Serological diagnosis of myasthenia gravis and its clinical significance.

Myasthenia gravis (MG) is the most common immune-mediated disorder of the neuromuscular junction. Anti-acetylcholine receptor (anti-AChR), anti-muscle-specific kinase (anti-MuSK), and anti-lipoprotein receptor-related protein 4 (anti-LRP4) antibodies are the three well-defined pathogenic antibodies. Patients with MG can also have other antibodies, such as anti-titin, anti-ryanodine receptor (anti-RyR), anti-Agrin and anti-KV1.4 antibodies. Since MG is heterogeneous in terms of pathophysiology, antibody status, and other factors, serological tests are crucial for clinical diagnosis confirmation and treatment choice. Herein, we review the different methods for detection of various antibodies involved in MG and their sensitivity and specificity. The understanding of these elements should be useful for improving the diagnosis and determining how to adapt the existing therapies to the requirements of each patient.

Influence of thermal air oxidation on the chemical composition and uranium binding property of intrinsic dissolved organic matter from biochar.

In this work, uranium (U(VI)) binding characteristics of the intrinsic dissolved organic matters (DOM) from the biochars prepared under thermal air oxidation (TAO) and non-TAO conditions were studied using synchronous fluorescence spectra (SFS) and Fourier transform infrared (FTIR) in conjunction with the general two-dimensional correlation spectroscopy (2D-COS), heterospectral 2D-COS and moving-window (MW) 2D-COS. The chemical compositions of the intrinsic DOMs from biochars with/without TAO were investigated by Fourier transform-ion cyclotron resonance mass spectrometry (FT-ICR MS). Results showed that the preferential binding of U(VI) to functional groups followed the order: 937 (carboxyl γC-OH), 981 (carboxyl γC-OH), 1511 (aromatic vC = C), 1108 (esters or ethers vC-O), 1282 (esters or carboxyl vC-O), 1698 (saturated carboxylic acid or ketone vC = O) cm-1 for biochar DOM after TAO (OB600), and 937 (carboxyl γC-OH), 1484 (lipids δC-H or phenolic vC-O), 1201 (esters or carboxyl vC-O), 1112 (esters or ethers vC-O), 1706 (saturated aldehyde, carboxylic acid or ketone vC = O), 1060 (phenolic, esters or ethers vC-O), 1014 (phenolic, esters or ethers vC-O) cm-1 for the pristine biochar (B600). Fulvic-like substances at 375 nm in the biochar DOM showed a preferential binding with U(VI) after TAO, while humic-like substances played a more critical role in the U(VI) complexation with biochar DOM obtained from non-TAO condition. The results also indicated that TAO increased the content of fluorescent DOM and the chemical stability of DOM-U(VI) complexes. The FT-ICR MS results showed an increase in the relative abundance of protein-like, carbohydrates-like, tannins-like, unsaturated hydrocarbons, and condensed aromatic structure and a decrease in the relative abundance of lipid-like and lignin-like after TAO. Consequently, although biochar after TAO had a much poorer content of intrinsic DOM, its intrinsic DOM showed a much higher capacity in U(VI) precipitation. Therefore, the TAO substantially changed the chemical composition, binding property and environmental behavior of intrinsic DOM from biochar.

Insight into the effects of biological treatment on the binding properties of copper onto dissolved organic matter derived from coking wastewater.

Biological treatment can remove more than 89.8% of total organic carbon (TOC) and 94.4% of fluorescent dissolved organic matter (DOM) in the coking wastewater, thereby affecting the migration, transformation and bioavailability and binding characteristics of heavy metals (HMs). The results of parallel factor analysis (PARAFAC) show that protein-like materials accounted for 97.53% in the coking wastewater DOM, a large number of humic-like substances are produced and accounted for more than 55.40% after biological treatment. A new spectral data processing method, the 1/n-th power transformation after two-dimensional correlated spectroscopy (2D-COS) in combination with synchronous fluorescence spectra (SFS), can identify small features obscured by strong peaks, and reveal more binding sites as well as preserve the sequential order information. The result indicates that the preferential bonding of Cu(II) is at 306 nm (protein-like) for coking wastewater DOM, and at 514 nm (humic-like) for effluent DOM. The C-O group of esters and alcohols can preferentially complexate with Cu(II) in the coking wastewater and effluent DOM. The log KM values of PARAFAC components with Cu(II) are in the range of 3.59-5.06 for coking wastewater DOM, and in the range of 4.80-5.64 for the effluent DOM. Log KM values for protein-like materials with Cu(II) are higher than these for fulvic- and humic-like substances. Humic-like substances can form more stable complexes with Cu(II) in the effluent DOM. Biological treatment increases the chemical stability of DOM-Cu(II) complexes, thereby further reducing the environmental risk of Cu(II).

Factors affecting minimal manifestation status induction in myasthenia gravis.

Background: Minimal manifestation status (MMS) is an important landmark in the treatment of myasthenia gravis (MG), and predictors of MMS induction have rarely been identified in previous studies. Objective: The objective of this study is to evaluate the clinical factors associated with MMS induction among patients with MG. Design: This two-step retrospective cohort study with a single center investigated the factors that may be associated with MMS induction and retested these predictors in a test cohort. Methods: A total of 388 diagnosed MG patients who visited Xiangya Hospital between 1 July 2015 and 1 July 2019 were involved. We performed detailed chart reviews and recorded all cases achieving MMS. Demographics and clinical characteristics were also collected and their relationships to achieving MMS were investigated. Results: MMS was achieved in 124 patients (50.2%), and the median time to achieve MMS was 26 months. Several factors were found to be associated with MMS induction in exploring cohort, including muscle-specific tyrosine-protein kinase receptor (MuSK) antibody positivity (adjusted hazard ratio, HR = 4.333, 95% confidence interval, CI: 1.862-10.082), isolated ocular involvement (adjusted HR = 1.95, 95% CI: 1.284-2.961), and low baseline quantitative myasthenia gravis score (QMG score; adjusted HR = 2.022, 95% CI: 1.086-3.764). These factors were then retested in the test cohort. Isolated ocular involvement or low baseline QMG scores were factors found to be beneficial for MMS induction were confirmed. Conclusion: Isolated ocular involvement and low baseline QMG score are predictors of MMS induction in MG patients.

Characteristics of myasthenia gravis in elderly patients: a retrospective study.

BACKGROUND: The incidence of myasthenia gravis (MG) is increasing, and its characteristics in elderly patients are believed to differ from those in younger patients. However, only a few studies have focused on elderly patients with MG. OBJECTIVE: To review the characteristics of MG in elderly patients and evaluate whether older age is an independent factor associated with achieving minimal manifestation status (MMS). METHODS: This retrospective cohort study included 367 patients (319 non-elderly and 48 elderly patients) with MG enrolled at Xiangya Hospital from September 1, 2016, to December 31, 2018. We collected demographic data and information regarding comorbidities, antibody status, Myasthenia Gravis Foundation of America classification, affected muscle groups, thymoma, and treatment. MMS was defined as the primary outcome. RESULTS: Comorbidities were more common in elderly than in younger patients with MG. Anti-acetylcholine receptor antibody was the dominant subtype, whereas anti-muscle-specific tyrosine kinase antibody was rare and detected only in non-elderly patients. Elderly patients were more likely than younger patients to have generalized MG, but the frequency of thymoma was lower (28.5% vs. 10.4%, p = 0.0078). MMS or better was achieved in 154 (48.3%) and 13 (27.1%) non-elderly and elderly patients, respectively. Older age did not appear to be an independent factor associated with MMS (hazard ratio = 0.625; 95% confidence interval, 0.345-1.131). CONCLUSIONS: Older age was not an independent factor for a worse prognosis in patients with MG. The treatment of elderly patients with MG should be individually tailored.

Effect of biochar-derived DOM on the interaction between Cu(II) and biochar prepared at different pyrolysis temperatures.

The structure and composition of biochar-derived dissolved organic matter (DOM) at different pyrolysis temperatures differed significantly, affecting the environmental geochemical behavior of heavy metals (HMs). Herein, the binding properties of Cu(II) onto walnut-shell DOM were investigated using spectroscopic methods. The results showed that the DOM at low pyrolysis temperatures (300 °C and 500 °C) showed higher Cu(II) affinity than that at high pyrolysis temperature (700 °C). There was a preferential Cu(II) binding with fulvic-like substances (360 nm) at 300 °C, and with protein-like materials (275 nm) at 500 °C and 700 °C. The C-O group of alcohols, ethers, and esters showed preferential binding with Cu(II) at 300 °C and 700 °C pyrolysis temperatures. However, preferential bonding of Cu(II) to the C-O stretching vibration and O-H bending vibration of carboxyl was exhibited at 500 °C pyrolysis temperature. Pyrolysis temperature played a crucial role in the release of biochar-derived DOM and in the migration and bioavailability of HMs. Meanwhile, the adsorption effect of Cu(II) increased by 11.2% for biochar at 300 °C, and decreased by 15.0% and 61.1% for biochar at 500 °C and 700 °C, respectively, after the removal of DOM, suggesting that the presence of DOM influenced the adsorption behavior of biochar towards Cu(II).

Tacrolimus as Single-Agent Immunotherapy and Minimal Manifestation Status in Nonthymoma Myasthenia Gravis.

BACKGROUND: Tacrolimus is a second-line immunosuppressant in myasthenia gravis (MG) therapy, which is mainly used in combination with corticosteroids to reduce steroid dose and maintain the effect of immunotherapy. However, few studies have focused on the effect of tacrolimus as single-agent immunotherapy on achieving minimal manifestation status (MMS). Thus, this study is aimed at exploring the efficacy and influencing factors of tacrolimus as single-agent immunotherapy in MG. METHODS: Clinical data of 75 nonthymoma MG patients treated with tacrolimus single-agent as initial immunotherapy were retrospectively analyzed. The therapeutic effect was evaluated by Myasthenia Gravis Foundation of America postintervention status. Clinical factors affecting the achievement of MMS and treatment reactivity of different MG subtypes were determined by Cox regression analysis. RESULTS: Tacrolimus was generally safe, with only two patients (2.7%) switching medications due to side effects. 32% of patients had improved symptoms after 1 month of treatment. 69.2% of patients achieved MMS or better after one year. The age < 39 years old, QMG score < 11 points, and AChR - Ab titer < 8.07 nmol/L were indicative of a favorable response, which was independent of gender, course of the disease. As for MG subtypes, ocular and seronegative MG showed better treatment sensitivity. CONCLUSIONS: Tacrolimus as single-agent immunotherapy takes effect quickly and can effectively enable nonthymoma MG patients to achieve MMS. Tacrolimus can be used alone for the initial immunotherapy of MG patients, especially for young, mild, and low antibody titer patients.

Single-cell RNA-Seq reveals transcriptional heterogeneity and immune subtypes associated with disease activity in human myasthenia gravis.

Myasthenia gravis (MG) is a rare autoimmune disease. Although the impact of immune cell disorder in MG has been extensively studied, little is known about the transcriptomes of individual cells. Here, we assessed the transcriptional profiles of 39,243 cells by single-cell sequencing and identified 13 major cell clusters, along with 39 subgroups of cells derived from patients with new-onset myasthenia gravis and healthy controls. We found that B cells, CD4+ T cells, and monocytes exhibited more heterogeneity in MG patients. CD4+ T cells were expanded in MG patients. We reclustered B cells and CD4+ T cells, and predict their essential regulators. Further analyses demonstrated that B cells in MG exhibited higher transcriptional activity towards plasma cell differentiation, CD4+ T cell subsets were unbalanced, and inflammatory pathways of monocytes were highly activated. Notably, we discovered a disease-relevant subgroup, CD180- B cells. Increased CD180- B cells in MG are indicative of a high IgG composition and were associated with disease activity and the anti-AChR antibody. Together, our data further the understanding of the cellular heterogeneity involved in the pathogenesis of MG and provide large cell-type-specific markers for subsequent research.

Evaluation of outcome measures for myasthenia gravis subgroups.

INTRODUCTION: Disease evaluation and long-term follow-up of myasthenia gravis (MG) patients rely on disease-specific measures. We evaluated four widely used MG-specific assessments, and compared the response to disease change in different MG subgroups. METHODS: We used the Cronbach's α coefficient to test reliability, Pearson correlation coefficients to test construct validity, as well as one-way ANOVA and independent-sample t-tests to access discriminant validity. Analyses of similar items between QMG and MG-ADL included paired-sample t-tests and mean score comparisons. Pearson correlation coefficients were used to describe the correlation between changes of QMG, MG-ADL, MG-QOL15r and MGC. The Wilcoxon matched-pairs signed-ranks test was performed to compare the outcomes. RESULTS: 872 MG patients were enrolled. QMG, MG-ADL, MG-QOL15r, and MGC all exhibited high reliability. All four scales displayed good discriminant validity according to the MGFA classification and MGC score. MG-ADL showed significant differences between patients grouped by age and gender, and MG-QOL15r showed significant differences between patients grouped by age. Analyses of similar items showed that MG-ADL achieved higher scores in bulbar items, whereas QMG produced higher scores in limb items. For patients in remission or minimal manifestation status, QMG exhibited significantly greater improvement than MG-QOL15r. In patients of MGFA I, II, III, and IV, QMG showed significantly greater improvement than MG-ADL. CONCLUSIONS: Patient-reported scale is an important supplement for a given period. MG-ADL has a better response to severe disease, and MG-QOL15r is more comprehensive for patients in remission or minimal manifestation status.

Clinical Evaluation of the Efficacy and Safety of Co-Administration of Wuzhi Capsule and Tacrolimus in Adult Chinese Patients with Myasthenia Gravis.

BACKGROUND: Tacrolimus has been recommended as an effective immunosuppressant for patients with myasthenia gravis (MG), while the high price, variable bioavailability, and narrow therapeutic window restrict its clinical application. Wuzhi capsule (WZC) could improve tacrolimus blood concentration by inhibiting the metabolism of cytochrome P450 3A (CYP3A) and P-glycoprotein (P-gp). There are few studies focused on the coadministration of WZC and tacrolimus in autoimmune diseases. This study was aimed at quantifying the efficacy and safety of coadministration of WZC and tacrolimus in adult Chinese patients with MG. METHODS: In this retrospective study, 122 patients with MG on tacrolimus were enrolled. The initial tacrolimus dose was 2 mg/d. Patients with standard initial tacrolimus concentration were classified into group A (standard-dose group). Those failed to reach target concentration were divided into group B (high-dose group) and group C (co-administering WZC group), according to treatment adjustment of increasing tacrolimus dose and co-administration of WZC, respectively. A logistic analysis was used to identify factors associated with clinical outcome. Adverse drug reactions (ADRs) were recorded for safety analysis. RESULTS: The tacrolimus concentration after coadministration of WZC was remarkably increased. It was higher compared with simply increasing the tacrolimus dose (p<0.001). The multivariate logistic analysis indicated that the baseline quantitative MG score was a predictive factor for clinical outcomes (OR=0.189; 95% CI 0.082-0.436; p<0.001). Fourteen patients (11.5%) reported ADRs after tacrolimus therapy. ADRs incidence was not related to WZC coadministration. CONCLUSION: The coadministration of WZC and tacrolimus can substantially elevate the tacrolimus concentration. It is a safe and economic treatment for adult Chinese patients with MG. Patients with a worse disease condition tend to present a better clinical outcome after tacrolimus therapy.

Effects on the complexation of heavy metals onto biochar-derived WEOM extracted from low-temperature pyrolysis.

Biochar-derived water-extractable organic matter (WEOM) was obtained under low-temperature pyrolysis (300 °C) using corncob as raw material. WEOM may affect the mobility and bioavailability of soil heavy metals (HMs) through complexation when biochar was used for soil HM remediation. Herein, the characteristics of complexation between HMs (Cr(III) and Cu(II)) and biochar-derived WEOM were investigated by using spectroscopic techniques in conjunction with parallel factor (PARAFAC) analysis and two-dimensional correlation spectroscopy (2D-COS). Six components were identified by PARAFAC modeling, in which protein-, fulvic- and humic-like components accounted for 48.86%, 25.63% and 25.51%, respectively. A nonlinear model was employed to determine the conditional stability constant (KM) and total ligand concentration (CL) of WEOM-HM complexes. The log KM values were in the range of 4.02-5.04 for WEOM-Cr(III) and 4.04-6.58 for WEOM-Cu(II). The 2D-COS in conjunction with log-transformed synchronous fluorescence spectroscopy (SFS) suggested that WEOM components were preferentially complexed with HMs in the following order: 433/270, 433/335, 496/270, 496/335, 370/335, 433/402, 496/402, 335/290, 402/290 for Cr(III), and 290/280, 390/280, 433/280, 496/280, 433/335, 496/335, 390/335, 433/420, 496/402, 335/290, 316/290 for Cu(II). The results of 2D-FTIR-COS suggested a preferential bonding of Cr(III) to the C-N group of alkyl, and Cu(II) to the CO group of alcohols, ethers and esters. Meanwhile, the CO group of ethers and the CN group of alkyl indicated preferential susceptibilities for the addition of Cr(III) and Cu(II) at different concentrations. In addition, protein-like components had remarkably higher total ligand concentration (CL) than fulvic- or humic-like components.

Study on the complexation of heavy metals onto biogas slurry DOM using two-dimensional correlation spectroscopy combined with the log-transformed synchronous fluorescence spectroscopy.

The fluorescent components of dissolved organic matter (DOM) in biogas slurry can react with heavy metals (HMs) and affect the migration, transformation, toxicity, and bioavailability of HMs in soil. Fluorescence quenching titration combined with two-dimensional correlation spectroscopy (2D-COS) can reveal the binding mechanism between HMs and different fluorescent components of biogas slurry DOM. The logarithmic-transformed (log-transformed) 2D-COS can be used to decrease the difference in the fluorescence intensity between low-intensity and high-intensity fluorophores that provides a better insight into the binding mechanism between biogas slurry DOM and HMs. Synchronous maps suggest that protein-like substances are more susceptive to the variation of the concentration of metal ions than fulvic-like substances. Asynchronous maps show that the preferential bonding of Cu(II) and Cr(III) to humic-like substances can be found in the biogas slurry DOM, as well as Fe(III) and Pb(II) to protein-like materials. DOM-Cu(II) may lead to an increasing risk of the migration of Cu(II) from soil to water environment due to the low log K values in the range from 2.93 to 3.46. Protein-like substances can also increase the environmental risk of HMs when these low-stable complexes occur migration and transformation. The potential environmental risk of protein-like with HMs follows the order: Pb(II) > Cu(II) > Cr(III). Here we demonstrate that the log-transformed 2D-COS can also identify fluorescence components at longer wavelength with relatively low content and reveals their preferential binding sequence and the number of binding sites. The study on the complexation between biogas slurry DOM and HMs provides a scientific basis for the environmental chemical behavior of HMs after the application of biogas slurry in agricultural soils.

Expanding the Clinico-Genetic Spectrum of Myofibrillar Myopathy: Experience From a Chinese Neuromuscular Center.

Background: Myofibrillar myopathy is a group of hereditary neuromuscular disorders characterized by dissolution of myofibrils and abnormal intracellular accumulation of Z disc-related proteins. We aimed to characterize the clinical, physiological, pathohistological, and genetic features of Chinese myofibrillar myopathy patients from a single neuromuscular center. Methods: A total of 18 patients were enrolled. Demographic and clinical data were collected. Laboratory investigations, electromyography, and cardiac evaluation was performed. Routine and immunohistochemistry stainings against desmin, αB-crystallin, and BAG3 of muscle specimen were carried out. Finally, next-generation sequencing panel array for genes associated with hereditary neuromuscular disorders were performed. Results: Twelve pathogenic variants in DES, BAG3, FLNC, FHL1, and TTN were identified, of which seven were novel mutations. The novel DES c.1256C>T substitution is a high frequency mutation. The combined recessively/dominantly transmitted c.19993G>T and c.107545delG mutations in TTN gene cause a limb girdle muscular dystrophy phenotype with the classical myofibrillar myopathy histological changes. Conclusions: We report for the first time that hereditary myopathy with early respiratory failure patient can have peripheral nerve and severe spine involvement. The mutation in Ig-like domain 16 of FLNC is associated with the limb girdle type of filaminopathy, and the mutation in Ig-like domain 18 with distal myopathy type. These findings expand the phenotypic and genotypic correlation spectrum of myofibrillar myopathy.

Glucose metabolism pattern of peripheral blood immune cells in myasthenia gravis patients.

BACKGROUND: We investigated the correlation between glucose metabolism patterns of different immune cells and the metabolic regulatory signaling pathways in myasthenia gravis (MG) and aimed to identify therapeutic targets for MG. METHODS: We isolated peripheral blood mononuclear cells (PBMCs) and sorted CD19+B cells, dendritic cells (DCs), CD4+ T cells, CD8+ T cells, CD4+CD25+ regulatory T cells (Tregs), CD4+CD25-T cells, and T helper (Th) cells such as Th1, Th2, and Th17 cells. Then, we detected the expression levels of PI3K/AKT/mTOR-HIF-1α, GLUT1, hexokinase (HK), phosphofructokinase (PFK), and pyruvate kinase (PK) by RT-PCR, measured the oxygen consumption rate and extracellular acidification rate of ex vivo freshly sorted cells using the Seahorse XFe96 Analyzer. In addition, we compared the glycolysis levels using these cells from the same MG patients. By performing in vitro experiments, we measured, the mRNA expression levels of mTOR, HIF-1α, B cell activating factor receptor (BAFF-R), GLUT1, HK, PFK, and PK, in addition to ECAR profiles, frequency of CD80 and CD86, and IgG levels from the culture supernatant of B cells (isolated from MG patients) treated with rapamycin and PX-478 (selective mTOR and HIF-1α inhibitor, respectively) from. RESULTS: Except PBMCs, Th2 and CD8+ T cells, the expression levels of the key enzymes involved in glycolysis and HIF-1α were significantly higher in B cells, DCs, Tregs, CD4+CD25-T cells, and Th1 and Th17 cells in MG patients, and the measurement of ECAR and OCR confirmed the metabolic status. In MG patients, B cells and DCs showed significantly higher levels of glycolysis and glycolytic capacity than CD8+ T cells, CD4+ T cells and its subsets. In vitro, except IgG levels, the increased glycolysis levels, expression of key glycolytic enzymes, BAFF-R and frequency of CD80 and CD86 of B cells, could be inhibited by rapamycin and PX-478. CONCLUSIONS: Different subtypes of immune cells in MG exhibit different glucose metabolism patterns. The mTOR-HIF-1α signaling pathway might be the immunometabolism reprogramming checkpoint of glycolysis-dependent activated B cells in MG.

Prognostic Analysis of Thymoma-Associated Myasthenia Gravis (MG) in Chinese Patients and Its Implication of MG Management: Experiences from a Tertiary Hospital.

BACKGROUND: Myasthenia gravis (MG) is an autoantibody-mediated neuromuscular disorder. Approximately 10-20% of all MG patients experience thymoma (benign tumor arising from thymus tissue). Thymectomy has been the standard of care for thymomatous myasthenia gravis (TMG). However, the clinical outcome of TMG after thymectomy has not been sufficiently studied, especially the long-term prognosis. Therefore, the aim of this study was to analyze the clinical characteristics contributing to the prognostic factors of TMG. METHODS: We reviewed 70 TMG patients in the Xiangya Hospital and classified them into the minimal manifestation (MM) group and No MM group, according to the long-term treatment outcome. MM-or-better status was defined as the goal treatment for TMG patients. We collected and analyzed the demographic data, the WHO classification of thymoma, MG-associated antibody levels, disease severity, treatment-related data as well as clinical outcome at six months. Variables selected by univariate analysis were used in the multivariate logistic regression model to identify the prognostic factors. RESULTS: The differences in clinical outcome at six months and worst QMGS were significant, while the differences in other factors were insignificant between groups. Clinical outcome at six months (OR=23.5 95% CI 2.4-231.5, P=0.007) and dyspnea before thymectomy (OR=0.2, 95% CI 0.03-0.75, P=0.021) were identified as the prognostic factors of long-term treatment. CONCLUSION: Demographic and clinical features were similar in TMG patients treated at our hospital. The early achievement of MM-or-better status may indicate a good outcome in the long term. Dyspnea before thymectomy appears to associate with a poor prognosis.

The innovation value chain of patents: Breakthrough in the patent commercialization trap in Chinese universities.

The innovation value chain is an effective tool for analysing innovation activities and reflects the process of value creation and increase in innovation activities. From the perspective of innovation value chains, we divided patent innovation activities into three stages: knowledge innovation stage, applied research stage and patent commercialization stage. The panel data from 64 universities directly managed by the Ministry of Education from 2009 to 2017 were used and several conclusions were drawn: 1) In the initial stage of knowledge innovation, the fundamental research fund plays a crucial promoting role, and knowledge innovation achievements are mainly published academic papers. 2) In the applied research stage, the knowledge innovation in the early stage and the fund investment in R&D activities have a significant positive effect on the patent output of universities, but the personnel investment has a negative effect. 3) In the final stage of patent commercialization, preliminary research results have a positive impact on patent commercialization, whose marginal effect depends on the industry-university-research relationship, external competition and reputation of the university. The evidence showed that there is a feedback channel between university patent commercialization and knowledge innovation, and new knowledge generated by the interaction with the outside world in the process of patent commercialization was transmitted to the subject of knowledge innovation through this channel, forming a virtuous dynamic cycle. By analysing the driving factors of the value chain of patent innovation in colleges and universities, we provided empirical evidence for the operation mechanism and policy formulation of college patents in China.

Multiple genetic factors affecting the pharmacokinetic and pharmacodynamic processes of tacrolimus in Chinese myasthenia gravis patients.

PURPOSE: Tacrolimus is a novel effective immunosuppressant for myasthenia gravis (MG) patients. However, the narrow therapeutic window, and high inter- and intrapatient variation in bioavailability largely limited its clinical application. This article intended to find the SNPs influencing clinical outcome and discover the possible mechanisms. METHODS: Based on the tagSNPs genotyped by Improved Multiple Ligase Detection Reaction, Plink 1.07 was used to find the SNPs having close interaction to tacrolimus serum concentration, QMG score changes or even reasonable drug dose. Then we searched several databases to predict the possible miRNA binding rs15524 sequence. Based on the prediction, dual-luciferase reporter assay and miRNA transfection were used to discover the mechanism of how SNP rs15524 controls tacrolimus serum concentration through influencing CYP3A5 expression. RESULTS: In this article, we found multiple SNPs on CYP3A4, CYP3A5, FKBP1A, NFATC2 genes were predicted closely related to tacrolimus serum concentration, therapeutic effect which reflected by QMG score changes or even reasonable drug dose. After in silico miRNA selection, possible relationship between hsa-miR-500a and rs15524 was found. With the help of dual-luciferase reporter assay, wild-type rs15524 (T allele) was found having a stronger binding affinity for hsa-miR-500a. Higher expression of CYP3A5 may also led by lower hsa-miR-500a level. CONCLUSIONS: SNP rs15524 may control CYP3A5 expression by affecting the binding affinity between CYP3A5 3'UTR and hsa-miR-500a. Wild type (T allele) 3'UTR of CYP3A5 has stronger binding affinity to hsa-miR-500a and cause lower CYP3A5 expression and higher tacrolimus serum concentration.

Corrigendum: Expanding the Clinico-Genetic Spectrum of Myofibrillar Myopathy: Experience From a Chinese Neuromuscular Center.

[This corrects the article DOI: 10.3389/fneur.2020.01014.].