Migraine preventive medications: a reappraisal

Newer acute care migraine medications demonstrate improved rapidity of action, consistent effectiveness, excellent safety profiles, and rarely cause rebound headaches. Their use could decrease the need for migraine-preventive medication. The present analysis derives a formula that can be used by practitioners to determine the cost-effectiveness of various migraine-preventive medications relative to selected acute-care medications. We propose a measure called the cost-equivalent number (CEN), the number of headaches per month at which the cost of the preventive medication equals the cost savings in acute-care treatment realized by using the preventive medication. The use of the CEN individualizes the decision of whether to use a migraine-preventive medication, weighing both the efficacy and cost of the preventive medication against the cost of the acute-care medication. A CEN lower than the migraine frequency suggests that use of a preventive medication will be cost-effective.     

Viable fungi in indoor air in homes and schools in the Sør-Varanger community during winter

The present study investigated the content of fungal aerospores in homes and schools of house-dust-mite (HDM)-sensitized and control children in a subarctic area. During winter, airborne microfungi were collected from the homes and schools of 19 HDM-sensitized children and 19 nonatopic controls, all living in the community of Sør-Varanger. northern Norway. The samples were cultivated and microfungal growth was identified microscopically. Indoor humidity, temperature, and carbon dioxide (C0₂) concentrations were measured. Housing conditions and sociodemographic and symptom data were obtained by a questionnaire. Penicillium was the most common microfungus in both homes and schools, followed by various yeasts, Aspergillus. Cladospohum , and Mucor. The number of infected homes was equal in the HDM-sensitized group and the control group, but aerospore counts were higher in the HDM-sensitized group than in the control group. The lowest aerospore counts were found in the schools. High aerospore counts also appeared to be related to high indoor humidity. The keeping of pets and damp indoor conditions were more frequent in homes of HDM-sensitized children than in the control group, whereas parental smoking and carpeting occurred with equal frequency in both groups. This indicates that no allergy sanitation measures had been undertaken, especially in the homes of the HDM-sensitized children.     

No association between serum eosinophil cationic protein and atopic dermatitis or allergic rhinitis in an unselected population of children

Background In order to obtain background references when dealing with serum eosinophil cationic protein (s‐ECP) measurements in children with allergic diseases, population‐based studies are important. The objectives of our study were to explore the strength of associations between the s‐ECP level and atopic dermatitis (AD), allergic rhinitis (AR) and asthma in an unselected northern Norwegian schoolchildren population. Methods s‐ECP was sampled from 396 schoolchildren aged 7–12 years from Sør‐Varanger community, northern Norway as a part of a population‐based study of allergy. In advance, anamnestic information concerning a history of AD, AR and asthma were obtained. The children underwent a clinical investigation, including skin prick tests and peak expiratory flow measurements, where the presence of AD, AR and asthma were evaluated. The associations of these diseases to the s‐ECP values were examined in bivariate statistical analysis. Results No statistical significant associations were detected in bivariate analysis between s‐ECP and AD, AR or asthma: the mean s‐ECP in children without self‐reported AD/AR/asthma was 4.6 µg/L [95% confidence interval (CI) 4.0–5.2]. The mean s‐ECP in children with self‐reported AD or AR or asthma was 5.2 µg/L (95% CI 4.1–6.2), 4.6 µg/L (95% CI 3.5–5.7) and 6.4 µg/L (95% CI 4.4–8.3), respectively. The highest mean s‐ECP level was measured in children with clinically diagnosed asthma; 7.1 µg/L (95% CI 4.0–10.3). Above the 75‐percentile level of s‐ECP, only 17.2% of the children had a history of asthma. Conclusions In this unselected children population, the occurrence of AD or AR was not reflected by an increase in the s‐ECP level. The s‐ECP was increased in children with asthma, but was not statistically significant. Furthermore, the majority of children with high s‐ECP values were not asthmatics. We conclude that the associations between s‐ECP and allergic diseases are weak in an unselected population of children.     

Anandamide modulates the neuroendocrine responses induced by extracellular volume expansion

相似文献   

Selective induction of a glycoprotein IIIa ligand-induced binding site by fibrinogen and von Willebrand factor

Ligand-induced binding sites (LIBS) are neoantigenic regions of glycoprotein (GP)IIb-IIIa that are exposed upon interaction of the receptor with the ligand fibrinogen or the ligand recognition sequence (RGDS). LIBS have been suggested to contribute to postreceptor occupancy events such as full-scale platelet aggregation, adhesion to collagen, and clot retraction. This study examined the induction requirements of a GPIIIa LIBS with regard to ligand specificity. Through the use of the anti-LIBS D3, we report that this complex- activating antibody induces fibrinogen- and von Willebrand factor- binding to GPIIb-IIIa on intact platelets. Bound ligand was detected by flow cytometric analysis and platelet aggregation assays. These bound ligands increased the number of D3-binding sites and altered the affinity of D3 for GPIIb-IIIa on platelets. In contrast, activation of platelet GPIIb-IIIa by D3 did not increase the binding of another RGD- containing ligand, vitronectin. Furthermore, bound vitronectin on thrombin-stimulated platelets did not cause the expression of the D3 LIBS epitope. We conclude direct activation of GPIIb-IIIa in the absence of platelet activation results in selective ligand interaction and that D3 LIBS induction requires the binding of the multivalent ligands, fibrinogen or von Willebrand factor. Thus, the region of GPIIIa recognized by D3 may be an important regulatory domain in ligand- receptor interactions that directly mediate platelet aggregation.     

Experience of managing open fractures of the lower limb at a major trauma centre

Introduction

In April 2012 the John Radcliffe Hospital in Oxford became a major trauma centre (MTC). The British Orthopaedic Association and British Association of Plastic, Reconstructive and Aesthetic Surgeons joint standards for the management of open fractures of the lower limb (BOAST 4) require system-wide changes in referral practice that may be facilitated by the MTC and its associated major trauma network.

Methods

From 2008 to 2013 a multistep audit of compliance with BOAST 4 was conducted to assess referral patterns, timing of surgery and outcomes (surgical site infection rates), to determine changes following local intervention and the establishment of the MTC.

Results

Over the study period, 50 patients had soft tissue cover for an open lower limb fracture and there was a significant increase in the proportion of patients receiving definitive fixation in our centre (p=0.036). The median time from injury to soft tissue cover fell from 6.0 days to 3.5 days (p=0.051) and the median time from definitive fixation to soft tissue cover fell from 5.0 days to 2.0 days (p=0.003). The deep infection rate fell from 27% to 8% (p=0.247). However, in 2013 many patients still experienced a delay of >72 hours between injury and soft tissue cover, primarily owing to a lack of capacity for providing soft tissue cover.

Conclusions

Our experience may be relevant to other MTCs seeking to identify barriers to optimising the management of patients with these injuries.