Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Localization in Wireless Sensor Network Using MDS

In this paper, determining the localization of nodes in a Wireless Sensor Network is a very important task, which involves collaboration between sensor nodes. Localization is a fundamental service since it is relevant to many applications and to the network main functions, such as: routing, communication, cluster creation, network coverage, etc. Collaboration is essential to self-localization, so that localization can be accomplished by the nodes themselves, without any human intervention. In this paper, we first analyze the key aspects that have to be considered when designing or choosing a solution for the localization problem. Then, we present MDS localization algorithm. With this analysis of results simulated. We identified the results in topologies by taking different cases and we have addresses shortcomings, which are caused by anisotropic network topology and complex terrain, of existing sensor positioning methods. Then, we explore the idea of using multidimensional scaling technique to compute relative positions of sensors in a wireless sensor network. A distributed sensor positioning method based on multidimensional scaling is proposed to get the accurate position estimation and reduce error cumulation. Comparing with other positioning methods, with very few anchors, our approach can accurately estimate the sensors’ positions in network with anisotropic topology and complex terrain as well as eliminate measurement error cumulation. We also propose an on demand position estimation method based on multidimensional scaling for one or several adjacent sensors positioning. Experimental results indicate that our distributed method for sensor position estimation is very effective and efficient

Localization in Wireless Sensor Network Using MDS

Abstract-In this paper, determining the localization of nodes in a Wireless Sensor Network is a very important task, which involves collaboration between sensor nodes. Localization is a fundamental service since it is relevant to many applications and to the network main functions, such as: routing, communication, cluster creation, network coverage, etc. Collaboration is essential to self-localization, so that localization can be accomplished by the nodes themselves, without any human intervention. In this paper, we first analyze the key aspects that have to be considered when designing or choosing a solution for the localization problem. Then, we present MDS localization algorithm. With this analysis of results simulated. We identified the results in topologies by taking different cases and we have addresses shortcomings, which are caused by anisotropic network topology and complex terrain, of existing sensor positioning methods. Then, we explore the idea of using multidimensional scaling technique to compute relative positions of sensors in a wireless sensor network. A distributed sensor positioning method based on multidimensional scaling is proposed to get the accurate position estimation and reduce error cumulation. Comparing with other positioning methods, with very few anchors, our approach can accurately estimate the sensors' positions in network with anisotropic topology and complex terrain as well as eliminate measurement error cumulation. We also propose an on demand position estimation method based on multidimensional scaling for one or several adjacent sensors positioning. Experimental results indicate that our distributed method for sensor position estimation is very effective and efficient

Argon Beam Coagulation as an Adjuvant for Extended Curettage for Giant Cell Tumors of the Bone: A Study of 50 Cases

Abstract Objective Extended curettage with adjuvants of giant cell tumors of bone is associated with a lower rate of recurrence of the tumor while preserving the adjacent joint. The present study was conducted to estimate the recurrence rate and functional outcome after using argon beam as an adjuvant for extended curettage. Methods We selected 50 patients with giant cell tumors, meeting all the inclusion criteria, who underwent extended curettage using high speed burr and argon beam photocoagulation between July 2016 to January 2019. On their follow-up visit, they were assessed for any complaints of pain and signs like tenderness, locally raised temperature, and decreased range of motion of the adjacent joint. Radiologically, the patients were assessed for any increased lucency around the cement mantle and uptake of the subarticular graft. Musculoskeletal Tumor Society Score (MSTS) was administered to the patients, and range of motion of the adjacent joint was compared with the contralateral joint. Results Recurrence was found in 4 patients, that is, an 8% recurrence rate. Twenty-six out of 28 patients with a tumor in the lower limb had a grade-5 weight bearing status 6 months from the surgery, and their range of motion was comparable to contralateral healthy joint with an average MSTS score of 27 (18–30). Conclusion Extended curettage of giant cell tumors using argon beam coagulation is associated with low recurrence rates of the tumor and is an effective modality in the treatment of these tumors besides having a functional outcome comparable to the healthy limb

Medial thigh flap: An eminent method of reconstruction of scrotal defect following fournier′s gangrene

Background and Objectives: Fournier′s gangrene is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal, and perineal regions. It is characterized by progressive spread of necrosis in the skin and subcutaneous tissue which results in defects of various sizes in perineal region. Various techniques have been described for the reconstruction of these defects such as split thickness skin grafts, muscle flaps (e.g., Gracilis flap), and fasciocutaneous flaps (e.g., pudendal flap), perineal flap, anterolateral thigh flap, deep inferior epigastric perforator flap, and anteromedial thigh flap. We intend to study the results of medial thigh flap procedure in patients with scrotal defect following Fournier′s gangrene. Materials and Methods: Medial thigh flap was performed in eight patients with Fournier′s gangrene. The patients were selected consecutively from December 2016 to December 2017. All patients were followed for 3-6 months postoperatively. Results: All flaps survived well. However, in two cases, there was partial distal necrosis. Both cases were managed conservatively. In all cases, donor site healed well except for one case in which infection of the donor site suture line occurred. It was managed by frequent dressing. Interpretation and Conclusions: The medial thigh flap is a reliable fasciocutaneous flap which can be done in reasonably short operative time to cover difficult defects with excellent results

An In Vitro and In Vivo Study of the Efficacy and Toxicity of Plant-Extract-Derived Silver Nanoparticles

Silver nanoparticles (AgNPs) display unique plasmonic and antimicrobial properties, enabling them to be helpful in various industrial and consumer products. However, previous studies showed that the commercially acquired silver nanoparticles exhibit toxicity even in small doses. Hence, it was imperative to determine suitable synthesis techniques that are the most economical and least toxic to the environment and biological entities. Silver nanoparticles were synthesized using plant extracts and their physico-chemical properties were studied. A time-dependent in vitro study using HEK-293 cells and a dose-dependent in vivo study using a Drosophila model helped us to determine the correct synthesis routes. Through biological analyses, we found that silver nanoparticles’ cytotoxicity and wound-healing capacity depended on size, shape, and colloidal stability. Interestingly, we observed that out of all the synthesized AgNPs, the ones derived from the turmeric extract displayed excellent wound-healing capacity in the in vitro study. Furthermore, the same NPs exhibited the least toxic effects in an in vivo study of ingestion of these NPs enriched food in Drosophila, which showed no climbing disability in flies, even at a very high dose (250 mg/L) for 10 days. We propose that stabilizing agents played a superior role in establishing the bio-interaction of nanoparticles. Our study reported here verified that turmeric-extract-derived AgNPs displayed biocompatibility while exhibiting the least cytotoxicity