Background and Purpose-We evaluated the clinical course of 19 acute stroke patients with rapid early improvement of neurological deficit within the 3-hour window, treated with intravenous thrombolytics. Results-No patient demonstrated a neurological deterioration during hospitalization. National Institutes of Health Stroke Scale (NIHSS) scores at therapy decision and discharge were 5 (4 to 6) and 0.5 (0 to 1.5), respectively. At 3-month follow-up, 1 patient had died; in remaining patients, NIHSS was 0 (0 to 1) and modified Rankin Scale 0.5 (0 to 1; Յ1 in 15 patients). Conclusions-Withholding of intravenous thrombolysis because of spontaneous early regression of neurological symptoms may not be justified.
The common marmoset (Callithrix jacchus jacchus) is a member of the Callithrichinae, a family of outbred New World primates with limited MHC polymorphisms and a propensity to develop spontaneous or experimentally induced autoimmunity. C. jacchus marmosets are susceptible to experimental allergic encephalomyelitis (EAE), and spontaneously develop autoimmune colitis and thyroiditis. Such disease models approximate the complexity of human autoimmune disorders, and allow an investigation of the respective roles of T-cell and antibody responses to self-antigens in outbred species. A key issue for further definition of the pathogenic antibody responses in human autoimmunity is to understand the diversity of the immunoglobulin repertoire in primate models. Here, we characterized the expressed immunoglobulin IGHV repertoire of the C. jacchus marmoset. Six IGHV subgroups were identified which show a high degree of sequence similarity to their human IGHV counterparts (IGHV1, IGHV3, IGHV4, IGHV5, IGHV6, and IGHV7). As in the expressed human IGHV repertoire, the framework regions are more conserved when compared to the complementarity-determining regions (CDRs), with the greatest degree of variability located in CDR3. Predicted structural features are highly conserved between C. jacchus and human IGHV. This information now provides a framework for studies of the antigen-specific repertoire of pathogenic antibodies in EAE and other immune-mediated diseases.
Despite the fact that ischemic stroke in the vertebrobasilar system (VBS) is significantly less frequent than in the carotid system, abnormalities found in Doppler and duplex examinations are about as prevalent in the VBS as in the carotid system. Because of the potentially severe clinical deficits associated with stroke of the VBS and the increased risk for stroke under conditions, such as underlying symptomatic vertebrobasilar stenosis and general anesthesia, it is highly desirable to have reliable methods available to identify pathological changes of the VBS. Furthermore, because the VBS via the circle of Willis can play a significant role as collateral blood supply system when vessels of the anterior circulation have been compromised, the knowledge of the VBS is necessary to estimate the overall integrity of the remaining blood flow to the brain.
The cover shows a confocal micrograph of myelinated nervous tissue at the rim of a demyelinating lesion in the brain white matter of a patient with multiple sclerosis (MS). Myelin surrounding the axon is stained by a monoclonal antibody obtained by recombinant expression of immunoglobulin genes from clonally expanded plasma cells as present in the cerebrospinal fluid of MS patients. The image was taken from the article by von Büdingen et al. (pp.
in which the authors demonstrate that myelin specific antibodies result from antigen driven immune responses found in the cerebrospinal fluid of MS patients.
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