Treating the Uninsured and Underinsured with Migraine in the USA.

PURPOSE OF REVIEW: To define, describe, and identify potential solutions for health disparities in the uninsured and underinsured with migraine in the USA. RECENT FINDINGS: Uninsured and underinsured patients with migraine experience health disparities in diagnosis and treatment of migraine. Migraine patients have higher healthcare costs and higher employment disability, which contribute to a higher likelihood of uninsured or underinsured status. Uninsured or underinsured status, combined with factors such as race, socioeconomic status, geographic location, and care location, are correlated with delays in or decreased migraine diagnosis and treatment. Migraine prevalence is increased in the uninsured and underinsured. Potential solutions include advocacy for policy changes that improve access to care, increasing awareness and representation of underrepresented groups, providing resources to patients to reduce costs, and active patient engagement in migraine care. Continued efforts from all stakeholders have the potential to reduce health disparities in uninsured and underinsured patients with migraine, reducing disability and improving quality of life.

Total Syntheses of (±)-Dracocephalone A and (±)-Dracocequinones A and B.

Described herein are the first total syntheses of (±)-dracocephalone A (1) and (±)-dracocequinones A (4) and B (5). The synthesis was initially envisioned as proceeding through an intramolecular isobenzofuran Diels-Alder reaction, a strategy that eventually evolved into a Lewis acid-promoted spirocyclization. This highly diastereoselective transformation set the stage for trans-decalin formation and a late-stage Suárez oxidation that produced a [3.2.1] oxabicycle suited for conversion to 1. Brønsted acid-mediated aromatization, followed by a series of carefully choreographed oxidations, allowed for rearrangement to a [2.2.2] oxabicycle poised for conversion to 4 and 5.

Lymphoepithelial carcinoma of the salivary glands.

RATIONALE: Lymphoepithelial carcinoma (LEC) is a rare malignancy with the histopathological feature of undifferentiated carcinoma and an intermixed reactive lymphoplasmacytic infiltration. Although clinically significant because of its malignant nature, it is difficult to make a differential diagnosis by preoperative imaging. Here, we report 3 cases of primary LEC arising in the major salivary glands, which showed unusual imaging features unlike other malignant tumors. PATIENT CONCERNS: Our first case is a 44-year-old man with LEC in the right parotid gland, the second case is a 71-year-old woman with LEC in the right submandibular gland, and the third case is a 35-year-old woman with LEC in the right parotid gland. All of the patients presented with a palpable mass of variable duration. DIAGNOSES: Computed tomography (CT) scans revealed a relatively well-defined, slightly hyperattenuated exophytic solid mass that had homogeneous well-enhanced regions. Ultrasonography (US) in the first 2 cases showed well-defined, hypoechoic solid masses with posterior enhancement. The CT findings seem to be benign tumors, but US features are compatible with highly cellular and hypervascular tumors. INTERVENTIONS: The resection of the involved salivary gland with postoperative radiation therapy was performed. OUTCOMES: There was no evidence of recurrence or metastasis after 5 years in all 3 patients. LESSONS: Understanding these unusual imaging findings may be helpful in detecting LEC, and may also help clinicians provide adequate management to patients, such as surgery with adjuvant radiotherapy, because of its malignant entity.