Background: The swift shift toward internet hospitals has relied on the willingness of medical practitioners to embrace new systems and workflows. Low engagement or acceptance by medical practitioners leads to difficulties in patient access. However, few investigations have focused on barriers and facilitators of adoption of internet hospitals from the perspective of medical practitioners. Objective: This study aims to identify both enabling and inhibiting predictors associated with resistance and behavioral intentions of medical practitioners to use internet hospitals by combining the conservation of resources theory with the Unified Theory of Acceptance and Use of Technology and technostress framework. Methods: A mixed methods research design was conducted to qualitatively identify the factors that enable and inhibit resistance and behavioral intention to use internet hospitals, followed by a quantitative survey-based study that empirically tested the effects of the identified factors. The qualitative phase involved conducting in-depth interviews with 16 experts in China from June to August 2022. Thematic analysis was performed using the qualitative data analysis software NVivo version 10 (QSR International). On the basis of the findings and conceptual framework gained from the qualitative interviews, a cross-sectional, anonymous, web-based survey of 593 medical practitioners in 28 provincial administrative regions of China was conducted. The data collected were analyzed using the partial least squares method, with the assistance of SPSS 27.0 (IBM Corp) and Mplus 7.0 (Muthen and Muthen), to measure and validate the proposed model. Results: On the basis of qualitative results, this study identified 4 facilitators and inhibitors, namely performance expectancy, social influence, work overload, and role ambiguity. Of the 593 medical practitioners surveyed in the quantitative research, most were female (n=364, 61.4%), had a middle title (n=211, 35.6%) or primary title (n=212, 35.8%), and had an average use experience of 6 months every year. By conducting structural equation modeling, we found that performance expectancy (β=−.55; P<.001) and work overload (β=.16; P=.005) had the most significant impact on resistance to change. Resistance to change fully mediated the influence of performance expectancy and partially mediated the influences of social influence (variance accounted for [VAF]=43.3%; P=.002), work overload (VAF=37.2%; P=.03), and role ambiguity (VAF=12.2%; P<.001) on behavioral intentions to use internet hospitals. In addition, this study found that the sex, age, professional title, and use experience of medical practitioners significantly moderated the aforementioned influencing mechanisms. Conclusions: This study investigated the factors that facilitate or hinder medical practitioners’ resistance to change and their behavioral intentions to use internet hospitals. The findings suggest that policy makers avoid the resistance and further promote the adoption of internet hospitals by ensuring performance expectancy and social influence and eliminating work overload and role ambiguity.

Background: The study assessed group differences in the thalamus microstructural parameters among healthy individuals and relapsing-remitting multiple sclerosis (RRMS) patients and examined the relationship between quantitative MRI (qMRI) parameters and neurological scores, T2 lesion load, and serum neurofilament light chain (sNfL) levels. Methods: A total of 30 patients with RRMS and 26 age- and sex-matched healthy controls were recruited in this study. The qMRI images were obtained from these individuals. T2 lesion load, thalamic volume, and parameters of thalamic subnuclei were estimated. The neurological functions of participants were assessed using a battery of tests. sNfL concentrations were measured using the single molecule array (SIMOA) technique. Results: T2 relaxometry in the whole thalamus and its subnuclei were increased, and showed an apparent correlation with T2 lesion load and the severity of MS (EDSS, MSSS, 9HPT, T25FW, SDMT). T1 variability was prolonged in most thalamic subnuclei, and it was correlated with the severity of MS (EDSS, 9HPT, SDMT). Thalamic volumetric parameters of MS patients were smaller than those of healthy controls (p < 0.001) and showed an apparent correlation with MS severity. Surprisingly, sNfL levels showed no correlation with T2 relaxometry, T1 variability, or thalamic volumetric parameters. Conclusion: Quantitative synthetic MRI, especially, the metric T2 relaxation times provides a surrogate parameter for assessing underlying thalamic and subnuclei damage in the RRMS group. Integrating structural and quantitative MRI allows a better assessment of the neurodegeneration in the normal-appearing thalamus of RRMS.

Background: Efgartigimod is a neonatal Fc receptor (FcRn) antagonist that reduces pathogenic IgG and improves clinical symptoms in generalized myasthenia gravis (gMG). However, its immunomodulatory effects on innate and adaptive immune cells beyond IgG depletion are rarely reported. Objective: This study aimed to investigate clinical and immunological responses during the initial treatment cycle of efgartigimod in naive acetylcholine receptor antibody‐positive (AChR‐Ab+) gMG patients, with a focus on peripheral immune cell dynamics. Methods: We conducted a longitudinal study between October 23, 2023, and December 10, 2024, based on the database of the Clinical Cohort Study of Myasthenia Gravis at Xuanwu Hospital, Capital Medical University. Seventeen naive AChR‐Ab+ gMG patients were enrolled after applying strict inclusion and exclusion criteria and received a four‐dose regimen of efgartigimod. Clinical efficacy was evaluated using Myasthenia Gravis Activities of Daily Living (MG‐ADL) and Quantitative Myasthenia Gravis (QMG) scores. Serum total IgG and AChR antibody levels were measured. Peripheral immune cell profiling included leukocytes, neutrophils, monocytes, platelets, and natural killer (NK) cells, as well as T and B cell subsets analyzed by flow cytometry. Longitudinal changes were assessed using linear mixed‐effects models. Results: All patients achieved clinical improvement, accompanied by significant reductions in serum total IgG and AChR antibody levels. Neutrophil and leukocyte counts progressively increased and peaked at Week 3 ( p < 0.05), whereas monocyte and platelet counts remained relatively stable throughout all visits. CD4+ and CD8+ T cells decreased transiently at Week 2 and partially recovered by Week 3 ( p = 0.091 and p = 0.005). The CD4/CD8 ratio remained stable. NK cells showed a temporary decrease at Week 2 with a borderline significant time effect ( p = 0.050), followed by partial recovery. Plasmablast proportions significantly increased at Week 2 ( p < 0.05), with a parallel trend in memory B cells. A transient increase in regulatory T cells was observed at Week 1 ( p < 0.05). Similar immune changes were observed in sensitivity analysis without corticosteroid use. Conclusion: This study provides the first longitudinal evidence of dynamic changes in innate and adaptive immune compartments during efgartigimod therapy in naive gMG patients. Beyond IgG clearance, efgartigimod might exert targeted immunoregulatory effects on neutrophils and lymphocyte subsets. These findings offer new insights into the broader immunological impact of FcRn‐targeted therapy in gMG and underscore the need for further mechanistic and functional studies.

Objectives: Myasthenia Gravis (MG) is an autoimmune disorder that can exacerbate for various reasons, including vaccination and infection. This study aimed to investigate the safety of COVID-19 vaccines for MG patients, factors influencing MG exacerbation after COVID-19 infection (MECI), the course and prognosis of MECI, and the impact of COVID-19 vaccine on infected MG patients. Methods: Patients were enrolled from the MG database in the Department of Neurology, Xuanwu Hospital, Capital Medical University. Two questionnaires were administered to collect data concerning COVID-19 vaccination (questionnaire 1, Q1) and infection (questionnaire 2, Q2) during two distinct periods. MG exacerbation was defined as an increase of at least two points in the MG activity of daily living (MG-ADL) score. COVID-19 severity was categorized as “hospitalization” or “home management”; Results: During the first data-collecting period, our database registered 1013 adult patients: 273 (26.9%) had received COVID-19 vaccinations and completed Q1, and 8 (2.9%) experienced MG exacerbation after vaccination. During the second data-collecting period, among the newly registered patients, 366 patients completed Q2. Of these, 244 were infected, with 39 (16.0%) experiencing MECI and 21 (8.6%) requiring hospitalization. Multivariate analysis showed that generalized myasthenia gravis was associated with MECI (OR 3.354, 95% CI: 1.423–7.908, p = 0.006). Among the 244 infected patients, 143 had received COVID-19 vaccinations, including 14 who received their booster dose within 6 months before COVID-19 and 129 who were vaccinated more than 6 months before COVID-19. The remaining 101 were unvaccinated. No significant associations were found between COVID-19 vaccination and COVID-19 severity (p = 0.292) or MECI incidence (p = 0.478); Conclusions: COVID-19 vaccines were found to be safe for MG patients in stable condition. Patients with gMG were more susceptible to experiencing MECI. No significant impact of the vaccine on COVID-19 severity or MECI incidence was observed.

Aims: To identify factors influencing remission and relapse, and to evaluate the safety of tacrolimus monotherapy (TAMO) in adult‐onset mild‐to‐moderate myasthenia gravis (MG). Methods: This retrospective analysis was conducted on MG patients receiving TAMO. Remission was defined as achieving minimal symptom expression (MSE), and multivariable Cox regression analysis identified predictors of remission and relapse. Cancer risk was assessed by standardized incidence ratio (SIR), based on the age‐specific cancer incidence rates in China in 2022. Results: Among 153 patients, 77.8% achieved MSE, with a median time of 6.0 months. Age at onset (hazard ratio [HR] = 0.982, 95% confidence interval [CI] = 0.968–0.995, p = 0.009) and new‐onset MG (HR = 2.065, 95% CI = 1.266–3.368, p = 0.004) were independent predictors of time to achieving MSE. The optimal cut‐off value for age at onset was 70 years. Relapse occurred in 31% of patients. Tacrolimus concentration at MSE (HR = 0.815, 95% CI = 0.695–0.956, p = 0.012) and dose reduction speed (HR = 1.717, 95% CI = 1.280–2.305, p < 0.001) were independent predictors of relapse. The cut‐off values were 5.30 ng/mL and 1.08 mg/year, respectively. Adverse drug reactions (ADRs) occurred in 45.0% of the 200 patients receiving TAMO, with hyperglycemia being the most common (17.5%). Eight patients developed cancer, and the SIR was 2.86 (95% CI = 1.23–5.63, p = 0.005) compared with the general Chinese population. Conclusion: TAMO was associated with higher rates of MSE in adult‐onset mild‐to‐moderate MG patients with new‐onset disease or with an onset age ≤ 70 years. To avoid MG relapse, tacrolimus concentration > 5.30 ng/mL at MSE and dose reduction speed ≤ 1.08 mg/year can be considered. Cancer surveillance may be considered for elderly patients undergoing long‐term tacrolimus therapy. Limitations include the retrospective, uncontrolled design, moderate sample sizes, and limited follow‐up duration; thus, long‐term safety, particularly cancer risk, requires further validation.

Background Neurofascin 155 autoimmune nodopathy (NF155 AN) is a recently recognised immune-mediated neuropathy distinct from chronic inflammatory demyelinating polyneuropathy. While adult-onset cases have been increasingly reported, the juvenile-onset form remains poorly characterised. Methods We retrospectively analysed 36 patients with NF155 AN, focusing on detailed characterisation of 16 juvenile-onset cases. Their clinical and laboratory data were reviewed. Results Juvenile-onset patients presented with sensorimotor neuropathy characterised by distal predominant weakness, tremor and sensory ataxia. Motor symptoms were the presenting feature in 75% of patients, which significantly differed from the adult cases (p=0.0015). Postural tremor was more frequent in juvenile patients (94%), while cranial nerve involvement was less common (19%). Electrophysiologically, absent compound muscle action potentials in lower limbs were significantly more prevalent in juvenile patients (peroneal: 78%; tibial: 66%; p<0.001 for both). Symmetrical spinal root/plexus hypertrophy on MR neurography and characteristic pathological findings were observed in both groups. Intravenous immunoglobulin response was generally poor, while delayed rituximab initiation still led to clinical improvement in the juvenile-onset group. Juvenile patients showed trends towards better functional outcomes. Conclusions Juvenile-onset NF155 AN is distinguished by motor-predominant onset, frequent tremor and characteristic electrophysiological abnormalities, yet demonstrates favourable prognosis with B-cell targeted therapy. Early recognition and timely diagnosis are essential for optimal outcomes.