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However, it has been concluded that this low efficiency photodegradation does not account for the therapeutic effect of phototherapy compared to more efficient isomerization processes. The most efficient processes involve isomerization between so-called Z and E forms and involve twists around the two key double bonds. All three isomers that have an E component are more water soluble than the natural Z,Z isomer and are excretable without glucuronidation. Binding of bilirubin to human albumin restricts configurational photoisomerization, at least initially, to the Z,E isomer. All three E isomers have absorption spectra that are similar to that of the Z,Z isomer and can undergo the reverse photoisomerization to the respective Z isomer. Z,Z to Z,E isomerization is highly quantum efficient, with 10% to 20% of bilirubin molecules that absorb light converted to the Z,E isomer. Reverse photoisomerization from Z,E to Z,Z occurs with 40% to 80% quantum efficiency (quantum yield). The reversibility and high efficiencies of this interconversion lead to a rapid establishment of equilibrium at a mix of approximately 20% Z,E- and 80% Z,Z-bilirubin, which can be observed in vivo after less than an hour of therapy at the levels of irradiance commonly used. The Z,E isomer has a serum half-life of approximately 15 hours, indicating a relatively slow excretion rate. The E isomers are not thermally stable and can revert to Z isomers in the dark at rates dependent on their environment. Structural isomerization, involving a cyclization with new bond formations within bilirubin, leads to a set of isomers collectively called lumirubin. The photo-formation of lumirubin at steady state has quantum efficiency on the order of only 0. Both structural considerations and experimental observations indicate that the lumirubins are formed from precursor E isomers. Lumirubin isomers are more water soluble than Z,Z-bilirubin and directly excretable at a relatively fast rate (serum half-life of approximately 2 hours). The relative contributions of the various photoproducts to the phototherapyenabled excretion of bilirubin remain controversial. However, it is thought that, despite its low efficiency of production, the excretion pathway via lumirubin has greater importance. The difference in the photo-reversibility of lumirubin and the Z,E isomer has clinical implications. If formation of the Z,E isomer were essential to the light-induced excretion of bilirubin, the maximum fraction of Z,E isomer produced of approximately 20% to 25% (the photo-stationary fraction) would predict a limit to the useful light intensity. Once the stationary amount were reached, only enough light to maintain that amount against the excretion rate would be useful. Higher irradiance would not increase therapeutic efficacy and would only heat the infant. This suggests the possible benefit of using intermittent phototherapy, wherein sufficient irradiance to produce a photostationary mixture of Z,Z and Z,E isomers is employed, followed by a dark period, and then cycled again. Unanticipated effects of phototherapy were an initial concern because of the potential for direct effect on structures at or near the body surface.
Vimax 30caps
Mehta R, Petrova A: Intrauterine neutrophil activation is associated with pulmonary hemorrhage in preterm infants. Rivas-Fuentes S, Garcia-Garcia E, Nieto-Castaneda G, Rosales C: Fcgamma receptors exhibit different phagocytosis potential in human neutrophils. Strunk T, Currie A, Richmond P, et al: Innate immunity in human newborn infants: prematurity means more than immaturity. Gessler P, Nebe T, Birle A, et al: Neutrophil respiratory burst in term and preterm neonates without signs of infection and in those with increased levels of C-reactive protein. Faurschou M, Borregaard N: Neutrophil granules and secretory vesicles in inflammation. Levy O: Antimicrobial proteins and peptides: anti-infective molecules of mammalian leukocytes. Sengelov H, Follin P, Kjeldsen L, et al: Mobilization of granules and secretory vesicles during in vivo exudation of human neutrophils. Mollinedo F, Nakajima M, Llorens A, et al: Major co-localization of the extracellular-matrix degradative enzymes heparanase and gelatinase in tertiary granules of human neutrophils. Sato S, Ouellet N, Pelletier I, et al: Role of galectin-3 as an adhesion molecule for neutrophil extravasation during streptococcal pneumonia. Sundqvist M, Osla V, Jacobsson B, et al: Cord blood neutrophils display a galectin-3 responsive phenotype accentuated by vaginal delivery. Cabrini M, Nahmod K, Geffner J: New insights into the mechanisms controlling neutrophil survival. Caielli S, Banchereau J, Pascual V: Neutrophils come of age in chronic inflammation. Haslett C: Granulocyte apoptosis and its role in the resolution and control of lung inflammation. Ballabh P, Simm M, Kumari J, et al: Neutrophil and monocyte adhesion molecules in bronchopulmonary dysplasia, and effects of corticosteroids. Hauck F, Klein C: Pathogenic mechanisms and clinical implications of congenital neutropenia syndromes. Mehta R, Petrova A: Intrapartum magnesium sulfate exposure attenuates neutrophil function in preterm neonates. Oei J, Lui K, Wang H, Henry R: Decreased neutrophil apoptosis in tracheal fluids of preterm infants at risk of chronic lung disease. Strunk T, Inder T, Wang X, et al: Infection-induced inflammation and cerebral injury in preterm infants. Musemeche C, Caplan M, Hsueh W, et al: Experimental necrotizing enterocolitis: the role of polymorphonuclear neutrophils. Buhrer C, Graulich J, Stibenz D, et al: L-selectin is down-regulated in umbilical cord blood granulocytes and monocytes of newborn infants with acute bacterial infection. Giannaki G, Rizos D, Xyni K, et al: Serum soluble E- and L-selectin in the very early neonatal period.