{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:28:21Z","timestamp":1786980501873,"version":"build-2736575974"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T00:00:00Z","timestamp":1670198400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T00:00:00Z","timestamp":1670198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100014718","name":"Innovative Research Group Project of the National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["8187051428"],"award-info":[{"award-number":["8187051428"]}],"id":[{"id":"10.13039\/100014718","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurol Sci"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To explore the factors and risk mapping model of progression from ocular myasthenia gravis (OMG) to generalized myasthenia gravis (GMG) in adult-onset patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective, observational cohort study was performed for 435 OMG patients with onset age older than 14\u00a0years old. Multivariate Cox regression was used to identify the independent factors affecting generalized conversions that then were incorporated into the construction of the nomogram.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Two hundred thirty-seven patients (54.5%) had transformed into GMG after a median of 1.1\u00a0years (range 0.1-\u20139.1\u00a0years). The 6-, 12-, and 24-month generalized conversion rates were 31.7%, 49.8%, and 65.4%, respectively. Multivariable analysis showed that the early-onset age, male sex, concomitant autoimmune diseases (AID), positive results of anti-acetylcholine receptor antibodies, repetitive nerve stimulation abnormalities, the presence of thymoma, and prednisone treatment were significantly associated with the generalized conversions (hazard ratio [HR]\u2009=\u20090.598, 0.686, 1.554, 1.541, 2.020, 2.510, and 0.556, respectively). A nomogram was established to predict the possibility of generalization-free survival (GFS) in adult-onset OMG patients, and the model demonstrated good predictive performance with a C-index of 0.736 (95% confidence interval 0.703\u2009~\u20090.769). Moreover, subgroup analyses were performed based on the presence or absence of prednisone therapy, and the results indicated that prednisone therapy has better prevention of generalized conversions in male, non-thymoma patients, and patients without other AID.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A new predictive nomograph and web-based survival calculator we developed show favorable applicability and accuracy in predicting long-term GFS in adult-onset OMG patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10072-022-06519-5","type":"journal-article","created":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T03:03:06Z","timestamp":1670209386000},"page":"1383-1391","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Dynamic nomogram for predicting generalized conversion in adult-onset ocular myasthenia gravis"],"prefix":"10.1007","volume":"44","author":[{"given":"Zhuajin","family":"Bi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yayun","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengcui","family":"Gui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suqiong","family":"Ji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5369-7751","authenticated-orcid":false,"given":"Bitao","family":"Bu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,12,5]]},"reference":[{"issue":"10","key":"6519_CR1","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1001\/jamaneurol.2015.1444","volume":"72","author":"CE Peeler","year":"2015","unstructured":"Peeler CE, De Lott LB, Nagia L et al (2015) Clinical utility of acetylcholine receptor antibody testing in ocular myasthenia gravis. JAMA Neurol 72(10):1170\u20131174. https:\/\/doi.org\/10.1001\/jamaneurol.2015.1444","journal-title":"JAMA Neurol"},{"issue":"1","key":"6519_CR2","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1186\/s12883-020-01805-1","volume":"20","author":"J Ding","year":"2020","unstructured":"Ding J, Zhao S, Ren K et al (2020) Prediction of generalization of ocular myasthenia gravis under immunosuppressive therapy in Northwest China. BMC Neurol 20(1):238. https:\/\/doi.org\/10.1186\/s12883-020-01805-1","journal-title":"BMC Neurol"},{"issue":"2","key":"6519_CR3","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1002\/mus.20950","volume":"37","author":"D Grob","year":"2008","unstructured":"Grob D, Brunner N, Namba T et al (2008) Lifetime course of myasthenia gravis. Muscle Nerve 37(2):141\u2013149. https:\/\/doi.org\/10.1002\/mus.20950","journal-title":"Muscle Nerve"},{"issue":"1","key":"6519_CR4","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/s12883-017-0857-7","volume":"17","author":"L Wang","year":"2017","unstructured":"Wang L, Zhang Y, He M (2017) Clinical predictors for the prognosis of myasthenia gravis. BMC Neurol 17(1):77. https:\/\/doi.org\/10.1186\/s12883-017-0857-7","journal-title":"BMC Neurol"},{"issue":"6","key":"6519_CR5","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1055\/s-0039-1700527","volume":"39","author":"M O'Hare","year":"2019","unstructured":"O\u2019Hare M, Doughty C (2019) Update on ocular myasthenia gravis. Semin Neurol 39(6):749\u2013760. https:\/\/doi.org\/10.1055\/s-0039-1700527","journal-title":"Semin Neurol"},{"issue":"2","key":"6519_CR6","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/j.ncl.2018.01.002","volume":"36","author":"MK Hehir","year":"2018","unstructured":"Hehir MK, Silvestri NJ (2018) Generalized myasthenia gravis: classification, clinical presentation, natural history, and epidemiology. Neurol Clin 36(2):253\u2013260. https:\/\/doi.org\/10.1016\/j.ncl.2018.01.002","journal-title":"Neurol Clin"},{"issue":"7","key":"6519_CR7","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1111\/j.1468-1331.2010.03017.x","volume":"17","author":"ZF Mao","year":"2010","unstructured":"Mao ZF, Mo XA, Qin C et al (2010) Course and prognosis of myasthenia gravis: a systematic review. Eur J Neurol 17(7):913\u2013921. https:\/\/doi.org\/10.1111\/j.1468-1331.2010.03017.x","journal-title":"Eur J Neurol"},{"issue":"4","key":"6519_CR8","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1002\/mus.25971","volume":"57","author":"SK Kamarajah","year":"2010","unstructured":"Kamarajah SK, Sadalage G, Palmer J et al (2010) Ocular presentation of myasthenia gravis: a natural history cohort. Muscle Nerve 57(4):622\u2013627. https:\/\/doi.org\/10.1002\/mus.25971","journal-title":"Muscle Nerve"},{"issue":"29","key":"6519_CR9","doi-asserted-by":"publisher","first-page":"1925","DOI":"10.1093\/eurheartj\/ehu207","volume":"35","author":"EW Steyerberg","year":"2014","unstructured":"Steyerberg EW, Vergouwe Y (2014) Towards better clinical prediction models: seven steps for development and an ABCD for validation. Eur Heart J 35(29):1925\u20131931. https:\/\/doi.org\/10.1093\/eurheartj\/ehu207","journal-title":"Eur Heart J"},{"issue":"1\u20132","key":"6519_CR10","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.jns.2008.05.023","volume":"273","author":"YH Hong","year":"2008","unstructured":"Hong YH, Kwon SB, Kim BJ et al (2008) Korean Research Group for Neuromuscular Diseases. Prognosis of ocular myasthenia in Korea: a retrospective multicenter analysis of 202 patients. J Neurol Sci 273(1\u20132):10\u20134. https:\/\/doi.org\/10.1016\/j.jns.2008.05.023","journal-title":"J Neurol Sci"},{"issue":"4","key":"6519_CR11","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1212\/WNL.0000000000002790","volume":"87","author":"DB Sanders","year":"2016","unstructured":"Sanders DB, Wolfe GI, Benatar M et al (2016) International consensus guidance for management of myasthenia gravis: executive summary. Neurology 87(4):419\u2013425. https:\/\/doi.org\/10.1212\/WNL.0000000000002790","journal-title":"Neurology"},{"key":"6519_CR12","doi-asserted-by":"publisher","unstructured":"Cornblath WT (2018) Treatment of ocular myasthenia gravis. Asia Pac J Ophthalmol (Phila) 7(4):257\u2013259. https:\/\/doi.org\/10.22608\/APO.2018301","DOI":"10.22608\/APO.2018301"},{"issue":"5","key":"6519_CR13","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1111\/ene.12359","volume":"21","author":"E Kerty","year":"2014","unstructured":"Kerty E, Elsais A, Argov Z (2014) EFNS\/ENS Guidelines for the treatment of ocular myasthenia. Eur J Neurol 21(5):687\u2013693. https:\/\/doi.org\/10.1111\/ene.12359","journal-title":"Eur J Neurol"},{"key":"6519_CR14","doi-asserted-by":"publisher","unstructured":"Li YM, Zhao P, Yang YH (2021) [Simulation study on missing data imputation methods for longitudinal data in cohort studies]. Zhonghua Liu Xing Bing Xue Za Zhi 42(10):1889\u20131894. Chinese. https:\/\/doi.org\/10.3760\/cma.j.cn112338-20201130-01363","DOI":"10.3760\/cma.j.cn112338-20201130-01363"},{"issue":"2","key":"6519_CR15","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1001\/archneur.60.2.243","volume":"60","author":"MJ Kupersmith","year":"2003","unstructured":"Kupersmith MJ, Latkany R, Homel P (2003) Development of generalized disease at 2 years in patients with ocular myasthenia gravis. Arch Neurol 60(2):243\u2013248. https:\/\/doi.org\/10.1001\/archneur.60.2.243","journal-title":"Arch Neurol"},{"issue":"1","key":"6519_CR16","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1080\/00207454.2017.1344237","volume":"128","author":"M Mazzoli","year":"2018","unstructured":"Mazzoli M, Ariatti A, Valzania F (2018) Factors affecting outcome in ocular myasthenia gravis. Int J Neurosci 128(1):15\u201324. https:\/\/doi.org\/10.1080\/00207454.2017.1344237","journal-title":"Int J Neurosci"},{"issue":"19","key":"6519_CR17","doi-asserted-by":"publisher","first-page":"2682","DOI":"10.4103\/0366-6999.166032","volume":"128","author":"LL Wang","year":"2015","unstructured":"Wang LL, Zhang Y, He ML (2015) Clinical features and prognosis of ocular myasthenia gravis patients with different phenotypes. Chin Med J (Engl) 128(19):2682\u20132684. https:\/\/doi.org\/10.4103\/0366-6999.166032","journal-title":"Chin Med J (Engl)"},{"issue":"2","key":"6519_CR18","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.clim.2003.10.004","volume":"110","author":"N Shinomiya","year":"2004","unstructured":"Shinomiya N, Nomura Y, Segawa M (2004) A variant of childhood-onset myasthenia gravis: HLA typing and clinical characteristics in Japan. Clin Immunol 110(2):154\u2013158. https:\/\/doi.org\/10.1016\/j.clim.2003.10.004","journal-title":"Clin Immunol"},{"issue":"1","key":"6519_CR19","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1111\/nyas.13507","volume":"1412","author":"JJ Plomp","year":"2018","unstructured":"Plomp JJ, Huijbers MGM, Verschuuren JJGM (2018) Neuromuscular synapse electrophysiology in myasthenia gravis animal models. Ann N Y Acad Sci 1412(1):146\u2013153. https:\/\/doi.org\/10.1111\/nyas.13507","journal-title":"Ann N Y Acad Sci"},{"issue":"3","key":"6519_CR20","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1007\/s13760-018-0943-7","volume":"118","author":"G Galassi","year":"2018","unstructured":"Galassi G, Mazzoli M, Ariatti A (2018) Antibody profile may predict outcome in ocular myasthenia gravis. Acta Neurol Belg 118(3):435\u2013443. https:\/\/doi.org\/10.1007\/s13760-018-0943-7","journal-title":"Acta Neurol Belg"},{"issue":"12","key":"6519_CR21","doi-asserted-by":"publisher","first-page":"2773","DOI":"10.1007\/s00415-018-9056-8","volume":"265","author":"F Li","year":"2018","unstructured":"Li F, Hotter B, Swierzy M (2018) Generalization after ocular onset in myasthenia gravis: a case series in Germany. J Neurol 265(12):2773\u20132782. https:\/\/doi.org\/10.1007\/s00415-018-9056-8","journal-title":"J Neurol"},{"issue":"4","key":"6519_CR22","doi-asserted-by":"publisher","first-page":"2449","DOI":"10.1007\/s13311-021-01129-z","volume":"18","author":"H Li","year":"2021","unstructured":"Li H, Ruan Z, Gao F et al (2021) Thymectomy and risk of generalization in patients with ocular myasthenia gravis: a multicenter retrospective cohort study. Neurotherapeutics 18(4):2449\u20132457. https:\/\/doi.org\/10.1007\/s13311-021-01129-z","journal-title":"Neurotherapeutics"},{"issue":"3","key":"6519_CR23","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1080\/01616412.2018.1557433","volume":"41","author":"SC Bokoliya","year":"2019","unstructured":"Bokoliya SC, Patil SA (2019) Assessment of pre and post-thymectomy myasthenia gravis. Neurol Res 41(3):275\u2013281. https:\/\/doi.org\/10.1080\/01616412.2018.1557433","journal-title":"Neurol Res"},{"issue":"3","key":"6519_CR24","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1002\/mus.24769","volume":"53","author":"M Benatar","year":"2016","unstructured":"Benatar M, Mcdermott MP, Sanders DB et al (2016) Muscle Study Group (MSG). Efficacy of prednisone for the treatment of ocular myasthenia (EPITOME): a randomized, controlled trial. Muscle Nerve 53(3):363\u20139. https:\/\/doi.org\/10.1002\/mus.24769","journal-title":"Muscle Nerve"},{"key":"6519_CR25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2020.117274","volume":"420","author":"R Verma","year":"2021","unstructured":"Verma R, Wolfe GI, Kupersmith MJ (2021) Ocular myasthenia gravis - how effective is low dose prednisone long term? J Neurol Sci 420:117274. https:\/\/doi.org\/10.1016\/j.jns.2020.117274","journal-title":"J Neurol Sci"}],"container-title":["Neurological Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10072-022-06519-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10072-022-06519-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10072-022-06519-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,17]],"date-time":"2023-03-17T13:05:16Z","timestamp":1679058316000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10072-022-06519-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,5]]},"references-count":25,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,4]]}},"alternative-id":["6519"],"URL":"https:\/\/doi.org\/10.1007\/s10072-022-06519-5","relation":{},"ISSN":["1590-1874","1590-3478"],"issn-type":[{"value":"1590-1874","type":"print"},{"value":"1590-3478","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,5]]},"assertion":[{"value":"24 April 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 November 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 December 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study has been approved by the Committee of Clinical Investigation at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan China (NO. TJ-IRB20220748).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed consent was obtained from each participant or their parents when underage according to the principles of the Declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}