Sensory sparing patterns and the sensory ratio in acute inflammatory demyelinating polyneuropathy

The relative preservation (sparing) of sural sensory nerve action potentials (SNAPs) is a useful diagnostic finding in patients with acute inflammatory demyelinating polyneuropathy (AIDP). However, recording of sural SNAPs is not always technically feasible, especially in obese, edematous, or elderly individuals. Hence, we systematically evaluated the predictive values of the commonly employed SNAPs in the diagnosis of AIDP within 2 weeks from onset of symptoms. Sensory sparing patterns and sensory ratios of the sural, radial, median, and ulnar SNAPs of AIDP patients were included in a retrospective and blinded analysis, and compared to patients with diabetic polyneuropathy (DPN) and controls. Logistic regression models for the sural plus radial SNAPs/median plus ulnar SNAPs (sensory ratio) were constructed. A sural sparing pattern was present only in the AIDP group (34.4%, P < 0.001). A radial sparing pattern did not discriminate the AIDP from the DPN groups. The sural/radial sensory ratio was useful to ascertain DPN, but did not discriminate AIDP from controls. The sensory ratio was higher in AIDP compared to DPN and controls and was an independent predictor for AIDP. This study implies that the sensory ratio is a useful predictor for the diagnosis of AIDP and may substitute for sural sparing in technically difficult situations.     

Oxidative stress in red blood cells, platelets and polymorphonuclear leukocytes from patients with myelodysplastic syndrome

Low-risk myelodysplastic syndrome (MDS) is characterized by cytopenia, mainly anemia, because of ineffective hematopoiesis. Some of the patients with ineffective erythropoiesis, with or without ring sideroblasts in their bone marrow, develop severe anemia requiring frequent blood transfusions and consequently develop iron overload. Excess free iron in cells catalyses the generation of reactive oxygen species (ROS) that cause cell and tissue damage. Using flow cytometry techniques, we compared the oxidative status of red blood cells (RBC), platelets and neutrophils in 14 MDS patients with those of normal donors. The results show that ROS were higher while reduced glutathione (GSH) was lower in their RBC and platelets compared with normal cells. In neutrophils, no difference was found in ROS, while the GSH levels were lower. A correlation (r = 0.6) was found between serum ferritin levels of the patients and the ROS in their RBC and platelets. The oxidative stress was ameliorated by a short incubation with the iron-chelators, the deferrioxamine and deferiprone or with antioxidants such as N-acetylcysteine, suggesting that MDS patients might benefit from treatment with iron-chelators and antioxidants.     

Rare and fatal complication of Gianturco tracheobronchial stent

Tracheobronchial stents are increasingly being used for the management of compromised large airways. Traditionally they have been used to palliate malignant conditions; however, they are now being used more frequently for nonmalignant conditions. The use of Gianturco self-expanding metal stent (William Cook, Bjaeverskov, Denmark) has been challenged for treatment of tracheobroncheomalacia, as fracture of the metal work could prove fatal. In this report we describe a case of fracture in the metal framework of a Gianturco stent resulting in recurrent pneumothoraces; heralding fatal haemoptysis as a result of perforation of the left subclavian artery.     

Randomized controlled trial comparing laparoscopic ovarian diathermy with clomiphene citrate as a first-line method of ovulation induction in women with polycystic ovary syndrome

BACKGROUND: Laparoscopic ovarian diathermy (LOD) is currently accepted asa successful second-line treatment for ovulation induction (OI)in clomiphene citrate (CC)-resistant women with polycystic ovarysyndrome (PCOS). The aim of this study was to test the hypothesisthat LOD may be superior to CC as a first-line treatment. METHODS: The study included 72 anovulatory women with PCOS who were randomizedto LOD (n = 36) or CC (n = 36). Women who remained anovulatoryafter LOD were offered CC. Similarly, women receiving CC whofailed to ovulate or conceive were offered LOD. Pregnancy rateswere compared between the two groups using ² and odds ratiowith 95% confidence interval (OR, 95% CI). RESULTS: After randomization, six women conceived before starting treatmentand another patient postponed treatment. The remaining 65 womenreceived the treatment (33 underwent LOD and 32 received CC).After the primary treatment, more pregnancies (44%) occurredin women receiving CC than in those undergoing LOD (27%), althoughthe difference did not reach statistical significance [P = 0.13,OR 2.1 (0.7 – 5.8)]. After adding the second treatment,the pregnancy rate was still higher, but to a less extent, inthe CC group [63% versus 52%, P = 0.2, OR 1.6 (0.6 – 4.2)]. CONCLUSIONS: LOD is not superior to CC as a first-line method of OI in womenwith PCOS. The trial is registered with ClinicalTrials.gov withan identifier number NCT00220545 [ClinicalTrials.gov] .     

Muscle resident macrophages control the immune cell reaction in a mouse model of notexin‐induced myoinjury

Objective

Skeletal muscle may be the site of a variety of poorly understood immune reactions, particularly after myofiber injury, which is typically observed in inflammatory myopathies. This study was undertaken to explore both the cell dynamics and functions of resident macrophages and dendritic cells (DCs) in damaged muscle, using a mouse model of notexin‐induced myoinjury to study innate immune cell reactions.

Methods

The myeloid cell reaction to notexin‐induced myoinjury was analyzed by microscopy and flow cytometry. Bone marrow (BM) transplantation studies were used to discriminate resident from exudate monocyte/macrophages. Functional tests included cytokine screening and an alloantigenic mixed leukocyte reaction to assess the antigen‐presenting cell (APC) function. Selective resident macrophage depletion was obtained by injection of diphtheria toxin (DT) into CD11b–DT receptor–transgenic mice transplanted with DT‐insensitive BM.

Results

The connective tissue surrounding mouse muscle/fascicle tissue (the epimysium/perimysium) after deep muscle injury displayed a resident macrophage population of CD11b+F4/80+CD11c−Ly‐6C−CX3CR1− cells, which concentrated first in the epimysium. These resident macrophages were being used by leukocytes as a centripetal migration pathway, and were found to selectively release 2 chemokines, cytokine‐induced neutrophil chemoattractant and monocyte chemoattractant protein 1, and to crucially contribute to massive recruitment of neutrophils and monocytes from the blood. Early epimysial inflammation consisted of a predominance of Ly‐6C^highCX3CR1^lowCD11c− cells that were progressively substituted by Ly‐6C^lowCX3CR1^high cells displaying an intermediate, rather than high, level of CD11c expression. These CD11c^intermediate cells were derived from circulating CCR2+ monocytes, functionally behaved as immature APCs in the absence of alloantigenic challenge, and migrated to draining lymph nodes while acquiring the phenotype of mature DCs (CD11c+Ia+CD80+ cells, corresponding to an inflammatory DC phenotype).

Conclusion

The results in this mouse model show that resident macrophages in the muscle epimysium/perimysium orchestrate the innate immune response to myoinjury, which is linked to adaptive immunity through the formation of inflammatory DCs.