Genetic and environmental influences on expression of recurrent headache as a function of the reporting age in twins.

Neurology. 2002;58(9 suppl 6):S3-S9.
That migraine is significantly underdiagnosed in the United States and other countries is well established. New data from a follow-up survey to the American Migraine Study II reveal that the presence of concomitant headache types and co-morbid conditions significantly affects the ability to detect and diagnose migraine. This article describes these data and explores the contribution of concomitant headache types and co-morbidities to the problem of underdiagnosis of migraine. Migraine continues to be underdiagnosed because of failure to recognize it (missed diagnosis) and because of misdiagnosis of migraine as another headache type. First, a diagnosis of migraine may be missed in the presence of other headache types that occur proportionally more frequently than migraine and thereby overshadow migraine. Second, migraine may be misdiagnosed when health-care providers inappropriately interpret specific symptoms and co-morbid conditions as indicators of the presence of a non-migraine headache type such as sinus or tension. By becoming aware of these diagnostic pitfalls and being more judicious and deliberate in diagnosing migraine and other headache types, health-care providers can improve the diagnosis of migraine and patients to receive appropriate therapy.
Comment: The diagnosis of migraine is less likely to be made if the patient has several types of headache presentations over time. Thus, a patient with the full spectrum of migraine, from episodic tension-type through migrainous (probable migraine) headache and on to migraine per se is far less likely to receive a diagnosis of migraine than a patient who experiences attacks of "pure" migraine. SJT     

老年糖尿病患者强化糖尿病教育的效果与评价

目的:观察强化糖尿病教育对老年2型糖尿病患者血糖控制的影响,并对教育的方法模式及患者的顺应性作出评价。方法:①随机选取老年2型糖尿病患者156例,均为2004-03/07青岛大学医学院附属医院门诊就诊患者,年龄(64.7±6.6)岁,病程(10.54±7.06)年。②入选患者在原有糖尿病治疗方案的基础上进行强化糖尿病教育:入选后半年之内每月进行一次糖尿病教育,半年后每3个月一次教育,教育以糖尿病有关知识专题集体讲座为主,辅以答疑。专人负责电话通知患者教育讲座的具体的时间、地点和内容。每次讲座时监测空腹血糖、餐后2h血糖,入选时、教育后第6,12个月测定糖化血红蛋白;同时记录患者接受教育频率,计算依从率。③采用随机区组设计的方差分析(广义线性模型)分析数据完整的患者的空腹血糖、餐后2h血糖及糖化血红蛋白随时间变化情况(入选时、第6,12个月时)。结果:①依从率:入选时156例,第2次教育时为125例,依从率74.8%,随着时间的延长,接受强化教育的患者逐渐减少,至第6个月时依从率28.1%,至1年时仅有33例接受教育,依从率为21.2%。②完成全程教育的33例患者的资料:教育第6,12个月时的空腹血糖、餐后2h血糖较入选时下降[空腹血糖:(7.9±2.1),(7.8±1.4),(9.7±2.1)mmol/L,F=31.05,P<0.01;餐后2h血糖:(12.0±4.0),(12.2±3.3),(17.8±3.8)mmol/L,F=56.61,P<0.01];糖化血红蛋白在教育第6,12个月也较入选时下降,但无统计学意义[(7.0±1.1)%,(6.9±1.1)%,(7.6±1.7)%,F=2.97,P=0.06]。结论:强化糖尿病教育可使老年2型糖尿病患者血糖有效持续稳定地控制,但患者接受强化教育的依从性差。     

Analysis of a linear peristaltic infusion device for the transfusion of red cells to pediatric patients

A linear peristaltic infusion device was evaluated for red cell (RBC) transfusion in the pediatric and neonatal setting. CPDA-1 RBC units (n = 24) divided into six groups of 4 units each underwent simulated transfusion. Blood was infused by using manufacturer-provided administration sets with either a 21-gauge needle or a 24-gauge catheter. Filters were used in two groups to evaluate the effect of negative pressure on filter function. Two groups of RBCs less than 1 week old were washed, irradiated, and infused at 5 mL per hour, by using a standard administration set, or at 10 mL per hour, by using a syringe set. Four-week-old RBCs (washed and irradiated, irradiated and filtered, filtered only, or unmanipulated) were infused at 100 mL per hour. Paired samples from 0 and 2 hours before and after infusion were analyzed for hemoglobin, hematocrit, RBC count, plasma hemoglobin, lactate dehydrogenase, potassium, alanine aminotransferase, and aspartate aminotransferase. Hausser and Nageotte hemocytometers were used to perform white cell (WBC) counts when a filter was used. By analysis of variance and percentage of change, data from 0 and 2 hours before and after infusion were compared. No clinically or statistically significant differences were seen for hemoglobin, hematocrit, or RBC count. The difference in preinfusion and postinfusion plasma hemoglobin levels in washed RBCs at 2 hours was statistically but not clinically significant (14.5 +/− 6.8 vs. 19.3 +/− 7.1 mg/dL). No clinically significant differences were noted for the remaining analytes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cannabidiolic acid prevents vomiting in Suncus murinus and nausea-induced behaviour in rats by enhancing 5-HT1A receptor activation

Background and Purpose

To evaluate the ability of cannabidiolic acid (CBDA) to reduce nausea and vomiting and enhance 5-HT_1A receptor activation in animal models.

Experimental Approach

We investigated the effect of CBDA on (i) lithium chloride (LiCl)-induced conditioned gaping to a flavour (nausea-induced behaviour) or a context (model of anticipatory nausea) in rats; (ii) saccharin palatability in rats; (iii) motion-, LiCl- or cisplatin-induced vomiting in house musk shrews (Suncus murinus); and (iv) rat brainstem 5-HT_1A receptor activation by 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) and mouse whole brain CB₁ receptor activation by CP55940, using [³⁵S]GTPγS-binding assays.

Key Results

In shrews, CBDA (0.1 and/or 0.5 mg·kg⁻¹ i.p.) reduced toxin- and motion-induced vomiting, and increased the onset latency of the first motion-induced emetic episode. In rats, CBDA (0.01 and 0.1 mg·kg⁻¹ i.p.) suppressed LiCl- and context-induced conditioned gaping, effects that were blocked by the 5-HT_1A receptor antagonist, WAY100635 (0.1 mg·kg⁻¹ i.p.), and, at 0.01 mg·kg⁻¹ i.p., enhanced saccharin palatability. CBDA-induced suppression of LiCl-induced conditioned gaping was unaffected by the CB₁ receptor antagonist, SR141716A (1 mg·kg⁻¹ i.p.). In vitro, CBDA (0.1–100 nM) increased the E_max of 8-OH-DPAT.

Conclusions and Implications

Compared with cannabidiol, CBDA displays significantly greater potency at inhibiting vomiting in shrews and nausea in rats, and at enhancing 5-HT_1A receptor activation, an action that accounts for its ability to attenuate conditioned gaping in rats. Consequently, CBDA shows promise as a treatment for nausea and vomiting, including anticipatory nausea for which no specific therapy is currently available.