The role of absorption capacity in thermal biofeedback treatment of vascular headache

The clinical utility of Tellegen's Absorption Scale was examined using a sample of 32 chronic vascular headache patients drawn from a larger treatment study investigating the efficacy of thermal biofeedback with vascular headache. A regression analysis found that acquisition of the hand-warming response was directly related to increase in capacity for absorption. Conversely, a trend was found for absorption capacity to be inversely related to reductions in headache frequency and intensity. Reasons for these differences in process and outcome variables are discussed.This research was supported in part by a grant No. NS23440 from NINDS.     

The relationship between capacity for absorption and chronic headache patients' response to relaxation and biofeedback treatment

A sample of 49 chronic headache patients (35 vascular and 14 tension) was separated according to capacity for absorption (as measured by Tellegen & Atkinson's 1974 scale) into groups high in absorption and groups low in absorption, with patients in the middle range being excluded. Absorption capacity was found to affect response to treatment in complex ways. Vascular headache patients high in absorption were significantly improved following relaxation training, but not after biofeedback training. Vascular headache patients low in absorption were significantly improved after biofeedback training. Tension headache patients low in absorption did not respond significantly to either form of treatment, while those high in absorption responded significantly to biofeedback training. Reasons for these differences in response to treatment were discussed.This research was supported by a grant from the National Institute of Neurological and Communicative Disorders and Stroke, NS-15235.     

Factors influencing recovery from headache after common whiplash.

OBJECTIVE--To assess the relation between pretraumatic and trauma related headache in patients suffering from whiplash. DESIGN--Follow up study of patients examined a mean (SD) of 7.4 (4.2) days after trauma and again at three and six months. SETTING--Patients referred from primary care. SUBJECTS--117 patients (mean age 30.8 (9.5) years. MAIN OUTCOME MEASURES--Prevalence of trauma related headache and the predictive relation by multiple logistic regression between different somatic and psychological variables and trauma related headache at each examination. RESULTS--Prevalence of trauma related headache decreased from 57% to 27%. History of pretraumatic headache proved a significant risk factor for presenting with trauma related headache. A significant relation between trauma related headache and the following variables was found: at seven days the initial wellbeing score, early onset of neck pain, depression scale from the personality inventory, and the initial intensity of neck pain; at three months, intensity of neck pain, and history of pretraumatic headache; and at six months neck pain, pain intensity, and history of pretraumatic headache. CONCLUSIONS--History of pretraumatic headache significantly increases the likelihood of presenting with trauma related headache but only in combination with findings indicative of clinically important injury to the cervical spine.     

Muscle tension and physiologic hyperarousal,performance, and state affectivity: assessing the independence of effects in frequent headache and depression

Anxiety, depression, and frequent headache are closely associated. The comorbidity may be due to selection bias (such as inherent in treatment seeking), shared environmental or genetic factors, or a common underlying process. In this study, comorbidity is considered an alternative explanation for correlates of frequent headache found in earlier work. This study addressed whether EMG, peripheral temperature, performance measures, and measures of affect were independently attributable to depression or headache proneness, after control of trait anxiety. Headache state was evaluated in parallel analysis. Seventy-two participants, comprising four groups, were tested: depressedt/ptheadache-prone, depressed/headache-resistant, not depressed/headache-prone, and not depressed/headache-resistant. Participants completed a performance task that allowed assessment of ambition and performance accuracy while measures of affect, headache state, EMG, and peripheral temperature were obtained. Headache proneness, independently of depression and trait anxiety, was related to heightened EMG. Depression was related to EMG, ambition, and performance accuracy independently of headache proneness and trait anxiety. Headache state was associated only with negative affect, independently of depression and anxiety. These results suggest that headache states during assessment, as well as comorbid depression and anxiety, are not primarily responsible for the heightened EMG found in headache-prone individuals. Negative affect often reported in the headache prone, however, may be due to concommitant anxiety. Other analyses address a variety of issues surrounding distinctions among these variables raised in previous research.     

Headache after carotid endarterectomy.

Forty-eight hours after undergoing a successful right carotid endarectomy a patient complained of headache in and behind the right eye radiating to the temple and forehead. The onset of headache was sudden, and the pain was severe and throbbing. After three weeks of regular four- to eight-hour attacks each day the headaches gradually became less frequent. Two months after operation they had disappeared completely. Headache as a complication of endarterectomy is rare, but typically it is vascular and subsides spontaneously in one to six months. If a predisposition to migraine were a precipitating factor many more cases would be expected. No possible explanation for for headache after carotid prearterectomy can account adequately for its apparent rarity.     

Direction of Temperature Control in the Thermal Biofeedback Treatment of Vascular Headache

In order to test for the specific therapeutic effects of thermal biofeedback (TBF) for hand warming on vascular headache (HA), 70 patients with chronic vascular HA were randomly assigned to TBF for hand warming, TBF for hand cooling, TBF for stabilization of hand temperature, or biofeedback to suppress alpha in the EEG. Patients in each condition initially had high levels of expectation of therapeutic benefit and found the treatment rationales highly credible. Participants in each condition received 12 treatment sessions on a twice-per-week basis. Based on daily HA diary data gathered for 4 weeks prior to treatment and 4 weeks after treatment, HA Index was significantly (p=.003) reduced as was HA medication consumption. There were no differential reducations in HA Index or Medication Index among the four conditions. Global self-reports of improvement gathered at the end of the post-treatment monitoring period also did not differ among the four conditions. We were unable to demonstrate a specific effect of TBF for hand warming on vascular HA activity.     

Metabolism of subtoxic level of selenite by double-perfused small intestine in rats

Intestinal metabolism of the subtoxic level of selenite in rats was investigated using a double-perfusion system, which is an in situ, in vitro preparation in which the intestinal lumen and its vasculature are perfused simultaneously. The toxicity of sodium selenite was determined by inhibition of 3-O-methyl glucose (3MG) absorption and by histological examination. Levels of 1.2 mM selenite were required to significantly (p<0.05) reduce 3MG intestinal absorption (58±11%, mean±SD). Cation-exchange chromatography was used to determine the chemical forms of Se from selenite after using luminal concentrations of 1–200 μM in vascular perfusates. The chemical forms were selenite, selenodiglutathione (GS-Se-SG), mixed selenoglutathione plus cysteine (GS-Se-CYS), selenodicysteine (CYS-Se-CYS), protein-bound Se, and unidentified selenocompounds. Selenite was the predominant selenocompound found in vascular perfusate, but protein-bound Se was the predominant metabolite from selenite present in the vascular effuents. There was a corresponding increase of all metabolites with increased levels of selenite with time of absorption, but not with increased concentration of luminal selenite.     

Energy metabolism in relation to oxygen partial pressure in human skeletal muscle during exercise.

1. The intramuscular oxygen partial pressure (pO2) in human gastrocnemius muscle was monitored during exercise and compared with metabolite concentrations reflecting the energy and the redox state in the tissue. Ten normal subjects and ten patients with peripheral vascular occlusive disease were investigated. 2. In normal subjects the pO2 at the end of exercise was related to the intensity of the exercise, expressed as effect (J/s) per contraction. 3. In both patients and normal subject the pO2 was related to the [ATP]/[ADP] ratio, the [lactate/[pyruvate] ratio and the phosphocreatine concentration in the muscle tissue at rest and during exercise. 4. At each pO2 value, a lower [lactate/[pyruvate] ratio was found in the muscle tissue of the patients compared with that of normal subjects. This was interpreted as a beneficial effect of the higher oxidative-enzyme capacity in the muscle of the patients. 5. The results show the importance of pO2 for the regulation of the energy and the redox state of the tissue. During exercise the changes induced in pO2 and thus the energy state will stimulate the respiratory rate. This might be an important link in triggering the oxidative-enzyme capacity in response to physical training as well as in peripheral vascular occlusive disease.     

BMI and headache among women: results from 11 epidemiologic datasets

Objective: To evaluate the association between BMI (kg/m²) and headaches among women. Methods and Procedures: Cross‐sectional analysis of 11 datasets identified after searching for all large publicly available epidemiologic cohort study datasets containing relevant variables. Datasets included National Health Interview Survey (NHIS): 1997–2003, the first National Health Examination and Nutrition Survey, Alameda County Health Study (ACHS), Tecumseh Community Health Study (TCHS), and Women's Health Initiative (WHI). The women (220,370 in total) were aged 18 years or older and had reported their headache or migraine status. Results: Using nonlinear regression techniques and models adjusted for age, race, and smoking, we found that increased BMI was generally associated with increased likelihood of headache or severe headache among women. A BMI of ～20 was associated with the lowest risk of headache. Relative to a BMI of 20, mild obesity (BMI of 30) was associated with roughly a 35% increase in the odds for experiencing headache whereas severe obesity (BMI of 40) was associated with roughly an 80% increase in odds. Results were essentially unchanged when models were further adjusted for socioeconomic variables, alcohol consumption, and hypertension. Being diagnosed with migraine showed no association with BMI. Discussion: Among US women, a BMI of ～20 (about the 5th percentile) was associated with the lowest likelihood of headache. Consistently across studies, obese women had significantly increased risk for headache. By contrast, the risk for diagnosed migraine headache per se was not obviously related to BMI. The direction of causation and mechanisms of action remain to be determined.     

Predicting the leakage performance of bodyworn disposable incontinence pads using laboratory tests

An international multi-centre project (The ISO Pad Leakage Project) was conducted to study the leakage performance of large bodyworn incontinence pads for heavily incontinent users and to create international standards for measuring their absorption capacities in the laboratory. This was achieved by recruiting 13 user test centres through which over 100 incontinent subjects tested each of six different products (each in three different sizes) for a period of about a week to a common protocol. Over 10 000 used pads were collected and weighed and the severity of leakage from each of them recorded. Correlations were sought between these data and the results from some 50 technical tests performed in a total of 16 technical test centres in order to discover the impact of different technical parameters on clinical pad performance. It was found that at low urine weights (less than 50 g, say) pad shaping was the most important predictor of pad leakage performance: shaped pads leaked less. With increasing urine weight, absorption capacity and absorption time increased in importance until at 350 g of urine these two parameters and shaping were of about equal significance: shaped pads with high absorption capacity and fast absorption time leaked least. A second series of analyses identified two absorption capacity tests which produced data correlating well with the overall leakage performance of pads, considering all urine weights together. Both tests were checked for repeatability (precision within laboratories) and reproducibility (precision between laboratories) and have been written up as working draft standards. In due course, either or both of them should be adopted as International Standards for measuring the absorption capacity of pads for heavily incontinent users. A second, similar project (ISO Pad Leakage Project 2) has begun. It focuses on small pads for lightly incontinent ambulatory women.     

Classification and Clinical Features of Headache Disorders in Pakistan: A Retrospective Review of Clinical Data

Background

Morbidity associated with primary headache disorders is a major public health problem with an overall prevalence of 46%. Tension-type headache and migraine are the two most prevalent causes. However, headache has not been sufficiently studied as a cause of morbidity in the developing world. Literature on prevalence and classification of these disorders in South Asia is scarce. The aim of this study is to describe the classification and clinical features of headache patients who seek medical advice in Pakistan.

Methods and Results

Medical records of 255 consecutive patients who presented to a headache clinic at a tertiary care hospital were reviewed. Demographic details, onset and lifetime duration of illness, pattern of headache, associated features and family history were recorded. International Classification of Headache Disorders version 2 was applied.66% of all patients were women and 81% of them were between 16 and 49 years of age. Migraine was the most common disorder (206 patients) followed by tension-type headache (58 patients), medication-overuse headache (6 patients) and cluster headache (4 patients). Chronic daily headache was seen in 99 patients. Patients with tension-type headache suffered from more frequent episodes of headache than patients with migraine (p<0.001). Duration of each headache episode was higher in women with menstrually related migraine (p = 0.015). Median age at presentation and at onset was lower in patients with migraine who reported a first-degree family history of the disease (p = 0.003 and p<0.001 respectively).

Conclusions/Significance

Patients who seek medical advice for headache in Pakistan are usually in their most productive ages. Migraine and tension-type headache are the most common clinical presentations of headache. Onset of migraine is earlier in patients with first-degree family history. Menstrually related migraine affects women with headache episodes of longer duration than other patients and it warrants special therapeutic consideration. Follow-up studies to describe epidemiology and burden of headache in Pakistan are needed.     

A positive response of ginger root zone and rhizome development to suitable sowing depth

Sowing depth significantly affects ginger (Zingiber officinale Roscoe) yields, and sowing depth can affect rhizosphere community structure through root exudates. However, the relationship between the reaction process in root zone and ginger rhizome development is unclear. In this study, we investigated the rhizome and root development and rhizosphere environment at different sowing depths (2 cm (SD2), 5 cm (SD5), and 10 cm (SD10)). It was found that SD10 significantly increased ginger yield, which is related to the development of vascular bundles and the expression of aquaporin. PLS-PM analysis found that root length, root absorption capacity, and soil enzymes have the strongest correlation with yield, while root diameter is negatively correlated with yield. Under SD10, the increase of auxin and ethylene content together with the expression of ARF7, LBD16, and PIN1 promoted the development of lateral roots. In addition, SD10 increased the secretion of root organic acids, amino acids, and carbohydrates, which in turn promoted the development of rhizosphere bacteria. The promotion of SD10 on nitrogen cycle and nitrogen fixation ability in turn promoted the development of ginger.

     

Observations in five cases of spontaneous cerebellar hemorrhage

Five cases of spontaneous intracerebellar hemorrhage are reported. Three had a vascular malformation and two had mild hypertension. The presenting symptom was sudden headache followed by nausea and vomiting. Signs of brain stem dysfunction without prominent cerebellar deficit were the commonest feature. Meningeal involvement was present in the majority of cases. Unsuspected sudden death can occur. It is suggested that patients below the age of 30 who present with sudden headache followed by brain stem dysfunction with or without a subarachnoid hemorrhage, and patients over the age of 45 who present this picture along with subarachnoid hemorrhage should be investigated urgently with contrast studies for possible cerebellar hemorrhage.     

Resistance and capacity function of blood vessels of the brain during activation of its cholinergic mechanisms]

Blood from the cat donor was perfused into the haemodynamically isolated cat brain. The changes of the vascular resistance and their capacity during the pharmacological activity of the endogenic cholinergic mechanism on the introduction of phosphacol into the bloodstream were investigated. Research has shown that the reduction of the activity of cholinergics leads to a decrease in pressure in the arteries of the brain and to an increase of the intercellular fluid absorption, caused by the neurogenic cholinergic influences. The possibility of a mediator realisation of the cholinergic influences on the brain vessels is discussed.     

Influence of pulmonary embolism on absorption of inhaled iodide-125

To evaluate the influence of embolus size on the absorption of 125I- deposited on the bronchoalveolar surface, we exposed isolated perfused rabbit lungs to an aerosol containing 125I- for 5 min. We monitored the blood radioactivity for the subsequent 2 h. Several groups of lungs were studied, including those in which blood flow was varied and those in which enough glass beads ranging in size from 58 to 548 micron were injected into the pulmonary artery to approximately double the vascular resistance. The results indicated that under control conditions approximately 94% of the 125I- deposited on the intrapulmonary bronchoalveolar surface was able to reach the pulmonary circulation during the 2-h perfusion period, and the bronchoalveolar surface was sufficiently perfused so that absorption was limited by the rate of diffusion into the blood rather than the rate of blood flow. In the absence of embolization, the initial absorption rate was approximately 10.4%/min regardless of the total flow rate. The 58-micron beads reduced the rate to approximately 7.5%/min, whereas the beads greater than or equal to 194 micron in diameter reduced the rate to approximately 4.5%/min. Thus the effect of the embolization on the absorption rate was directly related to the bead diameter, even though the number of beads injected was adjusted to produce about the same increase in vascular resistance.     

Toxicology of the prostaglandins

Available published material of adverse reactions to prostaglandins (PGs) at various dosages routes and levels is reviewed. Animal studies are of 2 kinds: studies of pharmacological effects and studies of toxicological reactions (i.e., acute dose levels). The pharmacology of PGs show the drugs have 3 areas of action: 1) smooth muscle effects, either contraction or relaxation (cardiovascular effects and reproductive tract; relaxation of vascular smooth muscles by some PGs and contraction by others); 2) nervous system effects; and 3) lipid and carbohydrate metabolism. In humans, PGE1 was administered intravenously and it was found that adverse effects were related to rate of administration rather than to total dose; side effects included flushing, headache, visual disturbances, and restlessness, factors which might suggest a correlation with central nervous system effects (as found in animal studies). PGE1 administered at acute doses orally, by inhalation, and intradermally show effects attributable to gastrointestinal disturbances, respiratory problems, and erythematous responses. In general, studies in humans of other PGs have found similar adverse reactions, all of which are explained by known mechanisms of action of PGs. Dose levels constituting acutity are dependent on route (i.e., oral doses are much higher than intravenous doses), with rapid intravenous infusion causing the most adverse reactions.     

Kinetics of uptake and release of Cd by potato tissue

Abstract. The absorption of Cd by potato tissue was studied. No enhancement of the absorption capacity for Cd was observed by storage of the sliced potato tissue in aerated doubly distilled water for a period of 48 h. Cd absorption as a function of the external Cd concentration followed a typical hyperbolic isotherm. A two-phase uptake process for the absorption of Cd was found: a rapid initial phase terminating after 30 min, was followed by a slower phase with a constant rate. Efflux, studied by means of compartmental analysis, of Cd showed three phases. The two first were shown to be extracellular in origin. The third phase, involving Cd remaining in the discs after efflux, probably involved Cd in different forms. Metabolic processes, however, did not seem to contribute to this phase.     

Study of platelet function by quantitative determination of the fluorescence intensity of 5HT-organelles

Assay of the fluorescence intensity of 5HT-organelles was performed to examine the functional properties of platelets from patients with meningococcal infection. Platelets were found to have a higher capacity for endocytosis at the height of the disease, tending to its normalization with treatment and convalescence. Incubation of donor's plasma rich in platelets with meningococcal lipopolysaccharide was discovered to lead to an appreciable increase in the absorption capacity of platelets. It is suggested that endotoxinemia is one of the factors responsible for the impairment of platelet function.     

Constructal Law of Vascular Trees for Facilitation of Flow

Diverse tree structures such as blood vessels, branches of a tree and river basins exist in nature. The constructal law states that the evolution of flow structures in nature has a tendency to facilitate flow. This study suggests a theoretical basis for evaluation of flow facilitation within vascular structure from the perspective of evolution. A novel evolution parameter (Ev) is proposed to quantify the flow capacity of vascular structures. Ev is defined as the ratio of the flow conductance of an evolving structure (configuration with imperfection) to the flow conductance of structure with least imperfection. Attaining higher Ev enables the structure to expedite flow circulation with less energy dissipation. For both Newtonian and non-Newtonian fluids, the evolution parameter was developed as a function of geometrical shape factors in laminar and turbulent fully developed flows. It was found that the non-Newtonian or Newtonian behavior of fluid as well as flow behavior such as laminar or turbulent behavior affects the evolution parameter. Using measured vascular morphometric data of various organs and species, the evolution parameter was calculated. The evolution parameter of the tree structures in biological systems was found to be in the range of 0.95 to 1. The conclusion is that various organs in various species have high capacity to facilitate flow within their respective vascular structures.     

Weekly headache periodicity and the effect of weather changes on headache

A weekly periodicity in the occurrence of headache was found in 53 patients with migraine and in 20 with tension headache during an observation period of four weeks. In the migraine group the frequency was highest on Thursday and on Saturday and lowest on Sunday–Monday, and in patients with tension headache it was lowest on Sunday–Tuesday and highest on Friday. During the observation period several climatic factors were recorded. After correction for the weekly periodicity a highly significant correlation was found in the migraine group between headache frequency, on the one hand, and atmospheric pressure and outdoor temperature recorded 1–3 days later, on the other.