RESUMO
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.
RESUMO
The objective of this retrospective study was to evaluate the myocardial protection of different periop erative procedures in 100 cases with heart-valve replacement (HVR) between 1980 and 1992. Before Feburary. 1989. HVRs of 48 cases (group Ⅰ) were undertaken with hypothermia (28C=30C) and cold cardioplegic solution (4C. 500ml). under morphine-diazepam-pancuronium anesthesia: following cardiac resuscitation, the procedures were performed including blood transfusion, diuresis, supplemental KCI. inotropic support with dopomine, norepincphrine and aramine. and continuous mechnical ventilation. Since 1989, the procedures were increased to be conducted in 52 cases (group Ⅱ) as followed: A. preoperative managements for achiving the optimum status of cardiac function: 1. oxygen therapy by mask. 2. antirhenmatic treatment for patients aged less than 35 years. 3. oral isosorbide and captopril for pulmonary hypertension, 4, infusion with fructose 1.6-diphusphatc and glucose-insulin-KC1 mixture. 5. clinical dose of digitora and diuretics for cardiac failure; B. methods during surgery: 1. anesthesia was induced with fentanyl, midazolam and pancuronium. and maintained with inhalation of nitrous oxide and infusion of fentanyl at 30-35?g/kg/min, 2, hy pothermia (24C-27C) and cold cardioplegic solution(600-1000ml) 3. immediately before the blockage of aorta was overcome. the artificial perfusion blood pressure was reduced; afterwards, it was gradually recovered, in order to prevent myocardium from injury of reperfusion. 4. intra-and extracoporal circulations worked together over half of blokage time of arota, to improve myoardial oxygen delivery; C. treatments in early postoperative stage: 1. continuous positive end-expiratory pressure ventilation, 2. infusion with magnesium-potassium aspartyl: and the others were similar to those before 1989. As compared with those in group 1. the rate of spontanous restoration of beats increased significantly (P