Sensitivity and specificity of a commercial ELISA test for anti-MAG antibodies in patients with neuropathy

For the diagnosis of anti-MAG polyneuropathy the commercial ELISA manufacturer currently recommends a cut-off of 1000 B\ufchlmann Titer Units (BTU). We analyzed sera from 80 anti-MAG neuropathy patients and 383 controls (with other neuropathies or healthy controls) to assess the ELISA sensitivity and specificity at different thresholds. A better combination of sensitivity/specificity was found at a threshold >1500 BTU than at >1000 BTU. The best value of specificity was obtained at threshold >7000 BTU. There was a diagnostic grey area between 1500 and 7000 BTU in which the clinical phenotypes as well as electrophysiological studies need to be carefully assessed particularly to differentiate CIDP and anti-MAG neuropathy

Prometheus. Altante di anatomia

L'Atlante di Anatomia Prometheus si propone come un valido ausilio per la preparazione dello studente e costituisce una guida chiara alla comprensione di quanto un argomento sia necessario alla conoscenza di base dell'anatomia ed in quale misura si correli con l'attivit\ue0 clinica del medico. In questa nuova edizione l'intento degli autori, cos\uec come nella prima, \ue8 quello di fornire informazioni pi\uf9 aggiornate, complete e adatte per l'insegnamento e lo studio dell'Anatomia Umana. La trattazione di ogni regione anatomica si apre con la descrizione dell'anatomia di superficie e prosegue con la struttura scheletrica, i muscoli, i vasi sanguigni e i nervi mediante la rappresentazione topografica della regione nel suo complesso e in rapporto con le altre regioni anatomiche. Ogni tavola \ue8 accompagnata da una descrizione anatomica, arricchita con riferimenti clinici essenziali: il testo \ue8 corredato da immagini cliniche e diagnostiche, come radiografie, RM, TC ed endoscopie. Quest'opera, per le immagini e il modo in cui esse sono state organizzate, si pone sicuramente ai vertici qualitativi della bibliografia attualmente disponibile in ambito anatomico. Novit\ue0 di questa seconda edizione - riorganizzazione del materiale relativo all'unit\ue0 Addome e Pelvi in due unit\ue0 separate Addome e Pelvi e perineo con l'aggiunta di molte nuove illustrazioni; - spostamento della trattazione sul midollo spinale e sulle meningi craniche dall'unit\ue0 Neuroanatomia alle unit\ue0 Dorso e Testa e collo; - ampliamento e spostamento della trattazione di Anatomia di superficie all'inizio di ciascuna unit\ue0; - inserimento di diverse illustrazioni di sezioni anatomiche alla fine di alcune unit\ue0, al fine di fornire agli studenti un'ulteriore prospettiva del corpo umano. Punti di forza - oltre 2400 illustrazioni accurate e diagrammi esplicativi; - oltre 150 tabelle riassuntive; - diagrammi schematici e tavole riassuntive aggiornate e semplificate; - indicatori che orientano il lettore a identificare la posizione delle strutture anatomiche e i livelli di dissezione; - brevi testi introduttivi per ogni nuovo argomento presentato; - immagini cliniche e diagnostiche, come radiografie, RM, TC ed endoscopie. Destinatari Principalmente studenti dei corsi di laurea in Medicina, Biologia, Scienze Motorie e Professioni Sanitarie

Anatomia Umana Funzionale

Questo volume di Anatomia umana funzionale comprende la II edizione del testo di Anatomia umana e istologia integrato con un approfondito capitolo dedicato all\u2019Anatomia funzionale dell\u2019Apparato locomotore, allo scopo di offrire allo studente le informazioni necessarie per la conoscenza dell\u2019Anatomia umana e dell\u2019Istologia. Il volume si propone quindi come supporto didattico ideale per gli studenti del corso di Laurea di Scienze Motorie, per quelli di indirizzo sanitario, in particolare i Tecnici Sanitari di Radiologia Medica e i Fisioterapisti, e pi\uf9 in generale per tutti i corsi di Laurea che necessitano di una approfondita conoscenza dell\u2019apparato locomotore. L\u2019evoluzione della scienza e delle tecniche di indagine ha reso necessario un adeguamento della materia alle nuove conoscenze e metodologie. E\u2019 stato dato particolare rilievo agli aspetti funzionali delle scienze morfologiche umane e contemporaneamente si sono messe in evidenza le basi istologiche e anatomiche di molte patologie, onde evidenziare l\u2019importanza di alcuni dettagli morfologici e facilitarne la memorizzazione. Per quanto riguarda l\u2019apparato locomotore, particolare attenzione \ue8 stata dedicata alla funzione dei singoli muscoli e alla loro valutazione clinica. I contenuti della disciplina sono stati esposti partendo dalla descrizione delle componenti elementari della sostanza vivente, affrontando successivamente i livelli di organizzazione e gli ordini di grandezza maggiori. In particolare: la trattazione della citologia e dell\u2019istologia enfatizza il significato funzionale dell\u2019organizzazione interna della cellula e della morfologia dei tessuti dell\u2019organismo dell\u2019importante e affascinante tema dello sviluppo dell\u2019organismo si \ue8 voluto fornire alcune elementari informazioni in due capitoli dedicati a una sintetica esposizione degli elementi di embriologia e dell\u2019organogenesi, cio\ue8 l\u2019origine e il progressivo sviluppo fetale di organi e apparati la trattazione sistematica dell\u2019anatomia degli apparati e dei sistemi \ue8 completata da un capitolo dedicato all\u2019anatomia topografica e di superficie

PROMETHEUS - Atlante di Anatomia

racchiude argomenti di filogenesi e ontogenesi dell’Uomo, anatomia di superficie e principi base della biologia del corpo umano. Segue la trattazione di ogni regione anatomic

Impact of environmental factors and physical activity on disability and quality of life in CIDP

A few observational studies and randomized trials suggest that exercise and rehabilitation may improve activity limitation and quality of life (QoL) in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), but the impact of other modifiable factors on the severity of the disease is not well understood. Using a structured questionnaire, we collected data on lifestyle and dietary habits of the patients included in the Italian CIDP database to investigate the possible influence of modifiable lifestyle factors on disability and QoL. Questionnaire data were available for 323 patients. The effect of lifestyle and dietary exposures on impairment, disability and QoL was evaluated using logistic regression models, adjusting for age, sex, disease duration, physical activity and smoking. Physical activity was associated with lower sensory impairment by the ISS scale, less disability by the INCAT and RODS scale and a better QoL in all the domains of EURO-QoL scale with the exception of anxiety/depression. None of the other parameters had an impact on these scales. This study adds evidence to the possible role of physical activity in improving symptom severity, disability and QoL in patients with CIDP. None of the other environmental factors investigated appeared to have an impact on the severity and health perception of CIDP

Predicting Outcome in Guillain-Barre Syndrome International Validation of the Modified Erasmus GBS Outcome Score

Background and ObjectivesThe clinical course and outcome of the Guillain-Barre syndrome (GBS) are diverse and vary among regions. The modified Erasmus GBS Outcome Score (mEGOS), developed with data from Dutch patients, is a clinical model that predicts the risk of walking inability in patients with GBS. The study objective was to validate the mEGOS in the International GBS Outcome Study (IGOS) cohort and to improve its performance and region specificity.MethodsWe used prospective data from the first 1,500 patients included in IGOS, aged >= 6 years and unable to walk independently. We evaluated whether the mEGOS at entry and week 1 could predict the inability to walk unaided at 4 and 26 weeks in the full cohort and in regional subgroups, using 2 measures for model performance: (1) discrimination: area under the receiver operating characteristic curve (AUC) and (2) calibration: observed vs predicted probability of being unable to walk independently. To improve the model predictions, we recalibrated the model containing the overall mEGOS score, without changing the individual predictive factors. Finally, we assessed the predictive ability of the individual factors.ResultsFor validation of mEGOS at entry, 809 patients were eligible (Europe/North America [n = 677], Asia [n = 76], other [n = 56]), and 671 for validation of mEGOS at week 1 (Europe/North America [n = 563], Asia [n = 65], other [n = 43]). AUC values were >0.7 in all regional subgroups. In the Europe/North America subgroup, observed outcomes were worse than predicted; in Asia, observed outcomes were better than predicted. Recalibration improved model accuracy and enabled the development of a region-specific version for Europe/North America (mEGOS-Eu/NA). Similar to the original mEGOS, severe limb weakness and higher age were the predominant predictors of poor outcome in the IGOS cohort.DiscussionmEGOS is a validated tool to predict the inability to walk unaided at 4 and 26 weeks in patients with GBS, also in countries outside the Netherlands. We developed a region-specific version of mEGOS for patients from Europe/North America.Classification of EvidenceThis study provides Class II evidence that the mEGOS accurately predicts the inability to walk unaided at 4 and 26 weeks in patients with GBS.Neurological Motor Disorder

CSF findings in relation to clinical characteristics, subtype, and disease course in patients with Guillain-Barre syndrome

Background and ObjectivesTo investigate CSF findings in relation to clinical and electrodiagnostic subtypes, severity, and outcome of Guillain-Barré syndrome (GBS) based on 1,500 patients in the International GBS Outcome Study.MethodsAlbuminocytologic dissociation (ACD) was defined as an increased protein level (>0.45 g/L) in the absence of elevated white cell count (ResultsIn 846 (70%) patients, CSF examination showed ACD, which increased with time from weakness onset: ≤4 days 57%, >4 days 84%. High CSF protein levels were associated with a demyelinating subtype, proximal or global muscle weakness, and a reduced likelihood of being able to run at week 2 (odds ratio [OR] 0.42, 95% CI 0.25–0.70; p = 0.001) and week 4 (OR 0.44, 95% CI 0.27–0.72; p = 0.001). Patients with the Miller Fisher syndrome, distal predominant weakness, and normal or equivocal nerve conduction studies were more likely to have lower CSF protein levels. CSF cell count was DiscussionACD is a common finding in GBS, but normal protein levels do not exclude this diagnosis. High CSF protein level is associated with an early severe disease course and a demyelinating subtype. Elevated CSF cell count, rarely ≥50 cells/μL, is compatible with GBS after a thorough exclusion of alternative diagnoses.Neurological Motor Disorder

Detection of disability worsening in relapsing-remitting multiple sclerosis patients: a real-world roving Expanded Disability Status Scale reference analysis from the Italian Multiple Sclerosis Register

Background and purpose: In relapsing-remitting multiple sclerosis patients (RRMS) disability progressively accumulates over time. To compare the cumulative probability of 6-month confirmed disability-worsening events using a fixed baseline or a roving Expanded Disability Status Scale (EDSS) reference, in a real-world setting. Methods: A cohort of 7964 RRMS patients followed for 2 or more years, with EDSS scores recorded every 6 months, was selected from the Italian Multiple Sclerosis Register. The overall probability of confirmed disability-worsening events and of confirmed disability-worsening events unrelated to relapse was evaluated using as reference a fixed baseline EDSS score or a roving EDSS score in which the increase had to be separated from the last EDSS assessment by at least 6 or 12 months. Results: Using a fixed baseline EDSS reference, the cumulative probability of 6-year overall confirmed disability-worsening events was 33.2%, and that of events unrelated to relapse was 10.9% (33% of overall confirmed disability-worsening events). Using a roving EDSS, the proportions were respectively 35.2% and 21.3% (61% of overall confirmed disability-worsening events). Conclusions: In a real-world setting, roving EDSS reference scores appear to be more sensitive for detecting confirmed disability-worsening events unrelated to relapse in RRMS patients