A multicenter study to evaluate the disease burden and health economics of inpatients with multiple sclerosis in China.

OBJECTIVE: To assess the disease burden and health economics of inpatients with multiple sclerosis (MS) in China by evaluating the direct, indirect, and intangible costs. METHODS: A total of 863 patients were included for a cross-sectional retrospective study in 50 centers. The direct economic burden was measured by the cost of hospitalization and out-of-hospital application drugs, and the indirect economic burden was measured by the human capital method. The disability-adjusted life year (DALY) was used to express the intangible economic burden. Cost-utility analysis (CUA) using DALYs as indicators of health benefits was performed by calculating the incremental cost-utility ratio. RESULTS: The mean direct economic burden/year, daily medication expenses/year, DALY, indirect economic burden, and indirect economic burden/year were 27,655.57 Yuan, 17,944.97 Yuan, 10.89 Yuan, 512,041.7 Yuan, and 11,299.85 Yuan, respectively. For the study period of two years, the direct economic burden, daily medication expense, and indirect economic burden were 48.6%, 31.5%, and 19.85% of the total economic burden, respectively. Disease burden and the number of episodes of remission were not statistically significant (p>0.001). The direct economic burden and total economic burden of the disease-modifying therapy (DMT) group were higher than those of the non-DMT group, but DALYs had no statistical significance (p>0.001). CUA showed that inpatients with MS in the DMT group received a DALY every time compared with the non-DMT group. CONCLUSION: The DALY losses are concentrated in young and middle-aged Chinese people. In this two-year study, CUA prompted the application of DMT drugs to increase the economic burden and DALYs. However, follow-up time is still short, and further follow-up observation is required.

Roles of sphingosine 1-phosphate in ischemic stroke: a potential therapeutic target for neuroprotection / 国际脑血管病杂志

Ischemic stroke is one of the most important causes of death and disability in humans,but the effective methods for treating brain injury after stroke are quite limited.Sphingosine 1-phosphate (S1P) is a pleiotropic lipid.There is certain interdependence between its metabolism and regulation and the molecular mechanisms involved in important biological events following cerebral ischemia.Membrane lipid therapy with S1P as the core may be an effective neuroprotective strategy of ischemic stroke.

An Expanded Neuroimmunomodulation Axis: sCD83-Indoleamine 2,3-Dioxygenase-Kynurenine Pathway and Updates of Kynurenine Pathway in Neurologic Diseases.

Many neurologic diseases are related to autoimmune dysfunction and a variety of molecules or reaction pathways are involved in the regulation of immune function of the nervous system. Soluble CD83 (sCD83) is the soluble form of CD83, a specific marker of mature dendritic cell, which has recently been shown to have an immunomodulatory effect. Indoleamine 2,3-dioxygenase (IDO; corresponding enzyme intrahepatic, tryptophan 2,3-dioxygenase, TDO), a rate-limiting enzyme of extrahepatic tryptophan kynurenine pathway (KP) participates in the immunoregulation through a variety of mechanisms solely or with the synergy of sCD83, and the imbalances of metabolites of KP were associated with immune dysfunction. With the complement of sCD83 to IDO-KP, a previously known immunomodulatory axis, this review focused on an expanded neuroimmunomodulation axis: sCD83-IDO-KP and its involvement in nervous system diseases.

Pathogenesis of neuromyelitis optica spectrum disorder / 中华神经医学杂志

Neuromyelitis optica spectrum disorder (NMOSD) is a kind of immune mediated inflammatory demyelinating disease of the central nervous system manifesting with optic neuritis and acute transverse myelitis,which takes a relapsing or progression course.The exact etiology and pathogenesis are not clear.There are a lot of researches on immune pathogenesis;in addition,the pathogenesis also involves genetic,environmental,oxidative stress and other factors.

The clinical analysis of nervous system damage in 4 cases with chronic manganese poisoning / 中国神经精神疾病杂志

Objective To summarize the clinical and laboratory features of chronic manganese poisoning. Methods A retrospective analysis was conducted on the clinical data of 4 cases with chronic manganese poisoning, including gener?al information, medical history, clinical manifestations, laboratory examination such as electrophysiological and imaging. Results Patients with chronic manganese poisoning mainly presented with mild mental disorder and autonomic nerve dis?order during early stage and then gradually developed extrapyramidal symptoms and signs. The laboratory examination of chronic manganese poisoning lacked of specificity. EMG showed neurogenic damage in 3 cases and normality in 1 case. EEG showed slightly increased full guide slow wave in 1 case and normality in 3 cases. cranial MRI revealed the damag?es in bilateral symmetry of the basal ganglia nuclei in 4 cases of Chronic manganese poisoning. There was no significant correlation between the changes of urinary manganese level before or after treatment and the clinical manifestations. Conclusions Although there is lack of specific clinical manifestations of chronic manganese poisoning, the possibility of this disease should be considered when patients with mild mental disorders or autonomic nerve disorder with or without extrapyramidal symptoms. The main treatment of chronic manganese poisoning includes excretion of manganese, symp?tomatic and supportive treatment. Patients usually have the sequelae of tremor, muscle tension, and other symptoms.

Review of seven cases of neurobrucellosis: clinical manifestations and imaging characteristics / 中华神经科杂志

Objective To explore the clinical features,laboratory tests,imaging characteristics of neurobrucellosis,and to improve the understanding of the disease.Methods A retrospective analysis was performed in seven patients with neurobrucellosis in our hospital from January 2002 to May 2013.Results The proportion of men and women was 6∶ 1,and the average age was 46 years.One case was attacked with the symptoms of cerebrovascular disease,another one with the symptoms of myelitis,and the other five with the symptoms of meningoencephalitis.Six had positive results of serum agglutination test,and the other one had a positive result of blood culture instead.Imaging findings lacked of specificity.There were two patients whose lesions were in the hemisphere cortex,subcortical,basal ganglia and other parts,four patients whose lesions were in the frontal lobe,one in the chest pulp,and one in both sides of cerebellum and pons.After systematical treatment,one case died,the other 6 cases recovered,and no one relapsed or got functional disability during the one-year follow-up.Conclusions Neurobrucellosis is a rare type of brucellosis,and its clinical manifestations lack of specificity,and imaging and serological detections are important for diagnosis.It is beneficial for patients if diagnosed early and treated systematically,so good understanding of this disease,early diagnosis and treatment are of great value.

Establishment of a Myelin Basic Protein Fragment-Induced Wistar Rat Model of Autoimmune Encephalomyelitis / 中国实验动物学报

Objective To establish an experimental autoimmune encephalomyelitis (EAE) model in Wistar rats with myelin basic protein fragment (MBP69-85) and observe its pathological changes. Methods MBP69-85 dissolved in normal saline was mixed with complete Freund's adjuvant (CFA) (including 6 mg bacille Calmette Guerin) to prepare the encephalitogenic emulsion. Ten out of 70 Wistar rats were chosen as a control group, the others were divided equally into group A,B,C according to the difference of the encephalitogenic emulsion. Rats in group A were immunized with 50 μg MBP69-85 +CFA (including 6 mg BCG). Rats in group B were immunized with 25 μg MBP69-85+CFA (including 6 mg BCG). Rats in group C were immunized with 25 μg MBP69-85+CFA (including 12 mg BCG). The pathological changes of brain and spinal cord tissues were examined by light microscopy after HE staining and immunohistochemistry of MBP and NF. Results Some of the Wistar rats immunized with 50 μg MBP69-85 showed disorder at 12～16 days after immunization. The clinical symptoms included tail acratia or paralysis of tail and limbs, head tilt, etc. and the mean score was 2.38±1.89. There were infiltration of inflammatory cells inside nervous tissue and perivascular cuffings in HE stained sections. The immunohistochemistry of MBP and NF showed demyelination in the white matter and axon injury. Conclusion To some extent, the establishment of EAE depends on the dose of the immunizing antigen. The BCG in CFA was not the major cause of morbility of the rats. The EAE model induced with MBP69-85 in Wistar rats, showing typical clinical symptoms and pathological changes of multiple sclerosis, is a reliable animal model for the study of pathogenesis and treatment of multiple sclerosis.

Hyperbaric oxygen-treatment decreased the expression of caspase-3 in the brain of hypoxic-Ischemic injuried rats / 基础医学与临床

Objective To explore the effect of hyperbaric oxygen (HBO) on the apoptosis resulted from hypoxic-ischemic brain damage (HIBD) and potential relation to caspase-3 expression.Methods Rats were divided into HIBD、HBO、sham operation group.To observe the morphologic change of brain tissues treated by HBO and compared with that of the hypoxia-ischemia rat model, then check the dynastic change of caspase-3 expression by immunohistochemistry at different time point. Results The expression of caspase-3 in the hippocampus and cortex was higher than that of sham group at 18, 24, 48 and 96 h time point(P