32 results on '"Pae E"'
Search Results
2. A Genome Segment on Mouse Chromosome 12 Determines Maxillary Growth
- Author
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Oh, J., primary, Wang, C.J., additional, Poole, M., additional, Kim, E., additional, Davis, R.C., additional, Nishimura, I., additional, and Pae, E.-K., additional
- Published
- 2007
- Full Text
- View/download PDF
3. Longitudinal Analysis of Clinical Markers following Antiretroviral Therapy Initiated during Acute or Early HIV Type 1 Infection
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Kassutto, S., primary, Maghsoudi, K., additional, Johnston, M. N., additional, Robbins, G. K., additional, Burgett, N. C., additional, Sax, P. E., additional, Cohen, D., additional, Pae, E., additional, Davis, B., additional, Zachary, K., additional, Basgoz, N., additional, D'agata, E. M. C., additional, DeGruttola, V., additional, Walker, B. D., additional, and Rosenberg, E. S., additional
- Published
- 2006
- Full Text
- View/download PDF
4. KIR genotype lacking of some conserved genes
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Uribe, M.R., primary, Adams, S., additional, Pae, E., additional, Stroncek, D., additional, and Marincola, F., additional
- Published
- 2005
- Full Text
- View/download PDF
5. Off-Label Reduced Dose Apixaban in Older Adults With Atrial Fibrillation and Associated Outcomes.
- Author
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Campbell AM, Pae E, Lee E, Jacisin T, Price A, and DeAngelo J
- Subjects
- Humans, Aged, Female, Male, Retrospective Studies, Aged, 80 and over, Dose-Response Relationship, Drug, Treatment Outcome, Ischemic Attack, Transient prevention & control, Ischemic Attack, Transient epidemiology, Atrial Fibrillation drug therapy, Atrial Fibrillation complications, Pyrazoles administration & dosage, Pyrazoles adverse effects, Pyrazoles therapeutic use, Pyridones administration & dosage, Pyridones adverse effects, Pyridones therapeutic use, Off-Label Use, Stroke prevention & control, Stroke epidemiology, Factor Xa Inhibitors administration & dosage, Factor Xa Inhibitors adverse effects, Factor Xa Inhibitors therapeutic use, Hemorrhage chemically induced, Hemorrhage epidemiology
- Abstract
Background: Apixaban is commonly used to prevent stroke in older adults with nonvalvular atrial fibrillation (AF). Although its package insert has specific dose reduction criteria, providers may dose reduce outside of these parameters based on clinical scenarios., Objective: The primary objective was to determine the incidence of apixaban off-label reduced dosing, while secondarily determining the safety and efficacy outcomes associated with such dosing., Methods: A retrospective analysis of patients aged 65 and older with orders for apixaban for AF was institutional review board (IRB)-approved and conducted across 3 academic medical centers. Patients receiving off-label reduced-dose apixaban (ie, "underdosed") were matched to a cohort of patients dosed according to the package insert at the standard dosing (5 mg twice daily) using stratified random sampling. Secondary outcomes included 1-year incidence of major bleeding, clinically relevant non-major bleeding (CRNMB), stroke or transient ischemic attack (TIA), and mortality. The Fisher exact tests were used to compare between-group differences., Results: Of the 1172 patients meeting initial inclusion criteria, 201 (17%) were dosed off-label, with 175 (15%) "underdosed." The 147 "underdosed" patients with documented follow-up were matched with 139 patients receiving standard Food and Drug Administration (FDA)-labeled dosing. There were no significant differences in incidence of stroke (2.7% vs 2.2%), major bleeding (0% vs 0.7%), and CRNMB (2.7% vs 1.4%) in the off-label reduced dosing versus standard dosing groups. All-cause mortality was higher in the off-label reduced-dose group (16 [10.9%] vs 2 [1.4%], P < 0.05)., Conclusion and Relevance: Older adults with nonvalvular AF are commonly prescribed lower-than-recommended doses of apixaban. However, no significant association was found between empiric off-label reduced dosing and stroke or bleeding outcomes., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2024
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6. TPCK inhibits AGC kinases by direct activation loop adduction at phenylalanine-directed cysteine residues.
- Author
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Anjum R, Pae E, Blenis J, and Ballif BA
- Subjects
- Amino Acid Motifs, Amino Acid Sequence, Amino Acid Substitution, Base Sequence, Conserved Sequence, Cysteine chemistry, DNA Primers genetics, HEK293 Cells, Humans, Molecular Sequence Data, Mutagenesis, Site-Directed, Phenylalanine chemistry, Protein Kinases genetics, Protein Serine-Threonine Kinases metabolism, Proto-Oncogene Proteins c-akt antagonists & inhibitors, Proto-Oncogene Proteins c-akt chemistry, Proto-Oncogene Proteins c-akt genetics, Pyruvate Dehydrogenase Acetyl-Transferring Kinase, Ribosomal Protein S6 Kinases, 90-kDa antagonists & inhibitors, Ribosomal Protein S6 Kinases, 90-kDa chemistry, Ribosomal Protein S6 Kinases, 90-kDa genetics, Sequence Homology, Amino Acid, Protein Kinase Inhibitors pharmacology, Protein Kinases chemistry, Tosylphenylalanyl Chloromethyl Ketone pharmacology
- Abstract
N-alpha-tosyl-L-phenylalanyl chloromethyl ketone (TPCK) has anti-tumorigenic properties, but its direct cellular targets are unknown. Previously, we showed TPCK inhibited the PDKl-dependent AGC kinases RSK, Akt and S6K1 without inhibiting PKA, ERK1/2, PI3K, and PDK1 itself. Here we show TPCK-inhibition of the RSK-related kinases MSK1 and 2, which can be activated independently of PDK1. Mass spectrometry analysis of RSK1, Aktl, S6K1 and MSK1 immunopurified from TPCK-treated cells identified TPCK adducts on cysteines located in conserved activation loop Phenylalanine-Cysteine (Phe-Cys) motifs. Mutational analysis of the Phe-Cys residues conferred partial TPCK resistance. These studies elucidate a primary mechanism by which TPCK inhibits several AGC kinases, inviting consideration of TPCK-like compounds in chemotherapy given their potential for broad control of cellular growth, proliferation and survival., (Copyright © 2012 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.)
- Published
- 2012
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7. The major genetic determinants of HIV-1 control affect HLA class I peptide presentation.
- Author
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Pereyra F, Jia X, McLaren PJ, Telenti A, de Bakker PI, Walker BD, Ripke S, Brumme CJ, Pulit SL, Carrington M, Kadie CM, Carlson JM, Heckerman D, Graham RR, Plenge RM, Deeks SG, Gianniny L, Crawford G, Sullivan J, Gonzalez E, Davies L, Camargo A, Moore JM, Beattie N, Gupta S, Crenshaw A, Burtt NP, Guiducci C, Gupta N, Gao X, Qi Y, Yuki Y, Piechocka-Trocha A, Cutrell E, Rosenberg R, Moss KL, Lemay P, O'Leary J, Schaefer T, Verma P, Toth I, Block B, Baker B, Rothchild A, Lian J, Proudfoot J, Alvino DM, Vine S, Addo MM, Allen TM, Altfeld M, Henn MR, Le Gall S, Streeck H, Haas DW, Kuritzkes DR, Robbins GK, Shafer RW, Gulick RM, Shikuma CM, Haubrich R, Riddler S, Sax PE, Daar ES, Ribaudo HJ, Agan B, Agarwal S, Ahern RL, Allen BL, Altidor S, Altschuler EL, Ambardar S, Anastos K, Anderson B, Anderson V, Andrady U, Antoniskis D, Bangsberg D, Barbaro D, Barrie W, Bartczak J, Barton S, Basden P, Basgoz N, Bazner S, Bellos NC, Benson AM, Berger J, Bernard NF, Bernard AM, Birch C, Bodner SJ, Bolan RK, Boudreaux ET, Bradley M, Braun JF, Brndjar JE, Brown SJ, Brown K, Brown ST, Burack J, Bush LM, Cafaro V, Campbell O, Campbell J, Carlson RH, Carmichael JK, Casey KK, Cavacuiti C, Celestin G, Chambers ST, Chez N, Chirch LM, Cimoch PJ, Cohen D, Cohn LE, Conway B, Cooper DA, Cornelson B, Cox DT, Cristofano MV, Cuchural G Jr, Czartoski JL, Dahman JM, Daly JS, Davis BT, Davis K, Davod SM, DeJesus E, Dietz CA, Dunham E, Dunn ME, Ellerin TB, Eron JJ, Fangman JJ, Farel CE, Ferlazzo H, Fidler S, Fleenor-Ford A, Frankel R, Freedberg KA, French NK, Fuchs JD, Fuller JD, Gaberman J, Gallant JE, Gandhi RT, Garcia E, Garmon D, Gathe JC Jr, Gaultier CR, Gebre W, Gilman FD, Gilson I, Goepfert PA, Gottlieb MS, Goulston C, Groger RK, Gurley TD, Haber S, Hardwicke R, Hardy WD, Harrigan PR, Hawkins TN, Heath S, Hecht FM, Henry WK, Hladek M, Hoffman RP, Horton JM, Hsu RK, Huhn GD, Hunt P, Hupert MJ, Illeman ML, Jaeger H, Jellinger RM, John M, Johnson JA, Johnson KL, Johnson H, Johnson K, Joly J, Jordan WC, Kauffman CA, Khanlou H, Killian RK, Kim AY, Kim DD, Kinder CA, Kirchner JT, Kogelman L, Kojic EM, Korthuis PT, Kurisu W, Kwon DS, LaMar M, Lampiris H, Lanzafame M, Lederman MM, Lee DM, Lee JM, Lee MJ, Lee ET, Lemoine J, Levy JA, Llibre JM, Liguori MA, Little SJ, Liu AY, Lopez AJ, Loutfy MR, Loy D, Mohammed DY, Man A, Mansour MK, Marconi VC, Markowitz M, Marques R, Martin JN, Martin HL Jr, Mayer KH, McElrath MJ, McGhee TA, McGovern BH, McGowan K, McIntyre D, Mcleod GX, Menezes P, Mesa G, Metroka CE, Meyer-Olson D, Miller AO, Montgomery K, Mounzer KC, Nagami EH, Nagin I, Nahass RG, Nelson MO, Nielsen C, Norene DL, O'Connor DH, Ojikutu BO, Okulicz J, Oladehin OO, Oldfield EC 3rd, Olender SA, Ostrowski M, Owen WF Jr, Pae E, Parsonnet J, Pavlatos AM, Perlmutter AM, Pierce MN, Pincus JM, Pisani L, Price LJ, Proia L, Prokesch RC, Pujet HC, Ramgopal M, Rathod A, Rausch M, Ravishankar J, Rhame FS, Richards CS, Richman DD, Rodes B, Rodriguez M, Rose RC 3rd, Rosenberg ES, Rosenthal D, Ross PE, Rubin DS, Rumbaugh E, Saenz L, Salvaggio MR, Sanchez WC, Sanjana VM, Santiago S, Schmidt W, Schuitemaker H, Sestak PM, Shalit P, Shay W, Shirvani VN, Silebi VI, Sizemore JM Jr, Skolnik PR, Sokol-Anderson M, Sosman JM, Stabile P, Stapleton JT, Starrett S, Stein F, Stellbrink HJ, Sterman FL, Stone VE, Stone DR, Tambussi G, Taplitz RA, Tedaldi EM, Telenti A, Theisen W, Torres R, Tosiello L, Tremblay C, Tribble MA, Trinh PD, Tsao A, Ueda P, Vaccaro A, Valadas E, Vanig TJ, Vecino I, Vega VM, Veikley W, Wade BH, Walworth C, Wanidworanun C, Ward DJ, Warner DA, Weber RD, Webster D, Weis S, Wheeler DA, White DJ, Wilkins E, Winston A, Wlodaver CG, van't Wout A, Wright DP, Yang OO, Yurdin DL, Zabukovic BW, Zachary KC, Zeeman B, and Zhao M
- Subjects
- Black or African American genetics, Alleles, Amino Acids physiology, CD8-Positive T-Lymphocytes immunology, Cohort Studies, Disease Progression, Genome-Wide Association Study, HIV Antigens immunology, HIV Infections ethnology, HIV Infections virology, HIV Long-Term Survivors, HLA-A Antigens chemistry, HLA-A Antigens genetics, HLA-A Antigens immunology, HLA-A Antigens metabolism, HLA-B Antigens chemistry, HLA-B Antigens immunology, HLA-B Antigens metabolism, HLA-C Antigens chemistry, HLA-C Antigens genetics, HLA-C Antigens immunology, HLA-C Antigens metabolism, Haplotypes, Hispanic or Latino genetics, Humans, Immunity, Innate, Logistic Models, Models, Molecular, Polymorphism, Single Nucleotide, Protein Conformation, Viral Load, White People genetics, Antigen Presentation, Genes, MHC Class I, HIV Infections genetics, HIV Infections immunology, HIV-1 immunology, HLA-B Antigens genetics
- Abstract
Infectious and inflammatory diseases have repeatedly shown strong genetic associations within the major histocompatibility complex (MHC); however, the basis for these associations remains elusive. To define host genetic effects on the outcome of a chronic viral infection, we performed genome-wide association analysis in a multiethnic cohort of HIV-1 controllers and progressors, and we analyzed the effects of individual amino acids within the classical human leukocyte antigen (HLA) proteins. We identified >300 genome-wide significant single-nucleotide polymorphisms (SNPs) within the MHC and none elsewhere. Specific amino acids in the HLA-B peptide binding groove, as well as an independent HLA-C effect, explain the SNP associations and reconcile both protective and risk HLA alleles. These results implicate the nature of the HLA-viral peptide interaction as the major factor modulating durable control of HIV infection.
- Published
- 2010
- Full Text
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8. Extensive HLA class I allele promiscuity among viral CTL epitopes.
- Author
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Frahm N, Yusim K, Suscovich TJ, Adams S, Sidney J, Hraber P, Hewitt HS, Linde CH, Kavanagh DG, Woodberry T, Henry LM, Faircloth K, Listgarten J, Kadie C, Jojic N, Sango K, Brown NV, Pae E, Zaman MT, Bihl F, Khatri A, John M, Mallal S, Marincola FM, Walker BD, Sette A, Heckerman D, Korber BT, and Brander C
- Subjects
- Amino Acid Sequence, Epitopes, T-Lymphocyte chemistry, HIV immunology, Humans, Molecular Sequence Data, Alleles, Epitopes, T-Lymphocyte genetics, Epitopes, T-Lymphocyte immunology, Histocompatibility Antigens Class I genetics, Histocompatibility Antigens Class I immunology, T-Lymphocytes, Cytotoxic immunology, T-Lymphocytes, Cytotoxic metabolism
- Abstract
Promiscuous binding of T helper epitopes to MHC class II molecules has been well established, but few examples of promiscuous class I-restricted epitopes exist. To address the extent of promiscuity of HLA class I peptides, responses to 242 well-defined viral epitopes were tested in 100 subjects regardless of the individuals' HLA type. Surprisingly, half of all detected responses were seen in the absence of the originally reported restricting HLA class I allele, and only 3% of epitopes were recognized exclusively in the presence of their original allele. Functional assays confirmed the frequent recognition of HLA class I-restricted T cell epitopes on several alternative alleles across HLA class I supertypes and encoded on different class I loci. These data have significant implications for the understanding of MHC class I-restricted antigen presentation and vaccine development.
- Published
- 2007
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9. Impact of HLA-B alleles, epitope binding affinity, functional avidity, and viral coinfection on the immunodominance of virus-specific CTL responses.
- Author
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Bihl F, Frahm N, Di Giammarino L, Sidney J, John M, Yusim K, Woodberry T, Sango K, Hewitt HS, Henry L, Linde CH, Chisholm JV 3rd, Zaman TM, Pae E, Mallal S, Walker BD, Sette A, Korber BT, Heckerman D, and Brander C
- Subjects
- Acquired Immunodeficiency Syndrome genetics, Acquired Immunodeficiency Syndrome virology, Amino Acid Sequence, Epitopes, T-Lymphocyte chemistry, Epstein-Barr Virus Infections genetics, Epstein-Barr Virus Infections virology, HIV-1 immunology, HLA-A Antigens chemistry, HLA-A Antigens genetics, HLA-A Antigens immunology, HLA-B Antigens chemistry, HLA-B Antigens immunology, HLA-C Antigens chemistry, HLA-C Antigens genetics, HLA-C Antigens immunology, Herpesvirus 4, Human immunology, Humans, Immunodominant Epitopes chemistry, Molecular Sequence Data, T-Lymphocytes, Cytotoxic chemistry, T-Lymphocytes, Cytotoxic metabolism, T-Lymphocytes, Cytotoxic virology, Acquired Immunodeficiency Syndrome immunology, Alleles, Epitopes, T-Lymphocyte immunology, Epstein-Barr Virus Infections immunology, HLA-B Antigens genetics, Immunodominant Epitopes immunology, T-Lymphocytes, Cytotoxic immunology
- Abstract
Immunodominance is variably used to describe either the most frequently detectable response among tested individuals or the strongest response within a single individual, yet factors determining either inter- or intraindividual immunodominance are still poorly understood. More than 90 individuals were tested against 184 HIV- and 92 EBV-derived, previously defined CTL epitopes. The data show that HLA-B-restricted epitopes were significantly more frequently recognized than HLA-A- or HLA-C-restricted epitopes. HLA-B-restricted epitopes also induced responses of higher magnitude than did either HLA-A- or HLA-C-restricted epitopes, although this comparison only reached statistical significance for EBV epitopes. For both viruses, the magnitude and frequency of recognition were correlated with each other, but not with the epitope binding affinity to the restricting HLA allele. The presence or absence of HIV coinfection did not impact EBV epitope immunodominance patterns significantly. Peptide titration studies showed that the magnitude of responses was associated with high functional avidity, requiring low concentration of cognate peptide to respond in in vitro assays. The data support the important role of HLA-B alleles in antiviral immunity and afford a better understanding of the factors contributing to inter- and intraindividual immunodominance.
- Published
- 2006
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10. Control of human immunodeficiency virus replication by cytotoxic T lymphocytes targeting subdominant epitopes.
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Frahm N, Kiepiela P, Adams S, Linde CH, Hewitt HS, Sango K, Feeney ME, Addo MM, Lichterfeld M, Lahaie MP, Pae E, Wurcel AG, Roach T, St John MA, Altfeld M, Marincola FM, Moore C, Mallal S, Carrington M, Heckerman D, Allen TM, Mullins JI, Korber BT, Goulder PJ, Walker BD, and Brander C
- Subjects
- AIDS Vaccines immunology, Amino Acid Sequence, Cohort Studies, Epitope Mapping, Epitopes genetics, Genetic Variation, HIV Infections genetics, HIV Infections virology, HIV-1 classification, HIV-1 genetics, HLA-B Antigens genetics, HLA-B15 Antigen, Humans, Immunodominant Epitopes genetics, In Vitro Techniques, Molecular Sequence Data, HIV Antigens genetics, HIV Infections immunology, HIV-1 immunology, HIV-1 physiology, T-Lymphocytes, Cytotoxic immunology, Virus Replication immunology
- Abstract
Despite limited data supporting the superiority of dominant over subdominant responses, immunodominant epitopes represent the preferred vaccine candidates. To address the function of subdominant responses in human immunodeficiency virus infection, we analyzed cytotoxic T lymphocyte responses restricted by HLA-B*1503, a rare allele in a cohort infected with clade B, although common in one infected with clade C. HLA-B*1503 was associated with reduced viral loads in the clade B cohort but not the clade C cohort, although both shared the immunodominant response. Clade B viral control was associated with responses to several subdominant cytotoxic T lymphocyte epitopes, whereas their clade C variants were less well recognized. These data suggest that subdominant responses can contribute to in vivo viral control and that high HLA allele frequencies may drive the elimination of subdominant yet effective epitopes from circulating viral populations.
- Published
- 2006
- Full Text
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11. HLA-B63 presents HLA-B57/B58-restricted cytotoxic T-lymphocyte epitopes and is associated with low human immunodeficiency virus load.
- Author
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Frahm N, Adams S, Kiepiela P, Linde CH, Hewitt HS, Lichterfeld M, Sango K, Brown NV, Pae E, Wurcel AG, Altfeld M, Feeney ME, Allen TM, Roach T, St John MA, Daar ES, Rosenberg E, Korber B, Marincola F, Walker BD, Goulder PJ, and Brander C
- Subjects
- Amino Acid Sequence, HIV Infections virology, Humans, Molecular Sequence Data, Antigen Presentation, Epitopes, T-Lymphocyte, HIV Infections immunology, HLA-B Antigens immunology, T-Lymphocytes, Cytotoxic immunology, Viral Load
- Abstract
Several HLA class I alleles have been associated with slow human immunodeficiency virus (HIV) disease progression, supporting the important role HLA class I-restricted cytotoxic T lymphocytes (CTL) play in controlling HIV infection. HLA-B63, the serological marker for the closely related HLA-B*1516 and HLA-B*1517 alleles, shares the epitope binding motif of HLA-B57 and HLA-B58, two alleles that have been associated with slow HIV disease progression. We investigated whether HIV-infected individuals who express HLA-B63 generate CTL responses that are comparable in breadth and specificity to those of HLA-B57/58-positive subjects and whether HLA-B63-positive individuals would also present with lower viral set points than the general population. The data show that HLA-B63-positive individuals indeed mounted responses to previously identified HLA-B57-restricted epitopes as well as towards novel, HLA-B63-restricted CTL targets that, in turn, can be presented by HLA-B57 and HLA-B58. HLA-B63-positive subjects generated these responses early in acute HIV infection and were able to control HIV replication in the absence of antiretroviral treatment with a median viral load of 3,280 RNA copies/ml. The data support an important role of the presented epitope in mediating relative control of HIV replication and help to better define immune correlates of controlled HIV infection.
- Published
- 2005
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12. Loss of HIV-1-specific CD8+ T cell proliferation after acute HIV-1 infection and restoration by vaccine-induced HIV-1-specific CD4+ T cells.
- Author
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Lichterfeld M, Kaufmann DE, Yu XG, Mui SK, Addo MM, Johnston MN, Cohen D, Robbins GK, Pae E, Alter G, Wurcel A, Stone D, Rosenberg ES, Walker BD, and Altfeld M
- Subjects
- Acute Disease, Adult, Amino Acid Sequence, Cells, Cultured, Female, Humans, Interferon-gamma biosynthesis, Interleukin-2 physiology, Male, Middle Aged, Molecular Sequence Data, AIDS Vaccines immunology, Acquired Immunodeficiency Syndrome immunology, CD4-Positive T-Lymphocytes immunology, CD8-Positive T-Lymphocytes immunology, HIV-1 immunology, Lymphocyte Activation
- Abstract
Virus-specific CD8(+) T cells are associated with declining viremia in acute human immunodeficiency virus (HIV)1 infection, but do not correlate with control of viremia in chronic infection, suggesting a progressive functional defect not measured by interferon gamma assays presently used. Here, we demonstrate that HIV-1-specific CD8(+) T cells proliferate rapidly upon encounter with cognate antigen in acute infection, but lose this capacity with ongoing viral replication. This functional defect can be induced in vitro by depletion of CD4(+) T cells or addition of interleukin 2-neutralizing antibodies, and can be corrected in chronic infection in vitro by addition of autologous CD4(+) T cells isolated during acute infection and in vivo by vaccine-mediated induction of HIV-1-specific CD4(+) T helper cell responses. These data demonstrate a loss of HIV-1-specific CD8(+) T cell function that not only correlates with progressive infection, but also can be restored in chronic infection by augmentation of HIV-1-specific T helper cell function. This identification of a reversible defect in cell-mediated immunity in chronic HIV-1 infection has important implications for immunotherapeutic interventions.
- Published
- 2004
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13. HIV-1-specific cytotoxicity is preferentially mediated by a subset of CD8(+) T cells producing both interferon-gamma and tumor necrosis factor-alpha.
- Author
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Lichterfeld M, Yu XG, Waring MT, Mui SK, Johnston MN, Cohen D, Addo MM, Zaunders J, Alter G, Pae E, Strick D, Allen TM, Rosenberg ES, Walker BD, and Altfeld M
- Subjects
- Adult, CD8-Positive T-Lymphocytes immunology, Caspase 3, Caspases metabolism, Female, Humans, Immunophenotyping, Male, Middle Aged, Substrate Specificity, CD8-Positive T-Lymphocytes metabolism, CD8-Positive T-Lymphocytes virology, HIV Infections immunology, HIV-1, Interferon-gamma metabolism, Tumor Necrosis Factor-alpha metabolism
- Abstract
CD8(+) T cells play a crucial role in the control of viral infections by direct elimination of infected cells and secretion of a number of soluble factors. Recent data suggest that HIV-1-specific CD8(+) T cell subsets may differ in their ability to exert these effector functions. Here, we directly compared the cytokine secretion patterns and cytotoxic capacity of HIV-1-specific CD8(+) T cells, using a flow-cytometric cytotoxicity assay based on caspase-3 activation in dying target cells. These experiments revealed considerable intraindividual and interindividual differences among epitope-specific T-cell effector functions: while the frequency of HIV-1-specific CD8(+) T cells secreting interferon-gamma but no tumor necrosis factor-alpha (TNF-alpha) following antigenic stimulation was only weakly correlated to their cytotoxic activity (R = 0.05, P =.57), a subset of CD8(+) T cells secreting both inter-feron-gamma and TNF-alpha was substantially more strongly associated with cytotoxicity (R = 0.67, P <.001). This subset of CD8(+) T cells also exhibited stronger intracellular perforin expression and more pronounced direct ex vivo HIV-1-specific cytoxicity than CD8(+) T cells secreting solely interferon-gamma following sorting of these subpopulations according to their cytokine profile. These results suggest that HIV-1-specific cytotoxicity of CD8(+) T cells is preferentially mediated by a subset of CD8(+) T cells secreting both interferon-gamma and TNF-alpha.
- Published
- 2004
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14. HIV-1 Nef is preferentially recognized by CD8 T cells in primary HIV-1 infection despite a relatively high degree of genetic diversity.
- Author
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Lichterfeld M, Yu XG, Cohen D, Addo MM, Malenfant J, Perkins B, Pae E, Johnston MN, Strick D, Allen TM, Rosenberg ES, Korber B, Walker BD, and Altfeld M
- Subjects
- Adult, Aged, Female, Genes, Viral immunology, Genes, nef immunology, Genetic Variation immunology, HIV Infections immunology, HIV-1 immunology, Humans, Immunity, Cellular, Male, Middle Aged, Viral Structural Proteins genetics, Virus Replication, CD8-Positive T-Lymphocytes immunology, Genes, nef genetics, HIV Infections genetics, HIV-1 genetics
- Abstract
Objective: To compare the magnitude, breadth and protein specificity of HIV-1-specific CD8 T-cell responses against the clade B consensus sequence during primary and chronic HIV-1 infection and to analyze the impact of viral diversity on the localization of detected responses., Methods: HIV-1-specific CD8 T-cell responses against the clade B consensus sequence in individuals with acute (n = 10), early (n = 19) and chronic (n = 10) infection were longitudinally assessed using an interferon-gamma EliSpot assay., Results: CD8 T-cell responses against clade B consensus sequences were preferentially directed against central regions of Nef during primary HIV-1 infection, despite a relatively higher degree of genetic diversity compared with other subsequently targeted regions. In subjects with acute and early infection, Nef-specific CD8 T-cell responses against the consensus Nef sequence represented 94 and 46% of the total magnitude of HIV-1-specific CD8 T-cell responses, respectively. Subjects with untreated chronic infection exhibited broadly diversified CD8 T-cell responses against more conserved viral regions, with only 17% of virus-specific T-cell responses targeting Nef. The initial immunodominance of Nef persisted in individuals with treated acute infection, but shifted rapidly to Gag, Env and Pol in subjects with continuous antigen exposure., Conclusion: These data show that despite relatively high sequence variability, viral regions within the clade B consensus sequence of Nef are preferentially recognized during primary HIV-1 infection. Later diversification of responses to other proteins during prolonged antigen exposure provides evidence of the initial preferential immunogenicity of Nef epitopes compared to similarly conserved regions within other viral proteins.
- Published
- 2004
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15. Gender really matters.
- Author
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Pae EK
- Subjects
- Faculty, Dental, Female, Humans, Workforce, Dentists, Women statistics & numerical data, Orthodontics
- Published
- 2001
- Full Text
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16. Role of lateral cephalograms in assessing severity and difficulty of orthodontic cases.
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Pae EK, McKenna GA, Sheehan TJ, Garcia R, Kuhlberg A, and Nanda R
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- Adolescent, Analysis of Variance, Chi-Square Distribution, Episode of Care, Female, Humans, Linear Models, Male, Malocclusion therapy, Models, Dental, Models, Statistical, Observer Variation, Prognosis, Reproducibility of Results, Severity of Illness Index, Time Factors, Cephalometry, Malocclusion diagnosis, Orthodontics, Corrective methods
- Abstract
To assess the role of lateral cephalometric films in the evaluation of orthodontic patients, 16 certified orthodontists examined 80 sets of dental casts and lateral cephalograms. The patients included 5 subgroups: Class I with mild crowding, Class II Division 2, Class III, open bites, and bimaxillary protrusion. A 5-point Visual Analogue Scale was used to assess the degree of severity and difficulty of each case. Severity was defined as the degree of deviation from ideal occlusion, while difficulty was defined as the probability of attaining an ideal occlusion when all treatment options were available. The examiner then chose one or more of the following treatment options: growth modification, extraction, nonextraction, and surgery. All examiners scored the degree of severity and difficulty of each case with casts only at Time 1 (T1), then with casts and cephalograms at Time 2 (T2). The observed ratings from the Visual Analogue Scale were scored by using the Rasch model, which transforms the nonlinear ordinal ratings to a linear interval scale. Intersubgroup differences and differences between T1 and T2 difficulty and severity were assessed by using a 5 x 2 repeated measures analysis of variance. A paired t test examined the amount and direction of the differences between T1 and T2 of each subgroup. Multiple contingency tables were used to compare treatment option changes between all subgroups at each time. Severity and difficulty scores highly correlated. Analysis of variance showed significant differences among subgroups for both severity and difficulty; however, there were significant time differences for severity only. Paired t tests revealed a small increase in severity for the bimaxillary protrusive group and small but significant decreases for the subgroups Class II Division 2 and Class III when cephalograms were added. The multicontingency table analysis demonstrated that a significant number of examiners did change their treatment options at T2 for bimaxillary protrusive, nonextraction, and Class II Division 2 patients. It was concluded that lateral cephalometric films showed a significant influence on a clinician's determination on severity of some types of orthodontic malocclusions.
- Published
- 2001
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17. Disruption of 3-phosphoinositide-dependent kinase 1 (PDK1) signaling by the anti-tumorigenic and anti-proliferative agent n-alpha-tosyl-l-phenylalanyl chloromethyl ketone.
- Author
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Ballif BA, Shimamura A, Pae E, and Blenis J
- Subjects
- 3-Phosphoinositide-Dependent Protein Kinases, 3T3 Cells, Animals, Cell Line, Transformed, Enzyme Activation, Humans, Mice, Phosphorylation, Proto-Oncogene Mas, Ribosomal Protein S6 Kinases antagonists & inhibitors, Ribosomal Protein S6 Kinases metabolism, Anticarcinogenic Agents pharmacology, Cell Division drug effects, Protein Serine-Threonine Kinases metabolism, Signal Transduction drug effects, Tosylphenylalanyl Chloromethyl Ketone pharmacology
- Abstract
The anti-tumorigenic and anti-proliferative effects of N-alpha-tosyl-l-phenylalanyl chloromethyl ketone (TPCK) have been known for more than three decades. Yet little is known about the discrete cellular targets of TPCK controlling these effects. Previous work from our laboratory showed TPCK, like the immunosuppressant rapamycin, to be a potent inhibitor of the 70-kilodalton ribosomal S6 kinase 1 (S6K1), which mediates events involved in cell growth and proliferation. We show here that rapamycin and TPCK display distinct inhibitory mechanisms on S6K1 as a rapamycin-resistant form of S6K1 was TPCK-sensitive. Additionally, we show that TPCK inhibited the activation of the related kinase and proto-oncogene Akt. Upstream regulators of S6K1 and Akt include phosphoinositide 3-kinase (PI 3-K) and 3-phosphoinositide-dependent kinase 1 (PDK1). Whereas TPCK had no effect on either mitogen-regulated PI 3-K activity or total cellular PDK1 activity, TPCK prevented phosphorylation of the PDK1 regulatory sites in S6K1 and Akt. Furthermore, whereas both PDK1 and the mitogen-activated protein kinase (MAPK) are required for full activation of the 90-kilodalton ribosomal S6 kinase (RSK), TPCK inhibited RSK activation without inhibiting MAPK activation. Consistent with the capacity of RSK and Akt to mediate a cell survival signal, in part through phosphorylation of the pro-apoptotic protein BAD, TPCK reduced BAD phosphorylation and led to cell death in interleukin-3-dependent 32D cells. Finally, in agreement with results seen in embryonic stem cells lacking PDK1, protein kinase A activation was not inhibited by TPCK showing TPCK specificity for mitogen-regulated PDK1 signaling. TPCK inhibition of PDK1 signaling thus disables central kinase cascades governing diverse cellular processes including proliferation and survival and provides an explanation for its striking biological effects.
- Published
- 2001
- Full Text
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18. Changes in orofacial muscle activity in response to changes in respiratory resistance.
- Author
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Song HG and Pae EK
- Subjects
- Airway Obstruction physiopathology, Animals, Diaphragm physiology, Electrodes, Implanted, Electromyography instrumentation, Facial Muscles physiology, Inhalation physiology, Intubation instrumentation, Intubation, Intratracheal instrumentation, Mechanoreceptors physiology, Muscle Contraction physiology, Neck Muscles physiology, Nose physiology, Oropharynx innervation, Oropharynx physiology, Pharyngeal Muscles innervation, Pressure, Rabbits, Respiratory Insufficiency physiopathology, Trachea physiology, Transducers, Pressure, Airway Resistance physiology, Mouth physiology, Pharyngeal Muscles physiology, Respiratory Physiological Phenomena
- Abstract
Increased resistance in the upper airway is known to be a contributing factor to deviant facial growth patterns. These patterns are the result of a prolonged presence of unbalanced oropharyngeal muscle activity. We hypothesized that mechanically increasing airway resistance would enhance the activity of the muscles facilitating respiration, and we attempted to demonstrate that the increased muscle activity is modulated by mechanoreceptors in the pharyngeal airway. The response of oropharyngeal muscles to increased airway resistance during spontaneous breathing was observed in 11 rabbits. Electromyographic signals from the ala nasi, orbicularis oris superior, genioglossus, mylohyoid muscles, and the diaphragm were recorded by fine-wire electrodes. Pressure changes were monitored by pressure transducers at the side branch of the cannule close to openings for the nose and the trachea. The study consisted of 2 experimental sessions. First, to evoke the response of muscles to the inspiratory resistance, increasing stepwise polyethylene tubes of various diameters were attached to the nasal and tracheal opening and the diameter of the tubes was gradually reduced. Muscle activity changes in response to the increased resistance were recorded during spontaneous nasal or tracheal breathing. Second, to examine muscle responses to negative pressure to the pharyngeal airway, irrespective of breathing activity, the pharynx was isolated as a closed circuit by a stoma constructed at a more caudal side in the trachea. Muscle responses to the negative pressure generated by a syringe in the pharyngeal segment were measured. Nasal breathing induced a greater muscle activity than did tracheal breathing, in general, at P <.05. When resistance was gradually increased, nasal breathing resulted in a greater increase in muscle activity than did tracheal breathing (P <.05), except in the diaphragm. Application of negative pressure to the isolated pharyngeal airway segment increased the muscle activity significantly (P <.05). We conclude that an increased airway resistance may facilitate oropharyngeal muscle activity through mechanoreceptors in the oropharyngeal airway.
- Published
- 2001
- Full Text
- View/download PDF
19. Effect of root and bone morphology on the stress distribution in the periodontal ligament.
- Author
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Choy K, Pae EK, Park Y, Kim KH, and Burstone CJ
- Subjects
- Algorithms, Alveolar Bone Loss pathology, Alveolar Bone Loss physiopathology, Alveolar Process physiology, Computer Simulation, Cuspid physiology, Forecasting, Humans, Models, Biological, Root Resorption pathology, Root Resorption physiopathology, Rotation, Stress, Mechanical, Tooth Root physiology, Alveolar Process anatomy & histology, Cuspid anatomy & histology, Periodontal Ligament physiology, Tooth Movement Techniques, Tooth Root anatomy & histology
- Abstract
To achieve predictable and physiologic orthodontic tooth movement, estimating the axis of rotation of a tooth and the level and location of maximum stress distributed in the periodontal ligament is essential. An extracted upper canine was scanned into a computer 2-dimensionally and divided into 80 nodes along the long axis of the tooth. A mathematical formula was derived, and stress was calculated on each node. The purpose of this study was to reveal the center of resistance, axis of rotation, and an ideal force magnitude associated with various periodontal conditions, such as potential root resorption, alveolar bone loss, and varying anatomic root shape by analyzing the stress distribution in the periodontal ligament. The study demonstrates that the location of center of resistance changes significantly with variation of shape and length of the root embedded in alveolar bone. In contrast, in response to alveolar bone loss, the relative location of the center of resistance to total root length remains constant. Analysis of the stress distribution pattern in our 2-dimensional model reveals that the relationship between location of force and axis of rotation is determined by s(2) (that is) a constant depends on shape and length of a root in alveolar bone. Tapered and short roots that result from alveolar bone loss or apical root resorption are prone to tipping. The optimal orthodontic force may vary depending on the maximum stress in the periodontal ligament.
- Published
- 2000
- Full Text
- View/download PDF
20. Measurements must be interval, not ordinal.
- Author
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Pae EK
- Subjects
- Calibration, Humans, Malocclusion classification, Malocclusion diagnosis
- Published
- 1999
- Full Text
- View/download PDF
21. Cephalometric characteristics of nonobese patients with severe OSA.
- Author
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Pae EK and Ferguson KA
- Subjects
- Adult, Analysis of Variance, Apnea classification, Body Mass Index, Cohort Studies, Face anatomy & histology, Humans, Male, Malocclusion pathology, Middle Aged, Obesity classification, Obesity complications, Polysomnography, Retrospective Studies, Sleep Apnea, Obstructive classification, Vertical Dimension, Cephalometry, Facial Bones pathology, Sleep Apnea, Obstructive complications
- Abstract
The purpose of this study was to determine the facial characteristics of nonobese patients with obstructive sleep apnea (OSA). Observational data on a cohort of patients was analyzed retrospectively. The subjects were classified into four groups: nonobese mild, obese mild, nonobese severe, and obese severe. The nonobese mild group included patients with a body mass index (BMI = kilogram/meter2) <25 and an apnea-hypopnea index (AHI) >5 and <15; the obese mild patients had a BMI >35 and an AHI >5 and <15; the nonobese severe patients had a BMI <25 and an AHI >40; the obese severe group had a BMI >35 and AHI >40. Thirty-three male patients referred for overnight polysomnography and lateral cephalometry who met the selection criteria were included. Between-group differences were examined pairwise by analysis of variance (ANOVA) with Bonferroni correction. Only two variables--lower facial height and overbite--were significantly different at p<0.05 between the nonobese severe group and the obese mild group. A discriminant analysis on the cephalometric measurements revealed that patients in the nonobese severe group could be distinguished from patients in other groups by their facial characteristics. OSA patients do not have a homogenous bony structure of the face. In particular, OSA severity in nonobese severe patients may be associated with a vertical skeletal disharmony.
- Published
- 1999
- Full Text
- View/download PDF
22. Tongue shape in obstructive sleep apnea patients.
- Author
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Pae EK and Lowe AA
- Subjects
- Adult, Cephalometry standards, Humans, Male, Middle Aged, Posture, Reference Standards, Sleep Apnea Syndromes pathology, Cephalometry instrumentation, Sleep Apnea Syndromes diagnosis, Tongue pathology
- Abstract
Clinicians have long suspected that tongue shape differs between obstructive sleep apnea (OSA) patients and normal subjects. The purpose of this study was to determine whether such differences exist. Because of the difficulty in specifying reproducible homologous landmarks for the tongue, a morphometric technique-the eigenshape analysis-was used. The eigenshape analysis transforms an outline contour into a set of discrete numbers that are tangent angles of the curvature along the outline at each digitized point on the outline. Pairs of cephalograms were taken of 80 male patients in upright and supine positions. The subjects were subgrouped into four categories according to severity of symptoms. The contour of the tongue was traced, digitized, and subgrouped. When the major portion of the tongue shape variations in the supine position were graphically compared between subgroups, variations in the nonapneic group were distinguished from those in the apneic groups. The results suggest that the eigenshape analysis on cephalograms in the supine position may be a useful tool to distinguish OSA subjects from nonapneic subjects.
- Published
- 1999
- Full Text
- View/download PDF
23. Shape of the face and tongue in obstructive sleep apnea patients--statistical analysis of coordinate data.
- Author
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Pae EK, Lowe AA, and Fleetham JA
- Subjects
- Adult, Analysis of Variance, Humans, Male, Middle Aged, Posture, Severity of Illness Index, Cephalometry, Face anatomy & histology, Sleep Apnea, Obstructive pathology, Tongue anatomy & histology
- Abstract
Objectives: To determine the shape difference of the face and tongue of obstructive sleep apnea (OSA) patients, in comparison to those of non-apneic patients., Design: Retrospective analysis of observational data on a cohort of patients., Setting: A university teaching hospital and sleep referral center. SAMPLE POPULATION AND METHOD: Eighty patients referred for overnight polysomnography and lateral cephalometry and who met the selection criteria were included. Upright and supine cephalograms were obtained and subgrouped based on the severity of clinical symptoms. Shape differences between the groups were assessed by a multiple analysis of variance and a Hotelling's T2., Measurements and Results: A set of anatomical landmarks were selected for outlines of the face and the tongue on cephalograms. X and Y coordinates of each landmark were utilized as variables. As symptoms become severe, the hyoid bone and the submental area positioned inferiorly and the fourth vertebra relocated posteriorly with respect to the lower mandibular border. When subjects changed their body position from the upright to the supine, the posterior part of the tongue appeared to sink down. The hyoid bone position to epiglottis-retrognathion line in the supine position distinguishes OSA patients from non-apneic subjects., Conclusion: Despite many limitations, we demonstrate that the supine cepahlometrics during wakefulness can be a useful adjunctive diagnostic tool for OSA, when cephalograms are analyzed in a coordinate data form.
- Published
- 1999
- Full Text
- View/download PDF
24. A thin-plate spline analysis of the face and tongue in obstructive sleep apnea patients.
- Author
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Pae EK, Lowe AA, and Fleetham JA
- Subjects
- Anthropometry, Cephalometry statistics & numerical data, Face physiopathology, Humans, Image Processing, Computer-Assisted, Male, Posture, Severity of Illness Index, Tongue physiopathology, Cephalometry methods, Face anatomy & histology, Sleep Apnea Syndromes physiopathology, Tongue anatomy & histology
- Abstract
The shape characteristics of the face and tongue in obstructive sleep apnea (OSA) patients were investigated using thin-plate (TP) splines. A relatively new analytic tool, the TP spline method, provides a means of size normalization and image analysis. When shape is one's main concern, various sizes of a biologic structure may be a source of statistical noise. More seriously, the strong size effect could mask underlying, actual attributes of the disease. A set of size normalized data in the form of coordinates was generated from cephalograms of 80 male subjects. The TP spline method envisioned the differences in the shape of the face and tongue between OSA patients and nonapneic subjects and those between the upright and supine body positions. In accordance with OSA severity, the hyoid bone and the submental region positioned inferiorly and the fourth vertebra relocated posteriorly with respect to the mandible. This caused a fanlike configuration of the lower part of the face and neck in the sagittal plane in both upright and supine body positions. TP splines revealed tongue deformations caused by a body position change. Overall, the new morphometric tool adopted here was found to be viable in the analysis of morphologic changes.
- Published
- 1997
- Full Text
- View/download PDF
25. Role of pharyngeal length in patients with a lack of overbite.
- Author
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Pae EK, Kuhlberg A, and Nanda R
- Subjects
- Adolescent, Cephalometry statistics & numerical data, Child, Discriminant Analysis, Disease Susceptibility, Female, Humans, Male, Malocclusion diagnostic imaging, Malocclusion etiology, Pharynx diagnostic imaging, Radiography, Dental statistics & numerical data, Regression Analysis, Retrospective Studies, Dental Occlusion, Pharynx anatomy & histology
- Abstract
Anterior open bites may be localized dental manifestations, which are caused by habits or skeletal disharmony, with or without functional aberration. Previous studies suggest various associations between open bites and underlying etiologic factors. We hypothesize that respiratory efficiency may be associated with anterior open bites. Under the assumption that breathing efficiency of the oropharynx and hypopharynx may be related to pharyngeal airway length, a cephalometric variable, vertical airway length (VAL), was measured on lateral cephalograms obtained from a total of 58 subjects with, so called, "open bite tendencies" (hereafter, open bite tendency). By means of the variable VAL, the association between pharyngeal length and open bite was investigated. In addition, the difference between actual open bite and open bite tendencies was also examined. The samples were randomly collected under stringent selection criteria from an existing database. A series of statistical analyses, such as unpaired t test, multiple regression, and discriminant analysis, was used to test the proposed hypothesis. The study found that none of the open bite tendency indicators used can segregate open bite subjects from nonopen bite subjects. The obtained discriminant function clearly divides the samples into two groups, i.e., open bite group and nonopen bite group, which were based on VAL and lower facial height. The study concludes that, first, an open bite tendency may be a different entity from an actual open bite or may be a misconceptualized term. Second, pharyngeal length may be a convenient indicator to diagnose open bite. We speculate that open bite may be different from an open bite tendency in pharyngeal length.
- Published
- 1997
- Full Text
- View/download PDF
26. A role of pharyngeal length in obstructive sleep apnea patients.
- Author
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Pae EK, Lowe AA, and Fleetham JA
- Subjects
- Analysis of Variance, Cephalometry, Humans, Male, Posture, Reproducibility of Results, Supine Position, Pharynx pathology, Sleep Apnea Syndromes pathology
- Abstract
A narrow pharyngeal pathway may be one of the most significant predisposing factors for obstructive sleep apnea (OSA). Accordingly, the objectives of many treatment modalities are focused on widening the constricted part of the pharynx. Despite the obvious limitations as a two-dimensional imaging technique, cephalometrics has been used more recently as a clinical screening tool for OSA. This study was designed to investigate whether pharyngeal variables more reliable than a single measurement of the most constricted area exist in cephalograms. A total of 80 pairs of upright and supine cephalograms were obtained and subclassified into four groups, in accordance with OSA severity. A medial axis program conveniently provided the variables for the study by transforming digitized outlines of the pharyngeal structure. The results indicate that the pharyngeal length and the pharyngeal width below the most constricted area may be the most important variables. We observed that the pharynx becomes considerably longer in the apneic group after a body position change from upright to supine. Pharyngeal length in the supine position may be more important than a one-dimensional measurement of the most constricted area in the diagnosis and treatment of OSA.
- Published
- 1997
- Full Text
- View/download PDF
27. Cephalometry needs innovation, not renovation.
- Author
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Pae EK
- Subjects
- Face, Facial Bones anatomy & histology, Humans, Maxilla anatomy & histology, Maxillofacial Development, Nose anatomy & histology, Sella Turcica anatomy & histology, Cephalometry methods
- Abstract
Units of length, degree, and area are used when measuring cephalograms. In particular, the measurement of angles is a conventional method of quantifying shape. Because angles do not provide information about direction, there is no way to tell how and where one part of the facial structure has moved with respect to the rest. A new landmark data system using x- and y-coordinates is proposed, and some of its advantages over conventional methods are explained.
- Published
- 1997
- Full Text
- View/download PDF
28. Cephalometric and demographic characteristics of obstructive sleep apnea: an evaluation with partial least squares analysis.
- Author
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Lowe AA, Ozbek MM, Miyamoto K, Pae EK, and Fleetham JA
- Subjects
- Adolescent, Adult, Aged, British Columbia epidemiology, Forecasting, Head anatomy & histology, Humans, Hyoid Bone anatomy & histology, Least-Squares Analysis, Male, Middle Aged, Nasopharynx anatomy & histology, Neck anatomy & histology, Obesity epidemiology, Outcome Assessment, Health Care, Palate, Soft anatomy & histology, Pharynx anatomy & histology, Polysomnography statistics & numerical data, Posture, Pulmonary Ventilation, Sleep Apnea Syndromes epidemiology, Sleep Apnea Syndromes pathology, Tongue anatomy & histology, Cephalometry statistics & numerical data, Demography, Sleep Apnea Syndromes classification
- Abstract
Obstructive sleep apnea (OSA) is caused by repeated obstruction of the upper airway during sleep. The purpose of this study was to test the relative contributions of specific demographic and cephalometric measurements to OSA severity. Demographic, cephalometric, and overnight polysomnographic records of 291 male OSA patients and 49 male nonapneic snorers were evaluated. A partial least squares (PLS) analysis was used for statistical evaluation. The results revealed that the predictive powers of obesity and neck size variables for OSA severity were higher than the cephalometric variables used in this study. Compared with other cephalometric characteristics, an extended and forward natural head posture, lower hyoid bone position, increased soft palate and tongue dimensions, and decreased nasopharyngeal and velopharyngeal airway dimensions had relatively higher associations with OSA severity. The respiratory disturbance index (RDI) was the OSA outcome variable that was best explained by the demographic and cephalometric predictor variables. We conclude that the PLS analysis can successfully summarize the correlations between a large number of variables, and that obesity, neck size, and certain cephalometric measurements may be used together to evaluate OSA severity.
- Published
- 1997
- Full Text
- View/download PDF
29. Cephalometric comparisons of craniofacial and upper airway structure by skeletal subtype and gender in patients with obstructive sleep apnea.
- Author
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Lowe AA, Ono T, Ferguson KA, Pae EK, Ryan CF, and Fleetham JA
- Subjects
- Adult, Female, Humans, Hyoid Bone pathology, Male, Palate, Soft pathology, Pharynx pathology, Posture, Reference Values, Respiratory System, Sex Factors, Tongue pathology, Sleep Apnea Syndromes pathology
- Abstract
To investigate whether patients with obstructive sleep apnea (OSA) have abnormalities in their craniofacial and upper airway (UA) structures compared with normal subjects, cephalometric comparisons were systematically performed in both the upright and the supine positions in subjects with and without OSA, who were then grouped according to their craniofacial skeletal type and gender. A total of 347 patients with OSA and 101 control subjects were divided into male and female groups and then classified into Class I (CI), Class II, Division 1 (CII/1), Class II, Division 2 (CII/2), and Class III (CIII) skeletal subtypes. In the upright position, the most atypical craniofacial and UA structure was shown in male patients with CI OSA. In patients with OSA, the degree of UA abnormalities was less in the supine position regardless of skeletal subtype. In the supine position, the most atypical craniofacial and UA structure was also shown in male patients with CI OSA; there were no significant differences between male patients with CII/2 OSA and control subjects or between female patients with CI OSA and control subjects. With a change in body position from upright to supine, distinctive changes in the UA structure in both patients with OSA and control subjects occurred, according to skeletal subtype and gender. We conclude that there are a series of characteristics of craniofacial and UA structure that differ between patients with OSA and control subjects matched for skeletal subtype and gender. These differences may predispose to UA obstruction during sleep in patients with OSA.
- Published
- 1996
- Full Text
- View/download PDF
30. The effect of the tongue retaining device on awake genioglossus muscle activity in patients with obstructive sleep apnea.
- Author
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Ono T, Lowe AA, Ferguson KA, Pae EK, and Fleetham JA
- Subjects
- Adult, Aged, Airway Resistance, Body Mass Index, Case-Control Studies, Female, Humans, Male, Middle Aged, Nose physiology, Oropharynx pathology, Posture, Pulmonary Ventilation physiology, Sleep Apnea Syndromes pathology, Supine Position, Tongue pathology, Tongue Habits, Wakefulness, Electromyography, Orthodontic Appliances, Sleep Apnea Syndromes physiopathology, Tongue physiopathology
- Abstract
Knowledge of how dental appliances alter upper airway muscle activity when they are used for the treatment of snoring and/or obstructive sleep apnea (OSA) is very limited. The purpose of this study was to define the effect of a tongue retaining device (TRD) on awake genioglossus (GG) muscle activity in 10 adult subjects with OSA and in 6 age and body mass index (BMI) matched symptom-free control subjects. The TRD is a custom-made appliance designed to allow the tongue to remain in a forward position between the anterior teeth by holding the tongue in an anterior bulb with negative pressure, during sleep. This pulls the tongue forward to enlarge the volume of the upper airway and to reduce upper airway resistance. In this study, two customized TRDs were used for each subject. The TRD-A did not have an anterior bulb but incorporated lingual surface electrodes to record the GG electromyographic (EMG) activity. The TRD-B contained an anterior bulb and two similar electrodes. The GG EMG activity was also recorded while patients used the TRD-B but were instructed to keep their tongue at rest outside the anterior bulb; this condition is hereafter referred to as TRD-X. The GG EMG activity and nasal airflow were simultaneously recorded while subjects used these customized TRDs during spontaneous awake breathing in both the upright and supine position. The following results were obtained and were consistent whether subjects were in the upright or the supine position. The GG EMG activity was greater with the TRD-B than with the TRD-A in control subjects (p < 0.05), whereas the GG EMG activity was less with the TRD-B than with the TRD-A in subjects with OSA (p < 0.01). Furthermore, there was no significant difference between the GG EMG activity of the TRD-A and the TRD-X in control subjects, whereas there was less activity with the TRD-X than with the TRD-A in subjects with OSA (p < 0.05). On the basis of these findings, it was concluded that the TRD has different effects on the awake GG muscle activity in control subjects and patients with OSA. The resultant change in the anatomic configuration of the upper airway caused by the TRD may be important in the treatment of OSA because such a change may alleviate the impaired upper airway function.
- Published
- 1996
- Full Text
- View/download PDF
31. A cephalometric and electromyographic study of upper airway structures in the upright and supine positions.
- Author
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Pae EK, Lowe AA, Sasaki K, Price C, Tsuchiya M, and Fleetham JA
- Subjects
- Airway Resistance physiology, Cephalometry, Electromyography, Humans, Hyoid Bone physiopathology, Neck Muscles physiopathology, Palate, Soft physiopathology, Pharyngeal Muscles physiopathology, Pharynx physiopathology, Posture physiology, Regression Analysis, Transducers, Pressure, Pulmonary Ventilation physiology, Respiratory System physiopathology, Sleep Apnea Syndromes physiopathology, Supine Position physiology, Tongue physiopathology
- Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction during sleep, usually in the supine position. To investigate the relationship between upper airway size and genioglossus (GG) muscle activity, upright and supine cephalograms were obtained in 20 OSA patients and 10 symptom-free control subjects. Tongue electromyographic (EMG) recordings were obtained with surface electrodes, and pressure transducers were placed in the 10 symptom-free controls. The tongue cross-sectional area increased 4.3% (p < 0.05), and the oropharyngeal area decreased 36.5% (p < 0.01) when the OSA patients changed their body position from upright to supine. No changes were observed in the tongue area, but soft palate thickness increased (p < 0.01) when the control subjects changed from the upright to the supine position. Furthermore, the oropharyngeal cross-sectional area decreased 28.8% (p < 0.01) despite a 34% increase (p < 0.05) in resting GG EMG activity. Posterior tongue pressure increased 17% (p < 0.05) with the change from upright to supine. On the basis of these findings, we propose that body posture has a substantial effect on upper airway structure and muscle activity. This postural effect should be taken into account when assessing upper airway size in the erect posture (conventional cephalography) and in the supine position (computed tomography). The vertical and anteroposterior position of the tongue and its relationship to airway size may be more important than soft palate size in the pathogenesis of OSA.
- Published
- 1994
- Full Text
- View/download PDF
32. Obstructive sleep apnea subtypes by cluster analysis.
- Author
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Tsuchiya M, Lowe AA, Pae EK, and Fleetham JA
- Subjects
- Body Mass Index, Cephalometry, Cervical Vertebrae pathology, Cluster Analysis, Humans, Hyoid Bone pathology, Hypopharynx pathology, Male, Malocclusion complications, Malocclusion pathology, Mandible pathology, Middle Aged, Nasopharynx pathology, Obesity complications, Oropharynx pathology, Palate pathology, Regression Analysis, Sleep Apnea Syndromes etiology, Sleep Apnea Syndromes pathology, Tomography, X-Ray Computed, Tongue pathology, Sleep Apnea Syndromes classification
- Abstract
A sample of 84 adult male patients with obstructive sleep apnea (OSA) were classified by a cluster analysis on the basis of apnea index (AI) and body mass index (BMI). Demographic, cephalometric, tongue, soft palate, and upper airway-size data were evaluated for the two subgroups of OSA patients and for 18 control subjects. One OSA group consisted of 43 patients with a high AI and low BMI ratio, the other group was comprised of 41 patients with a low AI and high BMI ratio. The patients with a high AI and low BMI ratio had retruded mandibles with high mandibular plane angles and proclined lower incisors. The patients with a low AI and high BMI ratio had inferior hyoid bones and large soft palates. A multiple regression analysis was performed between AI (the dependent variable) and the other variables (independent variables) for each of the subgroups. In the patients with a high AI and low BMI ratio, a high AI was related to a large skeletal anteroposterior discrepancy, a steep mandibular plane, and an inferoanterior position of the hyoid bone. In the patients with a low AI and high BMI ratio, a high AI was related to a large tongue and a small upper airway. In both groups, BMI was the major contributor to AI. In conclusion, these two groups may represent distinct subgroups of OSA patients and provide some insight into the contribution of obesity to the pathogenesis of OSA. The patients with a high AI and low BMI ratio have a skeletal mismatch, whereas the patients with a low AI and high BMI have atypical soft tissue structures.
- Published
- 1992
- Full Text
- View/download PDF
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