Application Of New Diagnostic Criteria Research Articles

The role of nerve growth factor (NGF) in the pathogenesis of leprosy

Leprosy is a chronic infectious disease caused by M. leprae with a primary lesion of the skin and peripheral nervous system. Currently, clinicians using bacterioscopic studies of scarification and skin biopsy mainly diagnose leprosy. However, the development and application of new diagnostic criteria, especially those associated with damage to nerve fibers, remains an urgent task of modern leprology. This review considers the important role of neurotrophic factor (nerve growth factor, NGF) in the pathogenesis of nervous system damage in leprosy and establishes the relationship between NGF levels and forms of the disease. The review includes data from foreign and domestic articles; the search was carried out using the “Scopus”, “PubMed”, “Web of Science”, “elIBRARY” databases.

Prevalence of high blood pressure under 2017 ACC/AHA guidelines: a systematic review and meta-analysis.

To understand the prevalence of high blood pressure among the general adult population under the new diagnostic criteria. PubMed and Embase databases were systematically searched. Two investigators independently performed data extraction and quality assessment, and the disagreements were resolved by consensus with a third investigator. The random-effects model was performed to pool the prevalence of high blood pressure among the population. Subgroup and meta-regression analyses were performed to explore the source of heterogeneity. The study protocol has been registered with PROSPERO, number CRD42019147330. In total, 52 articles included in the meta-analysis with a total of 54 studies. An obvious increase in the prevalence of high blood pressure was identified by the application of new diagnostic criteria. The pooled prevalence of high blood pressure among the population was 53.01% (95% confidence interval 51.13-54.88%). Subgroup analysis showed that the WHO region, national, and age could significantly influence the prevalence of hypertension (P < 0.01). Meta-regression analyses revealed that study quality and sex ratio (male, %) did not contribute to the heterogeneity of the results (P > 0.05). The sensitivity analysis showed that the results were stable. With the use of new diagnostic criteria, the prevalence of high blood pressure has shown an upward trend, especially in Europe countries. Prevention and control measures should focus more on improving cardiovascular and cerebrovascular status in Europe countries. Standard electronic blood pressure monitors were recommended for use in future studies, and at least two more readings should be taken during a visit.

SAT-369 Proposal of Optimal Cutoff value for Serum Cortisol after an Overnight 1-mg Dexamethasone Suppression Test - Results from Multicenter Collaborative Research in Japan.

In Japan, diagnostic criteria of subclinical Cushing’s syndrome (SCS) were formulated in 1996, using cutoff value for serum cortisol of 3.0 μg/dL after an overnight 1-mg dexamethasone suppression test (DST). It has made considerable contributions to the understanding and pathology of SCS. However, it has elicited two main problems: (i) the relatively low reliability of a low range of serum cortisol essential for the diagnosis by DST; (ii) different cutoff values for serum cortisol after a 1-mg DST compared with those of other countries. For the proposal of new diagnostic criteria, we conducted a retrospective cross-sectional study. 530 cases (270 men and 260 women, mean age: 60.1 ± 11.1 years) with an adrenal tumor were assessed. In the present study, the assay kits adopted for measurement of serum cortisol differed among facilities. A calibration formula was previously developed by Kuwa et al. for standardization of different kits. Using this formula, standardization of the serum cortisol values after a 1-mg DST and at night was done. As a result, using current criteria, the diagnosis of 11 out of 92 SCS cases was changed to “non-SCS”, and all of 189 non-SCS cases remained non-SCS after calibration. After all, diagnostic concordance rate before and after calibration was 96.1%, suggesting that the actual diagnosis did not change dramatically, by calibration. The cortisol values after a 1-mg DST were compared based on the presence or absence of complications (hypertension, impaired glucose tolerance or diabetes, and hypercholesterolemia). As a result, when serum cortisol after a 1-mg DST was stratified by increments of 1.0 μg/dL, the coincidental occurrence of hypertension and impaired glucose tolerance was more frequently observed in the 2-2.99 μg/dL group than in the 0-0.99 μg/dL group (39.3% vs. 23.5%, p=0.018), suggesting that the threshold for the onset of complications of adrenal tumors may be serum cortisol of 2-3μg/dL after a 1-mg DST. Under the consideration of international consistency, serum cortisol ≥1.8 μg/dL after a 1-mg DST may be useful for the detection of ‘not completely healthy’ subjects with adrenal tumor. Additionally, in the present study, almost all of the respective criteria, such as basal ACTH <10 pg/mL and/or nocturnal cortisol at 21.00-23.00 h ≥5 μg/dL, are satisfied in almost all cases who have serum cortisol ≥5 μg/dL after a 1-mg DST. It suggests that serum cortisol ≥5 μg/dL after a 1-mg DST warrant the significant autonomy of cortisol production. The current cutoff level of 3.0 μg/dL may be also useful, for lowering the risk of confusion in the application of new diagnostic criteria. Consequently, three hierarchical cortisol cutoff values, 5.0, 3.0 and 1.8 μg/dL are presented to the new diagnostic criteria of SCS in Japan.

Guillain–Barré syndrome subtypes: A clinical electrophysiological study of 100 patients

IntroductionA retrospective analysis was performed to document the clinical and electrophysiological features of Guillain-Barré syndrome (GBS) subtypes using different diagnostic criteria. MethodsOne hundred GBS patients were included. Clinical and laboratory features were analyzed, and patients were classified according to four sets of diagnostic criteria. Electrodiagnostic criteria were also analyzed. ResultsA total of 69 patients met Asbury and Cornblath's criteria, 96 met Van der Meché’s criteria, 99 met Wakerley's diagnostic classification and 86 met level 1 or 2 of the Brighton criteria. Rates of GBS subtypes were: 69% classic GBS; 8% Miller–Fisher syndrome; 12% paraparetic GBS; 2% pharyngeal–cervical–brachial GBS; and 9% unclassified. Those for electrodiagnostic subtypes were 52% demyelinating and 9% axonal according to Hadden's criteria vs 41% demyelinating and 41% axonal as per Rajabally's criteria. ConclusionIn this study of case distribution within the GBS spectrum of a retrospective cohort of French patients, the application of new diagnostic criteria enabled accurate diagnoses and classifications of the different subtypes, and also increased the recognition of axonal GBS.

Finding NMO: The Evolving Diagnostic Criteria of Neuromyelitis Optica.

Neuromyelitis optica (NMO) is an autoimmune demyelinating disorder of the central nervous system (CNS) with predilection for the optic nerves and spinal cord. Since its emergence in the medical literature in the late 1800's, the diagnostic criteria for NMO has slowly evolved from the simultaneous presentation of neurologic and ophthalmic signs to a relapsing or monophasic CNS disorder defined by clinical, neuroimaging, and laboratory criteria. Due to the identification of a specific autoantibody response against the astrocyte water channel aquaporin-4 (AQP4) in the vast majority of affected individuals, the clinical spectrum of NMO has greatly expanded necessitating the development of new international criteria for the diagnosis of NMO spectrum disorder (NMOSD). The routine application of new diagnostic criteria for NMOSD in clinical practice will be critical for future refinement and correlation with therapeutic outcomes.

Concurrencia de síndromes paraneoplásicos neurológicos, en paciente afecta de cáncer de mama y metástasis cerebral: revisión de la literatura

Neurological paraneoplastic syndromes are complex entities of difficult diagnosis. They can locate in any part of the nervous system producing important neurological dysfunctions. The discovery of new specific anti-neuronal antibodies and their relation with the associated immunological alterations help to make an early diagnosis. Association with breast cancer is not frequent. We present the case of a 62-year old patient with left breast carcinoma that had been treated by mastectomy and adjuvant chemotherapy one year before. She relapsed with cerebellum metastases and was treated by surgery and radiotherapy. The picture was complicated with a Lambert-Eaton-like myasthenic syndrome, neuroplastic sensory neuronopathy, limbic encephalitis and irreversible coma. The application of new diagnostic criteria, the molecular discoveries and the performance of therapeutic clinical trials could better the life expectancy of these patients.