BackgroundChina may have the largest population of headache sufferers and therefore the most serious burden of disease worldwide. However, the rate of diagnosis for headache disorders is extremely low, possibly due to the relative complexity of headache subtypes and diagnostic criteria. The use of computerized clinical decision support systems (CDSS) seems to be a better choice to solve this problem.MethodsWe developed a headache CDSS based on ICHD-3 beta and validated it in a prospective study that included 543 headache patients from the International Headache Center at the Chinese PLA General hospital, Beijing, China.ResultsWe found that the CDSS correctly recognized 159/160 (99.4%) of migraine without aura, 36/36 (100%) of migraine with aura, 20/21 (95.2%) of chronic migraine, and 37/59 (62.7%) of probable migraine. This system also correctly identified 157/180 (87.2%) of patients with tension-type headache (TTH), of which infrequent episodic TTH was diagnosed in 12/13 (92.3%), frequent episodic TTH was diagnosed in 99/101 (98.0%), chronic TTH in 18/20 (90.0%), and probable TTH in 28/46 (60.9%). The correct diagnostic rates of cluster headache and new daily persistent headache (NDPH) were 90.0% and 100%, respectively. In addition, the system recognized 32/32 (100%) of patients with medication overuse headache.ConclusionsWith high diagnostic accuracy for most of the primary and some types of secondary headaches, this system can be expected to help general practitioners at primary hospitals improve diagnostic accuracy and thereby reduce the burden of headache in China.

BackgroundThe overlap between probable migraine (PM) and probable tension-type headache (PTTH) often confuses physicians in clinical practice. Although clinical decision support systems (CDSSs) have been proven to be helpful in the diagnosis of primary headaches, the existing guideline-based headache disorder CDSSs do not perform adequately due to this overlapping issue. Thus, in this study, a CDSS based on case-based reasoning (CBR) was developed in order to solve this problem.MethodsFirst, a case library consisting of 676 clinical cases, 56.95% of which had been diagnosed with PM and 43.05% of which had been diagnosed with PTTH, was constructed, screened by a three-member panel, and weighted by engineers. Next, the resulting case library was used to diagnose current cases based on their similarities to the previous cases. The test dataset was composed of an additional 222 historical cases, 76.1% of which had been diagnosed with PM and 23.9% of which had been diagnosed with PTTH. The cases that comprised the case library as well as the test dataset were actual clinical cases obtained from the International Headache Center in Chinese PLA General Hospital.ResultsThe results indicated that the PM and PTTH recall rates were equal to 97.02% and 77.78%, which were 34.31% and 16.91% higher than that of the guideline-based CDSS, respectively. Furthermore, the PM and PTTH precision rates were equal to 93.14% and 89.36%, which were7.09% and 15.68% higher than that of the guideline-based CDSS, respectively. Comparing CBR CDSS and guideline-based CDSS, the p-value of PM diagnoses was equal to 0.019, while that of PTTH diagnoses was equal to 0.002, which indicated that there was a significant difference between the two approaches.ConclusionsThe experimental results indicated that the CBR CDSS developed in this study diagnosed PM and PTTH with a high degree of accuracy and performed better than the guideline-based CDSS. This system could be used as a diagnostic tool to assist general practitioners in distinguishing PM from PTTH.

Objective To observe the prevalence and characteristics of premonitory symptoms in Chinese migraineurs and explore their associations with migraine-related factors. Method Migraineurs who visited a tertiary headache clinic and one of nine neurology clinics between May 2014 and November 2019 were studied. Result Among the 4821 patients meeting the migraine criteria (International Classification of Headache Disorders, 3rd edition), 1038 (21.5%) patients experienced at least one premonitory symptom. The most common premonitory symptoms were neck stiffness, dizziness, yawning and drowsiness. The logistic regression analysis demonstrated that aura, photophobia, aggravation by routine physical activity, triggers, family history, depression, coffee consumption and physical exercise were associated with an increased probability of experiencing premonitory symptoms ( p ≤ 0.001). The premonitory symptoms of migraine with and without aura differ in prevalence and most common symptoms. The cluster analysis revealed pairwise clustering of the following premonitory symptoms: Photophobia/phonophobia, concentration change/dysesthesia, loquacity/overactivity, yawning/drowsiness, fatigue/dizziness, and mood change/irritability. The correlation analysis of triggers and premonitory symptoms revealed that temperature change, environment change, sleep disorder, activity and stress were related to multiple premonitory symptoms, and that food, light, menstruation, alcohol and odor were related to special premonitory symptoms ( p ≤ 0.001). Conclusion The prevalence of premonitory symptoms among migraineurs in China is 21.5%. Some factors influence the probability of experiencing premonitory symptoms. Paired premonitory symptoms in the clustering analysis may share similar origins. Certain triggers associated with multiple premonitory symptoms may induce brain dysfunction; however, other triggers that overlap with corresponding special premonitory symptoms may be premonitory symptoms or a form of premonitory symptom.

MT1-MMP (membrane type 1-matrix metalloproteinase) plays important roles in cell growth and tumor invasion via mediating cleavage of MMP2/gelatinase A and a variety of substrates including type I collagen. BST-2 (bone marrow stromal cell antigen 2) is a membrane tetherin whose expression dramatically reduces the release of a broad range of enveloped viruses including HIV from infected cells. In this study, we provided evidence that both transient and IFN-α induced BST-2 could decrease the activity of MMP2 via binding to cellular MT1-MMP on its C- terminus and inhibiting its proteolytic activity; and finally block cell growth and migration. Zymography gel and Western-blot experiments demonstrated that BST-2 decreased MMP2 activity, but no effect on the expression of MMP2 and MT1-MMP genes. Confocal and immunoprecipitation data showed that BST-2 co-localized and interacted with MT1-MMP. This interaction inhibited the proteolytic enzyme activity of MT1-MMP, and blocked the activation of proMMP2. Experimental results of C-terminus deletion mutant of MT1-MMP showed that activity of MMP2 was no change and also no interaction existed between the mutant and BST-2 after co-transfection with the mutant and BST-2. It meant that C-terminus of MT1-MMP played a key role in the interaction with BST-2. In addition, cell growth in 3-D type I collagen gel lattice and cell migration were all inhibited by BST-2. Taken together, BST-2, as a membrane protein and a tetherin of enveloped viruses, was a novel inhibitor of MT1-MMP and could be considerable as an inhibitor of cancer cell growth and migration on clinic.

Clinical decision support system (CDSS) is an effective tool for improving healthcare quality. Since the clinical symptoms of some primary headache disorders in individual patients often overlap and that ill-defined boundaries for some headache features may be vague, current rule-based CDSS cannot perform as well as expected. In this paper, we develop a CDSS for primary headache disorder diagnosis based on rulebased and case-based reasoning in order to simulate a headache specialist's thinking process. First, the new case is evaluated by rule-based reasoning, the rules come from headache clinical guideline; second, if rule-based reasoning was unable to get accurate answer, case-based reasoning will find the most similar case in case library based on similarity matching. In particular, we define a similarity calculating method for primary headaches case. The final results show that the proposed approach improves the diagnostic accuracy dramatically compared to the rule-based primary headache diagnosis systems.