Insomnia in epilepsy is associated with nocturnal seizures and anxiety.

PURPOSE: The purpose of this study was to identify the factors associated with insomnia in patients with epilepsy (PWE) and provide evidence for clinical prevention and treatment. METHODS: PWE who visited our epilepsy clinic from December 2021 to December 2022 were enrolled in our study. All participants completed the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS). Based on their ISI scores, they were categorized into two groups: PWE with insomnia (ISI score ≥ 10) and PWE without insomnia (ISI score < 10). Univariate analysis and stepwise logistic regression analysis were conducted to identify the factors associated with insomnia in PWE. RESULTS: A total of 196 Chinese PWE were recruited in this study(men, 39.8 %). Of these, 39 PWE(19.9 %) had insomnia.The incidence of nocturnal seizures (43.6 %vs19.7 %), depression (46.2 %vs9.6 %), anxiety (59.0 %vs11.5 %), and excessive daytime sleepiness(EDS,28.2 %vs5.7 %) in PWE with insomnia were significantly higher than in those without insomnia(all p＜0.01). Univariate regression analysis showed that seizures greater than or equal to once per month, nocturnal seizures, anxiety, depression, and EDS may associate with insomnia in PWE(all p＜0.05). Stepwise logistic regression analysis demonstrated that nocturnal seizures (OR = 2.611,95 % CI 1.040-6.478, P = 0.038) and anxiety (mild OR = 4.830,95 %CI 1.741-13.186, P = 0.002;moderate OR = 24.239,95 %CI 4.719-183.935, P＜0.001; severe OR = 37.653,95 %CI 4.931-782.741, P = 0.002) were independently associated with insomnia in PWE. CONCLUSION: PWE with insomnia are more likely to experience depression and EDS. Nocturnal seizures and anxiety are identified as independent factors associated with insomnia in PWE. Furthermore, Anxiety has a greater impact on insomnia in PWE and the likelihood of insomnia has increased significantly with the aggravation of anxiety levels.

Insomnia in patients with MRI-negative epilepsy: The associated factors and 3D-pCASL cerebral blood flow perfusion changes.

OBJECTIVE: This study aimed to identify the factors associated with insomnia in MRI-negative epilepsy and uncover the underlying pathological mechanism driving insomnia within the context of epilepsy. METHODS: We conducted a retrospective study of patients with MRI-negative epilepsy recruited consecutively from December 2021 to December 2022. All subjects completed the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS). Additionally, some subjects underwent the three-dimensional pseudo continuous arterial spin labeling(3D-pCASL) imaging examination. Bilateral frontal lobe, temporal lobe, hippocampus, thalamus, amygdala, caudate nucleus and lenticular nucleus were selected as regions of interest(ROI) and cerebral blood flow(CBF) values were measured in these regions. Subjects were classified into insomnia (ISI ≥ 10) or non-insomnia (ISI < 10) groups, and univariate and stepwise logistic regression analyses were employed to identify the factors associated with insomnia. Furthermore, CBF values in each ROI were compared between the two groups to identify the brain regions potentially related to the underlying pathological mechanism of insomnia in epilepsy. RESULTS: A total of 73 patients with MRI-negative epilepsy were recruited in this study(men, 49.3 %). Among them, 14 patients(19.2 %) had insomnia. Univariate regression revealed that nocturnal seizures, number of anti-seizure medication(ASM), anxiety, use of valproic acid(VPA), depression, and excessive daytime sleepiness(EDS) may be associated with insomnia in MRI-negative epilepsy (all p＜0.05). Stepwise regression demonstrated that nocturnal seizures, anxiety, and EDS were independently associated with insomnia in MRI-negative epilepsy (OR[95 %CI]P: 14.64[2.02-106.27]0.008,49.35[3.06-796.61]0.006, 13.28[1.25-140.66]0.032, respectively). Furthermore, CBF values in the left amygdala were significantly lower in patients with MRI- negative epilepsy who had insomnia. CONCLUSION: The prevalence of insomnia in MRI-negative epilepsy is 19.2%. Nocturnal seizures, anxiety, and EDS were independently associated with insomnia in MRI-negative epilepsy. The noteworthy decrease in CBF values in the left amygdala might be connected to the underlying pathological mechanism of insomnia in epilepsy.

Derivation and validation of a new prediction model for sudden unexpected death in epilepsy based on a longitudinal prospective population-based cohort.

OBJECTIVE: We conducted a population-based, prospective cohort study with a large sample size in Ningxia Province of the Northwest, a rural area in China, by developing a model to specifically assess risk factors of sudden unexpected death in epilepsy (SUDEP) in people with convulsive epilepsy by clinical variables. METHODS: Participants with convulsive epilepsy were recruited from January 1, 2008, to April 28, 2022, in rural Northwest China. They received regular assessments and management of epilepsy at the primary healthcare level and were followed up monthly. Information on the cause of death and relevant clinical details was obtained from death certificates or neurologist-conducted verbal autopsies. Survival analysis was employed to identify potential risk factors associated with SUDEP. RESULTS: Five variables were independently associated with SUDEP: generalized tonic-clonic seizures (GTCS) with ≥1 attack during the preceding month, GTCS with >3 attacks during the preceding year, body mass index (BMI) ≥24, age of onset ≤14 years, and duration >20 years. The area under receiver operator characteristic (ROC) curve (AUC) value (95% CI) of the model was 0.789 (0.735-0.843) in the derivation dataset and 0.830 (0.758-0.902) in the validation dataset. There was agreement between the observed and predicted probabilities of SUDEP. CONCLUSIONS: This study establishes that high GTCS frequency, early age of onset, long duration of epilepsy, and being overweight are associated with an increased risk of SUDEP in individuals with convulsive epilepsy. The study also developed and validated a personalized prediction model to accurately assess the risk of SUDEP.

Mortality and causes of death among people with convulsive epilepsy in northwestern China.

OBJECTIVE: We analyzed mortality and causes of death among people with convulsive epilepsy in rural areas of northwestern China. METHODS: We established a population-based prospective cohort of people with convulsive epilepsy in an epilepsy prevention and management program in rural northwestern China from January 2012 to December 2013. A uniform cause of death questionnaire was used to obtain detailed information on participants who died during the follow-up until December 2016. We calculated the standardized mortality ratios (SMRs) and proportional mortality rate for major causes of death. Cox proportional hazards regression analysis was used to investigate the risk factors associated with mortality. RESULTS: Among 4296 people with convulsive epilepsy, 216 died during a median follow-up of 59 months. The overall mortality rate was 10.9 per 1000 person-years, and the overall SMR was 2.0. Accidents (25.5%) ranked first in the cause of death, followed by status epilepticus (SE) (22.9%), probable sudden unexpected death in epilepsy (SUDEP) (22.7%), cerebrovascular disease (13.0%), and cardiovascular disease (6.5%). Drowning (10.6%), motor vehicle accidents (13.6%), and falls (4.6%) were the major causes of death by accidents. Female participants had a reduced risk of death from accidents with the hazard ratio (HR) of 0.3 (95% confidence interval (CI): 0.1-0.6). A high risk of death from cerebrovascular disease (HR: 7.2; 95% CI: 2.1-23.6) was found in participants with an onset age of epilepsy older than 16 years. SIGNIFICANCE: The risk of death from convulsive epilepsy in rural northwestern China is twice that of the general population. Accidents, SE, and SUDEP are the leading putative causes of death. Educating people with epilepsy in different regions may help reduce death-related events.

Orange red-emitting carbon dots for enhanced colorimetric detection of Fe3.

Carbon dots (CDs) have demonstrated considerable potential for use in sensing and bioimaging applications based on their unique intrinsic properties. However, CDs have typically been used as fluorescence sensors, as opposed to indicators, based on their ultraviolet absorption and discoloration performance. In this study, orange red-emitting CDs with a high quantum yield (QY) of 53% were constructed from 2,3-diaminopyridine via solvothermal synthesis. Different from the fluorescence quenching behavior reported previously, the constructed CDs demonstrated a unique character in their ultraviolet absorption and fluorescence emission in the presence of Fe3+. The color of the CD solution varied from mauve to orange following the addition of Fe3+ at concentrations exceeding 1 µM, which enabled these CDs to be used in the determination of the presence of Fe3+ in lake water. In addition, due to their negligible cytotoxicity, good solubility, and adequate dispersity, an outstanding cellular probe with near-infrared fluorescence was established. Overall, this study presents a unique CD-based sensor, details its fluorescence mechanism, visual colorimetry, and ultraviolet absorption variations, and confirms its applicability in near-infrared cellular imaging and environmental analyses.

High quantum yield blue- and orange-emitting carbon dots: one-step microwave synthesis and applications as fluorescent films and in fingerprint and cellular imaging.

A high quantum yield (QY) is the key requirement for implementing carbon dots (CDs) in nearly all applications. In this work, blue emissive N-doped CDs with a QY of 83% and orange emissive N-doped CDs with a QY of 47% were successfully prepared using resorcinol and phloroglucin as carbon resources in formamide by one-step microwave synthesis, respectively. Formamide not only plays a role as the solvent but also takes part in the formation of the high QY CDs. It is demonstrated that the as-prepared blue- and orange-emitting N-doped CDs with a high QY can be uniformly dispersed into glue and be fabricated as CD/glue fluorescent composites for fluorescent films and fingerprint imaging. Furthermore, these CDs also show excellent cellular imaging capability.

Nanostructured MXene-based biomimetic enzymes for amperometric detection of superoxide anions from HepG2 cells.

A novel MXene-based biomimetic enzyme was synthesized using adenosine triphosphate (ATP) as a template to modify a Mn3(PO4)2 nanostructure on Mxene-Ti3C2 nanosheets. The resulting composite was used as an electrode material in an electrochemical sensor for superoxide anion (O2•-). It displays excellent catalytic properties which is attributed to the synergistic effects of the two-dimensional conductive substrate and the Mn3(PO4)2 nanoparticles. The addition of ATP results in the formation of a porous and ordered nanostructure of Mn3(PO4)2. This facilitates the electron transfer between O2•- and electrode. The sensor, best operated at 0.75 V (vs. Ag/AgCl), displays a rapid amperometric response with a detection limit of 0.5 nM and an analytical range that extends from 2.5 nM to 14 µM. Conceivably, it has potential in the detection of O2•- released by living cells. Graphical abstract Nanostructured MXenes were synthesized by in-situ growth of Mn3(PO4)2 on Ti3C2 nanosheets under the induction of adenosine triphosphate (ATP). They display enzyme mimickong properties. A sensor fabricated with the composites can be used for the detection of superoxide anions released by HepG2 cells.

Orange, yellow and blue luminescent carbon dots controlled by surface state for multicolor cellular imaging, light emission and illumination.

Three kinds of carbon dots (CDs) with different photoluminescence (PL) (blue, yellow or orange) were synthesized by microwave heating. They display wavelength-independent excitation wavelengths (in the range from 444 to 574 nm), similar average particle size (from 3.7 to 4.2 nm), and fluorescence lifetimes (from 2.7 to 3.1 ns). Color and quantum yields (from 8 to 45% in ethanol) are related to the oxidation degree and the number of N-functional groups on their surface. The CDs are shown to be viable nanoprobes for multicolor imaging of cells. Three composite phosphors were obtained by coating the various CDs on starch particle. The resulting nanomaterials emit solid-state fluorescence with a quantum yield of ≥16%. They were used to fabricate luminescent blocks and light-emitting diodes with controllable color temperature. Graphical abstract (a) The synthesis process of the three carbon dots (CDs). The application in cell imaging (b), starch/CD phosphors (c), starch/CD phosphors-based luminescent blocks (d) and light-emitting diodes (e). (λex: excitation wavelength).

Premature mortality risk in individuals with convulsive epilepsy: Results from a longitudinal, prospective, population-based study.

OBJECTIVE: To assess premature mortality and identify associated risk factors among individuals with convulsive epilepsy in resource-poor settings using a longitudinal, prospective, population-based approach. METHOD: The study recruited people with convulsive epilepsy who underwent assessment and management of epilepsy at primary healthcare centers in rural Northwest China, including newly diagnosed individuals and previously identified prevalent cases. All participants were confirmed to have epilepsy by neurologists according to strict criteria and were followed up monthly by primary care physicians. Demographic data and cause of death (COD) were obtained from death certificates or verbal autopsies conducted by neurologists, following the International Classification of Diseases, 10th Edition. The standardized mortality ratio (SMR) and proportionate mortality ratio (PMR) for each cause of death were estimated using the Cause-Of-Death Surveillance Dataset of China (2020). Survival analysis was used to identify risk factors associated with all-cause mortality and death directly due to epilepsy. RESULTS: During 5.9 years of follow-up with 40,947 person-years, there were 781 (11.2%) deaths among 6967 participants. The risk of premature death in people with convulsive epilepsy was 2.7-fold higher than that in the general population. Young participants had a significantly higher risk (standardized mortality ratio 26.5-52.5) of premature death. The proportionate mortality ratio was higher for cerebrovascular disease (15%), sudden unexpected death in epilepsy (SUDEP) (13.4%), cardiovascular disease (11.7%), status epilepsy (SE) (11.3%), and epilepsy-related accidents (14.0%) than other premature mortality cause of deaths. Additionally, the highest standardized proportional mortality ratio (SPMR) was observed from drowning in all cause of death (10.4, 95% confidence interval [CI]: 7.6-13.8), followed by burning (9.0, 95% CI: 3.7-18.9). Factors that increased the risk of all-cause mortality included male sex, late age of onset, short disease duration, high body mass index, monotherapy, and the frequency of generalized tonic-clonic seizures (GTCS). High frequency of generalized tonic-clonic seizures (> 3 attacks in the last year) was an independent risk factor for premature death directly due to epilepsy (including sudden unexpected death in epilepsy, status epilepsy, and epilepsy-related accidents), while early age of onset (≤ 14 years) and long duration of epilepsy (> 20 years) were independent risk factors for sudden unexpected death in epilepsy. In addition, short duration of epilepsy (≤ 20 years) was an independent risk factor for status epilepsy. CONCLUSIONS: This study demonstrated that individuals with poorly controlled seizures are more likely to experience premature death, with most deaths being epilepsy-related and preventable. These findings underline the importance of effective seizure treatment and the potential impact on reducing premature mortality among people with convulsive epilepsy.

One-step microwave synthesis of N,S co-doped carbon dots from 1,6-hexanediamine dihydrochloride for cell imaging and ion detection.

As a new member of the fluorescent carbon nanomaterial family, carbon dots (CDs) not only have outstanding photoluminescence properties and small size characteristics, but also contain favourable low cytotoxicity and biocompatibility, which could be the best choice to detect of ions to replace quantum dots for ions detection. Here, the N,S co-doped carbon dots (N/S-CDs) was synthesized by one-step microwave using 1,6-hexanediamine dihydrochloride and dimethyl sulfoxide as precursors, and their morphology and structure were characterized by TEM, XRD, XPS and FTIR. The optimal emission wavelength of the CDs was 512 nm with green fluorescence, and was red-shifted gradually as the excitation wavelength aggrandized. The synthesized CDs owned a well quantum yield of 24 %. It was further applied for the detection of MnO4- and Cr2O72- with an excellent detection limit of 0.34 µM and 0.23µM, respectively. Cr2O72- did not influence the N/S-CDs PL response of MnO4- in the presence of excessive Pb2+. Moreover, the obtained N/S-CDs demonstrated preeminent biocompatibility and could be resoundingly applied for cellular imaging.

Indole Carbonized Polymer Dots Boost Full-Color Emission by Regulating Surface State.

Carbonized polymer dots (CPDs) are impressive imaging probes with great potential for enriching the library of metal-free fluorescent materials, yet current strategies have struggled to achieve products that emit full-color light in a single reaction system. Establishing an efficient and robust synthesis approach that unlocks the color barrier to the luminescence centers of specific CPDs remains a challenge. Herein, the surface-state engineering of pyridine and amide in the indole system to create a palette of resolvable full-color light-emissive CPDs is reported. Detailed structural analysis revealed that cationic polymerization and oxidation reactions potentially contribute to the formation of the main frameworks and emission centers of the final CPDs, with emissive oxygen- and nitrogen-based centers fixed by cross-linked polymer structures. This study provides valuable insight into the energy absorbance and photoluminescence mechanism of CPDs and introduces additional reactants (benzo heterocycle) into CPD research.

Core Structure Engineering in Hole-Transport Materials to Achieve Highly Efficient Perovskite Solar Cells.

In this work, the thiadiazolopyridine (PT) unit was introduced as the core structure, with N3 ,N3 ,N6 ,N6 -tetrakis(4-methoxyphenyl)-9-phenyl-9 H-carbazole-3,6-diamine as the peripheral group, to obtain a new compound, JY8, for use as a hole-transport material (HTM) in planar perovskite solar cells (PSCs). Compared with the previously reported JY5 with benzothiadiazole as the core structure, the PT unit with stronger electron-withdrawing ability enhanced the intermolecular dipole-dipole interaction. Moreover, the introduction of the PT unit made the central part in JY8 more planar than its analogue JY5, which is conducive to charge transport. Field-emission (FE)-SEM images suggested a smooth and condense morphology of the JY8 film, which could improve the contact between the perovskite layer and the metal electrode. Space-charge limitation of current results, steady-state, and time-resolved photoluminescence decay curves indicated that JY8 as HTM facilitated hole extraction and hole transport. Consequently, planar PSCs fabricated with JY8 as the HTM exhibited a decent efficiency of 19.14 % with a high fill factor of 81 %.

Anchoring ZnO Nanoparticles in Nitrogen-Doped Graphene Sheets as a High-Performance Anode Material for Lithium-Ion Batteries.

A novel binary nanocomposite, ZnO/nitrogen-doped graphene (ZnO/NG), is synthesized via a facile solution method. In this prepared ZnO/NG composite, highly-crystalline ZnO nanoparticles with a size of about 10 nm are anchored uniformly on the N-doped graphene nanosheets. Electrochemical properties of the ZnO/NG composite as anode materials are systematically investigated in lithium-ion batteries. Specifically, the ZnO/NG composite can maintain the reversible specific discharge capacity at 870 mAh g-1 after 200 cycles at 100 mA g-1. Besides the enhanced electronic conductivity provided by interlaced N-doped graphene nanosheets, the excellent lithium storage properties of the ZnO/NG composite can be due to nanosized structure of ZnO particles, shortening the Li⁺ diffusion distance, increasing reaction sites, and buffering the ZnO volume change during the charge/discharge process.