Prediction and associated factors of non-steroidal anti-inflammatory drugs efficacy in migraine treatment.

Background: The selection strategy of non-steroidal anti-inflammatory drugs (NSAIDs) for migraine is hard to judge whether it is effective, leading to unnecessary exposure to insufficient or lengthy treatment trials. The goal of the study was to investigate potential predictors of NSAIDs efficacy in migraine therapy and to explore their influence on efficacy. Methods: 610 migraine patients were recruited and assigned into responders and non-responders. Potential predictors among demographic and clinical characteristics for NSAIDs efficacy were extracted using multivariable logistic regression (LR) analysis, and were applied to construct prediction models via machine learning (ML) algorithms. Finally, Cochran-Mantel-Haenszel tests were used to examine the impact of each predictor on drug efficacy. Results: Multivariate LR analysis revealed migraine-related (disease duration, headache intensity and frequency) and psychiatric (anxiety, depression and sleep disorder) characteristics were predictive of NSAIDs efficacy. The accuracies of ML models using support vector machine, decision tree and multilayer perceptron were 0.712, 0.741, and 0.715, respectively. Cochran-Mantel-Haenszel test showed that, for variables with homogeneity of odds ratio, disease duration, frequency, anxiety, and depression and sleep disorder were associated with decreased likelihood of response to all NSAIDs. However, the variabilities in the efficacy of acetaminophen and celecoxib between patients with mild and severe headache intensity were not confirmed. Conclusion: Migraine-related and psychiatric parameters play a critical role in predicting the outcomes of acute migraine treatment. These models based on predictors could optimize drug selection and improve benefits from the start of treatment.

Safety and Efficacy of Endovascular Treatment on Pregnancy-Related Iliofemoral Deep Vein Thrombosis.

Objective: This study investigates the safety and efficacy of endovascular treatments on pregnancy-related iliofemoral deep vein thrombosis (DVT). Methods: We retrospectively reviewed data of 46 patients who had symptomatic pregnancy-related iliofemoral DVT and underwent endovascular treatment. The patients treated with catheter-directed thrombolysis (CDT) were classified as the CDT group. In contrast, those treated with CDT combined with pharmacomechanical thrombectomy (PMT) or angioplasty/stenting were classified as the pharmacomechanical catheter-directed thrombolysis (PCDT) group. Results: Based on the immediate post-operative clot burden reduction rate analysis of 46 patients: 22 cases were completely dissolved (lysis grades III), 12 were partially dissolved (lysis grades II), and 12 failed (lysis grades I). There was a statistically significant difference in the rate of clot burden reduction between the CDT group (n = 19) and the PCDT group (n = 27) (p = 0.001). There was no statistically significant difference in the number of bleeding events between the two groups (p = 0.989). At 24 months, cumulative venous patency in the CDT group was 50.0%, compared to 78.2% in the PCDT group. Furthermore, there was a statistically significant difference in Villalta score (p = 0.001) and venous severity scoring (VCSS score) (p = 0.005) between the two groups. Conclusions: CDT treatment combined with PMT or angioplasty/stenting is comparatively safe and effective for pregnant-related DVT patients. PCDT outperforms CDT in terms of immediate efficacy and reduces the incidence of post-thrombotic syndrome with better midterm outcomes.

One-year patency rate of native arteriovenous fistulas reconstructed by vascular stripping in hemodialysis patients with venous neointimal hyperplasia.

OBJECTIVE: There are limited therapeutic measures for stenosis of arteriovenous fistulas (AVFs) due to venous neointimal hyperplasia (VNH). In the current retrospective study, we reviewed the clinical data of hemodialysis patients who underwent AVF reconstruction by VNH stripping. The primary measure of interest was the secondary patency rate of the restored AVF. METHODS: The study included hemodialysis patients who underwent AVF reconstruction by VNH stripping (group A), AVF reconstruction proximal to the original fistula (group B), or creation of a new AVF (group C). Patency was evaluated immediately after the surgery and at follow-up visits. RESULTS: Of 353 patients who underwent AVF reconstructions, 327 (91.9%) were for late AVF failure. The final analysis included 305 patients: 76, 128, and 101 patients in groups A, B, and C, respectively. The three groups were comparable in age, sex, causes for AVF, AVF sites, and the artery for the AVF (P > .05). At 3-month follow-up, the secondary AVF patency rate was comparable across the three groups at 93.4%, 92.2%, and 92.1% in groups A, B, and C, respectively. The patency rate at 6 and 12 months was also comparable across groups A, B, and C at 89.5%, 89.8%, and 88.1% at 6 months and 84.2%, 85.9%, and 81.2% at 12 months, respectively. CONCLUSIONS: Reconstructing the AVF by surgically removing VNH is an effective technique for late hemodialysis access failure, with maximal preservation of blood vessels.

Restoration of autologous arteriovenous fistula by vascular stripping in a hemodialysis patient with venous neointimal hyperplasia.

A significant number of arteriovenous fistulae fail because of venous neointimal hyperplasia-associated vascular blockage. We developed a surgical technique for repairing arteriovenous fistulae by surgically removing neointimal hyperplasia and vessel re-anastomosis. Here, we report the successful treatment of a case that developed arteriovenous fistula stenosis because of venous neointimal hyperplasia.