA damage in leukemic cells according to the alkaline version of the comet

assay. In both cell line cultures exposed to ConA and ConBr, the treated cells clearly show a significant increase in the means of DNA damage index (p < 0.001) and tailed cells (p < 0.001) at all evaluated concentrations. Etoposide, used as the positive control, induced a significant increase in DNA damage and frequency when compared to the negative control, or vehicle (data not shown). While attempting to determine the mechanism responsible for their antiproliferative effects, both the induction of apoptosis or necrosis and the DNA integrity of cells that were treated with lectins were assayed. After 24 h, more than 90% of the counted HL-60 and MOLT-4 cells in the control groups were uniformly green, viable, and had normal morphology ( Fig. 4). As shown in Fig. 4A and B, both lectins reduced the number of viable cells in a concentration-dependent manner after 24 h of exposure at each evaluated concentration

(p < 0.001) in leukemic cell cultures (MOLT-4 and HL-60). However, the effect on cell viability was more pronounced in cultures Calpain treated with ConA. The mechanism of induction of cell death in leukemic cells appears to be the same among the tested lectins. The antiproliferative capacity of both lectins seems to be predominately related to the apoptosis activation rather than necrosis. At the highest tested concentration, MOLT-4 and HL-60 cells exposed to ConA and ConBr showed that more than 60% of analyzed cells shared apoptotic features. These features include condensed or fragmented chromatin, blebs, and apoptotic bodies. The increase in the population of necrotic cells was smaller, achieving 25.33 ± 0.59% and 21.99 ± 1.14% when MOLT-4-treated with 50 μg/mL of ConA and ConBr, respectively.

This number was divided by the known total number of PBL added, t

This number was divided by the known total number of PBL added, to obtain the percentage of the this website PBL that had adhered. At the endothelial layer, the PBL count was divided into those which were phase bright (above EC; fraction X) and those which were phase dark (migrated just below EC; fraction

Y). From these counts and the sum of PBL further into the gel (fraction Z), the percentages of adherent PBL that had undergone transendothelial migration ((Y + Z) / (X + Y + Z)) × 100% and the percentage of migrated cells that had penetrated into the collagen gel (Z / (Y + Z)) × 100% were calculated. The vertical position of those cells within the gels was also recorded. This was done by counting PBL in 18 μm ‘slices’ made up from 5 consecutive images (starting after the image of the endothelial monolayer referred to above), and assigning them a depth equal to the midpoint of that slice. The average depth of penetration was calculated by multiplying the midpoint depth by the number of cells found within that slice (averaged for the 5 fields), summing these values, and dividing the sum by the total number

of cells in the stack. The total gel thickness was also measured (from endothelial layer to base of dish), and the proportion of PBL within the upper and lower halves of the gel was also calculated. In addition, fibroblasts in the gel were counted and depth assigned in a similar manner; these large extended cells could appear in multiple images, and their nucleus was used to assign location. Several variants on this procedure were used for comparison. PBL were added to HUVEC on ‘empty’ gels, or added to selleck gels which contained fibroblasts but did not have an endothelial layer, or added to empty gels. Incubation and analysis of numbers and position of cells were carried out essentially as before. Percentage of PBL entering the gels in the latter cases (without a HUVEC layer) were calculated from the total number click here added to the top of the gel or relative

to the blank gel control. In separate assays, with HUVEC cultured on filters above gels (Fig. 1C), PBL were added to the filter and incubated as above for 24 h. At that time, non-adherent cells were washed from the filter and counted, the filter was removed, and the gel was then analysed as above for the number and position of PBL on or in it. In some cases, the culture was then returned to the incubator, and position of PBL re-evaluated after a further 20 h. At the end of the imaging of gels, constructs in which endothelial cells were cultured on the surface of the gel were treated with dispase II (1 mg/ml; Sigma) for 15 min to dissociate the endothelial monolayer and lymphocytes associated with it. After microscopic check of dissociation, the cells were collected using two washes with M199BSA. For gels without endothelial monolayers, non-adherent cells were collected from the top by two similar washes.

We also demonstrate that co-expression of cytFkpA in the cytoplas

We also demonstrate that co-expression of cytFkpA in the cytoplasm improves the functional protein yields of the anti-EpCAM ING1 and anti-IL1β XPA23 Fab CH5424802 fragments in the periplasm. When expressed alone, these Fabs express poorly (Table 1). Low periplasmic expression can be attributed to cell toxicity issues often resulting from poor translocation across the inner E. coli membrane and/or aggregation in the periplasm. Therefore, our

results are consistent with previous studies that showed more apparent beneficial effects of FkpA on the functional expression of toxic scFv antibody fragments ( Bothmann and Pluckthun, 2000). Interestingly, a recent study suggested that overproduction of FkpA, and to a lesser extent Skp, in E. coli enhances the viability of cells by elevating the expression of genes encoding heat-shock proteins or proteins leading to responses to misfolded protein stress ( Ow et al., 2010). It remains to be seen if the cell viability is also improved when cytFkpA is co-expressed in the bacterial cytoplasm.

The same group reported that co-production of FkpA together with Skp in the periplasm not only increases the solubility and secretion of a scFv to the extracellular medium, but also improves the cell viability. A major advantage of our approach is that the native sequences of Fabs or scFvs do not have to be altered. This approach is in contrast to previous efforts mTOR inhibitor that employ protein engineering techniques to optimize the sequence of antibody fragments by either introducing mutations to increase their solubility (i.e. by generating cysteine-free mutants allowing expression in the cytoplasm without the requirement

for refolding) (Proba et al., 1998 and Worn and Pluckthun, 1998), or by using fusion proteins (Bach et al., 2001 and Jurado et al., 2006). In conclusion, co-expression of the chaperone variant, cytFkpA, offers multiple benefits over alternative approaches for the selection of novel antibody candidates or the optimization of production of existing antibody fragments. Based on the results reported CYTH4 here, the novel expression platform we describe in this work is a useful tool for phage display and recombinant antibody manufacturing. We would like to thank Diane Wilcock for her critical reading of this manuscript. “
“Toxoplasma gondii (T. gondii) is an intracellular protozoan parasite that infects a large variety of domestic and wild mammals, including humans. In humans, infection with T. gondii is generally asymptomatic but during pregnancy, it can result in congenital infection with severe sequelae or late onset eye disease and is a frequent cause of encephalitis in severely immune suppressed patients with AIDS ( Araujo and Remington, 1987). Toxoplasmosis is also a serious complication following organ transplantation ( Aubert et al., 1996). So, detection of T.

The most common procedures and equations used in the statistical

The most common procedures and equations used in the statistical analysis of KIE measurements are listed in Table 1. The derivation and proofs of these expressions can be found in most common statistics or chemistry textbooks (Calcutt and Boddy, 1983 and Skoog et al., 1998) and are therefore not discussed in detail here. Error propagation should start with the individual rate measurements and their experimental errors, and should be carried throughout the entire data analysis whether the results reported are averaged values or subject to regression. When reporting the results from multiple assays the number of independent measurements must be clearly stated in the

figure or table legend. The standard deviation (sdev) describes the precision of a single measurement and thus shows how much variation or “dispersion” exists from the average. For a normal distribution of measurements it is common to report sdev Selleck Ibrutinib as in Table 1, which describes the deviation from the average value where 68.2% of the measured values are found (i.e., 1σ). In cases where higher precision is needed, the distribution in which 95.4% of the measured values are found Selleckchem AZD5363 (i.e., 2σ) can also be calculated ( Calcutt and Boddy, 1983; Skoog et al., 1998). The reliability of the reported value increases when more experiments are conducted, and for more than 7 independent measurements this reliability can be estimated from about twice the

standard error (a factor known as the 95% confidence interval). Standard errors (serr) describe the variability of a population of data and reveal information concerning the reproducibility

Baricitinib of the measurement. For less than 7 independent measurements, it is more meaningful to report standard deviation and the number of measurements (N). While either the standard deviation or error may be appropriate for a given set of data, the parameter used should always be clearly noted when reporting isotope effects. In addition, one should always state which statistical method was used in the analysis (i.e. method of least squares, confidence limits) so the reader can determine the meaning of the reported uncertainty. The final conclusions drawn from isotope effect studies rarely arise from a single KIE, but rather from the KIE as function of various parameters, i.e., the trend of the data collected over a range of experimental conditions. KIE measurements are often examined as a function of pH (Cook and Cleland, 1981a, Cook and Cleland, 1981b, Francis and Gadda, 2006 and Gadda et al., 2000), temperature (Kohen et al., 1999, Limbach et al., 2006, Nagel and Klinman, 2006, Roston et al., 2012 and Wang et al., 2006), pressure (Hay et al., 2007, Hay et al., 2010, Hay et al., 2012 and Pudney et al., 2010), concentration of another substrate (Fan and Gadda, 2005 and Hong et al., 2007), or fraction conversion (for competitive KIEs) (Kohen et al., 1999; Sikorski et al., 2004; Stojkovic et al.

Despite achievement and maintenance of global hemodynamic and oxy

Despite achievement and maintenance of global hemodynamic and oxygenation goals, patients may develop microcirculatory dysfunction with associated organ failure. A thorough understanding of the microcirculatory system under physiologic conditions will assist the clinician in early recognition of microcirculatory dysfunction in impending and actual disease states. Penelope S. Benedik and Shannan K. Hamlin Erythrocytes are not just oxygen delivery devices but play

an active metabolic role in modulating microvascular blood flow. Hemoglobin and red blood cell morphology change as local oxygen levels fall, eliciting the release of adenosine triphosphate and nitric oxide to initiate local vasodilation. Aged erythrocytes Bafilomycin A1 purchase undergo physical and functional selleck compound changes such that some of the red cell’s most physiologically helpful attributes are diminished. This article reviews the functional anatomy and applied physiology of the erythrocyte and the microcirculation with

an emphasis on how erythrocytes modulate microvascular function. The effects of cell storage on the metabolic functions of the erythrocyte are also briefly discussed. Shannan K. Hamlin and Penelope S. Benedik Blood rheology, or hemorheology, involves the flow and deformation behavior of blood and its formed elements (ie, erythrocytes, leukocytes, Aldol condensation platelets). The adequacy of blood flow to meet metabolic demands through large circulatory vessels depends highly on vascular control mechanisms. However, the extent to which rheologic properties of blood contribute to vascular flow resistance,

particularly in the microcirculation, is becoming more appreciated. Current evidence suggests that microvascular blood flow is determined by local vessel resistance and hemorheologic factors such as blood viscosity, erythrocyte deformability, and erythrocyte aggregation. Such knowledge will aid clinicians caring for patients with hemodynamic alterations. Penelope S. Benedik This article describes promising emerging technologies developed for measuring tissue-level oxygenation or perfusion, each with its own inherent limitations. The end user must understand what the instrument measures and how to interpret the readings. Optical monitoring using near-infrared spectrometry, Doppler shift, and videomicroscopy are discussed in terms of their application at the tissue level. Assessment of the metabolic state of the extracellular space with existing technology and proxy indicators of metabolic status are discussed. Also addressed are potential sources of variation for each technique, and the role that the clinician plays in the proper interpretation of the data.