Neuritis Research Articles

Paying attention to optic nerve injury disease and optic nerve regeneration study

Glaucoma,optical neuritis and trauma are optic nerve injury-related diseases.These ocular diseases cause irreversible damage of the vision and even blindness.The study on optic nerve regeneration is a powerful approach for rescuing vision and improving the quality of life of patients.Therefore,how to promote optic nerve regeneration is always the focus in ophthalmology.In recent years,great progression has achieved by modulation of cellular signal pathway,usage of glial cells,stem cells and neurotrophic factor,etc,which lays a basis for the treatment of optic nerve injury.Ophthalmologist should trace and participate in these researches to promote the development of regeneration medicine.This review summarizes these new approaches after discussing factors effecting optic nerve regeneration briefly and proposes questions to answer. Key words: Optic nerve/regeneration; Retinal ganglion cell; Glia cell; Stem cell; Neurotrophic factor

The clinical outcomes of idiopathic optic neuritis with no light perception in 21 eyes

To evaluate the treatment outcomes of idiopathic optic neuritis with no light perception in 21 eyes. This is a retrospective study. The hospital data of 17 patients (21 eyes) with idiopathic optic neuritis whose visual acuity were no light perception from August 2003 to April 2011 were retrospectively analyzed. These patients were treated with steroid pulse and other drugs. The clinical features, the time of appearance light perception, the best corrected visual acuity and VEP were measured. The follow-up was at least three months. Before the treatment, the average time of occurring no light perception were 1.0 ∼ 90.0 days, except 1 eye was 90.0 days while the other 20 eyes was (12.5 ± 10.6) days. After the treatment, vision improved in 14 eyes (66.7%) from Hand Move/30 cm to 20/20, the average time of appearance light perception was (9.9 ± 7.9) days. The best corrected vision acuity were 1 eye Hand Move, 2 eyes Finger Count, 1 eye 20/2000, 3 eyes 20/1000, 2 eyes 20/800, 1 eye 20/500, 1 eye 20/320, 1 eye 20/125, 1 eye 20/32, 1 eye 20/20. 5 eyes with no VEP wave pattern emerge P(100) after therapy, the other 2 eyes which had P(100) was flatten after therapy. The follow-up found that except 1 eye vision improve outside, the rest eye vision remained stable. The patients with optic neuritis who initially were no light perception should be treated promptly. The prognostic of vision can not be evaluated only by the duration time of no light perception, the appearing-time of light perception and the pattern of VEP.

Anti-MOG antibody in different types of immune-mediated optic neuritis

To investigate the expression of anti-myelin oligodendrocyte glycoprotein antibody (MOG-Ab) in different types of immune-mediated optic neuritis (IM-ON). Case-control and cross section study. The serum of 129 consecutive cases of immune-mediated optic neuritis (IM-ON group) seen in Neuro-ophthalmology clinic in Department of Neurology, Beijing Tongren Hospital during May 2010 and February 2011 were collected. All IM-ON cases were further classified into five different types as: 20 cases of multiple sclerosis related ON (MS-ON), 13 cases of neuromyelitis optical related ON (NMO-ON), 33 cases of autoimmune optic neuritis (AON), 43 cases of relapsing isolated optic neuritis (RION) and 20 cases of solitary isolated optic neuritis (SION). MOG-Ab was tested by ELISA. The positivity rate and titer of MOG-Ab among these groups were compared using chi-square test and ANOVA, t test by SPSS17.0 software. MOG-Ab was positive in 12 of all 129 tested IM-ON patients (9.3%), in which there were 5 of 20 MS-ON, none of 13 NMO-ON, 4 of 33 AON, 2 of 43 RION, and 1 of 20 SION patients. There were no statistical significant difference among five groups (Fisher's exact test, χ(2) = 7.051, P = 0.088), but MS-ON group showed statistically higher MOG-Ab positivity and titer than the "NMO spectrum optic neuritis" group which was merged from the other 4 IM-ON groups. MOG-Ab could be detected in different types of immune-mediated optic neuritis except NMO-ON and the expression of MOG-Ab was statistically higher in MS-ON group than the 'NMO spectrum optic neuritis' group.

Ocular changes during pregnancy

Pregnancy is often associated with ocular changes which are mostly transient but in some cases permanent. The ocular changes in pregnancy are either physiological or pathological. Pregnancy can improve or exacerbate the pre-existing ocular conditions. Pregnancy per se is associated with a hypercoagulable state and this may lead to occlusive vascular diseases of the choroid and retina. Diabetic retinopathy may result in worsening of the disease during pregnancy. On the other hand, there can be improvement of optic neuritis, uveitis, glaucoma or thyroid orbitopathy. Physiological changes include periocular skin, corneal and lens changes or changes in the intraocular pressure and visual field. Pathological changes include central serous retinopathy. Preeclampsia, eclampsia and HELLP syndrome are gestational diseases, which can also manifest themselves with ocular symptoms. Spontaneous vaginal delivery is not contraindicated in pregnant women with risk factors for retinal detachment if appropriate care is given before delivery, as necessary.

Expression of myelin basic protein in rat optic nerve with experimental allergic encephalomyelitis

Background Optic neuritis is closely associated with multiple sclerosis (MS).Its pathogenesis is uncompletely clear,and less basic researches are carried out at home and abroad. Objective This study was to reveal the expression of myelin basic protein (MBP) in the optic nerve of rat with experimental allergic encephalomyelitis (EAE) and to provide a theoretical evidence for the research of the relationship of optic neuritis with MS. Methods Fifty clean Wistar rats were randomized into the control group and immune 8,12,18 and 25 days groups.Myelencephalon was collected from 5 guinea pigs to prepare the homogenate and mixed with the isovolumetric complete Freud' s adjuvant (CFA).The 0.5 ml mixed antigen emulsifier was subcutancously injected into the 4 maps together with Bordetella pertussis 0.2 ml under the cutancous of dorsalis pedis at 0 and 48 hours to induce the EAE.Behavior of the rats was evaluated to score the neurological function.The optical nerve sections were prepared 8,12,18 and 25 days after immunology for the histopathological examination,and immunochemistry and Western blot were used to detect the expression of MBP in optic nerve.The use of the animals complied with the Regulation for the Administration of Affairs Concerning Experimental Animals by State Science and Technology Commission. Results The disorder of motor nerve was seen 12 days following the immune,and the clinical neural functional scores were significantly higher 12 day and peaked on 18 days myelination and then gradually reduced.The histopathological examination showed that the irregular alignment of neural fiber was found at 12 days,and changes of cellular structure,edema of neural shaft bunch were observed at 18 days.However,the abnormal cells were significantly less 25 days following the immune.Immunochemistry showed that the MBP was expressed mainly in the myelination of optic nerve fibers.The numbers of positive cells for MBP were (115.75±26.49)cells/5 fields at the 12th day,showing a significant lowing in comparison with (167.44±22.49)cells/5 fields of control group (t=4.537,P＜0.05 ).The positive cells were lest at the 18th day with the values ( 75.57 ± 34.54) cells/5 fields ( t =6.362,P＜0.01 ).At the 25th day,positive cells increased to ( 117.63 ± 13.78) cells/5 fields,which still was lower than those of the control group ( t =4.068,P＜0.05 ).Western blot assay illuminated that with the prolong of immune time,MBP/β-actin ratio in optic nerve was gradually reduced and followed the same pattern at the 12th day( t =4.639,P＜0.05 ).At 18 days after immune in comparison with the control group,the expression of MBP/β-actin ratio in optic nerve was the least (t=8.427,P＜0.01). Conclusions MBP can be degraded in rat optic nerve.This is a further evidence that optic neuritis is a severe demyelination disease.It is clearly related to MS. Key words: Experimental allergic encephalomyelitis; Myelin basic protein; Multiple sclerosis; Optic neuritis

Optic nerve's disease characteristics and its nursing analysis

Objective To explore the etiological factors,composition of the disease and nursing care for the disease of optic nerve.Methods The 375 cases patients' information were collected from October 2009 to May 2011 in the ward of neuro-ophthalmology.The retrospective study was used and the disease's characters and nursing care were summarized.Results After treatment,those patients had certain degree of curative effect and the visual acuity increased.In the etiological distribution,optic neuritis was the most factor and accounted for 37.60％ of the optic nerve disease.Health education,psychological nursing,nursing care of dysopia,and individual nursing were used for patients with optic nerve's disease.Conclusions The optic nerve diseases are very common in the ward of neuro-ophthalmology.The characteristics of the diseases include long course and complicated etiological factors.Effective nursing care and psychological intervention are very important for the patients with optic nerve disease and helpful for the recovery. Key words: Optic nerve disease; Nursing; Analysis of causes

Clinical study of optic neuritis combined with viral hepatitis

To investigate the clinical manifestation, management and prognosis of optic neuritis combined with viral hepatitis. Retrospective study case series. Clinical data from twenty patients with optic neuritis combined with hepatitis who were hospitalized in Beijing Tongren Hospital neural eye ward from September 2003 to June 2010 were collected, the clinical characteristics and visual field changes in the group of patients were summarized, and comparison between the vision before and after treatment was made by the Wingerchuk vision classification. Among the twenty patients, eighteen patients had chronic hepatitis B and two patients had chronic hepatitis C. Thirteen (65%) patient were monocular, sixteen (80%) patients were single-phase course. Twenty-seven eyes were affected. Disc edema was very common which was found in 14 eyes (52%), severe vision impairment (Best corrected visual acuity worse than 20/200) were recorded in 19 eyes (70%). Lower altitudinal visual field impairment was more common which was found in 10 eyes (50%). All patients were followed for 3 months after steroid therapy, complete visual recovery or significant improvement was seen in only 3 eyes (11%) or 4 eyes (15%). Minor improvement was seen in 12 eyes (44%), while 8 eyes (30%) had no improvement. In this study, optic neuritis combined with hepatitis usually showed severe visual impairment. Although the vision of some patients could completely recover after steroid therapy, most of the patients had poor recovery. Combination of steroid and anti-viral therapy should be considered in the management of optic neuritis combined with hepatitis.

Erythropoietin Reduces Axonal Loss After Optic Neuritis

Erythropoietin (EPO) is thought to provide trophic support to the nervous system, as demonstrated in animal models of optic neuritis and other models

Clinical observation of Mecobalamin and glucocorticoid for 74 patients with optic neuritis

Objective To observe the efficacy of glucocorticoid and Mecobalamin in the treatment of optic neuritis.Methods Seventy-four patients (118 eyes) with optic neuritis were enrolled in this study.There were 38 patients (55 eyes) with optic nerve papillitis,36 patients (63 eyes) with retrobulbar neuritis.The patients were divided into treatment and control group,37 patients (59 eyes) in each group.The treatment group received semi-retrobulbar injection of 500μg Mecobalamin per day,10 times for one course; after two to three courses changed oral 500 μg Mecobalamin,three times per day.Systemic intravenous injection of 15 dexamethasone mg per day for one week,then prednisolone 30 mg per day orally,the dosage was reduced every five days for 5 mg; oral administration of vitamin B1,10 mg three times per day,use of energy mixture,vasodilators.Control group underwent the same therapy as the treatment group without Mecobalamin.The efficacy differences between two groups were comparatively analyzed.Results Among 59 eyes in the treatment group,42 eyes (71.19％) were markedly effective,15 eyes (25.42％) were valid and two eyes (3.39％) were invalid.The total effective rate was 96.61％.Among 59 eyes in the control group,30 eyes (50.85％) were markedly effective,26 eyes (44.07％) were valid and three eyes (5.08％) were invalid.The total effective rate was 94.92 ％.The difference of total effective rate between two groups was not statistically significant (x2 =1.10,P＞0.05) ; but there was a difference in markedly effective ratebetween two groups (x2 =5.65,P＜0.05).Conclusion Mecobalamin combined with glucocorticoids was effective in the treatment of optic neuritis. Key words: Optic neuritis/therapy; Cobamides/therapeutic use; Glucocorticoids/therapeutic use; Treatment outcome

Is it efficacy for the treatment of idiopathic optic neuritis with glucocorticosteroid

Glucocorticosteroid (steroid) therapy is the major treatment for some important neuro-ophthalmological diseases. However, its efficacy, safety and abuse raise great controversy and debate for a long time, many clinical problems also remain to be solved. This paper discusses the issues relevant to the treatment of idiopathic optic neuritis by steroid and strongly advocate carrying out an evidence-based multicenter randomized clinical trial in China. It is suggested to establish a standard guideline or consensus for the treatment of neuro-ophthalmological diseases with steroid.

Recent progress on genetics of optic neuritis

Optic neuritis (ON) is a common disorder of the neuro-ophthalmology, which harms patients vision seriously. However, there are a lot of controversy and confusion about its etiology. While ON has familial characteristic and the tendency of heredity to some extent. Recently, association studies have made considerable progress with the rapid development of molecular biology techniques and statistical methods. In this article, the latest progresses in genetics of ON are reviewed.

Analysis of optical coherence tomography in early stage of optic neuritis in multiple sclerosis patients

To detect the changes in the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) in the eyes of multiple sclerosis patients during the early stage of optic neuritis. A prospective case series study. Suspected acute optic neuritis of multiple sclerosis (MS) patients who attended the department of ophthalmology in Peking Union Medical College hospital from Feb. 2007 to Nov. 2010 were collected. Twenty two MS patients were evaluated within the first week of the attack of acute optic neuritis. The average thickness of RNFL and GCC was measured and a three dimensional image of optic disk was reconstructed using optical coherence tomography (OCT). Within the first week of onset, the average thickness of RNFL and GCC of first attack eyes increased 75% and 64%, respectively. The average thickness of RNFL and GCC in relapsed eyes decreased 91.7% and 62.5% respectively. The average thickness of RNFL and GCC of the fellow eyes also increased 60% and 43% respectively, within the first week of onset. More cases of optic disk edema and thickening of RNFL were found by OCT than by direct ophthalmoscopy. Different changes of the thickness of RNFL and GCC and morphology of the optic disk were detected during the early stage of the initial attack or relapsed optic neuritis in MS patients. OCT could detect such differences.

The protective effects of erythropoietin/erythropoietin receptor system on optic nerve and retinal diseases

Erythropoietin(EPO) has an anti-apoptotic effect,and promotes the proliferation and differentiation of erythroid progenitor cells. Several studies have indicated that EPO can protect photoreceptor cells from the lightinduced retinal degeneration ;protect retinal neurons from ischemia-reperfusion injury and retinal ganglion cells after acute and chronic ocular hypertension; promote ganglion cell survival and axonal regeneration after optic nerve transaction; attenuate inflammation in multiple sclerosis optic neuritis; reduce the permeability of the retinal barrier and protect retinal neurons in diabetic retinopathy; enhance the stability of hypoxic retinal vessels in retinopathy of prematurity. Herein,we review the distribution of EPO and its receptor in retina,their expression in animal model of retinal diseases,and their effects and mechanisms in protection of retinal neurons and optic nerve. Key words: Erythropoietin; Erythropoietin receptor; Optic nerve; Retina; Neuroprotection

The Diagnosis and Differential Diagnosis of Chronic Abdominal Wall Pain

Objective To study the clinical character , diagnosis and differential diagnosis procedures of chronic abdominal wall pain( CAWP ).Methods:Observe and analysize on 27 CAWP patients and tell its difference from the pain resulted from the abdominal internals. Results 1.The main reasons of CAWP is neurogenic( n=18,67% ) , such as the entrapment of intercoastal nerve , postherpetic pain , neuritis caused by diabetic, etal.2.Myofascial pain of abdominal wall is secondatory ( n=7, 26% ).3.the other reasons is rare ( n=2, 7% ).The characteristics of CAWP were local abdominal pain related to posture, positive Carnette,Hover, Tinel s signs, local pain point blocking is effective.Conclusion The diagnosis and differential diagnosis of CAWP depended mostly the health record, clinical expression and radiology. The doctors were required to have better medical knowledge. Key words: Chronic abdominal wall pain; Diagnosis; Differential diagnosis

Axonal loss and neuroprotection in optic neuropathies.

Most optic neuropathies do not have effective treatments. Examples are ischemic optic neuropathy, Leber hereditary optic neuropathy, optic neuritis, and traumatic optic neuropathy. In some cases, the pathophysiology of the optic nerve injury is not fully understood. For example, while the demyelinative aspects of optic neuritis have been studied, the mechanism by which the axonal loss occurs is less apparent. In other cases, although the pathophysiology of the optic neuropathy may be understood, there is difficulty treating the disease, for example, with traumatic optic neuropathy. In response to this therapeutic dearth, the concept of neuroprotection has arisen. Neuroprotection is a therapeutic paradigm for preventing death of neurons from injury and maintaining function. In optic neuropathies, the corresponding neuron is the retinal ganglion cell. These cells are unable to divide, and optic neuropathies irrevocably result in their death; therefore, the primary target of neuroprotection are retinal ganglion cells and their axons. This review emphasizes that most optic neuropathies are axonal and thus good targets for neuroprotection.

Clinical features of multiple sclerosis-related optic neuritis in Hong Kong Chinese patients

Clinical features of multiple sclerosis-related optic neuritis in Hong Kong Chinese patients

Influence of different transfusion pathway in gastrointestinal cancer chemotherapy

Objective This study wag to compared the efficacy and toxicity in gastrointestinal cancer chemotherapy with oxaliplatin,leucovorin and 5-fluorouracil when it wad given with PICC line(Peripherally Inserted Central Catheter)combined chemotherapy pump or with peripheral vein catheter catheterization.Methods 58 patients with gastrointestinal cancer were treated by oxaliplatin,leucovofin and 5-fluomuracil.34cases in group A were given with PICC line(Peripherally Inserted Central Catheter)combined chemotherapy pump.The regimen was FOLFOX6 which consisted of 2-hour infusion of oxaliplatin(OXA)(100 ms/m2)and 2-hour infusion of leucovorin(CF)(400 mg/m2)on Day 1,and by5-fluorouracil(5-FU)400 mg/m2)on Day 1 and 46-hour infusion(2.4 g/m2)used by chemotherapy pump.and all chemotherapy drug were siven through PICC.the regimen wag repeated at 2-week intervals.24 crises in group B were given with peripheral vein catheter catheterization.The regimen consisted of infusion of OXA(130 mg/m2)Day 1 and infusion of CF(100 mg/m2)and 5-FU(450 mg/m2)on Day 1～5,the regimen wag repeated at 3-week intervals.The clinical efficacy and adverse events were evaluated.Results The achievement ratio of catheterization in group A wag 93.1%,the detain time wag 5～180 days,average detain time was 62 days,phlebitis developed in 8.8%(3/34),overall gesponse rate(OR)was 47.0%(16/34).The achievement ratio of catheterization in group B wag 88.2%,the detain time was 1-3 days.average detain time wag 2.5 days,phlebitis developed in 20.8%(5/24),overall response rate(OR)wag 37.5%(9/24).The rate of peripheral neuritis,gastrointestinal reaction,and myelosuppression in group A were higher than group B,there were significant different between two group.Conclusions Compared with peripheral vein catheter catheterization,it is more efficacy and less toxieity with oxaliplatin,leucovorin and 5-fluorouracil regimen in treating gastrointestinal cancer with PICC line,and improved quality of life of these patients.It can be popularized. Key words: Gastrointestinal cancer; Peripherally inserted central catheter; Peripheral vein catheter catheterization; Chemotherapy

Efficacy and Safety of Paclitaxel Liposomes in Treatment of 40 Patients with NSCLC

Objective To compare the efficacy and safety of domestic-made Paclitaxel liposomes with Paclitaxel in the treatment of NSCLC.Methods 82 patients with advanced NSCLC were prospectively randomized into two groups,experimental group were given Paclitaxel liposome at 135 mg/ m2 each cycle,and control group were given Paclitaxel at 135 mg/ m2.Both groups combined with DDP at 75 mg/ m2 per cycle every three weeks.The efficacy and safety were evaluated after two cycles.Results 82 patients were enrolled into this study.40 and 42 patients were enrolled into the experimental and control respectively.Of 82 cases,81 were eligible for analysis of side effects and overall response rate.The overall response rate was 27.5 % in experimental group and 24.4 % in control group.There was no significant difference between two groups.Though there was no significant difference in hematological toxicity and most of non-hematological toxicity between the two groups,peripheral neuropathy and the toxicity from the mixed solvent of polyethoxylated castor oil and ethanol were significantly lower in experimental group than those in control group.Conclusion Paclitaxel liposome combined with DDP in the treatment of advanced NSCLC can significantly reduce the incidence of peripheral neuritis and serious hypersensitive reactions with the similar response rate as that of Paclitaxel.

Management of Resistant Erythema Nodosum Leprosum With Prolonged Methotrexate and Prednisolone : A Report on 9 Patients

Introduction : Erythema Nodosum Leprosum is the chronic recurrent systemic complication of multi-bacillary leprosy particularly Lepromatous Lepromatous Leprosy and Borderline Lepromatous Leprosy. It is frequently associated with the development of neuritis, iritis, orchitis, arthritis / dactylitis of hands and feet, etc. Decades ago, it was well managed with thalidomide but now a high dose of Clofazimine and Steroid are the recommended drugs by the World Health Organization. Unfortunately there are some patients who do not respond to this regimen or experience relapse after they attempt ot reduce their steroid below 15-20mg / day. Objective : We undertook this study to find out an effective and safe treatment regimen for those resistant patients. Methodology : During 2007-2011, we treated 9 resistant ENL patients. They were ENL reaction with (a) Skin Ulcers-2, (b) Neuritis-2, (c) Nerve Abscess-1, (d) Iritis-1, 9e) Orchitis-2 and (f)Arthritis/Dactylitis-1. All had comparable clinical and bacteriological features and almost similar history of incomplete response to courses of conventional treatment in hospital, during last 1-1 1/2 years. We treated them all with a combination of Methotrexate and Predinisolone for 21/2 -31/2 years. Results : We observed smooth remission of ENL-reaction in all our patients. No remarkable side effects were seen in our patients, except mild weight gain in one, weight gain and facial swelling in one, two attacks of multiple folliculitis and one attack of extensive P. versicolor in another one and Norwegian scabies in one. Conclusion : A combination of low dose Prednisolone and Methotrexate was found safe and effective in managing resistant ENL reaction and we welcome controlled study in this regard. JCMCTA 2011; 22(2): 44-46

Clinical Observation of Sellate Ganglion Block in the Treatment of Facial Paralysis

Objective To observe the therapeutic effect of stellate ganglion block for the treatment of facial paralysis. Methods 128 patients were randomly divided into two groups. Control group was treated by routine therapy , treatment group was treated by routine therapy plus stellate ganglion block. The effects of the two groups were evaluated by facial paralysis scale. Effective rate and cure rate as well as the course of therapy after treatment were also observed and compared. Results The cure rate of treatment group was 65% , effective rate was 98%. The cure rate of control group was 35% .effective rate was 82%. The cure rate and effective rate of treatment group were significantly higher than that of control group (P < 0. 05 ). The mean effective time and cure time of treatment group were shorter than the control group (P < 0.05). Conclusion Stellate ganglion block plus routine therapy produced better therapeutic effect and shortened the therapeutic course of facial paralysis. Key words: Stellate ganglion; Nerve block; Facial neuritis; Treatment