CIDP3

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Author:
xijunzhu
ID:
310102
Filename:
CIDP3
Updated:
2015-11-03 14:56:33
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CIDP
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Exam 2
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  1. radiculo
    • spinal root 
    • finding during autopsy that spinal roots had more pathology than distal parts
  2. gadolinium
    • create contrast during MRI, b/c it affects the relaxation times of protons
    • MRI measures relaxation times for protons
    • can pas blood brain barrier, when barrier is compromised as in MS
    • affect water (a lot of protons)
    • Water protons in different tissues have different T1 values, which is one of the main sources of contrast in MR images.
  3. name of elbow nerve
    ulnar nerve
  4. process of measuring orthodromic signal
    • put sending electrode in middle of arm, place receiving electrode on palm (M-wave)
    • F-wave is created when the signal goes up and then comes down
  5. what kinds of presentation or antibodies are present in CIDP?
    • CD4, CD8,
    • lymphocytes and MHC on Schwann cells, lesions in CIDP
    • CD8 T cells become toxic when going after antigen on S.C, then destroy S.C
  6. where has gangliosides been implicated in?
    • nodes and paranodes
    • GBS, affect Na+ channels.
  7. what proteins are there antibodies against in CIDP
    • NF155 (paranodal regions between terminal loops and axonlemma)
    • CASPR-2
    • contactin
  8. which proteins are axon proteins?
    • contactin, NF, CASPR
    • NrCAM is SC protein
  9. myelin specific proteins
    • PLP (CNS)
    • P0 (PNS)
    • PMP22
    • connexin
  10. CREAN
    • rabbit, animal model of CIDP
    • chronic relapsing EAN
    • injected galactocerebroside, got galactocerebroside antibody which caused conduction block and demyelination
    • not implicated in humans
  11. anti-GM1 in rabbits
    affected Na channels, conduction block
  12. axon degeneration
    full recovery is more challenging
  13. immunosuppressive therapy
    no controlled studies, doesn't have proven efficacy
  14. abnormal temporal dispersion
    broad size of action potential
  15. plexus
    intersection of nerves
  16. difference in sural nerve demyelination and plexus in CIDP
    • sural nerve: has onion bulbs and few myelination
    • plexus: only at death, hypertrophy, small amount of myelination.
  17. what sarah remembered about gamma
    • couldn't breath (hospitalized 3-4 times, had to have another central line)
    • hooked up to a smaller machine than apheresis
    • slurred speech
    • received a higher infusion and head hurt so much that she vomited
  18. the dump
    to get walker, and canes
  19. 1996
    • didn't write anything of consequence,
    • when all her friends graduated
  20. MS person at the bar
    also took steroids
  21. negative consequence of steroid
    • mood disorder and depression
    • mania, weakness and fatigue 
    • painful hips and shoulders, porous bones
    • premature aging of the body
  22. mary
    from dublin, ireland, wrote on online forum, wore leg brace had CIDP looking for young adults with it
  23. osteopenia 
    osteoporosis
    • reduction in bone weight
    • bones are weak and brittle
  24. prednisone side effects
    • adrenal suppression (no adrenaline, which is bad when you need surgery like in Sarah's abdominal surgery)
    • heart not working well
    • weaken ability of body to fight infections
    • given steroid over and over (steroid induced psychosis)
    • british soldiers (blood) and revolutionary ones (antibodies)
    • screaming, full of adrenaline
  25. what did sarah do after she got back from Iowa
    • went to neurologist, thinking it was CIDP again, but it was viral syndrome
    • yelled and stayed in bed for 5 months
  26. prayer
    • prayed with schizophrenic and poor woman with sick son
    • everyone was treated as equals, on their final descent, needed to radiate mercy
  27. kimiko
    • painted her face blue with marker
    • naked, not allowed food unless she left the room, but she didn't leave room
    • ECT (electroconvulsive therapy to reverse mental problems)
  28. how did sarah use her day pass
    loading new software and manually reopening and reserving each one of her files
  29. when she was at 32
    her disease had been in remission for 7 years
  30. wanted to erase all traces of disease
    • stop taking steroids
    • no bracelet
    • plastic surgery as last thing to rid scars on her chest
  31. timeline
    • march 1995 diagnosed
    • line pulled may 1996
    • recovered from last acute CIDP relapse nov. 1999
    • recovery from severe depression march 2004
  32. quetiapine and olanzapine
    treat hypomania, mania
  33. what happened in 2004
    • problem from CIDP to drinking
    • sobriety afterward made her feel better than ever
  34. isabelle
    sarah visits, who has CIDP
  35. what are the two kinds of decay
    mine and every else's
  36. two types of CIDP
    motor and sensory
  37. where are gangliosides most abundant, what happens when it is targeted?
    located are nodes of rangier, disrupt the sodium channel distribution, hence axonal damage
  38. where is P0 primarily located?
    at the internode (not normally palmitoylated)
  39. how was GBS induced in Brun's paper?
    • non palmitoylated 
    • antigangliosides antibodies cause axonal GBS
  40. AIDP
    acute inflammatory demyelinating polyneuropathy
  41. what direction does SNAP record, where is the recording electrode?
    • up
    • in the study, SNAP was recorded on the caudal (near tail) nerve, while stimulating was at the tail
  42. CMAP in the study
    stimulating needle electrode at the hip (proximal) or knee (distal) and recording was at the gastrocnemius muscle (back part of lower leg)
  43. immunohistochemical studies
    detecting antigens in tissue section with antibody binding.
  44. paresis
    • weakness of voluntary movement 
    • used to determine clinical score in rats
  45. lymph node cells and how was it collected
    • fight viruses and enact immune response
    • lumph nodes removed from rats
  46. PLP and ConA in study
    • used as negative control in experiment b/c it is the main protein in CNS
    • ConA was used as positive control, gives rise to T cells
  47. CMAP amplitude decrease then increase
    degeneration/regeneration of axon or myelin
  48. sciatic nerve
    from lower spine to foot, largest single nerve
  49. what does the green neurofilament stained fibers mean?
    intact axons
  50. IL-17
    • Interleukin 17 is a cytokine that acts as a potent mediator in delayed-type reactions by increasing chemokine production in various tissues to recruit monocytes and neutrophils to the site of inflammation
    • comes from immune cell
  51. what were the different groups in the study?
    • no antigen, injected with CFA
    • noninjected
    • injected S-palm
    • injected with P0
  52. CFA
    complete freund adjuvant, bacteria attracts macrophages and cells in injection site to increase immune response (long lasting antibody responses)
  53. meta-studies
    • age/gender matched clinical studies
    • combine different studies into one to directly compare
  54. treatment options
    • IVIg 
    • plasma exchange
    • immunosuppressant (no controlled trials, azathioprine doesn't have proven efficacy)
    • Mab (monoclonal antibody)
  55. lorazepam
    • for panic attacks gave her too much
    • highly addictive
  56. maniac
    extremely active
  57. what happens to adrenal glands after being on too much steroids, what other effects does steroid have?
    • sluggish, can't produce cortisol
    • acne, weight gain, depression, maniac, hallucination (demerol used to calm Sarah down)
  58. hypomania
    euphoria, irritability

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