Rostral Prefrontal Cortex and the Focus of Attention in Prospective Memory

Prospective memory (PM) denotes the function to realize intentions after a delay while being immersed in distracting ongoing (OG) activity. Here, we scrutinize the often-reported involvement of rostral prefrontal cortex (rPFC; approximating Brodmann area 10) in such situations: This region might mediate attention between external stimuli and the internally maintained intention, that is, between stimulus-oriented (SO) and stimulus-independent (SI) processing. Using functional magnetic resonance imaging (fMRI) we orthogonally crossed 1) PM versus OG activity only, with 2) SO versus SI attention. In support of the hypothesis, common regions of medial rPFC exhibited greater blood oxygen level–dependent (BOLD) signal for the contrasts of both OG task only versus PM and SO versus SI attending. However, activation related to the former contrast extended more superiorly, suggesting a functional gradient along a dorsal–ventral axis within this region. Moreover, region-of-interest analyses revealed that PM versus OG task only was associated with greater BOLD signal in left lateral rPFC, reflecting the requirement to maintain delayed intentions. Distinct aspects of this region were also transiently engaged at transitions between SO and SI conditions. These results are consistent with the hypothesis that some of the rostral prefrontal signal changes associated with PM performance reflect relative differences in SO versus SI processing

Rhinitis associated with asthma is distinct from rhinitis alone: TARIA‐MeDALL hypothesis

Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of “one-airway-one-disease,” coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the “Epithelial Barrier Hypothesis.” This review determined that the “one-airway-one-disease” concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme “allergic” (asthma) phenotype combining asthma, rhinitis, and conjunctivitis.info:eu-repo/semantics/publishedVersio

Distinct roles for lateral and medial rostral prefrontal cortex in source monitoring of perceived and imagined events

Rostral prefrontal cortex (PFC) is known to be involved in source memory, the ability to recollect contextual information about an event. However it is unclear whether subregions of rostral PFC may be differentially engaged during the recollection of different kinds of source detail. We used event related functional MRI to contrast two forms of source recollection: (1) recollection of whether stimuli had previously been perceived or imagined, and (2) recollection of which of two temporally distinct lists those stimuli had been presented in. Lateral regions of rostral PFC were activated in both tasks. However medial regions of rostral PFC were activated only when participants were required to recollect source information for self-generated, “imagined” stimuli, indicating a specific role in self-referential processing. In addition, reduced activity in a region of medial ventro-caudal PFC/basal forebrain was associated with making “imagined-to-perceived” confabulation errors. These results suggest that whilst the processing resources supported by some regions of lateral rostral PFC play a general role in source recollection, those supported by medial rostral PFC structures may be more specialised in their contributions

International Severe Asthma Registry: Mission Statement

International audienceRegional and/or national severe asthma registries provide valuable country-specific information. However, they are often limited in scope within the broader definitions of severe asthma, have insufficient statistical power to answer many research questions, lack intra-operability to share lessons learned, and have fundamental differences in data collected, making cross comparisons difficult. What is missing is a worldwide registry which brings all severe asthma data together in a cohesive way, under a single umbrella, based on standardized data collection protocols, permitting data to be shared seamlessly. The International Severe Asthma Registry (ISAR; http://isaregistries.org/) is the first global adult severe asthma registry. It is a joint initiative where national registries (both newly created and pre-existing) retain ownership of their own data but open their borders and share data with ISAR for ethically approved research purposes. Its strength comes from collection of patient level, anonymous, longitudinal, real-life, standardized, high-quality data (using a core set of variables) from countries across the world, combined with organizational structure, database experience, inclusivity/openness, and clinical, academic, and database expertise. This gives ISAR sufficient statistical power to answer important research questions, sufficient data standardization to compare across countries and regions, and the structure and expertise necessary to ensure its continuance as well as the scientific integrity and clinical applicability of its research. ISAR offers a unique opportunity to implement existing knowledge, generate new knowledge, and identify the unknown, therefore promoting new research. The aim of this commentary is to fully describe how ISAR may improve our understanding of severe asthma

Defining a Severe Asthma Super-Responder:Findings from a Delphi Process

BACKGROUND: Clinicians are increasingly recognizing severe asthma patients in whom biologics and other add-on therapies lead to dramatic improvement. Currently, there is no agreed-upon super-responder (SR) definition. OBJECTIVE: To survey severe asthma experts using a modified Delphi process, to develop an international consensus-based definition of a severe asthma SR. METHODS: The Delphi panel was composed of 81 participants (94% specialist pulmonologists or allergists) from 24 countries and consisted of three iterative online voting rounds. Consensus on individual items, whether acceptance or rejection, required at least 70% agreement by panel members. RESULTS: Consensus was achieved that the SR definition should be based on improvement across three or more domains assessed over 12 months. Major SR criteria included exacerbation elimination, a large improvement in asthma control (two or more times the minimal clinically important difference), and cessation of maintenance of oral steroids (or weaning to adrenal insufficiency). Minor SR criteria were composed of a 75% exacerbation reduction, having well-controlled asthma, and 500 mL or greater improvement in FEV(1). The SR definition requires improvement in at least two major criteria. In the future, the SR definition should be expanded to incorporate quality of life measures, although current tools can be difficult to implement in a clinical setting and further research is needed. CONCLUSIONS: This international consensus-based definition of severe asthma SRs is an important prerequisite for better understanding SR prevalence, predictive factors, and the mechanisms involved. Further research is needed to understand the patient's perspective and to measure quality of life more precisely in SRs.Supports Open AccessPublished version, accepted version, submitted versio

International severe asthma registry (ISAR): protocol for a global registry

Background: Severe asthma exerts a disproportionately heavy burden on patients and health care. Due to the heterogeneity of the severe asthma population, many patients need to be evaluated to understand the clinical features and outcomes of severe asthma in order to facilitate personalised and targeted care. The International Severe Asthma Registry (ISAR) is a multi-country registry project initiated to aid in this endeavour. Methods: ISAR is a multi-disciplinary initiative benefitting from the combined experience of the ISAR Steering Committee (ISC; comprising 47 clinicians and researchers across 29 countries, who have a special interest and/or experience in severe asthma management or establishment and maintenance of severe asthma registries) in collaboration with scientists and experts in database management and communication. Patients (≥18 years old) receiving treatment according to the 2018 definitions of the Global Initiative for Asthma (GINA) Step 5 or uncontrolled on GINA Step 4 treatment will be included. Data will be collected on a core set of 95 variables identified using the Delphi method. Participating registries will agree to provide access to and share standardised anonymous patient-level data with ISAR. ISAR is a registered data source on the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance. ISAR’s collaborators include Optimum Patient Care, the Respiratory Effectiveness Group (REG) and AstraZeneca. ISAR is overseen by the ISC, REG, the Anonymised Data Ethics & Protocol Transparency Committee and the ISAR operational committee, ensuring the conduct of ethical, clinically relevant research that brings value to all key stakeholders. Conclusions: ISAR aims to offer a rich source of real-life data for scientific research to understand and improve disease burden, treatment patterns and patient outcomes in severe asthma. Furthermore, the registry will provide an international platform for research collaboration in respiratory medicine, with the overarching aim of improving primary and secondary care of adults with severe asthma globally.Pharmaceutical Sciences, Faculty ofOther UBCNon UBCReviewedFacult