ABSTRACT
Post-traumatic stress disorder (PTSD) is characterized by intrusive emotional memory, alertness and avoidance after individuals suffer from one or more traumatic events. With the exception of manifestations, sleep disturbances are also considered to be the core symptoms of PTSD. This article mainly discussed insomnia, nightmares, obstructive sleep apnea (OSA), and periodic limb movement during sleep (PLMS) in patients with PTSD. Existing evidence suggested that insomnia is a predictor of the development of PTSD. Cognitive behavioral therapy for insomnia is an important research direction for treating insomnia in PTSD patients. Nightmares are also the core symptom of PTSD. Prazosin and image rehearsal therapy are effective therapies to treat post-traumatic nightmares. The co-occurrence of obstructive sleep apnea (OSA) is over 40% in patients with PTSD. Preliminary studies have shown that continuous positive airway pressure therapy can improve PTSD symptoms in patients with PTSD comorbid OSA. In the process of diagnosis and treatment of PTSD patients, it is important to firstly evaluate whether PTSD patient comorbid OSA or insomnia, and then clinicians could further develop an appropriate treatment plan for these patients.
Subject(s)
Sleep Wake Disorders , Stress Disorders, Post-Traumatic , Continuous Positive Airway Pressure , Dreams , Humans , Sleep , Sleep Wake Disorders/etiology , Stress Disorders, Post-Traumatic/complications , Stress Disorders, Post-Traumatic/epidemiologyABSTRACT
OBJECTIVE: To explore the clinical efficacy and influencing factors of children receiving mite-specific subcutaneous immunotherapy (SCIT). METHODS: We retrospectively analyzed the data of children who had received mite SCIT for 3 years at the Desensitization Center of our hospital. We used the daily medication score (DMS) to evaluate the medication use status (the higher the score, the higher the amount of medications given and the less satisfactorily was the primary disease controlled) and we used the visual analogue scale (VAS) to evaluate clinical symptoms (the higher the score, the more severe the symptoms). Evaluation was performed after the first SCIT treatment and after treatment was given for 3 months, 4 months, 12 months, and 3 years. According to whether medication for the primary disease was stopped after 3 years, the patients were divided into two groups, the discontinued medication group (discontinued group) and the continued medication group (continued group). The general data, DMS, VAS and the decline rate of the two groups were compared, and logistic regression was performed to analyze the influencing factors of the outcome. RESULTS: A total of 711 children were enrolled in the study, with an average age of 8.38 years at the time of the first visit to the hospital. There were 442 males and 269 females. Skin prick test showed that 445 cases only had mite allergy, and 266 cases had mite allergy combined with other allergies. 360 cases have discontinued the medication for the primary disease after 3 years, and 351 cases had relieved symptoms, but still needed to continue with the medication. At the beginning of SCIT treatment, the DMS and VAS of the discontinued group were lower than those of the continued group ( P<0.05). Evaluations from 3 months to 3 years showed that both DMS and VAS continued to decrease compared with those from the beginning, and the decline rate of DMS and VAS of the discontinued group was higher than that of the continued group after 3 years of SCIT ( P<0.05). After 3 months of SCIT, the positive rates of nasal and ocular symptoms in the discontinued group were lower than those in the continued group ( P<0.05). After 3 years of SCIT, the positive rates of nasal, ocular, and chest symptoms in the discontinued group were lower than those in the continued group ( P<0.05). Univariate analysis combined with multivariate logistic regression showed that initial DMS>4 points and initial VAS>3.5 points were protective factors for the discontinuation of the medication for the primary disease at the end of 3 years of SCIT, while the female sex and DMS reduction rate after 12 months of treatment>50% were risk factors for discontinuation. CONCLUSIONS: Mite SCIT can help relieve clinical symptoms and reduce the use of medication for symptomatic treatment. Symptoms can be improved after 3 months of SCIT, with the fastest improvement shown in nasal and eye symptoms. It is not recommended to discontinue the medication for the primary disease for too much after 1 year of treatment.
Subject(s)
Asthma , Mites , Animals , Child , Female , Humans , Immunotherapy , Injections, Subcutaneous , Male , Retrospective StudiesABSTRACT
BACKGROUND: ET-26 hydrochloride (ET-26HCl) is a novel etomidate analogue designed to alleviate the adrenocortical suppression caused by etomidate while retaining the rapid sedative-hypnotic onset and stable hemodynamic features of etomidate. This study compared the anesthetic effect, hemodynamic stability, and recovery profiles of ET-26HCl, etomidate, and the sedative-hypnotic drug propofol in rats. METHODS: The metabolic half-life of ET-26HCl was determined in vitro using high performance liquid chromatography analysis of samples of rat plasma and liver homogenates taken from 3 animals. Hypnotic median effective doses (HD50) of ET-26HCl, etomidate, and propofol were determined by up-and-down methods. Anesthesia effect and mean arterial pressure were estimated using equivalent intravenous (IV) doses of propofol, etomidate, and ET-26HCl in the rats. Serum concentrations of corticosterone were analyzed by enzyme-linked immunosorbent assay. The ability of rats to recover from the sedative-hypnotic effects of the drugs was evaluated using open field and Morris water maze tests at equipotent doses of propofol, etomidate, ET-26HCl, and normal saline. RESULTS: The metabolic half-life of ET-26HCl was 81 ± 6 minutes in rat plasma and 126 ± 12 minutes in incubation liver homogenate (mean ± standard deviation), respectively. In vivo experiments showed that the potency of ET-26HCl to cause a loss of righting reflex in rats was 3 times lower than that of etomidate in the rats. IV propofol caused a greater decrease in mean arterial pressure relative to the baseline (-27.9 mm Hg) than did ET-26HCl (-10.7 mm Hg) and etomidate (-19.4 mm Hg) at equipotent doses. Serum corticosterone levels after drug administration were significantly higher in the ET-26HCl group than in the etomidate group at equivalent doses when measured 15 (P < .001), 30 (P < .001), and 60 (P = .002) minutes after stimulation with adrenocorticotropic hormone (ACTH1-24). Recovery of spatial orientation from anesthesia induced by an IV bolus injection was faster with ET-26HCl than with propofol, but recovery of spontaneous activity was slower. CONCLUSIONS: ET-26HCl has anesthetic potency and hemodynamic stability similar to etomidate, but it caused less adrenocortical hormone synthesis suppression than etomidate and faster spatial orientation recovery from anesthesia than propofol, which was similar to etomidate.
Subject(s)
Adrenal Cortex/drug effects , Behavior, Animal , Etomidate/analogs & derivatives , Etomidate/administration & dosage , Hemodynamics/drug effects , Hypnotics and Sedatives/administration & dosage , Adrenal Cortex Hormones/blood , Anesthetics/administration & dosage , Animals , Chromatography, High Pressure Liquid , Etomidate/pharmacology , Female , Male , Maze Learning , Propofol/administration & dosage , Rats , Rats, Sprague-Dawley , Reflex , TelemetryABSTRACT
OBJECTIVE: To estimate the median effective dose (EDs0) of oral administrated HX0969w, fospropofol disodium and propofol emulsion in rats, and to compare the sedative-hypnotic effects and safety of the three drugs. METHODS: The ED50 of the three drugs were determined using sequential method. Thirty healthy adult Sprague-Dawley rats were divided into three groups randomly, being orally administered with HX0969w (n=10), fospropofol disodium (n=10) and propofol emulsion (n=10), respectively. The neurobehavioral performance of the rats was observed. The time of loss of forepaw righting reflex (LRR) and the time of recovery of forepaw righting reflex (RRR) were recorded. RESULTS: The ED50 of oral HX0969w, fospropofol disodium and propofol emulsion were 96.5 mg/kg, 130.0 mg/kg and 113.8 mg/kg, respectively. HX0969w, fospropofol disodium and propofol emulsion had a mean LRR of (10.0 +/- 2.9) min,(7.5 +/- 2.8) min and (16.0 +/- 5.9) min; respectively; and a mean RRR of (66.9 +/- 21.5) min, (131.9 +/- 32.7) min and (198.9 +/- 110.0) min, respectively. CONCLUSION: HX0969w, fospropofol disodium and propofol emulsion can produce sedative-hypnotic effects and they are safe when administered by oral route. The two propofol prodrugs HX0969w and fospropofol disodium have shorter LRR than propofol emulsion. HX0969w also has a shorter RRR than fospropofol disodium and propofol emulsion.
Subject(s)
Hypnotics and Sedatives/administration & dosage , Organophosphorus Compounds/administration & dosage , Prodrugs/administration & dosage , Propofol/analogs & derivatives , Administration, Oral , Animals , Emulsions , Propofol/administration & dosage , Rats , Rats, Sprague-DawleyABSTRACT
BACKGROUND: The olfactory ensheathing cells (OECs) derived from olfactory bulb (OB) may improve motor function after transplantation in injured spinal cord. However, the effects of OEC transplantation on sensory function have not been reported yet. The purpose of this study is to investigate whether OEC transplantation could affect the sensory function and to analyze the underlying mechanism. RESULTS: OEC transplantation into the hemisected spinal cords can result in hyperalgesia, indicated by radiant and mechanical stimuli towards the plantar surface in rats. This could be associated with upregulation of Brain Derived Neurotrophic Factor (BDNF), indicated by RT-PCR. Immunofluorecent staining showed that BDNF was mainly located in the neurons of the laminas I and II of the dorsal horn. Moreover, a notable upregulation on the level of p-ERK (phosphorylation of extracellular signal-regulated kinase), the downstream molecule of BDNF, was detected by using Western Blot. These findings indicate that the increased BDNF level associated with the p-ERK was possibly involved in neuropathic pain in hemisected spinal cord subjected to OEC transplantation. CONCLUSIONS: The transplantation of OECs may induce the noticeable pain hypersensitivity in rats after hemisected spinal cord injury, and the possible mechanism may be associated with the phosphorylation of ERK and the activated BDNF overexpression.
Subject(s)
Brain-Derived Neurotrophic Factor/metabolism , Cell Transplantation/adverse effects , Extracellular Signal-Regulated MAP Kinases/metabolism , Neuralgia/etiology , Neuroglia/physiology , Olfactory Bulb/cytology , Animals , Brain-Derived Neurotrophic Factor/genetics , Cell Survival , Cells, Cultured , Disease Models, Animal , Extracellular Signal-Regulated MAP Kinases/genetics , Gene Expression Regulation/physiology , Hyperalgesia/etiology , Neurons/metabolism , Pain Measurement , Pain Threshold/physiology , Physical Stimulation/adverse effects , RNA, Messenger/metabolism , Rats , Signal Transduction/physiology , Spinal Cord Injuries/surgeryABSTRACT
OBJECTIVE: To explore the occurrence of complex sleep apnea syndrome in patients with obstructive sleep apnea during continuous positive airway pressure titration and evaluate their polysomnographic characteristics. METHODS: A total of 420 patients with obstructive sleep apnea were recruited to undergo an overnight continuous positive airway pressure titration at the Sleep Medicine Center, West China Hospital from January 2010 to December 2012. Their polysomnographic records of respiratory events, oxygen desaturation events and sleep stages were retrospectively reviewed. RESULTS: The incidence of complex sleep apnea syndrome was 7.9% (33/420) and central apnea index (9.0 ± 5.1) /h.No significant differences existed in age, gender, body mass index and titration pressure of continuous positive airway pressure between two groups. Compared with those with non-complex sleep apnea, complex sleep apnea patients had significant increases in apnea/hypopnea index (12.8/h vs 3.6/h, P < 0.05) and oxygen desaturation index (10.3/h vs 3.8/h, P < 0.05) which mainly happened in non-rapid eye movement stage. They also showed decreases in total sleep time ((365 ± 96) vs (402 ± 77) min), rapid eye movement stage (16% ± 8% vs 20% ± 10%) , increases in non-rapid eye movement stage 1 (24% ± 17% vs 15% ± 13%), wakefulness after sleep onset ((108 ± 93) vs (79 ± 61) min) and brief arousal index ((28 ± 15) vs (20 ± 12)/h). And the differences were statistically significant (all P < 0.05). CONCLUSIONS: Complex sleep apnea syndrome is common among Chinese patients with obstructive sleep apnea. Compared with those with non-complex sleep apnea, complex sleep apnea patients have reduced sleep time and worse sleep quality during continuous positive airway pressure therapy.
Subject(s)
Continuous Positive Airway Pressure/adverse effects , Sleep Apnea, Obstructive/therapy , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: Human adipose-derived stem cells (hASCs) play an important role in regenerative medicine. OBJECTIVE: Exploring the mechanism of Rg1 in the promotion of the proliferation and adipogenic differentiation of hASCs is important in regenerative medicine research. METHODS: To observe ginsenoside Rg1 in promoting the proliferation and adipogenic differentiation of hASCs, Rg1 medium at different concentrations was established and tested using the cell counting kit-8 (CCK-8) assay, oil red O staining, alizarin red, and alcian blue. Compared to the control, differentially expressed genes (DEGs) were screened via DEG analysis, which was carried out in the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. To explore the relationship among mRNA, long non-coding RNA (lncRNA) and microRNA (miRNA), we constructed a competing endogenous RNA (ceRNA) network. RESULTS: In this study, Rg1 was observed to promote the proliferation and adipogenic differentiation of hASCs. Additionally, enriched BPs and KEGG pathways may be involved in the promotion process, where FXR1 and Lnc-GAS5-AS1 were found to be regulatory factors. The regulatory network suggested that Rg1 could regulate the adipocytokine signaling pathway and IL-17 signaling pathway via FXR1 and Lnc-GAS5-AS1, which served as the mechanism encompassing the promotion of Rg1 on the proliferation and adipogenic differentiation of hASCs. CONCLUSION: A comprehensive transcriptional regulatory network related to the promotion ability of Rg1 was constructed, revealing mechanisms regarding Rg1's promotion of the proliferation and adipogenic differentiation of hASCs. The present study provides a theoretical basis for optimizing the function of hASCs.
Subject(s)
Ginsenosides , MicroRNAs , RNA, Long Noncoding , Adipokines/metabolism , Alcian Blue/metabolism , Cell Differentiation/drug effects , Cell Proliferation/drug effects , Cells, Cultured , Ginsenosides/pharmacology , Humans , Interleukin-17/metabolism , MicroRNAs/genetics , RNA, Long Noncoding/genetics , RNA, Long Noncoding/metabolism , RNA, Messenger/genetics , RNA-Binding Proteins/metabolism , Stem Cells/drug effectsABSTRACT
A comprehensive discharge planning assessment tool facilitates the provision of services that meet individual needs thus also facilitating the implementation of high-quality discharge planning. This project used a medical center in northern Taiwan as an example, applied interviews and the questionnaire method, and found that the sensitivity and specificity of existing rank assessment scales were all lower than the standard of 70%, too low to provide accurate screening for classification of needs. In revising the assessment items of, "The Patient Needs Rank Assessment Scale for Discharge Planning, a quantified score was set for the degree of need for each rank, to compute the cut point of each rank with the appropriate sensitivity and specificity. The results show that sensitivity and specificity after revision of the assessment scale all exceeded 70%. As far as satisfaction in clinical usage was concerned, personnel sought to match assessment standards with clinical patients'needs and accurately screened three grades of patient need. Initially, the increase in satisfaction was of clear statistical significance (p < .05). This showed that revision of, "The Patient Needs Rank Assessment Scale for Discharge Planning" can be applied to achieve accurate screening of patient need grades.