Recombinant allergens: what does the future hold?

This year we are celebrating not only the centenary of allergen-specific immunotherapy but also the 10-year anniversary of the first administration of recombinant allergen-based vaccines to allergic patients. By using recombinant DNA technology, defined and safe allergy vaccines can be produced that allow us to overcome many, if not all, of the problems associated with the use of natural allergen extracts, such as insufficient quality, allergenic activity, and poor immunogenicity. Here we provide an update of clinical studies with recombinant allergen-based vaccines, showing that some of these vaccines have undergone successful clinical evaluation up to phase III studies. Furthermore, we introduce a strategy for allergen-specific immunotherapy based on recombinant fusion proteins consisting of viral carrier proteins and allergen-derived peptides without allergenic activity, which holds the promise of being free of side effects and eventually being useful for prophylactic vaccination.     

Brexanolone and postpartum depression: what does it have to do with GABA?

Archives of Women's Mental Health -     

Insights into mechanisms behind arteriogenesis: what does the future hold?

Arteriogenesis, the enlargement of collateral vessels, seems a promising new target to improve blood flow to ischemic regions in patients suffering from cardiovascular conditions. With the growing knowledge of the mechanisms involved in arteriogenesis and the factors that influence the process, an increasing number of clinical trials are being performed to stimulate arteriogenesis, providing more insight in therapeutic opportunities for arteriogenesis. The expression of growth factors and the cooperation of surrounding and infiltrating cells seem to be essential in orchestrating the complex processes during arteriogenesis. In this review, we will discuss the regulating mechanisms of arteriogenesis, including the role of growth factors and different cell types and their implementation in a clinical setting. Furthermore, individual differences in the arteriogenic response will be considered, in light of the effect this will have on the success of therapeutic strategies to improve blood flow to ischemic tissue.     

Physicians at the medicine/psychiatric interface: what do internist/psychiatrists do?

Studies have convincingly demonstrated that some 50% of patients in primary care settings have both medical and psychiatric diagnoses requiring dual treatment. The concept of primary care psychiatry has emerged in recent years as one way to address this problem. In 1979 the first combined medicine-psychiatry residency was formed. There are now over 20 such programs, but there is little information on how these doubly trained physicians actually practice. In 1997, the authors surveyed the 268 physicians with board certification in both internal medicine and psychiatry that were listed with the American Board of Medical Specialties. Only 15% practiced any type of medicine at all; the rest were involved only in the practice of psychiatry. Although 75% identified themselves only as psychiatrists and worked predominantly in psychiatry, 95% reported using both their medical and psychiatric training in their professional work. They reported that the dual training made them better physicians, improved their professional credibility, and enhanced their diagnostic skills. Several significant barriers were discovered that directly affect the ability of physicians to practice in two fields. Findings, study limitations, and potential implications for the field and its patients are discussed.     

Sustained attention in the elderly: What do we know and what does it tell us about cognitive aging?

The ability to achieve and maintain the focus of cognitive activity on a given stimulation source or task, in other words to sustain attention or vigilance, is a fundamental component of human cognition. Given the omnipresent need for sustained attention in people's daily lives, a precise knowledge of the effects of normal aging on sustained attention is crucial. Findings in this topic are currently not consistent since they highlight either alteration or preservation or even the two, depending on the experimental approach used. Actually, the two existing approaches do not involve bottom-up and top-down processes at the same extent, which may in part account for this inconclusiveness. This review presents and attempts to explain these results by putting them into perspective with our current knowledge on cognitive aging and the two competing vigilance decrement theories, and discusses how they could inform us on our problems with sustaining attention over time.     

Adherence intervention research: what have we learned and what do we do next?

Although there is general agreement from studies demonstrating that adherence to inhaled corticosteroid therapy is often inadequate to establish consistent control, relatively little concurrence exists in reports of interventions to correct the problem. Half of the studies reviewed found that the experimental intervention did not change adherence, and behavior change reported by patients was often not accompanied by changes in treatment success. Studies used a variety of methods that differed in quality with findings that were often contradictory. Key limitations in many studies included reliance on inadequate adherence measures, inclusion of convenience samples of well-motivated patients, and assessments of intervention outcomes artificially boosted by attrition of least adherent participants. Research is encouraged into innovative interventions that are brief, easily implemented, and can be tailored to individual patients and diverse clinical settings. Of particular importance is inclusion of hard-to-reach patients, including urban and rural poor and the use of valid measures of adherence at intervals sufficient to establish enduring benefit.     

Head and neck paragangliomas: what does the pathologist need to know?

Paragangliomas can occur in a variety of anatomic locations in the head and neck region and can create diagnostic challenges for practicing pathologists. The most recent data suggest that at least 30–40% of paragangliomas are associated with inherited disease. Occasional VHL-, TMEM127-, and SDHA-related head and neck paragangliomas have been described; however, the bulk of hereditary disease in the head and neck paraganglioma is associated with SDHD, SDHC, SDHB, and SDHAF2 mutations. While the distinction of paragangliomas from other head and neck neoplasms is very important, the clinical responsibility of surgical pathologists has evolved and also includes the integration of SDHB immunohistochemistry into the routine pathology practice. In this article, we highlight an approach to clinicopathological diagnosis of head and neck paragangliomas along with a comprehensive discussion on genotype–biochemical profile correlation and synoptic report approach in paragangliomas.     

Allergen avoidance in asthma: what do we do now?

Although allergen exposure can clearly aggravate the condition of sensitized patients with asthma, there is uncertainty and controversy about exactly which allergen avoidance interventions should be recommended to patients with asthma. Interventions that appear logical may fail to be clinically efficacious for several reasons. Although narrow interventions, such as allergen-impermeable mattress covers to reduce exposure to dust mite allergens, may offer little benefit if used alone, recent evidence suggests that a multifaceted, home-based environmental intervention focusing on multiple exposures may provide clinical benefits to patients with asthma. The role of allergen avoidance in infancy in the primary prevention of asthma is a subject of active investigation, but data remain too preliminary to make public health recommendations in this regard.