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@#The treatment of insomnia currently involves drug and non-drug therapies, with varying treatment outcomes. There is no consensus on the treatment option for insomnia in patients in different post-stroke phases. This article provides a detailed literature review of common insomnia treatment methods based on their application in insomnia in the acute phase, subacute phase, and recovery phase following stroke, aiming to provide guidance for the treatment of post-stroke insomnia. Currently, there is a lack of high-quality randomized controlled trials on the treatment of stroke-related insomnia. Existing research does not support the use of benzodiazepine drugs for the treatment of stroke-related insomnia. Studies suggest that sleep hygiene education and cognitive behavioral therapy for insomnia, non-benzodiazepine drugs, melatonin receptor agonists, antihistamine H1 receptor medications, certain sedative antidepressants, orexin receptor antagonists, and traditional Chinese medicine therapy can improve sleep quality in the subacute and recovery phases after stroke, facilitating the recovery of neurological function in patients. However, there is insufficient evaluation of the impact on neurological function recovery and the side effects.
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@#Objective To analyze the electrophysiological characteristics of patients with severe Guillain-Barré syndrome and the related factors causing poor prognosis,and evaluate the value of neuroelectrophysiology in predicting poor prognosis. Methods The clinical data of 78 GBS patients admitted to our hospital from March 2020 to May 2022 were selected,divided into mild (n=52) and severe (n=26) according to the severity of the disease,and the good group (n=45) and bad group (n=33) according to the prognosis;Compare the clinical data of different groups,compare the neuroelectrophysiological characteristics of patients in different disease groups,analyze the relevant factors causing poor prognosis,build a line chart prediction model and verify it;analyze the value of electrophysiological characteristics for poor prognosis through the subject's working characteristics (ROC) curve. Results A comparison of the clinical data of two groups of patients with different severity found that the incidence of facial paralysis,chest tightness,diarrhea,mechanical ventilation,autonomic nervous dysfunction and other autoimmune diseases in the severe group was significantly higher than that of patients in the mild group (P<0.05). By comparing the electrophysiological characteristics of the two groups,it was found that the total peroneal nerve conduction rate and tibia motor conduction rate of the severe severe group were significantly lower than that of the mild group,while the F-wave abnormality rate and dCMAP wave amplitude abnormality rate were significantly higher than that of the mild group (P<0.05);single-factor and multi-factor results showed that the pre-hospital course of hospitalization was >2 weeks,elevated cerebrospinal fluid protein,and MRC score ≤30 at hospital,mechanical ventilation,combined with other autoimmune diseases,slowing of the total peroneal nerve conduction rate,slowing down the tibial motion conduction rate,increased F-wave abnormality rate,increased amplitude abnormality of dCMAP and axial cord injury are all risk factors affecting poor prognosis (OR values are greater than 1,P<0.05);the total score of the line chart prediction model is 613 points,and the corresponding adverse prognosis probability is 74.56%,which has good distinction,accuracy and effectiveness;the ROC curve obtains the total peroneal nerve conduction rate,tibial nerve motion conduction rate,F-wave abnormality,dCMAP wave amplitude abnormality four the area,positive/negative prediction value,sensitivity and specificity under the ROC curve of the joint prediction are significantly higher than that of individual predictions,with better prediction performance. Conclusion Analyzing the electrophysiological characteristics of severe GBS patients is conducive to a clearer understanding of the severity of patients' condition. It has a very important predictive value for poor prognosis,and is worth popularizing and applying in clinic.
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@#Objective Patients with obstructive sleep apnea (OSA) can present with excessive daytime sleepiness (EDS),insomnia,and other symptom subtypes. It remains unclear whether proteomics differs in patients with OSA with EDS and insomnia. Therefore,we examined the serum proteomics of patients with OSA with different clinical subtypes,in order to identify potential biomarkers for the classification of clinical subtypes of OSA,and provide insights into the molecular biological mechanisms underlying different subtypes of the disease. Methods We included six patients with OSA (three with EDS and three with insomnia) at the Second Affiliated Hospital of Air Force Medical University. All the patients underwent overnight polysomnography (PSG) and sleep scale evaluation,followed by blood sample collection on the next morning after PSG. Differentially expressed proteins were selected by label-free quantification,and bioinformatics analysis was performed. Results We identified a subset of 34 proteins that were differentially expressed between OSA with EDS and with insomnia. Compared with the OSA with insomnia group,the OSA with EDS group showed 20 up-regulated and 14 down-regulated serum proteins. The bioinformatics analysis revealed that the main functions of these proteins focused on DNA damage,reactive oxygen species elimination,immune regulation,and inflammatory response,and they were mainly involved in intracellular transport,secretion,and vesicle transport and other biological processes. The differentially expressed proteins were mainly localized in the cytoplasm,which might be secretory proteins. The APRT-AK1 interaction pathway might play an important role in different clinical subtypes of OSA. Conclusion We determined 34 differentially expressed proteins between OSA with EDS and OSA with insomnia,such as significantly up-regulated DDI2 and PRDX6 in the serum of patients with OSA with EDS,which can identify different clinical subtypes of OSA. In addition,the APRT-AK1 interaction pathway might play an important role in different subtypes of OSA.
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Parkinson's disease(PD)and restless legs syndrome(RLS)are relatively common movement disorders.There has been much debate over whether an etiological link exists between these two diseases and whether they share common pathophysiological mechanisms.PD and RLS may co-occur and respond well to dopaminergic agents, suggesting there is underlying dopamine dysfunction in both conditions.Despite the overlapping clinical features, the mechanisms underlying idiopathic RLS and RLS associated with PD may differ.In this article, we review studies related to the epidemiology, pathophysiology and genetics of PD with concurrent RLS, in order to provide evidence for exploring the link between RLS and PD.
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Restless legs syndrome is a common motor-sensory disease of the nervous system. The main manifestations are an urge to move the legs, usually accompanied by or thought to be caused by uncomfortable and unpleasant sensations in the legs. These symptoms may begin or worsen during periods of rest or inactivity such as lying down or sitting and be partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues. This article will systematically review the pathogenesis, clinical manifestations, diagnostic criteria, differential diagnosis and treatment of restless legs syndrome.
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Neck myoclonus is part of sleep-related dyskinesia characterized by sudden myoclonus during night sleep. Myoclonus causes pronounced brief rotation or flexion of the head. As a single event, neck myoclon ususually occurs during rapid eye movement (REM) sleep, and it lasts longer than 0.5-1.0 s. At present, neck myoclonus is rarely reported. A 28-year-old male whose clinical manifestation was repeated head swing during sleep was admitted to Tangdu Hospital. Video-polysomnography showed that all the events occurred during REM sleep, and some of them were accompanied by micro-arousal reaction and leg movement. Small does of clonazepam could relieve symptoms.
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Objective To assess the epidemiology and clinical characteristics of sleep disorders in a single center in northwest China.Methods Using the International Classification of Sleep Disorders, 3rd Edition, all consecutive patients which were suspected as sleep disorders in Tangdu Hospital between January 2007 and December 2016, were included retrospectively.Results The average age of 8 037 patients was (46.59±15.83) years with male-female ratio 1∶1.24.Chronic insomnia was found in 3 848 (47.9%) patients, obstructive sleep apnea was found in 2 648 (32.9%) patients, narcolepsy was found in 294 (3.7%) patients, Kleine-Levin syndrome was found in 11 (0.1%) patients, circadian rhythm sleep-wake disorders were found in 14 (0.2%) patients, rapid eye movement behavior disorder was found in 193 (2.4%) patients, restless legs syndrome was found in 139 (1.7%) patients, periodic limb movement disorder was found in 109 (1.4%) patients, and other possible sleep disorders were found in 478 (5.9%) patients, respectively.Chronic insomnia and obstructive sleep apnea combided with somatic diseases.Conclusions Patients diagnosed by polysomnography in our single center suggested consultation rate of sleep disorders was increasing in past ten years, of which chronic insomnia and obstructive sleep apnea were dominant and comorbided with somatic diseases.
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Objective To explore the expression and function of galanin and its receptor in the female mice of anxiety-and depression-like behavior.Methods In situ hybridization was used to detect the expression of galanin,GalR1,GalR2 and GalR3 in the hippocampus of C57BL/6J female mice.A total of thirty female mice was divided into two groups:experiment group (n=15) and control group (n=15).The experiment group was subjected to the chronic unpredictable mild stress (CUMS) for four weeks,and the control group was not subjected to any treatment.Four weeks later,a series of tests were performed on those two groups,including the sucrose preference test,the novel object recognition test,the open field test and suspension tail test.After behavior tests,the hippocampus RNA was extracted from eight mice in each group to test the expression of galanin and its receptor through qPCR.The rest part of mice were used to mark C-Fos immunostaining in the dentate gyms (DG) of hippocampus.Results The result of in situ hybridization showed that galanin,GalR1 and GalR2 distributed in the Hillus of ventral hippocamous,GalR3 had no positive signal.In the sucrose preference test,the experiment group drunk less sucrose when compared with the control group (P＜0.05).In the novel object recognition test,the experiment group contacted shorter time to the novel object when compared with the control group (P＜0.05).In the open field test,the experiment group had shorter in session time when compared with the control group (P＜0.05).In the suspension tail test,the experiment group had longer immobility time when compared with the control group (P＜0.05).The qPCR result showed that the higher expression of galanin and GalR1 in the hippocampus of experiment group (P＜0.05).More C-Fos positive cells in the DG of hippocampus of experiment mice were immunostained (P＜0.05).Conclusions Galanin,GalR1 and GalR2 mainly distribute in the Hillus of the ventral hippocampus.Galanin may be involved in the anxiety-and depression-like behavior of C57BL/6J through GalR1.
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Objective To describe clinical features,polysomnographic (PSG) alterations and characteristics of motor and distribution during rapid eye movement (REM) sleep in narcoleptic patients with REM sleep behavior disorder (RBD).Methods We retrospectively summarized general features of 22 narcoleptic patients with RBD,96 narcoleptic patients without RBD and 21 healthy subjects as controls.We compared their PSG and the related indexes in 3 groups.Then we analyzed a full-night video-PSG recording in a continuous series in 22 narcoleptic patients with RBD to identify their motor behavior and distribution features.Results There was no significant difference in PSG parameter and correlation index between the narcoleptic patients with RBD group and without RBD group.However,compared with normal control group (20.15 ± 4.52),narcoleptic patients with or without RBD (24.07 ± 5.44,23.40 ± 4.50) showed increased the body mass index(F =4.869,P =0.009),shortened NREM sleep and REM sleep (min) latency at night (4.41 ±7.01,3.55 ±3.98 and 14.69 ±9.62,x2 =31.697,P =0.000;69.39 ±81.39,71.04 ±74.45and 115.31 ± 45.13,x2 =11.485,P =0.003),increased percentage of sleep stage 1,decreased percentage of slow wave sleep,delayed the arousal time and increased number of arousal episode longer than 5 minutes.In narcoleptic patients with RBD,RBD episodes occurred frequentlyatany stage of REM sleep through whole night and the frequency of vocalizations did not significantly differ between the two halves of the night.Pantomimes were significantly more frequent in RBD episodes of the second half of the night.Conclusions The prevalence of RBD is high in narcoleptic patients.Sleep architecture doesn' t differ between narcoleptic patients with and without RBD.There is no correlation between the occurrence of RBD and narcoleptic duration.In narcoleptic patients with RBD,vocalizations and pantomimes accounted formajor proportion of RBD episodes while aggressive-violent movements are rare.
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Objective To investigate the clinical features of restless legs syndrome(RLS),its possible pathogenesis.and the effects of benserazide on the patients with RLS.Methods Twenty-three patients who met the primary diagnostic criteria of RLS were retrospectively analyzed.Results Twenty-three middle-aged or elderly patients aged 56 years in average had an average onset age of 52 years.Insomnia and daytime sleepiness were mostly common complains for these patients.Based on the diagnostic criteria of International RLS study group(IRLSSG),the average IRLSSG score was 25,and 16 cases(69%)of the patients were severe(21-30).Polysomnographic examination showed that 18 cases(78%)had periodic limb movement.in which the PLM index of 11 cases(61%)patients Was moderate(25-49).PLM-arousal index of all patients was increased.that of 16 cases(67%)patients being moderate.After treatment by levodopa/benserazide 100/25 mg at bedtime each night for 4 weeks,most of patients'subjective symptoms improved markedly.and the IRLSSG score Was obviously decreased.with an average score of 13,and 5 patients became completely normal.Among patients with periodic legs movement.the PLM index became normal in 5 patients and became mild in others.In addition.the PLM-arousal index in all patients Was markedly decreased.with that of 11 patients becoming normal.The sleep latency of 19 patients became normal.On the other hand,6 patients(26%)had transient headache,nausea,and lethargy.Conclusions Patients with discomfortable feeling of lower extremity which is mitigated after movement.and legs movement during sleep should be check up as early as possible.Benserazide may be considered as an effeetive medication for patients with RLS.
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Objective To introduce the clinical manifestations of REM sleep behavior disorder (RBD) which hasn't been reported in China ever before and to discuss the possible causes and mechanisms of the disease. Methods Ten cases of RBD verifted by polysomnography(PSG)were analyzed retrospectively. Results All patients were senile or in middle ages and most of them were male.The main clinical features included violent movements,shouting and other abnormal behaviors occuring in dreams when they fell asleep.Four cases were diagnosed as Parkinsonism,2 as multiple system atrophy and 1 as cerebral trauma.The causes of another 3 cases were unknown.all symptoms of them were relieved by using clonazepam administered prior to sleep.The PSG of all cases showed a loss of normal muscular atonia and an appearance of EMG activities during REM sleep. Conclusions RBD should be considered when patients showed abnormal especially violent behaviors in sleep.PSG should be essential for its correct diagnosis and the differentiation from partial complex epilepsy.Clonazepam given prior to sleep should be effective for treatment.
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Objective To investigate the distribution relationship of microglia and neuron in rat medullary visceral zone(MVZ) after stomatic nociception. Methods After 2ml formalin(2.5%)injection in rat stomach by tiny plastic tube,Anti-Fos protein(labeling neuron)and anti-OX 42(labeling microglia)single and double immunohistochemical ABC method staining on model medulla oblongata sections in different time point(0.5h,1h,2h and 3h) were used. Results 1.After wakefulness,the animal models appear restlessness and agitation in 1-2h.2.We found hemorrhage and exfoliation in model's gastric mucosa.3.Fos positive neurons and OX 42 positive microglias were observed in MVZ,whose distribution was congruous and appeared clearly character of locations.4.The results of immunochemical diplex staining indicate that many Fos positive neurons were surrounded by intensive OX 42positive microglias.5.OX 42 positive microglia showed a tendency,which increased in 0.5-2h and decreased in 3h.Conclusion Neurons and microglia in MVZ may be involved in visceral nociception transfer and adjustment function.
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Objective To investigate expression of Fos protein in rat brains following restraint stress. Methods The experimental rats were restrained in a small plastic tub for,1,3 and 6 hours,and were sacrificed at 30 min after removing restraint.Immunohistochemical ABC method was used to observe distribution of Fos protein-like immunoreactive(-LI)products in rats brain.Results Fos-LI neurons appeared in (1)Frontal brain:the cingulum,cortex(especially in third and fifth layer),lateral septal nucleus,central amygdaloid nucleus.(2)Diencephalon:the thalamic paraventricular nucleus,lateral geniculate body and medial genicular body,hypothalamic paraventricular nucleus,supraoptic nucleus,periventricular area of third ventricle,arcuate nucleus.(3)Brain stem:the superficial layer of superior colliculus,periaqueductal gray,cortical area of inferior colliculus,lateral parabrachial nucleus,locus coeruleus,A5 area,cochlear nuclei,medullary viceral zone in medulla oblongata.The expression of Fos-LI neurons peaked in rats restrained for 1h,at 3h,then began to decrease,at 6h,significantly decreased. Conclusion Fos-LI neurons appeared in many areas of brain induced with restraint stress.The number of Fos-LI neurons decreased following restraint time.
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Objective To observe the response and relationship between astrocytes and neurons to hypotension rats. Methods Transient hypotension animal models were induced by injecting sodium nitroprusside. The expression, distribution and relationship pattern of Fos-、GFAP- or TH- positive reaction in rat brain were studied with a triple method combining anti\|GFAP, Fos and TH immunohistochemical staining. Results Fos and GFAP positive staining appeared in some brain regions related with blood pressure regulation. The distribution of GFAP\|positive astrocytes was similar to that of Fos\|positive neurons. Fos\|and GFAP\|positive neurons exhibited clear character of nuclei and subnuclei distribution. Many FOs and TH single labeled neurons, or Fos and TH double labelled neurons in medulla oblongata and locus coeruleus arounded by GFAP positive processes were found and formed three kinds of complex\|like structures. Conclusion\ The present results indicated that the astrocytes were sensentive to the changes of blood pressure. The distribution of astrocytes had the specificity of functional location. We suggestal that the astrocytes and neurons might be involved together in information precessing within brain.\;[
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Objective To examine the localization of neurokinin B receptor (NK3)\|like immunoreactivity (\|LI) in the central nervous system of the mouse. Methods An immunohistochemcial staining method was used. Results NK3 receptor\|LI was localized in somatic and dendritic profiles in the most parts and in neuropil in a few regions of the mouse central nervous system. A large number of neurons with NK3\|LI was seen in the anterior olfactory nuclei, accumbens nucleus, septal area, ventral pallidum, pallidum, caudate putamen, nucleus of the stria terminalis, anterior hypothalamic area, tuber cincreum area, lateral hypothalamic area, perifornical nucleus, supraoptic nucleus, arcuate nucleus, mammillar nuclei, substatia nigra, ventral tegmental area, retrorubral area, superior and inferior colliculus, periaqueductal gray, nucleus of the solitary tract, and superficial layers of the medullary and spinal dorsal horns. The superfical layers of the cerebral cortex, piriform cortex, dorsal hippocampus, amygdal complex, reticular formation of the brainstem contained some neurons with NK3 receptor\|LI. In the ventral hippocampus, median and intralaminar nuclei of the thalamus and interpeduncular nuclei, NKR\|LI was localized in neuropil. Conclusion\ Neurons with NK3 receptor\|LI were widely distributed in the central nervous system. It may be involved in many physiological functions in the central nervous system of the mouse.\;[