Applying a biopsychosocial model to migraine: rationale and clinical implications

Migraine is a complex condition in which genetic predisposition interacts with other biological and environmental factors determining its course. A hyperresponsive brain cortex, peripheral and central alterations in pain processing, and comorbidities play a role from an individual biological standpoint. Besides, dysfunctional psychological mechanisms, social and lifestyle factors may intervene and impact on the clinical phenotype of the disease, promote its transformation from episodic into chronic migraine and may increase migraine-related disability.Thus, given the multifactorial origin of the condition, the application of a biopsychosocial approach in the management of migraine could favor therapeutic success. While in chronic pain conditions the biopsychosocial approach is already a mainstay of treatment, in migraine the biomedical approach is still dominant. It is instead advisable to carefully consider the individual with migraine as a whole, in order to plan a tailored treatment. In this review, we first reported an analytical and critical discussion of the biological, psychological, and social factors involved in migraine. Then, we addressed the management implications of the application of a biopsychosocial model discussing how the integration between non-pharmacological management and conventional biomedical treatment may provide advantages to migraine care.     

Skin pathology findings in a cohort of 1500 adult and elderly subjects

BACKGROUND: No extensive studies are available in the literature on the eventual skin pathology induced by neurologic or systemic diseases in elderly individuals. Other factors, such as health and hygiene, socioeconomic status, and climate can also play an important role. METHODS: Fifteen-hundred subjects (886 women and 614 men; mean age, 67.8 years; range, 39-90 years) were admitted to the Department of Geriatrics at the Oasi Institute between 1992 and 1997; all these subjects were carefully evaluated from a dermatologic point of view. Each subject underwent specialist examinations, routine blood analyses, thoracic X-rays, cerebral computerized tomography (CT) scan, and magnetic resonance imaging (MRI) when appropriate. A group of subjects without significant neurologic or systemic disease, comprising 116 women and 60 men (mean age, 64.5 years; range, range, 40-90 years), was selected and used as a normal control group. Subsequently, our attention was focused on the eventual presence of the following neurologic diseases: Alzheimer-type dementia, vascular dementia, mixed-type dementia, subcortical dementia, Parkinson's disease, vascular brain disease, hemiplegia, etc. Thus, different subgroups were formed on the basis of such diagnostic categories and the frequency of skin pathology in each subgroup was evaluated. RESULTS: Of the 1500 subjects, 1439 stated that they had never been affected by dermatologic disease. No statistically significant difference in frequency of skin pathology was found between normal controls and the different patient subgroups. Unsuspected and singular dermatoses were found, however, such as paraneoplastic syndromes, idiopathic tripe palms, white fibrous papulosis of the neck as an expression of photoaging, conditions induced by former popular traditions of Sicilian culture (anetoderma secondary to the application of Hirudo medicinalis and erythema ab igne), pigmented dermatoses never described before in Italy (prurigo pigmentosa and friction amyloidosis), and nail abnormalities (atypical half-and-half nail, and dyschromic nail changes in multiple system atrophy and in hemiplegia). CONCLUSIONS: The dermatologic screening performed in 1500 patients revealed several unexpected diagnoses and some original observations. Some rare dermatoses were described and certain hypotheses were suggested to explain the peculiar dyschromic changes of the fingernails in multiple system atrophy, the atypical cases of half-and-half nail, and the so-called idiopathic tripe palms associated with psoriasis.     

Deficit of in vivo mitochondrial ATP production in patients with Friedreich ataxia

Friedreich ataxia (FRDA), the most common of the inherited ataxias, is an autosomal recessive degenerative disorder, characterized clinically by onset before the age of 25 of progressive gait and limb ataxia, absence of deep tendon reflexes, extensor plantar responses, and loss of position and vibration sense in the lower limbs. FRDA is caused by a GAA triplet expansion in the first intron of the FRDA gene on chromosome 9q13 in 97% of patients. The FRDA gene encodes a widely expressed 210-aa protein, frataxin, which is located in mitochondria and is severely reduced in FRDA patients. Frataxin function is still unknown but the knockout of the yeast frataxin homologue gene (YFH1) showed a severe defect of mitochondrial respiration and loss of mtDNA associated with elevated intramitochondrial iron. Here we report in vivo evidence of impaired mitochondrial respiration in skeletal muscle of FRDA patients. Using phosphorus magnetic resonance spectroscopy we demonstrated a maximum rate of muscle mitochondrial ATP production (V(max)) below the normal range in all 12 FRDA patients and a strong negative correlation between mitochondrial V(max) and the number of GAA repeats in the smaller allele. Our results show that FRDA is a nuclear-encoded mitochondrial disorder affecting oxidative phosphorylation and give a rationale for treatments aimed to improve mitochondrial function in this condition.     

Body acceptance and culture: a study in northern and southern Italy

Fear of fatness and body dissatisfaction have been considered as influenced by cultural differences both in eating disordered and in normal young girls. The culture of the industrialized world and the rural cultures are the two ideal poles of this theoretical scheme. Culture may act both via the beauty standards suggested by media, and by cultural cognitive styles of interpretation of bodily sensations and emotions related to eating and food. The great intracultural differences existing between northern and southern Italy seems to be a good field of research. The hypothesis assumed that fear of fatness, body dissatisfaction and acceptance of mass media body ideals were lower in southern Italian female teenagers than in northern, while feelings of uncertainty in the identification of emotional states and sensations of hunger and satiety were higher. Two populations of female students drawn from two high schools in northern and southern Italy were compared on the results of DT (Drive to Thinness), BD (Body Dissatisfaction) and IA (Interoceptive Awareness) from the Eating Disorders Inventory (EDI) and I (Internalization) from the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ). Whilst the IA and I scores suggested real cultural differences, no significant differences were found for the scales DT and BD. The result could be due to the non‐clinical nature of the samples, to the limitations of the sampling process and to the self‐report structure of the instruments. Copyright © 2000 John Wiley & Sons, Ltd and Eating Disorders Association.     

Impact of attenuation correction and gated acquisition in SPECT myocardial perfusion imaging: results of the multicentre SPAG (SPECT Attenuation Correction vs Gated) study

Purpose

In clinical myocardial single photon emission computed tomography (SPECT), attenuation artefacts may cause a loss of specificity in the identification of diseased vessels that can be corrected by means of gated SPECT (GSPECT) acquisition or CT attenuation correction (AC). The purpose of this multicentre study was to assess the impact of GSPECT and AC on the diagnostic performance of myocardial scintigraphy, according to patient??s sex, body mass index (BMI) and site of coronary artery disease (CAD).

Methods

We studied a group of 104 patients who underwent coronary angiography within 1?month before or after the SPECT study. Patients with a BMI?>?27 were considered ??overweight??. Attenuation-corrected and standard GSPECT early images were randomly interpreted by three readers blinded to the clinical data.

Results

In the whole group, GSPECT and AC showed a diagnostic accuracy of 86.5% (sensitivity 82%, specificity 93%) and 77% (sensitivity 75.4%, specificity 81.4%), respectively (p?p <0.05).

Conclusion

AC improved specificity in the evaluation of right CAD in overweight men. In the other evaluable subgroups specificity was not significantly affected while sensitivity was frequently reduced.     

Plasma MMP and TIMP evaluation in patients with deep venous thrombosis: could they have a predictive role in the development of post‐thrombotic syndrome?

Post‐thrombotic syndrome (PTS) is a condition that can develop in about half of the patients with deep vein thrombosis (DVT) of lower limbs. In the present study, we evaluated the expression of inflammatory biomarkers in the early phases of DVT and their correlation with the onset of PTS. Patients were enrolled after the first episode of DVT and were followed up for 1, 4, 8, 12 and 18 months. At each visit, blood sample was collected to evaluate plasma levels of matrix metalloproteinase (MMP)‐1,‐2,‐3,‐7,‐8 and ‐9 MMP inhibitors, TIMP‐1,‐2, neutrophil gelatinase‐associated lipocalin (NGAL) and cytokines TNF‐α and IL‐6. Analysis included 201 patients [86 males (42·79%) and 115 females (57·21%); average age 56 ± 7 years]. Of the 201 patients, 47 (23·38%; 21 males, 26 females) developed PTS during the follow‐up period. The control group was made up of 60 individuals without DVT (22 males and 38 females). High plasma levels of MMPs, NGAL and cytokines were recorded during the acute phase after DVT. Moreover, patients with PTS showed higher levels of MMP‐1 and MMP‐8 with respect to patients without PTS. There is a close relationship between DVT, the individual risk of PTS and specific biomarkers such as MMPs and other related molecules, which may help guide prevention and therapy based on the patient's individual risk profile, and has to be studied in future.     

Effects of Class C and Class F Fly Ash on Mechanical and Microstructural Behavior of Clay Soil—A Comparative Study

A large amount of coal fly ash produced in thermal power plants is disposed of in landfills which causes many environmental problems. The utilization of fly ash can be encouraged in geotechnical engineering projects. In this paper, the effects of class C and class F fly ash on the mechanical and microstructural behavior and stabilization of clay soil were evaluated through a program of laboratory experiments. The experiments included compaction, unconfined compressive strength, consolidated-undrained triaxial, one-dimensional consolidation tests, and scanning electron microscopy analysis on samples of fly ash-stabilized clay soil after 1, 7, and 28 days of curing. The tests were conducted on mixtures of clay with class C or class F fly ash, ranging from 0% to 30% of the soil. Experimental results showed that the strength parameters and permeability of the stabilized soil improved while the compression and swelling indices decreased by the addition of fly ash and by the increase of curing days. The results obtained from the mechanical tests agreed with the results from the SEM analysis. Based on the results, the soil could be successfully stabilized by using class C fly ash. The improvements in strength, swelling, and permeability parameters of the stabilized soil were higher with the class C fly ash compared with class F fly ash.