丛集性头痛及其药物治疗进展

丛集性头痛是在某个时期内突然出现一系列的剧烈头痛.目前治疗仍以药物治疗为主,急性发作期主要控制症状,同时开始预防性治疗以控制进一步发作.本文综述丛集性头痛的临床特性以及药物治疗进展.     

自我效能护理模式对提高偏头痛军人生活质量和减少对军事训练影响的效果

目的探讨自我效能护理模式对偏头痛军人患者生活质量和训练的影响。方法采用前瞻性队列对照研究,交替随机将84例偏头痛患者分成对照组和试验组,对照组选择常规护理,试验组则选择自我效能护理模式,使用偏头痛特异性生活质量问卷版和创新性自制偏头痛军事训练影响问卷为评价工具,12周后评估护理效果。结果护理后试验组患者的偏头痛特异性生活质量量表和自制偏头痛军事训练影响量表得分均显著优于对照组,差异有统计学意义(P<0.05)。结论自我效能护理模式能减轻军人偏头痛程度,改善生活质量,降低偏头痛对军事训练的影响。     

The UK migraine patient survey: quality of life and treatment

This research confirms that a majority of migraine sufferers in the UK acknowledge an incidence, frequency and symptomatology that have a significant effect on quality of life (both activity-based and on personal relationships); despite this, a significant proportion self-medicate with unsuitable and ineffective agents owing to the low level of efficacy and general lack of satisfaction with recommended and prescribed therapies. 50,000 migraineurs (sample derived from the Consumer Research Bureau) in the UK were invited to self-complete a questionnaire (during Q2-Q3, 1998). 9770 questionnaires were included in the analysis. With the advent of improved diagnosis and medications, the present study was undertaken to assess the impact and severity of migraine on the normal activities, attitudes and relationships of known migraineurs. The efficacy and control achieved by a range of therapeutic interventions were also considered. In order to identify the headache characteristics of this self-selected migraine patient population, diagnosis was confirmed by information relating to quality of headache (frequency, duration and symptomatology); the extent of restrictions on specific daily activities was also used to provide severity characteristics. A majority believed that they could not control their migraine and a significant proportion believed that migraine controlled their day-to-day life. Despite this, sufferers may not consult general practitioners (GPs) owing to previous experience, expectations of inadequate therapeutic intervention and/or perceived lack of physician empathy. This study is both opinion-based and awareness-based, and confirms known statistics while also providing further clarification on the overall effect of migraine on associated emotional and physical relationships, and on migraineurs' use and opinion of a range of available medications.     

Disability and quality of life in post-traumatic stress disorder: impact of drug treatment

The degree of functional disability and quality of life (QOL) impairment in patients with post-traumatic stress disorder (PTSD) is at least comparable with, and in many instances greater than, that of patients with other anxiety and mood disorders. Multidimensional QOL assessments in PTSD have utility in capturing aspects of individual patient experience and satisfaction related to health and treatment, and have fairly robust sensitivity to treatment effects. Despite the growing number of epidemiological and clinical studies detailing QOL in PTSD, there are few studies of the impact of pharmacological agents on QOL outcomes, and none that have included an economic component to evaluate the resource consequences of the disorder. To date, the selective serotonin reuptake inhibitors have been shown to confer significant acute (and longer term) QOL and psychosocial benefits. Further investigation of the relationship of QOL to PTSD symptom severity, disability, treatment outcome and cost, among the different drug treatment modalities, is clearly needed.     

The impact of fragility fracture on health-related quality of life : the importance of antifracture therapy

Both general and specific health status instruments can be utilised in evaluating health-related quality of life (HR-QOL) deficits resulting from osteoporotic fractures. Osteoporotic hip, vertebral and wrist fractures significantly decrease HR-QOL in most HR-QOL domains investigated. The presence of multiple vertebral fractures leads to larger decrements in HR-QOL. More research needs to be completed with these HR-QOL tools to better assess the true burden of osteoporotic fractures, particularly in the case of hip fractures, as the burden is surely being underestimated without recognition of HR-QOL. Only when the burden of fragility fractures is understood, inclusive of HR-QOL, will the value of proven antifracture prevention and treatment therapies be appreciated. Information collected by HR-QOL instruments may provide new insight as to how to improve quality of life for patients with fractures and how to properly allocate healthcare spending.     

The impact of favorable and unfavorable life events on psychotropic drug response

A group of 410 primarily anxious psychiatric outpatients treated with chlordiazepoxide, 244 treated with diazepam, and 537 receiving placebo were asked to report any significant favorable or unfavorable life events which occurred during both the first and the second 2 weeks of a 4-week double-blind drug trial. The frequency with which favorable and unfavorable events were reported did not differ across medication groups. However, patients reporting unfavorable events showed significantly less improvement after 2 and 4 weeks of treatment than did patients reporting no events or patients reporting favorable events. The amount of improvement experienced by patients reporting positive events did not differ significantly from that of patients reporting no events. The size of the impact of reported events upon outcome did not vary with treatment agents. Essentially similar results were obtained when data based on 2- and 4-week patient improvement ratings were analyzed. It was concluded that the occurrence of significant life events during the course of drug trials of the type involved here did not affect the sensitivity with which drug-placebo differences could be detected.     

偏头痛的药物治疗及其安全性评价

偏头痛是神经科门诊最常见的疾病之一,其发病机制和药物治疗研究近年已取得新进展。本文介绍偏头痛的药物治疗包括急性发作的治疗及预防治疗。急性发作治疗的常用药物为非甾体类抗炎药、曲坦类、麦角碱类等。预防治疗的药物为三环类抗抑郁药、抗癫痫药、β-受体阻断剂、钙离子拮抗剂等。本文回顾这些药物的治疗作用和可能出现的不良反应,以期有益于临床安全合理用药。     

50例舒缓患者音乐疗法生活质量影响观察

目的：探讨音乐疗法对临终患者生活质量的影响。方法：选择舒缓疗护病房100例患者,实验组和对照组各50例。对照组给予常规治疗及护理,实验组增加音乐疗法干预,每次30 min,1次/d。结果：两组患者心率、疼痛指标和远期生活质量比较差异有统计学意义（P＜0.05）;两组患者呼吸和血压指标差异无统计学意义。结论：音乐疗法能缓解舒缓患者疼痛症状,提高生活质量。     

Postmenopausal hormone therapy: impact on menopause-related symptoms, chronic disease and quality of life

Quality of life in climacteric and postmenopausal women is often compromised. This overview addresses the many factors that may interfere with health and well-being in such women. Hormonal changes during the menopausal transition, finally resulting in estrogen deficiency, play a pivotal role in the incidence of climacteric symptoms and also in the development of chronic diseases. Such symptoms and diseases can contribute to impaired quality of life in climacteric and postmenopausal women. Postmenopausal hormone therapy (PHT) is the treatment of first choice to alleviate symptoms of estrogen deficiency. Besides effectively relieving climacteric symptoms and complaints, PHT can also protect against some chronic diseases, such as osteoporosis and colorectal cancer. Presently, available PHTs vary widely in type, estrogen and progestogen dosage, and route and duration of administration. Furthermore, the number of alternatives to treat climacteric symptoms, and/or to prevent chronic diseases, has increased. Therefore, doctors involved in the care of climacteric women in the 21st century are much more able to meet the specific needs of individual patients and improve health and quality of life.     

加巴喷丁治疗偏头痛对患者负性情绪、生活质量的影响研究

目的 研究加巴喷丁对偏头痛患者负性情绪、生活质量的影响.方法 随机选取我院收治的104例偏头痛患者,将其随机均分为观察组和对照组,分别予以加巴喷丁与氟桂利嗪进行治疗;观察两组治疗前后头痛缓解情况,并用SDS、SAS量表评估负性情绪,用HIT-6量表评估生活质量改善情况.结果 治疗后,两组头痛症状均有明显缓解.两组治疗前SDS、SAS、HIT-6得分相比,差异无统计学意义(P＞0.05).治疗后,观察组、对照组SDS得分分别为(25.5±4.4)、(28.0±3.9),SAS得分分别为(29.2±3.3)和(32.5±3.6),HIT-6得分分别为(23.3±5.2)和(31.9±6.5),差异具有统计学意义(P＜0.05).结论 加巴喷丁能显著改善偏头痛患者症状,降低患者负性情绪,提高患者生活质量,值得临床推广.     

The impact of antianginal drug therapy on asymptomatic myocardial ischemia

This study addresses the effect of the three major classes of antianginal agents on asymptomatic myocardial ischemia in patients with chronic stable angina pectoris. The authors found that each class (given as monotherapy) resulted in a 50% reduction in asymptomatic ischemia (both in the number of episodes and the ST product). Dual therapy resulted in an overall four fold reduction compared to placebo. Therapy also resulted in a beneficial alteration in the frequency distribution of asymptomatic ischemia. Stratification into three age groups demonstrated an equal prevalence of asymptomatic ischemia in each. All ages had nearly equivalent reductions in asymptomatic ischemia by monotherapy and dual therapy, but the youngest age group seemingly responded better to monotherapy than did the oldest age group.     

Aspects on the pathophysiology of migraine and cluster headache

The specific cause of migraine headache remains unknown. Current theories suggest that the initiation of a migraine attack involves a primary CNS dysfunction with subsequent activation of the trigeminovascular system. Studies in patients have revealed a clear association between headache and the release of the neuropeptide calcitonin gene-related peptide, probably from C fibres. In cluster headache and in a case of chronic paroxysmal headache there was in addition release of the parasympathetic neuropeptide vasoactive intestinal peptide, which was associated with headache, nasal congestion and rhinorrhea. Triptan administration, activating the 5-HT(1B/1D) receptors, caused the headache to subside and the neuropeptide release to normalise. These data suggest the involvement of sensory and parasympathetic mechanisms in the pathophysiology of primary headaches.     

The impact of diabetes mellitus on health-related quality of life in Saudi Arabia

ObjectiveTo evaluate the effect of different demographic, clinical and social factors on diabetic patients' quality of life (QOL).Research design and methodsA cross sectional study conducted on patients with type 2 diabetes who attended King Abdulaziz University Hospital outpatient clinics between February and March 2017. The patients were asked about sociodemographic data including age, sex, educational level, exercise history and marital status in addition to clinical data such as duration of diabetes, presence of comorbidities as well as medication history. The patients' QOL were assessed using EQ-5D-5L Arabic version.Results131 participants were included in the study with a median age 55 years old. Forty five percent of participants were male. Regarding EQ-5D scores, there were significant correlation with gender, exercise, hypertension, heart disease, marital status, educational level and duration of diabetes while there was a significant difference in EQ-VAS scores with respect to heart disease, level of education and duration of diabetes.ConclusionMore attention needs to be given to the assessment of the QOL of diabetic patients and assessing the effect of different treatment modalities on improvement of patients’ QOL.     

Inhaled drug therapy development for the treatment of migraine

Introduction: The inhalation of substances, both medicinally and recreationally, is a commonly used method of drug administration but has been underutilized in the treatment of neurologic disorders such as migraine. Three drugs have been studied as potential inhalable treatments for acute migraine: dihydroergotamine (MAP0004), prochlorperazine (Staccato prochlorperazine), and loxapine (Staccato loxapine).

Areas covered: This review discusses the available literature describing the pharmacokinetics, tolerability and efficacy of MAP0004, Staccato prochlorperazine and Staccato loxapine, including data from Phase II and Phase III clinical trials.

Expert opinion: Inhaled DHE offers rapid absorption with a pharmacokinetic profile similar to IV administration. Improved side effect profile results from more selective binding at antimigraine serotonergic receptors 5-HT_1B and 5-HT_1D. Inhaled prochlorperazine is rapidly absorbed and resulted in statistically significant migraine pain relief at 2 hours compared to placebo but is not currently being pursued by the manufacturer as a potential migraine abortive. Inhaled loxapine is also rapidly absorbed into systemic circulation but Phase IIb trials did not show statistically improved pain relief or pain freedom compared to placebo. MAP0004 will likely provide a good alternative to patients seeking rapid relief without the need for injection or other invasive routes.     

The pharmacological impact of ATP-binding cassette drug transporters on vemurafenib-based therapy

Melanoma is the most serious type of skin cancer and one of the most common cancers in the world. Advanced melanoma is often resistant to conventional therapies and has high potential for metastasis and low survival rates. Vemurafenib is a small molecule inhibitor of the BRAF serine-threonine kinase recently approved by the United States Food and Drug Administration to treat patients with metastatic and unresectable melanomas that carry an activating BRAF (V600E) mutation. Many clinical trials evaluating other therapeutic uses of vemurafenib are still ongoing. The ATP-binding cassette (ABC) transporters are membrane proteins with important physiological and pharmacological roles. Collectively, they transport and regulate levels of physiological substrates such as lipids, porphyrins and sterols. Some of them also remove xenobiotics and limit the oral bioavailability and distribution of many chemotherapeutics. The overexpression of three major ABC drug transporters is the most common mechanism for acquired resistance to anticancer drugs. In this review, we highlight some of the recent findings related to the effect of ABC drug transporters such as ABCB1 and ABCG2 on the oral bioavailability of vemurafenib, problems associated with treating melanoma brain metastases and the development of acquired resistance to vemurafenib in cancers harboring the BRAF (V600E) mutation.KEY WORDS: ABC transporter, Drug resistance, Melanoma, P-glycoprotein, VemurafenibAbbreviations: ABC, ATP-binding cassette; AML, acute myeloid leukemia; BBB, blood–brain barrier; CNS, central nervous system; CSCs, cancer stem cells; GI, gastrointestinal; MAPK, mitogen-activated protein kinase; MDR, multidrug resistance; NBDs, nucleotide-binding domains; PFS, longer progression-free survival; PKIs, protein kinase inhibitors; TKIs, tyrosine kinase inhibitors; TMDs, transmembrane domains