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.

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.

Gender differences in clinical manifestations and polysomnographic findings in Chinese patients with obstructive sleep apnea.

PURPOSE: The gender differences in patients with obstructive sleep apnea (OSA) are not fully understood so far, as previous studies had conflicting results. No reports have addressed the differences in OSA between Chinese men and women. Therefore, the purpose of this study was to investigate the clinical and polysomnographic differences between Chinese men and women with OSA. METHODS: This case-paired control retrospective study included 580 consecutive Chinese patients (290 males and 290 females) newly diagnosed as OSA by overnight polysomnography from the Sleep Disorders Center of Tangdu Hospital affiliated to the Fourth Military Medical University of China. Demographic, clinical, and polysomnographic data of men and women with OSA were compared. Order logistic regression analysis was used to determine the risk factors for OSA severity. RESULTS: Male and female patients had similar age (57.3 ± 9.2 vs. 58.2 ± 8.9, p > 0.05) and body mass index (BMI) (25.4 ± 3.4 vs. 25.5 ± 3.9, p > 0.05). Women more commonly presented with insomnia (70.3% vs. 40.3%, p < 0.001), poor sleep quality (58.3% vs. 40.7%, p < 0.001), and headache on awakening (23.1% vs. 13.8%, p < 0.01) than men, while men more frequently reported habitual snoring (69.0% vs. 52.1%, p < 0.001) compared with women. The apnea-hypopnea index (AHI) during total sleep time and non-rapid eye movement sleep was higher in men compared with women (25.8 ± 20.4 vs. 19.3 ± 16.8; 22.0 ± 18.2 vs. 15.1 ± 15.4; p < 0.001, respectively), whereas AHI during rapid eye movement sleep was higher in women than in men (4.2 ± 3.6 vs. 3.7 ± 4.3, p < 0.01). Compared with men, women had lower sleep efficiency (75.4 ± 15.7 vs. 78.1 ± 15.5, p < 0.05), longer REM latency (128.9 ± 88.6 vs. 107.7 ± 72.4, p < 0.01), and greater wakefulness after sleep onset (WASO) (98.3 ± 70.2 vs. 88.0 ± 70.3, p < 0.05). No significant differences in the lowest oxygen desaturation and oxygen desaturation index (ODI) were observed between men and women (80.4 ± 10.8 vs. 80.8 ± 9.0; 17.0 ± 20.9 vs. 13.1 ± 16.5; p > 0.05, respectively). In addition, ordinal logistic regression analysis identified neck circumference as an independent risk factor for OSA severity in male patients (OR, 1.161; 95% CI, 1.020-1.325; p < 0.05) and in female patients (OR, 1.163; 95% CI, 1.013-1.338; p < 0.05). CONCLUSIONS: Overall, female patients had less severe OSA when compared with male patients. The female patients more commonly reported "atypical" OSA symptoms, while male patients more frequently reported "typical" OSA symptoms. In clinical practices, physicians dealing with OSA need to take the gender disparity into consideration for more precise diagnosis and treatment, as women may be atypically symptomatic at a less severe OSA.

A meta-analysis of temozolomide versus radiotherapy in elderly glioblastoma patients.

Temozolomide (TMZ) alone has been proposed as a promising alternative to radiotherapy (RT) in elderly glioblastoma (GBM) patients. We report a meta-analysis to systematically evaluate TMZ monotherapy in older GBM patients. A systematic literature search was performed using PubMed, EMBASE and the Cochrane database. Studies comparing TMZ versus RT in elderly patients (≥ 65 years) with newly diagnosed GBM were eligible for inclusion. Two randomized clinical trials (RCTs) and three comparative studies were included in the analyses, which revealed an overall survival (OS) advantage for TMZ compared with RT (HR [hazard ratio] 0.86, 95 % CI [confidence interval] 0.74-1.00). However, a sensitivity analysis of 2 RCTs only supported its non-inferiority (HR 0.91, 95 % CI 0.66-1.27). Most elderly patients tolerated TMZ despite an increased risk of grade 3-4 (G3-4) toxicities, especially hematological toxicities. The quality of life was similar between the groups. In the MGMT analysis, methylated tumors were associated with a longer OS than unmethylated tumors among elderly patients receiving TMZ monotherapy (HR 0.50, 95 % CI 0.35-0.70). Moreover, in patients with methylated tumors, TMZ was more beneficial than RT alone in improving OS (TMZ vs. RT: HR 0.66, 95 % CI 0.47-0.93) whereas the opposite was true for those with unmethylated tumors (HR 1.32, 95 % CI 1.00-1.76). Although the meta-analysis demonstrated the non-inferiority to RT in improving OS, TMZ alone was not a straightforward solution for elderly GBM patients because of an increased risk of G3-4 toxicities, especially hematological toxicities. MGMT testing might be helpful for determining individualized treatment.

Deciphering linkages between DON and the microbial community for nitrogen removal using two green sorption media in a surface water filtration system.

The presence of dissolved organic nitrogen (DON) in stormwater treatment processes is a continuous challenge because of the intertwined nature of its decomposition, bioavailability, and biodegradability and its unclear molecular characteristics. In this paper, 21 T Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR MS) in combination with quantitative polymerase chain reaction was applied to elucidate the molecular change of DON and microbial population dynamics in a field-scale water filtration system filled with two specialty adsorbents for comparison in South Florida where the dry and wet seasons are distinctive annually. The adsorbents included CPS (clay-perlite and sand sorption media) and ZIPGEM (zero-valent iron and perlite-based green environmental media). Our study revealed that seasonal effects can significantly influence the dynamic characteristics and biodegradability of DON. The microbial population density in the filter beds indicated that three microbial species in the nitrogen cycle were particularly thrived for denitrification, dissimilatory nitrate reduction to ammonium, and anaerobic ammonium oxidation via competition and commensalism relationships during the wet season. Also, there was a decrease in the compositional complexity and molecular weight of the DON groups (CnHmOpN1, CnHmOpN2, CnHmOpN3, and CnHmOpN4), revealed by the 21 T FT-ICR MS bioassay, driven by a microbial population quantified by polymerase chain reaction from the dry to the wet season. These findings indirectly corroborate the assumption that the metabolism of microorganisms is much more vigorous in the wet season. The results affirm that the sustainable materials (CPS and ZIPGEM) can sustain nitrogen removal intermittently by providing a suitable living environment in which the metabolism of microbial species can be cultivated and enhanced to facilitate physico-chemical nitrogen removal across the two types of green sorption media.

Investigating removal mechanisms of long- and short-chain per- and polyfluoroalkyl substances using specialty adsorbents in a field-scale surface water filtration system.

This study assessed the application of two specialty adsorbents, also known as green sorption media (GSM), including clay-perlite and sand sorption media (CPS) and zero-valent iron and perlite green environmental media (ZIPGEM) to remove long- and short-chain per- and polyfluoroalkyl substances (PFAS) at field scale. The field-scale demonstration employed four GSM filter cells installed near the C-23 Canal (St. Lucie County, FL), which discharges water to the ecologically sensitive St. Lucie River estuary and to the Atlantic Ocean finally. Although prior lab-scale experiments had demonstrated the effectiveness of CPS and ZIPGEM in treating long-chain PFAS, their performance in field-scale application warranted further investigation. The study reveals the critical roles of divalent cations such as Ca2+ and monovalent cations such as ammonium and hydronium ions, as well as other water quality parameters, on PFAS removal efficacy. Ammonia, most likely resulting from photo- and bacterial ammonification, gives rise to elevated ammonium ion formation in the wet season due to the decrease in pH, which ultimately worsens PFAS adsorption. Moreover, there is a strong negative correlation between pH and PFAS removal efficiency in the presence of ammonia, as evidenced by the reduced removal of PFAS during events associated with low pH.

Correction: Land reclamation pattern and environmental regulation guidelines for port clusters in the Bohai Sea, China.

[This corrects the article DOI: 10.1371/journal.pone.0259516.].

Simultaneous removal of nutrients and biological pollutants via specialty absorbents in a water filtration system for watershed remediation.

To investigate watershed remediation within a Total Maximum Daily Load program, this study examined the field-scale filtration performance of two specialty absorbents. The goal was to simultaneously remove nutrients and biological pollutants along Canal 23 (C-23) in the St. Lucie River Basin, Florida. The filtration system installed in the C-23 river corridor was equipped with either clay-perlite with sand sorption media (CPS) or zero-valent iron and perlite green environmental media (ZIPGEM). Both media were formulated with varying combinations of sand, clay, perlite, and/or recycled iron based on distinct recipes. In comparison with CPS, ZIPGEM exhibited higher average removal percentages for nutrients. Findings indicated that ZIPGEM could remove total nitrogen up to 49.3%, total Kjeldahl nitrogen up to 67.1%, dissolved organic nitrogen (DON) up to 72.9%, total phosphorus up to 79.6%, and orthophosphate up to 73.2%. Both ZIPGEM and CPS demonstrated similar efficiency in eliminating biological pollutants, such as E. coli (both media exhibiting an 80% removal percentage) and chlorophyll a (both media achieving approximately 95% removal). Seasonality effects were also evident in nutrient removal efficiencies, particularly in the case of ammonia nitrogen; the negative removal efficiency of ammonia nitrogen from the fifth sampling event could be attributed to processes such as photochemical ammonification, microbial transformation, and mineralization of DON in wet seasons. Overall, ZIPGEM demonstrated a more stable nutrient removal efficiency than CPS in the phase of seasonal changes.

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.

Glaucocalyxin A, a negative Akt regulator, specifically induces apoptosis in human brain glioblastoma U87MG cells.

Akt is becoming an attractive target in the development of anti-tumor agents. In the present study, we aimed to discover novel negative Akt regulators against malignant glioma. An Akt regulator screening platform performed in an Akt-GFP overexpression cell line was developed, and natural product library was screened and evaluated using this platform. In addition, the cytotoxic effect of the regulator was detected by MTT assay. Cell apoptosis was assayed by Hoechst 33342 staining and flow cytometry analysis. Afterwards, the apoptotic signaling pathway was investigated by western blot analysis. Glaucocalyxin A, isolated from Rabdosia japonica, was identified as a potent negative regulator of Akt. In human-derived malignant glioma U87MG cells, glaucocalyxin A inhibited Akt phosphorylation, suppressed proliferation, and promoted apoptosis in a dose-dependent manner, but not in normal glial cells. Furthermore, glaucocalyxin A activated caspase-3, decreased BAD phosphorylation, and reduced the expression of X-linked inhibitor of apoptosis protein. Taken together, these results indicated that glaucocalyxin A may become a promising candidate in the treatment of malignant glioma.

A review of current management of brain metastases.

BACKGROUND: The brain metastasis (BM) represents one of the most common and refractory malignancies worldwide with a rising incidence in all countries. It is generally believed that once a BM has developed, this disease cannot be cured and has a poor prognosis. The challenges of managing this tumor include diagnosis and selective treatment options. In addition, patients with BM frequently have greater expectations of the current therapy outcomes, which hope to get long-term survival and good quality of life. METHODS: This is a review of current clinical practice based on an exhaustive literature search of PubMed, Embase, and Google Scholar. A series of case studies is presented to provide outcomes of the effective management in BMs that have required treatment for the terminal stage of patients with cancer, and makes recommendations for future practice. RESULTS: Current technical advances have been made in the diagnosis and treatment of BM. After surgery, radiotherapy, or stereotactic radiosurgery, and for some cases additional systemic chemotherapy for the primary cancer, most patients experience meaningful symptom relief, improved quality of life and longer survival time. An evidence-based summary of recommendations has been produced to guide neurosurgeons and oncologists in managing this particular group of patients. CONCLUSIONS: On the basis of the available data, this treatment approach for well-selected patients is currently not recommended in the treatment of BMs except in experienced medical centers. Clinical judgment is made balancing surgical, radiotherapy, chemotherapy and management principles to advocacy the best therapy outcome.

Hemorrhagic pituitary macroadenoma: characteristics, endoscopic endonasal transsphenoidal surgery, and outcomes.

PURPOSE: This study aims to assess the effect of endoscopic endonasal transsphenoidal surgery (EETSS) of hemorrhagic pituitary macroadenoma (HPMA). PATIENTS AND METHODS: We retrospectively reviewed 52 cases with HPMA collected from the Xijing Hospital from April 1995 to April 2009. There were 39 males and 13 females, ranging in age from 18 to 79 years (average 51.6 years). Patients presented with headache or acute ophthalmological symptoms after adenoma hemorrhage. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed pituitary macroadenoma with hemorrhage in all cases. Twenty-eight adenomas showed marked suprasellar extension, 19 showed moderate extension, and another 5 showed slight extension. All patients were promptly treated by emergency EETSS, usually within 24 h after hospitalization. RESULTS: Total removal of tumor was achieved in 46 cases (88.5%), and subtotal removal in 6 cases (11.5%). Postoperative radiotherapy and reoperation of the tumor were required in five patients with either residual or relapsed tumors. Follow-up ranged from 8 to 93 months (mean 41.6 months) for 43 cases. Visual acuity and visual field recovery and improvement was recorded in 92.1% and 94.3% of patients who had preoperative visual symptoms, respectively. CONCLUSIONS: The majority of macroadenomas are hemorrhagic, and they often occur in middle-aged, male subjects. Detection by imaging in the setting of pituitary apoplexy accurately predicts the nature of the apoplectic process and helps to guide the type and timing of surgery. Early EETSS is the most effective therapy and significantly improves visual outcomes and systemic conditions.

The validation of the standard Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30) in pre-operative patients with brain tumor in China.

BACKGROUND: Health related quality of life (HRQOL) has increasingly emphasized on cancer patients. The psychometric properties of the standard Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30, version 3.0) in brain tumor patients wasn't proven, and there was no baseline HRQOL in brain tumor patients prior to surgery. METHODS: The questionnaire EORTC QLQ-C30 (version 3.0) was administered at three time points: T1, the first or the second day that patients were hospitalized after the brain tumor suspected or diagnosed by MRI or CT; T2, 1 to 2 days after T1, (T1 and T2 were both before surgery); T3, the day before discharge. Clinical variables included disease histologic types, cognitive function, and Karnofsky Performance Status. RESULTS: Cronbach's alpha coefficients for multi-item scales were greater than .70 and multitrait scaling analysis showed that most of the item-scale correlation coefficients met the standards of convergent and discriminant validity, except for the cognitive functioning scale. All scales and items exhibited construct validity. Score changes over peri-operation were observed in physical and role functioning scales. Compared with mixed cancer patients assessed after surgery but before adjuvant treatment, brain tumor patients assessed pre-surgery presented better function and fewer symptoms. CONCLUSIONS: The standard Chinese version of the EORTC QLQ-C30 was overall a valid instrument to assess HRQOL in brain tumor patients in China. The baseline HRQOL in brain tumor patients pre-surgery was better than that in mixed cancer patients post-surgery. Future study should modify cognitive functioning scale and examine test-retest reliability and response validity.

Association between Obstructive Sleep Apnea and Type 2 Diabetes Mellitus: A Dose-Response Meta-Analysis.

MATERIALS AND METHODS: We screened four databases (PubMed, Embase, Cochran Library, and CNKI) for the observational studies about the OSA and T2DM. Studies were collected from database establishment to October 2020. We performed a traditional subgroup meta-analysis. What is more, linear and spline dose-response models were applied to assess the association between apnea-hypopnea index (AHI), an indicator to evaluate the severity of OSA, and the risk of T2DM. Review Manager, version 5.3, software and Stata 16.0 were used for the analysis. RESULT: Seven observational studies were included in the research. We excluded a study in the conventional meta-analysis. In the subgroup analysis, mild-dose AHI increased the risk of T2DM (odds ratio = 1.23, 95% confidence interval = 1.06-1.41, P < 0.05). Moderate-dose AHI increased the risk of T2DM with a higher odds ratio (OR = 1.35, 95% CI = 1.13-1.61, P < 0.05). Moderate-to-severe-dose AHI increased the risk of T2DM with a higher odds ratio (OR = 2.14, 95% CI = 1.72-2.67, P < 0.05). Severe-dose AHI increased the risk of T2DM with a higher odds ratio (OR = 2.19 95% CI = 1.30-3.68, P < 0.05). Furthermore, the spline and linear dose-response meta-analysis results revealed that the risk of T2DM increased with increasing AHI values. CONCLUSION: Through the dose-response meta-analysis, we found a potential dose-response relationship existed between the severity of OSA and the risk of T2DM. This relationship in our passage should be considered in the prevention of T2DM in the future.

Land reclamation pattern and environmental regulation guidelines for port clusters in the Bohai Sea, China.

Coastal land reclamation (CLR), particularly port reclamation, is a common approach to alleviating land shortages. However, the spatial extent, percentages, and processes of these newly reclaimed ports are largely unknown. The Bohai Sea is the most concentrated area of port reclamation worldwide. Thus, this study addresses the changes in the different coastline types and port reclamation process in the area. The reclamation area of the 13 ports in the Bohai Sea in 2002-2018 was 2,300 km2, which decreased the area of the sea by 3%. The natural coastline length in Tianjin decreased by 47.5 km, whereas the artificial coastline length increased by 46.6 km. Based on the port boundary, however, only 26.3% of the reclaimed areas have been used for port construction, which concentrates in the Tianjin and Tangshan ports. The ratio of built-up area within the ports is only 32.5%, and approximately 48.3% of the reclaimed areas have no construction projects. The port land reclamation in the Bohai Sea has been undergoing periods of acceleration, peak, deceleration, and stagnation since 2002. Hence, future port reclamation should not be totally prohibited, and fine management should be conducted based on the optimization of the reclaimed port area. The innovation of this research is its analysis of the port internal land use pattern, the percentage of built-up area in the ports, and the sustainability of port reclamation policies. The findings have vital implications for scientifically regulating the spatial pattern and exploring the utility of port reclamation.

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.

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.

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.

Health-related quality of life in glioma patients in China.

BACKGROUND: Health-related quality of life (HRQOL) has been increasingly emphasized in cancer patients. There are no reports comparing baseline HRQOL of different subgroups of glioma patients prior to surgery. METHODS: HRQOL assessments by the standard Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30, version 3.0), the Mini-Mental State Examination and Karnofsky Performance Status were obtained from glioma patients prior to surgery. RESULTS: Ninety-two pathologically confirmed glioma patients were recruited. There were 84.8% patients with emotional impairment, 75% with social and cognitive impairment, 70.7% with physical impairment, and 50% with role impairment. Eighty-two percent of patients reported fatigue symptoms, 72.8% reported pain, 50% reported appetite loss, 39.1% reported insomnia, and 36.9% reported nausea/vomiting, whereas other symptoms (dyspnea, diarrhea, constipation) in the QLQ-C30 were reported by fewer than 30% of patients. Fatigue and pain symptoms and all "functioning" scales were strongly correlated with global health status/quality of life (QoL). Fatigue was strongly related to all functioning scales, pain, appetite loss, and global health status/QoL. No difference in baseline HRQOL prior to surgery was reported between females and males, among different lesion locations, or between normal- and abnormal-cognition subgroups of glioma patients. Age, KPS, WHO grade, and tumor recurrence significantly affected HRQOL in glioma patients. CONCLUSIONS: These data provided the baseline HRQOL in glioma patients prior to surgery in China. Most pre-surgery glioma patients indicated emotional, social, cognitive, physical, and role impairment. Fatigue, pain, appetite loss, insomnia, and nausea/vomiting were common in these patients. The fatigue and pain symptoms and all types of functioning strongly affected global health status/QoL. Old age, worse performance status, WHO grade IV and tumor recurrence had deleterious effects on HRQOL.

Health-related quality of life in patients with high-grade glioma.

Health-related quality of life (HRQOL) has become an increasingly important endpoint in cancer studies; however, the research into the HRQOL of patients with high-grade glioma (HGG) is sparse compared with that for patients with other neoplasms. Owing to the specific location and poor prognosis, it is more important and difficult to study HRQOL in patients with HGG than in those with other tumors; furthermore, the study of HRQOL in patients with HGG differs from that for patients with other tumors. In this review, we identified and compared the most frequently used instruments to assess HRQOL; analyzed specific facets and determinants of HRQOL (such as sex, tumor location and histological classification, depression, and cognitive function), as well as the association between HRQOL and survival; and appraised the effects of new treatments on HRQOL in patients with HGG from randomized controlled trials. Furthermore, we detected broadly existing problems and many contradictory outcomes and gave some proper interpretation and suggestions regarding them.