A perforation score helps stratify patients into different risk g

A perforation score helps stratify patients into different risk groups. Key Word(s): 1. esophagus; 2. perforation; 3. Boerhaave’s; 4. perforation score; Presenting Author: FAN FENG Additional Authors: HONGWEI ZHANG Corresponding Author: FAN FENG Affiliations: Xijing Hospital Objective: Dissection of subcarinal

lymph nodes is technically difficult in that it may cause main bronchus injury and prolong operation time. The aim of the present study was to evaluate the clinical outcomes of clinical T1N0 esophageal squamous cell carcinoma (ESCC) patients with or without subcarinal lymph nodes dissection. Methods: A total of 283 patients with ESCC had undergone three stage esophagectomy. The clinical and pathological features were collected and correlations NVP-LDE225 price with subcarinal lymph nodes metastasis were selleck products analyzed. The survival of patients was analyzed. Results: Tumor length, clinical

T, N and TNM stage, pathological T, N, and TNM stage were associated with subcarinal lymph node metastasis. The survival of T1N0 patients with subcarinal lymph nodes clearance was comparable to that without subcarinal lymph nodes clearance. No significant difference was found between the patients with subcarinal lymph nodes metastasis and patients without metastasis and had less than 4 subcarinal lymph nodes dissection (P > 0.05). The survival of patients without metastasis and had 4–6 subcarinal lymph nodes dissection was significantly higher than that of the patients Dipeptidyl peptidase without metastasis and had less than 4 nodes dissection (P < 0.05), while patients without metastasis and had more than 6 subcarinal lymph nodes dissection had no survival benefit compared to that of the patients had 4–6 nodes dissection (P > 0.05). Conclusion: For clinical T1N0 ESCC patients, subcarinal lymph nodes clearance may be unnecessary. For the rest ESCC patients, we recommend that at least 4 subcarinal lymph nodes should be removed in order to improve patients’ survival. Key Word(s): 1. Esophageal cancer; 2. Subcarinal lymphnode; Presenting Author: RAVINDRA SATARASINGHE Additional

Authors: SATHYAJITH AMBAWATTE, NAYOMISHERMILA JAYASINGHE, JAYEWARDENE RATHNAYAKE, RAVI WIJESINGHE, PUBUDU DE SILVA, NARTHANIRASENDRANRASENDRAN RASENDRAN Corresponding Author: RAVINDRA SATARASINGHE, NAYOMISHERMILA JAYASINGHE Affiliations: Sri Jayewardenepura General Hospital Objective: To study the prevalence and demographics of peptic ulcer disease in a cohort of adult Sri Lankans presented to a tertiary referral centre. Methods: Case notes of 2728 patients who had undergone upper gastrointestinal endoscopy for various reasons in the principle author’s unit at Sri Jayewardenepura General Hospital, Kotte, Sri Lanka from 15th of February 2002 to 15th February 2013 were retrospectively analyzed to obtain the required information. Results: There were178 patients having peptic ulcer disease with an age range of 24 to 92 years with a mean age of 62.3 ±13.5 SD years.

Patient with schizophrenia performed worse than controls on all e

Patient with schizophrenia performed worse than controls on all emotions (Scholten et al., 2005) and alcoholic Korskakoff patients performed worse than controls on angry, fearful and surprised expressions (Montagne, Kessels, Wester, et al., 2006). In high-functioning adolescents with autism spectrum disorder (ASD), results with the ERT were mixed. That is, Kessels et al. (2010) did not demonstrate differences between adolescents with ASD and matched controls

on the ERT, whereas Law Smith et al. (2010) showed a worse performance on the emotions disgust, anger and surprise in a comparable Selleck LDK378 sample of adolescents with ASD. Patients with post-stroke depressive symptoms performed worse on the emotions anger, happiness, disgust, and sadness, while non-depressed

stroke patients performed at control level, but in this study, the emotions fear and surprise were not included (Montagne, Nys, et al., 2007). No impairments on the ERT were found in a group of patients with Noonan syndrome (Wingbermühle et al., 2012). PTSD patients had lower accuracy on fear and sadness compared with matched controls Selumetinib concentration (Poljac et al., 2011). With respect to neurodegenerative disease, specific impairments in the recognition of disgust and anger were found in a small group of patients with Huntington’s disease (Montagne, Kessels, Kammers, et al., 2006) and the perception of anger and surprise was compromised in frontotemporal dementia patients (Kessels et al., 2007). Moreover, other research groups also showed intensity-dependent deficits in emotion perception in clinical groups (see, e.g., Assogna et al., 2010; Csukly, Czobor, Szily, Takács, & Simon, 2009), indicating that morphing tasks may be of added value in clinical practice compared with existing, more static emotion-perception tasks. Finally, we would like to address some limitations of our study. First, while the overall sex distribution is balanced, females

are underrepresented in the 12- to 17-year olds, while males are overrepresented in the 18- to 25-year olds. Enzalutamide order In addition, our study sample consisted of participants from different countries, increasing the external validity of our findings, but all were from Western cultures. In relation to this, the ERT only contains Caucasian actors. Our results, as a result, cannot be generalized to people from non-Western cultures or different ethnic backgrounds. Furthermore, intelligence levels were estimated using different intelligence tests, and IQ estimates were not available for all adults. However, in clinical practice, educational level is more often applied than IQ for adjusting performance in adults, as IQ estimates may also not always be available. The use of regression-based normative data has also been under debate (e.g., Fastenau, 1998; Heaton, Avitable, Grant, & Matthews, 1999).

These findings were more pronounced in those with lower limb join

These findings were more pronounced in those with lower limb joint involvement and those who were inactive. This is likely to reflect reduced physical activity and in particular, reduced impact loading activity in children with haemophilia. These findings have been observed both

in populations of children receiving prophylaxis and receiving on-demand therapy [5, 16]. The aim of this study was to evaluate sports participation and the time spent in physical activity, including vigorous physical activity, in children with haemophilia. We were also interested in quantifying inactive time and determining whether children with haemophilia met the Australian government’s guidelines for recommended PS-341 cell line levels of physical activity and small-screen time in children and adolescents. The data reported here were obtained from a case-crossover study nested in a prospective cohort study. Details of that study have been described elsewhere [22]. Children between the ages of 4 and 18 years with moderate or severe haemophilia A or B were eligible for the study. The study was approved by The Human Research Ethics Committees of The University of Sydney and the three recruiting hospital sites. Participants or their parent or guardians gave written, informed consent. Following

recruitment to the study, parents of children with haemophilia were contacted by telephone to record SCH772984 cost characteristics including age, severity of haemophilia, prophylaxis schedule if on prophylaxis, orthopaedic history (including history of known 3-oxoacyl-(acyl-carrier-protein) reductase arthropathy) and the presence of inhibitors. At the same time, an interviewer-assisted modifiable activity questionnaire (Kriska’s MAQ) was administered. The questionnaire has been validated in adolescents and enables estimation of total

hours of activity per week for the past year, average intensity and average hours per week of vigorous activity [23]. Intensity of physical activity was expressed in metabolic equivalents (METS). Activities were allocated a MET value based on the Compendium of Physical Activities classification system [24]. One MET is equivalent to an energy expenditure of 1 kcal kg–1 h–1 or an oxygen consumption of 3.5 mL kg–1 min–1 which is approximately the energy expenditure or oxygen consumption at rest. Moderate intensity physical activity was defined as between 3 and 6 METS and vigorous physical activity was greater than 6 METS. The MAQ also enabled estimation of average daily small-screen recreation time which includes time spent watching television, playing computer games and other small-screen activities. It has been successfully used to measure habitual activity in children and adolescents with cystic fibrosis and has demonstrated test–retest reliability [25]. Participants were followed for one year and bleeding episodes monitored using a weekly short message service (SMS) system.

g , student dormitories, military recruits) Second, although the

g., student dormitories, military recruits). Second, although the Hepatitis C Follow-up Survey is nested within the NHANES, the data from the follow-up survey cannot be used to generate population estimates because of the small number of respondents and low response rate. Frequencies for some questions may be affected by differences in characteristics of respondents and nonrespondents. In addition, the small sample size limited our power to detect statistically significant differences between subgroups. Third, the data are self-reported and therefore subject

to the usual biases associated with such data (e.g., recall bias), including possibly not understanding questions find more regarding medical information, such as whether they have had a particular medical procedure performed or what they were told by a healthcare provider. Finally, the sample consisted of persons who were positive for anti-HCV, whether currently infected or not; thus, treatment would not have been indicated in all those

who received an ROF letter—however, 91 of 115 with HCV-RNA results learn more available were HCV-RNA positive when tested during the NHANES, suggesting chronic infection. In summary, we report results for a sample of NHANES participants who responded to a follow-up survey after having tested positive for past or current HCV infection from 2001 through 2008, which, to our knowledge, is the only survey of such individuals to be conducted as part of a national population-based study. These data indicate that

fewer than half of those infected with HCV may be aware of their infection. The findings suggest that more intensive efforts are needed to identify and test those at risk for HCV infection and the need to educate patients and providers about appropriate interaction on prevention decisions and actions. “
“Hepatitis C virus (HCV) can affect immune cells and induce various kinds of immune-related diseases including pyoderma gangrenosum. We experienced a difficult-to-treat case of pyoderma gangrenosum-like lesions in a patient with HCV infection. The patient was treated with pegylated interferon (PEG IFN)-α-2b and ribavirin (RBV) therapy and achieved a sustained Sitaxentan virological response. Before the eradication of HCV, the frequency of T-helper 17 cells was remarkably high in comparison to chronic hepatitis C patients without extrahepatic immune-related diseases. Moreover, we could detect negative and positive strand-specific HCV RNA in the CD19+ B lymphocytes and CD4+ T lymphocytes. However, after the eradication of HCV, the immunological status became normal and the pyoderma gangrenosum-like lesions became stable without immunosuppressive therapy. Here, we report a sequential immunological analysis during PEG IFN/RBV therapy and the beneficial effect of HCV eradication in difficult-to-treat pyoderma gangrenosum-like lesions.

These techniques require extra visits, chairtime, and laboratory

These techniques require extra visits, chairtime, and laboratory time and only mitigate the stress; the stress is not eliminated. A framework is presented here that eliminates the stress transmitted to the implants by encircling the abutment cylinders and not directly incorporating them into the framework. Furthermore, the framework mitigates the stress from the polymerization distortion of acrylic when processing the acrylic onto the prosthesis. “
“Purpose: Polymethyl methacrylate

(PMMA) resins are the most commonly used denture materials; however, they do not have a high flexural strength (FS). This study aimed to compare the mechanical properties of a polyamide-based, Sirolimus chemical structure injection-molded denture material (Deflex) with another injection-molded PMMA base material (SR-Ivocap) and a conventional compression-molded PMMA (Meliodent). Materials and Methods: Flexural properties (deflection, bending strength, and bending modulus) of denture base materials were evaluated (n = 10). Specimens meeting International Standards Organization (ISO) specification number 20795–1 requirements were prepared (65 × 10 × 3 mm3). A three-point bending test was carried out on an Instron testing

machine at a 5 mm/min crosshead speed. The Knoop hardness test was used p38 MAPK pathway to compare microhardness values. Data were analyzed using ANOVA, followed by REGWQ. Results: The group results, standard deviations, and statistical differences (p < 0.01) for Deflex, SR-Ivocap, and Meliodent were (A) flexural strength (MPa: 78.3 ± 1.0,a 69.8 ± 1.4,b 81.1 ± 1a), (B) flexural modulus (GPa: 0.70 ± 0.13,a 0.85 ± 0.27,a 1.70 ± 0.23b), (C) Knoop Hardness (kg/cm2: 7.5 ± 1.0,a 13.5 ± 1.4,b 16.9 ± 1.0c). Different superscript letters indicate significant difference. All Meliodent specimens fractured during flexural testing, but no Deflex specimens did. Conclusions: While polyamide denture material produced good fracture resistance, its modulus is not yet sufficiently high to be equal to standard PMMA materials. Clinical Implications. Polyamide has some attractive advantages, but will require modification

to produce consistently better properties than current PMMA materials. “
“Difficult impression removal has been linked to high rigidity and hardness of elastomeric impression Galeterone materials. In response to this concern, manufacturers have reformulated their materials to reduce rigidity and hardness to decrease removal difficulty; however, the relationship between impression removal and rigidity or hardness has not been evaluated. The purpose of this study was to determine if there is a positive correlation between impression removal difficulty and rigidity or hardness of current elastomeric impression materials. Light- and medium-body polyether (PE), vinylpolysiloxane (VPS), and hybrid vinyl polyether siloxane (VPES) impression materials were tested (n = 5 for each material/consistency/test method).

However, with increased use of marginal livers for therapeutic

However, with increased use of marginal livers for therapeutic

transplant, availability of livers that yield high quality hepatocytes is becoming limited. BGB324 research buy We have developed a hypothermic machine perfusion (HMP) process that restores function to ischemia-damaged livers leading to improved survival of transplants in a rat model. We therefore tested if this system could improve isolation of hepatocytes from marginal donors. In rat studies, livers (n=6/group) were subjected to 120 min warm ischemia (WI) followed by either 24 hr simple cold storage (SCS) or 24 hr SCS + 5 hr perfusion with a recovery solution (HMP). Hepatocytes were then isolated by collagenase digestion. HMP improved yield by 50% and improved viability from 66. 6% to 86. 5% (p<0. 05). Isolated OTX015 in vivo cells were plated on collagen coated plates. Plateability of the cells was improved by HMP

from 38. 5% to 72. 2% vs. SCS. Function of the cells was tested by ethoxycoumarin O-deethylase (ECOD) activity and urea production. HMP cells showed improved both phase I and phase II ECOD activity (90 vs 51 pmole/106 cells/min) for phase II, HMP vs SCS, p<0. 05). Urea production by HMP cells was also more than double that of SCS (p<0. 05). These results suggested that HMP provides improved yield, viability and function of hepatocytes isolated from ischemia damaged rat livers. We then tested the procedure in a series of three human livers. Livers not accepted for transplant were obtained from an OPO with cold storage times of 16-24 hrs. They were divided into two segments with one digested immediately and the other placed on HMP for 3 hrs and then digested. On a grading scale in which a score of <6 is acceptable for cell isolation, the liver scores PLEK2 were 5, 10 and 15. With a score of 5, HMP and SCS showed similar yield and viability but HMP cells had a 40% greater attachment after cryopreservation. The second liver (score of 10) was steatotic and 20 min WI. HMP improved yield (6 x 108 vs 1. 4 x 108 cells) and viability (73 vs 57%). HMP also improved ECOD activity

after cryopreservation (233 vs 77. 5 pmol/106 cells/min). The third liver had a WI of 60 min and >50% steatosis. SCS yielded no viable cells while HMP yielded 4. 3×108 cells from 500 g liver. Although plating efficiency was low after cryopreservation (10%) additional storage of cells in HMP solution increased it to 24%. The results demonstrate that HMP after the SCS process can improve cell isolation from both rat and human DCD livers. Also, additional hypothermic storage in the HMP solution improved viability and plating of human hepatocytes. Disclosures: Mark G. Clemens – Management Position: HepatoSys Inc; Stock Shareholder: HepatoSys Inc John W. Ludlow – Consulting: Zen Bio Inc. Charles Lee – Management Position: HepatoSys Inc. The following people have nothing to disclose: Cathy Culberson, Joshua D.

The designed PLP simplified the procedure and reduced the number

The designed PLP simplified the procedure and reduced the number of adjustments and visits. “
“This article presents a design to convert a partial removable dental prosthesis (PRDP) from Kennedy class II to class III using a dental implant. Incorporating semiprecision attachments, this design

provides desired esthetics, phonetics, and function. “
“Patients presenting with severe resorption of the residual alveolar ridges are relatively common today in both private practices and teaching institutions. The Bcl-2 inhibitor severely resorbed mandibular ridge is more challenging to impress than is the maxillary ridge. Accurately capturing the denture-bearing surface in its entirety is crucial to providing the patient with a functionally successful prosthesis. This article presents a technique to overcome the difficulties

Carfilzomib cost encountered in impressing the severely resorbed mandibular ridge using elastomeric impression materials and a modified special custom tray. “
“Repairs of the cleft nose, lip, and palatal deformity remain challenging endeavors for reconstructive surgeons. Postsurgical nasomaxillary hypoplasia is a common finding in patients with extensive clefts. This complex deformity has a pronounced impact on the social behavior and self image of the subject. Esthetic and functional rehabilitation of this postsurgical defect is scarcely reported in the literature. Support in the form of prostheses or stents to prevent tissue collapse is usually required in these patients following surgery. This clinical case presentation discusses the fabrication

of an internal nasal stent for a cleft nose, lip, and palate patient following surgical reconstruction. Two prostheses using two prosthetic materials (Polymethyl methacrylate, flexible resin) were prepared to compare their efficacy. The final prostheses improved the patient’s appearance, making the postsurgical defect less conspicuous. “
“Atrophic rhinitis is a chronic nasal disease characterized by progressive atrophy of the nasal mucosa accompanied by the formation of foul-smelling thick, dry crusts in the nasal cavities. Mild conditions of atrophic rhinitis can be treated by nasal irrigations and prescription STAT inhibitor of intravenous or topical aminoglycosides. In severe conditions, surgery can close the airways. The problem can also be managed by prosthodontic measures which include the fabrication of a poly methyl methacrylate acrylic resin nasal stents. This article describes a new procedure for fabricating a clear acrylic nasal stent with an alternative laboratory technique using small cylinders of soft putty as spacers for maintaining a 3-mm restricted nasal airway during processing. “
“The aim of the study was to assess the influence of interimplant divergence on retention of two Locator attachments before and after in vitro simulation of 3 to 5 years of use.

Abdominal CT scan was deferred due to the patient’s pregnant stat

Abdominal CT scan was deferred due to the patient’s pregnant state

and her apparent clinical improvement. However, abdominal pain recurred after about a week into the admission. An ultrasound was done to determine if gallstones were the cause of the pancreatitis and recurrent pain, but none were seen. Instead, the ultrasound showed splenomegaly and splenic varices, a normal-sized liver with smooth contour and homogeneous parenchymal echopattern, and a normal-sized portal vein. Left sided portal hypertension was considered which, in the setting of pancreatitis, was possibly due to splenic vein thrombosis. A Doppler study of the splenic vein was done showing sluggish but hepatopetal blood flow in the visualized areas of the splenic vein. Some segments of the vein were not adequately assessed due to overlying bowel gas. It was eventually decided that an endoscopic ultrasound 5-Fluoracil was necessary

see more to adequately assess the splenic vein, pancreas as well as the liver. On EUS, a thin-walled outpouching from the wall of the splenic artery measuring approximately 5 cm in diameter with flow on Doppler study, consistent with a pseudoaneurysm, was seen (Figure 1). No thrombosis was seen in the splenic vein. The visible portions of the pancreas and liver appeared normal. Given these new findings, preparations were begun for possible surgical management of the pseudoaneurysm. Patient was kept admitted and under close monitoring while the fetus was allowed to mature. At 34 weeks age of gestation, the baby was delivered by cesarean section. An abdominal CT scan was subsequently done confirming the presence of a splenic artery pseudoaneurysm measuring 9 cm in diameter with a thrombus noted within (Figure 2).

The pseudoaneurysm was compressing the adjacent splenic vein which explained the splenomegaly, splenic varices and the presence of a splenorenal shunt. Scattered calcifications were also noted throughout the pancreatic parenchyma suggestive of chronic pancreatitis. The patient finally underwent aneurysmectomy and splenectomy and was subsequently discharged after an unremarkable postop course. The patient has followed up at the outpatient clinic and has remained pain-free since her discharge. Results: Splenic artery pseudoaneurysms Arachidonate 15-lipoxygenase are rare. In a study done in the Mayo Clinic, cases referred for evaluation of visceral artery aneurysms over an 18-year period were retrospectively reviewed. In this time frame, only ten cases were identified as splenic artery pseudoaneurysms. The most common symptoms associated with this condition were bleeding and abdominal or flank pain. While true visceral artery aneurysms are usually associated with arteriosclerosis, pseudoaneurysms, including those arising from the splenic artery, usually develop secondary to previous inflammation or trauma.

Liver fibrosis

and hepatic stellate cell (HSC) activation

Liver fibrosis

and hepatic stellate cell (HSC) activation were assessed by sirius red staining and immunohistochemistry. Injury serum markers such as alanine transaminase (ALT), aspartate transam-inase (AST), and total antioxidant activity were evaluated. To confirm the protective effects against oxidant conditions, we used hydrogen peroxide or thioacetamide in order to induce oxidative stress conditions in vitro. We then quantified cellular reactive oxygen species (ROS) and enzymes related to oxidative stress resolution in HSCs and hepatocytes co-cultured with MSCs. Results: We confirmed that our cells showed MSC characteristics. They were adherent to plastic, positive for CD73/CD90/CD105 and negative for CD45, and were able to differentiate into adipocytes I-BET-762 nmr and osteocytes. In NOD-SCID cirrhotic mice, they were able to reduce liver fibrosis

(p<0.05) and hepatic αSMA-positive area (p<0.05). In addition, mice treated with MSCs showed lower R788 price levels of ALT (p<0.05) and AST (p<0.05), and higher total antioxidant activity (p<0.001). HSCs co-cultured with MSCs showed lower levels of ROS (p<0.05), consistent with up-regulated expressions of heme oxy-genase-1 (p<0.01) and superoxide dismutase-3 (p<0.001) in MSCs. Moreover, we confirmed that hepatocytes co-cultured with MSCs had lower levels of ROS (p<0.001), and higher expressions of NF-E2-related factor 2 (p<0.05) and glutathione S-transferase (p<0.01). Conclusions: These results demonstrate that infused MSCs are involved in the improvement of liver injury through stabilization of redox homeostasis, which strongly indicates the possibility of a less invasive

liver regeneration therapy for liver cirrhotic patients using cultured autologous BM-derived MSCs. Disclosures: The following people have nothing to disclose: CYTH4 Taro Takami, Shuji Terai, Luiz Fernando Quintanilha, Koichi Fujisawa, Naoki Yamamoto, Isao Sakaida As hepatic fibrosis progresses, elastin content and matrix crosslinking increase. This may limit reversibility of cirrhosis. Aims: 1 )develop an automated image analysis algorithm to quantify elastin in immunostained biopsies; 2)evaluate elastin as a predictor of clinical outcomes from cirrhosis due to CHC. Patients with a biopsy showing Ishak stage (IS) 5 or 6 fibrosis were selected from 1 centre within the Trent Study of Patients with Hepatitis C Virus Infection. An elastin-specific antibody (Abcam ab21610) was used for quantitative immunohisto-chemistry. A digital image analysis algorithm was developed with ImageJ software (NIH). The algorithm uses statistical colour modelling to avoid a need for manual thresholding and is an automated process. We evaluated hepatic elastin as a predictor of subsequent clinical outcomes, defined as the first event of variceal bleed, ascites, encephalopathy, hepatocellular carcinoma, liver transplantation or liver-related death. 48 patients were included (IS5: n=27; IS6: n=21).

Conclusion — Menstruation is the most prominent factor increasing

Conclusion.— Menstruation is the most prominent factor increasing the risk of aura as well as that of HoA and MoA. Smoking shows the most striking difference increasing the risk of aura, but decreasing the risk of HoA and MoA. “
“(Headache 2010;50:943-952) Interventional procedures such as peripheral nerve blocks (PNBs) and trigger point injections (TPIs) have long been used in the treatment of various headache disorders. There are, however, little data on their

efficacy for the treatment of specific headache syndromes. Moreover, there is no widely accepted agreement among headache specialists as to the optimal technique of injection, type, and doses of the local anesthetics used, and injection regimens. The role of corticosteroids in this setting is also debated. We performed a PubMed Metformin price search of the literature to find studies on PNBs and TPIs for headache treatment. We classified the abstracted studies based on the procedure performed and the treated condition. We found few controlled studies on the efficacy of PNBs for headaches, and virtually none on the use of TPIs for this indication. The most widely examined procedure in this setting was greater occipital nerve block, with the majority of studies being small and non-controlled. The techniques, as well as the type

and doses of local anesthetics used for nerve blockade, varied greatly among studies. The specific CH5424802 conditions treated also varied, and included both primary (eg, migraine, cluster headache) and secondary (eg, cervicogenic, posttraumatic) headache disorders. Trigeminal (eg, supraorbital) nerve blocks were used in few studies. Results were generally positive, but should be taken with reservation given the methodological limitations

of the available studies. The procedures were generally well tolerated. Evidently, there is a need to perform more rigorous clinical trials to clarify the role of PNBs and TPIs in the management of various headache disorders, and to aim at standardizing the techniques used for the various procedures in this setting. “
“Migraine is associated with a significant economic burden in Western countries. However, there is limited information regarding the impact of the cost of migraine click here in Asia. To quantify and compare the direct medical costs of refractory migraine (RM) and other migraine, using health insurance claims data in Taiwan. A retrospective matched case–control study was conducted utilizing data from the Taiwan National Health Insurance Research Database. RM cases were defined as patients with at least 1 neurological outpatient visit with a primary or secondary International Classification of Diseases, Ninth Revision, Clinical Modification code of 346.11 (common migraine with intractable migraine, so stated), diagnosed by certified neurologists in medical centers during 2007-2008. The first control group was the non-migraineurs matched with cases at a 4:1 ratio by age, gender, urbanization level of the residence, and income.