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AIM: Encephalopathy is a pivotal complication of sepsis yet the pathophysiology remains unclear.METHODS AND RESULTS: We tested the hypothesis that cerebral leukocyte-endothelial cell adhesion and microvascular leak are dependent on purinergic P2RX7 signaling that engages a specific β2-integrin/adhesion molecule/chemokine cascade culiminating in cerebral microglial activation and migration,neurovascular damage and septic encephalopathy.