Hair analysis for detection of triptans occasionally used or overused by migraine patients-a pilot study

Purpose The aim of this study is to evaluate the detection rate of almotriptan, eletriptan, frovatriptan, sumatriptan, rizatriptan, and zolmitriptan in the hair of migraineurs taking these drugs; the degree of agreement between type of self-reported triptan and triptan found in hair; if the concentrations in hair were related to the reported cumulative doses of triptans; and whether hair analysis was able to distinguish occasional use from the overuse of these drugs. Methods Out of 300 headache patients consecutively enrolled, we included 147 migraine patients who reported to have taken at least one dose of one triptan in the previous 3 months; 51 % of the patients overused triptans. A detailed pharmacological history and a sample of hair were collected for each patient. Hair samples were analyzed by liquid chromatography-electrospray tandem mass spectrometry (LC-MS/MS) by a method that we developed. Results All the triptans could be detected in the hair of the patients. The agreement between type of self-reported triptan and type of triptan found in hair was from fair to good for frovatriptan and zolmitriptan and excellent for almotriptan, eletriptan, sumatriptan, and rizatriptan (P < 0.01, Cohen’s kappa). The correlation between the reported quantities of triptan and hair concentrations was statistically significant for almotriptan, eletriptan, rizatriptan, and sumatriptan (P < 0.01, Spearman’ s rank correlation coefficient). The accuracy of hair analysis in distinguishing occasionally users from overusers was high for almotriptan (ROC AUC = 0.9092), eletriptan (ROC AUC = 0.8721), rizatriptan (ROC AUC = 0.9724), and sumatriptan (ROC AUC = 0.9583). Conclusions Hair analysis can be a valuable system to discriminate occasional use from triptan overuse

Manual therapy for chronic migraine: a pragmatic randomised controlled trial study protocol

Introduction Chronic migraine is a largely refractory condition affecting between 1 and 2.2% of the overall population worldwide, with females more affected than males. There are also high health and socioeconomic costs associated both for the individual and society. The mainstay of chronic migraine management is pharmacological, but the options available have limited efficacy and there are often unwanted side effects. There is some evidence for manual therapy as a treatment option for migraine, but its effectiveness for chronic migraine is unknown. Therefore, we have designed a pragmatic randomised control trial to investigate whether adding manual therapy to the tertiary specialist treatment of chronic migraine improves patient-reported outcomes. Methods A pragmatic, randomised controlled trial in a hospital tertiary headache clinic. Participants will be randomised into one of two groups: treatment as usual or treatment as usual plus manual therapy. The primary outcome measure will be a change in the Headache Impact Test score. Secondary outcomes will also be measured over the 12-week study period including changes in headache frequency, migraine specific quality of life and reductions in relevant medicine consumption. The manual therapy group will have five treatment sessions each lasting 30 min. The recruitment target of 64 participants will allow power at 80% with p = 0.05 using minimal clinical difference for Headache Impact Test of 3.7 and includes provision for a 10% dropout rate. Recruitment will take place between August 2018 and February 2019. The results will form part of a doctoral study and be published in peer-reviewed journals and presented at national/international conferences. Discussion Current pharmacological approaches have limited effects in the management of chronic migraine and there is a requirement to improve treatment options and reduce the health and economic burden of the condition. Manual therapy has been shown to be effective in other chronic pain conditions as well as other primary headaches. This study will explore the effectiveness of manual therapy as an adjunctive approach to the management of chronic migraine. Trial registration The trial has received a favourable opinion from the UK Health Research Authority (IRAS 228901) and is registered at ClinicalTrials.gov.number NCT03395457. Registered 1st March 2018

Analisi di nodi trave-pilastro in calcestruzzo armato soggetti ad azioni cicliche.

È ormai generalmente riconosciuto che i nodi trave-pilastro costituiscono una regione critica nelle strutture a telaio in c.a. soggette ad azioni sismiche di notevole intensità. Il comportamento del nodo influenza significativamente la risposta dell’intero sistema strutturale in termini sia di deformabilità che di resistenza, in particolare nel caso di nodi esterni di telai progettati per soli carichi gravitazionali. In questa memoria viene presentato un modello per componenti in grado di descrivere il comportamento di tale tipologia di nodi. Il modello permette di considerare separatamente la deformazione a taglio del nodo e le rotazioni delle sezioni di interfaccia trave-pilastro legate alla perdita di aderenza delle barre d’armatura nel nodo. Il modello proposto può costituire una semplice alternativa ai più complessi Multi Spring Models presentati in letteratura che, pur rappresentando adeguatamente il comportamento non lineare del nodo, presentano difficoltà intrinseche connesse alla definizione di alcuni parametri. Nella prima parte del lavoro sono presentati i metodi adottati per la stima della resistenza e della rigidezza dei nodi usati per calibrare le diverse componenti del modello. Il modello per componenti viene, infine, validato attraverso il confronto con i risultati sperimentali di una prova ciclica su un nodo esterno, presente in letteratura

A model for beam–column corner joints of existing RC frame subjected to cyclic loading

Beam-to-column joints are commonly considered critic regions for RC frames subjected to earthquake actions. When designed for gravity loads only, beam-to-column corner joints strongly affect the global structural behaviour of a frame, and they can be cause of its collapse, as shown by recent earthquakes in Europe. In the paper, a component-based f.e. model for external beam-to-column joints is presented to simulate the seismic behaviour of r.c. existing structures designed without any capacity design criteria (smooth bars with hooked-end anchorages and with no transverse reinforcements in the joint). The joint deformation is modelled by means of two separate contributions, the shear deformation of the panel zone, and the rotation at the interface sections between the joint and the structural members, due to the reinforcing bars' slip within the joint core. The work focuses on the evaluation of the joint strength and stiffness, and it points out the importance of modelling the bar bond slip within the panel zone to describe the actual frame response. The component-based f.e. model is validated by experimental results of tests on beam-to-column corner joints realized according to the construction practice of the 1960s-1970s in Italy, thus confirming the effectiveness of the presented model for the assessment of existing structures

Modelling of exterior beam to column joint in ’60-70s RC existing buildings

Beam-to-column joints are commonly considered critic regions for r.c. frames subjected to high-magnitude earthquakes. When designed for gravity loads only, beam-to-column corner joints can not on- ly strongly affect the global structural behaviour of a frame, but also be a cause of its collapse. In the paper a component-based f.e. model of external beam-to-column joints is presented. The joint deformation is mod- elled by means of two unrelated contributions, the shear deformation of the panel zone, and the rotation at the interface sections between the joint and the structural members, due to the reinforcing bars’slip within the joint core. The first part of this work focuses on the evaluation of the joint strength and stiffness. Finally, the component-based f.e. model is validated by experimental results of tests on beam-column corner joint realized according the construction practice of the 60’s-70’s, confirming the effectiveness of the presented model for the assessment of existing structures