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Nephrotic syndrome (NS) is associated with cerebral venous sinus thrombosis (CVST), which is a rare cerebrovascular disorder in children. Systemic anticoagulation with heparin is the standard therapy for CVST, and mechanical thrombectomy (MT) has been described as a salvage treatment for adult anticoagulant refractory CVST, However, it has never been reported in children. We describe a case of MT for refractory CVST in a child with NS. A 13-year-old boy with newly diagnosed NS presented to an emergency department with acute headache. A head computed tomography showed acute thrombus in the superior sagittal sinus, straight sinus and transverse sinus. The child was started on heparin therapy, but clinically deteriorated and became unresponsive. In view of the rapid deterioration of the condition after anticoagulation treatment, the patient received intravascular treatment. Several endovascular technologies, such as stent retriever and large bore suction catheter have been adopted. After endovascular treatment, the patient’s neurological condition was improved within 24 hours, and magnetic resonance venography of the head demonstrated that the CVST was reduced. The child recovered with normal neurological function at discharge. This case highlights the importance of considering MT for refractory CVST, and we suggest that MT may be considered for refractory CVST with NS in children.
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Mechanical thrombectomy is the most effective method for the treatment of adult acute ischemic stroke caused by occlusion of large blood vessels. Compared with traditional therapy, the curative effect is greatly improved. The evidence-based medicine evidence of the treatment is sufficient, and the efficacy is safe and reliable. Since 2015, it has been recommended by the guidelines of various countries. In 2018, the time window of mechanical thrombectomy has been extended from six hours to 24 hours, which benefits more adult patients with acute ischemic stroke. However, due to the lack of high-quality clinical research, there is no corresponding guide recommendation in children, which greatly limits its clinical application. There are some cases of mechanical thrombectomy in children and a few retrospective studies show that it is safe and effective in children in the world, but there are also some challenges. The article reviewed the challenges and implementation plan of thrombectomy in children to provide reference for clinical practice.
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Objective To explore the effects of vasoactive intestinal peptide (VIP)on the ratio of CD4+CD25+Treg/CD4+T cell and the expression of TGF-β1 in experimental autoimmune encephalomyelitis (EAE)rats. Methods We randomly divided 60 healthy female Wistar rats into normal control group,EAE control group,VIP low-dose group and VIP high-dose group.We used myelin basic protein (MBP)+ complete adjuvant (CFA)to establish EAE model. Since the day of model construction, the low- and high-dose VIP groups received intraperitoneal injection of 4 nmol/kg (0.2 mL)and 16 nmol/kg (0.8 mL)of VIP every other day,respectively;normal control group and EAE group received injection of saline of 0.8 mL for 10 days in a row.We recorded the peak of neurological dysfunction score (NDS)changes in the rats,observed the pathological changes and GFAP+astrocyte activation in the brain at the morbidity peak of rats with HE staining,and detected the ratio of CD4+CD25+Treg/CD4+T in the spleen with FACS and TGF-β1 cytokine level in brain tissue with ELISA.Results The peak nerve dysfunction score was decreased in each VIP dose group.In normal control group,there were decreased inflammatory cell infiltration and decreased number of active astrocytes in the brain tissue.The degree of infiltration of inflammatory cells and astrocyte activation in VIP control groups were significantly lower than those in EAE group.The CD4+CD25+Treg/CD4+T cell ratio of the spleen tissue in each dose VIP treated group rats was higher than that in EAE control group.The cytokine level of TGF-β1 in the brain tissue increased in each VIP dose group in the dose-dependent manner.Conclusion Through up-regulating the ratio of CD4+CD25+Treg/CD4+T cell in the spleen tissue,increasing TGF-β1 content in brain tissue,and inhibiting the infiltration of inflammatory cells and the astrocyte activation,VIP plays an important role in prevention and control of EAE.
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Objective To explore the effect of vasoactive intestinal peptide ( VIP) on the prevention and treatment of experimental autoimmune encephalomyelitis(EAE) rats by regulating the levels of IFN-γand IL-17A in brain tissue. Methods Sixty healthy female Wistar rats were randomly divided into 4 groups:normal control group, EAE control group, VIP low-dose group and VIP high-dose group.Myelin basic protein ( MBP)+complete Freurd′s adjuvant ( CFA) was used to establish an EAE model.The low and high-dose VIP groups were intraperitoneally injected with VIP 4 nmol/kg(0.2 ml) and 16 nmol/kg (0.8 ml) respectively every other day,while normal control group and EAE group with 0.8 ml saline for ten consecutive days.The incubation period, progression and peak of neurological dysfunction score ( NDS) changes of rats were recorded.The pathological changes, the GFAP+astrocyte activation in the brain at the morbidity peak of rats and the cytokine levels of IFN-γand IL-17A in brain tissue were observed.Results The incubation period was extended, the progression and peak NDS were shortened in the two VIP groups.In normal control group, there was no inflammatory cell infiltration or active astrocytes in brain tissue.The degree of infiltration of inflammatory cells and the degree of astrocyte activation in the VIP control group were significantly lower than in the EAE group.The cytokine levels of IFN-γand IL-17A in brain tissue were reduced in VIP groups.Conclusion By lowering IFN-γand IL-17A content in brain tissue, the infiltration of inflammatory cells and astrocyte activation are inhibited.VIP plays an important role in prevention and control of EAE.
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Objective To explore the effect of vasoactive intestinal peptide (VIP) on the content of IL-17A in the brain tissue of rat models of experimental autoimmune encephalomyelitis ( EAE) .Methods Sixty healthy female Wistar rats were randomly divided into normal control group, EAE control group, low-dose VIP group and high-dose VIP group. Ten healthy guinea pigs were used to prepare anti-IL-17A antibody.Myelin basic protein ( MBP) +complete adjuvant ( CFA) were used to establish the EAE model.Since the first day of modelling, the low-dose and high-dose VIP groups received intraperitoneal injection of VIP 4 nmol/kg (0.2 mL) and 16 nmol/kg (0.8 mL), respectively, every other day for 10 consecutive days.The normal control group and EAE group were injected with 0.8 mL saline instead of VIP.The incubation period, progression and the peak of neurological dysfunction scores ( NDS) of the rats were recorded.The levels of IL-17A in the brain tissue was determined by ELISA assay, and the GFAP+astrocyte activation in brain at morbidity peak in the rats was examined using anti-GFAP ( glial fibrillary acidic protein) antibodies.Results The incubation period were extended, the progression period was shortened and the peak neuological dysfunction score ( NDS) was decreased in the VIP-treated groups, in a dose-response relationship.The cytokine levels of IL-17A and the astrocyte activation degree in brain tissue were reduced in each VIP dose group, in a dose-response relationship.Conclusions VIP exerts therapeutic effect on experimental autoimmune encephalomyelitis through lowering the IL-17A content and inhibition of astrocyte activation in the brain tissue.
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Objective To investigate immunological mechanism underlying leflunomide ( LEF ) against experimental allergic encephalomyelitis ( EAE) by studying the effects of LEF on peripheral blood CD28/CTLA-4 costimulatory molecules expression in guinea pig with EAE.Methods 50 adult female guinea pigs were randomly divided into normal control group,low dose group,EAE control group,middle dose group,and high dose group, 10 guinea pigs in each group respectively.Low, medium and high dose group were treated with LEF 10 mg/kg· D, 20 mg/kg· D and 40 mg/kg· D orally, 1 times/day, to the termination of the experiment.The expression of CD28, CTLA-4 were detected by flow cytometry, incidence was recorded at the same time.Results Compared with EAE control group,high dose and middle dose group incubation period were prolonged, progress period were shorten and neurological dysfunction score decreased(P<0.05).Compared with normal control group, the expression of CD28 of EAE control group increased and the decreased expression of CTLA-4 (P<0.05).High, middle dose treatment group compared with EAE control group CD28 down regulated expression (P<0.05), but the expression of CTLA-4 increased(P<0.05).Among the treatment groups, of CD28 molecules with high dose group decreased significantly(P<0.05), the expression of CTLA-4 molecules with high dose treatment groups upregulated significantly (P<0.05).Correlation analysis showed that the EAE control group, the treatment group the CD28/CTLA-4 ratio in peripheral blood and nerve dysfunction score is proportional ( r=0.85, P=0.002; r=0.77, P=0.000).Conclusion LEF can reduce EAE guinea pig neurological symptoms, the better and the higher dose effect.Its mechanism may be through down-regulation of CD28 molecules in peripheral blood, upregulation of the expression of CTLA-4 molecule.so as to reduce the inflammatory response, relieve the clinical symptoms.
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Objective To investigate the value of the Changsha version of the Montreal Cognitive Assessment Scale (MoCA) in the assessment of vascular cognitive impairment after cerebral infarction .Methods 112 cases of clinically diagnosed cerebral infarc-tion were selected and divided into the normal cognition (NC) group and vascular cognitive impairment(VCI) group .The Changsha version of MoCA and the mini-mental state examination(MMSE) were adopted to detect the cognitive function ,the correlation of two scales was analyzed and the cutoff values of the Changsha version of MoCA were preliminarily studied .Results The total scores of the Changsha version of MoCA and MMSE in the VCI group were 15 .12 ± 4 .60 and 20 .44 ± 3 .22 respectively ,which were lower than 22 .75 ± 1 .79 and 25 .21 ± 1 .74 in the NC group ,the difference had statistical significance (P< 0 .05);the total scores of the Changsha version of MoCA was positively correlated with the total scores of MMSE (r=0 .84 ,P<0 .01);the best cut-off value of the Changsha version of MoCA was 20/21 ,the sensitivity and specificity were 92% and 95% respectively .Conclusion The Changsha version of MoCA can screen VCI well and has a high screening value ,and its optimal cutoff value is 20/21 .