P-772 Cardiovascular autonomic nervous function in singletons conceived after ART with frozen and fresh embryo transfer compared to naturally conceived children

Study question

Do children conceived after assisted reproductive technologies (ART) with frozen or fresh embryo transfer have altered cardiovascular autonomic nervous function compared to naturally conceived children?

Summary answer

Cardiovascular autonomic nervous function was comparable in singletons conceived after ART with frozen or fresh embryo transfer, and naturally conceived children.

What is known already

Cardiovascular autonomic nervous function (CANF) exert important homeostatic mechanisms to prevent major arterial blood pressure fluctuations by adjusting heart rate, cardiac contractility, and peripheral vascular tone. CANF is impaired in children with obesity and diabetes mellitus, and conductance artery stiffness is documented to influence CANF. Previous studies have reported that children conceived after ART are at risk of increased carotid intima-media thickness; insulin resistance; arterial stiffness; and hypertension. This is the first study to investigate CANF in children conceived after ART.

Study design, size, duration

CANF was studied in 110 singletons aged 7-12 years conceived after frozen embryo transfer (FET, N = 35), fresh embryo transfer (fresh-ET, N = 39) or natural conception (NC, N = 36). Children were born between 2009 and 2013. This study was conducted between June 2019 and October 2021.

Participants/materials, setting, methods

Participants were identified through the Danish IVF and Medical Birth Registries. CANF was evaluated by heart rate (HR) changes (ratio to rest) during deep breathing; Valsalva; and active stand test with continuous non-invasive hemodynamic measurements. Anthropometric measures, fasting blood samples, and maternal questionnaires were collected. Neonatal and maternal pregnancy data were collected from the Medical Birth Registry. Children with a history of congenital heart disease or mothers with gestational diabetes or diabetes mellitus were excluded.

Main results and the role of chance

A total of 110 singletons with a median age of 9.0 years were included in this study. We found no significant associations between conception method and our measures of CANF. For FET, fresh-ET, and NC, respectively, the HR-ratio for deep breathing was 1.62 (0.2 SD), 1.62 (0.16) and 1.63 (0.17) (ANOVA-P = 0.97). For Valsalva, the HR-ratio was 1.97 (0.4), 1.88 (0.41) and 1.63 (0.17), respectively (ANOVA-P = 0.24). For the active stand test, the HR-ratio was 1.43 (0.17), 1.41 (0.2) and 1.43 (0.19), respectively (ANOVA-P = 0.91). Associations remained non-significant after adjustment for age, sex, body surface area, body mass index, and mean arterial pressure. In the multivariate analysis, several other factors were significantly associated with HR-ratio for deep breathing: age (β = -0.06, P = 0.03), body surface area (β = 0.79, P = 0.01), body mass index (β = -0.03, P = 0.04), and mean arterial pressure (β =-0.01, P = 0.03), but not with other measures of CANF. All data for CANF were within reference limits. Also, mothers in the ART groups were older at childbirth than NC group as expected. No significant differences were observed in clinical characteristics, including neonatal and other maternal data.

Limitations, reasons for caution

This study is limited by its observational design to draw any firm conclusion on causality. Also, it is a limitation that the pubertal status was not systematically assessed as pubertal hormones may play a role in CANF.

Wider implications of the findings

This study contributes to the current knowledge about cardiovascular health risks in ART children. Reassuringly, this study found that children conceived after ART (frozen or fresh-ET) did not exhibit impaired cardiovascular autonomic nervous function compared to naturally conceived children.

Trial registration number

NCT03719703

The stiff male arterial system seems to establish itself well before puberty

Background

Increased vascular stiffness in adults is associated with symptomatic cardiovascular disease independently of other risk factors. From puberty and onwards, men have higher aortic pulse-wave velocity than women explaining part of the male overrepresentation of early cardiovascular disease. It is not known if the stiff male arterial system is related to adult life-style or develops under the influence of male hormones, or if it is already present before puberty. According to the hyperbolic Bramwell-Hill relation, early changes must be expected to become detectable in aortic distensibility before influencing aortic pulse-wave velocity.

Purpose

The objective of this study was to quantitate sex-related differences in aortic distensibility and pulse-wave velocity in pre-pubertal children.

Methods

150 children aged 8–9 years (75 girls and 75 boys) were recruited to a cardiovascular magnetic resonance imaging (CMR) study of the importance of in vitro fertilization (IVF) for aortic distensibility. Data did not show differences related to the mode of conception (natural vs. IVF), and pooled data are reported here. Conductance artery stiffness was determined from ascending, descending and abdominal aorta distensibility and from arch and abdominal aorta pulse-wave velocity (PWV). Data were analyzed blinded to child sex and mode of conception and related to left heart function as determined from flow and volumetric CMR data. The effects of sex on ascending aorta distensibility and total aortic PWV were examined in four linear regression models by stepwise adjustment for potential confounders.

Results

Systolic and diastolic blood pressures, cardiac output and total peripheral resistance did not differ between the sexes. Pulse pressure, however, was a mean of 2 mmHg lower and heart rate 7 bpm higher in girls (Table 1), and corresponding to the lower heart rate, left ventricle (LV) end-diastolic volume index and left ventricle stroke volume were 7 mL and 5 mL, respectively, higher in boys. LV peak-filling rate indexed to LV end-diastolic volume was 0.5 s-1 lower in boys, but in general LV filling and left atrium emptying parameters were equal. Distensibility of the ascending and descending aorta were both significantly higher in girls as compared to boys, whereas boys and girls had equal abdominal aortic distensibility and equal aortic pulse-wave velocities. Distensibility of the ascending aorta remained statistically significant after adjustment for potential confounders (Table 2).

Conclusion

Without yet significantly affecting pulse wave velocity or left ventricle function, pre-pubertal boys had significantly lower distensibility of the ascending aorta and the aortic arch than pre-pubertal girls. This is the part of the aorta primarily responsible for the aortic Windkessel function, and it seems that the stiffer arterial system seen in adult men as compared to adult women may already be present in childhood well before puberty.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation Table 1Table 2

Calcified cartilage differs in patients with end-stage primary osteoarthritis and secondary osteoarthritis due to rheumatoid arthritis of the hip joint

Objectives: Despite distinct aetiologies, the end-stages of primary osteoarthritis (OA) and secondary OA are described by common radiological features. However, the morphology of the bone-cartilage unit may differ depending on the pathogenesis. In this cross-sectional study, we aimed to investigate the histological differences in the bone-cartilage unit of the femoral head between patients with primary OA and secondary OA due to rheumatoid arthritis (RA).Method: Femoral heads were obtained from 12 patients with primary OA, six patients with secondary OA due to RA, and 12 control subjects. The femoral heads were investigated using stereological methods to ensure unbiased quantification.Results: The volume (mean difference [95% confidence interval]) (2.1 [0.5;3.8] cm³, p = 0.016) and thickness (413 [78.9;747] µm, p = 0.029) of the articular cartilage and the thickness of the calcified cartilage (56.4 [0.4;113] µm, p = 0.017) were larger in patients with primary OA than in patients with secondary OA due to RA. Femoral head volume (1.2 [-3.6;6.1] cm³, p = 0.598), bone volume fraction (-1.1 [-2.8;5.1] cm³, p = 0.553), subchondral bone thickness (-2.5 [-212;207] µm, p = 0.980), and osteophyte area (25.3 [-53.6;104] cm², p = 0.506) did not differ between patients.Conclusion: The thicker calcified cartilage in primary OA preceding the loss of articular cartilage can be attributed to endochondral ossification. Patients with secondary OA due to RA had severely thinner calcified cartilage as the pathogenesis is driven by inflammation and is characterized by a generalized and more severe loss of articular cartilage.

Cardiac diastolic function of 8–9-year-old singletons following fresh or frozen embryo transfer compared to naturally conceived – a cardiac magnetic resonance study

Background

Epigenetics may alter the cardiovascular system of children conceived after assisted reproductive technology (ART). Singletons born after frozen embryo transfer (FET) are more likely to be large for gestational age and fresh embryo transfer (ET) are at risk of being small for gestational age. Children conceived after ART may have endothelial dysfunction, and high body mass index and arterial blood pressure (ABP). Such changes may be associated with cardiac diastolic dysfunction.

Purpose

We investigate whether children conceived after fresh ET and FET are at risk of cardiac changes including left ventricular (LV) diastolic dysfunction.

Methods

150 9-year-old singletons have been recruited in a cardiac magnetic resonance imaging study (all scanned by April 2020). 50 children were born after natural conception (NC); 50 children after FET; and 50 children after fresh ET. Left atrium (LA) maximal volume, LA early emptying fraction (LAEEF), LV peak filling rates (PFR) and the peak ejection rate (PER)/PFR ratio are reported to assess the diastolic function.

Results

Preliminary data analyzed in a blinded manner from 59 children show no differences in ambulatory ABP, LV and right ventricular ejection fraction, end-diastolic and end-systolic volumes, stroke volumes and LV mass between the groups. With respect to LV diastolic function, no differences were seen in LA maximal volume and LAEEF; but the Fresh ET group tended to have lower PFR with a resultant PER/PFR ratio now increasing above unity compared to the other groups.

Conclusion

Preliminary data suggest a possible trend towards diastolic dysfunction in children born after fresh ET. If the lack of significant difference in heart function between NC and FET can be ascertained in the full cohort, this is reassuring.

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Novo Nordisk Foundation

Aids to management of headache disorders in primary care (2nd edition) : on behalf of the European Headache Federation and Lifting The Burden: the Global Campaign against Headache

The Aids to Management are a product of the Global Campaign against Headache, a worldwide programme of action conducted in official relations with the World Health Organization. Developed in partnership with the European Headache Federation, they update the first edition published 11 years ago.The common headache disorders (migraine, tension-type headache and medication-overuse headache) are major causes of ill health. They should be managed in primary care, firstly because their management is generally not difficult, and secondly because they are so common. These Aids to Management, with the European principles of management of headache disorders in primary care as the core of their content, combine educational materials with practical management aids. They are supplemented by translation protocols, to ensure that translations are unchanged in meaning from the English-language originals.The Aids to Management may be individually downloaded and, as is the case for all products of the Global Campaign against Headache, are available without restriction for non-commercial use.

Headache service quality: the role of specialized headache centres within structured headache services, and suggested standards and criteria as centres of excellence

In joint initiatives, the European Headache Federation and Lifting The Burden have described a model of structured headache services (with their basis in primary care), defined service quality in this context, and developed practical methods for its evaluation.Here, in a continuation of the service quality evaluation programme, we set out ten suggested role- and performance-defining standards for specialized headache centres operating as an integral component of these services. Verifiable criteria for evaluation accompany each standard. The purposes are five-fold: (i) to inspire and promote, or stimulate the establishment of, specialized headache centres as centres of excellence; (ii) to define the role of such centres within optimally structured and organized national headache services; (iii) to set out criteria by which such centres may be recognized as exemplary in their fulfilment of this role; (iv) to provide the basis for, and to initiate and motivate, collaboration and networking between such centres both nationally and internationally; (v) ultimately to improve the delivery and quality of health care for headache.

Real-time transmission of 16 Tb/s over 1020km using 200Gb/s CFP2-DCO

We demonstrate real-time transmission of 16 Tb/s (80x200Gb/s) over 1020km TeraWave ULL fiber with 170km span length using the world's first 200Gb/s CFP2-DCO module with a record low power consumption less than 0.1W/Gbps.

Increased pain sensitivity in migraine and tension-type headache coexistent with low back pain: A cross-sectional population study

BACKGROUND

Low back pain is common in the general population and in individuals with primary headaches. We assessed the relative frequency of self-reported back pain in persons with and without primary headaches and examined pain sensitivity.

METHOD

A population of 796 individuals completed a headache interview based on ICHD criteria and provided data of interest in a self-administered questionnaire. Headache cases were classified into chronic (≥15) (CH) or episodic (<15 headache days/month) (EH). A total of 495 had a pericranial total tenderness score (TTS), and 494 had cephalic and extracephalic pressure pain thresholds (PPTs) assessed.

RESULTS

Adjusted for age, gender, education and poor self-rated health, 1-year relative frequency of back pain was higher in individuals with CH (82.5%) and EH (80.1%) compared to no headache group (65.7%). In persons with back pain, TTS was higher in CH, (26.3 ± 12.1) than in EH, (18.5 ± 10.0; p < 0.001) and higher in both groups than in those with no headache, 10.8 ± 8.5 (p < 0.001 and p < 0.001, respectively). In persons with back pain, temporalis PPT were lower in CH, 169.3 ± 57.8, than in EH, 225.2 ± 98.1, and in no headache group, 244.3 ± 105.4 (p = 0.02 and p = 0.01, respectively). In persons with back pain, finger PPT were lower in CH, 237.1 ± 106.7, than in EH, 291.3 ± 141.3, or in no headache group, 304.3 ± 137.4 (p = 0.02 and p < 0.001, respectively).

CONCLUSION

Back pain is highly frequent in individuals with CH, followed by EH and no headache. In persons with CH, back pain is associated with lower cephalic and extracephalic PPTs suggesting central sensitization may be a substrate or consequence of comorbidity.

SIGNIFICANCE

We found that back pain has high relative frequency in individuals with CH followed EH and no headache. Back pain is associated with low cephalic and extracephalic PPTs in individuals with CH. Central sensitization may be a substrate or consequence of this comorbidity of back pain and CH.

Neuroticism, depression and pain perception in migraine and tension-type headache

OBJECTIVES

People with migraine and tension-type headache (TTH) have psychiatric comorbidities. We aimed to test differences in mental health constructs by type and frequency of primary headache and associated pain sensitivity.

MATERIALS AND METHODS

Data on headache features, neuroticism (Eysenck Personality Questionnaire) and depression (Major Depression Inventory) were obtained from 547 individuals classified into chronic (≥15) or episodic (<15 headache days/month) and into pure migraine (n=43), pure tension type headache (TTH, n=97), migraine and TTH (n=83) and no headache diagnosis (controls, n=324) groups. A pericranial total tenderness score (TTS) and pressure pain thresholds (PPTs) were measured. Differences in mental health constructs were examined by headache frequency and type using generalized linear mixed models adjusting for sociodemographic covariates.

RESULTS

Depression scores were highest among people with chronic headache, lower in those with episodic headache, and lowest in controls. The chronic and episodic headache groups had higher neuroticism scores than controls. Mental health construct scores were highest for the migraine and TTH group and lowest in the control group. TTS and cephalic PPTs were correlated with neuroticism and depression and were higher in the chronic headache group compared to the no headache group even when adjusted for neuroticism and depression.

CONCLUSIONS

Neuroticism and depression scores are associated with headache frequency (chronic vs episodic) and are highest for migraine and TTH followed by pure TTH then migraine. Mental health constructs were correlated with but did not influence differences in TTS and PPTs between headache groups.

Abstract P5-11-18: Trajectory of patient (Pt) reported physical function (PF) during and after neoadjuvant chemotherapy in the I-SPY 2 trial

Background

Patients (pts) receiving chemotherapy for breast cancer experience toxicities impacting short and long-term quality of life (QOL). Within I-SPY 2, a trial adaptively randomizing stage II/III breast cancer pts to neoadjuvant chemotherapy +/- an investigational agent, we are collecting pt reported outcome (PRO) data to understand the impact of investigational agents on QOL. This PRO sub-study provides a unique opportunity to study QOL longitudinally and explore how pt and tumor characteristics, exposure to investigational therapies, and surgical outcome impact QOL.

Methods

Pts enrolled in this trial receive paclitaxel (T) +/- an investigational agent for 12 weeks followed by 4 cycles of doxorubicin and cyclophosphamide (AC). Surveys include the EORTC QLQ-C30 and BR-23, and PROMIS measures for QOL metrics including but not limited to physical function (PF), anxiety, and depression. Surveys are administered pre-chemotherapy to 2 years post-surgery. PF data from the EORTC and PROMIS instruments was analyzed for 238 pts at 5 sites (UCSF, UCSD, U of Pennsylvania, U of Minnesota, and Swedish Cancer Center). 48 pts completed baseline, inter-regimen (between T and AC), pre-operative and post-surgery surveys. Of the 48 pts 32 completed a 6-month follow up (FUP) and 31 completed a 1-year FUP survey. A linear mixed effect model, adjusting for HER2 status and treatment type was used to evaluate changes in PF over time. Sample size is small and statistics are descriptive rather than inferential.

Results

Median age of pts in this analysis was 50 (range 27-72).

Table 1 shows PROMIS & EORTC PF scores in this cohort.Time Point  PROMISEORTC  nMeanSEMeanSEPre-TreatmentAll4852.51.092.02.0 HER2+1553.51.594.12.2 HER2-3352.11.391.12.8Inter-RegimenAll4845.51.282.22.7 HER2+1548.62.384.44.2 HER2-3344.11.381.23.4Pre-SurgeryAll4843.91.179.42.3 HER2+1545.12.275.34.1 HER2-3343.41.381.32.86-Month FUPAll3248.11.487.41.9 HER2+1247.52.285.03.3 HER2-2048.41.888.92.41 Year FUPAll3148.91.488.43.1 HER2+949.12.988.95.4 HER2-2248.81.788.33.8

At baseline, mean PROMIS PF scores were higher than the US average (mean = 50) but declined as expected throughout treatment. HER2+ patients experienced a similar degree of recovery as HER2- pts post-surgery despite adjuvant treatment with Herceptin. Analysis of post-operative PROMIS PF indicated an average score within the U.S. general population (mean =50) but did not return to higher functioning seen at baseline levels (mean 52.5, p-value &lt; 0.05). Analysis of the EORTC PF sub-scale demonstrated a similar trend; however, the baseline and post-operative difference was not significant (p-value=0.15 for both FUP). Finding supports PROMIS PF ability to measure high functioning cancer patients.

Conclusions: Among a subset of pts who completed all surveys in the I-SPY 2 QOL substudy, PF did not return to baseline at 6-12 months post-operatively. Through transition to an electronic platform of data collection we hope to improve compliance with survey completion. We continue to analyze other QOL measures and plan to correlate QOL data with treatment arm, adverse events, comorbidities, and response to neoadjuvant treatment.

Citation Format: Shah M, Jensen R, Yau C, Straehley I, Berry DA, DeMichele A, Buxton MB, Hylton NM, Perlmutter J, Symmans WF, Tripathy D, Yee D, Wallace A, Kaplan HG, Clark A, Chien AJ, I-SPY 2 Investigators, Esserman LJ, Melisko ME. Trajectory of patient (Pt) reported physical function (PF) during and after neoadjuvant chemotherapy in the I-SPY 2 trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-18.

800Gb/s (8x128Gb/s) unrepeatered transmission over 515-km large-area ultra-low-loss fiber using 2nd-order Raman pumping

We demonstrate unrepeatered transmission of 8x128Gb/s PDM-QPSK signals over a 515k-m fiber link. This ultra-long distance of 800 Gb/s unrepeatered transmission in a single fiber configuration is achieved by employing enabling techniques such as large-effective-area ultra-low-attenuation fibers, co-propagating and counter-propagating 2nd-order-pumped distributed Raman amplification, and remote optically pumped amplifier (ROPA). The ROPA itself is also counter-propagating 2nd-order Raman pumped. The designs and characteristics of the ROPA and 2nd-order pumped distributed Raman amplification are described, and optimization of the transmission performance of this ultra-long reach 800Gb/s unrepeatered transmission fiber link is discussed in this paper.

Phlebography as the Gold Standard in Thromboprophylactic Studies?

In 241 patients with total hip arthroplasty and entering a study on thrombosis prophylaxis, phlebography was adequately performed in 451 legs 7 to 11 days after surgery. The phlebograms were primary evaluated by 4 independent observers, and finally a consensus of the images in which disagreement primarily occurred was obtained. The diagnosis of thrombosis in the 4 primary observations varied between 65% and 83% (mean 70%) and the agreement on a negative diagnosis between 97% and 99% (mean 98%). Taking into account agreement by chance, kappa-values varied from 0.60 to 0.83 when the 6 different pairs of observations were compared. When comparing the primary evaluations with the final consensus, agreements on positive diagnosis varied between 70% and 90% (mean 80%) and on negative diagnosis between 97% and 99% (mean 98%). Kappa-values varied from 0.68 to 0.90. The factor of uncertainty in evaluation of phlebography may have to be considered when studies on postsurgical thromboprophylaxis are planned.

Comparison of Iopromide versus Iohexol in Aortobifemoral Arteriography

A double-blind randomized, clinical trial was conducted in 9 hospitals comparing the use of non-ionic contrast media (CM) iopromide 300 (Ultravist) and iohexol 300 (Omnipaque) during peripheral arteriography in a total of 446 patients. After premedication with morphine-scopolamine each patient was given two consecutive injections of 50 ml CM at a rate of 12 ml/s above the aortic bifurcation. Both CM were well tolerated. There were no differences between the two substances as far as general tolerance, pulse rate, blood pressure, sensation of heat or pain after CM injection were concerned.

Possible Mechanisms of Pain Perception in Patients with Episodic Tension-Type Headache. A New Experimental Model of Myofascial Pain

A new experimental human model of myofascial pain using intramuscular infusion of a combination of bradykinin, serotonin (5-hydroxytryptamine), histamine, and prostaglandin E2 was applied to patients with episodic tension-type headache (ETTH) in order to examine pain perception. Fifteen patients with ETTH and 15 healthy controls completed the randomized, balanced, double-blinded, placebo-controlled study. Pain intensity, punctate hyperalgesia and allodynia, and pain quality were recorded. The combination induced a moderate and prolonged pain in both patients (median 51 min) ( P = 0.001) and controls (median 22 min) ( P = 0.001). Patients reported more pain than controls both after the combination ( P = 0.045) and after placebo ( P < 0.001). The McGill pain score [PRI(R)] was significantly higher in patients ( P = 0.002) and in controls ( P = 0.001), whereas pain quality and hyperalgesia were similar after the combination compared with placebo in the two groups. Due to side-effects nine subjects did not complete the study. The increased pain response, but similar qualitative pain perception, in ETTH patients may be explained by sensitization of peripheral nociceptors even though central mechanisms may also be involved.

Increased Prevalence of Tension-Type Headache Over a 12-Year Period is Related to Increased Pain Sensitivity. A Population Study

We recently reported an increase in prevalence and frequency of tension-type headache (TTH) over a 12-year period in the young Danish population. The aim of the present study was to analyse whether this increase was related to increased pain sensitivity. The study was a cross-sectional replicate of a large Danish population study. It compared 113 subjects aged 25-36 years in 2001, with 221 comparable subjects in 1989. Tenderness was considerably higher in 2001 than in 1989. When stratified according to presence of headache, the increase in tenderness was clinically and statistically significant only in women with frequent TTH. The pressure pain threshold was significantly lower in 2001 compared with 1989 in women with frequent TTH. The increase in tenderness in the population may predict an even higher prevalence of TTH in future. The changes support the hypothesis of central sensitization in TTH.

Experimental Induction of Muscle Tenderness and Headache in Tension-Type Headache Patients

The aim of the present study was to investigate the impact of static contraction of the shoulder and neck muscles on muscle tenderness and headache in patients with tension-type headache. Twenty patients with frequent episodic tension-type headache and 20 healthy age- and sex-matched controls were examined using a placebo-controlled cross-over design. The subjects performed static contraction of the trapezius muscles (active procedure) or the anterior tibial muscles (placebo procedure) with 10% of maximal force for 30 min. Total tenderness score, local tenderness score and headache intensity were evaluated before and after the static work. Changes in headache intensity were followed for 24 h. Pericranial tenderness increased significantly more in patients than in controls after the active procedure ( P = 0.04). The increase in pericranial tenderness tended to be higher after the active procedure than after the placebo procedure in patients ( P = 0.08) and in controls ( P = 0.07). Sixty per cent of the patients and 20% of the healthy controls developed headache after the active procedure. Fifty per cent of the patients and none of the controls developed headache after the placebo procedure. There was no significant difference in headache development between the active and the placebo procedure in patients or controls. These findings demonstrate that tension-type headache patients are more liable to develop shoulder and neck pain in response to static exercise than healthy controls.

Physiotherapy for Tension-Type Headache: A Controlled Study

The role of non-pharmacological therapies in the preventive treatment of tension-type headache (TTH) is still an object of debate. The primary aim of this study was therefore to investigate the therapeutic effect of physiotherapy in properly classified patients with TTH in a controlled trial. Fifty patients with TTH, 26 with episodic, frequent (ETTH) and 24 with chronic TTH (CTTH) fulfilling the International Headache Society classification criteria were included in the study. After a 4-week run-in period, they were randomized to either an 8-week period of standardized physiotherapy (group 1) or to an 8-week observation period followed by an identical course of physiotherapy (group 2); after the physiotherapy all patients were followed for a 12-week follow-up period. We then evaluated the number of days with headache, severity and duration of the headache attacks, and drug consumption for symptomatic treatment before and after the course of physiotherapy. Forty-eight patients completed the study. The average number of days with headache per 4-week period was reduced from 16.3 days at baseline to 12.3 days in the last 4 weeks of treatment [from 14.5 days to 10.5 days ( P < 0.001) in group 1 and from 18.1 days to 14.1 days ( P < 0.001) in group 2]. Severity and duration of headache as well as drug consumption were unchanged throughout the study. Analysing the response to treatment separately in the various subgroups, we found that the number of responders was significantly higher among patients with CTTH vs. patients with ETTH ( P < 0.002) and in females vs. males ( P < 0.02). No differences were found between patients with and without disorder of pericranial muscles. We conclude that a standardized physiotherapy programme has a good therapeutic effect, albeit on a restricted group of patients.

Efficacy of Multidisciplinary Treatment in a Tertiary Referral Headache Centre

Despite the high prevalence of headaches, multidisciplinary headache clinics are few and their efficacy still needs validation. We set out to describe the procedures, characterize the patients and evaluate the treatment results in Danish Headache Centre. All clinical records for patients discharged in 2002 were systematically reviewed. Diagnoses were classified in accordance with ICHD-II. Outcome results were analysed with respect to headache diagnoses, frequency, intensity, absence from work and medication use. Five hundred and five patients were included and 336 were eligible for the study. Mean age was 46 years and male/female ratio 1 : 2.4. For patients without medication overuse headache (MOH) a reduction in headache frequency (P < 0.01) and intensity ( P < 0.05) was seen for frequent episodic and chronic tension-type headache (TTH), migraine, cluster and other headaches. No reduction was seen in post-traumatic headache. Absence from work decreased significantly for migraine ( P < 0.001) and frequent episodic TTH (P < 0.05). For patients with MOH a reduction in headache frequency was seen for TTH and migraine ( P < 0.001). A specialized headache centre is valuable in treatment of patients with complex headache disorders.

Assessment of Headache Diagnosis. A Comparative Population Study of a Clinical Interview With a Diagnostic Headache Diary

The level of agreement between headache information, attained by clinical interview and headache diary, was evaluated in subjects who frequently suffered from headache and were participating in an epidemiological study of headache. One hundred and six subjects were interviewed and asked to complete a diary for a period of 4–8 weeks; 46% completed the study. For migraine the diary and clinical diagnoses demonstrated agreement in 82%, κ value 0.57, sensitivity 90% and specificity 64%. For tension-type headache they demonstrated agreement in 87%, κ value 0.39, sensitivity 97%, specificity 29% and a good agreement of frequency of tension-type headache was also obtained. In migraine, but not in tension-type headache, accompanying symptoms tended to be overestimated in the interview. The diary was not useful for the diagnosis of migraine with aura, but proved valuable in distinguishing between migraine and tension-type headache, and in the identification of coexisting headache disorders. Combined use of a diagnostic diary and clinical interview is recommended.

The effect of pelvic floor muscle training on sexual function in men with lower urinary tract symptoms after stroke

BACKGROUND

Erectile dysfunction and lower urinary tract symptoms (LUTS) are common sequelae in men after stroke.

OBJECTIVE

The objective of this study was to evaluate the effect of pelvic floor muscle training (PFMT) on measured erectile function as an indicator of sexuality in men with LUTS after stroke.

METHOD

A sample of 516 men with stroke was invited to participate in this single-blinded, randomized controlled trial according to in- and exclusion criteria. This resulted in 31 participants who were randomized to either a Treatment Group (n = 16) or a Control Group (n = 15). The intervention included 12♣weeks of PFMT. The effect was measured on the International Index of Erectile Function (IIEF-5) questionnaire.

RESULTS

Thirty participants (median age: 68 years; interquartile range: 60-74 years) completed the study, 15 in each group. The results of the IIEF-5 sum score showed a significant improvement (P < 0.04) from pre-test to post-test in the Treatment Group, but not in the Control Group. Within pre-test and 6-month follow-up, the median sum score decreased in both groups, worsened in the Control Group [Treatment Group, 3 (17%) versus Control Group, 5 (31%)]. There were differences between the groups at post-test and at follow-up, but they were not statistically significant.

CONCLUSION

The results showed that, as measured by erectile function in men with LUTS after stroke, PFMT may have short-term and long-term effect, although no statistically significant effect was demonstrated between the groups.

Sleep and chronobiology in cluster headache

BACKGROUND AND AIM

Cluster headache (CH) is the headache disorder with the strongest chronobiological traits. The severe attacks of pain occur with diurnal and annual rhythmicity but the precise rhythm and involvement of potential zeitgebers is unknown. Patients complain of poor sleep quality yet this has never been studied. We investigated triggers, rhythms, sleep quality and chronotypes in CH.

METHODS

Patients and controls completed questionnaires and structured interviews composed of new and previously validated parts including the Pittsburgh Sleep Quality Index (PSQI) and Morningness-Eveningness Questionnaire (MEQ). Patients were characterized by a CH index, a unified measure of headache burden.

RESULTS

A total of 275 CH patients and 145 matched controls were included. The most common trigger was sleep (80%) and a relationship between clusters and daylight was identified. Of the patients, 82.2% reported diurnal and 56% annual rhythmicity. Patients reported impaired sleep quality (PSQI) (p < 0.0001) and an inverse relationship between time passed since last attack and sleep quality was identified (p < 0.0001). The CH index was positively related to the PSQI (p < 0.0001).

CONCLUSION

Diurnally, CH exhibits a relationship with night-time and annually with daylight hours. Patients' sleep quality is reduced compared with controls. Results suggest a complex relationship as sleep quality improves between clusters, but remains pathological.

The Concise Guide to PHARMACOLOGY 2013/14: overview

The Concise Guide to PHARMACOLOGY 2013/14 provides concise overviews of the key properties of over 2000 human drug targets with their pharmacology, plus links to an open access knowledgebase of drug targets and their ligands (www.guidetopharmacology.org), which provides more detailed views of target and ligand properties from the IUPHAR database. The full contents can be found at http://onlinelibrary.wiley.com/doi/10.1111/bph.12444/full. This compilation of the major pharmacological targets is divided into seven areas of focus: G protein-coupled receptors, ligand-gated ion channels, ion channels, catalytic receptors, nuclear hormone receptors, transporters and enzymes. These are presented with nomenclature guidance and summary information on the best available pharmacological tools, alongside key references and suggestions for further reading. A new landscape format has easy to use tables comparing related targets. It is a condensed version of material contemporary to late 2013, which is presented in greater detail and constantly updated on the website www.guidetopharmacology.org, superseding data presented in previous Guides to Receptors & Channels. It is produced in conjunction with NC-IUPHAR and provides the official IUPHAR classification and nomenclature for human drug targets, where appropriate. It consolidates information previously curated and displayed separately in IUPHAR-DB and GRAC and provides a permanent, citable, point-in-time record that will survive database updates.

Sleep in trigeminal autonomic cephalagias: a review

PURPOSE OF REVIEW

Sleep and cluster headache (CH) are believed to be interconnected but the precise relation to the other trigeminal autonomic cephalalgias (TACs) is uncertain and complex. A better understanding of these relations may eventually lead to a clarification of the underlying mechanisms and eventually to more effective therapeutic regimens. This review aims to evaluate the existing literature on the subject of TACs and sleep. An association between episodic CH and distinct macrostructural sleep phases, especially the relation to rapid eye movement (REM) sleep, has been described in some older studies but could not be confirmed in other, more recent studies. Investigations into the microstructure of sleep in these patients are lacking. Only a few case reports exist on the relation between sleep and other TACs.

SUMMARY

Recent studies do not find an association between CH and REM sleep. One older study suggests chronic paroxysmal hemicranias may be locked to REM sleep but otherwise the relation is unknown. Reports indicate that CH and obstructive sleep apnoea are associated in some individuals but results are diverging. Single cases show improvement of CH upon treatment of sleep apnoea, but the causal relationship remains in question. Other TACs are probably not connected to sleep and strictly nocturnal attacks should prompt investigations for secondary causes. The relation between CH and sleep is, however, fascinating and detailed sleep studies in carefully diagnosed patients are warranted.

Tube bundle system studies at Signal Peak Energy Bull Mountains #1 Mine

A tube bundle system (TBS) is a mechanical system for continuously drawing gas samples through tubes from multiple monitoring points located in an underground coal mine for analysis and display on the surface. The U.S. National Institute for Occupational Safety and Health (NIOSH), in collaboration with Signal Peak Energy (SPE), LLC, Bull Mountains No. 1 Mine, operated a TBS during mining of two bleederless, longwall panels. This paper describes the gas analysis data and its interpretation. As verified by the TBS, coal at the SPE mine tends to oxidize slowly. It was known that a reservoir of low-oxygen concentration atmosphere developed about 610 m (2,000 ft) behind the longwall face. A bleederless ventilation system facilitates formation of an inert atmosphere in this longwall gob and decreases the likelihood of spontaneous combustion. Connections of the mine atmosphere to the surface through subsidence cracks could allow airflow into the longwall gob, revive coal oxidation and increase spontaneous combustion risk. The atmospheric composition of the sealed areas was homogeneous, except in the immediate vicinity of suspected ingassing points. The TBS verified that gases within the partially sealed, bleederless longwall gob expanded into the longwall tailgate area when barometric pressure decreased. The concentration of carbon dioxide in the back return airflow at the longwall tailgate was observed to increase by a factor of three and possibly up to 10 times the typical background concentration of 0.5 to 1.0%, depending on the size of the longwall gob and the magnitude of barometric pressure decrease. TBS have the inherent disadvantage of slow response time due to travel time of the gas samples and sequential gas analyses. A TBS or similar continuous monitoring system could be beneficial in detecting and providing warning of potentially hazardous gas concentrations, if the slow response time of the system is always understood.

A consensus protocol for the management of medication-overuse headache: Evaluation in a multicentric, multinational study

INTRODUCTION

The management of medication-overuse headache (MOH) is often difficult and no specific guidelines are available as regards the most practical and effective approaches. In this study we defined and tested a consensus protocol for the management of MOH on a large population of patients distributed in different countries.

SUBJECTS AND METHODS

The protocol was based on evidence from the literature and on consolidated expertise of the members of the consensus group. The study was conducted according to a multicentric interventional design with the enrolment of 376 MOH subjects in four centres from Europe and two centres in Latin America. The majority of patients were treated according to an outpatient detoxification programme. The post-detoxification follow-up lasted six months.

RESULTS

At the final evaluation, two-thirds of the subjects were no longer overusers and in 46.5% of subjects headache had reverted back to an episodic pattern of headache. When comparing the subjects who underwent out-patient detoxification vs those treated with in-patient detoxification, both regimens proved effective, although the drop-out rate was higher in the out-patient approach.

CONCLUSIONS

The present findings support the effectiveness and usability of the proposed consensus protocol in different countries with different health care modalities.

Disability, anxiety and depression associated with medication-overuse headache can be considerably reduced by detoxification and prophylactic treatment. Results from a multicentre, multinational study (COMOESTAS project)

OBJECTIVE

The objective of this article is to investigate whether headache-related disability, depression and anxiety can be reduced by detoxification and prophylactic treatment in patients with medication-overuse headache (MOH).

METHODS

Patients with MOH were included from six centres in Europe and Latin America in a seven-month cohort study. Before and six months after treatment, the degree of disability was measured by the Migraine Disability Assessment (MIDAS) questionnaire, while anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS).

RESULTS

A total of 694 patients with MOH were included, of whom 492 completed the study. Headache days were reduced by 58.4% from 23.6 to 9.8 days per month at six months ( P < 0.001). The MIDAS score was reduced by 57.1% from baseline 59.9 to 25.7 ( P < 0.001). Number of patients with depression was reduced by 50.7% from 195 to 96 and number of those with anxiety was reduced by 27.1% from 284 to 207 (both P < 0.001).

CONCLUSIONS

Disability, depression and anxiety were considerably reduced in patients with MOH by detoxification and prophylactic treatment. This emphasises the urgent need for increased awareness about avoiding overuse of headache medications and demonstrates that not only headache frequency but also disability are remarkably improved by adequate intervention.