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Irani S, Zebib L, Simons ECG, Andino JJ, Palapattu G, Goh KM. Analyzing the Current State and Visibility of Diversity, Equity, and Inclusion Initiatives at Urology Residency Programs. Urology 2024:S0090-4295(24)00155-9. [PMID: 38508531 DOI: 10.1016/j.urology.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/23/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To analyze AUA urology residency program websites to determine visibility of diversity, equity, and inclusion (DEI) initiatives. There is growing interest in DEI initiatives by urology applicants, and in recent years, urology programs have invested in efforts to promote DEI. METHODS All ACGME-accredited urology residency program with a website were assessed. Military programs were excluded. A DEI Score Card was developed using published pillars of DEI, including five domains: departmental inclusion, pipeline growth, departmental education, community engagement, and faculty demographics. Program Doximity rank, address, and surrounding demographics were collected to determine predictors of investing in DEI. RESULTS One hundred forty-one urology residency websites were included for analysis. Only 40.7% of programs referenced DEI on their webpage, and 21.4% offered funded mentorship opportunities. Department education and community engagement were the least popular initiatives. The Western, Northeastern, and North Central sections had the highest DEI total score with wide variation across domains. Mention of DEI was not associated with program's county-level social vulnerability or percent minority but was associated with being a top 50 program (OR=4.0; 95% CI 1.8, 8.9; P = .0007). CONCLUSION Less than half of academic urology programs' websites referenced DEI initiatives. Using a DEI score card, our study shows that investment in DEI varies widely by AUA section, and greater investment is positively correlated with program rank. Our DEI score card serves as a tool that programs can use to assess their current DEI investment, identify areas for improvement, and ensure existing initiatives are visible to applicants.
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Affiliation(s)
- Sarosh Irani
- University of Michigan Medical School, Ann Arbor, MI
| | - Laura Zebib
- University of Michigan Medical School, Ann Arbor, MI
| | | | - Juan J Andino
- University of California Los Angeles, Department of Urology, Los Angeles, CA
| | | | - Keow Mei Goh
- Department of Urology, University of Michigan, Ann Arbor, MI.
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Wagner B, Irani S. Autoimmune and paraneoplastic seizures. Handb Clin Neurol 2024; 200:151-172. [PMID: 38494275 DOI: 10.1016/b978-0-12-823912-4.00009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Seizures are a common feature of autoimmune encephalitis and are especially prevalent in patients with the commonest autoantibodies, against LGI1, CASPR2 and the NMDA, GABAB, and GABAA receptors. In this chapter, we discuss the classification, clinical, investigation, and treatment aspects of patients with these, and other autoantibody-mediated and -associated, illnesses. We highlight distinctive and common seizure semiologies which, often alongside other features we outline, can help the clinical diagnosis of an autoantibody-associated syndrome. Next, we classify these syndromes by either focusing on whether they represent underlying causative autoantibodies or T-cell-mediated syndromes and on the distinction between acute symptomatic seizures and a more enduring tendency to autoimmune-associated epilepsy, a practical and valuable distinction for both patients and clinicians which relates to the pathogenesis. We emphasize the more effective immunotherapy response in patients with causative autoantibodies, and discuss the emerging evidence for various first-, second-, and third-line immunotherapies. Finally, we highlight available clinical rating scales which can guide autoantibody testing and immunotherapy in patients with seizures of unknown etiology. Throughout, we relate the clinical and therapeutic observations to the immunobiology and neuroscience which drive these seizures.
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Affiliation(s)
- Barbara Wagner
- Neuroscience Department, NDCN, University of Oxford and Oxford University Hospitals, Oxford, United Kingdom; Kantonsspital Aarau Switzerland, Tellstrasse, Aarau, Switzerland
| | - Sarosh Irani
- Neuroscience Department, NDCN, University of Oxford and Oxford University Hospitals, Oxford, United Kingdom.
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Wolf L, Usemann J, Collaud E, Derkenne MF, Fischer R, Hensen M, Hitzler M, Hofer M, Inci D, Irani S, Jahn K, Koutsokera A, Kusche R, Kurowski T, Latzin P, Lin D, Mioranza L, Moeller A, Mornand A, Mueller-Suter D, Murer C, Naehrlich L, Plojoux J, Regamey N, Rodriguez R, Rochat I, Sauty A, Schuurmans M, Semmler M, Trachsel D, Walter AL, Jung A. Data accuracy, consistency and completeness of the national Swiss cystic fibrosis patient registry: Lessons from an ECFSPR data quality project. J Cyst Fibros 2023:S1569-1993(23)00904-9. [PMID: 37996316 DOI: 10.1016/j.jcf.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/03/2023] [Accepted: 08/31/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Good data quality is essential when rare disease registries are used as a data source for pharmacovigilance studies. This study investigated data quality of the Swiss cystic fibrosis (CF) registry in the frame of a European Cystic Fibrosis Society Patient Registry (ECFSPR) project aiming to implement measures to increase data reliability for registry-based research. METHODS All 20 pediatric and adult Swiss CF centers participated in a data quality audit between 2018 and 2020, and in a re-audit in 2022. Accuracy, consistency and completeness of variables and definitions were evaluated, and missing source data and informed consents (ICs) were assessed. RESULTS The first audit included 601 out of 997 Swiss people with CF (60.3 %). Data quality, as defined by data correctness ≥95 %, was high for most of the variables. Inconsistencies of specific variables were observed because of an incorrect application of the variable definition. The proportion of missing data was low with <5 % for almost all variables. A considerable number of missing source data occurred for CFTR variants. Availability of ICs varied largely between centers (10 centers had >5 % of missing documents). After providing feedback to the centers, availability of genetic source data and ICs improved. CONCLUSIONS Data audits demonstrated an overall good data quality in the Swiss CF registry. Specific measures such as support of the participating sites, training of data managers and centralized data collection should be implemented in rare disease registries to optimize data quality and provide robust data for registry-based scientific research.
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Affiliation(s)
- Lara Wolf
- Department of Respiratory Medicine, University Children's Hospital Zurich, Switzerland; Departments of Pulmonology and Paediatric Pulmonology, Cantonal Hospital Winterthur, Switzerland
| | - Jakob Usemann
- Department of Respiratory Medicine, University Children's Hospital Zurich, Switzerland; Department of Pulmonology, University Children's Hospital Basel, Switzerland
| | - Eugénie Collaud
- Department of Respiratory Medicine, University Children's Hospital Zurich, Switzerland
| | | | - Reta Fischer
- Quartier Bleu, Pulmonology Outpatient Clinic, Berne, Switzerland
| | - Maxime Hensen
- Department of Paediatrics, Cantonal Hospital Fribourg, Switzerland
| | - Michael Hitzler
- Department of Paediatric Pulmonology, Cantonal Hospital Lucerne, Switzerland
| | - Markus Hofer
- Departments of Pulmonology and Paediatric Pulmonology, Cantonal Hospital Winterthur, Switzerland
| | - Demet Inci
- Department of Respiratory Medicine, University Children's Hospital Zurich, Switzerland
| | - Sarosh Irani
- Department of Pulmonology, Cantonal Hospital Aarau, Switzerland
| | - Kathleen Jahn
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Switzerland
| | - Angela Koutsokera
- Department of Pulmonology, Lausanne University Hospital, Switzerland
| | - Rachel Kusche
- Department of Pulmonology, Cantonal Hospital Aarau, Switzerland; Department of Paediatric Pulmonology, Cantonal Hospital Aarau, Switzerland
| | - Thomas Kurowski
- Department of Pulmonology, University Hospital Zurich, Switzerland
| | - Philipp Latzin
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital Berne University Hospital, Switzerland
| | - Dagmar Lin
- Department of Pulmonology, Inselspital Berne University Hospital, Switzerland
| | - Laurence Mioranza
- Paediatric Pulmonology and Cystic Fibrosis Unit, Division of Paediatrics, Department Woman-Mother-Child, Lausanne University Hospital, Switzerland
| | - Alexander Moeller
- Department of Respiratory Medicine, University Children's Hospital Zurich, Switzerland
| | - Anne Mornand
- Department of Paediatric Pulmonology, Geneva University Hospital, Switzerland
| | | | - Christian Murer
- Department of Pulmonology, Cantonal Hospital Lucerne, Switzerland
| | - Lutz Naehrlich
- Department of Paediatrics, Justus-Liebig-University Giessen, Germany; European Cystic Fibrosis Society Patient Registry, Karup, Denmark
| | - Jérôme Plojoux
- Deparment of Pulmonology, Geneva University Hospital, Switzerland
| | - Nicolas Regamey
- Department of Paediatric Pulmonology, Cantonal Hospital Lucerne, Switzerland
| | - Romy Rodriguez
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital Berne University Hospital, Switzerland
| | - Isabelle Rochat
- Paediatric Pulmonology and Cystic Fibrosis Unit, Division of Paediatrics, Department Woman-Mother-Child, Lausanne University Hospital, Switzerland
| | - Alain Sauty
- Department of Pulmonology, Réseau Hospitalier Neuchâtelois, Switzerland
| | - Macé Schuurmans
- Department of Pulmonology, University Hospital Zurich, Switzerland
| | - Michaela Semmler
- Department of Pulmonology, Inselspital Berne University Hospital, Switzerland
| | - Daniel Trachsel
- Department of Pulmonology, University Children's Hospital Basel, Switzerland
| | - Anna-Lena Walter
- Department of Pulmonology, Cantonal Hospital St. Gallen, Switzerland
| | - Andreas Jung
- Department of Respiratory Medicine, University Children's Hospital Zurich, Switzerland; Departments of Pulmonology and Paediatric Pulmonology, Cantonal Hospital Winterthur, Switzerland; European Cystic Fibrosis Society Patient Registry, Karup, Denmark.
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Zebib L, Irani S, Salami SS, Kraft K, Palapattu G, Goh KM. Michigan Urology Academy-Our Role in Diversifying the Urology Workforce. Urology 2023; 181:18-23. [PMID: 37595641 DOI: 10.1016/j.urology.2023.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE To evaluate the value/utility of developing an online mentorship program for underrepresented in medicine (URiM) students interested in urology. The Michigan Urology Academy (MUA) was launched in 2020 to increase exposure and provide mentorship to URiM students interested in urology, in an effort to address the continued low numbers of Black and LatinX urologists in the workforce. METHODS The 2-day virtual mentorship program was launched in June 2020 and held annually thereafter. Demographic information was collected, and surveys were distributed at 1week and 3months after the events. Surveys assessed participants' perception of the utility and effectiveness of the sessions. Thematic analysis was performed on qualitative data. Fourth-year med students were followed longitudinally to determine urology match results. RESULTS Over the last 3years, MUA hosted 208 students from 104 medical schools. Participants self-identified as 42.3% (n = 88) identified as African American/Black, 14.9% (n = 31) Hispanic/LatinX, 12.98% (n = 27) white, 18.75% (n = 39) as Asian/Indian 7.7% (n = 16) as Middle Eastern/North African, and 0.48% Native Hawaiian/Pacific Islander (n = 1). Overall, fourth-year MUA participants matched at a higher rate than the national average (80.2% vs 71.4%; P = .0486). Narrative feedback revealed five themes: (1) the importance of community support within urology, (2) the utility of vulnerability and storytelling, (3) the importance of representation of diverse backgrounds, (4) the desire for in-person mentorship opportunities, and (5) the need for transparency in application logistics. CONCLUSION Mentorship programs such as MUA allow URiM students to have greater exposure to the field of urology and to networking opportunities.
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Affiliation(s)
- Laura Zebib
- University of Michigan Medical School, Ann Arbor, MI
| | - Sarosh Irani
- University of Michigan Medical School, Ann Arbor, MI
| | - Simpa S Salami
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Kate Kraft
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | - Keow Mei Goh
- Department of Urology, University of Michigan, Ann Arbor, MI.
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Zappi S, Bernasconi L, Fischer I, Hoxha E, Wiech T, Minzer A, Irani S, Moosmann P, Kim MJ. Lesson for the clinical nephrologist: thrombospondin type-1 domain-containing protein 7A-associated membranous nephropathy and Fanconi syndrome in a patient with a squamous cell lung cancer. J Nephrol 2023; 36:2395-2399. [PMID: 37294401 DOI: 10.1007/s40620-023-01630-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 06/10/2023]
Affiliation(s)
- Stephanie Zappi
- Division of Nephrology, Cantonal Hospital Aarau, Aarau, Switzerland.
| | - Luca Bernasconi
- Institute of Laboratory Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Ingeborg Fischer
- Institute of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Elion Hoxha
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Torsten Wiech
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Sarosh Irani
- Clinic for Pulmonary and Sleep Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Peter Moosmann
- Division of Oncology, Hematology and Transfusion Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Min Jeong Kim
- Division of Nephrology, Cantonal Hospital Aarau, Aarau, Switzerland
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Irani S, Chang C, Morrison L, Waselewski M, Chang T. Youth experiences with and perspectives on long covid. BMC Public Health 2023; 23:2059. [PMID: 37864192 PMCID: PMC10588061 DOI: 10.1186/s12889-023-16899-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/04/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Research on the long-term effects of COVID-19 infection is ongoing, and the psychological and physical impacts of Long Covid on youth is poorly understood. To assess these impacts, we surveyed youth regarding their experiences with, and perspectives on, the long-term effects of COVID-19. METHODS We conducted a nationwide text message survey of youth ages 14-24 years in the United States. The survey asked four open ended questions regarding their experiences and perceptions regarding the long-term effects of COVID-19. Qualitative data was analyzed independently by three investigators using thematic analysis. Prevalence of codes were summarized using descriptive statistics. RESULTS Among 1150 participants, 991 responded to at least one survey question (response rate 86.1%). The vast majority of our sample had COVID-19 or knew someone who did (75%), and approximately one third (32%) of youth indicated that they knew someone who had experienced symptoms consistent with Long Covid. Many youth (50%) reported worry and concern about Long Covid even if they, or someone they knew, did not have Long Covid. Among youth who were not concerned about Long Covid, the most commonly reported reasons were having received the vaccine (29%) and not having a prior COVID-19 infection (24%). CONCLUSIONS Our findings suggest that among younger populations, there is significant concern regarding the long-term effects of COVID-19. Vaccination campaigns and youth-centered public health communication about Long Covid may not only reduce COVID-19 transmission, but also alleviate worries and concerns about Long Covid among youth.
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Affiliation(s)
- Sarosh Irani
- University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Claire Chang
- University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Leigh Morrison
- Department of Family Medicine, University of Michigan, 2800 Plymouth Rd Bldg 14, Room G128, Ann Arbor, MI, 48109, USA
| | - Marika Waselewski
- Department of Family Medicine, University of Michigan, 2800 Plymouth Rd Bldg 14, Room G128, Ann Arbor, MI, 48109, USA
| | - Tammy Chang
- Department of Family Medicine, University of Michigan, 2800 Plymouth Rd Bldg 14, Room G128, Ann Arbor, MI, 48109, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
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Lumsden DE, Lim M, Irani S. Letter to the editors: comment on "Status dystonicus in adult patients with anti-N-methyl-D-asparate-acid receptor encephalitis". J Neurol 2023:10.1007/s00415-023-11670-w. [PMID: 36943515 DOI: 10.1007/s00415-023-11670-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Daniel E Lumsden
- Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK.
- Perinatal Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Ming Lim
- Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK
- Department Women and Childrens Health, School of Life Course Sciences (SoLCS), Kings College London, London, UK
| | - Sarosh Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
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Geschwind M, Lopez-Chiriboga AS, Blackburn K, Turaga S, Binks S, Zitser J, Gelfand J, Day G, Dunham S, Rodenbeck S, Clardy S, Solomon A, Pittock S, McKeon A, Dubey D, Zekeridou A, Toledano M, Turner L, Vernino S, Irani S, Flanagan E. Autoimmune Encephalitis Misdiagnosis in Adults; A Multicenter Observational Study of Outpatient Subspecialty Clinics. Neurology 2022. [DOI: 10.1212/01.wnl.0000903448.98416.0e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
ObjectiveTo determine the diseases misdiagnosed as AE and potential reasons for misdiagnosis.BackgroundMisdiagnosis of autoimmune encephalitis (AE) may harm patients.Design/MethodsPatients with AE misdiagnosis were identified (1/1/2014-12/31/2020) from outpatient AE subspecialty clinics including: Mayo Clinic (n = 44); Oxford (n = 18); UT Southwestern (n = 18); UCSF (n = 17); Washington University (n = 6); University of Utah (n = 4). Inclusion criteria were adults (=18 years) with: 1) A prior diagnosis of AE; and 2) An alternative diagnosis made at a participating center. We collected data on clinical features, investigations, fulfillment of possible AE criteria, alternative diagnoses, and potential contributors to misdiagnosis.ResultsWe identified 107 patients misdiagnosed with AE. Thirty (28%) fulfilled diagnostic criteria for “possible AE”. Median onset age was 48 years (inter-quartile range, 35.5-60.5) and 65 (61%) were female. Correct diagnoses included: functional neurologic disorder, 27 (25%); neurodegenerative disease, 22 (21%); primary psychiatric disease, 19 (18%); cognitive deficits from comorbidities, 11 (10%); cerebral neoplasm, 10 (9%); and other, 18 (17%). Onset was insidious (>3 months) in 51 (48%). MRI brain was suggestive of encephalitis in 19/104 (18%) and CSF pleocytosis occurred in 16/84 (19%). Thyroid-peroxidase antibodies were elevated in 24/62 (39%). Positive neural autoantibodies were more frequent in serum (48/105[46%]) than CSF (7/91[8%]; p<0.001) and serum antibodies included: GAD65, 14; voltage-gated-potassium-channel-complex [LGI1, CASPR2 negative], 10; NMDA-receptor by cell-based assay only, 10 (6 negative in CSF); and other, 18. Immunotherapy adverse effects were observed in 17/84 (20%). Potential contributors to misdiagnosis included: over-interpretation of a non-specific positive serum antibody, 53 (50%); misinterpretation of functional, psychiatric, or non-specific cognitive dysfunction as encephalopathy, 41 (38%).ConclusionsRed flags suggesting alternative diagnoses to AE include lack of fulfillment of “possible autoimmune encephalitis” criteria, positive non-specific serum antibody, and insidious onset. Avoiding AE misdiagnosis will prevent morbidity from unnecessary immunotherapies and delayed treatment of the correct diagnosis.
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Blackman G, Lim MF, Pollak T, Al-Diwani A, Symmonds M, Mazumder A, Carter B, Irani S, David A. The clinical relevance of serum versus CSF NMDAR autoantibodies associated exclusively with psychiatric features: a systematic review and meta-analysis of individual patient data. J Neurol 2022; 269:5302-5311. [PMID: 35790561 PMCID: PMC9467941 DOI: 10.1007/s00415-022-11224-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND A variety of psychiatric syndromes are associated with NMDAR autoantibodies; however, their clinical relevance when only present in the serum is unclear. We explored whether patients with CSF NMDAR autoantibodies could be distinguished from patients with serum-only NMDAR autoantibodies. METHODS The electronic databases MEDLINE, EMBASE, PubMed, and PsycINFO were searched. Articles reporting adult patients with isolated psychiatric features and positive for NMDAR autoantibodies with relevant investigations were included. Patient level meta-analysis compared patients positive for CSF NMDAR autoantibodies with patients positive for serum NMDAR autoantibodies, but negative for CSF NMDAR autoantibodies. Dichotomous data were analysed using crude odds ratios (OR), whilst continuous data were analysed using Mann-Whitney Test (U). The protocol was prospectively registered (CRD42018082210). RESULTS Of 4413 publications, 42 were included, reporting 79 patients. Median age was 34 years (IQR 19 years); 56% (45/79) were female and 24% (16/68) had a tumour. In total, 41 patients were positive for CSF autoantibodies and 20 were positive for serum-only autoantibodies. Patients with CSF autoantibodies were significantly more likely to be female (p < 0.001) and have a rapid (< 3 month) onset of symptoms (p = 0.02) than patients with serum-only autoantibodies. They were also more likely to present with psychosis (p < 0.001), exhibit EEG (p = 0.006), MRI (p = 0.002), and CSF (p = 0.001) abnormalities, but less likely to present with insomnia (p = 0.04). CONCLUSIONS Patients with an isolated psychiatric syndrome with CSF NMDAR autoantibodies can potentially be distinguished from those with serum-only NMDAR autoantibodies based on clinicodemographic and investigation findings.
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Affiliation(s)
- Graham Blackman
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, London, UK.
| | - Mao Fong Lim
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, London, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Thomas Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, London, UK
| | - Adam Al-Diwani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Mkael Symmonds
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
- Department of Clinical Neurophysiology, John Radcliffe Hospital, Oxford, UK
- Epilepsy Research Group, Nuffield Department of Clinical Neurosciences, Oxford University, John Radcliffe Hospital, Oxford, UK
| | - Asif Mazumder
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
- Department of Radiology Guy's, St Thomas' NHS Foundation Trust, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sarosh Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
| | - Anthony David
- UCL Institute of Mental Health, University College London, London, UK
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Huong NHT, Toan ND, Quy DT, Khanh TH, Thinh LQ, Nhan LNT, Minh NNQ, Turner H, Thwaites L, Irani S, Hung NT, Tan LV. Study protocol: The clinical features, epidemiology, and causes of paediatric encephalitis in southern Vietnam. Wellcome Open Res 2022; 6:133. [PMID: 36300174 PMCID: PMC9579742 DOI: 10.12688/wellcomeopenres.16770.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 01/13/2023] Open
Abstract
Encephalitis is a major cause of morbidity and mortality worldwide. The clinical syndrome of encephalitis consists of altered mental status, seizures, neurologic signs, and is often accompanied by fever, headache, nausea, and vomiting. The encephalitis in children has been known that more common than in adult, with the incidence rate of infants was 3.9 times higher than that of people 20-44 years of age. The reported incidence of hospitalization attributed to paediatric encephalitis ranged from 3 to 13 admissions per 100,000 children per year with the overall mortality ranging from 0 to 7%. There are however more than 100 pathogens that can cause encephalitis and accurate diagnosis is challenging. Over 50% of patients with encephalitis are left undiagnosed despite extensive laboratory investigations. Furthermore, recent studies in high-income settings have suggested autoimmune encephalitis has now surpassed infectious aetiologies, mainly due to increased awareness and diagnostic capacity, which further challenges routine diagnosis and clinical management, especially in developing countries. There are limited contemporary data on the causes of encephalitis in children in Vietnam. Improving our knowledge of the causative agents of encephalitis in this resource-constrained setting remains critical to informing case management, resource distribution and vaccination strategy. Therefore, we conduct a prospective observational study to characterise the clinical, microbiological, and epidemiological features of encephalitis in a major children's hospital in southern Vietnam. Admission clinical samples will be collected alongside meta clinical data and from each study participants. A combination of classical assays (serology and PCR) and metagenomic next-generation sequencing will used to identify the causative agents. Undiagnosed patients with clinical presentations compatible with autoimmune encephalitis will then be tested for common forms of the disease. Finally, using direct- and indirect costs, we will estimate the economic burden of hospitalization and seven days post hospital discharge of paediatric encephalitis in our setting.
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Affiliation(s)
- Nguyen Hoang Thien Huong
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam,Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam,
| | | | - Du Tuan Quy
- Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam
| | | | - Le Quoc Thinh
- Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam
| | | | | | - Hugo Turner
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam
| | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam
| | - Sarosh Irani
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam,
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Huong NHT, Toan ND, Quy DT, Khanh TH, Thinh LQ, Nhan LNT, Minh NNQ, Turner H, Thwaites L, Irani S, Hung NT, Tan LV. Study protocol: The clinical features, epidemiology, and causes of paediatric encephalitis in southern Vietnam. Wellcome Open Res 2022; 6:133. [PMID: 36300174 PMCID: PMC9579742 DOI: 10.12688/wellcomeopenres.16770.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 01/13/2023] Open
Abstract
Encephalitis is a major cause of morbidity and mortality worldwide. The clinical syndrome of encephalitis consists of altered mental status, seizures, neurologic signs, and is often accompanied by fever, headache, nausea, and vomiting. The encephalitis in children has been known that more common than in adult, with the incidence rate of infants was 3.9 times higher than that of people 20-44 years of age. The reported incidence of hospitalization attributed to paediatric encephalitis ranged from 3 to 13 admissions per 100,000 children per year with the overall mortality ranging from 0 to 7%. There are however more than 100 pathogens that can cause encephalitis and accurate diagnosis is challenging. Over 50% of patients with encephalitis are left undiagnosed despite extensive laboratory investigations. Furthermore, recent studies in high-income settings have suggested autoimmune encephalitis has now surpassed infectious aetiologies, mainly due to increased awareness and diagnostic capacity, which further challenges routine diagnosis and clinical management, especially in developing countries. There are limited contemporary data on the causes of encephalitis in children in Vietnam. Improving our knowledge of the causative agents of encephalitis in this resource-constrained setting remains critical to informing case management, resource distribution and vaccination strategy. Therefore, we conduct a prospective observational study to characterise the clinical, microbiological, and epidemiological features of encephalitis in a major children's hospital in southern Vietnam. Admission clinical samples will be collected alongside meta clinical data and from each study participants. A combination of classical assays (serology and PCR) and metagenomic next-generation sequencing will used to identify the causative agents. Undiagnosed patients with clinical presentations compatible with autoimmune encephalitis will then be tested for common forms of the disease. Finally, using direct- and indirect costs, we will estimate the economic burden of hospitalization and seven days post hospital discharge of paediatric encephalitis in our setting.
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Affiliation(s)
- Nguyen Hoang Thien Huong
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam,Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam,
| | | | - Du Tuan Quy
- Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam
| | | | - Le Quoc Thinh
- Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam
| | | | | | - Hugo Turner
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam
| | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam
| | - Sarosh Irani
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam,
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Huong NHT, Toan ND, Quy DT, Khanh TH, Thinh LQ, Nhan LNT, Minh NNQ, Turner H, Thwaites L, Irani S, Hung NT, Tan LV. Study protocol: The clinical features, epidemiology, and causes of paediatric encephalitis in southern Vietnam. Wellcome Open Res 2022; 6:133. [PMID: 36300174 PMCID: PMC9579742 DOI: 10.12688/wellcomeopenres.16770.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 01/13/2023] Open
Abstract
Encephalitis is a major cause of morbidity and mortality worldwide. The clinical syndrome of encephalitis consists of altered mental status, seizures, neurologic signs, and is often accompanied by fever, headache, nausea, and vomiting. The encephalitis in children has been known that more common than in adult, with the incidence rate of infants was 3.9 times higher than that of people 20-44 years of age. The reported incidence of hospitalization attributed to paediatric encephalitis ranged from 3 to 13 admissions per 100,000 children per year with the overall mortality ranging from 0 to 7%. There are however more than 100 pathogens that can cause encephalitis and accurate diagnosis is challenging. Over 50% of patients with encephalitis are left undiagnosed despite extensive laboratory investigations. Furthermore, recent studies in high-income settings have suggested autoimmune encephalitis has now surpassed infectious aetiologies, mainly due to increased awareness and diagnostic capacity, which further challenges routine diagnosis and clinical management, especially in developing countries. There are limited contemporary data on the causes of encephalitis in children in Vietnam. Improving our knowledge of the causative agents of encephalitis in this resource-constrained setting remains critical to informing case management, resource distribution and vaccination strategy. Therefore, we conduct a prospective observational study to characterise the clinical, microbiological, and epidemiological features of encephalitis in a major children's hospital in southern Vietnam. Admission clinical samples will be collected alongside meta clinical data and from each study participants. A combination of classical assays (serology and PCR) and metagenomic next-generation sequencing will used to identify the causative agents. Undiagnosed patients with clinical presentations compatible with autoimmune encephalitis will then be tested for common forms of the disease. Finally, using direct- and indirect costs, we will estimate the economic burden of hospitalization and seven days post hospital discharge of paediatric encephalitis in our setting.
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Affiliation(s)
- Nguyen Hoang Thien Huong
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam,Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam,
| | | | - Du Tuan Quy
- Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam
| | | | - Le Quoc Thinh
- Children's Hospital 1, Ho Chi Minh City, 700000, Vietnam
| | | | | | - Hugo Turner
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam
| | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam
| | - Sarosh Irani
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam,
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Binks S, Crawford AH, Woodhall M, Fower A, Syme H, Kennedy LJ, Waters P, Davison L, Irani S, Pakozdy A. 067 One Health: Clinical characteristics of spontaneously-arising feline LGI1- autoantibody limbic encephalitis in a large international cohort. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionLeucine-rich glioma-inactivated 1 (LGI1) is one of the most common surface neuronal autoantigens associated with autoimmune limbic encephalitis (LE) in humans, with hallmarks of personality change, amnesia and seizures. Recently, these autoantibodies were described in domestic cats with LE, likewise with a distinctive phenotype of behavioural change and orofacial seizures.MethodsUsing a feline-specific cell-based assay for LGI1-autoantibodies, we tested serum from 123 cats with neurological signs, submitted by veterinary surgeons across Europe. Clinical presentation, investiga- tions, management and outcomes were captured by questionnaire and review of medical records.Results56 samples were positive for LGI1-autoantibodies. The median age was 45 months and 34/54 (63%) were female. Most (44/56, 79%) had LE but other clinical syndromes included epilepsy, encephalopathy and feline hyperesthesia syndrome. Focal seizures without generalisation were reported in 42/51 (82%) compared to 25/47 (53%) in seronegative cats (p=0.02). Among seropositive cats, MRI abnormalities were identified in 23/42 (55%), adverse drug reactions in 7/50 (14%), and 8/51 (16%) were euthanised due to refractory seizures or status epilepticus.ConclusionMany features are common to humans and cats with LGI1-autoantibodies. Feline patients represent a naturally-occurring disease model and an opportunity to benefit health in both species via a bi-directional translational model.
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Yapp N, Clayton L, Eriksson S, Sathyamoorthy T, Lunn M, Woodhall M, Walters P, Skelly D, Bogdanovic M, Irani S. 130 IgLON5-antibody disease: a case series. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IgLON5-antibody disease is a rare disorder first described in 2014 with features which interfaces both autoimmune and neurodegenerative pathophysiological processes. It has a strong HLA association, and the diagnosis is confirmed by the presence of antibodies which bind the extracellular domain of a neuronal cell adhesion protein, Iglon5. Post-mortem findings reveal this correlates with a tauopathy and subsequent neurodegeneration affecting the hypothalamus and tegmental brainstem. We present three cases and describe their history, disease progression, management and treatment responses. We found a remarkably consistent clinical phenotype which was characterised by REM and NREM parasomnias, bulbar dysfunction causing distinctive inspiratory noises, and mixed movement disorders. Our cases were diagnosed between 1.5-2 years from symptom onset. One patient died following treatment with IVIg, whilst two have been diagnosed within the last month and started on plasma exchange and immunotherapy. We will report their clinical follow up. IgLON5-antibody disease is often diagnosed late, it is thought after irreversible neurodegeneration has occurred and symptoms are advanced. We hope to raise awareness of the classical myriad of presenting symptoms and lead to earlier diagnosis, within which a window of opportunity may exist to instigate immunotherapy and arrest ongoing autoimmune processes.
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Binks S, Elliott K, Sempere V, Castrillo SM, Ambati A, Harper A, Honnorat J, Mignot E, Knight J, Irani S. 036 A GWAS of LGI1-antibody encephalitis. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionPatients with encephalitis with antibodies to leucine-rich glioma-inactivated 1 (LGI1-Ab-E) are typically elderly males with a distinct phenotype, and ~90% carry the class II major histocompatibility (MHC) allele, DRB1*07:01. This allele is found in ~25% of healthy controls, suggesting other genetic and environmental disease factors operate in patients with LGI1-Ab-E. Yet, a previous genome-wide associa- tion study did not find variants attaining genome-wide significance outside the MHC region.MethodsLGI1-Ab-E patients were genome-wide genotyped with standard arrays. Missing variants were imputed using Minimac4 and the Haplotype Reference Consortium panel. Population-matched controls were selected from UK Biobank. Genetic association with LGI1-Ab-E was determined with PLINK, SNPTEST and GWAMA and processed using bespoke bioinformatics pipelines.The discovery cohort of 131 French patients (92 men; 70%) was population-matched with 2613 controls (957 men; 36.6%): >6 million SNPs remained after quality control (lambda 1.04). The validation cohort comprises 97 US/UK cases (66 men; 68%) and 1940 matched controls (882 men; 45%), >5 million variants and lambda of 1.ResultsWe replicated the MHC association (rs2858869, p=3.371e-52 in the discovery cohort;rs2858870, p=1.085e-54 in the validation cohort) and will report the extent of non-MHC associations currently under- going bioinformatic assessment and validation.
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Michael S, Ramanathan S, Binks S, Leite MI, Sen A, Irani S. Parallel Session 2: Neurodegeneration| Wed 18 May, 1115 – 1230|4 Novel complex motor behaviours in LGI1-autoantibody encephalitis. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPathognomonic clinical signs are increasingly well recognised across the autoim- mune encephalitides. Faciobrachial dystonic seizures (FBDS) are exclusively present in patients with LGI1-autoantibodies. Owing to their recent description and rarity, however, the wider clinical phenotypes remain less well-defined.AimsTo describe novel clinical features in a large cohort of patients with LGI1-autoantibodies.MethodsPatients were recruited for clinical research following either direct referral to the Oxford Autoim- mune Neurology Service, or via notification to the national Association of British Neurologists Rare Disease Ascertainment and Recruitment (RaDaR) Surveillance Unit. Novel clinical signs were identified through clinical assessment of 107 LGI1-autoantibody patients. We use video footage to present the phenotypes.Results5/104* (5%) of patients with LGI1-autoantibodies displayed highly unusual manual stereotypies which we have termed ‘complex motor behaviours’. These behaviours consisted of the patients acting out intricate manual behaviours using imaginary objects, for example drinking from a cup, writing, and imitation of winding a piece of string around the fingers. They typically occurred during sleep or periods of relaxed wakefulness, were of short duration (30-60 seconds), and were associated with loss of awareness. All patients had multiple seizure semiologies (3-5) and associated visual hallucinations and sleep disorder.ConclusionsComplex motor behaviours were observed in 5% of patients with LGI1-autoantibodies and may represent either a novel seizure semiology or the sleep disorder agrypnia excitata. These findings expand the clinical phenotypes of LGI1-autoantibody encephalitis.
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Goebel A, Andersson D, Barker C, Basu N, Bullock C, Bevan S, Bashford-Rogers RJM, Choy E, Clauw D, Dulake D, Dulake R, Flor H, Glanvill M, Helyes Z, Irani S, Kosek E, Laird J, MacFarlane G, McCullough H, Marshall A, Moots R, Perrot S, Shenker N, Sher E, Sommer C, Svensson CI, Williams A, Wood G, Dorris ER. Research Recommendations Following the Discovery of Pain Sensitizing IgG Autoantibodies in Fibromyalgia Syndrome. Pain Med 2022; 23:1084-1094. [PMID: 34850195 PMCID: PMC9157149 DOI: 10.1093/pm/pnab338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Fibromyalgia syndrome (FMS) is the most common chronic widespread pain condition in rheumatology. Until recently, no clear pathophysiological mechanism for fibromyalgia had been established, resulting in management challenges. Recent research has indicated that serum immunoglobulin Gs (IgGs) may play a role in FMS. We undertook a research prioritisation exercise to identify the most pertinent research approaches that may lead to clinically implementable outputs. METHODS Research priority setting was conducted in five phases: situation analysis; design; expert group consultation; interim recommendations; consultation and revision. A dialogue model was used, and an international multi-stakeholder expert group was invited. Clinical, patient, industry, funder, and scientific expertise was represented throughout. Recommendation-consensus was determined via a voluntary closed eSurvey. Reporting guideline for priority setting of health research were employed to support implementation and maximise impact. RESULTS Arising from the expert group consultation (n = 29 participants), 39 interim recommendations were defined. A response rate of 81.5% was achieved in the consensus survey. Six recommendations were identified as high priority- and 15 as medium level priority. The recommendations range from aspects of fibromyalgia features that should be considered in future autoantibody research, to specific immunological investigations, suggestions for trial design in FMS, and therapeutic interventions that should be assessed in trials. CONCLUSIONS By applying the principles of strategic priority setting we directed research towards that which is implementable, thereby expediating the benefit to the FMS patient population. These recommendations are intended for patients, international professionals and grant-giving bodies concerned with research into causes and management of patients with fibromyalgia syndrome.
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Affiliation(s)
- Andreas Goebel
- Institute of Life Course and Medicine Sciences, Pain Research Institute, University of Liverpool, and Walton Centre NHS Foundation Trust, Liverpool, UK
| | - David Andersson
- Institute of Psychiatry, Psychology and Neuroscience, Wolfson Centre for Age Related Disease, King’s College, London, UK
| | - Chris Barker
- Lancashire and South Cumbria NHS Foundation Trust, UK
| | - Neil Basu
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Craig Bullock
- Versus Arthritis, Copeman House, St Mary’s Court, St Mary’s Gate, Chesterfield, UK
| | - Stuart Bevan
- Institute of Psychiatry, Psychology and Neuroscience, Wolfson Centre for Age Related Disease, King’s College, London, UK
| | | | - Ernest Choy
- CREATE Centre, Division of Infection and Immunity, Cardiff University, UK
| | - David Clauw
- Anesthesiology, Medicine (Rheumatology) and Psychiatry University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Zsuzsanna Helyes
- Department of Pharmacology and Pharmacotherapy, Medical School & Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Sarosh Irani
- Oxford Autoimmune Neurology Group, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Laird
- Eli Lilly and Company, Pain & Neurodegeneration Therapeutic Area, Lilly Research Centre, Windlesham, Surrey, UK
| | | | - Hayley McCullough
- Institute of Life Course and Medicine Sciences, Pain Research Institute, University of Liverpool, Liverpool, UK
| | - Andrew Marshall
- Institute of Life Course and Medicine Sciences, Pain Research Institute, University of Liverpool, and Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Robert Moots
- Faculty of Health Social Care and Medicine, Edge Hill University, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Serge Perrot
- Pain Center, Cochin Hospital, Paris University, Paris, France
| | - Nick Shenker
- Rheumatology Research Unit, Addenbrooke’s Hospital, Cambridge, UK
| | - Emanuele Sher
- Eli Lilly and Company, Pain & Neurodegeneration Therapeutic Area, Lilly Research Centre, Windlesham, Surrey, UK
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Germany
| | - Camilla I Svensson
- Department of Physiology and Pharmacology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Amanda Williams
- Health Psychology, UCL Research Department of Clinical, Educational & Health Psychology, University College London, UK
| | - Geoff Wood
- Cambridge Institute for Medical Research, Cambridge, UK
| | - Emma R Dorris
- School of Medicine, University College Dublin, Ireland
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Sun B, Akdeniz D, Kienzler AK, Tan J, Ramberger M, Dawes J, Trendafilova T, Bennett D, Waters P, Irani S. Dissecting the autoantibody repertoire in CASPR2-antibody encephalitis. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Autoantibodies to contactin-associated protein 2 (CASPR2) are found in patients with an immunothe- rapy-responsive encephalitis, and show a strong HLA-DRB1*11:01 restriction. However, no studies have focussed on how the autoreactive B cells are produced and perpetuate longitudinal autoantibody production. This question has therapeutic implications.To isolate B-cells reactive to CASPR2, we cultured naïve and memory B-cells from two CASPR2-antibody encephalitis patients and two healthy donors with screening for CASPR2-reactivity on live-cell based assays. CASPR2-reactive immunoglobulins were cloned and recombinantly expressed as monoclonal antibodies (mAbs). Naïve B-cell CASPR2-reactivity was detected in both patients and healthy donors, both at a frequency of ~ 1/250 B cells. However, memory B-cell CASPR2-reactivity was exclusive to patients at a frequency of ~1/250. CASPR2-specific mAbs showed discrete domain-specificities between the antigen-specific naïve and memory B-cell derived clones. Furthermore, only memory B-cell-derived CASPR2-specific mAbs were able to bind live rat hippocampal neurons and induce internalisation of surface CASPR2.In summary, we show that early B-cell tolerance against the neuronal antigen CASPR2 is not counter-se- lected in health; however, only patients have CASPR2-specific memory B-cells, suggesting that late B-cell tolerance dysfunction may have a key role in disease pathogenesis.bo.sun@ndcn.ox.ac.uk
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Butler C, Argyropoulos G, Moore L, Loane C, Roca-Fernandez A, Lage-Martinez C, Gurau O, Irani S, Zeman A. Pathological emotionalism following limbic encephalitis: the neural foundations of a novel disorder. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectiveWe investigated pathological emotionalism in a large cohort of patients that had presented with autoimmune limbic encephalitis(a-LE).Methods38 patients in the post-acute phase of a-LE completed questionnaires probing emotion regula- tion. They all underwent structural/functional MRI post-acutely, along with age- and sex-matched healthy controls. We investigated correlations of questionnaire scores with demographic, clinical, neuropsycho- logical and brain MRI data across patients. We also compared patients with pathological emotionalism and those without, along with healthy controls, on grey matter volume, resting-state functional connec- tivity and activity.ResultsPathological emotionalism was reported by 50% of the patients. It was not associated with depres- sion, impulsiveness, or memory impairment. However, it correlated with abnormalities in specific emotional brain networks: volume reduction in the anterior hippocampus, fusiform gyrus and cerebellum, abnormal hippocampal resting-state functional connectivity with the posteromedial cortex and middle frontal gyrus, and abnormal hemodynamic activity in the fusiform gyrus, inferior parietal lobule, and ventral pons.ConclusionsPathological emotionalism is common following a-LE, is not a manifestation of other neu- ropsychiatric disorders, and reflects abnormalities in networks of emotion regulation including, but not limited to the acute hippocampal focus. This condition provides novel insights into the neural basis of emotion regulation and its dysfunction in disease.christopher.butler@imperial.ac.uk
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Peris Sempere V, Muñiz-Castrillo S, Ambati A, Binks S, Pinto AL, Rogemond V, Pittock SJ, Dubey D, Geschwind MD, Gelfand JM, Dilwali S, Lee ST, Knight J, Elliott KS, Irani S, Honnorat J, Mignot E. Human Leukocyte Antigen Association Study Reveals DRB1*04:02 Effects Additional to DRB1*07:01 in Anti-LGI1 Encephalitis. Neurol Neuroimmunol Neuroinflamm 2022; 9:e1140. [PMID: 35115410 PMCID: PMC8815287 DOI: 10.1212/nxi.0000000000001140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/27/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES To study human leukocyte antigen (HLA) allele associations in anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis. METHODS A multiethnic cohort of 269 patients with anti-LGI1 encephalitis and 1,359 controls was included. Four-digit HLA sequencing and genome wide association single-nucleotide polymorphism typing imputation (0.99 concordance) were used for HLA typing. Significance of primary and secondary associations was tested using χ2, Fisher exact tests, or logistic regression with the control of population stratification covariates when applicable. RESULTS DRB1*07:01 and DQA1*02:01, 2 alleles in strong linkage disequilibrium, were associated with the disease (90% vs 24%, OR = 27.8, p < 10e-50) across ethnicity independent of variation at DRB3 and DQB1, 2 flanking HLA loci. DRB1*07:01 homozygosity was associated with a doubling of risk (OR = 2.1, p = 0.010), suggesting causality. DRB1*07:01 negative subjects were younger (p = 0.003) and more frequently female (p = 0.015). Three patients with malignant thymomas did not carry DRB1*07:01, whereas patients with other tumors had high DRB1*07:01 frequency, suggesting that the presence of tumors other than thymomas may be coincidental and not causal. In both DRB1*07:01 heterozygous individuals and DRB1*07:01 negative subjects, DRB1*04:02 was associated with anti-LGI1 encephalitis, indicating an independent effect of this allele (OR = 6.85, p = 4.57 × 10-6 and OR = 8.93, p = 2.50 × 10-3, respectively). DRB1*04:02 was also independently associated with younger age at onset (β = -6.68, p = 9.78 × 10-3). Major histocompatibility complex peptide-binding predictions using LGI1-derived peptides revealed divergent binding propensities for DRB1*04:02 and DRB1*07:01 alleles, suggesting independent pathogenic mechanisms. DISCUSSION In addition to the established primary DRB1*07:01 association in anti-LGI1 encephalitis, we observe a secondary effect of DRB1*04:02 with lower age at onset. Our study provides evidence for secondary effects within HLA locus that correlate with clinical phenotypes in anti-LGI1 encephalitis.
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Affiliation(s)
| | | | - Aditya Ambati
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Sophie Binks
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Anne-Laurie Pinto
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Veronique Rogemond
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Sean J. Pittock
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Divyanshu Dubey
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Michael D. Geschwind
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Jeffrey Marc Gelfand
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Sonam Dilwali
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Soon-Tae Lee
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Julian Knight
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Katherine S. Elliott
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Sarosh Irani
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
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Woodhall M, Mgbachi V, Fox H, Irani S, Waters P. Utility of Live Cell-Based Assays for Autoimmune Neurology Diagnostics. J Appl Lab Med 2022; 7:391-393. [PMID: 34996083 PMCID: PMC8741325 DOI: 10.1093/jalm/jfab133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/07/2021] [Indexed: 01/07/2023]
Affiliation(s)
- Mark Woodhall
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Victor Mgbachi
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Hannah Fox
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Sarosh Irani
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Patrick Waters
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, UK,Address correspondence to this author at: Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK. E-mail
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22
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Bomman S, Klair JS, Ashat M, El Abiad R, Gerke H, Keech J, Parekh K, Nau P, Hanada Y, Wong Kee Song LM, Kozarek R, Irani S, Low D, Ross A, Krishnamoorthi R. Outcomes of peroral endoscopic myotomy in patients with achalasia and prior bariatric surgery: A multicenter experience. Dis Esophagus 2021; 34:6310824. [PMID: 34184036 DOI: 10.1093/dote/doab044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/02/2021] [Accepted: 06/12/2021] [Indexed: 12/11/2022]
Abstract
Peroral endoscopic myotomy (POEM) in patients with achalasia who are status post bariatric surgery may be technically challenging due to postsurgical scarring and altered anatomy. The aim of the study was to assess the efficacy and safety of POEM for achalasia in patients with prior bariatric surgery. A review of prospectively maintained databases at three tertiary referral centers from January 2015 to January 2021 was performed. The primary outcome of interest was clinical success, defined as a post-treatment Eckardt score ≤ 3 or improvement in Eckardt score by ≥ 1 when the baseline score was <3, and improvement of symptoms. Secondary outcomes were adverse event rates and symptom recurrence. Sixteen patients status post Roux-en-Y gastric bypass (n = 14) and sleeve gastrectomy (n = 2) met inclusion criteria. Indications for POEM were achalasia type I (n = 2), type II (n = 9), and type III (n = 5). POEM was performed either by anterior or posterior approach. The pre-POEM mean integrated relaxation pressure was 26.2 ± 7.6 mm Hg. The mean total myotomy length was 10.2 ± 2.7 cm. The mean length of hospitalization was 1.4 ± 0.7 days. Pre- and postprocedure Eckardt scores were 6.1 ± 2.1 and 1.7 ± 1.8, respectively. The overall clinical success rate was 93.8% (15/16) with mean follow-up duration of 15.5 months. One patient had esophageal leak on postprocedure esophagram and managed endoscopically. Dysphagia recurred in two patients, which was successfully managed with pneumatic dilation with or without botulinum toxin injection. POEM appears to be safe and effective in the management of patients with achalasia who have undergone prior bariatric surgery.
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Affiliation(s)
- S Bomman
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - J S Klair
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - M Ashat
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - R El Abiad
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - H Gerke
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - J Keech
- Division of Thoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - K Parekh
- Division of Bariatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - P Nau
- Division of Thoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Y Hanada
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - L M Wong Kee Song
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - R Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - S Irani
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - D Low
- Division of Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - A Ross
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - R Krishnamoorthi
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
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23
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Huebner ST, Henny S, Giezendanner S, Brack T, Brutsche M, Chhajed P, Clarenbach C, Dieterle T, Egli A, Frey M, Heijnen I, Irani S, Sievi NA, Thurnheer R, Trendelenburg M, Kohler M, Leuppi-Taegtmeyer AB, Leuppi JD. Prediction of Acute COPD Exacerbation in the Swiss Multicenter COPD Cohort Study (TOPDOCS) by Clinical Parameters, Medication Use, and Immunological Biomarkers. Respiration 2021; 101:441-454. [PMID: 34942619 DOI: 10.1159/000520196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Whether immunological biomarkers combined with clinical characteristics measured during an exacerbation-free period are predictive of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) frequency and severity is unknown. METHOD We measured immunological biomarkers and clinical characteristics in 271 stable chronic obstructive pulmonary disease (COPD) patients (67% male, mean age 63 years) from "The Obstructive Pulmonary Disease Outcomes Cohort of Switzerland" cohort on a single occasion. One-year follow-up data were available for 178 patients. Variables independently associated with AECOPD frequency and severity were identified by multivariable regression analyses. Receiver operating characteristic analysis was used to obtain optimal cutoff levels and measure the area under the curve (AUC) in order to assess if baseline data can be used to predict future AECOPD. RESULTS Higher number of COPD medications (adjusted incident rate ratio [aIRR] 1.17) and platelet count (aIRR 1.03), and lower FEV1% predicted (aIRR 0.84) and IgG2 (aIRR 0.84) were independently associated with AECOPD frequency in the year before baseline. Optimal cutoff levels for experiencing frequent (>1) AECOPD were ≥3 COPD medications (AUC = 0.72), FEV1 ≤40% predicted (AUC = 0.72), and IgG2 ≤2.6 g/L (AUC = 0.64). The performance of a model using clinical and biomarker parameters to predict future, frequent AECOPD events in the same patients was fair (AUC = 0.78) but not superior to a model using only clinical parameters (AUC = 0.79). The IFN-lambda rs8099917GG-genotype was more prevalent in patients who had severe AECOPD. CONCLUSIONS Clinical and biomarker parameters assessed at a single point in time correlated with the frequency of AECOPD events during the year before and the year after assessment. However, only clinical parameters had fair discriminatory power in identifying patients likely to experience frequent AECOPD.
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Affiliation(s)
- Simona Tabea Huebner
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland, .,Faculty of Medicine, University of Basel, Basel, Switzerland,
| | - Simona Henny
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | | | - Thomas Brack
- Department of Internal Medicine, Cantonal Hospital Glarus, Glarus, Switzerland
| | - Martin Brutsche
- Division of Respiratory Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Prashant Chhajed
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Christian Clarenbach
- Division of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Dieterle
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Adrian Egli
- Division of Clinical Microbiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Martin Frey
- Division of Respiratory Medicine, Hospital Barmelweid, Barmelweid, Switzerland
| | - Ingmar Heijnen
- Division of Medical Immunology, Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Sarosh Irani
- Division of Respiratory Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | | | - Robert Thurnheer
- Division of Respiratory Medicine, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland
| | - Marten Trendelenburg
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, and Clinical Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Malcolm Kohler
- Division of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Anne Barbara Leuppi-Taegtmeyer
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Clinical Pharmacology, University Hospital Basel, Basel, Switzerland
| | - Joerg Daniel Leuppi
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
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Shakkottai A, Irani S, Nasr S, O’Brien L, Chervin R. 171: Obstructive sleep apnea in people with cystic fibrosis: Potential risk factors. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01596-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abboud H, Probasco JC, Irani S, Ances B, Benavides DR, Bradshaw M, Christo PP, Dale RC, Fernandez-Fournier M, Flanagan EP, Gadoth A, George P, Grebenciucova E, Jammoul A, Lee ST, Li Y, Matiello M, Morse AM, Rae-Grant A, Rojas G, Rossman I, Schmitt S, Venkatesan A, Vernino S, Pittock SJ, Titulaer MJ. Autoimmune encephalitis: proposed best practice recommendations for diagnosis and acute management. J Neurol Neurosurg Psychiatry 2021; 92:757-768. [PMID: 33649022 PMCID: PMC8223680 DOI: 10.1136/jnnp-2020-325300] [Citation(s) in RCA: 192] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/22/2020] [Accepted: 01/10/2021] [Indexed: 12/18/2022]
Abstract
The objective of this paper is to evaluate available evidence for each step in autoimmune encephalitis management and provide expert opinion when evidence is lacking. The paper approaches autoimmune encephalitis as a broad category rather than focusing on individual antibody syndromes. Core authors from the Autoimmune Encephalitis Alliance Clinicians Network reviewed literature and developed the first draft. Where evidence was lacking or controversial, an electronic survey was distributed to all members to solicit individual responses. Sixty-eight members from 17 countries answered the survey. Corticosteroids alone or combined with other agents (intravenous IG or plasmapheresis) were selected as a first-line therapy by 84% of responders for patients with a general presentation, 74% for patients presenting with faciobrachial dystonic seizures, 63% for NMDAR-IgG encephalitis and 48.5% for classical paraneoplastic encephalitis. Half the responders indicated they would add a second-line agent only if there was no response to more than one first-line agent, 32% indicated adding a second-line agent if there was no response to one first-line agent, while only 15% indicated using a second-line agent in all patients. As for the preferred second-line agent, 80% of responders chose rituximab while only 10% chose cyclophosphamide in a clinical scenario with unknown antibodies. Detailed survey results are presented in the manuscript and a summary of the diagnostic and therapeutic recommendations is presented at the conclusion.
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Affiliation(s)
- Hesham Abboud
- Neurology, Case Western Reserve University, Cleveland, Ohio, USA .,Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Cleveland, Ohio, USA
| | | | - Sarosh Irani
- Oxford Autoimmune Neurology Group, John Radcliffe Hospital, Oxford, UK
| | - Beau Ances
- Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | - David R Benavides
- Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael Bradshaw
- Neurology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA.,Billings Clinic, Billings, Montana, USA
| | - Paulo Pereira Christo
- Neurology, Minas Gerais Federal University Risoleta Tolentino Neves Hospital, Belo Horizonte, MG, Brazil
| | - Russell C Dale
- Neuroimmunology Group, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Mireya Fernandez-Fournier
- Neurology, La Paz University Hospital General Hospital Department of Neurology, Madrid, Madrid, Spain
| | | | - Avi Gadoth
- Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | - Soon-Tae Lee
- Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yuebing Li
- Neurology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marcelo Matiello
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne Marie Morse
- Pediatric Neurology, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | | | - Galeno Rojas
- Neurology, Sanatorio de La Trinidad Mitre, Buenos Aires, Argentina.,Neurology, Favaloro Foundation, Buenos Aires, Argentina
| | - Ian Rossman
- Neuro-developmental Science Center, Akron Children's Hospital, Akron, Ohio, USA
| | | | | | | | | | - Maarten J Titulaer
- Neurology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
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Klar VS, Ang Y, Lockwood PL, Attaallah B, Dickson S, Drew D, Kienast A, Maio MR, Plant O, Slavkova E, Toniolo S, Zambellas R, Irani S, Husain M. Validity of a new brief assessment of apathy: Caregiver version of the apathy motivation index. Alzheimers Dement 2020. [DOI: 10.1002/alz.037940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Williams J, McGlasson S, Irani S, Duffy D, Crow Y, Hunt D. Neuromyelitis optica in patients with increased interferon alpha concentrations. Lancet Neurol 2020; 19:31-33. [PMID: 31839246 DOI: 10.1016/s1474-4422(19)30445-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/16/2019] [Accepted: 11/13/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Jac Williams
- Anne Rowling Clinic, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Sarah McGlasson
- Medical Research Council Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Sarosh Irani
- Oxford Autoimmune Neurology Group, University of Oxford, Oxford, UK
| | - Darragh Duffy
- Laboratory of Dendritic Cell Immunobiology, Institut Pasteur, Paris, France
| | - Yanick Crow
- Medical Research Council Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - David Hunt
- Anne Rowling Clinic, University of Edinburgh, Edinburgh EH16 4SB, UK; Medical Research Council Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH16 4SB, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK.
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Grewe FA, Sievi NA, Bradicich M, Roeder M, Brack T, Brutsche MH, Frey M, Irani S, Leuppi JD, Thurnheer R, Clarenbach CF, Kohler M. Compliance of Pharmacotherapy with GOLD Guidelines: A Longitudinal Study in Patients with COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:627-635. [PMID: 32273691 PMCID: PMC7105357 DOI: 10.2147/copd.s240444] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/10/2020] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate the clinical implementation of pharmacotherapy recommendations for chronic obstructive pulmonary disease (COPD) based on the Global Initiative for chronic obstructive lung disease (GOLD) guidelines, in a longitudinal setting. Methods This is a sub-analysis of a prospective, non-interventional cohort study including patients with confirmed mild-to-very-severe COPD from seven pulmonary outpatient clinics in Switzerland. Follow-up visits took place annually for up to 7 years, from October 2010 until December 2016. For each visit, we evaluated the compliance of the prescribed pharmacotherapy with the concurrently valid GOLD guideline. We investigated whether step-ups or step-downs in GOLD stage or risk-group were accompanied by concordant changes in prescribed medication. Groups were compared via ANOVA. Results Data of 305 patients (62±7 years, 66% men) were analysed. In 59.1% of visits, the prescribed medication conformed to the respective valid GOLD-guideline. Patients with very severe COPD were most likely to receive pharmacotherapy in compliance with guidelines. Step-ups and step-downs in risk group, requiring escalation, or de-escalation of pharmacotherapy, were noticed in 24 and 43 follow-up visits, respectively. Step-ups were adequately implemented in 4 (16.7%) and step-downs in six cases (14.0%). Conclusion The compliance of COPD-pharmacotherapy with GOLD-guidelines is suboptimal, especially in lower risk groups. The high rates of missed out treatment-adjustments suggest that the familiarity of physicians with guidelines leaves room for improvement.
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Affiliation(s)
- Fabian A Grewe
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
| | - Matteo Bradicich
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
| | - Maurice Roeder
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Brack
- Pulmonary Division, Cantonal Hospital of Glarus, Glarus, Switzerland
| | - Martin H Brutsche
- Pulmonary Division, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Martin Frey
- Pulmonary Division, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Sarosh Irani
- Pulmonary Division, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Jörg D Leuppi
- University Department of Medicine, Cantonal Hospital Baselland and University of Basel, Basel, Switzerland
| | - Robert Thurnheer
- Pulmonary Division, Cantonal Hospital of Münsterlingen, Münsterlingen, Switzerland
| | | | - Malcolm Kohler
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland.,Zurich Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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Yahaghi L, Yaghmaei P, Hayati-Roodbari N, Irani S, Ebrahim-Habibi A. Betanin effect on PPAR-α and SREBP-1c expression in NMRI mice model of steatohepatitis with fibrosis. Physiol Int 2020; 107:67-81. [DOI: 10.1556/2060.2020.00001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 12/20/2019] [Indexed: 11/19/2022]
Abstract
AbstractPurposeBetanin is a betacyanin with antioxidant and anti-inflammatory activities whose effects were investigated in a nonalcoholic steatohepatitis (NASH) model.Main methodsNinety-six male naval medical research institute (NMRI) mice were divided into eight groups (n = 12) including normal control, high fat diet (HFD), Sham, and positive control treated with trans-chalcone. Three experimental groups were treated with 5 mg/kg, 10 mg/kg or 20 mg/kg betanin, and a betanin protective group was also defined.ResultsFour weeks of HFD treatment resulted in steatohepatitis with associated fibrosis. Significant increase was observed in serum levels of triglycerides (TG), total cholesterol (TC), glucose, insulin, leptin, liver enzymes, malondialdehyde (MDA), furthermore insulin resistance and (sterol regulatory element-binding protein-1c) SREBP-1c were detected. Levels of high-density lipoprotein cholesterol (HDL-C), adiponectin, superoxide dismutase (SOD), catalase (CAT), and PPAR-α (peroxisome proliferator-activated receptor-α) considerably decreased. Treatment by betanin, particularly the 20 mg/kg dosage, attenuated these changes.ConclusionBetanin is a potential treating agent of steatohepatitis and works through up-regulation of PPAR-α, down-regulation of SREBP-1c, modification of adipokine levels and modulation of lipid profile.
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Affiliation(s)
- L. Yahaghi
- 1Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Parichehreh Yaghmaei
- 1Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - N. Hayati-Roodbari
- 1Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - S. Irani
- 1Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - A. Ebrahim-Habibi
- 2Biosensor Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- 3Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Kohlbrenner D, Sievi NA, Roeder M, Thurnheer R, Leuppi JD, Irani S, Frey M, Brutsche M, Brack T, Kohler M, Clarenbach CF. Handgrip Strength Seems Not to Be Affected by COPD Disease Progression: A Longitudinal Cohort Study. COPD 2020; 17:150-155. [DOI: 10.1080/15412555.2020.1727428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Dario Kohlbrenner
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A. Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Maurice Roeder
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Robert Thurnheer
- Pulmonary Division, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland
| | - Joerg D. Leuppi
- University Clinic of Medicine, Cantonal Hospital Baselland and University of Basel, Liestal, Switzerland
| | - Sarosh Irani
- Pulmonary Division, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Martin Frey
- Pulmonary Division, Clinic Barmelweid, Barmelweid, Switzerland
| | - Martin Brutsche
- Pulmonary Division, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Thomas Brack
- Pulmonary Division, Cantonal Hospital of Glarus, Glarus, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Sievi NA, Brack T, Brutsche MH, Frey M, Irani S, Leuppi JD, Thurnheer R, Kohler M, Clarenbach CF. "Can do, don't do" are not the lazy ones: a longitudinal study on physical functioning in patients with COPD. Respir Res 2020; 21:27. [PMID: 31959169 PMCID: PMC6972031 DOI: 10.1186/s12931-020-1290-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/08/2020] [Indexed: 01/28/2023] Open
Abstract
Background and objective Reduced physical capacity (PC) and physical activity (PA) are common in COPD patients and associated with poor outcome. However, they represent different aspects of physical functioning and interventions do not affect them in the same manner. To address this, a new PC-PA quadrant concept was recently generated to identify clinical characteristics of sub-groups of physical functioning. The objective of this study was to I) proof the new concept and to verify their differentiating clinical characteristics, II) evaluate the consistency of the concept over time, III) assess whether patients changed their quadrant affiliation over time, IV) and to test if changes in quadrant affiliations are associated with changes in clinical characteristics. Methods In a longitudinal, prospective, non-interventional cohort with mild to very severe COPD patients, PC and PA as well as respiratory variables, COPD-specific health status, comorbidities, survival, and exacerbations were yearly assessed. Results Data from 283 patients were analysed at baseline. Mean (min/max) follow-up time was 2.4 (0.5/6.8) years. The PC-PA quadrants could be characterized as follows: I) “can’t do, don’t do”: most severe and symptomatic, several comorbidities II) “can do, don’t do”: severe but less symptomatic, several comorbidities III) “can’t do, do do”: few patients, severe and symptomatic, less comorbidities IV) “can do, do do”: mildest and less symptomatic, less comorbidities, lowest exacerbation frequency. Of the 172 patients with at least one follow-up, 58% patients never changed their quadrant affiliation, while 17% declined either PC, PA or both, 11% improved their PC, PA or both, and 14% showed improvement and decline in PC, PA or both during study period. None of the clinical characteristics or their annual changes showed consistent significant and relevant differences between all individual sub-groups. Conclusion Our findings suggest that there are no clinical characteristics allowing to distinguish between the PC-PA quadrants and the concept seems not able to illustrate disease process. However, the already low PA but preserved PC in the “can do, don’t do” quadrant raises the question if regularly assessment of PA in clinical practice would be more sensitive to detect progressive deterioration of COPD compared to the commonly used PC. Clinical trial registration www.ClinicalTrials.gov, NCT01527773.
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Affiliation(s)
- Noriane A Sievi
- Pulmonary Division, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Brack
- Pulmonary Division, Cantonal Hospital of Glarus, Glarus, Switzerland
| | - Martin H Brutsche
- Pulmonary Division, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Martin Frey
- Pulmonary Division, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Sarosh Irani
- Pulmonary Division, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Jörg D Leuppi
- University Department of Medicine, Cantonal Hospital Baselland and University of Basel, Basel, Switzerland
| | - Robert Thurnheer
- Pulmonary Division, Cantonal Hospital of Münsterlingen, Münsterlingen, Switzerland
| | - Malcolm Kohler
- Pulmonary Division, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Zurich Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Christian F Clarenbach
- Pulmonary Division, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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Stavrou M, Yeo JM, Slater AD, Koch O, Irani S, Foley P. Case report: meningitis as a presenting feature of anti-NMDA receptor encephalitis. BMC Infect Dis 2020; 20:21. [PMID: 31910823 PMCID: PMC6947964 DOI: 10.1186/s12879-020-4761-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/31/2019] [Indexed: 11/18/2022] Open
Abstract
Background Meningitis is a very rare atypical presenting feature of anti-NMDA receptor encephalitis. In our case report, we describe an unusual clinical presentation of anti-NMDA receptor encephalitis with a biphasic pattern of meningitis followed by encephalitis and discuss potential mechanisms underlying this presentation. We aim to widen the differential diagnosis to be considered in a patient presenting with clinical meningitis and pyrexia. Case presentation This is a case of a 33-year old Caucasian woman who initially presented with a lymphocytic meningitis attributed to a viral infection. She subsequently developed fluctuating consciousness, agitation, visual hallucinations, dyskinetic movements, a generalized tonic-clonic seizure, and autonomic instability. Investigations revealed a diagnosis of anti-NMDA receptor encephalitis secondary to a previously unidentified ovarian teratoma. She made an excellent recovery with immunotherapy and removal of the teratoma. Conclusion Clinicians should consider autoimmune encephalitides in individuals with meningitis, particularly where extensive investigations fail to identify a causative pathogen and there is rapid development of an encephalitic phenotype.
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Affiliation(s)
- Maria Stavrou
- Centre of Clinical Brain Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK. .,Anne Rowling Regenerative Neurology Clinic, 49 Little France Crescent, Edinburgh, EH16 4SB, UK. .,Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU, UK.
| | - Jing Ming Yeo
- Neurology Department, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | | | - Oliver Koch
- Regional Infectious Disease Unit, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Sarosh Irani
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Peter Foley
- Centre of Clinical Brain Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.,Anne Rowling Regenerative Neurology Clinic, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.,Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU, UK
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Gambazzi F, Frey LD, Bruehlmeier M, Janthur WD, Heuberger J, Spirig A, Williams R, Zweifel R, Boerner B, Tini GM, Irani S. Image analysis in posttreatment non-small cell lung cancer surveillance: specialists’ interpretations reviewed by the thoracic multidisciplinary tumor board. Multidiscip Respir Med 2019. [DOI: 10.4081/mrm.2019.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Data show that the initial specialist’s image interpretation and final multidisciplinary tumor board (MTB) assessment can vary substantially in the pretherapeutic cancer setting. The aim of this post hoc analysis was to investigate the concordance of the specialist’s and MTB’s image interpretations in patients undergoing systematic posttreatment lung cancer image surveillance.
Methods: In the initial prospective study, lung cancer patients who had received curative-intent treatment were randomly assigned to undergo either contrast-enhanced computed tomography (CE-CT) or integrated 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT). Imaging was performed every 6months for 2 years, and all imaging studies were finally assessed by our MTB. This post hoc analysis assessed differences between the initial specialist’s image interpretation and the final MTB’s image interpretation.
Results: In 89 patients, 266 imaging studies (129 PET-CT, 137 CE-CT) were analyzed. In 87.2% (88.4, 86.1%) of the studies, complete concordance was found. Out of the 12.8% (11.6, 13.9%) with discordant results, 7.5% (6.9, 8.0%) had implications for alterations in patient management (major disagreements). Twenty major disagreements were detected in 17 study patients. Retrospectively, in eight out of these 17 (47%) patients, in contrast to the MTB’s view, the specialist’s interpretation was more appropriate, whereas in nine out of 17 patients (53%), the MTB’s interpretation was more accurate.
Conclusions: In an experienced MTB, the agreement between imaging specialists and the rest of the MTB with regard to the interpretation of images is high in a setting of posttreatment lung cancer image surveillance. It seems that in cases of disagreements, the rates of more accurate interpretation are well balanced between imaging specialists and the MTB.
Trial registration: ISRCTN16281786, Date 23. February 2017.
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Gambazzi F, Frey LD, Bruehlmeier M, Janthur WD, Heuberger J, Spirig A, Williams R, Zweifel R, Boerner B, Tini GM, Irani S. Image analysis in posttreatment non-small cell lung cancer surveillance: specialists' interpretations reviewed by the thoracic multidisciplinary tumor board. Multidiscip Respir Med 2019; 14:34. [PMID: 31827794 PMCID: PMC6891985 DOI: 10.1186/s40248-019-0198-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Data show that the initial specialist’s image interpretation and final multidisciplinary tumor board (MTB) assessment can vary substantially in the pretherapeutic cancer setting. The aim of this post hoc analysis was to investigate the concordance of the specialist’s and MTB’s image interpretations in patients undergoing systematic posttreatment lung cancer image surveillance. Methods In the initial prospective study, lung cancer patients who had received curative-intent treatment were randomly assigned to undergo either contrast-enhanced computed tomography (CE-CT) or integrated 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT). Imaging was performed every 6 months for 2 years, and all imaging studies were finally assessed by our MTB. This post hoc analysis assessed differences between the initial specialist’s image interpretation and the final MTB’s image interpretation. Results In 89 patients, 266 imaging studies (129 PET-CT, 137 CE-CT) were analyzed. In 87.2% (88.4, 86.1%) of the studies, complete concordance was found. Out of the 12.8% (11.6, 13.9%) with discordant results, 7.5% (6.9, 8.0%) had implications for alterations in patient management (major disagreements). Twenty major disagreements were detected in 17 study patients. Retrospectively, in eight out of these 17 (47%) patients, in contrast to the MTB’s view, the specialist’s interpretation was more appropriate, whereas in nine out of 17 patients (53%), the MTB’s interpretation was more accurate. Conclusions In an experienced MTB, the agreement between imaging specialists and the rest of the MTB with regard to the interpretation of images is high in a setting of posttreatment lung cancer image surveillance. It seems that in cases of disagreements, the rates of more accurate interpretation are well balanced between imaging specialists and the MTB. Trial registration ISRCTN16281786, Date 23. February 2017.
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Affiliation(s)
- Franco Gambazzi
- 1Clinic of Thoracic Surgery, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Lukas D Frey
- 2Institute of Nuclear Medicine and PET-Center, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Matthias Bruehlmeier
- 2Institute of Nuclear Medicine and PET-Center, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Wolf-Dieter Janthur
- 3Clinic of Oncology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Juerg Heuberger
- 4Clinic of Radio-Oncology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Andres Spirig
- 5Department of Radiology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Richard Williams
- 5Department of Radiology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Roland Zweifel
- 6Institute of Pathology, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Bettina Boerner
- 7Clinic of Pulmonary and Sleep Medicine, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Gabrielo M Tini
- 7Clinic of Pulmonary and Sleep Medicine, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
| | - Sarosh Irani
- 7Clinic of Pulmonary and Sleep Medicine, Cantonal Hospital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland
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Irani S. The autoantibody mediated epilepsies. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mohan BP, Krishnamoorthi R, Ponnada S, Shakhatreh M, Jayaraj M, Garg R, Law J, Larsen M, Irani S, Ross A, Adler DG. Liquid Nitrogen Spray Cryotherapy in Treatment of Barrett's Esophagus, where do we stand? A Systematic Review and Meta-Analysis. Dis Esophagus 2019; 32:5304729. [PMID: 30715267 DOI: 10.1093/dote/doy130] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/06/2018] [Indexed: 12/11/2022]
Abstract
Radiofrequency ablation (RFA) is the preferred treatment option for Barrett's esophagus (BE) to achieve complete eradication (CE) of dysplasia (D), and intestinal metaplasia (IM). Cryotherapy, using liquid nitrogen (LNC), is a cold-induced tissue-injury technique option for the ablation of BE. We conducted a systematic review and meta-analysis to assess the overall efficacy and safety of LNC in the treatment of BE. We conducted a search of multiple electronic databases and conference proceedings from inception through June 2018. The primary outcome was to estimate the pooled rates of CE-IM, CE-D, and CE-HGD. The secondary outcome was to estimate the risk of adverse events and recurrence of disease after LNC. Nine studies reported 386 patients who were treated with LNC. The pooled rate of CE-IM was 56.5% (95% CI 48.5-64.2, I2 = 47), pooled rate of CE-D was 83.5% (95% CI 78.3-87.7, I2 = 22.8), and pooled rate of CE-HGD was 86.5% (95% CI 64.4-95.8, I2 = 88.1). Rate of adverse events was 4.7%, and the risk of BE recurrence was 12.7%. On subgroup analysis, the pooled rate of CE-IM with LNC in patients who failed RFA was 58.4% (95% CI 47.2-68.8, I2 = 32.5), and the pooled rate of CE-D in the same population was 81.9% (95% CI 72.5-88.6, I2 = 5.9). CE-D rates with LNC are comparable to RFA while CE-IM rates appear to be lower than the rates achievable with RFA. CE-IM rate in RFA failed patients is 58.4% and thus LNC is a rescue option to consider in this population.
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Affiliation(s)
- B P Mohan
- DCH Medical Center, University of Alabama, Tuscaloosa, Alabama
| | - R Krishnamoorthi
- Digestive Diseases Institute, Virginia Mason Medical Center, Seattle, Washington
| | - S Ponnada
- Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - M Shakhatreh
- Rapides Regional Medical Center, Alexandria, Louisiana
| | - M Jayaraj
- University of Nevada, Las Vegas, Nevada
| | - R Garg
- Cleveland Clinic Foundation, Cleveland, Ohio
| | - J Law
- Digestive Diseases Institute, Virginia Mason Medical Center, Seattle, Washington
| | - M Larsen
- Digestive Diseases Institute, Virginia Mason Medical Center, Seattle, Washington
| | - S Irani
- Digestive Diseases Institute, Virginia Mason Medical Center, Seattle, Washington
| | - A Ross
- Digestive Diseases Institute, Virginia Mason Medical Center, Seattle, Washington
| | - D G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Stathopoulos P, Chastre A, Waters P, Irani S, Fichtner ML, Benotti ES, Guthridge JM, Seifert J, Nowak RJ, Buckner JH, Holers VM, James JA, Hafler DA, O'Connor KC. Autoantibodies against Neurologic Antigens in Nonneurologic Autoimmunity. J Immunol 2019; 202:2210-2219. [PMID: 30824481 PMCID: PMC6452031 DOI: 10.4049/jimmunol.1801295] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/01/2019] [Indexed: 12/19/2022]
Abstract
The aim of this study was to test whether autoantibodies against neurologic surface Ags are found in nonneurologic autoimmune diseases, indicating a broader loss of tolerance. Patient and matched healthy donor (HD) sera were derived from four large cohorts: 1) rheumatoid arthritis (RA) (n = 194, HD n = 64), 2) type 1 diabetes (T1D) (n = 200, HD n = 200), 3) systemic lupus erythematosus (SLE) (n = 200, HD n = 67; neuro-SLE n = 49, HD n = 33), and 4) a control cohort of neurologic autoimmunity (relapsing-remitting multiple sclerosis [MS] n = 110, HD n = 110; primary progressive MS n = 9; secondary progressive MS n = 10; neuromyelitis optica spectrum disorders n = 15; and other neurologic disorders n = 26). Screening of 1287 unique serum samples against four neurologic surface Ags (myelin oligodendrocyte glycoprotein, aquaporin 4, acetylcholine receptor, and muscle-specific kinase) was performed with live cell–based immunofluorescence assays using flow cytometry. Positive samples identified in the screening were further validated using autoantibody titer quantification by serial dilutions or radioimmunoassay. Autoantibodies against neurologic surface Ags were not observed in RA and T1D patients, whereas SLE patients harbored such autoantibodies in rare cases (2/200, 1%). Within the CNS autoimmunity control cohort, autoantibodies against aquaporin 4 and high-titer Abs against myelin oligodendrocyte glycoprotein were, as expected, specific for neuromyelitis optica spectrum disorders. We conclude that neurologic autoantibodies do not cross disease barriers in RA and T1D. The finding of mildly increased neurologic autoantibodies in SLE may be consistent with a broader loss of B cell tolerance in this form of systemic autoimmunity.
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Affiliation(s)
- Panos Stathopoulos
- Department of Neurology, Yale School of Medicine, New Haven, CT 06511.,Department of Immunobiology, Yale School of Medicine, New Haven, CT 06511
| | - Anne Chastre
- Department of Neurology, Yale School of Medicine, New Haven, CT 06511.,Department of Immunobiology, Yale School of Medicine, New Haven, CT 06511
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - Sarosh Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - Miriam L Fichtner
- Department of Neurology, Yale School of Medicine, New Haven, CT 06511.,Department of Immunobiology, Yale School of Medicine, New Haven, CT 06511
| | - Erik S Benotti
- Department of Neurology, Yale School of Medicine, New Haven, CT 06511.,Department of Immunobiology, Yale School of Medicine, New Haven, CT 06511
| | - Joel M Guthridge
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104.,Oklahoma Clinical and Translational Science Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Jennifer Seifert
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045; and
| | - Richard J Nowak
- Department of Neurology, Yale School of Medicine, New Haven, CT 06511
| | - Jane H Buckner
- Translational Research Program, Benaroya Research Institute at Virginia Mason, Seattle, WA 98101
| | - V Michael Holers
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045; and
| | - Judith A James
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104.,Oklahoma Clinical and Translational Science Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - David A Hafler
- Department of Neurology, Yale School of Medicine, New Haven, CT 06511; .,Department of Immunobiology, Yale School of Medicine, New Haven, CT 06511
| | - Kevin C O'Connor
- Department of Neurology, Yale School of Medicine, New Haven, CT 06511; .,Department of Immunobiology, Yale School of Medicine, New Haven, CT 06511
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Sievi NA, Kohler M, Thurnheer R, Leuppi JD, Irani S, Frey M, Brutsche M, Brack T, Clarenbach CF. No impact of exacerbation frequency and severity on the physical activity decline in COPD: a long-term observation. Int J Chron Obstruct Pulmon Dis 2019; 14:431-437. [PMID: 30863043 PMCID: PMC6388775 DOI: 10.2147/copd.s188710] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction COPD exacerbations are associated with a concomitant profound reduction in daily physical activity (PA). Thereby, exacerbation frequency and severity may have an amplifying effect. Whether the reduced level of PA returns to the level prior to exacerbation or has a sustained negative impact on activity behavior over time is unclear. Methods The number of steps per day over 1 week, as a measure of daily PA, was assessed annually in a cohort of patients with COPD. Exacerbation frequency and severity were documented. Uni- and multivariate mixed effect models were used to investigate associations between change in number of steps per day (dependent variable) and exacerbations. Stratification by possible confounders was performed. Results One hundred and eighty one COPD patients (median [quartile] age 64 [59/69] years, 65% male, median [quartiles] FEV1 % pred. 46 [33/65]) suffered a total of 273 exacerbations during the observation period (median [quartiles] follow-up time of 2.1 [1.6/3.1] years). Neither the frequency nor the severity of exacerbations was significantly related to the overall decline in PA over time. Stratification by different possible confounders such as age, sex and disease severity did not yield a subgroup in which exacerbations enhance the decrease in PA over time. Conclusion The drop in PA during the phase of an acute exacerbation seems not to be a lasting phenomenon leading to a fundamental change in activity behavior. Trial registration www.ClinicalTrials.gov, NCT01527773
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Affiliation(s)
- Noriane A Sievi
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland,
| | - Malcolm Kohler
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland,
| | - Robert Thurnheer
- Pulmonary Division, Cantonal Hospital of Münsterlingen, Münsterlingen, Switzerland
| | - Joerg D Leuppi
- University Clinic of Medicine, Cantonal Hospital Baselland and University of Basel, Basel, Switzerland
| | - Sarosh Irani
- Pulmonary Division, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Martin Frey
- Pulmonary Division, Clinic Barmelweid, Barmelweid, Switzerland
| | - Martin Brutsche
- Pulmonary Division, Cantonal Hospital of St Gallen, St Gallen, Switzerland
| | - Thomas Brack
- Pulmonary Division, Cantonal Hospital of Glarus, Glarus, Switzerland
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Lee HJ, Kim B, Waters P, Woodhall M, Irani S, Ahn S, Kim SJ, Kim SM. Chronic relapsing inflammatory optic neuropathy (CRION): a manifestation of myelin oligodendrocyte glycoprotein antibodies. J Neuroinflammation 2018; 15:302. [PMID: 30382857 PMCID: PMC6208174 DOI: 10.1186/s12974-018-1335-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/16/2018] [Indexed: 12/21/2022] Open
Abstract
Background Key clinical features of chronic relapsing inflammatory optic neuropathy (CRION) include relapsing inflammatory optic neuritis (ON) and steroid dependency, both of which have been reported among patients with myelin oligodendrocyte glycoprotein antibodies (MOG-Abs). We investigated the relevance of the presence of serum MOG-IgG with the current diagnostic criteria for CRION among patients with idiopathic inflammatory optic neuritis (iON). Methods Retrospective reviews of a database prospectively collated between 2011 and 2017 from the tertiary referral center for multiple sclerosis and neuromyelitis optica were performed. Sixty-four patients with iON, who did not meet the diagnostic criteria for multiple sclerosis, neuromyelitis optica (NMO) spectrum disorder with/without NMO-IgG, or acute disseminated encephalomyelitis and who had no symptomatic central nervous system (CNS) lesions other than on the optic nerve, were included from a cohort of 615 patients with inflammatory demyelinating diseases of the CNS. Fulfillment of the current diagnostic criteria for CRION, assay results for the serum IgG1 MOG-Ab, and characteristics of CRION patients with MOG-IgG were compared to those of non-CRION patients with MOG-IgG. Results Twelve iON patients fulfilled the current diagnostic criteria for CRION, 11 patients were positive for MOG-IgG, and one patient was borderline. Among the other 52 iON patients not meeting the criteria for CRION, 14 had relapsing disease courses and 38 had monophasic courses, of which MOG-IgG positivity were 0% and 29%, respectively. CRION patients with MOG-IgG had more relapsing disease courses (first steroid-dependent worsening/relapse in 2.3 months, range 0.4–7.0) and poorer optical coherence tomography outcomes at follow-up than non-CRION patients with MOG-IgG. However, patients in the two groups did not differ in terms of age of onset, sex, or steroid treatment duration after initial attack. Conclusions CRION, according to the current diagnostic criteria, is a relapsing optic neuritis associated with MOG-IgG. Among iON patients with MOG-IgG, the absence of steroid-dependent attacks in the early stages of the disease may predict a long-term non-relapsing disease course and a more favorable outcome. Electronic supplementary material The online version of this article (10.1186/s12974-018-1335-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Haeng-Jin Lee
- Department of Ophthalmology, College of Medicine, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea
| | - Boram Kim
- Department of Neurology, College of Medicine, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Sarosh Irani
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Sohyun Ahn
- Department of Neurology, College of Medicine, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, College of Medicine, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea.
| | - Sung-Min Kim
- Department of Neurology, College of Medicine, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea.
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Waite K, Ryan-Ainslie J, Irani S, Karandikar S. Repair of traumatic post-coital recto-vaginal fistula - a video vignette. Colorectal Dis 2018; 20:938-939. [PMID: 30066988 DOI: 10.1111/codi.14363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/02/2018] [Indexed: 02/08/2023]
Affiliation(s)
- K Waite
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - J Ryan-Ainslie
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - S Irani
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - S Karandikar
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
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Sievi NA, Brack T, Brutsche MH, Frey M, Irani S, Leuppi JD, Thurnheer R, Kohler M, Clarenbach CF. Physical activity declines in COPD while exercise capacity remains stable: A longitudinal study over 5 years. Respir Med 2018; 141:1-6. [DOI: 10.1016/j.rmed.2018.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 10/14/2022]
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Symmonds M, Moran CH, Stephan KE, Leite MI, Buckley C, Irani S, Friston KJ, Moran RJ. S62. Computational diagnosis of ion channel dysfunction in NMDA receptor antibody encephalitis. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lang B, Maddison P, Dettmann I, Adcock J, Buckley C, Leite I, Vincent A, Komorowski L, Waters P, Irani S. 1645 Vgkc is dead: long live lgi1- and caspr2-antibodies. intracellular and non-neuronal targets of voltage-gated potassium channel complex antibodies. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Varley J, Piehl F, Andersson M, Lang B, Vincent A, Waters P, Irani S. 1633 Linear- versus conformational-protein directed autoantibodies in neuropsychiatric systemic lupus erythematosis. J Neurol Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Thouin A, Gastaldi M, Woodhall M, Jacobson L, Irani S, Vincent A. PO154 A comparison of nmdar-antibody detection methods. J Neurol Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lang B, Komorowski L, Adcock J, Waters P, Irani S. Intracellular and non-neuronal targets of voltage-gated potassium channel complex antibodies: Evidence for relative pathogenicity. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Thompson J, Bi M, Makuch M, Bien C, Chu K, Gelfand J, Geschwind M, Hirsch L, Somerville E, Lang B, Vincent A, Leite M, Waters P, Irani S. Reasons for early immunotherapy in 103 patients with faciobrachial dystonic seizures: Effect on short and long-term outcomes. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Small A, Irani S. Endoscopic ultrasound gallbladder drainage: Patient selection, preparation, and performance. Techniques in Gastrointestinal Endoscopy 2017. [DOI: 10.1016/j.tgie.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Irani S. 17 Autoantibody-mediated encephalitis. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-bnpa.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Clarenbach C, Sievi N, Brack T, Brutsche M, Frey M, Irani S, Leuppi J, Thurnheer R, Kohler M. P147 Is a questionnaire suitable to assess physical activity and its changes in COPD? Chest 2017. [DOI: 10.1016/j.chest.2017.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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