Graft terpolymers consist of a polymer backbone onto which are grafted two series of chemically dissimilar sidechains. Depending on monomer incompatibility, such terpolymers either order into periodic morphologies or remain microscopically mixed. Addition of a small quantity (<2 wt %) of dibenzylidene sorbitol, a smallmolecule gelling agent which self-associates through hydrogen bonding, to a homogeneous (Le., disordered) amphiphilic graft terpolymer results in a physical gel that exhibits two levels of structural organization. In this initial study, we report on the nature and evolution of such hierarchical order. Interactions between the gellant and terpolymer result in the formation of a fine percolation network comprised of fibrillar strands measuring 10-20 nm in diameter, as determined from scanning electron micrographs. Amorphous micrometersize spherules, similar in appearance to crystalline spherulites, subsequently develop through nucleation. Dynamic rheological measurements reveal that these two distinct levels of microstructural organization are (i) responsible for deformation mechanisms manifested at different strain levels and (ii) recoverable upon mechanical and thermal recycling. These polymer-rich gels constitute a new family of responsive materials which show promise in biomedical applications.Block and graft colterpolymers continue to receive considerable attention because they can be used commercially as adhesives,' compatibilizing agents,2 surface coating^,^ monoporous filters: and delivery system^.^ These materials, comprised of at least two dissimilar contiguous monomer sequences covalently bonded together, have also provided tremendous insight into the self-assembly of condensed matter.6-9 If the blocks or grafts are sufficiently incompatible, they undergo phase separation similar to that of the parent homopolymers. Due to the interblock covalent linkages, segmental mobility is restricted, and phase separation occurs on a much smaller size scale than that of immiscible blends.'O As a result of such enthalpy-or entropy-' driven microphase separation, a periodic microstructure forms, imparting the material with properties of its constituent blocks or grafts. If the contiguous monomer sequences are thermodynamically compatible, microphase segregation does not occur, and the colterpolymer remains disordered (i.e., microscopically homogeneous). Even in this state, however, the discrete blocks or grafts can strongly influence the morphology and localized interactions of an additive, such as a parent homopolymer.In contrast to the numerous studies of diblock and triblock copolymers, relatively few efforts have explored the phase behavior of block or graft terpolymers, composed of three chemically dissimilar monomer species, which are also capable of ordering into a variety of periodic morphologie~'~-'~ or remaining disordered. In this work, we have examined the effect of adding a small-molecule gelling agent, dibenzylidene sorbitol (DBS), to a homogeneous amphiphilic graft terpolymer which can be e...

BackgroundChronic spontaneous urticaria (CSU) poses problems with respect to high prevalence, reduced quality of life, lack of long term efficacy, and expense of current treatments for severe intractable symptoms. There have been many reports suggesting ‘stress’ factors may be implicated, but there are no studies that explore the efficacy of treatments including a psychological perspective. A whole person treatment approach (WPTA), which addresses psychological factors has been used, with effect, for 6 years in the Auckland City Hospital Immunology Department.FindingsIn a pilot study to demonstrate feasibility of recruitment and treatment of CSU patients in a time-limited, whole person treatment approach, within a conventional immunology department, four patients (three CSU and one idiopathic angioedema) were recruited into a brief WPTA course based in non-dualistic concepts of mind and body connectedness, and utilising psychotherapy-derived listening skills for up to 10 h long sessions, once per week. Treatment efficacy rating, using Urticaria Activity Score and the Urticaria Severity Score, and reduction of drug usage, showed patients experienced long term resolution of urticaria and cessation of hospitalisation for angioedema and came off regular antihistamine medication.ConclusionsA clinician treating chronic spontaneous urticaria in an Immunology department, using a whole person treatment paradigm, can safely explore unique meanings and emotional states, in a process acceptable to patients, resulting in a significant clinical benefit for symptoms. A much larger study comparing the outcome of WPTA versus standard treatment alone is warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s13601-015-0082-7) contains supplementary material, which is available to authorized users.

This supplement reports proceedings of the second international Global Urticaria Forum, which was held in Berlin, Germany in November 2015. In 2011, a report of the GA 2 LEN task force on urticaria outlined important and unanswered questions in chronic urticaria (CU). These included, but were not limited to, questions on the epidemiology and course of chronic spontaneous urticaria (CSU) [also called chronic idiopathic urticaria (CIU)], the resources allocated for the diagnosis and treatment of CSU, whether patients with angioedema as an isolated symptom can be regarded as a subgroup of CSU, and the efficacy and long-term safety of therapies. Many of these questions have been addressed by recent studies. Some of the answers obtained raise new questions. Here, we summarize some of the key insights on CU obtained over recent years, and we discuss old and new unmet needs and how to address them with future studies. We need to analyze the influence of recent advances in understanding of the burden of CU on patients and society, disease management and the CU patient journey. Our increased understanding of urticarial pathophysiology and consideration of the patient as a whole will need to be translated to better treatment algorithms and protocols. Actions to address these challenges include the 5th International Consensus Meeting on Urticaria, which will take place later this year. The formation of a global network of Urticaria Centers of Reference and Excellence over the next few years has also been proposed, with the aim of providing consistent excellence in urticaria management and a clear referral route, furthering knowledge of urticaria through additional research and educating/promoting awareness of urticaria.

Chronic spontaneous urticaria (CSU) is a very common skin condition that causes considerable suffering and is often poorly responsive to drug treatment regimens. Most clinicians accept that multiple factors play a role in the aetiology of CSU, but there is a widespread reluctance to accept a significant role for 'mindbody' factors, despite a large number of clinical reports and studies over many decades suggesting their relevance. This reluctance has multiple origins. A primary influence is the flawed dualistic model of mind and body relatedness underpinning much of modern medical care. In this view, if a pathophysiological mechanism can be discerned, then 'mind' factors can be largely ignored. Recent evidence demonstrating intimate structural and functional relations between peripheral nerves and mast cells, and local skin secretion of mast cell-influencing neuropeptides by nerves, provides an argument for discarding old 'organic' and dualistic conceptualisations of CSU. A sound, integrative, multifactorial approach requires a unitive 'mindbody' model in which physical and subjective dimensions of personhood are seen as coexisting and equally deserving of exploration and management. Another influence is the tendency for 'psychosomatic' research studies in CSU to focus on patient experience using broad group-based diagnostic categories, such as anxiety and depressive disorders, and generic measures of stress. Two case examples are given, illustrating that CSU arises in relation to highly individual and relevant 'stories', which would not usually be picked up by these generic measures. It is suggested that an appropriate 'mindbody' management programme leading to good clinical outcomes for CSU is dependent on clinicians discerning unique patient 'stories'. Finally, a lack of formal studies comparing drug and 'mindbody' treatment outcomes will continue to negatively influence the adoption of 'mindbody' approaches in CSU. There is an urgent need for properly structured comparative studies, and the essential elements of a suitable 'mindbody' approach appropriate to such research are briefly outlined.