Dengue is an important mosquito-borne disease, caused by one of the four serotypes of dengue virus.According to the reports from the World Health Organization, every year 50 to 100 million infections occur, including ...Dengue is an important mosquito-borne disease, caused by one of the four serotypes of dengue virus.According to the reports from the World Health Organization, every year 50 to 100 million infections occur, including 500 000 dengue hemorrhagic fever cases and 22 000 deaths, mostly among children.1 The main features of severe infection are hypotension, fluid leak and shock. Management of dengue shock syndrome and its pathophysiology are not fully understood. We reported two patients with dengue who developed hypotension without considerable fluid accumulation in the third space and explaining an alternative cause for hypotension in these patients.展开更多
Autonomic dysreflexia （AD） is a serious cardiovascular disorder in patients with spinal cord injury （SCI）. The primary underlying cause of AD is loss of supraspinal control over sympathetic preganglionic neurons ...Autonomic dysreflexia （AD） is a serious cardiovascular disorder in patients with spinal cord injury （SCI）. The primary underlying cause of AD is loss of supraspinal control over sympathetic preganglionic neurons （SPNs） caudal to the injury, which renders the SPNs hyper-responsive to stimulation. Central maladaptive plasticity, including C-fiber sprouting and propriospinal fiber proliferation exaggerates noxious afferent transmission to the SPNs, causing them to release massive sympathetic discharges that result in severe hypertensive episodes. In parallel, upregulated peripheral vascular sensitivity following SCI exacerbates the hypertensive response by augmenting gastric and pelvic vasoconstriction. Currently, the majority of clinically employed treatments for AD involve anti-hypertensive medications and Botox injections to the bladder. Although these approaches mitigate the severity of AD, they only yield transient effects and target the effector organs, rather than addressing the primary issue of central sympathetic dysregulation. As such, strategies that aim to restore supraspinal reinnervation of SPNs to improve cardiovascular sympathetic regulation are likely more effective for AD. Recent pre-clinical investigations show that cell transplantation therapy is efficacious in reestablishing spinal sympathetic connections and improving hemodynamic per- formance, which holds promise as a potential therapeutic approach.展开更多
文摘Dengue is an important mosquito-borne disease, caused by one of the four serotypes of dengue virus.According to the reports from the World Health Organization, every year 50 to 100 million infections occur, including 500 000 dengue hemorrhagic fever cases and 22 000 deaths, mostly among children.1 The main features of severe infection are hypotension, fluid leak and shock. Management of dengue shock syndrome and its pathophysiology are not fully understood. We reported two patients with dengue who developed hypotension without considerable fluid accumulation in the third space and explaining an alternative cause for hypotension in these patients.
基金supported by NIH NINDS R01NS099076,Morton Cure Paralysis Funds(MCPF)
文摘Autonomic dysreflexia （AD） is a serious cardiovascular disorder in patients with spinal cord injury （SCI）. The primary underlying cause of AD is loss of supraspinal control over sympathetic preganglionic neurons （SPNs） caudal to the injury, which renders the SPNs hyper-responsive to stimulation. Central maladaptive plasticity, including C-fiber sprouting and propriospinal fiber proliferation exaggerates noxious afferent transmission to the SPNs, causing them to release massive sympathetic discharges that result in severe hypertensive episodes. In parallel, upregulated peripheral vascular sensitivity following SCI exacerbates the hypertensive response by augmenting gastric and pelvic vasoconstriction. Currently, the majority of clinically employed treatments for AD involve anti-hypertensive medications and Botox injections to the bladder. Although these approaches mitigate the severity of AD, they only yield transient effects and target the effector organs, rather than addressing the primary issue of central sympathetic dysregulation. As such, strategies that aim to restore supraspinal reinnervation of SPNs to improve cardiovascular sympathetic regulation are likely more effective for AD. Recent pre-clinical investigations show that cell transplantation therapy is efficacious in reestablishing spinal sympathetic connections and improving hemodynamic per- formance, which holds promise as a potential therapeutic approach.
