{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T15:39:26Z","timestamp":1760369966755,"version":"build-2065373602"},"reference-count":65,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T00:00:00Z","timestamp":1703116800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Animals"],"abstract":"<jats:p>A one-year-old, female intact Samoyed, 12.5 kg, was presented with coughing for 2 weeks, progressive appendicular and axial muscle weakness, megaesophagus and labored breathing for 5 days. There was no improvement with standard treatment. Acquired myasthenia gravis was suspected and the dog was referred with increasing dyspnea. At presentation, the dog showed a severely reduced general condition, was non-ambulatory and showed abdominal and severely labored breathing. A marked hypercapnia (PvCO2 = 90.1 mmHg) was present in venous blood gas analysis. The serum anti-acetylcholine receptor antibody test was consistent with acquired myasthenia gravis (2.1 nmol\/L). The dog was anesthetized with propofol and mechanically ventilated with a Hamilton C1 ventilator. Immunoadsorption was performed with the COM.TEC\u00ae and ADAsorb\u00ae platforms and a LIGASORB\u00ae adsorber to eliminate anti-acetylcholine receptor antibodies. Local anticoagulation was performed with citrate. Treatment time for immunoadsorption was 1.5 h with a blood flow of 50 mL\/min. A total plasma volume of 1.2 L was processed. Further medical treatment included intravenous fluid therapy, maropitant, esomeprazole, antibiotic therapy for aspiration pneumonia and neostigmine 0.04 mg\/kg intramuscularly every 6 h for treatment of acquired myasthenia gravis. Mechanical ventilation was stopped after 12 h. A percutaneous gastric feeding tube was inserted under endoscopic control on day 2 for further medical treatment and nutrition. A second treatment with immunoadsorption was performed on day 3. Again, a total plasma volume of 1.2 L was processed. Immediately after this procedure, the dog regained muscle strength and was able to stand and to walk. After 6 days, the dog was discharged from the hospital. This is the first report of immunoadsorption for emergency management of a dog with acute-fulminant acquired myasthenia gravis. Immunoadsorption may be an additional option for emergency treatment in dogs with severe signs of acquired myasthenia gravis.<\/jats:p>","DOI":"10.3390\/ani14010033","type":"journal-article","created":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T03:36:17Z","timestamp":1703129777000},"page":"33","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Successful Emergency Management of a Dog with Ventilator-Dependent Acquired Myasthenia Gravis with Immunoadsorption"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7721-8847","authenticated-orcid":false,"given":"Florian","family":"S\u00e4nger","sequence":"first","affiliation":[{"name":"LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, 80539 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefanie","family":"D\u00f6rfelt","sequence":"additional","affiliation":[{"name":"AniCura Veterinary Hospital Haar, 85540 Haar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bettina","family":"Giani","sequence":"additional","affiliation":[{"name":"LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, 80539 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gesine","family":"Buhmann","sequence":"additional","affiliation":[{"name":"LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, 80539 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Fischer","sequence":"additional","affiliation":[{"name":"LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, 80539 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1831-377X","authenticated-orcid":false,"given":"Ren\u00e9","family":"D\u00f6rfelt","sequence":"additional","affiliation":[{"name":"LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, 80539 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/S0165-2427(99)00058-6","article-title":"Acquired myasthenia gravis: What we have learned from experimental and spontaneous animal models","volume":"69","author":"Shelton","year":"1999","journal-title":"Vet. Immunol. Immunopathol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.nmd.2016.03.002","article-title":"Myasthenia gravis and congenital myasthenic syndromes in dogs and cats: A history and mini-review","volume":"26","author":"Shelton","year":"2016","journal-title":"Neuromuscul. Disord."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.1111\/jvim.16223","article-title":"Clinical features and outcome of acquired myasthenia gravis in 94 dogs","volume":"35","author":"Forgash","year":"2021","journal-title":"J. Vet. Intern. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/S1474-4422(21)00357-4","article-title":"Advances in the understanding of disease mechanisms of autoimmune neuromuscular junction disorders","volume":"21","author":"Huijbers","year":"2022","journal-title":"Lancet Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1016\/j.cvsm.2020.07.015","article-title":"Use of Human Intravenous Immunoglobulin in Veterinary Clinical Practice","volume":"50","author":"Spurlock","year":"2020","journal-title":"Vet. Clin. Small Anim. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1111\/jvim.15855","article-title":"Classification of myasthenia gravis and congenital myasthenic syndromes in dogs and cats","volume":"34","author":"Mignan","year":"2020","journal-title":"J. Vet. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1111\/j.1939-165X.2010.00244.x","article-title":"Routine and specialized laboratory testing for the diagnosis of neuromuscular diseases in dogs and cats","volume":"39","author":"Shelton","year":"2010","journal-title":"Vet. Clin. Pathol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/S0165-2427(00)00255-5","article-title":"Titin and ryanodine receptor autoantibodies in dogs with thymoma and late-onset myasthenia gravis","volume":"78","author":"Shelton","year":"2001","journal-title":"Vet. Immunol. Immunopathol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0195-5616(03)00085-8","article-title":"Myasthenia gravis and disorders of neuromuscular transmission","volume":"32","author":"Shelton","year":"2002","journal-title":"Vet. Clin. Small Anim. Pract."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1111\/j.1476-4431.2011.00636.x","article-title":"Myasthenia gravis in dogs with an emphasis on treatment and critical care management","volume":"21","author":"Khorzad","year":"2011","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1016\/j.cvsm.2004.05.012","article-title":"Feline neuromuscular disorders","volume":"34","author":"Dickinson","year":"2004","journal-title":"Vet. Clin. Small Anim. Pract."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"664","DOI":"10.2460\/javma.236.6.664","article-title":"Mycophenolate mofetil treatment in dogs with serologically diagnosed acquired myasthenia gravis: 27 cases (1999\u20132008)","volume":"236","author":"Dewey","year":"2010","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1111\/j.1748-5827.2011.01024.x","article-title":"Immunomodulatory drugs and their application to the management of canine immune-mediated disease","volume":"52","author":"Whitley","year":"2011","journal-title":"J. Small Anim. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"886625","DOI":"10.3389\/fneur.2022.886625","article-title":"Corticosteroid Treatment-Resistance in Myasthenia Gravis","volume":"13","author":"Kaminski","year":"2022","journal-title":"Front. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1111\/j.1476-4431.2011.00669.x","article-title":"Outcome and medical management in dogs with lower motor neuron disease undergoing mechanical ventilation: 14 cases (2003\u20132009)","volume":"21","author":"Rutter","year":"2011","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1007\/s00415-016-8045-z","article-title":"Clinical features, pathogenesis, and treatment of myasthenia gravis: A supplement to the Guidelines of the German Neurological Society","volume":"263","author":"Melzer","year":"2016","journal-title":"J. Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/S1096-2867(97)80030-8","article-title":"Therapeutic plasmapheresis","volume":"12","author":"Bartges","year":"1997","journal-title":"Semin. Vet. Med. Surg. (Small Anim.)"},{"key":"ref_18","unstructured":"Allen, A.E., Bandt, C., and Bolfer, L. (2015, January 3\u20135). Concepts and clinical applications for therapeutic plasma exchange and plasmapheresis in small animal critical care medicine. Proceedings of the Emerg\u00eancia e Intensivismo, Encontro Ventil De Residentes Em Medicina Veterinaria, Centro de Conven\u00e7\u00f5es Expo Dom Pedro, Campinas, SP, Brazil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.12688\/f1000research.11841.1","article-title":"Plasmapheresis in neurological disorders: Six years experience from University Clinical center Tuzla","volume":"6","author":"Burina","year":"2017","journal-title":"F1000Research"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e211","DOI":"10.1002\/vrc2.211","article-title":"Feline acquired thymoma-associated myasthenia gravis managed with surgery and therapeutic plasma exchange","volume":"9","author":"Fischer","year":"2021","journal-title":"Vet. Rec. Case Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1002\/jca.21705","article-title":"Guidelines on the Use of Therapeutic Apheresis in Clinical Practice\u2014Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue","volume":"34","author":"Padmanabhan","year":"2019","journal-title":"J. Clin. Apher."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.2460\/javma.1990.196.08.1276","article-title":"Clinical remission following plasmapheresis and corticosteroid treatment in a dog with acquired myasthenia gravis","volume":"196","author":"Bartges","year":"1990","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1111\/vec.13022","article-title":"Concepts and clinical applications for therapeutic plasma exchange and plasmapheresis in small animal critical care medicine","volume":"31","author":"Vitalo","year":"2021","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.bbi.2006.10.001","article-title":"Possible therapeutic vaccines for canine myasthenia gravis: Implications for the human disease and associated fatigue","volume":"21","author":"Galin","year":"2007","journal-title":"Brain Behav. Immun."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2017","DOI":"10.1517\/13543784.9.9.2017","article-title":"Immunoadsorption, current status and future developments","volume":"9","author":"Braun","year":"2000","journal-title":"Expert Opin. Investig. Drugs"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.transci.2017.08.013","article-title":"Immunoadsorption in neurological disorders","volume":"56","author":"Oji","year":"2017","journal-title":"Transfus. Apher. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1002\/jca.21913","article-title":"Immunoadsorption in a dog with severe immune mediated hemolytic anemia","volume":"36","author":"Richter","year":"2021","journal-title":"J. Clin. Apher."},{"key":"ref_28","unstructured":"Bauer, H., Schmitz, A., and Fischer, A. (2023, January 21\u201323). Clinical validation of a new radioimmunoassay for the diagnosis of myasthenia gravis in dogs. Proceedings of the ECVN Congress, Venice, Italy."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"55","DOI":"10.2460\/javma.2000.216.55","article-title":"Risk factors for acquired myasthenia gravis in cats: 105 cases (1986\u20131998)","volume":"216","author":"Shelton","year":"2000","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1080\/13543776.2017.1272571","article-title":"Recent advances in acetylcholinesterase Inhibitors and Reactivators: An update on the patent literature (2012\u20132015)","volume":"27","author":"McHardy","year":"2017","journal-title":"Expert Opin. Ther. Pat."},{"key":"ref_31","first-page":"169","article-title":"Acquired myasthenia gravis in a poodle","volume":"52","author":"Richardson","year":"2011","journal-title":"Can. Vet. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1038\/ncpneuro0810","article-title":"Steroids and immunosuppressant drugs in myasthenia gravis","volume":"4","author":"Sathasivam","year":"2008","journal-title":"Nat. Clin. Pract. Neurol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/j.1939-1676.1997.tb00073.x","article-title":"Clinical Forms of Acquired Myasthenia Gravis in Dogs: 25 Cases (1988\u20131995)","volume":"11","author":"Dewey","year":"1997","journal-title":"J. Vet. Intern. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1002\/mus.1220","article-title":"Steroids are overutilized","volume":"25","author":"Rivner","year":"2002","journal-title":"Muscle Nerve"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1111\/j.1476-4431.2009.00433.x","article-title":"Use of mycophenolate mofetil as a rescue agent in the treatment of severe generalized myasthenia gravis in three dogs","volume":"19","author":"Abelson","year":"2009","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"396","DOI":"10.5326\/15473317-35-5-396","article-title":"Azathioprine therapy for acquired myasthenia gravis in five dogs","volume":"35","author":"Dewey","year":"1999","journal-title":"J. Am. Anim. Hosp. Assoc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1111\/j.1939-1676.2006.tb00771.x","article-title":"Management of Myasthenia Gravis Using Cyclosporine in 2 Dogs","volume":"20","author":"Bexfield","year":"2006","journal-title":"J. Vet. Intern. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/S0165-2427(99)00059-8","article-title":"A review of immunologic diseases of the dog","volume":"69","author":"Pedersen","year":"1999","journal-title":"Vet. Immunol. Immunopathol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"662856","DOI":"10.3389\/fneur.2021.662856","article-title":"Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence","volume":"12","author":"Ipe","year":"2021","journal-title":"Front. Neurol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s13760-016-0689-z","article-title":"A comparison between IVIG and plasma exchange as preparations before thymectomy in myasthenia gravis patients","volume":"117","author":"Shojaei","year":"2017","journal-title":"Acta Neurol. Belg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1007\/s11748-005-1001-y","article-title":"Beneficial effects of plasmapheresis before thymectomy on the outcome in myasthenia gravis","volume":"53","author":"Nagayasu","year":"2005","journal-title":"Jpn. J. Thorac. Cardiovasc. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1080\/08916934.2016.1214823","article-title":"Effect of therapeutic plasma exchange on immunoglobulins in myasthenia gravis","volume":"49","author":"Guptill","year":"2016","journal-title":"Autoimmunity"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1111\/bjh.12629","article-title":"The mechanisms of action of plasma exchange","volume":"164","author":"Reeves","year":"2014","journal-title":"Br. J. Haematol."},{"key":"ref_44","first-page":"419","article-title":"International consensus guidance for management of myasthenia gravis","volume":"87","author":"Sanders","year":"2016","journal-title":"Exec. Summ."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"403","DOI":"10.3389\/fimmu.2017.00403","article-title":"Dual Role of Fas\/FasL-Mediated Signal in Peripheral Immune Tolerance","volume":"8","author":"Yamada","year":"2017","journal-title":"Front. Immunol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1023\/A:1006650812886","article-title":"IgG Anti-IgA Subclasses in Common Variable Immunodeficiency and Association with Severe Adverse Reactions to Intravenous Immunoglobulin Therapy","volume":"20","author":"Sato","year":"2000","journal-title":"J. Clin. Immunol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1111\/j.1365-3148.2010.01022.x","article-title":"Use of intravenous immune globulin in the ICU: A retrospective review of prescribing practices and patient outcomes","volume":"20","author":"Foster","year":"2010","journal-title":"Transfus. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.jaci.2010.10.030","article-title":"The IgG molecule as a biological immune response modifier: Mechanisms of action of intravenous immune serum globulin in autoimmune and inflammatory disorders","volume":"127","author":"Ballow","year":"2011","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1345\/aph.19252","article-title":"A Multicenter Drug Use Surveillance of Intravenous Immunoglobulin Utilization in US Academic Health Centers","volume":"34","author":"Chen","year":"2000","journal-title":"Ann. Pharmacother."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1111\/j.1939-1676.1997.tb00475.x","article-title":"Intravenous human immunoglobulin for the treatment of immune-mediated hemolytic anemia in 13 dogs","volume":"11","author":"Kellerman","year":"1997","journal-title":"J. Vet. Intern. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"15002","DOI":"10.1038\/sigtrans.2015.2","article-title":"Intravenous immune globulin suppresses angiogenesis in mice and humans","volume":"1","author":"Yasuma","year":"2016","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.2460\/javma.1995.206.12.1895","article-title":"Treatment of nonregenerative anemia with human gamma-globulin in dogs","volume":"206","author":"Reagan","year":"1995","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1136\/jnnp-2011-301449","article-title":"Changes in quality of life scores with intravenous immunoglobulin or plasmapheresis in patients with myasthenia gravis","volume":"84","author":"Barnett","year":"2013","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2017","DOI":"10.1212\/WNL.0b013e31821e5505","article-title":"Comparison of IVIg and PLEX in patients with myasthenia gravis","volume":"76","author":"Barth","year":"2011","journal-title":"Neurology"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1002\/ana.410410615","article-title":"Clinical trial of plasma exchange and high-dose intravenous immunoglobulin in myasthenia gravis","volume":"41","author":"Gajdos","year":"1997","journal-title":"Ann. Neurol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1212\/WNL.52.3.629","article-title":"Plasma exchange versus intravenous immunoglobulin treatment in myasthenic crisis","volume":"52","author":"Qureshi","year":"1999","journal-title":"Neurology"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1002\/ana.22139","article-title":"Comparative analysis of therapeutic options used for myasthenia gravis","volume":"68","author":"Mandawat","year":"2010","journal-title":"Ann. Neurol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.2460\/javma.1997.211.11.1428","article-title":"Risk factors for acquired myasthenia gravis in dogs: 1154 cases (1991\u20131995)","volume":"211","author":"Shelton","year":"1997","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_59","first-page":"143","article-title":"Diagnostic and clinical classification of autoimmune myasthenia gravis","volume":"48\u201349","author":"Eymard","year":"2014","journal-title":"J. Autoimmun."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/S1474-4422(15)00145-3","article-title":"Myasthenia gravis: Subgroup classification and therapeutic strategies","volume":"14","author":"Gilhus","year":"2015","journal-title":"Lancet Neurol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1177\/1941875210382918","article-title":"Myasthenic Crisis","volume":"1","author":"Wendell","year":"2011","journal-title":"Neurohospitalist"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1212\/WNL.45.2.338","article-title":"Treatment of myasthenia gravis by immunoadsorption of plasma","volume":"45","author":"Grob","year":"1995","journal-title":"Neurology"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1136\/jnnp.57.5.578","article-title":"Immunoadsorption therapy for myasthenia gravis","volume":"57","author":"Shibuya","year":"1994","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1177\/1756285616637046","article-title":"Immunoadsorption versus plasma exchange versus combination for treatment of myasthenic deterioration","volume":"9","author":"Krenzer","year":"2016","journal-title":"Ther. Adv. Neurol. Disord."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1002\/jca.20317","article-title":"A randomized and controlled study comparing immunoadsorption and plasma exchange in myasthenic crisis","volume":"26","author":"Bucka","year":"2011","journal-title":"J. Clin. Apher."}],"container-title":["Animals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2615\/14\/1\/33\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:39:24Z","timestamp":1760132364000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2615\/14\/1\/33"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,21]]},"references-count":65,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["ani14010033"],"URL":"https:\/\/doi.org\/10.3390\/ani14010033","relation":{},"ISSN":["2076-2615"],"issn-type":[{"type":"electronic","value":"2076-2615"}],"subject":[],"published":{"date-parts":[[2023,12,21]]}}}