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Circadian rhythm sleep-wake disorders (CRSWDs ) is a group of sleep-wake disorders caused by circadian rhythm disorder. Patients complain of difficulty in falling asleep, early waking, daytime drowsiness, which are often misdiagnosed and delayed for treatment. The American Academy of Sleep Medicine (AASM) updated the diagnostic criteria in 2014, and issued relevant treatment guidelines in 2015. In recent years, many countries have issued relevant clinical practice guidelines or consensus. The treatment of circadian rhythm sleep-wake disorder is different from the common sleep-wake disorder, with the focus on non-pharmacologic circadian rhythm regulation to reset the normal 24-hour sleep-wake rhythm. This article mainly introduces its treatment strategy and method.
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Objective To investigate the expression of SOX2 in gastric carcinoma and to analyze its relationship with clinicopathological features.Methods Immunohistochemistry method was used to detect the level of SOX2 in 67 cases of gastric carcinoma group and 30 cases of normal gastric mucosa group.Results The positive expression rate of SOX2 in gastric carcinoma group (52.24 ％) was obviously lower than that in normal gastric mucosa group (93.33 ％) (x2 =16.326,P ＜ 0.01).The SOX2 expression was significantly correlated with differentiation,the depth of invasion,lymph node metastasis and TNM stage of the tumor (all P ＜ 0.05).Conclusions The low expression of SOX2 may contribute to the early carcinogenesis of gastric carcinoma,and the expression level of SOX2 is closely related with lymph node metastasis and TNM stage.The expression level of SOX2 is a useful marker for predicting the prognosis of gastric carcinoma.
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Sleep-wake disturbance is not only a risk factor for stroke,but also one of the serious complications of stroke.The main clinical manifestations of post-stroke sleep-wake disturbance are insomnia,arousal disorders,sleep-related movement disorders and parasomnias.Its mechanism is mainly associated with the sleep-wake center after stroke injury.
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<p><b>OBJECTIVE</b>To investigate the impact of obstructive sleep apnea-hypopnea syndrome (OSAHS) on cerebral microbleeds (CMBs) in patients with cerebral infarction.</p><p><b>METHODS</b>Consecutive patients with acute cerebral infarction who had cerebral microbleeds shown by susceptibility-weighted imaging (SWI) were enrolled to undergo polysomnography (PSG). The patients were divided into two groups, namely non-OSAHS group with apnea-hypopnea index (AHI) less than 5 and OSAHS group with greater AHI, and the clinical and radiological features of cerebral microbleeds were compared between them.</p><p><b>RESULTS</b>Forty-nine patients were enrolled in this study, including 27 (55.1%) with both cerebral infarction and OSAHS and 22 (44.9%) with cerebral infarction but not OSAHS. A comparison of the risk factors showed that hypertension, a smoking history, and a history of stroke were more prevalent in patients with OSAHS than in those without OSAHS (P<0.05). The incidences of subclinical stroke in OSAHS and non-OSAHS patients were 37.0% (10/27) and 9.0% (2/22) (P<0.05), respectively. Neurological imaging revealed a greater number of cerebral microbleeds in OSAHS group than in non-OSAHS group (P<0.05). In OSAHS patients, 77.8% of the microbleeds were distributed in cortical-subcortical areas, 55.6% in the basal ganglia area, and 25.9% in the infratentorial area, as compared to the percentages of 50.0%, 40.9% and 50.0% in non-OSAHS patients, respectively (P<0.05). In OSAHS patients, 40.7% also had leukoaraiosis, and 48.1% had two or more causes, as compared to the percentages of 13.6% and 18.2% in non-OSAHS patients, respectively (P<0.05).</p><p><b>CONCLUSIONS</b>OSAHS can be a risk factor for cerebral microbleeds. Patients with both cerebral infarction and OSAHS tend to have greater and more extensive lesions of cerebral microbleeds, more complicated cause of the disease, and a grater likeliness of stroke recurrence.</p>
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Aged , Female , Humans , Male , Middle Aged , Cerebral Hemorrhage , Pathology , Cerebral Infarction , Pathology , Risk Factors , Sleep Apnea, Obstructive , PathologyABSTRACT
As the early stage of dementia, vascular cognitive impairment no dementia (VCI-ND) has become a hot research topic in recent years. The effective identification of VCI-ND has important clinical significance for prevention and decreasing of dementia. This article reviews the advances in research on neuropsychology, neuroimaging, biological markers, as well as the prevention and treatment of VCI-ND.
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Objective To investigate the feature of the morphology changes in the upper airway in patients with acute cerebral infarction and to find a new method to prevent and cure cerebral infarction.Methods Sixty-six patients with cerebral infarction confirmed by brain MRI or CT scan(within 3 weeks of onset) were recruited.The patients were examined by upper airway MRI scan and polysomnography (PSG).Then the patients were divided into obstructive sleep apnea hypopnca syndrome(OSAHS)group and non-OSAHS group.In addition.16 patients showing OSAHS but without stroke history(OSAHS nonstroke group)were included in the study.The sagittal and horizontal lengths of the nasopharynx,palatopharynx,glossopharynx and hypopharynx were measured and their closs-sectional areas were calculated.The length,thickness and cross-sectional area of the palate were also measured.Statistic analysis of each data among the groups was performed using SPSS software.Results Among 66 cases with acute cerebral infarction,75.8 % (50/66)were diagnosed with OSAHS.The anteropesterior diameer,left and right diameters and smallest section area in upper airway were all smaller in the OSAHS group with acute cerebral infaretion than those in the non-OSAHS group and OSAHS non-stroke group.The narrowest segments in upper airway were nasopharynx and ompharynx.which are caused by shortened left and right diameters.The area of the soft palate in the OSAHS-stroke group was significant bigger((452.2±99.6)mm2)than that in non-OSAHS group((350.0±69.4)mm2,t:4.575,P<0.05).The lowest SO2 in OSAHS-stroke group(68.9 % ±10.5 % )was the lowest among three groups.The more severe the airway constriction was.the higher the apnea-hypopnea index(AHI)was and the lower the lowest SO2 was.Conclusion Patients withl stroke show higher incidence of OSAHS and present more severe multilevel upper airway constriction.Upper airway constriction may be the new target of early treatment for better prognosis of cerebral infarction.