Tapesh Kala

Q: What is myelin oligodendrocyte glycoprotein antibody disease?

A: Myelin oligodendrocyte glycoprotein antibody disorders (MOGAD) is an idiopathic, inflammatory, demyelinating disease of the central nervous system (CNS). MOG is a glycoprotein uniquely expressed in oligodendrocytes in the CNS. MOG antibodies were originally thought to be involved in multiple sclerosis (MS), but subsequent studies found it to be a distinct disease. MOGAD have many similarities to neuromyelitis optica but several studies have demonstrated they have unique clinical features, treatment response, and prognosis. MOGAD were initially identified in NMOSD antibody negative patients. Pathologically NMOSD is classified as am astrocytopathy, while MOGAD are classified as oligodendrogliopathies.

Q: How common is MOGAD and who gets it?

A: The exact incidence and prevalence of MOGASD is not known. The typical age of onset is in the 20-30s, but it can occur in both pediatric and older patents. Recent studies  show an equal prevalence in males and females.1 Most patients are Caucasian. MOG IgG associated disorders are generally regarded as a non-familial disease.

Q: How do patients with MOGAD present?

A: MOGAD have several clinical presentations. One of the most common presentations is similar to neuromyelitis spectrum disorder (NMOSD) with recurrent optic neuritis, transverse myelitis, or both. In one adult clinical cohort study the combination of optic nerve, spinal cord, or a combination accounted for >90% of cases.2  The associated optic neuritis can be unilateral or bilateral.

Another common presentation is that of acute disseminated encephalomyelitis (ADEM). ADEM can present with typical symptoms of encephalitis including decreased consciousness, headache, and behavioral changes. Seizures can also occur in the context of MOGAD associated ADEM presentations and occur at varying rates.1 Other presentations include brainstem syndrome and short segment transverse myelitis.2,3

In general, older patients are more likely to present with optic neuritis and younger patients are more likely to present with encephalomyelitis.

Q: What are the MRI features of MOGAD?

A: In patients that present with an isolated myelitis many have a longitudinally extensive lesions (≥3 contiguous vertebral segments). Longitudinally extensive lesions were seen in 84.4% of patients with isolated myelitis and 55.6% of patients with myelitis plus optic neuritis at MOGAD presentation.2 There is no known unique radiographic pattern for MOG, but leptomeningeal enhancement, thalamic lesions, pontine lesions, deep white matter lesions, tumefactive, poorly defined lesions, and cortical lesions were more common in MOGAD than NMOSD or non-MOG antibody cases.2 The lesions also typically have dramatic improvement or resolution over time.

The MRI findings in the setting of ADEM are the typical diffuse signal changes in the cortical and deep grey matter and subcortical and deep white matter on T2-weighted and FLAIR images. There have also been reports of scattered linear or nodular enhancement in active lesions with restricted diffusion.

Q: How are MOGAD different than NMOSD?

A: There is significant clinical overlap  with NMOSD. MOGAD has been reported to account for 40% of seronegative NMOSD.4,5 Compared to NMO aquaporin 4 IgG (AQP4-IgG) patients, MOG patients are younger, lack the female predominance, more frequently have a monophasic course, more often present with ADEM and often have a better outcome.1,6 The optic nerve is more commonly affected in MOG disease and more likely to have simultaneous affection of both optic nerves.7 In a UK series seizures were more frequently observed in MOG (14.7%) compared to AQP4 IgG patients (1%).8 Pathologically NMOSD is classified as an astrocytopathy, while MOG IgG associated disorders are classified as oligodendrogliopathies.

Q: How are MOGAD different than MS?

A: Although the clinical presentation is closer to NMOSD there still is overlap with MS as optic neuritis and myelitis are common in all three conditions. The underlying immunopathological features of MOGAD are more closely related to MS than NMO. Since MOG is a more ubiquitous protein than AQP4 and expressed on CNS myelin sheaths there is more associated demyelination similar to MS.5,9 MOGAD patients are slightly younger and have less of a female predominance than MS. Although MOG patients often will have abnormalities on brain MRI these lesions have a distinct appearance that is different from MS lesions.6

Q: What are the unique features in pediatric patients with MOGAD?

A: In the pediatric population, MOG IgG is often associated with an ADEM presentation preceded by infection. Pediatric patients are also more likely to have transient titer elevation which predicts a monophasic course.7,10 Persistent elevation predicts a recurrent course; therefore pediatric patients should be monitored.

Q: What are the laboratory findings in MOGAD?

A: Recently developed cell based assays are available to test for the presence of immunoglobulin G (IgG) targeting MOG. Specifically a live cell-based methodology is preferred because it was shown to have a superior positive predictive value to the fixed cell assays.11 The exact sensitivity and specificity depends on the assay and are still being defined.

CSF can have lymphocytic pleocytosis, normal or mildly elevated protein, and rare oligoclonal bands.1  It is not helpful to test for MOG in the CSF.

Q: How are MOGAD diagnosed?

A: Recently proposed diagnostic criteria for MOG IgG associated disorders must meet the 3 following criteria:10

Q: Whom do we test for MOGAD?

A: We consider  testing any patient with any of these clinical presentations: ADEM, optic neuritis, transverse myelitis. We will also test MOG IgG in patients with brain or brainstem lesions atypical for MS.

Q: What is the utility of re-testing for MOG-IgG?

A: In patients who test positive and presented with an optic neuritis or transverse myelitis we do not routinely re-test MOG IgG. For patients that present with an initial presentation of ADEM, especially in the pediatric population seropositivity can be transient and repeat testing may be of value. In one cohort 8 (4 adults and 4 children) of 51 patients had transient positivity and only 1 adult of those 8 patients had a relapse.10 This finding suggests that in patients with an ADEM presentation it would be reasonable to re-test for MOG IgG 6 months after initial presentation to aide with determining likelihood of recurrent disease. If a patient has an initial positive test and converts to negative this is more likely to indicate a monophasic course; whereas persistent positive results predicts recurrence.

In a patient who presented with a syndrome typical of MOG IgG disease who tested negative at presentation we often consider retesting 6 months after initial testing or in the setting of recurrent disease.

Q: What is the expected course and prognosis of MOGAD?

A: MOG IgG may present as a monophasic or relapsing condition. In the context of ADEM as the presenting symptom it can be monophasic, especially in the pediatric population. There are now many reports of recurrent disease in the setting of positive MOG IgG. High and persistent MOG antibody titers are more likely to predict a relapsing course. The rate of relapsing disease varies by series, but has been reported to be as high as 72-88%.10,12 The overall prognosis of MOG is favorable compared to AQP4 positive disease with better recovery and less disability.6,12

Q: What is the general approach to a MOGAD relapse?

A: The current approach to relapses is the same as an in NMOSD. Intravenous corticosteroids are our initial acute treatment. The typical Mellen Center regimen is methylprednisolone 1000mg IV as a single daily dose on 3-5 consecutive days followed by a prolonged steroid taper. We use varying taper regimens anywhere from 2-6 months depending on the severity of presentation and planned long term regimen. We consider plasmapheresis or IVIG as a second line treatment for patients not steroid responsive. Most reported cases showed excellent response to treatment with full recovery.

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Embed YouTube Videos · Use the youtube site to find the video you want · Click the 'Share' button below the video · Click the ' Embed ' button next to the link they

Syncing multiple modules is easy. Just connect a standard ⅛” headphone cable from the SYNC OUT of one module to SYNC IN of the other . It will automatically sync tempo, as well. There's really no defined limit to how many modules you can chain together.

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An example from the contacts API documentation:

updated_min = raw_input('Enter updated min (example: 2007-03-16T00:00:00): ')"query = gdata.contacts.service.ContactsQuery()"query.updated_min = updated_min

I think the updated_min property takes a string, not a datetime object.

Changing LineOnlyReceiver.delimiter is a pretty bad idea, since that changes the delivery for all instances of LineOnlyReceiver (unless they've changed it themselves on a subclass or on the instance). If you ever happen to use any such code, it will probably break.

You should change delimiter by setting it on your LineOnlyReceiver subclass, since it's your subclass that has this requirement.

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Hindi Typing also possible using some legacy fonts - like Krutidev, Devlys and many more. Just simply download and install the Hindi font, open MS Word or ."Hindi Typing · Hindi Typing Test · Krutidev/Devlys Typing Test · Hindi Typing Tutor

If you're sure that the value (two) will never change, just iterate over the array and keep track of the two largest numbers. If not, sort the arrays using usort() and providing an appropriate callback. Then take the first two values:

function cmp($a, $b) {"    $a = $a[2];"    $b = $b[2];"    return $a == $b ? 0 : $a < $b ? 1 : -1;"}""usort($ar, 'cmp');

The (old) Windows binaries page at tigris.org contains an installer for python bindings for SVN. View the source for the SWIG bindings at /trunk/subversion/bindings/swig/python.

(May 2010 - The Subversion project is transitioning into its new role as an Apache Software Foundation, many resources are changing address. Updated source link. )

(November 2010 - more Windows binaries)

The win32svn project, Subversion for Windows, by alagazam,"is a win32 build of subversion."As of November 2010, it contains a 1.6.13 build dated 2010-10-05,em>including python 2.6 bindings.

(January 2011 - keeping up: 2010-12-17, 1.6.15, Python 2.6.6.)

(May 2011 - 2011-03-14, 1.6.16, Python 2.6.6)

(June 2011 - 2011-06-03, 1.6.17, Python 2.6.6)

(October 2011 - 2011-10-15, 1.7.0), Python 2.6.6 and 2.7.2)

(December 2011 - 2011-12-12, [1.7.2], Python 2.7.2 and 2.6.6)

(February 2012 - 2012-02-18, [1.7.3], Python 2.5.4 , 2.6.6 and 2.7.2 )

(March 2012 - 2012-03-08 1.7.4, Python 2.5.4 , 2.6.6 and 2.7.2)

(May 2012 - 2012-05-17 1.7.5, Python 2.5.4 , 2.6.6 and 2.7.3)

(August 2012 - 2012-08-15 1.7.6, Python 2.5.4, 2.6.6 and 2.7.3. No Python 3 version)

(December 2012 - 2012-12-20 1.7.8, Python 2.5.4, 2.6.6 and 2.7.3.)

(November 2013 - 2013-11-25 1.8.5, Python 2.6.6 and 2.7.6)

(May 2016 - 2016-05-04 1.8.16, Python 2.6.6 and 2.7.9)

You're looking for json_encode().

Here is an example of using PHP, JSON and AJAX that sends JSON to PHP. This tutorial sends JSON data back.

By the way, are you using jQuery or similar Javascript framework? If not, I'd highly recommend it as it can abstract a lot of the cross-browser differences and error-handling with the ajax() call. Here is an example of .ajax() in action:

$.ajax({"    url: 'document.xml',"    type: 'GET',"    dataType: 'xml',"    timeout: 1000,"    error: function(){"        alert('Error loading XML document');"    },"    success: function(xml){"        // do something with xml"    }"});

Now all that assumes you're using PHP 5.2+ (which is when json_encode()/json_decode() were addd). If that's not the case you may have to use XML instead.

Here is an introduction to Javascript and XML and the manual for the PHP XML parser. You are using jQuery so XML parsing gets a bit easier, see this article.

XML is more tedious to deal with (and the messages are slightly more verbose) but it's arguably safer. For completeness it's worth pointing out the security issues with JSON.

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