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Background The immunopathology of autoimmune seronegative myasthenia gravis (SN MG) is poorly understood. Our objective was to determine immune profiles associated with a diagnosis of SN MG. Methods We performed high-dimensional flow cytometry on blood samples from SN MG patients (N = 68), healthy controls (N = 46), and acetylcholine receptor antibody (AChR+) MG patients (N = 27). We compared 12 immune cell subsets in SN MG to controls using logistic modeling via a discovery-replication design. An exploratory analysis fit a multinomial model comparing AChR+ MG and controls to SN MG. Results An increase in CD19+ CD20- CD38hi plasmablast frequencies was associated with lower odds of being a SN MG case in both the discovery and replication analyses (discovery P-value = .0003, replication P-value = .0021). Interleukin (IL) -21 producing helper T cell frequencies were associated with a diagnosis of AChR+ MG (P = .004). Conclusions Reduced plasmablast frequencies are strongly associated with a SN MG diagnosis and may be a useful diagnostic biomarker in the future.

A detailed understanding of the role of Tfh cells in MuSK-antibody positive myasthenia gravis (MuSK-MG) is lacking. We characterized phenotype and function of Tfh cells in MuSK-MG patients and controls. We found similar overall Tfh and follicular regulatory (Tfr) T cell frequencies in MuSK-MG and healthy controls, but MuSK-MG patients exhibited higher frequencies of Tfh17 cells and a higher ratio of Tfh:Tfr cells. These results suggest imbalanced Tfh cell regulation, further supported by increased frequencies of CD4 T cells co-producing IL-21/IL-17 and IL-17/IFN-γ, and increased Tfh-supported IgG production. These results support a role for Tfh cell dysregulation in MuSK-MG immunopathology.

BACKGROUND/OBJECTIVES: Telephone calls after dis-charge from the emergency department (ED) are increasinglyused to reduce 30-day rates of return or readmission, buttheir effectiveness is not established. The objective was todetermine whether a scripted telephone intervention by regis-tered nurses from a hospital-based call center would decrease30-day rates of return to the ED or hospital or of death.DESIGN: Randomized, controlled trial from 2013 to 2016.SETTING: Large, academic medical center in the south-east United States.PARTICIPANTS: Individuals aged 65 and older dis-charged from the ED were enrolled and randomized intointervention and control groups (N = 2,000).INTERVENTION: Intervention included a telephone callfrom a nurse using a scripted questionnaire to identifyobstacles to elements of successful care transitions: medica-tion acquisition, postdischarge instructions, and obtainingphysician follow-up. Control subjects received a satisfac-tion survey only.MEASUREMENTS: Primary outcome was return to theED, hospitalization, or death within 30 days of dischargefrom the ED.RESULTS: Rate of return to the ED or hospital or deathwithin 30 days was 15.5% (95% confidence interval(CI) = 13.2–17.8%) in the intervention group and 15.2%(95% CI = 12.9–17.5%) in the control group (P = .86).Death was uncommon (intervention group, 0; control group, 5 (0.51%), 95% CI = 0.06–0.96%); 12.2% ofintervention subjects (95% CI = 10.1–14.3%) and 12.5%of control subjects (95% CI = 10.4–14.6%) returned tothe ED, and 9% of intervention subjects (95% CI = 7.2–10.8%) and 7.4% of control subjects (95% CI = 5.8–9.0%) were hospitalized within 30 days.CONCLUSION: A scripted telephone call from a trainednurse to an older adult after discharge from the ED didnot reduce ED or hospital return rates or death within 30 days. Clinicaltrials.gov identifier: NCT01893931z.