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Access to Healthcare: More primary care and no financial barriers for anyone 获得医疗保健:更多初级保健,任何人都没有经济障碍
Pub Date : 2023-06-19 DOI: 10.17161/rrnmf.v4i2.19563
Joshua Freeman
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引用次数: 0
Quantitative sensory testing in a large cohort of neuropathy patients 大量神经病变患者的定量感觉测试
Pub Date : 2023-06-19 DOI: 10.17161/rrnmf.v4i2.19513
A. Lizarraga, Salman F Bhai, G. Wolfe, L. Herbelin, S. Nations, Morgan McCreary, D. Saperstein, R. Barohn
Background: Quantitative sensory testing (QST) is a subjective but reliable and quantifiable method to detect patient thresholds to different sensory stimuli. QST is used to measure small- and large-fiber nerve function and can be used in conjunction with other diagnostic modalities in the evaluation of peripheral neuropathy (PN). The utility of QST to distinguish among different types of PN, however, has not been explored. The objective of the study was to evaluate if different patterns of QST abnormalities could distinguish between PN types. Methods: This single-center retrospective cohort study evaluated the frequency of QST abnormalities to vibratory, cold and heat detection thresholds in a large population of PN cases evaluated at the University of Texas Southwestern Medical Center peripheral neuropathy clinic between 1995-2000. PN was categorized by etiology. Results: A total of 559 QST studies were performed in this study. The average age of patients (n=557) was 60 years with a male-to-female ratio of 1:1. The most common diagnosis was cryptogenic sensory polyneuropathy (CSPN, n=294), followed by Charcot–Marie–Tooth disease (n=84)). Meta-regression of vibration and cold indicate that the expected proportion of abnormal responses is less for the vibration test (p = 0.0002), relative to the cold test. However, no differences were observed between diagnoses. Conclusions: Though abnormal QST thresholds were seen in most patients with PN, patterns of QST abnormalities do not distinguish between different types of PN. The routine clinical utility of QST is likely limited.
背景:定量感觉测试(QST)是一种主观但可靠且可量化的方法,用于检测患者对不同感觉刺激的阈值。QST用于测量小纤维和大纤维神经功能,并可与周围神经病变(PN)的其他诊断方式结合使用。然而,QST区分不同类型PN的效用尚未得到探讨。该研究的目的是评估不同类型的QST异常是否可以区分PN类型。方法:这项单中心回顾性队列研究评估了1995-2000年间在德克萨斯大学西南医学中心周围神经病变诊所评估的大量PN病例中,QST异常到振动、冷和热检测阈值的频率。PN按病因分类。结果:本研究共进行了559项QST研究。患者平均年龄(n=557)为60岁,男女比例为1:1。最常见的诊断是隐源性感觉多神经病变(CSPN, n=294),其次是charcott - marie - tooth病(n=84)。振动和冷态的元回归表明,相对于冷态试验,振动试验的预期异常响应比例更小(p = 0.0002)。然而,在诊断之间没有观察到差异。结论:虽然大多数PN患者的QST阈值异常,但QST异常模式并不能区分不同类型的PN。QST的常规临床应用可能是有限的。
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引用次数: 0
Survival of the Fittest 适者生存
Pub Date : 2023-06-19 DOI: 10.17161/rrnmf.v4i2.19959
E. Rowe, Vernon D. Rowe
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引用次数: 0
A novel MUSK mutation in a patient with CMS9 一名CMS9患者的新型MUSK突变
Pub Date : 2023-06-19 DOI: 10.17161/rrnmf.v4i2.18588
J. Elliott
Congenital myasthenic syndromes (CMS) are a relatively rare cause of fatigable muscle weakness often with significant ocular, bulbar and respiratory impairment1. Mutations in the gene encoding muscle specific tyrosine kinase (MuSK) can lead to abnormal endplate and acetylcholine receptor functioning and cause an autosomal recessive post-synaptic CMS (CMS9). Only 23 patients with CMS9 have been characterized in the literature since the initial description in 20042.  Here, we report a newly diagnosed case of CMS9 in a 23-year-old female who harbored a novel c.296G>T (Cys99Phe) mutation in the MUSK gene, thereby expanding the phenotypic/genotypic characterization of this rare disorder.
先天性肌无力综合征(CMS)是一种相对罕见的引起疲劳性肌无力的原因,通常伴有明显的眼部、球和呼吸损伤1。编码肌肉特异性酪氨酸激酶(MuSK)的基因突变可导致终板和乙酰胆碱受体功能异常,并导致常染色体隐性突触后CMS (CMS9)。自2004年首次描述以来,文献中只有23例CMS9患者的特征。在这里,我们报告了一例新诊断的CMS9病例,患者为一名23岁的女性,她在MUSK基因中携带了一种新的c.296G>T (Cys99Phe)突变,从而扩大了这种罕见疾病的表型/基因型特征。
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引用次数: 0
Under the Watchful Eye of the Knife 在刀的注视下
Pub Date : 2023-06-19 DOI: 10.17161/rrnmf.v4i2.19854
Michael Abraham
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引用次数: 0
Emergent Comorbid Events in First Year of Immunomodulatory Treatment in Adults With Generalized Myasthenia Gravis treated in a Neurology Clinic: A Retrospective Review 神经病学临床治疗的成人全身性重症肌无力患者免疫调节治疗第一年的紧急共病事件:回顾性回顾
Pub Date : 2023-02-07 DOI: 10.17161/rrnmf.v3i4.16214
N. Katyal, Brian Blankenship, N. Narula, Eric A Grisham, R. Govindarajan
Background: Current treatments for myasthenia gravis, including immunomodulatory therapies, are associated with significant comorbid events. Method: Retrospective chart review of all adults diagnosed with generalized myasthenia gravis in our clinic over 5 years to evaluate potential associations between treatment regimens and emergent comorbid events according to system organ class. Comorbid events were categorized by affected system organ class as endocrine, neuropsychiatric, musculoskeletal, gastrointestinal, pulmonary, cardiovascular, urologic, infectious, and hematologic. MG treatment regimens at the latest available date during the 1-year follow-up were categorized by corticosteroid use and further stratified by medication class and combination therapy. Result: A total of 68 patients were included in the analysis (corticosteroid group, n = 43; non-corticosteroid group, n = 25). We found no significant differences in the frequencies of comorbid events between patients whose regimens included corticosteroids and patients with corticosteroid-free regimens. Patients who received pyridostigmine, high-dose corticosteroids, and corticosteroid-sparing agents in combination experienced higher incidences of emergent endocrine and neuropsychiatric events than those who received other corticosteroid-containing treatments. Conclusion: Polypharmacy that included high-dose corticosteroids was associated with a greater incidence of new endocrine and neuropsychiatric comorbid events within 1 year of diagnosis
背景:目前对重症肌无力的治疗,包括免疫调节治疗,与显著的合并症事件相关。方法:回顾性分析本院5年以上诊断为全身性重症肌无力的成人病例,根据系统器官分类评估治疗方案与紧急合并症之间的潜在关联。共病事件按受影响的系统器官分类为内分泌、神经精神、肌肉骨骼、胃肠、肺部、心血管、泌尿、感染性和血液学。在1年随访期间,MG治疗方案的最新可用日期按皮质类固醇使用进行分类,并进一步按药物类别和联合治疗分层。结果:共纳入68例患者(皮质类固醇组,n = 43;非皮质类固醇组,n = 25)。我们发现,在使用皮质类固醇治疗方案的患者和不使用皮质类固醇治疗方案的患者之间,合并症事件的频率没有显著差异。与接受其他含皮质类固醇治疗的患者相比,联合使用吡哆斯的明、大剂量皮质类固醇和皮质类固醇保留剂的患者出现紧急内分泌和神经精神事件的发生率更高。结论:包括大剂量皮质类固醇在内的多种药物治疗与诊断后1年内新的内分泌和神经精神合并症事件的发生率较高相关
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引用次数: 0
FDA should protect the American people, and Pharma should pay! FDA应该保护美国人民,制药公司应该付钱!
Pub Date : 2023-02-07 DOI: 10.17161/rrnmf.v3i4.18548
Joshua Freeman
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引用次数: 0
Steroid Responsive Acute Inflammatory Demyelinating Polyneuropathy Induced by an Immune Check Point Inhibitor 免疫检查点抑制剂诱导的类固醇反应性急性炎性脱髓鞘性多神经病变
Pub Date : 2023-02-07 DOI: 10.17161/rrnmf.v3i4.18080
N. Al-Bustani, Z. Hussain
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引用次数: 0
Knowledge and perceptions of the COVID-19 pandemic among patients with myasthenia gravis: follow up survey 重症肌无力患者对COVID-19大流行知识和认知的随访调查
Pub Date : 2023-02-07 DOI: 10.17161/rrnmf.v4i1.18415
Yingkai Li, Y. Harada, Marjan Cobbaert, V. Juel, L. Hobson‐Webb, S. Raja, N. González, J. Guptill
Introduction  We previously conducted a survey study in April 2020 at the beginning of the SARS-CoV-2 (COVID-19) pandemic to understand how it affected patients with myasthenia gravis (MG). Since then, significant advances have occurred in the following areas: knowledge about the SARS-CoV-2 virus, infection risk mitigation, patient management, risks for MG patients, and a global vaccination program. We conducted a follow-up survey in February 2021 to assess how these advances impacted the care and perception of MG patients.     Methods  We conducted a prospective online survey study of MG patients at a large academic practice in the Duke Health System.   Results  Seventy-eight patients participated in the survey including 55 from previous survey and 23 newly identified patients. The top reported change in the interaction with healthcare providers was an increase in telemedicine visits (74%). The median satisfaction score (0-100 scale) for telemedicine visits was 74. Ninety-six percent of survey participants expressed concern about pandemic and nearly half of participants showed anxiety based on Generalized Anxiety Disorder-7 score. The top 3 concerns related to COVID-19 were getting hospitalized (62%), exacerbation (62%) and death (53%).  Discussion   Although the results of follow-up survey were overall similar to the previous study, most of patients switched from in-person clinic visits to telemedicines. The overwhelmingly large portion of patients continue to have concern and anxiety for pandemic but the patients with severe symptoms have higher anxiety scores. Conclusion   This follow-up survey demonstrated the adjustment of MG patients to new methods of communication, significant psychological impact of COVID-19 on them and their good healthcare literacy.  
我们之前在2020年4月SARS-CoV-2 (COVID-19)大流行开始时进行了一项调查研究,以了解它如何影响重症肌无力(MG)患者。从那时起,在以下领域取得了重大进展:关于SARS-CoV-2病毒的知识、感染风险缓解、患者管理、MG患者的风险以及全球疫苗接种计划。我们在2021年2月进行了一项随访调查,以评估这些进展如何影响MG患者的护理和认知。方法我们在杜克健康系统的一个大型学术实践中对MG患者进行了一项前瞻性在线调查研究。结果共有78例患者参加调查,其中既往调查55例,新确诊患者23例。据报道,与医疗保健提供者互动的最大变化是远程医疗就诊的增加(74%)。远程医疗就诊满意度中位数(0-100分)为74分。96%的调查参与者表达了对流行病的担忧,近一半的参与者根据广泛性焦虑障碍-7评分表现出焦虑。与COVID-19相关的前三大担忧是住院(62%)、病情恶化(62%)和死亡(53%)。虽然随访调查的结果总体上与之前的研究相似,但大多数患者从亲自就诊转向远程医疗。绝大多数患者仍然对大流行感到担忧和焦虑,但症状严重的患者的焦虑评分较高。结论本次随访调查显示,MG患者适应新的沟通方式,新冠肺炎对他们的心理影响显著,健康素养良好。
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引用次数: 0
A novel DOK7 mutation causing limb-girdle congenital myasthenic syndrome 一种新的导致四肢带状先天性肌无力综合征的DOK7突变
Pub Date : 2023-02-07 DOI: 10.17161/rrnmf.v3i4.18087
A. Reynolds, A. Lin, Leo H. Wang
We report a case series of 5 Latino patients with limb-girdle pattern weakness, four patients are sisters, with one patient unrelated. Repetitive nerve stimulation showed a significant decrement in all cases. Targeted genetic testing for congenital myasthenic syndromes demonstrated a known DOK7 pathogenic mutation in each case, and in all five cases also revealed a novel DOK7 missense mutation in exon 7 with c.94G>A; providing strong evidence this mutation is pathogenic. DOK7-related congenital myasthenic syndrome often lacks oculobulbar involvement, and may present with limb-girdle weakness, mimicking limb-girdle muscular dystrophy.
我们报告了5例拉丁裔腰束型无力患者,其中4例为姐妹,1例无血缘关系。重复神经刺激在所有病例中均表现出明显的下降。先天性肌无力综合征的靶向基因检测显示,每个病例都有一个已知的DOK7致病突变,并且在所有5例病例中,还发现了一个新的DOK7外显子c.94G> a错义突变;提供了强有力的证据表明这种突变是致病的。与dok7相关的先天性肌无力综合征通常缺乏眼球受累,并可能表现为肢带无力,类似于肢带肌营养不良。
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RRNMF Neuromuscular Journal
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