Comparative effectiveness and safety of intravenous methylprednisolone and tacrolimus monotherapy in ocular myasthenia gravis with unsatisfactory prednisone responses: a retrospective study

BACKGROUND

Oral prednisone has been recognized as the first-line therapy for the treatment of ocular myasthenia gravis (OMG). However, its long-term use is complicated by numerous adverse effects and is ineffective for some OMG patients in reaching remission. This study aimed to evaluate the effectiveness and safety of intravenous methylprednisolone (IVMP) and tacrolimus monotherapy for OMG patients with unsatisfactory responses to conventional prednisone therapy.

METHODS

We retrospectively reviewed 57 OMG patients who had not achieved satisfactory improvement after prednisone therapy and thereby received IVMP or tacrolimus monotherapy for at least 6 months. Ocular symptoms were evaluated by the ocular-quantitative MG (QMG) score at each time point. A ≥ 2-point fall in ocular QMG score was defined as the cut-off point to indicate clinical improvement. Logistic regression analysis was performed to identify factors associated with the efficacy of IVMP at discharge. Adverse events were recorded.

RESULTS

Both IVMP and tacrolimus monotherapy demonstrated significant clinical efficacy, with no statistical differences observed at the study endpoint. The proportions of patients who reached the cut-off point for efficacy evaluation were higher in the IVMP group than in the tacrolimus group (1, 3, and 6 months: 51.7% (15/29) vs 12.0% (3/25), p = 0.002; 69.0% (20/29) vs 40.0% (10/25), p = 0.033; 69.0% (20/29) vs 46.4% (13/28), p = 0.085, respectively). Multivariate logistics analysis showed that high ocular QMG scores at baseline indicated favourable responses to IVMP treatment (OR = 1.781; 95% CI 1.066-2.975; p = 0.028). All the adverse events were transient and tolerable.

CONCLUSION

Our findings suggest that both IVMP and tacrolimus monotherapy hold promise as viable treatment options for OMG patients with unsatisfactory responses to oral prednisone. The study supports the safety and effectiveness of both therapies, with IVMP exhibiting faster improvement and favourable efficacy in patients with high ocular QMG scores.

[Metabolic characteristics of air microbial communities from sandstorm source areas of the Taklamakan desert]

The aim was to compare the characteristics and the differences in carbon catabolic diversity of air samples collected from five locations that around the edge of Taklamakan desert. The characteristics and the differences of carbon metabolic profiles were detected by using the BIOLOG micro plate (BIOLOG EcoPlate). The results showed that the average well color development (AWCD) curve of all five samples did not reach clear saturation during the incubation time (10 days), but differences among them were significant. The highest AWCD value appeared in Shache and the lowest was in Hotan, which were 0.24 and 0.1, respectively. Carbon utilization showed that all samples exhibited high level of polymer, carbohydrates, amino acids and carboxylic acid; however, amine and the phenol compound were the lowest. Principal components analysis (PCA) indicated that twenty categories of carbon significantly related to PC1 and twelve categories for PC2. Hierarchical cluster analysis showed these five areas could be divided into 2 clusters: (1) Hotan, Pishan, (2) Shache, Luntai, Ulugqat. Canonical correspondence analysis (CCA) showed that those community functional diversities were highly affected by some environmental factors, such as wind speed, altitude, humidity. Further investigation by correlation analysis revealed that the microbial communities using single carbon source were significantly affected by abiotic factors, such as the utilization of beta-methyl-D-glucoside, D-galacturonic acid and putrescine had significantly positive correlation (P < 0.05) with latitude; 2-hydroxy benzoic acid and alpha-D-lactose significantly related to wind speed (P < 0.05); and D-glucosaminic acid was positive with air pressure, but it negatively correlated with altitude (P < 0.05). In conclusion,the carbon sources provided by BIOLOG EcoPlate were utilized slowly by air microbial communities; and the characteristics of the air community carbon catabolic along the edge of the Taklamakan desert revealed regional feature, which may be affected by environmental factors.

[Congenital myopathy with type 1 fiber predominance in two children]

Non-progressive congenital myopathy is a group of muscle diseases occurring at birth or during teenage years. A number of new reports of congenital myopathy, such as homogeneous bodies myopathy, muscle quality control myopathy and type 1 fiber predominance have recently been reported, but they lack of sufficient quantity and constant clinico-pathologic manifestations. This paper reports two cases of congenital myopathy with type 1 fiber predominance confirmed by muscle biopsy. The clinical manifestations of the two children (a 4.5-year-old girl and an 11-year-old boy) included non-progressive symptoms of muscle weakness, skeletal deformities and other clinical features of congenital myopathy. The physical examinations showed a long face or figure and funnel chest or kyphosis/scoliosis, high palatal arch and wing-like shoulder. Serum levels of creatine kinase were normal but slightly elevated serum lactate dehydrogenase levels were noted in the two children. The skeletal muscle biopsy by ATPase staining showed that type 1 fibers accounted for more than 90% of the total number of muscle fibers. No other abnormal pathological changes, such as central cores, muscle tube and central nuclei, were found in the two children.

[SMAD4 gene polymorphisms and genetic susceptibility of coal work's pneumoconiosis]

OBJECTIVE

to explore whether 6 tagging single nucleotide polymorphisms (SNPs) within SMAD4 gene were involved in the genetic susceptibility of coal worker's pneumoconiosis (CWP) by case-control study.

METHODS

this study consisted of 438 CWP patients and 448 controls. All study subjects were Han Chinese, underground coal miners and recruited from coal mines of Xuzhou Mining Business Group Co Ltd. The 5 ml venous blood sample was obtained from all studied subjects and extracted genome DNA from the isolated leucocytes. Six SNPs were selected from the HapMap and detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).

RESULTS

the single SNP analyses showed that the genotype frequencies of SMAD4 (rs10502913) was significantly different from those in controls (P < 0.05). Multivariate logistic regression analyses revealed that SMAD4 (rs10502913) AA genotype was associated with increased risk of CWP (adjusted OR = 1.63, 95%CI = 1.00 - 2.69, P = 0.05) and this was evident among subgroups of those smoker (adjusted OR = 2.28, 95%CI = 1.09 ∼ 4.80, P < 0.05) and cases with stage I (adjusted OR = 2.42, 95%CI = 1.41 ∼ 4.14, P < 0.01). The SMAD4 (rs9304407) GG genotype was associated with an decreased risk of CWP (adjusted OR = 0.65, 95%CI = 0.43 ∼ 0.98, P < 0.05) and the further stratification analysis showed that the risk of CWP was decreased in nonsmoking groups.

CONCLUSIONS

our results suggest that individuals with the SMAD4 (rs10502913) AA genotype was associated with an increased risk of CWP. However, carriers of SMAD4 (rs9304407) GG genotype have a protective effect on the developing CWP.