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BACKGROUND@#Multifocal motor neuropathy (MMN), Lewis-Sumner syndrome (LSS), and many chronic inflammatory demyelinating polyradiculoneuropathies (CIDPs) are representative of acquired multifocal polyneuropathy and are characterized by conduction block (CB). This retrospective study aimed to investigate the demyelinating distribution and the selective vulnerability of MMN, LSS, and CIDP with CB (CIDP-CB) in nerves.@*METHODS@#Fifteen LSS subjects (107 nerves), 24 MMN subjects (176 nerves), and 17 CIDP-CB subjects (110 nerves) were included. Their clinical information was recorded, blood and cerebrospinal fluid tests were conducted, and nerve conductions of the median, ulnar, radial, peroneal, and tibial nerves were evaluated. CB, temporal dispersion, distal motor latency (DML), and F-wave latency were recorded, and nerve conduction velocity, terminal latency index, and modified F-wave ratio were calculated.@*RESULTS@#CB was more likely to occur around the elbow in CIDP-CB than in MMN (78.6% vs. 6.8%, P < 0.01) but less likely to occur between the wrist and the elbow than in LSS (10.7% vs. 39.3%, P < 0.05). Tibial nerve CB was most frequently observed in MMN (47.4%, P < 0.05). CIDP-CB was characterized by a prolonged DML in all nerves, and slow motor nerve velocity of the upper limb was significant when CB nerves were excluded (P < 0.05).@*CONCLUSIONS@#We report the different distributions of segmental and diffuse demyelination of the ulnar and tibial nerves in LSS, MMN, and CIDP-CB. These distinct distributions could help in differentiating among these conditions.
Subject(s)
Humans , Neural Conduction , Peripheral Nerves , Polyneuropathies , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating , Retrospective StudiesABSTRACT
Objective· To explore association between blood-brain barrier (BBB) permeability and physical disability in patients with neuromyelitis optica spectrum disorders (NMOSD).Methods· Clinical data of 105 patients with NMOSD was retrospectively analyzed in Department of Neurology at Changhai Hospital,Second Military Medical University and Renji Hospital,Shanghai Jiao Tong University School of Medicine from June 2009 to June 2016.According to the difference between the expanded disability status scale (EDSS) scores when discharged from hospital and when admitted to hospital,NMOSD patients were divided into disability-reduction group and disability-exacerbation group,and their clinical characteristics were compared between the two groups,then association between BBB permeability and physical disability was analyzed.Results · Between the disabilityreduction group and the disability-exacerbation group,there was no significant difference in gender,age,disease duration,inducing factor,clinical symptoms,and medication (all P＞0.05),and the abnormal rates of thoracic spinal cord in clinical examination were statistically different (P=0.023).There was no significant difference in biochemical data between the two groups (P＞0.05),and a statistically significant difference was observed in the rate of cerebrospinal/serum albumin ratio (QALB) in the cerebrospinal fluid examination (P=0.042).The percentages of exacerbation of disability in the QALB normal and high groups were 27.60％ (16/58) and 46.80％ (22/47),respectively,and there was a statistically significant difference between the two groups (x2=4.150,P=0.042).BBB permeability was positively correlated with physical disability (r=0.299,P=0.042).Conclnsion · The higher the BBB permeability of NMOSD patients on admission is,the higher the degree of physical disability is.The difference in BBB permeability provides key clues to the investigation of the immunological mechanisms of physical disability in NMOSD patients.
ABSTRACT
The neuromyelitis optica spectrum disorders (NMOSD) are a spectrum of central nervous system autoimmune diseases caused by humoralmediated immunity.NMOSD is characterized by specific expression of aquaporin-4 (AQP-4) antibody and involvement of optic nerve and spinal cord.However,the expression level of AQP-4 antibody is not directly proportional to disease activity and recurrence rate,suggesting that multiple mechanisms have been involved in mediating the process of disease.Many evidences of clinical and basic experiments indicated that B lymphocytes play an important role in the pathogenesis of NMOSD.This paper mainly summarized the role of B lymphocytes in the pathogenesis of NMOSD,including aspects of antigen presentation,humoral immunity,regulatory B cell effect and B cell immune tolerance.
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<p><b>OBJECTIVE</b>To determine the efficacy and safety of a diuretic agent, frusemide, combined with doxazosin in the treatment of nocturia in patients with benign prostate hyperplasia / lower urinary tract symptoms (BPH/LUTS).</p><p><b>METHODS</b>Sixty-four BPH/LUTS patients with nocturia were equally randomized into two groups, one treated with doxazosin (4 mg/d), and the other with frusemide (40 mg/d) and doxazosin (4 mg/d), given 6 h before sleep, both for 4 weeks. Urine volume, IPSS, QOL, serum electrolytes, plasma osmolality were recorded and compared between the two groups before and after the treatment.</p><p><b>RESULTS</b>Compared with the doxazosin group, the frusemide plus doxazosin group showed significantly reduced nocturia frequency (P < 0.01), increased daytime urine output (P < 0.01), decreased nocturia urine output (P < 0.01), unchanged total urine output (P > 0.05), improved IPSS and QOL (P < 0.05, P < 0.01), but with no remarkable differences in the levels of serum sodium, potassium, chlorine, and osmotic pressure (P > 0.05).</p><p><b>CONCLUSION</b>Four-week treatment with frusemide plus doxazosin was safe and effective for nocturia in patients with BPH/LUTS.</p>