The misdiagnosis of cluster headache: a nonclinic, population-based, Internet survey

OBJECTIVE: We conducted the first nonclinic, Internet-based survey of cluster headache to investigate this population with regard to diagnostic problems encountered, effective and ineffective medications, problems obtaining medications through third-party payers, and symptoms as they relate to International Headache Society criteria. BACKGROUND: Previous cluster headache surveys have been at specialty centers. These patients might be different from cluster headache sufferers in the general population. An Internet-based population of cluster headache sufferers who connected to a Web site responded to the questionnaire, and e-mailed it back to our site to be analyzed. We analyzed a total of 789 respondents, 76% men and 28% women. RESULTS: Eighty-seven percent of respondents qualified as having cluster headache according to International Headache Society criteria. However, diagnosis was delayed an average of 6.6 years from the onset of symptoms. The average number of physicians seen before the correct diagnosis was made was 4.3, and the average number of incorrect diagnoses was 3.9. Seventy-one percent of respondents had undergone unnecessary magnetic resonance or computed tomography scans, and 4% had unnecessary sinus or deviated septum surgery. We found that many inappropriate medications such as propranolol, amitriptyline, and antibiotics were prescribed and that successful medications for clusters such as sumatriptan and oxygen were often denied due to a failure to understand the nature of this disorder. Seventy-seven percent of respondents were smokers. Seventy-four percent stopped smoking in an attempt to improve their condition; however, only 3% experienced relief. CONCLUSIONS: The most alarming finding was the delay in diagnosing cluster headache in this population--an average of 6.6 years. The selection of medications demonstrated to be successful in the treatment of clusters proved effective for the majority of this population. Many respondents reported being denied some of these effective medications by their physicians or third-party payers. Using International Headache Society criteria for cluster headache, 87% of the respondents should have been correctly diagnosed by the first physician seen.     

GPC-3、CD147、CD10、CD138在肝细胞肝癌中的表达及临床意义

目的探究磷脂酰肌醇蛋白多糖-3(GPC-3)、白细胞分化抗原147(CD147)、白细胞分化抗原10(CD10)、多配体蛋白聚糖-1(又名CD138)在肝细胞肝癌(HCC)中的表达及临床意义。方法收集2014年1月至2018年12月该院行手术治疗并经术后病理证实的HCC患者肝癌组织标本120例及癌旁组织(距癌灶边缘2 cm)标本120例,行免疫组化检测,比较GPC-3、CD147、CD10、CD138在肝癌组织及癌旁组织中的表达,并分析其与肿瘤分化程度的关系。结果GPC-3、CD147、CD10在肝癌组织中的阳性率显著高于癌旁组织,CD138在肝癌组织中的阳性率显著低于癌旁组织,差异有统计学意义(P<0.05);高分化组GPC-3、CD147、CD10阳性率显著低于中低分化组,高分化组CD138阳性率显著高于中低分化组,差异有统计学意义(P<0.05)。结论GPC-3、CD147、CD10、CD138表达水平可能与HCC的发生发展相关,或可将其作为肿瘤标志物,进一步指导HCC的临床诊断及鉴别。     

Decreasing incidence of cluster headache: a population-based study in Olmsted County, Minnesota

The incidence of medically recognized cluster headache within Olmsted County, Minnesota, from 1989 through 1990, was determined by using modified International Headache Society criteria. The results were compared with previously published incidence data from 1979 through 1981. The overall age- and sex-adjusted incidence decreased from 9.8/100,000 person-years in 1979-1981 to 2.07/100,000 person-years in 1989-1990.     

Cluster headache: clinical presentation, lifestyle features, and medical treatment

BACKGROUND: Cluster headache (CH) is a rare but severe headache form with a distinct clinical presentation. Misdiagnoses and mismanagement among these patients are high. OBJECTIVE: To characterize clinical features and medical treatment in patients with CH. METHODS: We established a cohort of 246 clinic-based and non-clinic-based CH patients. The diagnosis of CH was verified according to International Headache Society (IHS) criteria. We used standardized questionnaires to assess associated factors as well as success or failure of treatments. RESULTS: The majority (75.6%) was not treated before at our clinic-77.6% were males; 74.8% had episodic CH, 16.7% had chronic CH, in the remaining patients, the periodicity was undetermined because they were newly diagnosed. Cranial autonomic features were present in 98.8%, nausea and vomiting in 27.8%, and photophobia or phonophobia in 61.2% of CH patients. Most (67.9%) reported restlessness during attacks and 23% a typical migrainous aura preceding the attacks. The rate of current smoking was high (65.9%). Half of the patients reported that alcohol (red wine in 70%) triggered CH attacks. Eighty-seven percent reported the use of drugs of first choice (triptans 77.6%, oxygen 71.1%) with sumatriptan subcutaneous injection being the most effective drug for acute therapy (81.2%). The most frequently used preventive medications were verapamil (70.3%) and glucocorticoids (57.7%) with equally high effectiveness. CONCLUSIONS: Apart from the IHS criteria additional features like nausea/vomiting and migrainous aura may guide the diagnosis of CH. A large number of CH patients do not receive adequate treatments.     

Neurostimulation for primary headache disorders: Part 2, review of central neurostimulators for primary headache, overall therapeutic efficacy, safety, cost, patient selection, and future research in headache neuromodulation

This article is the second of 2 articles reviewing neurostimulation for primary headaches. In Part 1, we described methods, pathophysiology and anatomy, and history of neuromodulation in the treatment of headache, as well as reviewing the literature on peripheral neuromodulation for primary headaches. Peripheral targets for stimulation include percutaneous nerves, transcranial holocephalic, occipital nerves, auriculotemporal nerves, supraorbital nerves, cervical epidural, and sphenopalatine ganglia. In Part 2, we describe available literature on central neuromodulation in primary headaches. Central stimulation targets include vagus nerve and deep brain structures. Part 2 also analyzes overall therapeutic efficacy, safety, cost, patient selection, and recommendations for further research of neurostimulation modalities based on available data.     

2006-2010年浙江省台州市学生肺结核流行病学分析

目的 了解浙江省台州市学生肺结核流行特征,为学校结核病防治工作提供依据。 方法 采用描述流行病学方法对台州市2006-2010年结核病管理信息系统中学生肺结核发病资料进行统计分析。 结果 2006-2010年学生肺结核发病610例,占总病例数的3.17%;学生整体肺结核报告发病率为11.87/10万,2009年学生整体报告发病率为最高,为15.79/10万;发病以高中学生为主,占学生发病数的69.67%;发生聚集性疫情34起205例,罹患率为11.33%,发病以4月为主,其发现方式主要是因症就诊(42.79%),依次为转诊(30.82%),中(高)考体检发现(17.54%)、密切接触者筛查(8.85%);就诊延误率达46.72%。 结论 台州市学校学生结核病发病人数处于较低水平,但发病率高于全国平均水平,并存在聚集性疫情,同时学生结核病就诊延误较为严重,应进一步加强学校结核病防治工作。     

Fatigue, depression, and insomnia: evidence for a symptom cluster in cancer

OBJECTIVES: To review the evidence for considering fatigue, depression, and insomnia as a symptom cluster in cancer. DATA SOURCES: Empirical studies, clinical articles, and review articles. CONCLUSION: The single- and multi-symptom measurement approaches are of limited usefulness in distinguishing fatigue, depression, and insomnia. Studies in which these symptoms have been measured concurrently in patients with cancer yield consistent evidence of high positive correlations. Results do not appear to be solely a function of overlap in measurement approaches. IMPLICATIONS FOR NURSING PRACTICE: Successful management of fatigue, depression, and insomnia in cancer patients are likely to combine pharmacologic and nonpharmacologic therapies.     

Cluster Headache Associated With Parainfluenza Virus, Preceded and Succeeded by Migraine

A serologically proven case of parainfluenza viral infection was associated with the onset and disapearance of cluster headache. The patient had long-standing migraine that ceased during the cluster headache period and recurred when the latter stopped. Possibly, the virus was neurally transmitted to the trigeminal-autonomic system, creating an inflammatory response that transiently precipitated cluster headache and obliterated migraine.     

Pain, depression, and fatigue as a symptom cluster in advanced cancer

Context

Pain, depression, and fatigue are common symptoms in cancer populations. They often coexist and have been suggested as a specific symptom cluster. Systemic inflammation (SI) may be a possible common mechanism.

Objective

This study examined whether pain, depression, and fatigue exist as a symptom cluster in advanced cancer patients with cachexia and might be related to the presence of SI.

Methods

Secondary data analysis was undertaken of two clinical trials in patients with cancer cachexia (n = 654). Pain, depression, and fatigue were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. Plasma C-reactive protein (CRP) was measured as a marker of SI in a subgroup (n = 436). Multivariate analysis and a series of regression analyses were undertaken relating pain, depression, fatigue, and CRP.

Results

Pain, depression, and fatigue clustered, with between two and four times as many patients having all three symptoms as would be expected if the symptoms only coexist by chance (P < 0.001). CRP was not related to the symptom cluster. There was a strong relationship between the pattern of symptoms and physical functioning (P < 0.001).

Conclusion

Pain, depression, and fatigue is an identifiable symptom cluster in a cohort of cachexic cancer patients and is associated with reduced physical functioning.     

Profiling nurses' job satisfaction,acculturation, work environment,stress, cultural values and coping abilities: A cluster analysis

This study aimed to determine whether definable profiles existed in a cohort of nursing staff with regard to demographic characteristics, job satisfaction, acculturation, work environment, stress, cultural values and coping abilities. A survey was conducted in one hospital in Singapore from June to July 2012, and 814 full‐time staff nurses completed a self‐report questionnaire (89% response rate). Demographic characteristics, job satisfaction, acculturation, work environment, perceived stress, cultural values, ways of coping and intention to leave current workplace were assessed as outcomes. The two‐step cluster analysis revealed three clusters. Nurses in cluster 1 (n = 222) had lower acculturation scores than nurses in cluster 3. Cluster 2 (n = 362) was a group of younger nurses who reported higher intention to leave (22.4%), stress level and job dissatisfaction than the other two clusters. Nurses in cluster 3 (n = 230) were mostly Singaporean and reported the lowest intention to leave (13.0%). Resources should be allocated to specifically address the needs of younger nurses and hopefully retain them in the profession. Management should focus their retention strategies on junior nurses and provide a work environment that helps to strengthen their intention to remain in nursing by increasing their job satisfaction.     

Neurostimulation for primary headache disorders, part 1: pathophysiology and anatomy, history of neuromodulation in headache treatment, and review of peripheral neuromodulation in primary headaches

Neurostimulation for primary headaches is being increasingly utilized as a treatment modality. Use of neuromoduation has generated multiple case reports as well as some controlled studies. This article is the first of 2 systematic reviews of available data regarding neurostimulation for primary headache conditions. The pathophysiology, relative anatomy, theoretical mechanisms, and history of neurostimulation for primary headache are covered in this section, Part 1 of 2. The literature regarding peripheral neurostimulatory targets is also reviewed in Part 1. These peripheral targets include: percutaneous nerves, transcranial holocephalic, occipital nerves, auriculotemporal nerves, supraorbital nerves, cervical epidural, and sphenopalatine ganglia. Part 2 will focus on central stimulation, covering vagus nerve, and deep brain stimulation. Part 2 also contains an overall analysis of efficacy, safety, cost, patient selection, and suggestions for further study based on available evidence.     

Self-Understanding, Empathy, Guided Discovery, and Schema Belief in Schema-Focused Cognitive Therapy of Personality Problems: A Process–Outcome Study

The aim of this study was to examine the dispositional and/or episodic influences of the process variables of self-understanding, empathy, guided discovery, and convictions about primary early maladaptive schema, which are central concepts in the schema-focused cognitive therapy of personality problems. The sample consisted of 35 patients with panic disorder and/or agoraphobia and DSM-IV Cluster C personality traits who participated in an 11-week inpatient program. Patients, therapists, and an expert observer rated individual therapy sessions. Greater patient-rated self-understanding the first session was related to greater decreases in schema belief and of emotional distress throughout therapy. Greater therapist-rated empathic experience the first session was related to greater decreases in distress throughout therapy. Session-by-session analyses revealed few sequential relationships. However, a greater in-session reduction of schema belief weakly predicted lower level of presessional distress the next session, and vice versa. The study illustrates how to intensively measure and model change in psychotherapy, using both growth curve and time series analyses.