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使用进展独立于复发活动框架揭示多发性硬化症的病理生物学基础
Olga Ciccarelli1, Frederik Barkhof1, Massimiliano Calabrese1
1From the Queen Square MS Centre (O.C., F.B., A.E., A.T.T.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health and Care Research (NIHR) (O.C.), University College London Hospitals (UCLH) Biomedical Research Centre; Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Department of Radiology and Nuclear Medicine (F.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Department of Neurosciences, Biomedicine and Movement Sciences (M.C.), University of Verona; Department of Medicine, Surgery and Neuroscience (N.D.S.), University of Siena; Neuroimaging Research Unit (M.F., M.A.R.), Division of Neuroscience, and Neurology Unit (M.F., M.A.R.), Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University (M.F., M.A.R.), Milan; Department of Neuroscience (C. Gasperini), San Camillo Hospital, Rome, Italy; Translational Imaging in Neurology (ThINK) Basel (C. Granziera, L.K.), Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) (C. Granziera, L.K.); University Hospital Basel and University of Basel (C. Granziera, L.K.), Switzerland; Section of Neuroradiology (À.R.), Department of Radiology, and Multiple Sclerosis Centre of Catalonia (J.S.-G., C.T.), Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Health Sciences (M.P.S.), University of Genova; and IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy.
在多发性硬化症 (MS) 中,不依赖复发活动的进展 (PIRA) 有助于追踪没有复发的残疾累积. 然而,PIRA和PIRMA在临床试验和实践中存在挑战,需要先进的成像来更充分地理解.
科学领域:
- 神经学 神经学
- 神经免疫学 神经免疫学
- 临床试验 临床试验
背景情况:
- 独立于复发活动的进展 (PIRA) 正式化了多发性硬化症 (MS) 与复发分开的残疾累积.
- 目前PIRA的定义依赖于时间窗口来区分炎症 (复发) 和神经退行 (进展).
- 独立于复发和MRI活动的进展 (PIRMA) 通过排除临床和MRI活动来进一步细化这一点.
研究的目的:
- 讨论PIRA和PIRMA在临床环境,试验和研究中的缺陷和实施挑战.
- 探索不与复发相关的MS中残疾累积的病理生物学.
- 提出"先进的PIRMA",使用成像来调查残疾累积机制,并确定未来的研究优先事项.
主要方法:
- 对PIRA和PIRMA定义及其临床实用性的概念分析.
- 对促进多发性硬化症残疾进展的病理生物学机制的审查.
- 关于"先进PIRMA"的建议,将传统和先进的成像技术纳入观察性研究中.
主要成果:
- 在临床实践和试验中,PIRA和PIRMA定义面临着挑战,特别是在频繁的评估和依赖EDSS等以运动为重点的尺度方面.
- 独立于复发的残疾累积可能涉及慢性活跃病变,皮质病变,缩,微质活化和白质损伤.
- 先进的成像技术对于更好地反映MS病原性机制至关重要,而不仅仅是临床描述.
结论:
- 在MS临床实践和试验中实施PIRA和PIRMA需要方法的改进,并考虑各种残疾措施.
- "高级PIRMA"的概念提供了一个框架,可以使用先进的成像来研究MS中渐进性残疾的复杂病理生物学.
- 需要进一步的研究,以充分理解和解决MS中残疾累积的所有机制,特别是那些与复发无关的机制.
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