Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis

Immunoglobulin; Myasthenia; ThymectomyInmunoglobulina; Miastenia; TimectomíaImmunoglobulina; Miastènia; TimectomiaBACKGROUND: Myasthenic crisis (MC) is a potentially life-threatening complication of myasthenia gravis. Its precipitating factors include surgical procedures, particularly thymectomy. The role of preoperative intravenous immunoglobulin (IVIg) in preventing MC in patients scheduled for thymectomy and other surgery with general anaesthesia is unknown. Our objective was to test the hypothesis that preoperative IVIg is effective in preventing myasthenic crisis in patients with myasthenia gravis scheduled for surgery under general anaesthesia, including thymectomy. METHODS: A prospective, randomized, double-blind, single-centre study was conducted over a 4-year period. The treatment group received IVIg, 0.4 g/kg/day preoperatively for 5 consecutive days, and the placebo group received saline solution under the same conditions. The two groups were age-matched, with similar functional status, and Myasthenia Gravis Foundation of America class. All patients had well-controlled myasthenia gravis with minimal manifestations before surgery. The primary outcome measured was MC. Intubation times, time in the recovery room, number of postoperative complications, and days of hospitalization were the secondary outcomes measured. RESULTS: A total of 47 patients were randomized, 25 to the IVIg group and 22 to placebo. There were 19 men and 28 women, with a mean age of 58.6 years, mean body mass index of 27.8 kg/m2, and mean acetylcholine receptor antibodies of 12.9 nmol/l. The mean forced vital capacity was 84.4%. The mean quantitative myasthenia gravis sum score was 6.3. Ten patients (five in each arm) had a history of MC. Thymectomy was performed in 16 patients. Only one patient in the placebo group presented with MC requiring non-invasive ventilation (but no reintubation) for 6 days. Neither differences between groups in the univariate analysis nor risk factors for MC in the multivariate analysis were found. CONCLUSIONS: Preoperative IVIg to prevent MC does not appear to be justified in well-controlled myasthenia gravis patients. This study provides class I evidence that preparation with IVIg to prevent MC is not necessary in well-controlled myasthenia gravis patients scheduled for surgery with general anaesthesia.This work was funded by a Fondo de Investigacion Sanitaria (FIS-FEDER) (grants PI16-01673 and PI19/00593) and an Interlaken Research Award Programme (2012-12094537

Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by a Fondo de Investigación Sanitaria (FIS-FEDER) (grants PI16-01673 and PI19/00593) and an Interlaken Research Award Programme (2012-12094537).Background: Myasthenic crisis (MC) is a potentially life-threatening complication of myasthenia gravis. Its precipitating factors include surgical procedures, particularly thymectomy. The role of preoperative intravenous immunoglobulin (IVIg) in preventing MC in patients scheduled for thymectomy and other surgery with general anaesthesia is unknown. Our objective was to test the hypothesis that preoperative IVIg is effective in preventing myasthenic crisis in patients with myasthenia gravis scheduled for surgery under general anaesthesia, including thymectomy. Methods: A prospective, randomized, double-blind, single-centre study was conducted over a 4-year period. The treatment group received IVIg, 0.4 g/kg/day preoperatively for 5 consecutive days, and the placebo group received saline solution under the same conditions. The two groups were age-matched, with similar functional status, and Myasthenia Gravis Foundation of America class. All patients had well-controlled myasthenia gravis with minimal manifestations before surgery. The primary outcome measured was MC. Intubation times, time in the recovery room, number of postoperative complications, and days of hospitalization were the secondary outcomes measured. Results: A total of 47 patients were randomized, 25 to the IVIg group and 22 to placebo. There were 19 men and 28 women, with a mean age of 58.6 years, mean body mass index of 27.8 kg/m, and mean acetylcholine receptor antibodies of 12.9 nmol/l. The mean forced vital capacity was 84.4%. The mean quantitative myasthenia gravis sum score was 6.3. Ten patients (five in each arm) had a history of MC. Thymectomy was performed in 16 patients. Only one patient in the placebo group presented with MC requiring non-invasive ventilation (but no reintubation) for 6 days. Neither differences between groups in the univariate analysis nor risk factors for MC in the multivariate analysis were found. Conclusions: Preoperative IVIg to prevent MC does not appear to be justified in well-controlled myasthenia gravis patients. This study provides class I evidence that preparation with IVIg to prevent MC is not necessary in well-controlled myasthenia gravis patients scheduled for surgery with general anaesthesia

Short term effects of ambient sulphur dioxide and particulate matter on mortality in 12 European cities : results from time series data from the APHEA project

Objectives: To carry out a prospective combined quantitative analysis of the associations between all cause mortality and ambient particulate matter and sulphur dioxide. Design: Analysis of time series data on daily number of deaths from all causes and concentrations of sulphur dioxide and particulate matter (measured as black smoke or particles smaller than 10 ìm in diameter (PM10)) and potential confounders. Setting: 12 European cities in the APHEA project (Air Pollution and Health: a European Approach). Main outcome measure: Relative risk of death. Results:In western European cities it was found that an increase of 50 ìg/m3 in sulphur dioxide or black smoke was associated with a 3% (95% confidence interval 2% to 4%) increase in daily mortality and the corresponding figure for PM10 was 2% (1% to 3%). In central eastern European cities the increase in mortality associated with a 50 ìg/m3 change in sulphur dioxide was 0.8% (−0.1% to 2.4%) and in black smoke 0.6% (0.1% to 1.1%). Cumulative effects of prolonged (two to four days) exposure to air pollutants resulted in estimates comparable with the one day effects. The effects of both pollutants were stronger during the summer and were mutually independent. Conclusions:The internal consistency of the results in western European cities with wide differences in climate and environmental conditions suggest that these associations may be causal. The long term health impact of these effects is uncertain, but today's relatively low levels of sulphur dioxide and particles still have detectable short term effects on health and further reductions in air pollution are advisable

Quantitative trait loci for head-bug resistance in sorghum

QTLs were mapped in F2 progeny derived from a cross between the head-bug resistant sorghum cultivar Malisor 84-7 and susceptible S 34. The phenotypic evaluation was conducted in Mali. The mapped population consisted of 217 F2 plants, with 345 homologous and heterologous RFLP probes and 49 microsatellite markers tested. Eighty-one RFLP markers revealed polymorphism between the two parents, and 14 microsatellite markers gave usable amplification products. A genetic map including 92 loci distributed over 13 linkage groups, and covering a total distance of 1160 cM was built. Three significant and seven putative QTLs were detected and placed on the ma

Quantitative trait loci for head-bug resistance in sorghum

QTLs were mapped in F2 progeny derived from a cross between the head-bug resistant sorghum cultivar Malisor 84-7 and susceptible S 34. The phenotypic evaluation was conducted in Mali. The mapped population consisted of 217 F2 plants, with 345 homologous and heterologous RFLP probes and 49 microsatellite markers tested. Eighty-one RFLP markers revealed polymorphism between the two parents, and 14 microsatellite markers gave usable amplification products. A genetic map including 92 loci distributed over 13 linkage groups, and covering a total distance of 1160 cM was built. Three significant and seven putative QTLs were detected and placed on the ma

Quantitative trait loci for head-bug resistance in sorghum

QTLs were mapped in F2 progeny derived from a cross between the head-bug resistant sorghum cultivar Malisor 84-7 and susceptible S 34. The phenotypic evaluation was conducted in Mali. The mapped population consisted of 217 F2 plants, with 345 homologous and heterologous RFLP probes and 49 microsatellite markers tested. Eighty-one RFLP markers revealed polymorphism between the two parents, and 14 microsatellite markers gave usable amplification products. A genetic map including 92 loci distributed over 13 linkage groups, and covering a total distance of 1160 cM was built. Three significant and seven putative QTLs were detected and placed on the map

Quantitative trait loci for head-bug resistance in sorghum

QTLs were mapped in F2 progeny derived from a cross between the head-bug resistant sorghum cultivar Malisor 84-7 and susceptible S 34. The phenotypic evaluation was conducted in Mali. The mapped population consisted of 217 F2 plants, with 345 homologous and heterologous RFLP probes and 49 microsatellite markers tested. Eighty-one RFLP markers revealed polymorphism between the two parents, and 14 microsatellite markers gave usable amplification products. A genetic map including 92 loci distributed over 13 linkage groups, and covering a total distance of 1160 cM was built. Three significant and seven putative QTLs were detected and placed on the map

Quantitative trait loci for head bug resistance in sorghum

An experiment was conducted during the 1997/99 cropping seasons, in Mali, France, to study the inheritance for resistance to head bug (Eurystylus oldi) of sorghum progenies using quantitative trait loci (QTL) maps. Cultivars Malisor 84-7 (resistant) and S 34 (susceptible) were used as parents. To build the sorghum genetic map, 345 restriction fragment length polymorphism (RFLP) probes in combination with 6 restriction enzymes (BamHI, DraI, EcoRI, EcoRV, HindIII and SstI) were screened for their ability to reveal polymorphism. Thousand kernel weight (TKW) and germination rate at grain maturity were measured. Head bug damage was assessed visually on a 1 to 9 scale on the infested part of the panicle (NOTF2). Among the 345 RFLP probes, 81 revealed polymorphism between the parents. Additionally, 14 microsatellite markers gave amplification products. The genetic map based on Malisor 84-7 × S 34 includes 13 linkage groups (LGs) covering a total distance of 1160 cM. Three significant and 7 putative QTLs were detected. One QTL for TKW reduction that accounted for 13% of the phenotypic variation was detected on LG C2. For this QTL, resistance is conditioned by the Malisor 84-7 allele and is dominant. Two QTLs were detected on LG D and LG E for visual damage score under natural head bug infestation, explaining 16 and 26% of the phenotypic variation for this trait, respectively. Resistance from the QTL on LG D is conditioned by the S 34 allele, whereas resistance from the QTL on LG E is provided by the Malisor 84-7 allele. In both cases, resistance is recessive. No significant QTLs were detected for NOTF2 and germination rate, but co-localization of 2 putative QTLs for these traits was observed on LG G2, and in both cases, resistance is conditioned by the S 34 allele

In silico mapping of important genes and markers available in the public domain for efficient sorghum breeding

Crop genome sequencing projects generate massive amounts of genomic sequence information, and the utilization of this information in applied crop improvement programs has been augmented by the availability of sophisticated bioinformatics tools. Here, we present the possible direct utilization of sequence data from a sorghum genome sequencing project in applied crop breeding programs. Based on sequence homology, we aligned all publicly available simple sequence repeat markers on a sequencebased physical map for sorghum. Linking this physical map with already existing linkage map(s) provides better options for applied molecular breeding programs. When a new set of markers is made available, the new markers can be first aligned on a sequence-based physical map, and those located near the quantitative trait locus (QTL) can be identified from this map, thereby reducing the number of markers to be tested in order to identify polymorphic flanking markers for the QTL for any given donor 9 recurrent parent combination. Polymorphic markers that are expected (on the basis of their position on the sequence-based physical map) to be closely linked to the target can be used for foreground selection in marker-assisted breeding. This map facilitates the identification of a set of markers representing the entire genome, which would provide better resolution in diversity analyses and further linkage disequilibrium mapping. Filling the gaps in existing linkage maps and fine mapping can be achieved more efficiently by targeting the specific genomic regions of interest. It also opens up new exciting opportunities for comparative mapping and for the development of new genomic resources in related crops, both of which are lagging behind in the current genomic revolution. This paper also presents a number of examples of potential applications of sequence-based physical map for sorghum