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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 compare the clinical characteristics of early-onset and late-onset myasthenia gravis(MG).Methods A total of 819 MG patients admitted in our department during the sanle period were reviewed retrospectively.The patients with MG were divided into two groups by the age of onset, which were the early-onset MG(＜49 years)and late-onset MG(≥50 years).Several clinical features were compared in the two groups including the percentage, initial symptoms, MG types,the positive rates of neostigmine test and repetitive nerve stimulation, thyroid function and thymie abnormalities. Results The more common onset age of MG was 0-49 years(early-onset).In both groups the male and female ratio was presented as the most common type in both groups(41.51%and 51.37% respectively in early-onset and late-onset groups).Type Ⅰ was more common in early-onset group while typeⅡB Was more common in lateonset group(P＜0.05).There Was no significant difference in the positive rates of neostigmine test and repetitive nerve stimulation between the two groups.The thyroid function alnormality ratio was higher in early-onset group. Hyperplastic thymus was common in early-onset group(67.57%)while both hyperplastic thymus and thymoma were common in late-onset group(48.68% and 47.37%).Conclusions The clinical characteristics of early-onset and late-onset myasthenia gravis(MG)Was different in MG type, the positive rate of thyroid function abnormalities and thymic pathologic type.
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Objective To analyze the clinical characteristics of myasthenia gravis(MG) associated with thyroid abnormalities.Methods A total of 300 MG patients admitted to the department of neurology from July 2008 to September 2009 were reviewed retrospectively.Based on the thyroid function and abnormality of thyroid related antibodies (thyroglobulin antibody and peroxidase antibody), the patients with MG were divided into two groups (260 cases without thyroid disease and 40 cases with thyroid abnormalities).The different clinical features, the relationship between the antithyroid antibodies and antiacetylcholine receptor antibody (AChRAb) and the distribution of T cell subsets between the two groups were compared.Results ( 1 ) Among the 300 MG patients, 13.3% of them was accompanied with thyroid disease and the most common abnormality was positive thyroid antibody.(2) Between the groups of MG with and without thyroid abnormalities, no significant differences on the sex percentage, age of onset, duration of disease, clinical classification and thymic abnormalities were found ( P ＞ 0.05 ).( 3 ) The blood levels of AChRAb in postsynaptic membrane in the thyroid antibody-positive patients were 1.15 ± 0.11, being much higher than those in the antibody-negative patients ( 1.01 ±0.11 ).(4) The percentage of CD8+ T cells was significantly decreased [(21.63 ±5.17)% vs (24.28 ±5.79)%] and the ratio of CD4+/CD8+ T cells was increased (2.10 ± 0.67 vs 1.81 ± 0.61, P ＜ 0.05 ) in the group of MG with thyroid abnormality as compared with the group of MG with normal thyroid.Conclusion In MG patients the incidence positive thyroid related antibodies was much higher than that of other thyroid abnormalities.It is suggested that there are higher levels of AChRAb in MG coexisting with positive thyroid antibodies and more abnormalities of T lymphocyte subset distribution in MG patients with thyroid disease.
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@#Objective To explore the relationship of D-Dimer and high sensitive C-reactive protein in serum in acute cerebral infarction. Methods 64 patients with acute cerebral infarction were measured with the D-Dimer and Hs-CRP and compared with that of 50 healthy subjects as the controls. Their scores of National Institutes of Health Stroke Scale (NIHSS) were recorded and the correlation with the D-Dimer and Hs-CRP level was analyzed. Results Compared with those in controls, the levels of D-Dimer and Hs-CRP in patients with acute cerebral infarction were significantly higher (P<0.05), and those in patients with large infarction area were significantly higher than those in patients with small infarction area (P<0.01). The levels of D-Dimer and Hs-CRP uncorrelated with the scores of NIHSS.Conclusion The D-Dimer and Hs-CRP level is helpful to assess the acute cerebral infarction.
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@#ObjectiveTo investigate the changes of non-linear dynamics characteristic of EEG in patient with acute cerebral stroke under eyes closed state. MethodsEEG were recorded in 31 patients with acute cerebral infarction and 22 healthy volunteers under eyes closed state. Correlation dimension (D2) and Approximate Entropy (ApEn) were calculated for all subjects. ResultsD2 and ApEn of uninjured forehead cortex (FP1,FP2)reduced significantly in the group of cerebral infarction as compared with the group of normal control at eyes closed state. ConclusionDynamic analysis based on D2 and ApEn topographic maps might be helpful in understand the changes of mental functions after stroke, that can be used in the study of mental function.
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@#ObjectiveTo investigate the changes of non-linear dynamics characteristic of electroencephalogram (EEG) under three states (eyes closed, mental arithmetic with eyes closed and orientation test with eyes closed), and the application of non-linear dynamic analysis for cognitive function research.MethodsEEG was recorded in 30 healthy young volunteers at three stages. The correlation dimension (D2) and approximate entropy (ApEn) were calculated for all subjects.ResultsD2 and ApEn increased significantly during mental tasks as compared to the rest state with eyes closed (P<0.01). In different mental tasks, the complexity of mental functions and the regions involved in the cognitive task were different.ConclusionNon-linear analysis methods are appropriate for the study of cognitive functions and can help to understand the working mechanism of brain during mental activities.
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Objective To compare the clinical features of patients with myasthenia gravis at various age groups,and to evaluate the therapeutic effects of acetylcholinesterase inhibitor alone,acetylcholinesterase inhibitor plus corticosteroid and acetylcholinesterase inhibitor plus thymectomy in children,young adults,and elderly patients with myasthenia gravis (MG).Methods The clinical data of 300 MG patients admitted to the department during the same period were reviewed retrospectively.The patients with MG were divided into three groups based on the age of disease onset:childhood group (age≤14,n=77),young adult group (age=15～59,n=183) and elderly group (age≥60,n=40).The clinical features of MG patients in various age groups were compared including the incidence,sex ratio,initial symptoms,clinical classification,positive rates of neostigmine test and repetitive nerve stimulation,and thymic abnormalities.Furthermore,the therapeutic effects of acetylcholinesterase inhibitor alone,acetylcholinesterase inhibitor plus corticosteroid,and acetylcholinesterase inhibitor plus thymectomy were investigated.Results The most common ages of MG onset were ranged from 15 to 59 years (young adults group).With increase in age,the incidence of MG lowered in females,while in males it became higher.Extra ocular muscles involvement as the initial symptom was higher in children and elderly patients than in young adults.The limb muscles involvement as the initial symptom was more common in young adults group.About 72.73% patients in childhood group were classified as type Ⅰ,while type ⅡB was the most commonly seen in young adults group (55.74%) and elderly group (50.00%).No significant difference was found among the three groups in the positive rates of neostigmine test and repetitive nerve stimulation.In childhood group,hyperplastic thymus was commonly observed,while thymoma was more common in elderly group.The therapeutic effects of acetylcholinesterase inhibitor alone were better in childhood group than in the other 2 groups (P0.05).The therapeutic effect of acetylcholinesterase inhibitor plus thymectomy was most satisfactory in childhood group,less satisfaetory in elderly group and paorest in young adults group ( P
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Objective To evaluate the role of lumbosacral somatosensory evoked potential (LSSEP) examination in the diagnosis of lumbosacral disc herniation (LDH). Methods Somatosensory evoked potential (SEP) from posterior tibial nerve, L_4, L_5 and S_1 dermatomes SEP, and lumbosacral SEP was recorded in 54 patients with radiculopathy caused by LDH. Results The SEP from posterior tibial nerve was abnormal in 22 cases (40.74%). The SEP from L_5 and/or S_1 dermatome was abnormal in 47 cases (87.04%, P
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Objective To evaluate the relationship between concentrations of nitric oxide (NO) and antigen-specific immunoglobulin G (IgG) in CSF and intracranial hypertension and epilepsy in patients with neurocysticercosis.Methods The NO concentration and the IgG level were measured in 40 cases of neurocysticercosisk, and the results were compared according to the patients whether had intracranial pressure or epilepsy. 23 patients with varicosis of great saphenous vein required subarachnoid anesthesia were served as control group.Results Compared with control group, the NO concentration in CSF significantly increased in patient group (P0.05) in the patients with epilepsy as compared with the cases without epilepsy.Conclusions The CSF NO concentrations are higher in the patients with neurocysticercosis who had intracranial hypertension or epilepsy. The IgG levels are also increased in the patients who had intracranial hypertension.
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Objective To observe the neuroprotective effect of arcaine,an antagonist of receptor of N-methyl-D-aspartate(NMDA) and(or) channel complex polyamines site,on cerebral ischemia.Methods Forty-five Wistar rats were randomly divided into 5 groups: control group,ischemia model group,24h preoperative group,1h preoperative group and 1h postoperative group.Acute cerebral infarction model was reproduced in rats of the latter four groups with middle cerebral artery occlusion(MCAO) using ligature method.Once the ischemia model was successfully established,rats in the latter three ischemia model groups were given arcaine(3mg/kg) at 24h and 1h before operation and 1h after operation,respectively,while normal saline(0.4ml/kg) was injected to the rats in the control group.Neurological function behavior and cerebral infarct volume were assessed,and pathological features of brain tissue were observed under light-and electron microscope.Results Neural function scores of the rats in 24h preoperative group,1h preoperative group and 1h postoperative group were 1.25?0.46,1.33?0.50 and 1.40?0.58,respectively,which were significantly different from that in ischemia model group(2.63?0.52,P