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Safety and efficacy of plasma exchange for the treatment of optic neuritis in neuromyelitis optica spectrum disorders: A protocol for systematic review and meta-analysis.

血浆置换治疗视神经脊髓炎谱系疾病视神经炎的安全性和有效性: 系统评价和荟萃分析方案。

  • 影响因子:1.95
  • DOI:10.1097/MD.0000000000021067
  • 作者列表:"Han M","Chen Y","Nong L","Liu Z","Hao L","Wang Z
  • 发表时间:2020-07-10
Abstract

BACKGROUND:Neuromyelitis optica spectrum disorders (NMOSD) is an inflammatory and heterogeneous astrocyte disorder of the central nervous system (CNS), concerned because of its high pathogenicity, high risk of recurrence, and poor prognosis. Optic neuritis (ON) is the first manifestation in 30% to 50% of NMOSD patients, and eventually involved optic nerve in 70% of patients. The idiopathic ON associated with NMO is called NMO-associated ON(NMO-ON). There are substantial costs to the countries and individuals associated with treatment of NMO-ON. Intravenous corticosteroids (IVCSs), as the first-line therapy, leads to unsatisfactory outcomes for NMO-ON and is associated with potential adverse events (AEs). Emerging evidences have proved the important value and potential prospect of plasma exchange (PLEX) in NMO-ON. Although PLEX is increasingly used in NMO-ON, its therapeutic effect and safety are still controversial. There are no systematic reviews yet that evaluated the effects of PLEX against other therapies in patients with NMO-NO. It is therefore timely to perform a systematic review to assess the efficacy and safety of PLEX on current research for its potential use in clinical practice in treating NMO-ON. METHODS:The systematic review will include all of the randomized controlled trials (RCT) on the efficacy and safety of PLEX for NMO-ON. A relevant literature search by sensitive search strategies was conducted using the following electronic databases from their inception to November 30, 2019: PubMed, Web of Science, EMBASE, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal database (VIP) and CBM. We will also search registers of clinical trials, potential gray literature, and conference abstracts. There are no limits on language and publication status. The literature screening, data extraction, and quality assessment will be conducted by 2 reviewers independently. The reporting quality and risk of bias will be assessed by other 2 researchers. Best-corrected visual acuity (BCVA), annualized relapse rate (ARR), the frequency and extent of adverse events (AEs) will be evaluated as the primary outcome. The secondary outcomes will include expanded disability status scales (EDSS), relapse-free rate, peri-papillary retinal nerve fibers layer (pRNFL) or macular volume, visual electrophysiology examinations, standard automated perimetry examinations, time to the next attack. Meta-analysis will be performed using RevMan5.3 software provided by the Cochrane Collaboration and Stata 12.0. RESULTS:This study will provide a comprehensive review based on current evidence of PLEX treatment for NMO-ON in several aspects, including BCVA, ARR, the frequency and extent of adverse events (AEs), EDSS, relapse-free rate, etc. CONCLUSION:: The conclusion of this study will provide evidence to determine whether PLEX is an effective and safe intervention for patients with NMO-ON. ETHICS AND DISSEMINATION:It is not necessary to obtain ethical approval for this study, given that this protocol is for a systematic review. The systematic review will be published in a peer-reviewed journal, presented at conferences and will be shared on social media platforms. PROSPERO REGISTRATION NUMBER:PROSPERO CRD 42020162585.

摘要

背景: 视神经脊髓炎谱系疾病 (NMOSD) 是一种中枢神经系统 (CNS) 的炎性和异质性星形胶质细胞疾病,因其高致病性、高复发风险和不良预后而备受关注。视神经炎 (ON) 在30% 至50% 的NMOSD患者中是首发表现,并且最终在70% 的患者中累及视神经。与NMO相关的特发性ON被称为NMO相关ON(NMO-ON)。对于NMO-ON治疗相关的国家和个人来说,存在大量的成本。静脉内皮质类固醇 (IVCSs) 作为一线治疗导致NMO-ON的结果不令人满意,并且与潜在的不良事件 (AEs) 相关。新兴的证据证明了血浆置换 (PLEX) 在NMO-ON中的重要价值和潜在前景。虽然PLEX在NMO-ON中的应用越来越多,但其治疗效果和安全性仍存在争议。目前还没有系统的综述来评估PLEX与其他疗法对NMO-no患者的影响。因此,及时进行系统综述,以评估PLEX对当前研究的有效性和安全性,以评估其在治疗NMO-on的临床实践中的潜在用途。 方法: 系统评价将包括所有关于PLEX治疗NMO-on的有效性和安全性的随机对照试验 (RCT)。采用敏感检索策略进行相关文献检索,检索范围为: PubMed、Web of Science、EMBASE、the Cochrane Library、中国知网 (CNKI) 、万方数据库、中国科技期刊数据库 (VIP) 和CBM。我们还将搜索临床试验,潜在灰色文献和会议摘要的注册。对语言和出版地位没有限制。文献筛选、数据提取和质量评估将由2名评审人员独立进行。报告质量和偏倚风险将由其他2名研究者进行评估。将评估最佳矫正视力 (BCVA) 、年复发率 (ARR) 、不良事件 (ae) 的频率和程度作为主要结局。次要结局将包括扩展残疾状态量表 (EDSS) 、无复发率、乳头周围视网膜神经纤维层 (pRNFL) 或黄斑体积、视觉电生理检查、标准自动视野检查、下一次发作的时间。将使用Cochrane协作和Stata 12.0提供的RevMan5.3软件进行Meta分析。 结果: 本研究将根据目前NMO-on的PLEX治疗证据,在几个方面提供全面的综述,包括BCVA,ARR,不良事件 (AEs) 的频率和程度,EDSS,无复发率等。结论::本研究的结论将为确定PLEX对NMO-ON患者是否有效且安全的干预提供证据。 伦理和传播: 鉴于本方案是为了系统评价,本研究没有必要获得伦理批准。该系统综述将发表在同行评审期刊上,在会议上展示,并将在社交媒体平台上分享。 普洛斯彼罗注册号: 普洛斯彼罗CRD 42020162585。

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影响因子:1.55
发表时间:2020-01-01
DOI:10.1097/PHM.0000000000001264
作者列表:["Gutiérrez-Cruz C","Rojas Ruiz FJ","De La Cruz Marquez JC","Gutiérrez-Davila M"]

METHODS:PURPOSE:The aim of the study was to assess dual-task cost to spatio-temporal gait parameters in people with multiple sclerosis and a matched control group. METHOD:The multiple sclerosis group was composed of 17 participants with a diagnosis of multiple sclerosis and an Expanded Disability Status Scale score of less than 6. A total of 17 healthy participants were allocated to the control group by stratification. Controls were matched on the basis of age, sex, sociocultural habits, and body structure. Dual-task cost was determined by within-group repeated-measures analysis of variance. Participants were instructed to ambulate under normal conditions and perform a discrimination and decision-making task concurrently. Then, between-group analysis of variance was used to assess differences in mean dual-task cost between groups and determine dual-task cost differential. Testing was performed using three-dimensional photogrammetry and an electronic walkway. RESULTS:Based on dual-task cost differential, gait cycle time increase (-5.8%) and gait speed decrease (6.3%) because of multiple sclerosis-induced impairment. CONCLUSIONS:During single- and dual-task conditions, gait speed was lower in multiple sclerosis participants, because of a shorter step length and increased swing time. Increased gait time might be the result of compensatory mechanisms adopted to maintain stability while walking specially during the double-support phases.

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翻译标题与摘要 下载文献
影响因子:1.55
发表时间:2020-01-01
DOI:10.1097/PHM.0000000000001272
作者列表:["Cattaneo D","Gervasoni E","Pupillo E","Bianchi E","Aprile I","Imbimbo I","Russo R","Cruciani A","Jonsdottir J","Agostini M","Beghi E","NEUROFALL Group."]

METHODS:OBJECTIVE:The aims of the study were to compare mobility in multiple sclerosis, Parkinson disease, and stroke, and to quantify the relationship between mobility and participation restrictions. DESIGN:This is a multicenter cross-sectional study. Included were compliant subjects with Parkinson disease, multiple sclerosis, and stroke seen for rehabilitation, with no comorbidities interfering with mobility. Functional scales were applied to each subject to investigate gait speed (10-meter walking test), balance while maintaining body position (Berg Balance Scale), dynamic balance and mobility (Timed Up and Go and Dynamic Gait Index), and participation (Community Integration Questionnaire). RESULTS:Two hundred ninety-nine patients (111 multiple sclerosis, 94 Parkinson disease, and 94 stroke) were enrolled. Stroke had the slowest gait speed (mean gait speed = 0.9 m/sec) compared with Parkinson disease (1.1 m/sec), and multiple sclerosis (1.2 m/sec) (P < 0.001). Multiple sclerosis was more limited than Parkinson disease and stroke in dynamic balance both in the Timed Up and Go Test (multiple sclerosis = 16.7 secs, Parkinson disease = 11.4 secs, stroke = 14.0 secs; P < 0.001) and Dynamic Gait Index (multiple sclerosis = 11.6 points, Parkinson disease = 12.9 points, stroke = 13.6 points; P = 0.03); ability to maintain balance and body position (Berg Balance Scale) was more affected in stroke and Parkinson disease than multiple sclerosis (multiple sclerosis = 42.6 points, Parkinson disease = 39.4 points, stroke = 39.7 points; P = 0.03). Balance disorders were associated with participation restrictions but not gait speed. CONCLUSIONS:Neurological conditions have differing impacts on gait and balance, leading to different levels of participation restriction.

关键词: 暂无
翻译标题与摘要 下载文献
影响因子:2.61
发表时间:2020-01-01
DOI:10.1111/ane.13152
作者列表:["Ferraro D","Guicciardi C","De Biasi S","Pinti M","Bedin R","Camera V","Vitetta F","Nasi M","Meletti S","Sola P"]

METHODS:OBJECTIVES:Cerebrospinal fluid (CSF) and blood neurofilaments (NFLs) are markers of axonal damage and are being investigated, mostly in relapsing-remitting (RR) MS, as a marker of disease activity and of response to treatment, while there are less data in progressive MS patients. Primary aim was to measure NFL in plasma samples of untreated patients with primary (PP) and secondary (SP) progressive MS and to correlate them with disability, disease severity, and prior/subsequent disability progression. MATERIALS AND METHODS:Neurofilament concentrations were measured using SIMOA (Single Molecule Array, Simoa HD-1 Analyzer; Quanterix). RESULTS:Neurofilament concentrations were measured on plasma samples of 70 progressive (27 PP and 43 SP), 21 RRMS patients, and 10 HCs. Longitudinal plasma NFL (pNFL) concentrations (median interval between sampling: 25 months) were available for nine PP/SP patients. PNFL concentrations were significantly higher in PP/SP compared to RRMS patients. They correlated with EDSS and MS Severity Score values. There was no difference in pNFL levels between PP/SP patients with EDSS progression in the preceding year (14% of patients) or during a median follow-up of 27 months (41%). In the longitudinal sub-study, pNFL levels increased in all patients between sampling by a mean value of 23% while EDSS mostly remained stable (77% of cases). CONCLUSION:In PP/SP progressive MS patients, pNFL levels correlate with disability and increase over time, but are not associated with prior/subsequent disability progression, as measured by EDSS, which may not be a sufficiently sensitive tool in this context.

脱髓鞘疾病方向

急性发作或亚急性损害神经中枢的疾病,发病高峰为二到三周,若治疗延误受损神经继发缺血变性则发生多发性硬化,发病严重时可侵犯脊髓前角细胞和脑干神经核以及大脑运动皮质锥体细胞危及生命,多为基因免疫异常或病毒感染所致。

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