Myofascial trigger points in migraine and tension-type headache

Abstract Background A myofascial trigger point is defined as a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. It has been suggested that myofascial trigger points take part in chronic pain conditions including primary headache disorders. The aim of this narrative review is to present an overview of the current imaging modalities used for the detection of myofascial trigger points and to review studies of myofascial trigger points in migraine and tension-type headache. Findings Different modalities have been used to assess myofascial trigger points including ultrasound, microdialysis, electromyography, infrared thermography, and magnetic resonance imaging. Ultrasound is the most promising of these modalities and may be used to identify MTrPs if specific methods are used, but there is no precise description of a gold standard using these techniques, and they have yet to be evaluated in headache patients. Active myofascial trigger points are prevalent in migraine patients. Manual palpation can trigger migraine attacks. All intervention studies aiming at trigger points are positive, but this needs to be further verified in placebo-controlled environments. These findings may imply a causal bottom-up association, but studies of migraine patients with comorbid fibromyalgia syndrome suggest otherwise. Whether myofascial trigger points contribute to an increased migraine burden in terms of frequency and intensity is unclear. Active myofascial trigger points are prevalent in tension-type headache coherent with the hypothesis that peripheral mechanisms are involved in the pathophysiology of this headache disorder. Active myofascial trigger points in pericranial muscles in tension-type headache patients are correlated with generalized lower pain pressure thresholds indicating they may contribute to a central sensitization. However, the number of active myofascial trigger points is higher in adults compared with adolescents regardless of no significant association with headache parameters. This suggests myofascial trigger points are accumulated over time as a consequence of TTH rather than contributing to the pathophysiology. Conclusions Myofascial trigger points are prevalent in both migraine and tension-type headache, but the role they play in the pathophysiology of each disorder and to which degree is unclarified. In the future, ultrasound elastography may be an acceptable diagnostic test

Circulating Glucagon 1-61 Regulates Blood Glucose by Increasing Insulin Secretion and Hepatic Glucose Production

Glucagon is secreted from pancreatic a cells, and hypersecretion (hyperglucagonemia) contributes to diabetic hyperglycemia. Molecular heterogeneity in hyperglucagonemia is poorly investigated. By screening human plasma using high-resolution-proteomics, we identified several glucagon variants, among which proglucagon 1-61 (PG 1-61) appears to be the most abundant form. PG 1-61 is secreted in subjects with obesity, both before and after gastric bypass surgery, with protein and fat as the main drivers for secretion before surgery, but glucose after. Studies in hepatocytes and in b cells demonstrated that PG 1-61 dose-dependently increases levels of cAMP, through the glucagon receptor, and increases insulin secretion and protein levels of enzymes regulating glycogenolysis and gluconeogenesis. In rats, PG 1-61 increases blood glucose and plasma insulin and decreases plasma levels of amino acids in vivo. We conclude that glucagon variants, such as PG 1-61, may contribute to glucose regulation by stimulating hepatic glucose production and insulin secretion

The 6-minute walk test as a pre-treatment predictor for adverse events in patients with lung cancer

Background Clinicians worldwide use the Eastern Cooperative Oncology Group Performance Score (PS) to evaluate the patient’s suitability to the appropriate anti-neoplastic treatment. The scale is outdated and can be in uenced by the doctor’s professional experience, interactions between patient and doctor, and the patient’s socioeconomic position. An over- or underestimation of PS has potentially fatal outcomes for the patients who either may not receive life prolonging treatment due to underestimation or experience unreasonable and potentially fatal complications due to overestimation. To our knowledge, no areas of specializations, other than oncology, are basing comprehensive medical decisions on subjective measures. Aim To investigate the feasibility of a 6MWT to predict complications to rst-line treatment. Material and methods Patients with small cell lung cancer (limited disease and extensive disease), or non- small lung cancer (NSCLC) stage I-IV were recruited. Patients were excluded if they had received anti-neoplastic treatment within ve years, had other cancer diagnoses (including mesothelioma), or if they were not ambulatory. The patients were tested with the 6-minute walk test (6MWT) close to the time of the diagnosis. Complications to rst-line treatment were collected with standardized guidelines and analyzed. Results The acceptance rate was 46.7 % (21/45 patients included). All patients were diagnosed with NSCLC (stages I and II: n=5, stage III: n=9, and stage IV: n=4). Response to rst-line treatment were categorized into no, minor and major complications. The patients with no complications walked 530 m ± 68 m, those with minor complications walked 436 m ± 61 m. and those with major complications walked 360 m ± 136 m. (p=0.043). PS did not re ect similar association (p=0.312), and several of the patients experiencing minor and major complications to the treatment were estimated in PS0. Conclusion The results from the present feasibility study shows that the 6MWT is feasible in newly diagnosed patients with lung cancer and shows statistical trends toward the 6MWTs ability to predict complications to rst-line treatment that should be investigated in a larger homogenous trial