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BACKGROUND:Double filtration plasmapheresis is an effective means for treatment of myasthenia gravis in recent years. There are many mechanisms underlying double filtration plasmapheresis for treatment of myasthenia gravis, but there is no unified understanding. OBJECTIVE:To analyze the clinical effect of double filtration plasmapheresis combined with glucocorticoid treatment for myasthenia gravis. METHODS:A total of 46 patients diagnosed as having advanced myasthenia gravis who were consecutively admitted were enroled and randomized into experimental group (n=26) and control group (n=20). Patients in the control group received glucocorticoid treatment, and those in the experimental group received double filtration plasmapheresis combined with glucocorticoid treatment. RESULTS AND CONCLUSION:The titers of anti-acetylcholine receptor antibody in the two groups were both decreased significantly after treatment (P < 0.05), especialy in the experimental group (P < 0.01); but the IgA and IgM clearance rate in the experiment group were significantly higher than that in the control group (P < 0.01). The quantitative myasthenia gravis score, symptom remission time, in-hospital time in the experimental group were al significantly less than those in the control group (P < 0.01). What’s more, the total effective rate was significantly higher in the experimental group than the control group. The double filtration plasmapheresis combined with glucocorticoid treatment for myasthenia gravis is safe and effective that can effectively remove the anti-acetylcholine receptor antibody, IgA and IgM.
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Objective To observe the clinical therapeutic effect of hyperbaric oxygen (HBO) therapy and swallowing training combined with Fengchi acupoint acupuncture on dysphagia caused by pseudobulbar paralysis after stroke. Methods Seventy-five patients were randomly divided into control group, HBO therapy group, swallow training group, acupuncture group and combined treatment group (n = 15). Patients in all groups were given cerebro-vascular disease routine treatment. In addition, the patients in HBO therapy group, swallowing training group and ac-upuncture group were given HBO therapy, swallowing training and Fengehi (GB20) acupoint acupuncture simultane-ously, respectively. The patients in combined treatment group were given HBO therapy combined with swallowing training and Fengchi acupoint acupuncture. Modified Kubota-Chiari's swallowing functional classification was used to assess swallowing function before and on the 3rd d,6th d,9th d, 12th d, 15th d, 18th d and 21st d after treatment. Results It was shown that the patients in all groups but the control group got significant improvement in swallowing after treatment, as demonstrated by the swallowing function scores (P < 0.05). Moreover, the priority order in im-provement of swallowing function and recovering rate were: combined treatment group > acupuncture group > swal-low training group > HBO therapy group > control group(P < 0.05). Conclusion The combination of HBO ther-apy, swallowing training and Fengchi acupoint acupuncture could act synergically to ameliorate dysphagia caused by pseudobulbar paralysis after stroke.
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@#Objective To observe the effect of hyperbaric oxygen,rehabilitation training or acupuncture at Fengchi acupoint on pseudobulbar paralysis after stroke.Methods 90 patients were divided into group Ⅰ(A,B,C) or Ⅱ(A,B,C) randomly.Patients in all groups were given conventional therapy,while those in groups ⅠB and ⅡB were given hyperbaric oxygen,ⅠC and ⅡC were given swallowing training and group Ⅱ was given acupuncture at Fengchi acupoint additionally.They were assessed with Modified Kubota-Chiari's swallowing functional classification before and after treatment.Results In all groups except ⅠA,swallowing function scores improved after treatment significantly(P<0.05).The scores were different significantly between group Ⅰ and group Ⅱ after treatment(P<0.05).Except 3 d after treatment,the scores were different significantly between sub-group of group Ⅰ or group Ⅱon other time points(P<0.05).Conclusion The hyperbaric oxygen is more effective than conventional therapy on pseudobulbar paralysis,but less than swallowing training.Acupuncture at Fengchi acupoint can improve their efficacy.
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@#ObjectiveTo observe the effect of equilibrium therapy of decontamination living creature of blood dilution (ETBD) on acute cerebral infarction.Methods124 inpatients were divided randomly into the treatment group and control group with 62 cases in each group. The patients of the treatment group were treated with routine medicine and ETBD. The patients of the control group were treated only with routine medicine. The blood-lipid and blood viscosity were tested and nerve function evaluation was performed before and on the 15th day after the treatment in two groups.ResultsAfter treatment, the levels of blood-lipid, blood viscosity and nerve functions of all patients in two groups were better than that before the treatment, but the effect of the treatment group was better than that of the control group ( P<0.05), and no obvious adverse reaction was found.ConclusionETBD is a safe, effect, simply and convenient therapeutic method for acute cerebral infarction and it is suitable for primarily medical units.
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To investigate the effect of immature dendritic cells (iDCs) on experimental autoimmune myasthenia gravis (MG), iDCs were generated in low dose of GM-CSF, and then they were pulsed with acetylcholine receptor (AchR) and transferred to allogeneic rats. After 3 weeks, all rats were immunized with AchR and complete Freund's adjuvant (CFA) and observed for the corresponding indices of MG for 7 weeks. Our results showed that compared with mature DCs (mDCs) generated at high dose of GM-CSF plus additional stimulation by lipopolysaccharide, iDCs expressed significantly lower levels of MHC-Ⅱ , CD80 and CD86, and their ability to uptake FITC-Dextran was stronger but the ability of stimulating proliferation of allogeneic T cells were weaker. Like controls,after immunization, all rats transferred with iDCs, mDCs and AchR-pulsed mDCs showed typical symptoms in 4 to 7 weeks. The amplitude of electromyogram wave dropped obviously, the level of serum AchRab increased and neuromuscular junction showed typical damage of MG. In contrast, no conspicuous changes were noted in rats transferred with AchR-pulsed iDCs. The results suggest that iDCs could be generated by inducing bone marrow precursors in low dose of GM-CSF, AchRpulsed iDCs could induce tolerance of EAMG. The dysfunction of DCs may play an important role in the initiation and maintenance of normal immune response in MG.
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BACKGROUND: It is recently found that some kinds of antibiotics can aggravate the obstruction of neuromuscular junction(NM J) transmission,exacerbate myasthenia gravis (MG). Hitherto, there are few reports about the effect of antibiotics on transitive function on animal models. Along with the appearance of new antibiotics, the effects of the antibiotics on NMJ transitive function need to be further observed.OBJECTIVE: To investigate the effect of aminoglycoside antibiotics, fluoroquinolone antibiotics and cephalosporin antibiotics on the transitive function of NMJ in MG, and to provide an experimental basis for using those antibiotics securely in clinic and for selecting those antibiotics to treat MG properly.DESIGN: Randomized controlled study based on experimental animals.SETTING: Department of nosocomial infection, neurology and pharmacy in a university hospital.MATERIALS: The experiment was conducted at the Neurological Institute of Tongji Medical College, Huazhong University of Science and Technology from March 2002 to January 2003. Totally 150 healthy female C57BL/6mice, 6 - 8 weeks old, weighting 18 - 20 g, were divided randomly into 4groups: normal group( n = 10), MG group( n = 10), saline group( n = 10)and antibiotics group( n = 120) . Mice in antibiotics group were divided randomly again into gentamicin group, etimicin group, ciprofloxacin group,fleroxacin group, cefuroxime group and cephradine group, with 20 mice in each group.INTERVENTIONS: C57BL/6 mice were immunized with the acetylcholine receptor(AChR) protein in complete Fruend' s adjuvant(CFA) to establish experimental autoimmune myasthenia gravis(EAMG) . Mice in saline group were injected normal saline and mice in antibiotics group were injected antibiotics(10 mg/kg), lasted 14 days. Mice in MG group were without any treatments. On the 7th day after the last immunization and the 14th day after the antibiotics treatments, MG scores was evaluated, repetitive nerve stimulation(RNS) and the levels of acetylcholine receptor antibody(AChRab)were tested at the same time.RESULTS; The mean symptom scores on the 14th day after the antibiotics treatment with gentamicin, etimicin, ciprofloxacin and fleroxacin were higher than that in MG group, and there was no significant difference in the mean symptom scores among cefuroxime group, cephradine group and MG group. The decrement percent of RNS in gentamicin group [ (21.22 ± 4.63)% ], etimicin group[ (19.08 ±4. 25)% ], ciprofloxacin group[ (22.25 ±4.95)% ] and fleroxacin group[ (21.71 ±4.99)% ] were higher than that in MG group[(15.75 ±2.22)% ], but no difference was found in the attenuation rate among cefuroxime group[(15.25 ±2. 87)% ],cephradine group[ ( 15.25 ± 3.30)% ] and MG group. The levels of AChRab in gentamicin, etimicin, ciprofloxacin and fleroxacin groups were also higher than that in MG group, but no difference was found among cefuroxime group, cephradine group and MG group.CONCLUSOIN: Aminoglycoside and fluoroquinolone antibiotics can aggravate the obstruction of NMJ transmission, and cephalosporin antibiotics have no obvious effect on the obstruction of NMJ transmission function in MG.
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Objective To study the effects of dendritic cells (DC) modified with transforming growth factor ?1 (TGF-?1) gene on experimental autoimmune myasthenia gravis (EAMG) in Lewis rats. Methods 30 female Lewis rats were divided randomly into 6 groups: normal group, EAMG group, DCs treatment group, pcDNA_3-TGF-?1-DCs treatment group, pcDNA_3-DCs treatment group and normal saline group. The rats were immunized with the acetylcholine receptor (AChR) protein extracted from electric organ of Narcine timilei and completed Freund’s adjuvant (CFA) in the experiment groups except normal group. 2?106 pcDNA_3-TGF-?1-DCs/rat were injected subcutaneously into the backs of the rats that had been immunized 5 days earlier with AChR+CFA. The rats in DCs treatment group, pcDNA_3-DCs treatment group and normal saline group were injected in parallel with untreated DCs, pcDNA_3-DCs and normal saline respectively. Then the clinical manifestations were observed everyday. And 7 weeks after the first immunization, repetitive nerve stimulation, detection of acetylcholine receptor antibody (AChRab) and ultrastructural study of neuromuscular junction (NMJ) were performed. Results (1) The mild symptoms were observed on 1 or 2 rats in the experiment groups except normal group after a week, which lasted for 2 to 5 days. After about 5 weeks, the rats in EAMG group, DCs treatment group, pcDNA_3-DCs treatment group and normal saline group presented some symptoms at different degree like myasthenia gravis, and only one of the rats in pcDNA_3-TGF-?1-DCs treatment group presented mildly decreased activity. (2) The significant decrement of repetitive nerve stimulation were found in EAMG group, DCs treatment group, pcDNA_3-DCs treatment group and normal saline group(16.75?6.13, 17.75?7.81, 18.25?8.22 and 16.50?7.14, respectively), but there was no attenuation in pcDNA_3-TGF-?1-DCs treatment group and normal group(3.20?3.70 and 5.60?2.70, respectively). The percentage of decrement in pcDNA_3-TGF-?1-DCs treatment group was lower than that in EAMG group(5.60?2.70 and 16.75?6.13, respectively,P0.05). (4) The combined AChRs in NMJ of the rats in pcDNA_3-TGF-?1-DCs group were higher than that in EAMG group, and the structure changes of the synapse were relieved.Conclusion It suggests that DCs, transfected with pcDNA_3-TGF-?1, when injected subcutaneously into Lewis rats with incipient EAMG, could inhibit the production of AChR-Ab, relieve the pathologic changes in NMJ and ameliorate the development of EAMG.
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Objective To compare the cerebral vessels stenosis in acute cerebral infarction patients with or without diabetes mellitus.Methods Using case-control study,51 acute cerebral infarction patients with diabetes mellitus and 64 patients without diabetes mellitus were checked by digital subtraction angiography(DSA).The condition of stenosis and obstruct of vessels in intracranial and extracranial were compared.Results Stenosis of intracranial arteries was frequent in both two groups.The main involved arteries included M1 and M2 segments of middle cerebral artery and external cranial segment of internal carotid artery.The rate of cerebrolvascular abnormality in the patients with diabetes mellitus(84.31%) was higher than that in the patients without diabetes mellitus(70.31%).Stenosis of multiple arteries(52.94%),arteriostenosis combined with ulcer or plaque(39.21%) and collateral circulation development(11.63%) were found in diabetic patients,while the rates were 18.75%,17.19% and 31.11%,repectively,in non-diabetic patients.These differences between two groups were statistical significances(all P
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Objective To study the pathway of IFN-?-iNOS-NO on T lymphocytic cells in the rats with experimental autoimmune myasthenia gravis (EAMG).Methods Lewis rats were divided randomly into groups EAMG , normal control(NC) and completed Freund's adjuvant control(CFA-C) . The rats were immunized in foot pad, abdomen and back subcutaneouly with the AChR protein extracted from electric organ of Narcine timilei and CFA in the EAMG group, or only with CFA in the CFA-C group. The above-mentioned emulsions were injected again after 4 weeks . At the 7th week after first immunization, T lymphocytic cells in every rat were separated from the spleen. After cultured in vitro for 48 h, the content of IFN-? in the supernatant of cultured T lymphocytic cells was detected by enzyme-linked immunoadsordent assay (ELISA), and the level of NO was examined with Griess reagent method. Results The contents of IFN-? were (81.68?10.23 ) pg/ml in EAMG group,(29.20?5.41) pg/ml in NC group,(31.54?6.12) pg/ml in CFA-Cgroup.The levels of NO were (23.68?7.13 )?mol/L in EAMG group ,(9.05?2.11) ?mol/L in NC group,(10.21?2.67 )?mol/L in CFA-C group.The contents of IFN-? and NO in EAMG group were increased markedly than groups NC and CFA-C(allP