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Yi JS, Davis AC, Pietsch K, Walsh JM, Scriven KA, Mock J, Ryan MA. Demographic Differences in Clinical Presentation of Pediatric Paradoxical Vocal Fold Motion (PVFM). J Voice 2024; 38:539.e1-539.e9. [PMID: 34642070 DOI: 10.1016/j.jvoice.2021.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/15/2021] [Accepted: 08/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Paradoxical vocal fold motion (PVFM) is involuntary closure of the vocal folds during inspiration, often presenting in children and young adults. Although common symptoms and triggers are known, differences in clinical presentation based on patient demographics are unknown. This study characterizes differences in clinical presentation of pediatric PVFM based on age, sex, and race/ethnicity. METHODS We reviewed electronic medical records of patients 0-21 years old with PVFM based on ICD codes from 2009 to 2019 within a tertiary academic health system. Demographics, symptoms, triggers, concurrent diagnoses, and laryngoscopy findings were abstracted. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated using logistic regression. RESULTS Among 96 individuals the mean age was 10.6 years (standard deviation ±6.5) and 66 (69%) were female. In comparison to 13-21 year olds, those 0-2 years more often had PVFM observed on laryngoscopy (OR = 17.84, 95% CI: 3.14-101.51) and had less shortness of breath (OR = 0.01, 95% CI: 0.00-0.09). Those 3-12 years had more asthma (OR = 3.07, 95% CI: 1.07-8.81) and cough (OR = 6.12, 95% CI: 1.77-21.13). Both 0-2 (OR = 0.07, 95% CI: 0.02-0.24) and 3-12 year olds (OR = 0.13, 95% CI: 0.04-0.40) presented less with activity as a trigger. Racial/ethnic minorities were more likely to present with pharyngeal findings (eg mucosal inflammation, adenotonsillar hypertrophy) on laryngoscopy (OR = 4.58, 95% CI: 1.45-15.37) compared to non-Hispanic Whites. Differences in clinical presentation by sex were not observed. CONCLUSION We identified several differences in symptoms, triggers, and laryngoscopy findings in pediatric PVFM based on age and race/ethnicity. Associations between sex and clinical presentation were not observed.
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Affiliation(s)
- Julie S Yi
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ashley C Davis
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kristine Pietsch
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jonathan M Walsh
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kelly A Scriven
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jeremy Mock
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Marisa A Ryan
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Otolaryngology - Head and Neck Surgery, Emory Voice Center, Emory University, Medical Office Tower, Atlanta, Georgia.
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Hura N, Yi JS, Lin SY, Roxbury CR. Magnetic Resonance Imaging as a Diagnostic and Research Tool in Patients with Olfactory Dysfunction: A Systematic Review. Am J Rhinol Allergy 2022; 36:668-683. [PMID: 35585698 DOI: 10.1177/19458924221096913] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with acquired, idiopathic olfactory dysfunction (OD) commonly undergo magnetic resonance imaging (MRI) evaluation to rule out intracranial pathologies. This practice is highly debated given the expense of MRI relative to the probability of detecting a treatable lesion. This, combined with the increasing use of MRI in research to investigate the mechanisms underlying OD, provided the impetus for this comprehensive review. OBJECTIVE The purpose of this systematic review was to both assess the utility of MRI in diagnosis of idiopathic OD and to describe MRI findings among mixed OD etiologies to better understand its role as a research tool in this patient population. METHODS A literature search of PubMed, Embase, Cochrane, Web of Science, and Scopus for studies with original MRI data for patients with OD was completed. Studies exclusively investigating patients with neurocognitive deficits or those studying traumatic or congenital etiologies of OD were excluded. RESULTS From 1758 candidate articles, 33 studies were included. Four studies reviewed patients with idiopathic OD for structural pathologies on MRI, of which 17 of 372 (4.6%) patients had a potential central cause identified, and 3 (0.8%) had an olfactory meningioma or olfactory neuroblastoma. Fourteen studies (42.4%) reported significant correlation between olfactory bulb volume and olfactory outcomes, and 6 studies (18.8%) reported gray matter volume reduction, specifically in the orbitofrontal cortex, anterior cingulate cortex, insular cortex, parahippocampal, and piriform cortex areas, in patients with mixed OD etiologies. Functional MRI studies reported reduced brain activation and functional connectivity in olfactory network areas. CONCLUSION MRI uncommonly detects intracranial pathology in patients with idiopathic OD. Among patients with mixed OD etiologies, reduced olfactory bulb and gray matter volume are the most common abnormal findings on MRI. Further research is required to better understand the role of MRI and its cost-effectiveness in patients with acquired, idiopathic OD.
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Affiliation(s)
- Nanki Hura
- Department of Otolaryngology - Head and Neck Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Otolaryngology - Head and Neck Surgery, 6595University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Julie S Yi
- Department of Otolaryngology - Head and Neck Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sandra Y Lin
- Department of Otolaryngology - Head and Neck Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher R Roxbury
- Section of Otolaryngology - Head and Neck Surgery, 21727The University of Chicago Medical Center, Chicago, Illinois, USA
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Abstract
OBJECTIVES We examined individual-level factors associated with hearing aid use by race and ethnicity in a nationally representative sample of Medicare beneficiaries. METHODS We used the Medicare Current Beneficiary Survey (cycles 2016-2018) for 10,301 older adults with hearing loss and hearing aid use as the primary outcome. Covariates included education, income, urban residence, chronic conditions, functional limitations, and Medicaid eligibility. Multivariable logistic regression stratified by race and ethnicity was used to identify factors associated with hearing aid use. RESULTS Factors associated with hearing aid use included higher education among White (OR = 1.35, 95%CI:1.16, 1.58), Black (OR = 1.76, 95%CI:1.02, 3.05), and Hispanic (OR = 1.77, 95%CI:1.17, 2.68) beneficiaries. Urban residence was associated with hearing aid use for Black participants (OR = 3.06, 95%CI:1.17, 8.03) and Medicaid eligibility for Hispanic participants (OR = 1.58, 95%CI:0.97, 2.59), although the confidence interval included the null hypothesis. DISCUSSION ndividual-level factors associated with hearing aid use differed by race and ethnicity among Medicare beneficiaries.
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Affiliation(s)
- Julie S Yi
- 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Cochlear Center for Hearing & Public Health, 25802Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Emmanuel E Garcia Morales
- Cochlear Center for Hearing & Public Health, 25802Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Nicholas S Reed
- Cochlear Center for Hearing & Public Health, 25802Johns Hopkins University School of Public Health, Baltimore, MD, USA.,Department of Otolaryngology-HNS, Division of Otology, Neurotology & Skull Base Surgery, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amber Willink
- Cochlear Center for Hearing & Public Health, 25802Johns Hopkins University School of Public Health, Baltimore, MD, USA.,The University of Sydney Menzies Centre for Health Policy, Sydney, NSW, Australia.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carrie L Nieman
- Cochlear Center for Hearing & Public Health, 25802Johns Hopkins University School of Public Health, Baltimore, MD, USA.,Department of Otolaryngology-HNS, Division of Otology, Neurotology & Skull Base Surgery, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA
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Yi JS, Garcia Morales EE, Betz JF, Deal JA, Dean LT, Du S, Goman AM, Griswold ME, Palta P, Rebok GW, Reed NS, Thorpe RJ, Lin FR, Nieman CL. Individual Life-Course Socioeconomic Position and Hearing Aid Use in the Atherosclerosis Risk in Communities Study. J Gerontol A Biol Sci Med Sci 2022; 77:645-653. [PMID: 35239947 PMCID: PMC8893260 DOI: 10.1093/gerona/glab273] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To measure the association between individual life-course socioeconomic position (SEP) and hearing aid use, we examined childhood and adulthood socioeconomic variables collected at the Atherosclerosis Risk in Communities (ARIC) study baseline visit (1987-1989)/Life Course Socioeconomic Status study (2001-2002) and hearing aid use data collected at visit 6 (2016-2017). METHODS ARIC is a prospective cohort study of older adults (45-64 years) recruited from 4 U.S. communities. This analysis included a subset of 2 470 participants with hearing loss at visit 6 (≥25 decibels hearing level [dB HL] better-ear) with complete hearing aid use data. Childhood SEP variables included parental education, parental occupation, and parental home ownership. Young and older adulthood SEP variables included income, education, occupation, and home ownership. Each life epoch was assigned a score ranging from 0 to 5 and then summed to calculate the individual cumulative SEP score. Multivariable-adjusted logistic regression was used to estimate the association between individual cumulative SEP and hearing aid use. Missing SEP scores were imputed for participants with incomplete socioeconomic data. RESULTS Of the 2 470 participants in the analytic cohort (median [interquartile interval] age 79.9 [76.7-84.0], 1 330 [53.8%] women, 450 [18.2%] Black), 685 (27.7%) participants reported hearing aid use. Higher cumulative SEP was positively associated with hearing aid use (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 1.04-1.14), and slightly stronger for childhood (OR = 1.09, 95% CI: 1.00-1.20) than older adulthood SEP score (OR = 1.06, 95% CI: 0.95-1.18). CONCLUSIONS In this community-based cohort of older adults with hearing loss, higher individual life-course SEP was positively associated with hearing aid use.
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Affiliation(s)
- Julie S Yi
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emmanuel E Garcia Morales
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joshua F Betz
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer A Deal
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lorraine T Dean
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Simo Du
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adele M Goman
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael E Griswold
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Priya Palta
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, New York, USA
| | - George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicholas S Reed
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Roland J Thorpe
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Frank R Lin
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carrie L Nieman
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Yi JS, Hura N, Roxbury CR, Lin SY. Magnetic Resonance Imaging Findings Among Individuals With Olfactory and Cognitive Impairment. Laryngoscope 2021; 132:177-187. [PMID: 34383302 DOI: 10.1002/lary.29812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/10/2021] [Revised: 06/25/2021] [Accepted: 07/25/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The underlying mechanism of the association between olfactory impairment and dementia may be explained by neurodegenerative changes detected on magnetic resonance imaging (MRI). The purpose of this systematic review is to describe neurodegenerative changes on MRI in patients with olfactory impairment and mild cognitive impairment (MCI) or dementia. STUDY DESIGN Systematic review. METHODS A literature search encompassing PubMed, Embase, Cochrane Library, Web of Science, Scopus, and Google Scholar for studies with MRI and olfactory testing among participants diagnosed with MCI or dementia was performed. Sample size, study design, cognitive impairment type, olfactory testing, and MRI findings were abstracted. Two investigators independently reviewed all articles. RESULTS The search yielded 556 nonduplicate abstracts, from which 86 articles were reviewed and 24 were included. Seventeen (71%) of 24 studies reported hippocampal volume findings, with 14 studies reporting a relationship between hippocampal volume and olfactory performance. Two (50%) of four prospective studies reported the potential utility of baseline hippocampal volume as a marker of dementia conversion from MCI. Five (21%) of 24 studies reporting olfactory functional MRI (fMRI) findings highlighted the utility of olfactory fMRI to identify individuals in the early stages of cognitive decline. CONCLUSION Current evidence suggests hippocampal volume correlates with olfactory performance in individuals with cognitive impairment, and that olfactory fMRI may improve early detection of AD. However, the predictive utility of these imaging markers is limited in prospective studies. MRI may be a useful modality for selecting patients at high risk of future cognitive decline for enrollment in early treatment trials. Laryngoscope, 2021.
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Affiliation(s)
- Julie S Yi
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Nanki Hura
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Christopher R Roxbury
- Department of Otolaryngology-Head and Neck Surgery, The University of Chicago Medical Center, Chicago, Illinois, U.S.A
| | - Sandra Y Lin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
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Yi JS, Pittman CA, Price CL, Nieman CL, Oh ES. Telemedicine and Dementia Care: A Systematic Review of Barriers and Facilitators. J Am Med Dir Assoc 2021; 22:1396-1402.e18. [PMID: 33887231 PMCID: PMC8292189 DOI: 10.1016/j.jamda.2021.03.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 11/18/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES An increasing reliance on telemedicine for older adults with cognitive impairment requires a better understanding of the barriers and facilitators for this unique patient population. DESIGN The study team queried PubMed, Embase, the Cochrane Library, PsycINFO, CINAHL, Scopus, and ClinicalTrials.gov on May 1, 2020, for studies in English published from January 2010 to May 2020. SETTING AND PARTICIPANTS We conducted a systematic review of articles investigating the use of telemedicine among older adults with Alzheimer's disease and related dementia (ADRD) or mild cognitive impairment (MCI) that focused on the patient and care partner perspectives. METHODS Telemedicine encounter purpose, technological requirements, and findings regarding sensory needs were extracted. The Cochrane Collaboration's Risk of Bias Tool was applied for quality assessment. RESULTS The search yielded 3551 abstracts, from which 90 articles were reviewed and 17 were included. The purpose of telemedicine encounters included routine care, cognitive assessment, and telerehabilitation. All studies reported successful implementation of telemedicine, supported by patient and care partner satisfaction, similar results on cognitive assessment and diagnosis compared to in-person visits, and improvement in outcome measures following rehabilitation. Sixteen studies relied on staff and care partners to navigate technologies. Six studies reported participants reporting difficulty hearing the provider during the telemedicine visits. Five studies excluded participants with visual or hearing impairment because of the potential difficulty of using telemedicine technology. No studies reported technological adaptations to account for sensory impairment. CONCLUSIONS AND IMPLICATIONS Telemedicine is well received among patients and care partners, but successful delivery incorporates support staff and the care partners to navigate technologies. The exclusion of older adults with sensory impairment, especially given that it is highly prevalent, in developing telemedicine systems may further exacerbate access to care in this population. Adapting technologies for sensory needs is critical to the advancement of accessible dementia care through telemedicine.
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Affiliation(s)
- Julie S Yi
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Corinne A Pittman
- Howard University College of Medicine, Washington, DC, USA; Cochlear Center for Hearing & Public Health-Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Carrie L Price
- Albert S. Cook Library, Towson University, Towson, MD, USA
| | - Carrie L Nieman
- Cochlear Center for Hearing & Public Health-Johns Hopkins University School of Public Health, Baltimore, MD, USA; Division of Otology, Neurotology & Skull Base Surgery, Department of Otolaryngology-HNS, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Esther S Oh
- Cochlear Center for Hearing & Public Health-Johns Hopkins University School of Public Health, Baltimore, MD, USA; Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Yi JS, Kim MJ, Jang YJ. An Asian perspective on improving outcomes for nasal bone fractures by establishing specific treatment options. Clin Otolaryngol 2016; 42:46-52. [PMID: 27086767 DOI: 10.1111/coa.12660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report treatment outcomes of patients with different types of nasal bone fracture, following a tailored treatment protocol. DESIGN The patterns and the severity of the fractures were determined by a preoperative facial photo and nasal bone computed tomography (CT) retrospectively. SETTING A tertiary referral centre. PARTICIPANTS We evaluated 129 patients who underwent surgery between March 2002 and January 2014. Patients were subjected to five different treatment methods depending on the severity of injury. MAIN OUTCOME MEASURES Medical records were reviewed to assess rates of complications and revision surgery. Cosmetic and functional (the degree of nasal obstruction) outcomes were measured using the Likert scale from 1 (very dissatisfied, severe obstruction) to 5 (very satisfied, no obstruction). RESULTS The mean elapsed time from injury to surgery was 14.9 days. The overall treatment failure rate, defined as a deformity that required revision, was 6.2%. The patient satisfaction scores for aesthetic and functional outcomes were 3.9 and 4.6 respectively. CONCLUSION The prudent selection of patients with indication for closed reduction, and further specification of variable treatment options for the various degrees of nasal bone fracture, may be helpful in achieving an improved treatment outcome. LEVEL OF EVIDENCE level IV.
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Affiliation(s)
- J S Yi
- Bundang CHA Medical Center, Department of Otolaryngology, CHA University, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - M J Kim
- Asan Medical Center, Department of Otolaryngology, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
| | - Y J Jang
- Asan Medical Center, Department of Otolaryngology, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
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Yi JS, Guidon A, Sparks S, Osborne R, Juel VC, Massey JM, Sanders DB, Weinhold KJ, Guptill JT. Characterization of CD4 and CD8 T cell responses in MuSK myasthenia gravis. J Autoimmun 2013; 52:130-8. [PMID: 24378287 DOI: 10.1016/j.jaut.2013.12.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [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: 06/29/2013] [Accepted: 12/08/2013] [Indexed: 01/22/2023]
Abstract
Muscle specific tyrosine kinase myasthenia gravis (MuSK MG) is a form of autoimmune MG that predominantly affects women and has unique clinical features, including prominent bulbar weakness, muscle atrophy, and excellent response to therapeutic plasma exchange. Patients with MuSK MG have predominantly IgG4 autoantibodies directed against MuSK on the postsynaptic muscle membrane. Lymphocyte functionality has not been reported in this condition. The goal of this study was to characterize T cell responses in patients with MuSK MG. Intracellular production of IFN-gamma, TNF-alpha, IL-2, IL-17, and IL-21 by CD4+ and CD8+ T cells was measured by polychromatic flow cytometry in peripheral blood samples from 11 Musk MG patients and 10 healthy controls. Only one MuSK MG patient was not receiving immunosuppressive therapy. Regulatory T cells (Treg) were also included in our analysis to determine if changes in T cell function were due to altered Treg frequencies. CD8+ T cells from MuSK MG patients had higher frequencies of polyfunctional responses than controls, and CD4+ T cells had higher IL-2, TNF-alpha, and IL-17. MuSK MG patients had a higher percentage of CD4+ T cells producing combinations of IFN-gamma/IL-2/TNF-gamma, TNF-alpha/IL-2, and IFN-gamma/TNF-alpha. Interestingly, Treg numbers and CD39 expression were not different from control values. MuSK MG patients had increased frequencies of Th1 and Th17 cytokines and were primed for polyfunctional proinflammatory responses that cannot be explained by a defect in CD39 expression or Treg number.
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Affiliation(s)
- J S Yi
- Division of Surgical Sciences, Department of Surgery, Duke University Medical Center, 204 SORF (Bldg. 41), 915 S. LaSalle Street, Box 2926, Durham, NC 27710, USA
| | - A Guidon
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, DUMC Box 3403, Durham, NC 27710, USA
| | - S Sparks
- Division of Surgical Sciences, Department of Surgery, Duke University Medical Center, 204 SORF (Bldg. 41), 915 S. LaSalle Street, Box 2926, Durham, NC 27710, USA
| | - R Osborne
- Division of Surgical Sciences, Department of Surgery, Duke University Medical Center, 204 SORF (Bldg. 41), 915 S. LaSalle Street, Box 2926, Durham, NC 27710, USA
| | - V C Juel
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, DUMC Box 3403, Durham, NC 27710, USA
| | - J M Massey
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, DUMC Box 3403, Durham, NC 27710, USA
| | - D B Sanders
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, DUMC Box 3403, Durham, NC 27710, USA
| | - K J Weinhold
- Division of Surgical Sciences, Department of Surgery, Duke University Medical Center, 204 SORF (Bldg. 41), 915 S. LaSalle Street, Box 2926, Durham, NC 27710, USA
| | - J T Guptill
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, DUMC Box 3403, Durham, NC 27710, USA.
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Kim HJ, Lee HJ, Yang JH, Yeo IS, Yi JS, Lee IW, Lee SB, Ryu SY, Kim JK, Yang PS. The influence of carotid artery catheterization technique on the incidence of thromboembolism during carotid artery stenting. AJNR Am J Neuroradiol 2010; 31:1732-6. [PMID: 20595362 DOI: 10.3174/ajnr.a2141] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Thromboembolic events related to CAS continue to be the main limitation to the widespread use of this technique as a first-line treatment for carotid occlusive disease. Our aim was to evaluate thromboembolism during CAS using DWI for catheterization techniques of the carotid artery. MATERIALS AND METHODS Thirty-two consecutive patients with symptomatic carotid stenosis underwent CAS involving 1 of 2 carotid artery catheterization techniques: One used a 7F or 8F catheter (group 1, n = 16) and the other used a coaxial system in which a 7F or 8F catheter was used in conjunction with a 4F or 5F catheter (group 2, n = 16). DWI was performed before and after CAS. Clinical variables, the number and location of NES on DWI after CAS, were compared between the 2 groups. RESULTS NES on DWI occurred in 53% of all patients. The incidence of NES was significantly higher in patients 65 years of age and older versus those younger than 65 years of age (P = .013). All NESs were asymptomatic, and their rate of occurrence did not differ significantly between groups 1 and 2. The incidence of NES in the other territories that were outside that of the treated carotid artery (P = .004) and the incidence of multiple NESs (P = .04) were significantly higher in group 1. CONCLUSIONS NES in the other territories mainly arises from the atherosclerotic aortic arch and arch vessels during the manipulation of endoluminal devices. The carotid artery catheterization technique using the coaxial system with a 7F or 8F catheter in conjunction with a 4F or 5F catheter reduced the incidence of NES in the other territories.
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Affiliation(s)
- H J Kim
- Departments of Radiology, Daejeon St. Mary’s Hospital, Medical School, The Catholic University of Korea, 520-2 Daeheung-Dong, Jung-Gu, Daejeon, Korea
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Kang UG, Jeon SH, Lee JE, Joo YH, Yi JS, Park JB, Juhnn YS, Kim YS. The activation of B-Raf and Raf-1 after electroconvulsive shock in the rat hippocampus. Neuropharmacology 2000; 39:703-6. [PMID: 10728891 DOI: 10.1016/s0028-3908(99)00184-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We demonstrated that ECS activates the kinase activity of B-Raf and Raf-1 in the rat hippocampus. The activity was maximal at one minute after ECS and temporally coincided with the increased membrane translocation of Rafs and the reported activity of MAPK, but not with the phosphorylation of Rafs.
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Affiliation(s)
- U G Kang
- Department of Psychiatry, Seoul National University College of Medicine, South Korea
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Mandard AM, Duigou F, Marnay J, Masson P, Qiu SL, Yi JS, Barrellier P, Lebigot G. Analysis of the results of the micronucleus test in patients presenting upper digestive tract cancers and in non-cancerous subjects. Int J Cancer 1987; 39:442-4. [PMID: 3557703 DOI: 10.1002/ijc.2910390405] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A micronucleus test was performed on 75 subjects of whom 38 presented with cancer of the upper digestive tract and 37 were free of disease; the absence of cancerous or pre-cancerous lesions in this latter group was confirmed by endoscopy and vital staining. The daily levels of alcohol and tobacco consumption of the 75 subjects were determined by precise questioning: 78% of the non-cancerous subjects smoked less than 10 g of tobacco per day whereas 79% of the cancer patients smoked 10 g or more daily. The alcohol intake of 78% of the non-cancerous subjects and 63% of the cancer patients was less than 101 ml per day. Only 10% of the cancer patients had combined daily intake levels corresponding to the threshold of sensitivity of the micronucleus test as defined by previous studies. The mean frequency of micronucleated buccal cells was 0.26% in the cancer patients and 0.13% in the non-cancerous subjects. All non-cancerous patients presented a negative test. Only 5% of the cancer patients presented a micronucleated cell frequency above 1% and could thus be considered as positive. It thus appears that the micronucleus test was not significantly positive in our population of 38 cancer patients.
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