Utilization of MG-ADL in myasthenia gravis clinical research and care

The Myasthenia Gravis Activities of Living (MG‐ADL) scale is an 8‐item patient‐reported scale that measures myasthenia gravis (MG) symptoms and functional status. The objective of the current review is to summarize the psychometric properties of the MG‐ADL and published evidence of MG‐ADL use. A targeted literature review for published studies of the MG‐ADL was conducted using a database and gray literature search. A total of 48 publications and 35 clinical trials were included. Studies indicated that the MG‐ADL is a reliable and valid measure that has been used as an outcome in clinical trials and observational studies to measure MG symptoms and response to treatment. While most often used as a secondary endpoint in clinical trials, its use as a primary endpoint has increased in recent years. The most common MG‐ADL endpoint is change in MG‐ADL score from baseline, although there has been an increase in the analysis of a responder threshold using the MG‐ADL. A new concept of minimal symptom expression (MSE) has emerged more recently. Duration of treatment effect is another important construct that is being increasingly evaluated using the MG‐ADL. The use of the MG‐ADL as a primary endpoint in clinical trials and in responder threshold analyses to indicate treatment improvement has increased in recent years. MSE using the MG‐ADL shows promise in helping to determine success of treatment and may be the aspirational goal of MG treatment for the future once validated, particularly given the evolving treatment landscape in MG.

Sociodemographic and clinical characteristics among men with metastatic prostate cancer: An aged-stratified analysis

256

Background: Data on age-specific comparisons in metastatic prostate cancer (MPC) is limited. This analysis evaluated socio-demographic and clinical characteristics among men with MPC aged <65 years versus ≥65 years.

Methods: Eighty-four US men aged ≥18 years with self-reported MPC completed a cross-sectional survey in January-February 2011 which collected data on socio-demographic and clinical characteristics including treatment history and source of care.

Results: Forty-nine men were aged <65 years; 35 men were ≥65 years. There were no differences (all P>0.05) between groups for marital status (80% of those <65 years and 83% of those ≥65 years were married), race/ethnicity (94% of both groups were white), education (88% of those <65 years and 77% of those ≥65 years had attended college), and annual household income (29% of those <65 years and 31% of those ≥65 years had incomes of $35,000-$54,999). Time since diagnosis differed between groups with 12%, 84%, and 4% of those aged <65 years and 3%, 69%, and 29% of those aged ≥65 years having been diagnosed <1, 1-9, and ≥10 year(s) ago, respectively (P<0.001). Respondents aged <65 years and ≥65 years reported similar experience with chemotherapy (37% in both groups had received chemotherapy), no anemia in last 4 weeks (80% and 83%, respectively), no bone fractures or spinal cord compression in last 4 weeks (90% and 94%, respectively), receiving previous radiation therapy (69% and 66%, respectively), receiving previous surgery (63% and 66%, respectively), and utilizing hormonal treatments previously or currently (86% and 90%, respectively) (all P>0.05). In addition, those <65 years versus ≥65 years did not differ regarding their self-reported source of primary care for prostate cancer (51% and 54% reported receiving their care from oncologists, respectively; 47% and 43% from urologists; 2% and 3% from family physicians/internists).

Conclusions: In this study of men with MPC, those aged <65 years and those ≥65 years reported similar prostate cancer treatment utilization as well as socio-demographic and clinical characteristics with the exception of a difference in time since diagnosis. Further research in larger populations is warranted.

Motion processing in autism: evidence for a dorsal stream deficiency

We report that motion coherence thresholds in children with autism are significantly higher than in matched controls. No corresponding difference in form coherence thresholds was found. We interpret this as a specific deficit in dorsal stream function in autism. To examine the possibility of a neural basis for the perceptual and motor related abnormalities frequently cited in autism we tested 23 children diagnosed with autistic disorder, on two tasks specific to dorsal and ventral cortical stream functions. The results provide evidence that autistic individuals have a specific impairment in dorsal stream functioning. We conclude that autism may have common features with other developmental disorders and with early stages of normal development, perhaps reflecting a greater vulnerability of the dorsal system.

In vivo correlation of thermodilution cardiac output and videodensitometric indicator-dilution curves obtained from contrast two-dimensional echocardiograms

In previous studies, indicator-dilution curves obtained by videodensitometry of contrast two-dimensional echocardiograms have shown close correlation with measurements of blood flow in vitro. In this study the technique was extended and contrast indicator-dilution curves obtained in vivo were correlated with simultaneous cardiac output measurements determined by thermodilution in eight dogs. Two-dimensional echocardiograms of the left ventricle were performed with the transducer on the myocardium during left atrial-pulmonary vein injection of 10 cc of a 1 X 10(-4) concentration of 30 mu diameter microballoons. A total of 148 injections were performed at 37 levels of cardiac output (1.70 to 7.90 liters/min) induced by alterations of left ventricular preload, isoproterenol and propranolol. Indicator-dilution curves were obtained from recordings of the analog signal of a linear videodensitometer focused on the left ventricle. Linear regression analysis between total area of the indicator-dilution curves and cardiac output yielded correlation coefficients (r) of 0.77 to 0.96 (mean 0.90) for individual dogs, and 0.65 for all cardiac output determinations in all dogs. Analysis of indicator-dilution curve area by the forward triangle-exponential decay method yielded enhanced individual coefficients of 0.90 to 0.97 (mean 0.94) with cardiac output and 0.61 for the group of animals. It is concluded that echographic indicator-dilution curves obtained from uniform size microballoons and videodensitometry may be obtained in vivo and correlate with cardiac output measurements.