Great occipital nerve long-acting steroid injections in cluster headache therapy: an observational prospective study

Background: Injections targeting the occipital nerve are used to reduce headache attacks and abort cluster bouts in cluster headache patients. There is no widely accepted agreement over the optimal technique of injection, type and doses of steroids and/or anesthetics to use, as well as injection regimens. The aim of this study was to verify the effectiveness and safety of greater occipital nerve long-acting steroid injections in the management of episodic and chronic cluster headache. Methods: We conducted a prospective observational cohort study on episodic (ECH) and chronic cluster headache patients (CCH). ECH were included in the study at the beginning of a cluster period. Three injections with 60 mg methylprednisolone were performed on alternate days. We registered the frequency and intensity of attacks three days before and 3, 7 and 30 days after the treatment, the latency of cluster relapse, adverse events, scores evaluating anxiety (Zung scale), depression (Beck’s Depression Scale) and quality of life (Disability Assessment Schedule II, 12-Item Self-Administered Version). Primary outcome was the interruption of the cluster after the three injections. Responders conducted a follow-up period of 12 months. Results: We enrolled 60 patients, 47 with ECH and 13 with CCH. We observed a complete response in 47.8% (22/46) of episodic and 33.3% (4/12) of chronic patients. Moreover, a partial response (reduction of at least 50% of attacks) was obtained in further 10.8% (5/46) of episodic and in 33.3% (4/12) of chronic patients at 1 month. Median pain-free period was of 3 months for CCH responders. Only mild adverse events were reported in 38.3% (23/58) cases. Conclusions: We suggest three greater occipital nerve injections of 60 mg methylprednisolone on alternate days as useful therapy in episodic and chronic cluster headache. This leads to a long pain-free period in chronic forms. Adverse effects are mild and support its use as first choice. Trial registration: The study was inserted in AIFA observational studies register

A real-world study on unmet medical needs in triptan-treated migraine: Prevalence, preventive therapies and triptan use modification from a large Italian population along two years

Although migraine is a disabling neurological condition that causes important disability, it remains an area of underdiagnosis and undertreatment worldwide. The aim of this study was to depict the burden of the unmet medical needs in migraine treated with triptans in a large Italian population

The inhibition of FGF receptor 1 activity mediates sorafenib-induced antiproliferative effects in human mesothelioma tumor-initiating cells

Tumor-initiating cells (TICs), the subset of cells within tumors endowed with stem-like features, being highly resistant to conventional cytotoxic drugs, are the major cause of tumor relapse. The identification of molecules able to target TICs remains a significant challenge in cancer therapy. Using TIC-enriched cultures (MM1, MM3 and MM4), from 3 human malignant pleural mesotheliomas (MPM), we tested the effects of sorafenib on cell survival and the intracellular mechanisms involved. Sorafenib inhibited cell-cycle progression in all the TIC cultures, but only in MM3 and MM4 cells this effect was associated with induction of apoptosis via the down-regulation of Mcl-1. Although sorafenib inhibits the activity of several tyrosine kinases, its effects are mainly ascribed to Raf inhibition. To investigate the mechanisms of sorafenib-mediated antiproliferative activity, TICs were treated with EGF or bFGF causing, in MM3 and MM4 cells, MEK, ERK1/2, Akt and STAT3 phosphorylation. These effects were significantly reduced by sorafenib in bFGF-treated cells, while a slight inhibition occurred after EGF stimulation, suggesting that sorafenib effects are mainly due to FGFR inhibition. Indeed, FGFR1 phosphorylation was inhibited by sorafenib. A different picture was observed in MM1 cells, which, releasing high levels of bFGF, showed an autocrine activation of FGFR1 and a constitutive phosphorylation/activation of MEK-ERK1/2. A powerful inhibitory response to sorafenib was observed in these cells, indirectly confirming the central role of sorafenib as FGFR inhibitor. These results suggest that bFGF signaling may impact antiproliferative response to sorafenib of MPM TICs, which is mainly mediated by a direct FGFR targeting

Influence of paper mill ashes on the properties of self-compacting concrete

Abstract Self compacting concrete (SCC) is characterized by a high workability that does not require any vibration to place it. Moreover, SCC must be stable during the placement and before setting in order to guarantee homogeneity and durability. The above performances can be obtained: 1) by decreasing the amount and size of the coarse aggregate; 2) by using a high volume of fines; 3) by the combined use of superplasticizer and viscosity modifying agent (VMA) in order to obtain high fluidity as well as high stability of the cement paste. Excessive amount of cement, dangerous for hydration heat, creep and shrinkage, can be avoided by using mineral additions. Some fine additions showing high specific surface area, such as silica fume or colloidal silica, are effective both as filler and viscosity improving agent. In this paper, SCCs containing ashes coming from the combustion of paper mill sludge as fine mineral addition were studied. In particular, workability and bleeding capacity of fresh mixtures, as well as compressive strength at different curing times of the hardened concrete, were examined. The paper mill ash (PMA) was used with two different rates and finenesses. When used without any preliminary grinding, no improvement in the concrete performance was observed since the high porosity penalizes the compressive strength and the moderate fineness (maximum size is about 240 µm, as received) does not improve the stability of the concrete mixture. The use of PMA seems to be effective for obtaining stable mixtures and avoiding VMA addition only after grinding, in order to significantly increase its fineness

Comportamento meccanico di calcestruzzi presollecitati con carichi ciclici di numero limitato

9° Convegno Nazionale AIMAT, Piano di Sorrento (NA), 29 giugno - 2 luglio 200