All patients were selected by using the following clinical criteria: (1) the presence Vemurafenib in vitro of fluctuating muscle weakness with early fatigability; (2) positive Prostigmin test; and (3) a rapid reduction in the amplitude of compound muscle action potentials evoked by a series of repetitive stimulations of a peripheral nerve at 3 Hz. The patients were divided into three groups according to pathological changes of thymus: (1) MG with TM; (2) MG with TH; and (3) MG with normal thymi. Thirty-five MG with TM (mean age = 52 ± 15, 20 M/15 F) and 30 MG with TH (mean

age = 58 ± 13, 14 M/16 F) had undergone a thymectomy. The surgical specimens were formalin-fixed and paraffin-embedded for conventional histology study, of which the results were classified according to the pathology and genetics of TM [17]. The normal thymi with CT scan were obtained from 21 patients with MG (mean age = 43 ± 10, 10 M/11 F). The healthy controls (HC) included 32 volunteers (mean age = 50 ± 9, 18 M/14 F). The study was approved by the local ethical committee of the 309 Hospital of Chinese People’s Liberation Army, and written informed consent was obtained from all subjects. Clinical outcome of patients with MG. 

The quantitative myasthenia gravis (QMG) score is a standardized quantitative strength scoring system developed specifically for myasthenia gravis, and it has been recommended for treatment trials by the Myasthenia Gravis Foundation of America Task Force on Research Standards [18]. This score is the sum of 13 components including learn more grade, double vision, ptosis, facial muscles, swallowing, speech after counting aloud from 1 to 50, arm-outstretched seconds, vital capacity, hand grip, head-lifted and leg-outstretched seconds, and each has a range of 0–3, with 0–39 as a total score. QMG score from baseline was calculated to reflect the severity of the disease. Cell isolation, RNA extraction and complementary DNA synthesis.  Twenty millilitres of heparinized venous blood was obtained from each subject before immunotherapy and/or thymectomy. PBMCs were isolated from the heparinized peripheral blood

with standard Ficoll–Paque (GE Healthcare, Uppsala, Sweden) density centrifugation. The mRNA was extracted from PBMCs PAK5 by using an RNeasy kit (Qiagen, Valencia, CA, USA). All samples were treated with DNase I to eliminate potential genomic DNA contamination. The quality and quantity of the RNA were determined by ultraviolet spectrophotometer. Target RNAs were reverse-transcribed by using an Omniscript RT Kit (Qiagen). All samples were treated according to identical protocols and in parallel. RNA and cDNA were stored at −80 °C until further processing. Total RNA isolation and quantitative real-time PCR analysis with reverse transcription.  The cDNAs were analysed by real-time PCR with SYBR Green I Master Mix reagent (TOYOBO, Osaka, Japan) on Rotor Gene 3000 instrument (Corbett Research, Sydney, Australia).