11:47 AM 9/11/2020 - Germans want the US forces out of Germany: this is their long term strategy after WW2 | US embassy to challenge Germany over attempts to tax American troops
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Germans want the US forces out of Germany: this is their long term strategy after WW2, and the recent events confirm this, including the decision by the German - Russian - New Abwehr puppet and The Useful Idiot Trump to withdraw the US troops from Germany, with the consent and approval of the German and the New Abwehr agent Putin. - M.N.
11:58 AM 9/11/2020 - Saved and Shared Stories in 25 Posts on RSS Dog | New Page
_______________________________________Saved and Shared Stories from Michael_Novakhov (6 sites)  | |||||||
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| mikenov on Twitter: US embassy to challenge Germany over attempts to tax American troops - Europe - Stripes stripes.com/news/europe/us | |||||||
US embassy to challenge Germany over attempts to tax American troops - Europe - Stripes stripes.com/news/europe/us | |||||||
| mikenov on Twitter: US power abuses since 9/11: Wars, torture, illegal acts aa.com.tr/en/americas/us | |||||||
US power abuses since 9/11: Wars, torture, illegal acts aa.com.tr/en/americas/us | |||||||
| mikenov on Twitter: RT @MoscowTimes: Russia plans to require long-staying foreigners to submit fingerprints and carry electronic migration cards as part of its | |||||||
Russia plans to require long-staying foreigners to submit fingerprints and carry electronic migration cards as part of its wide-ranging immigration reforms, Kommersant reported Friday Retweeted by  Michael Novakhov (mikenov) on Friday, September 11th, 2020 3:02pm6 likes, 5 retweets | |||||||
| mikenov on Twitter: RT @Comey: If we learn nothing else from this tragedy, we learn that life is short and there is no time for hate. Sandy Dahl, wife of F | |||||||
If we learn nothing else from this tragedy, we learn that life is short and there is no time for hate. Sandy Dahl, wife of Flight 93 pilot Jason Dahl, 2002 Shanksville, PA Retweeted by Michael Novakhov (mikenov) on Friday, September 11th, 2020 3:02pm3681 likes, 525 retweets | |||||||
| mikenov on Twitter: Putin holds key to Belarus crisis as Lukashenko heads to Moscow | Belarus | The Guardian theguardian.com/world/2020/sep | |||||||
Putin holds key to Belarus crisis as Lukashenko heads to Moscow | Belarus | The Guardian theguardian.com/world/2020/sep | |||||||
| mikenov on Twitter: Совещание с постоянными членами Совета Безопасности Президент России kremlin.ru/events/preside | |||||||
Совещание с постоянными членами Совета Безопасности Президент России kremlin.ru/events/preside | |||||||
| mikenov on Twitter: 9:45 AM 9/11/2020 - Mike Nova's Shared NewsLinks Review In 250 Brief Posts thenewsandtimes.blogspot.com/2020/09/945-am pic.twitter.com/wflJoPwh5x | |||||||
9:45 AM 9/11/2020 - Mike Nova's Shared NewsLinks Review In 250 Brief Posts thenewsandtimes.blogspot.com/2020/09/945-am pic.twitter.com/wflJoPwh5x  | |||||||
| Michael Novakhov - SharedNewsLinks: 9:45 AM 9/11/2020 - Mike Nova's Shared NewsLinks Review In 250 Brief Posts | |||||||
9:45 AM 9/11/2020_______________________________________________________________ Mike Nova's Shared NewsLinks Review In 250 Brief Posts - » Odor-sensing cells in nose seen as key entry point for SARS-CoV-2 » Transverse Myelitis, Possible Adverse Reaction to COVID-19 Vaccine, Explained » Coronavirus Infects, Hijacks Brain - How Does It Work? » How Russia Updated Its Disinformation Playbook for 2020 » mikenov on Twitter: RT @ForeignAffairs: With new players in the disinformation game, in all likelihood, 2020 will not be a replay of 2016. It will be far wors » AstraZeneca-Oxford vaccine trial pause a 'wake-up call', says WHO » Century 21, landmark of Lower Manhattan since 1961, files for bankruptcy and plans shutdown of all 13 locations » At least 3 dead in Northern Calif. wildfire threatening thousands of homes » Ex-Minneapolis cop Derek Chauvin appears in court for tax evasion charges » Настоящее Время: "Люди в разрисованных масках и сотрудники милиции". Избитый в изоляторе в Минске мужчина о жестокости силовиков » 1:56 PM 9/10/2020 - Mr. Lukashenko: Is this how you treat your fellow citizens who try to exercise their basic rights and freedoms? Shame on you! Resign! » 11:31 AM 9/10/2020 - News Review » 9:49 AM 9/10/2020 - "Wild animals roaming the cities of the "free" Western world - this is one of the most favorite memes, themes, propaganda scares, etc., etc. of the RUSSIAN INTELLIGENCE, POSSIBLY THE GRU AND THEIR MAFIA FRIENDS. » Tiger spotting in Tennessee prompts huge search efforts » 9:11 AM 9/10/2020 - Blogs Review: News - coronavirus and the brain | Sexual harassment in the FBI - the hidden epidemic. What do we really know about it? » 8:38 AM 9/10/2020 - News - coronavirus and the brain | |||||||
| Blogs from Michael_Novakhov (27 sites): Michael Novakhov - SharedNewsLinks: 9:45 AM 9/11/2020 - Mike Nova's Shared NewsLinks Review In 250 Brief Posts | |||||||
9:45 AM 9/11/2020_______________________________________________________________ Mike Nova's Shared NewsLinks Review In 250 Brief Posts - » Odor-sensing cells in nose seen as key entry point for SARS-CoV-2 » Transverse Myelitis, Possible Adverse Reaction to COVID-19 Vaccine, Explained » Coronavirus Infects, Hijacks Brain - How Does It Work? » How Russia Updated Its Disinformation Playbook for 2020 » mikenov on Twitter: RT @ForeignAffairs: With new players in the disinformation game, in all likelihood, 2020 will not be a replay of 2016. It will be far wors » AstraZeneca-Oxford vaccine trial pause a 'wake-up call', says WHO » Century 21, landmark of Lower Manhattan since 1961, files for bankruptcy and plans shutdown of all 13 locations » At least 3 dead in Northern Calif. wildfire threatening thousands of homes » Ex-Minneapolis cop Derek Chauvin appears in court for tax evasion charges » Настоящее Время: "Люди в разрисованных масках и сотрудники милиции". Избитый в изоляторе в Минске мужчина о жестокости силовиков » 1:56 PM 9/10/2020 - Mr. Lukashenko: Is this how you treat your fellow citizens who try to exercise their basic rights and freedoms? Shame on you! Resign! » 11:31 AM 9/10/2020 - News Review » 9:49 AM 9/10/2020 - "Wild animals roaming the cities of the "free" Western world - this is one of the most favorite memes, themes, propaganda scares, etc., etc. of the RUSSIAN INTELLIGENCE, POSSIBLY THE GRU AND THEIR MAFIA FRIENDS. » Tiger spotting in Tennessee prompts huge search efforts » 9:11 AM 9/10/2020 - Blogs Review: News - coronavirus and the brain | Sexual harassment in the FBI - the hidden epidemic. What do we really know about it? » 8:38 AM 9/10/2020 - News - coronavirus and the brain | |||||||
| Saved Stories - None: 9:45 AM 9/11/2020 - Mike Nova's Shared NewsLinks Review In 250 Brief Posts | |||||||
9:45 AM 9/11/2020_______________________________________________________________ Mike Nova's Shared NewsLinks Review In 250 Brief Posts - » Odor-sensing cells in nose seen as key entry point for SARS-CoV-2 » Transverse Myelitis, Possible Adverse Reaction to COVID-19 Vaccine, Explained » Coronavirus Infects, Hijacks Brain - How Does It Work? » How Russia Updated Its Disinformation Playbook for 2020 » mikenov on Twitter: RT @ForeignAffairs: “With new players in the disinformation game, in all likelihood, 2020 will not be a replay of 2016. It will be far wors… » AstraZeneca-Oxford vaccine trial pause a 'wake-up call', says WHO » Century 21, landmark of Lower Manhattan since 1961, files for bankruptcy and plans shutdown of all 13 locations » At least 3 dead in Northern Calif. wildfire threatening thousands of homes » Ex-Minneapolis cop Derek Chauvin appears in court for tax evasion charges » Настоящее Время: "Люди в разрисованных масках и сотрудники милиции". Избитый в изоляторе в Минске мужчина о жестокости силовиков » 1:56 PM 9/10/2020 - Mr. Lukashenko: Is this how you treat your fellow citizens who try to exercise their basic rights and freedoms? Shame on you! Resign! » 11:31 AM 9/10/2020 - News Review » 9:49 AM 9/10/2020 - "Wild animals roaming the cities of the "free" Western world - this is one of the most favorite memes, themes, propaganda scares, etc., etc. of the RUSSIAN INTELLIGENCE, POSSIBLY THE GRU AND THEIR MAFIA FRIENDS. » Tiger spotting in Tennessee prompts huge search efforts » 9:11 AM 9/10/2020 - Blogs Review: News - coronavirus and the brain | Sexual harassment in the FBI - the hidden epidemic. What do we really know about it? » 8:38 AM 9/10/2020 - News - coronavirus and the brain | |||||||
| mikenov on Twitter: 9:30 AM 9/11/2020 - Transverse Myelitis, Possible Adverse Reaction to COVID-19 Vaccine, Explained | Coronavirus Infects, Hijacks Brain - How Does It Work? | How Russia Updated Its Disinformation Playbook for 2020 fbinewsreview.blogspot.com/2020/09/930-am pic.twitter.com/7mJyq9rA1A | |||||||
9:30 AM 9/11/2020 - Transverse Myelitis, Possible Adverse Reaction to COVID-19 Vaccine, Explained | Coronavirus Infects, Hijacks Brain - How Does It Work? | How Russia Updated Its Disinformation Playbook for 2020 fbinewsreview.blogspot.com/2020/09/930-am pic.twitter.com/7mJyq9rA1A  | |||||||
| Michael Novakhov - SharedNewsLinks: 9:30 AM 9/11/2020 - Transverse Myelitis, Possible Adverse Reaction to COVID-19 Vaccine, Explained | Coronavirus Infects, Hijacks Brain - How Does It Work? | How Russia Updated Its Disinformation Playbook for 2020 | |||||||
 9:30 AM 9/11/2020 -
Michael Novakhov - SharedNewsLinks | In Brief | - | |||||||
| Blogs from Michael_Novakhov (27 sites): Michael Novakhov - SharedNewsLinks: 9:30 AM 9/11/2020 - Transverse Myelitis, Possible Adverse Reaction to COVID-19 Vaccine, Explained | Coronavirus Infects, Hijacks Brain - How Does It Work? | How Russia Updated Its Disinformation Playbook for 2020 | |||||||
9:30 AM 9/11/2020 -
Michael Novakhov - SharedNewsLinks | In Brief | - | |||||||
| Saved Stories - None: 9:30 AM 9/11/2020 - Transverse Myelitis, Possible Adverse Reaction to COVID-19 Vaccine, Explained | Coronavirus Infects, Hijacks Brain - How Does It Work? | How Russia Updated Its Disinformation Playbook for 2020 | |||||||
9:30 AM 9/11/2020 -
Michael Novakhov - SharedNewsLinks℠ | In Brief | - | |||||||
| Blogs from Michael_Novakhov (27 sites): The News And Times: 9:45 AM 9/11/2020 - Mike Nova's Shared NewsLinks Review In 250 Brief Posts | |||||||
9:45 AM 9/11/2020Blogs from Michael_Novakhov_______________________________________________________________Blogs from Michael_Novakhov (27 sites) The FBI News Review: 9:30 AM 9/11/2020 - Transverse Myelitis, Possible Adverse Reaction to COVID-19 Vaccine, Explained | Coronavirus Infects, Hijacks Brain - How Does It Work? | How Russia Updated Its Disinformation Playbook for 2020Michael Novakhov - | |||||||
| Blogs from Michael_Novakhov (27 sites): The FBI News Review: 9:30 AM 9/11/2020 - Transverse Myelitis, Possible Adverse Reaction to COVID-19 Vaccine, Explained | Coronavirus Infects, Hijacks Brain - How Does It Work? | How Russia Updated Its Disinformation Playbook for 2020 | |||||||
9:30 AM 9/11/2020 - Transverse Myelitis, Possible Adverse Reaction to COVID-19 Vaccine, Explained |Coronavirus Infects, Hijacks Brain - How Does It Work? |How Russia Updated Its Disinformation Playbook for 2020Michael Novakhov - SharedNewsLinksMichael Novakhov - SharedNewsLinks | In Brief | -Michael Novakhov - SharedNewsLinks Odor-sensing cells in nose seen as key entry point for | |||||||
| Michael Novakhov - SharedNewsLinks: Odor-sensing cells in nose seen as key entry point for SARS-CoV-2 | |||||||
By Waun'Shae Blount /Published Aug 24Scientists at Johns Hopkins Medicine, experimenting with a small number of human cell samples, report that the "hook" of cells used by SARS-CoV-2 to latch onto and infect cells is up to 700 times more prevalent in the olfactory supporting cells lining the inside of the upper part of the nose than in the lining cells of the rest of the nose and windpipe that leads to the lungs. These supporting cells are necessary for the function/development of odor-sensing cells. The findings, from a preliminary study of cells lining both the nose and trachea, could advance the search for the best target for topical or local antiviral drugs to treat COVID-19, and offer further clues into why people with the virus sometimes lose their sense of smell. A summary of the findings appears in a letter published Aug. 19 in the European Respiratory Journal. "Loss of the sense of smell is associated with COVID-19, generally in the absence of other nasal symptoms, and our research may advance the search for a definitive reason for how and why that happens, and where we might best direct some treatments," says Andrew Lane, professor of otolaryngology, head and neck surgery, and director of the Johns Hopkins Sinus Center. Lane's medical practice focuses on people with nasal and sinus problems, who oftentimes, he says, lose their sense of smella condition called anosmia. Scientists have known that SARS-CoV-2 latches on to a biological hook on the surface of many types of human cells, called an angiotensin-converting enzyme 2, or ACE2, receptor. The receptor reels in essential molecules. Johns Hopkins responds to COVID-19Coverage of how the COVID-19 pandemic is affecting operations at JHU and how Hopkins experts and scientists are responding to the outbreak In a bid to explore the ACE2 link to COVID-19 in more detail, Lane and Mengfei Chen, a research associate in Lane's lab, as well as others on the team took a close look at ACE2 levels in nasal tissue specimens from 19 adult men and women with chronic rhinosinusitis (inflammation of nasal tissue) and in tissues from a control group of four people who had nasal surgeries for issues other than sinusitis. The researchers also studied tissue samples of the trachea from seven people who underwent surgery for abnormal narrowing of the trachea. Cells from children were not examined for this study, in part because they tend to have low ACE2 levels in the cells lining the nose, which may contribute to generally less severe illness among children infected with the SARS-CoV-2 virus. None of the study participants had been diagnosed with COVID-19. The scientists used a high-resolution imaging technique called confocal microscopy to produce very sharp images of cells lining the nasal and tracheal airways. They used fluorescent stains to identify ACE2 receptors. They found high levels of ACE2 among nasal cells that give structural support called sustentacular cells. These cells are located in an area called the olfactory neuroepithelium, where odor-sensing neurons are found. The researchers say this area of the nose may be particularly vulnerable to infection and might be the only infected site even when there are no symptoms. Because of this, they urge people to wear masks and wear them correctly. For the study, depending on the biopsy sample, cells in the olfactory neuroepithelium had a 200-fold to 700-fold increase in ACE2 proteins compared with other samples from the nose and trachea. Because the cells with high levels of ACE2 are associated with odor sensing, the researchers suggest that infection of these cells may be the reason some people with COVID-19 experience loss of smell. Two of seven trachea specimens had low levels of ACE2 receptors, and the amount of those receptors was similar between study participants with and without chronic rhinosinusitus. Because the cells lining the nose may prove to be a key entry point for SARS-CoV-2, Lane says there may be ways to target those particular cells with topical antiviral drugs or other therapies directly to that area. | |||||||
| Blogs from Michael_Novakhov (27 sites): Michael Novakhov - SharedNewsLinks: Odor-sensing cells in nose seen as key entry point for SARS-CoV-2 | |||||||
By Waun'Shae Blount /Published Aug 24Scientists at Johns Hopkins Medicine, experimenting with a small number of human cell samples, report that the "hook" of cells used by SARS-CoV-2 to latch onto and infect cells is up to 700 times more prevalent in the olfactory supporting cells lining the inside of the upper part of the nose than in the lining cells of the rest of the nose and windpipe that leads to the lungs. These supporting cells are necessary for the function/development of odor-sensing cells. The findings, from a preliminary study of cells lining both the nose and trachea, could advance the search for the best target for topical or local antiviral drugs to treat COVID-19, and offer further clues into why people with the virus sometimes lose their sense of smell. A summary of the findings appears in a letter published Aug. 19 in the European Respiratory Journal. "Loss of the sense of smell is associated with COVID-19, generally in the absence of other nasal symptoms, and our research may advance the search for a definitive reason for how and why that happens, and where we might best direct some treatments," says Andrew Lane, professor of otolaryngology, head and neck surgery, and director of the Johns Hopkins Sinus Center. Lane's medical practice focuses on people with nasal and sinus problems, who oftentimes, he says, lose their sense of smella condition called anosmia. Scientists have known that SARS-CoV-2 latches on to a biological hook on the surface of many types of human cells, called an angiotensin-converting enzyme 2, or ACE2, receptor. The receptor reels in essential molecules. Johns Hopkins responds to COVID-19Coverage of how the COVID-19 pandemic is affecting operations at JHU and how Hopkins experts and scientists are responding to the outbreak In a bid to explore the ACE2 link to COVID-19 in more detail, Lane and Mengfei Chen, a research associate in Lane's lab, as well as others on the team took a close look at ACE2 levels in nasal tissue specimens from 19 adult men and women with chronic rhinosinusitis (inflammation of nasal tissue) and in tissues from a control group of four people who had nasal surgeries for issues other than sinusitis. The researchers also studied tissue samples of the trachea from seven people who underwent surgery for abnormal narrowing of the trachea. Cells from children were not examined for this study, in part because they tend to have low ACE2 levels in the cells lining the nose, which may contribute to generally less severe illness among children infected with the SARS-CoV-2 virus. None of the study participants had been diagnosed with COVID-19. The scientists used a high-resolution imaging technique called confocal microscopy to produce very sharp images of cells lining the nasal and tracheal airways. They used fluorescent stains to identify ACE2 receptors. They found high levels of ACE2 among nasal cells that give structural support called sustentacular cells. These cells are located in an area called the olfactory neuroepithelium, where odor-sensing neurons are found. The researchers say this area of the nose may be particularly vulnerable to infection and might be the only infected site even when there are no symptoms. Because of this, they urge people to wear masks and wear them correctly. For the study, depending on the biopsy sample, cells in the olfactory neuroepithelium had a 200-fold to 700-fold increase in ACE2 proteins compared with other samples from the nose and trachea. Because the cells with high levels of ACE2 are associated with odor sensing, the researchers suggest that infection of these cells may be the reason some people with COVID-19 experience loss of smell. Two of seven trachea specimens had low levels of ACE2 receptors, and the amount of those receptors was similar between study participants with and without chronic rhinosinusitus. Because the cells lining the nose may prove to be a key entry point for SARS-CoV-2, Lane says there may be ways to target those particular cells with topical antiviral drugs or other therapies directly to that area. | |||||||
| Saved Stories - None: Odor-sensing cells in nose seen as key entry point for SARS-CoV-2 | |||||||
By Waun'Shae Blount /Published Aug 24Scientists at Johns Hopkins Medicine, experimenting with a small number of human cell samples, report that the "hook" of cells used by SARS-CoV-2 to latch onto and infect cells is up to 700 times more prevalent in the olfactory supporting cells lining the inside of the upper part of the nose than in the lining cells of the rest of the nose and windpipe that leads to the lungs. These supporting cells are necessary for the function/development of odor-sensing cells. The findings, from a preliminary study of cells lining both the nose and trachea, could advance the search for the best target for topical or local antiviral drugs to treat COVID-19, and offer further clues into why people with the virus sometimes lose their sense of smell. A summary of the findings appears in a letter published Aug. 19 in the European Respiratory Journal. "Loss of the sense of smell is associated with COVID-19, generally in the absence of other nasal symptoms, and our research may advance the search for a definitive reason for how and why that happens, and where we might best direct some treatments," says Andrew Lane, professor of otolaryngology, head and neck surgery, and director of the Johns Hopkins Sinus Center. Lane's medical practice focuses on people with nasal and sinus problems, who oftentimes, he says, lose their sense of smell—a condition called anosmia. Scientists have known that SARS-CoV-2 latches on to a biological hook on the surface of many types of human cells, called an angiotensin-converting enzyme 2, or ACE2, receptor. The receptor reels in essential molecules. Johns Hopkins responds to COVID-19Coverage of how the COVID-19 pandemic is affecting operations at JHU and how Hopkins experts and scientists are responding to the outbreak In a bid to explore the ACE2 link to COVID-19 in more detail, Lane and Mengfei Chen, a research associate in Lane's lab, as well as others on the team took a close look at ACE2 levels in nasal tissue specimens from 19 adult men and women with chronic rhinosinusitis (inflammation of nasal tissue) and in tissues from a control group of four people who had nasal surgeries for issues other than sinusitis. The researchers also studied tissue samples of the trachea from seven people who underwent surgery for abnormal narrowing of the trachea. Cells from children were not examined for this study, in part because they tend to have low ACE2 levels in the cells lining the nose, which may contribute to generally less severe illness among children infected with the SARS-CoV-2 virus. None of the study participants had been diagnosed with COVID-19. The scientists used a high-resolution imaging technique called confocal microscopy to produce very sharp images of cells lining the nasal and tracheal airways. They used fluorescent stains to identify ACE2 receptors. They found high levels of ACE2 among nasal cells that give structural support called sustentacular cells. These cells are located in an area called the olfactory neuroepithelium, where odor-sensing neurons are found. The researchers say this area of the nose may be particularly vulnerable to infection and might be the only infected site even when there are no symptoms. Because of this, they urge people to wear masks and wear them correctly. For the study, depending on the biopsy sample, cells in the olfactory neuroepithelium had a 200-fold to 700-fold increase in ACE2 proteins compared with other samples from the nose and trachea. Because the cells with high levels of ACE2 are associated with odor sensing, the researchers suggest that infection of these cells may be the reason some people with COVID-19 experience loss of smell. Two of seven trachea specimens had low levels of ACE2 receptors, and the amount of those receptors was similar between study participants with and without chronic rhinosinusitus. Because the cells lining the nose may prove to be a key entry point for SARS-CoV-2, Lane says there may be ways to target those particular cells with topical antiviral drugs or other therapies directly to that area. | |||||||
| mikenov on Twitter: Odor-sensing cells in nose seen as key entry point for SARS-CoV-2 | Hub hub.jhu.edu/2020/08/24/odo | |||||||
Odor-sensing cells in nose seen as key entry point for SARS-CoV-2 | Hub hub.jhu.edu/2020/08/24/odo | |||||||
| Michael Novakhov - SharedNewsLinks: Transverse Myelitis, Possible Adverse Reaction to COVID-19 Vaccine, Explained | |||||||
It is still unclear whether the adverse event that caused AstraZeneca to pause enrollment in its COVID-19 vaccine trial was transverse myelitis or not. The New York Times is reporting this morning that in a statement to reporters yesterday an AstraZeneca spokesperson said the individual did not have a confirmed [emphasis added] case of transverse myelitis. The newspaper reported two days ago that an anonymous source said a woman in the United Kingdom who had the possible adverse reaction to the vaccine had received a diagnosis of transverse myelitis. Stat, which broke the story that the trial had been put on hold, reported yesterday that companys CEO, Pascal Soriot, told investors in a conference call today that the symptoms of the woman whose illness led the company to pause of the trial are consistent with transverse myelitis, although in the same story the biotech news site reported that diagnosis had not been confirmed. The Wall Street Journal reported yesterday that a form from July that was posted on an international registry of clinical trials said a study volunteer had developed symptoms of transverse myelitis. Meanwhile, health officials and experts are cautioning that it is common for vaccine trials to be put on hold as researchers investigate whether illnesses that occur in study volunteers are, in fact, related to the vaccine. Its quite common for serious adverse events to occur, most not relevant to the vaccine, Peter Hotez, dean of the National School of Tropical Medicine at Baylor told the Journal. Whether or not the adverse event is confirmed as a case of transverse myelitis or not, the news over the last few days has asking a lot of questions about transverse myelitis. Here is some information for people who are unfamiliar with it: What is transverse myelitis?In simple terms, it is inflammation of the spinal cord. Wolters Kluwer UpToDate, the database of reviews of medical topics, describes transverse myelitis as a mixed inflammatory disorder that affects neurons, axons, and oligodendrocytes [the cells that produce myelin] and myelin. A 2010 clinical practice article in the New England Journal of Medicine described the pathological hallmark of the condition as being the focal collection of lymphocytes and monocytes with varying degrees of demyelination, axonal injury and astroglial and microglial activation within the spinal cord. Why is it called transverse myelitis?Myelitis is the medical term for inflammation of the spinal cord. In some accounts, the modifier transverse is explained as referring to the pattern of symptoms that go across the body. But the better explanation is that transverse refers to the transverse, or horizontal, plane of the spinal cord and the fact that the inflammation is usually limited to a relatively small area of the spinal cord, not its whole length. Transverse also refers to the fact that both the ascending (that carry sensory messages to the brain) and descending (which direct voluntary movement) tracts of the spinal cord are affected. What causes transverse myelitis?A large proportion how large varies with the study of cases are associated with central nervous system autoimmune disorders, such as multiple sclerosis and neuromyelitis optica spectrum disorder, and other autoimmune disorders, such as sarcoidosis and Sjögren syndrome. In fact, transverse myelitis can be the first demyelinating event that precedes full-blown multiple sclerosis. Another large fraction of cases as large as two thirds in some studies of transverse myelitis cases are labeled idiopathic, meaning that the cause is uncertain. But that is a bit of a misnomer because a large proportion of those idiopathic cases occur after an illness or infection of some kind has occurred. Nevertheless, these are considered idiopathic because the causative nature of the infection is seldom proven, says the Wolters Kluwer UpToDate article on transverse myelitis. The thinking is that an infection can trigger an aberrant, unregulated immune response that turns on the body and, in this case, the spinal cord instead of taking on the invasive organism. Some of the infectious agents that have been linked to the development of transverse myelitis include the enteroviruses, the West Nile virus, and the Zika virus. Transverse myelitis can also be a complication of Lyme disease, which is typically caused by bacterium Borrelia burgdorfer There have been several case reports suggesting that COVID-19 itself could trigger transverse myelitis. For example, in a letter published in May in the Journal of Neurology, German clinicians described the case of a 60-year-old man who recovered quickly from COVID-19 pneumonia but then developed symptoms suggestive of transverse myelitis three days after he was discharged. Do other vaccines cause transverse myelitis?There are reports of instances when getting a vaccine appeared to lead to transverse myelitis. But Roger Baxter of the Northern California Kaiser Permanente Vaccine Study Center in Oakland, California, and his colleagues used the Vaccine Safety Database to look at the question more systematically. Among 64 million vaccine doses, they found 7 cases of transverse myelitis and no statistically valid association between those cases and prior vaccination. They reported the results of their study in the journal Clinical Infectious Diseases in 2016. in the Vaccine Safety Database to look at the question more systematically. How common is transverse myelitis?An incidence of between one to eight cases per million people is cited often. Such a proportion would mean a range of between 330 and 2,640 new cases in the United States annually. The authors of the NEJM clinical practice piece noted that if cases associated with multiple sclerosis and other demyelinating disorders are included, the estimated incidence increases to about 25 cases per million, which would translate into roughly 8,000 cases occurring in the U.S. annually. What are the symptoms?Transverse myelitis is divided into subtypes based on how large the area of inflammation is, whether it affects both sides of the spinal cord symmetrically, and other factors. The symptoms vary with these subtype and where on the length of the spinal cord the inflammation is present. In a nontechnical explanation on its website, the Johns Hopkins Transverse Myelitis Center says the four classic symptoms are weakness in the arms and legs, sensory symptoms such as numbing and tingling, pain and discomfort, and bladder dysfunction, bowel motility problems, or both. How is it diagnosed?Clinicians are encouraged to take a patient history and assess symptoms carefully because they can yield important diagnostic clues. After that, one of the first steps is an MRI scan of the spine, partly to rule out that the symptoms arent the result of a compressive lesion something (herniated disc, for example) impinging on the spinal cord that might be treated with surgery. The contrast agents used in MRI scans can also yield some diagnostic information that may (or may not) lead to transverse myelitis diagnosis. The diagnosis also hinges on the analysis of the cerebrospinal fluid, which is collected via lumbar puncture. High white blood cells can be indicative of inflammation. Measurements of antibody can indicate whether multiple sclerosis is likely. The authors of the NEJM article note that transverse myelitis syndrome has an extensive differential diagnosis, which means a number of other tests might be done to rule out other causes. For example, a brain MRI might be ordered to detect the presences of lesions that are indicative of multiple sclerosis. How is it treated?Treatment with intravenous corticosteroids is the standard first-line treatment and has been for a while. Although the NEJM article was published 10 years ago, the authors identify intravenous corticosteroids as the front-line treatment. The authors of Wolters Kluwer UpToDate article say their preferred regimens are methylprednisolone or dexamethasone for three to five days. The Johns Hopkins Transverse Myelitis Center notes the lack of evidence from clinical trials but says it is well recognized as a standard of care that patients suspected to have acute myelitis receive high-dose intravenous methyl-prednisolone for 3-5 days, unless there are compelling reasons not to. The standard second-line treatment if intravenous corticosteroids arent effective is plasma exchange, which involves filtering out a patients plasma and replacing it plasma from a donor or a saline solution that contains albumin. The Wolters Kluwer UpToDate authors say that for patients with significant deficits, waiting for end of the corticosteroid treatment isnt necessary. The Johns Hopkins Transverse Myelitis Center takes a slightly different approach, saying that plasma exchange is often used for patients with moderate to aggressive forms of transverse myelitis who dont show much improvement after being treated with intravenous and oral steroids. Immunosuppressant or immunomodulatory agents may be used to treat people with recurring transverse myelitis or cases that dont respond to intravenous corticosteroids or plasma exchange. The Wolters Kluwer UpToDate authors mention mycophenolate and intravenous rituximab. The Johns Hopkins center mentions intravenous cyclophosphamide. |
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