Immune-Mediated Myelopathies: A Review of Etiologies, Diagnostic Approach, and Therapeutic Management

2021 ◽  
Author(s):  
Lama Abdel-Wahed ◽  
Tracey A. Cho
Keyword(s):  
Spinal Cord ◽  
Targeted Therapy ◽  
Systematic Approach ◽  
Incidence Rates ◽  
Diagnostic Approach ◽  
Typically Develop ◽  
Optimal Outcomes ◽  
Immune Mediated ◽  
Broad Term ◽  
Low Incidence

AbstractMyelopathy is a broad term used to describe a heterogeneous group of disorders that affects the spinal cord; the focus of this article will be a subgroup of these disorders with an autoimmune and inflammatory-based pathology. Symptoms typically develop over hours or days and then worsen over a matter of days to weeks, but sometimes can have a more insidious or subacute presentation, which can make the diagnosis more puzzling. Despite relatively low incidence rates, almost a third of affected patients are left with severely disabling symptoms. Prompt recognition of the underlying etiology is essential so that a specific targeted therapy can be implemented for optimal outcomes. The authors discuss a systematic approach to immune-mediated myelopathies, with a focus on the unique characteristics of each that may aid in diagnosis.

scholarly journals Intramedullary spinal cord tumors: a review of current and future treatment strategies

2015 ◽  
Vol 39 (2) ◽  
pp. E14 ◽  
Author(s):  
Matthew K. Tobin ◽  
Joseph R. Geraghty ◽  
Herbert H. Engelhard ◽  
Andreas A. Linninger ◽  
Ankit I. Mehta
Keyword(s):  
Spinal Cord ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Incidence Rates ◽  
Subtotal Resection ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Low Incidence ◽  
New Research ◽  
Localized Drug Delivery

Intramedullary spinal cord tumors have low incidence rates but are associated with difficult treatment options. The majority of patients with these tumors can be initially treated with an attempted resection. Unfortunately, those patients who cannot undergo gross-total resection or have subtotal resection are left with few treatment options, such as radiotherapy and chemotherapy. These adjuvant treatments, however, are associated with the potential for significant adverse side effects and still leave patients with a poor prognosis. To successfully manage these patients and improve both their quality of life and prognosis, novel treatment options must be developed to supplement subtotal resection. New research is underway investigating alternative therapeutic approaches for these patients, including directed, localized drug delivery and nanomedicine techniques. These and other future investigations will hopefully lead to promising new therapies for these devastating diseases.

TBE in Italy

2020 ◽  
Keyword(s):  
Surveillance System ◽  
Ad Hoc ◽  
National Level ◽  
Case Series ◽  
Incidence Rates ◽  
Mountainous Regions ◽  
North East ◽  
The North ◽  
Tick Borne Encephalitis ◽  
Low Incidence

Italy is considered a low-incidence country for tick-borne encephalitis (TBE) in Europe.1 Areas at higher risk for TBE in Italy are geographically clustered in the forested and mountainous regions and provinces in the north east part of the country, as suggested by TBE case series published over the last decade.2-5 A national enhanced surveillance system for TBE has been established since 2017.6 Before this, information on the occurrence of TBE cases at the national level in Italy was lacking. Both incidence rates and the geographical distribution of the disease were mostly inferred from endemic areas where surveillance was already in place, ad hoc studies and international literature.1

scholarly journals The Potential of OMICs Technologies for the Treatment of Immune-Mediated Inflammatory Diseases

2021 ◽  
Vol 22 (14) ◽  
pp. 7506
Author(s):  
Charles Gwellem Anchang ◽  
Cong Xu ◽  
Maria Gabriella Raimondo ◽  
Raja Atreya ◽  
Andreas Maier ◽  
...  
Keyword(s):  
Inflammatory Diseases ◽  
Standard Of Care ◽  
Incidence Rates ◽  
Irreversible Damage ◽  
Omics Technologies ◽  
Progressive Development ◽  
Immune Mediated ◽  
Bowel Diseases ◽  
Affected Tissue ◽  
Systemic Nature

Immune-mediated inflammatory diseases (IMIDs), such as inflammatory bowel diseases and inflammatory arthritis (e.g., rheumatoid arthritis, psoriatic arthritis), are marked by increasing worldwide incidence rates. Apart from irreversible damage of the affected tissue, the systemic nature of these diseases heightens the incidence of cardiovascular insults and colitis-associated neoplasia. Only 40–60% of patients respond to currently used standard-of-care immunotherapies. In addition to this limited long-term effectiveness, all current therapies have to be given on a lifelong basis as they are unable to specifically reprogram the inflammatory process and thus achieve a true cure of the disease. On the other hand, the development of various OMICs technologies is considered as “the great hope” for improving the treatment of IMIDs. This review sheds light on the progressive development and the numerous approaches from basic science that gradually lead to the transfer from “bench to bedside” and the implementation into general patient care procedures.

scholarly journals Decreased angiogenesis as a possible pathomechanism in cervical degenerative myelopathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Christian Blume ◽  
M. F. Geiger ◽  
M. Müller ◽  
H. Clusmann ◽  
V. Mainz ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neurological Status ◽  
Consecutive Series ◽  
Inflammatory Reactions ◽  
Immune Mediated ◽  
Elisa Testing ◽  
Cord Injury ◽  
Blood Spinal Cord Barrier ◽  
Angiopoietin 2

AbstractEndogenous immune mediated reactions of inflammation and angiogenesis are components of the spinal cord injury in patients with degenerative cervical myelopathy (DCM). The aim of this study was to identify alteration of certain mediators participating in angiogenetic and inflammatory reactions in patients with DCM. A consecutive series of 42 patients with DCM and indication for surgical decompression were enrolled for the study. 28 DCM patients were included, as CSF samples were taken preoperatively. We enrolled 42 patients requiring surgery for a thoracic abdominal aortic aneurysm (TAAA) as neurologically healthy controls. In 38 TAAA patients, CSF samples were taken prior to surgery and thus included. We evaluated the neurological status of patients and controls prior to surgery including NDI and mJOA. Protein-concentrations of factors with a crucial role in inflammation and angiogenesis were measured in CSF via ELISA testing (pg/ml): Angiopoietin 2, VEGF-A and C, RANTES, IL 1 beta and IL 8. Additionally, evaluated the status of the blood-spinal cord barrier (BSCB) by Reibers´diagnostic in all participants. Groups evidently differed in their neurological status (mJOA: DCM 10.1 ± 3.3, TAAA 17.3 ± 1.2, p < .001; NDI: DCM 47.4 ± 19.7, TAAA 5.3 ± 8.6, p < .001). There were no particular differences in age and gender distribution. However, we detected statistically significant differences in concentrations of mediators between the groups: Angiopoietin 2 (DCM 267.1.4 ± 81.9, TAAA 408.6 ± 177.1, p < .001) and VEGF C (DCM 152.2 ± 96.1, TAAA 222.4 ± 140.3, p = .04). DCM patients presented a mild to moderate BSCB disruption, controls had no signs of impairment. In patients with DCM, we measured decreased concentrations of angiogenic mediators. These results correspond to findings of immune mediated secondary harm in acute spinal cord injury. Reduced angiogenic activity could be a relevant part of the pathogenesis of DCM and secondary harm to the spinal cord.

Insulin-like growth factor I treatment reduces clinical deficits and lesion severity in acute demyelinating experimental autoimmune encephalomyelitis

1995 ◽  
Vol 1 (1) ◽  
pp. 2-9 ◽  
Author(s):  
X Liu ◽  
D-L Yao ◽  
Hde F. Webster
Keyword(s):  
Spinal Cord ◽  
Autoimmune Encephalomyelitis ◽  
Limb Weakness ◽  
Inflammatory Lesions ◽  
Factor I ◽  
Immune Mediated ◽  
Igf I ◽  
Blood Spinal Cord Barrier ◽  
Clinical Deficits ◽  
Experimental Autoimmune

Our goal was to test the effects of insulin-like growth factor I (IGF-I) treatment on clinical deficits, lesion number and lesion size in acute demyelinating experimental autoimmune encephalomyelitis (EAE) induced in Lewis rats with an emulsion containing guinea pig spinal cord. In this EAE model, there is severe immune-mediated demyelination, which resembles that seen in actively demyelinating MS lesions. On day 12–13 after EAE induction, a total of 23 pairs of rats with the same mild degree of tail and hind limb weakness were given either intravenous IGF-I or placebo twice daily for 8 days. The daily IGF-I dose used in the first trial was 200 μg (about 0.6 mgkg-1) and in the second and third trials was 1 mg (about 3.0 mgkg-1). IGF-I treatment reduced permeability of the blood-spinal cord barrier to Evans blue-albumin. Maximum clinical deficit scores of IGF-I-treated rats were significantly lower and treated rats recovered faster than controls. IGF-I treatment produced significant reductions in weight loss and hind limb weakness. Treatment also improved treadmill walking, stride length and climbing performance. Morphometric analysis showed that spinal cord inflammatory lesions were significantly smaller and fewer in IGF-I-treated rots. The higher IGF-I dose produced a greater reduction in clinical and pathological deficits. We conclude that IGF-I treatment promotes clinical recovery by reducing EAE-induced blood-spinal cord barrier changes and the associated immune-mediated inflammatory lesions. Our results suggest that IGF-I may be useful in treating patients with multiple sclerosis and other demyelinating diseases.

scholarly journals Case Report: Efficacy of Pyrotinib in ERBB2 Amplification Pulmonary Adenoid Cystic Carcinoma

2021 ◽  
Vol 11 ◽  
Author(s):  
Zhongben Tang ◽  
Feng Lin ◽  
Jiarong Xiao ◽  
Xiaojun Du ◽  
Jian Zhang ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Adenoid Cystic Carcinoma ◽  
Large Scale ◽  
Case Reports ◽  
Growth Factor Receptor ◽  
Low Grade ◽  
Adenoid Cystic ◽  
Epidermal Growth ◽  
Low Incidence ◽  
Current Report

Primary pulmonary adenoid cystic carcinomas are salivary tumors that are low-grade malignant and prone to recurrence and metastasis. Surgery is currently the main treatment, but there is no standard with regard to postoperative adjuvant therapy. Adenoid cystic carcinoma is more sensitive to radiotherapy and patients benefit less from chemotherapy, but few studies have focused on targeted therapy, and their conclusions are inconsistent. With respect to primary pulmonary adenoid cystic carcinoma, large-scale studies cannot be conducted due to its low incidence, and studies on the targeted therapy of it are very scarce. A few case reports indicate that targeted therapy can be effective however, suggesting that it may be a good option. The current report is the first on the occurrence of human epidermal growth factor receptor 2 amplification in pulmonary adenoid cystic carcinoma. The patient was treated with pyrotinib for 6 months and achieved stable disease.

scholarly journals Incidence Of Diarrheal Infections In Ukraine: Epidemiological Peculiarities

2019 ◽  
Author(s):  
Nina Malysh ◽  
Oksana Chemych ◽  
Roman Rodyna ◽  
Inna Chorna ◽  
Svitlana Doan
Keyword(s):  
Drinking Water ◽  
Food Item ◽  
Analytical Study ◽  
Incidence Rates ◽  
Epidemiological Surveillance ◽  
Statistical Research ◽  
Factors Influencing ◽  
High Incidence ◽  
The World ◽  
Low Incidence

Abstract Background : Diarrheal infections remain relevant for many countries of the world. The processes of globalization, fundamental changes in nutrition and water consumption contributed to the fact that the significance of individual infection sources, etiological structure of diarrheal infections changed. Purpose of the study: on the background of the analytical study of the incidence of diarrheal infections in Ukraine under the current conditions, to determine the factors influencing epidemic situation. Methods: The reports of the Ministry of Health of Ukraine, Main Administrations of Statistics in Kharkiv, Odesa, Zaporizhia oblasts for 2011-2018 are used in the paper. Epidemiological and statistical research methods are applied. Results: The epidemic situation with diarrheal infections in Ukraine is characterized by a low incidence of typhoid fever (from 0.012 to 0.14 per 100 thousand people), shigellosis (from 1.97-6.13 per 100 thousand people), stable incidence rates without the downward trend, salmonellosis (from 17.35 till 24.1 per 100 thousand people), high incidence of diahrreal infections of specified etiology (from 115.5 to141.9 per 100 thousand people) and diahrreal infections of unspecified etiology (from 69.76 to 107.02 per 100 thousand people). The most complicated epidemic situation is observed in economically most developed regions of the country. Most diarrheal infectionsoutbreaks are connected with catering establishments 36.5 % and with children educational establishments 26.1 %. In the region with the highest shigellosis and salmonellosis incidence direct strong correlation relationships are established between the incidence and population, density, natural population movement. The oblasts with the highest diahrreal infections of specified etiology, rotaviral enteritis, diahrreal infections of unspecified etiology incidence are at least provided with water resources and have problems with provision of high-quality drinking water. There is a need to improve the system of epidemiological surveillance over diarrheal infections by extension of the indicators of microbiological study of drinking water quality in the regions of Ukraine, where high diahrreal infections of specified etiology, rotaviral enteritis, diahrreal infections of unspecified etiology incidence is registered; by increasing frequency of food item inspections in the oblasts, where mediana shigellosis and salmonellosis incidence exceeds the average one in Ukraine. Keywords: diarrheal infections, shigellosis, salmonellosis, rotaviral enteritis.

scholarly journals Incidence patterns for primary malignant spinal cord gliomas: a Surveillance, Epidemiology, and End Results study

2011 ◽  
Vol 14 (6) ◽  
pp. 742-747 ◽  
Author(s):  
Steven Hsu ◽  
Marisa Quattrone ◽  
Quinn Ostrom ◽  
Timothy C. Ryken ◽  
Andrew E. Sloan ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Techniques ◽  
Incidence Rates ◽  
Primary Site ◽  
Age At Diagnosis ◽  
P Value ◽  
Histological Subtype ◽  
Adjusted Incidence ◽  
Over Time ◽  
End Results

Object Primary malignant spinal glioma represents a significant clinical challenge due to the devastating effect on clinical outcomes in the majority of cases. As they are infrequently encountered in any one center, there has been limited population-based data analysis on the incidence patterns of these aggressive tumors. The objective of this study was to use publically available Surveillance, Epidemiology and End Results (SEER) program data to examine the overall incidence and incidence patterns over time with regard to age at diagnosis, sex, race, primary site of tumor, and histological subtype in patients in whom primary malignant spinal cord gliomas were diagnosed between 1973 and 2006. Methods The study population of interest was limited to primary, malignant, pathologically confirmed spinal cord gliomas based on data drawn from the SEER 9 standard registries for patients diagnosed between 1973 and 2006. Variables of interest included age at diagnosis, sex, race, primary site of tumor, and histological subtype of tumor. The SEER*Stat 6.5.2 program was used to calculate frequencies, age-adjusted incidence rates with 95% CIs, and annual percentage change (APC) statistics with a 2-sided p value. In addition, linear correlation coefficients (R2) were calculated for the time association stratified by variables of interest. Results The overall age-adjusted incidence rate for primary malignant spinal gliomas was 0.12 per 100,000, which increased significantly over the study period (APC = 1.74; p = 0.0004; R2 = 0.36). The incidence was highest in patients diagnosed at ages 35–49 (0.17 per 100,000), males (0.14 per 100,000), whites (0.13 per 100,000), and those with ependymomas (0.07 per 100,000). Over the study period, the incidence of ependymomas increased significantly (APC = 3.17; p < 0.0001; R2 = 0.58) as did the incidence of these tumors in whites (APC = 2.13; p = 0.0001) and for both males (APC = 1.90, p value < 0.0001) and females (APC = 1.60, p < 0.0001). The authors found no significant changes in the incidence over time by age of diagnosis. Conclusions This study demonstrates an increasing overall incidence of primary, malignant spinal cord glioma over the past 3 decades. Notably, for ependymoma the incidence has increased, whereas the incidence of most other glioma subtypes remained stable. This may be due to improved diagnostic and surgical techniques, changes in histological classification criteria, and changes in neuropathology diagnostic criteria. Although primary, malignant spinal cord gliomas are rare, an improved understanding of the incidence will assist investigators and clinicians in planning potential studies and preparing for allocation of resources to care for these challenging patients.

scholarly journals Spontaneous and Drug-induced Arteritis/Polyarteritis in the Göttingen Minipig—Review

2018 ◽  
Vol 46 (2) ◽  
pp. 121-130 ◽  
Author(s):  
Zuhal Dincer ◽  
Virginie Piccicuto ◽  
Ursula Junker Walker ◽  
Andreas Mahl ◽  
Sean McKeag
Keyword(s):  
Spinal Cord ◽  
Urinary Bladder ◽  
Blood Vessels ◽  
Polyarteritis Nodosa ◽  
Pain Syndrome ◽  
Vascular Changes ◽  
Drug Induced ◽  
Göttingen Minipig ◽  
Age Related ◽  
Immune Mediated

Arteritis/polyarteritis occurs spontaneously in many species used in preclinical toxicology studies. In Göttingen minipigs, arteritis/polyarteritis is an occasionally observed background change. In the minipig, this finding differs in frequency and nature from age-related polyarteritis nodosa in rats or monkeys, and Beagle pain syndrome in dogs. In minipigs, it can be present in a single small- or medium-sized artery of an organ or a few organs and is most commonly recorded in the cardiac and extracardiac blood vessels, vagina, oviduct, rectum, epididymis, spinal cord, pancreas, urinary bladder, kidneys, and stomach. The etiology is unknown although it has been considered in minipigs as well as in rats, dogs, and monkeys to be possibly immune mediated. This background change is important with respect to its nature and distribution in the minipig in order to distinguish it from drug-induced vascular changes, which might occur in similar locations and have similar morphologic features. This review summarizes the morphology, incidence, and predilection sites of arteritis as a spontaneously occurring background change and as a drug-induced vasculopathy in the minipig, and also describes the main aspects to consider when evaluating vascular changes in Göttingen minipig toxicity studies and their human relevance.

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