Research progress on insomnia treated by traditional Chinese medicine and acupuncture based on microbial-gut-brain axis theory

Insomnia,as one of the emotional diseases,has been increasing in recent years,which has a great impact on people's life and work.Therefore,researchers are eager to find a more perfect treatment.The microbiome-gut-brain axis is a new theory that has gradually become popular abroad in recent years and has a profound impact in the field of insomnia.In recent years,traditional Chinese medicine(TCM)has played an increasingly important role in the treatment of insomnia,especially acupuncture and Chinese herbal medicine.It is the main method of TCM in the treatment of insomnia.This paper mainly reviews the combination degree of"microorganism-gut-brain axis"theory with TCM and acupuncture under the system of TCM.To explore the mechanism of TCM and acupuncture in the treatment of insomnia under the guidance of"microorganismgut-brain axis"theory,in order to provide a new idea for the diagnosis and treatment of insomnia.

Mental health and insomnia problems in healthcare workers after the COVID-19 pandemic:A multicenter cross-sectional study

BACKGROUND Healthcare workers(HCWs)are at increased risk of contracting coronavirus disease 2019(COVID-19)as well as worsening mental health problems and insomnia.These problems can persist for a long period,even after the pandemic.However,less is known about this topic.AIM To analyze mental health,insomnia problems,and their influencing factors in HCWs after the COVID-19 pandemic.METHODS This multicenter cross-sectional,hospital-based study was conducted from June 1,2023 to June 30,2023,which was a half-year after the end of the COVID-19 emergency.Region-stratified population-based cluster sampling was applied at the provincial level for Chinese HCWs.Symptoms such as anxiety,depression,and insomnia were evaluated by the Generalized Anxiety Disorder-7,Patient Health Questionnaire-9,and Insomnia Severity Index.Factors influencing the symptoms were identified by multivariable logistic regression.RESULTS A total of 2000 participants were invited,for a response rate of 70.6%.A total of 1412 HCWs[618(43.8%)doctors,583(41.3%)nurses and 211(14.9%)nonfrontline],254(18.0%),231(16.4%),and 289(20.5%)had symptoms of anxiety,depression,and insomnia,respectively;severe symptoms were found in 58(4.1%),49(3.5%),and 111(7.9%)of the participants.Nurses,female sex,and hospitalization for COVID-19 were risk factors for anxiety,depression,and insomnia symptoms;moreover,death from family or friends was a risk factor for insomnia symptoms.During the COVID-19 outbreak,most[1086(76.9%)]of the participating HCWs received psychological interventions,while nearly all[994(70.4%)]of them had received public psychological education.Only 102(7.2%)of the HCWs received individual counseling from COVID-19.CONCLUSION Although the mental health and sleep problems of HCWs were relieved after the COVID-19 pandemic,they still faced challenges and greater risks than did the general population.Identifying risk factors would help in providing targeted interventions.In addition,although a major proportion of HCWs have received public psychological education,individual interventions are still insufficient.

Unraveling the mechanism of action of Shangxia Liangji formula for treating insomnia:a metabolomics and network pharmacology approach

Background:Insomnia is a prevalent clinical condition and Shangxia Liangji formula(SXLJF)is a well-established method of treatment.Nevertheless,the specific mechanism of action of SXLJF remains unclear.Methods:The mouse model of insomnia was established by intraperitoneal injection of para-chlorophenylalanine.Forty-two mice were randomly divided into a negative control group,model group,SXLJF group(18.72 g/kg/day),and positive control group(diazepam,2 mg/kg)and treated with the corresponding drugs for 7 consecutive days.The open field test and pentobarbital-induced sleeping test were conducted.LC-MS-based untargeted metabolomics and network pharmacology were applied to explore the potential targets of SXLJF for treating insomnia.Finally,key targets were validated using RT-qPCR.Results:Behavioral tests demonstrated that SXLJF reduced the total distance,average velocity,central distance,and sleep latency,and prolonged sleep duration.Metabolomics and network pharmacology revealed potential targets,signaling pathways,metabolic pathways,and metabolites associated with the anti-insomnia effects of SXLJF.Specifically,tyrosine hydroxylase(TH)and tyrosine metabolism emerged as crucial metabolic pathways and targets,respectively.RT-qPCR results supported the role of TH in the mechanism of SXLJF in treating insomnia.Conclusion:In conclusion,TH and tyrosine metabolism may represent significant targets and pathways for SXLJF in treating insomnia.

Traditional Chinese medicine treatment of insomnia based on microbial-gut-brain axis theory

In recent years,insomnia has gradually become a common disease in society,which seriously affects people's quality of life.At present,with the deepening of research on intestinal microbiota-gut-brain axis in Western medicine,many studies suggest that regulating the gastrointestinal tract can treat brain-related diseases.It is found that brain-gut-bacteria axis plays an important role in the prevention and treatment of primary insomnia.At present,although the clinical treatment of insomnia with Western medicine can improve the insomnia symptoms of patients to a certain extent,there are still obvious adverse reactions,such as anxiety and depression,drug addiction,etc.,so long-term oral drug therapy cannot be carried out.Traditional Chinese medicine(TCM)and acu-puncture techniques have certain therapeutic effects on insomnia.TCM believes that the brain and gastrointestinal system are connected through the meridian,and the pathophysiology is closely related.This paper will discuss the theory and feasibility of TCM for the treatment of insomnia from the pathological relation-ship between brain-gut axis,intestinal flora and insomnia.

Challenges in integrating traditional Chinese medicine and gut microbiota research for insomnia treatment

The gut microbiome is an extensive variety of bacteria with a range of metabolic capabilities that can be pathogenic,beneficial,or opportunistic.Changes in the gut microbiota's composition can affect the link between gut integrity and host health as well as cause disruptions to numerous neurological systems.The second most prevalent mental health problem,insomnia has a negative social and economic impact.Currently,it is becoming increasingly obvious how crucial it is to preserve the delicate balance of gut microbiota to treat illness-related symptoms like insomnia.Although traditional Chinese medicine has proposed an effective strategy against insomnia through gut microbiota alteration in animal models,studies in human models are limited.This decreases the predictive value of the studies in terms of human outcomes.This editorial places an emphasis on cultural sensitivity rather than scientific reasoning that promotes the use of traditional Chinese medicine(TCM).We aim to emphasize the concern that promoting TCM could divert resources from conventional medical research,leading to suboptimal care.

Differences in insomnia-related self-reported outcomes among elderly hospitalized patients

Insomnia is among the most common sleep disorders worldwide.Insomnia in older adults is a social and public health problem.Insomnia affects the physical and mental health of elderly hospitalized patients and can aggravate or induce physical illnesses.Understanding subjective feelings and providing reasonable and standardized care for elderly hospitalized patients with insomnia are urgent issues.AIM To explore the differences in self-reported outcomes associated with insomnia among elderly hospitalized patients.METHODS One hundred patients admitted to the geriatric unit of our hospital between June 2021 and December 2021 were included in this study.Self-reported symptoms were assessed using the Athens Insomnia Scale(AIS),Generalized Anxiety Disorder Scale-7(GAD-7),Geriatric Depression Scale-15(GDS-15),Memorial University of Newfoundland Scale of Happiness(MUNSH),Barthel Index Evaluation(BI),Morse Fall Scale(MFS),Mini-Mental State Examination,and the Short Form 36 Health Survey Questionnaire(SF-36).Correlation coefficients were used to analyze the correlation between sleep quality and self-reported symptoms.Effects of insomnia was analyzed using Logistic regression analysis.RESULTS Nineteen patients with AIS≥6 were included in the insomnia group,and the incidence of insomnia was 19%(19/100).The remaining 81 patients were assigned to the non-insomnia group.There were significant differences between the two groups in the GDA-7,GDS-15,MUNSH,BI,MFS,and SF-36 items(P<0.05).Patients in the insomnia group were more likely to experience anxiety,depression,and other mental illnesses,as well as difficulties with everyday tasks and a greater risk of falling(P<0.05).Subjective well-being and quality of life were poorer in the insomnia group than in the control group.The AIS scores positively correlated with the GAD-7,GDS-15,and MFS scores in elderly hospitalized patients with insomnia(P<0.05).Logistic regression analysis showed that GDS-15≥5 was an independent risk factor for insomnia in elderly hospitalized patients(P<0.05).CONCLUSION The number of self-reported symptoms was higher among elderly hospitalized patients with insomnia.Therefore,we should focus on the main complaints of patients to meet their care needs.

The Modulating Role of Cannabis in Insomnia: A Review of the Literature

The objective of this study was to carry out a review of the literature covering the topic of the association between sleep, insomnia and the medicinal use of cannabis. The guiding question for carrying out this study was whether the medicinal use of cannabis could have a significant positive impact on reducing insomnia. To this end, a review of the literature on the topic was prepared, both in English and Portuguese, from 2005 to 2023, in the PubMed, Scielo and LILACS databases. To search the databases, the keywords “cannabis”, “cannabidiol”, “tetrahydrocannabinol”, “insomnia” and “endocannabinoid” were used. In total, the initial search resulted in 17 articles. After a more careful analysis, only 6 of these articles met the inclusion criteria established for this study. Thus, it was concluded that, although some studies link the use of medicinal cannabis with an improvement in sleep quality, the current literature still lacks more studies on the topic.

Effect of Suan Zao Ren (Semen Ziziphi Spinosae) Extract on the TXNIP/NLRP3 Pathway in Insomniac Rats

Objectives This study aimed to investigate the therapeutic effects of Suan Zao Ren(Semen Ziziphi Spinosae,SZS)extract on insomnia induced by p-chlorophenylalanine(PCPA)in rats and its influence on the thioredoxin-interacting protein(TXNIP)/nucleotide-binding domain Leucine-rich repeat and pyrin domain-containing receptor 3(NLRP3)inflammasome pathway,and to preliminarily explore themechanism by which SZS extract improves insomnia.Methods Fifty male Sprague–Dawley(SD)rats were used,with 8 rats in the blank group and 42 rats in the modeling group.The modeling group was induced by intraperitoneal injection of PCPA at a dose of 500mg·kg^(-1) for six consecutive days,with daily cage exchange.After 6 days,40 successfully modeled rats were randomly divided into five groups:themodel group(equal volume of distilled water),the positive group(0.75 mg·kg^(-1)),and low-,medium-,and high-dose SZS extract groups(1.5,3,and 6 g·kg^(-1),respectively),with 8 rats in each group.Treatments were administered for seven consecutive days.Enzyme-linked immunosorbent assay was used to measure levels of 5-hydroxytryptamine(5-HT)and gamma-aminobutyric acid(GABA)in the rat cerebral cortex.The thiobarbituric acid(TBA)method was used to determine malondialdehyde(MDA)levels,and the hydroxylamine method was used to determine superoxide dismutase(SOD)levels.The 2,2′-azino-bis(3-ethylbenzthiazoline-6-sulfonic acid)method was used to measure total antioxidant capacity(TAOC)in the cerebral cortex.Pathological changes in the cerebral cortex were observed,and Western blot was used to detect the protein expressions of TXNIP,NLRP3,apoptosis-associated speck-like protein containing a Caspase activation and recruitment domain(CARD),and cysteine–aspartate-specific protease 1(Caspase-1)in the cerebral cortex.Results Compared with the blank group,the model group showed a significantly prolonged sleep latency(p<0.001)and a significantly shortened sleep duration(p<0.001).There were no changes in serum MDA and SOD levels.MDA levels in the cerebral cortex were significantly increased(p<0.001),while SOD and TAOC levels were significantly decreased(p<0.001).The 5-HT level was increased(p<0.05),and the GABA level was significantly decreased(p<0.001).SZS extract improved these conditions to varying degrees.Light microscopy showed no significant changes in cortical neurons but transmission electron microscopy revealed intact mitochondrial structures in the blank group,while the model group showed swollen and unclear mitochondria with reduced organelles.After 7 days of treatment,these conditions improved in the SZS extract groups.Compared with the blank group,the expressions of the four proteins in the model group were increased,and the expressions of these proteins were decreased in the SZS extract groups compared with the model group.Conclusion SZS extract may exert an antioxidant effect to treat insomnia by downregulating the expression of TXNIP/NLRP3 proteins and regulating oxidative stress levels in the cerebral cortex.

Research progress of neurotransmitters related to insomnia

Insomnia is currently a common phenomenon,which manifests itself as difficulty in falling asleep,problems remaining asleep,or early awakening,and has a serious impact on people’s lives.Neurotransmitters play a key role in regulating the sleep-wake cycle,among which gamma-aminobutyric acid(GABA),5-hydroxytryptamine(5-HT),noradrenaline(NE),acetylcholine(ACh),and melatonin have been widely studied.This review analyzes the research results in recent years and reveals the role of neurotransmitters in the occurrence of insomnia and their relevance.It provides new perspectives for further discussion on the diagnosis and treatment strategies of insomnia and research on targeted drugs.

Study on the Efficacy of Shugan Jieyu Capsules Combined with Trazodone in Patients with Post-Stroke Depression and Insomnia

Objective:To analyze the effectiveness of applying ShuGan JieYu Capsules(SGJYC)combined with trazodone in patients with post-stroke depression(PSD)with insomnia.Methods:60 cases of PSD with insomnia patients admitted to the hospital from May 2022 to May 2023 were selected and randomly divided into a reference group(trazodone)and a research group(SGJYC combined with trazodone)of 30 cases each.Statistics were analyzed using the Hamilton Depression Rating Scale(HAM-D),Pittsburgh Sleep Quality Index(PSQI),and Activities of Daily Living(ADL)scale before treatment and 4,8,and 12 weeks after treatment.Results:Before treatment,The results of HAM-D,PSQI,and ADL scale studies in the two groups before treatment were not statistically significant(P>0.05);4,8,and 12 weeks after treatment,the results of HAM-D and PSQI studies in the research group were lower than that of the reference group,and the results of ADL scale studies were higher than that of the reference group.There was a significant difference between the groups(P<0.05).The total adverse reaction rate of the research group was lower than that of the reference group,and there was a significant difference between the groups(P<0.05).Conclusion:The combination of SGJYC and trazodone reduced depression in post-stroke patients,corrected insomnia,improved sleep quality,was safe,and had a low rate of adverse reactions.

Development and validation of tongue imaging-based radiomics tool for the diagnosis of insomnia degree:a two-center study

Background:Traditional Chinese medicine(TCM)is commonly used for the diagnosis and treatment of insomnia,with tongue diagnosis being particularly important.The aim of our study was to develop and validate a novel tongue imaging-based radiomics(TIR)method for accurately diagnosing insomnia severity.Methods:This two-center analysis prospectively enrolled 399 patients who underwent tongue imaging between July and October 2021 and divided them into primary and validation cohorts by study center.Here,we referred to the Insomnia Severity Index(ISI)standard and the degree of insomnia was evaluated as absent,subthreshold,moderate,or severe.For developed the TIR diagnostic tool,a U-Net algorithm was used to segment tongue images.Subsequently,seven imaging features were selected from the extracted high-throughout radiomics features using the least absolute shrinkage and selection operator algorithm.Then,the final radiomics model was developed in the primary cohort and tested in the independent validation cohort.Finally,we assessed and compared the diagnostic performance differences between TCM tongue diagnosis and our TIR diagnostic tool with the ISI gold standard.The confusion matrix was calculated to evaluate the diagnostic performance.Results:Seven tongue imaging features were selected to build the TIR tool,with showing good correlations with the insomnia degree.The TIR method had an accuracy of 0.798,a macro-average sensitivity of 0.78,a macro-average specificity of 0.906,a weighted-average sensitivity of 0.798,and a weighted specificity of 0.916,showing a significantly better performance compared to the average performance of three experienced TCM physicians(mean accuracy of 0.458,P<0.01).Conclusions:The preliminary study demonstrates the potential application of TIR in the diagnosis of insomnia degree and measurement of sleep health.The integration of quantitative imaging analysis and machine learning algorithms holds promise for advancing both of TCM and precision sleep medicine.

The Moderating Effect of Organizational Identification on Occupational Stress and Insomnia Among Nurses

Objective:To explore the relationship between organizational identification,occupational stress,and insomnia among nurses and to analyze the moderating role of organizational identification between occupational stress and insomnia.Methods:Through stratified sampling,720 nurses working in a tertiary A-level hospital in Shandong Province from March to May 2021 were surveyed using an effort-reward imbalance questionnaire,an organizational identification questionnaire,and the Athens Insomnia scale.Results:Organizational identification was negatively correlated with occupational stress and insomnia(r_(1)=-0.121,P_(1)<0.01;r_(2)=-0.144,P_(2)<0.01).Occupational stress was positively correlated with insomnia(r=0.379,P<0.01).Organizational identity significantly moderated nurses’occupational stress and insomnia(β=-0.192,t=-2.558,P<0.05).Conclusion:Occupational stress and organizational identification can predict insomnia.Organizational identification could negatively mediate the relationship between occupational stress and insomnia.Improving organizational identification may help alleviate insomnia symptoms by relieving occupational stress.

Impact of applying the theory of human becoming and self-care deficit theory of nursing on insomnia in after stroke urinary incontinence patients

Objective:To determine the impact of applying the theory of human becoming and self-care deficit theory of nursing in overcoming insomnia in patients of urinary incontinence(UI)after stroke.Insomnia is a sleep disorder experienced by UI patients after stroke which can exacerbate problems related to brain damage and can complicate the recovery process.Methods:This study was a quasi-experimental conducted in 4 hospitals.Fifty-six patients were selected by convenience sampling and divided into 2 groups(the intervention and control group).Participants in the intervention group received“applying the theory of Human becoming and self-care deficit theory of nursing,”starting when the patient is about to go home from the hospital and continuing at the house.Measurement of insomnia is done using the Pittsburgh Sleep Quality Index(PSQI).Results:The mean insomnia scores of participants from both groups increased in the first and third measurements.The second and third insomnia measurements found a significant difference(P<0.001).This intervention decreased the average score of insomnia by 4.11 times in the second measurement and 5.82 times in the third measurement.The most important item that decreased in the third measurement of insomnia was sleep efficiency.Conclusions:Applying the theory of human becoming and self-care deficit theory of nursing in this study significantly decreased the insomnia score of post-stroke UI patients.It can be used as a guide for nurses,patients,and families in managing insomnia.In addition,the application of nursing theory in nursing practice can systematize nursing care plans and organize the knowledge of professionals into a conceptual framework,as well as provide effective guidance for nurses on what to do.

Discussion on Traditional Chinese Medicine Treatment of Liver-Depression-Spleen-Deficiency Type Insomnia Based on the State-Target Theory and the Regulation of Microbiome-Gut-Brain Axis

Insomnia has become an urgent clinical problem in modern society.Current research has found that the gut flora-gut-brain axis plays an important role in regulating insomnia.The state-target theory is a product of the combination of traditional Chinese medicine and modern molecular biology technology.This paper clarifies the correlation between the state-target theory,the intestinal flora-gut-brain axis,and liver-depression-spleen-deficiency insomnia.The use of traditional Chinese medicine to regulate the structure and abundance of intestinal flora was also explored,aiming to integrate traditional Chinese medicine with Western medicine for the prevention and treatment of liver-depression-spleen-deficiency insomnia.

Analysis of the Clinical Effect of Chinese Medicine Combined with Acupuncture and Moxibustion on Insomnia

Objective:To explore and analyze the clinical efficacy of Chinese medicine combined with acupuncture and moxibustion in the treatment of insomnia.Method:80 patients with primary insomnia were selected as the study sample,with 20 cases randomly selected as the control group and the rest as the observation group.The control group was treated with ordinary western medicine,while the observation group patients were treated with traditional Chinese medicine combined with acupuncture and moxibustion based on this syndrome differentiation.The comparison items were treatment effect,sleep quality,mental health,quality of life,specific sleep indicators,cerebral blood flow and neurotransmitters.Result:The treatment effectiveness showed that the observation group had a higher treatment effectiveness rate than the control group(P<0.05);The results of sleep quality showed that after treatment,the scores of the observation group were lower than those of the control group in seven dimensions:sleep quality,sleep time,sleep onset time,sleep efficiency,sleep disorders,hypnotic drugs,and daytime dysfunc‐tion score(P<0.05);The quality of life results showed that after treatment,the observa‐tion group had higher scores than the control group in eight dimensions:physiological function,physiological function,physical pain,health status,energy,social function,emotional function,and mental health(P<0.05);The results of slow wave sleep time and fast eye movement sleep time showed that after treatment,the HAMA and HAMD scores of the physiological mechanism in the observation group were lower than those in the control group(P<0.05);The results of cerebral blood flow and neurotransmitter indica‐tors show that after treatment,glutamateγ-The peak systolic blood flow velocity of ami‐nobutyric acid,vertebral artery,and basilar artery in the observation group was higher than that in the control group(P<0.05).Conclusion:The clinical treatment of Chinese medicine combined with acupuncture and moxibustion in the treatment of insomnia patients can significantly improve the clinical treatment effect,and improve the cerebral hemorrhage and neurotransmitter status of patients,promote the improvement of their physical and mental status,can more significantly improve the quality of sleep,reduce sleep difficulties,reduce the dosage of sleeping pills,which has important clinical application value.

Effect of Head Meridian Massage Combined with Auricular Acupoint Plaster on Patients with Insomnia

Objective:To study the effect of head meridian massage combined with auricular acupoint plasters on patients with insomnia.Methods:The sample consisted of 50 cases,and all of them were admitted to Yixing Hospital of Traditional Chinese Medicine from January 2022 to December 2023.The patients were divided into an observation group and a control group,with 25 cases in each group.The observation group was treated with a combination of head meridian massage and auricular acupoint plaster while the control group underwent conventional nursing care.The improvement of sleep quality and nursing effect were used as evaluation criteria to compare the clinical effects of the nursing programs.Results:After nursing intervention,the Pittsburgh sleep quality index(PSQI)score of the observation group,which was 7.17±1.41 points was lower than that of the control group(9.04±1.96 points),(t=3.8724,P<0.05).The total efficacy was 96.00%for the observation group and 76.00%for the control group(2=4.1528,P<0.05).Conclusion:Head meridian massage combined with auricular acupoint can improve the sleep quality of patients with insomnia.

Insomnia Burden among Informal Caregivers of Hospitalized Lung Cancer Patients and Its Influencing Factors

Objective This study aimed to reveal the insomnia burden and relevant influencing factors among informal caregivers(ICs)of hospitalized patients with lung cancer.Methods A cross-sectional study on ICs of hospitalized patients with lung cancer was conducted from December 31,2020 to December 31,2021.ICs’burden was assessed using the Caregiver Reaction Assessment(CRA),Hospital Anxiety and Depression Scale(HADS),and Insomnia Severity Index(ISI).Linear and logistic regression models were used to identify the influencing factors.Results Among 289 ICs of hospitalized patients with lung cancer,83(28.72%),53(18.34%),and 14(4.84%)ICs experienced mild,moderate,and severe insomnia,respectively.The scores concerning self-esteem,lack of family support,financial problems,disturbed schedule,and health problems were 4.32±0.53,2.24±0.79,2.84±1.14,3.63±0.77,and 2.44±0.95,respectively.ICs with higher Activities of Daily Living Scale(ADLS)scores were associated with a lower risk of insomnia,with an odd ratio(OR)and 95%confidence interval(CI)of 0.940(0.898–0.983).Among the ICs,female gender(OR=2.597),alcohol consumption(OR=3.745),underlying medical conditions(OR=11.765),long-term caregiving experience(OR=37.037),and higher monthly expenses(OR=5.714)were associated with a high risk of insomnia.Conclusion Of the hospitalized patients with lung cancer,51.9%experienced insomnia.Patients’ADL,ICs gender,alcohol consumption,underlying medical conditions,caregiving duration,and monthly expenses were influencing factors.Therefore,prompt screening and early intervention for ICs of patients with lung cancer is necessary.

Acupuncture at Back-Shu point improves insomnia by reducing inflammation and inhibiting the ERK/NF-κB signaling pathway

BACKGROUND Insomnia is a disease where individuals cannot maintain a steady and stable sleep state or fail to fall asleep.Western medicine mainly uses sedatives and hypnotic drugs to treat insomnia,and long-term use is prone to drug resistance and other adverse reactions.Acupuncture has a good curative effect and unique advantages in the treatment of insomnia.AIM To explore the molecular mechanism of acupuncture at Back-Shu point for the treatment of insomnia.METHODS We first prepared a rat model of insomnia,and then carried out acupuncture for 7 consecutive days.After treatment,the sleep time and general behavior of the rats were determined.The Morris water maze test was used to assess the learning ability and spatial memory ability of the rats.The expression levels of inflammatory cytokines in serum and the hippocampus were detected by ELISA.qRTPCR was used to detect the mRNA expression changes in the ERK/NF-κB signaling pathway.Western blot and immunohistochemistry were carried out to evaluate the protein expression levels of RAF-1,MEK-2,ERK1/2 and NF-κB.RESULTS Acupuncture can prolong sleep duration,and improve mental state,activity,diet volume,learning ability and spatial memory.In addition,acupuncture increased the release of 1L-1β,1L-6 and TNF-αin serum and the hippocampus and inhibited the mRNA and protein expression of the ERK/NF-κB signaling pathway.CONCLUSION These findings suggest that acupuncture at Back-Shu point can inhibit the ERK/NF-κB signaling pathway and treat insomnia by increasing the release of inflammatory cytokines in the hippocampus.

Molecular mechanisms of Tibetan medicine Sug-Mel-sum-thang in treating insomnia disorder:network pharmacology,molecular docking,and surface plasmon resonance

Background:The Tibetan medicine Sug-Mel-sum-thang(SMST)is often used to treat insomnia disorder(ID);however,the underlying mechanism remains unclear.In this study,network pharmacology prediction was conducted to analyze the molecular mechanisms of SMST in treating ID.Methods:The active ingredients of the three herbs used in SMST were obtained from the Shanghai Institute of Organic Chemistry,Chinese Academy of Sciences.Chemistry Database[DB/OL].The chemical formulae of the active ingredients were downloaded from PubChem in canonical SMILES format.These were then imported into the SwissTargetPrediction platform to identify drug targets.ID targets were obtained from databases such as DrugBank,GeneCards,and DisGeNET.Potential targets of SMST for the treatment of ID were identified using the online Venny mapping platform.The potential target protein-protein interaction was constructed using the STRING platform,and the obtained protein-protein interaction information was imported into Cytoscape 3.7.1 for image optimization and core gene extraction and ClueGO in Cytoscape 3.7.1 was used for the enrichment analysis of potential targets.Cytoscape 3.7.1 was also used to construct the regulatory network of the Tibetan medicine compound target pathway and conduct a topological analysis.Results:The mechanism of action of SMST in the treatment of ID involved 72 compounds,including nerolidol,apigenin,luteolin,and piperine.The key targets identified were COMT,CNR1,AKT1,SLC6A4,TNF,CTNNB1,and CHRNA4.The enrichment analysis obtained 69 KEGG pathways,mainly related to Alzheimer’s disease,cAMP signaling pathway,serotonergic synapse,and other pathways.The core active ingredient molecule docked with the target to a higher degree.The results showed that the active ingredient exhibited good binding activity with the related targets.Some parts with good docking fractions were selected for surface plasmon resonance analysis.Conclusion:Various active components in SMST play a role in the treatment of ID by acting on key targets,such as COMT and CNR1,to regulate multiple signaling pathways.

Hospital-acquired insomnia scale:A validity and reliability study

BACKGROUND Sleep breathing,one of the basic human needs,is a physiological need that affects cardiac functions,body temperature,daily vitality,muscle tone,hormone secretion,blood pressure,and many more.In the international literature,studies reported that patients have had sleep problems in the hospital since the 1990s,but no measurement tool has been developed to determine the causes of hospitalacquired insomnia in individuals.These findings suggest that sleep remains in the background compared to activities such as nutrition and breathing.Although patients generally experience hospital-acquired sleep problems,there is no measurement tool to determine hospital-acquired sleep problems.These features show the originality of the research.AIM To develop a measurement tool to determine the sleep problems experienced by patients in the hospital.METHODS A personal information form,hospital-acquired insomnia scale(HAIS),and insomnia severity index(ISI)were used to collect research data.The study population consisted of patients hospitalized in the internal and surgical clinics of a research hospital in Turkey between December 2021 and March 2022.The sample consisted of 64 patients in the pilot application stage and 223 patients in the main application stage.Exploratory factor analysis and confirmatory factor analysis(CFA)analyses were performed using the SPSS 20 package program and the analysis of moment structure(AMOS)package program.Equivalent forms method used.RESULTS The HAIS consisted of 18 items and 5 subscales.The Cronbach alpha values of the subscales ranged between 0.672 and 0.842 and the Cronbach alpha value of the overall scale was 0.783.The scale explained 58.269%of the total variance.The items that constitute the factors were examined in terms of content integrity and named as physical environmental,psychological,safety,socioeconomic,and nutritional factors.CFA analysis of the 5-factor structure was performed in the AMOS package program.The fit indices of the obtained structure were examined.It was determined that the values obtained from the fit indices were sufficient.A significant correlation was determined between the HAIS and the ISI,which was used for the equivalent form method.CONCLUSION The HAIS is a valid and reliable measurement tool for determining patients’level of hospitalacquired insomnia.It is recommended to use this measurement tool to determine the insomnia problems of patients and to adapt it in other countries.