{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T04:41:21Z","timestamp":1762058481004,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2022,7,12]],"date-time":"2022-07-12T00:00:00Z","timestamp":1657584000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>According to the American Academy of Neurology 2011 guidelines, there is insufficient evidence to support or refute the use of therapeutic plasma exchange (TPE) for myasthenia gravis (MG). The goal of this study was to determine whether a novel nanomembrane-based TPE could be useful in the treatment of MG. Thirty-six adult patients, MGFA 4\/4B and 5, with acute MG episodes were enrolled into a single-center retrospective before-and-after study to compare a conventional treatment group (n = 24) with a nanomembrane-based TPE group (n = 12). TPE or intravenous immunoglobulins (IVIG) infusions were used in impending\/manifested myasthenic crises, especially in patients at high-risk for prolonged invasive ventilation (IMV) and in those tolerating non-invasive ventilation (NIV). The clinical improvement was assessed using the Myasthenia Muscle Score (0\u2013100), with \u226520 increase for responders. The primary outcome measures included the rates of implemented TPE, IVIG, and corticosteroids immunotherapies, NIV\/IMV, early tracheotomy, MMS scores, extubation time, neuro-ICU\/hospital LOS, complications, and mortality rates. The univariate analysis found that IMV was lower in the nanomembrane-based group (42%) compared to the conventional treatment group (83%) (p = 0.02). The multivariate analysis using binary logistic regression revealed TPE and NIV as independent predictors for short-term (\u22647 days) respiratory support (p = 0.014 for TPE; p = 0.002 for NIV). The novel TPE technology moved our clinical practice towards proactive rather than protective treatment in reducing prolonged IMV during MG acute exacerbations.<\/jats:p>","DOI":"10.3390\/jcm11144021","type":"journal-article","created":{"date-parts":[[2022,7,12]],"date-time":"2022-07-12T03:50:36Z","timestamp":1657597836000},"page":"4021","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Our Clinical Experience in the Treatment of Myasthenia Gravis Acute Exacerbations with a Novel Nanomembrane-Based Therapeutic Plasma Exchange Technology"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4408-6443","authenticated-orcid":false,"given":"Dimitar","family":"Tonev","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Medical University of Sofia, Academician Ivan Geshov Blvd 15, 1431 Sofia, Bulgaria"},{"name":"Department of Anesthesiology and Intensive Care, University Hospital \u201cTsaritsa Yoanna-ISUL\u201d, Belo More Str. 8, 1527 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radostina","family":"Georgieva","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Medical University of Sofia, Academician Ivan Geshov Blvd 15, 1431 Sofia, Bulgaria"},{"name":"Neurological Intensive Care Unit, Department of Neurology, University Hospital \u201cTsaritsa Yoanna-ISUL\u201d, Belo More Str. 8, 1527 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evgeniy","family":"Vavrek","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Medical University of Sofia, Academician Ivan Geshov Blvd 15, 1431 Sofia, Bulgaria"},{"name":"Neurological Intensive Care Unit, Department of Neurology, University Hospital \u201cTsaritsa Yoanna-ISUL\u201d, Belo More Str. 8, 1527 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2570","DOI":"10.1056\/NEJMra1602678","article-title":"Myasthenia Gravis","volume":"375","author":"Gilhus","year":"2016","journal-title":"N. 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