What Can Precipitating Factors Teach us About the Pathogenesis of Migraine?

SYNOPSIS
Relationships between precipitating factors in the pathogenesis of migraine were studied in a sample of 217 migraineurs. The most frequently cited triggers were the menstrual cycle (51.5% of the women), alcoholic beverages (51.6%) and emotional or psychic stress (48.8%). Analysis of 4 subgroups of patients, i.e. those with only one of these 3 triggers or with none of these (controls), showed that alcohol-susceptible patients reported significantly (p<0.001) more alimentary triggers than the controls. A similar phenomenon was found in patients with menstrual-cycle related migraine, but in this group the difference with the controls fell short of reaching statistical significance. A further analysis showed that menstrual migraine attacks are more frequently preceded by depressive symptoms than other migraine attacks.
It is suggested that the gut of certain migraineurs may be unduly permeable, either intrinsically or extrinsically (e.g. under the influence of alcohol). In addition, in some patients with menstrual migraine, a depressive episode, associated with the menstrual period, may facilitate the development of a migraine attack.     

Skin rejuvenation with microthermal fractional photothermolysis

ABSTRACT:  Fractional resurfacing is gaining acceptance as a preferred method for skin resurfacing. Experience in treating photoaging, acne scars, and melasma is reviewed.     

Comparison of antireflux surgery among ethnicity

African Americans appear less likely than caucasians to undergo surgery for gastroesophageal reflux disease (GERD). When they do, they appear to have higher conversion and complication rates. Nevertheless, satisfaction with surgery is similar to caucasians. BACKGROUND: There is little information comparing the prevalence and treatment of GERD in various ethnic populations. The purpose of this study was to examine the variations in outcomes between caucasians and African Americans undergoing antireflux surgery. METHODS: The records of all patients who underwent antireflux surgery for GERD or paraesophageal hernia by a single surgeon from January 1997 through December 2001 were reviewed for preoperative and postoperative symptoms, complications, and postoperative satisfaction with surgery. RESULTS: Of the 204 procedures performed, 198 patients were either African American (24) or caucasian (174). Of the 18 African Americans undergoing laparoscopic antireflux surgery (LARS), five were converted to open and four had grade-1 or -2 complications. Of the 160 caucasians undergoing LARS, 27 were converted, and 17 had grade-1, -2, or -3 complications. African-American females had a heavier weight (222 lbs. versus 175 lbs., p<0.05) and conversion rate (55% versus 18%, p<0.05), compared to caucasian females. Satisfaction rates for African Americans were 88%, compared to 82% for caucasians. CONCLUSION: This study demonstrated significant differences between conversion rates in African Americans and caucasians with respects to frequency of surgery for GERD and conversion rates for LARS. Nevertheless, African Americans appear more satisfied with their surgical outcome. Further research is needed to determine whether African Americans truly have a lower incidence of GERD or if bias exists in referral patterns or cultural attitudes.     

Discussion of: Statistical and Regulatory Issues with the Application of Propensity Score Analysis to Nonrandomized Medical Device Clinical Studies

In this paper, the original up-and-down method, modified up-and-down method, the Robbins-Monro method, and a fixed-sample Spearman-Kärber method are compared for the point estimator as well as the confidence interval of LD₅₀. In particular, three different designs of the modified up-and-down approach based on the combination of experiments on one test space and reduced test space are investigated. The standard normal distribution and chi-square distribution are used as tolerance distributions. Simulation results indicate that the modified up-and-down method tends to be some-what better than the original up-and-down method in terms of the mean squared error under normal tolerance distribution. In case of chi-square distribution, the modified method is shown to be substantially better when the test space is wide and the initial dose is further away from the LD₅₀.     

Yo jyo hen shi ko, a novel Chinese herbal, prevents nonalcoholic steatohepatitis in ob/ob mice fed a high fat or methionine-choline-deficient diet.

BACKGROUND: Oxidative stress plays a role in the pathogenesis of nonalcoholic steatohepatitis (NASH). Yo jyo hen shi ko (YHK) is a complex compound purported to reduce reactive oxygen species (ROS) by blocking the propagation of radical-induced reactions. The aim of this study was to evaluate the role of the effect of YHK in experimental NASH. METHODS: NASH was induced in male ob/ob mice by a high-fat (HF) diet or methionine/choline-deficient (MCD) diet for 4 weeks. YHK-treated animals received YHK solution orally (20 mg/kg/day) in both experimental diets (n=6; each group) while control animals received only vehicle. RESULTS: The MCD and HF groups developed moderate diffuse macrosteatosis, hepatocellular ballooning, and a diffuse inflammatory infiltrate. With the addition of YHK, there was a marked reduction in macrosteatosis in both groups. This was associated with decreased lipoperoxide and reduced glutathione-GSH concentrations as well as reduced serum aminotransferases and improved histological markers of inflammation. These changes were also associated with weight loss in the MCD+YHK group and diminished weight gain in the HF+YHK group. CONCLUSION: YHK therapy blunts the development of macrosteatosis in these models of NASH and significantly reduces markers of oxidative stress. YHK also diminishes weight gain in this obesity prone model. Our findings warrant further study on the mechanisms involved with these effects.     

Autochthonous hepatitis E in Southwest England: natural history, complications and seasonal variation, and hepatitis E virus IgG seroprevalence in blood donors, the elderly and patients with chronic liver disease

AIMS: To report the natural history of autochthonous hepatitis E and hepatitis E virus (HEV) IgG seroprevalence in Southwest England. METHODS: Patients with unexplained hepatitis were tested for hepatitis E and cases followed until recovery or death. Five hundred blood donors, 336 individuals over the age of 60 years and 126 patients with chronic liver disease were tested for HEV IgG. RESULTS: Forty cases of autochthonous hepatitis E (genotype 3) were identified. Hepatitis E was anicteric in 25% of cases and usually caused a self-limiting hepatitis predominantly in elderly Caucasian males. Six of 40 had a significant complication and three patients died, two of who had previously undiagnosed cirrhosis. Hepatitis E shows a seasonal variation with peaks in the spring and summer and no cases in November and December. HEV IgG prevalence increases with age, is more common in men and is 16% in blood donors, 13% in patients with chronic liver disease and 25% in individuals over 60 years. CONCLUSION: Autochthonous hepatitis E is more common than previously recognized, and should be considered in the differential diagnosis in patients with hepatitis, whatever their age or travel history. It carries a significant morbidity and when seen in the context of chronic liver disease carries an adverse prognosis.     

Characterizing wild bird contact and seropositivity to highly pathogenic avian influenza A (H5N1) virus in Alaskan residents

Background

Highly pathogenic avian influenza A (HPAI) H5N1 viruses have infected poultry and wild birds on three continents with more than 600 reported human cases (59% mortality) since 2003. Wild aquatic birds are the natural reservoir for avian influenza A viruses, and migratory birds have been documented with HPAI H5N1 virus infection. Since 2005, clade 2.2 HPAI H5N1 viruses have spread from Asia to many countries.

Objectives

We conducted a cross-sectional seroepidemiological survey in Anchorage and western Alaska to identify possible behaviors associated with migratory bird exposure and measure seropositivity to HPAI H5N1.

Methods

We enrolled rural subsistence bird hunters and their families, urban sport hunters, wildlife biologists, and a comparison group without bird contact. We interviewed participants regarding their exposures to wild birds and collected blood to perform serologic testing for antibodies against a clade 2.2 HPAI H5N1 virus strain.

Results

Hunters and wildlife biologists reported exposures to wild migratory birds that may confer risk of infection with avian influenza A viruses, although none of the 916 participants had evidence of seropositivity to HPAI H5N1.

Conclusions

We characterized wild bird contact among Alaskans and behaviors that may influence risk of infection with avian influenza A viruses. Such knowledge can inform surveillance and risk communication surrounding HPAI H5N1 and other influenza viruses in a population with exposure to wild birds at a crossroads of intercontinental migratory flyways.