Background: Migraine surgery at 1 of 6 identified “trigger sites” of a target cranial sensory nerve has rapidly grown in popularity since 2000. This study summarizes the effect of migraine surgery on headache severity, headache frequency, and the migraine headache index score which is derived by multiplying migraine severity, frequency, and duration. Materials and Methods: This is a PRISMA-compliant systematic review of 5 databases searched from inception through May 2020 and is registered under the PROSPERO ID: CRD42020197085. Clinical trials treating headaches with surgery were included. Risk of bias was assessed in randomized controlled trials. Meta-analyses were performed on outcomes using a random effects model to determine the pooled mean change from baseline and when possible, to compare treatment to control. Results: 18 studies met criteria including 6 randomized controlled trials, 1 controlled clinical trial, and 11 uncontrolled clinical trials treated 1143 patients with pathologies including migraine, occipital migraine, frontal migraine, occipital nerve triggered headache, frontal headache, occipital neuralgia, and cervicogenic headache. Migraine surgery reduced headache frequency at 1 year postoperative by 13.0 days per month as compared to baseline ( I2 = 0%), reduced headache severity at 8 weeks to 5 years postoperative by 4.16 points on a 0 to 10 scale as compared to baseline ( I2 = 53%), and reduced migraine headache index at 1 to 5 years postoperative by 83.1 points as compared to baseline ( I2 = 2%). These meta-analyses are limited by a small number of studies that could be analyzed, including studies with high risk of bias. Conclusion: Migraine surgery provided a clinically and statistically significant reduction in headache frequency, severity, and migraine headache index scores. Additional studies, including randomized controlled trials with low risk-of-bias should be performed to improve the precision of the outcome improvements.
Wave overtopping can cause erosion on the landward slope due to high flow velocities and turbulence that cause high stresses on the cover. Innovative block revetments such as Grassblocks protect the subsoil of the dike against erosion. The blocks are permeable, which reduces the flow velocity and the pressures along the landward slope. The performance of these blocks is assessed in physical tests, which provides insights into the stability of the blocks. However, such experiments are expensive and accurate measurements are difficult due to highly turbulent conditions. Therefore, the goal of this study is to determine the hydrodynamic conditions at the dike cover caused by the wave run-up on the seaward slope and by the overtopping flow over the crest and landward slope. The geometry and wave conditions from the physical test at the Deltares Delta flume are implemented in an OpenFOAM® numerical model. Using the porousWaveFoam solver, a porous layer on the crest and landward slope is implemented, where the flow resistance of this porous layer largely depends on the resistance coefficients α [-] and β [-]. The numerical model is calibrated based on resistance coefficients as introduced earlier in the literature, which showed that the resistance coefficients of α=500 and β=2.0 performed best for the peak flow velocities and the peak pressures. The numerical model is evaluated by using these resistance coefficients in other time series of the physical tests. The evaluated model is then used to determine the hydrodynamic conditions on the landward slope, which showed that the pressure was the most influential hydrodynamic condition at the time of failure. Finally, the model showed that a porosity of n=0.6 and the porous layer thickness η=36 mm reduced the peak pressure the most.
Triple negative breast cancer (TNBC) is an aggressive form of breast cancer that does not express the estrogen receptor, progesterone receptor, and the HER2 receptor. Since it does not express these receptors, TNBC does not respond to many of the standard therapies for breast cancer. To decrease the number of deaths associated with breast cancer, we must identify therapeutic strategies that effectively prevent the growth and progression of TNBC. Recent studies from our laboratory and others show that the sodium glucose transporter 2 (SGLT2) inhibitor canagliflozin reduces proliferation of human prostate cancer cell lines. To determine whether SGLT2 inhibitors can also suppress TNBC growth, we tested the effect of canagliflozin and other SGLT2 inhibitors on proliferation and protein expression within the BT‐549 human breast cancer cells. Presto Blue assays revealed that two SGLT2 inhibitors, canagliflozin and ipragliflozin, significantly inhibited BT‐549 cell proliferation. However, the SGLT2 inhibitor empagliflozin produced little to no change in cell proliferation. We next examined the effect of SGLT2 inhibitors on Akt and Erk ½ MAP kinase, two proteins that promote TNBC growth. Western blot analysis revealed that canagliflozin reduced phosphorylation of Akt and Erk ½ within BT‐549 cells. Therefore, the ability of canagliflozin to block BT‐549 proliferation may be due in part to canagliflozin‐mediated decreases in Akt and Erk activity. The epidermal growth factor receptor (EGFR) activates both Akt and Erk ½ signaling in BT‐549 cells. To determine whether inhibition of EGFR signaling would alter the response to canagliflozin, we tested the combined effect of canagliflozin and EGFR inhibitors on BT‐549 cell proliferation. Canagliflozin alone was more effective at reducing BT‐549 cell proliferation than the EGFR inhibitors gefitinib and lapatinib. However, the combined effect of canagliflozin and gefitinib as well as the combined effect of canagliflozin and lapatinib was greater than that produced by either compound alone. These data suggest that combination treatments involving canagliflozin and EGFR inhibitors may serve as an effective therapy for patients with TNBC.Support or Funding InformationNIH grant 5T34GM007663This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
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