Primary headaches during the COVID-19 lockdown in Germany: analysis of data from 2325 patients using an electronic headache diary

Background Lockdown measures due to the COVID-19 pandemic have led to lifestyle changes, which in turn may have an impact on the course of headache disorders. We aimed to assess changes in primary headache characteristics and lifestyle factors during the COVID-19 lockdown in Germany using digital documentation in the mobile application (app) M-sense. Main body We analyzed data of smartphone users, who entered daily data in the app in the 28-day period before lockdown (baseline) and in the first 28 days of lockdown (observation period). This analysis included the change of monthly headache days (MHD) in the observation period compared to baseline. We also assessed changes in monthly migraine days (MMD), the use of acute medication, and pain intensity. In addition, we looked into the changes in sleep duration, sleep quality, energy level, mood, stress, and activity level. Outcomes were compared using paired t-tests. The analysis included data from 2325 app users. They reported 7.01 +/- SD 5.64 MHD during baseline and 6.89 +/- 5.47 MHD during lockdown without significant changes (p > 0.999). MMD, headache and migraine intensity neither showed any significant changes. Days with acute medication use were reduced from 4.50 +/- 3.88 in the baseline to 4.27 +/- 3.81 in the observation period (p < 0.001). The app users reported reduced stress levels, longer sleep duration, reduced activity levels, along with a better mood, and an improved energy level during the first lockdown month (p <= 0.001). In an extension analysis of users who continued to use M-sense every day for 3 months after initiation of lockdown, we compared the baseline and the subsequent months using repeated-measures ANOVA. In these 539 users, headache frequency did not change significantly neither (6.11 +/- 5.10 MHD before lockdown vs. 6.07 +/- 5.17 MHD in the third lockdown month, p = 0.688 in the ANOVA). Migraine frequency, headache and migraine intensity, and acute medication use were also not different during the entire observation period. Conclusion Despite slight changes in factors that contribute to the generation of headache, COVID-19-related lockdown measures did not seem to be associated with primary headache frequency and intensity over the course of 3 months

Validation of a Novel Methodology to Evaluate Changes in the Flare Geometry of Renovisceral Bridging Stent-Grafts After Fenestrated Endovascular Aneurysm Repair

Purpose: To validate a novel method to evaluate changes in the geometry of renovisceral bridging stent-grafts (BSGs) in patients undergoing fenestrated endovascular aneurysm repair (fEVAR). Materials and Methods: Retrospective analysis was conducted of serial computed tomography angiograms (CTAs) of 10 fEVAR patients (31 BSGs) with at least 2 years of CTA follow-up. Centerline reconstructions were made through the fenestrated stent-graft (FSG) and each BSG. Flare geometry was reconstructed based on marker coordinates and a mesh of the aortic lumen. The shortest distance was calculated from the top of the flare circumference to the FSG fabric. The amount of flaring was assessed with the flare to fenestration diameter ratio and BSG compression to diameter ratio (D-ratio). All measurements were performed by 2 observers. Interobserver variability was assessed; results are presented as the intraclass correlation coefficient (ICC) and repeatability coefficient (RC). Results: Excellent interobserver agreement was achieved for BSG diameter and flare to fenestration distance calculations (ICC 0.865 and 0.944; RC 2.2% and 4.5%, respectively). Six patients had BSG-related complications during follow-up: 2 type IIIc endoleaks and 4 BSG occlusions. Five of the 6 BSGs with complications showed a considerable change in the D-ratio compared with the first postoperative CTA. Conclusion: Precise assessment of the geometry of visceral BSGs in fEVAR is feasible with the presented method. Geometrical changes that may precede later complications can be detected, which could aid in localization of the origin, but a larger series of patients is necessary to define its true clinical merit

Haemodynamics in Different Flow Lumen Configurations of Customised Aortic Repair for Infrarenal Aortic Aneurysms

Objective: Customised aortic repair (CAR) is a new and minimally invasive technique for the endovascular treatment of abdominal aortic aneurysms (AAAs). The aneurysm is completely sealed with a non-contained, non-cross linked polymer, while a new flow lumen is created with balloons. For CAR, the haemodynamically most favourable balloon and flow lumen configuration has not been established before; therefore, four flow parameters were assessed in an in vitro model. Methods: Three in vitro balloon configurations were implanted in an in vitro AAA model; a configuration with crossing balloons (CC) and two parallel configurations (PC1 and PC2). These three models were consecutively placed in a flow system that mimics physiological flow conditions. Laser particle imaging velocimetry (PIV) was used to resolve spatial and temporal flow patterns during the cardiac cycle. In house built algorithms were used to analyse the PIV data for the computing of (i) flow velocity; (ii) vorticity; (iii) wall shear stress (WSS); and (iv) time averaged wall shear stress (TAWSS). Results: Suprarenal flow patterns were similar in all models. The CC showed a higher infrarenal velocity than PC1 and PC2 (38 cm/s vs. 23 cm/s vs. 23 cm/s), and a higher vorticity at the crossing of the lumens (CC: 337/s; PC1 127/s; PC2: 112/s). The lowest vorticity was observed in PC2, especially in the infrarenal neck (CC: 200/s; PC1 164/s; PC2: 98/s). Although WSS and TAWSS varied between configurations, values were the within non-pathological range. Conclusion: The flow lumens created by three balloon configurations used in an in vitro model of CAR have been studied, and resulted in different haemodynamics. The differences in velocity and lower vorticity, especially at the crossing section of the two balloons, showed that PC2 has favourable haemodynamics compared with the CC and PC1. Future research will be focused on the clinical applicability of CAR based on the PC2 design

Geometrical changes of stent graft configurations after complex endovascular surgery

An abdominal aortic aneurysm (AAA) is defined as a dilation of the abdominal aorta > 1.5 times the diameter of the non-dilated infrarenal aorta. Complex abdominal aortic aneurysm is defined as an aneurysm that involves the infrarenal abdominal aortic segment which extends up to, and sometimes includes, the renal artery origins. Complex AAAs account for approximately 15% of all AAAs. Surgery of AAA can be performed by open surgical repair (OSR) or endovascular aneurysm repair (EVAR). Several techniques, such as chimney-EVAR (ChEVAR), chimney-EVAS (ChEVAS) or fenestrated-EVAR (FEVAR) are used in the treatment of complex AAA. Still, not all potential causes of failure, especially during long term follow-up, for ChEVAR, ChEVAS and FEVAR are known, which complicates selecting the best treatment strategy for a specific patient. Identification, visualization and prediction of complications associated with these complex techniques have not yet been elaborated on a large scale so far. The overall focus of this thesis is recognition and detection of specific geometric changes of the anatomy and device configurations for ChEVAR, ChEVAS and FEVAR in the treatment of complex AAA in order to understand causes of failure. New software-based methodologies have been developed to identify gutters, component instability and geometrical changes of stent graft configurations. This thesis shows that changes in geometry after endovascular treatment of complex AAA are often subtle but may still lead to complications, based on in-vitro and in-vivo research. Understanding mechanisms behind potential modes of failure help identifying the best treatment strategy for a specific patient, but also the proper follow-up regime

Modelling, Control, and Handling Quality Analysis of the Flying-V

Over the last five decades, the majority of commercial aircraft consisted of the traditional tube-and-wing configuration. This traditional configuration is approaching a fuel efficiency asymptote. Besides that, with the increasing number of passengers and cargo transported by air every year, and environmental impact as an important factor in aircraft design, there is a necessity for a solution that is able to boost aircraft efficiency. Currently, the faculty of Aerospace Engineering at TU Delft is working on a promising aircraft configuration, namely the Flying-V. This is a specific type of flying wing that is tailless, V-shaped, and consists of two cylindrical pressurised cabins located in the leading edge of the wing. Wind tunnel experiments show that the aircraft is longitudinally statically stable up to an angle of attack of 20¶, after that pitch break occurs. Besides that, research performed on the aerodynamic coefficients obtained using the Vortex Lattice Method and results from the maiden flight test of a scale model of the aircraft conclude that the Dutch roll mode is unstable. Therefore, this research defines a set of key stability and handling quality requirements based on civil aviation authorities combined with military standards for cruise- and approach conditions. These key requirements are consequently assessed with a simulation model of the aircraft using aerodynamic coefficients obtained from the Vortex Lattice Method and wind tunnel experiments. In an attempt to make the key stability and handling quality characteristics of the TU Delft Flying-V adhere to the defined requirements, this thesis aims to contribute to this research field by designing a nonlinear Incremental Nonlinear Dynamic Inversion (INDI) flight control system that is applied to the simulation model of the aircraft. Finally, the performance of the aircraft using this flight control system is assessed and proposals for aerodynamic design changes and control layout design changes are given.Aerospace Engineerin

Hypocretin deficiency in narcoleptic humans is associated with abdominal obesity

OBJECTIVE: To determine the prevalence of obesity among patients with narcolepsy, to estimate associated long-term health risks on the basis of waist circumference, and to distinguish the impact of hypocretin deficiency from that of increased daytime sleepiness (i.e., reduced physical activity) on these anthropometric measures. RESEARCH METHODS AND PROCEDURES: A cross-sectional, case-control study was conducted. Patients with narcolepsy (n = 138) or idiopathic hypersomnia (IH) (n = 33) were included. Age-matched, healthy members of the Dutch population (Monitoring Project on Risk Factors for Chronic Diseases and Doetinchem Project; n = 10,526) were used as controls. BMI and waist circumference were determined. RESULTS: Obesity (BMI > or = 30 kg/m(2)) and overweight (BMI 25 to 30 kg/m(2)) occurred more often among narcolepsy patients [prevalence: 33% (narcoleptics) vs. 12.5% (controls) and 43% (narcoleptics) vs. 36% (controls), respectively; both p < 0.05]. Narcoleptics had a larger waist circumference (mean difference 5 +/- 1.4 cm, p < 0.001). The BMI of patients with IH was significantly lower than that of narcolepsy patients (25.6 +/- 3.6 vs. 28.5 +/- 5.4 kg/m(2); p = 0.004). DISCUSSION: Overweight and obesity occur frequently in patients with narcolepsy. Moreover, these patients have an increased waist circumference, indicating excess fat storage in abdominal depots. The fact that patients with IH had a lower BMI than narcoleptics supports the notion that excessive daytime sleepiness (i.e., inactivity) cannot account for excess body fat in narcoleptic patients

Determining the Evolution of Headache Among Regular Users of a Daily Electronic Diary via a Smartphone App: Observational Study

Background: Smartphone-based apps represent a major development in health care management. Specifically in headache care, the use of electronic headache diaries via apps has become increasingly popular. In contrast to the soaring volume of available data, scientific use of these data resources is sparse. Objective: In this analysis, we aimed to assess changes in headache and migraine frequency, headache and migraine intensity, and use of acute medication among people who showed daily use of the headache diary as implemented in the freely available basic version of the German commercial app, M-sense. Methods: The basic version of M-sense comprises an electronic headache diary, documentation of lifestyle factors with a possible impact on headaches, and evaluation of headache patterns. This analysis included all M-sense users who had entered data into the app on a daily basis for at least 7 months. Results: We analyzed data from 1545 users. Mean MHD decreased from 9.42 (SD 5.81) at baseline to 6.39 (SD 5.09) after 6 months (P<.001; 95% CI 2.80-3.25). MMD, AMD, and migraine intensity were also significantly reduced. Similar results were found in 985 users with episodic migraine and in 126 users with chronic migraine. Conclusions: Among regular users of an electronic headache diary, headache and migraine frequency, in addition to other headache characteristics, improved over time. The use of an electronic headache diary may support standard headache care