Frequency Of Attacks Research Articles

A preliminary study evaluating the response to greater occipital nerve (GON) blockage therapy in patients with vestibular migraine

We herein report the efficacy of greater occipital nerve (GON) blockage on headache and vertigo in patients with vestibular migraine (VM). VM is a clinical condition characterized by vestibular attacks associated with migrainous features. For the diagnosis, five episodes with vestibular symptoms of moderate or severe intensity, lasting 5 minutes to 72 hours are needed in an individual with a current or previous history of migraine.2 In addition, half of the vestibular symptoms require accompaniment of one or more migraine features, including migraine-like headache or photophobia, phonophobia, or visual aura. It has a prevalence of 2.7% in adults and is 1.5 to 5 times more common in women. GON blockage has been shown to be effective4 and superior to placebo5 in chronic migraine. Independently of medical treatment, GON blockage reduces the frequency, duration, and intensity of headache attacks, analgesic use, and improves patients’ quality of life.

Distributed denial of service attacks classification system using features selection and ensemble techniques

Distributed denial-of-service (DDoS) attacks are expanding threat to online services and websites. These attacks overwhelm targets with traffic from multiple sources to exhaust resources and make services unavailable. The frequency of DDoS attacks exhibits an ongoing upward trajectory over time. This persistent escalation highlights the need for effective countermeasures. While machine learning approaches have been extensively investigated for binary classification of DDoS attacks, multi-class classification has received comparatively less examination in the literature despite its greater practical utility. In this paper, we propose an intrusion detection system for detecting and classifying DDoS attacks, based on two main axes: feature selection for selecting the best relevant features and ensemble learning technique for improving performance by combining weak learners. The proposed model has been trained and evaluated on the CICDDoS2019 dataset. Experimental evaluation demonstrates improved performance using a subset of 16 relevant features identified, with a test accuracy of 82.35% attained for discriminating between the 12 classes represented in the dataset. By aggregating attacks sharing common characteristics resulting in 7 classes, the approach achieves surpassing 97% accuracy. Additionally, a binary classification delineating benign and DDoS attacks attain 99.90% accuracy.

Meta-analysis and trial sequential analysis of Shenshao Capsules in treatment of angina pectoris in coronary heart disease

The efficacy and safety of Shenshao Capsules in combination with conventional western medicine for the treatment of angina pectoris in coronary heart disease were systematically evaluated. Computer search of seven databases, including CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, and Cochrane Library, was conducted to identify randomized controlled trial(RCT) on Shenshao Capsules for the treatment of angina pectoris in coronary heart disease up to December 2023. According to inclusion and exclusion criteria, articles were screened, and data was extracted. Cochrane bias risk assessment tool 2.0(RoB 2.0) was used to evaluate the quality of the included articles. Meta-analysis was performed by RevMan 5.4 and Stata/SE 15.1 software, and evidence quality was rated by the GRADE system. TSA 0.9.5.10 beta software was used for the trial sequential analysis(TSA). Twelve RCTs, with a total of 1 128 participants(567 in the experimental group and 561 in the control group), were included. Meta-analysis showed that Shenshao Capsules + conventional western medicine significantly improved clinical efficacy(RR=1.20, 95%CI[1.15, 1.26], P<0.000 01) and electrocardiogram efficacy(RR=1.16, 95%CI[1.04, 1.30], P=0.01), reduced the frequency of weekly angina pectoris attacks(MD=-2.85, 95%CI[-5.27,-0.43], P=0.02), daily angina pectoris attacks(MD=-0.30, 95%CI[-0.57,-0.03], P=0.03) and the duration of angina pectoris attacks(RR=-2.28, 95%CI[-3.44,-1.12], P=0.000 1). There was no statistically significant difference in adverse reactions between the two groups(RR=1.33, 95%CI[0.71, 2.51], P=0.37). TSA indicated that the cumulative evidence for clinical efficacy exceeded the traditional boundary but did not exceed the TSA boundary, suggesting a potential false positive result. According to GRADE assessment, except for clinical efficacy, which was rated as low-quality evidence, the remaining outcomes were rated as very low-quality evidence. The results indicate that Shenshao Capsules + conventional western medicine may have certain advantages in improving clinical efficacy and electrocardiographic efficacy, reducing the frequency and duration of angina pectoris attacks. However, due to the limitations of this study, more rigorous and high-quality RCT is needed to validate its efficacy and safety.

Secure state estimation of networked switched systems under denial-of-service attacks

This paper studies the problem of secure state estimation of networked switched systems in the presence of denial-of-service (DoS) attacks, as well as disturbances and measurement noise. Firstly, a state transformation rule is designed to partition the original system into two subsystems, facilitating the design of discrete and continuous state observers. Secondly, by modifying the traditional super-twisting sliding-mode method and taking into account the frequency and duration characteristics of DoS attacks, we employ dynamic differential properties between different modes to design a switching law identification strategy. We show that this strategy can accurately estimate the switching state without imposing any requirement on the switching times and sequences. Thirdly, based on the identified activated mode, a set of mode-dependent continuous state sliding-mode observers is designed, that achieves continuous state estimation in finite time. The practicality and applicability of the developed results are validated through numerical simulations.

Comparison of clinic and demographic characteristics in vestibular migraine and migraine only patients

Background & Objective: The relationship between vertigo and migraine has been known for a long time. Many migraine patients are accompanied by vertigo. The term vestibular migraine (VM) is a clinical entity defined recently. Treatments for migraine only (MO) and VM patients differ partially. Therefore, it is essential to distinguish between these two clinical conditions. This study aims to reveal the clinical and demographic differences between MO and VM and determine the factors that will help diagnose and manage VM. Method: A total of 80 patients, 40 diagnosed with MO according to ICHD-3 and 40 diagnosed with VM, who applied to the Neurology clinic of a tertiary hospital between January and July 2023, were included in this prospective study. The patients’ ages, genders, education levels, medical and family history, migraine duration, migraine onset age, migraine attack frequency, and medication use were recorded. All patients completed a battery of questionnaires, including the Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6), Visual Analog Scale (VAS), World Health Organization Quality of Life-Bref (WHOQOL-BREF), Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence Scale (ABCS), and Beck Depression Inventory (BDI). Results: Patients with VM experienced significantly more sleep disturbances, depressive symptoms, movement disorders, imbalance, menstruation-related headaches, and aura compared to those with migraine MO. In contrast, MO patients reported more throbbing headaches and a better response to analgesics. Conclusion: MO and VM patients have distinct clinical characteristics. Recognizing these basic differences has important clinical benefits, allowing for precise diagnosis and treatment of VM.

Eating attitudes of migraine patients in Turkey: a prospective multi-center study

BackgroundMigraine is a disease characterized by headache attacks. The disease is multifactorial in etiology and genetic and environmental factors play role in pathogenesis. Migraine can also be accompanied by psychiatric disorders like neurotism and obsessive compulsive disorder. Stress, hormonal changes and certain food intake can trigger attacks in migraine. Previous studies showed that eating attitudes and disorders are prevalant in patients with migraine. Eating disorders are psychiatric disorders related to abnormal eating habits. Both migraine and eating disorders are common in young women and personality profiles of these patient groups are also similar. A possible relationship which shows that migraine and eating habits are related can lead to a better understanding of disease pathogenesis and subsequently new therapeutic options on both entities. Association of migraine in relation to severity, depression and anxiety and eating habits and disorders were aimed to be investigated in this study.MethodsThe study was designed as a prospective, multi-center, case control study. Twenty-one centers from Turkey was involved in the study. The gathered data was collected and evaluated at a single designated center. From a pool of 1200 migraine patients and 958 healthy control group, two groups as patient group and study group was created with PS matching method in relation to age, body-mass index, marital status and employment status. Eating Attitudes Test-26 (EAT-26), Beck’s Depression Inventory (BDI) and Beck’s Anxiety Inventory (BAI) were applied to both study groups. The data gathered was compared between two groups.ResultsEAT-26 scores and the requirement for referral to a psychiatrist due to symptoms related to eating disorder were both statistically significantly higher in patient group compared to control group (p = 0.034 and p = 0.0001 respectively). Patients with migraine had higher scores in both BDI and BAI compared to control group (p = 0.0001 and p = 0.0001 respectively). Severity of pain or frequency of attacks were not found to be related to eating attitudes (r:0.09, p = 0.055).ConclusionsMigraine patients were found to have higher EAT-26, BDI and BAI scores along with a higher rate of referral to a psychiatrist due to symptoms. Results of the study showed that eating habits are altered in migraine patients with higher risk of eating disorders. Depression and anxiety are also found to be common amongst migraine patients.

SSHAA: A Python Package Index for visualizing features of SSH attacks with text mining in classification

ABSTRACT With the proliferation of the Internet, the number of cyber-attacks has increased worldwide. To prevent cyber-attacks, network administrators need to use analytical tools to disclose six new critical statistics such as Internet Protocol (IP) authenticity and classification, IP ownership, frequency of attacks, time of day, day of the week, and country of attack. There are four SSH attack analysis tools available, but existing tools lack visualization and cannot provide the necessary attack statistics. This paper proposes SSHAA, the first open source PyPI analysis tool that meets the requirement. Text mining technology is used for extracting data from SSH log files, classifying IPs with identified country names and calculating a variety of statistics. PyPI allows SSHAA to run on Windows, MacOS, and Linux operating systems. This paper highlights how to debut a PyPI application using SSHAA which will be the world’s first tutorial in the security journals for maximum software dissemination. According to PePy, SSHAA has been downloaded 7668 times worldwide. The substantial number of downloads signifies the efficacy of the proposed tool. The proposed system offers ten functional statistics for SSH attack analysis. The six new functional statistics to information security are significant.

Research on Deployable Wings for MAVs Bioinspired by the Hind Wings of the Beetle Protaetia brevitarsis.

Deployable hind wings of beetles led to a bio-inspired idea to design deployable micro aerial vehicles (MAVs) to meet the requirement of miniaturization. In this paper, a bionic deployable wing (BD-W) model is designed based on the folding mechanism and elliptical wing vein structure of the Protaetia brevitarsis hindwing, and its structural static and aerodynamic characteristics are analyzed by using ANSYS Workbench. Finally, the 3D-printed bionic deployable wing was tested in a wind tunnel and compared with simulation experiments to explore the effects of different incoming velocity, flapping frequency, and angle of attack on its aerodynamic characteristics, which resulted in the optimal combination of the tested parameters, among which, the incoming velocity is 3 m/s, the flapping frequency is 10 Hz, the angle of attack is 15°, and the lift-to-drag ratio of this parameter combination is 4.91. The results provide a theoretical basis and technical reference for the further development of bionic flapping wing for MAV applications.

The Effect of Calcitonin Gene-Related Peptide Monoclonal Antibodies on Quality of Life among Migraine Patients: Pilot Study at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics.

Migraine has a negative impact on patients' quality of life, with the frequency of attacks being associated with greater disability and poorer health status. Frequent migraine-type headaches require prophylactic treatment, which has so far been of limited effectiveness until advent of calcitonin gene-related peptide (CGRP) monoclonal antibody. A prospective analysis was conducted of data from 41 migraine patients who experienced 4 or more monthly migraine days (MMD) longer than three months. At the beginning of the study, treatment with monoclonal antibodies against CGRP (fremanezumab 225 mg or erenumab 70 or 140 g per month) was prescribed according to the indications. The effect of the medications was evaluated after 3-month period. The mean age of patients was 37.17 (±11.78) years. It was found that 17 patients (41.5%) had episodic migraine (EM) and 24 (58.5%) had chronic migraine (CM). Fremanezumab was prescribed to 26 patients (63.4%) and erenumab to 15 patients (36.6%); among the latter, 13 patients used 70 mg/month and 2 patients used 140 mg/month. Three months after treatment, CM changed to EM for 19 patients (79.2%), 27 patients (65.9%) had ≥50% reduction in the number of MMD and total migraine disability assessment (MIDAS) score was reduced by >50% in 31 patients (75.6%). Also, all areas of quality of life of patients were improved after 3 months continued treatment compared to baseline. For more than half the patients using fremanezumab or erenumab after 3-month period, MMD decreased by ≥50% and total MIDAS score by >50 points. All areas of quality of life were improved after prophylactic treatment of migraine.

Real-world effectiveness, safety and immunogenicity of ocrelizumab in turkish multiple sclerosis patients: a single-center experience for 4-year follow-up.

The aim of this study was to evaluate postmarketing ocrelizumab safety and effectiveness in a real-world population with multiple sclerosis (MS) and matching these parameters among MS disease types. This was a retrospective, single-center study with MS patients treated with ocrelizumab. Demographic, clinical characteristics and immunological data were analyzed, including annualized relapse rate (ARR), relapse-free rate, Expanded Disability Status Scale (EDSS), complete blood count parameters, immunoglobulin (Ig) levels, liver function tests (LFT), hepatitis markers and adverse events in the 4-year follow-up. A total of 96 patients, 22 with relapsing-remitting MS (RRMS), 54 with secondary progressive MS (SPMS), and 20 with primary progressive MS (PPMS) who were treated with at least two doses of ocrelizumab between January 2018 and September 2023 were included in the study. Sixty-five (68%) were women and 31 (32%) were men. The mean age was 48.4 ± 11.1years (20-70years). Ninety-three patients were evaluated in the first year, 65 in the second year, 39 in the third year and 24 in the fourth year of treatment. 96% of patients were relapse-free rate in the first year, 91% in the second year, 85% in the third year and 75% in the fourth year. Eighty-six percent of patients were progression free in the 1st year of treatment, 71% in the 2nd year, in 64% in the 3rd year, and in 62% in the 4th year. During the follow-up of the cases, EDSS remained stable in 77% of RRMS patients, improved in 14%, and worsened in 9%; while EDSS remained stable in 65% of SPMS patients with attacks, it improved in 9% and worsened in 26%; while EDSS remained stable in 60% of PPMS patients, worsening was observed in 40%. There is a significant decrease in IgM and IgG values during the follow-up of ocrelizumab therapy (p < 0.001, p = 0.014). There is no significant difference in IgA, lymphocyte and neutrophil values (p = 0.713, p = 0.086, p = 0.999). No significant relationship was found between low serum IgM levels and the risk of developing infection (p > 0.05). Liver function tests was found to be within normal limits in 94% of the patients over a 4-year period. No hepatitis B, C or A infection, hepatitis B reactivation, tuberculosis, HIV infection, malignancy or drug related death occurred during 4-years follow-up. The most common side effect during ocrelizumab treatment is urinary tract infection (29%); others were upper respiratory tract infections (13%), numbness/tingling of the face, trunk, or extremities (8%), insomnia (6%), headache (5%), and soft tissue infections (cellulitis and dental abscess, 2%). Our results show that ocrelizumab reduces the frequency of attacks and prevent the disease progression in RRMS patients, and reducing the disease progression by primarily stabilizing EDSS scores in SPMS with attacks and PPMS. It is thought that the relatively high rates of urinary tract infection detected in this study may be related with advanced stage of the disease. The absence of hepatitis B reactivation, chronic infection or malignancy in the 4-year follow-up of our cases supports the long-term safety of ocrelizumab treatment. Ocrelizumab may be preferred as an effective and reliable treatment of different types of MS due to non-serious side effects.

Efficacy and safety of high-frequency repetitive transcranial magnetic stimulation (rTMS) for migraine: a meta-analysis of randomized controlled trials.

To assess the efficacy and safety of high-frequency repetitive transcranial magnetic stimulation in the prevention or treatment of migraine by conducting a pooled analysis of relevant randomized controlled trials. The PubMed, Embase, Cochrane, OVID, SCOPUS, Web of Science, and clinicaltrials.gov databases were systematically searched for randomized controlled trials (RCTs) comparing high-frequency rTMS and sham stimulation for the prevention or treatment of migraine. A meta-analysis of relevant outcome measures was performed using RevMan 5.3 software. Eight RCTs with a total of 384 patients were included. A total of 23 patients dropped out, and thus, 361 patients were ultimately included for analysis. The high-frequency rTMS group had a lower frequency of attacks than the sham group (MD = -5.10; 95% CI: -8.10, -2.09; P = 0.0009). The rTMS group has less intense headaches than the sham group (SMD = -0.74; 95% CI -1.04, -0.44; P < 0.00001). High-frequency rTMS improved patient disability (SMD = -0.45; 95% CI -0.75, -0.16; P = 0.003). High-frequency rTMS led to no advantage in reducing the number of abortive medications (MD = -1.10; 95% CI -3.28, 1.08; P = 0.32), but it increased the occurrence of adverse events (RR = 1.69; 95% CI 1.09, 2.64; P = 0.02). High-frequency rTMS reduces the frequency of attacks and headache intensity in migraine patients and improves the patient's disability, but it also increases adverse events.

Navigating health challenges: the interplay between occupation-imposed movement restrictions, healthcare access, and community resilience

BackgroundTransportation plays a significant role in health, community resilience, and access to basic needs such as healthcare, social services, education, and job opportunities. Health and community resilience are, however, impacted by a multitude of complex and unequal factors, such as transportation restrictions exacerbated by the Israeli occupation. The goal of the research was to examine the intricate relationships that exist in Palestine between movement restrictions imposed by occupation, health outcomes, and community resilience.MethodA self-structured questionnaire, devised based on expert conversations and previous literature, was used in this descriptive, quantitative study to explore health and resilience outcomes. Age, gender, marital status, place of residence, and means of transportation were among the various factors that were utilized to describe the socio-demographics of the study sample (n = 202). The researchers employed stepwise multiple regression and descriptive statistics for the data analysis.ResultsStudy findings indicated that transportation restrictions have significant direct and indirect health consequences. A significant direct effect is observed, signifying a negative correlation between restrictions and health; increased transportation restrictions are consistently correlated with a decline in health. The study emphasized how place of residence affects health outcomes, with higher scores for campers and people living in green line areas. It also underscores that public means of transportation are found to be better for health outcomes than private cars.ConclusionThis study emphasized that roadblocks, checkpoints, and military incursions make it difficult for Palestinians to receive medical care, which has a detrimental impact on their health and well-being. It also underscores the need for significant reforms in Palestinian health and transportation systems to enhance infrastructure and healthcare access. The Palestinian Authority should invest in public transportation and community resilience programs to address transportation-related health issues, especially in villages, due to frequent settler attacks.

Comparison of greater occipital nerve blockade with radiofrequency and steroid in chronic migraine

ObjectivesThe study aims to retrospectively compare steroid and radiofrequency treatments for the greater occipital nerve(GON) under ultrasound guidance in chronic migraine. MethodsMonthly average headache attack frequency, attack duration, visual analog scale(VAS) and the number of days analgesics were taken were recorded. Under ultrasound guidance, GON block was administered once a week for a total of four sessions. In the final session, 4 mg of dexamethasone was added to the local anesthetic for the steroid group (n:26). Pulsed radiofrequency (RF) treatment was applied to the RF group (n:25) just before the last session of the GON block. The pain course in the week following the procedure monthly average headache attack frequency, attack duration, VAS and the number of days analgesics were taken in a month were compared for both groups at 1–3–6 months. ResultsIn the first month, a statistically significant decrease in attack frequency was observed in the RF group. However, no statistically significant differences were found between the groups in other findings at different time intervals. A significant decrease headache attack duration,VAS, and the number of days analgesics were taken in a month was observed in both treatment groups. Both treatments were found to be effective, but the effect size of the treatment was higher in the RF group compared to the steroid group. ConclusionAlthough the results were better in the group receiving pulsed RF treatment, except for the attack frequency in the first month, no statistically significant superiority of one treatment method over the other was determined.

Worldwide Trends in COVID-19-Related Attacks Against Healthcare: A Review of the Safeguarding Health in Conflict Coalition Database.

During the COVID-19 pandemic, violence targeting healthcare reportedly increased. Attacks against healthcare can severely hamper the public health response during a pandemic. Descriptive data analysis of these attacks may be helpful to develop prevention and mitigation strategies. This study aimed to investigate trends regarding COVID-19-related attacks against healthcare from January 2020 until January 2023. COVID-19-related incidents occurring between January 2020 and January 2023 were extracted from the Safeguarding Health in Conflict Coalition database and screened for eligibility. Included incidents were linked to COVID-19 health measures or were attacks directly interfering with COVID-19 healthcare, including conflict-related attacks. Data collected per incident included temporal factors; country; setting; attack and weapon type; perpetrator; motive; number of healthcare workers (HCWs) killed, injured, or kidnapped; and health facility damage. The study identified 255 COVID-19-related attacks against healthcare, with 18 HCWs killed, 147 HCWs injured, and 86 facilities damaged. The highest attack frequency was reported during the beginning of the pandemic and predominantly concerned stigma-related attacks against healthcare. Reported incidents in 2021 included attacks targeting vaccination campaigns, as well as conflict-related attacks interfering with COVID-19 healthcare. COVID-19-related attacks against healthcare occurred in heterogeneous contexts throughout the pandemic. Due to underreporting, the data presented are a minimum estimate of the actual magnitude of violence. The findings of this study emphasize the importance of public education campaigns, improved coordination between healthcare organizations and law enforcement, and the possible need to bolster the security of medical facilities and health workers.

Effect of Colchicine Treatment on Clinical Course in Children with PFAPA Syndrome.

Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome (PFAPA) is the most common periodic fever condition in children. There is no consensus on treatment to prevent attacks and reduce their frequency. In this study, we aimed to evaluate the effectiveness of colchicine treatment in PFAPA syndrome. In addition, we described the demographic and clinical features of PFAPA patients. We retrospectively analyzed 58 PFAPA patients who were started on colchicine treatment between January 2017 and January 2022. Demographic data, clinical features, laboratory tests, genetic analysis of MEditerranean FeVer (MEFV) mutations, and autoinflammatory disease activity index (AIDAI) scores of all patients were evaluated. In addition, patients were divided into two groups according to MEFV variants and compared. Attack frequency, duration, and AIDAI scores decreased in all patients after colchicine treatment. Duration of follow-up was 13.53±6.65 months. The median±IQR age at diagnosis was 3.2 (2-5) years. Thirty three (56.9%) patients had heterozygous mutations of MEFV. The most common MEFV variants were M694V (63.6%). There was no significant difference between the two groups in terms of colchicine responses. Colchicine treatment is effective and safe in patients with PFAPA who have frequent attacks. No association was established between the presence of heterozygous mutations of MEFV and colchicine response.

Blockchain‐based decentralized oracle network framework for identity management in metaverse environment

AbstractManaging identities in metaverse environment is challenging due to the conflicting requirements of ensuring user privacy while enforcing accountability. Users may participate in the metaverse through multiple virtual identities or avatars for different applications/scenarios. Thus, virtual identities must be continuously generated and mapped with real identities. Further, user privacy needs to be protected while not ensuring blanket anonymity to indulge in objectionable or unlawful conduct. Ensuring privacy for the metaverse while still being able to pinpoint users for their actions in the metaverse is a significant research issue. Solving the aforementioned issue, we propose a third‐party identity management solution for the metaverse based on creating a decentralized oracle network (DON) providing identity authentication and mapping service. The proposed identity management framework is metaverse platform agnostic, ensuring users' privacy on the platform while still being able to uncover their real identities if warranted. The proposed framework is viable as evidenced by experimental results of DON and blockchain implementation. The DON based framework leverage the benefits of blockchain technology and introduces immutability, transparency, and traceability into the the metaverse environment. This ensures data integrity and minimizes the frequency of cyber attacks in the metaverse ecosystem.

A treatment algorithm for familial Mediterranean fever patients with menstruation-associated attacks.

Familial Mediterranean fever (FMF) is characterized by febrile polyserositis attacks. Menstruation could be a trigger for attacks. We aimed to analyze the features of adolescent FMF patients with menstruation-associated attacks and propose a management algorithm. All female FMF patients who had menarche and visited the Pediatric Rheumatology Unit between January-December 2022, were included into this study. Demographics, general characteristics, and the features of menstrual cycle and FMF attacks were noted. A total of 151 female FMF patients were included. Thirty-five (23.2%) had menstruation-associated attacks. Fever and arthritis were less frequent during the menstruation-associated attacks than the attacks not associated with menstruation in these patients (65.7% vs 88.6%, p= 0.01 and 2.9% vs 20%, p= 0.04; respectively). Patients with menstruation-associated FMF attacks were younger at symptom onset and diagnosis (2.5 vs 5 years, p= 0.004 and 4 vs 7 years, p= 0.01; respectively), had a higher rate of dysmenorrhea (74.3% vs 38.8%, p< 0.001, respectively) and higher pre- and post-menarche attack frequency (4 vs 2 and 10 vs 0, respectively; p< 0.001 for both) than patients whose attacks were not associated with menstruation. The interventions for menstruation-associated attacks included initiating colchicine, increasing the dose of colchicine, switching from coated to compressed colchicine tablets or anti-interleukin 1 drugs, and on-demand non-steroidal anti-inflammatory drugs, on-demand glucocorticoids, and on-demand anakinra. On-demand therapies were beneficial in controlling menstruation-associated attacks. This is the largest cohort of adolescent FMF patients with menstruation-associated attacks. Severe FMF may cause tendency to this association. On-demand therapies could be preferred in the management.

Sequential administration of peripheral nerve blocks andonabotulinumtoxinA for the treatment of chronic migraine andother headache disorders-A retrospective tolerability and safety study.

To determine the tolerability and safety of concurrent peripheral nerve blocks and onabotulinumtoxinA treatment during a single outpatient clinic procedure visit. Procedural interventions are available for the treatment of headache disorders. OnabotulinumtoxinA and peripheral nerve blocks are used as alternatives or in addition to oral therapies to reduce the frequency and intensity of migraine attacks. There is currently a lack of safety data focusing on the sequential administration of local anesthetic via peripheral nerve blocks and onabotulinumtoxinA during a single clinical encounter for the treatment of headache. The primary aim of the study was to determine the safety and tolerability of concurrent peripheral nerve blockade and onabotulinumtoxinA injections during a single outpatient clinic procedure visit. We hypothesized that the dual intervention would be safe and well tolerated by patients with chronic migraine and other headache disorders. A retrospective chart review was performed using clinical data from patients seen by multiple providers over a 16-month timeframe at one outpatient headache clinic. Patients were identified by procedure codes and those receiving peripheral nerve block(s) and onabotulinumtoxinA injections during a single encounter within the study period were eligible for inclusion. Inclusion criteria were (1) patients 18 years and older who were (2) receiving both peripheral nerve blocks and onabotulinumtoxinA injections for the treatment of chronic migraine. Patients were excluded if they were under age 18, received their procedure outside of the clinic (emergency room, inpatient ward), or were receiving sphenopalatine ganglion blocks. Age- and sex-matched patients who received one procedure, either peripheral nerve blocks or onabotulinumtoxinA, were used for control. The primary outcome of this safety study was the number of adverse events that occurred in the dual intervention group compared to the single intervention control arms. Information regarding adverse events was gathered via retrospective chart review. If an adverse event was recorded, it was then graded by the reviewer utilizing the Common Terminology Criteria for Adverse Events ranging from Grade 1 Mild Event to Grade 5 Death. Additionally, it was noted whether the adverse event led to treatment discontinuation. In total, 375 patients were considered eligible for inclusion in the study. After age and sex matching of controls, 131 patients receiving dual intervention were able to be compared to 131 patients receiving onabotulinumtoxinA alone and 104 patients receiving dual intervention were able to be compared to 104 patients receiving peripheral nerve block(s) alone. The primary endpoint analysis showed no significant difference in total adverse events between dual intervention compared to nerve blocks alone or onabotulinumtoxinA alone. The number of adverse events that led to treatment discontinuation approached but did not reach statistical significance for those receiving dual intervention versus onabotulinumtoxinA alone in the number of adverse events that led to treatment termination (4.6%, 6/131 vs. 0.8%, 1/131, p = 0.065); however, the number of patients who discontinued therapy was not significantly different between those groups (2.3%, 3/131 vs. 0.8%, 1/131; p = 0.314; odds ratio 0.3 [0-3.2]; p = 0.338). In this retrospective chart review, there was no significant difference in adverse events or therapy discontinuation between patients receiving sequential peripheral nerve block(s) and onabotulinumtoxinA injections versus those receiving either peripheral nerve block(s) or onabotulinumtoxinA injections alone. As a result, we concluded that the combination procedure is likely safe and well tolerated in routine clinical practice.

Structures, mechanisms and applications of RNA-centric CRISPR-Cas13.

Prokaryotes are equipped with a variety of resistance strategies to survive frequent viral attacks or invading mobile genetic elements. Among these, CRISPR-Cas surveillance systems are abundant and have been studied extensively. This Review focuses on CRISPR-Cas type VI Cas13 systems that use single-subunit RNA-guided Cas endonucleases for targeting and subsequent degradation of foreign RNA, thereby providing adaptive immunity. Notably, distinct from single-subunit DNA-cleaving Cas9 and Cas12 systems, Cas13 exhibits target RNA-activated substrate RNase activity. This Review outlines structural, biochemical and cell biological studies toward elucidation of the unique structural and mechanistic principles underlying surveillance effector complex formation, precursor CRISPR RNA (pre-crRNA) processing, self-discrimination and RNA degradation in Cas13 systems as well as insights into suppression by bacteriophage-encoded anti-CRISPR proteins and regulation by endogenous accessory proteins. Owing to its programmable ability for RNA recognition and cleavage, Cas13 provides powerful RNA targeting, editing, detection and imaging platforms with emerging biotechnological and therapeutic applications.

Auricular Therapy for Migraine.

Migraine brings hours or even days of disability, affecting 15% of the US population and one billion people worldwide. Migraine treatments have improved over the years and there is now a range of non-pharmacologic therapies that can be administered as monotherapy, combined with pharmacologic therapy or combined with other non-pharmacologic therapies to give greater options for those who do not tolerate, do not respond to, or who wish to reduce or avoid pharmacologic treatments. We conducted a review of the literature on auricular therapy as acute or preventive treatment for migraine, searching the databases of MEDLINE and ClinicalTrials.gov from 2013 to 2023. A total of 43 articles contained at least one search term, with three studies specific to acute or prevention of migraine (one for acute only, one for prevention only and one for both acute and prevention). The population was limited to, adults with migraine ages 18 or older, with the administration of auricular therapy as the intervention. While there have been studies on the use of auricular therapy for pain on two specific standardized auricular therapies, Battlefield Acupuncture (BFA) and National Acupuncture Detoxification Association (NADA), neither of these protocols were utilized in any of the studies specific to migraine management. Each of the three studies used different techniques, with one using acupuncture needles and five specific points and two using semi-permanent needles (remained in for a few days) that were placed in areas that showed high activity. Each of these studies showed auricular therapy to have benefit for the management of migraine. However, the authors of each of the studies recommended further studies. Auricular therapy may be a helpful adjunctive treatment to abort a current migraine attack or aid in reducing the frequency or severity of migraine attacks.