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

Mediating Effect of Communication Competence in the Relationship between Compassion and Patient-Centered Care in Clinical Nurses in South Korea

This study investigates the mediating effect of communication competence in the relationship between compassion and patient-centered care (PCC) in clinical nurses. We used a descriptive research approach, and our sample comprised nurses (n = 204) with more than one year of experience in patient nursing in a general hospital in South Korea. The data were collected between December 2020 and June 2021 and analyzed using descriptive statistics, t-tests, one-way analysis of variance, Pearson’s correlation coefficient analysis, and hierarchical multiple regression using SPSS 24.0. The Sobel test and PROCESS macro in SPSS were applied to verify the mediating effect. The mean scores for communication competence, compassion, and PCC were 3.67 ± 0.42, 64.04 ± 7.71, and 3.75 ± 0.46, respectively. Communication competence was found to partially mediate the relationship between compassion and PCC (z = 6.977, p < 0.001), and its explanatory power was 63.9%. To improve nurses’ PCC, developing a step-by-step and differentiated PCC improvement program that includes communication competence and compassion is necessary

Synthesis and Characterization of a Polyurethane Phase Separated to Nano Size in an Epoxy Polymer

Epoxy resins are widely applicable in the aircraft, automobile, coating, and adhesive industries because of their good chemical resistance and excellent mechanical and thermal properties. However, upon external impact, the crack propagation of epoxy polymers weakens the overall impact resistance of these materials. Therefore, many impact modifiers have been developed to reduce the brittleness of epoxy polymers. Polyurethanes, as impact modifiers, can improve the toughness of polymers. Although it is well known that polyurethanes (PUs) are phase-separated in the polymer matrix after curing, connecting PUs to the polymer matrix for enhancing the mechanical properties of polymers has proven to be challenging. In this study, we introduced epoxy functional groups into polyol backbones, which is different from other studies that focused on modifying capping agents to achieve a network structure between the polymer matrix and PU. We confirmed the molecular weight of the prepared PU via gel permeation chromatography. Moreover, the prepared material was added to the epoxies and the resulting mechanical and thermal properties of the materials were evaluated. Furthermore, we conducted tensile, flexural strength, and impact resistance measurements. The addition of PU to the epoxy compositions enhanced their impact strength and maintained their mechanical strength up to 10 phr of PU. Furthermore, the morphologies observed with field emission scanning electron microscopy and transmission electron microscopy proved that the PU was phase separated in the epoxy matrix

Classifiable Limiting Mass Change Detection in a Graphene Resonator Using Applied Machine Learning

Nanomechanical resonator devices are widely used as ultrasensitive mass detectors for fundamental studies and practical applications. The resonance frequency of the resonators shifts when a mass is loaded, which is used to estimate the mass. However, the shift signal is often blurred by the thermal noise, which interferes with accurate mass detection. Here, we demonstrate the reduction of the noise interference in mass detection in suspended graphene-based nanomechanical resonators, by using applied machine learning. Featurization is divided into image and sequential datasets, and those datasets are trained and classified using 2D and 1D convolutional neural networks (CNNs). The 2D CNN learning-based classification shows a performance with f1-score over 99% when the resonance frequency shift is more than 2.5% of the amplitude of the thermal noise range.Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.BN/Chirlmin Joo La

Nanoelectromechanical systems from carbon nanotubes and graphene

Carbon nanotubes and graphene have many interesting properties. To exploit the properties in applications their synthesis and incorporation in devices has to be understood and controlled. This thesis is based on experimental studies on synthesis of carbon nanotubes and fabrication of nanoelectromechanical systems from carbon nanotubes and graphene. Vertically aligned nanotube arrays with heights over 800 µm have been grown using acetylene with iron as catalyst on alumina support using thermal chemical vapor deposition. By varying the partial pressure of acetylene it was found that the addition-rate of carbon was proportional to the coverage of acetylene molecules on the catalyst nanoparticle. In certain conditions the macroscopic pattern of the catalyst areas influenced the microscopic properties of the carbon nanotubes. It was shown that the initial carbon-precursor flow conditions could determine the number of walls produced. The amount of carbon incorporated into nanotubes was constant but regions that experienced less carbon precursor gas flow due e.g. to depletion, produced longer but fewer-walled nanotubes. Arrays of vertically aligned nanotubes were shown to deflect as a single unit under electrostatic actuation, making possible the fabrication of varactors. Measurements of deflection were used to determine an eff ective Young's modulus of 6(+- 4) MPa. The capacitance of such a device could be reproducibly changed by more than 20 %. Devices based on the nanoelectromechanical properties of few-layer graphene were fabricated and characterized. Electrostatic actuation of buckled beams and membranes led to a "snap-through" switching at a critical applied voltage. By characterizing this behavior for diff erent sizes and geometries of membranes, it was possible to extract the bending rigidity of bilayered graphene, yielding a value of 35(+20,-15) eV. CNTFETs with suspended graphene gates were fabricated. It was shown that a moveable graphene gate could control the conductance of the carbon nanotube and improve the switching characteristics. Inverse sub-threshold slope down to 53 mV per decade were measured at 100 K. The experimental data were compared with theoretical simulations and it was inferred that the subthreshold slope could be improved beyond the thermal limit by improving the design of the device