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BACKGROUND:Cell death and neuroinflammation are two important targets in the treatment of spinal cord injury.Pyroptosis is a programmed cell death closely related to neuroinflammation and targeted inhibition of pyroptosis after spinal cord injury is a promising therapeutic strategy. OBJECTIVE:To summarize the molecular mechanism,positive and negative regulatory factors and therapeutic strategies of pyroptosis in spinal cord injury. METHODS:The search terms were"spinal cord injury,pyroptosis,nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3),Caspase,Gasdermin D(GSDMD),IL-1β,IL-18"and 93 English literatures included in PubMed and Web of Science were finally selected for review. RESULTS AND CONCLUSION:As a newly discovered programmed cell death,pyroptosis has been shown to play an important role in the secondary injury stage after spinal cord injury.Among the regulatory factors of pyroptosis after spinal cord injury,CD73,NRF2,GDF-11,dopamine,FANCC and miR-423-5P could inhibit pyroptosis,while TLR4 and Aopps could promote pyroptosis.In terms of treatment,the active ingredients of traditional Chinese medicine(paeonol,tripterine,betulinic acid,piperine,kaempferol,and camptothecin),exosomes of various cell origins,and some drugs(metformin,topotecan,lithium,zinc,and carbon monoxide-releasing molecule 3)can effectively inhibit pyroptosis and reduce secondary spinal cord injury,but the toxicity and specific dose of these drugs need to be further studied.The specific molecular mechanism by which pyroptosis aggravates spinal cord injury is still poorly understood.The role of non-classical pathways and other inflammasomes is worth further exploration.At present,the research on pyroptosis after spinal cord injury only stays at the animal experiment stage.There are no related clinical studies and no approved targeted therapeutic drugs.(6)The application of pyroptosis after spinal cord injury has great potential,and its specific regulatory mechanism should be further studied in the future to provide a new target for the treatment of spinal cord injury.
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Objective:To investigate the predictive value of platelet aggregation rate for early neurological deterioration (END) after intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS).Methods:Consecutive patients with AIS received IVT at the Department of Neurology, Haikou Hospital Affiliated to Xiangya School of Medical, Central South University from November 2020 to July 2023 were retrospectively included. The maximum platelet aggregation rate (MAR) was measured using the PL-12 multi-parameter platelet function analyzer. END was defined as an increase of ≥4 from baseline in the National Institutes of Health Stroke Scale (NIHSS) score within 24 h after IVT. The demographic, baseline data, laboratory findings, and imaging results between the END and non-END groups were compared, and the dynamic changes in MAR induced by arachidonic acid (AA) and adenosine diphosphate (ADP) before, immediately after, and 2 h after IVT were observed. Multivariate logistic regression analysis was used to determine the independent risk factors for END. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of MAR for END at different time points. Results:A total of 300 patients were included, aged 64.88±8.82 years, with a median baseline NIHSS score of 11 (interquartile range, 8-15) and the onset-to-needle time was 172.03±53.96 min. Among them, 66 patients (22.0%) developed END. The MAR-AA and MAR-DP levels before, immediately after, and 2 h after IVT in the END group were significantly higher than those in the non-END group (all P<0.05). Multivariate logistic regression analysis showed that MAR-AA (odds ratio 1.098, 95% confidence interval 1.039-1.161; P<0.001) and MAR-ADP (odds ratio 1.100, 95% confidence interval 1.038-1.167; P<0.001) at 2 h after IVT were the independent risk factors for END. ROC curve analysis shows that MAR-AA and MAR-ADP before, immediately after, and 2 h after IVT had good predictive value for END. Among them, the area under the curve corresponding to MAR-AA and MAR-ADP at 2 h after IVT was the largest, with values of 0.745 and 0.710, respectively. The optimal cutoff value of MAR-AA was 39.28%, and the sensitivity and specificity for predicting END were 74.2% and 76.1%, respectively. The optimal cutoff value of MAR-ADP was 43.35%, and the sensitivity and specificity for predicting END were 69.7% and 66.2%, respectively. Conclusion:The MAR measured by PL-12 is closely associated with the risk of END in patients with AIS after IVT treatment, and has good predictive value for END.
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Objective:To investigate the predictive value of platelet reactivity for early neurological deterioration (END) in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke within 48 h of onset admitted to the Department of Neurology, the Affiliated Haikou Hospital of Xiangya School of Medicine, Central South University from January 2017 to March 2019 were enrolled prospectively. Aspirin was taken on the day of admission, and the platelet aggregation rate was detected using a PL-11 Platelet Function Analyzer 7 d after taking it. END was defined as the National Institutes of Health Stroke Scale (NHISS) score at any time point within 7 d after admission increased by ≥2 or the motor function item score increased by ≥1 from baseline. The demographics, baseline data, imaging examination and laboratory findings of patients in the END and non-END groups were compared. Multivariate logistic regression analysis was used to determine the independent risk factors for END. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of platelet aggregation rate for END. Results:A total of 230 patients were included in the study. They aged 63.24±9.75 years, 126 were females (51.4%). The median baseline NIHSS score was 6 (interquartile range, 4-10). The median time from onset to admission was 15 h (interquartile range, 9-28 h). There were 54 patients (23.5%) in the END group and 176 (76.5%) in the non-END group. There were significant differences in arachidonic acid-induced maximum platelet aggregation ratio (MAR-AA), epinephrine-induced maximum platelet aggregation ratio (MAR-EPI) and collagen-induced maximum platelet aggregation ratio (MAR-COL) between the END group and the non-END group (all P<0.05). Multivariate logistic regression analysis showed that MAR-AA (odd ratio [ OR] 1.165, 95% confidence interval [ CI] 1.091-1.243; P<0.001) and MAR-EPI ( OR 1.035, 95% CI 1.006-1.067; P=0.023) were the independent risk factors for END in patients with acute ischemic stroke. ROC curve analysis showed that MAR-AA had good predictive value for END, and the area under the curve was 0.775 (95% CI 0.707-0.843; P<0.001). The optimal cut-off value was 21.80%. The sensitivity and specificity of MAR-AA for predicting END were 72.2% and 77.3%, respectively. Conclusions:The platelet function measured by PL-11 is closely related to the risk of END in patients with acute ischemic stroke. It has a better predictive value for END.
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Objective@#To investigate the clinical efficacy of dexamethasone combined with budesonide in the treatment of children with acute infectious laryngitis.@*Methods@#From May 2014 to May 2017, 85 children with acute infectious laryngitis in our hospital were randomly divided into observation group(43 cases) and control group(42 cases) according to the digital table.The control group was treated with dexamethasone, the observation group inhaled budesonide on the basis of the dexamethasone treatment.The clinical effect was compared between the two groups.@*Results@#The effective rate of the observation group was significantly higher than that of the control group(97.9% vs.85.7%), the difference was statistically significant(χ2=4.022, P<0.05). The symptoms disappeared time of laryngeal obstruction [(1.2±0.2)d vs.(1.8±0.4)d], hoarseness [(2.2±0.6)d vs.(2.7±0.9)d], dyspnea [(1.5±0.4)d vs.(2.2±0.6)d], fever [(2.3±0.7)d vs.(3.0±0.9)d]and cough [(5.1±1.2)d vs.(6.7±1.7)d], the hospitalization time [(6.7±1.3)d vs.(8.9±1.9)d]in the observation group were significantly shorter than those in the control group (t=8.778, 3.020, 6.343, 4.008, 5.023, 6.243, all P<0.05). There was no statisticallysignificant difference in the incidence rate of adverse reactions between the two groups(χ2=0.508, P>0.05).@*Conclusion@#The combination of dexamethasone and budesonide in the treatment of acute infectious laryngitis can significantly improve the therapeutic effect, shorten the time of improvement of clinical symptoms, and with high safety, so it is worthy of clinical application.
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Objective To observe continuous venous-venous hemofiltration (CVVH) for treatments and cares of severe acute pancreatitis(SAP). Methods From August 2004 to August 2006, 15 cases with SAP were in conventional treatment (the control group), from September 2006 to August 2010, 20 cases with SAP were nursed with CVVH(the observation group). We surveyed patients' vital signs (including body temperature, heart rate, breathing and blood pressure),mental symptoms, abdominal signs and monitored liver and kidney functions. Additionally we executed APACHE Ⅱ scores. We analyzed them retrospectively. Results The afore - mentioned indexes of two groups were significant in statistics, the observation group had lower incidence of MODS、MOF than the control group after 10 days caring. Conclusions The CVVH could correct systemic inflammatory reaction of SAP and prevent complications. Standard technical operation and intensive nursing can ensure smooth process of CVVH and decrease complications caused by CVVH.
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Objective: Through treatment based on differentiation of symptoms and signs and classification of defi nited patients of maternofetal blood group incompatibility, detecting anti-A or Anti-B antibody and erythrocyte immune complex chaplet rate(RICR) and erythrocyte receptor chaplet rate(RC3bR) , etc, to observe the therapeutic effect and mechanism of prescriptions mainly with Yinchenhao Decoction. Methods: Patients definited maternofetal blood group incompatibility were divided into control group and observation group according to random principle in 1:3 ratio. Then, observation group was divided into moist heat group(SRG), moist heat and defi ciency of spleen qi group (SR+PQXG) and moist heat and defi ciency of kidney qi group(SR+SQXG) according to syndrome differentiation. Corresponding prescriptions were used, every 30 doses 1 course. Before and after treatment, the anti-A or anti-B antibody and RICR, RC3bR were detected in peripheral blood. Results: In Yinchenhao Decoction group with 21 cases, the anti-A or anti anti-B antibody decreased, including 5 case (1:64) and 4 case (1:32). In group of syndrome differentiation with 63 cases, the anti-A or anti anti-B antibody decreased, including 33 case(1:64) and 20 case (1:32). Before and after treatment, RICR of control group and observation group were(19.43?5.29), (19.57?6.50)and (20.59? 7.96), (23.77?5.12), respectively. RC3bR were(11.62?4.16), (12.42?6.60)and(11.93?4.10), (13.96?6.40)respectively. There was signifi cant difference of before and after treatment in obserbation group(P0.05). Conclusion: In cutting down anti-A and anti-B antibody, and increasing RICR and RC3bR fi eld, the observation groups were better than control group.