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Migraine affects over a billion people worldwide and brings with it a huge burden of disability. It is a disease which disproportionally affects the working age population which heightens its economic impact, both at the individual family level and the societal level. Women are significantly more affected by migraine at every age and in all social and geographical groups. At the most severe end of the spectrum, chronic migraine is associated with poorer overall physical and mental health as well as increased risk of unemployment and lower household income. Estimates of the incidence and prevalence of migraine vary with sex, race, ethnicity, geography, socioeconomic, and educational status, suggesting there are many factors at play. In many cases, it is not clear whether these factors are causative of migraine, the effects of migraine, or (as is most likely) a combination of both. Future studies should aim to clarify these links, so that modifiable factors can be addressed where possible and those at risk of developing chronic migraine might receive targeted treatment at an early stage., (Copyright © 2023 Elsevier B.V. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Abdominal migraine and cyclical vomiting syndrome (CVS) are characteristic syndromes which have overlapping characteristics with migraine but lack the cardinal symptom of headache. Both abdominal migraine and CVS are characterized by recurrent attacks of nausea, vomiting, and/or abdominal pain lasting hours to a few days, with symptom freedom between attacks. Both abdominal migraine and CVS typically occur in children and adolescents, who often go on to develop more typical migraine headaches when older, but may also present for the first time in adults. Due to their shared characteristics and association with migraine headaches, abdominal migraine and CVS are sometimes called "migraine equivalents," and their pathophysiology is assumed to overlap with migraine headache. This chapter describes what is known about the clinical characteristics, epidemiology, pathophysiology, and prognosis of abdominal migraine and CVS, and explores their relationship to migraine. We also review the existing evidence for the nonpharmacological management, acute treatment of attacks, and preventive treatments for both abdominal migraine and CVS., (Copyright © 2023 Elsevier B.V. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Objectives: New daily persistent headache (NDPH) is a subset of chronic headache where the pain is continuous from onset. Phenotypically it has chronic migraine or chronic tension type features. NDPH is considered to be highly refractory. Occipital nerve stimulation (ONS) has been used for treatment of refractory chronic migraine but there are no specific reports of its use for NDPH with migrainous features., Materials and Methods: Nine patients with NDPH with migrainous features were identified as having had ONS implants between 2007 and 2014 in a specialist unit with experience of using ONS in chronic migraine. Moderate to severe headache days were compared at baseline and follow-up. A positive response was defined as at least 30% reduction in monthly moderate to severe headache days., Results: Patients had suffered NDPH for a median of 8 years (range 3-16 years) and had failed a median of 11 previous treatments (range 8-15). After a median follow-up of 53 months (range 27-108 months), only a single patient showed a positive response to ONS. At no point did the cohort as a whole show any change in monthly moderate to severe headache days or disability scores., Conclusion: Our experience suggests that ONS is not effective in the treatment of NDPH with migrainous features even in centers with experience in treating chronic migraine with ONS. The difference in response rates of chronic migraine and NDPH with migrainous features supports the concept of a different pathophysiology to the two conditions., (© 2020 The Authors. Neuromodulation: Technology at the Neural Interface published by Wiley Periodicals LLC on behalf of International Neuromodulation Society.)

Introduction: Synthesis of the available evidence on the effectiveness of medical and cloth facemask use by the general public in community settings is required to learn lessons for future respiratory epidemics/pandemics., Method: Search terms relating to facemasks, infection and community settings were used for PubMed, the Cochrane Library Database and Google Scholar. A meta-analysis was conducted using a random-effects model., Results: The review included 12 primary studies on the effectiveness of medical facemask use to prevent influenza, influenza-like illness, SARS-CoV, and SARS-CoV-2 transmission. The meta-analysis demonstrated that facemask use significantly reduces the risk of transmitting these respiratory infections (pooled OR = 0.66, 95% CI 0.54-0.81). Of the 12 studies, 10 clinical trials suggested that respiratory infection incidence is lower with high medical facemask compliance, early use and use in combination with intensive hand hygiene. One cohort study conducted during the SARS-CoV-2 pandemic demonstrated that facemasks are effective in reducing SARS-CoV-2 transmission when used before those who are infected develop symptoms. One case-control study reported that controls used medical facemasks more often than cases infected with SARS-CoV (p <  0.05). No primary study on cloth facemask effectiveness to prevent respiratory infection transmission was found., Conclusion: Based on the available evidence, medical facemask use by healthy and sick individuals is recommended for preventing respiratory infection transmission in community settings. Medical facemask effectiveness is dependent on compliance and utilization in combination with preventive measures such as intensive hand hygiene. No direct evidence is currently available in humans supporting the recommendation of cloth facemask use to prevent respiratory infection transmission., (Copyright © 2020. Published by Elsevier Ltd.)

Epilepsy is the most common serious neurological disorder, with a prevalence of 0.5-1% of the population. While the traditional antiepileptic drugs (AEDs) still play a significant role in treatment of seizures, there has been an influx of newer agents over the last 20 yr, which are now in common usage. Anaesthetists are frequently faced with patients with epilepsy undergoing emergency or elective surgery and patients suffering seizures and status epilepticus in the intensive care unit (ICU). This review examines perioperative epilepsy management, the mode of action of AEDs and their interaction with anaesthetic agents, potential adverse effects of anaesthetic agents, and the acute management of seizures and refractory status epilepticus on the ICU. Relevant literature was identified by a Pubmed search of epilepsy and status epilepticus in conjunction with individual anaesthetic agents.

In schizophrenia reduction of the P300 amplitude is a robust statistical finding but with inconsistent evidence of symptom correlates and of lateral asymmetry. Here relations were examined with active and withdrawn syndromes which in other cognitive and electrophysiological measurement modalities have been associated with opposite functional asymmetries. A standard oddball detection task was used to elicit auditory evoked potentials from dextral DSM-IV schizophrenic patients. On clinical ratings blind to the psychophysiology, eight were classified as withdrawn and 12 had a predominance of active syndrome features. Both patient groups had congruent P300 maxima at Pz or P4, attesting to their application to the detection task. Syndromes were differentiated by opposite asymmetries in P300, N200-P300 and N100 amplitudes at the posterior temporal sites: a reduction in P300 and N200-P300 amplitudes on the left in the active patients, and a reduction on the right in the withdrawn patients, with the opposite asymmetries in N100 amplitudes. The syndrome-related asymmetries in P300, also manifested in earlier attentional (N100) components are interpreted in terms of thalamo-cortical arousal systems having generalised, internalised influences, rather than in terms of later cognitive processes underpinning the P300. The findings endorse a syndromal approach to laterality research in schizophrenia.

We examined whether the degree of saturation of C-18 fatty acids influenced hepatic cholesterol metabolism in C3H mice. The mice were fed diets containing 20 g/100 g fat, enriched in stearic (18:0), oleic (18:1) or linoleic acid (18:2) with or without 1 g/100 g cholesterol. Plasma total cholesterol concentration was lower in mice fed the 18:0 diet relative to those fed the 18:1- or 18:2-enriched diets (P < 0.05) regardless of dietary cholesterol supplementation. Dietary cholesterol significantly raised hepatic total cholesterol concentration (P < 0.05) in those fed the 18:1- and 18:2-enriched diets, but not in mice fed the 18:0-enriched diet. Dietary cholesterol raised biliary cholesterol concentration (P < 0. 05) in mice fed the 18:1- and 18:2-enriched diets, but not in mice fed the 18:0-enriched diet. The cholesterol saturation index was variably affected by the fat diets. Feeding diets containing cholesterol suppressed the hepatic 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGR) activity and induced acyl coenzyme A:cholesterol acyl transferase (ACAT) activity compared with feeding diets without cholesterol (P < 0.05), indicating that the liver was exposed to dietary cholesterol. Hepatic ACAT activity was lower in mice fed the 18:0-enriched diet compared with those fed the 18:1- or 18:2-enriched diets (P < 0.05). Addition of cholesterol to the 18:1 diet induced the largest increase of hepatic ACAT activity, and this was associated with the enrichment of VLDL with cholesterol. Varying the degree of saturation of C-18 fatty acids influences the metabolism and disposition of hepatic cholesterol.

Both epidural and paravertebral blocks are effective in controlling post-thoracotomy pain, but comparison of preoperative and balanced techniques, measuring pulmonary function and stress responses, has not been undertaken previously. We studied 100 adult patients, premedicated with morphine and diclofenac, allocated randomly to receive thoracic epidural bupivacaine or thoracic paravertebral bupivacaine as preoperative bolus doses followed by continuous infusions. All patients also received diclofenac and patient-controlled morphine. Significantly lower visual analogue pain scores at rest and on coughing were found in the paravertebral group and patient-controlled morphine requirements were less. Pulmonary function was significantly better preserved in the paravertebral group who had higher oxygen saturations and less postoperative respiratory morbidity. There was a significant increase in plasma concentrations of cortisol from baseline in both the epidural and paravertebral groups and in plasma glucose concentrations in the epidural group, but no significant change from baseline in plasma glucose in the paravertebral group. Areas under the plasma concentration vs time curves for cortisol and glucose were significantly lower in the paravertebral groups. Side effects, especially nausea, vomiting and hypotension, were troublesome only in the epidural group. We conclude that with these regimens, paravertebral block was superior to epidural bupivacaine.

Cholesterol 7 alpha-hydroxylase (cyp7) is the rate-limiting enzyme in bile acid biosynthesis. Previously, dietary cholesterol was shown to induce cyp7 gene expression. However, recent studies have produced data that are inconsistent with this observation, suggesting the possibility that other factors in the diet are also important in the regulation of cyp7 by dietary cholesterol. The effect of dietary fats on the ability of dietary cholesterol to regulate cyp7 activity and mRNA abundance was assessed. High fat diets composed primarily of polyunsaturated (PUFA), monounsaturated (MUFA), or saturated (SFA) fatty acids induced hypercholesterolemia regardless of whether cholesterol was present or not. However, the effects of each diet on bile composition and hepatic cholesterol content were variable. Microsomal fatty acid profiles reflected the fatty acid composition of the diets. Addition of cholesterol to the PUFA diet increased cyp7 mRNA abundance and activity, analogous with the results observed in mice fed a chow plus cholesterol diet. On the other hand, addition of cholesterol to diets high in MUFA or SFA caused a significant reduction of cyp7 mRNA abundance and activity. Addition of cholesterol to all the diets caused the expected changes in low density lipoprotein receptor and 3-hydroxy-3-methylglutaryl coenzyme A reductase mRNA abundance but was not correlated with the changes in cyp7 mRNA abundance. The relationship between cyp7 mRNA abundance and hepatic total cholesterol content or hepatic microsomal cholesterol content was evident, suggesting that cholesterol status does not necessarily determine cyp7 mRNA abundance. The results of this study illustrate that the type of dietary fat is important in elaborating the regulatory potential of dietary cholesterol on cyp7 gene expression and suggest that the regulation of cyp7 gene expression does not involve the classical sterol-mediated pathway.

Intestinal and hepatic recovery of bile acids is principally mediated by sodium dependent bile acid transporters. Of these, the ileal sodium bile acid transporter (isbt) and the hepatic sodium bile acid cotransporting polypeptide (ntcp) may be most important in determining the efficiency of bile acid recovery within the enterohepatic circulation. We used molecular probes to explore the relationship between the bile acid recovery pathway, at the level of isbt and ntcp, and the biosynthetic pathway, at the level of cholesterol 7 alpha-hydroxylase (cyp7). Taurocholate feeding of mice suppressed ntcp, isbt, and cyp7 mRNA levels as compared to controls. Cholestyramine feeding induced both cyp7 and isbt mRNA gene expression. Cholesterol feeding induced cyp7 mRNA levels but suppressed isbt gene expression. These results suggest that in mice the bile acid recovery and biosynthetic pathways are coordinately regulated, and these pathways may be responsive to the size of the bile acid pool in the enterohepatic circulation.