Does the Sleep-Related Neurons Modulate the Sensation of Pain under the Use of GA?

General anesthetics (GA) has been discovered for centuries and was often used in surgeries. However, many patients are dying from the usage of GA for different reasons. Although scientists are working on to solve the problems, the mechanism of GA is still a mystery. Recently, scientists from Duke University found neurons that are active during sleep can be activated in anesthesia. These neurons are called Anesthetic Activated Neurons (AANs). This is a massive step for us to break the mystery. In this paper, we designed an experiment that aims to reveal one mechanism of GA: the relationship between sleep-related neurons and sensation of pain under the use of GA. The designed experiment involves several control groups that consist of mice with different treatments on their genes and different GA.

Sleep-related hypoxemia aggravates systematic inflammation in emphysematous rats

Background Sleep disturbance is common in patients with emphysema. This study aimed to develop a novel model of sleep-related hypoxemia （SRH） in emphysema （SRHIE） with rats, and to explore the inflammatory status of SRHIE in lung, liver, pancreas, carotid artery and whole blood.Methods Seventy-five male Wistar rats were assigned to 5 groups with 15 per group according to the exposure conditions. The protocols varied with the degree of hypoxia exposure and severity of pre-existing emphysema caused by cigarette smoke exposure： （1） SRH control （SRHCtrl） group, sham smoke exposure （smoke exposure, exposed to smoke of 15 cigarettes twice everyday, 16 weeks） and SRH exposure （12.5% O2, 3 hours, SRH exposure, divide total hypoxia time （1.5 hours or 3 hours） into 4 periods evenly （22.5 minutes or 45 minutes） and distribute these hypoxia periods evenly into physiological sleep time of rats identified by electroencephalogram, week 9 to week 16）; （2） Emphysema control （ECtrl） group, smoke exposure and sham SRH exposure （21% O2, 3 hours）; （3） Short SRH in emphysema （SRHShort） group, smoke exposure and short SRH exposure （12.5% O2, 1.5 hours）; （4） Mild SRH in emphysema （SRHMild） group,smoke exposure and mild SRH exposure （15% O2, 3 hours）; （5） Standard SRH in emphysema （SRHStand） group, smoke exposure and SRH exposure （12.5% O2, 3 hours）. ECtrl, SRHShort, SRHMild and SRHStand groups were groups with emphysematous rats. Two days before the end of exposure, 5 rats in each group were randomly selected for arterial blood gas analysis. In the rest 10 rats in each group, we obtained blood samples and bronchoalveolar lavage fluid （BALF）for routine tests. We also obtained tissue blocks of lung, liver, pancreas, and right carotid artery for pathologic scoring and measurements of liver oxidative stress （measuring hepatic oxidative stress enzymes, superoxide dismutase （SOD） activity, catalase （CAT） activity and malondialdehyde （MDA） concentration）.Results Emphysematous groups had higher mean linear intercept （MLI） and mean alveolar number （MAN） values than SRHCtrl group. MLI values in SRHStand group were the highest （ail P 〈0.05）. O2Sat in SRHStand rats when SRH exposure was （83.45±1.76）%. Histological scores of lung, liver, pancreas and right carotid artery were higher in emphysematous groups than SRHCtrl group, and SRHStand group were the highest （all P 〈0.05） （SOD and CAT values were lower and MDA values were higher in groups with emphysema than without and in SRHStand group than in ECtrl group （all P 〈0.05））. MDA values were the highest in SRHStand group （all P 〈0.05）. Total cellular score in BALF and White blood cell （WBC） in whole blood were the highest in SRHStand group （all P 〈0.05）. Lymphocyte ratios were the highest in SRHStand group both in BALF and blood （all P 〈0.05）. Red blood cell （RBC） and hemoglobin in emphysematous groups were higher than that in SRHCtrl group, and SRHStand group were higher than ECtrl group （all P 〈0.05）.Conclusions With a proper novo model of SRHIE with Wistar rats, we have demonstrated SRH may aggravate the degree of emphysematous changes, polycythemia,oxidative stress and systematic inflammation. SRH and emphysema may have a synergistic action in causing systematic damages, and lymphocyte may be playing a central role in this process. Longer duration and more severe extent of SRHIE exposure also seem to result in more serious systematic damages. The mechanisms of all these concerned processes remain to be studied.

Subjective sleepiness in heart failure patients with sleep-related breathing disorder

Background Previous studies show that sleep-related breathing disorder （SRBD） is common in patients with heart failure （HF） and is associated with increased mortality. This study aimed to determine whether there was significant difference of subjective daytime sleepiness between HF patients with and without SRBD. Methods We enrolled, prospectively, 195 consecutive HF patients with left ventricular ejection fractions （LVEF） ≤45% and all subjects underwent polysomnography to measure the sleep structure between 2005 and 2008. Patients were then assigned to those with SRBD including obstructive and central sleep apnea （apnea-hypopnea index （AHI） ≥5/hour of sleep） and those without SRBD （AHI 〈5/hour） according to the sleep study. The subjective sleepiness was assessed with Epworth sleepiness scale （ESS）. Results Among 195 HF patients, the prevalence of obstructive sleep apnea （OSA） was 53% and of central sleep apnea （CSA） was 27%. There was no significant difference of ESS scores between patients without SRBD （NSA） and with SRBD （NSA vs OSA： 6.7±0.6 vs 7.6±0.4, P=0.105 and NSA vs CSA： 6.7±0.6 vs 7.4±K）.5, P=0.235, respectively）, indicating that SRBD patients had no more subjective daytime sleepiness. Compared with NSA, patients with SRBD had increased arousal index （Arl） （NSA vs OSA： 14.1±1.4 vs 26.3 ±1.5, P〈0.001 and NSAvs CSA： 14.1±1.4 vs 31.3±3.5, P 〈0.001, respectively）, more awake number after sleep onset （NSA vs OSA： 19.2±1.5 vs 26.2±1.4, P=0.01 and NSA vs CSA： 19.2±1.5 vs 36.9±4.4, P 〈0.001, respectively）, and reduced proportion of slow-wave sleep （SWS） （NSA vs OSA： 13.8±1.7 vs 9.3±0.7, P=0.024 and NSA vs CSA： 13.8±1.7 vs 8.9±0.9, P=0.024, respectively）. Conclusions OSA and CSA remain common in patients with HF on optimal contemporary therapy. Patients with both HF and SRBD have no significant subjective daytime sleepiness compared with patients without SRBD, despite of significantly increased awake number, arousal and decreased proportion of deep sleep stages. It is not a credible way and means to exclude SRBD in patients with HF according to the absence of subjective daytime sleepiness.

Relationship of nocturnal concentrations of melatonin, gamma-aminobutyric acid and total antioxidants in peripheral blood with insomnia after stroke： study protocol for a prospective non-randomized controlled trial

Melatonin and gamma-aminobutyric acid（GABA） have been shown to regulate sleep. The nocturnal concentrations of melatonin, GABA and total antioxidants may relate to insomnia in stroke patients. In this prospective single-center non-randomized controlled clinical trial performed in the China Rehabilitation Research Center, we analyzed the relationship of nocturnal concentrations of melatonin, GABA and total antioxidants with insomnia after stroke. Patients during rehabilitation of stroke were recruited and assigned to the insomnia group or non-insomnia group. Simultaneously, persons without stroke or insomnia served as normal controls. Each group contained 25 cases. The primary outcome was nocturnal concentrations of melatonin, GABA and total antioxidants in peripheral blood. The secondary outcomes were Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, Fatigue Severity Scale, Morningness-Eveningness Questionnaire（Chinese version）, and National Institute of Health Stroke Scale. The relationship of nocturnal concentrations of melatonin, GABA and total antioxidants with insomnia after stroke was analyzed and showed that they were lower in the insomnia group than in the non-insomnia group. The severity of stroke was higher in the insomnia group than in the non-insomnia group. Correlation analysis demonstrated that the nocturnal concentrations of melatonin and GABA were associated with insomnia after stroke. This trial was registered at Clinical Trials.gov, identifier： NCT03202121.

Childhood epilepsy and sleep

Sleep and epilepsy are two well recognized conditions that interact with each other in a complex bi-directional way. Some types of epilepsies have increased activity during sleep disturbing it; while sleep deprivation aggravates epilepsy due to decreased seizure threshold. Epilepsy can deteriorate the sleep-related disorders and at the same time; the parasomnias can worsen the epilepsy. The secretion of sleep-related hormones can also be affected by the occurrence of seizures and supplementation of epileptic patients with some of these sleep-related hormones may have a beneficial role in controlling epilepsy.

A 7-year-old boy with recurrent cyanosis and tachypnea:A case report

BACKGROUND Brain tumors are the most common solid tumors in children and comprise 25%of all malignancies in children.Common presentations include headache,nausea and vomiting,gait abnormality,papilledema,and epileptic seizure;however,some symptoms can be very insidious,with atypical and misleading manifestations.CASE SUMMARY Here,we report a 7-year-old boy who presented with recurrent cyanosis and tachypnea after exercise for 2 years.His body mass index was 26.43 kg/m2.Hepatosplenomegaly,blood gas analysis,biochemical parameters,chest computed tomography scan,and echocardiograph suggested type II respiratory failure,pulmonary heart disease,and mild liver injury.Non-invasive breathing support,antibiotics,and anti-heart failure therapy were given.The patient’s pulse oxygen saturation increased to over 95%when he was awake but dropped to 50%-60%,accompanied by cyanosis,during sleep while receiving high-flow nasal cannula oxygen.Sleep-related breathing disorder was suspected.In the intensive care unit,however,polysomnography was unavailable.Brain magnetic resonance imaging revealed a space-occupying(cerebellum and brainstem)lesion,which was later confirmed to be pleomorphic xanthoastrocytoma by surgery and histopathology by tissue biopsy.CONCLUSION When treating patients with cyanosis and tachypnea,a broad differential diagnosis should be considered,including brain tumor.

Chinese children＇s respiratory diseases in 60 years

This year marks the 60th anniversary of the founding of the People＇s Republic of China. On this occasion,it is worthy to recall the past and look towards the future in order to do a better job in research and control of children＇s respiratory diseases.