Obesity-associated severe asthma represents a distinct clinical phenotype: analysis of the British Thoracic Society Difficult Asthma Registry Patient cohort according to BMI.

BACKGROUND: Obesity has emerged as a risk factor for the development of asthma and it may also influence asthma control and airway inflammation. However, the role of obesity in severe asthma remains unclear. Thus, our objective was to explore the association between obesity (defied by BMI) and severe asthma. METHODS: Data from the British Thoracic Society Difficult Asthma Registry were used to compare patient demographics, disease characteristics, and health-care utilization among three BMI categories (normal weight: 18.5-24.99; overweight: 25-29.99; obese: 30) in a well-characterized group of adults with severe asthma. RESULTS: The study population consisted of 666 patients with severe asthma; the group had a median BMI of 29.8 (interquartile range, 22.5-34.0). The obese group exhibited greater asthma medication requirements in terms of maintenance corticosteroid therapy (48.9% vs 40.4% and 34.5% in the overweight and normal-weight groups, respectively), steroid burst therapy, and short-acting b 2 -agonist use per day. Significant differences were seen with gastroesophageal reflux disease (53.9% vs 48.1% and 39.7% in the overweight and normal weight groups, respectively) and proton pump inhibitor use. Bone density scores were higher in the obese group, while pulmonary function testing revealed a reduced FVC and elevated carbon monoxide transfer coefficient. Serum IgE levels decreased with increasing BMI and the obese group was more likely to report eczema, but less likely to have a history of nasal polyps. CONCLUSIONS: Patients with severe asthma display particular characteristics according to BMI that support the view that obesity-associated severe asthma may represent a distinct clinical phenotype.

DW4TR: A Data Warehouse for Translational Research.

The linkage between the clinical and laboratory research domains is a key issue in translational research. Integration of clinicopathologic data alone is a major task given the number of data elements involved. For a translational research environment, it is critical to make these data usable at the point-of-need. Individual systems have been developed to meet the needs of particular projects though the need for a generalizable system has been recognized. Increased use of Electronic Medical Record data in translational research will demand generalizing the system for integrating clinical data to support the study of a broad range of human diseases. To ultimately satisfy these needs, we have developed a system to support multiple translational research projects. This system, the Data Warehouse for Translational Research (DW4TR), is based on a light-weight, patient-centric modularly-structured clinical data model and a specimen-centric molecular data model. The temporal relationships of the data are also part of the model. The data are accessed through an interface composed of an Aggregated Biomedical-Information Browser (ABB) and an Individual Subject Information Viewer (ISIV) which target general users. The system was developed to support a breast cancer translational research program and has been extended to support a gynecological disease program. Further extensions of the DW4TR are underway. We believe that the DW4TR will play an important role in translational research across multiple disease types.

Constraint-induced movement therapy for severe upper-extremity impairment after stroke in an outpatient rehabilitation setting: a case report.

PURPOSE: Laboratory studies confirm that constraint-induced movement therapy (CIMT) improves upper-extremity (UE) function after stroke. Due to strict patient criteria and the intensive resources required, CIMT has been slow to become part of rehabilitation practice. Our purpose was to determine the feasibility and effectiveness of an adapted experimental protocol within an outpatient clinical setting for a patient with moderate to severe UE impairment who did not meet traditional CIMT criteria. PATIENT DESCRIPTION: AJ, a 16-year-old male, experienced a left middle cerebral artery ischemic stroke due to carotid artery dissection one year before beginning CIMT. He demonstrated some proximal movement but no wrist or finger extension. He had received intensive rehabilitation for 12 months prior to beginning CIMT. INTERVENTION: Two occupational therapists and two physiotherapists collaborated to provide CIMT task training for 6 hours daily for 2 weeks. A knitted mitten extending to the elbow restrained the less-involved UE during 90% of waking hours. Tasks were tailored to AJ's interests, with the goal of integrating his affected UE into his behavioural repertoire. MEASURES AND OUTCOMES: After 2 weeks of CIMT, AJ improved in all measures (grip and lateral pinch strength, Action Research Arm Test [ARAT], and Box and Block Test) except the Chedoke McMaster Impairment Inventory. Greatest gains were seen at 6 months in the ARAT and Box and Block Test, which coincided with patient and family reports of AJ's using his arm in everyday functional tasks. IMPLICATIONS: Shared workload, emphasis on relevant functional tasks, and complete family participation likely influenced the success of CIMT. Our findings suggest that the strict CIMT criteria used in previous studies may exclude patients who might benefit from the treatment. Controlled trials should be undertaken to examine the effects of CIMT in patients with moderate to severe UE impairment.

The discovery net system for high throughput bioinformatics.

MOTIVATION: Bioinformatics requires Grid technologies and protocols to build high performance applications without focusing on the low level detail of how the individual Grid components operate. RESULTS: The Discovery Net system is a middleware that allows service developers to integrate tools based on existing and emerging Grid standards such as web services. Once integrated, these tools can be used to compose reusable workflows using these services that can later be deployed as new services for others to use. Using the Discovery Net system and a range of different bioinformatics tools, we built a Grid based application for Genome Annotation. This includes workflows for automatic nucleotide annotation, annotation of predicted proteins and text analysis based on metabolic profiles and text analysis.