2E) These changes were frequent at 50 weeks but were

2E). These changes were frequent at 50 weeks but were Pirfenidone chemical structure rare in younger mice. To determine whether altered expression of mitochondria-shaping proteins could account for the morphological changes, the expressions of optic atrophy 1 (Opa1), mitofusins (Mfn1 and 2), and the cytosolic dynamin-related protein 1 (Drp1) and its receptor on the outer mitochondrial membrane, Fis1, were compared. The expression of fusion protein Opa1 was 1.5-fold higher in Hint2−/− mice than in Hint2+/+ mice, whereas Mfn1 and Mfn2 were not different. Fis1 and Drp1 were slightly lower in Hint2−/− mice

(Supporting Fig. 2A,B). To determine whether the accumulation of lipids was related to defective mitochondrial β-oxidation of fatty acids, the activities of CPT1 and CPT2 and of medium- or short-chain hydroxyacyl-CoA dehydrogenase (Hadhsc), which catalyzes the NAD+-dependent dehydrogenation of 3-hydroxyacyl-CoA in the mitochondrial matrix, were measured. The activity of Hadhsc was decreased by 68% in Hint2−/− mice compared with Hint2+/+ mice (Fig. 3A) without a change in expression of the enzyme (Fig. 3B). The activity of CPT did not change (Supporting Fig. 7A). In plasma, free fatty acid concentrations were not different, triglyceride concentrations were

lower in Hint2−/− mice only at 30 weeks, and total cholesterol was slightly higher in Hint2−/− mice (Table 1). Because the Hadhsc enzyme can bind to glutamate dehydrogenase (GDH) in the mitochondrial matrix, which is a potential point of regulation for both enzymes, Palbociclib supplier the activity of Cediranib (AZD2171) GDH was also measured. GDH activity was decreased by 60% in Hint2−/− livers, with no change in GDH expression (Fig. 3C,D). To determine whether the protein-protein interaction of Hadhsc and GDH was disturbed by the absence of Hint2, the co-immunoprecipitation of GDH and Hadhsc was tested. Co-immunoprecipitation

was successful in Hint2+/+ and Hint2−/− mitochondria (Fig. 3E,F). Because the nonfasting interprandial insulin concentrations were two-fold higher in Hint2−/− than in Hint2+/+ mice (Table 1), a glucose tolerance test (GTT) and insulin tolerance test (ITT) were performed and insulin signaling was examined. The GTT yielded higher glucose values in Hint2−/− than in Hint2+/+ mice (area under the curve, 1,378 ± 312 versus 1,021 ± 281 mmol/L × 120 minutes, respectively; P = 0.09) (Fig. 4A). However, random interprandial blood glucose (Table 1) and fasting blood glucose were not different in Hint2−/− versus Hint2+/+ mice (Fig. 4A,C). The phosphorylation of the threonine-serine kinase, Akt, and the expression of downstream targets were measured in liver homogenates, muscle, and white adipose tissue (WAT) of fasted mice after insulin stimulation (Fig. 4B). Insulin induced phosphorylation of Akt at Ser473 and Thr308 in all tissues (Fig. 4B, Supporting Fig. 3A).

2E) These changes were frequent at 50 weeks but were

2E). These changes were frequent at 50 weeks but were Selleck SB203580 rare in younger mice. To determine whether altered expression of mitochondria-shaping proteins could account for the morphological changes, the expressions of optic atrophy 1 (Opa1), mitofusins (Mfn1 and 2), and the cytosolic dynamin-related protein 1 (Drp1) and its receptor on the outer mitochondrial membrane, Fis1, were compared. The expression of fusion protein Opa1 was 1.5-fold higher in Hint2−/− mice than in Hint2+/+ mice, whereas Mfn1 and Mfn2 were not different. Fis1 and Drp1 were slightly lower in Hint2−/− mice

(Supporting Fig. 2A,B). To determine whether the accumulation of lipids was related to defective mitochondrial β-oxidation of fatty acids, the activities of CPT1 and CPT2 and of medium- or short-chain hydroxyacyl-CoA dehydrogenase (Hadhsc), which catalyzes the NAD+-dependent dehydrogenation of 3-hydroxyacyl-CoA in the mitochondrial matrix, were measured. The activity of Hadhsc was decreased by 68% in Hint2−/− mice compared with Hint2+/+ mice (Fig. 3A) without a change in expression of the enzyme (Fig. 3B). The activity of CPT did not change (Supporting Fig. 7A). In plasma, free fatty acid concentrations were not different, triglyceride concentrations were

lower in Hint2−/− mice only at 30 weeks, and total cholesterol was slightly higher in Hint2−/− mice (Table 1). Because the Hadhsc enzyme can bind to glutamate dehydrogenase (GDH) in the mitochondrial matrix, which is a potential point of regulation for both enzymes, Selleckchem Epacadostat the activity of PTK6 GDH was also measured. GDH activity was decreased by 60% in Hint2−/− livers, with no change in GDH expression (Fig. 3C,D). To determine whether the protein-protein interaction of Hadhsc and GDH was disturbed by the absence of Hint2, the co-immunoprecipitation of GDH and Hadhsc was tested. Co-immunoprecipitation

was successful in Hint2+/+ and Hint2−/− mitochondria (Fig. 3E,F). Because the nonfasting interprandial insulin concentrations were two-fold higher in Hint2−/− than in Hint2+/+ mice (Table 1), a glucose tolerance test (GTT) and insulin tolerance test (ITT) were performed and insulin signaling was examined. The GTT yielded higher glucose values in Hint2−/− than in Hint2+/+ mice (area under the curve, 1,378 ± 312 versus 1,021 ± 281 mmol/L × 120 minutes, respectively; P = 0.09) (Fig. 4A). However, random interprandial blood glucose (Table 1) and fasting blood glucose were not different in Hint2−/− versus Hint2+/+ mice (Fig. 4A,C). The phosphorylation of the threonine-serine kinase, Akt, and the expression of downstream targets were measured in liver homogenates, muscle, and white adipose tissue (WAT) of fasted mice after insulin stimulation (Fig. 4B). Insulin induced phosphorylation of Akt at Ser473 and Thr308 in all tissues (Fig. 4B, Supporting Fig. 3A).

Furthermore, the high levels of CD95 and PD1 expression by CD4+ C

Furthermore, the high levels of CD95 and PD1 expression by CD4+ CTLs also implies that they have additional regulatory mechanisms (Supporting Fig. 4A). Future studies should determine which factors are responsible for the suppression of CD4+ CTLs in HCC patients. These data also suggest that the target of CD4+ CTLs in vivo could facilitate the boosting of the antitumor responses in HCC patients. It is currently not known why CD4+ CTLs are increased in HCC

patients with early stage disease. We found that the frequency of CD4+ CTLs in CHB and LC patients was much lower than in HCC patients, which was in accordance with the findings of a previous study15 that showed chronic HBV infection was not the principal reason for increased numbers of CD4+ CTLs in HBV-associated selleck products Hydroxychloroquine HCC patients. Three reasons may be involved in the increase in CD4+ CTL numbers in HCC patients: (1) the suppression of traditional cytotoxic immune cells might induce feedback compensation for the high incidence of CD4+ CTLs in HCC patients. For example, the cytolytic activity of CD8+ T lymphocytes and NK cells in

HCC patients is significantly abrogated during tumorigenesis.24, 33, 34 Indeed, Williams and Engelhard35 found that CD4+ T cells develop perforin-dependent cytotoxicity only in the absence of activated CD8+ T cells; (2) Abnormal immune activation due to the chronic inflammatory microenvironment is thought to be another major driving factor that induces CD4+ CTLs differentiation. Numerous reports have demonstrated that the presence of increased numbers of CD4+ CTLs is associated with chronic inflammatory processes, such as chronic viral infection or autoimmune diseases.5, 15, 17, 18, 36 Additionally, inflammation is also involved in all stages of tumor development and correlates with poor survival rates in HCC.37-40 Consistent with this hypothesis, we found that CD4+ CTLs in HCC

patients were highly medroxyprogesterone activated (high levels of CD38 and HLA-DR expression) (Supporting Fig. 4A); and (3) the increased numbers of CD4+ CTLs in tumor and nontumor regions may also be due to their recruitment into the liver from the peripheral blood, which is a similar finding to the previously reported role of CD8+ T cells.41 Future studies are warranted to confirm these hypotheses. In summary, this study demonstrated that a progressive decrease in the number of CD4+ CTLs was closely associated with HCC progression and poor survival rates in HCC patients. The intrinsic defects and extrinsic suppression by increased Treg cells may involve the impairment of CD4+ CTLs in HCC patients. These data highlight the novel role of CD4+ CTLs in the immunocompromised status of HCC patients, and also provide a potential therapeutic target for the treatment of HCC. Additional Supporting Information may be found in the online version of this article.

To test whether the observed and expected distributions differed

To test whether the observed and expected distributions differed Opaganib in vivo significantly, we used a second script (Supporting Information Text S2) to calculate the distribution of median LF/HF values expected from intrinsic variation alone given the sample size available by calculating median LF/HF values for sets of simulated values

of the same sample size as the observed number of paired-queen colonies. This calculation was repeated 1000 times and the bottom 5% provided the cutoff for statistical significance. To determine the relationships among relative size differences, social dominance, excavation performance and reproduction, paired queens were ordered at random and the proportional difference between paired queens in each variable was calculated as the natural log of the ratio of the first over the second queen. For all variables except size, 1 was added to the individual queen values to prevent division by zero. This created an index symmetrical around 1 (equal values), with roughly half of pairs above 1 and half below for any given variable. We then tested for relationships among these variables using multiple linear regressions. Given the sequential nature

of dominance, excavation and reproductive behaviors, we analyzed each of these dependent variables against only those independent variables which preceded its expression (i.e. only size differences were considered to affect dominance, while both size and dominance were included when analyzing excavation). Although P. barbatus queens can be maintained in pairs, queens were generally aggressive toward one another click here when forced to associate. Over both years, Immune system pairs of queens displayed at least one aggressive behavior in 78.5% of cases, ranging from 1 to 18 discrete aggressive actions displayed in a 15-min observation period. Of these,

in 47% (24 of 51 pairs) all aggression was displayed by one of the two queens. In the remaining pairs, aggressive behaviors were initiated to some extent by both queens. Aggressive behaviors did not appear to produce any visible injuries that could have physically impaired excavation behaviors. Aggressive behaviors were not more likely to be initiated by the larger queen in the pair (t53 = 1.05, P = 0.30, Fig. 1a). Despite the high level of initial aggression, continued aggression after excavation had commenced was relatively rare, observed between queens more than 2 hours after introduction in only 8 of the 65 total nests (12.3%). A queen performed at least one instance of excavation behavior in 61 of 63 single nests (97%) and in all 65 paired nests. Total excavations observed in single and paired nests did not differ in 2011 (singles: 15.33 ± 1.66 excavations, doubles: 14.14 ± 1.18; Student’s t-test, t53 = 0.71, P = 0.48) or in 2012 (singles: 33.97 ± 3.66, doubles: 40.18 ± 3.85; t53 = −1.17, P = 0.25; Fig. 2).

To test whether the observed and expected distributions differed

To test whether the observed and expected distributions differed Selleckchem SB203580 significantly, we used a second script (Supporting Information Text S2) to calculate the distribution of median LF/HF values expected from intrinsic variation alone given the sample size available by calculating median LF/HF values for sets of simulated values

of the same sample size as the observed number of paired-queen colonies. This calculation was repeated 1000 times and the bottom 5% provided the cutoff for statistical significance. To determine the relationships among relative size differences, social dominance, excavation performance and reproduction, paired queens were ordered at random and the proportional difference between paired queens in each variable was calculated as the natural log of the ratio of the first over the second queen. For all variables except size, 1 was added to the individual queen values to prevent division by zero. This created an index symmetrical around 1 (equal values), with roughly half of pairs above 1 and half below for any given variable. We then tested for relationships among these variables using multiple linear regressions. Given the sequential nature

of dominance, excavation and reproductive behaviors, we analyzed each of these dependent variables against only those independent variables which preceded its expression (i.e. only size differences were considered to affect dominance, while both size and dominance were included when analyzing excavation). Although P. barbatus queens can be maintained in pairs, queens were generally aggressive toward one another click here when forced to associate. Over both years, Succinyl-CoA pairs of queens displayed at least one aggressive behavior in 78.5% of cases, ranging from 1 to 18 discrete aggressive actions displayed in a 15-min observation period. Of these,

in 47% (24 of 51 pairs) all aggression was displayed by one of the two queens. In the remaining pairs, aggressive behaviors were initiated to some extent by both queens. Aggressive behaviors did not appear to produce any visible injuries that could have physically impaired excavation behaviors. Aggressive behaviors were not more likely to be initiated by the larger queen in the pair (t53 = 1.05, P = 0.30, Fig. 1a). Despite the high level of initial aggression, continued aggression after excavation had commenced was relatively rare, observed between queens more than 2 hours after introduction in only 8 of the 65 total nests (12.3%). A queen performed at least one instance of excavation behavior in 61 of 63 single nests (97%) and in all 65 paired nests. Total excavations observed in single and paired nests did not differ in 2011 (singles: 15.33 ± 1.66 excavations, doubles: 14.14 ± 1.18; Student’s t-test, t53 = 0.71, P = 0.48) or in 2012 (singles: 33.97 ± 3.66, doubles: 40.18 ± 3.85; t53 = −1.17, P = 0.25; Fig. 2).

To test whether the observed and expected distributions differed

To test whether the observed and expected distributions differed http://www.selleckchem.com/products/Liproxstatin-1.html significantly, we used a second script (Supporting Information Text S2) to calculate the distribution of median LF/HF values expected from intrinsic variation alone given the sample size available by calculating median LF/HF values for sets of simulated values

of the same sample size as the observed number of paired-queen colonies. This calculation was repeated 1000 times and the bottom 5% provided the cutoff for statistical significance. To determine the relationships among relative size differences, social dominance, excavation performance and reproduction, paired queens were ordered at random and the proportional difference between paired queens in each variable was calculated as the natural log of the ratio of the first over the second queen. For all variables except size, 1 was added to the individual queen values to prevent division by zero. This created an index symmetrical around 1 (equal values), with roughly half of pairs above 1 and half below for any given variable. We then tested for relationships among these variables using multiple linear regressions. Given the sequential nature

of dominance, excavation and reproductive behaviors, we analyzed each of these dependent variables against only those independent variables which preceded its expression (i.e. only size differences were considered to affect dominance, while both size and dominance were included when analyzing excavation). Although P. barbatus queens can be maintained in pairs, queens were generally aggressive toward one another Selleck Navitoclax when forced to associate. Over both years, PAK6 pairs of queens displayed at least one aggressive behavior in 78.5% of cases, ranging from 1 to 18 discrete aggressive actions displayed in a 15-min observation period. Of these,

in 47% (24 of 51 pairs) all aggression was displayed by one of the two queens. In the remaining pairs, aggressive behaviors were initiated to some extent by both queens. Aggressive behaviors did not appear to produce any visible injuries that could have physically impaired excavation behaviors. Aggressive behaviors were not more likely to be initiated by the larger queen in the pair (t53 = 1.05, P = 0.30, Fig. 1a). Despite the high level of initial aggression, continued aggression after excavation had commenced was relatively rare, observed between queens more than 2 hours after introduction in only 8 of the 65 total nests (12.3%). A queen performed at least one instance of excavation behavior in 61 of 63 single nests (97%) and in all 65 paired nests. Total excavations observed in single and paired nests did not differ in 2011 (singles: 15.33 ± 1.66 excavations, doubles: 14.14 ± 1.18; Student’s t-test, t53 = 0.71, P = 0.48) or in 2012 (singles: 33.97 ± 3.66, doubles: 40.18 ± 3.85; t53 = −1.17, P = 0.25; Fig. 2).

We would like, however, to highlight some key points PBC is char

We would like, however, to highlight some key points. PBC is characterized by a long natural history that is influenced by a number of factors that modulate mortality risk, including: clinical symptoms/signs of liver disease, associated autoimmune conditions, comorbidity with other nonautoimmune-associated conditions (i.e., osteoporosis), and response to ursodeoxycholic acid (UDCA). Table 1 summarizes the 10 most important studies dealing with the incidence of HCC in PBC patients, also reported in Liang et

al.’s review article,[1] for a total of 6,040 PBC patients. Five studies report a relationship between HCC and BMS-907351 clinical trial PBC histological stage; all of them clearly indicate that HCC arises in advanced histological stages. This behavior is most commonly observed in all types of liver disease in Western countries, with viral and nonviral selleck products etiology, with only very few exceptions. These data also confirm our previous observation, i.e., that the relative risk for HCC in female patients with stage IV PBC is similar to that of female patients with cirrhosis of different etiologies.[2] Only a few studies report a statistical analysis of the risk factors associated with

HCC development. The most impressive data regard the association with male gender and the lack of response to UDCA (although these data should be considered with caution). In our opinion it is remarkable that UDCA may favorably influence the natural history of PBC in responders. There are no sufficient elements to consider UDCA as a protective agent toward HCC, however. Screening for HCC with cross-sectional imaging, with or without alpha-fetoprotein at 6-month intervals, should be recommended for PBC patients with much advanced stage disease

(histological stage IV or Mayo prognostic score >4.1), or evidence of portal hypertension. Due to the lack of an evidence-based association with other extrahepatic liver malignancies, cancer screening in PBC patients should not differ from what is indicated in the general population. Having said that, it must be also kept in mind that, overall, PBC-related HCC appears to be a low-impact problem, since in a consecutive series of about 3,000 consecutive cases of HCC diagnosed in Italy and registered in the ITA.LI.CA database, only 10 (0.03%) are diagnosed in PBC patients. ANNAROSA FLOREANI, M.D. “
“The histone H3-lysine-4 methyltransferase mixed-lineage leukemia-3 (MLL3) and its closest homolog MLL4 (aka KMT2D) belong to two homologous transcriptional coactivator complexes, named MLL3- and MLL4-complexes, respectively. We previously reported that MLL3 plays crucial roles in multiple metabolic processes. However, the physiological roles of MLL4 in metabolism and the relationship between MLL3 and MLL4 in metabolic gene regulation remained unclear. To address these issues, we analyzed the phenotypes of newly generated MLL4 mutant mice, along with MLL3 mutant and MLL3;MLL4 compound mutant mice.

We would like, however, to highlight some key points PBC is char

We would like, however, to highlight some key points. PBC is characterized by a long natural history that is influenced by a number of factors that modulate mortality risk, including: clinical symptoms/signs of liver disease, associated autoimmune conditions, comorbidity with other nonautoimmune-associated conditions (i.e., osteoporosis), and response to ursodeoxycholic acid (UDCA). Table 1 summarizes the 10 most important studies dealing with the incidence of HCC in PBC patients, also reported in Liang et

al.’s review article,[1] for a total of 6,040 PBC patients. Five studies report a relationship between HCC and Inhibitor Library PBC histological stage; all of them clearly indicate that HCC arises in advanced histological stages. This behavior is most commonly observed in all types of liver disease in Western countries, with viral and nonviral selleck chemicals etiology, with only very few exceptions. These data also confirm our previous observation, i.e., that the relative risk for HCC in female patients with stage IV PBC is similar to that of female patients with cirrhosis of different etiologies.[2] Only a few studies report a statistical analysis of the risk factors associated with

HCC development. The most impressive data regard the association with male gender and the lack of response to UDCA (although these data should be considered with caution). In our opinion it is remarkable that UDCA may favorably influence the natural history of PBC in responders. There are no sufficient elements to consider UDCA as a protective agent toward HCC, however. Screening for HCC with cross-sectional imaging, with or without alpha-fetoprotein at 6-month intervals, should be recommended for PBC patients with PRKACG advanced stage disease

(histological stage IV or Mayo prognostic score >4.1), or evidence of portal hypertension. Due to the lack of an evidence-based association with other extrahepatic liver malignancies, cancer screening in PBC patients should not differ from what is indicated in the general population. Having said that, it must be also kept in mind that, overall, PBC-related HCC appears to be a low-impact problem, since in a consecutive series of about 3,000 consecutive cases of HCC diagnosed in Italy and registered in the ITA.LI.CA database, only 10 (0.03%) are diagnosed in PBC patients. ANNAROSA FLOREANI, M.D. “
“The histone H3-lysine-4 methyltransferase mixed-lineage leukemia-3 (MLL3) and its closest homolog MLL4 (aka KMT2D) belong to two homologous transcriptional coactivator complexes, named MLL3- and MLL4-complexes, respectively. We previously reported that MLL3 plays crucial roles in multiple metabolic processes. However, the physiological roles of MLL4 in metabolism and the relationship between MLL3 and MLL4 in metabolic gene regulation remained unclear. To address these issues, we analyzed the phenotypes of newly generated MLL4 mutant mice, along with MLL3 mutant and MLL3;MLL4 compound mutant mice.

She takes sumatriptan 100 mg once daily, occasionally twice, with

She takes sumatriptan 100 mg once daily, occasionally twice, with relief of the headaches within 2 hours. Once or twice per month, the headaches last Cobimetinib solubility dmso all day, and diclofenac powder either decreases the intensity of the pain or relieves the pain altogether. She was off sumatriptan for 2 weeks without improvement of the headaches. She has hypertension, which is well controlled on lisinopril. A nuclear cardiac stress test was

normal. She does not drink caffeinated beverages. Is there evidence to support the use of daily triptans for chronic, refractory, or intractable migraine? How might you distinguish triptan-overuse headache from chronic migraine? What are the indications for daily or near-daily triptan use? Is there long-term safety information? How does the long-term use of daily triptans compare with chronic opioids or butalbital combinations for intractable migraine? I will start off with the last question comparing daily triptan use with daily use of an opioid or butalbital

combination for the treatment of intractable migraine because I happen to have conducted research on the daily triptan vs daily opioid comparison. The butalbital combinations also contain caffeine, and I will address their daily use vs daily Y-27632 molecular weight triptan use when addressing the question about distinguishing triptan-overuse headache from chronic migraine. The research on the daily triptan vs daily opioid comparison I carried out in my headache practice with the help of Kamila Piekos, PharmD.[1] Dr. Piekos contacted by telephone patients who had daily headaches from chronic migraine and were taking a triptan or (long-acting) opioid daily. Daily triptan use was operationally defined as treatment with a triptan for headache

at least 5 days per week. The patients had to have been stable on their (triptan or opioid) headache treatment for at least 4 weeks prior to oxyclozanide the interview. Ineligible patients were those who were taking a (long-acting) opioid in addition to a triptan daily, which excluded 3 patients. Two patients in the daily triptan group could not be reached and were consequently also excluded from the study. Information was collected using the Migraine Treatment Satisfaction Questionnaire,[4] Headache Impact Test-6,[5] and a series of additional questions, which included a numerical, 11-point headache pain intensity score. The patients were informed of the purpose of the interview and provided their consent verbally. One patient in each group chose not to participate; these 2 patients were assigned the lowest possible response scores. Statistical significance was assessed using the chi-square test; a P value of .05 or less was considered statistically significant. A total of 53 patients were included in the study, consisting of 28 patients (53%) in the opioid group and 25 patients (47%) in the triptan group (Table 1). The average age of the patients in the opioid and triptan groups were 48.7 ± 7.

She takes sumatriptan 100 mg once daily, occasionally twice, with

She takes sumatriptan 100 mg once daily, occasionally twice, with relief of the headaches within 2 hours. Once or twice per month, the headaches last HSP inhibitor all day, and diclofenac powder either decreases the intensity of the pain or relieves the pain altogether. She was off sumatriptan for 2 weeks without improvement of the headaches. She has hypertension, which is well controlled on lisinopril. A nuclear cardiac stress test was

normal. She does not drink caffeinated beverages. Is there evidence to support the use of daily triptans for chronic, refractory, or intractable migraine? How might you distinguish triptan-overuse headache from chronic migraine? What are the indications for daily or near-daily triptan use? Is there long-term safety information? How does the long-term use of daily triptans compare with chronic opioids or butalbital combinations for intractable migraine? I will start off with the last question comparing daily triptan use with daily use of an opioid or butalbital

combination for the treatment of intractable migraine because I happen to have conducted research on the daily triptan vs daily opioid comparison. The butalbital combinations also contain caffeine, and I will address their daily use vs daily www.selleckchem.com/products/ABT-888.html triptan use when addressing the question about distinguishing triptan-overuse headache from chronic migraine. The research on the daily triptan vs daily opioid comparison I carried out in my headache practice with the help of Kamila Piekos, PharmD.[1] Dr. Piekos contacted by telephone patients who had daily headaches from chronic migraine and were taking a triptan or (long-acting) opioid daily. Daily triptan use was operationally defined as treatment with a triptan for headache

at least 5 days per week. The patients had to have been stable on their (triptan or opioid) headache treatment for at least 4 weeks prior to Thymidylate synthase the interview. Ineligible patients were those who were taking a (long-acting) opioid in addition to a triptan daily, which excluded 3 patients. Two patients in the daily triptan group could not be reached and were consequently also excluded from the study. Information was collected using the Migraine Treatment Satisfaction Questionnaire,[4] Headache Impact Test-6,[5] and a series of additional questions, which included a numerical, 11-point headache pain intensity score. The patients were informed of the purpose of the interview and provided their consent verbally. One patient in each group chose not to participate; these 2 patients were assigned the lowest possible response scores. Statistical significance was assessed using the chi-square test; a P value of .05 or less was considered statistically significant. A total of 53 patients were included in the study, consisting of 28 patients (53%) in the opioid group and 25 patients (47%) in the triptan group (Table 1). The average age of the patients in the opioid and triptan groups were 48.7 ± 7.