Clinical Profile and Quality of Life in Myasthenia Gravis Using MGQOL15 R(Hindi): An Indian Perspective.

Background: Myasthenia Gravis (MG) is a chronic fluctuating illness, due to the dysfunction of neuromuscular junction which is autoimmune in nature. The disease severely affects the Quality Of Life (QOL). Objective: The primary objective of our study was to assess the QOL in patients with MG using Short Form 36 (SF 36) and MGQOL 15 R (Hindi translated). The secondary objective was to assess the correlation of age, sex, illness duration, clinical characteristics, severity, and treatment with the QOL in MG patients. Methodology: A cross sectional study of 55 MG patients was done to analyse and evaluate the clinical status using Hybrid Myasthenia Gravis Foundation of America (HMGFA), Myasthenia gravis composite score (MGCS) and The Myasthenia Gravis Activities of Daily Living (MG - ADL). QOL was assessed by SF 36 and Hindi version of Myasthenia Gravis Quality of Life 15 - Revised (MG-QOL15R) score. Results: 78.2% patients had generalized MG. The mean MGC and MG-ADL scores were 5.27 and 3.29 (95% CI: 2.24 -4.34) respectively. The mean MGQOL15R score was 6.52 ± 7.7 and the score correlated with the symptoms. The SF 36 scores were the best and the worst in the bodily pain (93.72 ± 13.52) and general health subset (61.81 ± 39.64) respectively. Except for steroid dose, there was no significant correlation between SF36 and other factors. Conclusion: QOL in MG was found to be affected due to the disease. The MGQOL 15 R scores correlated with the clinical features, remission or active status, steroid use and thymectomy. No Significant association was observed between MG QOL scores and various lab parameters and repetitive nerve stimulation (RNS) test results. Higher dose of steroid was associated with poor QOL, while thymectomy was associated with better QOL scores. MGQOL15R (Hindi) is a quick and simple tool to assess the QOL in MG patients.

Mg-Doped PLA Composite as a Potential Material for Tissue Engineering-Synthesis, Characterization, and Additive Manufacturing.

Magnesium (Mg)/Polylactic acid (PLA) composites are promising materials for bone regeneration and tissue engineering applications. PLA is a biodegradable and biocompatible polymer that can be easily processed into various shapes and structures, such as scaffolds, films, and fibers, but has low biodegradability. Mg is a biocompatible metal that has been proven to have good biodegradability and osteoconductivity, which makes it suitable for bone tissue engineering. In this study, we prepared and characterized a Mg/PLA composite as a potential material for direct ink writing (DIW) in 3D printing. The results showed that the addition of Mg has a significant impact on PLA's thermal and structural properties and has also significantly increased the degradation of PLA. XRD was used to determine the degree of crystallinity in the PLA/Mg composite, which provides insight into its thermal stability and degradation behavior. The crystallization temperature of PLA increased from 168 to 172 °C for a 15 wt% Mg incorporation, and the melting temperature reduced from 333 °C to 285 °C. The surface morphology and composition of these films were analyzed with SEM. The films with 5 wt% of Mg particles displayed the best-ordered honeycomb structure in their film form. Such structures are considered to affect the mechanical, biological and heat/mass transfer properties of the Mg/PLA composites and products. Finally, the composite ink was used as a feed for direct ink writing in 3D printing, and the preliminary 3D printing experiments were successful in resulting in dimensionally and structurally integral scaffold samples. The shape fidelity was not very good, and some research is needed to improve the rheological properties of the ink for DIW 3D printing.

Additive manufacturing of PLA-Mg composite scaffolds for hard tissue engineering applications.

Polylactic acid (PLA) is considered as a great option to be employed as 3D porous scaffold in hard tissue engineering applications owing to its excellent biocompatibility and processability. However, relatively weak mechanical properties and inappropriate biodegradability limit its extensive usage. In order to overcome the mentioned challenges, micrometric magnesium particles were incorporated into the PLA matrix by the fused deposition modeling (FDM) technique. The effects of various Mg contents (i.e., 2, 4, 6, 8 and 10 wt%) on the structural, thermal, rheological, mechanical, wettability, degradability characteristics and cellular behavior of the 3D porous PLA-Mg composite scaffolds were examined. The developed PLA-Mg composites exhibit an interconnected porous structure with a mostly uniform distribution of Mg particles in the PLA matrix. It was found that incorporation of Mg particles into the PLA matrix enhances the mechanical, physical, chemical and biological characteristics of PLA. The cell studies demonstrate that the PLA-6Mg composite scaffold provides the best cellular response in terms of cell atachment and viability. The obtained results in this investigation greatly suggest that the 3D-printed PLA-Mg composite scaffold is a promising candidate for hard tissue engineering applications.

Microstructure and Properties of a Graphene Reinforced Cu-Cr-Mg Composite.

To improve the graphene/copper interfacial bonding and the strength of the copper matrix, Cu-Cr-Mg alloy powder and graphene nanosheets (GNPs) have been used as raw materials in the preparation of a layered graphene/Cu-Cr-Mg composite through high-energy ball-milling and fast hot-pressing sintering. The microstructure of the composite after sintering, as well as the effect of graphene on the mechanical properties and conductivity of the composite, are also studied. The results show that the tensile strength of the composite material reached a value of 349 MPa, which is 46% higher than that of the copper matrix, and the reinforcement efficiency of graphene is as large as 136. Furthermore, the electrical conductivity of the composite material was 81.6% IACS, which is only 0.90% IACS lower than that of the copper matrix. The Cr and Mg elements are found to diffuse to the interface of the graphene/copper composite during sintering, and finely dispersed chromium carbide particles are found to significantly improve the interfacial bonding strength of the composite. Thus, graphene could effectively improve the mechanical properties of the composite while maintaining a high electrical conductivity.

IL-6 levels are associated with clinical status in patients with Myasthenia Gravis / Os níveis de IL-6 estão associados com o status clínico de pacientes com Miastenia Gravis

BACKGROUND: Myasthenia gravis (MG) is an autoimmune disease marked by fluctuating course of muscle weakness. OBJECTIVES: The current study was designed to evaluate plasma levels of cytokines (IL-2, IL-4, IL-6, IL-10, TNF, IFN-γ, and IL17A) in patients with MG and controls and to investigate whether cytokines levels are associated with clinical parameters. This study was conducted at the Neuromuscular Diseases Outpatient Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Brazil. METHODS: Peripheral blood was drawn, and plasma levels of cytokines were measured by cytometric bead array (CBA) in 80 treated patients with MG and 50 controls. The MG Composite (MGC) was used to evaluate muscle weakness and severity of typical motor symptoms of MG. RESULTS: Patients with MG undergoing treatment exhibit lower levels of all evaluated cytokines compared to controls. There was a negative correlation between IL-6 levels and the MG Composite score, indicating that higher levels of IL-6 were associated with better control of the disease. CONCLUSION: This exploratory study suggests that IL-6 is associated with MG clinical status, as assessed by the MGC.

INTRODUÇÃO: A Miastenia Gravis (MG) é uma doença autoimune caracterizada por fraqueza muscular flutuante. OBJETIVOS: avaliar os níveis plasmáticos de citocinas (IL-2, IL-4, IL-6, IL-10, TNF, IFN-γ, e IL-17A) em pacientes com MG e controles e investigar se essas citocinas estão associadas com parâmetros clínicos. Este estudo foi conduzido no ambulatório de doenças neuromusculares do Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Brasil. MÉTODOS: Foi coletado sangue periféricos e os níveis plasmáticos das citocinas foram medidos por citometria em 80 pacientes com MG tratados e em 50 controles. O MG composite (MGC) foi utilizado para avaliar a fraqueza muscular e a gravidade dos sintomas motores típicos da MG. RESULTADOS: Os pacientes com MG em tratamento apresentaram menores níveis de todas as citocinas avaliadas comparados ao controle. Houve uma correlação negativa entre os níveis de IL-6 e o MGC, indicando que altos níveis de IL-6 estão associados com melhor controle da doença. CONCLUSÃO: este estudo exploratório sugere que a IL-6 está associada com o status clínico da MG, quando avaliado pelo MGC.

Synergistic Strengthening of Mechanical Properties and Electromagnetic Interference Shielding Performance of Carbon Nanotubes (CNTs) Reinforced Magnesium Matrix Composites by CNTs Induced Laminated Structure.

In this study, we reported a laminated CNTs/Mg composite fabricated by spray-deposition and subsequent hot-press sintering, which realized simultaneous enhancement effects on strength and electromagnetic interference (EMI) shielding effectiveness (SE) by the introduced CNTs and CNT induced laminated 'Mg-CNT-Mg' structure. It was found that the CNTs/Mg composite with 0.5 wt.% CNTs not only exhibited excellent strength-toughness combination but also achieved a high EMI SE of 58 dB. The CNTs increased the strength of the composites mainly by the thermal expansion mismatch strengthening and blocking dislocation movements. As for toughness enhancement, CNTs induced laminated structure redistributes the local strain effectively and alleviates the strain localization during the deformation process. Moreover, it could also hinder the crack propagation and cause crack deflection, which resulted in an increment of the required energy for the failure of CNTs/Mg composites. Surprisingly, because of the laminated structure induced by introducing CNTs, the composite also exhibited an outperforming EMI SE in the X band (8.2-12.4 GHz). The strong interactions between the laminated 'Mg-CNT-Mg' structure and the incident electromagnetic waves are responsible for the increased absorption of the electromagnetic radiation. The lightweight CNTs/Mg composite with outstanding mechanical properties and simultaneously increased EMI performance could be employed as shell materials for electronic packaging components or electromagnetic absorbers.

Stimulation of in vitro and in vivo osteogenesis by Ti-Mg alloys with the sustained-release function of magnesium ions.

Magnesium (Mg) is well-known for its bioactivity and degradability. However, due to its low evaporation temperature and limited solubility in titanium (Ti), the fabrication of Ti-Mg alloys remains a huge challenge. In this study, Ti-xMg (x = 0.312, 0.625, 1.25 and 2.5 wt.%) alloys were fabricated by the combination of mechanical alloying (MA) and spark plasma sintering (SPS). Mg mainly existed as a solid solute element in the Ti matrix, while it also existed as second-phase particles due to its precipitation and dispersion during the SPS process. At a low content of 0.625 wt.%, Mg could increase the mechanical strength of Ti by the solid solution strengthening. However, it was detrimental to material mechanical properties when the Mg content increased to 1.25 wt.%. Being immersed in phosphate buffered solution (PBS), Ti-Mg alloys exhibited a burst Mg2+ release behavior within the first day, and then the rates of Mg2+ release gradually decreased within the following 27 days. The results suggested that the cell viability was dependent on the content of Mg in the Ti-Mg alloys. The high Mg content (2.5 wt.%) in the Ti-Mg alloys could lead to significant cytotoxicity. However, appropriate Mg content (0.312∼0.625 wt.%) could promote cell attachment, proliferation and differentiation. The Ti-0.625Mg alloy exhibited the best in vitro biological performance among all groups. In vivo results obtained by implanting the Ti-0.625Mg alloy in the femurs of rats further revealed its enhanced regenerative potential and osteointegration compared to pure Ti implants.

Advanced phosphate and nitrogen removal in water by La-Mg composite.

A novel La-Mg composite was prepared for the removal of low concentration phosphate and ammonium nitrogen to alleviate the eutrophication problem. The composition and morphology of La-Mg composite was characterized; Its surface was composed of La, Mg, C, and O elements, with a specific surface area of 21.92 m2/g. La-Mg composite presented excellent removal of phosphate (100%) and nitrogen (96.8%), and the adsorption capacity reached 49.72 mg-P/g and 159.30 mg-N/g for separated adsorption. The composite also had a wide pH usability range (3-11 for P and 3-9 for N) and the adsorption process was almost not disturbed by coexisting ions. After adsorption, it could be regenerated by Na2CO3 and reused effectively. For actual water treatment, a very low residual P of 0.01 mg/L and N of 0.05 mg/L were achieved. Furthermore, Mechanism analysis showed that P adsorption involved ligand exchange and electrostatic attraction. The potential mechanisms of N adsorption involved electrostatic attraction and ion exchange. The results showed that the La-Mg composite is a novel and efficient adsorbent for actual water treatment to achieve ultra-low nutrients concentration.

Mg Doped Li-LiB Alloy with In Situ Formed Lithiophilic LiB Skeleton for Lithium Metal Batteries.

High energy density lithium metal batteries (LMBs) are promising next-generation energy storage devices. However, the uncontrollable dendrite growth and huge volume change limit their practical applications. Here, a new Mg doped Li-LiB alloy with in situ formed lithiophilic 3D LiB skeleton (hereinafter called Li-B-Mg composite) is presented to suppress Li dendrite and mitigate volume change. The LiB skeleton exhibits superior lithiophilic and conductive characteristics, which contributes to the reduction of the local current density and homogenization of incoming Li+ flux. With the introduction of Mg, the composite achieves an ultralong lithium deposition/dissolution lifespan (500 h, at 0.5 mA cm-2) without short circuit in the symmetrical battery. In addition, the electrochemical performance is superior in full batteries assembled with LiCoO2 cathode and the manufactured composite. The currently proposed 3D Li-B-Mg composite anode may significantly propel the advancement of LMB technology from laboratory research to industrial commercialization.

Fabrication of Ti + Mg composites by three-dimensional printing of porous Ti and subsequent pressureless infiltration of biodegradable Mg.

A semi-degradable Ti + Mg composite with superior compression and cytotoxicity properties have been successfully fabricated using ink jet 3D printing followed by capillary mediated pressureless infiltration technique targeting orthopaedic implant applications. The composite exhibited low modulus (~5.2 GPa) and high ultimate compressive strength (~418 MPa) properties matching that of the human cortical bone. Ti + Mg composites with stronger 3D interconnected open-porous Ti networks are possible to be fabricated via 3D printing. Corrosion rate of samples measured through immersion testing using 0.9%NaCl solution at 37 °C indicate almost negligible corrosion rate for porous Ti (~1.14 µm/year) and <1 mm/year for Ti + Mg composites for 5 days of immersion, respectively. The composite significantly increased the SAOS-2 osteoblastic bone cell proliferation rate when compared to the 3D printed porous Ti samples and the increase is attributed to the exogenous Mg2+ ions originating from the Ti + Mg samples. The cell viability results indicated absent to mild cytotoxicity. An attempt is made to discuss the key considerations for net-shape fabrication of Ti + Mg implants using ink jet 3D printing followed by infiltration approach.

The effects of ß-TCP on mechanical properties, corrosion behavior and biocompatibility of ß-TCP/Zn-Mg composites.

Zinc has attracted increasing attention in the field of degradable implant materials due to its suitable degradation rate. To further improve the mechanical properties and biocompatibility of zinc, Zn-1Mg-nvol%ß-TCP (n = 0, 1, 3, 5) composites were fabricated for biomedical application by the mechanical stirring combined with ultrasonic assisted casting and hot extrusion technology. The microstructure, mechanical properties and corrosion behavior of these composites were systemically investigated and the composite with the best comprehensive performance were selected for biocompatibility evaluation including L-929 cells cytotoxicity test and SD rat model experiment. Tensile test revealed that Zn-1Mg-1vol%ß-TCP composite possessed optimal mechanical properties. The yield strength (YS), ultimate tensile strength (UTS), elongation (σ) and elastic modulus (E) of the as-extruded Zn-1Mg-1vol%ß-TCP composite are 250.8 MPa, 330.5 MPa, 11.7% and 125.4 GPa respectively. The immersion tests showed that the corrosion resistance of the composite is slightly decreased with the increase of ß-TCP content. In addition, the addition of ß-TCP makes the cytocompatibility of the composites better than that of the Zn-1Mg alloy matrix. Various blood biochemical parameters in rat serum samples after implantation showed Zn-1Mg alloy and Zn-1Mg-ß-TCP composites has not significant tissue inflammation and showed good biocompatibility.

Magnesium-zinc scaffold loaded with tetracycline for tissue engineering application: In vitro cell biology and antibacterial activity assessment.

Recently, porous magnesium and its alloys are receiving great consideration as biocompatible and biodegradable scaffolds for bone tissue engineering application. However, they presented poor antibacterial performance and corrosion resistance which limited their clinical applications. In this study, Mg-Zn (MZ) scaffold containing different concentrations of tetracycline (MZ-xTC, x = 1, 5 and 10%) were fabricated by space holder technique to meet the desirable antibacterial activity and corrosion resistance properties. The MZ-TC contains total porosity of 63-65% with pore sizes in the range of 600-800 µm in order to accommodate bone cells. The MZ scaffold presented higher compressive strength and corrosion resistance compared to pure Mg scaffold. However, tetracycline incorporation has less significant effect on the mechanical and corrosion properties of the scaffolds. Moreover, MZ-xTC scaffolds drug release profiles show an initial immediate release which is followed by more stable release patterns. The bioactivity test reveals that the MZ-xTC scaffolds are capable of developing the formation of HA layers in simulated body fluid (SBF). Next, Staphylococcus aureus and Escherichia coli bacteria were utilized to assess the antimicrobial activity of the MZ-xTC scaffolds. The findings indicate that those scaffolds that incorporate a high level concentration of tetracycline are tougher against bacterial organization than MZ scaffolds. However, the MTT assay demonstrates that the MZ scaffolds containing 1 to 5% tetracycline are more effective to sustain cell viability, whereas MZ-10TC shows some toxicity. The alkaline phosphatase (ALP) activity of the MZ-(1-5)TC was considerably higher than that of MZ-10TC on the 3 and 7 days, implying higher osteoblastic differentiation. All the findings suggest that the MZ-xTC scaffolds containing 1 to 5% tetracycline is a promising candidate for bone tissue healing due to excellent antibacterial activity and biocompatibility.

Muscle weakness and functional disability in patients with myasthenia gravis.

INTRODUCTION: Muscle weakness and functional disability have not been evaluated in a population-based study of patients with myasthenia gravis (MG). METHODS: All patients with MG in a well-defined catchment area were identified in the Danish National Patient Registry. Of the 175 eligible patients, 90 participated and were studied using MG-specific scales, isometric dynamometry, and functional tests. Fifty age- and sex-matched subjects served as controls. RESULTS: Muscle strength was reduced by 13%, 21%, and 12% for shoulder abduction, knee extension, and ankle extension, respectively (P < 0.05). Chair stand and 400-meter walking were impaired by 24% and 23%, respectively (P < 0.05). Muscle strength and functional performances were related to MG-specific scales. DISCUSSION: MG patients have moderately reduced isometric muscle strength and impaired physical performance. Muscle weakness and functional tests relate closely to MG-specific scales, suggesting that dynamometry and functional tests can be used to monitor MG patients and as efficacy parameters in clinical trials. Muscle Nerve 59:218-223, 2019.

Physician- and self-assessed myasthenia gravis activities of daily living score.

INTRODUCTION: The Myasthenia Gravis-Activities of Daily Living (MG-ADL) profile scale is a simple-to-use instrument. We aimed to validate this scale in the Korean language and compare physician- and self-assessed MG-ADL scores (pMG-ADL-K and sMG-ADL-K). METHODS: pMG-ADL-K and sMG-ADL-K and MG Composite (MGC) scores were obtained from patients. The correlation between pMG-ADL-K and MGC and the relationship between the pMG-ADL-K and sMG-ADL-K were assessed using the Cronbach α and the Spearman coefficient. By intraclass correlation coefficient (ICC), the reliability of each sub-item of pMG-ADL-K and sMG-ADL-K was evaluated. RESULTS: We included data from 40 patients. The pMG-ADL-K score showed a strong correlation with the MGC score (rho = 0.80, P < 0.01). The Cronbach α was 0.98 between pMG-ADL-K and sMG-ADL-K, and sub-items showed good consistency (ICC 0.684-0.985, P < 0.001). DISCUSSION: The MG-ADL-K is a valid tool and the sMG-ADL-K shows excellent correlation with pMG-ADL-K. Both the pMG-ADL-K and sMG-ADL-K can be used to measure MG severity. Muscle Nerve 57: 419-422, 2018.

Ultrafine-grained porous titanium and porous titanium/magnesium composites fabricated by space holder-enabled severe plastic deformation.

Compaction of powders by equal channel angular pressing (ECAP) using a novel space holder method was employed to fabricate metallic scaffolds with tuneable porosity. Porous Ti and Ti/Mg composites with 60% and 50% percolating porosity were fabricated using powder blends with two kinds of sacrificial space holders. The high compressive strength and good ductility of porous Ti and porous Ti/Mg obtained in this way are believed to be associated with the ultrafine grain structure of the pore walls. To understand this, a detailed electron microscopy investigation was employed to analyse the interface between Ti/Ti and Ti/Mg particles, the grain structures in Ti particles and the topography of pore surfaces. It was found that using the proposed compaction method, high quality bonding between particles was obtained. Comparing with other powder metallurgy methods to fabricate Ti with an open porous structure, where thermal energy supplied by a laser beam or high temperature sintering is essential, the ECAP process conducted at a relatively low temperature of 400°C was shown to produce unique properties.

Porous titanium with entangled structure filled with biodegradable magnesium for potential biomedical applications.

A kind of Ti-Mg composite was prepared by infiltrating the biodegradable magnesium melt into the porous titanium (p-Ti) with entangled structure. The microstructure and the mechanical properties of the composites were investigated by using the metallographic technique and the compressive testing method. The novelty in the elastic property was discussed based on the experimental results and the referenced data. It was found that as the Ti volume fractions increased from 37.1% to 53.6%, the compressive plateau stress of the p-Ti/Mg composites increased from 175 MPa to 246 MPa, but the Young's modulus decreased from 47 GPa to 22 GPa. When the magnesium matrix was strengthened by adding 0.5 wt.% Zr, the plateau stress and the Young's modulus of the p-Ti/Mg(Zr) composites were reasonably enhanced. The stiffness of the p-Ti/Mg composites is comparable to that of the cortical bone, suggesting their considerable potentials for the load-bearing orthopedic applications.

Does change in acetylcholine receptor antibody level correlate with clinical change in myasthenia gravis?

INTRODUCTION: The objective of this study is to determine if change in acetylcholine receptor antibody (AChR-ab) levels reflects change in clinical severity in patients with myasthenia gravis (MG). METHODS: We reviewed results from a prospective trial in MG and from all 85 patients in an MG Clinic who had AChR-ab determinations performed at least twice by the same commercial laboratory. RESULTS: Change in AChR-ab levels correlated only weakly with change in clinical severity. AChR-ab levels fell in 92% of patients who improved and in 63% who did not. A fall in AChR-ab level had a positive predictive value for clinical improvement of 83% and a negative predictive value of only 59%. CONCLUSIONS: AChR-ab levels fell in almost all patients who improved, but also in most patients who did not. Thus, we do not recommend commercially available AChR-ab levels as a biomarker of improvement in MG. However, antibody levels might be useful as a marker for inadequate immunotherapy.