Image Processing in Biomedical Diagnosis

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[KRAS mutation does not influence oxaliplatin or irinotecan efficacy, in association with bevacizumab, in first line treatment of metastatic colorectal cancer].

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[KRAS mutation does not influence oxaliplatin or irinotecan efficacy, in association with bevacizumab, in first line treatment of metastatic colorectal cancer].

Bull Cancer. 2016 May 4;

Authors: Cabart M, Frénel JS, Campion L, Ramée JF, Dupuis O, Senellart H, Hiret S, Douillard JY, Bennouna J

Abstract
INTRODUCTION: The identification of RAS status (KRAS and NRAS) has changed the management of metastatic colorectal cancer (mCRC). The impact of the RAS mutation on cytotoxic chemotherapy efficacy has not yet been determined. Nevertheless, several retrospective studies suggest a greater efficacy of oxaliplatin in mCRC with KRAS mutation.
METHODS: We analyzed retrospectively the progression free survival (PFS) and overall survival (OS) in 216 patients with mCRC receiving first line treatment between 2008 and 2010 according to KRAS status and chemotherapy regimen used (oxaliplatin- or irinotecan-based, in association with fluoropyrimidine and bevacizumab).
RESULTS: In KRAS mutated tumors, median OS was 23.4 months with oxaliplatin-based regimen, and 23.6 months with irinotecan-based regimen, with no significant difference (HR 1.30; 95 % CI 0.81-2.09; P=0.27). In KRAS wild-type tumors, median OS was 30.3 months with oxaliplatin-based regimen, and 25.4 months with irinotecan-based regimen, with no significant difference (HR 0.81; 95 % CI 0.52-1.24; P=0.33). Similarly, KRAS mutational status had no significant effect on efficacy of oxaliplatin or irinotecan regarding PFS.
DISCUSSION: In this retrospective study, KRAS mutational status does not influence the efficacy of first line cytotoxic chemotherapy in association with bevacizumab.

PMID: 27155924 [PubMed - as supplied by publisher]

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Prevalence of leprous neuropathy determined by neurosensory testing in an endemic zone in Ecuador: Development of an algorithm to identify patients benefiting from early neurolysis.

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Prevalence of leprous neuropathy determined by neurosensory testing in an endemic zone in Ecuador: Development of an algorithm to identify patients benefiting from early neurolysis.

J Plast Reconstr Aesthet Surg. 2016 Apr 7;

Authors: Baltodano PA, Rochlin DH, Noboa J, Sarhane KA, Rosson GD, Dellon AL

Abstract
The success of a microneurosurgical intervention in leprous neuropathy (LN) depends on the diagnosis of chronic compression before irreversible paralysis and digital loss occurs. In order to determine the effectiveness of a different approach for early identification of LN, neurosensory testing with the Pressure-Specified Sensory Device™ (PSSD), a validated and sensitive test, was performed in an endemic zone for leprosy. A cross-sectional study was conducted to analyze a patient sample meeting the World Health Organization (WHO) criteria for Hansen's disease. The prevalence of LN was based on the presence of ≥1 abnormal PSSD pressure threshold for a two-point static touch. A total of 312 upper and lower extremity nerves were evaluated in 39 patients. The PSSD found a 97.4% prevalence of LN. Tinel's sign was identified in 60% of these patients. An algorithm for early identification of patients with LN was proposed using PSSD testing based on the unilateral screening of the ulnar and deep peroneal nerves.

PMID: 27156203 [PubMed - as supplied by publisher]

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German emigré psychologists in Tel Aviv (1934-1958): Max M. Stern and Margarete Braband-Isaac in conflict with Erich Neumann

Liebscher, M; (2016) German emigré psychologists in Tel Aviv (1934-1958): Max M. Stern and Margarete Braband-Isaac in conflict with Erich Neumann. History of the Human Sciences (In press). Green open access

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Computational studies of heavy element complexes.

O'Grady, E.M.; (2005) Computational studies of heavy element complexes. Doctoral thesis, University of London. Green open access

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Automated design of separation processes using implicit enumeration and interval analysis.

O'Grady, A.R.F.; (2005) Automated design of separation processes using implicit enumeration and interval analysis. Doctoral thesis, University of London. Green open access

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Lipidic peptide dendrimers: Potential gene delivery agents for the treatment of haemophilia B.

O'Donnell, M.W.; (2005) Lipidic peptide dendrimers: Potential gene delivery agents for the treatment of haemophilia B. Doctoral thesis, University of London. Green open access

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A Keck adaptive optics survey of a representative sample of gravitationally lensed star-forming galaxies: high spatial resolution studies of kinematics and metallicity gradients

Leethochawalit, N; Jones, TA; Ellis, RS; Stark, DP; Richard, J; Zitrin, A; Auger, M; (2016) A Keck adaptive optics survey of a representative sample of gravitationally lensed star-forming galaxies: high spatial resolution studies of kinematics and metallicity gradients. The Astrophysical Journal , 820 (2) p. 84. 10.3847/0004-637X/820/2/84 . Green open access

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Glutamate diffusion and AMPA receptor activation in the cerebellar glomerulus.

Nielsen, T.A.; (2005) Glutamate diffusion and AMPA receptor activation in the cerebellar glomerulus. Doctoral thesis, University of London. Green open access

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Re-industrialisation as progressive urbanism: why and how?

Edwards, M; Taylor, M; Re-industrialisation as progressive urbanism: why and how? In: Nawratek, K, (ed.) Urban Re-industrialization. Punctum Books (In press).

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Non-parametric analysis of the rest-frame UV sizes and morphological disturbance amongst L * galaxies at 4 < z < 8

Curtis-Lake, E; McLure, RJ; Dunlop, JS; Rogers, AB; Targett, T; Dekel, A; Ellis, RS; Curtis-Lake, E; McLure, RJ; Dunlop, JS; Rogers, AB; Targett, T; Dekel, A; Ellis, RS; Faber, SM; Ferguson, HC; Grogin, NA; Kocevski, DD; Koekemoer, AM; Lai, K; Mármol-Queraltó, E; Robertson, BE; - view fewer (2016) Non-parametric analysis of the rest-frame UV sizes and morphological disturbance amongst L * galaxies at 4 . Green open access

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Long-term follow-up after surgery in localized laryngeal amyloidosis.

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Long-term follow-up after surgery in localized laryngeal amyloidosis.

Eur Arch Otorhinolaryngol. 2016 May 7;

Authors: Hazenberg AJ, Hazenberg BP, Dikkers FG

Abstract
To study effectiveness of surgery and watchful waiting in localized laryngeal amyloidosis, retrospective case series. This retrospective study comprises all consecutive patients with localized laryngeal amyloidosis surgically treated in a tertiary hospital between 1994 and February 2016. Recurrence rate, revision surgery, progression to systemic amyloidosis, and changes in voice were monitored yearly. Eighteen patients were included. Seven women and eleven men had a median age 50 years (range 21-77 years) and median follow-up 6.4 years (2.4-17 years). Amyloid was located in subglottis (5), glottis (8), false vocal folds (8) and other supraglottic areas (5), in more than one laryngeal region (13) and bilaterally (12). Cold steel excision was used at the glottis; CO2 laser excision, sometimes assisted by microdebrider, at other laryngeal areas. Eleven patients needed revision surgery, ten within the first 4 years after surgical treatment. One patient needed his first revision surgery after 11 years. Five patients needed a second revision within 6 years after initial diagnosis. Two patients needed a third revision. Indications for first revision surgery were progression (8) with dysphonia (7), dyspnea (2), dysphagia (1), exclusion of malignancy (1), and aphonia (1). No patient developed systemic amyloidosis during follow-up. Although local progression of amyloid necessitates revision surgery once or twice in the first 4-6 years, progression slows down thereafter. Late progression, however, remains possible.

PMID: 27156084 [PubMed - as supplied by publisher]

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Photoinduced electron transfer in porous organic salt crystals impregnated with fullerenes

Chem. Commun., 2016, Accepted Manuscript
DOI: 10.1039/C6CC02377K, Communication

Tetsuya Hasegawa, Kei Ohkubo, Ichiro Hisaki, Mikiji Miyata, Norimitsu Tohnai, Shunichi Fukuzumi
Porous organic salt (POS) crystals composed of 9-(4-sulfophenyl)anthracene (SPA) and triphenylmethylamine (TPMA) were impregnated with fullerenes (C60 and C70), which were arranged in one dimensional close contact. POS crystals of...
The content of this RSS Feed (c) The Royal Society of Chemistry

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Effects of interstimulus intervals on behavioral, heart rate, and event-related potential indices of infant engagement and sustained attention

Abstract

Maximizing infant attention to stimulus presentation during an EEG or ERP experiment is important for making valid inferences about the neural correlates of infant cognition. The present study examined the effects of stimulus presentation interstimulus interval (ISI) on behavioral and physiological indices of infant attention including infants' fixation to visual presentation, the amount of heart rate (HR) change during sustained attention, and ERP components. This study compared an ISI that is typically used in infant EEG/ERP studies (e.g., 1,500–2,000 ms) with two shorter durations (400–600 ms and 600–1,000 ms). Thirty-six infants were tested cross-sectionally at 3, 4.5, and 6 months. It was found that using the short (400–600 ms) and medium (600–1,000 ms) ISIs resulted in more visually fixated trials and reduced frequency of fixation disengagement per experimental block. We also found larger HR changes during sustained attention to both of the shorter ISIs compared with the long ISI, and larger ERP responses when using the medium ISI compared to using the short and long ISIs. These data suggest that utilizing an optimal ISI (e.g., 600–1,000 ms), which increases the presentation complexity and provides sufficient time for information processing, can promote infant engagement and sustained attention during stimulus presentation.

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The interplay of subjective social status and essentialist beliefs about cognitive aging on cortisol reactivity to challenge in older adults

Abstract

Older adults are more likely than younger adults to experience stress when confronted with cognitive challenges. However, little is known about individual differences that might explain why some older adults exhibit stronger stress responses than others. We examined the interplay of two social-cognitive factors to explain older adults' cortisol reactivity: (1) subjective social status, and (2) essentialist beliefs about cognitive aging. We hypothesized that, depending on whether older adults believe that aging-related cognitive decline is inevitable versus modifiable, low subjective social status should lead to stronger or weaker cortisol reactivity. Using longitudinal data, we assessed the impact of cognitive challenges on stress reactivity in a sample of older adults (N = 389; 61–86 years). As predicted, regression analyses confirmed that 44 min after cognitively challenging tasks, older adults exhibited a significantly different cortisol reactivity depending on their subjective social status and their essentialist beliefs about cognitive aging. Specifically, older adults with low subjective social status and high essentialist beliefs showed a significantly elevated cortisol reactivity. We discuss the role of essentialist beliefs about cognitive aging to predict when and why high versus low subjective social status leads to stress responses in older adults.

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Woman dies before air ambulance arrives, still charged $25K

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A Robust Polyionized Hydrogel with an Unprecedented Underwater Anti-Crude-Oil-Adhesion Property

A polyionized hydrogel polymer (sodium polyacrylate-grafted poly(vinylidene fluoride) (PAAS-g-PVDF)) is fabricated via an alkaline-induced phase-inversion process. PAAS-g-PVDF coatings exhibit unprecedented anti-adhesion and self-cleaning properties to crude oils under an aqueous environment. A PAAS-g-PVDF-coated copper mesh can effectively separate a crude oil/water mixture with extremely high flux and high oil rejection driven by gravity, and is oil-fouling-free for long-term use.

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Molecular Lock: A Versatile Key to Enhance Efficiency and Stability of Organic Solar Cells

4,4′-Biphenol (BPO), a common, cheap chemical, is employed as a "molecular lock" in blends of fluorine-containing polymer or small molecule donors and fullerene acceptors to lock donors via hydrogen bond formed between the donor and BPO. The molecular lock is a versatile key to enhance the efficiency and stability of organic solar cells simultaneously.

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High-Flexibility, High-Toughness Double-Cross-Linked Chitin Hydrogels by Sequential Chemical and Physical Cross-Linkings

High-flexibility, high-toughness double-cross-linked (DC) chitin hydrogels are prepared through a sequential chemical and physical cross-linkings strategy. The incorporation of chemically and physically cross-linked domains imbues the DC chitin hydrogels with relatively high stiffness, high toughness, and toughness recoverability.

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Enhanced Photocatalytic H2 Production in Core–Shell Engineered Rutile TiO2

A rationally designed crystalline Ti³⁺ core/amorphous Ti⁴⁺ shell configuration can reverse the population disparity between holes and electrons reaching the surface of microsized rutile TiO₂ photocatalyst, thus significantly enhancing its photocatalytic activity by two orders of magnitude in terms of the hydrogen production rate under the irradiation of UV–vis light.

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Thermoresponsive Toughening with Crack Bifurcation in Phase-Separated Hydrogels under Isochoric Conditions

A novel mode of gel toughening displaying crack bifurcation is highlighted in phase-separated hydrogels. By exploring original covalent network topologies, phase-separated gels under isochoric conditions demonstrate advanced thermoresponsive mechanical properties: excellent fatigue resistance, self-healing, and remarkable fracture energies. Beyond the phase-transition temperature, the fracture proceeds by a systematic crack-bifurcation process, unreported so far in gels.

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Tailored Buckling Microlattices as Reusable Light-Weight Shock Absorbers

Structures and materials absorbing mechanical (shock) energy commonly exploit either viscoelasticity or destructive modifications. Based on a class of uniaxial light-weight geometrically nonlinear mechanical microlattices and using buckling of inner elements, either a sequence of snap-ins followed by irreversible hysteretic – yet repeatable – self-recovery or multistability is achieved, enabling programmable behavior. Proof-of-principle experiments on three-dimensional polymer microstructures are presented.

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Ultrabreathable and Protective Membranes with Sub-5 nm Carbon Nanotube Pores

Small-diameter carbon nanotubes (CNTs) are shown to enable exceptionally fast transport of water vapor under a concentration gradient driving force. Thanks to this property, membranes having sub-5 nm CNTs as conductive pores feature outstanding breathability while maintaining a high degree of protection from biothreats by size exclusion.

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Woman dies before air ambulance arrives, still charged $25K

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Regulation of podocalyxin trafficking by Rab small GTPases in 2D and 3D epithelial cell cultures

MDCK II cells, a widely used model of polarized epithelia, develop into different structures depending on culture conditions: two-dimensional (2D) monolayers when grown on synthetic supports or three-dimensional (3D) cysts when surrounded by an extracellular matrix. The establishment of epithelial polarity is accompanied by transcytosis of the apical marker podocalyxin from the outer plasma membrane to the newly formed apical domain, but its exact route and regulation remain poorly understood. Here, through comprehensive colocalization and knockdown screenings, we identified the Rab GTPases mediating podocalyxin transcytosis and showed that different sets of Rabs coordinate its transport during cell polarization in 2D and 3D structures. Moreover, we demonstrated that different Rab35 effectors regulate podocalyxin trafficking in 2D and 3D environments; trafficking is mediated by OCRL in 2D monolayers and ACAP2 in 3D cysts. Our results give substantial insight into regulation of the transcytosis of this apical marker and highlight differences between trafficking mechanisms in 2D and 3D cell cultures.

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Single-cell transcriptional analysis of normal, aberrant, and malignant hematopoiesis in zebrafish

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Eugenia Piddini: Chasing how cells outcompete one another

<p>In the tight-knit Sicilian tradition, Eugenia Piddini lived with her parents while attending college at the University of Palermo. But her family had always encouraged her to think ambitiously about her career, and so at 25, she struck out...

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RhoB controls endothelial barrier recovery by inhibiting Rac1 trafficking to the cell border

Endothelial barrier dysfunction underlies chronic inflammatory diseases. In searching for new proteins essential to the human endothelial inflammatory response, we have found that the endosomal GTPase RhoB is up-regulated in response to inflammatory cytokines and expressed in the endothelium of some chronically inflamed tissues. We show that although RhoB and the related RhoA and RhoC play additive and redundant roles in various aspects of endothelial barrier function, RhoB specifically inhibits barrier restoration after acute cell contraction by preventing plasma membrane extension. During barrier restoration, RhoB trafficking is induced between vesicles containing RhoB nanoclusters and plasma membrane protrusions. The Rho GTPase Rac1 controls membrane spreading and stabilizes endothelial barriers. We show that RhoB colocalizes with Rac1 in endosomes and inhibits Rac1 activity and trafficking to the cell border during barrier recovery. Inhibition of endosomal trafficking impairs barrier reformation, whereas induction of Rac1 translocation to the plasma membrane accelerates it. Therefore, RhoB-specific regulation of Rac1 trafficking controls endothelial barrier integrity during inflammation.

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Secretory cargo sorting by Ca2+-dependent Cab45 oligomerization at the trans-Golgi network

Sorting and export of transmembrane cargoes and lysosomal hydrolases at the trans-Golgi network (TGN) are well understood. However, elucidation of the mechanism by which secretory cargoes are segregated for their release into the extracellular space remains a challenge. We have previously demonstrated that, in a reaction that requires Ca²⁺, the soluble TGN-resident protein Cab45 is necessary for the sorting of secretory cargoes at the TGN. Here, we report that Cab45 reversibly assembles into oligomers in the presence of Ca²⁺. These Cab45 oligomers specifically bind secretory proteins, such as COMP and LyzC, in a Ca²⁺-dependent manner in vitro. In intact cells, mutation of the Ca²⁺-binding sites in Cab45 impairs oligomerization, as well as COMP and LyzC sorting. Superresolution microscopy revealed that Cab45 colocalizes with secretory proteins and the TGN Ca²⁺ pump (SPCA1) in specific TGN microdomains. These findings reveal that Ca²⁺-dependent changes in Cab45 mediate sorting of specific cargo molecules at the TGN.

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Neurons let it slide

<p>During mammalian brain development, many neurons migrate away from the site where they are born to settle in distant locations where they send out dendrites and axons to connect with other neurons. Both neuronal migration and axon/dendrite extension depend...

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A mitotic SKAP isoform regulates spindle positioning at astral microtubule plus ends

The Astrin/SKAP complex plays important roles in mitotic chromosome alignment and centrosome integrity, but previous work found conflicting results for SKAP function. Here, we demonstrate that SKAP is expressed as two distinct isoforms in mammals: a longer, testis-specific isoform that was used for the previous studies in mitotic cells and a novel, shorter mitotic isoform. Unlike the long isoform, short SKAP rescues SKAP depletion in mitosis and displays robust microtubule plus-end tracking, including localization to astral microtubules. Eliminating SKAP microtubule binding results in severe chromosome segregation defects. In contrast, SKAP mutants specifically defective for plus-end tracking facilitate proper chromosome segregation but display spindle positioning defects. Cells lacking SKAP plus-end tracking have reduced Clasp1 localization at microtubule plus ends and display increased lateral microtubule contacts with the cell cortex, which we propose results in unbalanced dynein-dependent cortical pulling forces. Our work reveals an unappreciated role for the Astrin/SKAP complex as an astral microtubule mediator of mitotic spindle positioning.

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De impact van het verlenen van stemrecht op de politieke interesse (kwantitatieve studie bij 16- en 17-jarigen)

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Helpt de participatiesamenleving in de strijd tegen de armoede?

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The use of fractional exhaled nitric oxide is valuable in select asthmatic patients

Purpose of review: Clinical management of asthma is challenging and measuring fractional exhaled nitric oxide (FeNO) can be another tool to assist in meeting this challenge. Recent findings: Asthma is a heterogeneous condition. There are many different phenotypes. FeNO can help the physician identify which patients have eosinophilic inflammation and would potentially respond to corticosteroid therapy. Summary: FeNO is a complement to standard asthma care. FeNO can be used in the initial diagnosis of asthma and aid in stratification of which patients would be steroid responsive but also for assessment of disease severity, response to treatment, and compliance.

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Vocal tract characteristics in Parkinson's disease

Purpose of review: Voice tremor is strongly linked to the Parkinson's disease speech–voice symptom complex. Little is known about the underlying anatomic source(s) of voice tremor when it occurs. We review recent literature addressing this issue. Additionally we report findings from a study we conducted employing rating of vocal tract structures viewed using nasolaryngoscopy during vocal and nonspeech tasks. Recent findings: In Parkinson's disease, using laryngeal electromyography, tremor has not been identified in muscles in the vocal folds even when perceived auditorily. Preliminary findings using nasolaryngoscopy suggest that Parkinson's disease voice tremor is not associated with the vocal folds and may involve the palate, the global larynx, and the arytenoids. Tremor in the vertical larynx on /a/, and tremor in the arytenoid cartilages on /s/ differentiated patients with Parkinson's disease from neurologically healthy controls. Visual reliable detection of tremor when it is absent or borderline present, is challenging. Summary: Parkinson's disease voice tremor is likely to be related to oscillatory movement in structures across the vocal tract rather than just the vocal folds. To progress clinical practice, more refined tools for the visual rating of tremor would be beneficial. How far voice tremor represents a functionally significant factor for speakers would also add to the literature.

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Gluten sensitivity: fact or fashion statement?

Purpose of review: In recent years, the concern over food sensitivities in general and gluten intolerance in particular has sharply increased. Patients and medical providers are awash in various claims about the potential implications of including or excluding gluten from the diet. Recent findings: Three main conditions are described with respect to gluten: wheat allergy, celiac disease, and nonceliac gluten sensitivity (NCGS). Wheat allergy is a type 1 hypersensitivity reaction to nongluten proteins within wheat. Celiac disease is an autoimmune reaction to the gluten protein resulting in damage to the small intestine with genetic associations. NCGS is a diagnosis of exclusion and, to date, no biomarkers have been identified for this condition. Summary: When evaluating and treating patients with potential reactions to gluten, it is important to distinguish among wheat allergy, celiac disease, and NCGS. Each condition has distinct dietary and treatment implications.

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A review of diet standardization and bolus rheology in the management of dysphagia

Purpose of review: Texture modification is a widespread practice as a strategy for the management of dysphagia and can be very effective in individual cases. However, it is often performed in a qualitative, subjective manner and practices vary internationally according to multiple sets of national guidelines. This article aims to identify best practice by reviewing the theory and practice of texture modification, focussing on recent advances. Recent findings: Instrumental assessment of texture modification in vivo is challenging, and studies including rheology and perception have indicated that fluid viscosity is only one of many factors affecting texture modification in practice. Systematic reviews have identified a historical lack of high-quality clinical evidence, but recent controlled studies are beginning to identify positive and negative aspects of thickened fluids. Research and practice to date have been limited by the lack of control and standardization of foods and drinks. However in 2015 a not-for-profit organization, the International Dysphagia Diet Standardisation Initiative, has published a framework for texture modification from thin liquids to solid foods based on all the existing documentation and guidance, and the – limited – available clinical evidence. Summary: Rheology exists in the lab; however, normal practice is often subjective or lacking control and standardization. In the near future, cohesion of practice and the availability of practical standardization tools may increase awareness and use of rheology.

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Safety considerations in providing allergen immunotherapy in the office

Purpose of review: This review highlights the risks of allergy immunotherapy, methods to improve the quality and safety of allergy treatment, the current status of allergy quality metrics, and the future of quality measurement. In the current healthcare environment, the emphasis on outcomes measurement is increasing, and providers must be better equipped in the development, measurement, and reporting of safety and quality measures. Recent findings: Immunotherapy offers the only potential cure for allergic disease and asthma. Although well tolerated and effective, immunotherapy can be associated with serious consequence, including anaphylaxis and death. Many predisposing factors and errors that lead to serious systemic reactions are preventable, and the evaluation and implementation of quality measures are crucial to developing a safe immunotherapy practice. Although quality metrics for immunotherapy are in their infancy, they will become increasingly sophisticated, and providers will face increased pressure to deliver safe, high-quality, patient-centered, evidence-based, and efficient allergy care. Summary: The establishment of safety in the allergy office involves recognition of potential risk factors for anaphylaxis, the development and measurement of quality metrics, and changing systems-wide practices if needed. Quality improvement is a continuous process, and although national allergy-specific quality metrics do not yet exist, they are in development.

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A service evaluation of cough reflex testing to guide dysphagia management in the postsurgical adult head and neck patient population

Purpose of review: The article reviews recent literature supporting the use of cough reflex testing (CRT), and outlines a service evaluation of CRT conducted with postsurgical head and neck cancer patients. There is a growing evidence base to support the use of CRT in dysphagia management to establish laryngeal sensation and screen for silent aspiration; however, there is a lack of evidence relating to using CRT within the head and neck population. Recent findings: Over a 3-month period, inpatients on an ear, nose and throat/maxillofacial ward underwent CRT as part of their clinical swallow evaluation. Data from these patients were collected, including their diagnoses, CRT findings, and subsequent management. The evaluation was limited by difficulties in maintaining a supply of citric acid, accessing medics to prescribe the citric acid, and staffing levels, as administration of the CRT initially required two members of staff to be present. Summary: The service evaluation findings, alongside current evidence examining noncancer mortality rates, suggests identification of silent aspiration is important in this population. CRT was useful to rationalize instrumental assessments and was easily incorporated into the swallowing evaluation. More evidence is needed to support the use of CRT within the head and neck population.

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Epidemiology of asthma

Purpose of review: This article reports the findings of recently published research articles and Centers for Disease Control (CDC) data on the epidemiology of asthma. Numerous otolaryngologic diseases are associated with asthma, such as allergic rhinitis, chronic rhinosinusitis, and obstructive sleep apnea. In addition, asthma causes a significant health burden and its prevalence is increasing. Recent findings: Currently, 8.4% of persons in the United States have asthma as compared with 4.3% of the population worldwide, and both numbers are on the rise. The average annual asthma prevalence is higher in children (9.5%) than adults (7.7%). The prevalence of asthma is higher in black persons than white persons, and the ethnicity most affected is the Puerto Rican population. Asthma prevalence increases with each successive lower poverty level group. There are interesting relationships between asthma and certain otolaryngologic diseases. The impact of asthma on both morbidity and mortality is particularly noteworthy. Summary: The prevalence of asthma is increasing both domestically and globally. The impact is most significant in the minority and lower socioeconomic populations. Future research should work to elucidate the reasons for this increase in asthma and promote better access to care for persons across all ethnic and socioeconomic classes.

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Vocal fold paresis: a review of clinical presentation, differential diagnosis, and prognostic indicators

Purpose of review: Vocal fold paresis is a complex, controversial, and unique clinical entity. Guidance in assessing and evaluating these patients is provided in this comprehensive review of the current literature discussing the varying clinical presentation, the broad differential and general prognosis. Recent findings: Patients with vocal fold paresis can present with elements of hyperfunction, which can often mask an underlying paresis. As such, repetitive phonatory tasks and videostroboscopic examination are critical for the assessment of patients with a suspected paresis. When analyzing stroboscopic findings, anatomical and motion asymmetries can strongly suggest the presence of a paresis. However, it is important to remember that other disorders can sometimes mimic or create a visual asymmetry when a true paresis may not be present. Laryngeal electromyography (LEMG) can serve as a valuable adjunct to confirm a paresis with the most reliable indicator being a decreased recruitment pattern. The differential is vast, including infectious, iatrogenic, systemic rheumatologic, and neurologic conditions. LEMG along with time of onset and the underlying cause of the paresis can be valuable prognostic indicators. Summary: Patients with paresis often present with symptoms of a hyperkinetic voice disorder. Regardless of the myriad of causes, their assessment hinges upon close clinical evaluation with videostroboscopy aided with LEMG.

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Editorial introductions

No abstract available

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Review of differential diagnosis and management of spasmodic dysphonia

Purpose of review: The recent literature on spasmodic dysphonia is reviewed with regard to pathogenesis, differential diagnosis, treatment options, audits, and current methods of management. Recent findings: Advances in technology have enabled clinicians to better understand the connection between brain and laryngeal function and dysfunction. Refinements in imaging and genetic investigation techniques have led to advances in the understanding of the underlying mechanism of this neurolaryngeal disorder. Development of diagnostic assessment tools and measures of quality of life hold the potential to improve treatment and care. Summary: Fifty articles published between 2014 and 2015 were selected for this review. The sources were drawn from several clinical specialties: 54% come under the scope of laryngology, 32% from neurology, and 14% from other areas. It remains poorly understood, misdiagnosed, and underdiagnosed. Its identification, diagnosis, treatment selection, and coordination of care require an expert specialist multidisciplinary team. More training is required to help people who have this chronic and psychosocially disabling voice disorder, which impinges on all aspects of their lives. Spasmodic dysphonia is now classified as a 'rare' disease in the United States. This designation will assist in international standards of diagnosis, assessment, treatment, and management.

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New advances in allergy immunotherapy

Purpose of review: The present article reviews the literature on new methods for administering specific immunotherapy for the treatment of immunoglobulin E-mediated hypersensitivity to airborne and food allergens. The discussion will focus on allergen modifications, and new routes for delivering proteins to allergen-presenting cells. Recent findings: Modified allergens address the issues of supply and standardization, but also have the potential to enhance the allergenicity of the protein, while decreasing the risk of producing severe reactions. The use of immunostimulatory adjuvants and recombinant proteins has increased, whereas new technologies, such as the encapsulation of allergens into nanoparticles, have also gained much attention. New delivery routes for specific immunotherapy continue to be explored, often in combination with allergen modification strategies, in order to shorten the duration of therapy, limit adverse events, and optimize patient adherence. Safety and long-term efficacy have been demonstrated for many of these new methods, and it is clear that there are multiple ways to stimulate the immune system for the purpose of allergen desensitization. Summary: Developments in the field of specific immunotherapy for allergic disease are accelerating rapidly because of advances in technology, but also because of the recognition that this disease-modifying therapy is a well tolerated, efficacious, and cost-effective option for individuals, which can improved their quality of life in a long-term fashion. Video abstract: http://ift.tt/1oTU0tC

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Research into the prevention and rehabilitation of dysphagia in head and neck cancer: a UK perspective

Purpose of review: There is an increasing recognition of dysphagia as a frequent, often severe and chronic side-effect of head and neck cancer treatment. There has been a global increase in the number of head and neck cancer survivors, increasing the urgency of finding ways to best manage swallowing difficulties. Recent findings: There are several research studies investigating strategies and developing interventions to prevent and treat this debilitating condition. The United Kingdom has a growing number of trials and feasibility studies in this area, which have secured national funding. Research themes include changes, modifications, and de-escalation of cancer treatments to reduce side-effects; interventions to encourage maintenance of eating and drinking and swallowing exercises during radiotherapy; and novel interventions to address post-treatment dysphagia. Research into this field presents with numerous challenges, including issues with recruitment, retention, and adherence to rehabilitation programmes. Summary: In this study, we present recent advances in knowledge, research themes, and current UK-based research. Our multicentre studies will facilitate standardization of outcome measures and strengthen multidisciplinary, academic, and international collaborations. Findings over the coming years will help progress our understanding of how best to prevent and manage dysphagia in head and neck cancer.

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Secondhand smoke and rhinitis

Purpose of review: The article reviews the most recent literature on the association between secondhand tobacco smoke exposure and rhinitis. The discussion will focus on the biologic links between tobacco exposure and rhinitis symptoms, evaluating this relationship in different populations. Recent findings: Significant associations between tobacco smoke exposure and rhinitis symptoms have been identified in US children and adults. This association is not just a US public health concern, as similar analyses have also recently been performed in other populations. Although pediatric data show a significant trend to greater prevalence of rhinitis with greater levels of secondhand smoke exposure, the adult data on secondhand smoke exposure are less consistent. The exact biological mechanism for these associations is likely multifactorial, but does not appear to be driven by an allergic, IgE-mediated reaction. Summary: The associations between secondhand tobacco smoke exposure and various upper respiratory inflammatory conditions, including rhinitis, have been observed. The causative biologic mechanisms, however, remain elusive and are a likely target for future research. At this point, evidence points toward nonallergic inflammation as the most likely mechanism. Clearly, further research is necessary before this mechanism is fully established.

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The role of allergy immunotherapy in the treatment of asthma

Purpose of review: Asthma and allergic rhinitis are two of the most widespread chronic medical conditions. Asthma, a condition which encompasses chronic inflammation of the lower airway resulting in expiratory obstruction, may represent an end phase along the allergic disease spectrum ultimately stemming initially from nasal allergic rhinitis and bronchial hyper-reactivity. The purpose of this review was to evaluate the available published literature over the past 12 months regarding the role of allergy immunotherapy in the treatment of asthma. Recent findings: Recent clinical trials, systematic reviews, and meta-analyses have demonstrated that allergen-specific immunotherapy (ASI), especially sublingual immunotherapy for as short as 12 months, may help improve asthma symptoms and reduce medication usage. However, studies have not demonstrated overall improvement in pulmonary function tests despite improvement in symptoms. Barriers to asthmatic patients initiating and maintaining ASI include lack of payment by health insurer, inconvenience, and potentially worsening asthma exacerbations/symptoms for patients with severe disease. Summary: ASI may change the natural course of allergic asthma by reducing the risk of acute respiratory exacerbations and symptoms. Additional studies are necessary to examine whether early treatment of allergy sensitivities with ASI may ultimately prevent the progression to asthma.

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Current concepts: diagnosis and management of food allergy in children

Purpose of review: Advances in the prevention and treatment of food allergy have been published in the last few years and are placed in context using a review format. Recent findings: Preventing food allergy has been studied for years with questions of whether avoidance or exposure was a better strategy. Recent research has suggested that peanut allergy can be substantially reduced in high-risk infants through intentional oral exposure. For children with food allergy, the primary treatment remains avoidance, but controlled trials have shown some success with oral immunotherapy and sublingual immunotherapy. Summary: Providers who see children with food allergies should be aware of the newer recommendations of preventing peanut allergy and the emerging therapies for children with immunoglobulin E-mediated food allergy.

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Allergy and laryngeal disorders

Purpose of review: This article reviews recent literature on the topic of allergic laryngitis. There has been sustained interest over the past 15 years and epidemiological and experimental studies have led to a clearer description of the nature of the condition and its clinical expression. Recent findings: Recent studies have suggested an epidemiological association between the presence of allergy and concurrent laryngeal symptoms and objective signs. Both population-based studies and smaller investigations have shown a significant relationship between these two variables. In addition, recent studies have questioned the inter-rater reliability and specificity of laryngeal endoscopic examinations, which have often been used to assign a presumptive diagnosis of laryngopharyngeal reflux. The presence of sticky, viscid, thick endolaryngeal secretions, however, appears to be associated with allergic laryngitis, confirming prior observations. Experimental interventions in both laboratory animals and humans suggest that there may be a direct causal relationship for an allergic cause, at least among some individuals. Summary: Epidemiological and experimental evidence suggests that allergy may be a valid trigger and causative mechanism in some individuals with laryngeal inflammation and symptomatology. Additional research is necessary to further characterize allergic laryngitis and to develop valid diagnostic protocols for assessment.

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Update: stability of allergen extracts to establish expiration dating

Purpose of review: The article reviews studies pertaining to US manufactured allergen extract stability that contribute to guidance for expiration dating for bulk concentrates, diluted patient testing and treatment vials, and adjustments following elevated temperature excursions. Recent findings: Studies on allergen stability were completed to satisfy the Food and Drug Administration requirements supporting labeled expiration dating for standardized short ragweed, dust mites, cat, grass, and venom extracts and are not published. These studies demonstrated the stability enhancing parameters of 50% glycerin and support the Food and Drug Administration mandated expiration of nonstandardized extracts allowing glycerin extracts twice the dating of nonglycerin aqueous extracts. Patient vials are commonly given 6–12 months dating. There is adequate evidence that human serum albumin stabilizes low protein diluted vials. High protease allergens such as molds and insects compromised potency of pollens when mixed. Subsequent work continued to define the effects of diluents on extract dilutions, temperature excursions that occasionally occur with shipping or refrigerator malfunctions, and allergen compatibility. Summary: Potency has been determined for allergen dilutions with diluents typically used for allergen immunotherapy. These studies along with changes of potency under various storage conditions and mixing designed to improve our guidance on expiration dating of allergen extracts will be discussed.

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