车祸伤小肠破裂40例诊治分析

目的提高因车祸致小肠破裂的诊治水平.方法对我院1994年1月-2004年12月诊治的因车祸引起小肠破裂的40例患者进行回顾性分析.结果所有患者均有不同程度的腹痛和腹膜刺激征,腹穿阳性率为75%,X线检查提示膈下游离气体阳性率62.5%,CT检查提示腹腔积液阳性率75%.患者治愈39例,死亡1例.结论①早期诊断车祸致小肠破裂的关键是必须结合病史、阳性体征、临床表现及辅助检查进行综合分析.②早期手术治疗是提高车祸致小肠破裂治愈率的关键.③手术探查必须全面、仔细,按顺序进行,避免漏诊.     

2005-2009年温州市甬台温高速公路（温州段）交通伤特点分析

目的通过调查分析甬台温高速公路（温州段）交通伤的特点,为进一步提高交通伤害救治水平提供依据。方法收集发生于宁波-台州-温州（简称甬台温）高速公路（温州段）交通事故的原始数据,用描述流行病学方法分析交通伤特点;采用SPSS18．0软件对调查指标进行分析。结果2005年1月1日至2009年12月31日（5年间普通程序处理的事故）甬台温高速公路发生交通事故308起,累计伤亡603人。其中死亡157人。交通事故以尾随相撞最为多发,占总事故的39．29％,主要原因为司机疲劳驾车及超速行驶。结论高速公路交通事故有时间、年龄分布不均衡性;男性青壮年为发生概率的高危人群,但高龄受累人群的死亡率更高。通过对温州段高速公路交通伤特点分析,可针对性地进行高速公路行车安全培训,借此创建安全的高速公路交通环境。     

Road crash in China from 2003 to 2005

Objective： To analyze characteristics and causes of road crash and injuries in China from 2003 to 2005.
Methods： The data of road crash in 2003-2005 were collected to study the characteristics including total vehicle number, occurrence rates of traffic accidents and serious traffic accidents so as to discuss the causes and characteristics of road crash in China.
Results： From 2003 to 2005, the numbers of traffic accidents, injuries and deaths as well as the mortality rates per 100 000 persons and per 10 000 vehicles declined in China. Until 2005, the total number of traffic accidents decreased to 450 000 and deaths to 99 000, with the mortality rate per 10 000 vehicles being 7.6 persons. While the drivers and passengers accounted for 33.2 % and 26.6 % of death casualties respectively in 2005. Most traffic accidents were caused by drivers, especially those with driving experience less than 3 years. Traffic accidents occurred on suburban roads accounted for 60%. The mortality rate of the traffic accidents per 100 km on the first grade road ranked the highest. The mortality rate of the traffic accidents on expressways ranked the highest, with continual increase of death and injury.
Conclusions. At present, the increase trend of traffic accidents and casualties in China has been slowed down to some extent and shows a declining tendency, but the situation is far away from being optimistic. In order to cut down the number of traffic accidents and casualties, we should pay more attention to training and managing drivers with less than three driving years and those driving buses. Strict prevention measures should be laid on traffic accidents on first grade roads, expressways and suburban roads as well as the enhancement on improving first-aid system.     

Frequency of fall-related injuries of female patients referred to the trauma center in the city of Kashan from years 2005 to 2008

Objective:Falls are one of the life events leading to injury and in serious cases cause high morbidity and mortality.This research was conducted to determine the fall incidence among female population ...     

Analysis of 4931 renal biopsy data in central China from 1994 to 2014

The purpose of this study is to investigate the changing spectrum and clinicopathologic correlation of biopsy-proven renal diseases in central China. We retrospectively analyzed data of 4931 patients who underwent renal biopsy in ten hospitals between September 1994 and December 2014. Among them, 81.55% were primary glomerular diseases (GD), and 13.02% were secondary GD. IgA nephropathy (IgAN) was the most common primary GD (43.45%), followed by focal glomerulonephritis (16.79%), mesangial proliferative glomerulonephritis (MsPGN, 14.35%), and membranous nephropathy (MN, 13.28%). IgAN was leading primary GD in patients under 60 years old, while MN was the leading one over 60 years old. The most frequent secondary GD was lupus nephritis (LN) (47.35%). The prevalence of IgAN, MN and minimal change disease was found to increase significantly (p?<?0.001, p?<?0.001, and p?<?0.01, respectively), while that of MsPGN, membranoproliferative glomerulonephritis and LN decreased significantly (p?<?0.001, p?<?0.001, and p?<?0.05, respectively). The main indication for renal biopsy was proteinuria and hematuria (49.03%), followed by nephrotic syndrome (NS, 20.36%). IgAN was the most common cause in patients with proteinuria and hematuria, chronic-progressive kidney injury, hematuria and acute kidney injury; and MN was the leading cause of NS. Primary GD remained the predominant renal disease in central China. IgAN and LN were the most prevalent histopathologic lesions of primary and secondary GD, respectively. The spectrum of biopsy-proven renal disease had a great change in the past two decades. Proteinuria and hematuria was the main indication for renal biopsy.     

Statistical analysis on 2213 inpatients with traffic injuries from January 2003 to September 2005 in Ningbo city

Objective: To analyze the epidemiological conditions and characteristics of inpatients with traffic trauma in order to provide objective data for basic research and clinical application of traffic trauma. Methods: The data of 2213 inpatients with traffic trauma admitted to Lihuili Hospital, Ningbo Medical Centre, Ningbo, China, from January 2003 to September 2005 were studied retrospectively. According to the transportation ways, the patients were divided into four groups; pedestrians, bicyclists, motorcyclists, and automobilists. And the data of injured regions, combined injuries and causes of death were analyzed statistically. Results: Among the 2213 patients, there were 550 pedestrians (23. 5%), 521 bicyclists (24.9%), 738 motorcyclists (33.3%), and 404 automobilists (18.3%). Male patients were more than female ones, with the ratio of male to female of 2.8:1. Single region injury was found in 1663 patients (75.15%) and multiple injuries in 550 patients (24.85%). In total, 2849 regions were injured. Fracture of extremities (53.3%) occurred most often, craniocerebral trauma (19.4%) next, then followed in turn by thoraco-abdominal visceral injury (6.56%), spine fracture (5.37%), fracture of ribs (4.88%), and pelvic fracture (4.18 %). The percentage of multiple injuries (33.2%) was highest and the percentage of thoraco-abdominal injury (18.0%) was higher in motorcyclists. The percentages of craniocerebral trauma in pedestrians and bicyclists were 27.8% and 28.2%, respectively. The incidence of fracture of extremities in motorcyclists reached 73.8%, but with the lowest case-fatality ratio of 1.4%. The incidence of traffic accidents caused by motorcyclists themselves (32.8%) was highest. A total of 56 patients died, with the case-fatality ratio of 2.53%. Among the deaths, 47 died from craniocerebral injury, 6 from multiple fractures combined with hemorrhagic shock, 2 from combined injury in the thoraco-abdominal region, and 1 from cervical cord injury. Conclusions: Nowadays, the patients with traffic trauma are mainly pedestrians, bicyclists and motorcyclists, and they suffer generally from fracture of extremities and craniocerebral injury. The main cause of death is craniocerebral injury. Another characteristic of traffic trauma is that the ratio of multiple injuries is higher.     

利多卡因对大鼠微栓栓塞致脑损伤的保护作用

目的观察利多卡因对大鼠微栓栓塞致脑损伤的保护作用。方法雄性Wistar大鼠65 只,随机分为5组,对照组(n=8):经右侧颈动脉注射20%葡聚糖(微球载体);微栓1组(n=14)及微栓2组(n=14),分别注射600和900个微球;保护1组(n=12)和保护2组(n=13),分别注射600和900个微球,并于注射微球前30 min经股静脉注射利多卡因1.5 mg/kg负荷剂量,继以2 mg·kg-1·h-1 持续输注直至注射微球后1 h,其余组给予等量生理盐水。另取雄性Wistar大鼠4只,按上述剂量、速率及途径给予利多卡因,用于测定利多卡因血药浓度。注射微球后第1-7天进行脑卒中行为评分; 第8-12天进行水迷宫试验(包括潜伏期和有效搜索策略比率);水迷宫试验后,每组取3只大鼠,取海马制成切片,观察CA1区神经元的病理变化。结果与对照组比较,微栓组和保护组脑卒中行为评分均升高;微栓2组注射微球后第12天潜伏期延长,有效搜索策略比率降低;与微栓1组比较,保护1组在注射微球后第3、4天脑卒中行为评分降低,注射微球后第9、12天有效搜索策略比率较高; 与微栓2组比较,保护2组在注射微球后第1-4、6天脑卒中行为评分降低,注射微球后第12天潜伏期缩短,第9、12天有效搜索策略比率升高(P<0.05或0.01)。与对照组比较,微栓组栓塞侧海马CA1 区的正常神经元计数减少;缺血坏死神经元计数微栓组和保护组均升高(P<0.05或0.01),但保护组少于微栓组(P<0.05)。利多卡因血药浓度为(2.20±0.18)μg/ml。结论利多卡因对大鼠微栓栓塞引起的脑损伤有一定的保护作用。     

Red blood cell transfusion in surgery: an observational study of the trends in the USA from 2011 to 2016

Guidelines recommend restrictive red blood cell transfusion strategies. We conducted an observational study to examine whether the rate of peri-operative red blood cell transfusion in the USA had declined during the period from 01 January 2011 to 31 December 2016. We included 4,273,168 patients from all surgical subspecialties. We examined parallel trends in rates of the following: pre-operative transfusion; prevalence of bleeding disorders and coagulopathy; and minimally invasive procedures. To account for changes in population and procedure characteristics, we performed multivariable logistic regression to assess whether the risk of receiving a transfusion had declined over the study period. Clinical outcomes included peri-operative myocardial infarction, stroke and all-cause mortality at 30 days. Peri-operative red blood cell transfusion rates declined from 37,040/441,255 (8.4%) in 2011 to 46,845/1,000,195 (4.6%) in 2016 (p < 0.001) across all subspecialties. Compared with 2011, the corresponding adjusted OR (95%CI) for red blood cell transfusion decreased gradually from 0.88 (0.86–0.90) in 2012 to 0.51 (0.50–0.51) in 2016 (p < 0.001). Pre-operative red blood cell transfusion rates and the prevalence of bleeding disorders decreased, whereas haematocrit levels and the proportion of minimally invasive procedures increased. Compared with 2011, the adjusted hazard ratios (95%CI) in 2012 and 2016 were 0.96 (0.90–1.02) and 1.05 (0.99–1.11) for myocardial infarction, 0.91 (0.83–0.99) and 0.99 (0.92–1.07) for stroke and 0.98 (0.94–1.02) and 0.99 (0.96–1.03) for all-cause mortality. Use of peri-operative red blood cell transfusion declined from 2011 to 2016. This was not associated with an increase in adverse clinical outcomes.     

Analysis of deaths related to anesthesia in the period 1996-2004 from closed claims registered by the Danish Patient Insurance Association

BACKGROUND: Anesthesia is associated with complications, and some of them may be fatal. The authors investigated the circumstances under which deaths were associated with anesthesia. In Denmark, the specialty anesthesiology encompasses emergency medicine, chronic and acute pain medicine, anesthetic procedures, perioperative care medicine, and intensive care medicine. METHODS: The authors retrospectively investigated anesthesia related deaths registered by the Danish Patient Insurance Association. RESULTS: From 1996 to 2004, 27,971 claims were made by the Danish Patient Insurance Association covering all medical specialties, of which 1,256 files (4.5%) were related to anesthesia. In 24 cases, the patient's death was considered to result from the anesthetic procedure: 4 deaths were related to airway management, 2 to ventilation management, 4 to central venous catheter placement, 4 as a result of medication errors, 4 from infusion pump problems, and 4 after complications from regional blockades. Severe hemorrhage caused 1 death, and in 1 case the cause was uncertain. CONCLUSIONS: Several of the 24 deaths could potentially have been avoided by more extended use of airway algorithm, thorough preoperative evaluation, training, education, and use of protocols for diagnosis and treatment.     

Analysis of Deaths Related to Anesthesia in the Period 1996-2004 from Closed Claims Registered by the Danish Patient Insurance Association

Background: Anesthesia is associated with complications, and some of them may be fatal. The authors investigated the circumstances under which deaths were associated with anesthesia. In Denmark, the specialty anesthesiology encompasses emergency medicine, chronic and acute pain medicine, anesthetic procedures, perioperative care medicine, and intensive care medicine.

Methods: The authors retrospectively investigated anesthesia related deaths registered by the Danish Patient Insurance Association.

Results: From 1996 to 2004, 27,971 claims were made by the Danish Patient Insurance Association covering all medical specialties, of which 1,256 files (4.5%) were related to anesthesia. In 24 cases, the patient's death was considered to result from the anesthetic procedure: 4 deaths were related to airway management, 2 to ventilation management, 4 to central venous catheter placement, 4 as a result of medication errors, 4 from infusion pump problems, and 4 after complications from regional blockades. Severe hemorrhage caused 1 death, and in 1 case the cause was uncertain.     

吻合血管的跖趾关节皮瓣移植急诊修复掌指关节部复合组织缺损

目的：用复合组织移植急诊修复手部掌指关节部复合组织缺损。方法：用吻合血管的跖趾关节复合组织皮瓣急诊修复手部掌指关节、肌腱、神经及皮肤缺损１６例，共１８个跖趾关节，皮瓣。面积最小４ｃｍ×７ｃｍ，最大８ｃｍ×１０ｃｍ。结果：皮瓣均成活，创面Ⅰ期愈合１２例，Ⅱ期愈合４例。术后随访６～１２个月，重建掌指关节活动度：主动屈曲平均２５度～７０度，被动屈曲３０度～８５度。主动背伸在－２０度～１０度范围。相应手指及皮瓣感觉均在Ｓ３以上。术后２个月Ｘ线片证实关节移植部位均骨性愈合，关节无狭窄。结论：该术式能在急诊时一次修复手掌指关节部多种组织缺损，最大限度地恢复手部功能     

我国2004年至2009年自体干细胞移植治疗糖尿病足文献计量分析

目的 用文献计量法总结我国2004年至2009年自体干细胞移植(ASCT)治疗糖尿病足的文献,介绍其发展、术式,预测发展趋势等.方法 以"糖尿病足"为检索词,从中文生物医学期刊文献数据库和中国生物医学文献数据库获取题录,再获取原文,按作者、手术方式、刊文期刊、发文机构、地区等行计量分析.结果 共检获104篇,主要发文期刊、发文机构、作者、地区发文数量及术式分别是中国组织工程研究与临床康复杂志(6篇),北京首都医科大学(10篇),谷涌泉(9篇),北京(17篇),手术方式以外周血干细胞移植(ABMSCT)和骨髓干细胞移植(APBSCT)为主.结论 概括性介绍我国发表的ASCT治疗糖尿病足的文献,为深入研究提供了可靠资料.阐述此课题的研究现状并预测主要发展趋势:在严格量化适应证前,ABMSCT及APBSCT为ASCT的主要手术方式;量化ASCT的适应证,与其他药物联用使ASCT更好地发挥作用必将是这一课题的研究热点.     

某院2014年上报全国细菌耐药监测网数据分析

目的通过分析本院2014年度上报全国细菌耐药监测网的数据,了解本院临床分离菌株的分布、标本来源、多重耐药菌的分布和病原菌的耐药性。 方法应用WHONET 5.6软件对2014年1月至2014年12月本院临床分离的病原菌的分布、标本来源、多重耐药菌分布和药物敏感性试验进行回顾性分析。 结果4 779株病原菌中革兰阴性菌占79.92%（3 819/4 779）,革兰阳性菌占20.08%（960/4 779）。排前5位的细菌分别是大肠埃希菌（1 477株,占30.91%）、肺炎克雷伯菌（677株,占14.17%）、铜绿假单胞菌（430株,9%）、不动杆菌属（290株,占6.07%）和粪肠球菌（270株,占5.65%）。临床各科室分离菌株数量排前5位的分别是儿科（801株,占16.76%）、普通外科（447株,占9.35%）、泌尿外科（424株,占8.87%）、呼吸内科（341株,占7.14%）和重症医学科（335株,占7.01%）。标本类型排列前5位的分别是呼吸道标本（1 824株,占38.17%）、尿液（1 050株,占21.97%）、分泌物（523株,占10.94%）、引流液（513株,占10.73%）和血液（361株,占7.55%）。共分离出耐甲氧西林凝固酶阴性葡萄球菌53株（53/148,35.81%）,产超广谱β-内酰胺酶细菌788株（788/2221,占35.48%）,耐碳青霉烯类的鲍曼不动杆菌9株（9/52,占17.31%）,耐甲氧西林金黄色葡萄球菌29株（29/205,占14.15%）,耐碳青霉烯类的肠杆菌科细菌15株（15/2712,占0.55%）;未分离到耐青霉素肺炎链球菌和耐万古霉素肠球菌。 结论通过分析2014年度耐药监测数据,了解本院临床分离菌株的分布、标本来源、多重耐药菌和细菌的耐药性,能够指导临床合理使用抗菌药物,提高临床用药的安全性。     

2004-2006年瑞金医院烧伤病房病原菌分布及分子流行病学分析

目的 了解瑞金医院烧伤病房院内感染病原菌的分布、耐药性和流行情况.方法 2004年1月-2006年12月,从瑞金医院烧伤住院患者创面分泌物、静脉导管、血液、尿液、大便等标本中分离获得甲氧西林耐药金黄色葡萄球菌(MRSA)17株,铜绿假单胞菌52株,鲍氏不动杆菌11株.分析3年间该烧伤病房病原菌的分布和药物敏感试验情况;采用随机扩增多态DNA(RAPD)对院内感染病原菌进行同源性分析.结果 金黄色葡萄球菌、铜绿假单胞菌和鲍氏不动杆菌是瑞金医院烧伤病房近年来的3种主要病原菌,金黄色葡萄球菌占首位,而3年间MRSA在金黄色葡萄球菌中的比例分别为77%(63/82)、85%(63/74)、75%(74/99).3年中MRSA的主要耐药模式为阿米卡星/庆大霉素/红霉素/克林霉素/左氧氟沙星;铜绿假单胞菌的耐药模式为阿米卡星/庆大霉素/哌拉西林/头孢他啶/头孢哌酮/氨曲南/亚胺培南;鲍氏不动杆菌的耐药模式为阿米卡星/庆大霉素/哌拉西林/头孢他啶/亚胺培南/环丙沙星.3种细菌行RAPD同源性分析均为同一型别.结论 笔者医院烧伤病房存在多种院内感染病原菌,细菌耐药情况严重,对这些细菌流行的控制应成为院内感染防治的重点.     

中药黄芪对脊髓星形胶质细胞单核细胞趋化蛋白-1分泌的影响

目的 :研究黄芪对体外培养的脊髓星形胶质细胞趋化蛋白 1(MCP 1)分泌的影响。方法 :自Wistar大鼠脊髓组织分离、纯化星形胶质细胞 ,体外培养 ,分别予以TNF α及TNF α 黄芪处理 ,ELISA方法检测培养上清液中MCP 1的表达。结果 :TNF α可以显著刺激星形胶质细胞合成、释放MCP 1,而黄芪可下调其刺激作用。结论 :受炎症因子刺激活化的星形胶质细胞可能是损伤脊髓局部MCP 1的来源之一 ,黄芪可以减少脊髓损伤后内源性MCP 1的产生 ,从而缓解继发性脊髓损伤 ,发挥脊髓保护作用。     

2012年至2016年儿童肝移植领域研究动态与热点前沿的可视化分析

目的  探讨近5年儿童肝移植国际研究动态与热点前沿。方法  以Web of Science核心库中的英文文献为数据源,采用CiteSpace软件可视化分析儿童肝移植领域近5年的核心力量、作者、期刊、学科知识基础、热点及前沿。结果  1 547条文献数据显示,美国是主要的发文量国家,占总发文量的25%;高发文量机构为日本国家儿童健康和发展中心,发文41篇;高产作者Kasahara M发文39篇,同时也是高被引作者;共形成两大作者合作群体;期刊《Pediatr Transplant》刊载该领域论文236篇,高被引期刊《Liver Transpl》被引频次达966次;近5年的学科知识基础研究集中在儿童肝移植的适应证、影响因素、术后并发症、存活率、健康状况等方面;高频关键词包括liver transplantation、children、recipients、experience、survival、outcomes等;高突变主题词包括orthotopic-liver-transplantation、high-risk、graft-function等。结论  儿童肝移植近5年的研究热点包括肝移植的手术适应证,尤其是胆道闭锁、术后存活率与预后、术后并发症及风险因素、儿童肝移植管理与经验等研究。研究前沿集中在原位肝移植、术后随访与管理、防治血管并发症及危险因素、儿童活体肝移植、术前评估及术后肝功能研究等方面。     

Pre-injury health-related factors in relation to self-reported whiplash: longitudinal data from the HUNT study, Norway

Purpose

To examine if pre-injury health-related factors are associated with the subsequent report of whiplash, and more specifically, both whiplash and neck pain.

Methods

Longitudinal population study of 40,751 persons participating in two consecutive health surveys with 11 years interval. We used logistic regression to estimate odds ratio (OR) for reporting whiplash or whiplash with neck pain lasting at least 3 months last year, related to pre-injury health as indicated by subjective health, mental and physical impairment, use of health services, and use of medication. All associations were adjusted for socio-demographic factors.

Results

The OR for reporting whiplash was increased in people reporting poor health at baseline. The ORs varied from 1.47 (95% CI 1.13–1.91) in people visiting a general practitioner (GP) last year to 3.07 (95% CI 2.00–4.73) in people who reported poor subjective health. The OR associated with physical impairment and mental impairment was 2.69 (95% CI 1.75–4.14) and 2.49 (95% CI 1.31–4.74), respectively. Analysis of reporting both whiplash and neck pain gave somewhat stronger association, with ORs varying from 1.50 (95% CI 1.07–2.09) in people visiting a GP last year to 5.70 (95% CI 3.18–10.23) in people reporting poor subjective health. Physical impairment was associated with an OR of 3.48 (95% CI 2.12–5.69) and mental impairment with an OR of 3.02 (95% CI 1.46–6.22).

Conclusion

Impaired self-reported pre-injury health was strongly associated with the reporting of a whiplash trauma, especially in conjunction with neck pain. This may indicate that individuals have, already before the trauma, adopted an illness role or behaviour which is extended into and influence the report of a whiplash injury. The finding is in support of a functional somatic disorder model for whiplash.     

活血化瘀法在泥石流伤员救治中作用的病例对照研究

目的：观察活血化瘀中药对泥石流损伤患者血清肿瘤坏死因子-α、白细胞介素-6的影响,探讨活血化瘀中药在灾害救治中的作用机制。方法：以2010年8月12日起由甘肃舟曲和成县转运至兰州的泥石流伤员为研究对象,分为2组。A组25例,男15例,女10例;平均年龄（39.0±3.9）岁;AIS评分1分2例,2分3例,3分17例,4分3例,无5分患者;ISS评分〈16分16例,16～25分7例,〉25分2例。B组25例,男11例,女14例;平均年龄（40.1±3.6）岁;AIS评分1分3例,2分4例,3分16例,4分2例,无5分患者;ISS评分〈16分15例,16～25分9例,〉25分1例。2组患者入院后完善全身检查,A组8例手术治疗,其中3例行切开复位钢板内固定术,4例行扩创引流术,1例行异物取除术;B组6例手术治疗,其中颅脑手术1例,胸部手术2例,软组织清创术3例。2组患者均常规预防感染、预防并发症、支持及消肿治疗,A组在此基础上另内服消肿止痛合剂,每次50ml,每日2次;外用伤科洁肤液外敷患部,每次20ml,每日4次,每次外敷20～30min。2组患者均以7d为1个疗程,共治疗2个疗程,分别于入院第2、7、14天运用免疫度量法测定促炎症细胞因子TNF-α、IL-6于血清中的含量,所测TNF-α、IL-6不同时间点的数据采用SPSS16.0统计学软件进行处理。结果：入院第2天,2组患者血清TNF-α、IL-6的含量比较,差异无统计学意义;第7、14天2组血清TNF-α、IL-6的含量比较,差异有统计学意义。入院第7、14天与入院第2天血清TNF-α、IL-6含量比较,差异有统计学意义。结论：活血化瘀中药能抑制创伤后致炎症因子释放。     

Analysis of pooled data from two pivotal controlled trials on the efficacy of topiramate in the prevention of migraine

CONTEXT: A substantial proportion of the patient population with migraine headache should be considered for preventive treatment based on the frequency and disability associated with this disorder. Use of the anticonvulsant topiramate was previously examined in two large, double-blind, randomized, placebo-controlled clinical trials of a subset of patients who have 3 to 12 migraine episodes per month. OBJECTIVE: To better characterize the efficacy of topiramate for prevention of migraine, with or without aura, by pooling and analyzing data from the two large clinical trials. METHODS: The pooled intent-to-treat population included 937 patients receiving topiramate at one of three dosages (50 mg/d, 100 mg/d, 200 mg/d) or placebo. Outcome measures included change in mean monthly migraine frequency and categorical responder rate throughout the 26-week doubleblind phase. Results: At daily doses of 100 and 200 mg, topiramate was associated with significant reductions in mean monthly migraine frequency throughout the double-blind phase compared with placebo (P<.001). Significantly more patients treated with these topiramate doses exhibited high-percentage reductions in monthly migraine frequency (>/=50% [P<.001], >/=75% [P<.001], 100% [P=.049]) versus placebo. The most common adverse events included anorexia, cognitive deficits, diarrhea, fatigue, nausea, and paresthesia. Topiramate (100 mg/d, 200 mg/d) was associated with significant and sustained reductions in mean monthly migraine frequency beginning as early as 1 week into therapy. CONCLUSION: Pooled efficacy data from two large, similarly designed, placebo-controlled migraine-prevention trials demonstrated that a statistically significant proportion of patients using topiramate met or exceeded two main outcome guidelines recommended by the International Headache Society (>/=50% and >/=75% reduction in frequency of monthly attacks). Based on efficacy and tolerability, topiramate at a dosage of 100 mg per day (50 mg twice daily) should be the target dosage for most patients with migraine.