Migraine and sleep disorders: a systematic review

Migraine and sleep disorders are common and often burdensome chronic conditions with a high prevalence in the general population, and with considerable socio-economic impact and costs. The existence of a relationship between migraine and sleep disorders has been recognized from centuries by clinicians and epidemiological studies. Nevertheless, the exact nature of this association, the underlying mechanisms and interactions are complex and not completely understood. Recent biochemical and functional imaging studies identified central nervous system structures and neurotransmitters involved in the pathophysiology of migraine and also important for the regulation of normal sleep architecture, suggesting a possible causative role, in the pathogenesis of both disorders, of a dysregulation in these common nervous system pathways. This systematic review summarizes the existing data on migraine and sleep disorders with the aim to evaluate the existence of a causal relationship and to assess the presence of influencing factors. The identification of specific sleep disorders associated with migraine should induce clinicians to systematically assess their presence in migraine patients and to adopt combined treatment strategies

Содержание фенольных соединений в листьях Platanthera bifolia из естественной и трансформированных экосистем на разных стадиях развития орхидеи

The representatives of the family Orchidaceae Juss. are often used as a source of natural antioxidants, including phenolic compounds, which play an important role in plant resistance under stressful conditions. This study investigates the content of lipid peroxidation products and soluble phenolic compounds in flowering plants of Platanthera bifolia (L.) Rich. growing in natural (forest park) and transformed (fly ash dumps of Thermal Power Stations) ecosystems of the Middle Urals, Russia, as well as the content of flavonoids at different stages of orchid development. Research has shown that in disturbed habitats, P. bifolia is capable of forming abundant populations containing a significant portion of the flowering plants. Additionally, flowering orchids from fly ash dumps contained an average 20 % more lipid peroxidation products, which indicated a shift in the redox balance towards oxidative processes. An increase by 2.4 times on average in the content of phenolic compounds, particularly flavonoids, was observed at all developmental stages of the plants growing in the transformed ecosystems. Regardless of the growing conditions, the non-flowering mature individuals were characterized by a minimum content of flavonoids, probably due to pre-generative metabolic restructuring. Yet, in the period of orchid blooming, the flavonoid content in their leaves increased again in all study sites. At the same time, the flavonoid proportion of the total soluble phenolic compounds was 42 % in the natural habitat, increasing to 66 % on average in the transformed ecosystems. Thus, flavonoids are involved in the protective adaptive responses of P. bifolia, not only ensuring the survival of this orchid but also contributing to the implementation of its ontogenetic program. © Siberian Federal University. All rights reserved.Acknowledgments. The reported study was partly funded by RFBR and the Government of the Sverdlovsk Region, project number 20-44-660011 and the Ministry of Science and Higher Education of the Russian Federation as part of State Task of the Ural Federal University, FEUZ-2020-0057. The authors are grateful to the reviewers, DSc Pozolotina V.N. (Institute of Plant and Animal Ecology Ural Branch of the RAS, Ekaterinburg) and DSc Dymova O.V. (Institute of Biology of Komi Scientific Centre of the Ural Branch of RAS, Syktyvkar) for valuable comments that helped improve this paper and to Dr. Tripti (Ural Federal University, Ekaterinburg, Russia) for editing of the English language

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

DISCREPANCIES OF BORDER TOURISM IN THE EAST OF RUSSIA

Relevance of the study of the development of tourism in the regions of the eastern part of the country is due to its high potential for environmentally friendly diversification of the economy of these territories experiencing significant environmental pressure due to natural resource orientation. High environmental quality is a condition for the sustainable development of this sector; it creates an additional economic motivation of the business community for its preservation, which corresponds to the basic principles of ecological economics. Purpose of the work is to obtain quantitative estimates of the influence of various factors on the economic results within the tourism sector related to the income of collective accommodation facilities (CAF). Methodology. To estimate the influence of various factors on the dynamics of economic indicators, linear regression analysis was used using the STATA software resources. Results obtained have revealed a number of positive trends in the development of the tourism sector in eastern Russia, despite significant external shocks after 2014. In all regions, the income of CAF increases adjusted to the index of the physical quantity of services paid to the population. Deductions to the budgetary system of the Russian Federation are growing everywhere, except for the Trans-Baikal Territory (here they decreased), while the total number of tourists increased slightly from 2009 to 2016. At the same time, a number of controversial trends were revealed that require the attention of public authorities responsible for the strategy of regional development. The results show that non-tourist activities bring a high income share for CAF in most of the regions examined, despite the increase in tourist flows in the east of the country. In recent years, the number of Chinese tourists in the territory of Lake Baikal is growing rapidly. Conclusions. The authors believe that on the basis of the obtained results there are enough grounds for the assumption about the growing share of shadow turnover in the tourism sector and, accordingly, for the urgent development of measures to counter these trends

Sharp Markov-Nikol'skii inequality with respect to the uniform norm and the integral norm with Chebyshev weight

We study the inequality between the uniform norm of the derivative of an algebraic polynomial of degree n and the integral norm of this polynomial with Chebyshev weight on a closed interval. We found exact constants and extremal polynomials for derivatives of any order. © 2014 Elsevier Inc.The authors would like to thank the referees for reading the paper carefully and valuable comments. This work was supported by the Program for State Support of Leading Universities of the Russian Federation (agreement no. 02.A03.21.0006 of August 27, 2013)