Mechanisms of the Rapid Effects of Ketamine on Depression and Sleep Disturbances: A Narrative Review.

Recently, sleep has been recognized as a crucial factor for health and longevity. The daily sleep/wake cycle provides the basis of biorhythm, which controls whole-body homeostasis and homeodynamics. Sleep disturbances can contribute to several physical and psychological disorders, including cardiovascular disease, obesity, depression, and cognitive dysfunction. The clinical use of the N-methyl-D-aspartate (NMDA) receptor antagonist ketamine began in the 1970s. Over the years, physicians have used it as a short-acting anesthetic, analgesic, and antidepressant; however, in-depth research has revealed new possible applications for ketamine, such as for treating sleep disturbances and circadian rhythm disorders. The aim of this narrative review is to examine the literature on the mechanistic role of the antidepressant ketamine in affecting sleep disturbance. Additionally, we discuss the pharmacologic and pharmacokinetic mechanisms of ketamine as an antidepressant and the predictive biomarkers for ketamine's effect on sleep and cognitive function.

[Application of preputial endoscopy in the treatment of phimosis].

OBJECTIVE: To explore the application value of preputial endoscopy in the treatment of phimosis. METHODS: The clinical data were obtained on 58 cases of phimosis with an obvious narrow ring at the prepuce mouth and unable to reveal the glans penis when pushed up, which were treated in hour department from October 2018 to May 2020. The patients underwent preputial endoscopic examination followed by circumcision (group A, n = 30) or simple circumcision (group B, n = 28). A ureteroscope was used for preputial endoscopy, and the foreign matter removed with forceps to prepare for later circumcision. Under surface anesthesia, the ureteroscope was entered into the preputial cavity to observe the intactness and smoothness of the right, left and anterior walls and the frenulum side, as well as possible bleeding, tumor or hypospadias. RESULTS: Preputial endoscopy was successfully performed in all the 30 cases, which revealed 1 case of adhesive integration of the inner preputial lamina to the glans, 1 case of hypospadias, 2 cases of preputial adhesion and 2 cases of glans hemorrhage. Pathological biopsy confirmed penile cancer in 1 of the 6 cases. Lateral wall hemorrhage was found in 4 cases, preputial stones in 3, which was removed with foreign matter forceps, and preputial infection in 5 cases, which was treated by intrapreputial irrigation and antibiotic anti-inflammation therapy. The preputial endoscopic examinations lasted (6.52 ± 2.03) min. The operation time was significantly shorter in group A than in B (ï¼»37.81 ± 4.09ï¼½ vs ï¼»48.04 ± 5.48ï¼½ min, P < 0.01), and so were the postoperative pain duration (ï¼»110.74 ± 22.09ï¼½ vs ï¼»121.43 ± 26.80ï¼½ min, P < 0.01) and postoperative recovery time (ï¼»7.96 ± 1.83ï¼½ vs ï¼»12.04 ± 3.28ï¼½ d, P < 0.01). CONCLUSIONS: Preputial endoscopy is a safe and efficient method for the diagnosis and treatment of phimosis, with the advantages of simple operation, short examination time and less intraoperative pain, making essential preparations for subsequent circumcision.

A Narrative Review of Cerebellar Malfunctions and Sleep Disturbances.

Cerebellar malfunctions significantly impact the regulation of the sleep-wakefulness transition. The possible mechanism for this effect is still unknown. Evidence on the role of cerebellar processing in the sleep-wake cycle is derived mainly from animal studies, and clinical management of the sleep-wake cycle is also challenging. The purpose of this review is to investigate the role of cerebellar activity during normal sleep and the association between cerebellar dysfunction and sleep disorders. Large-scale, multicenter trials are still needed to confirm these findings and provide early identification and intervention strategies to improve cerebellar function and the sleep quality of patients.

Highly Efficient Michael Reactions of Nitroolefins by Grinding Means.

AIM AND OBJECTIVE: The direct ß-functionalization of trans-ß-nitroolefins by Michael reaction is regarded as an efficient way to provide precursors for ß-functional amines. However, Michael additions by grinding means with solvent-free conditons are rarely reported. We have developed facile access to ß-functional nitroalkanes by grinding means under solvent-free conditions. MATERIALS AND METHODS: From commercially available materials including ethyl 2-nitroacetate, alkyl 2-cyanoacetates and malononitrile, the grinding reactions between these above-mentioned activated methylenecompounds and various trans-ß-nitroolefins were performed at room temperature and solvent-free conditions. RESULTS: A highly efficient direct Michael reaction of nitroolefins by simple grinding means has been developed. Various trans-nitrostyrenes were easily converted into corresponding ß-functional nitroalkanes in excellent yields within 5~10 min (up to 36 examples). CONCLUSION: Herein, we have developed a simple and efficient way to ß-functional nitroalkanes through Michael reactions by grinding means. The grinding Michael reaction is fast, clean and stable and these Michael adducts could be easily converted into the other amino compounds served as building blocks in organic synthesis.

Effects of Transcutaneous Electrical Acupoint Stimulation on the Stress Response During Extubation After General Anesthesia in Elderly Patients Undergoing Elective Supratentorial Craniotomy: A Prospective Randomized Controlled Trial.

BACKGROUND: Elderly patients have an increased risk of a stress response during extubation after general anesthesia. In this study, we aimed to investigate whether transcutaneous electrical acupoint stimulation (TEAS) might decrease the stress response and improve the quality of recovery in elderly patients after elective supratentorial craniotomy. MATERIALS AND METHODS: In this prospective randomized controlled study, patients were randomly assigned to either a TEAS group (n=37) or a control group (n=38). The primary outcomes were the hemodynamic parameters and plasma concentrations of epinephrine, norepinephrine, and cortisol. The secondary outcome included the consumption of remifentanil and propofol, time to extubation and reorientation, extubation quality score, postoperative quality of recovery, and postoperative complications. RESULTS: Compared with the control group, hemodynamic parameters and plasma concentrations of epinephrine, norepinephrine, and cortisol during extubation were decreased in the TEAS group. TEAS reduced the consumption of remifentanil (P<0.01), as well as incidence of postoperative complications. The extubation quality score was lower (P<0.01) and the quality of recovery score was higher (P<0.01) in the TEAS group than in the control group. However, the time to extubation and reorientation, and the consumption of propofol were not significantly different between the 2 groups. CONCLUSIONS: TEAS may decrease the stress response during extubation, improve quality of postoperative recovery, and decrease incidence of postoperative complications in elderly patients undergoing elective supratentorial craniotomy.

[Effect of Transcutaneous Acupoint Electrical Stimulation on Propofol Usage in Closed-loop Anes- thesia Delivery System in Pediatric Cardiac Surgery].

Objective To evaluate the effect of transcutaneous acupoint electrical stimulation (TEAS) on propofol usage in closed-loop anesthesia delivery system and pediatric hemodynamics. Methods Sixty children patients undergoing selective tonsillectomy and adenoidectomy surgeries were randomly allocated to the TEAS group (T) and the control group (C) , 30 in each group. Anesthesia maintenance in both groups was performed by propofol closed-loop anesthesia infusion system after induction of anesthesia. Patients in group T were treated with continuous TEAS (2/100 Hz sparsedense wave, 8 - 12 mA) at unilateral Hegu (L14) and Shenmen till the end of surgery. No TEAS was performed to patients in group C. Mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia (TO), immediately after intubation ( T1) , 5 min after intubation (T2) , 10 min after intubation (T3) , 15 min after intubation (T4) , the time for intubation (T5) , respectively. The total dose of propofol, times for propofol dose adjustment, average target concentration, cases of patients with extra Fentanyl were recorded during anesthesia maintenance. Bispectral index (BIS) was recorded. Pediatric Anesthesia Emergence Delirium (PAED) scale and Modified Children's Hospital of Eastern Ontario Pain Scale (MCHEOPS) were assessed at T5, 5 min after extubation (T6) , 10 min after extubation (T7) , 15 min after extubation (T8), 30 min after extubation (T9) , respectively. Epinephrine (NE) was measured at TO, T1, T5, and T9, concentrations of IL-1 and IL-6 were measured at TO, T5, 24 h after surgery ( T10) , 48 h after surgery (T11), respectively. Results Compared with group C, MAP at T4 and T5 and HR at T1-T5 all de- creased, PAED scale and MCHEOPS decreased at T5-T9, NE concentrations were significantly reduced at T5 and T9, concentrations of IL-1 and IL-6 decreased at T5, T10, T1 1 in group T (P <0. 05, P <0. 01). Compared with group C, the total dose of propofol, times for propofol dose adjustment, average target concentration were reduced in group T during surgery (P <0. 05, P <0. 01). Twenty cases (67%) used propofol in group C and 9 cases (30% ) used propofol in group T during surgery, with statistical difference (P <0. 01). Changes of BIS was not statistically different between the two groups (P >0. 05). Conclusion TEAS could inhibit stress response and inflammatory response of children patients, stabilize their hemo- dynamics during surgery, thereby reducing propofol dose in closed-loop anesthesia delivery system.

[Interaction between endogenous cystathionine synthase/hydrogen sulfide and heme oxygenase-1/carbon monoxide systems during myocardial ischemic-reperfusion: experiment with rats].

OBJECTIVE: To investigate the interaction between the cystathionine synthase gene (CBS)/hydrogen sulfide (H(2)S) and heme oxygenase-1 (HO-1)/carbon oxide (CO) systems during myocardial ischemia-reperfusion. METHODS: Twenty-four SD rats were randomly divided into 4 equal groups: ischemia-reperfusion (I/R) group undergoing intraperitoneal injection of normal saline (NS) and then 30 min later undergoing ligation of the left coronary artery (LCA) for 30 min, ischemia-reperfusion + zinc protoporphyrin (I/R + Z) group undergoing intraperitoneal injection of 45 micromol/kg zinc protoporphyrin, a HO-1 inhibitor, 30 min before the ligation of LCA, ischemia-reperfusion + hydroxylamine (I/R + H) group, undergoing intraperitoneal injection of 5 mmol/L hydroxylamine, a CBS inhibitor, 30 min before the ligation of LCA, and ischemia-reperfusion + zinc protoporphyrin + hydroxylamine (I/R + Z + H) group undergoing intraperitoneal injection of zinc protoporphyrin and hydroxylamine 30 min before the ligation of LCA. Another 6 rats underwent sham operation and intraperitoneal injection of NS 30 min before the operation and were used as control (C) group. The rats were killed 2 h after the reperfusion with their hearts taken out. Electron microscope was used to observe the mitochondrial structure. Homogenate of myocardium was prepared to examine the concentrations of H(2)S, CO, glutathione (GSH), malonyldialdehyde (MDA), activity of superoxide dismutase (SOD), and expression level of CBS-mRNA and HO-1-mRNA. RESULT: The concentration of CO, H(2)S, GSH, and MDA increased, SOD activity decreased, and HO-1-mRNA and CBS-mRNA expression levels increased in Group I/R as compared with Group C (all P < 0.01). In Group I/R + Z the CO level decreased, H(2)S and GSH levels increased, and HO-1-mRNA expression level decreased, but CBS-mRNA expression level increased as compared with Group I/R (all P < 0.05). In Group I/R + H the H(2)S and GSH levels decreased, CO level increased, and HO-1-mRNA expression level increased and CBS-mRNA expression level decreased as compared with Group I/R (all P < 0.05). In Group I/R + Z + H the H(2)S, CO, GSH, and SOD levels decreased, MDA level increased, and HO-1-mRNA and CBS-mRNA expression levels decreased as compared with Group I/R (all P < 0.05). Electron microscopy found that mitochondrial structure was destroyed in the Groups I/R, I/R + Z, I/R + H, and most seriously in Group I/R + Z + H. CONCLUSION: Both CBS/H(2)S and HO-1/CO systems play a protective role in myocardial ischemia-reperfusion and they interact on each other.