Disrupted topological properties of structural brain networks present a glutamatergic neuropathophysiology in people with narcolepsy.

STUDY OBJECTIVES: Growing evidences have documented various abnormalities of the white matter bundles in people with narcolepsy. We sought to evaluate topological properties of brain structural networks, and their association with symptoms and neuropathophysiological features in people with narcolepsy. METHODS: Diffusion tensor imaging was conducted for people with narcolepsy (n = 30) and matched healthy controls as well as symptoms assessment. Structural connectivity for each participant was generated to analyze global and regional topological properties and their correlations with narcoleptic features. Further human brain transcriptome was extracted and spatially registered for connectivity vulnerability. Genetic functional enrichment analysis was performed and further clarified using in vivo emission computed tomography data. RESULTS: A wide and dramatic decrease in structural connectivities was observed in people with narcolepsy, with descending network degree and global efficiency. These metrics were not only correlated with sleep latency and awakening features, but also reflected alterations of sleep macrostructure in people with narcolepsy. Network-based statistics identified a small hyperenhanced subnetwork of cingulate gyrus that was closely related to rapid eye movement sleep behavior disorder (RBD) in narcolepsy. Further imaging genetics analysis suggested glutamatergic signatures were responsible for the preferential vulnerability of connectivity alterations in people with narcolepsy, while additional PET/SPECT data verified that structural alteration was significantly correlated with metabotropic glutamate receptor 5 (mGlutR5) and N-methyl-D-aspartate receptor (NMDA). CONCLUSIONS: People with narcolepsy endured a remarkable decrease in the structural architecture, which was not only closely related to narcolepsy symptoms but also glutamatergic signatures.

ADHD in narcolepsy: A closer look at prevalence and ties.

The reported prevalence of attention deficit hyperactivity disorder (ADHD) in narcolepsy varies considerably, while the associated factors remain inadequately established. A systematic search of studies published in PubMed, EMBASE, and the Cochrane Library was performed from inception to March 2023. Ten studies with 839 patients with narcolepsy were included in the study. Utilizing a random effects model, the pooled prevalence of ADHD in narcolepsy was 25% (95% CI, 14-38%). Notably, patients with narcolepsy type 2 showed a significantly higher prevalence of ADHD than that of narcolepsy type 1 (46% vs. 20%, p = 0.045). Furthermore, the rate of ADHD was notably elevated in narcolepsy compared with the healthy controls (odds ratio 9.59, 95% CI, 4.06-22.63, p < 0.001). Several factors such as excessive daytime sleepiness (EDS), fatigue, insomnia severity, and the quality of life were significantly associated with ADHD in narcolepsy (all ps < 0.05). These findings highlight the importance of monitoring and managing ADHD in narcolepsy, and provide a clue to help reducing ADHD by intervening in these associated factors.

Spatiotemporal Dynamic Evolution and Its Driving Mechanism of Carbon Emissions in Hunan Province in the Last 20 Years.

Global warming caused by carbon emissions is an environmental issue of great concern to all sectors. Dynamic monitoring of the spatiotemporal evolution of urban carbon emissions is an important link to achieve the regional "double carbon" goal. Using 14 cities (prefectures) in Hunan Province as an example, based on the data of carbon emissions generated by land use and human production and life, and on the basis of estimating the carbon emissions in Hunan Province from 2000 to 2020 using the carbon emission coefficient method, this paper uses the Exploratory Spatial-Temporal Data Analysis (ESTDA) framework to analyze the dynamic characteristics of the spatiotemporal pattern of carbon emissions in Hunan Province from 2000 to 2020 through the Local Indicators of Spatial Association (LISA) time path, spatiotemporal transition, and the standard deviation ellipse model. The driving mechanism and spatiotemporal heterogeneity of urban carbon emissions were studied by using the geographically and temporally weighted regression model (GTWR). The results showed that: (1) In the last 20 years, the urban carbon emissions of Hunan Province have had a significant positive spatial correlation, and the spatial convergence shows a trend of first increasing and then decreasing. Therefore, priority should be given to this relevance when formulating carbon emission reduction policies in the future. (2) The center of carbon emission has been distributed between 112°15'57″~112°25'43″ E and 27°43'13″~27°49'21″ N, and the center of gravity has shifted to the southwest. The spatial distribution has changed from the "northwest-southeast" pattern to the "north-south" pattern. Cities in western and southern Hunan are the key areas of carbon emission reduction in the future. (3) Based on LISA analysis results, urban carbon emissions of Hunan from 2000 to 2020 have a strong path dependence in spatial distribution, the local spatial structure has strong stability and integration, and the carbon emissions of each city are affected by the neighborhood space. It is necessary to give full play to the synergistic emission reduction effect among regions and avoid the closure of inter-city emission reduction policies. (4) Economic development level and ecological environment have negative impacts on carbon emissions, and the population, industrial structure, technological progress, per capita energy consumption, and land use have a positive impact on carbon emissions. The regression coefficients are heterogeneous in time and space. The actual situation of each region should be fully considered to formulate differentiated emission reduction policies. The research results can provide reference for the green and low-carbon sustainable development of Hunan Province and the formulation of differentiated emission reduction policies, and provide reference for other similar cities in central China.

Case report: Overlapping anti-AMPAR encephalitis with anti-IgLON5 disease post herpes simplex virus encephalitis.

Autoimmune encephalitis (AE) is the result of an autoimmune process that occurs as a rapidly advancing encephalopathy. Autoimmune encephalitis was commonly linked to herpes simplex virus 1 (HSV-1) as the most frequently identified virus. The main areas affected by this invasion are the temporal lobe, frontal lobe, and limbic system. Limbic encephalitis is a highly uncommon occurrence involving anti-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) encephalitis and anti-IgLON family member 5 (IgLON5) disease, both belonging to the rare category. As far as we know, this is the first report showing that a patient diagnosed with AMPAR encephalitis overlapped with anti-IgLON5 disease post herpes simplex virus encephalitis (HSE), which helps to broaden the range of this uncommon autoimmune disease. We recommend autoantibody testing in all patients with HSE, particularly those involving neurological relapses or progression.

Anaerobic digestates grown oleaginous microalgae for pollutants removal and lipids production.

Anaerobic digestates were potential mediums for cultivating oleaginous microalgae, but their various components brought uncertainties for aglal growth and lipids production. In this study, three microalgae strains were tested to grow on four typical anaerobic digestates. The results showed that anaerobic food wastewater was an optimal medium for C. pyrenoidosa and S. obliquus culture (N. oleoabundanst cannot survive), achieving the highest biomass (2.15-2.32 g L-1) and lipids production (20.6-32.5 mg L-1·d-1). In contrast, three microalgae strains could grow suboptimally in anaerobic municipal (0.79-0.95 g L-1) and toilet (0.92-1.40 g L-1) wastewater, but showed poor performances in anaerobic swine wastewater. The growth of microalgae removed 40.9-63.4% of TOC, 83.7-96.3% of NH4+-N and 70.3-89.4% of TP in the three ADs. In addition, it was unfortunately found that the lipids content and saturation degree in fatty acids significantly decreased in ADs with sufficient nutrients. It suggests that some measures should be taken to balance biomass, lipids production and quality for cultivating microalgae in anaerobic digestates.

Densely granulated adenoma pattern is associated with an increased risk of obstructive sleep apnea in patients with acromegaly.

OBJECTIVES: To explore the prevalence of obstructive sleep apnea (OSA) and the association between the adenoma granulation patterns and OSA in patients with acromegaly. METHODS: An overnight polysomnography (PSG) assessment was carried out on participants with acromegaly. Results classified participants into a non-OSA group, mild to moderate OSA group, and severe OSA group. Morphological and biochemical analyses were performed. Demographic, clinical, biochemical, and polysomnographic data were compared among the three groups. Using logistic regression models, the risk of OSA in acromegalic subjects was estimated. RESULTS: OSA was reported in 36 of 49 patients (74%) with acromegaly. Contrasted with the non-OSA group, OSA patients had a larger proportion of the densely granulated (DG) pattern. The OSA groups with DG acromegaly had a smaller maximum tumor diameter and Vol/2 than those with the sparsely granulated (SG) pattern. Furthermore, a higher growth hormone (GH) level (45.0 ± 36.9 vs 18.6 ± 15.8, P = 0.047) and GH index (28.4 ± 13.8 vs 6.6 ± 8.2, P = 0.003) were found in DG acromegaly patients with severe OSA. Additionally, there was a trend toward higher standardized insulin-like growth factor 1 (IGF-1) in patients with DG acromegaly than in those with SG acromegaly in the severe OSA group. After adjusting for potential confounding variables, the DG pattern was correlated with the risk of OSA (OR = 14.84, 95%CI 1.36-162.20, P = 0.027) in patients with acromegaly. CONCLUSIONS: The findings indicate that a high prevalence of OSA exists in patients with acromegaly, and the DG pattern may be a risk factor for OSA in acromegaly.

Growth of Chlorella pyrenoidosa on different septic tank effluents from rural areas for lipids production and pollutants removal.

Septic tank effluent from rural areas was an ideal medium for cultivating oleaginous microalgae. However, the characteristics of septic tank effluents varied greatly due to the different incoming wastewater, and bring uncertain risks for algal growth. In this study, an oleaginous microalgae was cultivated in septic effluents from different mixed wastewater. The results showed that the effluent from pure toilet wastewater was the best medium to achieve the highest biomass yield (1.68 g·L-1) and productivity (154.6 mg·L-1·d-1). In contrast, the discharge of kitchen or laundry wastewater reduced the biomass production by 50.5-79.1%. That caused much lower lipids production in effluents from mixed wastewater regardless of its high lipids content and saturation degree. The results suggest that the discharge of kitchen or laundry wastewater bring risks for biomass and lipids production, and should be separated from the toilet wastewater before entering into septic tank.

Characteristics of Objective Sleep and Its Related Risk Factors Among Parkinson's Disease Patients With and Without Restless Legs Syndrome.

Objective: This study aimed to investigate the objective sleep characteristics and their related risk factors among Parkinson's disease (PD) patients with and without restless legs syndrome (RLS). Methods: A total of 125 patients with PD who underwent overnight polysomnography (PSG) were recruited consecutively. Eighty-one patients, including 27 PD with RLS (PD-RLS) and 54 PD without RLS (PD-NRLS), were included in the final analysis after 1:2 propensity score matching. Demographic, clinical, and polysomnographic data were compared between PD patients with and without RLS. The risk factors for sleep quality were examined using a multiple linear regression model. Results: The prevalence of RLS among PD patients was 28.0% (35/125). The PD-RLS group exhibited a higher score for the Unified Parkinson Disease Rating Scale (UPDRS) III than the PD-NRLS group. Also, the PD-RLS patients displayed significantly shorter total sleep times, worse sleep quality, decreased stage 3 duration, a longer wake time after sleep onset, and a higher arousal index than those without RLS (all p < 0.05). In the multiple linear regression model, PD duration (ß = -0.363, 95% CI: -0.652 to -0.074; p = 0.016), UPDRS-III (ß = -0.356, 95% CI: -0.641 to -0.071; p = 0.016), and periodic limb movement index (PLMI) (ß = -0.472, 95% CI: -0.757 to -0.187; p = 0.002) were determined to be the risk factors influencing sleep quality in PD-RLS patients. The UPDRS-III (ß = -0.347, 95% CI: -0.590 to -0.104; p = 0.006) and HAMD scores (ß = -0.343, 95% CI: -0.586 to -0.100; p = 0.007) were significantly associated with sleep quality after adjusting for confounding factors in PD-NRLS patients, respectively. Conclusions: PD-RLS patients exhibited more disturbed and fragmented sleep in objective sleep architecture than PD-NRLS patients. The severity of motor symptoms in PD was significantly associated with poor sleep quality in both PD-RLS and PD-NRLS patients. Notably, our findings indicated that periodic limb movements during sleep (PLMS) was the risk factor that influenced the objective sleep quality in PD patients with RLS.

Rapid eye movement sleep and slow wave sleep rebounded and related factors during positive airway pressure therapy.

This study aimed to investigate the clinical characteristics and predictors of increased rapid eye movement (REM) sleep or slow wave sleep (SWS) in patients with obstructive sleep apnea (OSA) following positive airway pressure (PAP) therapy. The study retrospectively analyzed data from patients with OSA who underwent both diagnostic polysomnography (PSG) and pressure titration PSG at the Tangdu Hospital Sleep Medicine Center from 2011-2016. Paired diagnostic PSG and pressure titration studies from 501 patients were included. REM rebound was predicted by a higher oxygen desaturation index, lower REM proportion, higher arousal index, lower mean pulse oxygen saturation (SpO2), higher Epworth sleepiness score and younger age (adjusted R2 = 0.482). The SWS rebound was predicted by a longer total duration of apneas and hypopneas, lower N3 duration, lower SpO2 nadir, lower REM proportion in diagnostic PSG and younger age (adjusted R2 = 0.286). Patients without REM rebound or SWS rebound had a high probability of comorbidities with insomnia and mood complaints. Some parameters (subjective and objective insomnia, excessive daytime sleepiness, age and OSA severity) indicate changes in REM sleep and SWS between diagnostic and titration PSG tests. Treatment of insomnia and mood disorders in patients with OSA may helpful to improve the use PAP.

Effects of transcranial direct current stimulation on performance and recovery sleep during acute sleep deprivation: a pilot study.

BACKGROUND: Previous studies claimed that transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) improves cognition in neuropsychiatric patients with cognitive impairment, schizophrenia, organic hypersomnia, etc, but few studies evaluated the effects of tDCS on cognitive improvement following sleep deprivation. The objective of this study was to determine whether tDCS (anode on the left DLPFC and cathode on the right DLPFC with a 2-mA current for 30 min) improves cognition following sleep deprivation. METHODS: Seven participants received active tDCS and eight participants received sham tDCS when their cognition declined during at least 30 h of sleep deprivation. All participants completed the psychomotor vigilance task, Trail Making Tests A and B, digit cancellation test, Stroop color word test, the Brief Visuospatial Memory Test-Revised and a procedural game every 2 h during the sleep deprivation and after recovery sleep. RESULTS: Compared to the sham stimulation, active tDCS (anode on the left DLPFC and cathode on the right DLPFC at a 2-mA current for 30 min) had beneficial effects on attention, memory, executive function, processing speed, and the ability to inhibit cognitive interference, and improved in subjective drowsiness and fatigue following sleep deprivation. The lasting effect of a single tDCS on cognition during sleep deprivation was greater than 2 h. In all participants, tDCS did not disturb recovery sleep, and cognitive performance recovered to the baseline levels after recovery sleep. CONCLUSIONS: The study results indicate that tDCS can improve cognition following sleep deprivation and does not disturb recovery sleep or cognitive performance after recovery sleep. The possible pathophysiological mechanisms might be related to the modulation of the corticothalamic pathway. We believe that tDCS can be applied in the treatment of sleep disorders involving sleepiness. TRIAL REGISTRATION NUMBER: ChiCTR2000029420. DATE OF REGISTRATION: 2020-1-31.

Association between leg motor restlessness and depression among Chinese males living at high-altitude: the mediating role of insomnia.

OBJECTIVE: Previous research has documented an association between insomnia and depression among patients with restless legs syndrome (RLS)/Willis-Ekbom disease. Given that leg motor restlessness (LMR) is closely related to RLS, the purpose of this study was to investigate the prevalence of insomnia and depression among individuals with LMR. In addition, we examined the associations among LMR, insomnia, and depression in a sample of young Chinese men living in high-altitude areas. METHODS: Chinese military personnel working on the Qinghai Tibet Plateau (Lhasa, an altitude of 3600 m) were recruited in 2019 to complete a series of questionnaires. Participants having the urge to move their legs but not meeting the diagnostic criteria for RLS were classified as having LMR. Hierarchical linear regressions and mediational analyses using the SPSS PROCESS macro in SPSS were conducted to examine the associations among LMR, insomnia, and depression. RESULTS: Of 196 participants, 36 (18%) had LMR. Only 1 participant was diagnosed with RLS. The proportions of participants suffering from insomnia who had LMR and did not have LMR were 44% and 22%, respectively. For depression, the proportions were 47% and 28%, respectively. Results of the hierarchical linear regressions showed that both LMR and depression were associated with increased insomnia symptoms. In addition, results from the mediational analyses indicated that the indirect effect of LMR on depression was significant and accounted for 52% of the total effect. CONCLUSIONS: Participants with LMR had a higher prevalence of insomnia and depression compared with those without LMR. In addition, LMR was correlated with depression, and insomnia played a significant role in this co-occurrence.

Lipids production and nutrients recycling by microalgae mixotrophic culture in anaerobic digestate of sludge using wasted organics as carbon source.

Insufficient organics in anaerobic digestate of sludge limited algal mixotrophic culture and caused low lipids production. In this study, enhancing lipids production and pollutants removal by adding acidified starch wastewater was tested for Chlorella pyrenoidosa mixotrophic culture. The results showed that an optimal addition of acidified starch wastewater into anaerobic digestate of sludge (1:1, v/v) improved biomass and lipids production by 0.5-fold (to 2.59 g·L-1) and 3.2-fold (87.3 mg·L-1·d-1), respectively. The acidified starch wastewater addition also improved the quality of algal biodiesel with higher saturation (typically in C16:0 and C18:0). In addition, 62% of total organic carbon, 99% of ammonium and 95% of orthophosphate in mixed wastewater were effectively removed by microalgae. This study provides a promising way to improve biodiesel production and nutrients recovery from anaerobic digestate of sludge using waste carbon source.

Cultivation of Chlorella pyrenoidosa in anaerobic wastewater: The coupled effects of ammonium, temperature and pH conditions on lipids compositions.

Anaerobic wastewater potentially was an ideal medium for cultivating microalgae. The coupled effect of ammonium, temperature and pH on lipids accumulation was a core issue during algal culture using anaerobic wastewater. Therefore, their combined effects on Chlorella pyrenoidosa culture and lipids accumulation in anaerobic effluent were investigated. Free ammonia induced from the rising pH and temperature inhibited algal growth, but significantly promoted lipid accumulation. The highest lipids content reached 30.2% when pH rose to 8.3-8.5 (25 °C, ammonium 280 mg/L), which was 1.6-fold higher than that under neutral condition. Moreover, the percentage of unsaturated fatty acids (un-SFAs) increased to 74.8-77.9% at pH 8.3-8.5, whereas it was only 56.1-58.9% under neutral condition. The C18:2 and C18:3 dominated the un-SFAs increase at high pH, typically the percentage of C18:3 increased by 74.5-153.1%. This study provides a potential way for lipid accumulation in algal culture using anaerobic wastewater.

Enhanced lipid and biomass production using alcohol wastewater as carbon source for Chlorella pyrenoidosa cultivation in anaerobically digested starch wastewater in outdoors.

Alcohol wastewater (AW) as carbon source for enhancing Chlorella pyrenoidosa growth and lipid accumulation in anaerobically digested starch wastewater (ADSW) was performed in outdoor cultivation. The biomass and lipid production significantly increased while adding optimal amount of AW (AW/ADSW=1:15) during exponential phase. In comparison with blank ADSW culture, the optimal AW addition increased the biomass production, lipid content and productivity by 35.29%, 102.68% and 227.91%, respectively. However, AW addition caused severe bacterial contamination and the total bacterial increased by 4.62-fold. Simultaneously, the optimal consortia of microalgae/bacteria effectively removed nutrients from the wastewater, including 405.18±36.47mgCODCr/L/day, 49.15±5.54mgN/L/day and 6.72±1.24mgP/L/day.