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Objective To identify the 2- year recurrence- related factors in patients with myasthenia gravis (MG) after treatment of low-dose tacrolimus. Methods The clinical data of 100 MG patients treated with low- dose tacrolimus from February 2011 to February 2016 were retrospectively analyzed. All patients were followed up at least 2 years, and the risk factors affecting the recurrence of MG patients were analyzed. Results At the end of follow-up, there were 49 cases who had recurrence, and the recurrence rate was 44.5％ (49 / 110). Logistic regression analysis result showed that reducing dosage or withdrawal, MG crisis and diabetes mellitus were the independent risk factors for recurrence of MG patients (OR = 134.113, 8.850 and 6.652; P < 0.01 or <0.05). Conclusions The rate of recurrence with low- dose tacrolimus treatment in patients with MG during 2 years is higher. Reducing dosage or withdrawal should be avoided, especially in patients with a history of MG crisis. Patients with diabetics mellitus need to control blood glucose stability to avoid recurrence.
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Objective To research the clinical characteristics of cerebral infarction involving the anterior and posterior circulation in the same time. Methods Collected the clinical data of 11 patients with cerebral infarction involving the anterior and posterior circulation in the same time, who was confirmed by clinical and radiographic examination. Results In the majority of 11 patients, they had multiple risk factors in the same time. By Chinese Ischemic Stroke Subclassification (CISS) criteria, there were 3 patients with large-artery atherosclerotic brain infarction (aortic arch atherosclerosis and intracranial and extracranial large arteries atherosclerosis coexist), 3 patients with cardiogenic stroke, 3 patients with undetermined etiology (intracranial and extracranial large arteries atherosclerosis and cardiogenic stroke maybe coexist), 2 patients with other etiologies(1 patient with Moyamoya disease, 1 patient with polycythemia vera). There were multiple vascular stenosis in the 3 patients with large artery atherosclerosis, and the posterior communicating artery was open. Conclusions Cerebral infarction involving the anterior and posterior circulation in the same time is rare, cardiogenic stroke is more often, the relevant examinations should be perfect to definite the rare cause.
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Objective To evaluate the therapeutic effects of thymectomy in myasthenia gravis (MG) patients with thymoma.Methods A total of 178 MG patients with thymectomy between July 2008 and December 2010 were included.All the subjects were received either cyclophosphamide alone or in combination with radiotherapeutic treatment after surgery.The MG absolute and relative clinical scores were used to assess the effectiveness of long-term trcatments.Clinical evaluations were conducted before,and at 1,6,12 and 24 months after operation.A comparative analysis on the inter-relationships among MG clinical presentation,WHO histology aud Masaoka stage was also conducted.Results (1) Of the 178 thymomapatients,103 were male and 75 were female,with a mean age of (43.7 ± 12.5)-years old.One hundred and twelve cases were taken cyclophosphamide,and 58 cases with invasive thymoma (stages Ⅱ,Ⅲ and Ⅳ or WHO type B3) were taken cyclophosphamide in combination with radiotherapy.Five patients refused cyclophosphamide or radiotherapy and 3 did not finish treatment.(2) The muscular strength improved obviously in 32.8％ (58/177) of the patients after 1 month after thymectomy,and 59.8％ (101/169),69.7％ (115/165) and 81.5％ (132/162) after 6 months,1 year and 2 years,respectively with MG score for disease severity decreased significantly with time.(3) No significant differences of the improvement rates were observed in patients within different WHO histology category.However,the rates were much higher in patients with Masaoka stage Ⅰ (91.4％) and stage Ⅱ (89.8％) than those in patients with stage Ⅲ (45.5％) and Ⅳ(28.6％) (all P＜0.001).Conclusions The remission rate of MG patients with thymomas increase after thymectomy plus cyclophosphamide or in combination with radiotherapy and reached 81.5％ after 2 years.The remission rate is associated with Masaoka stagc,but not with WHO histology.
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Objective To evaluate the efficacy and safety of tacrolimus in patients with generalized myasthenia gravis (MG).Methods A total of 69 cases admitted to our hospital were given 2-6 mg/day tacrolimus (FK506) for 12 months.The MG absolute and relative clinical scores were used to monitor the efficacy of tacrolimus.Clinical evaluation was conducted at month 1,3,6,and 12,while the serum concentration of FK506 was measured at one month after administration of tacromus for one month.Results The therapeutic response presenting as improved muscular strength showed within one month after administration of tacrolimus.The overall response rates (MG relative clinical score≥25％) at month 1,3,6 were 81.2％,87.6％,92.2％ respectively.It reached 93.8％ by the final visit at month 12.MG score to evaluate disease severity decreased significantly as the subjects continued to take tacrolimus.Statistic analysis suggested that the serum concentration of FK506 was correlated with its therapeutic effect.Serum trough levels in remission and response groups [(7.1 ± 3.9) μg/L and (6.3 ± 3.8) pg/L,respectively] were significantly higher than that of no response group [(3.4 ± 1.3) μg/L].The most common adverse effects included hyperglycemia (5 cases),myelosuppression (3 cases),and dizziness tinnitus (3 cases),majority of which were temporary and manageable.Conclusions Our study has shown that tacrolimus significantly improved muscular strength of generalized MG patients.The treatment is well tolerated.The therapeutic effect of tacrolimus is observed within 1 month after initial use.Adverse events were manageable and not common.
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Objective To investigation the clinical characteristics in myasthenia gravis (MG)patients with thymomas.Methods A total of 856 MG patients admitted to the department during 2008.7-2010.12 were reviewed retrospectively.The patients with MG were divided into two groups based on thymic pathology,which were 162 cases with thymoma and 694 cases without thymoma.We compared the different clinical features including the gender,age of onset,MG symptoms and the incidence rate of myasthenia crisis.And the relationship between the WHO types,Maosaoka stages of thymoma and the severe of MG was also studied.Results The percentage of thymoma-associated MG patients was 18.9 percent of hospitalized MG patients at the same period.Of the 162 thymoma-associated patients,94 were male and 68 were female,with a ratio of 1.38∶1 and a mean age of (42.9 ± 12.4)years old.Thymoma was more frequent in middle-old aged patients than in children.Compared with non-thymoma MG,more thymomatous patients showed generalised MG,but not only ocular muscles weakness (90.1％ vs 62.4％,P ＜ 0.001 ).There were significant differences of the incidence rate of myasthenic crisis in the two groups ( 14.8％ vs 2.3％ ).(2)WHO type B2 and Maosaoka Ⅰ,Ⅱ thymoma were the commonest types among all potentially MG-associated thymoma.No differences of Osserman MG classification was found in thymomatous patients with different pathologic changes.Conclusions The thymomatous MG patients had its distinctive clinical features:thymomas occured in about 19.7％ of MG patients with more men than women,more common in generalized,higher incidence of myasthenia crisis,with B2 type thymic pathology and Maosaoka Ⅰ,Ⅱstages.No correlation was found between pathologic and clinical stagcs.
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Objective To investigate the immunoregulatory role of Th17 cell and the related cytokines in myasthenia gravis.Methods Totally 51 myasthenia gravis (MG) patients were divided into MG with thymomas ( TM group) and the MG with normal thymus ( NT group),as well as 22 healthy subjects as controls.Th17 cells from peripheral blood mononuclear cells were measured by flow cytometry.Th17 related cytokines were detected by ELISA and real-time quantitative-PCR.Results The quantity of Th17 cells in MG patients with thymomas (1.53 ± 0.59 )％ were significantly increased compared with that of healthy control (0.94％±0.32％,P ＜ 0.05 ).There was no significant difference in the number of Th17 cells between healthy controls and NT group.The expression levels of IL-17 mRNA ( 23.7 ± 4.5 ) were upregulated significantly versus those in healthy controls (13.4 ± 3.2,P ＜0.01 ).The levels of mRNA expression of IL-1 β,IL-6 and IL-23 were up-regulated significantly in TM group.The mean concentration of IL-17 was up-regulated significantly in TM group (30.4 ±7.3) ng/L versus healthy controls [ ( 19.2 ±4.9)ng/L,P ＜ 0.05].Serum levels of IL-23 and IL-1β were always increased in TM group versus healthy controls.Conclusion The elevated levels of IL-17 and other Th17 related cytokines in thymomas may aggravate the autoimmunity disorder.
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Objective To investigate the expression of CD40,CD40L and MMP9 in carotid atherosclerotic plaques and evaluate their roles in carotid atherosclerotic plaque stability.Methods Carotid atherosclerotic plaques were isolated in carotid eversion endarterectomy (GEE) in 37 patients with high-grade stenosis (>70%) including 20 stroke (A group) and 17 non-stroke patients (B group).The control group included samples of normal carotid artery from 11 normal individuals,The RNA expression levels of CD40,CD40 L and MMP9 in all A,B and control groups were quantitatively detected by real-time quantification polymerase chain reaction (PCR) and the protein expression levels were detected by Western blotting analysis.The expression and distribution of CD40,CD40L and MMP9 in carotid atherosclerotic plaques were detected by immunohistochemistry staining.Then correlations between CD40-CD40L and MMP9 were statistically analyzed.Results The relative CD40 mRNA level in high-grade stenosis of A group,B group and normal control were 2.41±0.43,1.03±0.38 and 0.31±0.12,respectively,and MMP9 mRNA 6.88±1.57,1.90±0.44 and 0.39±0.12,respectively.The levels of CD40 and MMP9 mRNA in A group were significantly higher than those in B group (P=0.000),the levels of CD40 and MMP9 in B group were significantly higher than those in controls (P=0.000).There was a linear correlation between CD40 and MMP9 mRNA (r=0.929,P=0.000).However,there were no significantly difference in mRNA levels of CD40L between carotid atherosclerosis and controls.The protein expression levels of CD40,CD40L and MMP9 in A group were significantly higher than those in B group (FCD40=104.100,P=0.000;FCD40L=129.932,P=0.000;FMMP9=13.565,P=0.021) and B group higher than normal controls (FCD40=115.848,P = 0.000;FCD40L= 30.482,P=0.005;FMMP9=35.557,P=0.004).The areas of positive staining of CD40,CD40L and MMP9 in immunochemistry study in A group were significantly higher than those in B group and B group was significantly higher than controls.There were linear correlations between positive staining areas Of CD40 and CD40L,CD40 and MMP9,CD40L and MMP9 (r=0.963,0.959,0.929,P=0.000).Expressions of CD40,CD40L and MMP9 were significantly higher in the shoulder areas of the atherosclerotic plaques than in other areas.Conclusions The CD40-CD40L has an important role in the formation of carotid atherosclerosis and plaque instability,probably by up-regulating MMP9.The expression of CD40L may be regulated by post-transcriptional modification to exert biological effects.