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Objective: To determine the cerebrospinal fluid/serum albumin ratio (QALB) in patients with neurosyphilis, and to explore the correlation between the blood-brain barrier permeability and the cognitive impairment. Methods: A retrospective study was conducted on the clinical data from 93 patients with anti-human immunodeficiency virus (HIV)-negative neurosyphilis diagnosed by Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 2010 to Jan. 2018. According to the mini-mental state examination (MMSE) score, the patients were divided into cognitive dysfunction group (n = 38) and non-cognitive dysfunction group (n = 55), and the demographic data, clinical data and cerebrospinal fluid biochemical data were compared between the two groups. Pearson bivariate correlation analysis was used to analyze the relationship between blood-brain barrier permeability and cognitive dysfunction in neurosyphilis patients. Results: There were no significant differences in gender, age, education level, marital status, cerebrospinal fluid leukocyte count, cerebrospinal fluid protein, immunoglobulin G (IgG), IgG index, 24-h intrathecal IgG synthesis, or oligoclonal band between the cognitive dysfunction group and non-cognitive dysfunction group (all P 7× 10-3) patients versus the normal QALB (≤7 ×10-3) patients (92.11% [35/38] vs 67.27% [37/55], χ2 7.927, P = 0.002). Pearson bivariate correlation analysis showed that QALB was negatively correlated with MMSE score (r 0.410, P = 0.024). Conclusion: The neurosyphilis patients with blood-brain barrier damage are prone to cognitive dysfunction, and the higher the blood-brain barrier permeability, the more serious the cognitive dysfunction. Monitoring the permeability of blood-brain barrier can contribute to the assessment of intelligent damage in patients with neurosyphilis.
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Objective: To investigate the therapeutic effect of double filtration plasmapheresis (DFPP) on severe anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis and its clinical significance. Methods: We retrospectively analyzed the clinical data from 9 patients with severe anti-NMDAR encephalitis confrmed by Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 2014 to Mar. 2018. The 9 patients did not respond to methylprednisolone shock therapy. We collected the clinical manifestations, and examination results of laboratory, electroencephalogram and imaging, and analyzed the therapeutic effect of DFPP. Results: Nine anti-NMDAR encephalitis patients, including 5 females and 4 males, were admitted to neurology intensive care unit. Their ages were ranged from 15 to 69 years old, median age of onset was 37 years old, and average hospital stay was (33.2 ± 7.6) d. The main clinical symptoms were mental behavioral abnormalities (9 cases), autonomic dysfunction (9 cases), seizures (7 cases), central hypopnea (5 cases), and consciousness disorders (5 cases). One patient was complicated with ovarian teratoma. Nine patients were positive for anti-NMDAR antibodies in cerebrospinal fluid, and 7 patients were positive for anti-NMDAR antibodies in serum. All the 9 patients were examined by electroencephalogram, and 7 of them had abnormal findings, mainly with diffuse changes and abnormal slow waves. Brain magnetic resonance imaging showed that abnormal signals could be seen in the frontal lobe, parietal lobe, temporal lobe, hippocampus and other brain regions of 4 patients, and no abnormal signals were found in the other 5 patients. Nine patients were treated with DFPP after ineffective treatment with methylprednisolone, 5 of them recovered completely, and the other 4 cases had significantly improved residual symptoms. Conclusion: DFPP can be used as an alternative for patients with severe anti-NMDAR encephalitis who are not sensitive to glucocorticoid therapy. It has better clinical efficacy and it is not restricted by allogeneic plasma resources.
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<p><b>OBJECTIVE</b>To confirmed reliability and feasibility of intranasal nerve growth factor (NGF) bypassing the blood-brain barrier and its potential neuroprotective effects on acute cerebral ischemia.</p><p><b>METHODS</b>(1) To assay NGF concentrations in different brain regions after middle cerebral artery occlusion (MCAO). Rats were randomly divided into intranasal (i.n.) NGF, intravenous (i.v.) NGF, and untreated group (n = 4). The concentrations of NGF of different brain regions in the three groups after MCAO were measured by ELISA. (2) To observe neuroprotective action of NGF on focal cerebral ischemic damage. Rats were randomly assigned to 4 groups: i.n. vehicle, i.n. NGF, i.v. vehicle, i.v. NGF (n = 8). Treatment was initiated 30 minutes after onset of MCAO and given again 24 hours later. Three neurologic behavioral tests were performed 24 and 48 hours following onset of MCAO. Corrected infarct volumes were determined 48 hours after onset of MCAO.</p><p><b>RESULTS</b>The olfactory bulb in i.n. NGF group obtained the highest concentration (3252 pg/g) of NGF among all regions, followed by the hippocampus. The NGF concentrations in the olfactory bulb and hippocampus in i.n. NGF group were markedly higher than that in i.v. NGF and control groups. The infarct volume in i.n. NGF group was markedly reduced by 38.8% compared with i.n. vehicle group. I.n. NGF group vestibulum function markedly improved compared with i.n. vehicle group at 24 and 48 hours after onset of MCAO (P24h = 0.02 and P48h = 0.04, respectively).</p><p><b>CONCLUSION</b>Intranasal NGF could pass through the blood-brain barrier, reach the central nervous system, reduce infarct volume, and improve neurologic function in rats following MCAO. Intranasal delivery of NGF may be a promising treatment for stroke.</p>