Multiple sclerosis (MS) is an autoimmune disorder characterised by clinical relapse and remission and pathological demyelination with varying inflammation. Because it is suggested that T-cells expressing natural killer cell receptors (NKR) play important roles in regulating human autoimmune diseases, we have quantified populations T-cells expressing the NKR CD56, CD161 and CD94 in the peripheral blood of MS patients, in healthy control subjects (HS) and in patients with other neurological diseases (OND). CD161 + T-cells and CD94 + T-cells were significantly decreased in MS patients with primary progressive disease and secondarily change progressive disease respectively whereas CD56 + T-cell numbers were unchanged. In contrast NKT-cells that express the invariant V α 24-J α 18 + T-cell receptor identified here by specific receptor antibody and CD1d-tetrameric PBS57-loaded complexes, were increased in MS patients compared with HS. Reductions in CD161 + T-cells and CD94 + T cells relative to HS were also observed in the OND group and this was particularly prominent in Parkinsonian patients. A striking functional finding was that while NKT-cells in unfractionated peripheral blood from healthy subjects expanded in number and produced IFN-γ upon stimulation with α-galactosylceramide, NKT-cells from MS patients did not. Thus we have identified alterations in a number of potentially important lymphocyte sub-populations warranting further investigation in the immune response in MS.
The aim of this service evaluation study was to establish the extent of concordance in decision-making between the senior attending neurologist and the advanced nurse practitioner (ANP) in neurology, regarding identification and management of 15 participants with multiple sclerosis and reporting potential new/escalating neurological symptoms via the ANP telephone support service. Results showed 100% agreement between neurologist and ANP regarding whether to manage patient concerns via telephone or in the outpatient clinic. In the patients seen in clinic, no inconsistencies were noted in neurological findings recorded by both clinicians. Diagnostic concordance was 93.4%, with 80% management concordance between the ANP and neurologist. There was 100% agreement between the ANP and neurologist regarding the need for treatment escalation. The analysis of this study suggests that diagnostic and management decision-making provided by the ANP for patients with potential relapses and/or treatment escalation is on a par with that of the neurologist, which is the traditional model of care. Our findings support the increasing role of the ANP in the active and independent care of patients with MS.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.