Clinical research progress of dual orexin receptor antagonist lemborexant in the treatment of insomnia / 中华神经科杂志

In past two decades, understanding of the role of the orexin system in regulating sleep and wakefulness has increased rapidly. Lemborexant, as a dual orexin receptor antagonist, has been approved in some countries for the treatment of insomnia disorders. Existing studies have shown that its safety and tolerability are significantly superior to traditional hypnotic drugs, and it will be new option for treating insomnia disorders. This article reviews the pharmacology, clinical efficacy and safety of lemborexant.

Pathophysiology and cognitive behavioral therapy of chronic insomnia / 中国临床药理学与治疗学

The occurrence and development of chronic insomnia involves subjective and objective factors, which can be classified as predisposing factors, precipitating factors and perpetuating factors. Cognitive behavioral therapy for insomnia (CBT-I) evolves from the pathopsychological analysis of chronic insomnia patients, and selectively combines the sleep hygiene, cognitive therapy and behavioral therapy to improve the symptoms of patients. With the popularity of internet, the digital cognitive behavioral therapy for insomnia has an convenient advantage over the traditional therapy, and has become the focus of research. Researchers have proposed multiple therapies for chronic insomnia, including drug therapy and non-drug therapy, which improve the treatment effect of chronic insomnia from different perspectives.

Progress in clinical diagnosis and drug treatment of chronic insomnia / 中国临床药理学与治疗学

The clinical symptoms of chronic insomnia are various, the clinical diagnosis process needs to be combined with sleep parameters, daytime symptoms and psychological status of patients. Recently, the neuroimaging research suggests that chronic insomnia patients have certain structural changes and functional changes, which leads a new direction for the following research. The new drugs for the treatment of chronic insomnia, improving receptor specificity or increasing intervention targets, will provides more choices for patients.

Progresses in clinical manifestations and treatments of narcolepsy / 中国临床药理学与治疗学

Narcolepsy is a rare disease that presents with sleep-wake disorder, which divided into narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2). NT1 accounts for more than 75%, which is characterized by excessive daytime sleepiness (EDS), cataplexy attacks and nocturnal sleep symptoms (e.g. sleep paralysis, hallucinations, sleep disruptions, sleep movement disorders, etc.), accompanied by metabolic, psychiatric and emotional disturbances. The main clinical manifestation of NT2 is EDS, without cataplexy and nonspecific other symptoms of NT1. The treatments of narcolepsy mainly include the treatments of EDS and cataplexy, as well as the improvement of nocturnal sleep. This article will elaborate the advances in clinical manifestations and treatments of narcolepsy.

Pay close attention to clinical practice of adult insomnia diagnosis and treatment guidelines / 中华神经科杂志

The development of precision medical treatment to insomnia is inseparable from the standardization of clinical practice activities,which is usually highlighted in specific clinical guidelines.To promote clinical transformation of adult insomnia guidelines,the following suggestions should be considered:(1) avoiding the conversion of short-term insomnia to chronic insomnia;(2) emphasizing the psychotherapy as an optimal treatment or the principal method in a combined treatment;(3) prescribing medicines following the recommendations of guidelines;(4) taking regular assessment and adjusting treatment options as needed.

Autonomic disturbances in narcolepsy type 1 / 中华神经科杂志

The pathogenesis of narcolepsy type 1 is characterized by massive loss of hypocretin neurons in the lateral hypothalamus.Due to the extensive interaction between the hypocretin signalling pathway and the autonomic nerve centre of brain stem and spinal cord,narcolepsy type 1 patients often showed autonomic nervous dysfunctions,such as circadian rhythms/sleep abnormalities,energy metabolism and body temperature regulation disorder,pupil adjustment disorder,sexual dysfunction and autonomic fluctuations during cataplexy.We reviewed the autonomic dysfunction of the narcolepsy type 1 patients in general and during cataplexy,in order to strengthen the attention to autonomic nervous dysfunction in narcolepsy type 1.

Correlation analysis of two different techniques for the score of sleep breathing events: cardiopulmonary coupling vs polysomnography / 中华神经科杂志

Objective To explore the relationship between the respiratory disturbance index (RDI) detected by cardiopulmonary coupling (CPC) and all parameters of polysomnography (PSG), and to analyze the correlation of the two different analytical techniques for the interpretation of sleep breathing events.Methods In this case-control study, the patients′ CPC and PSG were simultaneously recorded at the Sleep Clinic at Changzheng Hospital from Janunary 2016 to December 2016.Effective recordings were obtained from 292 patients (male/female: 173/119).According to PSG, these patients were divided into two groups: obstructive sleep apnea hyponea syndrome (OSAHS) group (n=173, aged (50.1±13.3) years) and non-OSAHS group (n=119, aged (50.5±11.7) years).All the PSG parameters and the RDI detected by CPC were compared between the two groups.Pearson correlation was used to analyze the relationship between the CPC-RDI and polysomnography parameters, and Bland-Altman chart was used to test the correlation of the two methods.The receiver operator characteristic curve was used to research the value of CPC-RDI in diagnosis of OSAHS.Results The OSAHS group showed higher levels of total sleep time (TST, (445.94±82.64) min), apnea times ((108.16±35.70)/h), hypopnea rate ((55.62±17.44)/h), apnea hyponea index (AHI, (22.78±20.73)/h), Epworth Sleeping Scale (ESS) scores ((11.21±5.30) scores), CPC-RDI ((32.98±22.19)/h) compared with the non-OSAHS group ((417.21±96.10) min,t=2.730;(7.89±5.41)/h,t=30.384;(11.05±2.23)/h, t=27.709;(5.51±3.11)/h,t=9.014;(7.61±2.29)scores,t=6.973;(11.16±8.63)/h,t=10.205, all P<0.01), and a significant decrease in N1 latency ((14.79±9.29) min vs (18.18±8.98)min, t=-3.106), N3% ((6.53±4.95)% vs(8.83±7.29)%,t=-3.212) and the lowest oxygen saturation (SaO2;(77.91±12.21)% vs(92.72±5.17)%, t=-12.479, all P<0.05 respectively).Pearson correlation analysis indicated that RDI was positively correlated with TST, N2 sleeping time, N3 sleeping time, AHI, microarousals index, leg movements index, and ESS scores (P<0.01 respectively).Remarkably, the correlation between CPC-RDI and PSG-AHI was excellent (r=0.801, P<0.01), and CPC-RDI was negatively correlated with lowest SaO2 (r=-0.765, P<0.01).Bland-Altman showed that the points in the limits of agreement accounted for more than 95% of all points.If CPC-RDI is higher than 18.95, the subjects were more likely with OSAHS.The sensitivity was 62.9% and the specificity was 88.7%.In addition, the enhanced low-frequency coupling parameters in the CPC analysis technique can clearly analyze the central respiratory rhythm disturbance.Conclusions CPC technology is an effective assessment technology to diagnose sleep-disordered breathing, and correlates well with AHI detected by traditional PSG.It shows the advantage of screening for central sleep apnea.

Metabonomics in study of Parkinson's disease biomarkers / 中华神经医学杂志

Parkinson's disease (PD) is a common neurological degenerative diseases.Neuron degeneration process is irreversible;therefore,the correct diagnosis is critical and reliable biomarkers are urgently needed.With the development of molecular biology,some nonspecific biomarker detection methods,such as metabolomics,have been used in the study ofPD.Metabonomics provides a technology and a new technical platform for testing comprehensive metabolites of PD.Metabonomics is very important for biomarker screening in PD.In this paper,the concept,research methods and research progress of metabonomics in PD are reviewed.

Cellular prion protein-mediated hippocampal neuron axon elongation impairment involved in cognitive impairment induced by sleep deprivation / 中华神经科杂志

Objective To investigate the effect of rapid eye movement (REM) sleep deprivation on spatial memory and hippocampal cellular prion protein (PrPC) expression and to explore the underlying mechanism of cognitive impairment induced by sleep deprivation.Methods Adult Sprague-Dawley rats were sorted by weight,randomly divided into three groups:the cage control (CC) group,the tank control (TC) group,and the sleep deprivation (SD) group.Rats were deprived of REM sleep for 72 h using the modified multiple platform method.The Morris water maze task was used to assess hippocampal-dependent spatial memory.After sleep deprivation,the rats were sacrificed and their brain tissue was analyzed for PrPC protein expression via Western blotting.Hippocampal neuron axon elongation was examined as well after lentivector-mediated RNA interference (RNAi) of PrPC in primary cultured rat hippocampal neurons.Results REM sleep deprivation for 72 h resulted in spatial memory impairment.The number of times of rats passing through the platform was decreased significantly in the SD group (3.17 ±0.95) compared with the CC (7.17 ±0.95) and TC (6.50 ±0.62) groups (Z =2.026 6,Z =2.026 6,P ＜0.05),the mean value of proximity to the platform (mm) was greater for rats of the SD group (711.74 ± 33.99) compared to those of theCC (592.32±31.31) andTC (580.86±11.36) groups (Z=-2.001 6,Z=-2.4820,P ＜ 0.05).REM sleep deprivation for 72 h resulted in reduced PrPC level in the hippocampus (0.33 ± 0.10) compared with the CC (1.01 ±0.33) and TC (0.96 ±0.27) groups (Z=2.152 9,Z=2.152 9,P ＜ 0.05).In primary cultured hippocampal neurons,axon elongation(μm) was inhibited 7 days in infected neurons (326.28 ± 12.53) compared with normal (555.00 ±30.43) or negative control (558.70 ±23.10) cells (Z =4.768 4,Z =4.877 0,P ＜ 0.05).Conclusion These findings suggest that PrPC-mediated hippocampal neuron axon elongation inhibition is probably involved in spatial memory impairment induced by sleep deprivation in rats.

The features of high and low-frequency function of horizontal, semicircular canal in Meniere's disease / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the feature of horizontal semicircular canal function at high and low-frequencies in Meniere's disease.@*METHOD@#Thirty patients suffering from unilateral Meniere's disease were included in the research from 2013 June to 2014 June. Caloric test and video head impulse test were performed to evaluate the high low-frequency function of horizontal semicircular canal.@*RESULT@#these patients were devided by the severity of unilateral weakness in caloric test. The gain value in video head impulse test, which reflects the high-frequency function of semicircular canal, were not different between the normal and mild abnormal group (P > 0.05), but were obviously different between the normal and mild-severe abnormal group, slight abnormal and mild-severe abnormal group (P 0.05).@*CONCLUSION@#A part of Meniere's disease may have normal high, low-frequency function of horizontal semicircular canal. As patient suffering slight injury of low-frequency function, the high-frequency function keeps normal. As the injury of low-frequency function become mildly to severely, the damage of high-frequency function appears, but the symmetry still keeps balance.

Duration of hypertension is associated with cognitive function: a cross-sectional study in Chinese adults / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hypertension (HTN) is a very prevalent public health problem and as the population ages, cognitive impairment (CI) is also going to be a public health burden. However, the relationship between hypertension duration and cognitive function declination worldwide is still unknown. The aim of the study was to investigate the effects of HTN duration on CI in Chinese population.</p><p><b>METHODS</b>At baseline, 1 386 HTN patients and 293 normotensive (NT) people were enrolled. The HTN patients were further divided into four subgroups (duration of HTN <6 years, 6-10 years, 11-20 years, and >20 years) according to the HTN duration and were screened for cognitive function with neuropsychological tests including mini-mental-state-examination (MMSE) and clock-drawing-test (CDT) in comparison with the NT group.</p><p><b>RESULTS</b>More HTN patients had CI (45.3%) than NT subjects (30.4%), and increased with HTN duration (P < 0.000 1). Compared with the scores of MMSE and CDT in the NT group, the declines were higher in the HTN patients (P < 0.000 1), and in the four HTN subgroups, both MMSE and CDT scores fall when the HTN duration increased (P < 0.05). Furthermore, in the HTN population without CI, the trend in alteration of CI was relatively mild but still existed (P < 0.05).</p><p><b>CONCLUSION</b>People with HTN are more likely to have CI and the possibility and aggravation increases the prolongation of HTN duration, both in amnesic and nonamnesic function.</p>

Management of bilateral benign paroxysmal positional vertigo with Dix-Hallpike test / 中华内科杂志

Objective To explore the diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) with bilateral positive Dix-Hallpike test.Methods This is a retrospective study based on the clinical data of BPPV patients diagnosed in the Dizziness Clinic of Changzheng Hospital from January 2012 to December 2012.Totally 490 patients with vertigo and nystagmus provoked by Dix-Hallpike maneuver were included in the present analysis.Results Among all the patients,55 (11.2％) of them presented with bilateral nystagmus by the provocative test.According to the type of nystagmus provoked by DixHallpike maneuver,the 55 patients can be divided into the following four categories.(1) Bilateral geotropic (n =16) and apogeotropic nystagmus (n =5):all these patients were diagnosed with horizontal canal BPPV and free of vertigo after head side-shaking exercise in supine position and Barbecue maneuver.(2) Bilateral predominant down-beating nystagmus (n =2):patients in this group were diagnosed with anterior canal BPPV,and got recovered after Kim maneuver.(3) Bilateral torsional up-beating geotropic nystagmus (n =20):after a lying-down test,6 of the patients manifested as vertical up-beating nystagmus and 14 patientsremained torsional up-beating nystagmus.The formerwere diagnosed with bilateral posterior canal BPPV,and were cured after bilateral PRM therapy,and the latter were diagnosed with horizontal canal BPPV,who were cured after Barbecue maneuver.(4) Torsional up-beating geotropic nystagmus on one side and down-beating nystagmus on the other side (n =12).The down-beating nystagrnus on the other side disappeared when the patients was firstly seated up with head down in 30 degrees for half an hour before second Dix-Hallpike maneuver.These patients were diagnosed with unilateral posterior canal BPPV and cured by PRM therapy.Conclusions It is common for vertigo patients with bilateral nystagmus induced by Dix-Hallpike test.The diagnoses should be made by the types of nystagmus provoked step by step before maneuver therapy.

The association of duration of hypertension and changes in cognitive function in hypertension patients / 中华内科杂志

Objective To investigate the relationship between duration of hypertension and cognitive function in adult hypertension patients.Methods A total of 224 subjects with normal blood pressure were enrolled in group A,and 1 296 patients with poorly controlled hypertension were further divided by the duration of hypertension into group B (≤5 years),group C (6-10 years),group D (11-20years) and group E (＞ 20 years).Face-to-face surveys were conducted in all the subjects by trained physicians using Mini-Mental-State-Examination (MMSE) and Clock-Drawing-Test (CDT).The incidences of cognitive impairment were compared among the five groups and the relationship between duration of hypertension and cognitive function were analyzed by SPSS 18.0 software.Results (1) Compared with the normotensive group,the hypertensive group performed worse in the scores of MMSE,CDTs,the memory type cognitive function and the non-memory type cognitive function (MMSE:Z =-2.585,P =0.010;C DTs:Z =-3.689,P ＜ 0.001 ; memory type cognitive function:Z =-2.718,P =0.007 ; non-memory type cognitive function:Z =-1.994,P =0.046).(2) The incidences of cognitive impairment in the five groups were 3.6％ (8/224),6.6％ (26/393),16.6％ (72/433),19.7％ (55/279) and 33.5％(64/191),respectively.(3) Compared with the group A,the cognitive function was significantly worse in the group E (MMSE:Z =61.314,P ＜ 0.001 ; CDTs:Z =44.642,P ＜ 0.001 ; memory type cognitive function:Z =35.703,P ＜ 0.001 ; non-memory type cognitive function:Z =54.440,P ＜ 0.001).Conclusions Hypertension is a risk factor for the cognitive dysfunction.The incidence of cognitive dysfunction and the severity are positively associated with the duration of hypertension.In those with hypertension over 20 years,the cognitive dysfunction occurs much more obviously.

Clinical features of 51 patients with vestibular paroxysmia / 中华神经科杂志

Objective To explore the clinical features of vestibular paroxysmia (VP).Methods The clinical features of 51 patients with VP from January 2009 to April 2011 were analyzed retrospectively.The treatment effectiveness of antiepileptics was evaluated.Results The ratio of male to female was 1 ∶ 1.55 in the 51 patients with VP and the course of disease was 10 days to 20 years.In 46 patients (90.2％) the attacks occurred at rest,whereas 37 patients (72.5％) were precipitated by a head turn or a body turn.Three minutes hyperventilation-induced vertigo was found in 13 patients (25.5％) and Fukuda test was positive in 15 patients (29.4％).Forty patients (78.4％) were abnormal in brainstem auditory evoked potentials (BAEP) and the interpeak latency of wave Ⅰ-Ⅲ was prolonged than 2.2 ms in 26 patients (51.0％).There were 47 ears had neurovascular cross-compression (NVCC),which were unilateral in 37 patients and bilateral in 5 patients,with type Ⅰ in 23 ears(48.9％),type Ⅱ in 5 ears(10.6％),type Ⅲ in 17 ears(36.2％) and type Ⅳ in 2 ears(4.3％).Three month-treatment led to a significant reduction in the attack frequency(3 (2,7) per month vs 15 (9,30) per month,Z =-6.156,P ＜ 0.01),in the attack duration(2(1,4) s vs 12(6,20) s,Z =-6.066,P ＜0.01),and a reduction in the visual analogue scale of vertigo (1.86 ±0.57 vs 5.83 ± 1.12,t =1.984,P ＜ 0.01).Conclusions Briefvertigoattacksatrestis the character of VP.Three minutes hyperventilation-induced vertigo is helpful for the diagnosis of VP.The prolongation of the interpeak latency of wave Ⅰ-Ⅲ in BAEP is the character of VP.NVCC widely existed in the patients with VP and types Ⅰ and type Ⅲ was more common.Using antiepileptics,a better treatment effectiveness can be obtained.

Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage based on the analysis of on-admission information.

AIM: To provide a quick evaluation of rebleeding risk based on the on-admission patient information and to guide the management of patients for better outcome. MATERIAL AND METHODS: A retrospective review of 630 consecutive cases of subarachnoid hemorrhage (SAH) at a major medical center was conducted, of which 458 were included for analysis. Sixty three cases of in-hospital pre-intervention rebleeding were identified. Chi-square or Mann-Whitney tests were used to screen for possible risk factors and values of the associated risk factors were assessed by logistic multivariate regression. RESULTS: The identified risk factors were: short time interval between the first attack and hospitalization, gender (males were more susceptible), poor Hunt-Hess grade (III~V), high systolic pressure ( > 140 mmHg), intracerebral or intraventricular hematoma, high level of serum glucose ( > 6.32 mmol/L) and high white blood cell count ( > 12 x 10^9/L). Use of antifibrinolysis medication did not differ between groups. Subgroup analysis showed that posterior circulation aneurysms had a significantly higher rebleeding rate. Logistic regression analysis showed that intracerebral or intraventricular hematoma (p=0.010, OR=1.478) and blood glucose level above 6.32 mmol/L (p=0.011, OR=2.126) were independent risk factors. CONCLUSION: We found a particularly high risk of rebleeding in patients with intracerebral or intraventricular hematoma or relatively high serum glucose level on admission. Posterior circulation aneurysms rebleed seemed more prominently manifested. An earlier and more aggressive intervention may be applied to patients at high risk.

Mixoma auricular: una causa poco habitual de neuropatía periférica / Atrial myxoma: a rare cause of peripheral neuropathy

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Early diagnosis and treatment of combined thoracoabdominal injury / 中华创伤杂志

Objective To summarize the experience in early diagnosis and emergency treatment for combined thoracoabdominal injury (CTI). Methods Clinical data of 58 cases of CTI admitted to our hospital from June 2001 to August 2009 were analyzed retrospectively.All the patients were treated by closed drainage of thoracic cavity,of which 12 cases were treated with thoracotomy,31 with laparotomy,seven with thoracic and abdominal incisions and three with combined thoracoabdominal incision.Internal fixation for long limb bones was performed in 27 cases,spinal laminectomy and pedicle screw fixation in five and amputation in one. Results After operation,six cases were found to have adult respiratory distress syndrome (ARDS) and 12 cases were complicated with multiple organ dysfunction syndrome (MODS).Fifty-three cases were cured and five died. Conclusions CTI based multiple injuries are severe and complicated.CT scan in the early stage plays a significant role in the diagnosis of CTI and closed drainage of thoracic cavity is an important assurance of the security of abdominal operation.Early diagnosis,correct choice of operation procedures and reasonable handling order of injured organs can improve the successful rescue rate for multiple injury patients.

Advances in the diagnosis of pancreaticobiliary maljunction(PBM) / 中华肝胆外科杂志

Pancreaticobiliary maljunction(PBM)is closely related to many surgical diseases in which are commonly seen in clinical practice.However,diagnosis of PBM is difficult and it is easily missed.The lack of knowledge and awareness of PMB has once made PBM “the forgotten corner of abdominal surgery”.This essay summarized the current knowledge on the diagnosis of PBM by medical imaging.

Clinical features of 326 patients with benign paroxysmal positional vertigo / 中华神经科杂志

Objective To explore the clinical features and repositioning maneuver effects of benign paroxysmal positional vertigo ( BPPV ).Method The clinical features of 326 patients with BPPV from August 2009 to July 2011 were analyzed retrospectively.Different types of BPPV were compared.Results BPPV was more common in female and the peak period of onset was between the ages of 50 and 60.The average latency of vertigo attack was ( 1.52 ± 1.22) s and 43 patients ( 13.2％ ) had no obvious latency.The median duration of vertigo attack was 10 s,with less than 60 s in 312 patients (95.7％) and between 60—180 s in 13 patients (4.0％).The latency of vertigo attack of posterior semicircular canal-BPPV ( ( 1.74 ± 1.21 ) s) was longer than that of horizontal semicircular canal-BPPV ( ( 0.96 ± 1.06 ) s,t =5.546,P ＜0.01 ).But there were no differences in the gender,the course of disease and the duration of vertigo attack.The patients with posterior semicircular canal-cupulolithiasis were younger than those with posterior semicircular canal-canalithiasis.The duration of vertigo attack of posterior semicircular canalcupulolithiasis was longer than that of posterior semicircular canal-canalithiasis.The latency and the duration of vertigo attack of horizontal semicircular canal-cupulolithiasis were longer than that of horizontal semicircular canal-canalithiasis and the age was older.Conclusions The posterior semicircular canal is more involved in BPPV.The latency of vertigo attack of posterior semicircular canal-BPPV is longer than that of horizontal semicircular canal-BPPV.The latency and the duration of vertigo attack of horizontal semicircular canal-cupulolithiasis are longer than that of horizontal semicircular canal-canalithiasis and the age is older.