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Multiple sclerosis (MS) is an immune-mediated disease characterized by inflammatory demyelinating lesions of the central nervous system. It is one of the most common causes of neurological disability in young and middle-aged people. Clarifying the diagnosis and clinical classification of MS is very important for the early treatment and treatment strategy selection of MS patients. After fully collecting objective clinical evidence and excluding other differential diagnosis, clinicians can evaluate the dissemination in space and time of MS patients in reference to the current diagnostic criteria, and can make treatment strategy selection according to their clinical classification criteria. At present, more examination techniques and evaluation methods for MS diagnosis are being studied and discussed. It is believed that the sensitivity and specificity of MS diagnosis will be further improved in the future.
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Objective To study the seropositive ratio of the antibody to aquporin 4 (AQP4-IgG) and myelin oligodendrocytes glycoprotein antibody(MOG-IgG)in patients with autoimmune-associated central nervous system (CNS) diseases. Meanwhile, epidemiology and clinical manifestation and diagnosis,laboratory examination and magnetic resonance imaging(MRI)of AQP4-IgG seropositive and MOG-IgG seropositive patients are described. Methods 2068 patients serum samples were collected and enrolled in the multi-center research. The methodology of cell-mediated immunofluorescence staining was used to detect serum AQP4-IgG and MOG-IgG. Clinic medical records were collected and characteristics of epidemiology and manifestation were compared. Results 681 patients were AQP4-IgG seropositive and 110 patients were MOG-IgG seropositive. The female/male ratio and age of onset of patients with AQP4-IgG seropositive(616 female and 65 male,female:male=9.50:1.00;Age of onset=41.7±14.9)were significantly higher than that of patients with MOG-IgG (57 female and 53 male, female:male=1.08:1.00, P<0.0001; Age of onset=27.0 ±17.7, P<0.0001). The optic neuritis was significantly higher in patients with AQP4-IgG seropositive and patients with MOG-IgG seropositive (38.4% vs.53.5%, P<0.05).Among patients with AQP4-IgG seropositive, 42.14% conformed the diagnostic criteria of neuromyelitis optica (NMO),which was higher than that of patients with MOG-IgG seropositive (13.64%, P<0.0001). Laboratory examination showed that there was no significant difference in cerebrospinal fluid protein levels between patients with AQP4-IgG seropositive and those with MOG-IgG seropositive.MRI imaging suggested that AQP4-IgG positive patients were more common in cervical thoracic spinal cord lesions, while MOG-IgG positive patients were more involved in thoracolumbar spinal cord. The study also found that these two groups of patients could be comorbid with other autoimmune antibodies. Conclusions This multi-center research has revealed that patients with AQP4-IgG seropositive and those with MOG-IgG seropositive display differences in epidemiology,clinic manifestations and diagnosis,laboratory examination and MRI imaging. AQP4-IgG and MOG IgG auto-antibody detection are necessary for clinic diagnosis and differential diagnosis.
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[Objective]To compare the differences of neuromyelitis optica spectrum disorder(NMOSD)and multiple sclerosis (MS) on pregnancy ,and analyze the mutual impact of pregnancy on the diseases.[Methods]Prospectively collected clinical information of 235 NMOSD patients and 125 MS patients ,including the annualized relapse rate (ARR),the Expanded Disability Status Scale(EDSS)and pregnancy outcomes. 70 NMOSD patients and 30 MS patients were screened out as information patients. The ARR and EDSS score in two groups were compared during the year before pregnancy,during pregnancy and after 1 year postpartum, respectively. 50 cases of normal pregnant women for the same period as the control group ,then to compared the difference of three groups on pregnancy outcomes.[Results]Attacks occurring during pregnancy or one year after childbirth/abortion in NMOSD and MS were 53.25%(41/77)and 20.00%(7/35)(P=0.001);The ARR during the first 3 months postpartum periods of NMOSD and MS group(2.65,2.51)was significantly higher than during the year before pregnancy(0.27,0.49,P < 0.001)and during pregnancy (0.32,0.2,P<0.001);The EDSS score of two groups increased after 1 year postpartum(3.06 ± 2.16,2.19 ± 1.28)than that during the year before pregnancy(1.58 ± 0.48,1.92 ± 1.29,P < 0.001)and during pregnancy(1.92 ± 1.35,1.67 ± 0.70,P < 0.001). There was no difference on ARR and EDSS score between NMOSD and MS group. NMOSD ,MS and normal control group had no dif?ference on pregnancy outcomes and neonatal weight.[Conclusions]Compared with MS,the attack of NMOSD had more closer relation?ship with pregnancy;both NMOSD and MS would increase the risk of disease relapsing and disability after pregnancy;the diseases had no effect on pregnancy outcomes.
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Objective To investigate the distribution characteristics and risk factors of intracranial atherosclerotic stenosis ischemic stroke. Methods We retrospectively collected 342 consecutive patients with first-ever ischemic stroke. Clinical data was collected including demographics, the presence of risk factors,MRI with MRA and other routine admis?sion laboratory tests. Results Intracranial atherosclerotic stenosis (ICAS) was located most frequently in MCA (47.0%), Extracranial internal carotid artery was the most common affected artery (65.0%) among extracranial atherosclerotic steno? sis (ECAS). MetS (OR=1.586,95%CI:1.232~2.268), ApoB/ApoA1 ratio (OR=1.926,95%CI:1.051~4.288), were as?sociated with ICAS (vs ECAS), whereas hypertension (OR=3.603,95%CI:1.675~12.485), MetS (OR=2.268,95%CI:1.274~6.103), HbA1c (OR=2.015,95%CI:1.182~5.613) and ApoB/ ApoA I ratio (OR=1.948,95%CI:1.157~4.285) were related to ICAS (vs NCAS). Hypertension (OR=2.437,95%CI:1.492~3.505,P=0.005), Hcy (OR=2.437,95%CI:1.492~3.505,P=0.005) and HbA1c (OR=1.769,95%CI:1.034~3.121, P=0.005) were the independent risk factors re?lated to posterior circulation strokes (vs anterior circulation strokes ) in ICAS strokes. Conclusions The occurrence of ICAS may be more frequent than that of ECAS in ischemic stroke. Posterior circulation ICAS strokes seems to be close?ly associated with metabolic derangement.
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Objective To investigate the characteristics of ocular movement disorders in patients with multiple sclerosis (MS) and neuromyelitis optica (NMO), and explore the clinical application of videonystagmograph (VNG) exami?nation in the diagnosis and differential diagnosis of MS. Methods Sixteen MS ,10 NMO and 30 control ( sudden deafness ) patients were enrolled prospectively. Ocular movement disorders including saccades, gaze fixation, smooth pursuits, opto?kinetic nystagmus and spontaneous nystagmus were evaluated by using VNG. Results The positive rate of ocular motility disorders in MS patients detected by VGN was 68.75%. The incidences of abnormalities in saccades, smooth pursuits and optokinetic nystagmus were significantly higher in MS than in control groups (P= 0.000, 0.001 and 0.001, respectively). The positive rate of ocular motility disorders in NMO patients detected by VGN was 80.00%. The incidences of abnormal?ities in saccades, gaze fixation, smooth pursuits and optokinetic nystagmus were significantly higher in NMO than control groups (P=0.000, 0.012, 0.000 and 0.002, respectively). The positive rate of ocular motility disorders was not significant? ly different in MS and MS patients (68.5%vs. 80%,P>0.05). Compared with bedside physical examination, VNG showed a notable higher sensitivity in the detection of ocular motility disorders(68.75% vs. 37.50%). Furthermore, VNG disor?ders might indicate brain lesions undetected by MRI. Conclusion This small sample research indicates that VNG is a valuable tool in the detection of ocular motility disorders as well as brain lesions in MS and NMO patients. However, its role in the differential diagnosis between MS and NMO is not confirmed.
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Objective To explore the role of the polymorphism of HLA-DRB1/DPB1 in patients with multiple scle-rosis (MS) and optica neuromyelitis (NMO). Methods Fifty-three patients with MS, 30 patients with NMO and 93 normal controls were enrolled in the present study. The HLA-DRB1/DPB1 gene polymorphism and allele frequencies were deter-mined by sequencing-based typing. All the subjects were Southern Han Chinese and were born in Southern China. Re-sults The frequencies of DPB1*0501 were higher in NMO patients than in controls, P=0.001, P (corrected)=0.022. The frequencies of DRB1*1602 DPB1*0501 haplotype were higher in NMO patients than in MS patients, P<0.001,P (cor-rected)=0.040. Conclusions There is significant difference in HLA-DRB1/DPB1 gene polymorphism between MS and NMO patients in a Southern Han Chinese population. The HLA-DPB1*0501 allele might be the susceptibility gene poly-morphism of NMO.
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Objective To explore the clinical characteristics in patients with histiocytic necrotizing lymphadenitis (also called Kikuchi-Fujimoto' s disease,KD) and meningitis.Methods We reported a patient who developed meningitis preceding the other presentations of KD with abnormal serum autoimmune phenomena,and systematically reviewed 19 cases of KD with meningitis that had been reported worldwide,and analyzed the clinical parameters and treatments.Results The present case was a 25-year-old female subject with serum antinuclear factor antibody and anti-ribonucleoprotein antibody positive.The patient recovered after treatment with steroid and no recurrence was appeared.Among the 19 patients,the average age was 20.2 years,sex ratio was 10:9 (10 female:9 male),7 patients had abnormal serum autoimmune phenomena,7 patients'initial symptom was meningitis and 5 patients were administrated with steroid.Conclusions The onset age in KD with meningitis is earlier than the common KD,and sex ratio in KD with meningitis is close to 1∶ 1.A definitive diagnosis of the disease is determined by a lymph node biopsy at present.
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Objective To analyze the association between interleukin-23 receptor (IL23R) gene single nucleotide polymorphisms (SNPs) and multiple sclerosis (MS) in a Southern Han Chinese population.Methods Three SNPs (rs2201841,rs10889677,rs7517847) within the IL23R gene were detected in 178 MS patients and 221 controls using polymerase chain reaction and restriction fragment length polymorphism method (PCR-RFLP).Haplotypes of the IL23R gene were constructed with SHEsis software.Results The frequencies of the genotype or allele in the IL23R gene SNPs(rs2201841:TT,TC,CC in MS patients:5.7％ (10/175),45.7％ (80/175),48.6％ (85/175),in controls:7.4％ (16/217),41.0％ (89/217),51.6％ (112/217),x2 =1.08,P =0.58 ; rs10889677:AA,AC,CC in MS patients:52.0％ (89/171),42.7％ (73/171),5.3％ (9/171),in controls:57.7％ (123/213),36.2％ (77/213),6.1％ (13/213),x2 =1.71,P =0.43 ; rs7517847:GG,GT,TT in MS patients:16.9％ (29/172),51.7％(89/172),31.4％ (54/172),in controls:14.4％ (31/215),49.3％ (106/215),36.3％(78/215),x2=1.15,P =0.56)showed no significant difference between MS patients and controls.The genotype did not influence the age of onset,the duration or disease severity in MS patients.The SNPs rs2201841 and rs10889677 had strong linkage disequlibrium (D' =0.614,r2 =0.327).The haplotype frequencies showed no significant difference between the MS patients and controls.Conclusion There is no evidence in our study to support the association between IL23R SNPs and MS in a Southern Han Chinese population.
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Objective To analyze clinical and radiological characteristics in 5 cases of neuromyelitisoptica (NMO) with tumefactive-like demyelinating lesions (TDLs).Methods Five NMO patients with TDLs hospitalized during November 2007 and March 2012 were retrospectively analyzed for clinical and magnetic resonance imaging (MRI) features,as well as therapeutic efficiency and prognoses.Results The male-to-female ratio is 1∶4 and the range of onset ages is 15-44 years old.The median time when TDLs was developed was 36 months after the onset of NMO.The anti-aquaporin 4 was seropositive in all NMO patients with TDLs.Four patients had clinical manifestations of encephalopathy symptoms including coma (n =2),seizures (n =1),narcolepsy (n =1),homonymous hemianopia (n =1).All TDLs grew unilaterally.Two TDLs were located at parietal-occipital,1 at parietal,I at the cerebellum and 1 at the temporal.On MRI,there was no enhanced signal in 4 TDLs,and there was open-ring-like enhanced signals in 1 case.Three TDLs revealed mixed signals intensities on diffusion-weighted images and an increase in the apparent diffusion coeficient values.On the subsequent MRIs,the sizes of 5 TDLs were markedly reduced in 3 cases,disappeared in 1 and another 1 case remained the same.Meanwhile,3 lesions subsequently developed cavity forming.Five cases improved after treatment of high-dose corticosteroid and intravenous immune globulin.Conclusions TDLs is not uncommon in NMO.Encephalopathysymptoms are more frequently affected in NMO with TDLs.TDLs often accompany with extensive vasogenic edema,but without enhancement in acute stage.NMO-IgG antibody testing and brain MRI are important in the diagnosis of TDLs.The therapy of corticosteroid and intravenous immune globulin is recommended.
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Objective To investigate the associations of aquaporin-4 (AQP4) promoter polymorphisms with anti-AQP4 antibody and genetic susceptibility to multiple sclerosis (MS) and neuromyelitis optica (NMO) in Southern Chinese population.Methods The polymorphisms of AQP4promoter 0 and 1 were analyzed by PCR and DNA sequencing in 18 NMO,38 MS,13 recurrent myelitis (RM),6 recurrent optic neuritis (RON)patients and 39 healthy controls. Results Fourteen polymorphism loci were observed in AQP4-promoter 0,while 6 ones were observed in AQP4-promoter 1.Among them,the incidence rate of polymorphism at position - 1003 bp (A-G) of AQP4-promoter 0 in anti-AQP4 antibody-positive patients was significantly higher than that in anti-AQP4 antibody-negative patients and controls (former:13/18 vs 20/45,P =0.046; latter:13/18 vs 10/39,P =0.001 ).The incidence rates of polymorphism at position between -401 bp and -400 bp ( C inserted) of AQP4-promoter 1 in anti-AQP4 antibody-positive and -negative patients were significantly higher than that in controls( former:5/16 vs 0/28,P =0.008; latter:8/38 vs 0/28,P =0.027 ). The incidence rates of polymorphism at position - 1003 bp (A-G) of AQP4-promoter 0 and position between -401 bp and -400 bp ( C inserted)of AQP4-promoter 1 in patients with NMO and MS were significantly higher than that in controls( NMO:11/18 vs 10/39,P =0.010;4/15 vs 0/28,P =0.020; MS:19/38 vs 10/39,P =0.027;8/34 vs 0/28,P =0.018).Conclusions Polymorphisms loci were observed in AQP4-promoter 0 and AQP4-promoter 1,which may have an influence on the susceptibility to MS and NMO.Polymorphism at position - 1003 bp ( A-G) of AQP4-promoter 0 may be related to the emergence of anti-AQP4 antibody in patients with NMO and MS.
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Objective To analyze the relationship between diabetics and the onset, clinical outcomes and prognosis of brainstem infarction, and to evaluate the impact of diabetes on brainstem infarction. Method Compare 172 cases of acute brainstem infarction in patients with or without diabetes.Analyze the associated risk factors of patients with brain-stem infarction in diabetics by multi-variate logistic regression analysis. Compare the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin scale (mRS) Score, pathogenetic condition and the outcome of the two groups in different times. Results The systolic blood pressure ( SBP ), TG, LDL-C, apolipoprotein B ( Apo B ), glutamyl transpeptidase (γ-GT), fibrinogen(Fb), fasting blood glucose (FPG) and glycosylated hemoglobin( HbA1c)in diabetic group were higher than those in non-diabetic group , which was statistically significant ( P ＜ 0. 05 ). From multi-variate logistic regression analysis, γ-GT, Apo B and FPG were the risk predictors of diabetes with brainstem infarction( OR = 1. 017, 4. 667 and 3. 173, respectively), while HDL-C was protective( OR =0. 288). HbA1c was a risk predictor of severity for acute brainstem infarction( OR = 1. 299), while Apo A was beneficial( OR =0. 212). Compared with brain-stem infarction in non-diabetic group, NIHSS score and intensive care therapy of diabetic groups on the admission had no statistically significance, while the NIHSS score on discharge and the outcome at 6 months' of follow-up were statistically significant. Conclusions Diabetes is closely associated with brainstem infarction. Brainstem infarction with diabetes cause more rapid progression, poorer prognosis, higher rates of mortality as well as disability and higher recurrence rate of cerebral infarction.
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Objective To investigate the effect of splenectomy on infarct volume in middle cerebral artery occlusion in focal cerebral ischemia rats and its possible mechanisms.Methods Eighteen male Sprague-Dawley rats were randomly divided into spleneetomy,sham splenectomy,and control groups (n =6 in each group).A model of middle cerebral artery occlusion (MCAO) was induced by the intraluminal suture method 2 weeks after spleneetomy.The rats were decapitated and their brains were removed after 24 hours.The infarct volume was measured with Nissl body staining The number of macrophages in ischemic cortex was detected with immunofluorescence staining Results The infarct volume in the splenectomy group (34.93％ + 3.23％ )was significantly smaller than that in the sham splenectomy group (74.33％ + 2.36％ ; q =39.399,P ＜ 0.001 ) and the control group (77.30％ + 2.62％ ; q =42.369,P ＜ 0.001 ).However,there was no significant difference between the sham splenectomy group and the control group (q =2.970,P =0.082).The number of macrophages of the ischemic cortex in the splenectomy group (3.4 ± 1.07/per high power field) was significantly less than that in the sham splenectomy group (20.7±4.37/per high power field; q =17.300,P＜0.001) and the control group (18.87 ±4.17/per high power field; q =15.467,P ＜0.001).However,there was no significant difference between the sham splenectomy group and the control goup (q =1.833,P =0.384).Conclusions Splenectomy may reduce the infarct volume by reducing the number of macrophages in ischemic corticalregion.
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Objective To investigate the correlation between diabetes and brainstem infarction. Methods The diagnozed patients with acute cerebral infarction were recruited in the study. Firstly, they were divided into brainstem infarction group and non-brainstem infarction group, and then they were redivided into brainstem infarction with diabetes, brainstem infarction without diabetes, non-brainstem infarction with diabetes and non-brainstem infarction without diabetes groups according to whether they had diabetes or not. Carotid artery intima-media thickness (IMT) and carotid atherosclerosis were detected and identified with Doppler ultrasound; brain stem infarction and its location were identified with diffusion-weighted imaging; basilar artery atherosclerosis was detected with magnetic resonance angiography (MRA). A multivariate logistic regression analysis was used to screen the different risk factors impacting brainstem infarction. Neurological deficit was evaluated with the modified Rankin Scale (mRS)scores. Results A total of 286 patients with acute cerebral infarction were recruited: brain stem infarction in 63, and 34 of them with diabetes; non-brain stem infarction in 223, and 77 of them with diabetes. The proportions of diabetes (54. 0％ vs. 34. 5%, x2 = 7. 816, P = 0. 005),previous cerebral infarction (38. 1％ vs. 24. 2％ ,x2 =4. 771, P =0. 029), basilar artery atherosclerosis (73.0％ vs. 57. 4％,x2 =5. 028, P =0. 025), as wall as the levels of hemoglobin A1C (HbA1c) (7. 30 ± 2. 42％ vs. 6. 46 ± 1.82％, t = - 2. 531, P = 0. 011 ) and apolipoprotein B (ApoB) (0. 97 ± 0. 33 mmol/L vs. 0. 90 ± 0. 34 mmol/L, t =-2. 180, P = 0. 029) in the brainstem infarction group were significantly higher than those in the non-brainstem infarction group. Multivariate logistic regression analysis showed that diabetes (odds ratio [ OR] 2. 150, 95％confidence interval [ CI] 1. 214-3. 808; P =0. 009) and previous cerebral infarction (OR 1. 835, 95％ CI 1.004-3. 352, P = 0. 048) were the independent risk factors for brainstem infarction. There were significant differences in the levels of HbA1c (P ＜ 0. 001 ), fasting blood glucose (FBG) (P ＜0. 001), ApoB (P =0. 007) and high-density lipoprotein cholesterol (P =0. 018) as well as the proportion of basilar artery atherosclerosis (P = 0. 001 ) among the brainstem infarction with diabetes, without diabetes, non-brainstem infarction with diabetes and without diabetes groups. The levels of HbA1c (8. 81 ±2. 36％), FBG (8. 23 ±3. 12 mmol/L andApoB (1.04 ± 0. 41 mmol/L) as well as the proportion of basilar artery atherosclerosis (85. 3％ )were the highest in the brainstem infarction with diabetes group. Conclusions Diabetes is closely associated with brainstem infarction. Diabetes is more likely to result in pontine infarction.
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Objective To investigate the effect of ulinastatin (UTI) on the expression of brainderived neurotrophic factor ( BDNF ) and remyelination in mice with experimental autoimmune encephalomyelitis ( EAE).Methods Twenty-four C57BL/6 mice were randomly divided into UTI group (U),normal saline treated group (S) and normal control group (N,n = 8,respectively).Demyelinations in the spinal cord were observed by solochrome cyanin staining.The expression of BDNF,myelin basic protein (MBP),and 2',3 '-cyclic nucleotide 3'-phosphodiesterase (CNP) in brain tissue of each group were evaluated by Western blot.Results Average clinical scores in group U at the 12,13,14,22,23,31,33,34 and 35 days were 0,0.25,0.38,0.63,0.63,0.40,0.40,0.40 and 0.40 respectively.They were significantly lower than group S at the same time ( U= 16.00,15.00,14.50,7.50,0.00,14.50,14.50,12.00 and 14.50,all P ＜0.05).Solochrome cyanin staining showed that demyelination of spinal cord in group U was also significantly improved than group S.Expressions of BDNF ( 1.96 ± 0.29),MBP (2.67 ± 0.48 ) and CNP ( 1.75 ± 0.20) in group U were all significantly higher than group S ( There were 0.80 ± 0.15,1.36 ± 0.38 and 1.06 ± 0.18 respectively,all P ＜ 0.05).Conclusions UTI has protective effect on EAE.The possible mechanism is that it could promote remyelination,and protect oligodendrocytes and neurons in EAE model by increasing BDNF expression in brain.
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Objective To improve differential diagnosis between acute disseminated encephalomyelitis ( ADEM) and classical multiple sclerosis ( CMS).Methods All 20 cases of ADEM and 24 cases of CMS were examined.Their epidemiological and clinical findings,laboratory features and magnetic resonance imaging ( MRI) data were analyzed using x2 test for categorical variables,Wilcoxon Rank-Sum tests for continuous variables.Results ADEM and CMS showed no sex predominance.Patients with ADEM ((27 ±15) years) were younger than CMS ((37 ±13) years,Z= -2.218,P =0.027).The following findings were more commonly seen in ADEM compared with CMS:predemyelinating infectious disease (75% vs 4%,x2 =23.652,P = 0.000),fever (65% vs 4%,x2 =18.609,P = 0.000),meningeal irritation sign (40% vs 0,x2 = 9.189,P =0.002),seizure (25% vs 0,x2 =4.514,P = 0.034),and encephalopathy.ADEM patients were more likely to present with blood leucocytosis ( (11.9 ± 5.8) ×109/L vs (8.0±3.2) ×109/L,Z= -2.030,P=0.042),high C-reactive protein (2.74 mg/L vs 0.49 mg/L,Z = - 3.028,P = 0.002),increased erythrocyte sedimentation rate (11.00 mm/h vs 7.00 mm/h,Z= -2.406,P =0.016),and cerebrospinal fluid leucocytosis (9 × 106/L vs 2×106/L,Z =- 2.781,P = 0.005).There were no differences in cerebrospinal fluid protein and oligoclonal band between the two groups.The following MRI lesions were more commonly seen in ADEM patients:cortical gray matter lesions (14/20,x2=15.213,P=0.000),basal ganglia gray matter lesions (14/20,x2 =8.910,P = 0.003),and brainstem lesions ( 14/20,x2 = 5.867,P = 0.015).In contrast,lesions in subcortical white matter (21/24,x2 = 17.628,P =0.000),periventricular area (21/24,x2 =15.213,P=0.000) and corpus callosum ( 14/24,x2 = 8.640,P = 0.003 ) were more common in the MRI image of CMS patients.The lesions in spinal cord were usually centrally distributed in ADEM (83% ),while peripherally in CMS (85%,x2 = 11.542,P = 0.001).The lesions had poorly defined margins in ADEM (95%),but well defined margins in CMS (75%,x2 =21.787,P = 0.000).Conclusion There are differences in epidemiological and clinical findings,laboratory features and MRI appearances between ADEM and CMS.
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Objective To compare the efficiency of original neuromyelitis optica(NMO)-IgG assay of detecting NMO-IgG with a new anti-aquaporin-4(AQP4)assay of detecting AQP4,and to explore the accuracy of the method in the diagnosis of NMO and multiple sclerosis(MS).Methods The sera were obtained from 44 patients with NMO and 46 patients with MS and were tested by both NMO-IgG and antiAOP4 assays.NMO-IgG was identified by original NMO-IgG assay with a substrate from mouse brain.AntiAQIP4 was detected by anti-AQP4 antibody assay.The results from the two assays were statistically analyzed to compare accuracy and specificity of the methods.Results The results of the two assays were concordant in 45 testing negative cases and 36 positive cases(Kappa=0.798.P=0.000).The McNemar test showed that the positive rate of the two assays were not significantly different(P=1.000).The NMO-IgG assay showed 77.3% sensitivity,87% specificity,82.2% diagnosis accuracy,85%positive predictive value,87% negative predictive value.and 74.3%Younden index. The anti-AOP4 antibody assay showed 88.6% sensitivity,95.7%specificity,92.2% diagnosis accuracy,98.1% positive predictive value,89.8% negative predictive value.and 84.3% Younden index.Conclusions This study demonstrated that NMO-IgG and AQP4 antibody detection have high sensitivity and specificity to detect NMO and MS.Anti-AQP4 detected by anti-AQP4 antibody assay may be more useful for NMO diagnosis.
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Objective To discuss the diagnosis and treatment of cerebral sparganosis. Methods To summary four cases of cerebral sparganosis, focusing on the clinical course and imaging findings, with the goal of better diagnostic skills. Results All 4 cases had some kind of misdiagnosis and improvement after surgery or parasiticidal pharmacotherapy. Cerebral MRI and CT scans revealed relatively extensive white matter degeneration and focal enhancements. Subsequent scans showed changes in shape and location of the enhanced foci, indicating the migration of sparganum. Pathologic findings of 3 patients who had undergone surgery showed granuloma and sparganum. Conclusions Cerebral sparganosis has relatively special manifestions on imaging, which are of diagnostic value. The spaganum should be as completely removed as possible during surgery.
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Objective To investigate the characteristic MRI appearance of neuromyelitis optics (NMO) and muhip]e sclerosis (MS) in the spinal cord.Methods Twenty cases of MS and 23 cases of NMO were examined by MRL All image appearances were analyzed.Results The characteristic MRI appearance of NMO patients in the spinal cord was linear medullary lesion (LML), linear medullospinal lesion (LMSL), linear spinal lesion (LSL) and longitudinally extensive transverse myelitis (LETM), and spinal cord MRI with contiguous T2-weighted signal abnormality extending over 3 or more vertebral segments (23 cases), while in MS, spinal cord MRI with contiguous T2-weighted signal abnormality often extended less than 3 vertebral segments (only 12 cases, χ2 = 19.142, P < 0.01), and the distribution of spinal lesion usually was eccentric (17 cases, compared with NMO group, χ2 = 25.256, P < 0.01).Conclusions NMO is distinct from MS.In MRI, spinal lesion in NMO usually conforms to the distribution of aquaporin 4, while spinal lesion in MS always conforms to the demyelination.NMO has neuroimaging features that move it ever closer to distinct disease status.
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Objective To investigate the asseciation of 1188A/C polyrnorphism of Interlenkin-12B gene (IL-12B) with remit-relapse multiple sclerosis (RRMS) in the southern Chinese population.Methods Ninety-four patients with RRMS and 145 age- and-sex-matched normal controls were recnfited in this study.The polymorphism was detected by using polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) assay in these subjects.The frequencies of the alleles in each group were statistically analyzed.Results The frequency of the allele A increased significantly in RRMS patients (64.4%) compared with that in healthy controls (53.8%, χ2=5.228, P=0.022).An increased risk for MS was suggested in carriers of the A allele (OR=1.551, 95% CI=1.064-2.262).Conclusions The A allele in 1188A/C polymorphism of IL-12B gene may be a risk factor for RRMS in southern Chinese population.
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Objective To investigate brain-derived neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF) concentrations in serum and cerebrospinal fluid (CSF) in patients with multiple sclerosis (MS) and neuromyelitis optica (NMO),and their neuroprotective effects.Methods Sixty-two patients (49 patients were MS and 13 patients were NMO) and 21 controls were investigated in our studies.The disability severity in MS and NMO patients in their relapse period was assessed by the Expanded Disability Status Scale (EDSS).MRI scanning of brain,spinal cord or optic nerve was examined and the oligoclonal band in serum and CSF were detected.BDNF and GDNF concentrations in serum and CSF were assessed by Liquid Assay.Results There were no significant differences of BDNF (μg/L,5.616±0.650 in serum and 0.186±0.012 in CSF of MS patients;6.584±0.929 in serum and 0.176± 0.006 in CSF of NMO patients) and GDNF (μg/L,0.039 in serum and 0.080 in CSF of MS patients;0.029 in serum and 0.050 in CSF of NMO patients) concentrations in serum and CSF in patients with MS and NMO in relapse,compared with those in controls.There was a positive correlation between BDNF and GDNF concentrations in CSF (r=0.756,P=0.000),and a negative correlation between BDNF and GDNF concentrations in serum (r=-0.329,P=0.018).There were no correlations of BDNF and GDNF concentrations in serum and CSF with EDSS,blood brain barrier index,Delpech index and Tourtellotte synthesis rate.There were no significant differences of BDNF and GDNF concentration in serum and CSF between NMO/MS patients with and without atrophy.Conclusions The level of BDNF in patients with MS and NMO is correlated with that of GDNF,which may have a synergistic neurotrophic effect on MS and NMO.BDNF and GDNF are not associated with the blood-brain harrier destruction and lgG synthesis in central nervous system.However,associations of BDNF and GDNF with functional disability and neuron atrophy in NMO and MS patients still need further studies.