Thesis (D.PT.)--Sage Colleges, 2009. / "May 2009." "A Capstone project for PTY 768 presented to the Faculty of the Department of Physical Therapy Sage Graduate School in partial fulfillment of the requirements for the degree of Doctor of Physical Therapy." Includes bibliographical references.

Proefschrift Universiteit Maastricht. / Auteursnaam op omslag: Astrid Hoedemaekers. Met bibliogr., lit. opg. - Met samenvatting in het Nederlands.

重症肌無力是一種全身性的獲得性自身免疫性疾病，傳統的分型有眼肌型、延髓肌型和全身型。西醫目前主要以藥物治療和手術治療為主要方法，尚無特效藥物根治本病。中醫歷代文獻中並無“重症肌無力’，病名的記載，重症肌無力屬中醫學中“鞘、“棲症、“唯目、“胞垂、“臉廢等範疇。本病為現代難治性病症之一，而中醫對本病的治療有一定優勢。在治療上加用中醫中藥，可以減少免疫抑制劑帶來的副作用，中藥在重症肌無力的治療上起著保駕護航的作用，而且有重建自身免疫功能之功效。 通過對現代文獻中重症肌無力的中醫用藥進行統計，瞭解重症肌無力在醫學發展史上的歷史沿革與研究進展，汲取百家用藥經驗，對其病因病機，辨證分型進行探討，總結出中醫治療重症肌無力的用藥規律，為今後的學習、研究及應用提供一個思路和借鑒。 通過進人香港浸會大學圖書館“中文科技期刊資料庫（醫藥衛生及自然科學的生物學專輯）的“維普資訊網以“中藥治療重症肌無力’，為關鍵字進行搜索，搜索到近十年相關期刊文獻183 篇，根據文獻的納入標準與排除標準進行篩選後，得到5 0 篇符合標準的有關文獻，繼而進行資料整理和分析，對每一篇文獻中重症肌無力的治療方法、中醫用藥及研究進展進行記錄，針對中醫用藥情況建立頻數分佈表以分析其構成比， 從而探討中藥治療重症肌無力的用藥規律。最常見的重症肌無力中醫用藥有1 0 個，分別是黃、黨參、臼朮、當歸、升麻、甘草、拘把子、山藥、柴胡、陳皮。結論：黃是現代醫家普遍認同的重症肌無力中醫用藥，將為今後重症肌無力的中醫文獻及中醫基礎理論研究提供可行的借鑒。

This document only includes an excerpt of the corresponding thesis or dissertation. To request a digital scan of the full text, please contact the Ruth Lilly Medical Library's Interlibrary Loan Department (rlmlill@iu.edu).

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Myasthenia Gravis (MG) is an autoimmune disorder of neuromuscular transmission. Clinically, the disease is manifested by abnormal muscle fatigue with recovery on resting. Circulating nicotinic acetylcholine receptor antibodies (nAchR Ab) are highly characteristic of myasthenia gravis. These antibodies have been shown to be directly pathogenic at the muscle endplate and are responsible for impaired neuromuscular transmission through several mechanisms. While it is clear that the immune system does not function normally in MG, the mechanisms by which the response to nAchR is initiated and perpetuated remain unknown. Moreover, it is not clear whether immunoregulatory defects actually precede development of MG or are secondary features of the disease. The overall goal of the present investigation has been to more clearly define the nature of the immune regulatory defects existing in MG, both at the cellular level and in terms of possible relationship to disease progression. To begin these studies it was necessary to develop an assay that could be used to measure nAchR Ab secreted by lymphocytes in culture. Thus, we modified the original nAchR Ab immunoassay described by Lindstrom (1976) for this purpose. Additionally, in order to gain access to an appropriate patient base for our study, we established a further modification with improved sensitivity for detection of serum nAchR Ab. This important diagnostic test had not been available in this country. Therefore, our assay was made available in Canada for clinical purposes. Through the study of in vitro nAchR Ab and polyclonal IgG secretion by peripheral blood mononuclear cells (PBMNC), we were able to identify two previously unrecognized subgroups of seropositive, generalized MG patients. PBMNC from patients with long disease duration had low capacity for in vitro Ab production (Nonsecretors). Among patients of short disease duration, PBMNC produced nAchR Ab and also secreted higher than normal levels of polyclonal IgG (Secretors). The data suggested that there were nonspecific abnormalities affecting the immune response in myasthenia gravis. Moreover, regulation of B lymphocyte mediated immune function appeared to be related to disease progression. It was hypothesized that circulating auto-antibody may contribute to deregulation of the immune response at certain stages of disease through direct interactions with leukocyte determinants. Separation/reconstitution experiments with CD4+ enriched, T-helper/inducer lymphocytes and B enriched (E- cells) lymphocytes suggested that the control of antibody production in myasthenia gravis was operative at the T-helper/inducer level. Preliminary studies with serum pretreated, CD4+ enriched, T-helper/inducer lymphocytes suggested that serum of Secretor MG patients indeed contained a factor(s) which interfered with the function of a CD4+ lymphocyte subset. We further hypothesized that nAchR Ab would have the potential to behave as anti-lymphocyte Ab if nAchR were expressed on lymphocytes. Accordingly, direct binding studies, using the nicotinic antagonist, alpha-bungarotoxin, were carried out to look for such receptors on PBMNC. Specific, saturable binding of alpha-bungarotoxin to the rhabdomyosarcoma cell line, TE671, was confirmed and characterized. However, in parallel studies, alpha-bungarotoxin binding to PBMNC of healthy individuals or MG patients was not detected. These results suggested that nicotinic acetylcholine receptors, of the type expressed by muscle endplate, do not occur on human peripheral blood mononuclear cells. / Medicine, Faculty of / Pathology and Laboratory Medicine, Department of / Graduate

No description available.

Σκοποί της εργασίας ήταν η επιδημιολογική μελέτη της MuSK-MG (μυασθένεια με αντι-MuSK αντισώματα) στην Ελλάδα, ο προσδιορισμός των υποτάξεων των IgG αυτοαντισωμάτων της MuSK-MG, η επίδραση της χορήγησης 4 MuSK-MG ορών στον AChR (υποδοχέα ακετυλοχολίνης) των κυττάρων της μυϊκής κυτταρικής σειράς ΤΕ671 και ο προσδιορισμός των ανοσογόνων επιτόπων της MuSK. Η επιδημιολογική μελέτη της MuSK-MG έλαβε χώρα μεταξύ 1 Ιανουαρίου 1986 και 30 Ιουνίου 2006 κι αφορούσε σε 33 ασθενείς. Ο προσδιορισμός των υποτάξεων των IgG αυτοαντισωμάτων πραγματοποιήθηκε με ραδιοανοσοκατακρήμνιση στους ορούς 14 ασθενών. Ο προσδιορισμός των ανοσογόνων επιτόπων της MuSK πραγματοποιήθηκε συνθέτοντας το εξωκυτταρικό κομμάτι της MuSK με τη μέθοδο Geysen της σύνθεσης πεπτιδίων σε στερεά φάση κι ελέγχοντας, στη συνέχεια, με τη μέθοδο ELISA, τη δέσμευση μιας σειράς MuSK-MG ορών στο τμήμα της MuSK που συνθέσαμε. Η μέση ετήσια επίπτωση της MuSK-MG στην Ελλάδα ήταν 0,32 ασθενείς/εκατομμύριο πληθυσμού/έτος. Στις γυναίκες, η έναρξη της MuSK-MG εμφανίστηκε μετά τα 30, ενώ, στους άνδρες, η νόσος εμφανίζεται σε κάθε δεκαετία. Οι περισσότεροι ασθενείς εμφάνισαν συμπτώματα από τους προσωπικούς κι αυχενικούς μύες. Η συντριπτική πλειονότητα των αυτοαντισωμάτων της MuSK-MG ήταν IgG4 υποτάξης. Σχετικά με την επίδραση των 4 MuSK-MG ορών στον AChR, οι οροί αυτοί ήταν ανίκανοι στην πρόκληση αποδόμησης του AChR των κυττάρων. Τέλος, δεν κατέστη δυνατός ο προσδιορισμός των ανοσογόνων επιτόπων της MuSK, αφού υπήρχαν αμινοξικές αλληλουχίες, στις οποίες ο αρνητικός μάρτυρας του πειράματος δεσμευόταν ισχυρότερα σε σχέση με τους MuSK-MG ορούς που δοκιμάσαμε. / The purposes of this study were to determine the epidemiological characteristics of muscle-specific kinase-myasthenia gravis (MuSK-MG) in Greece, the IgG subclass of the anti-MuSK antibodies, the effect of 4 MuSK-MG sera on the AChR of the cells of muscle cell line TE671 and the immunodominant epitopes of MuSK. This population-based study was performed on MuSK-MG patients in Greece between 1 January 1986 and 30 June 2006. Epidemiological and clinical data for 33 patients were collected. In addition, the distribution of anti-MuSK IgG autoantibody subclasses in the sera of 14 patients was determined by immunoprecipitation. The determination of the immunodominant epitopes on MuSK was performed by synthesizing the extracellular part of MuSK via Geysen method of peptide synthesis. Then, we performed ELISA method in order to determine the epitopes. The average annual incidence was 0.32 patients/million population/year. In females, onset of MuSK-MG occurred after the age of 30, whilst, in males, the disease appears in any decade. Most patients presented with involvement of the facial and bulbar muscles. The vast majority of anti-MuSK antibodies were IgG4. As far as the the effect of 4 MuSK-MG sera on the AChR of the cells is concerned, these sera were incapable of destroying the AChR effectively. Finally, we did not determine the immunodominant epitopes on MuSK, as there were amino acid sequences on which the negative control was bound with greater affinity than the MuSK-MG sera we tested.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.