Headache With Autonomic Features in a Child: Cluster Headache or Contact‐Point Headache?

Headache and facial pain due to diseases of the nose and sinuses are not uncommon in children. However, nasal contact-point associated with headache is relatively uncommon and has unclear etiological significance. We herein report a child having headache with autonomic features and contact-point in the nose, and discuss the difficulties in diagnostic categorization.     

Traumatic Head Injury in Cluster Headache: Cause or Effect?

Post-traumatic headache (PTH) is a common and well-recognized entity. Tension-type headache and migraine are the commonest phenotypes that can result from head trauma, while the onset of cluster headache (CH) in close temporal relation to a head trauma has only been described in rare cases. Nevertheless, CH patients seem to incur more frequent traumatic head injuries during their lifetimes when compared to migraine controls and the general population. The basis of this association remains unclear, since only a limited number of methodologically robust studies have examined it. However, three main hypotheses can be proposed to explain this association: head trauma is the direct cause of CH; head trauma is a risk factor for the future development of CH; and head trauma is a consequence of a CH trait. A better understanding of the association between head trauma and CH may provide important insights into both the pathophysiology of CH and the mechanisms by which traumatic head injury predisposes patients to developing headaches.     

Deep Brain Stimulation in Cluster Headache: Hypothalamus or Midbrain Tegmentum?

Functional and structural neuroimaging studies have provided pivotal insights into the pathophysiology of trigeminal autonomic cephalalgias (TACs), particularly cluster headache (CH). Functional imaging studies using positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) in TACs have reported activation of the posterior hypothalamus. A structural neuroimaging study using voxel-based morphometry in CH reported increased volume of the hypothalamic gray, although another larger study failed to reproduce this finding. These studies in CH prompted the use of stereotactic stimulation of the target point identified by functional and structural neuroimaging. The precise anatomical localization of the deep brain stimulation (DBS) target places it at the midbrain tegmentum rather than the posterior hypothalamus. A comparison of the PET and fMRI studies in TACs reveals that the diencephalic/mesencephalic activation is more posteroinferior in the PET studies, straddling the hypothalamus and midbrain tegmentum, whereas the activation is centered on the hypothalamus in the higher spatial resolution fMRI studies. To optimize the outcomes from DBS, it is likely that patients will need to be studied individually using functional imaging techniques that have high spatial and temporal resolution to enable targeting of the appropriate locus with stereotactic stimulation.     

无症状脑梗死患者血清S100B蛋白和NSE测定的临床意义

无症状脑梗死常因无临床症状或临床症状较轻微使患者和医生忽视对本病的诊治而给患者带来伤害。NSE和S100B蛋白是反映脑损伤的神经化学标志物，有研究发现急性脑梗死患者血清中NSE和S100B蛋白的含量明显上升^[1,2]。由于脑梗死后血液中NSE和S100B蛋白的含量上升，美国学者建议临床脑梗死试验时，     

无症状脑梗死患者血清S100B蛋白和NSE测定的临床意义

无症状脑梗死常因无临床症状或临床症状较轻微使患者和医生忽视对本病的诊治而给患者带来伤害。NSE和S100B蛋白是反映脑损伤的神经化学标志物，有研究发现急性脑梗死患者血清中NSE和S100B蛋白的含量明显上升^[1,2]。由于脑梗死后血液中NSE和S100B蛋白的含量上升，美国学者建议临床脑梗死试验时，     

Faster,higher, stronger? Evidence for formulation and efficacy for ibuprofen in acute pain

A Cochrane review of ibuprofen in acute pain suggested that rapidly absorbed formulations of salts, or features to speed absorption, provided better analgesia than standard ibuprofen as the free acid. We examined several lines of evidence to investigate what benefit derived from fast-acting formulations. A systematic review of the kinetics of oral ibuprofen (30 studies, 1015 subjects) showed that median maximum plasma concentrations of fast-acting formulations occurred before 50 min (29–35 min for arginine, lysine, and sodium salts) compared with 90 min for standard formulations. An updated analysis of clinical trials (over 10,000 patients) showed that fast-acting formulations produced significantly better analgesia over 6 h and fewer remedications than standard formulations in both indirect and direct comparisons. In dental studies, 200-mg fast-acting ibuprofen (number needed to treat 2.1; 95% confidence interval 1.9–2.4) was as effective as 400 mg standard ibuprofen (number needed to treat 2.4; 95% confidence interval 2.2–2.5), with faster onset of analgesia. Individual patient data analysis in dental pain demonstrated a strong correlation between more rapid reduction of pain intensity over 0–60 min and better pain relief over 0–6 h. Rapid initial reduction of pain intensity was also linked with reduced need for remedication. Fast-acting formulations of ibuprofen demonstrated more rapid absorption, faster initial pain reduction, good overall analgesia in more patients at the same dose, and probably longer-lasting analgesia, but with no higher rate of patients reporting adverse events. Achieving a better analgesic effect with fast-acting nonsteroidal anti-inflammatory drug formulations has important implications for safety. Formulation chemistry is of potential importance for analgesics.     

血清S100B蛋白和NSE在新生儿感染性脑损伤中的诊断价值

目的评价血清S100B蛋白和神经元特异性烯醇化酶(NSE)在新生儿感染性脑损伤中的诊断价值。方法选择2017年3月至2018年3月蚌埠医学院第一附属医院新生儿重症监护病房(NICU)收治并确诊为感染性脑损伤的足月新生儿65例作为观察组;并选择同期住院患有感染性疾病而无脑损伤的足月新生儿27例作为对照组。利用电化学发光法检测两组血清S100B蛋白和NSE水平;绘制受试者工作特征(ROC)曲线分析S100B蛋白、NSE及二者联合检测诊断新生儿感染性脑损伤ROC曲线下面积、灵敏度和特异度;并分析观察组S100B蛋白、NSE与炎症指标降钙素原(PCT)、超敏C反应蛋白(hs-CRP)和白细胞(WBC)的相关性。结果观察组血清S100B蛋白和NSE水平均显著高于对照组(P0.05)。血清S100B检测诊断新生儿感染性脑损伤的最佳临界值、灵敏度和特异度分别为418ng/L、81.5%和92.6%,血清NSE检测的最佳临界值、灵敏度和特异度分别为16.54μg/L、56.9%和96.3%,二者联合检测的灵敏度和特异度分别为87.7%、96.3%。血清S100B、NSE检测ROC曲线下面积分别为0.896和0.769,二者联合检测ROC曲线下面积为0.953。S100B蛋白检测ROC曲线下面积大于NSE检测(Z=2.147,P0.05),二者联合检测ROC曲线下面积大于S100B(Z=2.43,P0.05)和NSE检测(Z=4.008,P0.05)。观察组血清S100B蛋白、NSE水平与PCT、hs-CRP、WBC之间均无相关性(P0.05)。结论血清S100B蛋白和NSE均可作为新生儿感染性脑损伤标志物,S100B蛋白诊断价值优于NSE,二者联合检测诊断价值优于单个标志物检测。     

Physiotherapy in Afghanistan – Needs and challenges for development

Purpose. The aim of this paper is to describe and analyse the current situation of the physiotherapy component of the Rehabilitation of Afghans with Disability (RAD) programme, in order to identify the needs and challenges for further development.

Method. The study was conducted as a field study with an anthropological approach by means of participant observation, unstructured and semi-structured interviews and photography.

Results. The therapists in RAD work in isolation with little opportunity for further education or professional development. Their approach is mainly medical, where the work is dictated by the patients' expectations and doctors' recommendations. They use primarily passive methods of treatment, and their work is affected by cultural, religious and situational factors. They demonstrate a low capacity of clinical reasoning in their practical work.

Conclusions. There is a need for further development of physiotherapy in Afghanistan. Active and individually adapted treatment methods, clinical reasoning processes and evidence-based practice should be encouraged. There are several challenges in this, based on Afghan culture and traditions, gender issues, religious factors, an authoritative society, a medical approach in treatment, and isolation and limitations in access to information. By means of an Action Research project the physiotherapists could be included in further development and research to promote a sustainable and culturally relevant development.     

Abnormalities of coagulation and fibrinolysis in insulin resistance. Evidence for a common antecedent?

Insulin resistance is associated not only with the classic cardiovascular risk factors of hypertension and dyslipidemia, but also with several disorders of coagulation and fibrinolysis. Elevated concentrations of the fibrinolytic inhibitor plasminogen activator inhibitor-1 are associated with insulin resistance. In experimental systems, increased expression and secretion of plasminogen activator inhibitor-1 by hepatocyte and endothelial cell lines can be induced by insulin, proinsulin-like molecules, triglyceride-rich lipoproteins and oxidized LDL, as well as by inducing insulin resistance in isolated hepatocytes. Concentrations of the endothelial cell protein von Willebrand factor are elevated in insulin-resistant states, suggesting that abnormalities of capillary endothelium, as well as those reported for endothelium-dependent vasodilatation, may play a role in the etiology of insulin resistance. Levels of a third coagulation factor, fibrinogen, are elevated in insulin-resistant subjects, an association that suggests a possible role for acute-phase cytokines in the abnormalities of coagulation and endothelial function. It is proposed that the recent observations of secretion of interleukin-6 by adipose tissue, combined with the actions of adipose tissue-expressed tumor necrosis factor-alpha in obesity-induced insulin resistance, could underlie the associations of insulin resistance with endothelial dysfunction, coagulopathy, and coronary heart disease.     

Tension Type Headache in Adolescence and Childhood: Where Are We Now?

Tension type headache (TTH) is a primary headache disorder considered common in children and adolescents. It remains debatable whether TTH and migraine are separate biological entities. This review summarizes the most recent literature of TTH with regards to children and adolescents. Further studies of TTH are needed to develop a biologically based classification system that may be facilitated through understanding changes in the developing brain during childhood and adolescence.     

Evidence based practice – what is it and how can it be encouraged in orthopaedic nursing?

Evidence based practice (EBP) has attained a position of importance as an integral part of good and effective healthcare practice. The author examines briefly the historical context of EBP. Then reviews some of the arguments against the use of EBP and explores some barriers to implementing EBP in orthopaedic nursing and reflects on possible ways forward.Evidence based practice is not new, but pressures to follow this approach are increasing. Many of these types of initiatives could be introduced blindly. However, orthopaedic nurses need to step back and, in an unbiased manner, question the underlying principles to ensure they understand what is being done and if it leads to better patient care.     

Chemokine-dependent B cell–T cell interactions in chronic lymphocytic leukemia and multiple myeloma – targets for therapeutic intervention?

Introduction: Chemokines and their receptors play essential roles in the development, maintenance and proper functioning of the immune system. B cell–T cell interactions are modulated by chemokines. In B cell malignancies, these interactions may have tumor-promoting consequences.

Areas covered: This review summarizes physiological B cell–T cell interactions and discusses their pathological role in the onset and progression of B cell malignancies with a special focus on chronic lymphocytic leukemia and multiple myeloma. Experimental data on chemokine-guided B cell-T cell actions in B cell malignancies from murine models as well as in vitro data are summarized and their potential as future therapeutic targets is critically discussed.

Expert opinion: Direct or indirect targeting of chemokine receptors involved in localization and T-cell-dependent activation of B lymphocytes can provide strong synergisms with conventional or immunomodulatory therapies by disrupting the microenvironmental conditions necessary for survival and proliferation of malignant B lymphocytes. However, further knowledge of these interactions between B and T cells is needed.     

How Well Do Headache Patients Remember? A Comparison of Self-Report Measures of Headache Frequency and Severity in Patients with Migraine

Objective.— To compare patient recall of migraine headache frequency and severity over 4 weeks prior to a return visit as reported in an interval questionnaire vs a daily diary.
Background.— Many therapeutic decisions in the management of migraine patients are based on patient recall of response to treatment. As consistent completion of a daily headache diary is problematic, we have assessed the reliability of patient recall in a 1-time questionnaire.
Methods.— Headache frequency and average severity (0 to 3-point scale) were reported in an interval questionnaire by 209 patients who had also maintained a daily diary over the same 4-week period.
Results.— Headache frequency over the previous 4 weeks as reported in interval questionnaires (14.7) was not different from that documented in diaries (15.1), P  = .056. However, reported average headache severity on a 0 to 3 scale as reported in the questionnaire (1.84) was worse than that documented in the diaries (1.63), P  < .001.
Conclusions.— In the management of individual patients, the daily diary is still preferable when available. Aggregate assessment of headache frequency in groups of patients based on recall of the prior 4 weeks is equally as reliable as a diary. Headache severity reported in questionnaires tends to be greater than that documented in daily diaries and may be less reliable.     

Does Relaxation Treatment Have Differential Effects on Migraine and Tension-type Headache in Adolescents?

The present study evaluated the effects of relaxation treatment in 36 adolescents aged 13 to 18 years (mean +/- SD, 15.4 +/- 1.55 years) suffering from migraine or migraine and tension-type headache as compared with a waiting-list condition group. The subjects rated various characteristics of migraine and tension-type headache in a diary. Significant reductions were found for total headache sum (P <.05) and intensity scores of total headache activity (P <.05) as well as for migraine intensity (P <.05) for subjects treated with relaxation as compared with those in the waiting-list condition group. However, no significant differences between the two groups were found for tension-type headache. Fifty percent of the adolescents treated with relaxation training attained a clinically significant improvement, compared with 12% of those in the waiting-list condition. It is suggested that treatment goals for migraine and migraine occurring with tension-type headache might be different and that relaxation training also might benefit from focusing on specific aspects of the two headache types.     

NSE、S100B蛋白联合检测对颅脑损伤临床诊断分型的意义

神经元特异性烯醇化酶（Neuron Specific enolase NSE）、S100B蛋白是两种高浓度存在于中枢和周围神经系统内的特异性蛋白。正常情况下，由于脑细胞和血脑屏障的完整性,NSE、S100B蛋白在外周血中表达浓度很低。但颅脑损伤时,NSE、S100B蛋白将不同程度地进入外周血．其血清浓度与脑损伤程度及疾病的预后密切相关。近年来,作为神经系统损伤的敏感性、特异性标志。NSE、S100B蛋白与脑损伤的关系已日益受到临床和科研工作者的关注。本文就NSE、S100B蛋白的生物学特性及其与脑损伤的关系、联合检测对颅脑损伤临床诊断分型的意义作一综述。     

NSE、S100B蛋白联合检测对颅脑损伤临床诊断分型的意义

神经元特异性烯醇化酶（Neuron Specific enolase NSE）、S100B蛋白是两种高浓度存在于中枢和周围神经系统内的特异性蛋白。正常情况下，由于脑细胞和血脑屏障的完整性,NSE、S100B蛋白在外周血中表达浓度很低。但颅脑损伤时,NSE、S100B蛋白将不同程度地进入外周血．其血清浓度与脑损伤程度及疾病的预后密切相关。近年来,作为神经系统损伤的敏感性、特异性标志。NSE、S100B蛋白与脑损伤的关系已日益受到临床和科研工作者的关注。本文就NSE、S100B蛋白的生物学特性及其与脑损伤的关系、联合检测对颅脑损伤临床诊断分型的意义作一综述。     

Temporal Dynamics of Reactive Oxygen and Nitrogen Species and NF-κB Activation During Acute and Chronic T Cell–Driven Inflammation

Molecular Imaging and Biology - Reactive oxygen and nitrogen species (ROS/RNS) production and the NF-κB activation are critically involved in inflammatory responses, but knowledge about the...